Talk:Taping and bracing
From Biomch-W
Notes
- I have only seen the abstracts for references 3,6,7 so my conclusions may be limited from these. I have used full texts of the others. --JoeWright 20:53, 2 April 2006 (CDT)
- I have not yet come across any outcome data supporting external tape or bracing for injury prevention or rehab. --JoeWright 20:53, 2 April 2006 (CDT)
- It would be useful if someone could do a mechanics analysis of various types of support. It would be good to get an idea of the kind of forces that may be going on, so as to add theoretical support to the empirical data. --JoeWright 20:53, 2 April 2006 (CDT)
- Most of the research seems to be an ankles so data on other joints would be good. --JoeWright 20:53, 2 April 2006 (CDT)
- Should there be references to support manufacturers? --JoeWright 20:53, 2 April 2006 (CDT)
- Data on other possible mechanisms such as psychological and warming? --JoeWright 20:53, 2 April 2006 (CDT)
History
This page was born after I asked a topic on the mailing list. Responses are below. I have excluded names but feel free to add them if you are the author.
you might want to look at the work being done by a US Company - just search for TheraTogs on the web - they supply this for orthotic use, but I suspect the issues are similar to those for sports.
There are masses of papers on the effects of taping and my students frequently do final year dissertations on the subject - the main findings are - The tape stretches after about 20 mins or so and loses whatever effect it did have structurally thereafter. The structural/mechanical effect varies with where the injury is and how bad it is. The majority of papers appear to be concerning ankles and there is strong evidence that newly applied tape can have a significant stabilising effect, and reduce ROM. There is a strong propreoception effect- especially around the ankle. Inversion injuries are protected to some extent when propreoception in the ankle itself is compromised, the feedback from tape pulling on the skin can give additional feedback.
Strapping does a couple of different things.
For 'instability', it is largely beleived to be due to proprioception - feedback on joint position due to friction/pressure on the skin.
for 'injury', strapping helps to reduce swelling in the joint - which causes pain, limits joint motion, and acts as a counterirritant.
For 'injury prevention'strapping may help by recruiting help of other structures - for instance, strapping fingers together makes injury to any one finger much less likely.
I think you have a good point and I agree with you. The literature I read about taping was that it lost approximately half its strength approximately an hour after use. I have some of those articles, but they are about 8 years old, but would be happy to share the sources with you, if you can't find anything recent. I have done some research, but not recently, on gait characteristics with semi-rigid bracing for ankles. We chose to use braces rather than tape, because of concerns similar to yours. Good luck with your search.
There are countless articles in the sport science and especially athletic training journals. All show that taping and many other methods do little to control motion. It may initially but with sweat etc it loses all effect except maybe psychological.
Was an Athletic Trainer for many years at a university and can personally attest to this as well.
It is my feeling and conviction that the demonstrated profilactic effect of tape (because there's no doubt on its effectiveness in reducing sprain incidences) is not relying onto tape taking over the high forces appearing in a sprain, but in keeping the foot in a position were a sprain is unlikely to happen and this way avoiding the appearance of such high forces.
The following two references which may be interesting to you. In the first one a reduction of peroneal reaction times is claimed. However I think that reaction times have a very limited potential in avoiding acute sprains. The second one pretty much describes the mechanism I believe to be the most responsible for sprain prevention using tape.
I've also attached also a copy of my PhD thesis on the subject of foot and ankle stabilisation.
Karlsson, J.; Andreasson, G.O. The effect of external ankle support in
chronic lateral ankle joint instability. An electromyographic study.
1992. The American Journal of Sports Medicine, 20(3), 257-261
Eils E, Rosenbaum D. The main function of ankle braces is to control the joint position before landing. 2003. Foot & Ankle, 24(3), 263-268
I'm sorry I cant point out any specific research in terms of the mechanical support taping may offer, but I recall from somewhere that strapping can provide an additional proprioceptive/somatosensory input to aid in planning stabilising muscular contractions around the injured joint. I do know that injuries to the soft tissues (ligaments, joint capsule) can lead to decrements in proprioception (see paper attached). In theory I suppose, external strapping can act as surrogate ligaments in certain circumstances, depending on the joint and the structures injured. Again, I apologise for the lack of supporting literature, but maybe it will provide some directions to your own literature search.
There is clear evidence that the taping (in various forms) alters specific mechanisms both mechanical, neurological and behavioural. The evidence that these changes directly manifest in improved performances (in athletes) is less clear.
Mechanical. The role of taping and bandaging has been shown to change resistacne through range - particularly at end of range. Prior to the focus on the neurological issues in joint stability it was felt that the taping and bracing acted as an external ligament. In the end it may alter the position of the joints while under low load and therefore this inturn may alter any preparatory actions performed by the athletes.
Neurological. Taping (in various forms) can influence the sensory feedback and modify some of the relationships between the cutaneous and muscle afferents. For example, were not able to find any alteration in the latency of the spinal reflex (Peroneals & ankle taping), but at higher neurological interactions can be changed with taping. i.e. the level of the EMG amplitude in the prepatory phase prior to landing can be altered with the use of tape.
Behavioural. Taping can also alter the motor patterns / behaviour of individuals. There are various taping techniques that can be utilised to alter the forces and the feedback to the muscle and joints . In particular taping techniques are able to resolve signs and symptoms by some process of "unloading". This is seen in many clinical scenarios (particulatrly the lower limb). The randomised clinical trial evidence of these changes is limited. We have just published evidence showing Low Dye taping removes the S/S of acute Plantar Fasciitis, there is also a very large volume of evidence that the patello-femoral syndrome can be managed with the use of taping and exercises. Finally, there is a recent study in the Australian Journal of Physiotherapy that demonstrates that specific gluteal taping alters gait patterns in people who are rehabilitating after a CVA.
As a podiatrist I very often use rigid strapping for plantar fascia (sole and heel) pain commonly called plantar faciitis. It is almost garunteed that the patient will experience less pain while strapped. Ankle trauma associated with excessive inversion / inversion moments are also very efficaciously treated with rigid strapping. Joints that are painful due to hypermobility, that is they move outside their efficient range of motion in normal use and cause stress to local or distal tissues, can be stabilised and reduced in pain by strapping. I would agree that strapping and elastic supports are used ineffectively as a support some times but they may have a warming effect and a phsycological boost. I would say then that used correctly strapping can add useful and effective forces to support an injured joint. If I get some time I'll do some paper analysis of the plantar fascia strapping. If we could post diagrams here it would help.
I have seen many articles about the use of tapes and bandages to avoid injury. It appears that these tapes have any action at the proprioceptors and kinestesy. So, the action mechanism is not purely mechanical.
Try these articles: - Autores: Cordova ML,Scott BD,Ingersoll CD,LeBlanc MJ Effects of ankle support on lower-extremity functional performance: a meta-analysis. Revista: Med Sci Sports Exerc. 2005 Apr; 37(4): 635-41 PubMed ID: 15809563. [PubMed - indexed for MEDLINE]
15 - Autores: Barkoukis V,Sykaras E,Costa F,Tsorbatzoudis H Effectiveness of taping and bracing in balance. Revista: Percept Mot Skills. 2002 Apr; 94(2): 566-74 PubMed ID: 12027354. [PubMed - indexed for MEDLINE]
I am not sure what you are referring to when you say 'strapping' but there is some evidence for the efficay of ankle braces for the prevention of ligament injuries. You should find it in the Cochrane Library. Alternatively, you might want to contact Eric Eils who has done some research in the area and is writing his thesis partly on this topic. If you have specific questions he might be able to give you some answers or point you towards the appropriate literature.
When a muscle contracts along its length, it also expands laterally. if this is considered as a Poisson ratio effect, where the muscle is considered in compression (this being the external stress that would have to be applied to induce this deformation) then restricting the lateral expansion has considerable effects on the stress within the muscle. I'm sure this approach is a little simplistic and there is a lot more here to be done but the following papers may give you some idea of the line of reasoning. I'm sorry I do not have pdf copies of these but if you can't get hold of them let me know and I can send them snail mail or scan them in. It suggest that the powerlifters costumes, and various muscle strappings could offer signifcant assistance to muscles.
R.M. Aspden. Constraining the lateral dimensions of uniaxially loaded materials increases the calculated strength and stiffness: application to muscle and bone. Journal of Materials Science: Materials in Medicine 1: 100-104, 1990.
D.W.L Hukins, R.M Aspden and D.S. Hickey. Thoracolumbar fascia can increase the efficiency of the erector spinae muscles. Clinical Biomechanics 5: 30-34, 1990.
