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Plantar flexion taping improves postural sway in those with Chronic Ankle Instability

Unlike other studies that have aimed to control inversion speed or load, Kodesh et al, in this study chose to tape in a way that created a plantar flexion force mimicking the posterior calf muscles. As the authors explain and reference, those with chronic ankle instability demonstrate “decreased plantar flexion and knee extension moments, decreased ankle and knee eccentric-concentric power and increased stiffness (Kim et al., 2018). Furthermore, individuals with CAI, exhibit altered muscle activity onset and decreased maximal torque (Fox et al., 2008; Herb et al., 2018) which may indicate difficulties in the production of sufficient joint moment, stiffness, ankle power and postural control (Kim et al., 2018; Sarvestan et al., 2020). These changes alter postural sway ability in individuals with CAI”

With this clear deficit in mind, the authors hypothesised that taping to generate a plantar flexion moment with Dynamic Tape would aid in load attenuation and postural control with antero-posterior sway being influenced more than medio-lateral.

Fig 1. The technique used in this study was applied in full plantar flexion such that the tape resists movement into dorsiflexion and then assists back into plantar flexion. This could be beneficial to the ankle strategy for balance maintenance when the deficits described above exist.

Subjects were allocated to the CAI group based on the outcome of the Cumberland Ankle Instability Tool(CAIT). This group was further divided into a Poor Stability group and a good stability group on the basis of their 30s single leg standing test. Those in the poor stability group were also found to have significantly higher circular area and COP AP sway at baseline than those in the good stability group.

The addition of Dynamic Tape resulted in significant improvements in velocity, circular area, path length and sway in the poor stability group. This improved in both those with CAI and those in the stable ankle (SA) group. There were no significant changes in the good stability group.

This study shows that where a clear deficit is identified and that is related to the condition or movements being observed, and when a Biomechanical Taping™ technique using Dynamic Tape® is applied in such a way to create a genuine force capable of addressing the deficit, significant improvement results.

Whether this improvement in postural control results in fewer ankle injuries in this group depends on whether that deficit is wholly or partially responsible for those injuries. A combination technique addressing the inversion movement may provide further benefits clinically. I for one, am not sure that I would choose to tape those whose mechanism of injury was plantar flexion/inversion into plantar-flexion (except during controlled rehab exercises) if they were participating in a jumping or running type of activity. I might consider it in those whose foot is planted fairly continuously during their activity e.g. skating.

While we are unable to determine whether the mechanism is purely due to a mechanical deceleration of motion assisting with sagittal plane control of the ankle, our own simple investigations like that in the video below have shown that these techniques can provide substantial resistance to dorsiflexion and assistance to plantar flexion.

Fig 2. Link to video showing the forces that can be introduced to aid in control of dorsiflexion

Furthermore, studies of kinesiology tape where the tape is applied in a lengthened position (minimal mechanical effect) have not resulted in the changes reported here. Further studies comparing a passive taping technique that uses the same tape and covers the same area of skin but applied in full dorsiflexion and with no tension, with an active technique like the one investigated here would help to dissect out the mechanisms further.

To learn how to apply this technique or undertake comprehensive training in Biomechanical Taping™ via our Accredited Biomechanical Taping Practitioner(ABTP) pathway visit our Education page.

Further research shows that Dynamic Tape application improves balance, co-ordination and limb loading in subjects with chronic ankle instability.

There is increasing evidence demonstrating the benefits of Dynamic Taping in those with ankle instability. This recent study by Lukasz Pawik et al, provides further support. In their study:

In Patients with Grade I and II Ankle Sprains, Dynamic Taping Seems to Be Helpful during Certain Tasks, Exercises and Tests in Selected Phases of the Rehabilitation Process: A Preliminary Report

Pawik and co-workers investigated the impact of Biomechanical Taping™ using the Dynamic Tape®, the original in the Biomechanical Tape® range of products on postural stability on a stable surface in 30 subjects with subacute (7-21 days) inversion ankle sprains. They also looked at the ability to load the affected limb.

Figure 1. The application used during the study

The results showed improvements in the mean radius of sway and also in the ability to asymmetrically load the affected limb particularly with eyes closed or with visual feedback.

While this study only included 30 subjects and 3 x 32second exercises it builds on previous studies showing improvements in Y balance test, Cumberland Ankle Instability Tool (CAIT) and Foot and Ankle Ability Measure (FAAM) (Pareira et al, 2017), Star Excursion Balance Test (SEBT) (Dogan and Güzel, 2021) and Sway Velocity and Path Length during single leg standing tasks in those with CAI and healthy subjects (Kodesh et al, 2021), interestingly using a calf/plantarflexion technique which may impact sagittal plane motion much more than a technique specifically designed to decelerate into inversion and to provide tri planar compression to enhance force closure such as in the example in Figure 1.

It is proposed that by creating a genuine mechanical force resisting motion into the direction that loads the affected ligaments, a higher force is required to produce the same load on the ligament. Furthermore, decelerating the motion may provide increased time to correct position or in fact provide a correcting force itself as seen I the neurological case described here.

Dynamic Tape permits full range of motion allowing the user to utilise normal foot and ankle balance strategies and to accommodate to the ground surface as it does not restrict range of motion. Restrictions with rigid taping and bracing has been shown to have adverse effects on balance (Bennell & Goldie, 1994). Reaching the end of range is not an issue generally. The problem arises when the end of range is reached with a force that is beyond the capacity of the restraining structures. Dynamic Tape aims to moderate this force while also allowing for timely adjustment to the pertubation where possible.

View one of the techniques that we use for later stage rehab (no or minimal residual swelling other than around the lateral malleolus itself) or see how the forces can be modified on this short video.

If you would like to preview our comprehensive online education pathway, find face to face workshops or look at some additional research, please visit our Education page.

Supporting Breast Cancer Awareness and Women in Sport

Dynamic Tape was very pleased to have been able to support the teams from ST7 at the recent AAU Nationals Volleyball tournament held in Florida.

In addition to raising money and awareness for breast cancer we feel that it is essential to support women’s sport in particular. We know that late teenage years and into college is when female participation in sport tends to decline and not recover. We aim to encourage and enable lifelong participation in physical activity and sport, and to help people reach their goals and dreams, staying healthy and able in the process.

The teams rocked their pink shirts for the DIG PINK campaign and we are told that all teams showed strong growth and had great performances. Well done to all involved and a special thank you to Zoe Mueller for bringing it all together.

Dynamic Tape reduces pain and muscle fatigue in those with CLBP – research commentary

Research on ‘Chronic Non-Specific Low Back Pain’ has always been one of my pet hates. Lack of a diagnosis does not a diagnosis make. Subjects within this classification can have wildly different contributing factors. The paper by Martin Rabey, Toby Hall et al from 2017 highlights this. Some may have nociceptive or inflammatory mediated pain while others may have far stronger influence from psychosocial amplifiers. Some may have tissue damage or be on the cusp of it, others may have little evidence of ongoing structural influences and so it goes on. Applying the same intervention to all and expecting an effect is a search for a panacea rather than a clinically reasoned, evidence informed management approach.

It is therefore interesting when a study shows an effect in this sort of group as is the case in the paper by Alhamari et al, published in late 2020. The immediate and short-term effects of dynamic taping on pain, endurance, disability, mobility and kinesiophobia in individuals with chronic non-specific low back pain: A randomized controlled trial.

The results showed that Dynamic Tape and Kinesiotape improved pain over the no tape condition. Again, it is hard to discern the mechanism as there is no specific deficit identified that the tape is trying to address. Dynamic Tape did however improve spinal mobility and spinal extensor muscle endurance over Kinesiotape and no tape groups. This supports the assertion that Dynamic Tape can provide significant force to do some of the work thereby reducing extensor muscle fatigue and possibly aiding in the control of movement through range, exactly what it was designed to do. Whether that has an effect on pain depends entirely on the nature of the pain and tissue damage. If the extensor muscles are a factor in the development of pain e.g. a muscle strain or perhaps due to fatigue then it could be anticipated that the application of Dynamic Tape may have a beneficial effect on pain.

There may be benefits in those without ongoing tissue damage but with maladaptive movement patterns, extension dominant splinting and guarding. This paper did show changes to kinesiophobia favouring Dynamic Tape but again, a large washout effect would be anticipated as many subjects in the cohort may not have fear of movement. Correctly identifying those who display these movement adaptations and combining the taping application with appropriate pain education may provide further benefit by reducing overwork of the splinting muscles that may be acting as peripheral drivers of pain, while also help to restore movement choice and re-educate more optimal movement patterns and control while reducing the perceived threat. Further, more robust and specific studies are required to evaluate the contribution of each.

Once again, we see that Dynamic Tape can effectively introduce force into the system to modify movement or load. Whether that is clinically beneficial depends on correctly identifying a deficit, its relationship to the presenting condition, the mechanisms by which introducing an external force with the tape can address this deficit, correct application and thorough evaluation to determine that a sufficient force was in fact created. Simply taping everyone with pain in a particular region the same way will yield mediocre results. Thorough understanding, assessment, clinical reasoning and application are central to the approach.

The effect over time is interesting in this paper and would support a clinically reasoned hypothesis that by a. doing some of the work of the weak, fatigued, overworked and peripherally sensitised structures that an immediate improvement in pain and endurance would result as observed b. by reducing load, pain and peripheral drive more normal movement can result and this can challenge beliefs around the association between movement, tissue damage and pain, and while a small improvement might occur immediately, this would take more time to manifest (particularly in those with a stronger contribution from psychosocial influencers and amplifiers or central nervous system changes) – as observed in disability, mobility and kinesiophobia. Appropriate preparatory education and instructions consistent with the pain mechanisms identified would potentially enhance this.

While further studies are required with more homogenous subject cohorts and clearly identified deficits/aims/proposed mechanisms, this study provides evidence that Dynamic Tape can introduce a force into the system which reduces work of muscle/improves endurance and reduces pain immediately and over time – presumably initially due to reduced load and firing of peripherally sensitised structures and potentially some contribution due to reduced kinesiophobia with these effects building over time due to a dampening down of the system from the top down and bottom up.

Dynamic Tape Win FICS Sponsor Award

We’re pleased to announce that we have been awarded the 2021 Sponsorship Award from FICS at their recent symposium. This award recognises our longstanding partnership with FICS and support for chiropractors worldwide. We’re delighted to have built a strong relationship with FICS over many years and we are extremely proud to be recognised in this way.

Accepting the award, our Managing Director, Will Cogley, talked about how Dynamic Tape has grown over more than 10 years from Ryan and Ylva working on a small Pacific island to find solutions for their clients to be trusted by clinicians across the world. We hope to continue this growth, including our forthcoming launch of the new Dynamic Tape powerband.

You can watch the acceptance speech in full here:

 

We’re Attending The FICS 2021 Symposium

We’re pleased to announce that we’ll be attending the FICS 2021 symposium between May 7th and May 8th. The theme of the symposium is ‘The Athlete’s Journey’, and there will be a variety of speakers and events to attend. Due to our longstanding relationship with FICS, we will be sponsoring the event.

Our Clinical Director, Ryan Kendrick, will be delivering a breakout session on functional taping between 6PM and 7PM BST on 8th May. FICS clinicians will also be eligible to sign up for a 20% discount in our US and Australia stores by signing up on this page.

We look forward to seeing you there!

Welcome To Our News Hub

We’re committed to enabling our users to access the latest updates and best practice in relation to our tape. That’s why we’ve created this news hub, where we will share the latest news about the company as well as insights on clinical best practice from our Clinical Director, Ryan Kendrick.

 

If you’re looking to learn more about our tape and how to use it, why not visit our YouTube, where you can find a wide range of videos, including explainers and instructional techniques? You could also try our introductory e-learning course, An Introduction To Dynamic Tape.

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