The effect of ankle taping on functional performance in participants with functional ankle instability

Validity and reliability of smartphone-based application for chronic ankle instability

Background/aims

Ankle instability is one of the most common injuries that can occur during everyday life, sports and exercise. Recently, smartphone accelerometers have been used to measure single leg balance associated with ankle instability, because they are easy to use, inexpensive and can be used in small spaces. Thus, the purpose of this study was to introduce and investigate the intra- and inter-rater reliability of the smartphone accelerometer when assessing ankle instability.

Methods

A total of 26 individuals who had ankle instability were recruited. The single leg stance balance was measured using a smartphone accelerometer (Accelerometer application) and a force platform (I-Balance) for 5 seconds with their eyes open or their eyes closed.

Results

In the eyes open position, intra-rater reliability of the smartphone accelerometer was excellent for both raters (intraclass correlation coefficient: 0.87–0.90); and the inter-rater reliability was moderate (intraclass correlation coefficient: 0.71). In the eyes closed position, the intra-rater reliability of the smartphone accelerometer was excellent for both raters (intraclass correlation coefficient: 0.90–0.93); the inter-rater reliability was good (intraclass correlation coefficient: 0.82). Additionally, there were fair positive correlations between the smartphone accelerometer and the Cumberland Ankle Instability Tool, and between the smartphone accelerometer and I-Balance (r=0.33, 0.30 respectively).

Conclusions

The present study demonstrated excellent intra-rater reliabilities of two raters and moderate to good inter-rater reliabilities. The smartphone accelerometer offers several important advantages as a potential portable medical device to assess ankle instability accurately. Although there was a positive correlation, the relationships between the smartphone accelerometer and Cumberland Ankle Instability Tool and that between the smartphone accelerometer and I-Balance were fair. Future studies should investigate the validity of the smartphone accelerometer as a portable medical device for determining ankle instability.

Acute Effect of Ankle Kinesio™ Taping on Lower-Limb Biomechanics During Single-Legged Drop Landing

CONTEXT

Chronic ankle instability is documented to be followed by a recurrence of giving away episodes due to impairments in mechanical support. The application of ankle Kinesiotaping (KT) as a therapeutic intervention has been increasingly raised among athletes and physiotherapists.

OBJECTIVES

This study aimed to investigate the impacts of ankle KT on the lower-limb kinematics, kinetics, dynamic balance, and muscle activity of college athletes with chronic ankle instability.

DESIGN

A crossover study design.

PARTICIPANTS

Twenty-eight college athletes with chronic ankle sprain (11 females and 17 males, 23.46 [2.65] y, 175.36 [11.49] cm, 70.12 [14.11] kg) participated in this study.

SETTING

The participants executed 3 single-leg drop landings under nontaped and ankle Kinesio-taped conditions. Ankle, knee, and hip kinematics, kinetics, and dynamic balance status and the lateral gastrocnemius, medial gastrocnemius, tibialis anterior, and peroneus longus muscle activity were recorded and analyzed.

RESULTS

The application of ankle KT decreased ankle joint range of motion (P = .039) and angular velocities (P = .044) in the sagittal plane, ground reaction force rate of loading (P = .019), and mediolateral time to stability (P = .035). The lateral gastrocnemius (0.002) and peroneus longus (0.046) activity amplitudes also experienced a significant decrease after initial ground contact when the participants' ankles were taped, while the application of ankle KT resulted in an increase in the peroneus longus (0.014) activity amplitudes before initial ground contact.

CONCLUSIONS

Ankle lateral supports provided by KT potentially decreases mechanical stresses applied to the lower limbs, aids in dynamic balance, and lowers calf muscle energy consumption; therefore, it could be offered as a suitable supportive means for acute usage in athletes with chronic ankle instability.

THE RELATIONSHIP BETWEEN SINGLE LEG BALANCE AND ISOMETRIC ANKLE AND HIP STRENGTH IN A HEALTHY POPULATION

Background

Impaired balance and strength commonly affect athletes with conditions like chronic ankle instability (CAI). Yet, clinical research surrounding the relationship between balance, strength, and CAI is still growing. Deeper investigation of these relationships is warranted to better inform clinical practice patterns when managing athletes with balance deficits.

Purpose

To investigate the relationship between single leg balance, ankle strength, and hip strength in healthy, active adults.

Study Design

Observational study.

Methods

Forty healthy participants (age 23.7 ± 4.9 years) were assessed for static balance, using a modified version of the Balance Error Scoring System (mBESS), as well as isometric strength of ankle and hip musculature via handheld dynamometry. Pearson's correlations were used to analyze relationships between balance and strength measures. Paired t-tests were utilized to compare dominant and non-dominant limb performance.

Results

Negligible to low, negative correlations were found between balance scores and hip extension strength (r = -0.24 to -0.38, p<0.05). High, positive correlations were found between ankle and hip strength measures (r = 0.75 to 0.84, p<0.05). When comparing dominant to non-dominant limbs, only minimal differences were noted in ankle eversion strength (mean difference = 6.0%, p<0.01) and hip extension strength (mean difference = 5.5%, p<0.01).

Conclusions

Minimal relationships were identified between static balance and isometric ankle and hip strength. Comparison of dominant and non-dominant limbs suggests that clinicians should expect relative symmetry in balance and strength in healthy adults. Thus, asymmetries found during clinical examination should raise suspicion of specific impairments that may lead to dysfunction.

Level of Evidence

2c.

Short-term and long-term effects of ankle joint taping and bandaging on balance, proprioception and vertical jump among volleyball players with chronic ankle instability

OBJECTIVE

This study hypothesized that the prolonged use of taping during athletic activities produces more significant increases in proprioception, balance, and vertical jump among volleyball players with CAI.

DESIGN

A randomized controlled study.

PARTICIPANTS

One-hundred participants with chronic ankle instability (CAI) participated in this study. Participants were distributed into 3-groups: taping group, bandaging group, and control group.

PRIMARY OUTCOME MEASURES

Proprioception (ankle range of motion absolute error), balance(Y-balance test), and vertical jump (vertical jump tester).

INTERVENTIONS

Three interventions were performed: ankle rigid taping, ankle bandaging, and placebo taping. The measurements were performed at baseline, immediately, 2-weeks and 2-months after support.

RESULTS

Immediately after supports, there were non-significant differences between all groups for proprioception, balance (P < .05). There was a significant difference between banding and control groups, and taping and control groups for the vertical jump (P < .05). After 2-weeks and 2-months, there were significant differences between bandaging and control groups, and taping and control groups for proprioception, balance, and vertical jump (P < .05). There were non-significant differences between taping and bandaging groups (P < .05) during all assessments.

CONCLUSION

This study indicated that ankle taping and bandaging immediately improve vertical jump only; while they improve proprioception, balance, and vertical jump after 2-weeks and 2-months.

Acute Effect of Kinesiology Taping on Postural Stability in Individuals With Unilateral Chronic Ankle Instability

Background

Chronic ankle instability (CAI), which is characterized by deficient postural control, could be improved through kinesiology taping (KT). However, the effect of KT on postural control in CAI individuals is controversial. Therefore, this study aimed to investigate the acute effect of KT on postural control through computerized dynamic posturography (CDP) and self-perceived sensation in CAI individuals.

Methods

Participants with CAI received four different ankle treatments randomly, including KT, athletic taping (AT), sham taping (ST), and no taping (NT). A series of postural stability measurements was performed using CDP subsequently. The measurements included sensory organization test (SOT), unilateral stance (US), limit of stability (LOS), motor control test (MCT), and adaption test (ADT). In addition, self-perceived sensation was measured through visual analog scaling. Repeated measures analysis of variance was conducted to determine whether the difference among KT, AT, ST, and NT was significant; Bonferroni test was used for post hoc analysis.

Results

No significant difference was observed for parameters in SOT, US, and LOS in four different taping treatments. In MCT, the amplitude scaling scores of KT were 35.87% significantly lower than that of NT [p < 0.001, 95% confidence interval (CI) = 0.548–1.795] in forward-small slip and 21.58% significantly lower than that of ST (p = 0.035, 95% CI = 0.089–3.683) in backward-large slip. In ADT, sway energy scores were 7.59% significantly greater in ST than in AT (p = 0.028, 95% CI = −8.343 to −0.320). For perceived stability, KT was significantly greater than ST (p < 0.001, 95% CI = 0.552–1.899) and NT (p < 0.001, 95% CI = 0.797–2.534), and AT was significantly greater than ST (p = 0.001, 95% CI = 0.423–2.246) and NT (p < 0.001, 95% CI = 0.696–2.852). For perceived comfort, KT was significantly greater than AT (p = 0.001, 95% CI = 0.666–3.196) and NT (p = 0.031, 95% CI = 0.074–2.332), and ST was significantly greater than AT (p = 0.007, 95% CI = 0.349–2.931).

Conclusion

KT and AT have limited effect to facilitate postural control for CAI individuals during SOT, US, and LOS. However, KT and AT could provide effective support to cope with sudden perturbation in MCT and ADT. Moreover, KT provided excellent perceived stability and comfort, whereas AT provided excellent perceived stability but least comfort.

Comparison of virtual reality exercise versus conventional exercise on balance in patients with functional ankle instability: A randomized controlled trial

BACKGROUND

Recently, a variety of virtual reality (VR)-based interventions have been studied. However, they were only partially applied to physical therapy.

OBJECTIVE

The present study investigated the effects of a VR exercise program by comparing the results of VR and conventional exercise on balance in patients with functional ankle instability (FAI).

METHODS

Twenty-one participants with symptoms of FAI participated in this study. In the VR training program, the strength and balance exercises were done for 10 minutes each using a program included in the Nintendo Wii Fit Plus for VR intervention. In the conventional program, four ankle strength exercises using the TheraBand and the balance exercises were performed for 10 minutes each. Static and dynamic balance were measured in the overall, anterior-posterior, and medial-lateral directions.

RESULTS

Static balance in the VR exercise was significantly lower in the overall direction than in the conventional exercise. Dynamic balance in the virtual reality exercise was significantly lower than in the conventional exercise at level 2, level 4, and level 8 balance in the medial-lateral direction.

CONCLUSIONS

This study has shown that VR exercise is more effective in the overall direction (static) and medial-lateral direction (dynamic) of balance than conventional method in patients with FAI.

Do External Supports Improve Dynamic Balance in Patients with Chronic Ankle Instability? A Network Meta-analysis

BACKGROUND

To improve ankle stability in patients who have experienced an ankle sprain with residual symptoms of instability and/or objective joint laxity, external supports (such as taping, bracing, and orthotic insoles) are used sometimes. However, available randomized trials have disagreed on whether restraints improve balance in those individuals. In this situation, a network meta-analysis can help because it allows for comparing multiple treatments simultaneously, taking advantage not only of direct but also indirect evidence synthesis.

QUESTIONS/PURPOSES

The aim of this network meta-analysis was to assess (1) the impact of taping and orthotic devices on dynamic postural control in individuals with ankle instability and (2) the presence of a placebo effect in participants treated with sham taping and complications resulting from the administered treatments.

METHODS

We searched the PubMed, Scopus, and CENTRAL databases up to February 13, 2019 for completed studies. Randomized trials assessing the results of real and/or sham taping, wait-and-see protocols, ankle bracing, and foot orthotics for ankle instability as determined by one or more ankle sprains followed by ongoing subjective symptoms and/or mechanical laxity were included. We evaluated dynamic postural control in terms of the Star Excursion Balance Test in the posteromedial direction (SEBT-PM), which is considered the most representative of balance deficits in patients with ankle instability. Standardized mean differences were re-expressed to percentage differences in SEBT-PM, with higher scores representing possible improvement. Subsequently, those data were checked against the established minimal detectable change of 14% for this scale to make judgements on clinical importance. We also assessed the presence of a placebo effect by comparing the results of sham taping with no treatment and complications resulting from the administered treatments. Additionally, we judged the quality of trials using the Cochrane risk of bias tool and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. A total of 22 trials met our inclusion criteria, 18 of which were deemed to be at a low risk of bias. A network of treatments consisting of 13 studies was created, and the level of evidence was judged to be high. As far as participants' allocation to treatment arms, 85 patients followed a wait-and-see protocol, 29 received placebo taping, 99 were treated with taping, 16 were treated with bracing, 27 were administered insoles, and six individuals were offered a combination of insoles with bracing. Of note, with statistical power set at 80%, a minimum of 16 patients per treatment group was required to provide sufficient statistical power and detect a SEBT-PM percentage difference of 14%.

RESULTS

A network meta-analysis did not demonstrate a benefit of taping or bracing over no treatment (percentage difference in SEBT-PM between taping and bracing versus control: -2.4 [95% CI -6 to 1.1]; p = 0.18, and -7.5 [95% CI -15.9 to 1]; p = 0.08, respectively). This was also the case for sham taping because the measurement increase failed to exceed the minimal detectable change (percentage difference in SEBT-PM between sham taping and untreated control: -1.1 [95% CI -6.9 to 4.7]; p = 0.72). Importantly, there were no reported adverse events after treatment application.

CONCLUSIONS

Evidence of moderate strength indicated that external supports of any type were no more effective than controls in improving dynamic postural control in patients with at least one ankle sprain and residual functional or mechanical deficits. Therefore, implementing those tools as a standalone treatment does not appear to be a viable strategy for the primary management of ankle instability. It is conceivable that combinations of rehabilitation and external supports could be more effective than external supports alone, and future trials should evaluate the potential of such combinations in enhancing not only clinician-reported but also patient-oriented outcomes using long-term follow-up measurements.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Effects of Vibration Rolling with and without Dynamic Muscle Contraction on Ankle Range of Motion, Proprioception, Muscle Strength and Agility in Young Adults: A Crossover Study

Vibration rolling (VR) has emerged as a self-myofascial release (SMR) tool to aid exercise performance when warming up. However, the benefits of VR on exercise performance when combined with dynamic muscle contraction are unclear. The purpose of this study was to investigate the immediate effects of the combination of VR with dynamic muscle contraction (DVR), VR, and static stretching (SS) during warm-up on range of motion (ROM), proprioception, muscle strength of the ankle, and agility in young adults. In this crossover design study, 20 recreationally active adults without musculoskeletal disorders completed three test sessions in a randomized order, with 48 h of rest between each session. Participants completed one warm-up intervention and its measurements on the same day; different warm-up interventions and measurements were performed on each of the three days. The measurements included ankle dorsiflexion and plantarflexion ROM, ankle joint proprioception, muscle strength, and agility. After DVR and VR intervention, ankle dorsiflexion ROM (both DVR and VR, p < 0.001), plantarflexion ROM (both DVR and VR, p < 0.001), plantar flexor muscle strength (DVR, p = 0.007; VR, p < 0.001), and agility (DVR, p = 0.016; VR, p = 0.007) significantly improved; after SS intervention, ankle dorsiflexion and plantar flexion ROM (dorsiflexion, p < 0.001; plantar flexion, p = 0.009) significantly improved, but muscle strength and agility were not enhanced. Compared with SS, DVR and VR significantly improved ankle plantar flexor muscle strength (p = 0.008 and p = 0.001, respectively). Furthermore, DVR significantly improved ankle dorsiflexion compared with VR (p < 0.001) and SS (p < 0.001). In conclusion, either DVR, VR, or SS increased ankle ROM, but only DVR and VR increased muscle strength and agility. In addition, DVR produced considerable increases in ankle dorsiflexion. These findings may have implications for warm-up prescription and implementation in both rehabilitative and athletic practice settings.

Improvements in strength and functional performance after Kinesio taping in semi-professional male soccer players with and without functional ankle instability

OBJECTIVE

The objectives of this study were to compare the immediate effects of two methods of Kinesio taping on muscle strength, functional performance, and balance in athletes with and without functional ankle instability (FAI).

METHODS

The present study investigated the effects of distal taping (muscle application over peroneus longus) and proximal- distal taping (muscle application over gluteus medius and peroneus longus) on the strength of evertor and hip abductor muscles, side hop test, figure of 8 hop test, and star excursion balance test in semi-professional male soccer players with and without FAI (n=15 in each group). A Multifactorial repeated measure ANOVA was used for comparison.

RESULTS

There were significant differences for factor effect in all outcome measures (P<0.05), except for the figure of 8 hop test. No significant differences for group effects and group by factor interaction effects (P>0.05) was observed except for the side hop test.

CONCLUSION

Kinesio taping had immediate effects on improving strength, performance and balance. However, there were no differences on the method of application. Clinicians can consider the application Kinesio taping during the rehabilitation process of athletes with FAI, to improve balance and strength. The long-term impacts of taping on the functional, balance and strength measures should be investigated in future studies.

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.

Does the single-limb stance reflect chronic ankle instability in an athlete?

BACKGROUND

The single-limb stance with closed eyes has been widely used to evaluate chronic ankle instability as static balance; however, there was lack of consideration of whether difference in age, frequency of previous ankle sprain or physical ability influenced single-limb stance.

RESEARCH QUESTION

We hypothesized that the single-limb stance might not reflect subjective ankle instability and function on physical activity in people who perform sports activities.

METHODS

In total, 102 high school basketball players were recruited to evaluate their physical performance at the beginning of the season. Participants were divided into five groups based on the frequency of previous ankle sprain. Karlsson ankle function score (K score) was considered as a subjective ankle function score, that was divided into various components. Each component and the single-limb stance test with center of pressure (COP) analysis was observed between the frequency of ankle sprains with one-way ANOVA and compared using Spearman's rank correlation coefficient to verify the relationship between the K score and COP.

RESULTS

For COP parameters, no difference was observed in the history of ankle sprains. The K score was lower in participants with three previous ankle sprains than in those with a different number of ankle sprains for instability, stiffness, running, work activities, support, and total K score for all parameters. There were weak negative correlations (r = -0.19∼-0.35) between K score and COP parameters among participants with no history of ankle sprain or only once. In contrast, there were strong positive correlations (r = 0.69∼0.87) among history of ankle sprain at third.

SIGNIFICANCE

The single-limb stance might not accurately reflect an athlete's ankle instability and function on physical activity. Clinically, therapists should choose suitable evaluation tools depending on the athlete's activity level to check for chronic ankle instability.

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.

The use of parametric effect sizes in single study musculoskeletal physiotherapy research: A practical primer

Many researchers often do not report effect sizes at all, and, if they do report them, often do not report the correct measure for the design that has been used in the research. With the increased level of attention being given to the reporting of effect sizes and their corresponding confidence intervals, it is important that there is field-specific literature pertaining to the calculation and reporting of these measures. This paper acts as a practical primer for the calculation and reporting of effect size measures aimed at, but not limited to, the field of musculoskeletal physiotherapy research. This primer involves a discussion on which effect sizes are appropriate for within and between-subject single study research, illustrating, through examples based on musculoskeletal research data, how these measures are calculated, interpreted, and reported.

Short-term effect of spiral taping on the pain and walking performance of individuals with chronic ankle instability

[Purpose] This study was designed to investigate the effects of spiral taping (ST) on the pain and walking performance of individual with chronic ankle instability (CAI). [Subjects and Methods] 12 men and 13 women (mean: 21.52 years; range: 20–31 years) with unilateral CAI (Cumberland ankle instability score: ≤24) were included. All the participants received 3 mm-wide ST. The latter was applied in a 3 × 4 cross shape onto the medial malleolus, the lateral malleolus, and the anterior talotibial joint of the unstable ankle. The pain and walking performance were measured on the visual analogue scale (VAS) and with a timed up and go test (TUGT) at the baseline and 30 minutes after the intervention. [Results] VAS and TUGT scores were significantly improved after application of the ST. [Conclusion] The results indicated that ST can improve the pain and walking performance of CAI individuals.