EFFECT OF KINESIO ® TAPE ON STABILIZATION AND ...
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KINESIO® TAPE AND CHRONIC ANKLE SPRAINS
EFFECT OF KINESIO ® TAPE ON STABILIZATION AND STRENGTHENING IN
PEOPLE WITH CHRONIC ANKLE SPRAINS
An Independent Research Project
Presented to
The Faculty of the Marieb College of Health and Human Services
Florida Gulf Coast University
In Partial Fulfillment
of the Requirement for the Degree of
Doctorate of Physical Therapy
By
Dana Shea & Joseph Lucchesi
2018
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS
APPROVAL SHEET
This independent research
is submitted in partial fulfillment of the requirements for
the degree of
Doctorate of Physical Therapy
__________________________________________________
Dana Shea
__________________________________________________
Joseph Lucchesi
Approved: April 2018
__________________________________________________
Dr. Jason Craddock, EdD, ATC, LAT, CSCS
Committee Chair
__________________________________________________
Dr. Mollie Venglar, DSc, MSPT, NCS
Committee Member
The final copy of this research project has been examined by the signatories, and we find that both the
content and the form meet acceptable presentation standards of scholarly work in the above mentioned
discipline.
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS
Acknowledgments
This research was supported by Florida Gulf Coast University, Department of
Rehabilitation Sciences. We thank our colleagues from Florida Gulf Coast University
who provided insight and expertise that greatly assisted the research. We thank Dr. Jason
Craddock and the Athletic Training Department for assistance with the Biodex Isokinetic
Dynamometer and Dr. Mollie Venglar for assistance with Kinesiotaping and Dr. Jason
Craddock and Dr. Mollie Venglar for comments that greatly improved the manuscript.
We would also like to show our gratitude to our committee members and Dr. Stephen
Black for sharing their pearls of wisdom with us during the course of this research. We
would also like to acknowledge and thank the volunteers from the Athletic Training
Program who provided their time to help complete our project with their participation and
several anonymous reviewers who assisted in the formatting and editing of the final
project.
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 1
Table of Contents
Abstract 2
Introduction 3
Literature Review 3
Chronic Ankle Sprains 5
Muscle Strength 6
Range of Motion 8
Placebo Effect 9
Study Methods 10
Data Collection 18
Data Analysis 19
Results 20
Discussion 22
Conclusion 23
References 25
Appendix A Compilation of KT-related studies 29
Appendix B Ankle Strengthening Program 35
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 2
Abstract
Introduction: Kinesio® Tape is an elastic therapeutic tape used for treating a
variety of dysfunctions including sports injuries to promote healing, decrease pain,
increase range of motion and increase strength according to its creator, Dr. Kenso Kase.
It is claimed to provide treatment by lifting the skin and allowing increased blood flow.
The aim of this experiment was to measure the effect of KT® Tape on stabilization and
strengthening the ankle musculature in those with chronic ankle instability. Methods:
Two participants completed a provided strengthening program with one subject using the
KT® Tape during the workouts to assess the effect. Ankle stability and peak torque of the
ankle evertors was measured prior to and following the strengthening program using the
Biodex Balance System SD and Biodex Isokinetic Dynamometer. Results: The results
found that the KT® Tape added to a strengthening regime showed greater increase in
peak torque of ankle evertors compared to completing the ankle strengthening program
alone. Ankle stability however decreased in both the experimental and control group.
Conclusion: This study’s results indicate that the KT® Tape has a positive effect on
muscle strength, increasing peak torque of the evertors, compared to strengthening
program alone, however the experimental group had greater decreased ankle stability
overall compared to the control group. This study’s results are limited due to small
sample size and requires more research to prove results are legitimate.
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Introduction
Taping procedures are commonly seen in sport and used in rehabilitation of
athletes for not only treatment but for enhancing performance. Different techniques can
allow the restriction or facilitation of movement, or stabilization of a particular joint. Two
types of taping techniques are normally used, elastic and non-elastic (Lee et al. 2010).
Researchers investigating the effectiveness of taping techniques (including elastic and
non-elastic) have conflicting results among various populations in regards to change in
the chance of sports injury, osteoarthritis, myofascial pain syndrome, pain, swelling,
muscle spasms, and increase range of motion and muscle power, as well as correct
walking pattern and functionality (Fu et al. 2007, Lee et al. 2010, Williams 2012). With
this plethora of uses for athletic taping, it is easy to see how it can be incorporated into
care for an athlete to possibly decrease chance of injury and increase performance. The
purpose of this study was to examine the effect of Kinesio® Tape on force production in
the ankle evertors. According to claims made by Kinesio® Tape, the researchers believe
it should increase the strength of the evertors of the ankle thus increasing ankle stability
in those with chronic ankle instability. Physical therapists could utilize this knowledge to
potentially expedite rehabilitation and allow for athletes to meet strength goals to return
to activity.
Literature Review
Kinesio® Tape, commonly referred to as KT® tape, has recently become a
popular form of elastic tape used with an application method developed by Kenzo Kase
in 1996. The popularity of KT® tape and its widespread use increased with its presence
at the 2008 Olympic Games, where it was displayed on the bodies of many professional
athletes (Williams 2012). KT® tape can be stretched to 120-140% of its original length
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 4
and can be applied tactilely in several different ways. This elasticity, as compared to
regular athletic tape, reportedly allows more movement of the target muscle and may
reduce pain, swelling, muscle spasms and possibly assist in preventing injury during play
(Kase et al. 1996). The tape is composed of material which is said to have the ability to
imitate skin behavior, which allows freedom of motion. Kase suggests that because of
this, KT® tape should be able to enhance the contraction ability of the muscle. In
addition, the elasticity of the tape can create skin folds resulting in increased space
underneath the skin to improve circulation of blood and lymph, activate neurological
suppression to reduce pain and increase joint range of motion, and adjust incorrect
alignment of muscle myofascia and joint (2003). The taping technique of applying the
tape at the origin of the muscle and ending it at the insertion is alleged to facilitate and
stimulate muscle function. The elastic properties of the tape stimulate the muscle in the
direction of the contraction which should enhance movement. It may also stimulate
mechanoreceptors in the skin simply from placing the tape on and thus increasing the
recruitment of motor units. One other idea is that it may stimulate the fascia in the muscle
over which it is placed, creating more muscle tension and thus facilitating contraction.
(Gloria et al. 2016).
Despite the recent popularity of the taping method, there is limited research available to
support or contradict these claims made by Kase et al. (Appendix 1). Due to lack of
conclusive evidence regarding use of KT® tape, it is important to continue to assess its
effects on different muscle groups to provide a comprehensive idea of what the tape is
doing. A placebo effect has shown significant improvement in the wellness of patients
whether it be pain or weakness of musculature, even though no direct physiologic
changes are taking place (Miller 2006). While examining KT® tape’s effects on ankle
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 5
force production and on balance in persons with chronic ankle sprains, the researchers
will need to respect the possibility of the placebo effect. If the research utilizing KT®
tape can support what the developers of the tape claim; it would make an excellent
rehabilitation tool when working with athletes in rehabilitation.
Chronic Ankle Sprains
Lateral ankle sprains are the most common injuries befalling athletes. Not only is
the injury itself debilitating, but here is a high rate of reoccurrence after initial injury as
well which can lead to even more issues in the future including chronic ankle instability.
Chronic ankle instability is the result of repetitive ankle sprains with persisting symptoms
post-injury. Symptoms from acute sprains can last for 6 months without the presence of a
recurring sprain and an athlete returning to full activity in their sport. Chronic ankle
instability is thought to be caused by functional instability, mechanical instability or both
(Holmes & Delahunt, 2009).
Functional instability will occur from the damage sustained from a lateral ankle
sprain. Functional instability is the tendency for individuals to feel the ankle “give way”
during normal activity (Holmes & Delahunt, 2009). Damage will occur to ligamentous
tissue, nerves and musculotendinous tissue around the ankle complex. Ligament injury
can lead to laxity in the different joints of the ankle. The neuromuscular deficits from
damage to nerves, muscles and tendons will manifest as impaired balance, decreased
proprioception, decreased firing of the surrounding musculature including the fibularis
muscles for eversion of the ankle, decreased nerve conduction velocity, lack of sensation,
decreased strength and lack of AROM; especially dorsiflexion of the ankle. Also,
formation of scar tissue can cause impingement in the ankle complex promoting
functional instability (Hertel 2000).
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Mechanical instability is defined as insufficiencies in the ankle complex including
pathological laxity, impaired arthrokinematics of normal joint motion, and synovial and
degenerative changes (Hubbard, Kramer, Denegar, Hertel 2007). Many sources will use
mechanical and functional instability as interchangeable terms. However, these two are
not synonymous and each contain components that contribute to chronic ankle instability.
Muscle Strength
The ankle complex has many different muscles acting on it at all times; in the
case of lateral ankle sprains the musculature of primary concern is the invertors and
evertors of the foot. The musculature helps along with the ligamentous structures to
prevent ankle sprains. An inversion injury is the most common cause of an ankle sprain,
commonly expressed as “rolling” or “twisting” one’s ankle. The evertor muscles should
work against extreme inversion of the ankle. These muscles include fibularis longus,
fibularis brevis and fibularis tertius (Moore, Dalley & Agur, 2013). Reaction time of the
fibularis muscles in those with chronic ankle sprains has been shown to be much slower
than compared to stable ankles (Karlsson & Andreasson, 1992) (Lofvenberg, Karrholm,
Sundelin & Ahlgren, 1995). This suggests that if the reaction time could be reduced,
ankle stability would be improved by better resisting the inversion force.
According to Kase, the application of KT® tape beginning at the origin of the
muscle and moving towards its insertion should result in increased force of contraction
and improved muscle strength (Lee et. al., 2012). When applied to the fibularis muscles
this should thus increase resistance to inversion. However, several studies have shown
contradictory evidence regarding this effect.
A study completed by Janwantanakul & Gaogasigam (2005) on the effect of
inhibition and facilitation taping techniques concluded that there was no effect on the
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contraction of the VMO muscle in healthy participants. This study’s limitations included
a slightly narrow scope, focusing only on females and only having 30 participants.
Another study done on the taping of the anterior thigh once again showed neither an
increase or decrease in muscle strength in healthy athletes (Fu et al. 2007). This study
also had a small number of participants, seven males and seven females, which may limit
the validity of its results. Alano de Almedia Lin’s study (2012) on the effect of KT® tape
also found no effect on the peak torque of the knee extensors, thus concluding that it
would not increase muscle strength. This study had a slightly broader scope, with 20
subjects per group, and a total of 60 participants. The design of this study was a
randomized, controlled trial, which enhances the validity of its results.
A study by Briem et al. (2011) found that KT® tape had no significant effect on
mean or maximum muscle activity compared to a no-tape condition in premier league
athletes with poor functional ankle stability. This study included 51 male athletes whose
functional stability was tested using the Star Excursion Balance Test. The study actually
found non-elastic athletic tape to provide the most stability and improvements in score on
the Star Excursion Balance Test in the athletes who participated. However, the results
cannot be generalized to a broad population due to its use of only male professional
soccer players.
Another study by Nakajima and Baldridge (2013) looked at the effect of KT®
Tape on vertical jump height and dynamic postural control with facilitation taping to the
ankle in 52 young healthy individuals. This study also found the tape had no significant
effect on vertical jump height compared to no tape, but did find significant improvements
in dynamic postural control when assessed with the Star Excursion Balance Test. This
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study used both female and male participants which allows it more generalizability to the
typical population.
A cross over study design was performed in 2012 by Bicici, Karatas, and Baltaci
to test if KT® Tape would have an effect on functional performance in athletes with
chronic inversion ankle sprains. The study recruited 15 male basketball players between
ages of 18-22 years. The researchers used functional performance tests such as the
Hopping Test, Single Limb Hurdle Test, Star Excursion Balance Test and Kinesthetic
Ability Trainer. The researchers found no significant differences in performance of the
tests with or without KT® Tape for the majority of the tests. However, results showed
faster performance times in the single limb hurdle with KT® Tape compared to no tape.
These researchers utilized a stability taping method.
Though these studies would indicate a lack of effect, several studies involving
taping on other muscle groups have indicated an increased effect on muscle strength or
neuromuscular activity (Aktas 2011, Gomez Soriano et al. 2014, Hsu et al. 2009,
Lumbroso et al. 2013). There have been more recent studies that have found positive
results with use of the tape. See Appendix A for a full description of these studies.. The
lack of conclusive results between studies indicates that more testing needs to be done
with larger scaled experiments and more testing of direct facilitation of the ankle
musculature to see the effect of KT® Tape on ankle instability.
Range of Motion
One of KT® tape’s purported functions is to increase the range of motion of a
joint. This is done through the increase in blood circulation in the taped area (Kase et al.,
1996). By increasing the blood flow to the area, it has been suggested that the KT® tape
unloads the fascia around the muscles (connective tissue surrounding the muscles), which
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 9
will relieve pain by reducing mechanical loads on the underlying nerves, theorizing that
this may help increase ROM limited by pain. (Merino-Marban, 2011). Researchers have
also theorized that the tape may simulate cutaneous mechanoreceptors that can affect
range of motion (Halseth et al., 2004). This increased range of motion could help in the
overall muscle function and may enhance force output. There are a limited number of
studies, with conflicting results. Research performed by Merino-Marban (2011) regarding
hamstring extensibility, indicate the taping has no acute effect on increasing range of
motion. Wong (2012) found similar results in his study on knee extension with the use of
KT® tape. However, as Lumbroso et al. (2013) concluded during their study on ankle
dorsiflexion with KT® Tape facilitation of the gastrocnemius, this resulted in an
immediate increase in range of motion at the ankle joint. This suggests that the KT® tape
may possibly work better with different muscle groups. Inconsistent research conclusions
may reflect the limited number of studies in this area, as well as their small scope and
focus on a similar age range and group of people, namely, young healthy athletes.
Placebo Effect
Due to the controversial results in the different experiments with KT® tape, the
idea that a placebo effect may be taking place should be considered. Inclusion of a
placebo treatment in studies can cause participants to “feel” better without ever having
received the experimental treatment due to “psychosomatic mechanisms” (Miller 2006).
These mechanisms are how a patient’s central nervous system reacts to being given
“treatment” for an ailment such as an analgesic for pain. When patients receive the
placebo that they believe is actual medicine, the body produces its own endogenous
opioids to decrease pain. Stress levels have shown to decrease allowing a return to
homeostatic regulation, and immunosuppressive effects begin to decrease. Although the
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placebo effect is still being researched, these may be some mechanisms by which the
placebo effect is working (Miller 2006). In the case of KT® tape, “sham-tape” has been
used in several studies to rule out a placebo effect (Lin et al. 2012, Merino-Marban et al.
2011, Soriano et al. 2014). These studies found no differences between usage of KT®
tape or sham-tape on increased muscle strength. However, since this technique was not
used consistently in every study, it is difficult to say if there is a placebo effect with the
application of sham tape versus KT® tape.
The purpose of this study was to examine the effect of KT® tape ankle
stabilization with facilitation of the ankle musculature. Per the claims of its manufacturer
and previously published studies, the researchers hypothesized that KT® tape would
influence the strength of the ankle fibularis muscles and promote ankle stabilization in
those with chronically unstable ankles.
Study Methods
This study was a prospective, quantitative, pilot case study design, using different
conditions to allow within subjects comparison of the results of KT® tape on force
production of the fibularis muscles and ankle stabilization in two healthy young adults
with chronic ankle instability. Due to the nature of the intervention, participants were
aware of which treatment they were receiving, which prohibited concealment.
Participants
Participants were recruited from the athletic training undergraduate class. Due to
the commonality of ankle sprains, this study looked to use the general population of
young healthy adults to allow results to be applied to a less specific population. These
participants were selected through volunteering. Inclusion criteria included subjective
history of unilateral chronic ankle instability and with no current acute sprain symptoms.
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The participants were informed of all aspects of the study, its purpose, potential risks and
benefits, consistent with the university Institutional Review Board for Protection of
Human Subjects. Due to the nature of the intervention, the study was low risk for
potential complications or adverse reactions. There was no jumping, cutting, or running
in this study, simply slow and controlled concentric lower extremity exercise of
approximately 36-45 total repetitions performed on non-consecutive days with adequate
rest periods between sets. Lactic acid accumulation and subsequent decreased motor
firing have been theorized in high-repetition concentric exercise in subjects with high
proportions of fast-twitch muscles (Tesch et al, 1983). However, Tesch et. al’s study used
different parameters- 120 repetitions consecutively with no rest period. This current study
is reinforced with ideal parameters to minimize risk of adverse effects.
Tests and Measures
The values needed for this study included force production of the evertors and
ankle stability in different planes and overall ankle stability in order to find if ankle
strengthening can promote ankle stability in the chronically unstable ankle. Each
participant was measured for force production using peak torque of the evertors via the
Biodex Isokinetic Dynamometer. Ankle stability was tested with the Biodex Balance
System SD. The Biodex Balance system has a free-moving platform that allows the
following measures to be collected: an anterior/posterior index, medial/lateral index. The
Biodex Balance system measures ankle stability by quantifying the ability of the
participant to control the platform angle, and the resulting index number is the variance
from the level position (Cachupe, Shifflett, Kahanov & Wughalter, 2001). Each
participant tested on the chronically unstable ankle only. The participants were not taped
during the pre-test or post-test.
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The Biodex Isokinetic Dynamometer has been shown to have acceptable validity
and reliability when used for measuring force production (Drouin 2004). Previous studies
have also used the isokinetic dynamometer to measure muscle strength through force
production (Aktas 2011; Lumbroso 2013).
The participants had maximum concentric inversion and eversion measured at 60
º/sec and 120 º/sec. The full range of inversion and eversion was measured and the
participant completed concentric eversion 5 times for 2 sets for each speed. These
parameters were found to be used in multiple studies and suggested in the Biodex manual
for the isokinetic dynamometer (Biodex , 2017, Lins 2013). Participants only tested their
unstable ankle. The participants were instructed to go through their full range of inversion
and eversion and to stop if any pain occurred. The Biodex was setup according to the
manual’s instructions (Figure 1-2.2).
Figure 1. Positioning for Measurement of Ankle Inversion/Eversion
(Biodex, 2017)
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 13
Figure 2.1. Position of Biodex for Eversion
Figure 2.2. Position of Biodex for Eversion (Setup)
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The Biodex Balance System has been found to be a reliable measurement for
dynamic balance in persons with history of an ankle sprain. The Balance system uses a
free-moving circular platform to measure overall stability, anterior-posterior stability, and
medial-lateral stability. Intraclass reliability for overall stability has been found to be
0.94, for anterior-posterior stability 0.95 and for medial-lateral stability 0.93. (Cachupe,
Shifflett, Kahanoc, Wughalter 2001).
The participants completed the athlete single-leg balance assessment, parameters
being already set in the Balance System, using the LE of the unstable ankle (Figures 2.3-
2.4). The participants were blinded of their results for both pre and post-tests.
Figure 2.3. Biodex Balance System Set-up
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 15
Figure 2.4. Biodex Balance System Set-up
After both pre-tests were complete, participant 1 was randomly chosen to
complete the taping for the ankle strengthening program. The participant was instructed
in KT® tape facilitation of the Fibularis Longus and Brevis muscles (Figures 3.1-3.3).
The participant was instructed to contact the researchers at any time if any issues
occurred with the taping during the strengthening program.
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 16
Figure 3.1. Kinesio Taping of the Fibularis Brevis
Figure 3.2 Kinesio Taping of Fibularis Longus and Brevis
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 17
Figure 3.3. Completed Kinesio Taping of Fibularis Longus and Brevis
Training Program
After completion of testing, both participants completed an ankle strengthening
program designed by the researchers (Appendix 2). The program was four weeks in
length, 3 days of exercise per week. The participant who was taught to tape applied it to
facilitate the Fibularis muscles on the unstable ankle before every workout and removed
the tape once the workout was finished. The removal of the tape after each work-out was
to provide a wash-out period. KT® Tape has shown to have some increased effect when
left on for multiple days and because our study is not focusing on this, a wash-out period
was necessary between every workout. Wash-out periods are necessary in clinical studies
to prevent a carry-over effect of the treatment performed into the next testing session.
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 18
KT® tape has demonstrated the ability to affect peak torque and force over multiple days
in only a few studies (Fu et al. 2007, Lumbroso et al. 2013). Therefore, if KT® tape had
the ability to accrue effects over multiple days, this may skew results of peak torque if the
participant had amassed effects of the KT® tape over time. However, no research could
be found on a determined wash-out period known for KT® tape, so the researchers chose
the removal of the tape after every session and new tape before each session at their own
discretion. The participant was instructed to apply his own tape to his ankle before every
workout. This removed the potentially confounding factor of different tape applications
by different people. The participant was taught by a professor certified in KT® Tape,
however there may have been some error due to the participant not being certified in
application of the tape. The participant was contacted regularly to see if there were
questions about the application and the participant was told to ask if uncomfortable with
the taping method and required more assistance. The other participant used no tape for
the workouts. After the four weeks, measurements of force production and ankle
stabilization were repeated, The results of peak torque and ankle stability pre and post
strengthening program for the unstable ankle for each participant were compared. The
post-test results between each participant was also compared. This allowed for “within
participant” comparison of the effect of the strengthening program on ankle stability with
and without with KT® Tape facilitating the fibularis muscles and “between participant”
comparison of change in peak torque with or without KT® Tape and ankle stability.
Data Collection
Peak torque of the evertors and ankle stability of the unstable ankle was measured
in each participant. The Balance System measured overall stability, anterior/posterior
index and medial/lateral index. The results were collected to find if there was a greater
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 19
effect on ankle stability with the Kinesio® Tape and the exercise program (participant
#1) compared to only the exercise program (participant #2). Force production of the
invertors and evertors was measured using the Biodex 4 Isokinetic Dynamometer and
ankle stability was measured using the Biodex Balance System provided by Florida Gulf
Coast University. The results can be found below in the Results section.
Data Analysis
Data Analysis was conducted by calculating percent change within each
participant’s pre-test and post-test results for the following categories: Total Ankle
Stability, Anterior/Posterior Index, Medial/Lateral Index, Peak Torque @ 60°/sec, and
Peak Torque @ 120°/sec.
(𝑃𝑜𝑠𝑡−𝑡𝑒𝑠𝑡)−(𝑃𝑟𝑒−𝑡𝑒𝑠𝑡)
|𝑃𝑟𝑒−𝑡𝑒𝑠𝑡| x 100% = Percent Change
(Percent Change and Percent Difference [PDF], n.d.)
Comparison via percent change calculation was suitable for this purpose as this value
describes changes in data points over time. This method allows quantification of how
much one participant differed from the other participant. (Percent Change, n.d.)
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 20
Results
Table 1
Participants Height, Weight ROM
Height Weight ROM
Inversion
ROM Eversion
Participant 1 72 inches 203 lbs 59 degrees 36 degrees
Participant 2 72 inches 155 lbs 53 degrees 48 degrees
Table 2
Participant 1, Pre-Test and Post-test Results
Peak
Torque
(60
deg/sec)
Peak
Torque
(120
deg/sec)
Overall
Ankle
Stability
Index
Medial/Lateral
Ankle
Stability Index
Anterior/Posterior
Ankle Stability
Index
Pre-Test 4 5 1.1 0.7 0.9
Post-Test 10 7 0.8 0.5 0.5
Table 3
Participant 2, Pre-test and Post-test Results
Peak
Torque
(60
deg/sec)
Peak
Torque
(120
deg/sec)
Overall
Ankle
Stability
Index
Medial/Lateral
Ankle
Stability Index
Anterior/Posterior
Ankle Stability
Index
Pre-Test 2 3 0.9 0.6 0.6
Post-Test 3 3 0.8 0.6 0.4
Table 4
Percent Change
Participant
#
% Change:
Total Ankle
Stability
% Change:
Ant/Post
Index
% Change:
Med/Lat
Index
% Change:
Peak Torque
@ 60°/sec
% Change:
Peak Torque
@ 120°/sec
#1 -27.7% -44.4% -29.6% + 150% + 40%
#2 -11.1% 0% -33.3% + 50% 0%
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 21
The study participants included two college-aged males of similar
anthropomorphic composition. The above results are explained as follows and are shown
in the above tables. In Table 1, the peak torque value measured at both speeds increased
for Participant #1 from 4 to 10 and from 5 to 7. Also seen in Table 1 is the decrease in all
the ankle stability indexes. Table 4 shows the percent change from the pre-test and post-
test results in each category. Participant #1 (experimental) had an increase in peak torque
of the evertors at both 60°/sec and 120°/sec with a percent change increase of 105% at
60°/sec and a percent change increase of 40% at 120°/sec.
Participant #2, who did not use the tape during the workouts, had only a slight
increase in peak torque at 60°/second and no change at the other speed, seen in Table 2.
This participant also has a decrease in Overall Ankle Stability Index, and
Anterior/Posterior Ankle Stability Index and no change in the Medial/Lateral Index, as
seen in Table 2. It can be seen that Participant #2 had a smaller change in peak torque and
in ankle stability compared to Participant #1.
In Table 4, Participant #2 (control) had an increase in peak torque of the evertors
at 60°/sec of 50% and no percent change at and 120°/sec. Participant #1 had a decrease in
percent change of 27.7% in total ankle stability, a decrease of 44.4% in ant/post stability
and a decrease of 29.6% in med/lat stability. Participant #2 had a decreased percent
change in total overall stability as well, but of 11.1%, no percent change in ant/post
stability and 33.3% decrease in med/lat stability. The overall decrease in total stability
was averaged to be -19.4. Overall, peak torque increased for Particpant #1 but ankle
stability decreased in each plane. Participant #2 had increased peak torque only with
eversion performed at 60°/sec with total ankle stability and med/lat stability decreasing.
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 22
Discussion
The original hypothesis stated that Kinesio® Tape should increase the strength of
the evertors of the ankle thus increasing ankle stability in those with chronic ankle
instability. The above results do not support the original hypothesis. From the above
results, the KT® tape did affect the peak torque of the ankle evertors. Both participants
had increased peak torque however, Participant #1, who performed the taping before each
workout, had greater increases in peak torque in both categories compared to Participant
#2, where peak torque was only increased in 1 category. This would suggest that the use
of KT® Tape along with a strengthening program does cause an increase in muscle
strength when compared to using a strengthening program alone. However, in regards to
ankle stability, the increased strength did not have the positive effects that were expected.
Both participants had decreases in ankle stability overall and in all measured planes.
Participant #1 had a percent change decrease in total ankle stability and in all planes. The
percent change decrease was greater in Participant #1 for overall stability and ant/post
stability, while Participant #2 had a greater decrease in percent change in stability in the
med/lat plane. Overall, Participant #1 had a larger percent change of decreased ankle
stability with a larger increase of peak torque of the ankle evertors. From these results it
can be suggested that while the strengthening program and KT® Tape increase the peak
torque, the increased peak torque caused a decrease in total ankle stability. This may
indicate that stronger ankle musculature may not provide a more stable ankle and may, in
fact, decrease stability, creating a higher risk for repeated ankle injury for those with
chronic instability. Potential bias and study limitations may have occurred by limiting the
sample size to only two participants. While this possibility has been considered, the
sample size was selected due to study feasibility and access to participants. It should also
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 23
be noted that the history of injury for each participant was not considered, aside from
chronic ankle sprains. Also noted was the application of the KT® Tape was applied by
the participant, who was not certified in taping, but was shown by a certified individual,
however due to human error there may have been possible erroneous application of the
tape.
Conclusion
The study performed was a pilot study, therefor there are limitations to the study
preventing the results from being entirely generalizable. The study had a very limited
number of participants, of one gender and of a similar age and build. With these two
participants the results found may not be generalized to populations. Other limiting
factors include complete adherence of the participants to the strengthening program, as it
was completed individually and was not supervised by the researchers. Also, the taping
technique could have been erroneous as it was also performed by the participant and not
supervised by a researcher or by the original certified professional. However, the
participant was told to contact the researchers if re-teaching was needed and the
participant was contacted regularly to assure confidence in application technique. Inter-
participant competition is another confounding factor, though the participants were
blinded from the results, both were present during the data collection.
The final results from the study can suggest that KT® Tape does have an effect on
strength of the ankle musculature, causing a greater increase in gains in strength when
applied with a strengthening program compared to utilizing a strengthening program
alone. This was evidenced by the objective increases in Peak Torque created by both
participants. However, the increased strength and peak torque seem to have a deleterious
effect on ankle stability predisposing those with chronic ankle instability to increase risk
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 24
of injury. This can be inferred based on the decreases in ankle stability displayed by the
participants with loss of nearly 28% Total Ankle Stability and 11% respectively. More
research must be done on the topic in order to have results with increased reliability due
to the limited nature of this pilot study. Reproducing this study with a larger population, a
more generalized group of participants and a longer strengthening program would
provide more reliable information regarding the direct effect of KT® Tape on ankle
stability.
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 25
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KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 29
Appendix A: Compilation of KT-related studies
Author Study Results
Aktas, Gulcan & Baltaci,
Gul (2011)
Determine if knee brace,
kineseotaping or both is
more effective regarding
muscular strength and
functional performance
measured through hop test
and muscular strength
KT® application increased
hop distance in non-
dominant and dominant
lower extremity, and in
isokinetic knee extension
peak torque, was more
effective than the other
applications in terms of
muscular strength and jump
performance
Fu, T.C., Wong, A.M., Pei,
Y., Wu, K.P., Chou, S.,
and Lin, Y (2007)
Determine the effects of
Kinesio taping on dominate
lower extremity muscle
strength after application of
taping on anterior knee and
thigh, and immediate and
delayed effects measured
through the Cybex NORM
isokinetic dynamometer
No significant difference
was found between the
three group’s (without tape,
immediately after taping,
12 hr after taping with tape
still applied) peak torque
and total work of the
quadriceps and hamstring
muscles. Suggests the tape
does not enhance or inhibit
muscle strength.
Halseth, T., McChesney,
J.W., DeBeliso, M.,
Vaughn, R., & Lien, J.,
(2004)
Determine if KT® taping
the anterior and lateral
portion of the ankle would
enhance ankle
proprioception compared to
the untapped ankle
No significant difference
found in absolute or
constant error between the
two conditions (tape or no
tape) indicating that KT®
tape does no enhance
proprioception.
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 30
Appendix A: Compilation of KT-related studies (continued)
Author Study Results
Hsu YH, Chen WY, Lin
HC, Wang WTJ, Shih YF
(2009)
Determine the effect of
KT® vs sham-tape on
kinematics, muscle activity
and strength of the scapula,
lower trapezius and
serratus anterior in baseball
players.
KT® significantly
increased the scapular
posterior tilt at 30° and 60°
during arm raising and
increased the lower
trapezius muscle activity in
the 60–30° arm lowering
phase (p < 0.05) in
comparison to the placebo
taping
Janwantanakul, P., &
Gaogasigam, C. (2005)
Determine the effect of
KT® on muscle activity of
the vastus lateralis and
vastus medialis obliques
with the application of
inhibition taping,
facilitation taping and no
tape through EMG activity
recorded with bipolar
surface electrodes during
stair climbing
The activity of vastus
lateralis and vastus
medialis obliquus during a
stair descent task was not
significantly affected by
the application of
inhibition or facilitation
tape to vastus lateralis
compared with no tape
condition.
Lee, H.L., Lee, C.R., Park,
S.J., Lee, S.Y., Jeong,
T.G., Son, G.S., Lee, J.Y.,
Kim, E.C., &Kim, Y.K.
(2011)
Examine the effect of KT®
on ankle range of motion
and calf muscle strength by
comparing the facilitation
technique and inhibition
technique measured
through goniometry and
MicroFET3 hand
dynamometer
No significant difference
was found between the
group with facilitation
taping and the group with
inhibition taping, however
some results show
inhibition taping increased
flexibility but not to a
significant amount.
Lins, C.A.A., Neto, F.C.,
Carlos de Amorim, A.B.,
Macedo, L.B., &
Brasilerio, J.S. (2013)
Determine if KT® can
increase proprioception
(joint position sense) of the
knee in women with taping
to the rectus femoris,
vastus lateralis and vastus
medialis measured with the
Biodex Multi-Joint System
3 isokinetic dynamometer.
No significant difference
was found between the
control group (no tape), the
tape group (facilitation
taping) or the sham-tape
group indicating KT® has
no immediate effect on
proprioception
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 31
Appendix A: Compilation of KT-related studies (continued)
Author Study Results
Lumbroso, D., Ziv, E.,
Vered, E., Kalichman,
L.(2013)
To evaluate the effect of the
KT® application on
hamstrings and the
gastrocnemius in terms of
hip, knee and ankle ROM
and quadriceps, hamstrings
and gastrocnemius strength
measured with a straight leg
raise test (SLR), a knee
extension angle test (KEA)
and a hydrolic push
dynamometer.
KT® application over the
gastrocnemius caused a
significant immediate
increase of its peak force.
The effects on muscle force
increased two days after
wearing KT®. KT
®application over the
hamstrings did not cause an
immediate change of its peak
force. However, after two
days of wearing KT®,
hamstring peak force
significantly increased. A
significant increase in ROM
was found in all
measurements. SLR and
ankle dorsiflexion
significantly increased
immediately after application
of KT, but KEA improved
significantly only after two
days of wearing KT on the
gastrocnemius.
Merino-marban, R. (2011) Determine the effect of
KT® on hamstring
extensibility using the X-
shaped taping technique
using a passive SLR.
Comparison between the
three groups (KT®, sham
tape, no tape) found no
significant difference in
hamstring length indicating
there are no acute effects of
KT® on hamstring
extensibility
Soriano, J.G., Vicen J.A.,
Aparicio-Garcia, C., Ruiz-
Lazaro, P., Simon-Martinez,
C., Bravo-Esteban, E.,
Rodriguez-Fernandez, J.M.
(2014)
Determine if KT® would
modulate muscle tone or
other associated measures
such as muscle extensibility,
strength and evoked EMG
activity of the
gastrocnemius.
No significant differences
were found for resistive
passive torque to ankle dorsi-
flexion at either 10 /s or 180
/s, between time interaction
nor between the two
conditions analyzed (sham
tape and KT®)
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 32
Appendix A: Compilation of KT-related studies (continued)
Author Study Results
Woodward, K. A.,
Unnithan, V., & Hopkins,
N. D. (2015)
Determine if KT®
improves skin blood flow
of the forearm in adolescent
male soccer players with
tape applied to the volar
aspect of the dominant arm
compared to no tape.
No differences were
observed for baseline Skin
Blood Flow (SkBF) or
cutaneous vascular
conductance(CVC)
between trials After local
heating, no differences
were evident for SkBF or
CVC between trials or
measurement sites
indicating that KT® did
not affect skin forearm
blood flow.
Vithoulka, I., Beneka, A.,
Malliou, P., Aggelousis,
N., Karatsolis, K., &
Diamantopoulos, K.
(2010)
Determine the effect of
Kinesio Taping® on
quadriceps strength at
maximum concentric and
eccentric isokinetic
exercise mode in healthy
non-athlete women to
examine the Kinesio taping
effect in increasing or
decreasing the
muscular quadriceps
strength. Three different
quadriceps taping modes
have been used (no taping,
placebo taping, KT®)
Significant differences in
max eccentric torque
during both the concentric
and eccentric mode of the
quadriceps muscle
suggesting that application
of Kinesio Taping® on the
anterior surface of the
thigh, in the direction of
vastus medialis, lateralis
and rectus femoris fascia,
could increase the eccentric
muscle strength
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 33
Appendix A: Compilation of KT-related studies (continued)
Author Study Results
Wong, O.M.H., Cheung,
R.T.H., Li, R.C.T (2012)
To determine the difference
in isokinetic knee
performance with and
without KT® application
over the vastus medialis
measured with the Biodex
system 4 isokinetic
dynamometer.
There was no significant
difference in extension
peak torque with and
without KT® and at
different angular velocities.
There was no significant
difference in normalized
work done of knee
extension and flexion
between taped and control
condition at any angular
velocities. However, time
to the peak torque of
extension was significantly
shortened with KT®
application onto the skin
overlying VM and this
change was found at all
three testing velocities
Csapo, R., & Alegre, L. M.
(2015)
To determine whether
certain applications of
KT® can facilitate
contraction and increase
muscle strength in healthy
adults using a meta-
analysis of studies
researching the efficacy of
KT® applications
Eight out of nineteen
studies showed some
statistically significant
beneficial effect of KT®
on muscle strength,
however the results of the
meta-analysis suggest KT®
has no or negligible effects
on muscle strength
Fratocchi, G., Di Mattia,
F., Rossi, R., Mangone,
M., Santilli, V., & Paoloni,
M.(2013)
Determine the effect of
KT® applied over the
biceps brachii on maximal
isokinetic elbow torque
compared to no tape and
placebo tape measured
using an Isokinetic Pulley
System.
A significant difference of
concentric peak torque of
the elbow was found
between the KT® group
and the no tape group, but
no significant difference
was found between the no
tape group and the placebo
tape group indicating that
KT® increases concentric
peak elbow torque when
applied over the biceps
brachii.
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 34
Appendix A: Compilation of KT-related studies (continued)
Authors Study Results
Williams, S.(2012) The aim of this review was
to evaluate, using meta-
analysis, the effectiveness
of KT® in the treatment
and prevention of sports
injuries looking at studies
that researched KT® and
its effect on pain, range of
motion, strength,
proprioception and muscle
activity.
Pain: 2/8 studies showed
statistically significant
positive results
ROM: 16/72 studies
showed statistically
significant positive results
Strength: 6/16 studies
showed statistically
significant positive results
Proprioception: 2/4 studies
showed statistically
significant positive results
Muscle activity: 4/22
studies showed statistically
significant positive results
These results indicate that
KT® may have a small
beneficial effect on
strength, force sense error
and active range of motion
of an injured area, but
further clarification is
needed
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 35
Appendix B: Ankle Strengthening Program
Parameters: The following parameters have been extracted from the textbook
“Therapeutic Exercise: Foundations and Techniques” 6th edition by Carolyn Kisner &
Lynn Allen Colby. This book is referenced on the Physical Therapy Board Exam.
Frequency: 3x/week, non-consecutive days
Duration: 4 weeks
Rest Intervals: 2-3 minutes between sets
Mode: Weight-bearing status varies depending on the exercise, but all exercises are
dynamic with concentric and eccentric components. Cueing and instruction should
include an emphasis on eccentric control for each exercise.
(Kisner & Colby, 2012 pp. 172-176)
1- Rocker board- Using a rocker board to develop control of ankle motions while
seated. This is more difficult with just one foot on the board. Progress to standing
while doing this activity. This is to further develop ankle control and strength and
improve proprioception. The progression for ankle activities is 5x up/down then
5x left/right, then 1x each number on the face of an imaginary clock, CW then
CCW. This is 1 set. Perform 3 sets of this activity with 2-3 minutes rest between
sets.
(Sprained Ankle Exercises, 2015)
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 36
Appendix B: Ankle Strengthening Program (continued)
2- Open-Chain Resisted Plantarflexion w/ Elastic Band- Long-sitting position
with leg resting on a rolled towel to slightly elevate the heel off of the table. Hold
both ends of an elastic band that is looped under the forefoot, then plantarflex
against the resistance (Gas pedal). Perform this at a resistance in which 12-15 reps
is challenging. Perform 3 sets of this activity with 2-3 minutes rest between sets.
(Ankle Therapeutic Exercises, 2016)
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 37
Appendix B: Ankle Strengthening Program (continued)
3- Open-Chain Resisted Eversion w/ Elastic Band- Long-sitting position on table,
place a loop of elastic tubing around both feet and evert both feet against
resistance simultaneously. Keep knees still and turn the foot outward, not
allowing the thigh to abduct or externally rotate. Perform this at a resistance in
which 12-15 reps is challenging. Perform 3 sets of this activity with 2-3 minutes
rest between sets.
(Ankle Therapeutic Exercises, 2016)
4- Open-Chain Resisted Dorsiflexion w/ Elastic Band- Anchor elastic band to
wall or have someone safely assist by holding the band at a consistent
tightness/resistance. Long-sitting position on table, place a loop of elastic tubing
around the forefoot and dorsiflex against the resistance provided by the elastic
tubing. Alternate feet. Perform this at a resistance in which 12-15 reps is
challenging. Perform 3 sets of this activity with each foot with 2-3 minutes rest
between sets.
(Ankle Therapeutic Exercises, 2016)
KINESIO® TAPE AND CHRONIC ANKLE SPRAINS 38
Appendix B: Ankle Strengthening Program (continued)
5- Open-Chain Resisted Inversion w/ Elastic Band- Long-sitting position on
table, place a loop of elastic tubing around one feet and invert foot against
resistance. This may be done by looping the tubing around the opposite foot to
provide a lever or having someone safely assist. Keep knees still and turn the foot
inward, not allowing the thigh to adduct or internally rotate. Perform this at a
resistance in which 12-15 reps is challenging. Perform 3 sets of this activity with
2-3 minutes rest between sets.
(Resisted Inversion, 2017)