Kinesio Tapping & Ankle Injuries

Ankle injuries and taping are frequently discussed, particularly given the prevalence of ankle injuries in most field sports and the widespread use of various taping methods across sports. Today, I reviewed a mix of papers that unintentionally focused primarily on the use of kinesiology tape in chronic ankle instability. This is by no means a comprehensive commentary on the use of tape in chronic ankle instability. Rather, it is a simple summary of some of the findings I reviewed and my thoughts on them.  

Before examining the literature, I think it is worth acknowledging that taping, like much of clinical practice, lies in the mixed realm of science and art. Using generic taping methods to assess effectiveness has the same limitations as applying a single intervention to the complex human organism. Where you tape, how you tape, the type of tape you use, the direction of pull, and the force applied to the tape can all affect the response experienced during tapping.

Balance

• Yang et al. (2018) found that Kinesio tape improved dynamic balance in people with and without ankle instability compared to other taping methods, did not reduce mobility and did not impact vertical jump performance.

• Choi & Lee (2020) found that ankle Kinesio taping improved static and dynamic balance in a fatigued muscle state.

• Lee & Lee (2017) observed that single-leg balance on an unstable surface with ankle balance taping and placebo taping improved compared to no taping. However, no significant difference in scores for stable surface and tandem stance between tape and no-tape conditions was observed.

Lee & Lee's (2017) finding that taping and placebo taping confer benefits supports the notion of taping's psychological benefits. I am less willing to adopt that dualistic perspective so readily. However, I think the potential for Kinesio tape to improve function in a fatigued state is the more interesting area for me. This aligns at least with the mechanistic theory underlying the use of Kinesio tape, which posits that it can influence superficial fluid dynamics in the skin. That could theoretically affect the lymphatic system, which may aid in clearing the accumulation of fatiguing metabolites. It may also affect tissue layer glide and tension, which could affect neurological conduction or muscle function, either directly or through altered feedback. Local circulatory effects beyond the lymphatic system may also occur and may play minor roles in fatigability.

Image 1. Ankle balance taping (Lee & Lee 2017)

Image 2. Placebo ankle balance taping (Lee & Lee 2017)

Performance

• Sarvestan & Svoboda (2019) found that Kinesio-taping increased ankle ROM in the sprinting part of the Illinois agility test, 5-0-5, 10m shuttle and T agility test compared to the non-taped condition and the athletic tape condition.

• Sarvestan et al. (2020) further found that application of Kinesio tape among athletes with chronic ankle instability could provide lateral mechanical support to the ankle, potentially decreasing the velocity of frontal plane sway and decreasing the magnitude of muscle activation.

• Sule & Nesrin (2019) found that distal fibular taping decreased pain intensity during range of motion weight-bearing conditions while increasing range of motion.

Most of these again focused on Kinesio taping; the performance benefits of taping may be due to various factors. Especially in populations with chronic ankle instability who may have altered cortical maps, structural changes at the ankle, altered lower limb mechanics from injury or fear of pain and re-injury that impact their capacity to express their performance potential. To anyone who has ever been taped, you may agree that when it is done well, you almost feel as if you have been given some kind of cybernetic enhancement. So, if we aren’t impacting proprioception, the state of biology in local tissue, the mechanics at the ankle or mechanics up the chain, or reducing pain, it could still be increasing confidence, reducing fear, increasing sensation of safety and creating a perception of strength or stability that aids in supporting an environment for greater capacity expression.

Muscle activity

• Van Deun et al. (2007) reported later-onset times for ankle, hip and hamstrings muscles compared to controls and that people with chronic ankle instability had more fixed muscle activations, whereas healthy controls showed more variability in patterns during transitioning from double to single leg.

• Webster, Pietrosimone, & Gribble (2016) looked at muscle activity during landing before and after fatigue in people with chronic ankle instability and found higher activation in the peroneus longus and gluteus maximus before landing and that the tibialis anterior was most impacted by fatigue. No difference in gluteus medius activation was observed.

• Jaber et al. (2018) found that patients with chronic ankle instability showed reduced postural control with less tibialis anterior and gluteus maximus activity in the star excursion balance test.

I think the finding of Van Deun et al. (2007) that patients with chronic ankle instability generally have less movement strategy diversity, or what I would typically refer to as movement or system redundancy. This likely reflects a broader principle: a healthy system should have multiple ways to accomplish a given task, especially when the task is relatively simple, such as standing on one leg. Having more redundant patterns to utilise in a given context should, in theory, aid injury protection, because if one system or strategy fails to meet the demands placed on it, there are numerous others to fulfil the role.

Webster, Pietrosimone, & Gribble (2016) found that glut max and peroneus longus activity is higher in chronic ankle instability patients before landing, which may be an expression of the above idea. Perhaps they have limited strategies for landing preparation and are already committed to a plan that lacks sufficient redundancy to adapt to perturbations. The fatiguability of the tibialis anterior identified here, combined with Choi & Lee (2020), who noted that Kinesio tape may improve balance task performance during fatigue, may be another reason to consider mixed taping methods, such as Kinesio tape.

The finding by Jaber et al. (2018) that less glut max and tibialis anterior activity during the star excursion balance test in patients with chronic ankle instability is a good reminder to always consider the entire kinetic chain. It also raises the question of whether proximal muscle function can be affected by distal taping.

Injury risk

• Teyhe et al. (2015) found that an ankle dorsiflexion asymmetry greater than 5° increased the risk of injury.

I appreciate the simplicity of the ankle dorsiflexion range-of-motion clearing test that the FMS team now uses, as it addresses many of the compensation issues we often have to manage when performing the various knee-to-wall tests. I also prefer to use the inclinometer to measure range when I am interested in recording and obtaining a clear understanding of the patients’ capacity. Alternatively, it is a quick screen if you want to determine whether you need to look more closely at ankle range now or whether you can move it down your hypothesis list as a potential barrier.

A 4-minute video from Functional Movement Systems is available here to demonstrate the test. They, of course, use one of their FMS kits in the video, but it is entirely unnecessary.

https://www.youtube.com/watch?v=zqHT2UdtW3I

References

1. Choi, H., & Lee, J. (2020) Immediate effect of balance taping using kinesiology tape on dynamic and static balance after ankle muscle fatigue. Physical rehabilitation and prevention in sports injuries, 8(2), 162. https://doi.org/10.3390/healthcare8020162

2. Jaber, H., Lohman, E., Daher, N., Bains, G., Nagaraj, A., Mayekar, P., Shanbhag, M., Alameri, M., (2018). Neuromuscular control of ankle and hip during performance of the star excursion balance test in subjects with and without chronic ankle instability. Plos one, 13(8). https://doi.org/10.1371/journal.pone.0201479

3. Lee, S., & Lee, J. (2017). The immediate effects of ankle balancing taping with kinesiology tape on ankle active range of motion and performance in the balance error scoring system. Physical therapy in sport, 2, 99-105. https://doi.org/10.1016/j.ptsp.2016.08.013

4. Sarvestan, J., Ataabadi, P., Swoboda, Z., Kovacikiva, Z., Needle, A. (2020). The effect of ankle KinesioTM taping on ankle joint biomechanics during unilateral balance status among collegiate athletes with chronic ankle sprain. Physical therapy in sport, 45, 161-167. https://doi.org/10.1016/j.ptsp.2020.06.007

5. Sarvestan, J., & Svoboda, Z. (2019). Acute effect of ankle kinesio and athletic taping on ankle range of motion during various agility tests in athletes with chronic ankle sprain. Journal of sport rehabilitation, 29(5) 527-532. https://doi.org/10.1123/jsr.2018-0398

6. Teyhe, D., Shaffer, S., Butler, R., Goffar, S., Kiesel, K., Rhon, D., Williamson, J., & Plisky, P. (2015).  What risk factors are associated with musculoskeletal injury in US army rangers? A prospective prognostic study. Clinical orthopaedic and related research, 473, 2948-2958. https://doi.org/10.1007/s11999-015-4342-6

7. Van Deun, S., Staes, F., Stappaerts, K., Janssens, L., Levin, O., & Peers, K., (2007) Relationship of chronic ankle instability to muscle activation patterns during the transition from double-leg to singe-leg stance. The American journal of sports medicine, 35(2), 274-281. https://doi.org/10.1177/0363546506294470

8. Webster, K., Pietrosimone, B., & Gribble, P. (2016). Muscle activation during landing before and after fatigue in individuals with or without chronic ankle instability. Journal of athletic training, 51(8), 629-636. https://doi.org/10.4085/1062-6050-51.10.01

9. Yang, Y., Gu, Y., Chen, J., Luo, W., He, W., han, Z., & Tian, J. (2018). Kinesio taping is superior to other taping methods in ankle functional performance improvement: a systematic review and meta-analysis. Clinical rehabilitation, 32(11), 1472-1481. doi: 10.1177/0269215518780443