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. 2025 Oct 1;18(5):1086–1095. doi: 10.70252/XPTX6116

The Effect of Ankle Bracing on Athletic Performance Variables in Healthy Young Adult Athletes

Penny L Head 1,‡,✉, Kurt Neelly 1,‡, Karen Furgal 1,‡, Sydney Graves 1,*, Meredith Jordan 1,*, Mackenzie Polston 1,*, Zach Powars 1,*, Hailey Shuttleworth 1,*, Daniel Smalling 1,*
PMCID: PMC12510708  PMID: 41080422

Abstract

Acute ankle sprains are common in sports and carry a significantly increased risk of recurrence after an initial injury. Bracing has been shown to reduce injury recurrence; however, athletes may decline this prophylactic measure due to fear of negative effect on athletic performance. Previous research examining the impact of bracing on performance has demonstrated conflicting results. The purpose of this study was to examine the effect of bracing on choice reaction time and foot speed in healthy, young adults using computerized agility testing. Twenty-eight healthy athletes aged 18–25 years completed the study. Subjects performed testing for choice reaction time (CRT), foot speed-forward (FSF), and foot speed-backwards (FSB) using Quick Board technology. Testing was performed in 3 bracing conditions: non-braced (NB), braced dominant ankle (BD), and braced non-dominant ankle (BND). Separate repeated ANOVAs were used to compare the effect of bracing for each performance variable. No significant effect of bracing on CRT (p=0.95) or FSF (p=0.075) was observed; however, there was a significant effect on FSB (p=0.035). Post-hoc testing revealed foot speed in the backwards direction was significantly lower in the BND condition vs. the NB condition (p=0.029). While bracing does not significantly impact CRT or FSF, bracing the non-dominant ankle may limit performance in athletic tasks that require posterior movement. These results provide valuable insights for clinicians and athletes when weighing the benefits of prophylactic bracing against the potential negative impact on performance.

Keywords: Ankle injury, choice reaction time, foot speed, Quick Board

Introduction

Ankle sprains are one of the most common musculoskeletal injuries, with an estimated 2 million occurring each year in the United States.1 Ankle sprains are especially prevalent in athletes, accounting for 16–40% of all sports-related injuries.2 The incidence rate of ankle sprains varies by sport with the highest rates typically reported in multidirectional sports that require running, jumping, and cutting activities, such as basketball, soccer, football, and volleyball.2,3 The high incidence rate of ankle sprains is partly due to the frequency of recurrent injury following an initial ankle sprain.3 A systematic review by Attenborough et al noted that 46% of ankle sprains in volleyball, 43% in football, 28% in basketball, and 19% in soccer were recurrent ankle sprains.4

It is well established the history of a previous ankle sprain is a strong risk factor for sustaining a recurrent ankle sprain.5–7 Kucera et al found that individuals with a history of an ankle sprain have an approximate 3.5 times greater risk of incurring another ankle sprain compared to those with no history.5 In addition to the increased risk of reinjury following an initial ankle sprain, there is also a concern regarding the development of chronic ankle instability (CAI). CAI is a multifaceted condition characterized by injury recurrence, perceived ankle instability, lingering pain, and persistent functional disability following at least 1 significant ankle sprain.8 A systematic review by Lin et al reported the prevalence of CAI to be 46%, with a range of 9 to 76%, for individuals with a history of ankle sprains.9

Ankle bracing is often used as a prophylactic measure to prevent both first-time ankle sprains and reinjury following initial ankle sprains. Bracing is thought to provide mechanical support to the ankle by preventing extreme ranges of motion, as well as by restricting anterior translation of the talus.10 Research supports the use of bracing for reducing the risk of both first-time (RR 0.69, 95% CI 0.49–0.96) and recurrent (RR 0.30, 95% CI 0.21–0.43) injury.11 In addition, to reducing the incidence of ankle sprains, bracing has also been shown to reduce the severity of the injury.12

While evidence supports the utilization of prophylactic ankle bracing, athletes may be reluctant or unwilling to wear a brace. One commonly cited reason for such reluctance is the perception that wearing a brace will negatively impact their athletic performance, especially in the areas of agility and mobility.12–14 Rehabilitation professionals may also be reluctant to recommend prophylactic bracing for athletes due to concerns about potential adverse effects, such as compromised dynamic balance and ankle joint proprioception. In a survey of 377 clinicians, Denton et al found that those concerned about the potential negative impact on ankle muscle strength were less likely to recommend bracing.15

While several studies have examined the impact of ankle bracing on athletic performance tasks, the results are inconclusive.16–20 Previous studies have investigated tasks such as agility time, sprint time, and vertical jump height; however, to the authors’ knowledge, no research has examined the impact of bracing on choice reaction time or foot speed. The purpose of this study was to examine the effect of ankle bracing on the performance variables of choice reaction time and foot speed in healthy, young adult recreational and competitive athletes. We hypothesized there would be no significant difference in performance between braced and non-braced conditions for choice reaction time and foot speed tasks.

Methods

Participants

The current study was approved by Western Kentucky University’s Institutional Review Board. This research was carried out fully in accordance to the ethical standards of the International Journal of Exercise Science.21 Prior to initiating the study, all participants read and signed an informed consent document. All data collection was performed during a single test session on the University’s campus.

An a priori sample size calculation was conducted using G*Power software 3.1.9.4 (Universitat Kiel, Germany). Based on a moderate effect size (f=0.25), an alpha level of 0.05, and a desired statistical power of 0.80, a total of 28 healthy recreational and competitive athletes (17 males; mean age=22.3 +/−2.1 years) were recruited from the University and local community using convenience sampling. Recreational athletes were defined as individuals who engaged in sports or physical activity 1–3 times per week for enjoyment, fitness, or social interaction, without the primary goal of competitive performance or professional status.22 Competitive athletes were defined as individuals who participated in organized team or individual sports involving regular competition against others and requiring some form of systematic and intense training.23

Inclusion criteria included male or female athletes aged 18 to 25 years, who participated in multidirectional athletic activity at least 1 time per week. Multidirectional activities were operationally defined as those requiring jumping movements and/or rapid changes of direction, such as basketball, volleyball, soccer, football, pickleball, etc. Exclusion criteria included a history of lower extremity surgery, a musculoskeletal lower extremity injury within the previous 3 months, or any neurologic or vestibular disorder; CAI as indicated by a score of ≤25 on the Cumberland Ankle Instability Tool (CAIT)24; or self-elected to wear an ankle brace or tape during athletic activity within the previous 3 months.

Protocol

This study used a one-way repeated measures design to examine the effect of ankle bracing on choice reaction time and foot speed. The independent variable was the brace condition [non-braced (NB), dominant lower extremity braced (BD), and non-dominant lower extremity braced (BND)] with the dominant lower extremity defined as the leg preferred to kick a ball.25 The dependent variables included choice reaction time (CRT), foot speed in a forward direction (FSF), and foot speed in a backward direction (FSB).

All participants completed a standardized questionnaire to collect demographic and health history information. As CAI could potentially impact the results of the study, all participants were asked to complete the CAIT to determine eligibility to continue participation in the study. Each eligible participant was properly fitted for a BREG lace-up ankle brace (BREG, Carlsbad, CA, USA) (Figure 1) based on self-reported shoe size and comfort. The BREG ankle brace consists of a lace-up boot, medial and lateral nylon straps that cross on the dorsal aspect of the foot and fasten to the medial and lateral aspects of the brace, and an elastic cuff that fastens around the circumference of the lower leg.

Figure 1.

Figure 1

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BREG lace-up ankle brace. Sourced from www.breg.com

Data collection was performed using the Quick Board HD Pro Sensor Board (Quick Board LLC, Germantown, TN, USA). The Quick Board (QB) is an interactive visual-motor training system designed to assess and enhance neuromuscular control, reaction time, and coordination. The device consists of a ground platform embedded with 5 pressure-sensitive foot targets. A visual representation of the platform’s targets is provided using an Apple iPad Pro mounted at eye level on a tripod directly in front of the participant (Figure 2). The QB system can be programmed to illuminate the targets on the iPad in various sequences to prompt rapid foot response on the corresponding platform target.

Figure 2.

Figure 2

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Quick Board set-up.

CRT is defined as the ability to choose a correct response to an external stimulus and execute the chosen movement quickly and accurately.26 CRT was assessed using the Double Leg React test on the QB system. This test is used to assess lower extremity reaction time and has been shown to have high test-retest reliability with an ICC of 0.89.26 To perform this test, each participant began standing on the QB with feet on either side of the center target. A video demonstration of the test procedure was played for the participant on the iPad. Once the participant confirmed understanding of the procedure, the iPad counted down from 3 and then prompted a series of randomly illuminated targets that represented the platform targets. Using the iPad for visual reference, the participant was asked to touch the corresponding platform target with their foot as quickly as possible and then return the foot back to the starting position. Participants were instructed to step on the right and left targets (front and back) with the corresponding foot (i.e. no cross-over was permitted) but could choose to step on the middle target with either the left or right foot. Once the correct target was touched, another random target was illuminated. Data was collected for 20 seconds for each trial, recording reaction time as the time from the appearance of the visual cue on the iPad to the touching of the correct target on the platform.

Foot speed, defined as the total number of foot contacts in a given period of time, was assessed using the Quick Steps Test on the QB system. This test is designed to assess lower extremity speed and neuromotor control and has been shown to have a high test-retest reliability with an ICC of 0.89.26 Foot speed was assessed in both the forward and backward directions. To perform these tests, each participant began by standing on the QB with feet on either side of the center target. A video demonstration of the test procedure was played for the participant on the iPad. Once the participant confirmed understanding of the procedure, the iPad counted down from 3 and then prompted the participant to begin the test. For FSF, the participant rapidly tapped the top right target with the right foot, immediately followed by the top left target with the left foot. The participant then quickly returned both feet to the starting position in the same order (i.e. right foot followed by left foot). This sequence was repeated as rapidly as possible for 10 seconds. For FSB, the participant rapidly tapped the bottom right target with the right foot, immediately followed by the bottom left target with the left foot. The participant then quickly returned both feet to the starting position in the same order (i.e. right foot followed by left foot) and repeated the sequence as rapidly as possible for 10 seconds. The number of touches completed in 10 seconds was recorded by the QB for both the forward and backward directions.

Prior to data collection, randomization of the testing order (CRT, FSF, FSB) and the bracing conditions (NB, BD, BND) were performed using a random number generator. Following a standardized warm-up session, each participant performed a minimum of 3 practice trials prior to each QB testing procedure during the first assigned brace condition. Participants were allotted additional practice trials if necessary to increase comfort level with the testing procedure. To minimize the effect of fatigue, a 30-second rest period was allotted between each practice trial, and a 60-second rest period was allotted between the final practice trial and the first data collection trial.

Three data collection trials were then performed for each testing procedure and brace condition with a 30-second rest period between trials and a 60-second rest period between testing procedures. The average of the 3 trials was used for data analysis. Participants completed all 3 QB tests (CRT, FSF, and FSB) prior to alternating the brace condition. A 5-minute rest period was allotted between bracing conditions. A total of 27 test trials were completed for each participant.

Statistical Analysis

Measures of central tendency were used to describe participant demographics (Table 1). Initial Shapiro-Wilk testing indicated a non-normal distribution for the CRT-BD data. Further inspection identified 1 participant as an outlier. Removal of this participant resulted in a final sample size of 27 participants with normally distributed data. Separate one-way repeated measures ANOVAs were conducted to assess differences among the 3 bracing conditions (NB, BD, BND) for each performance variable (CRT, FSF, and FSB). Mauchly’s Test was used to test the assumption of sphericity. When a significant main effect was observed, post-hoc pairwise comparisons with Bonferroni adjustment were conducted to evaluate differences among bracing conditions.27 The level of significance was set at p ≤ 0.05 and effect sizes were assessed using the partial eta-squared coefficient (0.01 small, 0.06 medium, and 0.14 large).28 All statistical analyses were performed using SPSS version 28.0 (SPSS Inc., Chicago, IL, USA).

Table 1.

Means, standard deviations (SD), and percentage distributions of demographic variables

Demographic Variable Mean (SD) Percent (n)
Age (yrs) 23.3 (2.1) --
Height (in) 68.7 (3.9) --
Weight (lb) 168.5 (32.9) --
Gender (% male) -- 60.7 (17)
Leg dominance (% right) -- 89 (25)
Participation level (% recreational) -- 85.7 (24)
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Results

Means and standard deviations for CRT, FSF, and FSB are presented in Table 2. No significant main effect of bracing condition was found for CRT (F2,52 = 0.055, p = 0.95) or FSF (F2,52 = 2.72, p = 0.075). However, there was a significant main effect of brace condition for FSB (F2,52 = 3.591, p = 0.035, np2 = 0.121). Post-hoc pairwise comparisons for FSB revealed that the BND condition resulted in significantly fewer foot contacts (i.e. decreased foot speed) compared to the NB condition (p = 0.029).

Table 2.

Means and standard deviations for performance variables

Performance Variable Non-Braced Braced-Dominant Braced-Non-Dominant
CRT 0.727 (0.07) 0.727 (0.07) 0.723 (0.06)
FSF 30.47 (4.17) 30.95 (4.94) 29.65 (4.28)
FSB* 30.51 (4.96) 29.83 (4.82) 29.04 (5.27)
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*

Significant main effect for brace condition (p = 0.035)

Discussion

The purpose of this study was to examine the effect of ankle bracing on the performance variables of CRT and foot speed in healthy, young adult athletes. We hypothesized there would be no significant difference between braced and non-braced conditions for these performance variables. The results of the study partially support our hypothesis in that there were no significant differences between bracing conditions for CRT and FSF. However, there was a significant difference between the NB and BND conditions for FSB, with bracing on the non-dominant ankle resulting in significantly fewer foot contacts or decreased foot speed compared to no bracing.

The lack of a significant effect of bracing on the CRT or FSF tasks suggests that wearing an ankle brace does not impair performance on either reactive agility (choice reaction) or planned agility (foot speed). Although a lack of research exists specifically examining the effect of ankle bracing on Quick Board-derived measures of CRT or foot speed, several studies have investigated the impact of bracing on agility performance measured by change-of-direction tasks.18,20,29 A meta-analysis by Cordova et al reported no significant influence of ankle bracing on agility speed.18 Similarly, Jeffriess et al found that ankle taping had no effect on planned change-of-direction or reactive agility performance in the Y-shaped agility test in healthy basketball players.29 Mann et al also reported no significant impact of ankle bracing on T-drill agility test performance.20 Collectively, these findings align with the current study’s results, suggesting that ankle bracing does not hinder agility-related components of athletic performance.

The significant finding of decreased FSB in the BND condition vs. the NB condition suggests that bracing the non-dominant ankle may impair motor performance during tasks that require rapid, repetitive movement in the posterior direction. In a study comparing forward stepping and backward stepping, Berchicci et al found that step direction demonstrated different cognitive processing and cortical organization, with backward stepping requiring enhanced cognitive control.30 While both the FSF and FSB tasks required an element of backward stepping, the FSB task required the initial step to be backward. The protocol also required that the initial step backward be taken with the right foot. In the BND condition, 89% of participants reported right leg dominance. For these participants, the non-dominant ankle (left) would require weight-bearing dorsiflexion to allow the right leg to perform the initial step backward. A study by DiStefano et al reported a significant decrease in peak ankle dorsiflexion when wearing a lace-up brace compared to no bracing during a double-leg jump-landing task.31 Collectively, these findings may explain the decreased number of foot contacts (i.e. foot speed) in the FSB task for the BND condition.

The current study is not without limitations. The majority of the study participants (85.7%) were recreational athletes. It is important to realize that the results may differ in competitive athletes. In addition, this study utilized healthy individuals. Future research is needed to determine the impact of bracing on CRT and foot speed in individuals who have suffered recent ankle sprains or those that have developed CAI. Another potential limitation is that the FSB task required all participants to initiate movement with the right foot versus self-selection of which foot initiated the task. Given that the majority of participants were right-leg dominant, this may have placed disproportionate mechanical demands or asymmetrical sensory input on the BND ankle in that condition, potentially influencing performance outcomes.

In conclusion, the findings of this study indicate that ankle bracing does not significantly impair reactive agility (CRT) or forward-directed planned agility (FSF). However, bracing the non-dominant ankle may reduce backward-directed planned agility (FSB), suggesting a potential performance limitation in athletic tasks that require posterior movement. These results provide valuable insight for clinicians and athletes when weighing the benefits of prophylactic bracing against the potential negative impact on performance.

Acknowledgements

This study was supported by an internal grant from the College of Health and Human Services at Western Kentucky University.

References

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Articles from International Journal of Exercise Science are provided here courtesy of Western Kentucky University

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