The Effect of Recurrent Ankle Inversion Sprain and Taping on Proprioception at the Ankle
Abstract & commentary
Synopsis: Proprioceptive deficits in plantar flexion and dorsiflexion movements were not found in sprained ankles, and taping had no effect on proprioceptive acuity.
Source: Refshauge KM, et al. The effect of recurrent ankle inversion sprain and taping on proprioception at the ankle. Med Sci Sports Exerc 2000;32:10-15.
A deficit in proprioceptive acuity has been implicated as one reason for the functional instability that frequently results from inversion sprain of the ankle. Proprioception refers to a sense of joint movement and position, and has been postulated to be compromised with disruption of joint mechanoreceptors during forced inversion of the ankle. This paper sought to determine if proprioceptive deficits existed in subjects with a history of recurrent ankle sprain, and if the application of tape would improve proprioceptive acuity. The study population included 43 subjects between 18 and 41 years old; 25 with a history of inversion ankle sprain, and 18 control subjects matched by age, height, weight, and activity level. Inclusion criteria for the injured group were a history of at least three sprains, with one as recently as the past two years. Eligibility for inclusion in the control group was no history of having sustained an ankle sprain.
The model for testing proprioception in this study was for subjects to identify the direction of movement during repeated plantar/dorsiflexion movements at three velocities (0.1°, 0.5°, and 2.5°/s). Subjects were positioned with the knee at approximately 60° flexion and the foot secured on a footplate at a starting position of 20° plantar flexion. A linear servomotor driven by a variable ramp generator imposed small plantar flexion and dorsiflexion movements in random fashion after a random time interval of between 2 and 10 seconds. Subjects were asked to report the direction of movement when they could do so with certainty.
Subjects were tested for movement perception under taped and untaped conditions in random order. The taping procedure followed one typically used in athletic therapy clinical practice. Inelastic tape was used and a combination of heel locks, anchors, stirrups, and figures of 6 were applied.
Separate analyses for plantar flexion and dorsiflexion movements found no differences in direction of movement at any velocity. The data were then averaged for subsequent analyses. No significant difference was found in proprioceptive acuity between the injured and uninjured groups at any velocity. There was also no significant difference between the taped and untaped conditions at any velocity for either group.
COMMENT BY DAVID H. PERRIN, PhD, ATC
The high rate of injury recurrence to physically active people having sustained inversion sprain of the ankle is well known to physicians and clinicians. A host of factors have been implicated as potential causes of functional instability, including mechanical instability, muscle weakness, and proprioceptive deficits. The literature is somewhat inconclusive in confirming any one or combination of these factors as being the cause of functional instability.
To address the problem of recurrent ankle sprains, physicians often prescribe therapeutic exercise, and ankle orthoses or the application of tape during physical activity. The exact mechanism for the perceived efficacy of orthoses and tape by clinicians and patients is unclear. This study sought to determine if subjects with recurrent ankle sprain actually had proprioceptive deficits and if the application of tape could improve proprioceptive acuity. Unfortunately, the design of the study falls short in answering these questions.
The mechanism for inversion ankle sprain includes components of inversion and plantar flexion. Yet one could surmise that the damage inflicted to the joint mechanoreceptors likely results from forced inversion. The experimental setup for testing movement perception in this study only assessed movement in the plantar flexion and dorsiflexion directions. An experimental model that includes assessment of movement perception during inversion and eversion motions would seem to be important.
The ankle taping procedure used for this study is one commonly seen in athletic therapy clinical practice. This procedure is designed to limit excessive ankle inversion, while restricting plantar/dorsiflexion to a much smaller extent—the latter movements being essential to most activities of running and jumping. Consequently, if tape is indeed effective in improving movement perception, one would expect to see a greater effect during inversion/eversion than plantar/dorsiflexion movements.
Finally, Refshauge and colleagues did not present any data establishing the reliability and precision of measurement of this model for testing proprioception or movement perception. If the measurement was insufficiently sensitive to detect deficits in proprioception in ankle-sprained subjects, it seems unlikely that it would have detected any effect of taping on movement perception.
Additional research on the mechanisms involved in chronic ankle functional instability is clearly needed. Only by knowing the causes of this orthopedic epidemic can physicians and clinicians implement effective treatment and rehabilitation protocols.
Taping had no effect on proprioceptive acuity in subjects with a history of ankle sprain, as measured by:
a. active joint reposition sense.
b. ability to detect direction of movement.
c. passive joint reposition sense.
d. threshold to detection of passive movement.
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