File
Burger M.1, Dreyer D.1, Fisher R.1, Foot D.1, Galante M.1, O'Connor D.1, Zalgaonkir S.1
1Stellenbosch University, Physiotherapy Division, Department of Interdisciplinary Health Science, Cape Town, South Africa
Background: Ankle sprains have the highest recurrence rates of all lower limb musculoskeletal injuries with a twofold increase risk of recurrence in the year following the initial ankle injury. Recurrent ankle sprains commonly lead to chronic ankle instability, decreased physical activity levels and quality of life and is also associated with increasing rates of post-traumatic ankle osteoarthritis. Bracing and neuromuscular/proprioceptive/balance training have shown to be effective in preventing recurrent ankle sprains. While previous systematic reviews have concluded that proprioceptive and neuromuscular training (PNT) (as a sole intervention without the addition of co-interventions such as strengthening and plyometrics) and bracing were both effective in reducing the recurrence of ankle sprains, to date no systematic review have focused on the effectiveness of PNT compared to bracing in reducing the recurrence rate of ankle sprains in athletes.
Purpose: To critically appraise, evaluate and establish the best available evidence to determine the effectiveness of proprioceptive and neuromuscular training (PNT) compared to bracing in reducing the recurrence rate of ankle sprains in athletes.
Methods: The following seven computerised bibliographic databases were searched: Pubmed, Science Direct, EBSCO Host: SPORTDiscus, EBSCO Host: CINAHL, Cochrane, Scopus and PEDro. The main search terms were ankle sprains, proprioceptive training, neuromuscular training and bracing. The quality of the trials were critically appraised according to the PEDro scale. A meta-analysis was conducted and The RevMan 5© software was used to pool the results.
Results: Three randomised control trials with an average PEDro score of 5.3/10, met the inclusion criteria. A Meta-analysis of the data showed no significant difference (p=0.97) between PNT and bracing in reducing the recurrence rate of ankle sprains in athletes at 12 months after initiation of the study.
Conclusion(s): The meta-analysis of the overall effect suggested that current evidence (Level II) does not favour the use of PNT over bracing in reducing the recurrence rate of ankle sprains. Further research should be conducted to determine the combined effect of PNT and bracing in reducing recurrence rate of ankle sprains, as well as patient-reported outcomes such as pain, ankle instability and severity of injury.
Implications: Since the current meta-analysis of the overall combined effect suggested that evidence does not favour the use of PNT over bracing in reducing the recurrence rate of ankle sprains, it seems that either one intervention can be used which in turn provides the therapist with the ability to tailor the rehabilitation specifically to the patients profile. PNT and bracing work through different pathways to prevent recurrence of ankle sprains. PNT aims at gradually repairing the underlying neuromuscular impairment by re-educating and strengthening the ligament, muscles and protective reflexes of the ankle. The exact duration can be as short as six weeks and as long as 36 weeks. PNT, however, does not provide immediate support, and while bracing does deliver immediate support, it does not address the underlying neuromuscular impairment. A brace could be more beneficial for patients that do not have the time nor the funding to attend regular PNT sessions.
Funding acknowledgements: We did not receive any funding for this study.
Topic: Sport & sports injuries
Ethics approval: Due to the nature of the research methodology (Systematic Review/ Meta-analysis), we did not require ethical approval for this study.
All authors, affiliations and abstracts have been published as submitted.
