Technology and Health Care 23 (2015) 333–341 DOI 10.3233/THC-150902 IOS Press
333
Immediate effects of ankle balance taping with kinesiology tape on the dynamic balance of young players with functional ankle instability Byeong-Gyu Leea and Jung-Hoon Leeb,∗ a Department
b Department
of Physical Therapy, Inje University Busan Paik Hospital, Korea of Physical Therapy, College of Nursing and Healthcare Sciences, Dong-Eui University,
Korea Received 25 August 2014 Accepted 25 January 2015 Abstract. BACKGROUND: Soccer, one of the most popular and well-known sports worldwide, involves complex motions such as running, quick changes in direction, jumping, and landing, all of which have a high risk of injury. Among them, ankle injuries are the most frequent. OBJECTIVE: This study investigated the immediate effects of ankle balance taping (ABT) with kinesiology tape on the dynamic balance of young male soccer players with functional ankle instability (FAI). METHODS: Nine young male soccer players with FAI in their dominant ankle were randomly subjected to no-, placebo-, and real-ABT conditions. After the appropriate treatment was administered, the dynamic balance was measured using the Star Excursion Balance Test (SEBT). RESULTS: In terms of the anterior and posterolateral reach distances on the SEBT, the real-ABT condition showed statistically significant increases compared to the no- and placebo-ABT conditions (p < 0.05), while in the case of posteromedial reach distances, the real-ABT condition showed a statistically significant increase (p < 0.05) compared to the no-ABT condition. CONCLUSION: ABT using kinesiology tape can be expected to improve the dynamic balance of young male soccer players with FAI. Keywords: Ankle balance taping, dynamic balance, functional ankle instability, star excursion balance test, young soccer player
1. Introduction Soccer, one of the most popular and well-known sports worldwide [1], involves complex motions such as running, quick changes in direction, jumping, and landing and carries a high risk of injury [2]. Among them, lower extremity injuries occur at the highest frequency (70%), particularly the ankle (19%) [3]. ∗
Corresponding author: Jung-Hoon Lee, Department of Physical Therapy, College of Nursing and Healthcare Sciences, Dong-Eui University, 176 Eomgwangno, Busanjin-gu, Busan 614-714, Korea. Tel.: +82 51 890 4222; Fax: +82 51 890 4229; E-mail: [email protected]. c 2015 – IOS Press and the authors. All rights reserved 0928-7329/15/$35.00
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B.-G. Lee and J.-H. Lee / Immediate effects of ankle balance taping with kinesiology tape Table 1 General subjects’ characteristics Variable Age (years) Height (cm) Weight (kg) Cumberland Ankle Instability Tool (CAIT)
Mean ± SD Male (n = 9) 14.11 ± 0.33 155.66 ± 10.33 47.11 ± 13.12 18.44 ± 1.94
The inversion sprain occurs as a result of weight put on the inverted ankle through direct contact to the medial side of the ankle during tackles when landing from a jump or running [4,5]. Soccer players < 15 years tend to have a greater prevalence of injuries than older players [6–9]. Dick et al. [10] reported that leg injuries showed the highest rate of injury among youth soccer players, with ankle sprains accounting for most and the rate of re-injury increasing. Repeated damage that occurs during childhood can lead to ankle sprains in adulthood [11]. Chronic ankle sprains in youth soccer players generally result from inversion sprains and repeat damage to the ankle, resulting in ankle instability [12]. Ankle instability can be divided into mechanical ankle instability from deformation of the joint or structural changes and functional ankle instability (FAI), which is a subjective feeling of weakened muscles, decreased coordination, and lack of postural control caused by a lack of motor sensory functions in the ankle muscles, tendons, and soft tissues [13]. After an ankle sprain, > 40% of patients continue to feel ankle instability or swaying without any structural limitations to the ankle [14] and eventually develop chronic instability. Muscle strength loss and decreased coordination in soccer players that result from ankle instability further increase ankle instability and can lead to ankle injury reoccurrence and decreased field performance; thus, intensive preventative care is needed [15]. Ankle taping using rigid adhesive tape is used to protect ankles that are unstable or at risk of injury [16] through mechanical restriction of ankle movement [17,18]; immediate support after damage or to suppress oedema; and as a recurrence prevention measure [16]. However, the ankle joint limitations caused by ankle taping using adhesive rigid tape leads to impaired postural control [19]. On the other hand, kinesiology taping using elastic tape stabilizes and supports the ankle muscles and joints without limiting the range of motion [20]. Kinesiology taping improves proprioception and the joint position sense [21,22] through cutaneous mechanoreceptor stimulation [21,23,24]. According to this mechanism, the application of kinesiology tape to the ankle may improve functional dynamic balance. However, some studies reported that the ankle taping method according to the Kinesio perfect taping manual [25] did not show improve proprioception at the ankle in healthy individuals [26], dynamic balance in young individuals with chronic ankle instability [27], or postural control deficits in individuals with FAI [28] even though a recent study reported a reduction in force sense errors in individuals with FAI [29]. Therefore, a more effective ankle taping method using kinesiology tape is needed. The specific ankle taping method requires greater ankle joint stability by controlling the internal or external movements of the calcaneus bone to assist with inversion or eversion, the main cause of ankle injury, as well as adjustment of the posterior gliding of the talus for dorsiflexion without ankle joint limitations. In addition, studies on the effects of kinesiology taping on ankle instability in young soccer players in whom ankle injury frequently occurs are lacking. Therefore, the purpose of this study was to investigate the immediate effects of new ankle balance taping (ABT) using kinesiology tape on the dynamic balance of young male soccer players with FAI. The hypothesis of this study was that the application of real ABT using kinesiology tape in young
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Fig. 1. Performance in the (A) anterior, (B) posteromedial, and (C) posterolateral directions of the Star Excursion Balance Test using the left leg.
male soccer players with FAI may improve their dynamic balance compared to placebo-ABT and noABT because the elasticity of the kinesiology tape supports the ankle joint without limiting its range of motion (dorsiflexion, inversion, and eversion) and assist with the various ankle joint movements.
2. Methods 2.1. Subjects For the sample size calculation [30], the effect size of 8.7 [31], significance level (α) of 0.05, desired power (1-β ) of 0.90, and 20% dropout rate were applied. A sample size of 12 was calculated. Thus, 12 young male soccer players volunteered and signed a consent form from the university’s institutional review board before participating. Each participant had experienced previous sprains in their dominant ankle. The other inclusion criteria were: (1) previous ankle sprain severe enough to make it difficult to bear weight upon it or require surgery but no treatment in the past 3 months; (2) instability or swaying in the ankle joint; (3) Cumberland Ankle Instability Tool (CAIT) test score 27 (i.e., the CAIT was the first to quantify FAI degree and consisted of a total of nine questions and a perfect score of 30, where 28 is normal and 27 is considered to have FAI [32]); (4) currently not participating in any ankle treatment program; and (5) no ankle oedema. Among the participants, three were excluded for a CAIT test score > 24. Of the nine total subjects, the right leg was dominant for eight subjects, while one was left. The subjects’ basic characteristics are shown in Table 1. 2.2. Star Excursion Balance Test (SEBT) Nine young male soccer players were randomly subjected to three different conditions (no-, placebo-, and real-ABT) on their dominant ankle with ample time between conditions. The dynamic balance for each condition was then measured. The randomization process was controlled by an assistant who did not participate in the study. The dynamic balance was measured using the SEBT, a reliable, inexpensive, and fast test [33,34]. First, 5-cm-wide adhesive masking tape was used to create a Y-shaped figure on the floor that pointed in the anterior, posteromedial, and posterolateral directions. The subjects were asked to stand in the centre of the Y facing forward [31]. Next, with the dominant leg (i.e., the leg with the FAI) fixed, the non-dominant leg was extended as far as possible in the intended direction to lightly touch the top of the tape with the big toe; the leg was returned to the original two-foot standing position in the centre; the procedure was then repeated in the next direction [35] (Fig. 1). During extension of the leg as far as it
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Fig. 2. Use of real ankle balance taping.
could go, flexion of the knee and the hip joint of the fixed leg was permitted, but the task was considered unperformed or instructed to repeat the task if the: (1) subject could not stand on one leg; (2) fixed leg moved from the centre grid; (3) extended opposite leg did not show a light touch while being supported on one leg; or (4) leg doing the touching could not return to the centre [36]. After completing the motions in all three directions, each of the distances from the centre of the Y, where the subject stood, to the point the extended toe reached was measured using a tape measure. Normalized distance as a percentage of leg length was calculated by dividing each of the reached distance values from all three directions (anterior, posteromedial, and posterolateral) by the value derived by multiplying the leg length (i.e., the distance from the anterosuperior iliac spine to the centre of the medial malleolus) [31] by three and then dividing the value by 100 [36]. 2.3. ABT protocol First, the subjects were comfortably seated; then a physical therapist with > 10 years’ taping therapy experience was subjected to the kinesiology tape (BB TAPE, WETAPE Co., Ltd., Seoul, Korea) application that had been stretched 30–40% to the ankle of the dominant leg (the leg with the FAI). The real-ABT method consisted of four steps. First, for the posterior talar glide to increase ankle dorsiflexion with the ankle in a slightly dorsiflexed position, the taping begins from the talus in both directions to the calcaneus (Fig. 2A). Second, to induce ankle inversion, with the ankle inverted, the taping begins 5 cm above the medial malleolus and passes the lateral calcaneus below the subtalar joint to a point outward on the top of the foot (Fig. 2B). Third, to induce ankle eversion, with the ankle everted, the taping begins 5 cm above the medial malleolus and passes the lateral calcaneus below the subtalar joint to a point inward on the top of the foot (Fig. 2C). Fourth, to strengthen the posterior talar glide to increase ankle dorsiflexion, with the ankle in a slightly dorsiflexed position, one additional taping is applied on top of the taping used in the first method (Fig. 2D).
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Table 2 Comparison of the anterior, posteromedial, and posterolateral reach distances among the three conditions Distance Anterior Posteromedial Posterolateral ABT, Ankle balance taping.
No-ABT 64.93 ± 4.74 58.72 ± 3.76 66.30 ± 5.07
Mean ± SD (cm) Placebo-ABT 66.07 ± 5.54 62.42 ± 5.34 68.81 ± 4.31
p Real-ABT 71.78 ± 3.74 68.53 ± 5.31 74.21 ± 3.95
0.022 0.004 0.004
Table 3 Comparison of normalized distance as a percentage of leg length among the three conditions Distance Normalized (% of leg length)
No-ABT 76.71 ± 6.44
Mean ± SD (cm) Placebo-ABT 80.82 ± 7.64
p Real-ABT 88.25 ± 7.28
0.016
ABT, Ankle balance taping.
Fig. 3. Use of placebo ankle balance taping on the (A) medial area of the right ankle and (B) lateral area of the right ankle.
For the placebo-ABT method, each of the tapings begins from the medial and lateral malleolus and applied to the halfway point of the lower extremity (Fig. 3). 2.4. Data analysis For the data analysis, PASW Statistics 18.0 (SPSS Inc., Chicago, IL, USA) was used and the KruskalWallis test was used for the comparative analysis of the reached distances in each of the three directions under the three conditions (no-, placebo-, and real-ABT). The Mann-Whitney U test was used to analyse the differences among the conditions. Values < 0.05 were considered statistically significant. 3. Results The results indicated that the changes in the anterior, posteromedial, and posterolateral reached distances of the SEBT in each of the three conditions (no-, placebo-, and real-ABT) (Table 2). According to the results from the post hoc test, the anterior and posterolateral reached distances under the real-ABT condition showed a statistically significant increase (p < 0.05) compared to the no- and placebo-ABT conditions (Fig. 4). In the case of the posteromedial reached distance, the real-ABT condition showed a statistically significant increase (p < 0.05) compared to the no-ABT condition (Fig. 4). The normalized distance as a percentage of leg is shown in Table 3. The real-ABT condition compared to the no- and
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*
78
*
76
Distance(cm)
74 72 70 68 66 64 62 60
no-ABT
placebo-ABT
real-ABT
Anterior
* 72
Distance(cm)
Distance(cm)
74 80 78 76 74 72 70 68 66 64 62 60
70 68 66 64 62 60 58 56
no-ABT
placebo-ABT
real-ABT
no-ABT
Posterolateral
placebo-ABT
real-ABT
Posteromedial
Fig. 4. Comparison of the reach distances among the three conditions (∗ p < 0.05).
*
100
*
Distance(cm)
95 90 85 80 75 70 65
no-ABT
placebo-ABT
real-ABT
Normalized(% of leg length) Fig. 5. Comparison of the normalized distance as a percentage of leg length among the three conditions (∗ p < 0.05).
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placebo-ABT conditions showed statistically significant increases in the reached distances, respectively (p < 0.05) (Fig. 5).
4. Discussion In this study, the real- compared to the no-ABT condition showed significant increases in the anterior, posteromedial, and posterolateral reached distances of the SEBT and, compared to the placebo-ABT condition, showed significant increases in the anterior and posterolateral reached distances of the SEBT. However, the placebo- compared to the no-ABT condition did not show statistically significant increases in the reached distances. Proprioception, the joint position sense, senses the positions of the joints and all extremities after movement and helps return them to their normal positions [37]. Kinesiology taping has been shown to improve proprioception [21,22]. Depending on ankle joint movements, evaluation using the SEBT test with the application of kinesiology tape with 30–40% elasticity on the skin around the ankle with FAI, would show changes in the skin covered by the tape [38], which stimulates the cutaneous mechanoreceptors [21,23,24] to activate the proprioceptors of the ankle joint [20,22]. Therefore, ABT using kinesiology tape on the ankle joint with FAI during the SEBT test would improve the ankle joint position sense to assist in maintaining the normal position by the ankle joint, which would increase ankle joint stability and result in an increased distance reached by the opposite leg. A study by Zajt-Kwiatkowska et al. [39] reported that kinesiology taping (ankle taping using kinesiology tape) affected the lower extremity functions of unstable ankles. However, Shields et al. [28] indicated that no effect on postural control deficits was seen in individuals with FAI. In particular, Hettle et al. [27] stated that no particular effects on functional performance were observed in the SEBT used in the present study after ankle taping using kinesiology tape on ankle instability. These findings may have resulted from differences in the ankle taping methods used in other studies. The specific ABT method used in this study may provide greater ankle joint stability through the adjustment of the posterior gliding of the talus for dorsiflexion and fine internal or external movements of the calcaneus to assist with inversion or eversion, the main causes of the ankle injury, unlike the ankle taping methods used in other studies [26–28]. The elasticity of the ABT both supports the ankle joint without limiting its range of motion and enhances its movement (dorsiflexion, inversion, and eversion); thus, during the SEBT test, the ABT applied to assist the various ankle joint movements would stretch as the skin around the ankle stretches. Because of the increase in tension, the action created by the tape’s elasticity as it returned to its original length would help it quickly recover its normal position. The stability in the ankle joint with FAI would be secured and allow for the movement of the opposite leg to increase. This study had several limitations. First, the subjects were a few young male soccer players, which makes it difficult to generalize the results. Second, how long the ABT used in this study can maintain its effect on the dynamic balance was not evaluated. Third, no study compared the effects of the ABT versus a non-elastic tape. Fourth, no other dynamic balance assessment tools were utilized. Fifth, no evaluation of the use of ABT on lower-extremity kinetics and kinematic changes was performed. Sixth, we did not confirm whether there was a posterior gliding of the talus for dorsiflexion and internal or external movement of the calcaneus for inversion or eversion by the ABT application. Future studies that can address these limitations are needed.
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5. Conclusions In conclusion, ABT using kinesiology tape showed increased dynamic balance in young male soccer players with FAI. Therefore, the application of ABT in youth players with FAI will increase their dynamic balance.
Conflict of interest The authors declare that they have no conflict of interest.
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Immediate effects of ankle balance taping with kinesiology tape on the dynamic balance of young players with functional ankle instability Byeong-Gyu Leea and Jung-Hoon Leeb,∗ a Department
b Department
of Physical Therapy, Inje University Busan Paik Hospital, Korea of Physical Therapy, College of Nursing and Healthcare Sciences, Dong-Eui University,
Korea Received 25 August 2014 Accepted 25 January 2015 Abstract. BACKGROUND: Soccer, one of the most popular and well-known sports worldwide, involves complex motions such as running, quick changes in direction, jumping, and landing, all of which have a high risk of injury. Among them, ankle injuries are the most frequent. OBJECTIVE: This study investigated the immediate effects of ankle balance taping (ABT) with kinesiology tape on the dynamic balance of young male soccer players with functional ankle instability (FAI). METHODS: Nine young male soccer players with FAI in their dominant ankle were randomly subjected to no-, placebo-, and real-ABT conditions. After the appropriate treatment was administered, the dynamic balance was measured using the Star Excursion Balance Test (SEBT). RESULTS: In terms of the anterior and posterolateral reach distances on the SEBT, the real-ABT condition showed statistically significant increases compared to the no- and placebo-ABT conditions (p < 0.05), while in the case of posteromedial reach distances, the real-ABT condition showed a statistically significant increase (p < 0.05) compared to the no-ABT condition. CONCLUSION: ABT using kinesiology tape can be expected to improve the dynamic balance of young male soccer players with FAI. Keywords: Ankle balance taping, dynamic balance, functional ankle instability, star excursion balance test, young soccer player
1. Introduction Soccer, one of the most popular and well-known sports worldwide [1], involves complex motions such as running, quick changes in direction, jumping, and landing and carries a high risk of injury [2]. Among them, lower extremity injuries occur at the highest frequency (70%), particularly the ankle (19%) [3]. ∗
Corresponding author: Jung-Hoon Lee, Department of Physical Therapy, College of Nursing and Healthcare Sciences, Dong-Eui University, 176 Eomgwangno, Busanjin-gu, Busan 614-714, Korea. Tel.: +82 51 890 4222; Fax: +82 51 890 4229; E-mail: [email protected]. c 2015 – IOS Press and the authors. All rights reserved 0928-7329/15/$35.00
334
B.-G. Lee and J.-H. Lee / Immediate effects of ankle balance taping with kinesiology tape Table 1 General subjects’ characteristics Variable Age (years) Height (cm) Weight (kg) Cumberland Ankle Instability Tool (CAIT)
Mean ± SD Male (n = 9) 14.11 ± 0.33 155.66 ± 10.33 47.11 ± 13.12 18.44 ± 1.94
The inversion sprain occurs as a result of weight put on the inverted ankle through direct contact to the medial side of the ankle during tackles when landing from a jump or running [4,5]. Soccer players < 15 years tend to have a greater prevalence of injuries than older players [6–9]. Dick et al. [10] reported that leg injuries showed the highest rate of injury among youth soccer players, with ankle sprains accounting for most and the rate of re-injury increasing. Repeated damage that occurs during childhood can lead to ankle sprains in adulthood [11]. Chronic ankle sprains in youth soccer players generally result from inversion sprains and repeat damage to the ankle, resulting in ankle instability [12]. Ankle instability can be divided into mechanical ankle instability from deformation of the joint or structural changes and functional ankle instability (FAI), which is a subjective feeling of weakened muscles, decreased coordination, and lack of postural control caused by a lack of motor sensory functions in the ankle muscles, tendons, and soft tissues [13]. After an ankle sprain, > 40% of patients continue to feel ankle instability or swaying without any structural limitations to the ankle [14] and eventually develop chronic instability. Muscle strength loss and decreased coordination in soccer players that result from ankle instability further increase ankle instability and can lead to ankle injury reoccurrence and decreased field performance; thus, intensive preventative care is needed [15]. Ankle taping using rigid adhesive tape is used to protect ankles that are unstable or at risk of injury [16] through mechanical restriction of ankle movement [17,18]; immediate support after damage or to suppress oedema; and as a recurrence prevention measure [16]. However, the ankle joint limitations caused by ankle taping using adhesive rigid tape leads to impaired postural control [19]. On the other hand, kinesiology taping using elastic tape stabilizes and supports the ankle muscles and joints without limiting the range of motion [20]. Kinesiology taping improves proprioception and the joint position sense [21,22] through cutaneous mechanoreceptor stimulation [21,23,24]. According to this mechanism, the application of kinesiology tape to the ankle may improve functional dynamic balance. However, some studies reported that the ankle taping method according to the Kinesio perfect taping manual [25] did not show improve proprioception at the ankle in healthy individuals [26], dynamic balance in young individuals with chronic ankle instability [27], or postural control deficits in individuals with FAI [28] even though a recent study reported a reduction in force sense errors in individuals with FAI [29]. Therefore, a more effective ankle taping method using kinesiology tape is needed. The specific ankle taping method requires greater ankle joint stability by controlling the internal or external movements of the calcaneus bone to assist with inversion or eversion, the main cause of ankle injury, as well as adjustment of the posterior gliding of the talus for dorsiflexion without ankle joint limitations. In addition, studies on the effects of kinesiology taping on ankle instability in young soccer players in whom ankle injury frequently occurs are lacking. Therefore, the purpose of this study was to investigate the immediate effects of new ankle balance taping (ABT) using kinesiology tape on the dynamic balance of young male soccer players with FAI. The hypothesis of this study was that the application of real ABT using kinesiology tape in young
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335
Fig. 1. Performance in the (A) anterior, (B) posteromedial, and (C) posterolateral directions of the Star Excursion Balance Test using the left leg.
male soccer players with FAI may improve their dynamic balance compared to placebo-ABT and noABT because the elasticity of the kinesiology tape supports the ankle joint without limiting its range of motion (dorsiflexion, inversion, and eversion) and assist with the various ankle joint movements.
2. Methods 2.1. Subjects For the sample size calculation [30], the effect size of 8.7 [31], significance level (α) of 0.05, desired power (1-β ) of 0.90, and 20% dropout rate were applied. A sample size of 12 was calculated. Thus, 12 young male soccer players volunteered and signed a consent form from the university’s institutional review board before participating. Each participant had experienced previous sprains in their dominant ankle. The other inclusion criteria were: (1) previous ankle sprain severe enough to make it difficult to bear weight upon it or require surgery but no treatment in the past 3 months; (2) instability or swaying in the ankle joint; (3) Cumberland Ankle Instability Tool (CAIT) test score 27 (i.e., the CAIT was the first to quantify FAI degree and consisted of a total of nine questions and a perfect score of 30, where 28 is normal and 27 is considered to have FAI [32]); (4) currently not participating in any ankle treatment program; and (5) no ankle oedema. Among the participants, three were excluded for a CAIT test score > 24. Of the nine total subjects, the right leg was dominant for eight subjects, while one was left. The subjects’ basic characteristics are shown in Table 1. 2.2. Star Excursion Balance Test (SEBT) Nine young male soccer players were randomly subjected to three different conditions (no-, placebo-, and real-ABT) on their dominant ankle with ample time between conditions. The dynamic balance for each condition was then measured. The randomization process was controlled by an assistant who did not participate in the study. The dynamic balance was measured using the SEBT, a reliable, inexpensive, and fast test [33,34]. First, 5-cm-wide adhesive masking tape was used to create a Y-shaped figure on the floor that pointed in the anterior, posteromedial, and posterolateral directions. The subjects were asked to stand in the centre of the Y facing forward [31]. Next, with the dominant leg (i.e., the leg with the FAI) fixed, the non-dominant leg was extended as far as possible in the intended direction to lightly touch the top of the tape with the big toe; the leg was returned to the original two-foot standing position in the centre; the procedure was then repeated in the next direction [35] (Fig. 1). During extension of the leg as far as it
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Fig. 2. Use of real ankle balance taping.
could go, flexion of the knee and the hip joint of the fixed leg was permitted, but the task was considered unperformed or instructed to repeat the task if the: (1) subject could not stand on one leg; (2) fixed leg moved from the centre grid; (3) extended opposite leg did not show a light touch while being supported on one leg; or (4) leg doing the touching could not return to the centre [36]. After completing the motions in all three directions, each of the distances from the centre of the Y, where the subject stood, to the point the extended toe reached was measured using a tape measure. Normalized distance as a percentage of leg length was calculated by dividing each of the reached distance values from all three directions (anterior, posteromedial, and posterolateral) by the value derived by multiplying the leg length (i.e., the distance from the anterosuperior iliac spine to the centre of the medial malleolus) [31] by three and then dividing the value by 100 [36]. 2.3. ABT protocol First, the subjects were comfortably seated; then a physical therapist with > 10 years’ taping therapy experience was subjected to the kinesiology tape (BB TAPE, WETAPE Co., Ltd., Seoul, Korea) application that had been stretched 30–40% to the ankle of the dominant leg (the leg with the FAI). The real-ABT method consisted of four steps. First, for the posterior talar glide to increase ankle dorsiflexion with the ankle in a slightly dorsiflexed position, the taping begins from the talus in both directions to the calcaneus (Fig. 2A). Second, to induce ankle inversion, with the ankle inverted, the taping begins 5 cm above the medial malleolus and passes the lateral calcaneus below the subtalar joint to a point outward on the top of the foot (Fig. 2B). Third, to induce ankle eversion, with the ankle everted, the taping begins 5 cm above the medial malleolus and passes the lateral calcaneus below the subtalar joint to a point inward on the top of the foot (Fig. 2C). Fourth, to strengthen the posterior talar glide to increase ankle dorsiflexion, with the ankle in a slightly dorsiflexed position, one additional taping is applied on top of the taping used in the first method (Fig. 2D).
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Table 2 Comparison of the anterior, posteromedial, and posterolateral reach distances among the three conditions Distance Anterior Posteromedial Posterolateral ABT, Ankle balance taping.
No-ABT 64.93 ± 4.74 58.72 ± 3.76 66.30 ± 5.07
Mean ± SD (cm) Placebo-ABT 66.07 ± 5.54 62.42 ± 5.34 68.81 ± 4.31
p Real-ABT 71.78 ± 3.74 68.53 ± 5.31 74.21 ± 3.95
0.022 0.004 0.004
Table 3 Comparison of normalized distance as a percentage of leg length among the three conditions Distance Normalized (% of leg length)
No-ABT 76.71 ± 6.44
Mean ± SD (cm) Placebo-ABT 80.82 ± 7.64
p Real-ABT 88.25 ± 7.28
0.016
ABT, Ankle balance taping.
Fig. 3. Use of placebo ankle balance taping on the (A) medial area of the right ankle and (B) lateral area of the right ankle.
For the placebo-ABT method, each of the tapings begins from the medial and lateral malleolus and applied to the halfway point of the lower extremity (Fig. 3). 2.4. Data analysis For the data analysis, PASW Statistics 18.0 (SPSS Inc., Chicago, IL, USA) was used and the KruskalWallis test was used for the comparative analysis of the reached distances in each of the three directions under the three conditions (no-, placebo-, and real-ABT). The Mann-Whitney U test was used to analyse the differences among the conditions. Values < 0.05 were considered statistically significant. 3. Results The results indicated that the changes in the anterior, posteromedial, and posterolateral reached distances of the SEBT in each of the three conditions (no-, placebo-, and real-ABT) (Table 2). According to the results from the post hoc test, the anterior and posterolateral reached distances under the real-ABT condition showed a statistically significant increase (p < 0.05) compared to the no- and placebo-ABT conditions (Fig. 4). In the case of the posteromedial reached distance, the real-ABT condition showed a statistically significant increase (p < 0.05) compared to the no-ABT condition (Fig. 4). The normalized distance as a percentage of leg is shown in Table 3. The real-ABT condition compared to the no- and
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*
78
*
76
Distance(cm)
74 72 70 68 66 64 62 60
no-ABT
placebo-ABT
real-ABT
Anterior
* 72
Distance(cm)
Distance(cm)
74 80 78 76 74 72 70 68 66 64 62 60
70 68 66 64 62 60 58 56
no-ABT
placebo-ABT
real-ABT
no-ABT
Posterolateral
placebo-ABT
real-ABT
Posteromedial
Fig. 4. Comparison of the reach distances among the three conditions (∗ p < 0.05).
*
100
*
Distance(cm)
95 90 85 80 75 70 65
no-ABT
placebo-ABT
real-ABT
Normalized(% of leg length) Fig. 5. Comparison of the normalized distance as a percentage of leg length among the three conditions (∗ p < 0.05).
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placebo-ABT conditions showed statistically significant increases in the reached distances, respectively (p < 0.05) (Fig. 5).
4. Discussion In this study, the real- compared to the no-ABT condition showed significant increases in the anterior, posteromedial, and posterolateral reached distances of the SEBT and, compared to the placebo-ABT condition, showed significant increases in the anterior and posterolateral reached distances of the SEBT. However, the placebo- compared to the no-ABT condition did not show statistically significant increases in the reached distances. Proprioception, the joint position sense, senses the positions of the joints and all extremities after movement and helps return them to their normal positions [37]. Kinesiology taping has been shown to improve proprioception [21,22]. Depending on ankle joint movements, evaluation using the SEBT test with the application of kinesiology tape with 30–40% elasticity on the skin around the ankle with FAI, would show changes in the skin covered by the tape [38], which stimulates the cutaneous mechanoreceptors [21,23,24] to activate the proprioceptors of the ankle joint [20,22]. Therefore, ABT using kinesiology tape on the ankle joint with FAI during the SEBT test would improve the ankle joint position sense to assist in maintaining the normal position by the ankle joint, which would increase ankle joint stability and result in an increased distance reached by the opposite leg. A study by Zajt-Kwiatkowska et al. [39] reported that kinesiology taping (ankle taping using kinesiology tape) affected the lower extremity functions of unstable ankles. However, Shields et al. [28] indicated that no effect on postural control deficits was seen in individuals with FAI. In particular, Hettle et al. [27] stated that no particular effects on functional performance were observed in the SEBT used in the present study after ankle taping using kinesiology tape on ankle instability. These findings may have resulted from differences in the ankle taping methods used in other studies. The specific ABT method used in this study may provide greater ankle joint stability through the adjustment of the posterior gliding of the talus for dorsiflexion and fine internal or external movements of the calcaneus to assist with inversion or eversion, the main causes of the ankle injury, unlike the ankle taping methods used in other studies [26–28]. The elasticity of the ABT both supports the ankle joint without limiting its range of motion and enhances its movement (dorsiflexion, inversion, and eversion); thus, during the SEBT test, the ABT applied to assist the various ankle joint movements would stretch as the skin around the ankle stretches. Because of the increase in tension, the action created by the tape’s elasticity as it returned to its original length would help it quickly recover its normal position. The stability in the ankle joint with FAI would be secured and allow for the movement of the opposite leg to increase. This study had several limitations. First, the subjects were a few young male soccer players, which makes it difficult to generalize the results. Second, how long the ABT used in this study can maintain its effect on the dynamic balance was not evaluated. Third, no study compared the effects of the ABT versus a non-elastic tape. Fourth, no other dynamic balance assessment tools were utilized. Fifth, no evaluation of the use of ABT on lower-extremity kinetics and kinematic changes was performed. Sixth, we did not confirm whether there was a posterior gliding of the talus for dorsiflexion and internal or external movement of the calcaneus for inversion or eversion by the ABT application. Future studies that can address these limitations are needed.
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5. Conclusions In conclusion, ABT using kinesiology tape showed increased dynamic balance in young male soccer players with FAI. Therefore, the application of ABT in youth players with FAI will increase their dynamic balance.
Conflict of interest The authors declare that they have no conflict of interest.
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