Background
Ankle sprains are one of the most common injuries in the United States with approximately 28,000 occurring per day (Kaminski et al., 2013). Ankle sprains are estimated to make up 45% of all athletic injuries. As an athletic trainer in the secondary school setting, these seem to occur on a weekly basis. This results in time away from sport, pain, and disability. There is also potential for monetary costs like doctor office visits, imaging, and durable medical equipment. The teams at Forest Hills Northern have experienced these issues over the years. Due in part to some quarantine boredom in mid-2020, balance training was a solution found by way of a 16-year old research study. This solution does not take long to perform, but it requires consistency and long-term commitment.
The Study
McGuine and Keene’s 2006 study, The Effect of a Balance Training Program on the Risk of Ankle Sprains in High School Athletes, provided the groundwork for the program implemented at Forest Hills Northern starting in the 2020-2021 school year. The randomized-control trial (n = 765) noted a 38% decrease in ankle sprains among high school basketball and soccer players that participated in the balance program. The program was four weeks of progressively difficult exercises (5 days/week). The initial week was on a firm surface with eyes open, but progressed to eyes closed and on a balance board. A “maintenance program” was implemented from week five until the end of the season (3 days/week). These exercises were not performed on competition days. The exercises were performed for thirty seconds per side followed by a thirty-second rest. Total time per day equated to fewer than 5 minutes. Furthermore the program required minimal equipment. The ankle sprains that occurred in the “balance training” subjects were also less severe from a time-loss perspective compared to the “no training” control subjects.
A systematic review by Bellows and Wong (2018) noted a similar reduction in ankle sprains following balance training, ranging from a 35-38% reduction. Benefits were seen regardless of ankle injury history. However, greater benefits were noted in subjects with a previous history of an ankle sprain. As a side note, it was also found that ankle braces reduced the risk of sprain between 65 and 69%.
Implementation
The Forest Hills Northern varsity volleyball team served as the “pilot” team in the Fall 2020 season. The boys and girls basketball and competitive cheer programs followed suit in the winter season. All of these teams are still active participants in the 2021-22 school year. I arrive in the first fifteen minutes of practice and talk everyone through the stances before or after they warm up for the day.
Conclusion
While no injury is fully preventable, it is possible to lessen the likelihood one occurs, thereby reduced monetary expenses. With estimated emergency costs ranging from $702-$1408 (Shah et al., 2016), prevention of lateral ankle sprains is crucial. Twelve balance boards cost approximately $400, less than the cost of one injury.
Preventing sprains also has the added benefit of minimizing time away from sport. Spending 30-50 minutes per week may seem excessive when that time could be spent learning aspects of the sport. However, consider that an injured student-athlete may be losing 5-10 hours of practice and gameplay per week if injured. The program is a brief time investment that pays dividends by minimizing days of lost participation and keeping student-athletes healthy.
After 18 months of initiating this program at Forest Hills Northern, it is reducing our injury rates, severity of injury, and days out of activity. I encourage any athletic program interested in this relatively inexpensive form of injury prevention to pursue it. Balance programs are underutilized and are a simple and effective way to decrease the risk of ankle sprains.
Sources
Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie D; National Athletic Trainers’ Association. National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013 Jul-Aug;48(4):528-45. doi: 10.4085/1062-6050-48.4.02. PMID: 23855363; PMCID: PMC3718356.
McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006 Jul;34(7):1103-11. doi: 10.1177/0363546505284191. Epub 2006 Feb 13. PMID: 16476915.
Bellows R, Wong CK. The effect of bracing and balance training on ankle sprain incidence among athletes: a systematic review with meta-analysis. Int J Sports Phys Ther. 2018 Jun;13(3):379-388. PMID: 30038824; PMCID: PMC6044595.
Shah, S., Thomas, A. C., Noone, J. M., Blanchette, C. M., & Wikstrom, E. A. (2016). Incidence and Cost of Ankle Sprains in United States Emergency Departments. Sports health, 8(6), 547–552. https://doi.org/10.1177/1941738116659639