ATHLETIC TRAINERS USE OF PROPHYLACTIC DEVICES IN THE ANKLE

A THESIS

Submitted to the Faculty of the School of Graduate Studies
and Research of California University of Pennsylvania in
partial fulfillment of the requirements for the degree of
Master of Science

By
Amber Jean Boyle

Research Advisor, Dr. Carol Biddington
California, Pennsylvania
2012

ii

iii
ACKNOWLEDGEMENTS
I would like to take this opportunity to identify and
thank the individuals who have played an important role in
my life and in the completion of this thesis. First, I
would like to thank my family for helping me become the
individual that I am today. Without your guidance and
support, I would not be where I am today and have
accomplished so many of my goals.
Next, I would like to thank my Cal U family. I will
never forget my first experience as a certified athletic
trainer. The experiences I encountered here will last a
lifetime and I will be forever grateful for welcoming me
with open arms. Also, I would like to thank all of my
professors, ACI’s, and fellow classmates from Franklin
College for preparing me to enter the real world. You will
always be thought of in the highest regard.
Lastly, I would like thank my thesis chairperson,
Carol Biddington, and my committee members, Mike Meyer and
Mary Popovich. Words cannot describe how grateful I am for
all of you help during the research process. I have learned
more about the research process from you than I ever
thought. The knowledge, input, and guidance you have
provided has made the completion of my thesis a great
experience.

iv
TABLE OF CONTENTS
Page
SIGNATURE PAGE

. . . . . . . . . . . . . . . ii

AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS

. . . . . . . . . . . . . . iv

. . . . . . . . . . . . . . . vii

. . . . . . . . . . . . . . . . 1

. . . . . . . . . . . . . . . . . . 4

Research Design
Subjects

. . . . . . . . . . . . . . 4

. . . . . . . . . . . . . . . . . 5

Preliminary Research. . . . . . . . . . . . . 5
Instruments . . . . . . . . . . . . . . . . 6
Procedures

. . . . . . . . . . . . . . . . 6

Hypotheses

. . . . . . . . . . . . . . . . 8

Data Analysis
RESULTS

. . . . . . . . . . . . . . . 8

. . . . . . . . . . . . . . . . . . 10

Demographic Data . . . . . . . . . . . . . . 10
Hypothesis Testing

. . . . . . . . . . . . . 17

Additional Findings . . . . . . . . . . . . . 20
DISCUSSION . . . . . . . . . . . . . . . . . 22
Discussion of Results . . . . . . . . . . . . 22
Conclusions . . . . . . . . . . . . . . . . 27
Recommendations. . . . . . . . . . . . . . . 27

v
REFERENCES . . . . . . . . . . . . . . . . . 29
APPENDICES . . . . . . . . . . . . . . . . . 31
APPENDIX A: Review of Literature

. . . . . . . . 32

Importance and Background of Ankle Prophylactics

. 33

Mechanism and Frequency of Ankle Injuries . 34
Chronic Ankle Instability

. . . . . . . . 36

Prevention of Ankle Injuries . . . . . . . 39
Clinical Practice of Taping and Bracing . . . . . 42
Types of Ankle Taping and Bracing
Clinical Education

. . . . 42

. . . . . . . . . . . 44

Ankle Taping and Bracing . . . . . . . . . . . 46
Effects on Functional Performance. . . . . 46
Reliability of Injury Prevention . . . . . 50
Summary . . . . . . . . . . . . . . . . . . 52
APPENDIX B: The Problem . . . . . . . . . . . . 54
Statement of the Problem . . . . . . . . . . . 55
Definition of Terms . . . . . . . . . . . . . 55
Basic Assumptions . . . . . . . . . . . . . . 56
Limitations of the Study . . . . . . . . . . . 56
Significance of the Study

. . . . . . . . . . 57

APPENDIX C: Additional Methods .

. . . . . . . . 59

Panel of Experts Letter (C1) . . . . . . . . 60
Certified Athletic Trainers Use of Prophylactic
Devices Survey (C2) . . . . . . . . . . . . . 62

vi
Institutional Review Board (C3) . . . . . . . . 67
Cover Letter (C4).

. . . . . . . . . . . . . 82

REFERENCES . . . . . . . . . . . . . . . . . 84
ABSTRACT . . . . . . . . . . . . . . . . . . 87

vii
LIST OF TABLES
Table

Page

1.

Demographics of Athletic Trainers

. . . . . . . 10

2.

Gender Classification . . . . . . . . . . . . 10

3.

Highest Level of Education . . . . . . . . . . 11

4.

Work Setting Classification . . . . . . . . . . 11

5.

Prophylactic Devices Preference. . . . . . . . . 11

6.

Most Commonly Used Ankle Taping to Prevent Injury . 12

7.

Most Commonly Used Ankle Taping After Injury . . . 13

8.

Most Commonly Used Ankle Brace to Prevent Injury

9.

Most Commonly Used Ankle Brace After Injury

. 13

. . . 14

10.

Most Commonly Used Ankle Brace Brand . . . . . . 14

11.

Materials Used in an Ankle Taping

12.

Reasons for Ankle Prophylactic Taping, Bracing,
or Both at the Same Time . . . . . . . . . . . 16

13.

3x3 Chi-Square Independence Test for preference of
prophylactic device/athletic trainer employment
setting . . . . . . . . . . . . . . . . . . 17

14.

7x3 Chi-Square Independence Test for preference of
taping technique to prevent injury/athletic trainer
employment setting . . . . . . . . . . . . . 18

15.

8x3 Chi-Square Independence Test for preference of
taping technique after injury/athletic trainer
employment setting . . . . . . . . . . . . . 19

16.

3x3 Chi-Square Independence Test for preference of
brace type after injury/athletic trainer employment
setting . . . . . . . . . . . . . . . . . . 20

. . . . . . . 15

1
INTRODUCTION

The primary purpose of this study was to examine
Certified Athletic Trainers use of ankle prophylactics in
the prevention and treatment of injury. It is important to
examine this relationship because athletic trainers
frequently use ankle taping and/or bracing and have
specific reasons as to why they choose one over the other.
Athletic trainers must choose between the two types of
ankle prophylactics every day when preventing and treating
ankle injuries. There was minimal research that supported
the preference health care professionals utilize for ankle
prophylactics. However, research has indicated similarities
and differences between the two types. Both taping and
bracing use result in little to no decrease in functional
performance. According to research by Nelson et al,1 bracing
is a better option to use when one focuses on only injury
prevention. Bracing tends to keep the foot in a more
stabilized, closed packed position longer than taping does.
Meana et al2 reported that ankle tapings have a decrease in
50 percent of the ankle range of motion after a 30 minute
exercise session, while bracing keeps the restricted range
of motion longer. In addition, bracing is also a better
option when looking from a cost standpoint. Buying

2
individual braces for each ankle is far cheaper than buying
several boxes of tape.
Since most of the research points to using bracing
over taping as a better option, it is important to see if
athletic trainers are following research or using tape more
often.

There are various other reasons that one would

choose either device over the other, which should be
determined as well.
Ankle injuries are highly prevalent among athletes.
Abián-Vicén et al3 states acute lateral ankle injuries are
the most common athletic-related injuries with an incidence
rate of 38% to 50% of all athletic injuries reported.
According to Nelson et al,1 ankle injuries occur most in
football and men’s and women’s basketball. Not only is
there a high incidence of initial ankle injuries, but there
is also a high rate (as high as 80%) of re-injury.4
Because of the prevalence of ankle injuries in the
active population, preventative methods for ankle injuries
have been implemented for the athletic population by
athletic trainers. Ankle taping and bracing are used for
prophylactic and protective purposes in athletic activity
on a daily basis.

Hubbard and Kaminski5 and Delahunt et al6

describe how improving propioception and neuromuscular
control is needed to improve mechanical ankle instability.

3
The incorporation of prophylactics is also commonly used
with athletes who have sustained previous ankle injuries or
who are recovering from initial ankle injuries. Delahunt et
al6 state prophylactics have shown to decrease the incidence
of ankle injuries, though the exact reasoning is not known.
Due to the high frequency use of ankle prophylactics
in sports, how these affect athletic performance have been
questioned. Conflicting information has been found on
whether or not taping and bracing affect sports
performance. Abian-Vicen et al3 found ankle taping has no
effect on jumping or balancing. Macpherson et al7 found no
functional differences between football players with and
without ankle bracing during functional activity. However,
Mackean et al8 found decreases in vertical jump and jump
shot with female basketball players wearing taping or
bracing.
This study will attempt to answer the following
questions. Will preference of prophylactic device be
dependent upon Athletic Trainers employment setting? Will
Athletic Trainers employment setting be dependent upon
preference of taping technique to prevent injury? Will
Athletic Trainers employment setting be dependent upon
preference of taping technique after injury?

4
METHODS

The primary purpose of this study was to examine
Certified Athletic Trainers use of ankle prophylactics in
the prevention and treatment of injury. A comparison of
these findings to current recommendations in the literature
was drawn. This section will include the following
subsections: Research Design, Subjects, Instruments,
Procedures, Hypotheses, and Data Analysis.

Research Design

A descriptive design was used in this study. The
dependent variables in this study were taping or bracing
and preventing or post-injury prophylactic use. The
independent variable was employment setting of Certified
Athletic Trainers: high school, high school/clinic, or
college.
The strength of this study was that content validity
was established for the survey after review by the panel of
experts. The limitation of this study was that only
Athletic Trainers who are members of the National Athletic
Trainers’ Association (NATA) were surveyed because not all
Certified Athletic Trainers are members of the NATA.

5
Subjects

The subjects used for this study were 1000 male and
female National Athletic Trainers’ Association (NATA)
members, with 500 from the college work setting and 500
from the high school or high school/clinic setting.
Participants were randomly selected from the NATA
membership roles. Each participant who returned a survey (N
= 196) was implying informed consent by returning the
survey to the researcher via SurveyMonkey.com.

Preliminary Research

Prior to distribution of the survey, a review of the
survey was conducted using a panel of three experts
(Appendix C1).

This panel reviewed the survey and provided

suggestions for improvements.

The panel included three

certified athletic trainers from California University of
Pennsylvania.

6
Instruments

The Certified Athletic Trainers Use of Ankle
Prophylactic Devices Survey (Appendix C2) was used in this
study.

This survey was developed by the researcher for the

purpose of determining the use of ankle prophylactic
devices when preventing and treating injury. Basic
demographic information was obtained, including work
setting, age, and years of experience. The survey also
contained questions regarding the type of ankle taping or
bracing used by athletic trainers to prevent and treat
ankle injuries. In addition, the survey allowed for
athletic trainers to provide their reasons for choosing one
type of prophylactic device over the other. The survey had
13 questions and took approximately 5 to 10 minutes to
complete.

Procedures

The California University of Pennsylvania’s
Institutional Review Board was sent the Protection of Human
Subjects form (Appendix C3) for approval before the study
was conducted. A survey (Appendix C2) was developed by the
researcher and was deemed valid after review by a panel of

7
three experts.

The researcher utilized SurveyMonkey.com to

create a direct link to the electronic survey. The
researcher completed the Research Survey Request Form on
the NATA website and it was distributed by the NATA
electronically randomizing members who were in the high
school, high school/clinic, and collegiate work setting. A
cover letter (Appendix C4) was sent with the survey link
explaining the purpose of the study to the Certified
Athletic Trainers. A link on the cover letter provided the
athletic trainers direct access to begin the survey.
The NATA sent the survey to a maximum of 1000 members
by email with the cover letter and link to the survey.

A

follow-up email was also sent by the NATA as a reminder one
week after the initial email. The researcher was not given
any demographic information or access to the email
addresses of the athletic trainers, therefore, the surveys
remained anonymous and the identities of the subjects was
protected.

8
Hypotheses

The following hypotheses were based on previous
research and the researcher’s intuition based on a review
of the literature.
1.

Athletic Trainers preference of prophylactic
device will be dependent upon employment setting.

2.

Athletic Trainers preference of taping technique
to prevent injury will be dependent upon
employment setting.

3.

Athletic Trainers preference of taping technique
after injury will be dependent upon employment
setting.

Data Analysis

All data was analyzed by SPSS version 18.0 for windows
at an alpha level of 0.05.
1: A 3 (Taping Technique – tape, brace, or both at the same
time) X 3 (Certified athletic trainer employment setting –
high school, high school/clinic, and college) Chi square
test of independence was used to determine if preference of
prophylactic device was dependent upon employment
setting.

9
2: A 8 (Taping technique to prevent injury – closed basket
weave, open basket weave, spatting, peroneal, fibular,
spartan slipper(boot,) subtalar sling, and other) X 3
(Certified athletic trainer employment setting – high
school, high school/clinic, and college) Chi square test of
independence was used to determine if preference of taping
technique to prevent injury was dependent upon employment
setting.
3: A 8 (Taping technique after injury – closed basket
weave, open basket weave, spatting, peroneal, fibular,
spartan slipper(boot,) subtalar sling, and other) X 3
(Certified athletic trainer employment setting – high
school, high school/clinic, and college) Chi square test of
independence was used to determine if preference of taping
technique after injury was dependent upon employment
setting.

10
Results

The purpose of this study was to examine athletic
trainers use of prophylactic devices in the prevention and
treatment of ankle injuries. The data was obtained using a
survey created by the researcher.

This section contains

the following subsections: Demographic Data, Hypothesis
Testing, and Additional Findings.

Demographic Data

A sample of 1000 certified athletic trainers, who are
members of the National Athletic Trainers’ Association,
were randomly selected to participate in the survey.

Of

the 1000 asked to participate, 196 responded and completed
the survey. According to Patten,9 based on the population of
athletic trainers who indicated they work in the collegiate
or high school setting, a sample size of 375 was needed.
This indicates a return rate of 52.4%. Table 1 represents
general characteristics associated with the athletic
trainers and Table 2 represents the gender classifications.
Table 1. Demographics of Athletic Trainers
Characteristic
Range
Age
22-64
Years of Experience
0.5-41

Mean ± SD
36.9 ± 11.3
13.3 ± 10.3

11

Table 2. Gender Classification
Classification
Frequency
Male
85
Female
111

Percent
43.4
56.6

Table 3 represents the highest level of education
completed by the athletic trainer.
Table 3. Highest Level of Education
Classification
Frequency
Bachelor’s Degree
56
Master’s Degree
132
Doctoral Degree
6

Percent
28.9
68.0
3.1

Table 4 represents the classification of work setting
for the athletic trainers.
Table 4. Work Setting Classification
Classification
Frequency
College
115
High School
46
High School/Clinic
35

Percent
58.7
23.5
17.8

Table 5 represents athletic trainers’ preference of
ankle prophylactic device after an acute ankle injury.
Participants were asked to choose between the three options
available of ankle taping, ankle brace, or both at the same
time when treating an acute ankle injury.
Table 5. Prophylactic Device Preference
Classification
Frequency
Taping
68
Brace
15
Both at same time
98

Percent
37.6
8.3
54.1

12

Table 6 represents the most commonly used ankle taping
to prevent injury.

Subjects were asked to choose the ankle

taping type that they use most commonly for preventative
purposes.

The following preferences elicited a percent

less than 1: Spatting and Fibular. The “Other” preference
included: subject does not perform preventative ankle
taping, Stirrup 8, and subject prefers ankle braces to
taping.
Table 6. Most Commonly Used Ankle Taping To Prevent Injury
Classification
Frequency
Percent
Closed basket weave
148
85.5
Open basket weave
5
2.9
Peroneal
4
2.3
Spartan Slipper (boot)
2
1.2
Subtalar Sling
5
2.9
Other
8
4.6

13
Participants were asked to choose which ankle taping
they most often choose after an ankle injury has occurred.
Table 7 represents this data. The following preferences
elicited a percent less than 1: Spatting and Fibular. The
“Other” response included: Modified Closed basket weave
with stiffer tape, depends on type and severity of ankle
injury, and a combination of subtalar sling and open basket
weave.
Table 7. Most Commonly Used Ankle Taping After Injury
Classification
Frequency
Percent
Closed basket weave
112
65.5
Open basket weave
21
12.3
Peroneal
6
3.5
Subtalar Sling
9
5.3
Spartan Slipper (boot)
16
9.4
Other
5
14.8

Table 8 represents the most common ankle brace type
chosen by athletic trainers to prevent injury.
Table 8. Most Commonly Used Ankle Brace To Prevent Injury
Classification
Frequency
Percent
Lace-up
159
88.3
Semi-rigid
16
8.9
Air/Gel Bladder
1
0.6
Rigid
4
2.2

14
Table 9 represents the most commonly used ankle brace
type chosen by athletic trainers after an ankle injury has
occurred.
Table 9. Most Commonly Used Ankle Brace After Injury
Classification
Frequency
Percent
Lace-up
115
63.9
Semi-rigid
29
16.1
Air/Gel Bladder
23
12.8
Rigid
13
7.2

Table 10 represents the most commonly used ankle brace
brand used by athletic trainers. Participants were asked to
choose one of the options to represent their preference in
ankle brace brands.

The following preferences elicited a

percent less than 1: Össur Americas (Gameday, Exoform,
etc), Pro-Tech Athletics, and Everlast Ultra. The response
“Other” included: Hely Weber, Bioskin – Trilok, Malleoloc,
and it varies depending on what the athlete can afford.
Table 10. Most Commonly Used Ankle Brace Brand
Classification
Frequency
Percent
Med Spec (ASO)
81
47.4
Active Ankle
16
9.4
Systems, Inc
Swede-O, Inc
15
8.8
DJO (DonJoy, Aircast,
9
5.3
Empi, etc)
McDavid
34
19.9
Cramer
10
5.8
Other
4
2.3

15
Participants were asked during the survey to indicate
by answering yes or no whether or not they use the various
materials in their standard ankle taping.

They were also

asked to provide other materials that they often use if
they were not one of the choices. These materials included:
Powerflex, heel and lace pads, and kinesiotape.

This data

is represented in Table 11.
Table 11. Materials Used in an Ankle Taping
Classification
Frequency
Athletic White Tape
Yes
172
No
1
Heavy-weight/
Elastikon tape
Yes
112
No
40
Light-weight
stretchy tape
Yes
75
No
63
Mole Skin
Yes
80
No
61
Leukotape
Yes
18
No
99
Pre-Wrap
Yes
161
No
6

Percent
99.4
0.6
73.7
26.3
54.3
45.7
56.7
43.3
15.4
84.6
96.4
3.6

16
Table 12 represents the various reasons that athletic
trainers chose to justify their preference of ankle
prophylactic.
Table 12. Reasons for Ankle Prophylactic Taping, Bracing,
or Both at the Same Time
Classification
Frequency
Percent
P Value
χ2
Subject’s knowledge
of the literature
Yes
108
67.5
.000
18.789
No
52
32.5
Budgetary limits
Yes
74
47.7
.522
.410
No
81
52.3
Athlete preference
Yes
102
65.0
.000
13.392
No
55
35.0
Personal opinion/
experience?
Yes
165
98.8
.000
156.214
No
2
1.2
Provides more stability
than the other choices?
Yes
125
79.1
.000
52.082
No
33
20.9
Prevents injury or
re-injury better
than the other choices?
Yes
118
74.7
.000
35.377
No
40
25.3
Preference is easier to
apply or does not take
as much time to apply
as the other choices?
Yes
43
28.1
.000
30.026
No
110
71.9
It is how the subject
was taught and/or how
all of his or her peer
AT’s choose
Yes
68
43.6
.129
2.299
No
88
56.4
Other
6

17
Hypothesis Testing
All hypotheses were tested an alpha level of .05.
Hypothesis 1: A 3 (Preference of prophylactic Device –
tape, brace, or both at the same time) X 3 (Certified
athletic trainer employment setting – high school, high
school/clinic, and college) Chi square test of independence
was used to determine if preference of prophylactic device
was dependent upon employment setting. A significant
interaction was found (χ2 = 15.13, P < 0.01).
Conclusion: Athletic trainers in the collegiate
setting were more likely to use both bracing and taping at
the same time after an acute ankle injury than athletic
trainers in the high school and high school/clinic settings
(Table 13).
Table 13. 3x3 Chi-Square Independence Test for preference
of prophylactic device/athletic trainer employment setting
Classification
Both at
Taping
Brace
χ2 P Value
same time
College
54
48
4
15.13 .004
High School
28
11
4
High School/
16
9
7
Clinic

18
Hypothesis 2: A 7 (Taping technique to prevent injury
– closed basket weave, open basket weave, peroneal,
fibular, spartan slipper(boot,) subtalar sling, and other)
X 3 (Certified athletic trainer employment setting – high
school, high school/clinic, and college) Chi square test of
independence was used to determine if preference of taping
technique to prevent injury was dependent upon employment
setting. The choice of spatting was not included in the
test because no subjects chose that option. A significant
interaction was found (χ2 = 29.272, P < 0.01).
Conclusion: Athletic trainers in the collegiate
setting were more likely to use the closed basket weave
taping technique for prevention of injury than high school
and high school/clinic athletic trainers (Table 14).
Table 14. 7x3 Chi-Square Independence Test for preference
of taping technique to prevent injury/athletic trainer
employment setting
Taping
College High
High
χ2
P Value
Technique
School School/
Clinic
Closed Basket
93
33
22
29.272 .004
weave
Fibular
0
1
0
Open Basket
3
2
0
Weave
Peroneal
0
0
4
Spartan Slipper
1
0
1
(boot)
Subtalar Sling
2
2
1
Other
3
2
2

19
Hypothesis 3: An 8 (Taping technique after injury –
closed basket weave, open basket weave, spatting, peroneal,
fibular, spartan slipper(boot,) subtalar sling, and other)
X 3 (Certified athletic trainer employment setting – high
school, high school/clinic, and college) Chi square test of
independence was used to determine if preference of taping
technique after injury was dependent upon employment
setting. No significant relationship was found (χ2 = 17.226,
P

0.05).
Conclusion: Athletic trainers’ preference of taping

technique after an ankle injury is not dependent upon
employment setting (Table 15).
Table 15. 8x3 Chi-Square Independence Test for preference
of taping technique after injury/athletic trainer
employment setting
Taping
College
High
High
χ2
P Value
Technique
School
School/
Clinic
Closed Basket
65
30
17
17.226 .244
weave
Fibular
0
2
1
Open Basket
11
5
5
Weave
Peroneal
4
0
1
Spartan Slipper 12
0
4
(boot)
Spatting
0
0
1
Subtalar Sling
5
2
2
Other
18
7
4

20
Additional Findings
In addition to hypothesis testing, additional tests
were performed. For the first additional finding, a Chi
Square Goodness of Fit tests were calculated comparing the
frequency (yes or no) for reasons athletic trainers chose
for their preference of prophylactic device. The following
reasons were selected by athletic trainers as “yes” for
significant results: Subjects knowledge of the literature
(χ2 = 18.789, P < 0.01); Athlete preference (χ2 = 13.392, P
< 0.01); Personal opinion/experience (χ2 = 156.241, P <
0.01); provides more stability than other choices
(χ2 = 52.082, P < 0.01); and prevents injury better than the
other choices (χ2 = 35.377, P < 0.01).

The following reason

was selected by athletic trainers as no for significant
results: preference is easier to apply or does not take as
much time to apply as other choices (χ2 = 30.026, P < 0.01).
No significant results were found for “Budgetary limits”
and “It is how the subject was taught and/or how all of his
or her peer AT’s choose”.

Refer to Table 12 for

statistical results.
The second test performed was a Chi-Square Test of
Independence comparing employment setting with preference
of brace type after injury. A significant interaction was

21
found (χ2 = 12.58, P = 0.05).

Athletic trainers in the

collegiate setting chose the lace-up type while the other
employment settings did not (Table 16).
Table 16. 3x3 Chi-Square Independence Test for preference
of brace type after injury/athletic trainer employment
setting
Brace
College High
High
X2
P Value
Type
School School/
Clinic
Lace-up
64
29
22
12.58
.050
Air Gel/Bladder 19
1
1
Semi-Rigid
16
8
8
Rigid
7
5
1

22
DISCUSSION

This study has produced a number of findings related
to the use of prophylactic devices.

The following section

will discuss these findings and is divided in the following
subsections: Discussion of Results, Conclusions, and
Recommendations.

Discussion of Results

This study focused on the athletic trainers’
preference of prophylactic devices before and after an
ankle injury. Ankle injuries are very common orthopedic
injuries that may lead to chronic ankle instability. These
injuries may cause athletic trainers to recommend and use
prophylactic devices in order to prevent or treat injuries.
The researcher examined different demographic information
such as work setting, gender, and years of experience to
determine if it affected their preference of prophylactic
device.
The researcher’s first hypothesis focused on the
belief that preference of prophylactic device would be
dependent upon employment setting. There was no previous
research performed examining athletic trainers preference

23
of prophylactic devices.

Based on the researchers own

experience and intuition, one might believe athletic
trainers from the collegiate setting would be more likely
to use tape or bracing than athletic trainers in a high
school or high school/clinic setting. It was determined
athletic trainers who work in the collegiate setting were
more likely to use prophylactic devices after an acute
ankle injury than those who work in a high school or high
school/clinic setting.

These results are similar to the

study completed by Mickel et al10 which stated the use of
bracing as cost effective, as well as the best method to
prevent injury versus tape. The researchers recommended
bracing over taping, however the results of this study
indicated that athletic trainers chose to use both bracing
and taping.

One of the reasons for this may be attributed

to comfort for the athlete. Reuter et al11 surveyed the
participants of their study to describe which prophylactic
device is more stable and more comfortable.

The

researchers found taping to be more stable but less
comfortable while bracing was found to be more comfortable
but less stable.

The athletic trainers’ preference of

using both tape and bracing could be attributed to both
aspects: comfort and stability.

24
The second hypothesis examined in this study stated
athletic trainers’ preference of ankle taping technique to
prevent injury will be dependent upon employment setting.
The researcher hypothesized athletic trainers in the
collegiate setting would be more likely to use a standard
ankle taping than the other employment settings. There is
no previous research to indicate if taping technique
preference changes with employment setting; however, from
the researcher’s prior experience, there seems to be a
difference because of a variety of reasons.
The results coincide with the hypothesis indicating
that collegiate athletic trainers use a closed basket
weave. There have been previous studies completed that
indicate certain taping techniques are more efficient and
stable than others. Abian-Vicen et al12 found taping with
elastic tape (elastikon, Powerflex) and inelastic tape
provided the same amount of restricted range of motion and
stability, but elastic was found to be more comfortable.
Abian-Vicen et al12 recommended the use of elastic tape
because of these reasons. The researchers in this study
found a significant majority of athletic trainers chose an
all inelastic tape, which is a direct contradiction to the
research. One of the reasons may be related to education,

25
since standard closed basket weave ankle procedures with
inelastic tape is taught first to athletic training
students as well as emphasis placed on the effectiveness of
this taping procedure.
The third and final hypothesis stated preference of
taping technique after injury would be dependent upon
employment setting. Again, there has been no previous
research to support this specific hypothesis. However, the
researcher hypothesized after injury the collegiate
employment setting would choose an ankle taping that has
different materials generally thought of as stronger
taping. However, no significant results were shown to
support this hypothesis. With a lack of significance, the
results demonstrated athletic trainers from different
employment settings do not prefer a certain taping
technique after an ankle injury.
In addition to examining the hypotheses, the
researcher discovered additional findings by using
supplementary demographic and preference questions. The
first additional finding examined athletic trainers reasons
for choosing their preference of ankle prophylactic. There
were a number of significant findings when a majority of
athletic trainers chose similar reasons.

The significant

26
reasons were: subject’s knowledge of the literature,
athlete preference, personal opinion/experience, preference
provides more stability than other choices, preference
prevents injury or re-injury better than the other choices,
and lastly the preference is easier to apply or does not
take as much time to apply. The two reasons that did not
yield significant results were: budgetary limits and chosen
preference based on skills learned or peer choice.
The second additional finding used athletic trainers’
employment setting and their preference of brace type after
an ankle injury. There were significant results indicating
that athletic trainers in the collegiate setting chose a
lace-up brace while others in the high school and high
school/clinic settings did not.

This finding coincides

with research completed by Rezents et al,13 which found that
lace-up ankle braces were found to be more supportive and
preferred by athletes.

27
Conclusions

The results of this study both support and oppose the
results of previous studies. The overall results indicated
that athletic trainers chose both bracing and taping after
an acute injury, which did not defend Mickel et al10 who
found that bracing is more stable and cost effective.
Based on the results of this study, the researcher can
concluded athletic trainers have similar preferences of
prophylactic devices in the collegiate setting. This could
be a credit to similarity of the college level, the
maturity level of athletes, the increased risk of injury,
or a number of reasons.

Recommendations

The results of this study demonstrated athletic
trainers chose standard closed basket weave ankle tapings
and the use of a brace after an ankle injury. In order to
aid in determining if employment setting changes the way
athletic trainers chose a prophylactic device, future
research is suggested. For example, in the collegiate
setting, athletic trainers could specify their NCAA

28
division level of I, II, or III and in the high school
setting, athletic trainers could choose their
classification of A, AA, AAA, etc.
In addition, further research should obtain more
information about the reasons athletic trainers chose their
preference. Another follow-up study might focus more on
athlete preferences of prophylactic devices by gender,
sport, and athletic level, then compare to the athletic
trainer preferences.

29
REFERENCES
1. Nelson A, Collins C, Yard E, Fields S, Comstock RD,
Ankle injuries among United States high school sports
athletes, 2005–2006. J Athletic Training. September
2007;42(3):381–387.
2. Meana M, Alegre LM, Elvira JLL, Aguado X. Kinematics of
ankle taping after a training session. International J
Sports Medicine [serial online]. January 2008;29(1):70-76.
3. Abián-Vicén J, Alegre L, Fernández-Rodríguez J, Lara A,
Meana M, Aguado X. Ankle taping does not impair performance
in jump or balance tests. J Sports Science Medicine.
September 2008;7(3):350-356.
4. Gribble PA, Robinson RH. Alterations in knee kinematics
and dynamic stability associated with chronic ankle
instability. J Athletic Training [serial online]. August
2009;44(4):350-355.
5. Hubbard TJ, Kaminski TW. Kinesthesia is not affected by
functional ankle instability status. J Athletic Training
2002;37(4):481–486.
6. Delahunt E, McGrath A, Doran N, Coughlan G. Effect of
taping on actual and perceived dynamic postural stability
in persons with chronic ankle instability. Archives
Physical Medicine Rehabilitation [serial online]. September
2010;91(9):1383-1349.
7. Macpherson K, Sitler M, Kumura I, Horodyski M. Effects
of a semirigid and softshell prophylactic ankle stabilizer
on selected performance tests among high school football
players. J Orthopaedic Sports Physical Therapy. March 1995;
21(3):147-152.
8. Mackean L, Bell G, Burnham R. Prophylactic ankle
bracing vs taping: effects on functional performance in
female basketball players. J Orthopaedic Sports Physical
Therapy. August 1995;22(2):77-81.

30
9. Patten ML. Proposing Emprical Research: A Guide to the
Fundamentals. Glendale: Pyrczak Publishing; 2005.
10. Mickel TJ, Bottoni CR, Tsuji G, Chang K, Baum L,
Tokushige KS. Prophylactic bracing versus taping for the
prevention of ankle sprains in high school athletes: A
prospective, randomized trial. J Foot Ankle Surgery.
November 2006;45(6):360-365.
11. Reuter GD, Dahl AR, Senchina DS. Ankle spatting
compared to bracing or taping during maximal-effort sprint
drills. International J Exercise Science. 2004;4(1):305-20.
12. Abián-Vicén J, Alegre L, Fernández-Rodríguez J, Aguardo
X. Prophylactic ankle taping: Elastic versus inelastic
taping. Foot Ankle International. March 2009;30(3):218-25.
13. Rezents RL. A comparison of ankle braces and their
prevention of injuries; A closer look at stability vs range
of motion. Saint Martin’s University Biology J. May
2006;1:255-266.

31

APPENDICES

32

APPENDIX A
Review of Literature

33
REVIEW OF LITERATURE

Ankle injuries are one of the most common athletic
injuries. Because of the high incidence rate, health care
providers, including athletic trainers, physicians, and
orthopedic surgeons, have turned to the use of prophylactic
devices to rehabilitate and prevent injury and re-injury.
The prophylactic devices most commonly used are ankle
taping and bracing. Multiple types of ankle tapings and
braces can be used by an athletic trainer, but there has
been little research on which type is preferred or most
popular.
The purpose of this Review of Literature is to
enlighten the reader on previous work examining the use of
tape by athletic trainers and their preferences in taping
and bracing types when preventing or rehabilitating an
ankle injury.

This will be accomplished in the following

sections: Importance and Background of Ankle Prophylactics,
Clinical Practice of Taping and Bracing, and Ankle Taping
and Bracing. Each section will be further divided into
subsections as well. Under the Importance and Background of
Ankle Prophylactics, the Mechanism and Frequency of Ankle
Injuries, Chronic Ankle Instability, and Prevention of
Ankle Injuries will be discussed; Clinical Practice of

34
Taping and Bracing will include Types of Ankle Taping and
Bracing as well as Clinical Education; and lastly, Ankle
Taping and Bracing will discuss the Effects on Functional
Performance and Reliability of Injury Prevention. A summary
of the review of literature is also provided.

Importance and Background of Ankle Prophylactics

Mechanism and Frequency of Ankle Injuries
Acute ankle injuries are the most commonly occurring
injury during athletic-related activities.

These injuries

make up approximately 38% - 50% of all injuries reported.1
According to Robbins and Waked,2 the most common type of
ankle injury is a lateral ligamentous sprain, accounting
for about 85% of injuries. The ankle is the least stable in
the open packed position of plantar-flexion and inversion,
which is how most ankle injuries occur.2 Mechanisms of ankle
sprains also differ by sport. In football, the most common
mechanism is contact with another player, while in
basketball it is landing from a rebound or jump.3 The
inversion and plantarflexion mechanism causes the
anterolateral structures to be stretched which makes the
ankle far less stable and increases the risk of re-injury.
Repeated stretching of these structures in the ankle can

35
lead to instability and the need for the use of
prophylactic devices.
According to Robbins and Waked,2 ankle sprains occur
because footwear causes a decrease in one’s foot position
awareness compared to when barefoot as well as changes in
the foot position resulting in an increase in chance of
injury.

Wearing braces or taping helps to correct the foot

back to its normal position which helps decrease the chance
of injury. However, the researchers concluded that taping
and bracing also decrease the range of motion ankles have,
which may increase the chances of re-injury. Their final
conclusion is that the active population should find
correct footwear that does not alter foot kinematics and
position awareness so ankle injuries can be prevented
without limiting range of motion. Hubbard and Hertel4 also
concluded that both hypermobility and hypomobility at the
talocrural, subtalar, and inferior tibiofibular joints can
significantly contribute to chance of injury/re-injury.
The frequency of ankle injuries also varies by sport.
According to a study completed by Nelson et al3 the
researchers investigated the prevalence of ankle injuries
by sex, type of exposure, and sport. One hundred high
schools across the country submitted their injury data from
the 2005-2006 school year. Using the injury surveillance

36
system, the researchers collected data about ankle injury
type, athletes’ sex, and sport. The results indicated that
ankle injuries occurred at a much higher rate during
competition than in practice. In addition, the sports with
the most incidences were, from highest to lowest, boys’
basketball, then girls’ basketball, and finally football.
The researchers concluded that sports with jumping in close
proximity to others and with quick changes of direction
were the most often associated with ankle injuries.3 Nelson
et al3 also noticed a significantly higher number of injury
occurrences during competition than in practice in all
sports except for women’s volleyball.

Chronic Ankle Instability
Along with the high incidence of ankle injuries in
physical activity, a high occurrence of re-injury to the
ankle is also an area of great concern to athletic
trainers. Re-injury rates have been recorded as high as 80%
in the active population.5 Because of this high rate,
individuals who have suffered multiple consecutive ankle
injuries in addition to continuous symptoms such as
instability in the ankle are diagnosed with chronic ankle
instability.5,6

37
The presence of chronic ankle instability is thought
to be due to mechanical ankle instability (MAI) and
functional ankle instability (FAI).4,5 MAI refers to the
occurrence of excessive ankle range of motion due to laxity
in the ligamentous structures, namely the anterior
talofibular and calcaneofibular ligaments.5,7 It also
includes arthrokinematic restrictions, degenerative
changes, and synovial changes.5,7 MAI instability affects
all the joints associated with the ankle including the
subtalar, talocrural, and inferior tibiofibular joints.7 FAI
components include decreased propioception, neuromuscular
control, strength, and postural control.5,7 All these
components are implemented into ankle rehabilitation
programs to help decrease re-injury rates. Studies conflict
with whether or not FAI and MAI occur simultaneously with
an ankle injury, however it is generally accepted that the
two types of instability are apparent with most cases of
CAI.5
Chronic ankle instability has been found to not only
solely affect kinematics of the ankle, but also the rest of
the lower extremity kinetic chain.8 Time to stabilization
upon landing after jumping has been found to be increased
with chronic ankle instability with knee and hip flexion
landing angles to be decreased.8 Gribble and Robinson8

38
completed a study in order to examine the contributions of
lower extremity kinematics during an assessment of dynamic
stability in people with chronic ankle instability. The
subjects were separated into groups (those with CAI and
those without), but all completed three drop landing tests
while their ankle plantarflexion, knee flexion, and hip
flexion were measured at the point of impact; ground
reaction force data was also collected. The results
indicated that the subjects with CAI had decreased dynamic
stability in addition to a decreased knee flexion angle.
The researchers concluded that decreased amount of knee
flexion and dynamic stability could cause an increase in
re-injury rates.8 Further research is also suggested to
determine if prophylactic devices and various ankle
rehabilitation programs could enhance the kinematic pattern
of the lower extremity.8
In a study completed by Delahunt et al,5 participants
were all CAI sufferers. The researchers wanted to determine
which type of taping (lateral subtalar sling or fibular
repositioning) could enhance dynamic postural stability in
patients with chronic ankle instability. The participants
completed the Star Excursion Balance test under three
conditions: no tape, lateral subtalar sling taping, and
fibular repositioning taping. The researchers concluded

39
that neither taping condition increased nor decreased the
stability of the ankle. In addition, the subjects reported
an increase in feelings of stability and reassurance when
wearing the lateral subtalar sling taping over the fibular
repositioning taping.5
The use of prophylactics has been shown to decrease
the incidence rate of ankle injuries, although the exact
reasoning is not known.5 Possible factors that ankle taping
and bracing could help improve for MAI included joint
arthrokinematic stabilization and chronic laxity and for FAI
taping and bracing could aid in providing increases in
proprioception and neuromuscular control.5 There have been
numerous studies completed investigating these possible
reasons, although research has not been consistent.

Prevention of Ankle Injuries
As previously stated, ankles are commonly injured.
Because of this, the prevention of ankle injuries is
extremely important to be able to keep athletes on the
field. Most health care providers agree that establishing
excellent neuromuscular control, proprioception, and
strengthening are needed to increase dynamic stability and
prevent re-injury.2 Vaes et al9 completed a study that
followed volleyball teams throughout a whole season. They

40
were separated into two groups: control and testing. The
testing group was given a balance board training program to
complete and the control did not, and injury reports were
then recorded. The results showed a significant decrease in
the amount of ankle injuries in the testing group as well
as a significant reduction in ankle sprain risk, but for
only those with a history of injury. The researchers
concluded that the use of this balance board program is
effective in preventing ankle sprains and re-injury.9
Similarly, following an ankle injury, athletes need to
re-establish the same characteristics. After injury, there
are certain neurological deficits that need to be
addressed. However, until this can be established, the use
of ankle prophylactics may be needed for added support.
According to Hubbard and Kaminski,10 ankle injuries cause a
decrease in kinesthesia and proprioception. In this study,
subjects with decreased kinesthesia caused by an ankle
injury were tested under three conditions to determine if
kinesthesia could be increased using taping or bracing. The
participants were tested on a kinesthesia measurement
system while wearing no prophylactic devices, taping, and
two types of braces. The results indicated that the
kinesthesia measurements were significantly better in the
unbraced condition than in the two braced conditions, but

41
not the taping condition. The researchers concluded that
bracing caused a decrease in kinesthesia awareness in the
lower extremity, but stated that much more research needs
to be done to determine the exact affect taping and bracing
has on kinesthesia.10
Vaes et al9 investigated the effectiveness of external
support on stabilization. They tested strapping, taping,
and nine different braces. Once applied to the ankle, the
talar tilt was measured in comparison to no support to find
out the differences. The results indicated that taping and
two of the nine braces significantly decreased the talar
tilt levels. The researchers concluded that there should be
three levels of effectiveness when referring to lower
extremity external support and the effectiveness of this
support should be determined before using it to treat or
prevent ankle injuries.9
Refshauge et al11 determined whether or not
proprioception is affected in people who have frequent
ankle sprains. In addition, the researchers wanted to know
if wearing ankle braces would help to increase the
proprioception back to normal. Subjects (separated into
recurrent sprains and no sprains) were tested with both
tape and no tape on their proprioceptive abilities. The

42
results concluded that there were no significant
differences between the two groups.11

Clinical Practices of Taping and Bracing

Types of Ankle Taping and Bracing
Several different kinds of ankle tapings and bracings
are commonly used by athletic trainers. However, there has
been minimal research on which type of taping or bracing is
most reliable or most preferred.
Rezents12 compared two types of ankle braces to
determine which is better for athletic performance. The
ankle braces used were Active Ankle and ASO lace-ups. The
researcher measured all ranges of motion with and without
the braces. The results indicated that the ASO brace had a
greater decrease in ROM than the Active Ankle. In addition,
when the athletes were surveyed, 93% stated they preferred
the ASO brace because it felt more secure.
Pope et al13 compared four types of ankle tapings. The
taping techniques used were: taping with no figure eight,
taping with figure eights, taping with no heel locks,
taping with heel locks. They were applied to a model of the
human ankle joint and then subjected to functional tests on
a mechanical testing machine. The tests included

43
determining how far the ankle ROM could go before
subjecting it to injury, torque to failure, and deflection.
It was previously determined that eight degrees of angular
deflection causes pain and that torques of 420 nanometers
could be applied before injury occurs. The researchers
determined that the ankle taping that included figure
eights was the best. It was the only method that had the
strength to withstand the most exterior forces than the
other tapings and it was recommended over the others.13
In a similar study Abián-Vicén et al14 compared two
types of ankle tapings. The purpose was to determine the
level of fatigue for two types of tape after a 30 minute
exercise session. The participants were tested with no
tape, an elastic tape, and an inelastic tape. Measurements
of ankle passive range of motion (PROM) were taken before
and after exercise. The subjects were also asked about
their level of comfort and restriction provided by the
tape. The researchers found that after the exercise session
there was less restriction in ankle plantarflexion and
inversion for both types of tape, but that the subjects
perceived the elastic tape as more comfortable and less
restrictive.14 The researchers recommended using elastic
tape over inelastic tape because range of motion was

44
restricted the same for both types, but elastic was
preferred by athletes.14

Clinical Education
To become a Certified Athletic Trainer, one must first
enroll into an Accredited Athletic Training Education
Program. In this program, students complete competencies
and proficiencies in order to obtain the skills needed to
graduate and become certified.

According to the National

Athletic Trainers’ Association, athletic training
educational competencies are “the minimum requirements for
a student’s entry level education.”15(p.2) The Commission on
Accreditation of Athletic Training Education separated the
competencies into twelve content areas and are the
foundation of a student’s education.16 One of these content
areas is Risk Management and Injury Prevention.

Under this

content area, students become proficient in taping and
proper administrations of bracing for prevention and
treatment of injuries.
The Commission on Accreditation of Athletic Training
Education (CAATE) along with the National Athletic Trainers
Association developed the standards and educational
competencies that all Certifed Athletic Trainers must
learn.15,16

According to CAATE, students must complete a

45
competency pertaining to fitting a brace properly. Students
must “appropriately select and fit appropriate standard
protective equipment on the patient for safe participation
in sport and/or physical activity to prevent/minimize the
risk of injury to head, torso, spine, and extremities.”16(p.5)
A certified athletic trainer must know how to use a variety
of different braces for every joint in the body as well as
the advantages and disadvantages of using them to be able
to implement using prophylactic braces on athletes.16
There are taping competencies created by CAATE for
athletic training students as well.

Certified athletic

trainers will be able to “explain, fabricate, and apply
appropriate preventative taping and wrapping
procedures…Procedures and devices should be consistent with
sound anatomical and biomechanical principles.”16(p.5) All of
these competencies are created to not only make sure that
all athletic training students receive the same education,
but they also serve to set a foundation for students’
education.

46
Ankle Taping and Bracing

Effects on Functional Performance
High rates of ankle injury have caused many athletes
and athletic trainers to use protective equipment in order
to prevent an initial injury or a re-injury.

The most

common methods for the ankle are a standard ankle tape or
ankle brace. There have been multiple studies conducted on
the functional performance of athletes who wear these
protective measures. The factors most often compared are
speed, agility, vertical jump, and balance performance.
Recently, there have been conflicting results between
studies on functional activities being affected by taping
or bracing.
A study completed by Abián-Vicén et al1 tested the
effects of ankle taping on balance and jump tests. All
subjects completed three tests with both tape and without
tape. The results indicated no significant differences
between the two testing groups. The researchers concluded
that preventative taping measures do not affect the balance
and jumping abilities of young, healthy athletes.1
There have also been studies7,8 that have been
completed on the use of prophylactic taping and bracing on
certain sports. These studies were conducted in basketball

47
and football.

Macpherson et al7 compared the effects of

softshell and semirigid prophylactic ankle stabilizers on
male football players’ functional performance in speed,
agility, and vertical jump. They concluded that neither of
the ankle stabilizers caused a difference in speed,
agility, or vertical jump.7
In a similar study, MacKean et al17 compared bracing
and taping on functional performance of female basketball
players. The athletes were evaluated in basketball-related
activities (sprint, jump shot, and vertical jump) in five
different scenarios: no tape, preventative taping, and
three different types of bracing.

Overall, the results

indicated that taping and bracing did slightly affect the
subjects’ abilities in basketball-related drills.

Vertical

jump and jump shot were decreased when the athletes wore
tape and braces.

This led the researchers to believe that

the protective measures caused adverse reactions in female
basketball players.17
Hardy et al18 and Ozer et al19 investigated the
effectiveness of ankle prophylactics on balance and
proprioception. Hardy et al18 had each participant complete
three Star Excursion balance tests while wearing no brace,
a semi-rigid brace, and a lace-up ankle brace. The Star
Excursion balance tests consist of maintaining balance

48
while moving opposite leg in eight different directions.
The researchers concluded that bracing had no effect at all
on the balance during reaching tasks.18 Similarly, Ozer et
al19 measured the effectiveness of not only bracing but
ankle taping on balance, jumping, coordination, and
proprioception. Each participant was tested for each
variable while wearing no ankle devices barefoot, braces,
and tapings. The results indicated that there were no
significant differences between the braces or taping when
compared to barefoot measures on any of the variables
tested. The researchers concluded that either method is
useful in preventing ankle injuries without altering
functional performance.19 Both of these articles measured
similar functional performance, yet they arrived at
different conclusions.
In addition to research that has been performed to
date on ankle prophylactic affects on functional
performance, there has been some research on the
perceptions and/or placebo affect that may accompany these
devices. Reuter et al20 compared four types of prophylactic
devices (spatting, taping, bracing, and no taping/bracing)
on athletes wearing football cleats. The researchers
studied measurements of functional performance (maximal
effort sprint and cutting drill) and feelings of comfort

49
and stability. The results found that the subjects
perceived no support or the bracing as more comfortable and
stable than either taping or spatting in the sprint, but
found that no support was far less stable in the cutting
drills than the other three conditions.

There were no

performance differences between any of the conditions. This
led the researchers to conclude that spatting does not
affect performance, is the same as taping in stability and
comfort, and the same as bracing in stability but not
comfort.20
Sawkins et al21 wanted to find out if there was a
placebo effect in athletes who wear ankle taping and
believe they will not be reinjured. The participants were
tested under three conditions: no tape, real tape, and a
placebo tape. They completed the Star Excursion balance
test and a hopping test. The results indicated that there
were no differences between the conditions in the
functional tests. However, the researchers found that the
subjects felt more confidence, stability, and reassurance
when wearing both the placebo tape and the real tape. The
researchers did not come to an actual conclusion, but
stated that further research needs to be done in this area
to determine if there is a placebo effect.21

50
Reliability of Injury Prevention
The effectiveness of tape has long since been debated
in research, with some experts saying that after a period
of time the tape loosens up and is not effective any
longer.

In one study, Meana et al22 aimed to compare the

effectiveness of ankle taping after a 30 minute training
session. Ankle ROM was recorded before and after the
training session. The results indicated that there was
almost 50% decrease in ROM after the training session. The
researchers concluded that further testing needs to be done
in order to determine the effectiveness of wearing ankle
taping in those who have no history of ankle injury.22
Another study completed by Delahunt et al23 examined the
effects of a standard ankle taping on ankle joint movement
in the frontal and sagittal plane on patients with chronic
ankle instability. Each subject completed three drop
landing tests under three conditions: no tape, taping, and
post-exercise taping. The results indicated that there were
no significant differences between pre and post exercise
taping. Both taping conditions caused a decrease in the
amount of plantarflexion after the drop landings. The
researchers concluded that ankle taping may help to
increase stability in the ankle.23

51
Mickel et al24 compared the use of bracing versus
taping and the incidence of ankle sprains in one season of
high school football season. The athletes were randomly
placed into one of two groups: braced or taped every day.
After the season, six ankle sprains had occurred and there
was no significant difference between the two variables. In
addition, the cost of using tape throughout the season
compared to a one-time fee of ankle braces is significantly
higher when using tape. The researchers concluded that
using braces would be more efficient than using tape.24
Similarly, Frey et al25 completed a study that determined
the effectiveness of ankle bracing on the frequency of
ankle injuries in high school volleyball players over the
course of one season. Subjects were separated into two
groups: those who wear braces and those who do not wear
braces as the control. The researchers used information
about previous injury and sex to determine the results.
They found that there were no differences between the
frequency of ankle injuries between the two groups.
However, they found that there were difference in
protecting against re-injury for those who had a previous
injury. The Aircast Sports Stirrup and Active Ankle Trainer
II protected against injury with no history, but did not
prevent injury to those who had prior history. Also, in the

52
female group there were significantly more injuries when
wearing non-rigid braces compared to more rigid braces. The
researchers concluded that this information is very helpful
for people deciding on which ankle brace to use in
volleyball.25

Summary

The review of literature focuses on the importance and
background of ankle prophylactics, clinical practice of
taping and bracing, and ankle taping and bracing. Athletic
trainers must choose between the two types of ankle
prophylactics every day when preventing and treating ankle
injuries.
There is very little research that states what the
preference of athletic trainers is for ankle prophylactics.
However, research does state the similarities and
differences between the two types. Both taping and bracing
have little to no decrease in functional performance.
According to research,3,7,9 bracing is a better option to use
when one focuses on only injury prevention.

Bracing tends

to keep the foot in more stabilized, closed pact position
longer than taping does.12,22

In addition, bracing is also a

better option when looking at a cost standpoint. Buying

53
individual braces for each ankle is far cheaper than buying
several boxes of tape.24
Since most of the research points to using bracing
over taping as a better option, it is important to see if
athletic trainers are following research or using tape more
often.

There are various other reasons that one would

choose either device over the other, which should be
determined as well.

54

APPENDIX B
The Problem

55
STATEMENT OF THE PROBLEM

The primary purpose of this study is to examine
Certified Athletic Trainers use ankle prophylactics in the
prevention and treatment of injury. It is important to
examine this relationship because athletic trainers
frequently use ankle taping and bracing and have specific
reasons as to why they choose one over the other. Finding
out if athletic trainers knowledge of the literature
associated with ankle prophylactics corresponds with their
preference in choosing between them can help to determine
why an individual would or would not choose one device over
the other. Additionally it would be beneficial for athletic
trainers to assess their knowledge of the research and if
they are up to date.

Definition of Terms
The following definitions of terms will be defined for
this study:
1)

Ankle Prophylactics – referring to types of ankle
taping, bracing, or both completed for the prevention
of injury26

56
2)

Functional Performance – an individual’s personal
skill in the following aspects: jumping, running,
sprinting, balance, and agility26

3)

Proprioception – the unconscious perception of
movement and spatial orientation arising from stimuli
within the body itself26

4)

Neuromuscular Control – pertaining to stability and
balance of both nerves and muscles26

5)

Spatting – use of taping to prevent ankle injuries on
the outside of a shoe26

Basic Assumptions
The following are basic assumptions of this study:
1)

All respondents will answer the survey honestly to the
best of their ability.

2)

All respondents will be given adequate time to
complete the survey.

3)

There will be an adequate return rate.

Limitations of the Study
The following are possible limitations of the study:
1)

Only surveying Certified Athletic Trainers in high
school and collegiate settings.

57
2)

Only surveying Certified Athletic Trainers who are
members of the National Athletic Trainers’
Association.

3)

Opinions/knowledge may be skewed by the Athletic
Trainers educational background.

4)

Incorrect names or email addresses of Athletic
Trainers could be included in the list serve.

Significance of the Study
Athletic trainers must choose between the two types of
ankle prophylactics every day when preventing and treating
ankle injuries. There is very little research that states
what the preference of health care professionals is for
ankle prophylactics.

Both taping and bracing have little

to no decrease in functional performance. According to
research, bracing is a better option to use when one
focuses on only injury prevention.3,7,9 Bracing tends to keep
the foot in more stabilized, closed pact position longer
than taping does.12,21 In addition, bracing is also a better
option when looking at a cost standpoint.23 Buying
individual braces for each ankle is far cheaper than buying
several boxes of tape.
Since most of the research points to using bracing
over taping as a better option, it is important to see if

58
athletic trainers are following research or using tape more
often.

There are various other reasons that one would

choose either device over the other, which should be
determined as well.

59

APPENDIX C
Additional Methods

60

APPENDIX C1
Panel of Experts Letter

61

Dear________________:
I am a graduate athletic training student at California
University of Pennsylvania pursuing a Master of Science
degree in Athletic Training. To fulfill the thesis
requirement for this program, I am conducting a descriptive
study. The primary purpose of this study is to examine how
Certified Athletic Trainers use ankle prophylactics in the
prevention and treatment of injury.
In order to increase the content validity of the
instrument, a panel of experts has been chosen to review
the survey. You have been selected as one of the three
professionals to be on this panel. Due to your position and
experience, your feedback is very important to the success
of this study. The information obtained by this panel of
experts review will be used to make revisions and create
the final survey to be distributed to the population
sample. Your responses are voluntary and will be
confidential.
Please answer the following questions based on the attached
survey and make any other additional comments you deem
appropriate. Please return your comments and revisions via
email no later than November 7, 2011. If you have any
questions or concerns, please do not hesitate to contact
me.
1.

Are the questions appropriate, valid, and
understandable?

2.

Comment on the overall presentation of the survey.

3.

Which questions, if any, should be restated from the
survey? Why?

4.

Which questions, if any, should be added to the
survey? Why?

Thank you in advance for your time and efforts.
Sincerely,
Amber Boyle, ATC
California University of Pennsylvania

62

APPENDIX C2
Certified Athletic Trainers Use of
Ankle Prophylactic Devices Survey

63

64

65

66

Approved by the California University of
Pennsylvania IRB

67

Appendix C3
Institutional Review Board

68

69

70

71

72

73

74

75

76

77

78

79

80

81

Institutional Review Board
California University of Pennsylvania
Morgan Hall, Room 310
250 University Avenue
California, PA 15419
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair

Dear Amber Boyle:

Please consider this email as official notification that your proposal titled
"Athletic Trainers Use of Prophylactic Devices in the Ankle” (Proposal #11016) has been approved by the California University of Pennsylvania
Institutional Review Board as submitted.
The effective date of the approval is 12-06-2011 and the expiration date is 1205-2012. These dates must appear on the consent form .
Please note that Federal Policy requires that you notify the IRB promptly
regarding any of the following:
(1) Any additions or changes in procedures you might wish for your study
(additions or changes must be approved by the IRB before they are
implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are necessitated
by any events reported in (2).
(4) To continue your research beyond the approval expiration date of 12-052012 you must file additional information to be considered for continuing
review.
Please contact instreviewboard@calu.edu
Please notify the Board when data collection is complete.

Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

82

Appendix C4
Cover Letter

83

Dear Fellow Certified Athletic Trainer:
My name is Amber Boyle and I am currently a graduate student at California University
of Pennsylvania pursing a Master of Science in Athletic Training. Part of the graduate
study curriculum is to complete a research thesis through conducting research. The
primary purpose of this study is to examine how Certified Athletic Trainers use ankle
prophylactics in the prevention and treatment of injury.
High school and collegiate Athletic Trainers who are members of the National Athletic
Trainers’ Association are being asked to submit this questionnaire; however, your
participation is voluntary and you do have the right to choose not to participate. You also
have the right to discontinue participation at any time during the survey completion
process at which time your data will be discarded. The California University of
Pennsylvania Institutional Review Board has reviewed and approved this project. This
approval is effective 12/06/11 and expires 12/05/12.
All survey responses are anonymous and will be kept confidential, and informed consent
to use the data collected will be assumed upon return of the survey. Aggregate survey
responses will be housed in a password protected file on the CalU campus. Minimal risk
is posed by participating as a subject in this study. I ask that you please take this survey
at your earliest convenience as it will take approximately 5- 10 minutes to complete. If
you have any questions regarding this project, please feel free to contact the primary
researcher, Amber Boyle at boy7061@calu.edu. You can also contact the faculty
advisor for this research Carol Biddington, EdD at biddington@calu.edu or 724-9384356. Thanks in advance for your participation. Please click the following link to access
the survey
https://www.surveymonkey.com/s/ATCankleprophylacticdevicesurvey
Thank you for taking the time to take part in my thesis research. I greatly appreciate your
time and effort put into this task.
Sincerely,
Amber Boyle, ATC
Primary Researcher
California University of Pennsylvania
250 University Ave
California, PA 15419
574-274-7504
Boy7061@calu.edu

84
REFERENCES
1. Abián-Vicén J, Alegre L, Fernández-Rodríguez J, Lara A,
Meana M, Aguado X. Ankle taping does not impair performance
in jump or balance tests. J Sports Science Medicine [serial
online]. September 2008;7(3):350-356.
2. Robbins S, Waked E. Factors associated with ankle
injuries: Preventative measures. Sports Medicine. February
1998;25 (1):63-72.
3. Nelson A, Collins C, Yard E, Fields S, Comstock RD,
Ankle injuries among United States high school sports
athletes, 2005–2006. J Athletic Training [serial online].
September 2007;42(3):381–387.
4. Hubbard, TJ, Hertel J. Mechanical contributions to
chronic lateral ankle instability. Sports Medicine
(Auckland, N.Z.) [serial online]. March 2009;36(3):358-374.
5. Delahunt E, McGrath A, Doran N, Coughlan G. Effect of
taping on actual and perceived dynamic postural stability
in persons with chronic ankle instability. Archives
Physical Medicine Rehabilitation [serial online]. September
2010;91(9):1383-1349.
6. Youdas, JW, McLean TJ, Krause DA, Hollman JH. Changes in
active ankle dorsiflexion range of motion after acute
inversion ankle sprain. J Sport Rehabilitation[serial
online]. August 2009;18(3):358-374.
7. Macpherson K, Sitler M, Kumura I, Horodyski M. Effects
of a semirigid and softshell prophylactic ankle stabilizer
on selected performance tests among high school football
players. J Orthopaedic Sports Physical Therapy. March
1995;21(3):147-152.
8. Gribble PA, Robinson RH. Alterations in knee kinematics
and dynamic stability associated with chronic ankle
instability. J Athletic Training [serial online]. August
2009;44(4):350-355.
9. Vaes P, Duquet W, Handelberg F, Casteleyn P, Tiggelen R,
Opdecam P. Influence of ankle strapping, taping, and nine
braces: A stress roentgenologic comparison. J Sport
Rehabilitation [serial online]. August 1998;7(3):157.

85

10. Hubbard TJ, Kaminski TW. Kinesthesia is not affected by
functional ankle instability status. J Athletic Training.
April 2002;37(4):481–486.
11. Refshauge KM, Kilbreath SL, Raymond J. The effect of
recurrent ankle inversion sprain and taping on
proprioception at the ankle. Med Sci Sports Exercise. June
2000;32(1):10-15.
12. Rezents RL. A comparison of ankle braces and their
prevention of injuries; A closer look at stability vs range
of motion. Saint Martin’s University Biology J. May
2006;1:255-266.
13. Pope MH, Renstrom P, Donnermeyer D, Morgenstern S. A
comparison of ankle taping methods. Medicine Science Sports
Exercise. 1987;19(2):143-147.
14. Abián-Vicén J, Alegre L, Fernández-Rodríguez J, Aguardo
X. Prophylactic ankle taping: Elastic versus inelastic
taping. Foot Ankle International. March 2009;30(3):218-25.
15. National Athletic Trainers’ Association: Education.
Available at: http://www.nata.org/education/competencies.
Accessed November 30, 2011.
16. CAATE: Commission on Accredition of Athletic Training
Education. Available at: http://www.caate.net. Accessed
October 24, 2011.
17. Mackean L, Bell G, Burnham R. Prophylactic ankle
bracing vs taping: effects on functional performance in
female basketball players. J Orthopaedic Sports Physical
Therapy. August 1995;22(2):77-81.
18. Hardy L, Huxel K, Brucker J, Nesser T. Prophylactic
ankle braces and star excursion balance measures in healthy
volunteers. J Athletic Training [serial online]. July
2008;43(4):347-351.

86
19. Ozer D, Senbursa G, Baltaci G, Hayran M. The effect on
neuromuscular stability, performance, multi-joint
coordination and proprioception of barefoot, taping or
preventative bracing. Foot (Edinb). December
2009;19(4):205-10.
20. Reuter GD, Dahl AR, Senchina DS. Ankle spatting
compared to bracing or taping during maximal-effort sprint
drills. International J Exercise Science. 2004;4(1):305-20.
21. Sawkins K, Refshauge K, Kilbreath S. The placebo effect
of ankle taping in ankle instability. Medicine Science
Sports Exercise: Official J American College Sports
Medicine. 2007;39(5):781-787.
21. Meana M, Alegre LM, Elvira JLL, Aguado X. Kinematics of
ankle taping after a training session. International J
Sports Medicine [serial online]. January 2008; 29(1):70-76.
23. Delahunt E, O'Driscoll J, Moran K. Effects of taping
and exercise on ankle joint movement in subjects with
chronic ankle instability: a preliminary investigation.
Arch Phys Med Rehabil. August 2009;90(8):1418-22.
24. Mickel TJ, Bottoni CR, Tsuji G, Chang K, Baum L,
Tokushige KS. Prophylactic bracing versus taping for the
prevention of ankle sprains in high school athletes: A
prospective, randomized trial. J Foot Ankle Surgery.
November 2006;45(6):360-365.
25. Frey C, Feder KS, Sleight J. Prophylactic ankle brace
use in high school volleyball players: a prospective study.
Foot Ankle Int. April 2010;31(4):296-300.
26. Prentice WE. Arnheim’s Principles of Athletic
Training: A Competency Based Approach. 12th ed. New York,
NY: McGraw-Hill; 2005.

87
ABSTRACT
TITLE:

ATHLETIC TRAINERS USE OF PROPHYLACTIC
DEVICES IN THE ANKLE

RESEARCHER:

Amber Boyle, ATC, PES

ADVISOR:

Dr. Carol Biddington

DATE:

April 2012

PURPOSE:

The primary purpose of this study was to
examine athletic trainers use of
prophylactic devices in the ankle.

Design:

Descriptive Survey

Settings:

Population-Based Survey

Participants:

There were 196 randomly selected ATCs
currently working in the collegiate, high
school, or high school/clinic setting as
participants.

INTERVENTIONS: The dependent variables were taping or
bracing and preventing or post-injury
prophylactic use. The independent variable
was employment setting of athletic trainers
and included high school, high
school/clinic, and college.
RESULTS:

Statistical significance was found in two of
the three hypotheses which indicate that
athletic trainers from the collegiate
setting choose to apply both bracing and
taping after an acute ankle injury. In
addition, a closed basket weave taping
technique is the preferred ankle taping for
collegiate athletic trainers to prevent
injury.

CONCLUSIONS:

Based on the results of this study, we can
conclude that collegiate athletic trainers
have a similar preference of prophylactic
device to prevent and treat ankle injuries.