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Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). Chronic ankle instability (CAI) is the process caused by repetitive ankle sprains and multiple episodes of the ankle “giving way” with persistent symptoms. It mainly affects the sports population and is related to multiple inversion injuries.
- kinesio taping
- chronic ankle instability
- ankle sprain
- ankle injuries
1. Introduction
Ankle injuries are the most common injury in healthy active individuals [1,2,3], affecting women more frequently than men (13.6 vs. 6.94 per 1000 exposures), children more frequently than adolescents (2.85 vs. 1.94 per 1000 exposures) and adolescents more frequently than adults (1.94 vs. 0.72 per 1000 exposures) [4]. These high incidence rates show that these injuries can cause high costs for health care systems; Gribble et al. showed that ankle injuries cost USD 6.2 billion in high school athletes in the US and EUR 208 million in the Netherlands annually [5,6].
The sports in which ankle injuries are most common are indoor and court sports [7,8], with an incidence rate of 7 per 1000 exposures, compared to water/ice sports (3.7/1000 exposures), field-based sports (1.0/1000 exposures) and outdoor pursuits sports (0.88/1000 exposures) [4]. About 30% of ankle injuries occur during training sessions and the remaining 70% during matches, where performance becomes much more demanding [9,10,11,12].
Chronic ankle instability (CAI) is the process caused by repetitive ankle sprains and multiple episodes of the ankle “giving way” with persistent symptoms [13,14,15]. It mainly affects the sports population and is related to multiple inversion injuries [16,17]. The prevalence of CAI in a population with a history of ankle injuries is 46%, ranging from 9 to 76% [2]. The wide range in prevalence data is influenced by multiple factors, such as gender and age, which can have a very important impact on the development of this type of injury [18]. As mentioned above, women and young people are more likely to develop ankle injuries and CAI [19,20]. The meta-analysis by Chiao-I Lin et al. showed that the prevalence of CAI was much higher in subjects under 18 years old, with a rate of 63% compared to the entire population considered [2].
In the study by Chiao-I Lin et al., recurrent ankle sprain (61%) was most prevalent in soccer athletes, and the highest rate of perceived ankle instability (41%) was in track and field athletes with a history of ankle sprain [2].
This type of instability can be related not only to mechanical instability or ligamentous laxity but also to functional instability, with frequent “giving way” during normal daily activities [21,22,23]. If the soft tissues are not damaged despite repeated injuries, then the clinical condition is identified as functional ankle instability (FAI) [24]. The risk factors underlying CAI are not exclusively linked to ligament laxity but also to a proprioceptive deficit, to muscle weakness of the lateral compartment of the leg, mainly the peroneus brevis and longus, to their delayed neuromuscular activation and to a loss of static and dynamic balance in a monopodalic load [25,26,27,28,29,30]. Other risk factors are related to high BMI, participation in sports, having an increased talar curvature and not using external supports [31].
To establish the severity of ankle instability in people affected, three scores with a defined cutoff score are recommended by the International Ankle Consortium: The Ankle Instability Instrument (AII), answering “yes” to at least five questions; The Cumberland Ankle Instability Tool (CAIT), with <24 points and The Identification of Functional Ankle Instability (IdFAI), with >11 points [32].
Since CAI can become a demanding issue for athletes who are forced to stop at every episode of sensation of “giving way” of their ankle, it is important to look for prevention strategies and methods that improve the condition and performance of athletes. Given this background and the incidence of these injuries, it was important to evaluate how the kinesio taping (KT) acts on the injured ankle [33]. This elastic bandage was introduced in the 1970s by Kenzo Kase and has become very popular over the last few decades, used widely in physiotherapy for musculoskeletal disorders affecting both the upper and lower limbs. In particular, it has become more widespread in sports and other rehabilitation fields due to its intrinsic stretching capacity, which allows it to maintain sufficient mobility in the areas where it is applied compared to inelastic bandages [34,35]. A very important aspect of KT is its ability to retract after being applied due to its surface texture, which allows a slight traction of the underlying tissues, granting greater stability to the targeted area [36,37].
Discussion
CAI is a frequent complication of ankle sprains that may be associated with long-term consequences in athletes. Although taping is a common intervention that is widely used by clinicians and athletic trainers for the treatment of sports injuries and various neuro-musculoskeletal disorders, no studies have evaluated its effectiveness specifically for sports performance and ankle function in athletes affected by chronic ankle instability.
This is the first systematic review and meta-analysis to investigate only the effect of KT on the sports performances and ankle functions of athletes with CAI. In all of the studies included, KT was analysed as the only treatment implemented on athletes, without concomitant physiotherapy or other types of exercises, so that the potential improvement parameters registered were exclusively attributed to KT. Nevertheless, the recent literature supports a multifactorial approach as the most effective on CAI using multiple interventions such as KT associated with specific proprioceptive exercises [56].
Among the most popular contact sports (football, basketball, volleyball, baseball), the ankle is the joint district most prone to injury [1,2,3]. Without recovering sufficient stability of the ankle, athletes can suffer multiple sprains and relapses during sports seasons, potentially reaching a condition of chronic instability [57,58,59,60].
Many articles have been published in the literature about the application of KT in athletes [2,18,19], most of them concerning the upper limb and generally the shoulder complex. In contrast, the available articles about KT and CAI have been very limited and quite recent [48]. This can be explained by the increasing use of KT in recent years and the large interest in evaluating its real effectiveness, even though it is an elastic bandaging technique that was proposed in the early seventies.
Among the eight articles included in this review, the sports performance and ankle functions that could be meta-analysed were (1) gait functions, (2) joint ROM, (3) muscle activation, (4) sway parameters, (5) dynamic balance, (6) lateral landing from a monopodalic drop and (7) agility. The main finding of this review, as reported in Table 4, is that KT had a significant impact only on the following outcomes: (1) gait functions, as reported by Kim et al. [48], who included gait velocity, step length, stride length and Heel-Heel (H-H) distance of the base of support; (2) reducing ankle joint ROM in inversion–eversion; (3) decreasing muscle activation of the peroneus longus; (4) decreasing postural sway in mid-lateral movements, as reported by Sarvestan et al. (2020 [55]).
2.1. Gait Functions
In patients with CAI, the entire gait cycle can be altered by an increase in ankle inversion, which can cause both a shorter step length and an increase in the base of support and a reduction in gait speed [61,62]. In our review, the gait functions on which the tape had the greatest impact were the increase in step length and stride length with a relative ES of 2.27 and 2.28, respectively, an increase in speed, with an ES of 1.98 and the reduction in H-H base distance, with an ES of 1.92.
The increase in stride velocity, expressed in m/s, corresponds to a greater looseness during the phases of gait, which, associated with a smaller width of the base of support in dynamics, indicates a greater sense of stability of the athlete during movement [63,64,65,66]. A wider base of support in dynamics usually allows lowering the centre of mass (COM), increasing the body’s stability [67,68].
In the 22 athletes included in the study, the width of the base of support decreased because taping seems to have provided greater stabilisation during walking. The main problem with the study by Kim et al. [48] is the wide range of the confidence interval (95% C.I.) of the gait functions, with values between 1.21 and 3.33; these can be justified by the low number of athletes included in the study, i.e., a very limited sample size, although the methodology of the study was of good quality (21/28).
2.2. Ankle Joint ROM
Ankle joint motion has also been found to influence the lower extremity landing pattern in people with CAI [69]. It has been repeatedly confirmed to have a great influence on bilateral postural stability [69,70]. For joint ROM, the only parameter in which taping had a significant impact was in the post-tape reduction in inversion–eversion ankle range, as shown by Sarvestan et al. [55], with an ES of 0.52 and a p-value of 0.05, while no substantial change was found in all other joint parameters of the ankle, knee and hip. During the agility tests evaluated by Sarvestan et al. in a previously included study [52], the change in grades in dorsi–plantar flexion during movement was assessed. The results were not included in the meta-analysis because they were not comparable, although Sarverstan et al. reported an improvement in ankle sagittal ROM during linear sprinting. An increase in ankle ROM could reduce the vertical ground reaction forces and the impact on the entire lower limb [30,71].
Sarvestan et al. measured the peak joint movement in dorsiflexion and plantar flexion in the sagittal plane and in inversion–eversion in the frontal pllane [55]. It was shown that, after the use of the tape, the joint peak in the frontal plane decreased drastically, limiting excessive rotation of the calcaneus and consequently reducing the oscillations in inversion and eversion during walking, favouring greater stability. Similar results regarding gait functions were also found by Kim et al. [48].
Inversion–eversion tilt is a movement that, both in a mechanical and perceptive sense, reduces the feeling of ankle stability [72]. According to Smith et al. [72], application of the tape decreased the sensation of instability in inversion–eversion, suggesting an effect that contributes to preventing recurrent ankle sprains.
2.3. Muscle Contraction
In the literature, the possible action of KT in improving muscle contraction is much debated. Some authors speculate that cutaneous stimulation of the tape may induce a greater sensitisation of type 2 mechanoreceptors and improve the recruitment of motor units [73,74]. Other possible explanations may be related to a concentric traction that the tape exerts on the fascia, which may improve muscle contraction by shortening the distance between the origin and insertion of the muscle [75,76,77].
In contrast, Sarvestan et al. [55] analysed whether the tape could modify muscle contractions using an electromyographic examination, and an opposite effect was found after application of the KT on the lateral leg muscles. The only muscle among those considered on which the KT had a considerable impact was the peroneus longus with an ES of 0.55 and a p-value of 0.05. In the leg with the KT applied, there was a strong decrease in muscle activation justified by a supporting action that the tape provided when applied laterally along the ankle, partially reducing activity of the eversion muscles, especially the peroneus longus. However, this element has both a positive aspect in a phase in which the athlete is looking for an external element of support that allows him to have a more stable ankle during sport performance, but can also have a negative effect on active stabilisation from lateral muscles, which risk being partially lacking and inhibited with the tape on, as demonstrated in Sarvestan et al. [55].
2.4. Postural Sway during Movement
Athletes with CAI often do not have instant and corrective ankle reactions when they make contact with the ground. A lack of corrections during movements greatly accentuate body postural sway [72]. Some studies conclude that postural sway depends on a loss of balance, which is an important indicator of possible falls during dynamic performances and in pre-fatigue conditions [78,79,80].
Sarvestan et al. [55] showed that in the mid-lateral direction, KT significantly reduced sway speed and reduced peak acceleration with an ES of 1.25 and a p-value of 0.03. In contrast, there were no significant changes in speed and sway area in the anterior–posterior direction. Many studies in the literature have confirmed the effectiveness of KT in improving postural sway parameters, both in relation to speed and sway area, especially in mid-lateral directions [81,82]. Reducing sway velocity in the mid-lateral direction suggests better control in prone-supination movement, corresponding to greater overall stability [82].
2.5. Dynamic Balance
The meta-analysis for dynamic balance was carried out on the studies of Souza et al. and Gehrke et al. [50,51], which had in common the use of the SEBT test. Data relating to dynamic balance of Alawna et al. [53], in which the Y Balance Test was used, were not meta-analysed, as they were not comparable. Table 4 shows that the ES did not reveal a statistically significant impact, with p-values between 0.26 and 0.75. However, both studies only evaluated 34 athletes in total. In the general population with CAI, Hadadi et al. [83] showed that KT had a significant effect on both static and dynamic balance. Other researchers, however, found no improvement in dynamic balance after the application of KT [84,85].
2.6. Lateral Landing from Monopodalic Drop
Lateral landing is very difficult, having an impact on the entire lower limb due to the dissipation of energy that is required [86]. For this reason, an alteration in the motor patterns or in the joints involved, such as CAI, can adversely affect the ability to land, even more so if the landing is performed after a monopodalic drop, which is a more challenging function [87,88].
In this review, lateral landing from a monopodalic drop was only assessed by Lin et al. [54] who considered ground reaction forces, loading rate and loading time. The p-values of the loading rate and the loading time were between 0.15 and 0.63. Therefore, it was not possible to define a significant impact of the KT on these functions. For the ground reaction forces, although the p-values were <0.05 and therefore statistically significant, they had an overall ES—including both the measurements before and after the application of the tape—that did not show a real effectiveness in improving the performance of lateral landing from a monopodalic drop. The values on the CoP (centre of pressure) were not considered for the purposes of the meta-analysis because they did not include interquartile ranges, only median values.
In another study [71], Lin et al. also concluded that KT was not sufficient to improve both frontal and sagittal postural control during landing, while Mason-Mackay et al. [89] added that KT must be combined with specific training to improve landing techniques and strategies.
2.7. Agility
Agility is an athletic condition that is essential in sports such as those included in this review (football, basketball, volleyball, baseball). This skill allows players to make heterogeneous movements in rapid succession, such as changing direction, turning quickly and cutting, all activities that have a significant impact on the ankle [49,51].
In our analysis, agility was assessed by Sarvestan et al. [49] and Gehrke et al. [51] by measuring the time used to perform on tests such as Illinois, 5-0-5, 10-m Shuttle and Figure of 8. No significant improvement was shown, with ES values ranging between −0.35 and 0.34 for males and between −0.53 and 0.31 for females.
2.8. Time of Application
In all of the included studies, only Sarvestan et al. [55] reported the time of application of the KT before tests and measurements were carried out. They waited 25 min between application of the tape and the start of the tests.
Some authors have found a positive effect of KT to increase balance and proprioception in patients with CAI between 48 and 72 h [90]. Assessing the effectiveness of KT in the tests seen in this review with a longer application time could be an important aspect to evaluate in future studies.
This entry is adapted from the peer-reviewed paper 10.3390/medicina58050620
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