Neuromuscular properties and functional aspects of taped ankles

Effect of a semirigid ankle brace on the in vivo kinematics and muscle activity of patients with functional ankle instability during simulated ankle sprain

INTRODUCTION

Ankle braces can effectively decrease the incidence of recurrent ankle sprain; however, whether the brace can decrease the severity of sprain and its related mechanism during sprain remain unknown.

METHODS

Twenty-two patients with functional ankle instability (FAI) (12 males and 10 females) and 16 healthy subjects (8 males and 8 females) were enrolled in this study. All of the subjects walked on a custom-built tilting platform that offered a 30° inversion (IV) to mimic the IV of ankle sprain. We collected the kinematic and surface electromyography data of patients with FAI with or without ankle brace and normal controls 6 times.

RESULTS

The FAI without brace group showed significantly higher maximum IV angles and average IV velocities than the control group (P < .001). The FAI with brace group revealed significantly lower maximum IV angles and average IV velocities than the FAI without brace group (P < .001); this group also showed significantly higher maximum external rotation (ER) angle and average ER velocities than the FAI with brace (P < .001) and control (P < .001) groups. The FAI with brace group indicated significantly lower average EMGPrep (P = .047), EMGTilt (P = .037), and EMGafterTilt (P = .004) of the peroneus longus than the FAI without brace group.

CONCLUSIONS

The ankle brace could effectively decrease IV angles and their velocities and increase ER angles and their corresponding velocities during ankle sprain in patients with FAI. It could also decrease the activity of the peroneus longus muscle during ankle sprain.

Effectiveness of kinesiotaping in patients with subacromial impingement syndrome: A systematic review with meta-analysis

OBJECTIVE

To determine the effectiveness of kinesiotaping (KT) with or without co-interventions for clinical outcomes in patients with subacromial impingement syndrome (SIS).

DESIGN

Systematic review with meta-analysis of randomized clinical trials.

DATA SOURCES

Eight databases (MEDLINE, CENTRAL, EMBASE, PEDro, LILACS, CINAHL, SPORTDiscus, and Web of Science) were searched from inception until March 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Clinical trials that determine the effectiveness of KT with or without co-interventions for clinical outcomes in patients with SIS who are older than 18 years of age.

RESULTS

Ten trials for the quantitative analysis were included. For pain intensity at 1-3 weeks, the overall pooled MD was -0.73 cm, 95% CI = -1.50 to 0.04 (p = 0.06), and at 3-6 weeks, it was -0.13 cm, 95% CI = -1.37 to 0.36 (p = 0.25). For shoulder function, the MD was -0.02, 95%CI = -0.30 to 0.26 (p = 0.89). For shoulder Range of Motion (ROM) flexion, the MD was -16.70, 95% CI = -0.52 to 33.92 (p = 0.06). Additionally, there was a low to moderate quality of evidence according to the GRADE rating.

CONCLUSION

Kinesiotaping with or without co-interventions was not superior to other interventions for improving shoulder pain intensity, function and ROM flexion in patients with SIS.

People with chronic ankle instability benefit from brace application in highly dynamic change of direction movements

Background

The application of ankle braces is an effective method for the prevention of recurrent ankle sprains. It has been proposed that the reduction of injury rates is based on the mechanical stiffness of the brace and on beneficial effects on proprioception and neuromuscular activation. Yet, how the neuromuscular system responds to the application of various types of ankle braces during highly dynamic injury-relevant movements is not well understood. Enhanced stability of the ankle joint seems especially important for people with chronic ankle instability. We therefore aimed to analyse the effects of a soft and a semi-rigid ankle brace on the execution of highly dynamic 180° turning movements in participants with and without chronic ankle instability.

Methods

Fifteen participants with functional ankle instability, 15 participants with functional and mechanical ankle instability and 15 healthy controls performed 180° turning movements in reaction to light signals in a cross-sectional descriptive laboratory study. Ankle joint kinematics and kinetics as well as neuromuscular activation of muscles surrounding the ankle joint were determined. Two-way repeated measures analyses of variance and post-hoc t-tests were calculated.

Results

Maximum ankle inversion angles and velocities were significantly reduced with the semi-rigid brace in comparison to the conditions without a brace and with the soft brace (p ≤ 0.006, d ≥ 0.303). Effect sizes of these reductions were larger in participants with chronic ankle instability than in healthy controls. Furthermore, peroneal activation levels decreased significantly with the semi-rigid brace in the 100 ms before and after ground contact. No statistically significant brace by group effects were found.

Conclusions

Based on these findings, we argue that people with ankle instability in particular seem to benefit from a semi-rigid ankle brace, which allows them to keep ankle inversion angles in a range that is comparable to values of healthy people. Lower ankle inversion angles and velocities with a semi-rigid brace may explain reduced injury incidences with brace application. The lack of effect of the soft brace indicates that the primary mechanism behind the reduction of inversion angles and velocities is the mechanical resistance of the brace in the frontal plane.

Functional deficits in chronic mechanical ankle instability

BACKGROUND

The interaction of functional and mechanical deficits in chronic ankle instability remains a major issue in current research. After an index sprain, some patients develop sufficient coping strategies, while others require mechanical support. This study aimed to analyze persisting functional deficits in mechanically unstable ankles requiring operative stabilization.

METHODS

We retrospectively analyzed the functional testing of 43 patients suffering from chronic, unilateral mechanical ankle instability (MAI) and in which long-term conservative treatment had failed. Manual testing and arthroscopy confirmed mechanical instability. The functional testing included balance test, gait analysis, and concentric-concentric, isokinetic strength measurements and was compared between the non-affected and the MAI ankles.

RESULTS

Plantarflexion, supination, and pronation strength was significantly reduced in MAI ankles. A sub-analysis of the strength measurement revealed that in non-MAI ankles, the peak pronation torque was reached earlier during pronation (maximum peak torque angle at 20° vs. 14° of supination, p < 0.001). Furthermore, active range of motion was reduced in dorsiflexion and supination. In balance testing, patients exhibited a significant increased perimeter for the injured ankle (p < 0.02). During gait analysis, we observed an increased external rotation in MAI (8.7 vs. 6.8°, p<0.02).

CONCLUSIONS

This study assesses functional deficits existent in a well-defined population of patients suffering from chronic MAI. Impairments of postural sway, gait asymmetries, and asymmetric isokinetic strength can be observed despite long-term functional treatment. The finding that pronation strength is particularly reduced with the foot in a close-to-accident position indicates potential muscular dysfunction in MAI. Possibly, these deficits alongside the underlying mechanical instability characterize patients requiring mechanical stabilization.

The effect of ankle Kinesio™ taping on ankle joint biomechanics during unilateral balance status among collegiate athletes with chronic ankle sprain

OBJECTIVES

To determine the effects of ankle Kinesio-taping (KT) on postural sway, lower limb ROM, and muscle activity during a unilateral balance tasks.

DESIGN

Case control study design.

SETTING

Data were collected at the human movement analysis laboratory.

PARTICIPANTS

30 collegiate athletes with chronic ankle sprain (11 females and 19 males, 23.91 ± 2.58 years).

MAIN OUTCOME MEASURE

Hip, knee and ankle joints ranges of motion (ROMs); postural sway area and velocities in both anteroposterior and mediolateral directions; and muscular activity amplitudes (% peak) of lateral and medial gastrocnemius, tibialis anterior and peroneus longus in a 20s single leg balance test in two non-taped (control) and KT (intervention) conditions.

RESULTS

Significant decrease observed in ankle lateral ROM (p = 0.048, d = 0.52), mediolateral postural sway velocity (p = 0.029, d = 1.25), and peroneus longus activity amplitudes (p = 0.042, d = 0.55) after KT application.

CONCLUSION

Acute application of KT among athletes with chronic ankle instability could provide lateral mechanical support to the ankle, potentially decreasing the velocity of frontal plane sway, and decreasing the magnitude of muscle activation. These data suggest that KT may be beneficial for improving static joint stability among individuals with chronic ankle sprain, and thus could be considered an option to allow safe return-to-activity.

Taping Benefits Ankle Joint Landing Kinematics in Subjects With Chronic Ankle Instability

Context: Although taping has been proven effective in reducing ankle sprain events in individuals with chronic ankle instability, insight into the precise working mechanism remains limited. Objectives: To evaluate whether the use of taping changes ankle joint kinematics during a sagittal and frontal plane landing task in subjects with chronic ankle instability. Design: Repeated measure design. Setting: Laboratory setting. Participants: A total of 28 participants with chronic ankle instability performed a forward and side jump landing task in a nontaped and taped condition. The taping procedure consisted of a double “figure of 6” and a medial heel lock. Main Outcome Measures: 3D ankle joint kinematics was registered. Statistical parametric mapping was used to assess taping effect on mean ankle joint angles and angular velocity over the landing phase. Results: For both the forward and side jump, a less plantar flexed and a less inverted position of the ankle joint were found in the preparatory phase till around touchdown (TD) in the taped condition (P < .05). In addition, for both jump landing protocols, a decreased dorsiflexion angular velocity was found after TD (P < .05). During the side jump protocol, a brief period of increased inversion angular velocity was registered after TD (P < .05). Conclusions: Taping is capable of altering ankle joint kinematics prior to TD, placing the ankle joint in a less vulnerable position at TD.

Comparison of the Effect of 8-Week Rebound Therapy-Based Exercise Program and Weight-Supported Exercises on the Range of Motion, Proprioception, and the Quality of Life in Patients with Parkinson's Disease

Introduction

Parkinson's disease (PD) is a chronic, progressive disorder that mainly affects the central nervous system and, consequently, the patient's functional status. This study aimed to compare the effect of 8-week rebound therapy-based exercise program and weight-supported exercises on the range of motion, proprioception, and the quality of life in patients with PD.

Methods

Twenty patients were randomly divided into two equal groups of weight-bearing exercises and rebound exercise with no significant differences in age, weight, and height. The variables of the range of motion, proprioception, and the quality of life were assessed in pre- and posttest. Data were analyzed using repeated measure ANOVA and t-test at a significant level of P < 0.05.

Results

All of the variables in the two groups were significantly improved after 8 weeks of exercise, whereas the improvement rate in the rebound therapy group was more than the weight-bearing exercises group in range of motion (134.60 ± 13.22 vs. 118.38 ± 12.48), proprioception (7.60 ± 3.22 vs. 10.38 ± 2.48), and the quality of life (147.60 ± 13.22 vs. 118.38 ± 12.48) of the patients (P < 0.001 for all variables).

Conclusions

Given that both rebound and weight-supported exercises are effective on improving the range of motion, proprioception, and the quality of life of people with PD, it is recommended that the benefits of these exercises to be used in physical rehabilitation programs. However, rebound therapy exercises have had a greater effect on people with PD, and it seems better to use these exercises more than others.

Effects of Rigid and Kinesio Taping on Shoulder Rotation Motions, Posterior Shoulder Tightness, and Posture in Overhead Athletes: A Randomized Controlled Trial

Context:Alterations in posture and motion patterns are thought to play a role in developing shoulder injuries in overhead athletes. Taping is widely used in the sporting population, but there are limited empirical data regarding its effectiveness.Objectives:To determine and compare the effects of rigid and kinesio taping on shoulder rotation motions, posterior shoulder tightness (PST), and posture in overhead athletes.Design:Randomized controlled trial.Setting:Athletic training rooms.Participants:Eighty-six asymptomatic elite overhead athletes.Interventions:Participants were randomly divided into 4 groups: rigid taping group (RTG) that underwent therapeutic rigid taping, kinesio taping group (KTG) that underwent therapeutic kinesio taping, placebo group that underwent placebo kinesio taping (shoulder and scapular region taping for taping groups), and control group (no taping).Main Outcome Measures:Shoulder rotation motions, PST, and head and shoulder posture were evaluated at baseline, immediately after application and 60 to 72 hours after application for all groups.Results:Glenohumeral internal rotation increased immediately (P < .001) and at 60 to 72 hours after application in the KTG (P = .01), whereas it decreased immediately after application in the RTG (P < .001). Immediately after application, total rotation range of motion increased in the KTG (P =.02) and decreased in the RTG (P < .001), and there was a difference between groups (P = .02). Immediately after application, PST increased in the RTG (P < .001); after 60 to 72 hours, it decreased in the KTG (P = .04) and increased in the RTG (P = .01). Posture outcomes did not change significantly (P > .05).Conclusions:Kinesio taping may improve and rigid taping may worsen glenohumeral internal rotation and PST in overhead athletes. For increasing total rotation range of motion, kinesio taping is superior to rigid taping. Taping did not affect posture. Short-term kinesio taping in overhead athletes may be useful to improve glenohumeral internal rotation, total rotation range of motion, and PST.

Ankle taping can reduce external ankle joint moments during drop landings on a tilted surface

Ankle taping is commonly used to prevent ankle sprains. However, kinematic assessments investigating the biomechanical effects of ankle taping have provided inconclusive results. This study aimed to determine the effect of ankle taping on the external ankle joint moments during a drop landing on a tilted surface at 25°. Twenty-five participants performed landings on a tilted force platform that caused ankle inversion with and without ankle taping. Landing kinematics were captured using a motion capture system. External ankle inversion moment, the angular impulse due to the medio-lateral and vertical components of ground reaction force (GRF) and their moment arm lengths about the ankle joint were analysed. The foot plantar inclination relative to the ground was assessed. In the taping condition, the foot plantar inclination and ankle inversion angular impulse were reduced significantly compared to that of the control. The only component of the external inversion moment to change significantly in the taped condition was a shortened medio-lateral GRF moment arm length. It can be assumed that the ankle taping altered the foot plantar inclination relative to the ground, thereby shortening the moment arm of medio-lateral GRF that resulted in the reduced ankle inversion angular impulse.

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.

Using Ankle Bracing and Taping to Decrease Range of Motion and Velocity During Inversion Perturbation While Walking

CONTEXT

Prophylactic ankle supports are commonly used. However, the effectiveness of external supports in preventing an inversion stress has been debated.

OBJECTIVE

To evaluate how ankle bracing and taping affect inversion range of motion, time to maximum inversion, inversion velocity, and perceived ankle stability compared with a control condition during a dynamic inversion perturbation while walking.

DESIGN

Crossover study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 42 physically active participants (16 men, 26 women; age = 21.2 ± 3.3 years, height = 168.9 ± 8.9 cm, mass = 66.1 ± 11.4 kg) volunteered.

INTERVENTION(S)

Participants walked on a custom-built walkway that suddenly inverted their ankles to 30° in 3 conditions: brace, tape, and control (no external support). We used an ASO ankle brace for the brace condition and a closed basketweave technique for the tape condition. Three trials were completed for each condition. Main Outcome Measure(s) Maximum inversion (degrees), time to maximum inversion (milliseconds), and inversion velocity (degrees per second) were measured using an electrogoniometer, and perceived stability (centimeters) was measured using a visual analog scale.

RESULTS

Maximum inversion decreased more in the brace condition (20.1°) than in the control (25.3°) or tape (22.3°) conditions (both P values = .001), and the tape condition restricted inversion more than the control condition (P = .001). Time to maximum inversion was greater in the brace condition (143.5 milliseconds) than in the control (123.7 milliseconds; P = .001) or tape (130.7 milliseconds; P = .009) conditions and greater in the tape than in the control condition (P = .02). Inversion velocity was slower in the brace condition (142.6°/s) than in the control (209.1°/s) or tape (174.3°/s) conditions (both P values = .001) and slower in the tape than in the control condition (P = .001). Both the brace and tape conditions provided more perceived stability (0.98 cm and 0.94 cm, respectively) than the control condition (2.38 cm; both P values = .001).

CONCLUSIONS

Both prophylactic conditions affected inversion range of motion, time to maximum inversion, inversion velocity, and perceived ankle stability. However, bracing provided more restriction at a slower rate than taping.

Review of ankle inversion sprain simulators in the biomechanics laboratory

Ankle inversion ligamentous sprain is one of the most common sports injuries. The most direct way is to investigate real injury incidents, but it is unethical and impossible to replicate on test participants. Simulators including tilt platforms, trapdoors, and fulcrum devices were designed to mimic ankle inversion movements in laboratories. Inversion angle was the only element considered in early designs; however, an ankle sprain is composed of inversion and plantarflexion in clinical observations. Inversion velocity is another parameter that increased the reality of simulation. This review summarised the simulators, and aimed to compare and contrast their features and settings.

Effects of Ankle Kinesio Taping on Postural Control in Stroke Patients

BACKGROUND

To investigate the effects of kinesio taping on postural control in stroke patients.

MATERIALS AND METHODS

Forty stroke patients aged 30 to 60 years were randomly divided into an experimental and a control group. In the experimental group, kinesio tape (KT) was applied directly on the skin over the affected ankle in the direction of dorsiflexion and eversion to correct the equinovarus deformity. The tape was kept on the ankle for 1 day. The results were measured with the forward reach test, lateral reach test, Berg Balance Scale (BBS), and timed up and go test. Center of pressure (COP) displacement and velocity were also measured while the patients stood on a force plate. All variables were measured on the first day immediately after taping and 24 hours later in the KT group, and on the first day and also 24 hours later in the control group.

RESULTS

There was a statistically significant difference in BBS between the first day and 24 hours later in the KT group (P = .01). The forward reach test and mediolateral displacement of the COP differed significantly after taping in the experimental group compared to the control group (P = .04). Immediately after taping, BBS improved significantly in the KT group (P = .02).

CONCLUSIONS

The application of KT improved forward reach test results and displacement of the COP in stroke patients.

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.

Early intervention to improve hand function in hemiplegic cerebral palsy

Children with hemiplegic cerebral palsy often have marked hand involvement with excessive thumb adduction and flexion and limited active wrist extension from infancy. Post-lesional aberrant plasticity can lead to progressive abnormalities of the developing motor system. Disturbances of somatosensory and visual function and developmental disregard contribute to difficulties with hand use. Progressive soft tissue and bony changes may occur, leading to contractures, which further limit function in a vicious cycle. Early intervention might help to break this cycle, however, the precise nature and appropriateness of the intervention must be carefully considered. Traditional approaches to the hemiplegic upper limb include medications and botulinum toxin injections to manage abnormalities of tone, and surgical interventions. Therapist input, including provision of orthoses, remains a mainstay although many therapies have not been well evaluated. There has been a recent increase in interventions for the hemiplegic upper limb, mostly aimed outside the period of infancy. These include trials of constraint-induced movement therapy (CIMT) and bimanual therapy as well as the use of virtual reality and robot-assisted therapy. In future, non-invasive brain stimulation may be combined with therapy. Interventions under investigation in the infant age group include modified CIMT and action observation therapy. A further approach which may be suited to the infant with thumb-in-palm deformity, but which requires evaluation, is the use of elastic taping. Enhanced cutaneous feedback through mechanical stimulation to the skin provided by the tape during movement has been postulated to modulate ongoing muscle activity. If effective, this would represent a low-cost, safe, widely applicable early intervention.

Biomechanical comparison of 3 ankle braces with and without free rotation in the sagittal plane

CONTEXT

Various designs of braces including hinged and nonhinged models are used to provide external support of the ankle. Hinged ankle braces supposedly allow almost free dorsiflexion and plantar flexion of the foot in the sagittal plane. It is unclear, however, whether this additional degree of freedom affects the stabilizing effect of the brace in the other planes of motion.

OBJECTIVE

To investigate the dynamic and passive stabilizing effects of 3 ankle braces, 2 hinged models that provide free plantar flexion-dorsiflexion in the sagittal plane and 1 ankle brace without a hinge.

DESIGN

Crossover study.

SETTING

University Movement Analysis Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Seventeen healthy volunteers (5 women, 12 men; age = 25.4 ± 4.8 years; height = 180.3 ± 6.5 cm; body mass = 75.5 ± 10.4 kg).

INTERVENTION(S)

We dynamically induced foot inversion on a tilting platform and passively induced foot movements in 6 directions via a custom-built apparatus in 3 brace conditions and a control condition (no brace).

MAIN OUTCOME MEASURE(S)

Maximum inversion was determined dynamically using an in-shoe electrogoniometer. Passively induced maximal joint angles were measured using a torque and angle sensor. We analyzed differences among the 4 ankle-brace conditions (3 braces, 1 control) for each of the dependent variables with Friedman and post hoc tests (P < .05).

RESULTS

Each ankle brace restricted dynamic foot-inversion movements on the tilting platform as compared with the control condition, whereas only the 2 hinged ankle braces differed from each other, with greater movement restriction caused by the Ankle X model. Passive foot inversion was reduced with all ankle braces. Passive plantar flexion was greater in the hinged models as compared with the nonhinged brace.

CONCLUSIONS

All ankle braces showed stabilizing effects against dynamic and passive foot inversion. Differences between the hinged braces and the nonhinged brace did not appear to be clinically relevant.

The effect of ankle muscle strength and flexibility on dolphin kick performance in competitive swimmers

The velocity of a swimmer is determined by biomechanical and bioenergetics factors. However, little is known about the effect of ankle flexibility on dolphin kick performance. Next to this, scientific evidence is lacking concerning the influence of ankle muscle strength. Therefore, the aim of this study was to investigate the effect of ankle flexibility and muscle strength on dolphin kick performance in competitive swimmers. Ankle range of motion (ROM) and ankle muscle strength were measured in 26 healthy competitive swimmers. The effect of both was assessed on the swimmer's velocity and lower extremity joint angles during three maximal dolphin kick trials. Additionally, the effect of a flexibility restriction by a tape on the dolphin kick performance was assessed. Correlations were calculated between the flexibility, muscle strength and dolphin kick performance and differences were investigated between the unrestricted and restricted condition. Muscle strength of dorsal flexors and internal rotators were positively significantly correlated with the velocity. Active and passive plantar flexion ROM and internal rotation ROM were not significantly correlated. A plantar flexion-internal rotation restriction during the dolphin kick showed a significant decrease in velocity. This restriction was associated with a changed movement pattern in the knee towards more flexion. The results suggest that dolphin kick velocity might be enhanced by ankle muscle strength exercises and that subjects with a restricted ankle flexibility might profit from a flexibility program.

Expecting ankle tilts and wearing an ankle brace influence joint control in an imitated ankle sprain mechanism during walking

A thorough understanding of the functional aspects of ankle joint control is essential to developing effective injury prevention. It is of special interest to understand how neuromuscular control mechanisms and mechanical constraints stabilize the ankle joint. Therefore, the aim of the present study was to determine how expecting ankle tilts and the application of an ankle brace influence ankle joint control when imitating the ankle sprain mechanism during walking. Ankle kinematics and muscle activity were assessed in 17 healthy men. During gait rapid perturbations were applied using a trapdoor (tilting with 24° inversion and 15° plantarflexion). The subjects either knew that a perturbation would definitely occur (expected tilts) or there was only the possibility that a perturbation would occur (potential tilts). Both conditions were conducted with and without a semi-rigid ankle brace. Expecting perturbations led to an increased ankle eversion at foot contact, which was mediated by an altered muscle preactivation pattern. Moreover, the maximal inversion angle (-7%) and velocity (-4%), as well as the reactive muscle response were significantly reduced when the perturbation was expected. While wearing an ankle brace did not influence muscle preactivation nor the ankle kinematics before ground contact, it significantly reduced the maximal ankle inversion angle (-14%) and velocity (-11%) as well as reactive neuromuscular responses. The present findings reveal that expecting ankle inversion modifies neuromuscular joint control prior to landing. Although such motor control strategies are weaker in their magnitude compared with braces, they seem to assist ankle joint stabilization in a close-to-injury situation.

[Neuromuscular deficits in chronic ankle instability. Frequency and significance - multicenter study]

The peroneal reaction time (PRT) is used in the assessment of neuromuscular deficits in chronic functional ankle instability. Powered by the Editorial Manager and Preprint Manager from Aries Systems Corporation the present study was conducted to determine the PRT in a large collective of patients with chronic ankle instability because it is unclear if this parameter of neuromuscular deficit is prolonged. In this study 186 patients underwent a diagnostic algorithm consisting of anamnesis, clinical examination, X-ray and determination of the PRT on a tilting platform. A prolonged PRT as a manifestation of a neuromuscular deficit could be detected in the majority of the patients (n = 143, 77%). Comparing the affected and healthy legs 77 patients (41%) showed a significant difference in talar shift (p = 0.002) and talar tilt (p = 0.04) in the radiological stress views. Of these 77 patients only 15 (8%) showed radiological evidence of a mechanical problem. As a consequence of recurring ankle sprains a post-traumatic deficit in proprioception has to be expected in most cases. In general a conservative therapy approach should be followed including specific training to improve neuromuscular and proprioceptive deficits.

Medial compressible forefoot sole elements reduce ankle inversion in lateral SSC jumps

Sideward movements are associated with high incidences of lateral ankle sprains. Special shoe constructions might be able to reduce these injuries during lateral movements. The purpose of this study was to investigate whether medial compressible forefoot sole elements can reduce ankle inversion in a reactive lateral movement, and to evaluate those elements' influence on neuromuscular and mechanical adjustments in lower extremities. Foot placement and frontal plane ankle joint kinematics and kinetics were analyzed by 3-dimensional motion analysis. Electromyographic data of triceps surae, peroneus longus, and tibialis anterior were collected. This modified shoe reduced ankle inversion in comparison with a shoe with a standard sole construction. No differences in ankle inversion moments were found. With the modified shoe, foot placement occurred more internally rotated, and muscle activity of the lateral shank muscles was reduced. Hence, lateral ankle joint stability during reactive sideward movements can be improved by these compressible elements, and therefore lower lateral shank muscle activity is required. As those elements limit inversion, the strategy to control inversion angles via a high external foot rotation does not need to be used.

Effects of previous lateral ankle sprain and taping on the latency of the peroneus longus

The latency of the peroneus longus may be a key factor in the prevention of lateral ankle sprains (LASs). In addition, ankle taping is often applied to help prevent LASs. The purpose of this study was to determine the effects of a previous LAS and ankle taping on the latency of the peroneus longus after an inversion perturbation. Twenty-six participants, including 13 participants with no previous history of a LAS and 13 participants with a history of a single LAS completed the testing. Ankle taping was applied in a closed basket weave technique on one of the two testing days. The latency of the peroneus longus was determined by the onset of muscle activity exceeding 10 SD from baseline activity, after initiation of the 25 degrees inversion perturbation. A significant main effect (p < 0.05) was present for the ankle support condition, with ankle taping causing a significant reduction in latency of the peroneus longus (65.04 +/- 10.81 to 57.70 +/- 9.39 ms). There was no difference (p > 0.05) in latency between the injury groups. Ankle taping, immediately after application, reduces the latency of the peroneus longus among participants with and without a history of a LAS.

A composite athletic tape with hyperelastic material properties improves and maintains ankle support during exercise

STUDY DESIGN

Controlled laboratory testing using a single-group, prospective, repeated-measures design.

OBJECTIVES

To compare the material properties of a hyperelastic athletic tape to a conventional tape and to compare the passive ankle support of these tapes before and after exercise.

BACKGROUND

The near-linear material properties of conventional athletic tape may interfere with ankle motion, resulting in reduced athletic performance. Conventional athletic tape is also known to lose much of its initial support during exercise. It was assumed that a tape constructed of Kevlar fibers embedded in a silicon matrix would possess hyperelastic material properties that would improve ankle support.

METHODS

A tensile testing machine was used to determine the tensile material properties of 11 samples of conventional and hyperelastic tape. The ankles of 11 young, healthy athletes were taped, one ankle with conventional tape and the other ankle with hyperelastic tape. The passive ankle support of each tape was measured with an instrumented linkage (the ankle flexibility tester) before and after 30 minutes of exercise.

RESULTS

The composite tape had a significantly higher load to failure than the conventional tape. It had significantly lower initial stiffness and higher late stiffness than conventional tape, thus demonstrating highly hyperelastic behavior. The hyperelastic tape maintained a significantly higher portion of its support during the 30 minutes of exercise than the conventional tape.

CONCLUSIONS

Composite athletic tape with highly hyperelastic properties can be constructed and maintains a larger portion of its support during short-duration exercises (less than 30 minutes) than conventional athletic tape.

Effects of kinesio tape compared with nonelastic sports tape and the untaped ankle during a sudden inversion perturbation in male athletes

STUDY DESIGN

Controlled laboratory study.

OBJECTIVES

To examine the effect of 2 adhesive tape conditions compared to a no-tape condition on muscle activity of the fibularis longus during a sudden inversion perturbation in male athletes (soccer, team handball, basketball).

BACKGROUND

Ankle sprains are common in sports, and the fibularis muscles play a role in providing functional stability of the ankle. Prophylactic ankle taping with nonelastic sports tape has been used to restrict ankle inversion. Kinesio Tape, an elastic sports tape, has not been studied for that purpose.

METHODS

Fifty-one male premier-league athletes were tested for functional stability of both ankles with the Star Excursion Balance Test. Based on the results, those with the 15 highest and those with the 15 lowest stability scores were selected for further testing. Muscle activity of the fibularis longus was recorded with surface electromyography during a sudden inversion perturbation. Each participant was tested under 3 conditions: ankle taped with nonelastic white sports tape, ankle taped with Kinesio Tape, and no ankle taping. Differences in mean muscle activity were evaluated with a 3-way mixed-model analysis of variance (ANOVA) for the 3 conditions, across four 500-millisecond time frames, and between the 2 groups of stable versus unstable participants. Differences in peak muscle activity and in the time to peak muscle activity were evaluated with a 2-way mixed-model ANOVA.

RESULTS

Significantly greater mean muscle activity was found when ankles were taped with nonelastic tape compared to no tape, while Kinesio Tape had no significant effect on mean or maximum muscle activity compared to the no-tape condition. Neither stability level nor taping condition had a significant effect on the amount of time from perturbation to maximum activity of the fibularis longus muscle.

CONCLUSION

Nonelastic sports tape may enhance dynamic muscle support of the ankle. The efficacy of Kinesio Tape in preventing ankle sprains via the same mechanism is unlikely, as it had no effect on muscle activation of the fibularis longus.

Evaluation of arthrometer for ankle instability: a cadaveric study

BACKGROUND

Stress tests are used to diagnose both acute and chronic lateral ankle instability. Commonly used stress tests require radiography and their reliability and sensitivity is still under debate. We developed a non radiographic ankle arthrometer to objectively assess mechanical ankle stability. This device was validated against stress radiographs in a cadaver investigation.

MATERIALS AND METHODS

Nine cadaver specimens were tested under: 0, 15, and 30 degrees ankle plantarflexion and 50 N, 100 N, 150 N, and 200 N anterior drawer load application. First, intact specimens were tested. Then the anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament were sequentially cut. Anterior drawer displacement was analyzed simultaneously by a displacement transducer and by radiographic measurement. Stiffness was calculated as the linear increment of the load deformation curve. Results of a commercially available stress testing device served as a standard.

RESULTS

Stable and unstable ankles were differentiated by ankle arthrometer displacement and stiffness analyses (p = 0.012 and 0.003) with the arthrometer adjusted to 0 degrees of plantarflexion and 50 N anterior drawer load application. Standardized stress testing device and ankle arthrometer stress radiographic measurements correlated significantly (p = 0.000 to 0.027). Transducer measured anterior drawer instability was highly sensitive (96.3%), while specificity was 44.4%. Setting a cut off value of 4.5 N/mm, the stiffness analyses discriminated stable and unstable ankles with a sensitivity of 91.7% while the specificity was 62.5%.

CONCLUSION

The ankle arthrometer was able to measure anterior subluxation of the talus in relation to the tibia in a cadaver experiment. The procedure is non-radiographic and highly sensitive in differentiating unstable from stable ankles.

CLINICAL RELEVANCE

Availablity of a nonradiographic device to measure ankle instability could improve diagnostic accuracy and facilitate decision making in patients with chronic ankle instability.

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.

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.

Ankle instability in sports

Ankle stability is integral to normal motion and to minimizing the risk of ankle sprain during participation in sport activities. The ability of the dynamic and static stabilizers of the ankle joint to maintain their structural integrity is a major component of the normal gait cycle. In sports, this quality assumes even greater importance given the range of movement and stresses imposed on the ankle during various sporting disciplines. In the general population, the incidence of ankle sprain is very high. In several studies, injuries to the lateral ankle ligaments have been shown to be the most common sports-related injuries, accounting for approximately 25% of all sports-related injuries. Furthermore, up to 80% of all ankle sprains involve the lateral ligament complex. Other studies have estimated their incidence as approximately 5000 injuries per day in the United Kingdom and 23 000 in the United States. Aggressive treatment of the sprained ankle is essential to maintain foot and ankle mobility and prevent prolonged disability and subsequent overuse injuries among athletes, both professional and "weekend warriors" alike.

Duration of strength retention of ankle taping during activities of daily living

BACKGROUND AND PURPOSE

Taping has been used for the prevention and treatment of ankle injuries. The change in tape strength has not been specifically quantified during activities of daily living (ADL) by any investigation so far. Therefore the primary aim of this study was to investigate the change in ankle tape strength over a 24-h period, while subjects performed their ADL.

SUBJECTS

Twenty-four healthy subjects (mean age: 24.3+/-7.4) participated in this study.

METHODS

Ankle taping was applied to all subjects for a 24-h period. Outcome measures were recorded at six different time intervals and are as follows: before and immediately after taping, 15, 30, 60 min, and 24h post taping. Strength of tape was quantified as the moment required to rotate the foot passively into inversion, measured using a handheld dynamometer. The range of motion (ROM) was also measured using a goniometer. The muscle activity of the ankle evertors were monitored while recording the outcome measures to ensure that the passive rotation of the ankle into inversion by the investigator was not impeded by their contraction.

RESULTS

A significant change in the moment required to rotate the foot into inversion and ROM was found between all time intervals tested (p<0.001). There was a 58% reduction in MOM and a 155% increase in ROM after 24h.

DISCUSSION AND CONCLUSION

This study has quantified for the first time the reduction in the support provided by ankle taping while subjects performed their ADL. This can assist clinicians on deciding the frequency of tape reapplication that may required to provide adequate support to the ankle.

Prophylactic ankle taping: elastic versus inelastic taping

BACKGROUND

The ankle is frequently injured in sporting activities, and therefore it is frequently protected with prophylactic ankle taping. This study aimed first, to compare the mechanical fatigue of two types of prophylactic ankle taping after 30 minutes of intense exercise, one made with elastic tape (ET) and the other with inelastic tape (IT), and second, to investigate the subjects' perception on the tape restriction and comfort.

MATERIALS AND METHODS

Twenty-seven active women (mean age, 20.6 +/- 4.1 years), without previous ankle injuries volunteered for the study. The participants were tested on three different conditions: with elastic ankle taping, with inelastic taping, and without taping, before and after 30 minutes of intense exercise. The ankle passive ranges of movement (ROMs) were measured before and after exercise, and a subjective scale on taping comfort and restriction was completed by the subjects.

RESULTS

Both types of ankle taping showed less ROM restriction after 30 minutes of exercise in inversion (IT = 27% and ET = 21%), and plantarflexion (IT = 8% and ET = 6%). The IT showed more loss of restriction than the ET, with significant differences in inversion (p < 0.05). The participants perceived the ET as more comfortable and less restrictive.

CONCLUSION

We would recommend the use of ET as the first choice for prophylactic ankle taping because it produces the same restriction in the ROM as the IT with less taping fatigue, and is perceived as more comfortable and less restrictive by the users.

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.

Prophylactic ankle bracing reduces rearfoot motion during sudden inversion

The purpose of this study was to evaluate the effects of ankle bracing on rearfoot angular displacement and angular velocity during a sudden inversion movement. A 1 x 3 factorial design was used. The single independent variable was ankle brace condition with three levels: semi-rigid, lace-up and control. The two dependent variables were rearfoot average angular displacement and average angular velocity. Twenty-four healthy volunteers participated in this study. A motion analysis system was used to capture, model and calculate two-dimensional rearfoot motion while the subjects' ankle/foot complex was inverted to 35 degrees on a platform device. All subjects performed five trials of each ankle brace condition, and the average of these trials was used for statistical analysis. The semi-rigid brace significantly reduced rearfoot angular displacement and angular velocity compared with the lace-up (P<0.05) and control conditions (P<0.05). Additionally, the lace-up style brace demonstrated significantly less rearfoot angular displacement and angular velocity compared with the control condition (P<0.05). These results demonstrate that a semi-rigid ankle brace is more superior then a lace-up style brace in limiting rearfoot angular displacement and angular velocity. Moreover, the lace-up style brace offers significant restriction of these measures compared with no support.

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.

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.

Diagnosis and Management of the Painful Ankle/Foot. Part 2: Examination, Interpretation, and Management

Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue-specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non-capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non-surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care.

Effect of peripheral afferent alteration of the lateral ankle ligaments on dynamic stability

BACKGROUND

The sensorimotor influence of the lateral ankle ligaments in muscle activation is unclear.

HYPOTHESIS

The lateral ankle ligaments have significant sensorimotor influence on muscle activation.

STUDY DESIGN

Controlled laboratory study.

METHODS

Muscle-firing characteristics in response to a high-speed inversion perturbation and during gait were assessed in 13 normal subjects. Solutions (1.5% lidocaine or a placebo of saline) were injected bilaterally into the anterior talofibular and calcaneofibular ligaments (1.5 ml per ligament) to alter peripheral afferent influence. Subjects were again tested with the same protocol.

RESULTS

The protective response of the anterior tibialis and peroneal muscles during inversion perturbation and mean muscle activation amplitude decreased during running after both injections. After injection, no significant differences were seen for muscle reflex latencies, maximum amplitude, time to maximum amplitude during inversion perturbation, or mean amplitude during walking.

CONCLUSION

The lateral ankle ligaments have a sensorimotor influence on muscle activation.

CLINICAL RELEVANCE

Induced edema from the injected solutions may have altered the sensorimotor influence of the lateral ankle ligaments, thereby inhibiting the dynamic ankle stabilizers. This finding suggests that dynamic stability may be compromised because of swelling after joint injury.

Acute ankle sprains: keys to diagnosis and return to play

The diagnosis and treatment of acute ankle injuries present challenges to both primary care physicians and orthopedic specialists. Determining the position of the ankle when the injury occurred may help distinguish sprains from fractures so that unnecessary x-rays can be avoided. Stepwise rehabilitation restores function and diminishes the risk of reinjury. Physicians can stress functional measures of recovery to objectively assess readiness for return to play and balance the risks of incomplete rehabilitation against the desire for an early return to sports.

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.

Failure and fatigue characteristics of adhesive athletic tape

PURPOSE

Athletic tape has been commonly reported to lose much of its structural support after 20 min of exercise. Although many studies have addressed the functional performance characteristics of athletic tape, its mechanical properties are poorly understood. This study examines the failure and fatigue properties of several commonly used athletic tapes.

METHODS

A Web-based survey of professional sports trainers was used to select the following three tapes for the study: Zonas (Johnson & Johnson), Leukotape (Beiersdorf), and Jaylastic (Jaybird & Mais). Using a hydraulic material testing system (MTS), eight samples of each tape were compared in three different mechanical tests: load-to-failure, fatigue testing under load control, and fatigue testing under displacement control. Differences in tape microstructure were used to interpret the results of the mechanical tests.

RESULTS

Significant differences (P < 0.001) in failure load, elongation at failure, and stiffness were found from failure tests. Significant differences were also found (P < 0.001) in fatigue behavior under both modes of control. As a representative example, in one normalized displacement control fatigue test after 20 min of cycling, 21% (Zonas), 29% (Leukotape), and 57% (Jaylastic) of the mechanical support was lost. After cycling, all tapes loaded to failure showed increased stiffness (P < 0.001), indicating significant energy absorption during cycling. Observed differences in the tapes' microstructure were qualitatively consistent with the measured differences in their mechanical properties.

CONCLUSION

In understanding the shortcomings of currently available tapes, the results of these tests can now be used as benchmarks with which to compare and develop future tape designs. Ultimately, these improved tapes should reduce ankle injuries among athletes.

A multi-station proprioceptive exercise program in patients with ankle instability

PURPOSE

The aim of the present study was to investigate the effects of a 6-wk multi-station proprioceptive exercise program that is easy to integrate in normal training programs.

METHODS

Patients with chronic ankle instability were used, and results of three testing procedures before and afterward were compared: joint position sense, postural sway, and muscle reaction times to sudden inversion events on a tilting platform. A total of 30 subjects with 48 unstable feet were evaluated (exercise group: N = 31; control group: N = 17).

RESULTS

In the exercise group, the results showed a significant improvement in joint position sense and postural sway as well as significant changes in muscle reaction times.

CONCLUSION

Based on the present results, a multi-station proprioceptive exercise program can be recommended for prevention and rehabilitation of recurrent ankle inversion injuries.