Effects of kinesio taping on proprioception at the ankle.pdf

©Journal of Sports Science and Medicine (2004) 3, 1-7

http://www.jssm.org

Research article

THE EFFECTS OF KINESIO TM TAPING ON PROPRIOCEPTION

AT THE ANKLE

Travis Halseth 1 , John W. McChesney 2 , Mark DeBeliso 2 , Ross Vaughn 3 and Jeff

Lien 4

1 Athletic Department, University of the Pacific, USA

2 Department of Kinesiology, Boise State University, USA

3 College of Education, Boise State University, USA

4 Athletic Department, Boise State University, USA

Received: 06 September 2003 / Accepted: 21 November 2003 / Published (online): 01 March 2004

ABSTRACT

An experiment was designed to determine if Kinesio TM taping the anterior and lateral portion of the ankle

would enhance ankle proprioception compared to the untaped ankle. 30 subjects, 15 men, 15 women,

ages 18-30 participated in this study. Exclusion criteria: Ankle injury < 6 months prior to testing,

significant ligament laxity as determined through clinical evaluation by an ATC, or any severe foot

abnormality. Experiment utilized a single group, pretest and posttest. Plantar flexion and inversion with

20° of plantar flexion reproduction of joint position sense (RJPS) was determined using an ankle RJPS

apparatus. Subjects were barefooted, blindfolded, and equipped with headphones playing white noise to

eliminate auditory cues. Subjects had five trials in both plantar flexion and inversion with 20° plantar

flexion before and after application of the Kinesio TM tape to the anterior/lateral portion of the ankle.

Constant error and absolute error were determined from the difference between the target angle and the

trial angle produced by the subject. The treatment group (Kinesio TM taped subjects) showed no change in

constant and absolute error for ankle RJPS in plantar flexion and 20º of plantar flexion with inversion

when compared to the untaped results using the same motions. The application of Kinesio TM tape does

not appear to enhance proprioception (in terms of RJPS) in healthy individuals as determined by our

measures of RJPS at the ankle in the motions of plantar flexion and 20º of plantar flexion with inversion.

KEY WORDS: Reproduction of joint position sense, Kinesio TM tape, target angle

INTRODUCTION

traditional white athletic tape in the sense that it is

elastic and can be stretched to 140% of its original

length before being applied to the skin. It

subsequently provides a constant pulling (shear)

force to the skin over which it is applied unlike

traditional white athletic tape. The fabric of this

specialized tape is air permeable and water resistant

and can be worn for repetitive days. Kinesio TM tape

is currently being used immediately following injury

and during the rehabilitation process.

The proposed mechanisms by which

Kinesio TM tape works are different than those

underlying traditional ankle taping. Rather than

In recent history, ankle taping has been the principal

means of preventing ankle sprains in sport (Robbins

et al., 1995). Despite the fact that ankle bracing is

growing in popularity, anecdotal evidence suggests

that ankle taping with white athletic tape is still very

popular among athletes, athletic trainers, and

physicians. However other means of ankle taping

have emerged for the treatment and prevention of

ankle injuries. Kinesio TM taping is a novel method of

ankle taping utilizing a specialized type of tape by

the same name. Kinesio TM tape differs from

Kinesio TM tape and proprioception

being structurally supportive, like white athletic

tape, Kinesio TM tape is therapeutic in nature.

According to Kenzo Kase, the creator of Kinesio TM

tape, these proposed mechanisms may include: (1)

correcting muscle function by strengthening

weakened muscles, (2) improving circulation of

blood and lymph by eliminating tissue fluid or

bleeding beneath the skin by moving the muscle, (3)

decreasing pain through neurological suppression,

and (4) repositioning subluxed joints by relieving

abnormal muscle tension, helping to return the

function of fascia and muscle (Kase et al., 1996). A

fifth mechanism has been suggested by Murray

(2001), which describes Kinesio TM tape causing an

increase in proprioception through increased

stimulation to cutaneous mechanoreceptors. This

proposed fifth mechanism has been examined using

our current research method.

Little is known of a possible proprioceptive

effect of Kinesio TM tape, however it has been

anticipated that there will be a facilitatory effect of

cutaneous mechanoreceptors as seen in studies

examining the effects of linen-backed adhesive

athletic tape (Murray, 2001). Kinesio TM tape may

have a similar effect on ankle proprioception due to

its aforementioned characteristics. This concept

underlies our hypotheses stating that proprioception

will be enhanced through increased cutaneous

feedback supplied from the kinesio TM tape.

Applying pressure to, and stretching the skin

can stimulate cutaneous mechanoreceptors. The

sense of stretching is thought to possibly signal

information of joint movement or joint position

(Grigg, 1994). Furthermore, it has been stated that

cutaneous mechanoreceptors might play a role in

detecting joint movement and position resulting

from the stretching of skin at extremes of motion,

much like joint mechanoreceptors (Riemann and

Lephart, 2002). While the exact role of cutaneous

mechanoreceptors is still under discussion, it has

become evident they can signal joint movement and

to some extent joint position (Simoneau et al., 1997).

It is important to note the exact role cutaneous

mechanoreceptors play in joint movement and

position. Several authors have attributed these

cutaneous afferents with a precise ability to convey

joint movements through skin strain patterns

(Riemann and Lephart, 2002). It was hoped that the

results of this study would add to the body of

literature on proprioception.

There have been studies documenting a

significant effect of the application of white athletic

tape to the ankle on ankle proprioception (Karlsson

and Andreasson, 1992; Robbins et al., 1995; Heit et

al., 1996; Simoneau et al., 1997). However, very

little research has been done examining the effect

alternative tape applications (such as that of

Kinesio TM tape) may have on increasing cutaneous

afference. Murray and Husk (2001) examined the

effect of kinesio taping on ankle proprioception.

They concluded that kinesio taping for a lateral

ankle sprain improved proprioceptive abilities in

non-weight bearing positions in the midrange of

ankle motion where ligament mechanoreceptors

were inactive.

The return of normal proprioception following

orthopedic injury has been, and should continue to

be, a major clinical rehabilitation goal (Lephart et

al., 1997). Increased somatosensory stimulation that

can be used as proprioceptive input, that is imparted

by an elastic tape such as Kinesio TM tape, may

enhanced an athlete's postural control system and

facilitate their earlier return to activity.

The popularity of the application of tape

during the rehabilitation process, and the need for

empirical evidence on the effect of Kinesio TM tape

and it's potential effect on proprioception were

compelling reasons to perform this experiment. The

purpose of this study was to determine the effect of

the application of this novel tape and specialized

taping method to an aspect of ankle proprioception,

reproduction joint position sense (RJPS). It was

hypothesized that using Kinesio TM taping on the

ankle/lower leg would: (1) decrease (improve) the

absolute error (AE) of RJPS when compared to the

untaped ankle in two ranges of motion: plantar

flexion (PF) and inversion at 20º of plantar flexion

(INV/PF), (2) decrease (improve) the constant error

(CE) of RJPS when compared to the untaped ankle

in PF and INV/PF, and (3) show no significant

differences in wither constant or absolute error

measures amongst gender in either range of motion.

METHODS

Thirty healthy (15 women, 15 men) subjects were

screened using a questionnaire, which asked for

details on age, gender, and medical history.

Individuals with a history of any previous serious

ankle injury or surgery, and/or those who currently

had ankle pathology, were excluded from this study.

Thirty subjects were interviewed and received a pre-

participation orthopedic ankle exam by a certified

athletic trainer (ATC) to rule out any abnormalities

(i.e. abnormal ligament laxity, congenital

deformities, neurological deficits, etc.) that may

have affected experimental data. The orthopedic

evaluation included an assessment for presence of

pain, stress tests to determine ligamentous stability,

circulatory tests, assessment of cutaneous sensation,

and tests of active, passive, and resisted ranges of

motions.

Reproduction of joint position sense (RJPS)

was measured in accordance with the subject’s

Halseth et al.

ability to actively recreate a randomly selected target

position. These ankle measures were taken for both

plantar flexion and inversion with 20º plantar flexion

before and after the application of Kinesio TM tape.

An active RJPS paradigm was selected in order to

utilize a well accepted repositioning technique

originally forwarded for the ankle by Glencross and

Thornton (1981) and then further developed by

Barrack and colleagues (1983) for RJPS at the knee.

Due to the fact that cutaneous mechanoreceptors are

stimulated during both passive and active

movements, it was assumed that the chosen

paradigm would successfully test for a treatment

effect of Kinesio TM tape.

Ankle position data was measured using and

instrumented platform (Figure 1) with a moveable

footplate capable of providing measures of ankle

joint position. The footplate was stabilized

throughout testing with the use of a counterbalance

system, which created an unresisted range of motion

at the talocrural joint. Attached to the platform was a

precision potentiometer (Spectrol, Type 157,

Ontario, CA), which allowed a measure of specific

angular position digitally, displaying the position to

the nearest tenth of a degree on a digital liquid

crystal display and computer data collection system

(see below). Joint repositioning trials were colleted

at a rate of 100 Hz. Laboratory tests of this apparatus

have demonstrated a repeatable range of motion

error of less that ± 0.05°. The potentiometer was

aligned with lateral aspect of the ankle to assure that

the numbers supplied were accurate readings for the

talocrural joint in the sagittal plane. During

inversion with 20° of plantar flexion condition, the

potentiometer was aligned with the center of axis of

motion of the sub-talar joint in the coronal plane

with an anterior tilt of 20°. This information was

then recorded on a computer through a 16-bit analog

to a digital board using Bioware ® V.3.22 (Kistler

Instrument Corporation, Amherst, NY) data

collection software. A range of motion block was

used to set the talocrural neutral position (0º),

achieved when the foot is at a right angle to the tibia.

Upon completion of data collection with each

subject the RJPS apparatus was recalibrated to

assure accuracy throughout data collection.

Procedures

To ensure RJPS was affected only by

mechanoreceptors within the ankle, subjects were

blindfolded and asked to wear headphones playing

white noise to ensure both visual and auditory cues

did not affect the results. In attempts to limit

undesired cutaneous feedback, no straps were used

to hold the subject’s foot to the platform. RJPS was

then assessed in conditions of no ankle tape (no-

tape) and kinesio taped (taped) ankle in the motions

of plantar flexion and inversion with 20º plantar

flexion. All subjects were placed in a seated position

with the foot resting on the footplate of the

apparatus.

RJPS measures were taken by passively

placing the dominant ankle to a random target angle

and asking the subject to actively reposition their

ankle to the target angle from a neutral starting

position. Target angle positions in the plantar flexion

rang varied from only 1º to 35º in attempts to

eliminate extreme ranges of plantar flexion.

Inversion with 20º of plantar flexion had an angular

position range from 1º to 10º. Five trails were given

at each range of motion with absolute and constant

error recorded for each.

Subjects were allowed to sit comfortably with

their foot on the testing apparatus. They were then

passively placed to a random target position. The

subjects were held in that position for five seconds,

asked to remember the target angle, and then

passively returned to their neutral starting position.

Subjects were then asked to actively reposition their

foot as closely to the target angle as possible.

Through headphone communication, audio mixed

over the white noise, subjects were instructed to

press an indicator button placed in their right hand,

signaling the completion of their target-reposition

task (Figure 2). Data was recorded in the Bioware

system after passive target positioning (by the

researcher), and following the subject’s signal of

completion of the target-repositioning task.

Figure 2. Subject positioning during data collection.

Figure 1. Ankle joint position sense apparatus.

A cross-over design was employed with

respect to the order of the un-taped and taped

conditions. Specifically, the application of the

Kinesio TM tape and proprioception

Kinesio TM tape occurred after completion of the first

10-trail assessment of RJPS in plantar flexion and

inversion with 20º of plantar flexion for 15 (or half)

of the participants. The other participants performed

the positioning tasks under the taped condition first,

followed by the un-taped condition. The participants

were randomly assigned with regard to the order of

the taped and un-taped conditions. There was a 5

minute waiting period between conditions and RJPS

assessment. All thirty subjects we assessed of a

period of one week.

angle and the trial angle for each subject. Constant

error examined the direction of imprecision,

measuring the number of positive or negative

degrees the actively reproduced ankle position was

from the target position. Whereas absolute error took

only the number of degrees the actively reproduced

ankle position was from the target position. In

examining possible gender differences, changes in

absolute error and constant error between un-taped

conditions and taped conditions were examined for

both plantar flexion and 20° of plantar flexion with

inversion.

This study used a pretest-posttest design. The

independent variable was the Kinesio TM taping

procedure, and the dependent variable was

reproduction of joint position sense. Results were

evaluated for statistical significance (p < 0.05) using

a paired, two-tail t -test computed for both constant

and absolute error values among subjects and

independent t -tests to evaluate across genders.

Taping

Subjects were taped for a lateral ankle sprain in

accordance to Kenzo Kase’s Kinesio TM taping

manual (Kase et al., 1996). Taping procedures were

applied by the principal investigator (a certified

athletic trainer) to ensure consistency throughout the

study.

For taping, each subject’s foot was placed in

relaxed position while they sat on a taping table with

the ankle in slight plantar flexion. The first strip of

tape was placed from the anterior midfoot, stretched

approximately to 115-120% of its maximal length

and attached just below the anterior tibial tuberosity

over the tibialis anterior muscle. The second strip

began just above the medial malleolus and wrap

around the heel like a stirrup, attaching just lateral to

the first strip of tape. The third strip stretched across

the anterior ankle, covering both the medial and

lateral malleolus. Finally, the fourth strip originated

at the arch and stretched slightly, measuring 4-6

inches above both the medial and lateral malleolus

(Figure 3).

RESULTS

Upon completion of data analysis, no significant

differences of absolute error between the no-tape

condition (M=2.19° ± 1.20°) and the taped condition

(M=2.07° ± 0.98°) were found in plantar flexion, nor

were any significant differences seen between the

no-taped condition (M=1.87° ± 0.89°) and the taped

condition (M=1.95° ± 0.90°) in the combined

motion of inversion with 20° of plantar flexion

(Figure 4). These results contest our first hypotheses,

which stated Kinesio TM taping would decrease

(improve) the absolute error on RJPS when

compared to the untaped ankle.

Absolute Error Differences Between PF

& PF/Inversion

Untaped

Kinesio taped

Plantarflexion PF/Inversion

Figure 4. Group absolute error (AE) differences

between pre and post tape conditions.

Figure 3. Tape strips comprising Kinesio TM tape job.

Numbers indicate order of application.

No significant difference in constant error was

shown in plantar flexion between the no-tape

condition (M = -0.28°±2.01°) and the taped

condition (M = 0.08°±1.77°). Furthermore, there

was no evidence of significant change in the

Data Analysis

Constant error and absolute error values were

examined by taking the difference between the target

Halseth et al.

combined motion of inversion with 20° of plantar

flexion between the no-taped condition (M =

0.24°±1.80°) and the taped condition (M = -0.02°±

1.46°) (Figure 5). These results discount our second

hypotheses, which stated Kinesio TM taping would

decrease (improve) the constant error of RJPS when

compared to the un-taped ankle.

proprioception when measured by active ankle RJPS

in healthy subjects. These results do not concur with

Murray’s (2001) findings, which showed that

Kinesio TM tape enhanced RJPS through increases in

cutaneous stimulation received from the Kinesio TM

tape .

It is important to note, however, since the

present study did not specifically measure changes

in cutaneous sense, that kinesio TM tape cannot be

ruled out as a contributor to increasing cutaneous

sense. We can only speculate on the role cutaneous

sense may or may not play in RJPS. It may be that

kinesio TM tape does contribute to increasing

cutaneous feedback, however it appears that it plays

only a minimal role in RJPS. This explanation has

been forwarded by authors who have suggested

muscle and joint mechanoreceptors are the primary

contributors to proprioception (Grigg et al., 1973;

Gandevia and McCloskey, 1976; Barrack et al.,

1984; Riemann and Lephart, 2002). Conversely,

cutaneous ankle mechanoreceptors may rapidly

accommodate and not provide useful feedback

during repeated movements.

While comparing differences in CE and AE

between genders, no significant differences were

noted in either plantar flexion or inversion with 20º

plantar flexion. These findings concur with those of

the Walter’s study (2000), which showed no

significant gender differences when examining the

effects of taping on RJPS.

The findings of the present study lend support

to the concept that ankle taping has no significant

effect on ankle RJPS in plantar flexion or inversion

with 20º of plantar flexion. In Walters’ study (2000)

examining the effects of taping on RJPS, she found

no significant differences in absolute error or

constant error when comparing data before and after

the application of tape to the ankle in the ranges of

plantar flexion and plantar flexion with inversion.

The application of Kinesio TM tape for a lateral ankle

sprain in this study was less restrictive than her

application of the more traditionally restrictive

Gibney Basketweave, and no significant changes in

absolute error or constant error were witnesses in

either study. The present findings suggest that these

two distinctively different taping procedures are

similar in the sense that neither enhances RJPS.

With regard to methodology and its effect on

results, Heit et al., (1996) examined the effects of

bracing and taping on proprioception, noting that

both treatments significantly improved RJPS in

plantar flexion (AE). In comparison to the present

study, their un-taped condition demonstrated an AE

of 5.93°±1.91° compared to our observation of an

AE of 2.19°±1.20°. When taped, their subjects

demonstrated a significant change in AE of

3.90°±1.80° compared to our non-significant

Constant Error Differences Between PF

& PF/Inversion

Untaped

Kinesio taped

-1

-2

-3

-4

Plantarflexion PF/Inversion

Figure 5. Groups constant errors (CE) differences

between pre and post kinesio tape conditions.

The data was also analyzed according to

gender. No significant (p > 0.05) differences were

detected in changes of absolute or constant error in

plantar flexion or plantar flexion with inversion

(Table 1) between genders. The third research

hypothesis was supported.

Table 1. Mean (SD) values for Error Measure

Differences (degrees, °) amongst genders.

Plantar flexion PF/Inversion

Men Women Men Women

AE -.15 (1.79) -.10 (.99) .40 (1.19) .23 (1.34)

CE .32 (2.38) .44 (1.46) -.11 (1.46) -.86 (1.58)

Abbreviations: AE= Absolute error, CE= Constant

error. * No significant difference between men and

women error values.

In summary, group data revealed no AE or CE

effects of Kinesio TM tape in any of the ranges of

motion. In gender analysis, Kinesio TM tape had no

effect on the changes of absolute error or constant

error amongst gender in either plantar flexion or 20°

plantar flexion with inversion.

DISCUSSION

Results indicated no significant differences in either

absolute or constant error between the no-tape and

Kinesio TM taped conditions in either plantar flexion

or inversion with 20º of plantar flexion, indicating

that kinesio TM tape likely does not enhance

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