Effects of semi-rigid ankle orthoses on tasks related to athletic performance following a bout of fatiguing exercise

doi:10.4236/ojtr.2013.12003

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Vol.1, No.2, 10-16 (2013) Open Journal of Therapy and Rehabilitation

http://dx.doi.org/10.4236/ojtr.2013.12003

Effects of semi-rigid ankle orthoses on tasks

related to athletic performance following a

bout of fatiguing exercise

James A. Y aggie1, W. Jeffrey Armstrong2*, Christina Smith3, Andrew Miller3,

Rebekah Trimbach3

1Department of Health and Human Performance, The University of Findlay, Findlay, USA

2Department of Health & Physical Education, Western Oregon University, Monmouth, USA;

*Corresponding Author: [email protected]

3Department of Physical Therapy, The University of Findlay, Findlay, USA

Received 1 October 2013; revised 1 November 2013; accepted 12 November 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Despite the perceived protection of semi-rigid

ankle orthoses (SRAO), coaches and clinicians

are often concerned w ith the restriction that the

SRAO may pose on functional performance. The

purpose of this study was to determine the ef-

fect of SRAO on performance-selected tasks,

following fatiguing activity. Twenty active, col-

lege-age subjects (22.7 ± 1.2 years; weight 71.7 ±

13.0 kg; height 171.7 ± 9.4 cm), without lower

extremity trauma within 2 years, consented par-

ticipation. Randomized trials for balance (star

excursion balance test (SEBT)), agility (shuttle

run (SR)), and power (vertical jump (VJ)) were

compared between 4 conditions [fatigued,

braced (FB); fatigued, un-braced (FUB); non-

fatigued, braced (NFB); non-fatigued, un-braced

(NFUB)]. Participants were bilaterally fitted with

a well-known, commercially available SRAO for

all braced trials. Two Wingate supramaximal ex-

ercise bouts were used as the fatiguing protocol.

RMANOVA was performed for each functional

test to determine main effect s (SPSS, IL; α = 0.05

for all tests). No main effects for VJ & SR were

observed under any of the bracing conditions.

Main effect for bracing was observed for the

SEBT. Tukey p airwise comparisons revealed that

there were significant increases in distance

reached for the posterior-medial direction (NFB

= 0.91 cm ± 0.2; FB = 0.95 ± 0.2; p = 0.046) and

medial direction (NFB = 0.74 cm ± 0.1; FB = 0.79

± 0.1; p = 0.039) during the braced conditions.

Although subjects reported that the SRAO re-

stricted ROM during most SEBT directions in-

volving inversion and eversion, overall perfor-

mance was not hindered by the application of

the brace. Further, the only main effects ob-

served with functional performance involved in-

creases in SEBT that cou ld likely be attributed to

comfort and confidence of motion while wearing

an ankle device. It was concluded that articu-

lated SRAO effectively limits ankle mobility, but

does not appear to hinder athletic performance

following a fatiguing bout.

Keywords: Agility; Ankle Braci ng; Balance; Fatigue;

Stability; Vertical Jump

1. INTRODUCTION

Athletes rely heavily on stability and balance for a th l et i c

performance. Unfortunately, the movements required in

some sports leave athletes at risk for injury. A review

conducted by Fong et al. [1] examined the distribution of

injuries in athletics via meta-analysis and concluded that

the ankle was the commonest body segment injured in

sports [1]. Further, lateral ankle sprains can account for

15% to 30% of all injuries in sports [2]. Risk factors for

such injuries include participation in sports that require

jumping, landing, and cutting maneuvers, and the risk for

injury is increased more with a history of previous ankle

sprain(s) [3]. Moreover, the risk for injury may increase

late in activity when the athlete becomes physically fa-

tigued [4]. This is likely due to instability at the ankle

and more proximal joints as the result of decreased pro-

prioception [ 5, 6] .

Consequently, ankle bracing has become increasingly

J. A. Y aggie et al. / Open Journal of Therapy and R ehabilitation 1 (2013) 10-16 11

prevalent in sports [7-9] and has lead clinicians, coaches

and athletes to utilize ankle strapping as a preventative

measure. The objective of ankle bracing is to provide

mechanical support at the joint b y limiting inversion and

eversion but not restrict dorsiflexion and plantarflexion,

thus allowing the athlete to maintain function for perfor-

mance [2]. Clinical methods to stabilize the ankle include

the use of tape, ACE bandages, soft braces, semi-rigid

braces, and rigid braces are available depending on the

types of movement needed at the ankle for competition

[2,10]. However, as the amount of stability increases at

the joint, the mobility at the joint decreases, and most

athletes have personal preferences for brace use and type.

According to Rosenbaum [2], semi-rigid braces provide

the most mechanical support at the ankle secondary to

rigid braces but still retain functional medial to lateral

mobility.

Among the types and styles of commercially available

ankle orthoses, the Active Ankle® (Active Ankle Sys-

tems, Louisville, KY) is a lightweight, comfortable, du-

rable brace, and has a quick-fit, single strap system that

adjusts to both high and low top shoes. The brace offers

flexibility, security, and is said to provide more support

than the leading air-stirrup brace, the leading lace-up

brace, and adhesive tape [11]. Although, Shaw et al. [12]

found the lace-up brace performed better than the Active

Ankle® brace when testing for dynamic stability using

“Time to Stabilization”, others have found that the Ac-

tive Ankle® provides a great deal of mechanical support.

Lindey et al. [13] examined functional range of mo-

tion of the ankle in semi-rigid braces and adhesive tapes.

The three semi-rigid braces tested were the Active

Ankle®, Airstirrup Ankle® (Aircas t In c . , S u mmit, NJ) and

Ankle Li game nt Prot ecto r® (Donjoy Orthopedics, Carlsbad,

CA). Out of the braces and adhesive tape, the Active

Ankle® brace had the best maximum dorsiflexion, plantar

flexion and functional range of motion [13].

Bot and van Mechelen [14] studied the impact ankle

bracing on performance of vertical jump, running speed,

agility, and broad jump. The authors concluded that an-

kle bracing has no effect on performance of those four

athletic tasks [14]. However, the researchers did suggest

that if the ankle joint range of motion (ROM) is re-

stricted by the brace, athletic performance will diminish

[14]. Similarly, Cordova et al. [7] conducted a meta-

analysis assessing the effects of ankle braces on func-

tional performance, as well as, the kinetics and kinemat-

ics of the joint. These results suggested that ankle brac-

ing produces minimal to small decrements on lower ex-

tremity functional performance [7]. The authors did note

negative effects on examining vertical jump performance

when ankle plant ar-fle xion was res t rict e d t hrough a brace.

The impact of ankle instability becomes particularly

noticeable when the muscles surrounding the joint be-

come fatigued. Gribble et al. [6] noted that fatigue may

impair proprioceptive and kinesthetic properties of the

joints because fatigue increases the threshold of the mus-

cle spindle discharge which disturbs afferent feedback

thereby altering joint awareness. Without adequate mus-

cle spindle reaction, the joint and associated structures

are subject to excessive stretch and injury.

It is been hypothesized that ankle braces may improve

dynamic stability with the onset of fatigue [12]. Shaw et

al. [12] used force plates to determine if braces decrease

time to stabilization in fatigued subjects. The results

showed that both the lace-up ankle brace (Sweede-O®,

Sweede-O, Inc., North Branch, MN) and the semi-rigid

brace (Active Ankle®) had a decrease in time to stabili-

zation [12].

Statement of the Problem. Bracing may offer support

to the ankle joint at a time when muscular support in

impeded during the fatigued state. Further, the qualities

and properties of ankle strapping may lead to a restric-

tion of the joint with little impact on athletic perfor-

mance. However, there is limited research investigating

the functionality of a brace following exhausting bouts of

lower extremity activity. The present stud y evaluated the

effects on various athletic demands before and after fa-

tigue, as well as in braced and unbraced conditions.

2. METHODS

Subjects. Twenty healthy, college age subjects (11 fe-

males and 9 males; mean age = 23 ± 1 years; mean

weight = 71.7 ± 13 kg; mean height = 171.7 ± 9.4 cm)

were recruited through convenience sampling and con-

sented to participation thro ugh completion IRB app roved

informed consent documentation in accordance with the

Declaration of Helsinki. All participants were recreation-

ally active, participating in a minimum of 20 - 30 min-

utes of activity at least three times a week.

Exclusion criteria included acute lower extremity inju -

ries, severe ankle injuries within the past two years or

any lower extremity surgeries that would inhibit the cur-

rent research study. Additionally, participants were ex-

cluded if they have any medical conditions, i.e., cardio-

vascular or vestibular, that could be exacerbated by the

fatiguing protocol in this study.

Bracing. The Active Ankle® T-2 ankle orthosis

(Cramer Products, Inc., KS, Figure 1) was applied bilat-

erally following the manufacturer’s guidelines. Range of

motion (ROM) measurements were taken at the begin-

ning of each testing session and documented to note the

restrictions created by the brace. On the days where the

brace was worn, measurements were taken before and

after brace application. Measurements were also taken at

the end of each testing session in order to account for

loosening of the brace. The motions measured included

ankle dorsiflexion, plantarflexion, inversion, and ever-

J. A. Y aggie et al. / Open Journal of Therapy and R ehabilitation 1 (2013) 10-16

Figure 1. Activ e Ankle T-2 brace.

sion. Measurement protocol followed the guidelines from

Norkin and White [15]. The same researcher applied the

brace and assessed ROM with the same 6-inch goniome-

ter for each subject. The brace was reapplied if it did not

produce appropriate restrictions. Once the brace was ap-

plied correctly, it was not adjusted during testing .

Fatigue Protocol. Subjects performed two Wingate

(WAnT) supramaximal exercise bouts separated by a 2-

minute rest as the fatigue protocol. This was performed

on a modified Monark cycle ergometer (Model #858E,

Stockholm, Sweden) at a resistance of 0.075 kilopounds

per kilogram of body weight in order to standardize the

fatigue method. Each WAnT was 30 seconds in length

and was performed at maximal effort. For the purposes

of this study the investigators chose to fatigue the entire

lower extremity following WAnT protocol used by Yag-

gie and Armstrong [5]. Other studies have used localized

fatigue protocols, however strictly fatiguing the ankle

joint does not account for any compensation by more

proximal joints and musculature [5]. Also, fatiguing the

entire lower extremity more closely mimics the condi-

tions that may occur within athletic competition. Using

supramaximal WAnT exercise bouts Yaggie and Arm-

strong [5] found significant postural sway and instability

post-fatigue. Furthermore, the WAnT uses an ergometer

that requires concentric patterns of muscle activity to

fatigue the muscle rather than eccentric muscle activity

that has been shown to produce damage that further re-

duces forceful contractions and delays recovery [5].

Performance Tests. The subjects participated in tests

of athletic performance on two non-consecutive days

while wearing an ankle brace during fatigued and non-

fatigued conditions on one day and the same tests were

performed without the brace in fatigued an d non-fatigued

states on the other day. Half of the subjects wore the

brace on the first day, while the other half of the subjects

performed the tests without the brace. The order of per-

formance testing [Countermovement Vertical Jump (CMJ),

Shuttle Run (SR), and Star Balance Excursion Test

(SEBT)] was randomized through a Balance Latin Sq uare

design.

The CMJ was performed following the guidelines set

up by Brown and Ferrigno [16]. This tested the effect of

ankle bracing and fatigue on the individual’s power per-

formance. A countermovement jump was performed with

the subject standing with feet shoulder-width apart. The

subject was instructed to quickly squat down, flexing

hips and knees to 90˚, to apply a pre-stretch to the mus-

cles. The subject then forcefully jumped up, reaching up

with the dominant hand with the aim of moving as many

levers as possible. Subjects performed 3 jumps with one-

minute rest time between trials, and the best attempt was

recorded.

The 20-yard shuttle was also performed following the

guidelines set up by Brown and Ferrigno [16]. This eva-

luated the effects of ankle bracing and fatigue on the

individual’s speed and agility performance. Subjects be-

gan with feet hip-width apart, straddling a starting line.

Five-yards to the right and 5-yards to the left tape mark-

ers were in place for the individuals to touch. Subjects

turned to the right, ran 5-yards and touc hed the line with

his/her right hand. He/she then turn back to the left, ran

10 yards to the line passing the starting point, and

touched the line with his/her left hand. Lastly, the subject

turned back to the right and ran 5-yards through the

start/finish line (Figure 2). The recorder started the stop-

watch upon verbalizing “Go” and stopped it when the

subject crossed the start/finish line at the end. To prevent

inter-rater differences, the same researcher described and

recorded results for each subject. The 3 trials were per-

formed with a rest time of one minute between trials.

Times were recorded and averaged together in an attempt

to eliminate human error as there was risk for a time de-

lay in the start and stop of a hand-held stopwatch.

The SEBT was incorporated to assess the subject’s

balance. The SEBT was set up with a line drawn in eight

directions, with a 45-degree angle to the next direction

10-yards

Start/Stop line

10-yards

Figure 2. 20-yard shuttle run.

J. A. Y aggie et al. / Open Journal of Therapy and R ehabilitation 1 (2013) 10-16 13

(Figure 3). The subjects stood on their dominant leg at

the intersection of the eight lines, while extending the

opposite leg as far as possible in each of the eight direc-

tions: anterior, anterior-medial, medial, posterior-medial,

posterior, posterior-lateral, lateral, and anterior-lateral

directions [17]. Each subject completed the SEBT three

times, performing a reach in all directions per trial. To

prevent inter-rater differences, the same researcher marked

and recorded the subjects’ distance. The average distance

in each direction was calculated. If the subject’s foot

touched the ground, a loss of balance was noted. A rest

break of one minute betwee n e ach set was allot ted.

Following data collection, a RM-ANOVA was per-

formed for each functional test to determine main effects

of bracing and fatigue. If main effects were noted, pair-

wise comparisons were run to determine the specific

differences in each functional performance. All tests

were statistically scrutinized (α = 0.05) using SPSS for

Windows (V. 17, Chicago, IL).

The various testing conditions are abbreviated as fol-

lows:

non-fatigued braced = NFB

non-fatigue unbraced = NFUB

fatigue braced = FB

fatigued unbraced = FUB

3. RESULTS

Countermovement Jump Height (CMJH). Mean

CMJH (±S.D.) are reported in Table 1. On average, the

height of the jump trials after fatigue were less than that

of the non-fatigued trials, yet the values were not sig-

nificantly different (p = 0.269; power = 0.91). Bracing

the ankle did not have a sign ificant effect in either condi-

tion (p = 0.329 and p = 0.127 for FB and FUB, respec-

tively). Although, the mean jump height (47.59 ± 15.6

cm) for FB was higher than that of the FUB trials (45.61

± 14.2 cm) these numbers were not statistically signifi-

Figure 3. Performance of the SEBT.

cant (p = 0.093). However, this may indicate that the

bracing may attenuate the effects of fatigue. The NFUB

jumps averaged 49.42 ± 15.3 cm and NFB jumps aver-

aged 48.17 ± 16.4 cm with no significant difference to

note.

Shuttle Run (SR). Mean SR scores (±S.D.) are re-

ported in Table 1. No significant difference existed be-

tween the two non-fatigued conditions in the amount of

time it took to complete the 20-yard shuttle run (p =

0.632). The mean time for the subjects to complete the

shuttle test during NFB conditions was 5.57 ± 0.8 sec-

onds and the mean for NFUB conditions was 5.62 ± 0.9

seconds. There also lacked a significant difference be-

tween the fatigued conditions (p = 0.377). The average

time for FB trails was 6.02 ± 0.9 seconds while th e mean

for FUB trials was 5.89 ± 0.8 seconds. According to

these data, it did not appear that wearing an ankle brace

aided nor hindered performance under fatigued or rested

conditions. However, the fatigued trials, as predicted,

were consistently slower than all non-fatigued trials

(NFUB v. FUB (p = 0.038); NFB v. F B (p = 0.0010)).

Star Balance Excursion Test (SEBT). Results of the

SEBT are displayed above in Table 2. Fatigue trials dif-

fered from the non-fatigued trials (braced vs. unbraced

conditions). There was no main effect in the following

directions; Anterior, Anterior Lateral, Lateral, Posterior

Lateral, Posterior, and Anterior Medial (p  0.05). There

was a significant increase in Posterior Medial ( p = 0.046)

following the fatiguing bout. Independent t-tests were

run on the data to assess these potential differences in-

dependent of the more homogenous conditions. The re-

Table 1. Countermovement Jump Height (CMJH) and Shuttle

Run (SR) ± S.D.

NFUB FUB NFB FB

CMJH (cm)49.42 ± 15.345.61 ± 14.2 48.17 ± 16.4 47.59 ± 15.6

SR (s) 5.62 ± 0.95.89 ± 0.8 5.57 ± 0.8 6.02 ± 0.9

Table 2. Mean SEBT (±S.D.) normalized by subject leg length.

NFUB FUB NFB FB

Anterior 0.89 ± 0.10.90 ± 0.1 0.88 ± 0.10.90 ± 0.1

Anterior-Lateral0.94 ± 0.10.96 ± 0.1 0.93 ± 0.10.94 ± 0.1

Lateral 0.96 ± 0.10.97 ± 0.1 0.94 ± 0.10.95 ± 0.1

Posterior-Lateral1.02 ± 0.11.03 ± 0.1 0.99 ± 0.11.01 ± 0.2

Posterior 1.01 ± 0.11.04 ± 0.1 1.02 ± 0.21.03 ± 0.2

Posterior-Medial0.89 ± 0.10.92 ± 0.1 0.91 ± 0.20.95 ± 0.2

Medial 0.74 ± 0.10.76 ± 0.1 0.77 ± 0.10.79 ± 0.1

Anterior-Medial0.80 ± 0.10.82 ± 0.1 0.79 ± 0.10.82 ± 0.1

J. A. Y aggie et al. / Open Journal of Therapy and R ehabilitation 1 (2013) 10-16

sults indicated the NFB was significantly less than the

FB condition (p = 0.013). The significant difference be-

tween the extreme conditions (p = 0.046) was in favor of

NFUB condition.

Range of Motion. As anticipated, the brace effectively

restricted inversion and eversion upon application but

had minimal effect on dorsiflexion and plantarflexion.

The brace remained intact throughout the trials without

adjustment by the particip ant or the tester. Upon re-mea-

sure of the ROM after participation it was noted that the

restriction applied in all directions decreased (p  0.05,

refer to Table 3). No other significant results were ob-

served.

4. DISCUSSION

Ankle bracing is becoming increasingly more preva-

lent in the prevention of injuries in athletics today. Dur-

ing athletic events power, agility, and balance are impor -

tant for optimal performance. This study investigated the

effects of ankle bracing on performance during tasks fo-

cusing on the above demands before and after fatigue.

Following the aforementioned exhausting conditions no

significant differences between braced and non-braced

conditions during the shuttle run or the vertical jump

were found.

Results from these two tests partially support the hy-

potheses. It was hypothesized that NFB conditions would

have no effect on performance. During the vertical jump,

shuttle run, and SEBT performance was not significan tly

affected when comparing NFB. These findings help us to

conclude that bracing does not affect an athlete’s per-

formance during athletic events even late in participa-

tion.

One of our hypotheses stated that FB conditions would

decrease performance when compared to NFUB condi-

tions. However, when compared to FUB, it was believed

that the ankle brace would allow an individual to perform

at a higher level in times of fatigue. The results did not

support this hypothesis. No significant differences were

found when comparing results for the vertical jump or

the shuttle run. With this finding the investigators are

unable to make any conclusions stating that bracing as-

sists with power and agility performance at times of fa-

tigued. Perhaps the fatiguing bout did not sufficiently

exhaust the subject pool to a degree that the effect of

Table 3. Range of motion measurements pre-post trials (±S.D).

Plantarflexion Dorsiflexion Inversion Eversion

No brace 26.3 ± 7.8 31.1 ± 8.4 30.2 ± 11.8 30.6 ± 9.3

Brace, pre-test 27.6 ± 7.5 30.0 ± 9.0 14.3 ± 7.3 15.6 ± 7.0

Brace, post-test 28.0 ± 5.7 30.6 ± 8.2 16.8 ± 11.4 20.1 ± 12.1

braci ng would be noted .

The results of the SEBT indicated that there is no sig-

nificant difference when comparing braced and unbraced

conditions. The significant differences were noted when

comparing fatigue trials vs. non-fatigue trials in favor of

fatigue. It was hypothesized that fatigue would decrease

performance, but the results were just the opposite. This

could have been a result of having all subjects perform

non-fatigue trials prior to fatigue trials resulting in a

learning effect. The only two directions with significant

increases were posterior-medial and medial directions.

The other six directions did not have any significant dif-

ferences besides extreme conditions. In the posterior-

medial and medial directions, performance was increased

in the braced conditions. Ankle braces are to provide

mechanical support at the joint. In doing so, the ankle

brace limits eversion but primarily limits inversion.

While reaching laterally during the SEBT, the planted

ankle is rotated into a position of inversion; and when

reaching medially the planted ankle rotates into a posi-

tion of eversion. With this understanding, one would

think that there would be more of a difference between

BF and UBF when reaching laterally due to a greater

limitation of inversion by the brace. This was not the

case. The researchers hypothesized that the significant

difference in these two directions could have been due to

the fact that subjects reported these directions most chal-

lenging. The authors believe that since these were the

most difficult directions, the ankle relied on the brace

more for stability while fatigued than when reaching in

any other direction.

Finally, it was hypothesized that FB conditions would

demonstrate better control than when FUB. These data

support this in the three medial directions (medial, ante-

rior-medial, and posterior-medial) but not with the other

five directions. This further supports that the ankle brace

provides benefit in the more challenging directions. Al-

though FUB results were better than FB in five of the

eight directions, the differences were not significant.

The ankle brace provided adequate restriction in the

directions of inversion and eversion with minimal effect

to plantarflexion and dorsiflexion. The limitations to

these ranges did not significantly impact performance

during the shuttle run, the vertical jump or the SEBT.

This supports the hypothesis that the ankle brace would

effectively limit range of motion as anticip ated yet would

not hinder performance of agility, power and balance.

During administration of the test, subjective informa-

tion was gathered from subjects to get an idea of comfor t

level and level of support felt by each individual. With

performance of the vertical jump and shuttle run most

subjects did not have any complaints, however, a few

individuals stated that the brace felt limiting with the

SEBT. Out of seven subjects that provided feedback on

J. A. Y aggie et al. / Open Journal of Therapy and R ehabilitation 1 (2013) 10-16 15

the SEBT during testing, five people stated that the test

felt harder or they felt more off-balance during perfor-

mance. Three of these individuals had worn braces in the

past, two had not. Two people actually stated that they

felt more support with the brace during the SEBT and

both of these subjects had worn braces in the past.

As with any research project this study is not without

its limitations. One limitation was not identifying previ-

ous use of ankle braces and the circumstances. Patients

who had previous experience with bracing of the tested

ankle may have grown accustomed to the support. This

could have caused them to perform better with the brace

in comparison to trials without the brace, especially in

instances of chronic instability present. Chronic instabi-

lity was not assessed which could have also affected our

results thereby creating a second limitation. Also, our

study was limited by the small sample size and testing of

only healthy, active individuals. If individuals who had

ankle instability were assessed and tested then results

might have shown that performance with the brace is

actually better than without the brace. Lastly, because of

time constraints we could only test subjects on two days

and therefore had to test non-fatigued before fatigued

conditions. Testing fatigued conditions first would not

have allowed us to test non-fatigued conditions on the

same day. This limited the randomization of the testing.

These limitations prov ide suggestions for future resear ch

with a larger sample size, patients who either have or

have not worn braces in the past, and/or more randomi-

zation of the f atigue s essions.

Within our study, learning affect could have influ-

enced results. After patients had performed one day of

testing they knew what to expect when they came in for

the second day, even though the bracing conditions

changed. Perhaps in future studies the researchers could

allot time for a practice day that will allow participants to

become proficient in the tests thereby excluding the

learning effect noted in the present study. This would

make the testing days more about performance in the set

conditions. In addition to the learn ing effect, we also no-

ticed that an individual’s competitive drive affected their

effort. For example, after performing the first vertical

jump trial many individuals with competitive drive tried

to jump higher with each successive trial. Also, subjects

could hear their shuttle run results and see the marks on

the SEBT, which p rovided them with feedback regarding

performance. To limit this in future studies we believe

the individual needs to be blinded to their results.

5. CONCLUSION

Due to increased ankle injuries over the years, the use

of ankle braces is becoming more prevalent. However, as

the brace provides more stability at the joint, the mobility

at the joint decreases potentially affecting performance.

We attempted to determine if bracing the ankle hinders

an athlete’s power, agility or balance before and after

fatiguing the lower extremity. Under controlled testing

conditions, results show that bracing does not affect an

athlete’s performance during athletic events even late in

participation. Given more time, the researchers would

have like to randomize fatigue and non-fatigue trials and

incorporate an additional practice trial day to decrease

learning effect. Future research should examine a variety

of semi-rigid braces to determine if they have an effect

on an athlete’s performance. Additionally, studies could

exam the difference between localized and generalized

fatiguing protocols and the effect they have in similar

testing conditions as this may produce different results.

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