The Effect of Recurrent Ankle Inversion Sprain and Taping on Proprioception at the Ankle.

Refshauge KM, Kilbreath SL, Raymond J, (School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, Sydney, Australia), Med Sci Sports Exerc. 2000;32:10-15.

The purpose of this study was to determine whether proprioception in the dorsiflexion/plantar-flexion movement pattern was impaired after recurrent ankle inversion sprains. The proprioceptive effects of taping were also evaluated in the same movement pattern.

Of the 43 subjects participating in this study, 25 had a history of recurrent inversion ankle sprains and constituted the experimental group. A recurrent inversion ankle sprain was defined as at least 3 ankle sprains, one of which occurred within the last 2 years but not within the last 3 weeks. Testing was identical and randomized for the ankle while taped and untaped. The remaining 18 subjects formed the control group and were matched to the experimental group.

The authors chose to use the 2 movements of dorsiflexion and plantar flexion of the ankle. One reason was to eliminate a forced choice between movement and no movement. Also, the authors assumed that proprioception could be impaired in either plantar flexion or inversion because of the mechanism of injury. Passive movement was performed to help eliminate muscle afferent input while still allowing joint mechanoreceptor input for proprioceptive feedback. Cutaneous stimuli were not eliminated because the ankle was strapped in the apparatus at the dorsum.

The experimental setup allowed the subject to be seated with approximately 60 degrees of knee flexion with no visual input for the foot. The tested ankle was strapped onto a footplate in the subject's midrange of dorsiflexion and plantar flexion. The passive movements at the prescribed velocities were imposed by a linear motor driven by a ramp generator. Ten trials were performed for the taped and untaped ankle at 3 random velocities (0.1, 0.5, and 2.5 [degrees]/s).

Using the Mann-Whitney rank sum test, the authors found no significant difference in direction detection between the dorsiflexion and plantar-flexion data. A repeated measures 3-way ANOVA was then used to compare the parameters (velocities, taped and untaped, and sprains versus controls). The results demonstrated a significant interaction only between tape and velocity. Increasing the velocity of imposed movements had a different effect on the taped ankle versus the untaped ankles.

The authors postulated that, because the velocities of 0.1 and 0.5 [degrees]/s are those of normal postural sway, the previously documented proprioceptive deficits seen during balance tests are not from the dorsiflexion/plantar-flexion plane. Also, with no difference existing at the 2.5 [degrees]/s velocity and because detection of movement increases with increasing velocities, the authors assumed that the dorsiflexion/plantar-flexion plane would not likely be impaired at the speeds of running and jumping.

The authors also proposed that, because this study was performed with the muscles relaxed, passive stretching of the muscle allowed afferent activity, further validating that muscle afferents appear to compensate for any loss of input from joint receptors due to ankle inversion sprains. They agree that these findings on movement sense cannot be generalized to position sense. Also, only the dorsiflexion/ plantar-flexion plane was tested, and this did not account for the inversion plane or a combination movement.

The authors were surprised at the lack of improvement provided by the tape in this study as compared with previous orthotic studies. They hypothesized that the tape would increase cutaneous input, which would enhance the detection of movement. According to their explanation, because this taping method restricted inversion, not plantar flexion, an enhancement of proprioception was not gained.

In conclusion, the authors did not find a proprioceptive deficit in dorsiflexion/ plantar-flexion passive movements at various velocities while testing the chronic inversion sprained ankle. Taping did not improve the individual's proprioceptive acuity in this plane of motion with this apparatus.

Rose L Smith, PT, SCS, ATC University of Cincinnati Cincinnati, Ohio