Immediate effect of kinesiology tape on ankle stability

Abstract

Background
Lateral ankle sprain is one of the most common musculoskeletal injuries, particularly among the sporting population. Due to such prevalence, many interventions have been tried to prevent initial, or further, ankle sprains. Current research shows that the use of traditional athletic tape can reduce the incidence of sprain recurrence, but this may be at a cost to athletic performance through restriction of motion. Kinesiology tape, which has become increasingly popular, is elastic in nature, and it is proposed by the manufacturers that it can correct ligament damage. Kinesiology tape, therefore, may be able to improve stability and reduce ankle sprain occurrence while overcoming the problems of traditional tape.

Aim
To assess the effect of kinesiology tape on ankle stability.

Methods
27 healthy individuals were recruited, and electromyography (EMG) measurements were recorded from the peroneus longus and tibialis anterior muscles. Recordings were taken from the muscles of the dominant leg during induced sudden ankle inversion perturbations using a custom-made tilting platform system. This was performed with and without using kinesiology tape and shoes, creating four different test conditions: barefoot(without tape), shoe(without tape), barefoot(with tape) and shoe(with tape). For each test condition, the peak muscle activity, average muscle activity and the muscle latency were calculated.

Results
No significant difference (p>0.05) was found by using the kinesiology tape on any of the measured variables while the wearing of shoes significantly increased all the variables.

Conclusion
Kinesiology tape has no effect on ankle stability and is unable to nullify the detrimental effects that shoes appear to have.

Full text

SlevinZM, etal. BMJ Open Sp Ex Med 2020;6:e000604. doi:10.1136/bmjsem-2019-000604 1
Open access Original research
Immediate effect of kinesiology tape on
ankle stability
Zack M Slevin,1 Graham P Arnold,1 Weijie Wang,1 Rami J Abboud 2
To cite: SlevinZM, ArnoldGP,
WangW, etal. Immediate
effect of kinesiology tape on
ankle stability. BMJ Open
Sport & Exercise Medicine
2020;6:e000604. doi:10.1136/
bmjsem-2019-000604
Accepted 8 January 2020
1Institute of Motion Analysis &
Research (IMAR), University of
Dundee, Dundee, UK
2Dean's Ofce, University
of Balamand Faculty of
Engineering, El- Koura, Lebanon
Correspondence to
Dr Graham P Arnold;
g. p. arnold@ dundee. ac. uk
Professor Rami J Abboud;
rjabboud@ balamand. edu. lb
© Author(s) (or their
employer(s)) 2020. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
BMJ.
ABSTRACT
Background Lateral ankle sprain is one of the most
common musculoskeletal injuries, particularly among
the sporting population. Due to such prevalence, many
interventions have been tried to prevent initial, or further,
ankle sprains. Current research shows that the use of
traditional athletic tape can reduce the incidence of
sprain recurrence, but this may be at a cost to athletic
performance through restriction of motion. Kinesiology
tape, which has become increasingly popular, is elastic
in nature, and it is proposed by the manufacturers that it
can correct ligament damage. Kinesiology tape, therefore,
may be able to improve stability and reduce ankle sprain
occurrence while overcoming the problems of traditional
tape.
Aim To assess the effect of kinesiology tape on ankle
stability.
Methods 27 healthy individuals were recruited, and
electromyography (EMG) measurements were recorded
from the peroneus longus and tibialis anterior muscles.
Recordings were taken from the muscles of the dominant
leg during induced sudden ankle inversion perturbations
using a custom- made tilting platform system. This
was performed with and without using kinesiology
tape and shoes, creating four different test conditions:
barefoot(without tape), shoe(without tape), barefoot(with
tape) and shoe(with tape). For each test condition, the peak
muscle activity, average muscle activity and the muscle
latency were calculated.
Results No signicant difference (p>0.05) was found
by using the kinesiology tape on any of the measured
variables while the wearing of shoes signicantly
increased all the variables.
Conclusion Kinesiology tape has no effect on ankle
stability and is unable to nullify the detrimental effects that
shoes appear to have.
INTRODUCTION
Lateral ankle sprains (LAS) plague numerous
individuals in the sporting community.1
Although regarded as a trivial injury, LAS
causes distress, lost time from sport or work
and most importantly can lead to instability
with recurrent sprains.2 For these reasons,
an effective method for protecting the ankle
from sprains must be sought.
Existing research accepts that a large inver-
sion moment about the subtalar joint axis
leads to damage of the lateral ankle ligaments.3
However, one area of much controversy in the
literature is the role of the peroneal muscles,
the primary evertors of the ankle, and whether
they can realistically protect the ankle during
a sprain scenario. It has been concluded by
many studies that there is a delayed peroneal
reaction to sudden inversion in those with
unstable ankles compared with stable.4
The other stabilising muscle of the ankle,
which opposes the action of the peroneus
longus, is the tibialis anterior, which is
greatly under reported with regard to LAS.
However, Willems et al5 suggested that there
is some implication of the tibialis anterior in
LAS. In a normal reaction to a sudden ankle
inversion the peroneal muscles react first,
followed by the tibialis anterior. However,
in those with recurrent LAS this sequence
is lost, with the tibialis anterior contracting
almost instantaneously with the peroneus
longus. Furthermore, an increased activa-
tion of tibialis anterior during gait has been
demonstrated in those with ankle instability.6
Therefore, the dysfunction of the tibialis
anterior, as well as the peroneus longus, must
be associated with LAS.
To reduce the incidence of ankle sprains
and provide ankle support, ankle tape and
braces have become increasingly popular,
with promising results.7 8 While mechanical
Key messages
►Kinesiology tape had no effect on the peak muscle
activity, the average muscle activity or the muscle
latency for the peroneus longus or tibialis anterior
during a sudden ankle inversion.
►Shoes increased all the mentioned variables during
a sudden ankle inversion. Results of note are an in-
creased activity of the tibialis anterior, a prolonged
peroneus longus latency and a shortened latency
from peroneus longus activation to tibialis anterior
activation.
►Therefore, kinesiology tape appears to have no
effect on ankle stability while shoes appear to be
detrimental.
►It is hoped that the results of this study can be used
by athletes, patients, clinicians and researchers
alike to make informed decisions.
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Open access
Figure 1 Schematic representation of experimental setup.
support is likely to be a part of the mechanism of offering
stability, it has been suggested that the primary function
of taping is to improve the deficient proprioception of
unstable ankles.9 However, one issue that has been high-
lighted with regard to the use of ankle supports is the
negative effects they may cause to athletic performance
on account of their rigidity.10
A different design of tape has recently become popular
on the market; kinesiology tape. It is easily recognisable
with its bright colours and is commonly seen on high
profile athletes. It is proposed by the manufacturers
that the tape can correct ligament damage and improve
proprioception.11 Given the elastic nature of the tape, it
may also be able to overcome the issues of rigid tradi-
tional tape. However, despite the popularity of kinesiology
tape, the literature is limited and research that has been
published is very inconclusive, with any clear benefits yet
to be seen, particularly in regard to ankle stability.12
Very few studies have been conducted with kinesiology
tape applied to the ankle, and none to date have included
shoes or made observations regarding the tibialis ante-
rior during a sudden inversion. Therefore, the aim of this
study was to assess the effect of kinesiology tape on ankle
stability through its effects on the stabilising muscles of
the ankle: the peroneus longus and the tibialis anterior.
METHODOLOGY
Patient and public involvement
Patients were not involved in this study. Participants, who
were members of the general public, were not involved
in the design of the study. They first became involved in
the research process during the recruitment via email
or seeing a volunteer recruitment poster. They were
not asked to assess the burden of intervention or time
required, nor were they involved in result dissemina-
tion. All participation was entirely voluntary and without
remuneration or incentive. Volunteers were able to with-
draw from the study at any time and without having to
give reason.
Sampling
Twenty- seven volunteers were recruited to take part in
the research study. Volunteers had to be over 18 years
of age and in good health with no physical deformities
or injuries to the lower limbs during the past 6 months.
Participants were required to read a participant infor-
mation sheet and sign consent forms before the study
commenced.
Experimental apparatus
A custom- made software program designed to control
tilting platforms while simultaneously recording measure-
ments from a portable electromyography (EMG) system
was used. This setup was also used in a similar study by
Kerr et al13 and is depicted in figure 1.
The tilting platforms composed of two aluminium foot-
plates on bars propped off the ground by a supporting
block at each end and about which the bar could rotate.
Tilting of the platforms was pneumatically driven, rotating
at an angular velocity of 100°/s. The degree of rotation
was computer controlled and could be measured via a
feedback loop from the platforms. From a safety aspect
and to avoid potential injuries, the plates were coated
with an adhesive layer to prevent foot slippage, handrails
were fitted in front of the platforms to support subjects
further and only 20° of varus foot tilt was allowed which
was less than that used in other studies but more than
adequate to evoke a peroneal response.14 Reinforcement
blocks were also placed under the platforms to ensure
there was maximum of 20° inversion.
The portable EMG system used was the Mobi8 (TMS
International Netherland). The activities of the two
muscles, the peroneus longus and tibialis anterior, were
measured during the plate inversions. In the interest of
time and conservation of tape, only the dominant leg was
assessed and chosen due to its higher incidence of ankle
sprain.2 To prepare the skin for electrode placement and
reduce interference, any hair present was removed using
a razor, and the skin was cleaned with alcohol gel and
wipes to eradicate any presence of dead skin and oils.
Each muscle belly was located through voluntary muscle
contraction and two silver/silver chloride surface EMG
electrodes were placed on the skin for each muscle as per
the Surface EMG for Non- Invasive Assessment of Muscles
(SENIAM) recommendations. Electrodes were disc
shaped with a diameter of 10 mm and an interelectrode
distance of 20 mm was kept. A reference electrode was
also placed on the clavicle. The electrodes were attached
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SlevinZM, etal. BMJ Open Sp Ex Med 2020;6:e000604. doi:10.1136/bmjsem-2019-000604
Open access
Figure 2 The four different test conditions: (A) barefoot (B)
shoes (C) tape with bare feet (D) tape with shoes.
Figure 3 Taping technique.
to an amplifier and the recorded signals were amplified
and filtered before being transmitted to the computer.
Procedure
Four test conditions were used as shown in figure 2. To
ensure randomisation, the order of test condition for
each subject was assigned using a random number gener-
ator. Subjects were first allocated to either tape or no tape
and then within each of these conditions, shoes or no
shoes. This was for practicality, as applying and removing
the tape twice would be time consuming and costly in the
use of tape. Standard running shoes were used for the
shod conditions in each subject (Nike Dart 7) and each
subject acted as their own control.
The tape used was Kinesio Tex tape (Kinesio USA, Albu-
querque, New Mexico, USA) and the taping technique
was that proposed by the manufacturer for a postacute
LAS correction,11 this is shown in figure 3. Two strips
were used, the first (dark blue in figure 3), applied at
50% tension, was for functional correction to assist dorsi-
flexion and eversion. This was applied from insertion
to origin. The second (light blue in figure 3), applied
at 75%–100% tension, was intended for the correction
of the anterior talofibular ligament, the most commonly
damaged during an LAS.2 All tape was applied by the
same lead investigator.
Subjects were asked to stand on the tilting platforms
with each foot at the centre so that their weight was evenly
distributed across each plate. The software program used
allowed different test sequences to be generated, saved
and repeated. Therefore, for each of the four test condi-
tions, a different sequence of inversions between the left
and right leg was used to create simulated unexpected
inversion scenarios that the volunteers do not get accus-
tomed to.
The platforms began in the neutral position, parallel to
the ground (0°), then underwent a random sequence of
three left and three right (six in total) inversions to 20°.
After each inversion, the platform would remain in inver-
sion for 5 s to produce an average muscle activity. The
plates would then return to the neutral position and the
sequence would continue. There was a period of 2 min
between each condition to allow for rest and preparation
for the next sequence. The synchronised EMG system
recorded muscle activity in situ and the recordings were
collected at a sampling rate of 2000 Hz.13
Data processing
Following the amplification, filtering and rectifying of
the recorded EMG signals a custom- made extraction
programme allowed the three variables of interest to be
calculated for each inversion. Those variables were the
peak activity (greatest muscle activity following inver-
sion), average activity (average muscle activity in the
5 s following inversion) and muscle latency (time from
beginning of tilt to first muscle reaction).
Statistical analysis
The results for the peak, average and latency were then
collated from each subject under the four different test
conditions for statistical analysis, which was conducted
using IBM SPSS SENIAM V.22.0 Statistics software. For
each muscle and variable (ie, the peak peroneus longus
muscle activity), SPSS was used with the general linear
model, repeated measures function. This gave an esti-
mate of mean, SE of mean and 95% CI for each variable,
as well as a pairwise comparison between each of the four
test conditions for each variable and in each muscle.
RESULTS
Of the 27 participants recruited, 16 were male and 11
females. The participants had a mean age of 21.1 (±1.45)
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Open access
Table 1 Peroneus longus muscle activity
Variable Condition Mean (SE) P value
Peak activity
(µV)
Barefoot 247 (±19.1) –
Tape (barefoot) 249 (±16.1) 0.891
Shoe 367 (±21.6) 0.000*
Tape and shoe 337 (±19.0) 0.000*
Average
activity (µV)
Barefoot 70.0 (±5.89) –
Tape (barefoot) 77.6 (±5.79) 0.059
Shoe 109 (±7.27) 0.000*
Tape and shoe 109 (±6.83) 0.000*
Latency (ms) Barefoot 183 (±8.59) –
Tape (barefoot) 200 (±6.43) 0.074
Shoe 205 (±6.53) 0.026*
Tape and shoe 197 (±6.16) 0.082
*Indicates a signicant difference (p<0.05) compared with the
barefoot condition.
Table 2 Tibialis anterior muscle activity
Variable Condition Mean (SE) P value
Peak activity
(µV)
Barefoot 125 (±14.8) –
Tape (barefoot) 125 (±11.5) 0.976
Shoe 167 (±15.8) 0.010*
Tape and shoe 163 (±15.8) 0.027*
Average
activity (µV)
Barefoot 31.5 (±4.41) –
Tape (barefoot) 33.9 (±3.86) 0.527
Shoe 39.9 (±3.64) 0.012*
Tape and shoe 37.5 (±2.81) 0.069
Latency (ms) Barefoot 214 (±6.11) –
Tape (barefoot) 221 (±4.78) 0.383
Shoe 221 (±3.98) 0.353
Tape and Shoe 215 (±3.97) 0.917
*Indicates a signicant difference (p<0.05) compared with the
barefoot condition.
Figure 4 Graph shows the comparison of mean (SE)
difference in latency between the peroneus longus and
tibialis anterior between test conditions.
years, height of 174 (±7.94) cm and weight of 74.0 (±10.8)
kg.
Peroneus longus results
The mean peak activity, average activity and latency
period for the peroneus longus are shown in table 1. For
the peak and average activity, the shod conditions caused
a significant increase compared with the non- shod condi-
tions. For the latency, shoe caused a significant increase
compared with barefoot and, while not significantly, tape
and shoe also increased the latency. The contrary is true
for the tape, with no significant differences observed
between the taped and non- taped conditions, therefore,
these pairwise comparisons are not included in the tables.
Tibialis anterior results
Table 2 shows the results for the tibialis anterior. For
the peak activity, the shod conditions caused a signifi-
cant increase compared with barefoot and this was also
the case for shoe in the average activity. Tape and shoe
did cause an increase in average activity, however, not of
statistical significance. There were no significant differ-
ences between the taped and non- taped conditions and
similarly to the table for the peroneus longus results
these have not been included. There were also no signif-
icant differences between any conditions in the latency
for the tibialis anterior.
Latency between peroneus longus activation to tibialis
anterior activation
The time taken for the tibialis anterior to activate
following the peroneus longus under each of the condi-
tions was calculated by subtracting the peroneus longus
latency time from the tibialis anterior time in each trial
and finding the mean. This is demonstrated in figure 4.
Although not statistically significant, barefoot had the
longest time while shoe had the shortest. There was no
significant difference between the conditions.
DISCUSSION
The aim of this study was to assess the effect of kinesi-
ology tape on ankle stability, in particular, its effects on
the primary stabilising muscles of the ankle: the peroneus
longus and the tibialis anterior. In order to make this
assessment, EMG measurements of the peroneus longus
and tibialis anterior were recorded during the sudden
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SlevinZM, etal. BMJ Open Sp Ex Med 2020;6:e000604. doi:10.1136/bmjsem-2019-000604
Open access
ankle inversion perturbations, with and without the use
of kinesiology tape and shoes. From the EMG recordings,
the peak muscle activity, the average muscle activity and
the muscle latency were analysed.
Peak and average activity
The results of the study showed a significant increase in
activity of the peroneus longus and tibialis anterior when
shoes were worn. This was expected for the peroneus
longus following studies by Kerr et al13 and Ramanathan
et al.15 16 The mechanism likely to be most accountable is
due to the greater inversion moment arm that is created
by the sole of the shoe raising the foot off the ground.
This in turn increases the overall inversion moment.
Therefore, in attempting to restore equilibrium about
the ankle, the internal eversion moment must increase,
and as the moment arm cannot be lengthened, it is the
eversion force from the peroneal muscles that needs to
increase.
The results for the tibialis anterior show that wearing
shoes also increase its activity, similar to the peroneus
longus, which is counterintuitive given their antagonistic
actions. However, as established by Hopkins et al,6 the
tibialis anterior has an increased activity during the gait
of those with functional instability. Therefore, increased
tibialis anterior activity caused by the shoes may be due
to their impairment to proprioception, creating a state
of functional instability in the ankle. Another possible
reason for this increased activity, which may also explain
the increased peroneus longus activity, is again related
to the diminished sensory input when wearing shoes.9 17
If there is reduced proprioceptive feedback to the foot
and ankle, the ankle musculature, including the pero-
neus longus and tibialis anterior, will contract to a greater
extent in order to reinforce and stabilise the ankle. Thus,
producing the observed results.
The lack of significant difference between the activi-
ties for the taped and non- taped conditions indicates
that the tape offered no mechanical support or proprio-
ceptive improvement, contrary to that proposed by the
manufacturers. This mirrors the findings of Briem et al18
who despite using a different taping method, also found
that kinesiology tape had no effect on peroneus longus
activity.
Furthermore, it may be the case that the tape in fact
reduces proprioception rather than improves it. This
is based on the comparison between barefoot and tape
for the average peroneus longus activity, which verged
on being significant (p<0.059). An explanation for this
difference is that the tape covering the relatively large
portion of the plantar surface of the foot impedes the
tactile interface with the plate and reduces sensory input.
Therefore, once the plates come to rest at the 20° inver-
sion stance (when average activity is being measured) the
reduced sensory input, particularly of the shear forces
between the foot and the platform plate, causes an overall
larger peroneal response for the taped condition. This is
in attempt to stabilise the ankle.
Latency
The results from the current study found that shoes caused
a significantly longer latency period compared with the
non- shod conditions for the peroneus longus. Taking
into consideration that the peroneal latency is prolonged
in unstable ankles, due to afferent denervation,19 it would
seem reasonable that the sensory disruption caused by
the shoes would also lead to this result. However, this is
in contrast to the findings of Kerr et al13 who reported
no difference in the reaction time when shoes were
worn. Furthermore, of the two studies by Ramanathan et
al,15 16 one found that shoes caused no significant differ-
ence to the latency while the other suggested that shoes
shorten the latency compared with barefoot, which is the
opposite of that found in the current study. One thing
noticed between these various studies was the different
types of shoes used, such as boots, running shoes and
typical leisure shoes which were all of various dimensions
and materials. It may be the case that different types of
shoes cause different reactions of the peroneus longus.
This uncertainty warrants further research as it may be
possible to design a shoe that is less damaging to ankle
stability.
Again, there was no significant difference between the
taped and non- taped conditions, with the tape unable
to shorten the prolonging effect of the shoe to the reac-
tion time. These results appear to follow the trend set
by Briem et al18 and Correia et al.20 Moreover, the tape
increased the latency when compared with barefoot,
however, this was not of significance (p<0.074). This is
likely to be due to the disruption of the sensory input at
the plantar surface.
There were no significant differences between the
results for the tibialis anterior latency for the difference
test conditions. The other aspect of the tibialis anterior
reaction time analysed was its period of latency after
the peroneus longus contraction. This was considered
pertinent following the study by Willems et al5 who
stated that a faster tibialis anterior reaction time is a
risk factor for LAS. In the current study, the results
showed that shod conditions had a shorter latency
period from peroneus longus activation to tibialis ante-
rior activation when compared with the non- shod. This
is yet another result eluding to the increased risk of
LAS that shoes cause. The tape caused no significant
differences.
Limitations
It is acknowledged that for the current study only subjects
with healthy ankles were recruited while from the litera-
ture it was ascertained that the greatest differences seen
from interventions were in those with unstable ankles.7
However, given the instability that is conceded from
wearing shoes, the shoes effectively created an ‘unstable’
group.13 15 16 Therefore, comparing shoe to tape and shoe
was similar to testing an intervention in a group with
unstable ankles.
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Open access
Acknowledgements The authors would like to acknowledge Ian Christie for his
valuable contribution of bespoke illustrations.
Contributors All coauthors are in agreement to be accountable for the work
presented in this manuscript. ZMS: planning and conducting the study, analysing
the data, reporting the study and generating the write up. GPA: coplanning,
analysing data. WW: statistical analysis. RJA: reporting the study, revision of
original manuscript, designing the footplates, submitting the study.
Funding This study was internally funded by the department.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the University Medical School
Research Ethics Committee (Ref: SMED REC 109/18).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the
article or uploaded as online supplementary information. All data relevant to the
study are included in the article.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the
use is non- commercial. See:http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
ORCID iD
Rami JAbboud http:// orcid. org/ 0000- 0002- 1753- 9606
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