Prophylactic ankle stabilizers affect ankle joint kinematics during drop landings

Is ankle taping effective to limit the ankle dorsiflexion in a single-training session? An observational study in semi-professional basketball players

BACKGROUND

Ankle taping (AT) is effective in preventing ankle sprain injuries in most common sports and is employed in rehabilitation and prevention sports.

OBJECTIVE

This study aimed to investigate the effectiveness of AT to restricting excessive frontal plane ankle movements in semi-professional basketball players throughout the training session.

DESIGN AND SETTING

A cross-sectional study was performed at the Universidad Europea de Madrid.

METHODS

Forty male and female semi-professional basketball players were divided into two groups. The ankle dorsiflexion range of motion (ROM) and interlimb asymmetries in a weight-bearing lunge position were evaluated at four time points: 1) with no tape, 2) before practice, at 30 min of practice, and 3) immediately after practice.

RESULTS

In male basketball players, no differences were observed in the right and left ankles between the baseline and 30 min and between baseline and 90 min of assessment. In female athletes, significant differences were reported between baseline and pre-training assessments for the right ankle and also significant differences between baseline and 90 min in both ankles.

CONCLUSIONS

Ankle taping effectively decreased the ankle dorsiflexion ROM in male and female basketball players immediately after application. However, ROM restriction was very low after 30 and 90 min, as assessed in a single basketball practice. Therefore, the classic taping method should be revised to develop new prophylactic approaches, such as the implementation of semi-rigid bracing techniques or the addition of active stripes during training or game pauses.

Assessing the effect of prophylactic ankle taping on ankle and knee biomechanics during landing tasks in healthy individuals: A cross-sectional observational study

BACKGROUND

Current research supports the fact that prophylactic ankle taping (AT) is effective in preventing ankle injuries in amateur and elite sports athletes.

OBJECTIVE

This study aimed to investigate the effect of AT on balance, knee valgus during drop jump and single-leg countermovement jump (SL-CMJ) landings, and ankle range of motion (ROM) restriction in healthy participants.

DESIGN AND SETTING

A cross-sectional observational study was conducted at the Universidad Europea de Madrid, Madrid, Spain.

METHODS

Participants: Thirty-nine healthy individuals participated in this study and performed the movements under two conditions (with and without tape). Outcome measurements: ankle ROM, balance, SL-CMJ height, flight time, ground time, and knee valgus. Before any intervention, a random process was developed with a 1:1 allocation ratio, and the participants were assigned to groups A (tape-no tape) and B (no tape-tape).

RESULTS

Significant differences between tape and no-tape moments were observed for drop jump knee valgus flexion (P = 0.007), with an increase in knee valgus in participants with ankle taping. Similarly, the Y-balance testshowed a significant decrease in all variables (P = 0.001 and), ankle dorsiflexion (P = 0.001) in participants with ankle taping.

CONCLUSIONS

AT is effective for immediate ankle ROM restriction. However, an increase in knee valgus during drop jump task and a decrease in lower limb balance were observed during drop jump task. Based on these results, it can be concluded that AT application in healthy individuals should not be recommended as it results in increase in injury risk factors.

Effects of anticipation on joint kinematics during inversion perturbation in individuals with chronic ankle instability

BACKGROUND

Although chronic ankle instability (CAI) patients display altered reactive joint kinematics after inversion perturbation, little is known about the effects of anticipation on reactive joint kinematics among CAI, coper, and control groups.

OBJECTIVE

To assess changes in reactive joint kinematics after different inverted landing situations including planned- and unplanned-condition among groups of CAI, coper, and control.

METHODS

Sixty-six volunteers participated (22 per group). Participants completed three trials of both planned and unplanned single-leg landing onto an inverted force platform while reactive joint kinematic data were collected from initial-contact to 200 ms after initial-contact. Two-way repeated measures ANOVAs were used to examine the differences between condition (planned-, unplanned-conditions) and group (CAI, coper, control).

RESULTS

There were significant group by condition interactions for total ankle displacement in the frontal plane (p < 0.01) and maximum ankle inversion velocity (p = 0.01). CAI patients displayed increased ankle displacement (p < 0.01) and maximum inversion velocity (p < 0.01) under the unplanned condition compared to the planned condition. However, copers did not show any differences in ankle displacement and maximum inversion velocity between the two conditions.

CONCLUSIONS

CAI patients displayed greater changes in ankle joint displacement and maximum ankle inversion velocity occurred after inversion perturbation under unplanned condition compared with copers and controls. Current data suggest that altered reactive joint kinematics under the unanticipated condition in CAI patients may contribute to the condition of CAI after ankle sprains. Clinicians should focus on rehabilitation programs to recover and/or develop feedback control for CAI patients during functional movements under unanticipated condition to prevent further injuries.

Effects of Different Ankle Supports on the Single-Leg Lateral Drop Landing Following Muscle Fatigue in Athletes with Functional Ankle Instability

Background: Ankle support has been utilized for athletes with functional ankle instability (FAI), however, its effect on the landing performance during muscle fatigue is not well understood. This study aimed to examine the effects of ankle supports (ankle brace vs. Kinesio tape) on athletes with FAI following fatigued single-leg landing. Methods: Thirty-three young FAI athletes (CAIT scores < 24) were randomly allocated to control (Cn), ankle brace (AB) and Kinesio tape (KT) groups. All athletes performed single-leg lateral drop landings following ankle fatigue protocol. The fatigue-induced changes in kinetic parameters were measured among three groups. Results: A significant increase in peak vertical ground reaction force (vGRF) was found in the AB group (0.12% body weight (BW)) compared to that of the KT (0.02% BW) and Cn (median = 0.01% BW) groups. Significant decrease in both COP medial-lateral (ML) and anterior-posterior (AP) ranges were also found in the KT group (median = −0.15% foot width (FW) & median = −0.28% foot length (FL)) than those of the Cn group (median = 0.67% FW& median = 0.88% FL). Conclusions: Ankle braces might hamper the ability to absorb the impact force during landing. On the other hand, Kinesio tape might be beneficial for the postural control during landing.

The Effect of Ankle Bracing on Kinematics in Simulated Sprain and Drop Landings: A Double-Blind, Placebo-Controlled Study

BACKGROUND

The efficacy of external ankle braces to protect against sudden inversion sprain has yet to be determined while taking into account the possible placebo effect of brace application.

PURPOSE

To assess the protective effect of an external ankle brace on ankle kinematics during simulated inversion sprain and single-legged drop landings among individuals with a history of unilateral lateral ankle sprain.

HYPOTHESIS

The primary hypothesis was that active and placebo external braces would reduce inversion angle during simulated inversion sprain.

STUDY DESIGN

Controlled laboratory study.

METHODS

Sixteen participants with ankle instability and previous sprain performed single-legged drop landings and sudden inversion tilt perturbations. Kinematics of the affected limb were assessed in 3 conditions (active bracing, passive placebo bracing, and unbraced) across 2 measurement days. Participators and investigators were blinded to the brace type tested. The effect of bracing on kinematics was assessed with repeated measures analysis of variance with statistical parametric mapping, with post hoc tests performed for significant interactions.

RESULTS

Only active bracing reduced inversion angles during a sudden ankle inversion when compared with the unbraced condition. This reduction was apparent between 65 and 140 milliseconds after the initial fall. No significant differences in inversion angle were found between the passive placebo brace and unbraced conditions during sudden ankle inversion. Furthermore, no significant differences were found among all tested conditions in the sagittal plane kinematics at the knee and ankle.

CONCLUSION

During an inversion sprain, only the actively protecting ankle brace limited inversion angles among participants. These results do not indicate a placebo effect of external bracing for patients with ankle instability and a history of unilateral ankle sprain. Furthermore, sagittal plane knee kinematics appear to remain unaffected by bracing during single-legged landing, owing to the limited effects of bracing on sagittal ankle kinematics. These results highlight the role of brace design on biomechanical function during sports-related and injury-prone movements.

CLINICAL RELEVANCE

Athletes prone to reinjury after lateral ankle sprain may benefit from brace designs that allow for full sagittal range of motion but restrict only frontal plane motion.

Effects of a semi-rigid ankle brace on ankle joint loading during landing on inclined surfaces

Ankle bracing is commonly used to prevent ankle sprain occurrences. The present study investigated the effects of a semi-rigid ankle brace on the ankle joint complex during landing on inclined surfaces. Seventeen recreational athletes performed a single leg landing task onto three different surface alignments (everted, neutral, inverted), with and without the brace. Ground reaction forces (GRF), kinematics, and brace pressure were recorded. Six two-way repeated measures MANOVA tested for differences in GRF, talocrural and subtalar kinematics and kinetics. Participants landed with a significantly less plantar flexed (P < 0.001) and more everted (P = 0.001) foot during the braced condition. Although no differences were observed for the joint moments, an increased subtalar compression force (P = 0.009) was observed with the brace. Landing on the inverted surface resulted in significantly higher peak magnitudes of the vertical and the mediolateral GRF and the talocrural inversion moment compared to landing on the neutral surface. Ankle bracing altered ankle kinematics by restricting the ROM of the ankle joint complex. This study confirmed that landing on inverted surfaces may increase the risk for lateral ankle ligaments injuries. The significantly higher subtalar compression force during the brace condition might contribute to overuse injuries.

Effect of prophylactic ankle taping on ankle and knee biomechanics during basketball-specific tasks in females

OBJECTIVE

The aim of this study was to investigate the effects of ankle taping on ankle and knee joint biomechanics during cutting and rebound activities in females.

DESIGN

Cross-sectional.

SETTING

Laboratory.

PARTICIPANTS

Twenty semi-professional female basketball players performed a cut and rebound task under two conditions (taped and no-tape).

MAIN OUTCOME MEASURES

Kinematic and ground reaction force data were collected during the deceleration phase of each movement task.

RESULTS

Taping resulted in a significant reduction in peak ankle dorsiflexion, inversion and internal rotation angles and range of motion (ROM) at the ankle joint; and reduced knee ROM in the sagittal plane during the rebound task only. Taping significantly reduced peak knee flexion moment (0.29 Nm/kg, P = 0.013) and increased knee internal rotation moment (0.63 Nm/kg, P = 0.026) during the cutting task compared to control. Taping also significantly reduced the internal rotation moment (0.07 Nm/kg, P = 0.025), and medial shear forces (0.14 N/kg, P = 0.012) in the rebound task.

CONCLUSION

Results of the study suggest that ankle taping restrict ankle range of movement in the rebound task only and ankle taping appears to have upstream effects on the knee, which may have injury implications.

The effect of different ankle and knee supports on balance in early ambulation of post-stroke hemiplegic patients

The purpose of this study was to compare the effects of different ankle and knee supports on balance in early ambulation of post-stroke hemiplegic patients. This is a randomized experimental study. The study sample included 20 hemiplegic patients who were able to stand with support and who had been diagnosed with a cerebrovascular accident within the last month. A knee immobilization brace (KIB) was first placed on each individual (first application), followed by placement of knee immobilizer brace and Foot Lifter Orthosis ® (FLO) (second application), and lastly, placement of KIB and rigid taping (RT) (third application). The balance parameters of the patients were evaluated using the Korebalance system. The mean age of the patients was 65.1 ± 4.7 years, and the mean number of days that had passed since stroke occurred was 14.6 ± 4.97. In calculating the front/left balance scores of the applications, statistically significant differences were observed in the comparisons of all three supports and first-second applications performed (p = 0.041 and p = 0.021, respectively). Regarding the total scores between the applications, statistically significant differences were determined in balance in the comparisons on all three supports, in comparisons between the first and second applications, and in the comparisons between the second and third applications (p = 0.004, p = 0.007, and p = 0.001, respectively). Based on the findings from this study, it is recommended that the use of a knee immobilizer brace in combination with a foot lifter orthosis for post-stroke hemiplegic patients in early ambulation can lead to considerably improved standing balance.

Effect of External Ankle Support on Ankle and Knee Biomechanics During the Cutting Maneuver in Basketball Players

BACKGROUND

Despite the high prevalence of lower extremity injuries in female basketball players as well as a high proportion of athletes who wear ankle braces, there is a paucity of research pertaining to the effects of ankle bracing on ankle and knee biomechanics during basketball-specific tasks.

PURPOSE

To compare the effects of a lace-up brace (ASO), a hinged brace (Active T2), and no ankle bracing (control) on ankle and knee joint kinematics and joint reaction forces in female basketball athletes during a cutting maneuver.

STUDY DESIGN

Controlled laboratory study.

METHODS

Twenty healthy, semi-elite female basketball players performed a cutting task under both ankle brace conditions (lace-up ankle brace and hinged ankle brace) and a no-brace condition. The 3-dimensional kinematics of the ankle and knee during the cutting maneuver were measured with an 18-camera motion analysis system (250 Hz), and ground-reaction force data were collected by use of a multichannel force plate (2000 Hz) to quantify ankle and knee joint reaction forces. Conditions were randomized using a block randomization method.

RESULTS

Compared with the control condition, the hinged ankle brace significantly restricted peak ankle inversion (mean difference, 1.7°; P = .023). No significant difference was found between the lace-up brace and the control condition ( P = .865). Compared with the lace-up brace, the hinged brace significantly reduced ankle and knee joint compressive forces at the time of peak ankle dorsiflexion (mean difference, 1.5 N/kg [ P = .018] and 1.4 N/kg [ P = .013], respectively). Additionally, the hinged ankle brace significantly reduced knee anterior shear forces compared with the lace-up brace both during the deceleration phase and at peak ankle dorsiflexion (mean difference, 0.8 N/kg [ P = .018] and 0.9 N/kg [ P = .011], respectively).

CONCLUSION

The hinged ankle brace significantly reduced ankle inversion compared with the no-brace condition and reduced ankle and knee joint forces compared with the lace-up brace in a female basketball population during a cutting task. Compared with the lace-up brace, the hinged brace may be a better choice of prophylactic ankle support for female basketball players from a biomechanical perspective. However, both braces increased knee internal rotation and knee abduction angles, which may be problematic for a population that already has a high prevalence of knee injuries.

The effect of knee joint Mulligan taping on balance and gait in subacute stroke patients

[Purpose] This study aimed to determine the effects of Mulligan taping on balance and gait in subacute stroke patients. [Subjects] Thirty patients with subacute stroke were randomly divided into two groups: the experimental group (n = 15) and the control group (n = 15). Mulligan taping was applied to the knee joints of participants in the experimental group while placebo taping was applied to knee joints of subjects in the control group. Biodex was used to assess their balance ability and the GAITRite System was used to test gait. All measurements were performed before and after the intervention. [Results] Dynamic standing balance of the experimental group significantly improved after taping. Gait, gait cadence, velocity, step length, and stride length also improved significantly. However, no significant differences in standing balance or gait were observed for the control group. Furthermore, significant differences in dynamic standing balance, cadence, and velocity were found between the two groups after the intervention. [Conclusion] Our results demonstrate that Mulligan taping is effective for improving balance and gait in subacute stroke patients. Thus, this technique is a potential method for actively facilitating rehabilitation programs for hemiplegia patients.

The effect of non-elastic taping on balance and gait function in patients with stroke

[Purpose] This study investigated the influence of exercise on balance ability and gait function in stroke patients after applying non-elastic tape, which can stabilize muscles and joints, to the lower extremities of the affected side. [Subjects and Methods] The subjects were 30 patients diagnosed with stroke. They were divided into an experimental group (n = 15) and a control group (n = 15). The experimental group performed mat and treadmill exercises three times a week for six weeks with non-elastic tape applied to the lower extremities of the affected side. The control group performed the same exercises but without taping. [Results] The intervention significantly improved Berg balance scale scores and timed up and go (TUG) test scores as well as reduced stance duration and stride duration in the experimental group. In the control group, statistically significant improvements were observed in TUG test scores. [Conclusion] Although some differences did not reach the level of statistical significance, the application of non-elastic tape stabilized the joints of the lower extremities, thereby increasing balance and reducing stance duration and one step duration, which resulted in a reduction of overall gait duration.

The effect of ankle bracing on lower extremity biomechanics during landing: A systematic review

OBJECTIVES

To examine the evidence for effect of ankle bracing on lower-extremity landing biomechanics.

DESIGN

Literature review.

METHODS

Systematic search of the literature on EBSCO health databases. Articles critiqued by two reviewers.

RESULTS

Ten studies were identified which investigated the effect of ankle bracing on landing biomechanics. Overall results suggest that landing biomechanics are altered with some brace types but studies disagree as to the particular variables affected.

CONCLUSIONS

There is evidence that ankle bracing may alter lower-extremity landing biomechanics in a manner which predisposes athletes to injury. The focus of studies on specific biomechanical variables rather than biomechanical patterns, analysis of pooled data means in the presence of differing landing styles between participants, variation in landing-tasks investigated in different studies, and lack of studies investigating goal-directed sport-specific landing tasks creates difficulty in interpreting results. These areas require further research.

Prevention of Lower Extremity Injuries in Basketball: A Systematic Review and Meta-Analysis

Context:

Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates.

Objective:

To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears.

Data Sources:

PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015.

Study Selection:

Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis.

Study Design:

Systematic review and meta-analysis.

Level of Evidence:

Level 2.

Data Extraction:

Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture).

Results:

Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P < 0.001) and ankle sprains (OR, 0.45; 95% CI, 0.29-0.69; P < 0.001), yet not ACL ruptures (OR, 1.09; 95% CI, 0.36-3.29; P = 0.87) in basketball athletes.

Conclusion:

In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries.

The effects of a semi-rigid brace or taping on talocrural and subtalar kinematics in chronic ankle instability

BACKGROUND

A semi-rigid brace or taping is often used to prevent giving-ways in the joint with chronic ankle instability (CAI). However, it remains unknown whether the application of a semi-rigid brace or taping modifies abnormal kinematics in CAI joints. The objective of this study was to determine if the application of a semi-rigid brace or taping of the ankle normalizes abnormal weight-bearing kinematics in CAI joints during ankle internal rotation in plantar flexion.

METHODS

A total of 14 male patients with unilateral CAI (mean age 21.1 ± 2.5 years) were enrolled. Three-dimensional bone models created from the computed tomography images were matched to the fluoroscopic images to compute the 6 degrees-of-freedom talocrural, subtalar, and ankle joint complex (AJC) kinematics for the healthy and contralateral CAI joints, as well as for CAI joints with a brace or taping. Selected outcome measures were talocrural anterior translation, talocrural internal rotation, and subtalar internal rotation.

RESULTS

There was no significant difference in talocrural anterior translation and internal rotation induced by applying either a semi-rigid brace or taping (P > .05). For subtalar internal rotation, there was a tendency toward restoration of normal kinematics in CAI joints after applying a semi-rigid brace or taping. However, the difference was not significant (P > .05).

DISCUSSION

Application of a semi-rigid brace or taping had limited effects on the CAI joint during weight-bearing ankle internal rotation in plantar flexion. Further studies using a variety of testing conditions should be conducted in the future.

LEVELS OF EVIDENCE

Therapeutic, Level IV: Cross-Sectional Case Series.

Gait kinematics after taping in participants with chronic ankle instability

CONTEXT

Chronic ankle instability is characterized by repetitive lateral ankle sprains. Prophylactic ankle taping is a common intervention used to reduce the risk of ankle sprains. However, little research has been conducted to evaluate the effect ankle taping has on gait kinematics.

OBJECTIVE

To investigate the effect of taping on ankle and knee kinematics during walking and jogging in participants with chronic ankle instability.

DESIGN

Controlled laboratory study.

SETTING

Motion analysis laboratory.

PATIENTS OR PARTICIPANTS

A total of 15 individuals (8 men, 7 women; age = 26.9 ± 6.8 years, height = 171.7 ± 6.3 cm, mass = 73.5 ± 10.7 kg) with self-reported chronic ankle instability volunteered. They had an average of 5.3 ± 3.1 incidences of ankle sprain.

INTERVENTION(S)

Participants walked and jogged in shoes on a treadmill while untaped and taped. The tape technique was a traditional preventive taping procedure. Conditions were randomized.

MAIN OUTCOME MEASURE(S)

Frontal-plane and sagittal-plane ankle and sagittal-plane knee kinematics were recorded throughout the entire gait cycle. Group means and 90% confidence intervals were calculated, plotted, and inspected for percentages of the gait cycle in which the confidence intervals did not overlap.

RESULTS

During walking, participants were less plantar flexed from 64% to 69% of the gait cycle (mean difference = 5.73° ± 0.54°) and less inverted from 51% to 61% (mean difference = 4.34° ± 0.65°) and 76% to 81% (mean difference = 5.55° ± 0.54°) of the gait cycle when taped. During jogging, participants were less dorsiflexed from 12% to 21% (mean difference = 4.91° ± 0.18°) and less inverted from 47% to 58% (mean difference = 6.52° ± 0.12°) of the gait cycle when taped. No sagittal-plane knee kinematic differences were found.

CONCLUSIONS

In those with chronic ankle instability, taping resulted in a more neutral ankle position during walking and jogging in shoes on a treadmill. This change in foot positioning and the mechanical properties of the tape may explain the protective aspect of taping in preventing lateral ankle sprains.

The effect of ankle taping on the ground reaction force in vertical jump performance

The purpose of this study was to investigate the effects of closed basket weave (CBW) ankle taping on the vertical ground reaction force during the contact phase before the take-off in vertical jump performance. We hypothesized that ankle taping would limit the capability for explosive force generation during the contact phase before the take-off in jump performance. Twelve healthy young men (age, 20.2 ± 1.3 years; height, 1.76 ± 0.05 m; body mass, 66.1 ± 6.1 kg; mean ± SD) performed a vertical jump performance on a force plate without (CON) or with ankle taping (CBW technique) of the right ankle joint. Vertical jump ability was assessed using 2 styles of vertical jump with no arm swing: a countermovement jump (CMJ) and squat jump (SJ). From the vertical ground reaction force (GRF), maximum jump height, vertical impulse (VI), rate of force development, maximum GRF (GRFmax), and time-series GRF (GRFts) during the contact phase before the take-off in jump performance were determined. Jump height was significantly lower for CBW (36.6 ± 6.6 cm) than CON (38.1 ± 6.7 cm) in CMJ, but not in SJ. Rate of force development and GRFts at 35, 40, 45, 50, 55, 60, and 65% of total time of the contact phase in jumping performance were also significantly smaller for CBW than CON in CMJ, but not in SJ. Conversely, VI and GRFmax were not significantly different between the groups in either jump condition. These results suggest that ankle taping impairs CMJ performance, because of a decreased ability to develop large force rapidly on the ground before the take-off.

Does Wearing a Prophylactic Ankle Brace During Drop Landings Affect Lower Extremity Kinematics and Ground Reaction Forces?

The objective of the study was to determine if prophylactic ankle bracing worn by females during landings produces abnormal lower extremity mechanics. Angular kinematic and ground reaction force (GRF) data were obtained for 16 athletically experienced females who performed brace and no-brace drop landings. The brace condition displayed reduced in/external rotation and flexion displacements about the ankle and knee joints and increased vertical and mediolateral GRF peak magnitudes and rate of vertical GRF application (pairedttest,P< .05). The ankle and knee joints landed in a less plantar flexed and more flexed position, respectively. No significant ab/adduction outcomes may have occurred due to interparticipant variability and/or a lack of brace restriction. Conclusion: During typical landings, this lace-up brace increases vertical GRF, decreases ankle and knee joint displacements of flexion and int/external rotation, but minimally affects ab/adduction displacements.

Comparison of custom-moulded ankle orthosis with hinged joints and off-the-shelf ankle braces in preventing ankle sprain in lateral cutting movements

BACKGROUND

A custom moulded ankle orthosis with hinged joints potentially offers a better control over the subtalar joint and the ankle joint during lateral cutting movements, due to total contact design and increase in material strength.

OBJECTIVES

To test the above hypothesis by comparing it to three other available orthoses.

STUDY DESIGN

Repeated measures.

METHODS

Eight subjects with a history of ankle sprains (Grade 2), and 11 subjects without such history performed lateral cutting movements in four test conditions: 1) non-orthotic, 2) custom-moulded ankle orthosis with hinges, 3) Sport-Stirrup, and 4) elastic ankle sleeve with plastic support. A VICON motion analysis system was used to study the motions at the ankle and subtalar joints.

RESULTS

The custom-moulded ankle orthosis significantly lowered the inversion angle at initial contact (p = 0.006) and the peak inversion angle (p = 0.000) during lateral cutting movements in comparison to non-orthotic condition, while the other two orthoses did not. The three orthoses did not affect the plantarflexion motions, which had been suggested by previous studies to be important in shock wave attenuation.

CONCLUSIONS

The custom-moulded ankle orthosis with hinges could better control inversion and thus expected to better prevent ankle sprain in lateral cutting movements.

CLINICAL RELEVANCE

Custom-moulded ankle orthoses are not commonly used in preventing ankle sprains. This study raises the awareness of the use of custom-moulded ankle orthoses which are expected to better prevent ankle sprains.

Is the inverted surface landing more suitable in evaluating ankle braces and ankle inversion perturbation?

OBJECTIVE

To investigate biomechanical (kinematic) differences between 2 ankle brace testing protocols: landing on an inverted surface (IS) and inversion drop on an inversion platform.

DESIGN

Five trials in each of 4 dynamic movement conditions were performed: inversion drop and drop landing from 0.45 m onto an IS without and with an ankle brace. A 7-camera motion analysis system was used to obtain the 3-dimensional kinematics. A 2 × 2 (brace × movement) repeated measures analysis of variance was used to evaluate selected variables for inversion drop and IS landing.

SETTING

Research laboratory.

PATIENTS

Eleven healthy subjects participated in the study.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Maximum ankle frontal plane and sagittal plane joint angles, range of motion, and maximum angular velocity.

RESULTS

The IS landing resulted in significantly earlier maximum inversion, inversion velocities, dorsiflexion range of motion (ROM), contact dorsiflexion velocity, and maximum dorsiflexion velocity compared with the inversion drop. The ankle brace application during the IS landing reduced the contact plantarflexion angle, dorsiflexion ROM and maximum dorsiflexion velocity, and maximum inversion.

CONCLUSIONS

The results from this study showed that the IS landing protocol produced significantly earlier maximum inversion angle and velocity and inversion velocities compared with the inversion drop protocol. These results showed that the IS landing is more demanding and should be considered in future investigations of ankle braces and lateral ankle performance/injury mechanisms.

Efficacy of an ankle brace with a subtalar locking system in inversion control in dynamic movements

STUDY DESIGN

Controlled laboratory study.

OBJECTIVES

To examine effectiveness of an ankle brace with a subtalar locking system in restricting ankle inversion during passive and dynamic movements.

BACKGROUND

Semirigid ankle braces are considered more effective in restricting ankle inversion than other types of brace, but a semirigid brace with a subtalar locking system may be even more effective.

METHODS

Nineteen healthy subjects with no history of major lower extremity injuries were included in the study. Participants performed 5 trials of an ankle inversion drop test and a lateral-cutting movement without wearing a brace and while wearing either the Element (with the subtalar locking system), a Functional ankle brace, or an ASO ankle brace. A 2-way repeated-measures analysis of variance (ANOVA) was used to assess brace differences (P?.05).

RESULTS

All 3 braces significantly reduced total passive ankle frontal plane range of motion (ROM), with the Element ankle brace being the most effective. For the inversion drop the results showed significant reductions in peak ankle inversion angle and inversion ROM for all 3 braces compared to the no brace condition; and the peak inversion velocity was also reduced for the Element brace and the Functional brace. In the lateral-cutting movement, a small but significant reduction of the peak inversion angle in early foot contact and the peak eversion velocity at push-off were seen when wearing the Element and the Functional ankle braces compared to the no brace condition. Peak vertical ground reaction force was reduced for the Element brace compared to the ASO brace and the no brace conditions.

CONCLUSIONS

These results suggest that the tested ankle braces, especially the Element brace, provided effective restriction of ankle inversion during both passive and dynamic movements.

The effect on neuromuscular stability, performance, multi-joint coordination and proprioception of barefoot, taping or preventative bracing

OBJECTIVE

The objective of this study was to assess the effects of taping and preventive bracing on functional balance, jumping performance, multi-joint coordination and proprioception on comparison to barefoot and each other.

DESIGN

Controlled trial as an experiment with the independent variable testing in 3 trials: control (barefooted), preventive bracing, and taping.

SETTING

The sports physiotherapy research laboratory.

PARTICIPANTS

Twenty physically active male university students aged between 20 and 28 who had been free from lower extremity pathology for 12 months and had no previous history of ankle sprain served as participants.

MAIN OUTCOME MEASURES

Single leg balance (s), jumping performance (cm), coordination and proprioception assessments by the Functional Squat System. The software automatically calculated the absolute average error (cm) and the standard deviation (SD) of the average error. Average errors were independently quantified as a function of the action mode (concentric versus eccentric) and of the lower limb (dominant versus non-dominant).

RESULTS

There was no significant difference among the groups for balance tests (p>0.05). For vertical jump performance of bilateral and the dominant leg there were significant differences that the barefoot group had better results compared to the other groups (p=0.059; 0.017). According to the coordination results of Functional Squat System participants were better in brace and tape situations since the deviations were less for all concentric and eccentric positions. Deviation results for the proprioception test were different for first visual and non-visual deviations for dominant leg (p<0.05).

CONCLUSION

In conclusion, bracing and taping may play an important role in preventing injury or rehabilitation of the injured ankle by improving concentric and eccentric coordination, proprioception with the ability of reproducing motion in closed kinetic chain while decreasing vertical jump performance. No superiority of brace over tape or vice versa was found in this study.

Prophylactic ankle braces and star excursion balance measures in healthy volunteers

CONTEXT

The effects of prophylactic ankle braces on lower extremity functional performance in healthy participants have not been studied extensively.

OBJECTIVE

To determine if prophylactic ankle braces affected multidirectional reach distances during a test of dynamic balance.

DESIGN

Crossover.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty-six healthy, physically active volunteers (18 men, 18 women; age = 23.6 +/- 2.7 years, height = 173.8 +/- 9.3 cm, mass = 74.4 +/- 12.7 kg, reach-leg length = 91.9 +/- 5.1 cm).

INTERVENTION(S)

Volunteers performed balance testing in 3 conditions: unbraced, while wearing a semirigid ankle brace, and while wearing a lace-up ankle brace.

MAIN OUTCOME MEASURE(S)

We used the Star Excursion Balance Test, calculating the mean of 3 attempts in 8 directions (anterior, anterior-medial, medial, posterior-medial, posterior, posterior-lateral, lateral, and anterior-lateral), normalized by the participant's reach-leg length. Data were collected after 6 practice attempts for each of the conditions according to a balanced Latin square.

RESULTS

Bracing condition had no effect (P > .05) on any of the Star Excursion Balance Test directional measures. The largest mean difference due to bracing was 2.5% between the lace-up brace condition and the control in the posterior reach direction. This indicates that the actual reach differences due to bracing were less than 5.08 cm (2 inches) in length.

CONCLUSIONS

Clinicians can be confident that the prophylactic use of ankle braces does not disrupt lower extremity dynamic balance during a reaching task in healthy participants.

Lower extremity kinematics and ground reaction forces after prophylactic lace-up ankle bracing

CONTEXT

Long-term effects of ankle bracing on lower extremity kinematics and kinetics are unknown. Ankle motion restriction may negatively affect the body's ability to attenuate ground reaction forces (GRFs).

OBJECTIVE

To evaluate the immediate and long-term effects of ankle bracing on lower extremity kinematics and GRFs during a jump landing.

DESIGN

Experimental mixed model (2 [group] x 2 [brace] x 2 [time]) with repeated measures.

SETTING

Sports medicine research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 37 healthy subjects were assigned randomly to either the intervention (n = 11 men, 8 women; age = 19.63 +/- 0.72 years, height = 176.05 +/- 10.58 cm, mass = 71.50 +/- 13.15 kg) or control group (n = 11 men, 7 women; age = 19.94 +/- 1.44 years, height = 179.15 +/- 8.81 cm, mass = 74.10 +/- 10.33 kg).

INTERVENTION(S)

The intervention group wore braces on both ankles and the control group did not wear braces during all recreational activities for an 8-week period.

MAIN OUTCOME MEASURE(S)

Initial ground contact angles, maximum joint angles, time to reach maximum joint angles, and joint range of motion for sagittal-plane knee and ankle motion were measured during a jump-landing task. Peak vertical GRF and the time to reach peak vertical GRF were assessed also.

RESULTS

While participants were wearing the brace, ankle plantar flexion at initial ground contact (brace = 35 degrees +/- 13 degrees , no brace = 38 degrees +/- 15 degrees , P = .024), maximum dorsiflexion (brace = 21 degrees +/- 7 degrees , no brace = 22 degrees +/- 6 degrees , P = .04), dorsiflexion range of motion (brace = 56 degrees +/- 14 degrees , no brace = 59 degrees +/- 16 degrees , P = .001), and knee flexion range of motion (brace = 79 degrees +/- 16 degrees , no brace = 82 degrees +/- 16 degrees , P = .036) decreased, whereas knee flexion at initial ground contact increased (brace = 12 degrees +/- 9 degrees , no brace = 9 degrees +/- 9 degrees , P = .0001). Wearing the brace for 8 weeks did not affect any of the outcome measures, and the brace caused no changes in vertical GRFs (P > .05).

CONCLUSIONS

Although ankle sagittal-plane motion was restricted with the brace, knee flexion upon landing increased and peak vertical GRF did not change. The type of lace-up brace used in this study appeared to restrict ankle motion without increasing knee extension or vertical GRFs and without changing kinematics or kinetics over time.

Effect of the Ankle Stabilizing Orthosis on Foot and Ankle Kinematics During Cutting Maneuvers

This study was to examine the stability and functionality of the Ankle Stabilizing Orthosis (ASO) in normal ankle kinematics during sideward and forward lateral cutting. Fifteen college students with normal ankles were randomly assigned to each of the following four conditions: sideward and forward lateral cutting, with and without the ASO. Ankle inversion-eversion and dorsiflexion-plantarflexion angular displacements and velocities during movement were recorded by a 3-D Qualisys system and analyzed with repeated measures ANOVA and Bonferroni test. In forward lateral cutting, the ASO decreased inversion angle at touchdown. On both lateral cutting conditions, the ASO decreased inversion angle at footflat and push-off, and decreased plantarflexion angle at touchdown. Furthermore, the ASO did not change inversion-eversion and dorsiflexion-plantarflexion angular velocities or stance phase duration. The ASO is likely to prevent ankle sprains during activities that involve lateral cutting while not hindering athletic performance. Information presented may help clinicians it brace prescription.

The Effect of External Ankle Support on Vertical Ground-Reaction Force and Lower Body Kinematics

Objective:

To examine the effects of external ankle support on vertical ground-reaction forces (VGRF) and kinematic data.

Methods:

Subjects completed 2 braced and 2 nonbraced 0.61-m hanging drop landings onto a force platform. Kinematic data were collected with 8 digital-optical cameras sampling at 120 Hz.

Subjects:

12 Division I female volleyball players.

Statistical Analysis:

A repeated-measures ANOVA with Bonferroni correction (P < .05) was used to determine whether significant differences existed between test conditions for peak VGRF, loading rate, hip angle, knee angle, and ankle angle at right-foot contact for peak 1 and peak 2 of the VGRF curve over the first 100 milliseconds of the landing phase, as well as total hip range of motion (ROM), total knee ROM, and total ankle ROM for the entire landing phase.

Results:

There were significant increases in peak P1 and LR1 and a significant decrease in ankle-angle change at right-foot contact in braced trials compared with the nonbraced condition.

Bracing and rehabilitation—what's new

Based on the recent evidence, ankle bracing and taping do appear to have positive effects on ankle support. For example, both bracing and taping restrict inversion range of motion, with tape and stirrup-style braces providing the best support. Although exercise reduces this restriction, the range remains consistent with levels considered to be within the normal range. Ankle supports also appear to improve the strength of the muscular response to perturbation, potentially providing a stronger muscular contraction. In contrast, ankle supports fail to improve the neuromuscular response time to unexpected perturbations. Thus, it appears that the stronger response may occur too slowly to protect the joint. This slowness of the neuromuscular response, however, may be offset by the support's ability to slow the inversion motion. The slowing of inversion appears to allow the neuromuscular system to respond at or before the point of ligament damage. Finally, ankle supports appear to improve balance only in individuals with previously injured ankles. This suggests that supports may have a selective effect in protecting injured but not uninjured individuals. Despite these positive effects, some cautions should be emphasized. First, most of the studies cited have been performed in the laboratory setting with joint velocities and loads much below what are encountered in the athletic and daily activities. Whether tape and braces can maintain their effectiveness under the more extreme conditions of functional activities remains unclear. Additionally, some evidence suggests that ankle supports may transfer loads to other joints putting them at risk for injury. Thus, further study is needed to determine the risk-to-benefit ratio of ankle supports. Finally, much of the research presented has been done only on uninjured ankles. Based on the current evidence, it seems possible that the effectiveness of ankle supports may differ depending on the population, and it seems clinically important to know whether we can expect the same results for injured and uninjured ankles. Proper and early rehabilitation is important in preventing residual ankle symptoms. Reports indicate that up to 73% of people who sustain a lateral ankle sprain have recurrent sprains, but it is unknown how many of these participants partake in rehabilitation. Proper immobilization and acute care of the injured ankle is imperative. An immobilization boot or strapping that can be removed during early non-weight bearing exercises seems to be most effective. Strength and balance training of the uninjured contralateral limb can be used to assist reaching full recovery in a shorter period of time. Functional exercises can also be performed earlier in the rehabilitation process by reducing the gravitational forces so patients can perform in a pain-free range and still receive the benefits of early activity. Evidence shows that daily ankle disk training assists in preventing ankle sprains, and is a relatively inexpensive and easy alternative to traditional rehabilitation protocols.

The effect of ankle braces on the prevention of dynamic forced ankle inversion

BACKGROUND

Athletes often employ prophylactic braces to reduce the risk of ankle injuries.

HYPOTHESIS

Ankle braces do not significantly decrease the risk of forced inversion on a standardized one-footed jump landing.

STUDY DESIGN

Controlled laboratory study.

METHODS

Fourteen healthy men with a mean age of 25.1 years were tested. Three braces, two semirigid (Aircast and Bledsoe) and one lace-up (Swede-O), were fitted to each subject. Forced dynamic ankle inversion of 24 degrees was to be resisted as the subjects landed on one foot with a force of two body weights on a stimulus presented randomly in 5 of 15 jump trial blocks onto a hard, level force plate. Subjects first completed 1 no-brace block of 5 trials to establish baseline performance, then 3 randomly ordered 15-trial blocks testing performance with each of the braces, and then finally a no-brace 5-trial block.

RESULTS

The average no-brace success rate was 24%, which demonstrated the challenging nature of the task. All three braces increased the success rate (average, 44%); however, only the two semirigid braces proved to be significantly better than the unbraced state.

CONCLUSION

This test holds promise for evaluating brace efficacy when landing with one foot unexpectedly on an object that acts to forcibly invert the ankle.

Effect of ankle taping and bracing on vertical ground reaction forces during drop landings before and after treadmill jogging

STUDY DESIGN

Single-group repeated-measures experimental design.

OBJECTIVES

The purpose of this study was to evaluate the effects of prophylactic ankle stabilization on vertical ground reaction forces before and after treadmill jogging.

BACKGROUND

Previous research has demonstrated acute effects of ankle taping and bracing on ankle joint kinematics and vertical ground reaction forces during drop landings. Based on the number of investigations demonstrating increased range of motion of the braced or taped ankle following exercise, it may be plausible that the aforementioned landing alterations may return to normal following an exercise bout.

METHODS AND MEASURES

Fourteen healthy recreational participants performed stiff and soft drop landings before and after a 20-minute treadmill exercise bout under 3 different ankle stabilizer conditions (no stabilizer, ankle brace, and ankle tape). A forceplate was used to collect ground reaction force data under the dominant foot. The first and second peak impact force, as well as the time to each of the 2 peak forces, were determined for each trial and used as dependent variables.

RESULTS

The time to reach peak forces were significantly less under the ankle brace and tape conditions in comparison to the control (no-stabilizer) condition.

CONCLUSIONS

It appears that ankle taping and bracing decrease the time to reach peak impact forces. These alterations indicate that during dynamic activity the musculoskeletal structures of the body may be subjected to loads within shorter time periods. Whether these effects are detrimental over time remains speculative at this point and requires further research.

Landing adaptations after ACL reconstruction

PURPOSE

The purpose of this study was to determine whether fully rehabilitated ACL reconstructed (ACLr) recreational athletes utilize adapted lower-extremity joint kinematics and kinetics during a high-demand functional task.

METHODS

The kinematic and kinetic performance of 11 healthy and 11 hamstring ACLr recreational athletes were compared during a 60-cm vertical drop landing.

RESULTS

At initial ground contact, the ACLr group demonstrated greater hip extension and ankle plantarflexion compared with the healthy group. The peak vertical ground-reaction force was not different between groups, but the ACLr group delayed the time to its occurrence. The knee extensors provided the major energy absorption function for both groups; however, the ACLr group performed 37% more ankle plantarflexor work and 39% less hip extensor work compared with the healthy group.

CONCLUSIONS

The hamstring ACLr recreational athletes utilized an adapted landing strategy that employed the hip extensor muscles less and the ankle plantarflexor muscles more. The harvesting of the medial hamstring muscles for ACL reconstruction may contribute to the utilization of this protective landing strategy.

Does taping influence electromyographic muscle activity in the scapular rotators in healthy shoulders?

Although taping techniques are commonly used in addition to exercise programmes in the rehabilitation of shoulder instability and secondary subacromial or internal impingement, few studies exist on the effect of taping on the muscle activity of the scapular rotators. The purpose of our study was to examine the influence of one particular tape on muscular activity in scapular muscles. Twenty healthy shoulders were examined with surface EMG recordings on the three parts of trapezius and serratus anterior muscle during dynamic full range of motion abduction and forward flexion. The movement direction, and tape and no-tape conditions were randomized. The statistical analyses with ANOVA repeated Measures (GLM model) showed significant differences among the means between the four muscles (P<0.05), two movement directions (P<0.05), applied resistance (P<0.01), and movement period (P<0.01). However, no significant difference was observed based on the application of tape. The results of our investigation revealed no significant influence of tape application on EMG activity in the scapular muscles in healthy subjects. Future research will be necessary to examine other parameters of neuromuscular control in order to determine possible proprioceptive changes in muscle recruitment with tape application.

Effectiveness of taping and bracing in balance

Taping and bracing are thought to be effective methods in restricting the ankle's joint motion and assisting prevention of injuries. Research evidence suggests that taping and bracing enhance both the mechanical support and the proprioception of the ankle. However, there is little research concerning the influence of taping and bracing on sport performance. Research has mainly examined tasks with demands on the frontal plane. Therefore, the present study examined the effect of taping and bracing on the performance of a task with demands on the frontal plane. A sample of 30 physical education students (Mage=21.9 yr.) performed a balance task requiring estimation of balance and both right and left deviations. The subjects performed the balance task on four different conditions, with tape, with Swede-O (a lace-up, boot style stabilizer), with Aircast (an inflatable cast), and without any stabilizer. There were no significant differences among the conditions. These findings indicate that taping and bracing do not have negative effects on balance in the frontal plane. This study created concerns regarding the appropriate stabilizer for different tasks, bilateral coordination after the application of a stabilizer, and the influence of psychological factors on prevention of injury.