The effect of taping on the proprioception of the ankle in a non-weight bearing position, amongst injured athletes

Abstract

Background

It is hypothesized that the application of adhesive tape prevents further sprains by enhancing proprioceptive acuity via the activation of the skin proprioceptive receptors of the surrounding area.

Objectives

To investigate the effects of taping on the proprioception of the ankle amongst injured athletes, when tested in a non-weight bearing position.

Methods

A pretest–posttest, quasi-experimental, same-subject design was applied. Twenty athletes, who had suffered at least one unilateral Grade I or Grade II ankle inversion sprain in the past volunteered to participate in the study. The Angle-reproduction test in two movement planes (inversion and plantar flexion) and four target angles (10° and 30° of plantar flexion, and 5° and 20° of inversion) was applied to all subjects under two conditions; without tape and with the application of the basket-weave heel lock taping technique. For the needs of the test, the Penny & Giles twin axis XM 180 goniometer and torsiometer was used.

Results

The t-tests yielded statistically significant differences between taped and untaped conditions at each target angle (plantar flexion 10°: p = 0.014, plantar flexion 30°: p = 0.034, inversion 5°: p = 0.009, inversion 20°: p = 0.008).

Conclusions

Adhesive taping seems to improve the ankle position awareness and thus the proprioceptive capability of the ankle in a non-weight bearing position. Further research, in the mode of a prospective matched controlled study, should explore the long-term effect of ankle taping in athletes involved in high contact sports.

Introduction

Ankle inversion sprains are amongst the commonest injuries of the lower extremities, especially in athletes involved in high contact sports [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]. A common sequel of an ankle sprain is the development of functional instability at the ankle joint [4], [10], [14], [15], [16], [17], [18], [19] and the tendency for the sprain to re-occur [12], [20], thus resulting in chronic ankle instability.

It is hypothesized that one of the major neuromuscular causes of chronic ankle instability is proprioceptive deficit which may occur as a result of direct trauma to mechanoreceptors of the ankle, and can cause inadequate foot position awareness [5], [12], [13], [15], [21], [22], [23], [24], [25], [26]. Proprioception is the concept dealing with an individual's awareness of movement and position sense of the body and body parts [13]. Current evidence suggests that afferent nerve fibres arising from the proprioceptive receptors of ligaments, joint capsule, cutaneous and muscle tissues are responsible for providing the appropriate proprioceptive signals [7], [12], [13], [27], [28], [29], [30], [31], [32]. Particularly, cutaneous and muscle tissues play an important role in the proprioception of the ankle, because of the high density of cutaneous receptors [33], [34], [35], [36] and the existence of a number of small, deep muscles around the ankle area, that function primarily in a proprioceptive/kinaesthetic fashion [37]. Thus, impairment of foot position awareness as a consequence of decreased proprioception, is indeed associated with the presence of re-occurrence of ankle inversion sprains [12], [13], [21], [25]. Inversion and plantar flexion beyond the normal range of movement (ROM) have been cited as the primary mechanism of ankle inversion sprains [7], [12], [38]. Therefore, it is not unreasonable to assume that if proprioception is impaired, it could predominantly be, in these two planes of movement [12]. Unfortunately, to the authors’ knowledge there has been no study investigating the effects of proprioception in both these movement planes amongst subjects with sustained ankle inversion sprains. Thus, this issue requires further investigation.

One of the most popular methods of supporting a weakened ankle from undergoing a further sprain is by applying external support by means of an ankle tape. Although the primary aim of the ankle tape is to support the unstable ankle and prevent joint hypermobility (without restricting normal motion) [2], [10], [22], [39], [40], it is hypothesized that it prevents further sprains by enhancing proprioceptive acuity [10], [12], [25], [40], [41], [42]. This is believed to be achieved through the activation of the skin proprioceptive receptors which offer additional awareness of the foot position and the direction of motion [42], [43], [44]. In particular, Refshauge et al. [12] hypothesized that, since the tape is in such close contact with the skin, it may provide strong cutaneous proprioceptive cues, and can therefore, improve the ankle's ability to detect movement. Indeed, strong proprioceptive cues are necessary just before foot contact in anticipation of the forces that may cause inversion (and may therefore lead to an inversion sprain) [1], [13]. Interestingly though, the muscles (especially peronei), during rhythmic and cyclical gait, prior to the leg contacting the ground have been found to have limited pre-activation [45], [46]. Taking into account the latter, especially for athletes, strong proprioceptive feedback not only from muscles but from all other available sources (i.e. skin, ligaments, etc.) is needed in order for them to have the most appropriate response when their foot first touches the ground. Ankle taping could facilitate these structures for providing proprioceptive feedback and could therefore be an appropriate method for improving ankle proprioception [10], [12], [25], [40], [41], [42]. Furthermore, considering the fact that the majority of ankle sprains occur when the foot is just touching the ground thus, before full loading of the limb [1], the individual's ability to be able to detect the exact position of the ankle without loading of the limb may be very important. Thus, it may be more appropriate for proprioception to be explored in a non-weight bearing position. As far as the taping technique is concerned, the closed basket weave with a double heel lock is one of the most popular ones that are used for offering ankle support and one of the most regularly used techniques for assessing proprioception [3].

There are many different methods indicated in the literature for assessing the effects of tape on ankle proprioception [2], [7], [8], [9], [12], [13], [23], [39], [47], [48]. The present authors believe that, in order for a proprioceptive test to be appropriate, it should involve direct, active testing of ankle proprioception, in order to encompass not only the passive, but also the active afferents which are believed to be important for proprioception [37]. According to Jerosch et al. [8], the Angle-reproduction test directly assesses the perception of joint position. In this test, each subject is asked to reproduce a particular joint angle (which was previously indicated with visual feedback), but remove any visual feedback from the subject. Thus, in order for each subject to perform well in this test, he must possess good kinesthetic awareness as well as good joint position sense. In addition, good reliability and validity of this test has previously been established [6], [49]. Many researchers, by using a variety of other methods like electromyographic signal of the peroneus muscles, goniometric, thermologic or isokinetic methods, have concluded that there is a positive effect of taping on the proprioception of the ankle [7], [13], [23], [39], [47], [48]. On the other hand, other authors have contradicted such findings. Jerosch et al. [8] concluded that there were no significant results regarding the application of adhesive tape when compared to two braces (a lace-on brace and a stirrup brace) which demonstrated a significant increase in proprioception. Allison et al. [2] stated that neurophysiological responses to sudden inversion are not altered by mechanical or sensory input from the application of the tape. Refshauge et al. [12] concluded that, the protective effect of the tape was not related to ankle proprioception in the sagittal plane. Kaminski and Gerlach [9] explored the effect of tape and neoprene ankle support on both active and passive joint position sense and found no significant changes.

Despite the contradictory results of the above studies, further analysis of their designs demonstrates methodological weaknesses. In some of these, the samples included only healthy subjects [2], [7], [9], [13] and assessment was performed by utilizing only subjective criteria [13]. In other studies, a non-useful and non-used taping technique was applied [2], [12]. Some of these studies used passive movement tests [2], [47], [48] or estimated proprioception indirectly, i.e. via the reaction time of the peroneal muscles [2], [10], [23], [47], [48], instead of utilising an active and direct method for measuring proprioception, as previously discussed. One study [13] applied taped and untaped measures on different subjects thus, neglecting the possibility of different proprioceptive capabilities across groups. Additionally, many studies have used fully weight-bearing positions for measuring proprioception [13], [39], [47], [48], not taking into account the fact that the majority of ankle sprains occur when the foot is just touching the ground, thus, before full loading of the limb [1]. Finally, the majority of the studies have used complex and costly equipment, which is not feasible for routine use in a clinical setting [2], [8], [9], [12], [23], [39], [47], [48].

Taking into account the above, there is still some contradiction across the literature on the effect of taping on the ankle proprioception [2], [8], [9], [12], [13], [23], [47], [48]. Also, it remains unclear how useful could the application of adhesive tape be, for preventing further ankle sprains during athletic activities. In addition, certain factors such as exploring the effects of the tape by measuring proprioception via an active, clinically useful and direct way (such as the Angle-reproduction test), and in a non-weight bearing position, or by utilizing the two most predominantly affected from the injury motion planes, have not been thoroughly addressed. Thus, the effect of tape following inversion sprain needs further research. Given the above, the main aim of the study was to investigate the effect of taping on the proprioception of the ankle amongst athletes with ankle inversion sprains, and take into account the previously mentioned factors.