Athletic Training and Sports Health Care

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Original Research 

Effects of Fibular Repositioning Tape on Ankle Kinematics and Muscle Activity

Megan N. East, MA, ATC; J. Troy Blackburn, PhD, ATC; Lindsay J. DiStefano, PhD, ATC; Steve M. Zinder, PhD, ATC; Marc F. Norcross, MA, ATC

Abstract

Fibular repositioning tape purportedly corrects the anterior fibular fault that often accompanies chronic ankle instability (CAI). Although anecdotal evidence suggests that fibular repositioning tape possesses clinical use, the associated mechanisms are unclear in patients with CAI. The purpose of this study was to evaluate the effects of fibular repositioning tape on ankle kinematics and lower extremity muscle activity during landing. Thirty individuals with unilateral CAI were randomly assigned to one of three groups: fibular repositioning tape (n = 10), placebo tape (n = 10), or control (n = 10). Ankle kinematics and lower extremity muscle activity were recorded during a single-leg landing task before and after a taping intervention. The fibular repositioning tape group landed in a less plantarflexed position at ground contact (P < .001) and demonstrated decreased tibialis anterior extremity muscle activity prior to ground contact (P < .001) following the taping intervention. These results suggest that fibular repositioning tape causes changes in landing kinematics that may enhance ankle joint stability, potentially reducing the risk of recurrent ankle sprain associated with CAI.

Abstract

Fibular repositioning tape purportedly corrects the anterior fibular fault that often accompanies chronic ankle instability (CAI). Although anecdotal evidence suggests that fibular repositioning tape possesses clinical use, the associated mechanisms are unclear in patients with CAI. The purpose of this study was to evaluate the effects of fibular repositioning tape on ankle kinematics and lower extremity muscle activity during landing. Thirty individuals with unilateral CAI were randomly assigned to one of three groups: fibular repositioning tape (n = 10), placebo tape (n = 10), or control (n = 10). Ankle kinematics and lower extremity muscle activity were recorded during a single-leg landing task before and after a taping intervention. The fibular repositioning tape group landed in a less plantarflexed position at ground contact (P < .001) and demonstrated decreased tibialis anterior extremity muscle activity prior to ground contact (P < .001) following the taping intervention. These results suggest that fibular repositioning tape causes changes in landing kinematics that may enhance ankle joint stability, potentially reducing the risk of recurrent ankle sprain associated with CAI.

Ms East is from Indiana University, Bloomington, Ind; Drs Blackburn and Zinder and Mr Norcross are from the University of North Carolina, Chapel Hill, NC; and Dr DiStefano is from the University of Connecticut, Storrs, Conn.

This investigation was approved by the Office of Human Research Ethics Biomedical Institutional Review Board at the University of North Carolina at Chapel Hill.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to J. Troy Blackburn, PhD, ATC, University of North Carolina at Chapel Hill, 124 Fetzer, CB # 8700, Chapel Hill, NC 27599-8700; e-mail: troyb@email.unc.edu.

Received: August 31, 2009
Accepted: January 06, 2010

Lateral ankle sprains are among the most common injuries in the physically active population.1 The most common mechanism of injury for a lateral ankle sprain involves a plantarflexed, inverted, and internally rotated position, and typically occurs immediately following ground contact during gait or landing from a jump.1,2 Approximately 85% of all ankle sprains are due to inversion and cause subsequent damage to the lateral ligament complex.3 Many individuals experience residual symptoms, and approximately 70% experience recurrent sprains.4 Typical residual symptoms include pain during activity, recurrent swelling, a sensation of giving way, and muscle weakness.5 The development of these lingering symptoms and associated repetitive ankle sprains has been termed chronic ankle instability (CAI).

Several studies have identified a more inverted ankle position, lesser dorsiflexion displacement, and lesser peroneus longus activity during quiet stance, gait, and landing in participants with CAI compared with healthy control participants.6–11 The peroneal musculature provides eccentric resistance to ankle inversion, serving as a protective mechanism against lateral ankle sprains and contributing to dynamic ankle joint stability.12 Peroneal activity alterations coupled with the vulnerable ankle position of inversion may explain why individuals with CAI experience repetitive ankle sprains.7,8

Recently, the role of positional faults at the ankle complex has become a topic of much debate. Mulligan13 proposed that an anterior fault of the distal fibula on the tibia occurs in some individuals after lateral ankle sprains. During the plantarflexion and inversion mechanism of lateral ankle sprain, the anterior talofibular ligament places tension on the distal fibula, causing it to move anteriorly.13 This anterior fault effectively decreases tensile force in the anterior talofibular ligament due to shortening. This slackening of the anterior talofibular ligament limits its ability to resist inversion, allowing a greater amount of inversion to occur before substantial resistance is provided and potentially leading to repetitive sprains and instability in the lateral ankle complex.

Manual repositioning of the fibula by either rigid tape or manual therapy has been shown to have positive effects on ankle joint pain, range of motion, and disability.13,14 Mulligan13 proposed that fibular repositioning tape can correct an anterior positional fault, maintain normal fibular alignment, and be used clinically as a treatment following ankle sprains. In addition, fibular repositioning tape is believed to prevent anterior fibular displacement and may be effective in ankle injury prevention.

A recent prospective investigation reported that prophylactic use of fibular repositioning tape decreased the rate of ankle sprains in basketball players.15 Despite the increasing clinical use of fibular repositioning techniques for the treatment and prevention of ankle injuries, there is little evidence in the literature regarding why this technique appears to be effective or what mechanisms result in improved function. Changes in muscle activation and ankle joint position have been proposed as possible mechanisms for improved function and reduction of ankle injury risk with fibular repositioning tape, but we are unaware of any previous investigations that have directly evaluated the influence of fibular repositioning tape on these factors. Therefore, the purpose of this study was to investigate the immediate effects of fibular repositioning tape on ankle kinematics and lower extremity electromyography in participants with CAI while performing a single-leg landing task.

Methods

Experimental Design

We used a randomized, single-blind, repeated-measures design to investigate the effects of fibular repositioning tape on ankle joint kinematics and muscle activity during a landing task. Participants were randomly assigned to one of three groups (fibular repositioning tape, placebo tape, or control [no tape]) without replacement and were blinded to group assignment. Kinematic and electromyography data were sampled during a single testing session before and after a taping intervention.

Participants

Thirty participants volunteered to participate in this study. On arriving at the laboratory, participants completed a questionnaire to ensure that they met the inclusion criteria and to screen for exclusion criteria. Participants were eligible for participation if they were between the ages of 18 and 30 and were identified as having unilateral CAI. Chronic ankle instability criteria included self-reported previous history of at least one inversion ankle sprain that required a period of protected weight bearing or immobilization; self-reported tendency for the ankle to give way during activity; and self-reporting that the involved ankle was less functional compared with the uninvolved ankle at the time of testing. Exclusion criteria included any history of lower extremity fracture, ankle surgery, or an acute ankle sprain within the 6 weeks prior to data collection. Signs and symptoms of an acute ankle sprain were any pain, redness, swelling, or self-reported impaired function at the time of testing. Prior to testing, all participants read and signed an approved informed consent document.

Experimental Procedures

Electromagnetic motion capture sensors (miniBirds, Ascension Technologies, Burlington, Vt) were placed on the limb with the chronically unstable ankle on the shank, posterior calcaneus, and lateral dorsum of the foot using double-sided tape and secured with pre-wrap and athletic tape (Figure 1). Preamplified surface electromyography electrodes (Delsys Bagnoli-8; Delsys Inc., Boston, Mass) were secured over the area of greatest muscle bulk of the tibialis anterior and peroneus longus muscles, and a reference electrode was placed over the tibial tuberosity. The electrode sites were shaved, lightly abraded, and cleansed with iso-propyl alcohol to reduce impedance. The electrodes were secured to the skin using adhesive collars, pre-wrap, and athletic tape. Manual muscle tests were performed to ensure proper positioning of the electrodes and the absence of crosstalk.

Electromyography Electrode and Electromagnetic Sensor Locations for Landing Assessments.

Figure 1. Electromyography Electrode and Electromagnetic Sensor Locations for Landing Assessments.

The test limb was then digitized using The Motion Monitor motion capture software (Innovative Sports Training, Chicago, Ill) while participants stood in a neutral and relaxed stance. A segment-linkage model of the lower extremity was constructed by digitizing the medial and lateral femoral epicondyles, the medial and lateral malleoli, and the most distal aspect of the second phalanx. Knee and ankle joint centers were defined as the midpoints of the digitized femoral epicondyles and malleoli, respectively.

Ankle kinematic and electromyography data were sampled during a single-leg drop landing task. Participants stood on their healthy/nontest limb on a box 30 cm in height placed 10 cm from the edge of a non-conductive force plate (model 4060-nc; Bertec Corp., Columbus, Ohio) with the CAI/test limb in a relaxed, non-weightbearing position. Participants then dropped from the box and landed on the test limb in the middle of the force plate and maintained a single-leg stance for approximately 2 seconds after ground contact. The primary investigator explained and demonstrated the drop landing task, and participants practiced the task a maximum of 3 times. All participants performed the landing task barefoot to control for any potential influences of various shoe types. Participants performed 5 trials of the landing task, with 30 seconds of rest between trials to minimize the risk of fatigue. Trials with incorrect landings (ie, foot of test limb did not land completely on the force plate or foot of non-test limb touched the ground) were discarded and repeated.

After recording the first 5 drop landings, participants received either fibular repositioning tape, placebo tape, or no tape, as determined by group assignment. All taping procedures were performed by the same trained clinician (M.N.E.). For fibular repositioning tape, participants were seated with their foot in a relaxed position. The skin was prepared with adhesive spray, and a 20-cm length of Cover-Roll (BSN Medical, Miramar, Fla) was applied obliquely in a posterolateral direction starting at the distal end of the lateral malleolus. A posterolateral force was then applied to the distal fibula via a 20-cm length of non-stretch tape (Leukotape; BSN Medical) (Figure 2). A second reinforcing strip was then applied in the same manner. For the placebo tape, the same process was followed as for applying the fibular repositioning tape, without a posterolateral force applied during application. The control group received no tape and rested quietly during the treatment period. The time between testing sessions for all participants was 10 minutes. After the treatment period, an additional 5 landing trials were performed as previously described.

Fibular Repositioning Tape. The Arrow Indicates the Direction of the Posterolateral Force Used to Apply the Leukotape ((BSN Medical, Miramar, Fla).

Figure 2. Fibular Repositioning Tape. The Arrow Indicates the Direction of the Posterolateral Force Used to Apply the Leukotape ((BSN Medical, Miramar, Fla).

A 5-second maximal voluntary isometric contraction against manual resistance was then performed for each muscle to provide a normalization criterion for electromyography activity. For the peroneus longus, the investigator stabilized the tibia and manually resisted eversion and plantarflexion. The tibialis anterior was tested by stabilizing the tibia and manually providing resistance to dorsiflexion and inversion.

Data Sampling and Reduction

All data were sampled via Motion Monitor software. Electromagnetic sensor data were sampled at 100 Hz, whereas electromyography and force plate data were sampled at 1000 Hz. Kinematic data were time synchronized with electromyography and force plate data and resampled to 1000 Hz. The 3-dimensional global and local coordinate systems were defined as follows: the positive x-axis was directed anteriorly/forward, the positive y-axis was directed to the left of the participant, and the positive z-axis was directed upward/superiorly. Kinematic and kinetic data were low-pass filtered at 10 Hz (fourth order, zero phase lag Butterworth). Ankle angles were calculated as the foot reference frame relative to the shank reference frame using Euler angles rotated in a YXZ sequence.

Ankle angles in the frontal and sagittal planes at initial ground contact and the maximum angles during the loading phase of the drop landing task were identified using a custom software program (MatLab; The Math-works, Inc., Natick, Mass). Initial ground contact was defined as the time point at which the vertical ground reaction force obtained from the force plate exceeded 10 N. The loading phase was defined as the time period from initial ground contact to the first local minimum of the vertical ground reaction force (Figure 3).

Vertical Ground Reaction Force (GRFv) and Tibialis Anterior Electromyography Data During the Single-Leg Drop Landing Task. the Data Represent a Single Trial for a Single Participant. The Dashed Vertical Lines Represent Electromyography Onset, Initial Ground Contact, and the First Local Minimum in the GRFv, from Left to Right, Respectively. The Preparatory Phase Was Defined as the Interval Between Electromyography Onset and Initial Ground Contact. The Loading Phase Was Defined as the Interval from Initial Ground Contact to the First Local Minimum in the GRFv.

Figure 3. Vertical Ground Reaction Force (GRFv) and Tibialis Anterior Electromyography Data During the Single-Leg Drop Landing Task. the Data Represent a Single Trial for a Single Participant. The Dashed Vertical Lines Represent Electromyography Onset, Initial Ground Contact, and the First Local Minimum in the GRFv, from Left to Right, Respectively. The Preparatory Phase Was Defined as the Interval Between Electromyography Onset and Initial Ground Contact. The Loading Phase Was Defined as the Interval from Initial Ground Contact to the First Local Minimum in the GRFv.

Raw electromyography data were passively demeaned, band-pass filtered (20 to 350 Hz; fourth order, zero phase lag Butterworth), and smoothed using a 20 ms root mean square sliding window function. Mean electromyography amplitudes of the peroneus longus and tibialis anterior were calculated for the preparatory and loading phases of the landing, as well as the onset time for each muscle relative to initial ground contact. The preparatory phase was defined as the time period between electromyography onset and initial ground contact. Onset was defined as the instant at which the electromyography amplitude exceeded 3 standard deviations above baseline electromyography for at least 50 ms. Baseline electromyography was calculated as the mean amplitude over a 100 ms “quiet” interval while the participants were standing on the box. The definition of the loading phase for electromyography analyses was the same as that used for kinematic data. Electromyography amplitudes were normalized to the mean amplitude of the maximal voluntary isometric contraction for each muscle during the middle 200 ms of the trial.

Statistical Analyses

A 3 (fibular repositioning tape, placebo tape, control group) × 2 (pretest, posttest) mixed-model repeated-measures analysis of variance was used to evaluate the study’s hypotheses. Dependent (between pretest and posttest points) and independent (between groups) samples t tests were used to evaluate pairwise differences post hoc after a Bonferroni adjustment for Type I error rate following significant interaction effects. All data were analyzed using SPSS version 13.0 statistical software (SPSS, Inc., Chicago, Ill) with an a priori alpha level set at .05. Because there were 4 planned pairwise comparisons evaluated post hoc, the family-wise Type I error rate (.05) was divided by 4 to yield a pairwise Type I error rate of .0125.

Results

Of the original 30 participants, the data for 1 participant in the fibular repositioning tape group and 1 in the placebo tape group were not included in statistical analyses due to data reduction errors. Specifically, the algorithms used for data reduction were unable to detect valid electromyography onsets. Therefore, data from 9 fibular repositioning tape participants, 9 placebo tape participants, and 10 control participants were used for data analyses. In addition, the algorithms used for data reduction were unsuccessful in 4 trials (among 3 participants) of 280 (less than 2%) total trials included in data analyses. These trials were discarded and, in those participants, mean values were calculated across the 4 remaining trials instead of 5 in that test condition.

A total of 6 trials (2%) had to be repeated due to landing errors, and no pattern of errors was noted across groups or conditions. Participant demographics are presented in Table 1 for the 28 participants included in the analyses. Because the purpose of this investigation was to determine whether fibular repositioning tape produces kinematic and electromyography changes relative to the placebo tape and control groups, only the resulting Group × Test interaction effects are reported.

Means ± Standard Deviations for Subject Demographics (N = 28)

Table 1: Means ± Standard Deviations for Subject Demographics (N = 28)

Ankle Kinematics

Means and standard deviations for ankle angles in the sagittal plane are presented in Table 2. A significant Group × Test interaction effect (F2,25 = 17.492, P <.001) was identified for the sagittal plane angle at initial ground contact (Figure 4). Participants in the fibular repositioning tape (mean difference: 95% CI, −8.49°; −5.97°, −11.00°) and placebo tape (mean difference: 95% CI, −4.59°; −2.43°, −6.77°) groups landed in a less plantarflexed position at initial ground contact at posttest when compared with pretest. In addition, the fibular repositioning tape (mean difference: 95% CI, 12.21°; 6.70°, 17.72°) and placebo tape (mean difference: 95% CI, 10.31°; 3.26°, 17.01°) groups demonstrated a more dorsiflexed position at initial ground contact at posttest when compared with the control group but were not different from each other. There were no other significant differences between or within the groups. The Group × Test interaction effect for the maximum sagittal plane angle was not significant (P > .05).

Means ± Standard Deviations for Sagittal Plane Ankle Anglesa

Table 2: Means ± Standard Deviations for Sagittal Plane Ankle Angles

Group × Time Interaction Effect for the Sagittal Plane Ankle Angle at Initial Ground Contact. FRT = Fibular Reposition Tape; PT = Placebo Tape. *Significantly Different from Pretest (P ≤ .0125) †Significantly Different from Control at Posttest (P ≤ .0125).

Figure 4. Group × Time Interaction Effect for the Sagittal Plane Ankle Angle at Initial Ground Contact. FRT = Fibular Reposition Tape; PT = Placebo Tape. *Significantly Different from Pretest (P ≤ .0125) †Significantly Different from Control at Posttest (P ≤ .0125).

Means and standard deviations for ankle angles in the frontal plane are presented in Table 3. The Group × Test interaction effects for both the angle at initial ground contact and the maximum angle during the loading phase were not significant (P > .05).

Means ± Standard Deviations for Frontal Plane Ankle Anglesa

Table 3: Means ± Standard Deviations for Frontal Plane Ankle Angles

Lower Extremity Electromyography

Means and standard deviations for tibialis anterior electromyography amplitudes are presented in Table 4. There was a significant Group × Test interaction effect (F2,25 = 11.082, P < .001) for tibialis anterior electromyography amplitude during the preparatory phase of the landing (Figure 5). Participants in the fibular repositioning tape group demonstrated decreased electromyography amplitude during the preparatory phase at posttest compared with pretest (mean difference: 95% CI, −11.24% maximal voluntary isometric contraction; −6.35% maximal voluntary isometric contraction, −16.15% maximal voluntary isometric contraction). There were no other significant differences between or within groups. The Group × Test interaction effect for tibialis anterior electromyography amplitude during the loading phase of the landing was not significant (P > .05).

Means ± Standard Deviations for Normalized Tibialis Anterior Electromyography Amplitudes (% Maximal Voluntary Isometric Contraction)

Table 4: Means ± Standard Deviations for Normalized Tibialis Anterior Electromyography Amplitudes (% Maximal Voluntary Isometric Contraction)

Group × Time Interaction Effect for Preparatory Tibialis Anterior Extremity Muscle Activity Amplitude. MVIC = Maximal Voluntary Isometric Contraction; FRT = Fibular Reposition Tape; PT = Placebo Tape. *Significantly Different from Pretest (P ≤ .0125).

Figure 5. Group × Time Interaction Effect for Preparatory Tibialis Anterior Extremity Muscle Activity Amplitude. MVIC = Maximal Voluntary Isometric Contraction; FRT = Fibular Reposition Tape; PT = Placebo Tape. *Significantly Different from Pretest (P ≤ .0125).

Means and standard deviations for peroneus longus electromyography amplitudes are presented in Table 5. The Group × Test interaction effects for electromyography amplitudes during the preparatory and loading phases of the landing task were all not significant (P > .05). Similarly, the interaction effects for tibialis anterior and peroneus longus onsets were not significant (Table 6).

Means ± Standard Deviations for Normalized Peroneus Longus Electromyography Amplitudes (% Maximal Voluntary Isometric Contraction)

Table 5: Means ± Standard Deviations for Normalized Peroneus Longus Electromyography Amplitudes (% Maximal Voluntary Isometric Contraction)

Means ± Standard Deviations for Tibialis Anterior and Peroneus Longus Electromyography Onsets Relative to Initial Ground Contact (ms)a

Table 6: Means ± Standard Deviations for Tibialis Anterior and Peroneus Longus Electromyography Onsets Relative to Initial Ground Contact (ms)

Discussion

Our principal findings were that fibular repositioning tape alters ankle kinematics in the sagittal plane and lower extremity muscle activity during landing. Specifically, the fibular repositioning tape caused participants to land in a less plantarflexed position at initial ground contact and reduced preparatory tibialis anterior electromyography amplitude. These results suggest that fibular repositioning tape could have beneficial effects on ankle joint landing mechanics, and could potentially decrease the risk of subsequent ankle injury associated with CAI.

The lateral ankle ligament complex is most vulnerable to injury when the ankle is plantarflexed, inverted, and internally rotated.1 Several previous studies have demonstrated that participants with CAI display potentially detrimental alterations in ankle kinematics compared with healthy ankles, which may lead to repetitive ankle sprains.6–11 Our results indicate that intervention via fibular repositioning tape may place the ankle in a less vulnerable position for injury by decreasing the plantarflexion angle at initial ground contact.

This effect causes more of the wider anterior portion of the talus to approximate the ankle mortise, increasing joint congruency and stability provided by bony contact. However, the influence of fibular repositioning tape on sagittal plane ankle angle at initial contact was not statistically different from that of placebo tape.

Comparison of our results to those of previous studies is extremely limited because, to our knowledge, there is only one other study15 examining the effects of fibular repositioning tape, which was a prospective investigation of the incidence of ankle sprains in recreational basketball players and the potential prophylactic use of fibular repositioning tape. However, the results from that study indicated that participants treated with fibular repositioning tape were 5 times less likely to sustain an ankle sprain compared with a control group who were not.15 Although there were substantial limitations to that study, including a lack of group randomization and controlling for wearing other external ankle supports, our findings of a less plantarflexed position at initial ground contact could help explain the reduced rate of ankle sprains of participants using fibular repositioning tape.

Previous research examining other forms of external ankle supports, such as bracing and other conventional taping procedures, has reported reductions in sagittal plane motion during dynamic tasks. McCaw and Cerullo16 and DiStefano et al17 evaluated the effect of ankle braces on ankle kinematics during landing tasks and reported reductions in ankle plantarflexion angle at initial ground contact and maximum dorsiflexion angle during impact. Similarly, a recent meta-analysis of ankle bracing literature reported that ankle taping and bracing reduced sagittal plane ankle motion.18 Although our results agree with the reduction in plantarflexion angle during initial ground contact, we did not find a significant difference in the maximum amount of dorsiflexion achieved during loading, as in previous studies.

The lack of agreement with previous literature regarding the maximum sagittal plane ankle angle is likely due to the fact that traditional ankle taping/bracing and fibular repositioning tape have substantially different indications for clinical use. Ankle taping and bracing provide mechanical restraint to joint motion.18 In contrast, the intended purpose of fibular repositioning tape is to restore proper arthrokinematics at the distal tibiofibular joint.13 Although both techniques function through different mechanisms, the results of this study indicate that they have similar effects on foot position prior to ground contact (ie, a less plantarflexed position).

In addition to providing increased mechanical support to a joint, taping and bracing is thought to enhance proprioception through the stimulation of cutaneous receptors.19–21 Several studies have shown that taping and bracing have positive effects on joint position sense in the shoulder, knee, and ankle.19–21 In the ankle, improvements in sagittal plane joint position sense were achieved simply by placing athletic tape over the anterior talus and Achilles’ tendon.21 These results provide evidence that the stimulation of cutaneous receptors can affect joint proprioception independent of mechanical restriction. We suggest that both fibular repositioning tape and placebo tape influence ankle joint function in a similar manner. However, these taping procedures span the talocrural joint; thus it is possible that fibular repositioning tape provides a small amount of mechanical restriction to plantarflexion, which may have contributed to the less plantarflexed ankle position at initial ground contact. Future research is necessary to evaluate the relative contributions of fibular repositioning tape to mechanical restrictions of joint motion and proprioceptive function.

The musculature surrounding the ankle joint plays a key role in dynamic joint stability.12,22 Several studies have documented lesser activity of the peroneus longus during various tasks in participants with CAI.7,8,11,12 We hypothesized that there would be an increase in tibialis anterior activity associated with a more dorsiflexed position and an increase in peroneus longus activity associated with a more everted position during landing following the fibular repositioning tape treatment. However, electromyography amplitudes of both muscles at posttest were unchanged relative to pretest values or even decreased in the case of the tibialis anterior during the preparatory phase.

This discrepancy may be explained by changes in the length of the tibialis anterior moment arm across the sagittal plane range of motion of the ankle joint. As the ankle moves from plantarflexion to dorsiflexion, the moment arm of the tibialis anterior increases in length.23 The longer tibialis anterior moment arm in dorsiflexion represents a more mechanically efficient position, thus less force and less electromyography activity is needed to produce the same sagittal plane moment. Therefore, the less plantarflexed position displayed at posttest in the fibular repositioning tape group at initial ground contact may explain the reduction in tibialis anterior electromyography amplitude.

Furthermore, this decrease in tibialis anterior activity may be beneficial with respect to lateral ankle joint injury risk given the muscle’s capacity to produce ankle inversion moment. However, similar to the findings regarding ankle kinematics at initial ground contact, a mechanical effect cannot be ruled out whereby fibular repositioning tape maintains the ankle in a more dorsiflexed position at initial ground contact, requiring less tibialis anterior activity.

Peroneus longus electromyography activity did not differ across groups. However, although not addressed in the Results section, the test’s main effect (ie, comparison of electromyography amplitude collapsed across groups between pretest and posttest) was significant for both the preparatory and loading phases of the landing. In both phases, peroneus longus electromyography amplitude decreased at posttest in all 3 groups, suggesting a potential learning effect. Because the order of the conditions was not counterbalanced, it is possible that participants needed less peroneal activity as they became more familiar with the task. This effect was consistent across all groups because the Group × Test interaction effect was not significant. Although this decreased peroneal activity potentially increases injury risk via a reduction in eccentric resistance to inversion, it may also be interpreted as beneficial by providing less eccentric resistance to dorsiflexion, permitting a less plantarflexed position at initial ground contact.

Following visual inspection of the data, we noted trends suggesting an effect of fibular repositioning tape that may have been masked by our relatively small sample size per group. Exploratory post hoc analyses were conducted on all nonsignificant interaction effects to evaluate differences between groups within each test session and differences between test sessions within each group. These analyses revealed a significant decrease in mean electromyography amplitude of the peroneus longus during the preparatory phase in the fibular repositioning tape group from pretest to posttest (P = .044), whereas the placebo tape group was not statistically different from pretest to posttest. Although not statistically significant, there was also a trend for a decrease in mean electromyography amplitude of the tibialis anterior during the loading phase in the fibular repositioning tape group from pretest to posttest (P = .06). A relatively low power of 0.41 may explain why this was not significant because we would have needed 26 participants per group to achieve statistical power of 0.80. These findings suggest that significant effects of the fibular repositioning tape may have been masked by the small group sizes included in this study.

Limitations and Future Research

A limitation of this study is that we did not definitively know whether each participant possessed an anterior fibular fault. Although Hubbard et al24 found that, on average, participants with CAI displayed anterior fibular displacement, not all participants in their study possessed a fault (13 of 30 did not).16 Without diagnostic imaging, we do not know how many, if any, of the participants in the fibular repositioning tape group actually possessed the fault. A related limitation is that we do not know whether the fibular repositioning tape actually changed any existing fibular positional faults. Mulligan13 proposed that fibular repositioning tape repositions the fibula, but to our knowledge this assumption has not been demonstrated experimentally. Therefore, we do not know to what extent, if any, the fibula’s position was actually changed due to the fibular repositioning tape intervention.

In addition, the processes by which we identified participants with CAI were subjective in nature, as we did not incorporate an instrument such as the FADI25 to quantify chronic instability. Furthermore, we did not assess the time since the most recent ankle injury. Though we are confident that the participants in this investigation possessed CAI, these limitations suggest the potential for a wide range of instability and disability across participants, thus contributing to the inherent variability of the data.

This study was unique because, to our knowledge, it was the first study to examine the effects of fibular repositioning tape on ankle kinematics and lower extremity electromyography. Although we cannot definitively speculate on the mechanisms underlying the changes in ankle kinematics and electromyography in the absence of diagnostic imaging, these data provide biomechanical and neuromuscular support for the previously reported prophylactic effects of fibular repositioning tape on ankle injury risk. Future research should address our limitations by using imaging techniques before and after application of fibular repositioning tape to objectively determine its effect on fibular position and the risk of subsequent injury in participants with CAI. Larger sample sizes may also allow for differentiation of the effects of fibular repositioning tape and placebo tape. In addition, recent research26 has demonstrated that individuals experiencing acute ankle sprains also possess an anterior fibular fault, supporting future investigation of the effects of fibular repositioning tape in the acute ankle sprain population.

Clinical Relevance

This study has demonstrated that the fibular repositioning tape technique influences ankle kinematics during landing among participants with CAI in manners consistent with a reduced risk for lateral ankle sprain. Specifically, participants landed with significantly less plantarflexion at initial ground contact following the fibular repositioning tape treatment. Because lateral ankle sprains most commonly occur when the ankle is in a plantarflexed, inverted, and internally rotated position,11 fibular repositioning tape could potentially reduce the risk of ankle sprain by enhancing joint stability provided by bony contact forces.

References

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Means ± Standard Deviations for Subject Demographics (N = 28)

DEMOGRAPHICSFIBULAR REPOSITIONING TAPE GROUP (n = 9)PLACEBO TAPE GROUP (n = 9)CONTROL GROUP (n = 10)
Age (y)21±223±420±2
Height (cm)172±12177±11174±8
Mass (kg)71±2286±3275±16

Means ± Standard Deviations for Sagittal Plane Ankle Anglesa

GROUPINITIAL GROUND CONTACT
MAXIMUM
PRETESTPOSTTESTPRETESTPOSTTEST
Fibular reposition tape34±6−25±6a,c21±726±10
Placebo tape−32±9−27±9b,c20±622±8
Control−38±5−37±521±320±3

Means ± Standard Deviations for Frontal Plane Ankle Anglesa

GROUPINITIAL GROUND CONTACT
MAXIMUM
PRETESTPOSTTESTPRETESTPOSTTEST
Fibular reposition tape−13±12−15±1115±710±9
Placebo tape−15±11−12±1212±411±5
Control−9±10−9±1113±913±8

Means ± Standard Deviations for Normalized Tibialis Anterior Electromyography Amplitudes (% Maximal Voluntary Isometric Contraction)

GROUPPREPARATORY PHASE
LOADING PHASE
PRETESTPOSTTESTPRETESTPOSTTEST
Fibular reposition tape40±1529±14a49±940±16
Placebo tape27±1424±1247±1047±17
Control37±1437±1664±1660±14

Means ± Standard Deviations for Normalized Peroneus Longus Electromyography Amplitudes (% Maximal Voluntary Isometric Contraction)

GROUPPREPARATORY PHASE
LOADING PHASE
PRETESTPOSTTESTPRETESTPOSTTEST
Fibular reposition tape42±1935±1967±3055±28
Placebo tape37±1236±1467±2859±24
Control58±2352±1986±2875±24

Means ± Standard Deviations for Tibialis Anterior and Peroneus Longus Electromyography Onsets Relative to Initial Ground Contact (ms)a

GROUPTIBIALIS ANTERIOR
PERONEUS LONGUS
PRETESTPOSTTESTPRETESTPOSTTEST
Fibular repositioning tape129±14126±16129±5121±33
Placebo tape146±27134±16163±49144±25
Control137±11143±22146±18156±22
Authors

Ms East is from Indiana University, Bloomington, Ind; Drs Blackburn and Zinder and Mr Norcross are from the University of North Carolina, Chapel Hill, NC; and Dr DiStefano is from the University of Connecticut, Storrs, Conn.

This investigation was approved by the Office of Human Research Ethics Biomedical Institutional Review Board at the University of North Carolina at Chapel Hill.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to J. Troy Blackburn, PhD, ATC, University of North Carolina at Chapel Hill, 124 Fetzer, CB # 8700, Chapel Hill, NC 27599-8700; e-mail: .troyb@email.unc.edu

10.3928/19425864-20100428-05

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