immediate effects of mulligan's fibular repositioning taping on postural control in athletes...

7262019 Immediate Effects of Mulligans Fibular Repositioning Taping on Postural Control in Athletes With and Without Chrohellip

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Original research

Immediate effects of Mulligans 1047297bular repositioning taping on

postural control in athletes with and without chronic ankle instability

Marjan Someeh a Ali Asghar Norasteh a Hassan Daneshmandi a Abbas Asadi b

a Department of Physical Education and Sport Sciences University of Guilan Rasht Iranb Young Researchers and Elite Club Roudbar Branch Islamic Azad University Roudbar Iran

a r t i c l e i n f o

Article history

Received 24 June 2013

Received in revised form

15 July 2014

Accepted 4 August 2014

Keywords

Ankle sprain

Taping

Postural control

a b s t r a c t

Objective To determine whether 1047297bular repositioning tape in1047298uenced the postural control performance

in athletes with and without chronic ankle instability (CAI)

Setting Research laboratory

Design A cross-sectional study within subjects experimental study design between 4 ankle conditions

(taped and untaped CAI and healthy athletes)

Participants Sixteen volunteer professional athletes with unilateral CAI (10 men and 6 women age

232 plusmn 3 y height 1754 plusmn 103 cm and weight 73 plusmn 145 kg) and sixteen volunteer healthy professional

athletes (10 men and 6 women age 228 plusmn 17 y height 1736 plusmn 122 cm and weight 664 plusmn 114 kg)

Interventions Fibular repositioning taping (FRT)

Main outcome measurements Star excursion balance test (postural control) in anteromedial (AM) medial

(M) and posteromedial (PM) directions were measured for the both group in two conditions tape and

untape

Results FRT improved signi1047297cantly postural control (M AM and PM) in both groups ( p lt 005)

Conclusion We observed that FRT can signi1047297cantly improve postural control in athletes with CAI and

healthy athletes Therefore FRT can be an effective management for athletes who suffer from CAI Also

this type of taping can apply immediately prior to activity and sport event to increase joint awareness of ankle

copy 2014 Elsevier Ltd All rights reserved

1 Introduction

Ankle inversion sprains are the commonest injuries of the lower

extremities especially in athletes involved in high contact sports

(Kirk Saha amp Bowman 2000 Refshauge Kilbreath amp Raymond

2000) A common sequela of an ankle sprain is the tendency for

the sprain to re-occur (Refshauge et al 2000) and the potential for

subsequent development of functional instability of the ankle(Caul1047297eld 2000 Ryan 1994) which might result in the condition

termed chronic ankle instability Chronic ankle instability (CAI) is

dependent on the interaction of various mechanical and functional

de1047297ciencies which give rise to the two frequently encountered

clinical phenomena subjective reporting of giving way of the ankle

joint or a feeling of ankle instability (Hertel 2002) Mechanical

insuf 1047297ciencies proposed to be associated with the development of

CAI include pathologic laxity articular synovial changes degener-

ative changes and arthrokinematic restrictions (Hertel 2002)

Functional insuf 1047297ciencies proposed to contribute to the develop-

ment of CAI include impaired proprioception impaired neuro-

muscular control impaired postural control and de1047297cits in strength

(Hertel 2002) It has been well documented that postural control is

impaired in individuals with CAI (Arnold De La Motte Linens amp

Ross 2009 Gribble amp Hertel 2003) Thus postural control im-pairments may be a causal mechanism of CAI and a potential

component of a classi1047297cation scheme designed to predict those

more likely to develop CAI

To evaluate proprioceptive and neuromuscular de1047297cits after CAI

postural control has typically been assessed with varied tests The

Star Excursion Balance Test (SEBT) is one such test that provides a

signi1047297cant challenge to an athletes postural control system (Hertel

Miller amp Denegar 2000) The SEBT involves having a participant

maintain a base of support with one leg while maximally reaching

in different directions with the opposite leg without compromising

the base of support of the stance leg (Munro amp Herrington 2010) Corresponding author

E-mail address abbas_asadi1175yahoocom (A Asadi)

Contents lists available at ScienceDirect

Physical Therapy in Sport

j o u r n a l h o m e p a g e w w w e l s e v i e r c om p t s p

httpdxdoiorg101016jptsp201408003

1466-853Xcopy

2014 Elsevier Ltd All rights reserved

Physical Therapy in Sport 16 (2015) 135e139



The SEBT has been widely used in research and clinical practice to

examine numerous topics such as CAI and offers a simple low-cost

alternative to more sophisticated laboratory assessments for use in

clinical setting (Hopper Samsson Hulenik Hallamp Robinson 2009)

Strong test-retest reliability for SEBT has been demonstrated by

Munro and Herrington (2010) (ICC frac14 088e094) In addition it has

been well documented that SEBT is valid method for determining

postural control de1047297cits in subjects with CAI (Hertel et al 2000

Hopper et al 2009)

One of the most popular methods of supporting an ankle from

undergoing further injury 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 it is hypothesized that it prevents

further sprains by enhancing proprioceptive acuity (Barboukis

Sykaras Costa amp Tsorbatzoudis 2002 Refshauge et al 2000

Richie 2001 Wilkerson 2002) 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 (Stanek McLoda McGaw amp Launder 2006)

There are several methods of ankle joint taping (eg basket

weave heel lock lateral subtalar sling and etc) however one that

has received little attention in the literature is the 1047297bular reposi-

tioning taping (FRT) or Mulligan ankle taping (Hopper et al 2009)FRT works on the premise that after an acute ankle sprain there is

anterior positional fault at the inferior tibio1047297bular joint (Mulligan

2003) This premise has also been suggested by a number of au-

thors (Delahunt McGrath Doran amp Coughlan 2010 Hopper et al

2009 Hubbard Hertel amp Sherbondy 2006 Moiler Hall amp

Robinson 2006) For example Moiler et al (2006) has shown

that the use of FRT signi1047297cantly reduced the incidence of ankle joint

injury in a group of basketball players However the exact mech-

anism underlying this reduced incidence of ankle joint injury could

not be elucidated

While previous studies have explored the in1047298uence of taping on

postural control in subjects with CAI no study has directly exam-

ined FRT on postural control in professional athletes with and

without CAI In this current study we used FRT because previousauthors suggestedthat thistaping methodcould correct an anterior

positional fault of the 1047297bula and also maintain correct 1047297bular

alignment (Delahunt et al 2010 Moiler et al 2006) however

there is no current research evidence to support this Therefore it is

important to understand the effects of FRT in athletes since many

assumptions have been made from studies using this taping Thus

the purpose of the present study was to examine the effects of FRT

on postural control in professional athletes with and without CAI

2 Methods

21 Participants

The participants were sixteen professional athletes with CAI and

sixteen healthy professional athletes (Table 1) A estimated sample

size for b frac14 080 with a frac14 005 was calculated a prior based on

tabled data from previous research (Hertel amp Olmsted-Kramer

2007) Subjects in both groups were matched for sex limb domi-

nance foot curvature sport experience level and plusmn10 of age

weight and height Subsequent analysis found no signi1047297cant dif-

ferences between groups in demographics data (age p frac14 044

weight p frac14 016 height p frac14 0437) The both groups were profes-

sional athletes who involved in ball sport events such as football

volleyball and handball that trained at least three times a week for

90 min Athletes in the healthy group were matched with the CAI

group both for their sport experiences and their leg dominance For

example we compared volleyball players with CAI whose position

was spiker with players in the same position without ankle insta-

bility This approach was maintained for all participants The par-

ticipants read and signed the information consent form that was

approved by a university institutional review board

22 Procedures

This cross-sectional study used a within subjects experimental

study design between 4 ankle conditions (taped and untaped CAI

and healthy athletes) Subjects were pre-screened to verify the

inclusion criteria and then reported to the research laboratory for

one session For this study CAI was de1047297ned by a history of at leasttwo acute ankle sprains that resulted in pain and swelling and a

history of multiple episodes of the ankle giving way in the past 6

months Subjects were excluded if they had a previous fracture in

lower extremity an acute sprain within the past 6-week or bilateral

CAI Prior to participating subjects were screened using two

questionnaires which were adapted from the Foot and Ankle

Disability Index (FADI) and FADI sport (Gribble Brittany Taylor amp

Shinohara 2010) Subjects were recruited onto the study if they

had less than 90 and 75 of the total scores for the FADI and FADI

sport questionnaires respectively Subjects read and signed an

informed consent form and after 48 h subjects were tested in a

laboratory Subjects height was measured using a wall-mounted

stadiometer (Seca 222 Terre Haute IN) recorded to the nearest

centimeter Body mass was measured to the nearest 01 kg using amedical scale (Tanita BC-418MA Tokyo Japan) Also foot curvature

was determined using Feiss line orthopedic examination (Magee

2002 Sporndly-Ness Dasberg Nielson Boesen amp Langberg

2011) According to Gribble Hertel amp Pliskys study (2012) in order

to decrease possible errors in the SEBT performance results due to

foot type feiss line measurement was used to match participants

foot types For example when we had an athlete with pes cavus in

CAI group we selected an athlete with pes cavus in healthy group

This approach was maintained for all participants

After measurement of weight and height subjects performed a

10 min warm up including 5 min cycling and 5 min stretching and

ballistic movements Then subjects randomly performed postural

control test (star excursion balance test) with and without FRT The

CAI group performed the SEBT with the injured (affected) leg andthe side of leg was matched with the healthy group Only the

injured (affected) leg in the CAI group was taped and this leg was

matched in the healthy (control) group Pre and post taping both

groups (CAI and healthy group) performed SEBT The order of

condition (with or without FRT) and reaching directions were

randomized A 10-min rest break was allowed between conditions

(Fig 1)

23 Instrumentation

231 Taping

The subjects were instructed to shave their ankles 24 h prior to

the testing day The area to be taped was cleaned with an alcohol

swab Taping speci1047297

c spray (QDA Tape Adherent Spray Cramer

Table 1

Participants characteristics (mean plusmn SD)

Athletes with CAI

(10 men and 6 women)

Healthy athletes


Age (y) 232 plusmn 3 228 plusmn 17

Height (cm) 1754 plusmn 103 1736 plusmn 122

Weight (kg) 7306 plusmn 145 664 plusmn 114

FADI score () 745 plusmn 862 100 plusmn 0

FAD I spor t sco re ( ) 6 3 5 plusmn 768 100 plusmn 0

Sporting background (y) 72 plusmn 34 75 plusmn 28

M Someeh et al Physical Therapy in Sport 16 (2015) 135e139136



USA) was used for increasing adhesiveness and decreasing skin

sensitiveness The tape wasapplied when the participants were in a

supine position on a plinth The FRT technique requires approxi-

mately two 20 cm lengths of rigid tape The rigid tape (Euro Tape

Muiler USA) was applied with the ankle in neutral position start-

ing obliquely at the distal end of the lateral malleolus while a pain-

free postero-lateral-superior glide was applied to the 1047297bula at the

level of the inferior tibio1047297bular joint and then wraps slightly di-

agonal around the tendoachilles and anchored above the initial

tape attachment A second reinforcing strip was then applied in the

same manner The FRT application is shown in Fig 2 and further

detailed by Moiler et al (2006) The same physiotherapist experi-enced in the FRT method applied the taping to all the subjects

232 Postural control

In this study we used the star excursion balance test (SEBT) for

the postural control assessment The SEBT is a functional test that

incorporates single-leg stance on one leg with maximal reach of the

opposite leg The SEBT was performed with the subjects standing at

the center of a grid on the 1047298oor with 8 lines extending at 45 in-

crements from the center of the grid The 8 lines positioned on the

grid were labeled according to the direction of excursion relative to

the stance leg anterolateral (AL) anterior (A) anteromedial (AM)

medial (M) posteromedial (PM) posterior (P) posterolateral (PL)

and lateral (L) In the current study we used line AM M and PM

(Fig 3) because Hertel et al (2000) reported a high relationshipbetween these lines and postural control de1047297cits in subjects with

CAI A verbal and visual demonstration of the testing procedure was

given to each subject by the examiner Each subject performed 4

practice trials in each of the 3 directions for each leg to become

familiar with the task After 5 min rest the subjects performed the

testing procedure To perform the SEBTs the subject maintained a

single-leg stance while reaching with the contralateral leg (reach

leg) as far as possible along the appropriate vector The subject

lightly touched the furthest point possible on the line with the most

distal part of the reach foot The subject was instructed to touch the

furthest point on the line with the reach footas lightly as possible in

order to ensure that stability was achieved through adequate

neuromuscular control of the stance leg The subject then returned

to a bilateral stance while maintaining equilibrium The examiner

manually measured the distance from the center of the grid to the

touch point with a tape measure in centimeters Measurements

were taken after each reach by the same examiner Three reaches in

each direction were recorded The orders of directions were

randomly chosen by the subjects Subjects were given 15 s of rest

between reaches The average of the 3 reaches in each of the 3

directions were calculated (Gribble amp Hertel 2003 Gribble et al

2012) Trials were discarded and repeated if the subject (1) did

not touch the line with the reach foot while maintaining weightbearing on the stance leg (2) lifted the stance foot from the center

grid (3) lost balance at any point in the trial or (4) did not maintain

start and return positions for one full second If a subject was

judged by the examiner to have touched down with the reach foot

in a manner that caused the reach leg to considerably support the

body the trial was discarded and repeated In other words if the

reach foot was used to widen the base of support the trial was not

recorded The base of support was the stance foot for the entire trial

with the fraction of a second in which the reach foot very lightly

touched the ground (Gribble amp Hertel 2003)

233 Normalizing SEBT data

Each participants legs were measured from the anterior supe-

rior iliac spine to the distal tip of the medial malleolus using astandard tape measure while participants lay supine Leg length

was used to normalize excursion distances by dividing the distance

reached by leg length then multiplying by 100 (Gribble amp Hertel

2003)

234 Data analysis

Tests for normal distribution (KolmogoroveSmirnov) were

conducted on all data before analysis We used a 2 2 3

Fig 1 Study design

Fig 2 FRT method Fig 3 SEBT procedure

M Someeh et al Physical Therapy in Sport 16 (2015) 135e139 137



repeated-measures analysis of variance for analysis The between-

subjects factor was group with 2 levels (CAI healthy athletes)

while the within-subjects factors were side with 2 levels (taped

untaped) and direction with 3 levels (AM M PM) In the event of F

ratio Tukeys post hoc test was used for further analysis The alpha

level was set at p 05 for all analyses The statistical tests were

performed using the SPSS statistical package version 16 (Chicago

IL USA)

3 Results

Data normality was established using the KolmogoroveSmirnov

test (M p frac14 0856 AM p frac14 0830 PM p frac14 0925 and overall

reaching p frac14 0967) There were no signi1047297cant differences between

trials for each direction We found a signi1047297cant group-by-condition

interaction that revealed greater reaching distance in all directions

for healthy athletes compared to athletes with CAI before taping

(M F frac14 1704 p frac14 0001 AM F frac14 1618 p frac14 0001 PM F frac14 1564

p frac14 0001 overall F frac14 474 p frac14 0038) Moreover after taping there

was a signi1047297cant increase in reaching distance for the M direction in

CAI (F frac14 426 p frac14 005) and healthy athletes (F frac14 1463 p frac14 0002)

In the AM direction athletes with CAI improved their reach when

compared with their performance beforetaping (F frac14 856 pfrac14 001)

whereas the changes in healthy athletes were not statistically sig-

ni1047297cant (F frac14 299 p frac14 01) Both the CAI and healthy groups indi-

cated signi1047297cant improvements in PM (CAI F frac14 724 p frac14 001

healthy F frac14 1116 p frac14 0005) and overall reach (CAI F frac14 1625

p frac14 0001 healthy F frac14 1300 p frac14 0003) at pre-to-post FRT Table 2

shows means standard deviations p values standard error of

measurement effect sizes and percentage of improvement in CAI

and healthy athletes pre to post FRT

4 Discussion

The novel approach used in this study was to examine the effect

of FRTon postural control in professional athletes with and without

CAI In this study SEBT in the AM M and PM directions were usedto determine postural control as Hertel et al (2000) had reported a

high correlation between these directions and postural control

de1047297cits in CAI subjects

In the current study we found that postural control in CAI

athletes was less than healthy athletes These 1047297ndings are in line

with previous studies that reported de1047297cits in postural control due

to CAI and a large number of researchers have examined the in-

1047298uence of CAI on postural control and found de1047297cits or impair-

ments in postural control in subjects with CAI (Holmes amp Delahunt

2009 McKeonamp Hertel 2008 Munn Sullivan amp Schneiders 2010)

The mechanism(s) for this 1047297nding is suggested to be de1047297cits in

proprioception and neuromuscular control following ankle sprains

(Alt Lohrer amp Gollhoger 1999) Moreover ankle and hip strategy

play an important role for maintaining stability and balance Itappears that CAI is associated with de1047297cits in ankle and hip strategy

resulting in de1047297cits in balance and postural control (Holmes amp

Delahunt 2009)

In this study we observed that FRT increased reach distance in

CAI and healthy athletes Overall reach distance also signi1047297cantly

improved for both groups Protective devices such as bracing and

taping increases skin mechanoreceptor inputs resulting in an

enhancement in proprioception and postural control (Brown amp

Mynark 2007)

Results of the present study concur with Moiler et al (2006) but

are not in line with those observed by Hopper et al (2009)

Delahunt et al (2010) and others (Ozer Senbursa Baltaci amp

Hayran 2009 Sawkins Refshauge Kilbreath amp Raymond 2007)

Hopper et al (2009) examined the effects of FRT on static and dy-

namic postural stability and found no signi1047297cant effects These

authors measured static balance by means of postural sway on a

forceplate which may not be the most sensitive for detecting

postural stability de1047297cits in CAI subjects (McKeon amp Hertel 2008)

Holmes and Delahunt (2009) reported that the SEBT is more sen-

sitive than other tests for measuring postural control in CAI sub-

jects With regard to this Delahunt et al (2010) investigated the

effects of FRT on SEBT in A PM and PL directions in CAI subjects

They reported that FRT increased reach distance but these in-

creases were not statistically signi1047297cantOne possible explanation for the contrast between our 1047297ndings

and Delahunt et al could be differences in line directions studied

Hertel et al (2000) reported high correlation between directions

which used in our study and postural control de1047297cits in CAI sub-

jects In the study by Sawkins et al (2007) the investigators aimed

to investigate the effect of two different taping techniques (real vs

placebo vs no tape) on dynamic postural stability in a group of

subjects with CAI Results of this study did not show a statistically

signi1047297cant effect across conditions for SEBT reach distance perfor-

mance Ozer et al (2009) examined the effects of taping (basket

weave technique) on single leg balance and found no signi1047297cant

effects possibly due to this type of testing being not sensitive for

measuring postural control de1047297cits in CAI subjects (McKeon amp

Hertel 2008 Munn et al 2010) Compared to two previousstudies it was dif 1047297cult to speci1047297cally compare our 1047297ndings with the

results of other studies due to differences in research methodology

and the different taping techniques used

With regard to our 1047297ndings Moiler et al (2006) reported that

FRT can decrease the risk of ankle sprain in basketball players with

CAI Our study indicated that FRT can increase postural control and

since there is a suggested reverse relationship between postural

control and risk of ankle sprain (McGuine Greene Best amp Leverson

2000) our results are in line with Moiler et al (2006) Provision of

support and proprioceptive input are the main purported mecha-

nisms that enable taping to prevent injury and increase postural

control (Sesma Mattacola Uhl Nitz amp McKeon 2008) In addition

to these mechanisms it has been proposed that the effectiveness of

FRT may result from prevention of 1047297bular displacement It appearsthat when the foot is forcibly inverted the mechanical stress is

Table 2

Mean plusmn standard deviations for normalized maximum excursion distance (excursion distanceleg length 100) M Medial AM Anteromedial PM Posteromedial

Directions Group Untapped Taped P SEM ES D

M Athletes with CAI 938 plusmn 6 974 plusmn 66 005 17 060 41

Healthy athletes 1039 plusmn 72 1069 plusmn 63 0002 16 041 15

AM Athletes with CAI 909 plusmn 58 945 plusmn 66 001 14 062 4


PM Athletes with CAI 964 plusmn 72 1018 plusmn 83 001 19 075 53


Overall Athletes with CAI 2812 plusmn 178 2938 plusmn 198 0001 44 070 44





transferred to the anterior talo1047297bular ligament pulling the 1047297bula

forward which is suggested by some authors to create an anterior

positional fault (Delahunt et al 2010 Moiler et al 2006)

The limitations of this study include the low number of women

athletes which prevents generalization of the results as well as the

lack of assessor and subject blinding Additionally the results of the

current investigation are based on a professional sporting popula-

tion and further research is needed to determine if similar effects

are obtained in the non-professional sporting population

5 Conclusion

This investigation was designed to investigate the use of a

speci1047297c ankle taping (FRT) technique in athletes with CAI and

compared them to healthy athletes during a dynamic balance task

Our results revealed that Mulligans 1047297bular repositioning taping

signi1047297cantly improved acute postural control in athletes with CAI

and healthy athletes Although we only examined acute effects of

FRT more studies are necessary to explore the long-term effects of

this taping Moreover the effect of FRT on pain and disability in CAI

is worthy of further study With regard to results of the current

investigation FRT might be an effective management for athletes

who suffer from de1047297cits following CAI in events that need requirestability and balance Additionally this type of taping when applied

immediately prior to activity and sport event might help to increase

joint awareness of the ankle FRT might offer the advantage of quick

and easy self-application and the use of signi1047297cantly less tape than

traditional taping procedures

Con1047298ict of interest

None declared

Ethical approval

The methods used in this study have been approved by the in-

ternal review board at the University of Guilan

Funding

None declared

References

Alt W Lohrer H amp Gollhofer A (1999) Functional properties of adhesive ankletaping neuromuscular and mechanical effects before and after exercise Foot and Ankle International 20 238e245

Arnold B L De La Motte S Linens S amp Ross S E (2009) Ankle instability isassociated with balance impairments a meta-analysis Medicine and Science inSports and Exercise 41 1287e1295

Barboukis V Sykaras E Costa F amp Tsorbatzoudis H (2002) Effectiveness of taping and bracing in balance Percept Motor Skills 94 566e574

Brown C amp Mynark R (2007) Balance de1047297

cits in recreational athletes withchronic ankle instability Journal of Athletic Training 42 367e373Caul1047297eld B (2000) Functional instability of the ankle joint Physiotherapy 86 (8)

401e411Delahunt E McGrath A Doran N amp Coughlan G F (2010) Effect of taping on

actual and perceived dynamic postural stability in persons with chronic ankleinstability Archives of Physical Medicine and Rehabilitation 91 1383e1389

Gribble P A Brittany L Taylor J amp Shinohara U (2010) Bracing does not improvedynamic stability in chronic ankle instability subjects Physical Therapy in Sport11 3e7

Gribble P A amp Hertel J (2003) Considerations for normalizing measures of thestar excursion balance test Measurement in Physical Education and ExerciseScience 7 89e100

Gribble P A Hertel J amp Plisky P (2012) Using the star excursion balance test toassess dynamic postural control de1047297cits and outcomes in lower extremityinjury A literature and systematic review Journal of Athletic Training 47 339e357

Hertel J (2002) Functional anatomy pathomechanics and pathophysiology of lateral ankle instability Journal of Athletic Training 37 364e375

Hertel J Miller S J amp Denegar C R (2000) Intratester and intertester reliabilityduring the star excursion balance tests Journal of Sport Rehabilitation 9104e116

Hertel J amp Olmsted-Kramer L C (2007) De1047297cits in time to boundary measures of postural control with chronic ankle instability Gait and Posture 25 33e39

Holmes A amp Delahunt E (2009) Treatment of common de1047297cits associated withchronic ankle instability Sports Medicine 39 207e224

Hopper D Samsson K Hulenik T Hall T amp Robinson K (2009) The in1047298uence of mulligan ankle taping during balance performance in subjects with unilateralchronic ankle instability Physical Therapy in Sport 10 125e130

Hubbard T J Hertel J amp Sherbondy P (2006) Fibular position in individuals withself-reported chronic ankle instability Journal of Orthopaedic and Sports PhysicalTherapy 36 3e9

Kirk T Saha S amp Bowman L S (2000) A new ankle laxity tester and its use in themeasurement of the effectiveness of taping Medical Engineering and Physics

22(10) 723e731Magee D J (2002) Orthopedic physical assessment (4th ed) Elsevier SciencesMcGuine T A Greene J J Best T amp Leverson G (2000) Balance as a predictor of

ankle injuries in high school basketball players Clinical Journal of Sport Medi-cine 10 239e244

McKeon P O amp Hertel J (2008) Systematic review of postural control and lateralankle instability Part I can de1047297cits be detected with instrumented testing

Journal of Athletic Training 43 293e304Moiler K Hall T amp Robinson K (2006) The role of 1047297bular tape in the prevention

of ankle injury in basketball a pilot study Journal of Orthopaedic and SportsPhysical Therapy 36 661e668

Mulligan R F (2003) Self treatments for backs necks limbs A new approachWellington (New Zealand) Plane View Services

Munn J S Sullivan J amp Schneiders A G (2010) Evidence of sensorimotor de1047297citsin functional ankle instability a systematic review with meta-analysis Journalof Science and Medicine in Sport 13 2e12

Munro A G amp Herrington L C (2010) Between-session reliability of the starexcursion balance test Physical Therapy in Sport 11 128e132

Ozer D Senbursa G Baltaci G amp Hayran M (2009) The effect on neuromuscularstability performance multi-joint coordinationand proprioception of barefoot

taping or preventativebracing The Foot 19 205e

210Refshauge K M Kilbreath S L amp Raymond J (2000) The effect of recurrent ankleinversion sprain and taping on proprioception at the ankle Medicine and Sci-ence in Sports and Exercise 32(1) 10e15

Richie D H (2001) Functional instability of the ankle and the role of neuromus-cular control a comprehensive review Journal of Foot and Ankle Surgery 40(4)240e251

Ryan L (1994) Mechanical stability muscle strength and proprioception in thefunctionally unstable ankle Australian Journal of Physiotherapy 40 41e47

Sawkins K Refshauge K Kilbreath S amp Raymond J (2007) The placebo effect of ankle taping in ankle instability Medicine and Science in Sports and Exercise 39781e787

Sesma A R Mattacola C G Uhl T L Nitz A J amp McKeon P O (2008) Effect of foot orthotics on single and double limb dynamic balance tasks in patients withchronic ankle instability Foot and Ankle 1 330e337

Sporndly-Ness S Dasberg B Nielson R O Boesen M I amp Langberg H (2011)The navicular position test-areliable measure of the navicular bone positionduring rest and loading International Journal of Sports Physical Therapy 6 199e205

Stanek J M McLoda T A McCaw S amp Launder K (2006) The effects of externalsupport on electromechanical delay of the peroneus longus muscle Electro-myography and Clinical Neurophysiology 46 (6) 349e354

Wilkerson G (2002) Biomechanical and neuromuscular effects of ankle taping andbracing Journal of Athletic Training 37 (4) 436e445




The SEBT has been widely used in research and clinical practice to

examine numerous topics such as CAI and offers a simple low-cost

alternative to more sophisticated laboratory assessments for use in

clinical setting (Hopper Samsson Hulenik Hallamp Robinson 2009)

Strong test-retest reliability for SEBT has been demonstrated by

Munro and Herrington (2010) (ICC frac14 088e094) In addition it has

been well documented that SEBT is valid method for determining

postural control de1047297cits in subjects with CAI (Hertel et al 2000

Hopper et al 2009)

One of the most popular methods of supporting an ankle from

undergoing further injury 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 it is hypothesized that it prevents

further sprains by enhancing proprioceptive acuity (Barboukis

Sykaras Costa amp Tsorbatzoudis 2002 Refshauge et al 2000

Richie 2001 Wilkerson 2002) 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 (Stanek McLoda McGaw amp Launder 2006)

There are several methods of ankle joint taping (eg basket

weave heel lock lateral subtalar sling and etc) however one that

has received little attention in the literature is the 1047297bular reposi-

tioning taping (FRT) or Mulligan ankle taping (Hopper et al 2009)FRT works on the premise that after an acute ankle sprain there is

anterior positional fault at the inferior tibio1047297bular joint (Mulligan

2003) This premise has also been suggested by a number of au-

thors (Delahunt McGrath Doran amp Coughlan 2010 Hopper et al

2009 Hubbard Hertel amp Sherbondy 2006 Moiler Hall amp

Robinson 2006) For example Moiler et al (2006) has shown

that the use of FRT signi1047297cantly reduced the incidence of ankle joint

injury in a group of basketball players However the exact mech-

anism underlying this reduced incidence of ankle joint injury could

not be elucidated

While previous studies have explored the in1047298uence of taping on

postural control in subjects with CAI no study has directly exam-

ined FRT on postural control in professional athletes with and

without CAI In this current study we used FRT because previousauthors suggestedthat thistaping methodcould correct an anterior

positional fault of the 1047297bula and also maintain correct 1047297bular

alignment (Delahunt et al 2010 Moiler et al 2006) however

there is no current research evidence to support this Therefore it is

important to understand the effects of FRT in athletes since many

assumptions have been made from studies using this taping Thus

the purpose of the present study was to examine the effects of FRT

on postural control in professional athletes with and without CAI

2 Methods

21 Participants

The participants were sixteen professional athletes with CAI and

sixteen healthy professional athletes (Table 1) A estimated sample

size for b frac14 080 with a frac14 005 was calculated a prior based on

tabled data from previous research (Hertel amp Olmsted-Kramer

2007) Subjects in both groups were matched for sex limb domi-

nance foot curvature sport experience level and plusmn10 of age

weight and height Subsequent analysis found no signi1047297cant dif-

ferences between groups in demographics data (age p frac14 044

weight p frac14 016 height p frac14 0437) The both groups were profes-

sional athletes who involved in ball sport events such as football

volleyball and handball that trained at least three times a week for

90 min Athletes in the healthy group were matched with the CAI

group both for their sport experiences and their leg dominance For

example we compared volleyball players with CAI whose position

was spiker with players in the same position without ankle insta-

bility This approach was maintained for all participants The par-

ticipants read and signed the information consent form that was

approved by a university institutional review board

22 Procedures

This cross-sectional study used a within subjects experimental

study design between 4 ankle conditions (taped and untaped CAI

and healthy athletes) Subjects were pre-screened to verify the

inclusion criteria and then reported to the research laboratory for

one session For this study CAI was de1047297ned by a history of at leasttwo acute ankle sprains that resulted in pain and swelling and a

history of multiple episodes of the ankle giving way in the past 6

months Subjects were excluded if they had a previous fracture in

lower extremity an acute sprain within the past 6-week or bilateral

CAI Prior to participating subjects were screened using two

questionnaires which were adapted from the Foot and Ankle

Disability Index (FADI) and FADI sport (Gribble Brittany Taylor amp

Shinohara 2010) Subjects were recruited onto the study if they

had less than 90 and 75 of the total scores for the FADI and FADI

sport questionnaires respectively Subjects read and signed an

informed consent form and after 48 h subjects were tested in a

laboratory Subjects height was measured using a wall-mounted

stadiometer (Seca 222 Terre Haute IN) recorded to the nearest

centimeter Body mass was measured to the nearest 01 kg using amedical scale (Tanita BC-418MA Tokyo Japan) Also foot curvature

was determined using Feiss line orthopedic examination (Magee

2002 Sporndly-Ness Dasberg Nielson Boesen amp Langberg

2011) According to Gribble Hertel amp Pliskys study (2012) in order

to decrease possible errors in the SEBT performance results due to

foot type feiss line measurement was used to match participants

foot types For example when we had an athlete with pes cavus in

CAI group we selected an athlete with pes cavus in healthy group

This approach was maintained for all participants

After measurement of weight and height subjects performed a

10 min warm up including 5 min cycling and 5 min stretching and

ballistic movements Then subjects randomly performed postural

control test (star excursion balance test) with and without FRT The

CAI group performed the SEBT with the injured (affected) leg andthe side of leg was matched with the healthy group Only the

injured (affected) leg in the CAI group was taped and this leg was

matched in the healthy (control) group Pre and post taping both

groups (CAI and healthy group) performed SEBT The order of

condition (with or without FRT) and reaching directions were

randomized A 10-min rest break was allowed between conditions

(Fig 1)

23 Instrumentation

231 Taping

The subjects were instructed to shave their ankles 24 h prior to

the testing day The area to be taped was cleaned with an alcohol

swab Taping speci1047297

c spray (QDA Tape Adherent Spray Cramer

Table 1

Participants characteristics (mean plusmn SD)

Athletes with CAI


Healthy athletes


Age (y) 232 plusmn 3 228 plusmn 17

Height (cm) 1754 plusmn 103 1736 plusmn 122

Weight (kg) 7306 plusmn 145 664 plusmn 114

FADI score () 745 plusmn 862 100 plusmn 0

FAD I spor t sco re ( ) 6 3 5 plusmn 768 100 plusmn 0

Sporting background (y) 72 plusmn 34 75 plusmn 28
































































2003)

234 Data analysis



Fig 1 Study design












IL USA)

3 Results





















4 Discussion


















Delahunt 2009)






Mynark 2007)










































Table 2























5 Conclusion

















None declared

Ethical approval



Funding

None declared

References



































































































2003)

234 Data analysis



Fig 1 Study design












IL USA)

3 Results





















4 Discussion


















Delahunt 2009)






Mynark 2007)










































Table 2























5 Conclusion

















None declared

Ethical approval



Funding

None declared

References














































IL USA)

3 Results





















4 Discussion


















Delahunt 2009)






Mynark 2007)










































Table 2























5 Conclusion

















None declared

Ethical approval



Funding

None declared

References
















































5 Conclusion

















None declared

Ethical approval



Funding

None declared

References





































immediate effects of mulligan's fibular repositioning taping on postural control in athletes...

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