THE EFFECTS OF KINESIOTM TAPING ON PROPRIOCEPTION
AT THE ANKLE
|
1
Athletic Department, University of the Pacific, USA
2 Department of Kinesiology, Boise State University, USA
3 College of Education, Boise State University, USA
4 Athletic Department, Boise State University, USA
| Received |
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06 September 2003 |
| Accepted |
|
21
November 2003 |
| Published |
|
01
March 2004 |
©
Journal of Sports Science and Medicine (2004) 3, 1-7
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| ABSTRACT |
|
An
experiment was designed to determine if KinesioTM taping the anterior
and lateral portion of the ankle would enhance ankle proprioception
compared to the untaped ankle. 30 subjects, 15 men, 15 women, ages
18-30 participated in this study. Exclusion criteria: Ankle injury
< 6 months prior to testing, significant ligament laxity as determined
through clinical evaluation by an ATC, or any severe foot abnormality.
Experiment utilized a single group, pretest and posttest. Plantar
flexion and inversion with 20° of plantar flexion reproduction of
joint position sense (RJPS) was determined using an ankle RJPS apparatus.
Subjects were barefooted, blindfolded, and equipped with headphones
playing white noise to eliminate auditory cues. Subjects had five
trials in both plantar flexion and inversion with 20° plantar flexion
before and after application of the KinesioTM tape to the anterior/lateral
portion of the ankle. Constant error and absolute error were determined
from the difference between the target angle and the trial angle
produced by the subject. The treatment group (KinesioTM taped subjects)
showed no change in constant and absolute error for ankle RJPS in
plantar flexion and 20º of plantar flexion with inversion when compared
to the untaped results using the same motions. The application of
KinesioTM tape does not appear to enhance proprioception (in terms
of RJPS) in healthy individuals as determined by our measures of
RJPS at the ankle in the motions of plantar flexion and 20º of plantar
flexion with inversion.
KEY
WORDS: Reproduction of joint position sense, KinesioTM Tape,
target angle
|
| INTRODUCTION |
|
In
recent history, ankle taping has been the principal means of preventing
ankle sprains in sport (Robbins et al., 1995).
Despite the fact that ankle bracing is growing in popularity, anecdotal
evidence suggests that ankle taping with white athletic tape is
still very popular among athletes, athletic trainers, and physicians.
However other means of ankle taping have emerged for the treatment
and prevention of ankle injuries. KinesioTM taping is
a novel method of ankle taping utilizing a specialized type of tape
by the same name. KinesioTM tape differs from traditional
white athletic tape in the sense that it is elastic and can be stretched
to 140% of its original length before being applied to the skin.
It subsequently provides a constant pulling (shear) force to the
skin over which it is applied unlike traditional white athletic
tape. The fabric of this specialized tape is air permeable and water
resistant and can be worn for repetitive days. KinesioTM
tape is currently being used immediately following injury and during
the rehabilitation process.
The proposed mechanisms by which KinesioTM tape works
are different than those underlying traditional ankle taping. Rather
than being structurally supportive, like white athletic tape, KinesioTM
Tape is therapeutic in nature. According to Kenzo Kase, the creator
of KinesioTM tape, these proposed mechanisms may include:
(1) correcting muscle function by strengthening weakened muscles,
(2) improving circulation of blood and lymph by eliminating tissue
fluid or bleeding beneath the skin by moving the muscle, (3) decreasing
pain through neurological suppression, and (4) repositioning subluxed
joints by relieving abnormal muscle tension, helping to return the
function of fascia and muscle (Kase et al., 1996).
A fifth mechanism has been suggested by Murray (2001),
which describes KinesioTM tape causing an increase in
proprioception through increased stimulation to cutaneous mechanoreceptors.
This proposed fifth mechanism has been examined using our current
research method.
Little
is known of a possible proprioceptive effect of KinesioTM
tape, however it has been anticipated that there will be a facilitatory
effect of cutaneous mechanoreceptors as seen in studies examining
the effects of linen-backed adhesive athletic tape (Murray, 2001).
KinesioTM tape may have a similar effect on ankle proprioception
due to its aforementioned characteristics. This concept underlies
our hypotheses stating that proprioception will be enhanced through
increased cutaneous feedback supplied from the KinesioTM
tape.
Applying
pressure to, and stretching the skin can stimulate cutaneous mechanoreceptors.
The sense of stretching is thought to possibly signal information
of joint movement or joint position (Grigg, 1994).
Furthermore, it has been stated that cutaneous mechanoreceptors
might play a role in detecting joint movement and position resulting
from the stretching of skin at extremes of motion, much like joint
mechanoreceptors (Riemann and Lephart, 2002).
While the exact role of cutaneous mechanoreceptors is still under
discussion, it has become evident they can signal joint movement
and to some extent joint position (Simoneau et al., 1997).
It is important to note the exact role cutaneous mechanoreceptors
play in joint movement and position. Several authors have attributed
these cutaneous afferents with a precise ability to convey joint
movements through skin strain patterns (Riemann and Lephart, 2002).
It was hoped that the results of this study would add to the body
of literature on proprioception.
There
have been studies documenting a significant effect of the application
of white athletic tape to the ankle on ankle proprioception (Karlsson
and Andreasson, 1992;
Robbins et al., 1995;
Heit et al., 1996;
Simoneau et al., 1997).
However, very little research has been done examining the effect
alternative tape applications (such as that of KinesioTM
tape) may have on increasing cutaneous afference. Murray and Husk
(2001) examined
the effect of kinesio taping on ankle proprioception. They concluded
that kinesio taping for a lateral ankle sprain improved proprioceptive
abilities in non-weight bearing positions in the midrange of ankle
motion where ligament mechanoreceptors were inactive.
The
return of normal proprioception following orthopedic injury has
been, and should continue to be, a major clinical rehabilitation
goal (Lephart et al., 1997).
Increased somatosensory stimulation that can be used as proprioceptive
input, that is imparted by an elastic tape such as KinesioTM
tape, may enhanced an athlete's postural control system and facilitate
their earlier return to activity.
The
popularity of the application of tape during the rehabilitation
process, and the need for empirical evidence on the effect of KinesioTM
tape and it's potential effect on proprioception were compelling
reasons to perform this experiment. The purpose of this study was
to determine the effect of the application of this novel tape and
specialized taping method to an aspect of ankle proprioception,
reproduction joint position sense (RJPS). It was hypothesized that
using KinesioTM taping on the ankle/lower leg would:
(1) decrease (improve) the absolute error (AE) of RJPS when compared
to the untaped ankle in two ranges of motion: plantar flexion (PF)
and inversion at 20º of plantar flexion (INV/PF), (2) decrease (improve)
the constant error (CE) of RJPS when compared to the untaped ankle
in PF and INV/PF, and (3) show no significant differences in wither
constant or absolute error measures amongst gender in either range
of motion.
|
| METHODS |
Thirty
healthy (15 women, 15 men) subjects were screened using a questionnaire,
which asked for details on age, gender, and medical history. Individuals
with a history of any previous serious ankle injury or surgery, and/or
those who currently had ankle pathology, were excluded from this study.
Thirty subjects were interviewed and received a pre-participation
orthopedic ankle exam by a certified athletic trainer (ATC) to rule
out any abnormalities (i.e. abnormal ligament laxity, congenital deformities,
neurological deficits, etc.) that may have affected experimental data.
The orthopedic evaluation included an assessment for presence of pain,
stress tests to determine ligamentous stability, circulatory tests,
assessment of cutaneous sensation, and tests of active, passive, and
resisted ranges of motions.
Reproduction of joint position sense (RJPS) was measured in accordance
with the subject's ability to actively recreate a randomly selected
target position. These ankle measures were taken for both plantar
flexion and inversion with 20º plantar flexion before and after the
application of KinesioTM tape. An active RJPS paradigm
was selected in order to utilize a well accepted repositioning technique
originally forwarded for the ankle by Glencross and Thornton (1981)
and then further developed by Barrack and colleagues (1983)
for RJPS at the knee. Due to the fact that cutaneous mechanoreceptors
are stimulated during both passive and active movements, it was assumed
that the chosen paradigm would successfully test for a treatment effect
of KinesioTM tape.
Ankle position data was measured using and instrumented platform (Figure
1) with a moveable footplate capable of providing measures of
ankle joint position. The footplate was stabilized throughout testing
with the use of a counterbalance system, which created an unresisted
range of motion at the talocrural joint. Attached to the platform
was a precision potentiometer (Spectrol, Type 157, Ontario, CA), which
allowed a measure of specific angular position digitally, displaying
the position to the nearest tenth of a degree on a digital liquid
crystal display and computer data collection system (see below). Joint
repositioning trials were colleted at a rate of 100 Hz. Laboratory
tests of this apparatus have demonstrated a repeatable range of motion
error of less that ± 0.05°. The potentiometer was aligned with lateral
aspect of the ankle to assure that the numbers supplied were accurate
readings for the talocrural joint in the sagittal plane. During inversion
with 20° of plantar flexion condition, the potentiometer was aligned
with the center of axis of motion of the sub-talar joint in the coronal
plane with an anterior tilt of 20°. This information was then recorded
on a computer through a 16-bit analog to a digital board using Bioware®
V.3.22 (Kistler Instrument Corporation, Amherst, NY) data collection
software. A range of motion block was used to set the talocrural neutral
position (0º), achieved when the foot is at a right angle to the tibia.
Upon completion of data collection with each subject the RJPS apparatus
was recalibrated to assure accuracy throughout data collection.
Procedures
To ensure RJPS was affected only by mechanoreceptors within the ankle,
subjects were blindfolded and asked to wear headphones playing white
noise to ensure both visual and auditory cues did not affect the results.
In attempts to limit undesired cutaneous feedback, no straps were
used to hold the subject's foot to the platform. RJPS was then assessed
in conditions of no ankle tape (no-tape) and kinesio taped (taped)
ankle in the motions of plantar flexion and inversion with 20º plantar
flexion. All subjects were placed in a seated position with the foot
resting on the footplate of the apparatus.
RJPS measures were taken by passively placing the dominant ankle to
a random target angle and asking the subject to actively reposition
their ankle to the target angle from a neutral starting position.
Target angle positions in the plantar flexion rang varied from only
1º to 35º in attempts to eliminate extreme ranges of plantar flexion.
Inversion with 20º of plantar flexion had an angular position range
from 1º to 10º. Five trails were given at each range of motion with
absolute and constant error recorded for each.
Subjects were allowed to sit comfortably with their foot on the testing
apparatus. They were then passively placed to a random target position.
The subjects were held in that position for five seconds, asked to
remember the target angle, and then passively returned to their neutral
starting position. Subjects were then asked to actively reposition
their foot as closely to the target angle as possible. Through headphone
communication, audio mixed over the white noise, subjects were instructed
to press an indicator button placed in their right hand, signaling
the completion of their target-reposition task (Figure
2). Data was recorded in the Bioware system after passive target
positioning (by the researcher), and following the subject's signal
of completion of the target-repositioning task.
A cross-over design was employed with respect to the order of the
un-taped and taped conditions. Specifically, the application of the
KinesioTM tape occurred after completion of the first 10-trail
assessment of RJPS in plantar flexion and inversion with 20º of plantar
flexion for 15 (or half) of the participants. The other participants
performed the positioning tasks under the taped condition first, followed
by the un-taped condition. The participants were randomly assigned
with regard to the order of the taped and un-taped conditions. There
was a 5 minute waiting period between conditions and RJPS assessment.
All thirty subjects we assessed of a period of one week.
Taping
Subjects were taped for a lateral ankle sprain in accordance to Kenzo
Kase's KinesioTM taping manual (Kase et al., 1996).
Taping procedures were applied by the principal investigator (a certified
athletic trainer) to ensure consistency throughout the study.
For taping, each subject's foot was placed in relaxed position while
they sat on a taping table with the ankle in slight plantar flexion.
The first strip of tape was placed from the anterior midfoot, stretched
approximately to 115-120% of its maximal length and attached just
below the anterior tibial tuberosity over the tibialis anterior muscle.
The second strip began just above the medial malleolus and wrap around
the heel like a stirrup, attaching just lateral to the first strip
of tape. The third strip stretched across the anterior ankle, covering
both the medial and lateral malleolus. Finally, the fourth strip originated
at the arch and stretched slightly, measuring 4-6 inches above both
the medial and lateral malleolus (Figure
3).
Data Analysis
Constant error and absolute error values were examined by taking the
difference between the target angle and the trial angle for each subject.
Constant error examined the direction of imprecision, measuring the
number of positive or negative degrees the actively reproduced ankle
position was from the target position. Whereas absolute error took
only the number of degrees the actively reproduced ankle position
was from the target position. In examining possible gender differences,
changes in absolute error and constant error between un-taped conditions
and taped conditions were examined for both plantar flexion and 20°
of plantar flexion with inversion.
This study used a pretest-posttest design. The independent variable
was the KinesioTM taping procedure, and the dependent variable
was reproduction of joint position sense. Results were evaluated for
statistical significance (p < 0.05) using a paired, two-tail t-test
computed for both constant and absolute error values among subjects
and independent t-tests to evaluate across genders.
|
| RESULTS |
Upon
completion of data analysis, no significant differences of absolute
error between the no-tape condition (M=2.19° ± 1.20°) and the taped
condition (M=2.07° ± 0.98°) were found in plantar flexion, nor were
any significant differences seen between the no-taped condition (M=1.87°
± 0.89°) and the taped condition (M=1.95° ± 0.90°) in the combined
motion of inversion with 20° of plantar flexion (Figure
4). These results contest our first hypotheses, which stated KinesioTM
taping would decrease (improve) the absolute error on RJPS when compared
to the untaped ankle.
No significant difference in constant error was shown in plantar flexion
between the no-tape condition (M = -0.28°±2.01°) and the taped condition
(M = 0.08°±1.77°). Furthermore, there was no evidence of significant
change in the combined motion of inversion with 20° of plantar flexion
between the no-taped condition (M = 0.24°±1.80°) and the taped condition
(M = -0.02°± 1.46°) (Figure 5).
These results discount our second hypotheses, which stated KinesioTM
taping would decrease (improve) the constant error of RJPS when compared
to the un-taped ankle.
The data was also analyzed according to gender. No significant (p
> 0.05) differences were detected in changes of absolute or constant
error in plantar flexion or plantar flexion with inversion (Table
1) between genders. The third research hypothesis was supported.
In summary, group data revealed no AE or CE effects of KinesioTM
tape in any of the ranges of motion. In gender analysis, KinesioTM
tape had no effect on the changes of absolute error or constant error
amongst gender in either plantar flexion or 20° plantar flexion with
inversion.
|
| DISCUSSION |
Results
indicated no significant differences in either absolute or constant
error between the no-tape and KinesioTM taped conditions
in either plantar flexion or inversion with 20º of plantar flexion,
indicating that KinesioTM tape likely does not enhance
proprioception when measured by active ankle RJPS in healthy subjects.
These results do not concur with Murray's (2001)
findings, which showed that KinesioTM tape enhanced RJPS
through increases in cutaneous stimulation received from the KinesioTM
tape .
It is important to note, however, since the present study did not
specifically measure changes in cutaneous sense, that KinesioTM
tape cannot be ruled out as a contributor to increasing cutaneous
sense. We can only speculate on the role cutaneous sense may or may
not play in RJPS. It may be that KinesioTM tape does contribute
to increasing cutaneous feedback, however it appears that it plays
only a minimal role in RJPS. This explanation has been forwarded by
authors who have suggested muscle and joint mechanoreceptors are the
primary contributors to proprioception (Grigg et al., 1973;
Gandevia and McCloskey, 1976;
Barrack et al., 1984;
Riemann and Lephart, 2002).
Conversely, cutaneous ankle mechanoreceptors may rapidly accommodate
and not provide useful feedback during repeated movements.
While comparing differences in CE and AE between genders, no significant
differences were noted in either plantar flexion or inversion with
20º plantar flexion. These findings concur with those of the Walter's
study (2000),
which showed no significant gender differences when examining the
effects of taping on RJPS.
The findings of the present study lend support to the concept that
ankle taping has no significant effect on ankle RJPS in plantar flexion
or inversion with 20º of plantar flexion. In Walters' study (2000)
examining the effects of taping on RJPS, she found no significant
differences in absolute error or constant error when comparing data
before and after the application of tape to the ankle in the ranges
of plantar flexion and plantar flexion with inversion. The application
of KinesioTM tape for a lateral ankle sprain in this study
was less restrictive than her application of the more traditionally
restrictive Gibney Basketweave, and no significant changes in absolute
error or constant error were witnesses in either study. The present
findings suggest that these two distinctively different taping procedures
are similar in the sense that neither enhances RJPS.
With regard to methodology and its effect on results, Heit et al.,
(1996) examined
the effects of bracing and taping on proprioception, noting that both
treatments significantly improved RJPS in plantar flexion (AE). In
comparison to the present study, their un-taped condition demonstrated
an AE of 5.93°±1.91° compared to our observation of an AE of 2.19°±1.20°.
When taped, their subjects demonstrated a significant change in AE
of 3.90°±1.80° compared to our non-significant observation of an AE
of 2.07°±0.98°. Heit and co-workers' (1996)
methods utilized a Cybex II™ electronic goniometer, which required
foot straps to hold the foot in place while testing. It is possible
that these straps may have provided additional cutaneous feedback
cues to the subject during the reproduction task, thus facilitating
the subject's ability to more accurately reposition themselves to
the previous target position. This may offer one explanation for the
difference in their findings. Unlike the present study design, which
utilized randomly selected target positions with each individual trial,
Heit and co-workers used predetermined target positions that were
repeated over a sequence of trials. By repeating these predetermined
target positions, it is possible that a learning effect could have
been introduced, thus enabling the subjects to improve (decrease)
absolute error scores over the duration of their four trial sequence.
Another difference between these studies can be seen in the positioning
of the subject. It has been suggested that gravitational positioning
may have an affect RJPS measures (Brock, 1994).
The subjects in this study were seated vertically to eliminate any
possible gravitational effects that may have accompanied lying prone
during non-weight bearing testing, dissimilar to Heit and co-workers'
methods.
The present results also differ with the findings of Simoneau and
co-workers (1997),
who witnessed significant change in RJPS error in plantar flexion
upon application of two five inch strips of white athletic tape applied
to the lower leg. Strips of white athletic tape were placed along
the Achilles tendon and down the anterior aspect of the ankle. Simoneau
and co-workers' (1997)
findings indicated that proprioception, as assessed by RJPS, might
have been facilitated through the increase in cutaneous feedback supplied
by the two strips of athletic tape. However, the findings of this
study do not concur.
Again, as was the case in Heit et al.'s study, subjects in Simoneau
and co-workers' study were positioned to a predetermined target position
for four consecutive trials, possibly introducing a learning effect.
Finally, Simoneau placed two straps around each calf to ensure accurate
foot positioning throughout the duration of his data collection. However,
it is reasonable to believe these straps may have influenced cutaneous
feedback in the ankle due to their contact with the gastrocnemius
and soleus muscles (primary plantarflexors of the foot). With this
increased cutaneous feedback and possible mechanical restriction,
it is plausible that the subjects' ability to actively recreate target
position was affected.
|
| CONCLUSIONS |
The
application of KinesioTM tape does not appear to enhance
RJPS, when measured by active ankle RJPS in healthy subjects. The
hypotheses stating that ankle taping would decrease (improve) absolute
error and constant error of RJPS were not supported by the data.
Despite the unknown proprioceptive effects of KinesioTM
tape, it has been suggested as a possible proprioceptive facilitator
in the acute phases of the injury process (Murray, 2001).
Conversely the present results suggest that the application of KinesioTM
tape to lower leg and ankle does not provide proprioceptive enhancement
as measured by RJPS. If KinesioTM taping is a mechanism
that facilitates RJPS, further investigation on subjects suffering
from acute proprioceptive loss due to injury is needed so a possible
enhancement of proprioception can be specifically examined.
In order to fully understand the effect of KinesioTM tape
on proprioception, further research needs to be conducted on other
joints, on the method of application of KinesioTM tape,
and the health of the subject to whom it is applied. Further research
may provide vital information about a possible benefit of KinesioTM
taping during the acute and sub acute phases of rehabilitation, thus
facilitating earlier return to activity participation.
|
| ACKNOWLEDGEMENTS |
Tape for this research project was donated by KinesioTM
U.S.A. Corporation Limited, Albuquerque, NM.
|
| KEY
POINTS |
-
Proprioception research
- Evaluation
of a new taping method
- Augmentation
of sensory feedback
- Rehabilitation
technique
|
| AUTHORS
BIOGRAPHY |
Travis HALSETH
Employment:
Asst. athletic trainer at the Univ. of the Pacific in Stockton,
California. Head athletic trainer with the Women's basketball
team at the Univ. of the Pacific
Degrees: MS, ATC
Research interests: Proprioception, Athletic Training
|
|
John
W. McCHESNEY
Employment:Director of the Athletic Training/ Motor Control
Lab. at Boise State Univ. and an Assoc. Prof. in the Department
of Kinesiology.
Degrees: ATC, PhD
Research interests: Somatosensory contributions to motor
performance
|
|
Mark
DeBELISO
Employment: Ass. Prof. at Boise State Univ.
Degree: PhD
Research interests: Mechanics of sport movements and
work tasks as well as strength/ power training for all walks
of life.
|
|
Ross VAUGHN
Employment: Interim Assoc. Dean of the College of Education
at Boise State Univ. and a Prof. in the Depart. of Kinesiology.
Degree: PhD
Research interests: Sports biomechanics.
|
|
Jeff LIEN
Employment: Assoc. Athletic Trainer at Boise State Univ.
Degrees: MS, ATC
Research interests: Proprioception and biomechanics of
the track athlete
|
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John
W. McCHESNEY, Director Athletic Training
Education Program, Athletic Training/Motor