During basketball season there is not a day that goes by where I don’t get a Google Alert about some NBA, WNBA or NCAA star basketball player that is out because of an ankle injury.
This season one NBA superstar has been out three times due to a reoccurring ankle injury to the same ankle. Despite years of chronic ankle instability, and many minutes of playing time lost, will this superstar wear an ankle brace when he returns? Probably not … but why is that? Here is an elite athlete that makes millions from his spectacular play that is now becoming undependable and unreliable due to a reoccurring ankle injury that (in my opinion) could be fixed with an effective and functional ankle brace.
When I talk about ankle braces that can help fix chronic ankle instability issues I am specifically talking about semi-rigid hinged ankle braces. These are the types of functional ankle braces that can effectively support the ankle joint over extended periods of time. These differ from lace-up style ankle braces that offer the least amount of ankle support and are not effective enough to offer extended joint support.
As all athletic trainers know – it’s not only the basketball superstars that sustain an ankle injury and refuse to wear ankle protection. Regardless of the athlete’s skill level or ankle strength, injuries are still inevitable due to the environmental factors like jumping and cutting that are an integral part of the game.
Basketball is one of the most popular sports in the United States, with an estimated 1 million high school interscholastic participants.19 Ankle injuries are the most common musculoskeletal injury sustained in sports such as basketball that require sudden stops and cutting movements,3,18,20,21,32 and these injuries impose severe monetary consequences on the US health care system.12,27 Ankle injuries can affect athletes long after they are finished playing competitive high school sports, with the development of chronic ankle instability,9 increased likelihood for the onset of osteoarthritis,13,28 decreased levels of physical activity, and lower quality of life.1,8
Reports state that up to 70% of high school varsity basketball athletes have suffered an ankle sprain in their career, yet the number of players who wear ankle braces, either preventatively or post-injury, is still low. But why?
Here are some excuses that I’ve heard over the years from basketball players as to why, even with chronic ankle instability, they refuse to wear an ankle brace. I’ve also included some way we as athletic trainers can overcome these objections in order to help save athletes from themselves and keep them healthy, safe, and in the game.
Excuse #1: The Brace is Too Bulky
To a basketball player anything more than a sock is too bulky. Yes, some of the older designed semi-rigid ankle braces are bulky but that is because they were designed 20-30 years ago when technology was not as advanced as it is today. My recommendation for these athletes is to seek out newer ankle braces that were designed in the past 10 years. These braces will be using the latest research, materials and technology to be more organic in shape and fit the ankle better.
However, it is important that the athlete understand that with sufficient ankle support to help correct his condition, and keep them in the game, some additional structural support is inevitable. You can’t have ankle support without a structured support mechanism.
At Ultra Ankle, we reduced the bulk of a “structured support mechanism” by using an advanced resin to make the shell of our ankle braces more flexible. This flexible soft shell design uses a player’s body heat to form-fit to the ankle, which helps reduce that unwanted bulky look and feel of semi-rigid plastic braces. When the flexible shell takes the shape of the joint it can control the joint as much or more than some rigid plastic ankle braces, making the extra height or bulk unnecessary.
Excuse #2: The Brace Will Restrict My Performance
Different ankle braces offer different levels of restriction. The only time this restriction is related to performance is when a brace keeps an ankle from functioning in it’s normal range of motion – in which case an ankle brace is working against your ankle and therefore inhibiting your performance. In order to protect the joint, without impacting performance, an ankle brace should only restrict excessive inversion, eversion and rotation.
With a hinged ankle brace there should be no restriction of performance because the brace allows full plantar and dorsiflexion. Yes, some excessive lateral mobility might be limited due to the support necessary to stabilize the ankle and help prevent reinjury. In this case, it’s important to sell the athlete on the fact that the hinged ankle brace offers them unlimited ankle ROM to run and jump without restriction while still protecting their ankle.
The only style of ankle brace that is known to negatively effect performance is the lace-up ankle brace because if you bind up a joint it’s going to have a negative effect on ROM and strength. As shown in a study conducted by the University of South Alabama, “wearing a lace-up ankle brace negatively affects ankle joint motion and muscle function by significantly decreasing plantar flexion-dorsiflexion ROM across the velocity spectrum and by significantly decreasing muscle torque, work, and power.”
Excuse #3: The Ankle Brace is Uncomfortable
Of all the excuses I hear from basketball players, this can be a legitimate negative to wearing a semi-rigid hinged ankle brace. Mainly because some of the designs that are still being worn by athletes are old and outdated. Researching newer ankle bracing technologies and advanced designs should help alleviate some of the discomfort they are experiencing.
If an athlete still feels that ankle braces are uncomfortable, regardless of how new the technology is, it’s important for them to remember that, just like their basketball shoes, ankle braces will have a break in period to adjust to the ankle. A hinged ankle brace will feel tremendously different after 30 minutes of usage compared to when you first apply the brace because it needs to find its axis with the ankle joint to achieve ultimate comfort.
The worst thing you can do with any hinged brace, knee or ankle, is judge its comfort level when first applied. Nine times out of ten this is when the athlete refuses to wear the brace – not knowing the brace will feel significantly different if they would just give it 20-30 minutes to heat up and become aligned with the ankle. Typically, this is where the athletic trainer must step in and explain the break-in period that is necessary with any new peace of athletic gear. This, along with the features of the technology and why it is more beneficial for them to prevent additional injuries instead of getting re-injured and sitting on the sidelines, is helpful in increasing athlete compliance.
As mentioned early in this blog, with todays technology and design software we can develop ankle braces that are not only less bulky, but more comfortable as well. Elite ankle braces are designed to be more organic in shape, resembling the anatomy of the ankle. We can design some areas to be more flexible to form around the malleolus, and other areas to be more rigid to provide the necessary support.
When evaluating different ankle brace designs, seek out a brace that looks like the ankle looks and functions like the ankle functions. With this type of ankle brace, and the suggestions I provided in this blog, your basketball players may be more willing to wear a hinged ankle brace which will in turn provide them the support they need to safely stay in the game.
Written by Rick Peters
Rick Peters is a Certified Athletic Trainer who has been advancing ankle bracing technology for three decades. Peters patented his first ankle brace in 1985, revolutionizing the industry by adding a hinge to traditional stirrup braces for greater mobility. In 1989 he was a founder and became President of Active Ankle Systems. In 1998 he co-founded Ultra Athlete LLC to develop the next generation of ankle bracing technology. Peters has 18 ankle brace patents and is considered an authority on ankle bracing technology worldwide.