Ankles Back in Control


Evert Verhagen


The project team is composed of Kasper Janssen (Sports Physician / PhD candidate), Evert Verhagen (Associate Professor), and Willem van Mechelen (Professor). Within this project there is strong collaboration with VeiligheidNL, KNGF, NHG, and VSG.


Background: There is extensive evidence that there is an up to twofold increased risk for ankle re-injury  during the first year post-injury. Recurrences may result in disability and can lead to chronic pain or instability in 50% of these cases, requiring prolonged medical care. This increased ankle sprain recurrence risk has been found to exist even after completion of medical treatment, showing the need for advocation of secondary preventive measures. Braces as well as proprioceptive training have been proven equally effective for the secondary prevention of ankle sprains. About half of all recurrent ankle sprains can be prevented, while previously uninjured individuals do not seem to benefit from these preventive measures. The most recent KNGF guideline on acute ankle injuries (2006), also widely used by other medical professionals, advocates a combination of braces during competition sport and proprioceptive training as home based exercises. From a cost-effectiveness viewpoint the question arises whether both, seemingly equally effective, preventive measures should be advocated together, or if one of these individual measures is individually more cost-effective.

Objectives: This randomised controlled trial evaluates the cost-effectiveness the current ruling widespread Royal Dutch Physiotherapy Association (KNGF) guideline (i.e. this guideline is being used by physical therapists, (sports) physicians, as well as orthopedic surgeons), in which the combined use of braces and proprioceptive training after ankle sprain treatment is advocated (usual care), against the use of braces and proprioceptive training as separate secondary preventive measures.

Methods:A total of 384 athletes (201 males; 183 females), aged 12-70, who had sustained a lateral ankle sprain up to two months before inclusion were randomized to a neuromuscular training group (n=107); brace group (n=113); and a combined intervention group (n=120). Randomization was stratified for medical treatment of the inclusion sprain. The neuromuscular training group received an eight-week home-based exercise program. The brace group received a semi-rigid ankle brace to be worn during all sports activities for a period of twelve months. Participants allocated to the combined group received both interventions; the ankle brace to be worn during all sports activities for a period of eight weeks. During follow-up of one year ankle sprain recurrences and associated costs were registered.