Balance training reduces ankle sprains by about a third in sporting populations, with the clearest benefit in people who have sprained an ankle before
Interpretation
A meta-analysis of 7 RCTs (3,726 participants) found risk ratio 0.65 overall and 0.64 in people with a previous sprain; the primary-prevention estimate (0.57) rests on two non-significant trials (Schiftan 2015). An 8-week unsupervised home programme cut recurrences from 33% to 22% in 522 athletes aged 12-70 with a near-even sex split (Hupperets 2009), and a cluster RCT in 765 high-school athletes found 6.1% vs 9.9% sprains with no significant effect in those without previous sprain (McGuine 2006). An overview of 46 reviews rates neuromuscular training moderate and bracing strong for preventing recurrence (Doherty 2017; Vuurberg 2018). Graded moderate rather than strong because the trials are mostly team sports; no trial has tested runners or triathletes, and trail-running sprain rates are poorly measured (Viljoen 2021).
Practical implication
Triathletes with a previous ankle sprain, especially one never rehabilitated, should add a few minutes of progressive single-leg balance work several times a week, for at least 8 weeks, before and during winter trail running, and consider a brace if sprains recur. For people who have never sprained an ankle the benefit is unproven. Extrapolated from team-sport trials, not runners.
Sources
7 sources, independently verified.
7 RCTs, 3,726 sporting participants. Proprioceptive (balance) training reduced ankle sprains: risk ratio 0.65 (95% CI 0.55-0.77) overall, 0.64 (0.51-0.81) in people with a previous sprain, and 0.57 (0.34-0.97) without, the last from two individually non-significant trials, so primary prevention is inconclusive. Mostly team sports.
Usual care plus an 8-week unsupervised home proprioceptive programme vs usual care; 1-year follow-up. Recurrence 22% vs 33% (RR 0.63, 95% CI 0.45-0.88; 35% reduction; NNT 9); time-loss and cost-incurring sprains also reduced. Benefit significant only in athletes whose original sprain was not medically treated.
Sprains 6.1% with balance training vs 9.9% in controls (1.13 vs 1.87 per 1000 exposures, P = .04). Previous sprain roughly doubled risk. In athletes without a previous sprain, 4.3% vs 7.7% was not significant (P = .059). Adolescent team-sport athletes.
Overview of 46 systematic reviews (mean AMSTAR 6.5/11). Acute sprain: strong evidence for NSAIDs and early mobilisation, moderate for exercise and manual therapy, conflicting for surgery and acupuncture, insufficient for ultrasound. Preventing recurrence: strong evidence for bracing, moderate for neuromuscular training.
Delayed physical examination at 4-5 days most reliably assesses severity; a short immobilisation may relieve pain and swelling; tape or brace with an exercise programme best for acute ligament rupture; supervised exercise-based programmes preferred over passive modalities; NSAIDs used with caution as they may suppress healing; braces effective for preventing recurrent sprains.
Lateral ankle sprains are the most common musculoskeletal injury in physically active people; recurrence is high and many develop chronic ankle instability, linked to reduced physical activity, lower quality of life and post-traumatic ankle osteoarthritis. Abstract gives no figures.
16 studies, 8,644 trail runners, mostly single-day races. Injury incidence 1.6-4,285.0 per 1000 h. Foot was the most common injury location, then knee, lower leg, thigh and ankle; skin injuries most common type, with ligament sprains among listed types.