Original ResearchDoes kinesiology taping of the ankles affect proprioceptive control in professional football (soccer) players?
Introduction
Football has been shown to have the highest incidence of injuries among comparable team sports, with the ankle being the most commonly injured area (Wong & Hong, 2005). The average recovery time for severely injured ankles in professional footballers is 61 days, and up to 28 days for moderate injuries (Oztekin, Boya, Ozcan, Zeren, & Pinar, 2009). A large study of 380 athletes demonstrated that following an ankle injury, 73% will suffer a further similar injury, and 59% will continue to have residual symptoms (Yeung, Chan, So, & Yuan, 1994). These findings may be factors in the higher prevalence of ankle osteoarthritis observed in former elite football players, compared to the normal population (Kuijt et al., 2012, Turner et al., 2000). A retrospective analysis of data collected from 14,776 players in the English Football Association academies between 1998 and 2006, showed there was a mean incidence of one ankle injury per player per year (Cloke, Spencer, Hodson, & Deehan, 2008). In view of the findings of these studies, it can be concluded that footballers are a particularly high risk group of athletes for ankle injury. Furthermore, it could be argued that current methods of rehabilitation may be inadequate due to the high percentage of re-injuries, persistent symptoms, and long term complications.
Ankle injuries, such as an inversion strain of the sub-talar joint, commonly result in trauma to the soft and bony tissues, which are associated with pain and changes in the normal function of the joint (Hertel, 2002). Such changes have been shown to include a reduction in proprioceptive capabilities, which some research has suggested is an important risk factor for further injury (Bressel et al., 2003, Freeman et al., 1965, Friel et al., 2006, Garn and Newton, 1988, Hertel, 2002, Lephart et al., 1997, Noronha et al., 2006, Refshauge et al., 1999). Three major sensory systems are involved in balance, namely: vision, the vestibular system, and the somatosensory system (Winter 1995). The latter is normally considered to be what strictly constitutes proprioception, and consists of mechanoreceptors which generate our joint position sense (JPS), and the sometimes separately termed kinaesthesia; the sensation of movement. These sensations are conveyed by afferent nerves from mechanoreceptors in the ligaments and joint capsules, muscle spindles in the muscle belly, golgi tendon organs in the muscle's tendon, and cutaneous receptors in the skin (Refshauge et al., 1999). Studies investigating factors contributing to JPS have demonstrated that the cutaneous input, particularly skin stretch, has a greater impact on the accuracy of an individual's JPS, than input from the ligaments or joint capsules (Clark et al., 1979, Collins et al., 2005). While this has only been demonstrated in the index finger, elbow and knee, it suggests that an intervention which can facilitate the cutaneous aspect of proprioception may be clinically beneficial.
Kinesiology tape (KT) is used widely in sport for the treatment and prevention of injuries and enhancement of performance (Williams, Whatman, Hume, & Sheerin, 2012). KT demonstrates significantly lower initial stiffness, higher late stiffness, and more consistent maintenance of support than inelastic tape (Seigler, Marchetto, Murphy, & Gadikota, 2011). This means KT allows more movement to occur initially in a joint, but becomes more resistant the more it is stretched. This is ideal for joint applications, as it allows the joint to move through a normal range, but becomes more resistant as the joint moves toward its end range. It is also more resilient to repeated stretching, making it more appropriate for use in sport where repetitive movements take place. While there is some evidence to demonstrate its efficacy in the enhancement of muscular activity for the purposes of performance gains (Aktas and Baltaci, 2011, An et al., 2012, Bicici et al., 2012, Gomez-Soriano et al., 2013, Lins et al., 2013), a systematic review and meta-analysis concluded that there was no evidence to support the clinical use of KT for individuals with musculoskeletal conditions (Parreira et al., 2014, Williams et al., 2012). However, the meta-analysis only included one trial measuring proprioception, and the systematic review only included self-reported pain, quality of life, and disability outcome measures. One of the proposed mechanisms of action of KT, is the facilitation of neurological activity in the receptors of the skin, thereby enhancing proprioception (Kase, Wallis, & Kase, 2003). If this mechanism can be demonstrated, KT may have a role in the rehabilitation of individuals who have suffered an ankle injury.
Proprioception has been described as more than the cumulative input of sensory information, as an individual's proprioceptive performance also relies on their ability to integrate such information (Han, Waddington, Adams, Anson, & Liu, 2016) and use it to “effect performance changes during task execution” (Hiller, Immink & Thewlis, 2015). For example, the central processing of proprioceptive signals from the foot, has been shown to be critical for effective balance control, an important component in the prevention of ankle injury (Goble et al., 2011). A recent systematic review has identified that there is no single measure of proprioception, but of the 32 different tools identified, the most common construct measured was active or passive joint position matching, followed by passive motion detection (Hiller et al., 2015). However, these methods do not require central processing of sensory input, to effect a simultaneous motor output. Despite previous studies investigating the effects of KT on ankle proprioception, no study has used a weight bearing task which requires movement of the whole body and the joint to which the tape is applied to control balance (Briem et al., 2011, Elshemy and Battecha, 2013, Halseth et al., 2004, Konradsen and Ravn, 1991, Semple et al., 2012). It is hypothesised that such a testing method would be likely to demonstrate effects from the application of KT, as continuous changes in skin stretch from joint movement would be affected by the associated stretch of the affixed tape. This study therefore used a bipedal standing balance and fine movement control test, to assess the effect of KT on the proprioception of healthy professional footballers. The null hypothesis being: the bilateral application of KT to professional footballers' ankles will not affect their proprioception when assessed with a fine movement and balance control test.
Section snippets
Participants
Inclusion criteria: professional full time football players, over 18 years of age from a UK Championship League Football Club.
Exclusion criteria: players who are currently injured or deemed not fit to play by the head of the medical department. Players were not excluded on the basis of previous injuries, as any deficits in physical function resulting from previous injury should have been identified by the regular screening undertaken in the medical department, and resolved through appropriate
Results
A convenience sample of 20 players agreed to take part, all of whom completed both tests. The mean percentage test scores for participants in the not taped and taped conditions are presented in Table 1. No significant difference was observed between the not taped and taped scores with a mean difference in percentage accuracy score of 4.2 (p = 0.285). The null hypothesis that the bilateral application of KT to professional footballers' ankles will not affect their proprioception when assessed
Discussion
The purpose of this study was to establish whether it is possible to improve professional footballers' proprioception via the bilateral application of KT to their ankles. The study assessed participants' proprioception using a standing fine movement and balance control test, and found that there was no significant difference in participants' percentage accuracy scores with or without KT applied to their ankles. This assessment method was chosen as it required the participants to use all the
Conclusion
The results of this study indicate that the application of KT to healthy professional footballers' ankles does not improve their proprioception. The use of KT on healthy individuals for the purpose of reducing injury risk is not supported by this study. The results of this study add to the existing evidence which shows that KT has no significant effects on proprioception. Further high quality research investigating the physiological effects of KT is needed, as previous systematic reviews and
Conflict of interest
None declared.
Ethical Approval
The study was approved by the Keele University School of Health and Rehabilitation Ethics Committee.
Funding
None declared.
Acknowledgements
The authors wish to acknowledge the assistance of Dr Oliver Thomson, Dr Annette Bishop, Dr Martyn Lewis and Phil Hayward.
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