Fibular taping does not alter lower extremity spinal reflex excitability in individuals with chronic ankle instability

Physical Therapy Intervention Effects on Alteration of Spinal Excitability in Patients With Chronic Ankle Instability: A Systematic Review and Meta-analysis

CONTEXT

Chronic ankle instability (CAI) is a common injury in athletes. Different forms of physical therapy have been applied to the population with CAI to assess their impact on spinal excitability.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to investigate the effectiveness of various physical therapy interventions on the alteration of spinal excitability in patients with CAI.

DATA SOURCES

Four databases (EMBASE, MEDLINE, Cochrane CENTRAL, and Scopus) were searched from inception to November 2022.

STUDY SELECTION

A total of 253 studies were obtained and screened; 11 studies on the effects of physical therapy intervention on the alteration of spinal excitability in patients with CAI were identified for meta-analysis.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 3a.

DATA EXTRACTION

A total of 11 studies that included the maximal Hoffmann reflex normalized by the maximal muscle response (H/M ratio) in the peroneus longus and soleus muscles were extracted and summarized. The quality of the studies was assessed using the PEDro scale.

RESULTS

The extracted studies had an average PEDro score of 4.7 ± 1.4, indicating that most of them had fair-to-good quality. The physical therapy interventions included cryotherapy, taping, mobilization, proprioceptive training, and dry needling. The overall effects showed that the H/M ratios of the peroneus longus (P = 0.44, I2 = 0%) and soleus (P = 0.56,I2 = 22%) muscles were not changed by physical therapy in patients with CAI.

CONCLUSION

The meta-analysis indicated that physical therapy interventions such as cryotherapy, taping, mobilization, proprioceptive training, and dry needling do not alter the spinal excitability in patients with CAI. Given that only 1 study reported ineffective changes in spinal excitability with dry needling, more research is essential to establish and validate its efficacy.

PROSPERO REGISTRATION

CRD42022372998.

What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis

PURPOSE

To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI).

MATERIALS AND METHODS

Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus.

RESULTS

Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03-1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01-1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior).

CONCLUSIONS

FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.

Comparison of effects of Mulligan taping and Kinesio taping on ankle neuromuscular control in response to a sudden inversion perturbation in individuals with chronic ankle instability

OBJECTIVES

This study was aimed to compare the effects of Mulligan taping (MT) with Kinesio taping (KT) and the un-taped ankle on neuromuscular control during a sudden inversion perturbation in individuals with chronic ankle instability (CAI).

DESIGN

Randomized, single blind cross-over.

SETTING

Biomechanics lab.

PARTICIPANTS

16 individuals with chronic ankle instability.

MAIN OUTCOME MEASURES

The outcome measures were the onset time and magnitude of short (SLR) and medium latency response (MLR) for peroneus brevis (PB), peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) muscles and the TA/P and SOL/TA antagonist co-activation.

RESULTS

In the groups of KT and MT, the onset time was significantly decreased at post-taping compared to pre-taping, such that for the onset time of PB MLR, the groups of KT and MT had an earlier onset time than the un-taped group. For the magnitude of TA SLR and PB MLR, groups exhibited different behaviors. In the KT group, the magnitude was significantly increased post-taping, however, in the MT group, it was decreased. Regarding the TA/P and SOL/TA co-activation, the groups of KT and MT showed significant changes post-taping.

CONCLUSION

This study suggests that KT and MT significantly affect neuromuscular control in response to a sudden perturbation in individuals with CAI, although the behavior of KT and MT appears to be somewhat different from each other.

Ankle Muscle Activations during Different Foot-Strike Patterns in Running

This study analysed the landing performance and muscle activity of athletes in forefoot strike (FFS) and rearfoot strike (RFS) patterns. Ten male college participants were asked to perform two foot strikes patterns, each at a running speed of 6 km/h. Three inertial sensors and five EMG sensors as well as one 24 G accelerometer were synchronised to acquire joint kinematics parameters as well as muscle activation, respectively. In both the FFS and RFS patterns, according to the intraclass correlation coefficient, excellent reliability was found for landing performance and muscle activation. Paired t tests indicated significantly higher ankle plantar flexion in the FFS pattern. Moreover, biceps femoris (BF) and gastrocnemius medialis (GM) activation increased in the pre-stance phase of the FFS compared with that of RFS. The FFS pattern had significantly decreased tibialis anterior (TA) muscle activity compared with the RFS pattern during the pre-stance phase. The results demonstrated that the ankle strategy focused on controlling the foot strike pattern. The influence of the FFS pattern on muscle activity likely indicates that an athlete can increase both BF and GM muscles activity. Altered landing strategy in cases of FFS pattern may contribute both to the running efficiency and muscle activation of the lower extremity. Therefore, neuromuscular training and education are required to enable activation in dynamic running tasks.

Acute Effect of Kinesiology Taping on Postural Stability in Individuals With Unilateral Chronic Ankle Instability

Background

Chronic ankle instability (CAI), which is characterized by deficient postural control, could be improved through kinesiology taping (KT). However, the effect of KT on postural control in CAI individuals is controversial. Therefore, this study aimed to investigate the acute effect of KT on postural control through computerized dynamic posturography (CDP) and self-perceived sensation in CAI individuals.

Methods

Participants with CAI received four different ankle treatments randomly, including KT, athletic taping (AT), sham taping (ST), and no taping (NT). A series of postural stability measurements was performed using CDP subsequently. The measurements included sensory organization test (SOT), unilateral stance (US), limit of stability (LOS), motor control test (MCT), and adaption test (ADT). In addition, self-perceived sensation was measured through visual analog scaling. Repeated measures analysis of variance was conducted to determine whether the difference among KT, AT, ST, and NT was significant; Bonferroni test was used for post hoc analysis.

Results

No significant difference was observed for parameters in SOT, US, and LOS in four different taping treatments. In MCT, the amplitude scaling scores of KT were 35.87% significantly lower than that of NT [p < 0.001, 95% confidence interval (CI) = 0.548–1.795] in forward-small slip and 21.58% significantly lower than that of ST (p = 0.035, 95% CI = 0.089–3.683) in backward-large slip. In ADT, sway energy scores were 7.59% significantly greater in ST than in AT (p = 0.028, 95% CI = −8.343 to −0.320). For perceived stability, KT was significantly greater than ST (p < 0.001, 95% CI = 0.552–1.899) and NT (p < 0.001, 95% CI = 0.797–2.534), and AT was significantly greater than ST (p = 0.001, 95% CI = 0.423–2.246) and NT (p < 0.001, 95% CI = 0.696–2.852). For perceived comfort, KT was significantly greater than AT (p = 0.001, 95% CI = 0.666–3.196) and NT (p = 0.031, 95% CI = 0.074–2.332), and ST was significantly greater than AT (p = 0.007, 95% CI = 0.349–2.931).

Conclusion

KT and AT have limited effect to facilitate postural control for CAI individuals during SOT, US, and LOS. However, KT and AT could provide effective support to cope with sudden perturbation in MCT and ADT. Moreover, KT provided excellent perceived stability and comfort, whereas AT provided excellent perceived stability but least comfort.

The Effect of Fibular Reposition Taping on Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

Clinical Scenario: History of acute ankle sprains can result in chronic ankle instability (CAI). Arthrokinematic changes resulting from CAI may restrict range of motion and contribute to postural control deficits. Mulligan or fibular reposition taping (FRT) has been suggested as a means to realign fibular positional faults and may be an effective way to improve postural control and balance in patients with CAI. Clinical Question: Is there evidence to suggest that FRT will improve postural control for patients with CAI in the affected limb compared with no taping? Summary of Key Findings: Three of the 4 included studies found no significant difference in postural control in patients receiving FRT compared with sham or no tape. Clinical Bottom Line: There is moderate evidence refuting the use of FRT to improve postural control in patients with CAI. Strength of Recommendation: There is grade B evidence to support that FRT does not improve postural control in people with CAI.