A Multidimensional Assessment of a Novel

Adaptive Versus Traditional Passive Ankle

Sprain Protection Systems
Steffen Willwacher,*y Prof., Anna Bruder,y MS, Johanna Robbin,y BEng,
Jakob Kruppa,y BEng, and Patrick Mai,yz MS
Investigation performed at Offenburg University of Applied Sciences, Offenburg, Germany;
biomechanical data collection performed in the laboratory of the Institute of Functional
Diagnostics, Cologne, Germany

Background: Ankle braces aim to reduce lateral ankle sprains. Next to protection, factors influencing user compliance, such as
sports performance, motion restriction, and users’ perceptions, are relevant for user compliance and thus injury prevention. Novel
adaptive protection systems claim to change their mechanical behavior based on the intensity of motion (eg, the inversion veloc-
ity), unlike traditional passive concepts of ankle bracing.
Purpose: To compare the performance of a novel adaptive brace with 2 passive ankle braces while considering protection, sports
performance, freedom of motion, and subjective perception.
Study Design: Controlled laboratory study.
Methods: The authors analyzed 1 adaptive and 2 passive (one lace-up and one rigid brace) ankle braces, worn in a low-cut,
indoor sports shoe, which was also the no-brace reference condition. We performed material testing using an artificial ankle joint
system at high and low inversion velocities. Further, 20 male, young, healthy team sports athletes were analyzed using 3-dimen-
sional motion analysis in sports-related movements to address protection, sports performance, and active range of motion di-
mensions. Participants rated subjective comfort, stability, and restriction experienced when using the products.
Results: Subjective stability rating was not different between the adaptive and passive systems. The rigid brace was superior in
restricting peak inversion during the biomechanical testing compared with the passive braces. However, in the material test, the
adaptive brace increased its stiffness by approximately 400% during the fast compared with the slow inversion velocities, dem-
onstrating its adaptive behavior and similar stiffness values to passive braces. We identified minor differences in sports perfor-
mance tasks. The adaptive brace improved active ankle range of motion and subjective comfort and restriction ratings.
Conclusion: The adaptive brace offered similar protective effects in high-velocity inversion situations to those of the passive
braces while improving range of motion, comfort, and restriction rating during noninjurious motions.
Clinical Relevance: Protection systems are only effective when used. Compared with traditional passive ankle brace technolo-
gies, the novel adaptive brace might increase user compliance by improving comfort and freedom of movement while offering
similar protection in injurious situations.
Keywords: ankle sprain; injury; protective equipment; adaptive technology; inversion

Ankle sprains are among the most common traumatic inversion angles .30° and peak ankle inversion velocities
injuries in athletes,5 with the highest incidences observed .500 deg/s.10
in indoor and court sports.4 Ankle sprains represent 10% to Successful prevention of ankle injury and reinjury
28% of all sports-related injuries, and approximately includes neuromuscular training with passive protection
73% of competitive and recreational athletes experience systems (eg, ankle braces).16 Ankle brace design should
recurrent ankle sprains.6,22 Data captured from ankle sprain protect the joint from excessive motions. However, clinical
injuries suggest that most ankle sprains occur at ankle experience suggests that poor comfort (caused, eg, by poor
fit, restricted motion, or pressure peaks due to rigid parts)
or a potential reduction of sports performance (eg, due to
The American Journal of Sports Medicine restricted joint movement) might lead to noncompliance
2023;51(3):715–722
DOI: 10.1177/03635465221146294 of athletes in use of braces for ankle sprain prevention.7,13
Ó 2023 The Author(s) Therefore, we propose to test the preventive effects of

715
716 Willwacher et al The American Journal of Sports Medicine

ankle protection technology (including ankle braces) in 4 Therefore, the purpose of the present study was to eval-
domains: uate the performance of a novel adaptive ankle brace com-
pared with traditional passive ankle brace concepts while
(1) The protection domain (ie, reduction of peak ankle
considering the highlighted domains of ankle protection
inversion angles during sudden inversion or supination
technology. We hypothesized that the adaptive ankle brace
motions): these motions can be induced on tilt plat-
would restrict movement less during slower, nonexcessive
forms or during change of direction tasks. However,
ankle motions. Because of the adaptive stiffening of the
because of ethical restrictions, peak ankle angles
novel ankle brace during high angular velocities, we
need to stay within physiological (ie, noninjurious)
hypothesized a similar protective effect of the adaptive
ranges during biomechanical testing. Therefore, the
brace to those of the passive braces during sudden inver-
true protective potential of ankle protection technology
sion motions. Because of the greater freedom to move, we
can only be estimated from these interventions and
further hypothesized an improved sports performance
should be supplemented by systematic material testing
and subjective comfort rating of athletes using the adap-
using artificial ankle joints or cadaveric specimens.
tive compared with the passive ankle braces.
This approach allows for systematic variation of load-
ing parameters (eg, angular velocities, ankle ranges
of motion). The passive nature of these tests is justified
by the lack of active muscular control of ankle inver-
METHODS
sion motion typically reported in unexpected sudden
Participants
inversion motions.8
(2) The sports performance domain: it is unlikely that Twenty male, regional-level team sports (soccer, handball,
competitive athletes will sacrifice their sports perfor- basketball) athletes (age, 24.3 6 3.4 years; height, 1.84 6
mance to prevent injuries. Team sports performance 0.05 m; weight, 81.3 6 7.4 kg; 16 right-leg dominant, 4
can be quantified for acceleration, change of direction, left-leg dominant) participated in the study. Based on an
or jumping tasks, which frequently occur during foot- a priori power analysis, 20 participants was considered suf-
ball, basketball, or handball. ficient to identify a difference of 4° in maximal inversion
(3) Subjective comfort and stability rating: subjective per- angle between 2 conditions (alpha, .05; power, 0.8; SD,
ception of the stabilizing effect of an ankle protection 6°1). Participants were injury-free in the 12 months preced-
technology with a high comfort rating would likely ing data collection and signed written informed consent
increase user compliance. before their participation. Only 1 participant had under-
(4) Freedom of movement during nonexcessive ankle gone anterior cruciate ligament reconstruction surgery,
ranges of motion: reducing the physiological degrees approximately 3 years before data collection. The other
of freedom of the ankle joint would likely reduce com- participants had not undergone lower extremity surgery.
fort perception and sports performance. Four participants reported previous ankle sprain injuries
Optimizing the trade-off between the 4 domains might .12 months before data collection (ranging from 2 to 13
enhance the preventive effect of an ankle protection device. years before data collection; 2 participants sprained their
Passive ankle protection systems, including ankle ankles on the left and 2 on the right side). All methods
braces, have frequently been assessed within the litera- used in the study had been approved by the research ethics
ture.3,17 However, in most of these studies, the 4 men- committee of the university.
tioned domains have only partially been addressed.
Further, almost all studies considered passive ankle
braces. Recent advances have allowed for the creation of Experimental Protocol
an adaptive protection behavior of sports protection tech-
nologies. Although it was elegantly shown that an ankle We analyzed 1 adaptive brace (Sportomedix Malleo Fast
brace incorporating such an adaptive protection technology Protect, with Betterguards adaptive technology) and 2 pas-
protects the ankle against sudden inversion motions com- sive ankle braces (lace-up, Basko; rigid brace, T2 Active
pared with a placebo control condition,1 an assessment of Ankle). The Betterguards adaptive technology consists of
adaptive ankle braces against traditional passive ankle a semiflexible mini-piston embedded in an adaptor element
braces while considering the 4 domains of ankle protection crossing the lateral side of the ankle, including a valve.
has not yet been performed. This valve allows fluid to pass within the piston while

*Address correspondence to Steffen Willwacher, Prof., Department of Mechanical and Process Engineering, Offenburg University of Applied Sciences,
Badstr. 24, 77652 Offenburg, Germany (email: [email protected]) (Twitter handle: @S_Willwacher).
y
Department of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany.
z
Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.
Submitted June 24, 2022; accepted November 10, 2022.
One or more of the authors has declared the following potential conflict of interest or source of funding: The study was financially supported by Bet-
terguards Technology GmbH, Berlin, Germany. S.W. is a paid consultant to Betterguards Technology GmbH, a manufacturer of adaptive protection sys-
tems, and has received fees for consulting services. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not
conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
AJSM Vol. 51, No. 3, 2023 Assessment of Adaptive Ankle Protection Systems 717

extending at physiological movement velocities. In critical 1). We quantified the external joint moment by multiplying
movement velocities, the valve closes within milliseconds the resultant force applied by the material testing machine
because of fluid dynamic drag forces and inhibits the fur- within the pulling rope with the respective moment arm to
ther extension of the mini-piston, resulting in a limited the ankle joint center. Joint angles were measured using
range of motion. Participants wore all braces in the identi- an embedded electrogoniometer. All measurements were
cal low-cut indoor sports shoe (Mizuno Wave Mirage 3), sampled with a frequency of 2000 Hz. We subtracted the
which also served as the no-brace reference condition. joint moment that occurred due to the inherent friction
To address the 4 domains of effective ankle protection, within the apparatus by performing a measurement without
we developed a test battery of different motion tasks. Par- any shoes or orthoses. From the measurements, we calcu-
ticipants wore the braces on both the left and the right lated mean (0°-40° inversion) stiffness as the change in
ankle joints during each task and brace condition. We cap- external joint moment divided by the change in joint angle
tured joint kinematics with a 3-dimensional (3D) motion within the respective interval.
capture system (200 Hz, 12 Miqus M3 cameras; Qualisys We further analyzed ankle joint kinematics during
AB) synchronized with ground-embedded force platforms. a maximum effort 90° change of direction task. The partic-
We attached spherical retroreflective markers (diameter, ipants performed these cutting maneuvers from a 4-step
13 mm) to 38 bony landmarks.14,15,21 We attached foot approach and were instructed to perform the task with max-
markers at the corresponding positions on the shoe. We fil- imal intensity. The final biomechanical task for analyzing
tered all marker trajectories with a recursive, fourth-order joint protection was repeated side-shuffle motions from the
digital Butterworth filter (cutoff frequency, 10 Hz).11 A 3D left to the right leg. We instructed the participants to vary
rigid body model of the pelvis and the lower extremities, the intensity of task execution within each of the 3 per-
consisting of 9 rigid body segments (including a rearfoot formed trials. We quantified the mean horizontal GRF
and a forefoot segment), was used to calculate 3D joint applied within each ground contact. We then extracted
angles at the hip, knee, and ankle joint.19,20 Specifically, only those ground contacts in which the mean horizontal
the ankle joint movement was defined as the movement GRF was within 70% to 90% of the maximum value
of the rearfoot segment relative to the shank segment. obtained in any ground contact in any brace condition.
Joint angles were extracted as Cardan angles from the With this approach, we could compare ankle joint kinemat-
rotation matrix between rearfoot and shank segments ics between conditions for the same relative task intensity.
using a flexion-extension, inversion-eversion, internal-
external rotation sequence of rotation. Sports Performance Domain

Protection Domain To compare the effects on sports performance between

brace conditions, participants performed a linear accelera-
To test the protective effects of the braces, we used a tilting tion task, a vertical countermovement jump (CMJ), a 90°
platform that induced a combination of tilt around an change of direction, and a single-leg side-hopping task
antero-posterior (30° platform tilt) and mediolateral (10° over a distance of 30 cm with maximum effort.
platform tilt) axis at an angular velocity of 440 deg/s unex- The linear acceleration task was performed from
pectedly.2 Thus, the platform provoked sudden inversion a standing start position in front of a floor-mounted force
and plantarflexion motion of the ankle joint complex. While platform (2000 Hz, 0.9 3 0.6 m; AMTI).19 We analyzed
the tilting was induced on the right foot, the left foot was the GRFs of the first contact after the onset of the motion.
supported by 3 one-dimensional force sensors, measuring We divided the change in running velocity (achieved
vertical ground-reaction forces (GRFs). Using these force through integrating the body mass–normalized horizontal
measurements via real-time feedback, we controlled the GRF component) by ground contact time to achieve the
weight distribution between legs (80% on the tilted side). mean horizontal acceleration as our performance criterion
We further controlled a relaxed standing position by real- during this task. For the CMJ, we quantified performance
time monitoring surface electromyography (EMG) of the per- via the achieved jump height. We did not find any statisti-
oneus longus and tibialis anterior muscles using a wireless cally significant differences between brace conditions for
EMG system (2000 Hz; Aktos; Myon AG). entry and exit center of mass velocity (estimated via the
For ethical reasons, we could not test the protective velocity of the center of the pelvis), as well as for the cut-
capacity of the ankle braces at tilt angles .30° and very ting angle. Therefore, we quantified performance during
high tilt velocities. Because ankle sprains occur more often the cutting task through the execution, that is, ground con-
in these more extreme test scenarios,10 we developed tact time. The pelvis velocity was determined by numerical
a mechanical test procedure with an artificial lower leg differentiation of the horizontal components of the mid-
and foot (Figure 1). In this artificial device, the lower leg point of the pelvis segment (ie, the midpoint between the
and foot are connected by a joint in which the axis is moti- 4 pelvis markers). The actual change of direction angle
vated by the natural tilt of the human subtalar joint axis. during the cutting task was determined using the angles
We performed mechanical testing at 33 6 11 deg/s and 415 between the horizontal components of the velocity vectors
6 17 deg/s to simulate slow and fast ankle inversion of the pelvis markers averaged over 5 data frames before
motions, respectively. Inversion movements up to 40° were and after ground contact. Performance during the side-
induced by a rope that pulled the lateral part of the foot hopping task was evaluated by the execution time needed
upward (into combined inversion and plantarflexion) (Figure to perform 5 right-left single-leg jumps.
718 Willwacher et al The American Journal of Sports Medicine

Figure 1. Mechanical tests performed with the artificial ankle (representing the right lower leg and foot) on the different brace
conditions. Inversion is induced by pulling the rope connected to the lateral aspect of the foot upward. All braces were tested
with the same shoe as during the biomechanical testing. Results represent the mean of 3 trials per condition.

Subjective Comfort and Stability Perception Domain range of movement achieved in the frontal plane during
10 motion cycles quantified freedom of motion.
We asked the participants for their subjective comfort and
stability rating of the analyzed braces on a 10-cm visual Statistical Analysis
analog scale (VAS). For comfort and stability ratings,
higher VAS values represent a more comfortable or more We present all parameters as group means (and standard
stable condition, while for the rating of perceived restric- deviations). We applied 1-factor (brace condition)
tion, a higher value refers to less restriction. repeated-measures analysis of variance to identify the
ankle brace condition main effects for our parameters of
Freedom of Motion Domain interest. In the case of a brace condition main effect, we
performed pairwise comparisons between brace conditions
We assessed ankle range of movement in the frontal plane using dependent-sample t tests. Because of the explorative
during a sitting, low-speed ankle inversion-eversion move- nature of the study, we did not correct for multiple compar-
ment. The participants were advised to follow a metronome isons when analyzing differences between individual
set to 20 beats per minute (0.33 Hz) and achieve maximal braces. Furthermore, Cohen d effect sizes were calculated
active eversion and inversion excursions. The maximum to evaluate the strength of the observed effects for each
AJSM Vol. 51, No. 3, 2023 Assessment of Adaptive Ankle Protection Systems 719

brace compared with the no-brace condition, using the P = .006; d = 0.31) and rigid (–2.7% to baseline; P = .017;
equation d = 0.22) braces, while the difference for the adaptive brace
(–1.7% to baseline; P = .072; d = 0.13) compared with the
MBrace  MNo Brace no-brace condition did not reach the level of significance
d 5 qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi ð1Þ
2 2
ðSDBrace 1 SDNo Brace Þ (Figure 2E; see also Appendix Table A1, available online).
2 We observed no significant main effect of ankle brace con-
with MBrace and MNo Brace being the mean values of a brace ditions on linear acceleration performance (see Appendix
condition and the no-brace condition, respectively. SDBrace Table A1, available online).
and SDNo Brace are the standard deviations of a brace con- Because we did not find any significant differences
dition and the no-brace condition, respectively. All analy- between conditions regarding entry and exit velocity and
ses were performed using MATLAB statistics and the actual angle of the change in direction (see Appendix
machine learning toolbox (R2019b; The MathWorks Inc). Table A1, available online), sports performance during
The significance level was set to an a level of 5% (P \ .05). the cutting maneuver can be quantified via the execution
(ie, ground contact) time. Here, we found no significant
main effect of ankle brace conditions (Figure 2G; see also
Appendix Table A1, available online).
RESULTS We could not identify significant differences in side-
hop execution times between brace conditions (Figure
Protection Domain 2H; see also Appendix Table A1, available online).
We observed significant main effects of the ankle brace con-
dition for all biomechanical parameters related to ankle Subjective Comfort and Stability Perception Domain
joint protection (Figure 2, A-C; see also Appendix Table
A1, available in the online version of this article). Post hoc We observed significant main effects of ankle brace condi-
analyses revealed that the adaptive brace decreased peak tion for all subjectively rated parameters (see Appendix
inversion during induced sudden inversion and plantarflex- Table A1, available online). The participants rated better
ion motions on the tilt platform (–4.0% to baseline; P = .056; comfort and reported that they felt less restricted when
d = 0.40) less than the lace-up (–7.7% to baseline; P = .003; wearing the adaptive brace compared with the 2 passive
d = 0.74) and rigid (–27.1%; P \ .001; d = 2.52) braces (Fig- braces (Figure 2, J and L; see also Appendix Table A1,
ure 2A; see also Appendix Table A1, available online). The available online). Each of the braces improved the stability
difference to the lace-up brace was, on average, 1.0° (P = rating of the participants, and there was no significant dif-
.039; d = 0.37) (see Appendix Table A1, available online). ference between products regarding the stability rating
In the change of direction and side-shuffling tasks, the (Figure 2K; see also Appendix Table A1, available online).
rigid brace achieved significant reductions in peak inver-
sion compared with all other conditions (see Appendix Freedom of Motion Domain
Table A1, available online). The adaptive brace or lace-up
brace did not result in significant reductions of peak inver- Compared with the no-brace baseline condition, the adap-
sion in these neuromuscular controlled motion tasks. tive brace reduced the frontal plane ankle range of move-
Interestingly, the participants reached higher absolute ment less (–20.4%; P \ .001; d = 1.06) than passive ankle
peak inversion angles during the preplanned change of braces (lace-up: –45.8%; P \ .001; d = 2.39; rigid brace:
direction and side-shuffling tasks compared with the unex- –54.8%; P \ .001; d = 3.57) (Figure 2I; see also Appendix
pected tilt platform inversion (Figure 2, B and C; see also Table A1, available online).
Appendix Table A1, available online).
The material testing with the artificial ankle joint at 2
different angular velocities revealed the adaptive behavior DISCUSSION
of the adaptive brace. Although its stiffness remained rel-
atively low during the slow inversion motion (Figure 1; The purpose of the present study was to evaluate the per-
see also Appendix Table A1, available online), its stiffness formance of a novel adaptive ankle brace compared with
increased comparable with those of the lace-up and rigid traditional passive ankle brace concepts while considering
braces, respectively, during the fast inversion motion (Fig- different domains relevant to the user compliance of ankle
ures 1 and 2D; see also Appendix Table A1, available protection systems.
online). The results of the material testing at slow and high
inversion velocities confirmed the adaptivity of the adap-
tive brace system (Figure 1). We observed a 400% increase
Sports Performance Domain in stiffness created during the fast simulated inversion
compared with the slow simulated inversion. The tradi-
We identified significant main effects of ankle brace condi- tional brace concepts did not show this adaptive behavior
tion for the parameters CMJ height and ground contact and showed similar results in the slow and fast supination
time during the change of direction task (Figure 2, E and conditions. The adaptive brace achieved slightly higher
G; see also Appendix Table A1, available online). CMJ stiffness values than the traditional braces in the fast con-
heights were reduced for the lace-up (–3.8% to baseline; dition. Further, the adaptive brace created higher resisting
720 Willwacher et al The American Journal of Sports Medicine

Figure 2. Summary of differences observed for key biomechanical parameters within the 4 domains of ankle sprain protection (A
to D: Protection dimension; E to H: Sports performance dimension; I: Freedom of movement dimension; J to L: Subjective Per-
ception dimension). Numeric data of these results are summarized in Appendix Table A1 (available online). Horizontal lines indi-
cate a statistically significant difference between 2 conditions (P \ .05). Mean Lin., average linear; CMJ, countermovement jump;
RoM, range of motion; VAS, visual analog scale.
AJSM Vol. 51, No. 3, 2023 Assessment of Adaptive Ankle Protection Systems 721

moments for most of the range of motion covered during

the material test (Figure 1).
However, during the biomechanical testing, the adaptive
brace limited peak ankle inversion less than did the rigid
brace, with peak inversion values similar to those of the
lace-up brace within the different sports-specific motions
analyzed. The rigid brace reduced peak inversion most sub-
stantially during these movements, with reductions
between 5.3° and 7.2° compared with the no-brace baseline.
The contradiction between material and biomechanical
test results might be resolved when considering the inver-
sion velocities in the different testing situations. Figure 3
highlights the mean peak inversion velocities observed
during our material and biomechanical testing in relation
Figure 3. Comparison of peak inversion velocities. Black
to data from individuals who have experienced an ankle
crosses indicate individual data of ankle injuries that have
inversion injury, summarized in a recent review article.10
occurred in either a laboratory or a real game play situation,
However, when comparing the peak inversion velocities
as summarized by Lysdal et al.10 Continuous horizontal lines
observed during our material and biomechanical testing,
indicate peak inversion velocities measured during the bio-
the different methods of measuring ankle inversion need
mechanical and material testing. The colored areas highlight
to be considered. During the biomechanical testing, in
either values of 61 SD around the mean values between
order not to destroy the integrity of the heel cap and ankle
orthotic conditions (actual mean 6 SD values in parentheses)
braces, we had to place the markers on the heel cap of our
or the area between the actually measured and estimated
baseline shoe. However, this approach is known to overes-
peak inversion velocity considering heel-shoe movement in
timate rearfoot motion up to 2.3-fold, on average.12 On the
the material testing condition. Because angular velocity
other hand, inversion was measured directly using an elec-
measurements during the material testing did not consider
trogoniometer integrated into the artificial ankle joint dur-
the overestimation of rearfoot motion due to marker place-
ing the material testing. This situation represents the
ment on the heel cap of the shoe, we further estimated
direct measurement of foot motion within a shoe/orthotic
a comparable peak inversion velocity for the material testing
condition. To compare the peak inversion velocities
based on the overestimation factor determined by
between the different test situations, we have considered
Reinschmidt et al12 (factor, 2.3).
the potential overestimation during the material test, as
shown in Figure 3.
When considering these adjustments, the mean inver- observed no significant main effects of orthotic conditions
sion velocities observed for the sports-specific task in this except for CMJ. Here, the adaptive brace did not show
study were lower than the velocities observed during the a significant difference from the baseline condition
fast material testing situation. Furthermore, by comparing (–1.7%), while the lace-up and rigid braces showed signifi-
the measured inversion velocities against inversion veloci- cantly lower CMJ heights (–3.8% and –2.7%, respectively,
ties reported in the literature for actual injury situations compared with baseline) than the adaptive brace. Overall,
(Figure 3),10 it is apparent that the material testing more we concluded that differences between adaptive and pas-
closely resembles the real ankle strain injury mechanism sive ankle braces regarding sports performance are likely
than the biomechanical testing with real participants. minor. However, future studies should evaluate these
Therefore, it may be concluded that the novel adaptive orthotic conditions in more realistic game/sports situations
ankle brace provides a similar or slightly better protection to strengthen the ecological validity of the test scenario.
against inversion-related ankle injuries in situations that When considering the freedom of movement during
resemble high injury risk. slower motions with low injury risk, the adaptive brace
The comparison of peak inversion velocities between outperformed the passive brace conditions in this study.
testing conditions further highlights the need for material Active range of motion values were increased by 46% and
testing using artificial ankle joints or cadaveric prepara- 76% for the adaptive brace compared with the lace-up
tions to understand the effects of adaptive technologies and rigid brace conditions, respectively. This result
that change their behavior based on the intensity of move- matched the subjective perception of feeling restricted.
ment. Using such methodological approaches allows for the Here, the adaptive brace was subjectively rated as restrict-
testing of protection technologies in situations that have ing the motion of the ankle joint clearly less than the pas-
been shown to cause injuries. Overall, it appears that the sive brace conditions.
adaptive ankle brace offers a similar amount of protection Furthermore, the participants rated the adaptive brace
under high-risk, high–inversion velocity conditions. as more comfortable. Interestingly, the participants rated
Next to protecting against excessive ankle inversion, the adaptive product as providing a similar amount of sta-
users of ankle protection systems still want to perform bility to the passive braces. This subjective stability rating
well in their respective sports when wearing a protection seems to be more in line with the findings from the mate-
system. Sports performance was evaluated in the current rial testing than the findings from the biomechanical test-
study during sports-relevant motions. In these tasks, we ing of the protective effects of the products.
722 Willwacher et al The American Journal of Sports Medicine

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