Category Archives: Evidence based facts

Do This, Not That

by Colleen Morgan, PT, MS, OCS, CSCS

Whether you are a weekend warrior or competitive athlete,

a life-long “gym rat” or exercise newbie, it’s important to know which gym exercises are worth your time and energy.  Learn what exercises most physical therapists would categorize as worthless (perhaps even downright dangerous) and explore some healthy alternatives in our recurring blog column “Do This, Not That!”

Do This!

Not That!

Bird dog may look (and sound) like a weird exercise, but similar to the plank, it’s a great “whole body” exercise.  This is a surprisingly functional exercise: Remember how tired you were after you knelt to clean the bathtub?  Stabilization of your core, upper body, and lower body occurs as soon as you get onto hands and knees.  The exercise becomes progressively more challenging as you lift just one arm, just one leg, alternating arm and leg, and finally same-sided arm and leg.  Keep that tummy tight to support your back! Seated back extensions against resistance.Sitting imposes the greatest compressive load through the lumbar spine.  Forcefully extending your back against resistance creates a compressive force rather than a stabilizing force through your lumbar spine.  Add on the fact that you are sitting and you have a potential recipe for harmful spinal compression!
 OLYMPUS DIGITAL CAMERA  image024

What is a burpee?

 By Mike Kwong, PTA, CSCS

Ever overhear a personal trainer at a gym tell his/her client to perform 10 burpees as a part of their training program? Do you have a kid in team sports moan about the amount of burpees that his/her coach made them do during practice? Have you ever wondered what a “burpee” actually is? It sounds like a cross between a 7-11 Slurpee and the noise you make after drinking it! So, what is this infamous burpee that people are talking about?

The Burpee, also known as a squat thrust, is a full body exercise used in strength training and as aerobic exercise. It is performed in the following steps:

  1. Begin in a standing position.
  2. Drop into a squat position with your hands on the ground. (count 1)
  3. Extend your feet back in one quick motion to assume the front plank position. (count 2)
  4. Return to the squat position in one quick motion. (count 3)
  5. Return to standing position. (count 4)

Burpee

A Brief History of The Famous Mr. Burpee

According to the Oxford English Dictionary, the exercise was named in the 1930’s for American physiologist Royal H. Burpee, who developed the Burpee Test. He earned a PhD in Applied Physiology from Columbia University in 1940 and created the “Burpee” exercise as part of his PhD thesis as a quick and simple way to assess fitness. The exercise was popularized when US Armed Services adopted it as a way to assess the fitness level of recruits when the US entered WWII. Consisting of a series of the exercises performed in rapid succession, the test was meant to be a quick measure of agility, coordination and strength.

There are several variants to the traditional burpee, with the more popular ones adding a push up, jump, or pull up to the exercise. Here are a few:

  1. Burpee push up: the athlete adds a push up after assuming the plank position
  2. Jump up Burpee: the athlete jumps up as high as they can at the end of the movement and before they start their next burpee
  3. Long-jump Burpee: the athlete jumps forward, not upward
  4. Jump-over Burpee: the athlete jumps over an obstacle between burpees
  5. Pull-up Burpee: the athlete combines a pull-up with the jump or performs the pull-up instead of the jump
  6. Double Burpee: instead of 1 push up, do 2 in a row. This cancels the drive from landing after the jump and makes the next jump harder. Each part of the burpee may be repeated to make it harder.
  7. Side Burpee:  The athlete bends at waist and places hands shoulder-width apart to the side of right or left foot. Jump both legs back and diagonally to the right. Jump back in, jump up, and repeat. jumping back and to the left side.

Here at CPMC’s Physical Therapy and Sports Wellness Clinic, we use the burpee (and variations of it) as one of our exercises in our Total Body Fitness classes. Recently, we have been holding our own fitness challenge: how many can you do in 30 seconds? The results have been amazing!  Come try it out for yourself!

Sports Wellness Center
Physical Therapy Clinic – Pacific Campus
2360 Clay Street, San Francisco, CA 94115
wellness@sutterhealth.org
415.600.5860

Jumping: What Goes Up, Must Come Down

by Thommy Chui, PT, MS, OCS, CSCS, TPI CGFI MP2

Growing up with two older brothers and a lot of neighborhood friends, jumping was just something we did during play: over lines on the sidewalk, on trampolines and even daring each other to leap off progressively taller benches and rocks. Eight year old kids with supple joints and no fear of injury tend not to worry about things like proper jumping mechanics.  As I got older and involved in competitive sports, more emphasis was placed on being able to jump higher and farther, but with little or no instruction on how to do it properly.  Although I survived these athletic endeavors of my youth relatively unscathed, as a physical therapist I see unsafe jumping mechanics contributing to injury in many of the young athletes I work with.

The act of jumping seems innocent enough: springing up from the ground into the air by force from your legs. Regardless of how you take off or how high you jump, everyone has to land on the ground.  What comes up, must come down after all.  Did you know that the body must absorb an impact 2-4 times its body weight in that landing?  In my experience, coaches and athletes devote lots of time on developing the mechanics and explosiveness necessary to jump from the ground, but very little if any on training the body to safely absorb the impact of landing.   In fact, the majority of sports injuries involving the lower extremities occur not during the take off phase but during landing, particularly in sports such as gymnastics and ice skating where accurate landings are crucial.  To prevent these injuries, it is essential that athletes work to develop proper strength and landing mechanics.

Common Landing Faults:

  • Landing with flat feet –  limits the ability of the musculature around the ankle and knee to shock absorb. The balls of your feet are the last part of your foot to leave the floor when jumping—they should be the first to touch the floor when landing
  • Landing with our knees facing inward- loads the joints unevenly and can lead to injury. Your knee caps should stay aligned over the middle of your feet when landing
  • Not incorporating hip and knee flexion – not bending hips and knees upon landing adds stress to joints and ligaments.  The goal is to land with “soft” knees and hips

Improving your landing mechanics:

  • Practice!  Start with small double foot jumps (vertical) or hops (horizontal).  Focus on landing softly, keeping knees aligned over your feet and allowing the knees and hips to bend upon landing to shock absorb.  Try to make your landings as quiet as possible, if you hear a thud on impact you’re landing too hard
  • Progress with bigger jumps and hops or practice landing only on 1 leg to simulate what might happen in a game setting. Stand on top of a bench or box, step off and practice your soft landings
  • Surface makes a difference. Practice ideally on the type of surface you’ll be performing on.  Grass, rubberized mats and gym floors are best for reducing impact forces.  Try to avoid repetitive jumping/landing on hard surfaces like cement
  • Having adequate core and leg strength is vital.   Injury can still occur with perfect landing mechanics if your muscles are not strong enough to absorb the impact.  Strengthen your glutes, quadriceps, hamstrings and calves to protect your joints and ligaments


Check out our video library for the core and lower extremity strengthening exercises listed below and many more ideas on how to develop better strength for jumping mechanics!

1.  Band sidesteps in standing and crouched position

2.  Double leg squats

3.  Lunges

4.  Calf raises with eccentric control

5.  Squat hops with eccentric control

References

Prapavessis, H. , McNair, P.  Effects of Instruction in Jumping Technique and Experience Jumping on Ground Reaction Forces.  JOSPT 1999;29 (6) 352-356.
Umberger, B.R. Mechanics of the Vertical Jump and Two-Joint Muscles: Implications in Training Strength and Conditioning 1998.
Mostafa, A., Hinrichs, R.N.  A Mechanics Comparison Between Landing From a Countermovement Jump and Landing From Stepping off a Box. Journal of Applied Biomechanics 2012, 28, 1-9. 

Do This, Not That!

by Colleen Morgan, PT, MS, OCS, CSCS

Whether you are a weekend warrior or competitive athlete,

a life-long “gym rat” or exercise newbie, it’s important to know which gym exercises are worth your time and energy.  Learn what exercises most physical therapists would categorize as worthless (perhaps even downright dangerous) and explore some healthy alternatives in our recurring blog column “Do This, Not That!”

Do This!

Not That!

Lunges help to improve quadriceps strength using a functional movement pattern your body may use throughout the day.  You can vary the degree of knee bend depending on your comfort level and stability.  Since you are standing, you are also working on your balance and core stability.  If you’ve mastered your forward lunges, progress to lunges in multiple directions. Seated knee extensions against resistance.  Upon mentioning this popular exercise to a physical therapist, expect their reaction to include the following: redness of the face, difficulty speaking, and spontaneous combustion.  Okay, so that’s an exaggeration, but if you know anything about the knee joint, you will loathe this exercise.  Seated knee extensions against resistance isolate your quadriceps, but put unnatural, excessive load and stress on your patellofemoral joint and ACL, which can lead to knee pain and injury.
 Lunge
 Seated Knee Extension Machine

Ski/Board Strong, All Day Long: Week 6

Welcome to the FINAL week of the Ski and Snowboard Series. This is a progressive strength and conditioning program specific to snow sports injury prevention and performance enhancement.  If you have not been skiing this year yet or are feeling like you need a little zip in your technical moves, the following blog is for you!

The previous blogs in this series direct you in beginning hip, core, and balance exercises.  Here are the links to the blogs and videos:

Week 1: Glut med and balance progressions

Week 2: Front plank and squat progressions

Week 3: Clams and side plank progressions

Week 4:  Bridge and hip power progressions

Week 5: Lunge and rotational stability progressions.

If you have not done any of the previous weeks exercises, you may not be fit enough to safely perform the following plyometric exercises just yet.  If you’re just tuning in, we strongly recommend going back to cover the basics before attempting these advanced exercises.

What are plyometrics?  A plyometric activity occurs a muscle is lengthened quickly and then shortened quickly (called a stretch shorten cycle).  This is highly effective in developing power.

Unfortunately there is little understanding by many on how to prepare for and how often to do plyometric training.  We do know that the most important component of plyometrics is ensuring that you warm up with dynamic stretching and mobility work.  It is also important to perform a consistent strengthening program for 1-2 months (similar to weeks 1-5 above) prior to the first session of plyometrics.

Perform the following exercises in the video 1-2 sessions per week at most.  Start with moderate intensity/speed and increase as you feel that your body can accelerate in a controlled manner.  Perform on a solid surface using two feet and progress towards the unstable surface (BOSU ball) and to one foot.  Perform each exercise for 1 minute and repeat 2 times each.  Make sure that you do not have any pain while performing these exercises.

Continue performing the exercises above for the remainder of the snow season including 3-5 of the most challenging exercises from the previous blogs listed above.  This will help keep you healthy and strong for the entire ski and snowboard season.

Check back with our blog for the next few months as we outline common injuries and exercise remedies.

Happy Skiing and Boarding!  Own the slopes!

Still not motivated or don’t have enough time to practice every day?  Come to Total Body Fitness every Tuesday and Saturday where we will feature specific exercises geared towards snow sports fitness.

Ski/Board Strong, All Day Long: Week 5

Welcome back to the fifth week of the Ski and Snowboard Series.  This is a progressive strength and conditioning program specific to snow sports injury prevention and performance enhancement.  By now you should have a good base strength to protect you from injuring yourself the first day out on the slopes.  Also by now, hopefully you have made it to the slopes!  The previous weeks direct you in beginning hip, core, and balance exercises.

Week 1:  Glut med and balance progressions

Week 2:  Front plank and squat progressions

Week 3:  Clams and side plank progressions

Week 4: Bridge and hip power progressions

The coming ski and snowboard posts will be emphasize development of your speed, agility, and power necessary for some seriously technical moves!

Lunge Progression – Week 5

The lunge exercise is one of the best total lower body exercises there is.   Eccentric muscle contractions in the gluts, hamstrings and quadriceps occur while performing the lunge, which creates strength for powerful movements.  The lunge will prepare your legs for more technical moves such as jumping and moguls.

Start: Stationary lunge.  Step one foot forward making sure that your front knee does not go beyond the toes.  Keep the trunk upright and abdominals engaged while lowering the back knee towards the ground.  Repeat 2 sets of 10-20 repetitions on each side.

Progress:  Perform the dynamic lunge by stepping back between each repetition.  To further advance it, add a rotational twist into the front leg.  Perform 2 sets of 10 – 20 repetitions or to fatigue.  

Squat and Rotation Progression – Week 5

Since much of our time on skis and snowboard are spent in a slight squat, this is a very sport specific exercise to improve your stability with shredding, moguls, or for creating power prior to aerial moves.

Start: Squat with rotational chop.  While holding a squat, use a weight or medicine ball to perform a low to high diagonal movement.  To progress in intensity move the weight faster without letting your hips/trunk sway.  Perform 2 sets of 30 seconds or to fatigue.  Repeat the other direction moving the weight low to high from your opposite side.

Progress: Single leg squat with rotational chop.  Perform 2 sets of 30 seconds or to fatigue.  Repeat the other direction moving the weight low to high from your opposite side.  Perform on each leg. 

Still not motivated or don’t have enough time to practice every day?  Come to Total Body Fitness every Tuesday and Saturday where we will feature specific exercises geared towards snow sports fitness.

Check back for next week’s installment of the ski and snowboard series!

Ski/Board Strong, All Day Long: Week 4

Hooray for SNOW!!!  Welcome back to the fourth week of the Ski and Snowboard Series.  This is a progressive strength and conditioning program specific to snow sports injury prevention and performance enhancement.  By now you should have a good base strength to protect you from injuring yourself the first day out on the slopes.  Also by now, hopefully you have made it to the slopes!  The previous weeks direct you in beginning hip, core, and balance exercises.

Week 1:  Glut med and balance progressions

Week 2: Front plank and squat progressions

Week 3:  Clams and side plank progressions

Now, we are going to work on power development:

Bridge Progression – Week 4

If there was a single exercise we’d perform on a deserted island, it’d be an exercise called bridging, or just, the bridge.  The bridge reverses so many deficits that can be detrimental to our level of conditioning.  The bridge will strengthen your core, gluteals, hamstrings, and stretch the hip flexors.  This exercise progression is great for prepping for the slopes and can be a lifelong injury prevention exercise.

Start: Double or single leg bridge.  Perform 2 sets of 10-20 repetitions or to fatigue.  Make sure your lumbar spine and pelvis is neutral and that you engage your lower abdominals.  During the single leg bridge keep your pelvis flat like a table top.

Progress:  Perform the progression above on a physio ball

Hip Power Progression – Week 4

Last week, we introduced the clamshell exercise to help stabilize the hip joint and ligaments during movements requiring change of direction.  The large outer layer of the hip musculature (the gluteus maximus) along with the hamstrings are responsible for large bursts of power.  The squat below will help develop this movement, and work on upper body muscle imbalances at the same time.  To work on hip extensors, power, AND balance, perform the RDL progression.

Start: Overhead squat.  Make sure to keep your elbows locked and arms right overhead.  Squat down as far as you can before your arms start migrating forward or your heels start leaving the ground.  Perform 2 sets of 10-20 or to fatigue.

Progress: Single leg Romanian dead lift (RDL).  Perform 3 sets of 10-20 reps or to fatigue on each side.

Still not motivated or don’t have enough time to practice every day?  Come to Total Body Fitness every Tuesday and Saturday where we will feature specific exercises geared towards snow sports fitness.

Check back for next week’s installment of the ski and snowboard series!

Ski/Board Strong, All Day Long: Week 3

Welcome back to the third week of the Ski and Snowboard Series.  This is a progressive strength and conditioning program specific to snow sports injury prevention and performance enhancement.

Missed the earlier posts?  See them here: Week 1 and Week 2

Gluteal Progresssion – Week 3

Although it is essential to perform challenging and fatiguing large muscle strengthening exercises, it is also essential to continue working on small muscle stabilizers.  Keeping stabilizing muscles active during skiing and snowboarding will protect the joints and ligaments during movements involving large torques or change of direction.  As explained last week, holding that crouched posture down the slopes takes endurance mixed with bursts of power.  If you don’t have enough endurance to last the entire run it will be difficult for joint stabilizers to do their job during technical moves requiring quick changes of direction or bursts of energy.  Here is a video of how to keep those hip rotators strong.

Start: Sidelying clam.  Perform 2 sets of 10-20 repetitions or to fatigue.  Make sure your hips stay stacked and that you engage your lower abdominals to prevent low back twisting.

Progress:  Add resistance tubing when you can perform 20 repetitions before tiring.

Core Progression – Week 3

This closed chained progression is the best core stabilization exercise for the lower abdominals.    Having a strong core that coordinate with the hips well will dramatically improve your balance and power during technical moves.  The progression to dynamic rotations is even more specific for improving stability during change of direction on the slopes.

Start: Side plank.  Modify to bent knees if the full plank is too difficult or if you are just beginning.  Perform 3 sets of 30 seconds or to fatigue on each side.

Progress: Dynamic rotations with the upper torso.  Perform 3 sets of 10-20 reps or to fatigue on each side. 

Still not motivated or don’t have enough time to practice every day?  Come to Total Body Fitness every Tuesday and Saturday where we will feature specific exercises geared towards snow sports fitness.

Check back for next week’s installment of the ski and snowboard series!

Foods for Joint Health

If you’re one of the millions of people who suffer from arthritis, you may find a surprising ally in helping to manage joint pain—your diet.

If you thought it wasn’t possible to change the way your joints feel by changing your eating habits, think again!  Research supports the notion that the following foods may indeed help your joints.

Omega-3 decreases the production of chemicals that spread inflammation.

Foods with omega-3 include fatty fish (salmon, cod, sardines) and seeds/nuts (walnuts, soybean, flax seeds, canola oil, pumpkin seeds).  Omega-3 contains vitamin D, which helps with calcium absorption in bones and prevents swelling and soreness in the joints.  Eat 4-ounces of salmon or a handful of walnuts per day. Drink 2 glasses of milk or spend 15 minutes daily in the sun to boost your vitamin D intake.  You should have at least 800 International Units (IU’s) of vitamin D daily.  If you don’t get it naturally, then supplementation is a good alternative.

Extra-virgin olive oil contains oleocanthal which blocks enzymes involved in inflammation. One tablespoon per day on salads or bread is all you need.


Vitamin C-rich foods
such as sweet peppers, citrus fruits and strawberries protect collagen which is a major component of cartilage, the substance that provides cushioning between joints. Eat an orange or a cup of broccoli to promote wellness. Broccoli and cauliflower are also antioxidant-rich foods that counteract free radicals in the body which can damage cartilage.

Tart cherries have been found to cut inflammation by 50%. Recommendations are for ½ cup per day in any form: fresh/frozen/canned/dried/juice.

 

 

Brazil nuts have high amounts of selenium, a mineral that helps rid your cells of damaging free radicals. Low selenium may be linked to rheumatoid arthritis. All you need is 3-4 nuts or 3-ounces of tuna, beef or turkey per day.

Onions and leeks contain quercetin, an antioxidant that decreases inflammation. Other foods that have quercetin are kale, cherry tomatoes, and apples. Recommendations are for 1/2 cup per day.

 

 


Green Tea
has been known to have an antioxidant compound, epigallocatechin-3-gallate which decreases inflammation and possibly the severity of arthritis. Drink 1 cup per day, avoiding the decaffeinated version because some of the compounds are taken away.

Last but not least, drink water!
Don’t forget that water is essential for your body, including the cartilage in your joints. According the Mayo Clinic, men should intake 3 liters of water total in beverages per day.  For women, it’s 2.2 liters total per day.

Foods to Avoid

Some foods can actually flare up joint conditions, such as:


Shellfish, meats, high fat dairy foods, and beer
convert purine to uric acid which forms crystals in the joints (gout). Limit intake to 5-6 oz of lean meat/poultry/fish per day.

Sunflower, safflower, corn and soybean oils are high in Omega-6 fatty acids, which unlike Omega-3, increases inflammation.  Omega-6 fatty acids are prevalent in baked goods and snacks.  Try switching to healthy oils like olive or nut oils to reduce your Omega-6 intake.

Sugar may give you a quick energy boost, but it doesn’t last.  If the sugar is not used for energy, it converts to fat and that extra weight places more pressure on your joints. Sugar may also increase inflammation in your joints. Replace sweets with 1 cup of fresh fruit per day.

In addition to a healthy diet, low impact exercise can strengthen the muscles that support your joints and contribute to decreased pain with daily activities.

Our CPMC Fit For Life exercise program features a total-body approach to low impact fitness and is open to the community. Come join us!

Click Here to Learn More About CPMC’s Fit For Life Exercise Program
(opens a new window)

References:

http://www.lifescript.com/health/centers/osteoarthritis/articles/fight_arthritis_10_foods_that_help_and_hurt.aspx

http://today.msnbc.msn.com/id/21246089/ns/today-today_health/t/fight-arthritis-these-foods/

http://www.mayoclinic.com/health/water/NU00283/

Bracing for action: Are ankle braces effective for volleyball players?

Ankle sprains are the most common recreational sports injury, with ankle injuries making up about 25% of all adult sports injuries. To combat ankle sprains, ankle braces have become popular in sports that require jumping and cutting. In volleyball, ankles account for about 40% of all injuries. Volleyball players in particular have embraced the use of prophylactic ankle braces, with some coaches making ankle bracing mandatory for their players. With rates that high, who wouldn’t want to protect their ankles? But are braces really effective in reducing the risk of ankle sprains? We’re going to answer some frequently asked questions about ankle braces, based on the most current literature available.

Do ankle braces prevent injury?

In healthy, active people without a history of ankle sprains, studies have not shown a benefit to wearing prophylactic braces (those intended to prevent injury). Most studies do not report injury severity, so it is certainly possible that braces affect the severity of sprains—unfortunately there just isn’t good data out there to support it.

Do ankle braces prevent re-injury?

It does appear that braces are effective for ankles that have been sprained before, especially within the first year after injury. Ankle sprain rates double in the 1-2 years following a sprain. Furthermore, 30-50% of people who sprain their ankle develop chronic instability. Prevention of reinjury following a sprain is therefore vital, and several studies have shown that bracing does reduce the risk of reinjury. It is less clear if long-term use of bracing is necessary for injury prevention. A combination of bracing with specific ankle exercises is likely the best course of action in preventing re-injury. Read on for further information.

Does the type of brace matter?

Probably not. However, braces may vary in the type of support they offer. For example, lace-up braces add stability both on the sides and in the front and back, while stirrup type braces (such as Active Ankle) only support the ankle on the sides. This won’t make a difference in most people– as the majority of ankle sprains are inversion/lateral sprains– but if you have anterior/posterior instability it may make a difference. The second way braces work is by increasing proprioception and feedback to your sensory and musculoskeletal systems. Proprioception is your brain/body’s unconscious awareness of a joint’s location in space. Increased proprioception helps your muscles react faster and stronger when they are needed to support your ankle against a potentially injuring force. All types of braces will help give proprioceptive input. To date, studies looking at type of brace haven’t agreed upon the superiority of one brace type over another in injury prevention.

Will ankle bracing hurt my ankles?

There is currently no evidence supportive of ankle weakness or loss of function stemming from the use of ankle bracing. Contrary to the beliefs of some avid non-bracers, braces won’t weaken your lateral ankle muscles or cause them to ‘get lazy’ and stop working.

Will ankle bracing hurt my knees?

Probably not.  There is evidence to show that ankle injury rates increase with knee bracing, however no similar conclusions have been made linking knee injury rates to ankle bracing. Some lab studies have shown slight increases in knee rotation with ankle bracing versus without. It makes sense that if you restrict movement enough at one joint, other joints may compensate with extra movement. However, current studies are not substantial enough for this to factor into recommendations about ankle bracing.

Will ankle bracing hurt my vertical jump?

It shouldn’t. Several studies have shown that ankle bracing does not impair physical performance in activities like jumping, running, or agility. In other words, no looking down at your ankle brace in disbelief after burying that perfect set into the net during your company’s picnic volleyball game.

What are some other options to prevent ankle sprains?

Training: Training is a key component of staying healthy as an athlete, but often athletes forget to train their ankles. Incorporating ankle exercises can be as easy as trying to stand on one leg and balance. Once that’s easy, try balancing while doing arm exercises, standing on an unstable surface, or closing your eyes. You can also try leg exercises like squats, lunges, or side leg lifts on a BOSU or balance board. Agility and jump training programs, including training yourself to land from jumps with good body mechanics, may also improve your ankle strength and stability. Keep in mind that even the best training programs take 8-12 weeks to show benefits. If you’re coming off of a recent ankle sprain, you may benefit from the advice of a physical therapist to progress your exercises at a reasonable pace while your ankle heals.

Footwear: There has not been evidence that high tops or other shoe designs prevent ankle sprains. However, supportive shoes without too much wear and tear are important. Some minimalist footwear and shoes like shape-ups may promote increased movement in your foot and ankle. This may help strengthen your foot muscles during regular activities or running, but may also increase your risk of injury during jumping and landing, so keep those off the court.

Taping: Taping may provide a similar effect to bracing in the proprioception department, and has been proven to be about as effective to bracing to prevent re-injury. However, the mechanical stability of taping has been shown to decrease quickly: within 10 minutes of activity after taping, it is already 40% less effective mechanically, and may provide negligible support within an hour. Taping is also time consuming and requires a trained professional for optimal results. However, if you leave your brace at home, taping may be an alternative to bracing that is helpful in preventing reinjury.

Here are a few other things to consider when deciding whether or not to use an ankle brace:

-Most volleyball players have a ‘dominant ankle’, the ankle opposite their hitting arm. This ankle is more likely to be injured because they land on it more often. Setters may be at risk for more ankle sprains on the right because that is the ankle closest to the net, increasing risk for under the net contact after jump sets.

-If you play indoor and outdoor volleyball, consider that you may not be able to use bracing on the beach or grass, but should definitely be working on ankle strengthening and stability exercises to prevent injury outdoors.

-In almost all cases, bracing is not going to provide enough support to prevent a sprain when one player lands in a bad position on another player’s foot after jumping high off of the ground. The forces are just too high for the brace to control.

Recommended Reading

Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010 Dec;44(15):1082-8.

Dizon JM, Reyes JJ. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. J Sci Med Sport. 2010;13(3):309-17.

Study Designs (publishing date TBD)

Janssen KW, van Mechelen W, Verhagen EA. Ankles back in randomized controlled trial (ABrCt): braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Design of a randomised controlled trial. BMC Musculoskelet Disord. 2011; 27;12:210.

Janssen KW, van der Wees PJ, Rowe BH, de Bie R, van Mechelen W, Verhagen E. Interventions for preventing ankle ligament injuries. Cochrane Database of Systematic Reviews. 2011; Issue 12.

Additional References

Frey C, Feder KS, Sleight J. Prophylactic ankle brace use in high school volleyball players: a prospective study. Foot Ankle Int. 2010;31(4):296-300.

Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc. 2010;42(3):413-21.

SantosMJ, McIntire K, Foecking J, Liu W. The effects of ankle bracing on motion of the knee and the hip joint during trunk rotation tasks. Clin Biomech. 2004;19(9):964-71.

Venesky K, Docherty CL, Dapena J, Schrader J. J Prophylactic ankle braces and knee varus-valgus and internal-external rotation torque. Athl Train. 2006;41(3):239-44.

Verhagen EA, Van der Beek AJ, Bouter LM, Bahr RM, Van Mechelen W. A one season prospective cohort study of volleyball injuries. Br J Sports Med. 2004;38(4):477-81.