Influence of taping on joint proprioception: a systematic review with between and within group meta-analysis

Taping is increasingly used to manage proprioceptive deficits, but existing reviews on its impact have shortcomings. To accurately assess the effects of taping, a separate meta-analyses for different population groups and tape types is needed. Therefore, both between- and within-group meta-analyses are needed to evaluate the influence of taping on proprioception. According to PRISMA guidelines, a literature search was conducted across seven databases (Web of Science, PEDro, Pubmed, EBSCO, Scopus, ERIC, SportDiscus, Psychinfo) and one register (CENTRAL) using the keywords "tape" and "proprioception". Out of 1372 records, 91 studies, involving 2718 individuals, met the inclusion criteria outlined in the systematic review. The meta-analyses revealed a significant between and within-group reduction in repositioning errors with taping compared to no tape (Hedge's g: -0.39, p < 0.001) and placebo taping (Hedge's g: -1.20, p < 0.001). Subgroup and sensitivity analyses further confirmed the reliability of the overall between and within-group analyses. The between-group results further demonstrated that both elastic tape and rigid tape had similar efficacy to improve repositioning errors in both healthy and fatigued populations. Additional analyses on the threshold to detection of passive motion and active movement extent discrimination apparatus revealed no significant influence of taping. In conclusion, the findings highlight the potential of taping to enhance joint repositioning accuracy compared to no tape or placebo taping. Further research needs to uncover underlying mechanisms and refine the application of taping for diverse populations with proprioceptive deficits.

The roles of lower-limb joint proprioception in postural control during gait

The objective of the present study was to investigate the roles of lower-limb joint proprioception in postural control during gait. Seventy-two healthy adults including 36 younger and 36 older adults participated in two experimental sessions, i.e., lower-limb joint proprioception assessment session and gait assessment session. Lower-limb joint proprioception was assessed by joint position sense errors measured at the ankle, knee and hip of the dominant side. Postural control during gait was characterized by step length, step width and local dynamic stability. Results showed that hip proprioception contributed the most to postural control during gait among the lower-limb joint proprioception components, and that mechanisms for the hip proprioception effects were different between age groups. These findings highlighted the importance of incorporating hip proprioception enhancement exercises in postural control training programs, and the necessity of considering age-related differences in the effects of hip proprioception when designing these exercises.

Acute Effect of Ankle Kinesio and Athletic Taping on Ankle Range of Motion During Various Agility Tests in Athletes With Chronic Ankle Sprain

Background:Taping is a preventive measure commonly used for protecting and strengthening the ankle joint to prevent further musculoskeletal damage. Ankle taping prevents excessive range of motion (ROM) of the ankle joint and allows the improvement of proprioception to adjust balance. Appropriate ankle stability is essential for various activities, such as sprinting, turning, cutting, and jumping, which are associated with agility.Aim:To assess the acute effect of Kinesio taping and athletic taping on the ankle ROM of athletes with chronic ankle sprain during various agility tests that include sprinting, turning, and cutting actions.Methods:Twenty-five physically active volunteers with chronic ankle sprain performed the Illinois, 5–0–5, 10-m shuttle, hexagon, compass drill, and T agility tests in 3 ankle conditions (nontaped, Kinesio taped, and athletic taped), in random order. Ankle ROM was recorded using the Vicon motion capture system.Results:In comparison with the nontaped ankle condition, in the ankle Kinesio-taping condition, the results showed a significant increase of ankle ROM in the sprinting part of the Illinois, 5–0–5, 10-m shuttle, and T agility tests (P ≤ .01), whereas in the ankle athletic-taping condition, no significant difference was found in ankle ROM during all agility tests.Conclusion:In sports that need linear sprinting, Kinesio taping seems to be a suitable intervention for the improvement of sports performance as it provides increased ankle ROM.

Joint position reproduction and joint position discrimination at the ankle are not related

Purpose: Limited data in current literature can be found on the relation between the two commonly-used active proprioception assessment methods -active joint position reproduction (JPR) and active movement extent discrimination assessment (AMEDA). The current study compared the two active methods, JPR and AMEDA, to investigate their interrelationship over two studies that differed in task difficulty, using active ankle inversion movements made in weight-bearing to maximise ecological validity.Methods: 50 participants volunteered in this research, 20 of whom on a harder protocol and the other 30 on an easier protocol, were tested by both methods, JPR and AMEDA. Proprioceptive acuity was represented by absolute error (AE) and variable error (VE) for JPR and by AE and the area under the curve (AUC) for AMEDA.Results: Proprioceptive acuity scores are found to be significantly correlated within test methods but not between methods for either hard or easy tasks, where JPR AE and VE scores were not correlated with either AMEDA AE or AUC. Further, proprioceptive acuity scores were significantly higher on the easy task when tested with the AMEDA method, but not with JPR method.Conclusion: Scores obtained from the two active movement proprioception tests, movement extent discrimination and joint position reproduction, were not significantly correlated. Taken together with previous findings, these results show that for proprioception, scores from the three classical psychophysical methods for measuring sensitivity (adjustment, limits and constant stimuli) are not correlated with each other. This suggests that each proprioception measurement system assesses a different aspect of proprioception.

Ankle Bracing Alters Coordination and Coordination Variability in Individuals With and Without Chronic Ankle Instability

CONTEXT

Ankle bracing is an effective form of injury prophylaxis implemented for individuals with and without chronic ankle instability, yet mechanisms surrounding bracing efficacy remain in question. Ankle bracing has been shown to invoke biomechanical and neuromotor alterations that could influence lower-extremity coordination strategies during locomotion and contribute to bracing efficacy.

OBJECTIVE

The purpose of this study was to investigate the effects of ankle bracing on lower-extremity coordination and coordination dynamics during walking in healthy individuals, ankle sprain copers, and individuals with chronic ankle instability.

DESIGN

Mixed factorial design.

SETTING

Laboratory setting.

PARTICIPANTS

Forty-eight recreationally active individuals (16 per group) participated in this cross-sectional study.

INTERVENTION

Participants completed 15 trials of over ground walking with and without an ankle brace.

MAIN OUTCOME MEASURES

Coordination and coordination variability of the foot-shank, shank-thigh, and foot-thigh were assessed during stance and swing phases of the gait cycle through analysis of segment relative phase and relative phase deviation, respectively.

RESULTS

Bracing elicited more synchronous, or locked, motion of the sagittal plane foot-shank coupling throughout swing phase and early stance phase, and more asynchronous motion of remaining foot-shank and foot-thigh couplings during early swing phase. Bracing also diminished coordination variability of foot-shank, foot-thigh, and shank-thigh couplings during swing phase of the gait cycle, indicating greater pattern stability. No group differences were observed.

CONCLUSIONS

Greater stability of lower-extremity coordination patterns as well as spatiotemporal locking of the foot-shank coupling during terminal swing may work to guard against malalignment at foot contact and contribute to the efficacy of ankle bracing. Ankle bracing may also act antagonistically to interventions fostering functional variability.

Age-Related Differences in the Relationships Between Lower-Limb Joint Proprioception and Postural Balance

OBJECTIVE

In the present study we aimed to investigate the relationships between lower-limb joint proprioception and postural balance. Age-related differences in such relationships were also identified.

BACKGROUND

Impaired postural balance is reportedly one of the most common risk factors for fall accidents. Interventions have been proposed to improve postural balance by enhancing proprioceptive feedback. However, there is still no consensus on the optimal design for these interventions; therefore, there is a need to better reveal the contributions of lower-limb joint proprioception to postural balance.

METHOD

Twenty-eight young and 28 older adults participated. Lower-limb joint proprioception was assessed by joint position sense errors measured at the ankle, knee, and hip of the dominant side, respectively. Postural balance was assessed by using center-of-pressure measures during bilateral static stance.

RESULTS

Ankle joint position sense error was positively correlated with root mean squared distance of the center of pressure in the anterior-posterior and medial-lateral directions in both young and older adults. Different from young adults, hip joint position sense error was positively correlated with root mean squared distance of the center of pressure in the anterior-posterior and medial-lateral directions in older adults only.

CONCLUSION

Declined ankle and hip proprioception could be risk factors for falls in older adults. Age-related differences in the effects of hip proprioception suggests that hip proprioception is more important for maintaining balance in older adults. Ankle proprioception contributes the most to balance maintenance. Thus, ankle proprioception enhancement exercises should be considered in fall prevention interventions.

Kinesiology taping does not alter shoulder strength, shoulder proprioception, or scapular kinematics in healthy, physically active subjects and subjects with Subacromial Impingement Syndrome

OBJECTIVE

To examine the effect of kinesiology tape (KT) on shoulder strength, proprioception, and scapular kinematics in healthy and Subacromial Impingement Syndrome (SAIS) subjects.

DESIGN

Placebo-controlled quasi-experimental study.

SETTING

Research laboratory.

PARTICIPANTS

A total of 30 physically active subjects participated. Ten healthy subjects with no previous history of shoulder pathology received KT on the dominant shoulder. Twenty subjects with shoulder pain for a minimum of two weeks and presenting with clinical signs of impingement were allotted to receive KT (n = 10) or placebo taping (PT, n = 10) on the involved shoulder.

MAIN OUTCOME MEASURES

All participants were tested pre- and post-application. Shoulder internal/external rotation (IR/ER) strength was assessed with isokinetic dynamometry (average peak torque/body weight). Shoulder IR/ER proprioception was assessed through threshold to detect passive motion (mean absolute error in degrees). Scapular position at 90° and 120° of shoulder abduction during arm raising/lowering were assessed using a 3D motion analysis system.

RESULTS

No significant within group or between group differences were demonstrated for any measure.

CONCLUSIONS

Taping does not appear to aid/impair shoulder strength, shoulder proprioception, or scapular kinematics. Future research should explore if the effects of KT are time-dependent and similar in other pathologies.

PERONEUS LONGUS ACTIVITY IN DIFFERENT TYPES OF TAPING: ATHLETES WITH ANKLE INSTABILITY

ABSTRACT Introduction: Participation in sport among university athletes in Malaysia has progressed right up to Olympic level. However, some of these athletes are prevented from competing due to injuries. Ankle injuries, in particular, are among the common types of injury. Even so, there is still lack of local data and research describing the incidence of ankle injuries. Objectives: To determine peroneus longus muscle activity in different taped ankles and positions among subjects with functional ankle instability (FAI). Methods: Twenty-three subjects with ankle instability (AJFAT score > 26) volunteered to take part in the study. The subjects were tested under three conditions; 1) no tape (NT), 2) Kinesio(r) tape (KT), and 3) rigid tape (RT). The subjects completed two postural stability tests, followed by a sudden inversion perturbation test with EMG, recording throughout the procedures. The EMG data were analyzed, filtered, full-wave rectified and normalized. The data were analyzed by analysis of variance (Independent T-test and ANOVA) to evaluate differences in peak muscle activation (mV) and peroneal latency (ms). Results: Peak muscle activation of the peroneus was activated more in the RT group during both the Static and Dynamic Stability Tests. Apart from that, there were no statistically significant differences. During sudden inversion perturbation, the RT group was the one that was most activated (p=0.001). Peroneal latency was even delayed in KT and RT during the three tests, and shorter in the NT group. There were significant differences during the Dynamic Stability Test, between the NT and KT groups (p=0.001) and between the NT, RT and KT groups (p=0.001). Conclusion: RT tape may enhance the peroneus longus response by maintaining a higher level of muscle activation, especially during dynamic movements and sudden inversion of the ankle, and may selectively benefit individuals with FAI. The KT ankle did not show superior effect to the NT ankle, and demonstrated minimal benefit when used in FAI. Also, its use may be more likely to cause reinjury to the ankle.

Extended use of Kinesiology Tape and Balance in Participants with Chronic Ankle Instability

CONTEXT

Participants with chronic ankle instability (CAI) have been shown to have balance deficits related to decreased proprioception and neuromuscular control. Kinesiology tape (KT) has been proposed to have many benefits, including increased proprioception.

OBJECTIVE

To determine if KT can help with balance deficits associated with CAI.

DESIGN

Cohort study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty participants with CAI were recruited for this study.

INTERVENTION(S)

Balance was assessed using the Balance Error Scoring System (BESS). Participants were pretested and then randomly assigned to either the control or KT group. The participants in the KT group had 4 strips applied to the foot and lower leg and were instructed to leave the tape on until they returned for testing. All participants returned 48 hours later for another BESS assessment. The tape was then removed, and all participants returned 72 hours later to complete the final BESS assessment.

MAIN OUTCOME MEASURE(S)

Total BESS errors.

RESULTS

Differences between the groups occurred at 48 hours post-application of the tape (mean difference = 4.7 ± 1.4 errors, P < .01; 95% confidence interval = 2.0, 7.5) and at 72 hours post-removal of the tape (mean difference = 2.3 ± 1.1 errors, P = .04; 95% confidence interval = 0.1, 4.6).

CONCLUSIONS

The KT improved balance after it had been applied for 48 hours when compared with the pretest and with the control group. One of the most clinically important findings is that balance improvements were retained even after the tape had been removed for 72 hours.

Effect of ankle kinesio taping on vertical jump with run-up and countermovement jump in athletes with ankle functional instability

[Purpose] Limited research has been performed in spite of biomechanical evaluation of jump landing with kinesio taping. Therefore, the main objective of this study was to evaluate the effect of kinesio taping applied to athletes. In this study, the authors wished to investigate the effect of kinesio taping during a vertical jump with run-up and countermovement jump on ankle functional instability. [Subjects and Methods] Ten male athletes with ankle functional instability (FI) were recruited in this study from a college volleyball team. Each participant was requested to perform two tasks, the countermovement jump and vertical jump with run-up. Infrared high-speed cameras and force plates were used to assess the effect of ankle taping. [Results] The results showed that the peak ground reaction force in the sagittal plane during a vertical jump with run-up slowed down after kinesio taping and that the peak ankle plantar flexion moment in both types of jump also decreased. [Conclusion] In conclusion, this study proved the effect of kinesio taping on ankle functional instability, which was evaluated by measuring the vertical ground reaction force and peak plantar flexion moment. Its finding may allow us to provide some recommendations for athletes and trainers.

The effect of kinesio tape on force sense in people with functional ankle instability

OBJECTIVE

To evaluate the effect of kinesio tape (KT) on proprioception of the ankle.

DESIGN

Case-control study.

SETTING

Controlled laboratory.

PARTICIPANTS

Twenty-eight subjects participated in this study: 14 subjects were in the control group (no history of ankle injuries) and 14 subjects were in the functional ankle instability (FAI) group (history of ankle injuries and a recent history of giving way).

INTERVENTIONS

Subjects in the FAI group received lateral ankle sprain KT application, whereas those in the control group received no tape application.

MAIN OUTCOME MEASURES

Proprioception was measured using eversion force sense. This task was performed at 30% of the eversion maximum voluntary isometric contraction. Force sense was tested at baseline, immediately after KT application, and 72 hours after KT application.

RESULTS

Results revealed a significant time by group interaction (P = 0.03). At baseline and immediately after KT, subjects in the FAI group had significantly more force sense errors than those in the control group. However, after wearing the tape for 72 hours, no significant differences were identified between the groups.

CONCLUSIONS

We found that after wearing KT for an extended amount of time, proprioceptive deficits were improved. After the tape application, the improvements resulted in similar conscious proprioceptive awareness in both the subjects with and without ankle instability.

The effects of transcutaneous electrical nerve stimulation on joint position sense in patients with knee joint osteoarthritis

OBJECTIVE

To study the effects of transcutaneous electrical nerve stimulation (TENS) on joint position sense (JPS) in knee osteoarthritis (OA) subjects.

METHODS

Thirty subjects with knee OA (40-60 years old) using non-random sampling participated in this study. In order to evaluate the absolute error of repositioning of the knee joint, Qualysis Track Manager system was used and sensory electrical stimulation was applied through the TENS device.

RESULTS

The mean errors in repositioning of the joint, in two position of the knee joint with 20 and 60 degree angle, after applying the TENS was significantly decreased (p < 0.05).

CONCLUSION

Application of TENS in subjects with knee OA could improve JPS in these subjects.

Relationship between mechanical ankle joint laxity and subjective function

BACKGROUND

An increase in ankle joint laxity has been reported in patients with chronic ankle instability (CAI). However, it is not known if this increase in joint laxity is responsible for the subjective level of functional deficits also reported in these patients.

METHODS

One hundred twenty subjects with unilateral CAI (55 males, 65 females; age, 20.6 ± 1.5 years; mass, 74.5 ± 13.6 kg; height, 174.2 ± 9.7 cm) participated in the study. Mechanical joint stability was measured with an instrumented ankle arthrometer. The arthrometer measured ankle joint motion for anterior/posterior translation and inversion/eversion angular displacement. Subjective level of function was assessed with the foot and ankle disability index (FADI) and foot and ankle disability index sport (FADIS). Bivariate correlations using Pearson Product Moments were made between all dependent variables taken on the unstable ankles.

RESULTS

The strongest relationship was between anterior laxity and the FADIS (r = -0.88, p < 0.0001). As scores on the FADIS decreased, anterior laxity increased. Similar significant results were reported for anterior laxity and the FADI (r = -0.65, p = 0.013), as well as inversion laxity and the FADI (r = -0.53, p = 0.017) and FADIS (r = -0.45, p = 0.013).

CONCLUSION

These data demonstrate that there appears to be a relationship between anterior and inversion ankle laxity and subjective function in those with CAI. Although numerous insufficiencies develop after an ankle sprain, increased laxity may cause some of the subjective functional deficits reported in those with CAI.

CLINICAL RELEVANCE

Strategies to prevent increased laxity following ankle sprain may improve the patient's subjective level of function.

The influence of Kinesio Taping on the effects of physiotherapy in patients after laparoscopic cholecystectomy

Physiotherapy in patients after laparoscopic cholecystectomy (CHL) is impeded by postoperative pain which causes a decline in patients' activity, reduces respiratory muscles' function, and affects patients' ability to look after themselves. The objective of this work was to assess the influence of Kinesio Taping (KT) on pain level and the increase in effort tolerance in patients after CHL. The research included 63 patients after CHL. Test group and control group included randomly selected volunteers. Control group consisted of 32 patients (26 females, 6 males), test group consisted of 31 patients (22 females, 9 males). Both groups were subjected to complex physiotherapy, and control group had additional KT applications. Before surgery, during and after physiotherapy, patients were given the following tests: 100-meter walk tests, subjective pain perception assessment, and pain relief medicines intake level assessment. The level of statistical significance for all tests was established at P < 0.05. Statistical analysis showed a significant decrease in the time required to cover a 100-meter distance and a decrease in pain perception presented by significantly lower painkillers' intake in the test group in comparison with the control group. The improvement in clinical condition observed in the research indicates the efficiency of KT as a method complementing physiotherapy in patients after laparoscopic cholecystectomy.

Effect of Tanner stage on proprioception accuracy

The aim of this study was to compare the proprioceptive accuracy in the dominant and nondominant lower extremities between early and late stages of adolescence in boys. Participants displaying sexual development consistent with Tanner stages I or II were included in the early adolescent group, and those displaying development consistent with Tanner Stages IV or V were included in the late adolescent group. Proprioception was evaluated using the following 4 tests: one-leg-standing test, a single-limb-hopping test, an active angle-reproduction test, and a passive angle-reproduction test. There were statistically significant differences between the early and late stages of adolescence in nondominant ankles with regard to this single-limb-standing test. There were no statistically significant differences between the early and late adolescent stages, and between dominant and nondominant extremities with regard to the single-limb-hopping test. There were no statistically significant differences between early and late adolescent stages with regard to passive and active ankle plantar- and dorsiflexion position reproduction. Based on these findings, we concluded that sexual maturation categorized by Tanner stage does not affect proprioceptive ability in adolescent individuals.

CLINICAL RELEVANCE

This method, as a clinical assessment of detecting deficits in neuromuscular control examined by foot and ankle surgeons and a rehabilitation technique to treat functional instability of the ankle used by physical therapists, might be applied to adolescents. Therefore, clinicians may obtain reliable information from the functional test battery during the assessment of ankle joint performance in adolescents.

Effects of vision and tactile stimulation of the neck on postural control during unperturbed stance and cervical joint position sense in young asymptomatic adults

STUDY DESIGN

Before and after intervention trials.

OBJECTIVE

To evaluate the effects of visual input and tactile stimulation of the neck on postural control during unperturbed stance and cervical joint position sense.

SUMMARY OF BACKGROUND DATA

Although beneficial effects on lower-limb joints proprioception have been reported when vision was available and when tactile stimulation was applied around lower-limb joints, there has hitherto been no study investigating whether and how vision and tactile stimulation applied to the neck could modify postural control during unperturbed stance and joint position sense.

METHODS

The effects of visual input and tactile stimulation of the neck on postural control during unperturbed stance (Experiments 1 and 2) and cervical joint position sense (Experiments 3 and 4) were assessed in four separate experiments. During these experiments, two experimental tasks (a postural task during unperturbed stance and the CRT to NHP) were executed without (No vision) and with the availability of the vision (Vision) and without (No tactile stimulation condition) and with the application of strips of adhesive bandage to the skin over and around the neck (Tactile stimulation condition). Twelve different subjects participated in the four experiments.

RESULTS

For experiments 1 and 2, decreased centre of foot pressure displacements were observed in the Vision relative to the No vision and in the Tactile stimulation relative to the No tactile stimulation condition. For experiments 3 and 4, more accurate and more consistent repositioning performances were observed in the Vision relative to the No vision and in the Tactile stimulation relative to the No tactile stimulation condition, as indicated by decreased absolute and variable errors, respectively.

CONCLUSION

Altogether, our results suggest that subjects were able to take advantage of vision and increased neck cutaneous information provided by the by strips of adhesive bandage applied to the neck to improve postural control during unperturbed stance and cervical joint position sense.

Análise da influência da bandagem funcional de tornozelo no tempo de reação do fibular longo em sujeitos saudáveis

OBJETIVOS: O objetivo deste estudo foi analisar a influência da bandagem funcional de tornozelo no tempo de reação do fibular longo de indivíduos sadios. MÉTODOS: A amostra foi composta por oito indivíduos do gênero masculino, fisicamente ativos, sem histórias prévias de lesões de tornozelo e, com os resultados negativos aos testes de instabilidade articular de tornozelo. Foram usados como instrumentos da pesquisa, a bandagem funcional de tornozelo tipo bota fechada, para realizar o teste uma plataforma capaz de inclinar 30o no plano frontal simulando a entorse lateral do tornozelo e um eletromiógrafo de oito canais (Bortec Electronics Incorporation, Canadá) para aquisições dos sinais eletromiográficos. Os sinais EMG foram coletados juntamente com o sinal da plataforma (sincronismo). A coleta dos dados foi realizada em dois momentos, primeiramente sem a bandagem e logo após com a bandagem. RESULTADOS: Os indivíduos tinham idade média de 23,3 anos (± 2,8), massa corpórea de 74,4kg (± 9,4), estatura de 1,7m (± 0,4) e IMC de 23,7kg/m2 (± 2,4). O estudo encontrou diferença estatisticamente significativa p = 0,018 na situação da bandagem funcional de tornozelo com diminuição do tempo de reação do fibular longo. CONCLUSÃO: Acreditamos que esta melhora se deva ao íntimo contato da bandagem com os receptores cutâneos do tornozelo, aumentando a ativação do reflexo fibular, com consequente ganho proprioceptivo e, assim, aumentando a habilidade dos sujeitos em responder a situações súbitas de entorses. O estudo demonstrou diminuição no tempo de reação do fibular longo de indivíduos sadios com o uso da bandagem funcional de tornozelo quando submetidos à inclinação lateral súbita do tornozelo.

Effect of ankle taping on mechanical laxity in chronic ankle instability

BACKGROUND

The high percentage of re-injury after an initial ankle sprain necessitates examination of preventative methods. The purpose of this project was to investigate the effect ankle tape has on mechanical laxity in subjects with CAI.

MATERIALS AND METHODS

Twenty subjects with unilateral CAI (seven males and 13 females; age, 20.6 +/- 1.8 years; mass, 69.9 +/- 13.7 kg; height, 172.3 +/- 9.3 cm) and 20 healthy subjects (seven males and 13 females; age, 21.9 +/- 4.3 years; mass, 72.0 +/- 14.6 kg; height, 171.1 +/- 6.7 cm) participated in the study. Both ankles of each subject were tested under two conditions: 1) before the application of tape; and 2) immediately after 30 minutes of exercise with the ankle taped. Mechanical laxity was measured with an instrumented ankle arthrometer. Two (group) x two (time) repeated measures ANOVA analysis was used for analysis.

RESULTS

There were significant group by time interactions (p = 0.014) for anterior displacement with significantly increased anterior displacement in the involved ankle of the CAI group relative to the matched control limb both before and after tape application. Similarly, there were significant time main effects for posterior displacement (p = 0.004), inversion (p = 0.001) and eversion (p = 0.043) rotation. Specifically, tape application decreased posterior displacement, inversion and eversion rotation only in the CAI group. Additionally, a significant group main effect for inversion rotation (p = 0.001) was also noted. Followup testing indicated significantly greater inversion rotation for the CAI ankle compared to the matched healthy ankle before tape application.

CONCLUSION

Mechanical laxity significantly decreased in CAI subjects after tape application. Although there was still a significant difference in mechanical laxity between the involved ankle vs. the uninvolved ankle of the CAI group, as well as the matched healthy group, laxity decreased in the CAI ankle after the application of tape.

CLINICAL RELEVANCE

Ankle taping may be able to improve mechanical instability in those with CAI.

The influence of ankle support on postural control

Postural control assessments are commonly administered to athletes as part of a pre-season screening. Establishing a baseline level of function permits the clinician to compare post-injury results to normal functioning during the return to play decision-making process. In the athletic setting, follow-up tests may be completed on the sideline immediately following injury. We sought to examine the effect of commonly administered external ankle joint support on postural control using the balance error scoring system (BESS) and the NeuroCom sensory organization test (SOT). Nineteen volunteers free from balance issues completed three sessions with varied ankle support: bilateral prophylactic ankle taping, laced bracing device, or barefoot. Each session included an initial balance assessment on the BESS and SOT, a 20 min treadmill walk, and post-walk balance test. Fewer errors, indicating improved balance, were committed on the BESS during the barefoot condition than the braced ankle condition (p=0.044) at the pre-walk assessment. During the post-walk assessment, fewer errors were committed during the barefoot condition compared to the braced ankle condition (p=0.034) and the taped ankle condition (p=0.037). All ankle support conditions showed similar improvements in balance between the pre and post-walk assessments on the BESS (p<0.001) and SOT composite balance score (p=0.009). These findings indicate that ankle support devices may influence postural control on the BESS, but not on the NeuroCom SOT. Clinicians using the BESS as a balance assessment device at multiple time points should be consistent in the application of ankle support devices.

Effect of inversion and ankle bracing on peroneus longus Hoffmann reflex

This study examined peroneus longus (PL) Hoffmann reflex (H-reflex) during sudden inversion perturbation of the ankle/foot complex under an ankle brace and non-brace condition. Ten healthy subjects volunteered. H-reflexes were tested on the up-sloping portion of the recruitment curve, utilizing a control trial M-wave above motor threshold to maintain consistency between subjects and conditions. The PL H/maximum M-wave (M(max)) ratio was established using the PL H-reflex and PL M(max) peak-to-peak measures. The mean ratio across five trials for each subject under each ankle brace (brace, no brace) and surface (flat, inversion) conditions was utilized for analysis. The 1 x 4 repeated measures ANOVA revealed a significant main effect for treatment condition (P<0.0001). The PL H/M(max) ratio significantly increased during sudden inversion-no ankle brace condition compared with the flat surface no-ankle brace condition (P=0.04). Application of an ankle brace had no effect on PL H/M(max) ratio during inversion (P=0.78). During this study PL H/M(max) ratios increased during an inversion perturbation in healthy ankles. This is believed to occur due to heightened sensorimotor demand placed on the nervous system during this motion. Moreover, application of an ankle brace during inversion does not appear to affect PL H/M(max) ratio.

The placebo effect of ankle taping in ankle instability

PURPOSE

Recurrence of ankle sprains is common among athletes. Although ankle taping reduces the risk of injury, the mechanism underlying its effectiveness remains unclear. Anecdotal reports suggest a role of the belief among athletes that taping will protect them from injury. That is, taping may have a placebo effect. The purpose of the present study was to determine whether there was a placebo effect with ankle taping in individuals with ankle instability.

METHODS

Thirty participants with ankle instability completed a hopping test and a modified star excursion balance test under three conditions: (i) real tape, (ii) placebo tape, and (iii) control (no tape). Participants were blinded to the purpose of the study and were informed that the study aimed to compare two methods of ankle taping referred to as mechanical (real) and proprioceptive (placebo). The order of testing the three conditions and the two functional tests was randomized.

RESULTS

There was no significant difference in performance among the three conditions for the hopping test (P = 0.865) or the modified star excursion balance test (P = 0.491). However, a secondary exploratory analysis revealed that participants' perceptions of stability, confidence, and reassurance increased with both real and placebo ankle taping when performing the functional tasks.

CONCLUSION

The role of the placebo effect of ankle taping in individuals with ankle instability remains unclear. Clinicians should, therefore, continue to use ankle-taping techniques of known efficacy. They should, however, focus on maximizing patients' beliefs in the efficacy of ankle taping, because its application reassured participants and improved their perceived stability and confidence. The effect of ankle taping on participants' perceptions may contribute to its effectiveness in preventing injury.

Lumbar extensor fatigue and circumferential ankle pressure impair ankle joint motion sense

Fatigue of the lumbar extensor muscles has been associated with a degradation of balance, but the mechanism is not well understood. The ankle plays a major role in upright standing, and loss of proprioceptive acuity at the ankle could contribute to a degradation of balance. Therefore, the first objective of this study was to investigate the effect of lumbar extensor fatigue on ankle proprioceptive acuity. The second objective was to investigate the effect of circumferential ankle pressure (CAP) on ankle proprioceptive acuity to evaluate CAP as a potential intervention to mitigate any loss of proprioceptive acuity at the ankle with lumbar extensor fatigue. To address these objectives, ankle joint motion sense was evaluated with and without CAP, both before and after the lumbar extensors were fatigued. Results showed an impairment in joint motion sense with both fatigue and CAP. These results indicate that lumbar extensor fatigue impairs ankle proprioceptive acuity, which may help explain observed increases in postural sway subsequent to lumbar extensor fatigue.

Efficacy of Isokinetic Exercise on Joint Position Sense and Muscle Strength in Patellofemoral Pain Syndrome

OBJECTIVE

The objective of this study was to demonstrate the impairment of knee joint position sense in individuals with patellofemoral pain syndrome and investigate the effects of isokinetic exercise on knee joint position sense and muscle strength.

DESIGN

A total of 24 male patients complaining of anterior knee pain caused by overexertion and 24 male healthy individuals without symptoms were included for this investigation. Isokinetic exercise protocol was carried out at angular velocities of 60 degrees/sec and 180 degrees/sec. These sessions were repeated three times per week and lasted for 6 wks. At the beginning and after 6 wks of knee passive joint position sense, quadriceps and hamstring muscle strength and pain assessments were performed.

RESULTS

After the isokinetic exercise, flexion peak torque (P < 0.05), extension peak torque (P < 0.01), flexion total work (P < 0.001), extension total work (P < 0.001), passive reproduction of knee joint position sense for 40 degrees of flexion (P < 0.05) and 50 degrees of extension (P < 0.01), and pain score (P < 0.001) improved significantly in the patellofemoral pain syndrome group.

CONCLUSION

Isokinetic exercises have positive effects on passive position sense of knee joints, increasing the muscular strength and work capacity. These findings show that using the present isokinetic exercise in rehabilitation protocols of patients with patellofemoral pain syndrome not only improves the knee joint stabilization but also the proprioceptive acuity.

Effects of the subtalar sling ankle taping technique on combined talocrural-subtalar joint motions

BACKGROUND

The findings of research on the effectiveness of ankle taping for protection against ligament injury have been inconsistent, and the topic remains controversial. The precise orientation of the force vectors created by tension within the various tape strip components of an ankle taping procedure may be a critical factor influencing the degree of motion restraint that is provided. We hypothesized that the addition of the subtalar sling component to the widely recognized standard (Gibney) ankle taping procedure would enhance restraint of ankle motion. This was a controlled laboratory study, with fully repeated measures (subjects served as their own controls).

METHODS

An ankle arthrometer was used to quantify anteroposterior (AP) translation and frontal plane inversion-eversion (I-E) tilt of the talocrural-subtalar joints under untaped and taped conditions in normal subjects. A 15-minute exercise session was conducted to loosen the tape before measurement of its effect on motion restraint.

RESULTS

The ankle taping procedure that incorporated the subtalar sling provided significantly greater restriction of postexercise AP translation (p < 0.001, eta(2) = 0.63) and postexercise I-E tilt (p < 0.001, eta(2) = 0.66).

CONCLUSIONS

The subtalar sling ankle taping procedure provides greater restriction of motions associated with ankle instability than the more widely used Gibney procedure.

Effects of circumferential ankle pressure on ankle proprioception, stiffness, and postural stability: a preliminary investigation

STUDY DESIGN

Cross-sectional repeated-measures design.

OBJECTIVE

Determine the effects of circumferential ankle pressure (CAP) intervention on proprioceptive acuity, ankle stiffness, and postural stability.

BACKGROUND

The application of CAP using braces, taping, and adaptive shoes or military boots is widely used to address chronic ankle instability (CAI). An underlying assumption is that the CAP intervention might improve ankle stability through increased proprioceptive acuity and stiffness in the ankle. METHOD AND MEASURES: A convenience sample of 10 subjects was recruited from the local university community and categorized according to proprioceptive acuity (high, low) and ankle stability (normal, CAI). Proprioceptive acuity was measured when blindfolded subjects were asked to accurately reproduce a self-selected target ankle position before and after the application of CAP. Proprioceptive acuity was determined in 5 different ankle joint position sense tests: neutral, inversion, eversion, plantar flexion, and dorsiflexion. Joint position angles were recorded electromechanically using a potentiometer. Passive ankle stiffness was computed from the ratio of applied static moment versus angular displacement. Active ankle stiffness was determined from biomechanical analyses of ankle motion following a mediolateral perturbation. Postural stability was quantified from the center of pressure displacement in the mediolateral and the anteroposterior directions in unipedal stance. All measurements were recorded with and without CAP applied by a pediatric blood pressure cuff. Data were analyzed using a separate mixed-model analysis of variance (ANOVA) for each dependent variable. Post hoc comparison using Tukey's honestly significant difference (HSD) test was performed if significant interactions were obtained. Significance level was set at P<.05 for all analyses.

RESULTS

Significant group (high versus low proprioceptive acuity) x CAP interactions were identified for postural stability. Passive ankle stiffness was not increased by an application of CAP. Active ankle stiffness was significantly different between the high and low proprioceptive acuity groups and was not affected by an application of CAP. Significant group (normal versus CAI) x CAP interactions were observed for mediolateral center-of-pressure displacement with a main effect of group on neutral joint position sense.

CONCLUSIONS

Application of CAP increased proprioceptive acuity and demonstrated trends toward increased active stiffness in the ankle, hence improved postural stability. The effects tend to be limited to individuals with low proprioceptive acuity.

Spinal position sense in ankylosing spondylitis

STUDY DESIGN

A cross-sectional comparison of spinal position sense in 50 patients with mild ankylosing spondylitis and 50 healthy controls.

OBJECTIVES

To determine if spinal position sense is impaired in patients with mild ankylosing spondylitis.

SUMMARY OF BACKGROUND DATA

Pathologic processes in ankylosing spondylitis target sites in the spine where joint capsules, ligaments, and tendons attach into bone. Because these sites contain receptors conveying position sense, proprioception may become impaired, and this may contribute to the spinal deformity that often develops in the more advanced stages of the disease. If deficits in proprioception are apparent then specialized exercise regimes aimed at improving proprioception in ankylosing spondylitis patients could prove beneficial.

METHODS

Position sense was assessed in patients and controls by determining the absolute error in reproducing upright and flexed postures in the coronal and sagittal planes using an electromagnetic tracking device, the 3-Space Fastrak (Polhemus, Colchester, VT). Measurements were taken from sensors placed on the skin overlying T1, T7, L1, and S2. In patients, the association between position sense and validated radiographic, disease activity, and functional scores was explored.

RESULTS

No deficits in spinal position sense were found in patients with mild ankylosing spondylitis. In these subjects, repositioning errors were < or = 3.88 degrees in flexed postures and < or = 2.76 in upright postures. Corresponding results for controls were < or = 4.86 degrees and < or = 3.42 degrees, respectively. Weak correlations were found between position sense and other ankylosing spondylitis outcome measures, which included indexes of function, disease activity, and posture and mobility, but in all cases, the overall trend was for position sense acuity to improve slightly with more advanced disease.

CONCLUSION

Spinal position sense is unaffected in patients with mild ankylosing spondylitis and is therefore unlikely to be a useful outcome measure in this condition.

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.

Effects of Extensive Training on Female Teenage Gymnasts’ Active and Passive Ankle-Joint Position Sense

Objective:

To compare the ankle-joint position-sense patterns of gymnasts and nongymnasts.

Design:

Proprioceptive ability was evaluated with active and passive angle-reproduction tests.

Participants:

40 subjects assigned to 2 groups: group 1 (n = 20), healthy subjects, and group 2 (n = 20), teenage female gymnasts.

Measurements:

Joint-position sense was actively measured with a Cybex NORM™ isokinetic dynamometer and passively with a proprioception-testing device.

Results:

A Mann-Whitney U test was used to compare the mean values of the gymnasts’ and controls’ ankles. Results revealed statistically significant differences (P < .05) between the 2 groups. No statistically significant difference between the dominant and nondominant ankles in the 2 groups was observed.

Conclusions:

The results suggest that extensive training might affect ankle-joint position sense, but genetics and natural selection could be the reason. It is thought that athletes are able to develop enhanced neurosensory pathways as a result of long-term training.

Proprioception of the ankle: a comparison between female teenaged gymnasts and controls

Proprioceptive mechanisms appear to play a role in stabilizing the joints and may serve as a means for interplay between static stabilizers and dynamic muscular restraints. The purpose of our study was to investigate whether or not gymnastic training has any effect on the balance and on proprioception in an ankle, as seen in gymnasts and in nongymnasts. We evaluated the proprioceptive ability of the ankle using four different tests (a one-leg-standing test, a single-limb-hopping test, an active angle-reproduction test, and a passive angle-reproduction test). Proprioception of the ankle was measured in 40 subjects who were assigned to two experimental groups. Group 1 (n: 20) were healthy control subjects, and group 2 (n: 20) were teenaged female gymnasts. The sense of position of a joint was actively measured using a Cybex NORMTM isokinetic dynamometer and measured passively with a proprioception-testing device. A Mann-Whitney U test was used to compare mean values of the gymnasts to the controls. Results revealed statistically significant differences (p<0.05) between two groups. We found no statistically significant differences between the dominant and nondominant ankle in volunteers or in gymnasts, in all tests. The results of this study suggest that gymnastic training has a positive influence on sense of position of the ankle joint and on balance, in addition to increasing muscle tone.

Control of acceleration during sudden ankle supination in people with unstable ankles

STUDY DESIGN

Comparative study of differences in functional control during ankle supination in the standing position in matched stable and unstable ankles (ex post facto design).

OBJECTIVES

To document acceleration and deceleration during ankle supination in the standing position and to determine differences in control of supination perturbation between stable and unstable ankles.

BACKGROUND

Repetitive ankle sprain can be explained by mechanical instability only in a minority of cases. Exercise therapy for ankle instability is based on clinical experience. Joint stability has not yet been measured in dynamic situations that are similar to the situations leading to a traumatic sprain. The process of motor control during accelerating ankle supination has not been adequately addressed in the literature.

METHODS AND MEASURES

Patients with complaints of ankle instability (16 unstable ankles) and nonimpaired controls (18 stable ankles) were examined (N = 17 subjects, 10 women and 7 men). The average age was 23.7 +/- 5.0 years (range, 20-41 y). Control of supination speed was studied during 50 degrees of ankle supination in the standing position using accelerometry (total supination time and deceleration times) and electromyography (latency time). Timing of motor response was estimated by measuring electromechanical delay.

RESULTS

The presence of an early, sudden, and presumably passive slowdown of ankle supination in the standing position was observed. Peroneal muscle motor response was detected before the end of the supination. Unstable ankles showed significantly shorter total supination time (109.3 ms versus 124.1 ms) and significantly longer latency time (58.9 ms versus 47.7 ms).

CONCLUSIONS

Functional control in unstable ankles is less efficient in decelerating the ankle during the supination test procedures used in our study. Our conclusions are based on significantly faster total supination and significantly slower electromyogram response in unstable ankles. The results support the hypothesis that both decelerating the total supination movement during balance disturbance and enhancing the speed of evertor activation through exercise can be specific therapy goals.

Effects of shoe sole thickness on joint position sense

The objective of this study was to determine the effects of shoe sole thickness on joint position sense in the sagittal and frontal plane by determining the estimate angle error. Joint position sense was measured by manipulating angle and direction of a slope surface board (30 cm x 30 cm x 1.5 cm) to perform the movements of dorsiflexion, plantar flexion, inversion and eversion. Sandwiching wooden wedges with pre-determined angles between 0 and 25 degrees between the slope surface boards made the slope surface angles. Twenty healthy college male students were asked to estimate the angle and direction of movements under each of the shod conditions while standing on the slope surface board. Estimate angle error was calculated for each movement under all shod conditions. For all shod conditions, estimate angle error was the greatest for plantar flexion and inversion compared to dorsiflexion and eversion. Independent of shod condition, subjects had the most difficulty estimating plantar flexion and inversion movements.

The Effects of External Bracing on Joint Position Sense Awareness for the Chronically Unstable Ankle

Context:

The effect of externally bracing chronically unstable ankles on joint position sense awareness has had limited study yet is clinically relevant.

Objective:

To determine active joint position sense awareness, effects of bracing, and differences between flexible and semirigid braces.

Design:

Between-ankle-group (chronic and healthy), repeated-measures, including brace condition for the joint position of 15° inversion from subtalar neutral.Setting:Research laboratory.

Participants:

24 subjects with healthy and 12 with chronically unstable ankles.

Main Outcome Measures:

Blindfolded subjects attempted to find a passively placedjoint position under conditions of unbraced, flexible, and semirigid braced. A 3-way repeated-measures ANOVA and post hoc Tukey test for significant interaction effects were conducted.

Results:

Significant main effects were observed for ankle status, brace, and gender, but no significant interaction effects.

Conclusion:

Chronically unstable ankles have greater error in joint position sense awareness. However, this deficit might be reduced by using an external semirigid brace.

The influence of foot positioning on ankle sprains

The goal of this study was to examine the influence of changes in foot positioning at touch-down on ankle sprain occurrence. Muscle model driven computer simulations of 10 subjects performing the landing phase of a side-shuffle movement were performed. The relative subtalar joint and talocural joint angles at touchdown were varied, and each subject-specific simulation was exposed to a set of perturbed floor conditions. The touchdown subtalar joint angle was not found to have a considerable influence on sprain occurrence, while increased touchdown plantar flexion caused increased ankle sprain occurrences. Increased touchdown plantar flexion may be the mechanism which causes ankles with a history of ankle sprains to have an increased susceptibility to subsequent sprains. This finding may also reveal a mechanism by which taping of a sprained ankle or the application of an ankle brace leads to decreased ankle sprain susceptibility.

The effects of ankle compliance and flexibility on ankle sprains

PURPOSE

The goal of this study was to examine the influence of changes in subtalar joint flexibility and compliance on ankle sprain occurrence.

METHODS

Muscle model driven simulations of 10 subjects performing the landing phase of a side-shuffle movement were performed. The passive flexibility or compliance of the subtalar joint was varied, and each subject-specific simulation was exposed to a set of perturbed floor conditions.

RESULTS

Increases in flexibility and compliance both led to an increase in the occurrence of excessive supination, while changes in flexibility had a greater influence. Changes in flexibility or compliance caused only small changes in the occurrence of excessive supination torques.

CONCLUSION

These results suggest that increased mechanical laxity does not directly cause an increase in sprain occurrence during side-shuffle movements.

Spinal position sense is independent of the magnitude of movement

STUDY DESIGN

Position sense in the spine was recorded at T1, T7, L1, and S2 in three incremental angular ranges of flexion and on return to upright standing from these movements.

OBJECTIVES

To determine the effect of angular range of movement on position sense. The main purpose was to establish a protocol for whole spine assessment of position sense in healthy and pathologic spines.

SUMMARY OF BACKGROUND DATA

Position sense is one dimension of proprioception, classically assessed by the ability to reproduce preselected target positions. This approach was used in the current study to determine whether spinal position sense is affected by the magnitude of movement traversed in repositioning tasks.

METHODS

Spinal position sense was assessed in 20 healthy subjects during repeated flexion movements carried out in one-third, half, and two thirds of the full range of movement in the sagittal and coronal planes. During each movement, the 3-Space Fastrak (Polhemus Inc., Colchester, VT) was used to record angular movement of the spine at four sensor locations (T1, T7, L1, and S2). The absolute difference in the sensor angles between repeated trials was calculated for each flexed position and on return to upright standing from these. These absolute differences were used as a measure of position sense.

RESULTS

Absolute position sense after one-third angular movements was accurate to within 4.30 degrees +/- 2.84 degrees in flexed positions and 2.70 degrees +/- 2.20 degrees in upright postures. Corresponding results for two-thirds movements were 4.75 degrees +/- 2.63 degrees and 3.33 degrees +/- 2.60 degrees, respectively. Range of movement had no significant influence on the accuracy of position sense.

CONCLUSIONS

1) Healthy individuals are able to reposition their spine accurately under conditions of incremental increases in angular range. 2) Range-related variations in position sense are small and unlikely to be of clinical significance.

Prophylactic ankle stabilizers affect ankle joint kinematics during drop landings

PURPOSE

Ankle joint dorsiflexion contributes to energy absorption during landing, but wearing ankle stabilizers is known to restrict passive measures of dorsiflexion. This study compared the effects of various ankle stabilizers on ankle joint kinematics during soft and stiff landings.

METHODS

Subjects (N = 14) performed two-legged landings off a 0.59-m platform. Kinematics of the right ankle were calculated from a sagittal plane video recording (120 Hz). Five soft and five stiff landings were performed in five ankle stabilizer conditions (no stabilizer, taping, Swede-O, AirCast, and Active Ankle), a total of 50 trials per subject. Style and stabilizer conditions were randomized across subjects. Each subject's five-trial mean value of selected kinematic variables for each landing style/stabilizer condition was entered into a two-way repeated MANOVA (alpha = 0.05).

RESULTS

Differences between soft and stiff landing conditions were similar to those reported in the literature. Compared with the No stabilizer condition, most stabilizer conditions significantly reduced ankle dorsiflexion ROM and angular velocity during landing.

CONCLUSIONS

The results indicate that some ankle stabilizers adversely affect ankle joint kinematics during landing.