Should Indoor Volleyball Players Wear Ankle Braces?

Ankle sprains are the most common acute injury in indoor volleyball, and very few things spark intense debate in the volleyball community more than the question about using ankle braces to prevent these type of injuries. 

Photo courtesy of USAVolleyball

I'm going to review this subject by not only listing some studies about ankle braces, but more importantly tapping the awesome collective wisdom of my USA Volleyball Sports Medicine colleagues Aaron Brock, ATC and Jill Wosmek, ATC who work with Men's and Women's National Teams respectively.  I am not going to review ankle taping, since many athletes do not have access to proper ankle tape applications by athletic trainers, and even when done well, tape looses most of the protective effect within 30 minutes of application.

The majority of ankle sprains are when the ankle inverts (rolls in) and this most often occurs with play at the net where athletes make contact with another players foot when landing from a jump during hitting or blocking. The theory behind bracing is to reduce abnormal ankle motion, but some fear that depending on bracing might make lower leg supporting muscles weaker and maybe even increase the risk of knee injuries.

I do not endorse or have any investment in particular types of braces, and will only list particular brands and makers if they were mentioned in studies and all opinions are our own and do not represent official policy of USA Volleyball or any other group or employer.

What does the medical literature say about this?

• A prospective study of high school players made the conclusion that two types of braces (Active Ankle Trainer II and Aircast Sports Strirrup) protected players who never had a previous ankle sprain, but did not prevent subsequent sprains in players with a past history of sprain.
• Moving up to the collegiate ranks, prophylactic use of double-upright padded ankle braces significantly reduced the ankle injury rate compared to national statistics studying ankle injuries.
• Focusing more on female volleyball players, technical and proprioceptive training were effective methods on preventing ankle sprains in athletes with four or more ankle sprains, while bracing was more effective in only those with less than four past injuries
•  Elite volleyball players with recurrent sprain who underwent injury awareness training, technical training (emphasized proper take-off and landing technique for blocking and attacking) and balance board work enjoyed a twofold reduction in incidence of new ankle injury
• Limited evidence suggests that ankle braces do not increase the risk of knee injuries. The same review found that addressing the strength of the leg muscles (evertors, invertors, dorsiflexors, and plantar flexors), hip extensors and abductors  and ankle dorsiflexion limitations may be an ankle injury-prevention strategy.

What do my expert volleyball medicine colleagues have to add?

In his experience working as the Director of Sports Medicine and Performance and the Head Men's Athletic Trainer for USA Volleyball, Aaron Brock has the following insight:

• The great majority of ankle sprains seen with the US Men's National Team have been to the unprotected ankle. 
• No conclusive evidence exists that ankle braces adversely affect on court performance
• It is still possible to sprain an ankle while wearing ankle braces but the risk is significantly diminished. Also, ankle sprains while wearing braces usually result in a less severe sprain.  
• In his opinion, the best way to prevent ankle injuries is the use of ankle braces

As the Head Athletic Trainer for the USA Women's National Team and formerly the athletic trainer for Penn State Men's and Women's Volleyball Teams, Jill Wosmek offers her professional recommendations:

• Type of shoe is also important for proper heel position that isn't "too high" and thus having more side to side motion
• For younger players, she recommends braces as the type of volleyball play is a bit more chaotic and the athletes are not as strong
• Many college teams have bracing/taping as team rules that influence decisions
• On the US Women's National Team, the majority do not tape or brace but must heed disclaimer that level of play is higher, there are not a lot of under the net collisions, and the team spends a lot of time with strength and proprioceptive training

Does this information make you more or less apt to use ankle bracing and strengthening programs to reduce the risk of ankle sprains?

Watch this Video on How to Prevent the Six Most Common Volleyball Injuries