The role of fibular tape in the prevention of ankle injury in basketball: A pilot study

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVES

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

DESIGN

Randomized, single blind cross-over.

SETTING

Biomechanics lab.

PARTICIPANTS

16 individuals with chronic ankle instability.

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Current Concept Review: State of Acute Lateral Ankle Injury Classification Systems

Acute lateral ankle sprain (ALAS) is one of the most frequent musculoskeletal injuries, with a great impact on health and socioeconomic factors. There are few consensuses on this subject and multiple therapeutic options that are difficult to compare due to the lack of a universally adopted classification system. The objective of this study is to is to report the actual knowledge on how ALAS are classified and reported and not to make any therapeutic recommendation. A comprehensive literature review of the literature was carried out through a search in the MEDLINE, Cochrane Library and Google Scholar databases, with identification of articles that describe ways to classify lateral ankle sprains or with relevant content for their classification. Twenty-five different classification systems were identified. The majority of articles referring to ALAS use an unspecific classification. Most classification systems divide sprains into 3 degrees. The most used parameters are the anatomy of the injury, clinical parameters, functional loss and the presence of instability. No articles were found to verify the validity of the systems used, namely regarding their association with therapeutic proposals or prognostic predictions. Based on the available evidence, recommendations cannot be made regarding the most appropriate classification system. The considerable heterogeneity of the existing literature makes it difficult to compare studies and to optimize the treatment and follow-up of these injuries. Future research in this area is necessary to define a practical and rigorous system that can be used universally.

Short-Term Effect of Manual Therapy & Taping on Subacute Ankle Sprains with Potential Syndesmotic Sprain: A Case Series

STUDY DESIGN

Case Series.

BACKGROUND

Syndesmotic ankle sprains can occur in up to 17% of ankle trauma and can lead to long-term disability. This study describes the management of seven patients with subacute, high-grade ankle sprains with concerns of concurrent syndesmotic strain utilizing manual therapy and rigid sports taping.

METHODS

Seven active duty military members with clinically diagnosed, high-grade ankle sprains and concern for syndesmotic sprain participated in this case series. All patients received multi-modal treatment consisting of manual therapy, rigid sports taping, progressive exercises, and proprioceptive training. Decrease in Numeric Pain Rating Scale (NPRS) following manual therapy and taping treatment, number of sessions before discharge, and the Global Rating of Change (GROC) at discharge were retrospectively reviewed.

RESULTS

All patients demonstrated an immediate decrease in NPRS following treatment on average of 5 points (range, 3-8 points) with a functional asterisk sign. The improvement in pain and function was maintained until the next treatment session with a mean GROC score of +3. The mean time until recovery was 5.4 weeks (range, 1-8 weeks).

DISCUSSION

A multimodal approach for patients diagnosed clinically with high-grade ankle sprains and concern for syndesmotic sprain was useful to immediately reduce pain and improve function, and improvements were maintained throughout the duration of care. This study is the first to assess a combination of manual therapy and rigid sports taping for the treatment of suspected syndesmotic ankle sprains, and more stringent research is needed to validate the findings.

LEVEL OF EVIDENCE

Therapy, 4.

Effectiveness of Mobilization of the Talus and Distal Fibula in the Management of Acute Lateral Ankle Sprain

OBJECTIVE

Distal fibular mobilization with movement (MWM), with and without a posterior gliding fibular tape, and anteroposterior mobilization of the talus (MOB) are widely used to treat acute lateral ankle sprains. The purpose of this study was to investigate the short-term and long-term relative effectiveness of these techniques.

METHODS

In this double-blind randomized controlled trial, 45 amateur soccer players with acute (<72 hours) lateral ankle sprain were randomly allocated to 6 sessions (3/wk within the first 2 weeks) of either MWM, MWM with tape (MWMtape), or MOB. All participants also received general advice, transcutaneous electrical nerve stimulation, edema draining massage, and a program of proprioception exercises. Participant ratings of function on the Foot and Ankle Ability Measure and Patient Global Impression of Improvement Scale were the primary outcomes measured over 52 weeks. Secondary outcomes were ankle pain, pressure pain threshold, range of motion, volume, and strength.

RESULTS

MWM and MWMtape were equally effective and participants demonstrated greater function on the Foot and Ankle Ability Measure at 12 and 52 weeks when compared with those receiving MOB; however, the latter demonstrated superior function at 2 weeks. No differences between groups were observed for Patient Global Impression of Improvement Scale or any of the secondary outcomes.

CONCLUSION

There are limited differences in the short term among techniques, with the exception of better sport function with MOB. Over the longer term, the distal fibular MWM is most effective to achieve activities of daily living and sport function when added to usual physical therapy care. The addition of a posterior gliding fibular tape provides no additional benefit.

IMPACT

Distal fibular mobilization with movement may be the most appropriate choice of treatment for acute lateral ankle sprain to achieve long-term activities of daily living and sport function. In the short term, anteroposterior mobilization of the talus offers greater improvement in sport function. The use of fibular tape provides no added benefit as an adjunct to a treatment that includes distal fibular mobilization with movement.

Response profile of fibular repositioning tape on ankle osteokinematics, arthrokinematics, perceived stability and confidence in chronic ankle instability

BACKGROUND

Preliminary evidence suggests that fibular repositioning tape reduces risk of recurrent ankle injuries, but the underlying mechanism has not been investigated.

OBJECTIVE

To investigate the effects of fibular repositioning tape on ankle osteokinematics, arthrokinematics and perceived stability and confidence in individuals with chronic ankle instability immediately post-tape and following exercise.

DESIGN

Cross-sectional repeated measures study.

METHOD

Passive ankle plantarflexion-inversion range of motion, weight-bearing dorsiflexion range of motion, anteroposterior translation, inversion-eversion tilt, and perceived ankle stability and confidence during hopping were assessed before and immediately after the application of fibular repositioning tape and after 15 min of exercise in 14 individuals with chronic ankle instability.

RESULTS

Ankle plantarflexion-inversion range of motion, inversion-eversion tilt and anteroposterior translation were reduced immediately after the application of tape compared to pre-tape (p < 0.01). After exercise, total inversion-eversion tilt was significantly lower than pre-tape (p = 0.01), but there were no differences for any of the other mechanical outcomes. Dorsiflexion range of motion did not differ between conditions (p > 0.11). Perceived ankle stability, ankle and task confidence were greater immediately post-tape and post-exercise compared to pre-tape (p < 0.01).

CONCLUSIONS

Fibular repositioning tape was associated with a restriction of ankle total inversion-eversion tilt and improved perceived ankle stability and confidence both immediately after application of tape and after participating in exercise. This data provides grounds for exploring mechanical and psychological mechanisms underpinning any clinical efficacy of fibular repositioning tape.

Can fibular reposition taping improve balance performance in individuals with chronic ankle instability? A randomized controlled trial

BACKGROUND

Lateral ankle sprain results in positional faults in the fibula which are thought to limit accessory motion in the ankle, leading to hypomobility and negatively influencing sensorimotor function and postural control. Although it has been shown that fibular reposition taping (FRT) is effective in the prevention of recurrent lateral ankle sprain, its ability to produce significant changes in balance measures in patients with chronic ankle instability is inconclusive.

OBJECTIVE

This study aimed to determine whether a FRT intervention affects balance performance in patients with chronic ankle instability.

DESIGN

Randomized controlled trial.

METHODS

Sixty individuals with chronic ankle instability were randomly allocated to three groups: FRT, sham taping, or no intervention (control group). Kinesiotape was applied and then re-applied on 3 occasions per week for 2 weeks. Static and dynamic balance were measured with three functional tests before and 1 day after the last session of intervention with the tape removed: single-leg stance test, single-leg hop test for distance, and modified Star Excursion Balance Test (mSEBT).

RESULTS

The results of ANCOVA showed that there were no significant differences between the three groups except for mSEBT reach distance in the posterolateral direction, which was significantly greater in the FRT group than the control group (p = 0.03).

CONCLUSION

Applying FRT for 2 weeks did not significantly affect static or dynamic balance measures in individuals with chronic ankle instability, hence its clinical efficacy to influence balance remains uncertain in this population.

CLINICAL TRIAL REGISTRATION NUMBER

IRCT20171122037576N2.

Prevention of Lateral Ankle Sprains

CONTEXT

Given the frequency of ankle sprains, especially in the athletic population, prevention is a primary task of athletic trainers and other sports health care professionals.

OBJECTIVE

To discuss the current evidence as it relates to prophylactic programs for the prevention of ankle sprains and to provide critical interpretation of the evidence supporting and refuting the implementation of preventive programs.

CONCLUSIONS

External prophylactic supports and preventive exercise programs are effective for reducing the risk of ankle sprains in both uninjured and previously injured populations. Ankle bracing appears to offer the best outcomes in terms of cost and risk reduction. However, there remains a paucity of well-designed, prospective randomized controlled trials relevant to the primary prevention of lateral ankle sprains, especially across a range of sport settings.

Effectiveness of taping on functional performance in elite athletes: A systematic review

Taping has been showing its effect on the rehabilitation aspect with numerous reviews. However, there is lack of evidence on the effect of taping on functional performance, espectially in elite sports settings. This review aimed to evaluate the effectiveness of taping intervention on sports-related functional performance among the elite athlete population. Online databases such as Ovid MEDLINE, ProQuest, PubMed, ScienceDirect, Scopus, SPORTDiscus, and Web of Science were searched. Eligibility criteria were listed as follows: (i) English, (ii) academic journal, (iii) research article, (iv) elite or professional athletes, (v) experimental research design, (vi) sport, (vii) taping, and (viii) functional performance. Specific emphases were targeted on within-subject comparison and healthy subjects. The PEDro scale was utilized for appraising on the statistical information, as well as internal and external validity. The Cohen's d effect size with 95 percent confidence intervals was used to compare taped versus not-taped condition. Nine studies were included in this review and 25 comparisons were extracted. Positive effects were found on balance performance with rigid tape, and horizontal jump performance with elastic tape. Alternatively, negative effects were found on vertical jump performance. An interesting finding was noted on the effect of taping applied after 24 h. Overall, taping could be a beneficial practice for elite sports performance.

Acute effects of distal fibular taping technique on pain, balance and forward lunge activities in Chronic Ankle Instability

BACKGROUND

Chronic Ankle Instability (CAI) is characterized by altered muscle activation, reduced range of motion (ROM) and balance deficits.

OBJECTIVE

The aim of this study was to determine whether fibular taping technique influenced the pain intensity, dorsiflexion ROM and dynamic balance in participants with CAI.

METHODS

Twenty-six participants (16 males and 10 females; age 28.8 ± 5.74 y) with unilateral CAI who scored 85 points or less on the Foot and Ankle Outcome Score (FAOS) were included in our study. Mulligan distal fibular taping technique was applied. Visual Analog Scale, Star Excursion Balance Test in anterior, posteromedial and posterolateral directions and a Weight Bearing Lunge Test were taken before, after, 1 hour after and 24 hours after taping.

RESULTS

Distal fibular taping technique decreases pain intensity (at rest, during range of motion and weight bearing conditions), while it increases forward lunge distance and reach distance in anterior, posteromedial and posterolateral directions (p= 0.001).

CONCLUSIONS

Our study showed that distal fibular taping reduces pain intensity, postural control and dorsiflexion range of motion in individuals with CAI. Further studies are needed with participants with a lower functional level and a higher pain intensity.

Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix

BACKGROUND

Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered.

OBJECTIVE

Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps.

METHODS

Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure.

RESULTS

A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5).

CONCLUSIONS

Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.

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.

Interventions to Prevent Unintentional Injuries Among Adolescents: A Systematic Review and Meta-Analysis

Globally, every day, ∼2,300 children and adolescents succumb to unintentional injuries sustained from motor vehicle collisions, drowning, poisoning, falls, burns, and violence. The rate of deaths due to motor vehicle injuries in adolescents is 10.2 per 100,000 adolescents. We systematically reviewed published evidence to identify interventions to prevent unintentional injuries among adolescents aged 11-19 years. We defined unintentional injuries as a subset of injuries for which there was no evidence of predetermined intent, and the definition included motor vehicle injuries, suffocation, drowning, poisoning, burns, falls, and sports and recreation. Thirty-five studies met study eligibility criteria. The included studies focused on interventions to prevent motor vehicle injuries and sports-related injuries. Results suggest that possession of a graduated driver license (GDL) significantly reduced road accidents by 19% (relative risk [RR]: .81; 95% confidence interval [CI]: .75-.88; n = 5). There was no impact of GDL programs on incidence of injuries (RR: .78; 95% CI: .57-1.06; n = 2), helmet use (RR: 1.0; 95% CI: .98-1.02; n = 3), and seat belt use (RR: .99; 95% CI: .97-1.0; n = 3). Sports-related injury prevention interventions led to reductions in the incidence of injuries (RR: .66; 95% CI: .53-.82; n = 15), incidence of injury per hour of exposure (RR: .63; 95% CI: .47-.86; n = 5), and injuries per number of exposures (RR: .79; 95% CI: .70-.88; n = 4). Subgroup analysis according to the type of interventions suggests that training ± education and the use of safety equipment had significant impacts on reducing the incidence of injuries. We did not find any study focusing on interventions to prevent suffocation, drowning, poisoning, burns, and falls in the adolescent age group. The existing evidence is mostly from high-income countries, limiting the generalizability of these findings for low- and middle-income countries. Studies evaluating these interventions need to be replicated in a low- and middle-income country-context to evaluate effectiveness with standardized outcome measures.

The Mulligan ankle taping does not affect balance performance in healthy subjects: a prospective, randomized blinded trial

[Purpose] The aim of this study was to evaluate the immediate effects of Mulligan fibular taping on static and dynamic postural balance in healthy subjects using computerized dynamic posturography (CDP). [Subjects and Methods] Forty-four volunteers (26 males and 18 females) aged 21 ±2 years participated in the study. The Mulligan tape was applied by a specialist in this technique. The placebo group received a treatment with a similar tape but with several cuts to avoid the fibular repositioning effect produced by Mulligan tape. Main outcome measures: The Sensory Organization Test (SOT) and the Motor Control Test (MCT) were performed by each subject at baseline and after the interventions. Outcome measures included equilibrium and strategy scores from each trial and condition of the SOT, and speed of reaction (latency period) from the MCT. [Results] Mulligan ankle taping did not have an impact on postural control during static and dynamic balance in subjects with healthy ankles when compared with placebo taping. [Conclusion] There was no difference in, equilibrium and strategy (SOT) and speed of reaction (MCT) in any of the subjects in this study. Therefore, this study suggests that Mulligan ankle taping does not have an impact on balance in healthy subjects.

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

OBJECTIVE

To determine changes in spinal reflex excitability of the soleus and fibularis longus muscles before and after fibular taping intervention.

METHODS

Twenty-one individuals (age = 23.4 ± 2.7 y, height = 171.0 ± 12.8 cm, mass = 69.7 ± 11.8 kg) with chronic ankle instability (CAI) and at least 5° ankle dorsiflexion asymmetry volunteered for this randomised crossover design study. Each participant received a fibular taping with tension or fibular taping without tension during separate sessions. Spinal reflex excitability of the soleus and fibularis longus was determined by obtaining maximum values for H-reflex (Hoffmann reflex) and maximum compound muscle action potential (Mmax), which was expressed as a ratio (H/M ratio). Measures were obtained immediately before and after a fibular taping intervention.

RESULTS

The application of tape to the fibula, regardless of tension, did not produce a change in spinal reflex excitability for the soleus (F1,39 = .01, P = .91) or fibularis longus (F1,39 = .001, P = .99).

CONCLUSIONS

Fibular taping with and without tension did not result in an immediate change in spinal reflex excitability of the soleus or fibularis longus in individuals with CAI. Although fibular taping has been shown to reduce recurrent ankle sprains in individuals with CAI, the mechanism of effectiveness may not involve an immediate increase in spinal reflex excitability.

Influence of Mulligan Ankle Taping on Functional Performance Tests in Healthy Athletes and Athletes With Chronic Ankle Instability

Context:

Ankle sprains or chronic ankle instability (CAI) is common in athletes and a common method for decreasing the effects of ankle instable is using tape.

Objective:

To determine whether Mulligan ankle taping (MAT) influenced the functional performance (FP) tests in athletes with and without CAI.

Design:

A cross-sectional study using a within-subject experimental design between four ankle conditions (taped and untaped, athletes with and without CAI).

Setting:

Research laboratory.

Participants:

Sixteen professional athletes with unilateral CAI (10 men and 6 women; age 23.2 ± 3 years, height 175.4 ± 10.3 cm, weight 73 ± 14.5 kg, and body mass index 23.8 ± 3.6%) and 16 uninjured professional athletes (10 men and 6 women; age 22.8 ± 1.7 years, height 173.6 ± 12.2 cm, weight 66.4 ± 11.4 kg, and body mass index 22.2 ± 3.3%) volunteered to participant in this study.

Intervention:

Mulligan ankle taping.

Main Outcome Measures:

FP tests including single leg hopping course, Figure-of-8 hop and side hop were measured for both the groups in two conditions: taped and untaped.

Results:

There were significant differences between injured and uninjured athletes in all FP tests (P< .05). MAT significantly improved FP tests in both groups (P< .05).

Conclusion:

We found that MAT can improve FP tests in athletes with CAI and uninjured athletes. Therefore, it seems that MAT can be an effective method for enhancing athletes’ performance in sports that require lateral movements.

Immediate effects of Mulligan's fibular repositioning taping on postural control in athletes with and without chronic ankle instability

OBJECTIVE

To determine whether fibular repositioning tape influenced the postural control performance in athletes with and without chronic ankle instability (CAI).

SETTING

Research laboratory.

DESIGN

A cross-sectional study, within subjects experimental study design between 4 ankle conditions (taped and untaped: CAI and healthy athletes).

PARTICIPANTS

Sixteen volunteer professional athletes with unilateral CAI (10 men and 6 women; age 23.2 ± 3 y, height 175.4 ± 10.3 cm, and weight 73 ± 14.5 kg) and sixteen volunteer healthy professional athletes (10 men and 6 women; age 22.8 ± 1.7 y, height 173.6 ± 12.2 cm, and weight 66.4 ± 11.4 kg).

INTERVENTIONS

Fibular repositioning taping (FRT).

MAIN OUTCOME MEASUREMENTS

Star excursion balance test (postural control) in anteromedial (AM), medial (M), and posteromedial (PM) directions were measured for the both group in two conditions: tape and untape.

RESULTS

FRT improved significantly postural control (M, AM and PM) in both groups (p < 0.05).

CONCLUSION

We observed that FRT can significantly improve postural control in athletes with CAI and healthy athletes. Therefore, FRT can be an effective management for athletes who suffer from CAI. Also, this type of taping can apply immediately prior to activity and sport event to increase joint awareness of ankle.

Chronic ankle instability in sporting populations

BACKGROUND

Chronic ankle instability (CAI) is a term used to identify certain insufficiencies of the ankle joint complex following an acute ankle injury. Acute ankle injuries are often associated with sporting mishaps; however, this review was the first to identify the aspects of CAI (perceived instability, mechanical instability and recurrent sprain), and persisting symptoms following an ankle sprain, that have been reported within sporting cohorts.

OBJECTIVE

To determine the presence of common aspects of CAI within individual sports.

METHODS

A systematic search of the MEDLINE, Web of Science, CINAHL, SPORTDiscus and AMED databases up until 1 October, 2013 produced 88 studies appropriate for review. A calculated weighted percentage of the outcome data allowed the comparison of figures across a range of sports.

RESULTS

Soccer, basketball and volleyball were the most represented sports and recurrent ankle injury/sprain was the most reported aspect of CAI. Soccer had the highest percentage of participants with recurrent sprain (61%) and mechanical instability (38%), whilst track and field had the highest percentage of participants with perceived instability (41%). Gymnasts had the highest percentage of ankles with persisting symptoms following an initial ankle sprain.

CONCLUSION

This review was the first to assess aspects of CAI within sporting cohorts and has identified limitations to the research reporting these data. The problem of CAI across a range of sports remains unclear and thus advocates the need for further controlled research in the area to ascertain the true extent of CAI within sporting populations.

Joint mobilization acutely improves landing kinematics in chronic ankle instability

PURPOSE

The objective of this study is to examine the acute effect of ankle joint mobilizations akin to those performed in everyday clinical practice on sagittal plane ankle joint kinematics during a single-leg drop landing in participants with chronic ankle instability (CAI).

METHODS

Fifteen participants with self-reported CAI (defined as <24 on the Cumberland Ankle Instability Tool) performed three single-leg drop landings under two different conditions: 1) premobilization and, 2) immediately, postmobilization. The mobilizations performed included Mulligan talocrural joint dorsiflexion mobilization with movement, Mulligan inferior tibiofibular joint mobilization, and Maitland anteroposterior talocrural joint mobilization. Three CODA cx1 units (Charnwood Dynamics Ltd., Leicestershire, UK) were used to provide information on ankle joint sagittal plane angular displacement. The dependent variable under investigation was the angle of ankle joint plantarflexion at the point of initial contact during the drop landing.

RESULTS

There was a statistically significant acute decrease in the angle of ankle joint plantarflexion from premobilization (34.89° ± 4.18°) to postmobilization (31.90° ± 5.89°), t(14) = 2.62, P < 0.05 (two-tailed). The mean decrease in the angle of ankle joint plantarflexion as a result of the ankle joint mobilization was 2.98° with a 95% confidence interval ranging from 0.54 to 5.43. The eta squared statistic (0.32) indicated a large effect size.

CONCLUSION

These results indicate that mobilization acted to acutely reduce the angle of ankle joint plantarflexion at initial contact during a single-leg drop landing. Mobilization applied to participants with CAI has a mechanical effect on the ankle joint, thus facilitating a more favorable positioning of the ankle joint when landing from a jump.

Fibular taping does not influence ankle dorsiflexion range of motion or balance measures in individuals with chronic ankle instability

OBJECTIVES

To determine the effects of fibular taping on ankle dorsiflexion range of motion (ROM) and dynamic balance in individuals with chronic ankle instability (CAI).

DESIGN

Single-blind, randomized crossover.

METHODS

Twenty-three individuals (age=23.4 ± 2.5 years, height=171.6 ± 12.4 cm, mass=71.5±13.1 kg) with CAI were allocated to either a fibular taping intervention or sham taping intervention (tape applied without tension) over the course of two visits. Weight-bearing ankle dorsiflexion ROM and components of the Star Excursion Balance Test (SEBT) were measured before and after intervention.

RESULTS

There was not a significant change in ankle dorsiflexion ROM when comparing the taping interventions (F1,43=1.03, P=.32), but both interventions resulted in a small increase (F1,43=8.07, P=.007) in dorsiflexion ROM (pre=36.7° ± 6.9°, post=37.7° ± 6.2°). This increase in ROM did not exceed the established minimal detectable change for dorsiflexion ROM. Fibular taping with tension produced an increase (F1,41=5.84, P=.02) (pre=69.0 ± 9.1%, post=70.6±8.6%) in posterolateral reach distance when compared to taping without tension (pre=72.7 ± 11.0%, post=71.4 ± 9.6%), but this increase did not exceed the established minimal detectable change. There was not a significant change in dynamic balance between groups for the anterior (F1,41=2.33, P=.14) and posteromedial (F1,41=.41, P=.53) reach directions.

CONCLUSIONS

Although small changes in ankle dorsiflexion ROM and posterolateral reach distances were observed, these changes did not exceed established minimal detectable change values for these measures. These results suggest that the benefits of fibular taping are not related to an increase in ankle dorsiflexion ROM or dynamic balance.

Effects of Inversion Perturbation After Step-Down on the Latency of the Peroneus Longus and Peroneus Brevis

The purpose of this investigation was to determine the effect of different types of ankle sprains on the response latency of the peroneus longus and peroneus brevis to an inversion perturbation, as well as the time to complete the perturbation (time to maximum inversion). To create a forced inversion moment of the ankle, an outer sole with fulcrum was used to cause 25 degrees of inversion at the ankle upon landing from a 27 cm step-down task. Forty participants completed the study: 15 participants had no history of any ankle sprain, 15 participants had a history of a lateral ankle sprain, and 10 participants had a history of a high ankle sprain. There was not a significant difference between the injury groups for the latency measurements or the time to maximum inversion. These findings indicate that a previous lateral ankle sprain or high ankle sprain does not affect the latency of the peroneal muscles or the time to complete the inversion range of motion.

Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability

OBJECTIVE

To investigate whether 2 different mechanisms of ankle joint taping ([1] lateral subtalar sling or [2] fibular repositioning) can enhance actual and perceived dynamic postural stability in participants with chronic ankle instability (CAI).

DESIGN

Laboratory-based repeated-measures study.

SETTING

University biomechanics laboratory.

PARTICIPANTS

Participants (n=16) with CAI.

INTERVENTIONS

Participants performed the Star Excursion Balance Test (SEBT) under 3 different conditions: (1) no tape, (2) lateral subtalar sling taping and (3) fibular repositioning taping.

MAIN OUTCOME MEASURES

Reach distances in the anterior, posteromedial, and posterolateral directions on the SEBT. Participants' perceptions of stability, confidence, and reassurance when performing the SEBT under 2 different taping conditions.

RESULTS

Taping did not improve reach distance on the SEBT (P>.05). Feelings of confidence increased for 56% of participants (P=.002) under both tape conditions. Feelings of stability increased for 87.5% of participants (P<.001) using condition 2 (lateral subtalar sling taping) and 75% of participants (P=.001) using condition 3 (fibular repositioning taping). Feelings of reassurance increased for 68.75% of participants (P=.001) using condition 2 (lateral subtalar sling taping) and 50% of participants (P=.005) using condition 3 (fibular repositioning taping).

CONCLUSIONS

No significant change in dynamic postural stability was observed after application of either taping mechanism; however, participants' perceptions of confidence, stability, and reassurance were significantly improved. Further research is necessary to fully elucidate the exact mechanisms by which taping may help reduce the incidence of repeated injury in subjects with CAI.

Mechanisms of basketball injuries reported to the HQ Air Force Safety Center a 10-year descriptive study, 1993-2002

BACKGROUND

Basketball is the most popular sport among the U.S. Air Force (USAF) active duty population and causes a large number of lost-workday injuries. The purpose of this study is to describe how basketball injuries occur to allow development of effective countermeasures.

METHODS

This study used data derived from safety reports obtained from the USAF Ground Safety Automated System. Basketball injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study conducted in 2003. Narrative data from 32,818 safety reports were systematically reviewed and coded in order to categorize and summarize mechanisms associated with these injuries.

RESULTS

A total of 2204 mishap reports involving active duty USAF members playing basketball were documented by the study. This study identified seven mechanisms causing basketball injury. Two similar causes involving jumping (landing awkwardly and landing on someone's foot) accounted for 43% of basketball injuries followed by collisions with other players (10%).

CONCLUSIONS

This study shows that mechanisms of basketball-related injury can be identified using the detailed information found in USAF safety reports. Knowledge of leading hazards or mechanisms for basketball injuries can be used to prioritize and develop prevention strategies.

A primer on selected aspects of evidence-based practice relating to questions of treatment. Part 1: asking questions, finding evidence, and determining validity

The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This first commentary in a 2-part series will review principles relating to steps 1, 2, and 3 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in formulating foreground questions, searching for the best available evidence, and determining validity of results in studies of interventions for orthopaedic and sports physical therapy.

A primer on selected aspects of evidence-based practice to questions of treatment. Part 2: interpreting results, application to clinical practice, and self-evaluation

The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This second commentary in a 2-part series will review principles relating to steps 3 through 5 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in interpreting results, applying the evidence to patient care, and evaluating proficiency with EBP skills in studies of interventions for orthopaedic and sports physical therapy.

Snapping popliteus tendon in a 21-year-old female

STUDY DESIGN

Case report.

BACKGROUND

Determining the cause of painful snapping on the lateral aspect of the knee can be a challenge. The differential diagnosis includes iliotibial band friction syndrome, lateral meniscus tear, intra-articular loose body, discoid lateral meniscus, snapping biceps femoris tendon, degenerative joint disease, proximal tibiofibular joint instability, and snapping popliteus tendon.

CASE DESCRIPTION

A 21-year-old female presented with a 7-year history of a painful snapping on the lateral aspect of her left knee. She reported the snapping occurred with all activities involving knee flexion and extension, including running and walking. With a diagnosis of snapping iliotibial band, she had received a variety of physical therapy interventions, including various lower extremity stretching and strengthening exercises. Nonsteroidal anti-inflammatory medications were also prescribed by her physician. Conservative and pharmoclogical interventions were unsuccessful in improving her symptoms. Similarly, our attempt with conservative treatment consisting of ice, taping, and a short period of immobilization was not successful.

OUTCOMES

The patient underwent a surgical procedure consisting of removal of a prominent tubercle on the lateral femoral condyle and tenodesis of the popliteus tendon to the proximal aspect of the fibular (lateral) collateral ligament, followed by a postoperative program of physical therapy including range-of-motion and progressive strengthening exercises. At 6 weeks following surgery, the patient had returned to all activities with complete resolution of her symptoms.

DISCUSSION

Painful snapping at the lateral aspect of the knee may be caused by a variety of disorders, including the popliteus tendon. Clinical diagnosis is challenging. Clinical suspicion of a snapping popliteus tendon as a source of the signs and symptoms of the condition is important for inclusion in the differential diagnosis.

LEVEL OF EVIDENCE

Differential diagnosis, level 4.