Taping Vs Bracing

Blaine Whyte CAT(C)

SMSCS

OverviewOverview

TapingTapingBracingBracingTaping and bracing studiesTaping and bracing studiesEffects of taping and bracing on performanceEffects of taping and bracing on performanceProprioceptionProprioceptionPeronealPeroneal activationactivationDeceleration and ROM restrictions Deceleration and ROM restrictions Brace reviewBrace reviewConclusion and questionsConclusion and questions

TapingTaping

2 year study -2,526 basketball players 13

• Taping reduced the incidence of sprains (14.7 sprains per 1,000 player games versus 32.8 sprains per 1,000 player games).

• Decrease in severity of ankle sprains in taped group.

BracingBracing

2-year study 1,601 intramural basketball players 11

•Injury rate of 1.6 per 1,000 athlete-exposures (brace group)

•Injury rate of 5.2 per 1,000 athlete-exposures (no brace group)

– using a semirigid ankle orthosis

www.fisiokinesiterapia.biz

BracingBracing

1 year study – 504 soccer players - sport stirrup 4

•significant reduction in the incidence of ankle sprains in the braced group with previous sprains (0.14) compared with the nonbraced group with previous sprains (0.86). (injuries/1000 playing hours)

• incidence of ankle sprains was significantly higher in the nonbraced group with previous sprains (0.86) compared with the nonbraced group without previous sprains (0.46).

Thus, in this study, a semirigid orthosis significantly reduced the incidence of recurrent ankle sprains in soccer players with previous history of ankle sprains.

Braces and tapeBraces and tape

6 year retrospective study -compared taping with laced ankle stabilizers in 297 college football players 14

• Laced ankle stabilizers (2.56 sprains/1,000) were twice as effective in preventing ankle injuries than taping (4.91 sprains/ 1,000).

• Suggested that by retightening the stabilizers, the players periodically returned the stabilizers to their level of maximal support, while the tape loosened with time and mechanical stress.

• Their study, however, compared only two groups (prophylactic taping and laced stabilizers) and did not contain a control group with athletes wearing no prophylactic measures.

Braces and TapeBraces and Tape

Tape becoming loose

- tape can loose 40% of its initial support after 10 minutes of use 12

- losses in taping restriction for both inversion and eversion at 20 minutes into exercise. Semirigid orthosis may be more effective than taping in providing initial ankle protection and in guarding against ligamentous reinjury. 10

Braces and TapeBraces and Tape

Time, experience, and cost- requires the time and expertise of the trainer or coach to

apply the tape – football season – 97 minutes/ ankle during the season.

- the projected cost savings for an athletic program using he projected cost savings for an athletic program using prophylactic bracing could be substantial when compared with theprophylactic bracing could be substantial when compared with the use use of prophylactic taping of the ankle.of prophylactic taping of the ankle.

-- the use of braces is more cost effective and braces are more the use of braces is more cost effective and braces are more easily to apply than tape easily to apply than tape 2

- Taping over an entire season could be as high as three or four hundred dollars 12

PerformancePerformance

• Twenty-six male athletes performed an agility run, a 40-yard sprint, and a vertical jump while wearing: 1) adhesive tape, 2) Air-Stirrup brace, and 3) no support (control). Observed data suggest that both taping and bracing have no substantial effect on agility, sprinting speed, or vertical jumping ability.3

• Many performance variables have been studied

- vertical jump

- sprinting

- agility

- peak impact forces

PerformancePerformance

• Most studies comparing the effects of taping and bracing on performance have not demonstrated significant differences.

• Some researchers found that various forms of ankle support decreased vertical jump height by 3% to 5%, whereas others did not observe a significant effect 16

• Comparing braces

- no clear conclusions can be drawn concerning the relative effects of different brace designs (eg, semirigidversus lace up)

PerformancePerformance

• Forceplate was used to collect ground reaction force data under the dominant foot. Athletes performed stiff and soft drop landings before and after a 20-minute treadmill exercise bouts

• It appears that ankle taping and bracing decrease the time to reach peak impact forces.

• Whether these effects are detrimental over time remains speculative at this point and requires further research. 15

Biomechanical and Neuromuscular Effects of Biomechanical and Neuromuscular Effects of Ankle Taping and Bracing Ankle Taping and Bracing

Gary B. WilkersonGary B. WilkersonThe effects of ankle taping and bracing onThe effects of ankle taping and bracing on–– proprioceptiveproprioceptive input to the central nervous input to the central nervous

systemsystem–– peronealperoneal muscle activity, muscle activity, –– deceleration of ankle motion may be as deceleration of ankle motion may be as

important as restriction of the range of ankle important as restriction of the range of ankle inversion for sprain prevention. inversion for sprain prevention.

ProprioceptionProprioception

Active replication of reference ankle positionsActive replication of reference ankle positions–– stirrup brace improved the accuracy of ankle position in 3 planestirrup brace improved the accuracy of ankle position in 3 planess–– tape straps adhered to the skin significantly improved joint postape straps adhered to the skin significantly improved joint position ition

sense in sense in nonweightnonweight--bearing plantar flexionbearing plantar flexion–– taping and a lacetaping and a lace--up brace both significantly improved the ability of up brace both significantly improved the ability of

subjects to actively reproduce a specific plantarsubjects to actively reproduce a specific plantar--flexion joint angleflexion joint angle. .

Awareness of ankleAwareness of ankle--joint positionjoint position–– most important immediately before ground contact most important immediately before ground contact –– peronealperoneal muscle activation is essential to counteract a potentially muscle activation is essential to counteract a potentially

injurious force after landing.injurious force after landing.

PeronealPeroneal activationactivation

PeronealPeroneal Activation while taped Activation while taped –– found that the found that the peroneusperoneus brevisbrevis muscle was active for muscle was active for

a longer period of time at the end of the swing phase, a longer period of time at the end of the swing phase, just before just before footstrikefootstrike, when the ankle was taped , when the ankle was taped

–– taping did not prevent the taping did not prevent the evertorevertor musculature from musculature from being vigorously activatedbeing vigorously activated

–– the greatest improvement in response speed was in the greatest improvement in response speed was in ankles with the greatest degree of instabilityankles with the greatest degree of instability

–– that reduction in the angular velocity of displacement that reduction in the angular velocity of displacement with tape, combined with restricted displacement with tape, combined with restricted displacement amplitude, permitted relatively greater amplitude, permitted relatively greater peronealperonealactivation per degree of motion than the activation per degree of motion than the untapeduntapedconditioncondition

Deceleration of Deceleration of ankle motionankle motion

•• WeightWeight--bearing sprain simulationbearing sprain simulation•• induced 50induced 50°° of inversion displacement of inversion displacement –– using radiographic using radiographic

cinematography to assess the effect of ankle bracing on cinematography to assess the effect of ankle bracing on inversion velocity. A stirrupinversion velocity. A stirrup--type brace decreased the distance type brace decreased the distance that stable and mechanically unstable ankles were displaced that stable and mechanically unstable ankles were displaced during a 40during a 40--millisecond highmillisecond high--velocity phase of the sprain velocity phase of the sprain simulation by approximately 15% to 20%. simulation by approximately 15% to 20%.

•• trapdoor platforms trapdoor platforms -- relatively similar to those observed for relatively similar to those observed for subtalarsubtalar eversioneversion during running, the velocity of ankle during running, the velocity of ankle displacement associated with jump landing may exceed displacement associated with jump landing may exceed 10001000°°··ss−−1 1

Deceleration of Deceleration of ankle motionankle motion

•• When sprains occur between 30 and 50 milliseconds after When sprains occur between 30 and 50 milliseconds after ground contact inversion velocity must be greater than ground contact inversion velocity must be greater than 10001000°°··ss−−1 to produce ankle displacement beyond 501 to produce ankle displacement beyond 50°° in less than in less than 50 milliseconds 50 milliseconds

•• The research done in this area suggests that both the The research done in this area suggests that both the deceleration and motiondeceleration and motion--restriction effects of taping and bracing restriction effects of taping and bracing are rate dependent and are relatively more effective at high are rate dependent and are relatively more effective at high velocities of ankle displacement.velocities of ankle displacement.

Bracing OptionsBracing OptionsUpwards of 30 to 35 different types of ankle braces on the market

Types of braces include lace up, semi rigid, stirrup, air stirrup. Each of these groups have different manufacturers

Questions to ask prior to deciding

Brace used for prophylaxis or post-traumatically?

Is it easily applied and re-adjustable during play?

Is it economical?

Is it realistic for the sport they are involved in?

Life expectancy?

Will you get compliance?

When to braceWhen to brace

• Acute ankle sprains• Use of a semi-rigid ankle support resulted in a significantly shorter time to return to work and sport when compared with an elastic bandage and tape 17

• After recurrent sprains• Reduction in the incidence of ankle sprains in athletes with previous sprains4

• For prevention • The prophylactic use of semirigid ankle braces appears warranted to reduce the incidence of initial and, in particular, recurrent ankle sprain injuries for individuals who participate in activities that have the highest risk for these injuries 8

ConclusionConclusionThe use of either tape or braces reduces The use of either tape or braces reduces the incidence of ankle sprains.the incidence of ankle sprains.The use of tape or braces results in less The use of tape or braces results in less severe ankle sprains. severe ankle sprains. Braces seem to be more effective in Braces seem to be more effective in preventing ankle sprains than tape. preventing ankle sprains than tape. There is conflicting studies regarding There is conflicting studies regarding taping and bracing effecting performancetaping and bracing effecting performanceBenefits through Benefits through proproiceptionproproiception, , peronealperonealfiring and deceleration of ankle motionfiring and deceleration of ankle motion

ReferencesReferences1. The Effect of Preventive Measures on the Incidence of Ankle S1. The Effect of Preventive Measures on the Incidence of Ankle Sprains [Critical Review] prains [Critical Review] VerhagenVerhagen, , EvertEvert A. L. M. A. L. M. MScMSc**††; van ; van MechelenMechelen, Willem MD, PhD*, Willem MD, PhD*††; de ; de VenteVente, , WiekeWiekeMScMSc*May 2, 2000. *May 2, 2000. 2. Journal of Foot and Ankle Surgery 2. Journal of Foot and Ankle Surgery -- Volume 45, Issue 6, November 2006, Pages 360Volume 45, Issue 6, November 2006, Pages 360--365365Prophylactic Bracing Versus Taping for the Prevention of Ankle SProphylactic Bracing Versus Taping for the Prevention of Ankle Sprains in High School prains in High School Athletes: A Prospective, Randomized TrialAthletes: A Prospective, Randomized Trial3. Title The effects of 3. Title The effects of semirigidsemirigid airair--stirrup bracing vs. adhesive ankle taping on motor stirrup bracing vs. adhesive ankle taping on motor performance performance VerbruggeVerbrugge JDJD Source Journal of Orthopaedic and Sports Physical Therapy Source Journal of Orthopaedic and Sports Physical Therapy 1996 May;23(5):3201996 May;23(5):320--5.5.4. American Journal of Sports Medicine Volume 22, Issue 5, 1994,4. American Journal of Sports Medicine Volume 22, Issue 5, 1994, Pages 601Pages 601--606 606 SurveSurve, I., , I., SchwellnusSchwellnus, M.P., , M.P., NoakesNoakes, T., Lombard, C. A fivefold reduction in the incidence of recu, T., Lombard, C. A fivefold reduction in the incidence of recurrent rrent ankle sprains in soccer players using the sportankle sprains in soccer players using the sport--stirrup stirrup orthosisorthosis5. Riemann BL. Schmitz RJ. Gale M. 5. Riemann BL. Schmitz RJ. Gale M. McCawMcCaw ST Effect of ankle taping and bracing on vertical ST Effect of ankle taping and bracing on vertical ground reaction forces during drop landings before and after treground reaction forces during drop landings before and after treadmill joggingadmill joggingSource Journal of Orthopaedic and Sports Physical Therapy 2002Source Journal of Orthopaedic and Sports Physical Therapy 20026. 6. Journal of Athletic TrainingJournal of Athletic Training 37 (4), pp. 43637 (4), pp. 436--445 Biomechanical and Neuromuscular 445 Biomechanical and Neuromuscular Effects of Ankle Taping and Bracing Effects of Ankle Taping and Bracing Gary B. WilkersonGary B. Wilkerson

7.Medicine and science in Sports and exercise 7.Medicine and science in Sports and exercise Volume 39, Issue 5, May Volume 39, Issue 5, May 2007, Pages 7812007, Pages 781--787787 The placebo effect of ankle taping in ankle instability OctThe placebo effect of ankle taping in ankle instability Oct--Dec 2002Dec 2002

References contReferences cont’’dd8. Journal of Orthopaedic and Sports Physical Therapy Volume 33,8. Journal of Orthopaedic and Sports Physical Therapy Volume 33, Issue 10, October 2003, Pages Issue 10, October 2003, Pages 572572--577577 The Role of Ankle Bracing for Prevention of Ankle Sprain InjuriThe Role of Ankle Bracing for Prevention of Ankle Sprain Injurieses9. 9. GeneeskundeGeneeskunde en en SportVolumeSportVolume 39, Issue 1, February 2006, Pages 1239, Issue 1, February 2006, Pages 12--19 Prevention of recurrent 19 Prevention of recurrent ankle sprainsankle sprains10. American Journal of Sports Medicine Volume 18, Issue 5, 199010. American Journal of Sports Medicine Volume 18, Issue 5, 1990, Pages 498, Pages 498--506506 Comparison of Comparison of support provided by a support provided by a semirigidsemirigid orthosisorthosis and adhesive ankle taping before, during, and after and adhesive ankle taping before, during, and after exercise exercise -- Greene TA. Hillman SK.Greene TA. Hillman SK.11. 11. SitlerSitler M, Ryan J, Wheeler B, et al. The efficacy of a M, Ryan J, Wheeler B, et al. The efficacy of a semirigidsemirigid ankle stabilizer to reduce acute ankle stabilizer to reduce acute ankle injuries in basketball: a randomized clinical study at Wesankle injuries in basketball: a randomized clinical study at West Point. Am J Sports Med 1994; t Point. Am J Sports Med 1994; 22:45422:454––461. 461. 12. Miller Orthopedics Today Volume 18 Number 9, September 1998 12. Miller Orthopedics Today Volume 18 Number 9, September 1998 –– Braces superior to tape for Braces superior to tape for ankle injuries among football playersankle injuries among football players13. 13. GarrickGarrick JG, JG, RequaRequa RK. Role of external support in the prevention of ankle sprainsRK. Role of external support in the prevention of ankle sprains. Med . Med SciSciSports 1973; 5:200Sports 1973; 5:200––203. 203. 14. 14. RovereRovere GD, Clarke TJ, Yates CS, et al. Retrospective comparison of tapGD, Clarke TJ, Yates CS, et al. Retrospective comparison of taping and ankle ing and ankle stabilizers in preventing ankle injuries. Am J Sports Med 1988; stabilizers in preventing ankle injuries. Am J Sports Med 1988; 16:22816:228––233 233 15. 15. Riemann BLRiemann BL. . Schmitz RJSchmitz RJ. . Gale MGale M. . McCawMcCaw STSTTitle Effect of ankle taping and bracing on vertical ground reacTitle Effect of ankle taping and bracing on vertical ground reaction forces during drop landings tion forces during drop landings before and after treadmill joggingbefore and after treadmill joggingSource Journal of Orthopaedic and Sports Physical Therapy 2002 DSource Journal of Orthopaedic and Sports Physical Therapy 2002 Dec;32(12):628ec;32(12):628--35.35.16. Journal of Athletic Training16. Journal of Athletic Training 37 (4), pp. 43637 (4), pp. 436--445 Biomechanical and Neuromuscular Effects of 445 Biomechanical and Neuromuscular Effects of Ankle Taping and Bracing Gary B. Wilkerson OctAnkle Taping and Bracing Gary B. Wilkerson Oct--Dec 2002Dec 200217. 17. KerkhoffsKerkhoffs GMMJ, GMMJ, StruijsStruijs PAA, Marti RK, PAA, Marti RK, AssendelftAssendelft WJJ, WJJ, BlankevoortBlankevoort L, L, DijkDijk van van CN TI: Different functional treatment strategies for acute laterCN TI: Different functional treatment strategies for acute lateral ankle ligament al ankle ligament injuries in adultsinjuries in adults