Effect of ankle taping on mechanical laxity in chronic ankle instability

Diagnostic Evaluation of Mechanical Ankle Instability by Comparing Injured and Uninjured Contralateral Ankles Using Arthrometry

CONTEXT

Individuals with mechanical ankle instability (MAI) have obvious lateral ligament laxity and excessive ankle joint motion beyond the physiological range. Arthrometry has been introduced to quantitatively measure the laxity of the ankle joint. However, the diagnostic accuracy of arthrometry in MAI is still debatable.

OBJECTIVES

To (1) evaluate the difference in laxity between bilateral ankles in patients with and those without MAI and (2) calculate the diagnostic accuracy of ankle arthrometry using bilateral comparisons.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 38 individuals with unilateral MAI (age = 31.24 ± 7.90 years, height = 168.93 ± 7.69 cm, mass = 65.72 ± 10.47 kg) and 38 individuals without MAI (control group; age = 32.10 ± 7.10 years, height = 166.59 ± 7.89 cm, mass = 62.93 ± 10.72 kg).

MAIN OUTCOME MEASURE(S)

Bilateral ankle laxity in each participant was quantitatively measured by performing the arthrometric anterior drawer test. Continuous data of loading force and joint displacement were recorded. Data from both ankles were compared for the ankle joint displacement at a loading force of 75 N (D75) and load-displacement ratio from 10 to 40 N (LDR 10-40).

RESULTS

The D75 between injured and uninjured ankles in patients with MAI was different (t37 = 9.78, P < .001). The mean LDR 10-40 in injured ankles was higher than that in uninjured ankles (t37 = 9.80, P < .001). In the control group, no differences were found between the left and right ankles. The MAI group had larger bilateral differences than the control group (t37 range = 7.33-8.18; P < .001). When LDR 10-40 was used to diagnose MAI, the arthrometer showed sensitivity and specificity of 0.900 and 0.933, respectively, with a cutoff value of 0.0351 mm/N.

CONCLUSIONS

An ankle arthrometer can be used to quantitatively measure the difference in bilateral ankle laxity in patients with MAI. Arthrometer-measured LDR 10-40 can be used to diagnose MAI with high diagnostic accuracy.

Lack of Definition of Chronic Ankle Instability With Arthrometer-Assisted Ankle Joint Stress Testing: A Systematic Review of In Vivo Studies

Despite extensive research on ankle instability a consensual and clear objective definition for pathological mechanical lateral ankle instability is yet to be determined. This systematic review aimed to summarize current available arthrometric devices, measuring methods and lateral ankle laxity outcomes in patients with chronic ankle instability that underwent objective arthrometric stress measurement. Sixty-eight studies comprising a total of 3,235 ankles with chronic ankle instability were included. Studies reported a wide range of arthrometric devices, testing position and procedures, and measuring methods. For the anterior drawer test, the average mean differences between injured and uninjured ankles ranged from -0.9 to 4.1 mm, and total translation in the injured ankle from 3.2 to 21.0 mm. Most common pathological threshold was ≥4 mm or ≥10 mm unilaterally and ≥3 mm bilaterally. For the talar tilt test, the average mean differences between injured and uninjured ankles ranged from 0.0° to 8.0°, and total tilt from injured ankle from 3.3 to 60.2°. Most common pathological threshold was ≥ 10° unilaterally and ≥ 6° mm bilaterally. It was found high heterogeneity in the scientific literature regarding the arthrometric devices, use of concomitant imaging and measuring methods of arthrometer-assisted anterior drawer and talar tilt tests which led to variable laxity outcomes in individuals with chronic ankle instability. Future studies should focus on standardizing the testing and measuring methods for an objective definition of mechanical ankle instability.

Effects of Kinesiology Taping on Muscle Strength, Dynamic balance, and Functional Movement in Wrestlers with Chronic Ankle Instability

OBJECTIVES This study aimed to investigate the effect of the Kinesio taping on ankle strength, Dynamic balance and, functional movement in wrestlers with chronic ankle instability.METHODS Twenty wrestlers who registered in the Korea Wrestling Association were participated in this study. They were divided into two groups (chronic ankle instability group [n=10] or control group [n=10]) based on Cumberland’s ankle instability questionnaire. Ankle strength (dorsiflexion, plantarflexion, inversion, and eversion) were measured using manual muscle tester, and the dynamic balance was measured using Y-Balance test (anterior, postero-medial, postero-lateral, and composite). Functional movement hop test (side hop, square hop, and figure-of-8 hop) were used to evaluate functional movement.RESULTS The significant interaction was observed between group and time on the Y-balance test (composite score), and functional movement hop test (figure-of-8 hop) (group × time, all P for interaction < 0.05).CONCLUSIONS These results suggest that Kinesio taping has a positive effect on dynamic balance and functional movement. Also, Kinesio taping may be able to use an alternative and effective methods to maintain ankle stability and performance in the wrestlers with chronic ankle instability.

Gait Biomechanics Following Taping and Bracing in Patients With Chronic Ankle Instability: A Critically Appraised Topic

Clinical Scenario: Approximately 30% of all first-time patients with LAS develop chronic ankle instability (CAI). CAI-associated impairments are thought to contribute to aberrant gait biomechanics, which increase the risk of subsequent ankle sprains and the development of posttraumatic osteoarthritis. Alternative modalities should be considered to improve gait biomechanics as impairment-based rehabilitation does not impact gait. Taping and bracing have been shown to reduce the risk of recurrent ankle sprains; however, their effects on CAI-associated gait biomechanics remain unknown. Clinical Question: Do ankle taping and bracing modify gait biomechanics in those with CAI? Summary of Key Findings: Three case-control studies assessed taping and bracing applications including kinesiotape, athletic tape, a flexible brace, and a semirigid brace. Kinesiotape decreased excessive inversion in early stance, whereas athletic taping decreased excessive inversion and plantar flexion in the swing phase and limited tibial external rotation in terminal stance. The flexible and semirigid brace increased dorsiflexion range of motion, and the semirigid brace limited plantar flexion range of motion at toe-off. Clinical Bottom Line: Taping and bracing acutely alter gait biomechanics in those with CAI. Strength of Recommendation: There is limited quality evidence (grade B) that taping and bracing can immediately alter gait biomechanics in patients with CAI.

Effects of Nonelastic Taping and Dual Task on Kinematics and Kinetics of the Ankle Joint

Objectives

The purpose of this experimental study was to investigate the effects of nonelastic taping and dual task on ankle kinematics and kinetics in gait analysis of healthy adults.

Methods

A total of 21 healthy adults completed trials of gait analysis using a Vicon system combining ground walking with different cognitive task conditions (none, modified Stroop color/character naming, and serial-7 subtraction), with or without nonelastic taping. Ankle kinematics and kinetics including speed, ankle plantarflexion and inversion angle, ground reaction force (GRF), and stride time variability (STV) under all conditions of taping (YES or NO) and cognitive task (none, naming, and subtraction) were characterized and analyzed with repeated-measures ANOVA.

Results

As regards cognitive performance, the serial-7 subtraction performance under walking conditions with and without taping was significantly poorer than simple sitting condition (P < 0.001). For kinematics and kinetics, STV showed statistically significant decrease (P=0.02) when subjects underwent taping application. Vertical GRF was significantly greater under taping than barefoot (P=0.001). Ankle plantarflexion at initial contact (IC) under the dual-task walking was significantly more than under simple walking (P=0.008).

Conclusions

Applications of nonelastic taping and dual task may lead to the STV, vertical GRF, ankle plantarflexion, and speed alterations because of restricted joint range of motion and changed sensorimotor neural circuit. When healthy adults performed dual-task walking, central neural resources allocation was disturbed, leading to weakened performance in both motor and cognitive tasks.

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.

Inferior tibiofibular joint mobilization with movement and taping does not improve chronic ankle dorsiflexion stiffness: a randomized placebo-controlled trial

OBJECTIVE

This study compared the modification of musculoarticular stiffness (MAS) and clinical outcomes after mobilization with movement (MWM) on the inferior tibiofibular joint and a placebo MWM. Moreover, injured and non-injured ankle MAS were compared after MWM therapy.

METHODS

A single-blinded randomized trial was conducted on 75 participants (mean age: 22.3 ± 2.17 years) with chronic self-reported asymmetric perception of ankle dorsiflexion stiffness. Participants were allocated to one of three groups: inferior tibiofibular MWM (ITFMWM), placebo and non-injured. Sinusoidal oscillation methods were used for experimental quantification of the MAS and clinical outcomes were assessed using the weight-bearing lunge test (WBLT), pain and stiffness perception. Three assessments were made: one pre-treatment (T0), one after the manual technique (T1) and one after taping (T2).

RESULTS

Two-way ANOVA showed no significant differences between the groups and no interaction effect for the outcome measures. However, a significant difference for the time effect (T0-T1-T2) was found in the three groups for WBLT dorsiflexion range of motion (p < 0.001, Cohen's d = 0.21) and stiffness perception (p < 0.001, Cohen's d = 0.54) but the minimal clinically important differences were not reached for either value.

DISCUSSION

The results could not support that a single session of ITFMWM modifies MAS or the clinical outcomes compared to placebo treatment. Furthermore, injured MAS does not differ from non-injured MAS in chronic ankle dorsiflexion stiffness. Further studies should assess subjects' responsiveness concerning the Mulligan concept and focus on a medium- to long-term follow-up.

Immediate Effects of Ankle Non-elastic Taping on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized, Controlled Trial

OBJECTIVE

The purpose of this study was to determine the immediate effects of ankle non-elastic taping on balance and gait ability in patients with chronic stroke.

METHODS

Thirty patients (inpatients and outpatients) with stroke were randomly assigned to 2 groups: the non-elastic taping group (n = 15) and the placebo-taping group (n = 15). Patients in the non-elastic taping group received Endura sports taping for their ankle joint, and patients in the placebo-taping group received Endura fix tape for their ankle joint. The Balance System SD assessed balance, and the GAITRite system assessed gait ability. We recorded measurements before and after intervention.

RESULTS

The non-elastic taping group showed a significant improvement in static and dynamic standing balance (P ≤ .001) after intervention; in addition, this group showed significant increases in the velocity, cadence, step length, and stride length of gait (P ≤ .001) after intervention. However, the placebo-taping group showed no significant improvements in standing balance and gait ability after intervention (P >.05). Furthermore, significant differences in static and dynamic standing balance, cadence, and velocity were observed between the 2 groups after intervention (P ≤ .001).

CONCLUSIONS

Our results demonstrate that the application of ankle non-elastic taping is effective at improving balance and gait abilities in patients with stroke. Ankle non-elastic taping appears to be an effective method to facilitate active rehabilitation in patients with hemiplegia.

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.

Individuals with recurrent ankle sprain demonstrate postural instability and neuromuscular control deficits in unaffected side

PURPOSE

To compare proprioception, postural stability, and neuromuscular control between patients with mechanical laxity and recurrent ankle sprain.

METHODS

Among 86 patients with ankle instability, 45 patients had mechanical laxity (mean age 27.2 ± 7.0 years) and 41 had recurrent ankle sprain (mean age 25.1 ± 9.2 years). Both the affected and unaffected ankles of each patient were evaluated. Proprioception and neuromuscular control tests were conducted using an isokinetic machine, and postural stability was tested using a postural stabilometry system.

RESULTS

Proprioception was not significantly different between the unaffected or affected ankles of the mechanical laxity group compared with those of the recurrent ankle sprain group (n.s). Static and dynamic postural stability and neuromuscular control were similar in the affected ankles between the two groups (n.s). However, postural stability (static, overall: p = 0.009, anterior-posterior: p = 0.028, medial-lateral: p = 0.022; dynamic, overall: p = 0.012, anterior-posterior: p = 0.004, medial-lateral: p = 0.001) and neuromuscular control (inversion: p = 0.031, eversion: p = 0.039, dorsiflexion: p = 0.029, plantarflexion: p = 0.035) were significantly decreased in the unaffected ankles of the recurrent ankle sprain group compared with those of the mechanical laxity group.

CONCLUSION

The unaffected ankles of the recurrent ankle sprain group showed significant decreases in both postural stability and neuromuscular control compared with the mechanical laxity group. Clinicians and therapists should consider unaffected ankle rehabilitation in patients with recurrent ankle sprain to prevent future sprain events.

LEVEL OF EVIDENCE

Case-control study, III.

In vivo arthrometer measurements of mechanical ankle instability-A systematic review

Chronic ankle instability is caused by functional and/or mechanical deficits. To differentiate the two entities, mechanical ankle instability can be assessed using arthrometers. The measurement of mechanical instability is essential, since it can only be addressed surgically. The aim of this systematic literature review was to find out whether chronic mechanical ankle instability could be adequately and objectively assessed using in vivo arthrometer measurements. Articles were included if the main focus was to evaluate the contribution of mechanical deficits to chronic ankle instability and if they provided sufficient description of the device used. This systematic review was performed according to the PRISMA-recommendations. Initially 47 articles were screened for eligibility, of which 33 studies reporting 10 different devices were included. While the reliability of the measurements was mostly good to excellent, only two studies aimed to assess the sensitivity and specificity of their results in regard to chronic ankle instability. Several devices reported conflicting results about mechanical deficits. In summary, this systematic review reveals a substantial deficit in diagnostic accuracy when assessing mechanical ankle instability in a clinical setting. Biases in recruiting and classification of participants raise the question whether the two entities of functional and mechanical ankle instability are properly defined. Clinical Significance: In recent years, this may have led to a misinterpretation of mechanical deficits and the subsequent need for surgical intervention. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Nonelastic and Kinesio Tex Tapes Improve Perceived Stability But Not Postural Control in Participants With Chronic Ankle Instability

The development of chronic ankle instability (CAI) is common following a lateral ankle sprain. Taping using nonelastic and Kinesio Tex (KT) tapes remain popular treatment strategies. The purpose of this investigation was to determine if KT tape improves static and dynamic postural control relative to nonelastic tape and a control condition. Twenty-four participants completed all three conditions. No immediate improvements in postural control were noted in either taping condition. Both nonelastic and KT tape improved perceived stability relative to the control condition. In conclusion, nonelastic and KT tape should not be used to immediately improve postural control in CAI participants.

Effects of Taping on Achilles Tendon Protection and Kendo Performance

Context:It has been reported that there is a high rate of Achilles tendon injury among kendo athletes. For protection and to support the area, kendo athletes habitually use taping during practice or games.Objective:To investigate the effect of various taping techniques on injury prevention and functional performance in kendo athletes.Design:Case-control study.Setting:Laboratory.Participants:15 University Kendo Team athletes with at least 2 y kendo experience.Main Outcome Measures:Athletes completed 5 stepping backwards and striking cycles under 4 taping conditions: no taping, athletic taping of ankle joint (AT-Ankle), athletic taping of Achilles tendon (AT-Achilles), and Kinesio-Tex taping of Achilles tendon (KT-Achilles). Jump distance, lower limb angular motion, left foot-ground contact time, Achilles tendon force (ATF), and soleus and medial gastrocnemius muscle activities were measured.Results:Lowest peak ATF was found in AT-Achilles during heel-down phase, with statistically significant difference from KT-Achilles peak force. Significant decline of soleus muscle electromyography amplitude was also found when compared to no taping during heel-down phase and other conditions during pushing phase. Conversely, KT-Achilles showed significant decrease in foot-ground contact time compared with no taping and greater ankle range of motion than in AT-Ankle.Conclusion:To protect the Achilles tendon, AT-Achilles taping is recommended since it tends to decrease ATF. Conversely, to enhance athlete performance, we recommend KT-Achilles taping to speed up kendo striking motion. However, the Achilles tendon must withstand greatest forces concurrently. This finding implies that AT-Achilles taping can protect the injured Achilles tendon and KT-Achilles taping can enhance performance on the kendo striking motion.

Effect of kinesiotaping, non-elastic taping and bracing on segmental foot kinematics during drop landing in healthy subjects and subjects with chronic ankle instability

OBJECTIVE

To evaluate the effects of kinesiotape, non-elastic tape, and soft brace on segmental foot kinematics during drop landing in subjects with chronic ankle instability and healthy subjects.

DESIGN

Controlled study with repeated measurements.

SETTING

Three-dimensional motion analysis laboratory.

PARTICIPANTS

Twenty participants with chronic ankle instability and 20 healthy subjects.

INTERVENTIONS

The subjects performed drop landings with 17 retroreflective markers on the foot and lower leg in four conditions: barefoot, with kinesiotape, with non-elastic tape and with a soft brace.

MAIN OUTCOME MEASURES

Ranges of motion of foot segments using a foot measurement method.

RESULTS

In participants with chronic ankle instability, midfoot movement in the frontal plane (inclination of the medial arch) was reduced significantly by non-elastic taping, but kinesiotaping and bracing had no effect. In healthy subjects, both non-elastic taping and bracing reduced that movement. In both groups, non-elastic taping and bracing reduced rearfoot excursion in inversion/eversion significantly, which indicates a stabilisation effect. No such effect was found with kinesiotaping. All three methods reduced maximum plantar flexion significantly.

CONCLUSIONS

Non-elastic taping stabilised the midfoot best in patients with chronic ankle instability, while kinesiotaping did not influence foot kinematics other than to stabilise the rearfoot in the sagittal plane.

CLINICAL TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT01810471.

Patient-Reported Outcome Measures in Individuals With Chronic Ankle Instability: A Systematic Review

CONTEXT

A comprehensive systematic literature review of the health-related quality-of-life (HRQOL) differences among individuals with chronic ankle instability (CAI), ankle-sprain copers, and healthy control participants has not been conducted. It could provide a better indication of the self-reported deficits that may be present in individuals with CAI.

OBJECTIVE

To systematically summarize the extent to which HRQOL deficits are present in individuals with CAI.

DATA SOURCES

We searched for articles in the electronic databases of EBSCO Host and PubMed Central using key words chronic, functional, mechanical, coper, instability, sprains, and patient-assessed. We also performed a hand search of reference lists, authors, and patient-reported outcomes (PROs) of the articles screened for inclusion.

STUDY SELECTION

Studies were included if they (1) incorporated a PRO as a participant descriptor or as a study outcome to compare adults with CAI to ankle-sprain copers or healthy controls, (2) were written in English, and (3) were published in peer-reviewed journals.

DATA EXTRACTION

Two authors independently assessed methodologic quality using the modified Downs and Black Index. Articles were filtered into 3 categories based on between-groups comparisons: CAI and copers, CAI and healthy control participants, copers and healthy participants. We calculated Hedges g effect sizes and 95% confidence intervals to examine PRO group differences.

DATA SYNTHESIS

Of the 124 studies assessed for eligibility, 27 were included. A total of 24 articles compared PROs in individuals with CAI and healthy controls, 7 compared individuals with CAI and copers, and 4 compared copers and healthy controls. Quality scores on the modified Downs and Black Index ranged from 52.9% to 88.2%, with 8 high-, 16 moderate-, and 3 low-quality studies. Overall, we observed moderate to strong evidence that individuals with CAI displayed deficits on generic and region-specific PROs compared with copers and healthy controls. However, evidence that differences exist between copers and healthy controls was conflicting. In addition, for dimension-specific outcomes, evidence to suggest that fear of reinjury is heightened in individuals with CAI was limited.

CONCLUSIONS

The evidence suggested that CAI is associated with functional and HRQOL deficits, particularly when examined with region-specific PROs. However, PROs do not appear to differ between copers and healthy controls.

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

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

Ankle ligament laxity and stiffness in chronic ankle instability

BACKGROUND

The contribution of mechanical laxity and ligament stiffness to chronic ankle instability is unclear, particularly when using the inversion laxity test, and may have implications for diagnosis, prognosis, and treatment. Our purpose was to determine if individuals with chronic ankle instability demonstrate greater mechanical ligament laxity and altered stiffness compared to controls and copers (those with a healed sprain) during an instrumented arthrometer inversion stress test.

METHODS

Recreationally active individuals were classified as those with chronic ankle instability (n = 16), copers (n = 16), or controls (n = 16) based on injury history and self-reported score on the Cumberland Ankle Instability Tool (CAIT). Three trials of an inversion stress test were applied with an instrumented arthrometer utilizing a reliable tester. Talocrural inversion (degrees) and stiffness values were extracted. One-way ANOVAs were calculated, and Tukey post hoc testing was applied (α ≤ .05).

RESULTS

Groups were not different in age, height, or weight. The chronic ankle instability group (19 ± 6) had significantly lower CAIT scores than the control (30 ± 1) and coper (29 ± 1) groups (P < .001). The chronic ankle instability group (23 ± 12 degrees) demonstrated significantly greater inversion than the controls (13 ± 9 degrees) (P = .04) but was not significantly different than the copers (17 ± 10 degrees). No significant differences were detected in stiffness between the groups.

CONCLUSION

The chronic ankle instability group demonstrated decreased self-reported ankle function and increased mechanical laxity utilizing an instrumented arthrometer for inversion compared to the control group but not the coper group. Laxity, but not stiffness, may be a factor affecting chronic ankle instability and self-reported function.

LEVEL OF EVIDENCE

Level III, comparative study.

Effect of kinesio taping on jumping and balance in athletes: a crossover randomized controlled trial

The purpose of this crossover randomized controlled trial was to verify the effect of Kinesio Taping (KT) applied to the triceps surae with the aim to improve muscle performance during vertical jump (VJ), horizontal jump (HJ), and dynamic balance (DB) in healthy college athletes. The participants were 20 athletes (11 men) who competed in 4 different sports modalities (track and field, handball, volleyball, and soccer). Participants had a mean age of 22.3 ± 3.3 years, mean height of 1.74 ± 0.08 m, and mean body mass of 67.8 ± 10.1 kg. The intervention consisted of applying KT from the origin of the triceps surae to its insertion with the purpose of increasing muscle performance, and the placebo consisted of applying tape with nonelastic properties. There were no significant differences between KT and placebo conditions for height (m) in VJ (KT, 0.18 ± 0.06; placebo, 0.17 ± 0.06; p = 0.14), distance (m) in HJ (KT, 1.48 ± 0.3; placebo, 1.47 ± 0.3; p = 0.40), and DB in distance reached (m) in the star excursion balance test, normalized by lower limb length (anterior: KT, 90.0 ± 6.7; placebo, 89.5 ± 7.5; p = 0.56; posterolateral: KT, 92.5 ± 7.5; placebo, 93.2 ± 5.8; p = 0.52; posteromedial: KT, 98.3 ± 6.7; placebo, 98.7 ± 7.4; p = 0.69). The KT technique was not found to be useful in improving performance in some sports-related movements in healthy college athletes; therefore, KT applied to the triceps surae should not be considered by athletes when the sole reason of the application is to increase performance during jumping and balance.

Difference in postural control between patients with functional and mechanical ankle instability

BACKGROUND

Lateral ankle sprain is one of the most common injuries. Since the structural and pathological differences in mechanical ankle instability (MAI) and functional ankle instability (FAI) may not be the same, it may be better to treat these as separate groups. The purpose of this study was to compare the difference in postural sway between MAI and FAI in patients with chronic ankle instability (CAI).

METHODS

Twenty-six patients with CAI and 14 healthy control participants were included in the study. The CAI patients were subdivided into MAI (15 patients) and FAI (11 patients) groups. Patients who were diagnosed with lateral ankle ligaments rupture by magnetic resonance imaging and ultrasonography were assigned to the MAI group. All participants performed single-limb postural sway tests 3 times on each leg with eyes closed and open. The average distances from the mean center of pressure position in the mediolateral and anteroposterior directions were recorded and compared among the 3 groups.

RESULTS

The unstable ankles in the MAI group showed significantly greater postural sway in the anterior, posterior, and medial directions compared with those in the control group with eyes closed. With eyes open, significantly greater postural sway was found in the anterior direction. In the FAI group, no difference was found in postural sway compared with those in the control group. The MAI group showed significantly greater postural sway in the anterior direction compared with the FAI group with eyes closed and open. No significant difference in postural sway was found between the unstable and stable ankles in the MAI or FAI groups, with or without vision.

CONCLUSIONS

Patients with MAI have deficits in postural control, especially in anterior-posterior directions. However, no difference was found in postural sway in patients with FAI compared with healthy people.

CLINICAL RELEVANCE

As MAI patients suffer from deficits in postural control, balance training should be applied in those patients. In addition, special training should also include the contralateral side after a unilateral ankle ligament injured.

The effects of ankle Kinesio taping on ankle stiffness and dynamic balance

The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted.

Clinical examination results in individuals with functional ankle instability and ankle-sprain copers

CONTEXT

Why some individuals with ankle sprains develop functional ankle instability and others do not (ie, copers) is unknown. Current understanding of the clinical profile of copers is limited.

OBJECTIVE

To contrast individuals with functional ankle instability (FAI), copers, and uninjured individuals on both self-reported variables and clinical examination findings.

DESIGN

Cross-sectional study.

SETTING

Sports medicine research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Participants consisted of 23 individuals with a history of 1 or more ankle sprains and at least 2 episodes of giving way in the past year (FAI: Cumberland Ankle Instability Tool [CAIT] score = 20.52 ± 2.94, episodes of giving way = 5.8 ± 8.4 per month), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers: CAIT score = 27.74 ± 1.69), and 23 individuals with no history of ankle sprain and no instability (uninjured: CAIT score = 28.78 ± 1.78).

INTERVENTION(S)

Self-reported disability was recorded using the CAIT and Foot and Ankle Ability Measure for Activities of Daily Living and for Sports. On clinical examination, ligamentous laxity and tenderness, range of motion (ROM), and pain at end ROM were recorded.

MAIN OUTCOME MEASURE(S)

Questionnaire scores for the CAIT, Foot and Ankle Ability Measure for Activities of Daily Living and for Sports, ankle inversion and anterior drawer laxity scores, pain with palpation of the lateral ligaments, ankle ROM, and pain at end ROM.

RESULTS

Individuals with FAI had greater self-reported disability for all measures (P < .05). On clinical examination, individuals with FAI were more likely to have greater talar tilt laxity, pain with inversion, and limited sagittal-plane ROM than copers (P < .05).

CONCLUSIONS

Differences in both self-reported disability and clinical examination variables distinguished individuals with FAI from copers at least 1 year after injury. Whether the deficits could be detected immediately postinjury to prospectively identify potential copers is unknown.

Role of external prophylactic support in restricting accessory ankle motion after exercise

BACKGROUND

To both prevent and accelerate recovery and return-to-play from ankle sprains, clinicians frequently employ the use of external prophylactic support (EPS), such as taping and bracing, to provide mechanical support to the ankle joint. While common practice clinically, research has been inconclusive in demonstrating the effectiveness of EPS in restricting accessory motion (laxity) throughout activity, as well as its efficacy in restricting laxity in patients with complaints of ankle instability, and patients with a history of ankle sprain. The purpose of this study was to investigate the effectiveness of EPS type (None, Tape, Brace) on ankle laxity before and after exercise in subjects with varying degrees of previous ankle injury.

METHODS

Ankles from 24 participants (age, 20.6 ± 1.6 years; height, 173.6 ± 8.3 cm; mass, 72.8 ± 12.2 kg) were placed into one of three groups: healthy control (CON), potential coper (COP), and functionally unstable (UNS). Ankle laxity was assessed using an ankle arthrometer at 4 points in time; prior to EPS application, immediately following EPS application, following a 20-minute functional exercise protocol with EPS, and following removal of EPS. Peak ankle anterior displacement (ANT), inversion rotation (INV), and eversion rotation (EVR) were compared between groups and across conditions using a three-way ANOVA.

RESULTS

Taping and bracing each decreased laxity from pre-application to pre-exercise and post-exercise. Tape provided greater restriction post-exercise in inversion and eversion rotation. Additionally, the UNS group demonstrated significantly greater anterior displacement post-exercise following removal of the brace compared to other groups.

CONCLUSION

Compared to pre-application and post-removal, EPS significantly decreased ankle laxity before and after physical activity, with taping providing better restriction in inversion and eversion rotation throughout exercise.

CLINICAL RELEVANCE

Following EPS removal, bracing revealed a greater increase in post-exercise laxity in subjects with ankle instability, suggesting tape may be more beneficial for controlling laxity in these patients.

The effect of ankle taping or bracing on proprioception in functional ankle instability: a systematic review and meta-analysis

OBJECTIVES

To determine if wearing an ankle brace or taping the ankle, compared to no brace or tape, improves proprioceptive acuity in people with a history of ankle sprain or functional ankle instability.

DESIGN

Systematic review and meta-analysis.

METHODS

Studies using controlled, cross-over designs whereby participants who had sprained their ankle at least once or had functional ankle instability, underwent some form of proprioceptive sensation testing with and without ankle brace or tape, were included. Proprioceptive acuity was reported for the ankle tape/brace condition and the condition where no tape or brace was worn. Meta-analysis was employed to compare proprioceptive acuity with and without ankle tape/brace.

RESULTS

Eight studies were included in the review. Studies measured either sense of movement or sense of joint position. The mean differences in 19 of 32 comparisons were not significant. Of the remaining mean differences, 10 were positive, indicating better proprioceptive acuity in the taped/braced condition and 3 were negative, indicating poorer proprioceptive acuity. Overall, there was no significant effect with ankle tape/brace compared to the no tape/brace condition (mean difference: 0.08°, 95% CI: -0.39 to 0.55). This finding was consistent when the two aspects of proprioception (sense of movement or joint position) were considered separately.

CONCLUSIONS

The pooled evidence suggests that using an ankle brace or ankle tape has no effect on proprioceptive acuity in participants with recurrent ankle sprain or who have functional ankle instability.

Chronic ankle instability: diagnosis and treatment

BACKGROUND

Chronic ankle instability (CAI) is a very common injury but still remains an area of debate.

QUESTIONS

This review aims to define the current diagnosis and treatment of persons with CAI.

METHODS

A PubMed (MEDLINE) search of the years 2010 and 2011 (1 January 2010 to 15 July 2011) was performed using three keywords: ankle and chronic and instability. The number of articles in English language that was identified was 57.

RESULTS

Low reliability has been found in effectively testing CAI in a clinical setting. No single force-plate measure is very effective in predicting if an individual had CAI or not. Availability of a nonradiographic device (ankle arthrometer) to measure ankle instability could improve diagnostic accuracy and facilitate decision making in patients with CAI. The sensitivity of magnetic resonance imaging (MRI) may not be adequate to detect lesions in these patients before surgery. In a symptomatic patient, negative results on MRI must be viewed with caution and an arthroscopy may still be required for a definitive diagnosis and treatment. Conservative treatment (rehabilitation, taping, brace) may reduce the occurrence of recurrent ankle sprains and may be effective in managing CAI. In patients with CAI, strengthening of the muscles around the ankle with well-planned proprioceptive exercises helped the patients return to normal living and sports activities, and prevents unnecessary surgery, especially in cases with functional instability. There is no consensus regarding optimum surgical treatment for CAI, but all of them often have good results.

CONCLUSIONS

Conservative treatment of patients with CAI must be the first-line therapy. Surgical treatment must be indicated only when conservative treatment fails.

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.