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In his latest blog FIFPro Chief Medical Officer Vincent Gouttebarge discusses ankle injuries and related external ankle support mechanisms. The prevalence of ankle injuries is detailed along with a comparison of injury rates of players using external supports against those who did not.

Dr. Gouttebarge uncovers players' underlying thoughts about these support mechanisms and the protection they provide.

 

KEY POINTS

  • Ankle injuries account for up to 20% of all injuries in professional football.

  • Taping and braces have been used to prevent the (re)occurrence of ankle injuries because both enhance the stabilization of the ankle joint by reducing its range of motion.

  • 28% of professional footballers surveyed by FIFPro suffered at least one ankle injury during the 2014/15 season.

  • 36% of professional footballers with a recent ankle injury were using external ankle support (taping or brace) before their injury.

  • 49% of professional footballers without a recent ankle injury were using external ankle support during the 2014/15 season.

  • Between 68 and 80% of professional footballers surveyed think that external ankle support is preventive for ankle injuries.

 

 

Alongside knee and hamstring injuries, ankle injuries are the most common musculoskeletal injuries occurring among professional footballers. Ankle injuries account for up to 20% of all injuries in professional football, mostly sprains involving the lateral ligaments (Waldén 2005; Hägglund 2009; Ekstrand 2011).

Between the Champion League seasons 2001/02 and 2011/12, a total of 1080 ankle injuries were recorded (13% of all injuries), showing a slight decline over time (an average 3.1% decrease per season) (Waldén 2013). Based on five Australian A-League seasons, FIFPro and PFA Australia showed that a squad of 25 players could expect two to three severe ankle injuries per season that lead on average to 6-12 matches missed per season (Gouttebarge 2015).

The most common cause for ankle injuries is tackling and foul play (Giza 2003; Andersen 2004). When it comes to the prevention of ankle injuries, several strategies and interventions have been suggested in recent years, including neuromuscular training (comprising coordination, strength and balance) but also external ankle support such as taping and brace (Handoll 2001; Janssen 2014).

Importance of external ankle support: taping and brace

Next to neuromuscular training, taping and brace have been used in order to prevent the (re)occurrence of ankle injuries. Both taping and brace are generally used to enhance the stabilization of the ankle joint by reducing its range of motion, ultimately limiting injury risk. In contrast to braces, the ability of tape to restrict the ankle’s range of motion may decrease as its use continues because of sweat, reduced adherence to the skin and mechanical failure. In football, as foot control and ball sensation are extremely important, players tend to resist using ankle braces and prefer to use taping (mostly players with a history of ankle injury). In a study across English football leagues, 50% of professional footballers who had sustained ankle injuries did not use external ankle support while 25% of them reported to use taping and 7% to use some other form of external support (Woods 2003).

In the past decade, modern ankle braces based on the latest technology and material have been designed and made available on the global market. Whether this latest development leads to an increase of brace use among professional footballers remains unknown. Consequently, FIFPro has conducted a short study (using an electronic survey) among professional footballers regarding ankle injuries and players’ perception on the use of taping and brace as a preventive strategy. In the study, ankle injury was defined as one that involved the ankle joint (bone, joint, ligament), occurred during a team activity (training or competition), needed medical attention and resulted in a player being unable to take full part in the next football activity (training or competition) (Fuller 2006).

 

Commentary from the international ankle expert 

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Professor Niek van Dijk is head of the Orthopaedic Department at the Academic Medical Center from Amsterdam. Professor van Dijk has been the world’s leading expert for the past 30 years when it comes to ankle injuries and surgery among professional athletes.

 

“I see on average 10 to 15 professional athletes with ankle injuries each month. Of these, 30-40% are professional footballers suffering especially from impingement (painful mechanical limitation of the ankle) combined with ligament laxity, stress fracture, and in the older footballers bone/cartilage degeneration. From these professional footballers with ankle injuries, 35-50% needs surgery. The average time until return to sport is six weeks for impingement and 8-10 weeks for bone/cartilage degeneration and stress fracture. For the prevention of ankle injuries, taping and brace has been shown to be effective so I would advise it for athletes and thus for professional footballers.”

 

Characteristics of the professional footballers surveyed by fifpro

Between 15 June and 15 July 2015, players’ unions from 18 European countries were asked to invite 15 professional footballers each to participate in the study. From the 270 players contacted, 133 professional footballers (49%) were willing to participate and completed the electronic survey. On average, participants have been playing football at the professional level for eight years. 72% of the participating footballers did not suffer from an ankle injury during the 2014/15 season, while 28% of the players suffered from at least one ankle injury during the past season.

external ankle support among footballers with recent ankle injury

The large majority of players (70%) who suffered an ankle injury in the past season reported that they had sustained a single ankle injury, while 20% had suffered from two or three ankle injuries (10% more than three). 39% suffered ankle injuries during training, 31% during competition, and 30% during both training and competition. When asked about their most severe ankle injury during the 2014/15 season, 41% of the players said they were sidelined for less than one week and 40% for one to four weeks. 19% of players were unable to train or compete for more than four weeks as a consequence of their  injury.

Before their first injury, around 28% of the players taped one or both ankles and only 8% used a brace. The remaining players reported that they were not using any external ankle support. After their first injury, 50% of players were taping one or both ankles and 11% were using a brace.

 

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external ankle support among footballers without recent ankle injury

A large majority of players (60%) who did not suffer ankle injuries in the past season reported that they had suffered from an ankle injury in the past during their career, while40% had never suffered from an ankle injury during their career. From these players without an ankle injury during the 2014/15 season, 40% were taping one or both ankles, and 9% were using a brace.

Players' perception about preventive effect of external ankle support

Among players that reported ankle injuries in the 2014/15 season, 61% had the perception that taping was preventive for ankle injuries, and 19% believed that using a brace was preventive. Only 3% thought that using a brace would not be preventive for ankle injuries, while the remaining players were unsure. 44% of players mentioned that they intended to use an external ankle support in the future.

Among the players who did not sustain an ankle injury in the 2014/15 season , 50% had the perception that taping was preventive for ankle injuries, and 18% that brace was preventive. 11% thought that both taping or brace would not be preventive for ankle injuries. 26% of players mentioned that they intended to use taping in the future as external ankle support while 17% said they would use a brace.

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