Effects of Kinesio Tape Compared With Nonelastic Sports ...

328 | may 2011 | volume 41 | number 5 | journal of orthopaedic & sports physical therapy

[ research report ]

Ankle sprains are common in the general population and the most common type of injury in team sports.7 As the ankle reinjury rate is known to be high, it is important to identify

specific injury prevention strategies.1,24 Measures to prevent injury have typically included specific strength training of the fibularis muscles,26

proprioceptive train-ing,26,39 and external support, such as braces and nonelastic athletic tape.2,12,26,39

Tests of postural control have shown that individuals with ankle instability have poorer frontal plane stability than those with unaffected ankles.32 Due to their role as the primary everters and dy-namic stabilizers of the ankle, the func-tion of the fibularis (peroneus) muscles in relation to ankle stability and lateral sprains has been extensively studied. Studies have presented conflicting re-sults with respect to the possibility of a longer latency of the fibularis muscles in individuals with unstable ankles.41 There is, however, evidence to suggest that dy-namic fibularis activity may be impaired in those with functional ankle instabil-ity and should be restored to maximize ankle stabilization.29 Karlsson and An-dreasson15 studied athletes with unilat-eral ankle instability and found that the application of athletic tape improved the reaction time of the fibularis muscles dur-ing simulated ankle sprain using a trap door and that those with greater instabil-ity showed greater improvements. The mechanism responsible for improving postural control with the application of

TT STUDY DESIGN: Controlled laboratory study.

TT OBJECTIVES: To examine the effect of 2 adhesive tape conditions compared to a no-tape condition on muscle activity of the fibularis longus during a sudden inversion perturbation in male athletes (soccer, team handball, basketball).

TT BACKGROUND: Ankle sprains are common in sports, and the fibularis muscles play a role in pro-viding functional stability of the ankle. Prophylactic ankle taping with nonelastic sports tape has been used to restrict ankle inversion. Kinesio Tape, an elastic sports tape, has not been studied for that purpose.

TT METHODS: Fifty-one male premier-league athletes were tested for functional stability of both ankles with the Star Excursion Balance Test. Based on the results, those with the 15 highest and those with the 15 lowest stability scores were selected for further testing. Muscle activity of the fibularis lon-gus was recorded with surface electromyography during a sudden inversion perturbation. Each par-ticipant was tested under 3 conditions: ankle taped with nonelastic white sports tape, ankle taped with Kinesio Tape, and no ankle taping. Differences in mean muscle activity were evaluated with a 3-way

mixed-model analysis of variance (ANOVA) for the 3 conditions, across four 500-millisecond time frames, and between the 2 groups of stable versus unstable participants. Differences in peak muscle activity and in the time to peak muscle activity were evaluated with a 2-way mixed-model ANOVA.

TT RESULTS: Significantly greater mean muscle activity was found when ankles were taped with nonelastic tape compared to no tape, while Kinesio Tape had no significant effect on mean or maximum muscle activity compared to the no-tape condition. Neither stability level nor taping condition had a significant effect on the amount of time from perturbation to maximum activity of the fibularis longus muscle.

TT CONCLUSION: Nonelastic sports tape may enhance dynamic muscle support of the ankle. The efficacy of Kinesio Tape in preventing ankle sprains via the same mechanism is unlikely, as it had no effect on muscle activation of the fibularis longus. J Orthop Sports Phys Ther 2011;41(5):328-335, Epub 5 January 2011. doi:10.2519/jospt.2011.3501

TT KEY WORDS: electromyography, joint instabil-ity, SEBT, sprain

1Assistant Professor, University of Iceland, School of Health Sciences, Research Centre of Movement Science, Reykjavík, Iceland. 2Physical Therapist, Landspitali University Hospital, Reykjavík, Iceland. 3Physical Therapist, Sjúkrathjálfun Íslands, Physical Therapy, Reykjavík, Iceland. 4Associate Professor, University of Iceland, School of Health Sciences, Research Centre of Movement Science, Reykjavík, Iceland. The National Bioethics Committee reviewed and approved the study protocol. Address correspondence to Dr Kristin Briem, Assistant Professor, 220 Stapi v/Hringbraut, University of Iceland, Reykjavik IS101, Iceland. E-mail: [email protected]

KRISTIN BRIEM, PT, PhD1 • HREFNA EYTHÖRSDÖTTIR, PT2 • RAGNHEIDUR G. MAGNÚSDÓTTIR, PT3

RÚNAR PÁLMARSSON, PT3 • TINNA RÚNARSDÖTTIR, PT3 • THORARINN SVEINSSON, PhD4

Effects of Kinesio Tape Compared With Nonelastic Sports Tape and the

Untaped Ankle During a Sudden Inversion Perturbation in Male Athletes

SUPPLEMENTAL VIDEO ONLINE

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journal of orthopaedic & sports physical therapy | volume 41 | number 5 | may 2011 | 329

tape or bracing may be stimulation of the cutaneous exteroreceptors from the foot and ankle.6,30 It has also been proposed that greater preactivation of the fibularis muscles prior to inversion stress may overcome the electromechanical delay (from activation to force production of the muscle), which could result in a larger spindle response.11,27

Nonelastic adhesive tape has been used for injury prevention and during rehabilitation after ankle injury. This type of tape has been shown to be effec-tive in restraining ankle inversion, and its use may decrease the incidence of ankle sprains.8,42 The mechanisms responsible may not only be due to the mechanical restriction of the range of ankle inver-sion. Hypotheses as to other prophylactic benefits of applying adhesive tape include deceleration of the inversion motion,42 af-ferent input to the central nervous sys-tem,15,22,33,37,42 and placebo effects.34

In 1980, a new type of elastic tape called Kinesio Tape (KT) was introduced by Kenzo Kase.16 It is purported to im-prove local circulation, reduce edema, facilitate or relax muscle, and improve joint function by enhancing sensory mechanisms. Although the efficacy of the tape has not been extensively studied, its popularity as part of clinical practice in physical therapy is growing. Recent studies indicate that KT may provide some short-term gains with respect to pain and range of motion of the shoul-der17,40 and cervical spine,9 and that ap-plication of the tape may affect muscle activation levels.13,38 KT is latex free and quick drying, and is typically applied in single strips and left on the skin for 3 to 5 days at a time. When used to prevent ankle sprains, it may therefore be better tolerated and more cost effective than taping with nonelastic athletic tape. Due to its elastic properties, the ability of KT to enhance functional stability of the an-kle relies on its purported effects on pro-prioception and muscle activation rather than mechanical support. However, this has, to our knowledge, not been studied to date.

The main purpose of the study was, therefore, to investigate the effect of tap-ing on the level of activation of the fibu-laris longus muscle during a sudden ankle inversion perturbation. KT was con-trasted with nonelastic white sports tape (WT) and a no-tape (NT) condition. We hypothesized that, overall, due to the cu-taneous input from both tape conditions, peak and mean muscle activation levels would be greater than those seen in the NT condition. A secondary purpose was to study whether functional ankle stabil-ity affected the level of muscle activation during the 3 conditions. We hypothesized that athletes who demonstrated relatively less stability during functional testing would generally present with greater muscle activation levels during unilat-eral stance on an unstable surface than individuals with greater stability, there-by reflecting relatively greater efforts in maintaining their balance and the effects of greater preactivation prior to inversion stress on peak muscle activation.

METHODS

Participants

Fifty-one healthy male partici-pants were recruited from 3 premier-league teams (soccer, basketball, and

team handball) within a single sports club in Iceland. Those under 18 years of age or who had had any injury to the lower extremities within the 6 weeks prior to data collection were excluded from the study. Both lower extremities

of all participants were evaluated with the star excursion balance test (SEBT), which has been shown to be a sensitive and reliable measure for quantifying dy-namic balance.10,19,28 Poor postural con-trol is associated with a greater risk of ankle sprain, and postural control defi-cits have been identified in both the in-jured and uninjured sides of those who have suffered acute lateral ankle sprain as compared with controls.25 In individuals with chronic ankle instability, the SEBT has been shown to identify interlimb performance deficits as well as deficits in comparisons with stable controls.10,28 The methods used for testing were in ac-cordance with the simplified 3-item ver-sion of the test published by Hertel et al.10 Based on the results of this test, the 15 in-dividuals with the highest and the 15 in-dividuals with the lowest scores of either lower extremity were selected for further testing. The 30 participants had a mean SD age of 24.5 5.0 (range, 18-37) years and a body mass index of 24.6 3.1 (range, 19.6-31.6) kg/m2. SEBT scores ranged from 70 to 115 and were calcu-lated as distance reached, divided by leg length. The study protocol was approved by The National Bioethics Committee and each participant signed an informed consent form prior to participation.

Study ProtocolThe study consisted of a repeated-mea-sures design, with 30 participants who were tested under 3 conditions presented in randomized order. Leukotape P non-elastic sports tape (BSN Medical, Ham-burg, Germany) and Kinesio Tex Gold elastic sports tape (Kinesio USA, LLC, Albuquerque, NM) were used for the 2 taping conditions. All taping was ap-plied by a single athletic trainer, who was blinded to the participants’ group assign-ment, in a standardized manner, after the participants’ skin had been cleaned and hair removed. The KT was applied in a single strip, from origin to insertion of the fibularis longus muscle, according to the guidelines provided by the Kine-sio Taping Association.18 A slit was cut

FIGURE 1. Setup for perturbation. A 10-kg weight was dropped onto the posterolateral edge of the balance board to create a sudden inversion stress.

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[ research report ]in the tape to accommodate the surface electrode. The application procedure for the WT was a common combination of stirrups, horseshoe strips, and heel-locks.

During each trial, the participant stood on 1 foot on a balance board, as a 10-kg weight was dropped down a slot onto the backside of the lateral side of the board, without warning, creating an inversion perturbation of 15° (FIGURE

1, ONLINE VIDEO). The balance board was aligned with the slots down which the weight was dropped, to ensure that the weight consistently landed in the same place. The slot also served the purpose of guiding the weight to the side (away from the test area) after it landed. The slots were wide enough for the weight to pass through them without touching, so as to avoid sounds made by friction. Three tri-als, with a 40-second rest between each, were collected for each condition. At the end of each session, the participant was asked to determine which of the 3 con-ditions he perceived as being the most stable and the least stable.

ElectromyographyMuscle activity data, recorded with sur-face electrodes, were sampled at 1600 Hz from the fibularis longus muscle of the tested ankle using a wireless elec-tromyography (EMG) system (Kine Pro, Hafnarfjordur, Iceland), with a signal bandwidth of 10 to 500 Hz. Simultane-ously, signals were collected by another electrode placed close to the balance board to determine the timing of the perturbation. Data were collected for a total of 10 seconds for each trial, and 2 seconds were used for data analysis. Vari-ables of interest included the mean and peak magnitude of the EMG signal and the time from perturbation to peak EMG. Fibularis muscle response has been mea-sured during simulated inversion injury and is reported to have an expected laten-cy period of 50 to 90 milliseconds.22,27,42 The time to peak and duration of the response is task dependent. The data were viewed across 4 time frames: base-line activity during the 500 milliseconds

prior to the inversion perturbation, the 500 milliseconds immediately after the applied perturbation, and 2 additional 500-millisecond blocks during the recov-ery period after the inversion stress (time frames 3 and 4). The 500-millisecond pe-riods were chosen to capture an adequate representation of mean baseline activity while participants balanced on the un-stable surface, as well as the magnitude of the response to perturbation, allow-ing for latency, peak, and duration of the response to be measured. The skin was cleaned and hair removed prior to surface electrode placement, following SENIAM recommendations.35 The raw EMG data were high-pass filtered at 30 Hz, full-wave rectified, and the root-mean-square of the signal was derived using a moving window of 100 milliseconds. All data were normalized to the maximum signal collected during 3 maximal voluntary iso-metric contractions (MVIC). The MVICs were gathered with the participants in a sidelying position, hips and knees flexed to approximately 90°, and the foot in a neutral position. A belt restrained the lower leg, while an examiner manually

resisted eversion contractions during each test, which lasted 5 seconds.

Statistical AnalysisData were analyzed with SPSS, Version 16.0. An analysis of variance (ANOVA) was used to evaluate differences in muscle activity. For mean EMG activity, the data were analyzed across the 4 time frames of interest for the 3 conditions measured (within-subject variables), with stability level introduced as a between-subjects variable (3-way mixed-model ANOVA, 4 time frames by 3 conditions by 2 groups). Peak EMG and time to peak EMG were analyzed for the 3 conditions measured (within-subject variables), with stabil-ity level introduced as a between-subject variable (2-way mixed-model ANOVA; 3 conditions by 2 groups). If a significant interaction was identified, pairwise com-parisons were performed to examine dif-ferences between time frames, condition, or group. Demographic variables were compared between groups using indepen-dent t tests, while categorical data were analyzed with a chi-square test of inde-pendence. The alpha level was set at .05.

TABLE 1Descriptive Data of Participants With a History of Ankle Sprain

*Data are mean SD (range).

More Stable Group (n = 15) Less Stable Group (n = 15)

Age, y* 25.0 5.0 (18-36) 23.9 6.1 (18-37)

Body mass index, kg/m2* 23.9 3.5 (19.6-31.6) 25.2 2.5 (21.2-29.4)

History of ankle sprains, n 13 13

History of bilateral ankle sprains, n 7 7

History of repeat sprains, n 6 4

History of sprains of the tested lower extremity, n 10 10

TABLE 2Descriptive Data for the

Star Excursion Balance Test*

*Values are mean SD (range), except where otherwise indicated. The score was calculated as distance reached, normalized by the length of the lower extremity.†Calculated as test limb/contralateral limb × 100.


Test limb 101.9 4.9 (97-115) 81.2 4.1 (70-86)

Contralateral limb 95.9 5.7 (86-103) 86.7 5.1 (73-96)

Interlimb ratio (%)† 106.5 (4.2) 93.8 (3.1)

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RESULTS

There were no statistically sig-nificant differences in the mean age (P = .223) and BMI (P = .607) be-

tween the stable (n = 15) and less stable (n = 15) groups, and the participants’ his-tory of ankle sprains within each group was also similar (TABLE 1). The mean SD score the athletes achieved on the SEBT (mean distance reached, normal-ized by lower extremity length) was 102 5 for the more stable group, which was significantly greater than the score of 81 4 for the less stable group (P<.001) (TABLE 2).

Mean Muscle ActivationThere was no 3-way interaction (P = .569); however, a time-by-group interac-tion was found (P = .035), due to greater levels of mean EMG signal amplitude demonstrated by the less stable group, compared to the more stable group, dur-

ing the first 500 milliseconds after the inversion stress was applied (P = .011) (FIGURE 2). No interactions were found for condition by group (P = .836) or con-dition by time (P = .328). There was a significant main effect of condition (P = .032) with respect to mean muscle activa-tion. The overall mean (SE) normalized EMG value for the WT condition across all 4 time frames was 14.5 (1.3), which was significantly greater than that dem-onstrated during the NT condition (11.7 [1.6]; P = .037). The KT condition dem-onstrated mean values almost identical to the NT condition (11.8 [1.6]; P = .869); but differences between KT and WT did not reach statistical significance (P = .068) (FIGURES 3 and 4).

Peak Muscle ActivationThere was no condition-by-group inter-action (P = .345) with respect to peak muscle activation. Across all conditions, less stable participants demonstrated greater peak muscle activity than more

stable participants, during the 500 mil-liseconds immediately following inver-sion stress (P = .025) (FIGURE 5). No main effect of condition was found (P = .081), with mean (SE) peak muscle activation at similar levels for WT (65.2 [2.2]), KT (64.3 [2.9]), and NT (64.4 [2.3]).

With respect to the mean time from perturbation to peak activity, there was no significant condition-by-group inter-action (P = .069) (FIGURE 6) and the timing was generally similar between conditions (P = .541) and groups (P = .998).

Perception of StabilityAnswers to the question of perceived stability among the 3 conditions differed between individuals with more versus less stability (TABLE 3). Chi-square tests revealed a significant difference between groups in their perception of which con-dition offered the most stability (P = .012) and the least stability (P = .013) during the perturbation trials.

DISCUSSION

The primary purpose of the study was to investigate the effects of elas-tic versus nonelastic adhesive tape,

compared to a no-tape condition, on muscle activation of the fibularis longus in a group of athletes tested with an ankle inversion perturbation. In addition, re-sponse to the perturbation was compared

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FIGURE 2. Mean (SE) muscle activation across each of the 4 time frames. *Significant difference (P = .011) between the more stable group (n = 15) and less stable group (n = 15). Abbreviation: %MVIC, percent of maximal voluntary isometric contraction.

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FIGURE 3. Mean (SE) overall muscle activation between conditions across all 4 time frames for both groups (n = 30). *Significant difference (P = .032). Abbreviation: %MVIC, percent of maximal voluntary isometric contraction.

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[ research report ]

between individuals with 2 levels of dy-namic stability, as tested with the SEBT. Only the WT condition had any effect on the level of muscle activity of the fibularis muscle, whereas KT had no effect on any of the variables of interest when com-pared to the NT condition. Less stable participants demonstrated greater EMG activity across all conditions than those who were in the more stable group dur-ing the 500 milliseconds immediately after perturbation.

When the participants were taped with WT, their mean muscle activity over the 2-second trials was, on average, sig-nificantly greater than that found during the NT conditions. Although the dif-ference in mean muscle activity during the WT versus the KT condition did not reach statistical significance (P = .068), a greater sample size might have demon-strated statistical significance. The lack of a condition-by-time interaction under-scores that the difference in muscle ac-tivity was present across all time frames

(FIGURE 4). With respect to the effects of WT, our results are in agreement with those of previous studies that have shown increased muscle activity after applica-tion of nonelastic adhesive tape.22,23 This has been thought to occur via cutaneous cues provided by the adhesive tape. How-ever, the nonelastic versus elastic proper-ties of the 2 types of tape may not offer identical stimuli during the dynamic tri-als of the present study. The WT might have pulled more aggressively on the skin than the KT as the athletes balanced on the board, not just during but also prior to the perturbation, as well as during recovery. Ankle taping with nonelastic athletic tape plays a role in providing support for the ankle31,42 and may further enhance muscle response of the fibularis longus by maintaining greater levels of muscle activation. Our hypotheses as to the effects of KT were not supported by the data. Among other benefits, KT has been proposed to provide positional stimulus through the skin and sensory

stimulation.16 Our results indicate that no facilitation occurred and that KT neither affected muscle activation nor resulted in an improved sense of stability for athletes with ankle instability. Therefore, the role of elastic tape, such as KT, with respect to prevention of inversion ankle sprains, is unsubstantiated, as it is not designed to restrain movement and seems to have no effect on muscle activation of fibularis longus.

The muscle response of the fibularis longus and brevis is the strongest of the ankle muscle responses during inver-sion stress.27 Our results demonstrated a significant increase in muscle activity of

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FIGURE 4. Mean (SE) muscle activation demonstrated across time (4 × 500 milliseconds) for the 3 conditions (n = 30). No statistically significant interaction. Abbreviation: %MVIC, percent of maximal voluntary isometric contraction.

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FIGURE 5. Mean (SE) peak activation following perturbation. A statistically significant difference (P = .025) was found between the peak values of the more stable group (stable, n = 15) compared with peak values of the less stable group (unstable, n = 15). Abbreviation: %MVIC, percent of maximal voluntary isometric contraction.

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FIGURE 6. Mean time (SE) from perturbation to peak muscle activation for participants with more stability (stable, n = 15) compared with those with less stability (unstable, n = 15), while taped with Kinesio Tape and white athletic tape, and with no tape. No statistical differences were noted. Abbreviation: EMG, electromyographic.

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fibularis longus after the perturbation. As hypothesized, the group of athletes with less stability demonstrated greater mus-cle activation than those scoring higher on the SEBT, although this was only ap-parent immediately after the perturba-tion. This is in contrast to recent findings of Palmieri-Smith et al,29 who reported that the affected side showed lower nor-malized EMG values for the fibularis lon-gus muscle compared to the uninvolved side during no-tape conditions. However, methodological differences make direct comparisons difficult. In their study, the foot was inverted to 30° via a trap door during gait; whereas the participants in our study balanced on 1 lower extremity on an unstable surface, then underwent a 15° dynamic perturbation. Furthermore, the participants in their study were not functionally tested for stability but re-cruited according to self-reported func-tional instability, which may represent a different population than the one in the present study. The time from perturba-tion to peak EMG did not differ between groups, as previous studies comparing muscle reaction time of stable and un-stable ankles during no-tape conditions have shown,4,5,41 although other studies have shown results to the contrary.15,20 Neither elastic nor nonelastic tape had an overall effect on time to peak EMG; however, the condition-by-group interac-tion was close to being statistically sig-nificant. When analyzing these data, the highly variable nature of the EMG signal has led some authors to accept an alpha level of .1, in an effort to avoid a type II

error.3 We feel the trend observed in our study (P = .069) may have clinical sig-nificance in view of our relatively small sample size. Our stable group, compared to the unstable group, demonstrated a slightly shorter time from perturbation to peak EMG during the KT and NT con-ditions, a trend reversed during the WT condition. Moreover, when asked which condition offered the best stability, 11 of 15 athletes in the unstable group felt that the WT offered the best stability, com-pared to 3 of 14 in the stable group. This reflects the between-group differences seen in time to peak EMG. Karlsson and Andreasson15 found that the application of tape to the unstable ankle significantly shortened fibularis response time, as seen in our results. Shima et al36 found that ankle taping delayed the reflex la-tency of the fibularis in healthy athletes, with and without history of ankle injury, as observed in our stable-athlete group. Therefore, it seems that nonelastic tape may offer a selective neuromuscular re-sponse, depending on functional stability, as defined by functional testing.

LimitationsWe acknowledge that our results only re-flect the level of activation as a percent-age of the participants’ MVIC activity and do not represent the muscle output with respect to actual force, which was not measured. Recent studies, however, have not found evidence of strength deficits in concentric, eccentric, or isometric ever-sion ankle strength in individuals with functional ankle instability.14,21,29 Our

definition of stable and unstable ankles relied solely on the participants’ perfor-mance on the SEBT. We did not take into account subjective reports of number of repeated sprains, for example, as many of our athletes routinely wore braces for prophylactic purposes and would, there-fore, not be expected to necessarily sprain their ankles, despite detectable function-al deficits while unsupported. Moreover, the athletes’ recovery from ankle sprains, in terms of ankle stability and function, would be affected by the type and amount of rehabilitation they received, as well as their compliance. Given the difference in mean reach values between our stable and unstable groups (21 points), which was considerably greater than that found in the studies previously cited, and the difference in perceived stability between the 2 groups, we feel confident that the 2 groups truly represent persons with different levels of stability, although we cannot claim this is solely due to differ-ences at the ankle. Nonelastic adhesive tape is known to lose some of its restric-tive properties after exercise,22,31 and we did not evaluate the effects of either tape after exercise. The efficacy of the KT may have been affected by the slit for the elec-trode. However, many applications of KT involve splitting the tape, with each tail of the strip bordering the index muscle, as in the setup of the present study. Fur-thermore, previous studies have simi-larly adapted placement of KT strips for the purpose of investigating the effects of taping on muscle activity and found significant differences in surface EMG recordings.38

CONCLUSION

Ankle taping with nonelastic athletic tape may enhance muscle response of the fibularis longus

by maintaining greater levels of muscle activation. This may selectively benefit individuals with functionally unstable ankles. The role of elastic tape, such as KT, with respect to prevention of inver-sion ankle sprains via effects on the mus-

TABLE 3The Condition the Participants Perceived

as Being the Most and Least Stable

Abbreviations: KT, Kinesio Tape; NT, no tape; WT, white athletic tape.*Statistically significant difference between groups in the condition perceived as offering the most stability (P = .012) and the least stability (P = .013). One subject from the more stable group neglected to answer 1 of the 2 questions.

Most Stable* Least Stable*

KT WT NT KT WT NT

More stable group 7 3 4 2 11 2

Less stable group 3 11 1 5 3 7

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[ research report ]

REFERENCES

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9. Gonzalez-Iglesias J, Fernandez-de-Las-Penas C, Cleland JA, Huijbregts P, Del Rosario Guti-

errez-Vega M. Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial. J Orthop Sports Phys Ther. 2009;39:515-521. http://dx.doi.org/10.2519/jospt.2009.3072

10. Hertel J, Braham RA, Hale SA, Olmsted-Kram-er LC. Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability. J Orthop Sports Phys Ther. 2006;36:131-137. http://dx.doi.org/10.2519/jospt.2006.2103

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12. Hopper DM, McNair P, Elliott BC. Landing in netball: effects of taping and bracing the ankle. Br J Sports Med. 1999;33:409-413.

13. Hsu YH, Chen WY, Lin HC, Wang WT, Shih YF. The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome. J Elec-tromyogr Kinesiol. 2009;19:1092-1099. http://dx.doi.org/10.1016/j.jelekin.2008.11.003

14. Kaminski TW, Perrin DH, Gansneder BM. Eversion strength analysis of uninjured and functionally unstable ankles. J Athl Train. 1999;34:239-245.

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16. Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the Kinesio Taping Method. Tokyo, Japan: Ken Ikai Co Ltd; 2003.

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18. Kinesio Taping Association. Association Work-book 3: Muscles in the Superficial Layer. To-kyo, Japan: Kinesio Taping Association; 2006.

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23. Macgregor K, Gerlach S, Mellor R, Hodges PW. Cutaneous stimulation from patella tape causes a differential increase in vasti muscle activity in people with patellofemoral pain. J Orthop Res. 2005;23:351-358. http://dx.doi.org/10.1016/j.orthres.2004.07.006

24. McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: in-jury rate and risk factors. Br J Sports Med. 2001;35:103-108.

25. McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective? J Athl Train. 2008;43:305-315.

26. Mohammadi F. Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players. Am J Sports Med. 2007;35:922-926. http://dx.doi.org/10.1177/0363546507299259

27. Nieuwenhuijzen PH, Duysens J. Proactive and reactive mechanisms play a role in stepping on inverting surfaces during gait. J Neuro-physiol. 2007;98:2266-2273. http://dx.doi.org/10.1152/jn.01226.2006

28. Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train. 2002;37:501-506.

29. Palmieri-Smith R, Hopkins T, Brown T. Pe-roneal activation deficits in persons with functional ankle instability. Am J Sports Med. 2009;37:982-988.

30. Pijnappel H. Handbook of Medical Taping Con-cept. Madrid, Spain: Aneid Press; 2009.

31. Purcell SB, Schuckman BE, Docherty CL, Schrader J, Poppy W. Differences in ankle range of motion before and after exercise in 2 tape conditions. Am J Sports Med. 2009;37:383-389. http://dx.doi.org/10.1177/0363546508325925

32. Rahnama L, Salavati M, Akhbari B, Mazaheri M. Attentional demands and postural control in athletes with and without functional ankle instability. J Orthop Sports Phys Ther. 40:180-187. http://dx.doi.org/10.2519/jospt.2010.3188

33. Robbins S, Waked E, Rappel R. Ankle taping improves proprioception before and after exercise in young men. Br J Sports Med. 1995;29:242-247.

34. Sawkins K, Refshauge K, Kilbreath S, Ray-mond J. The placebo effect of ankle taping in ankle instability. Med Sci Sports Exerc. 2007;39:781-787. http://dx.doi.org/10.1249/MSS.0b013e3180337371

35. SENIAM. Recommendations for sensor loca-tions in hip or upper leg muscles. Available at: www.seniam.org. Accessed 20 April, 2010.

36. Shima N, Maeda A, Hirohashi K. Delayed latency of peroneal reflex to sudden inver-sion with ankle taping or bracing. Int J Sports Med. 2005;26:476-480. http://dx.doi.org/10.1055/s-2004-821064

37. Simoneau GG, Degner RM, Kramper CA, Kittle-son KH. Changes in ankle joint proprioception resulting from strips of athletic tape applied over the skin. J Athl Train. 1997;32:141-147.

38. Slupik A, Dwornik M, Bialoszewski D, Zych E. Effect of Kinesio Taping on bioelectrical activity of vastus medialis muscle. Pre-liminary report. Ortop Traumatol Rehabil.

cle activation of the fibularis longus, is unsubstantiated. t

KEYPOINTSFINDINGS: KT did not alter muscle activity in healthy males before, during, or after a sudden inversion perturbation, while balancing on a tilt board. This is in con-trast to the nonelastic tape condition, in which significantly greater muscle activity was seen, as compared to the untaped condition.IMPLICATION: The role of KT with respect to prevention of ankle injuries still needs to be substantiated.CAUTION: The results of the study must be viewed in context of the controlled experimental set-up.

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MORE INFORMATIONWWW.JOSPT.ORG@

2007;9:644-651. 39. Stasinopoulos D. Comparison of three

preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players. Br J Sports Med. 2004;38:182-185.

40. Thelen MD, Dauber JA, Stoneman PD. The clinical efficacy of kinesio tape for shoul-

der pain: a randomized, double-blinded, clinical trial. J Orthop Sports Phys Ther. 2008;38:389-395. http://dx.doi.org/10.2519/jospt.2008.2791

41. Vaes P, Duquet W, Van Gheluwe B. Peroneal reaction times and eversion motor response in healthy and unstable ankles. J Athl Train. 2002;37:475-480.

42. Wilkerson GB. Biomechanical and neuromus-cular effects of ankle taping and bracing. J Athl Train. 2002;37:436-445.

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instructions to authors

In the May 2011 issue of the JOSPT, in the article “Effects of Kinesio Tape Com-pared With Nonelastic Sports Tape and the

Untaped Ankle During a Sudden Inversion Perturbation in Male Athletes” by Briem et al

(J Orthop Sports Phys Ther 2011;41[5]:328-335. doi:10.2519/jospt.2011.3501), the inter-limb ratio values in TABLE 2 were placed in the wrong columns. The correctly placed values are printed below. These changes are reflected

in the electronic version of the article available at www.jospt.org (http://dx.doi.org/10.2519/jospt.2011.3501). t

erratum

journal of orthopaedic & sports physical therapy | volume 41 | number 8 | august 2011 | 621

TABLE 2Descriptive Data for the

Star Excursion Balance Test*

*Values are mean SD (range), except where otherwise indicated. The score was calculated as distance reached, normalized by the length of the lower extremity.†Calculated as test limb/contralateral limb × 100.


Test limb 101.9 4.9 (97-115) 81.2 4.1 (70-86)

Contralateral limb 95.9 5.7 (86-103) 86.7 5.1 (73-96)

Interlimb ratio (%)† 106.5 (4.2) 93.8 (3.1)

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www.jospt.org

http://dx.doi.org/10.2519/jospt.2011.3501

http://dx.doi.org/10.2519/jospt.2011.3501

Effects of Kinesio Tape Compared With Nonelastic Sports ...

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