BRACE YOURSELF

By R. J. Duggan, D.P.M., A.T.C., F.A.C.F.A.S

USAV Sports Medicine and Performance Commission,

Medical Resource Advisory Team

In the last several years there has been much discussion regarding the type, number, treatment and rehabilitation of ankle injuries occurring in volleyball participants. The player on the attack that has some contact at the net or whose foot crosses the midline of the court seems to have higher injury rates to the ankle. The information indicates that our athletes are increasing the risk for time lost due to inversion ankle sprains because of the contact or positioning while at the net.

The vast majority of ankle injuries are inversion type ankle sprains, which occur on the lateral or outside aspect of the ankle. The inversion sprain is classified by severity and given a grade from one to three. This grading system can also be used to describe the level of injury to the ligaments involved and will depend on the amount of force applied. Early on, the ligament will stretch. As more stress is applied, the ligament will partially tear, and finally, a complete rupture is seen. Treatment is directed toward protection and prompt return to activity. Once the treatment has progressed to the final phase, the athlete must work on improving factors that will prevent the injury from happening again. This is where taping and bracing of the ankle play an important role. Not only is the brace designed to protect against reoccurrence, but it also plays a part in helping the body sense the ankle's position in space. This is an important component in the rehabilitation program.

The issue of ankle injuries in volleyball needs to be approached comprehensively. Not only are our athletes experiencing more ankle injuries, but our athletes also are depending on ankle braces rather than a rehabilitation or strength program to "strengthen" their ankles. This is seen more in the younger players.   The boys and girls, ages seventeen and under, are being identified as those at high risk.

Recently, at a national competition at Disney's Wide World of Sports in Orlando, Florida, over four hundred girls participated in a four-day tournament. In that time frame, seventeen volleyball players presented to medical staff for evaluation. Of these, fifteen had complaints of ankle injury. All fifteen had inversion sprains that occurred while at the net. Contact was noted in almost every case that could be defined.

The unexpected item of interest was that 14 of 17 of the athletes were wearing braces on their injured ankle at the time of injury. After discussions with the injured athletes, it was found that many of the teams considered the braces to be a part of their team's uniform. At this point, the effectiveness of the braces comes into question.

Athletic trainers evaluated the athletes and several facts surfaced. First, previous ankle injuries were noted in about half of the reported inversion sprains. Second, a comprehensive rehabilitation program was not given to these athletes. The third discovery was that four of the girls wore braces that did not fit them. One of these girls had developed a sub-acute compartment syndrome directly from the lateral upright of the brace. Any brace that is used to modify motion of an extremity must be used with caution. Very few braces will be a one size fits all. Braces may actually cause injury if not selected, sized and fitted appropriately.

The question then is: What is the appropriate position for coaches and trainers to take with regards to ankle bracing and our players?

The answer must take into consideration all the components of athlete development. First, the rules may need to be addressed to decrease the risk to our players and still maintain the integrity of the sport competition. Secondly, the athlete must obtain or be offered qualified medical evaluation by a physician that understands the athlete and the demands that the sport of volleyball places on the body. Third, injuries must be rehabilitated to the point where the chance of re-injury is as small as possible. Finally, bracing must be utilized to the benefit of the athlete and time must be invested to assure fit with function.

The outcome of our efforts in the area of ankle injury prevention will be an increase in the lifelong participation in and enjoyment of volleyball.

(This article appeared in Volleyball USA, Fall, 1999.)