Sports Medicine Research: In the Lab & In the Field: Fibular Taping Versus Traditional Taping in Patients With Chronic Ankle Instability (Sports Med Res)


Wednesday, December 4, 2013

Fibular Taping Versus Traditional Taping in Patients With Chronic Ankle Instability

Fibular taping does not influence ankle dorsiflexion range of motion or balance measures in individuals with chronic ankle instability

Wheeler T, Basnett C, Hanish M, Miriovsky D, Danielson E, Barr J, Threlkeld J, Grindstaff T. Journal of Science and Medicine in Sport. 2013; 16: 488-492.

Take Home Message: Among patients suffering from chronic ankle instability, fibular taping increased ankle dorsiflexion range of motion and balance, but not enough to be clinically meaningful.

Chronic ankle instability (CAI) is defined as recurrent ankle sprains and repetitive episodes of the ankle “giving way”.  Some patients with CAI have restricted ankle dorsiflexion range of motion (ROM) along with hypomobility of the posterior aspect of the talocrural joint and distal tibiofibular joint, which can cause mal-alignment of the talus and fibula. Fibular taping, which may prevent recurrent ankle sprains, is believed to simulate a distal tibiofibular posterior glide joint mobilization that is often used to promote ankle dorsiflexion ROM. If we can verify that fibular taping promotes ankle dorsiflexion ROM or balance then it may help us identify other uses for fibular taping and better educate our patients about why it works.  Therefore, “the purpose of the study was to examine the immediate effects of fibular taping on ankle dorsiflexion ROM and dynamic balance in individuals with CAI”. Twenty three individuals with CAI and a dorsiflexion deficit randomly received a fibular taping or sham taping (tape applied without tension) on different days, which were separated by 1 to 7 days. An investigator who was blinded to the type of taping evaluated dorsiflexion during a weight-bearing lunge and balance with the Star Excursion Balance Test in the anterior, posteromedial, and posterolateral directions. The participants completed these tasks before and after each taping intervention. Compared with not being taped, both taping interventions resulted in greater ankle dorsiflexion ROM; however, the average improvement was only one degree. The two taping interventions had a similar influence on dorsiflexion ROM as well as dynamic balance when participants reached in an anterior or posteromedial direction. The only time participants performed better with the fibular taping compared with the sham taping was when they reached in the posterolateral direction during the balance test; however, the difference was small and within the possible range of measurement error. 

This authors showed that fibular taping has very little influence dorsiflexion ROM and balance among patients who have CAI.  Fibular taping may not be beneficial for ROM and dynamic balance but it has been beneficial in other ways.  Other studies have shown that fibular taping may prevent ankle sprains, increase stability awareness, and make the patient feel more confident about their ankle.  Since fibular taping provides positive effects for the patient, it should still be used as a treatment option for patients who have CAI.  While the authors hoped to shed light on why this taping is beneficial they found that the benefit may not be related to improved dorsiflexion or balance. However, it would be helpful if future research would conduct these tests and then examine if individuals with or without improvement in dorsiflexion and balance actually have a reduced risk of ankle sprains. This could help us clarify that the benefit of fibular taping is not related to improved dorsiflexion or balance or if we can use the response to the taping to determine who might get benefit from the taping. From a clinical point-of-view, fibular taping provides benefits in so we should still use it to help prevent ankle sprains but we should be cautious and not attribute these benefits to changes in balance or ROM.

Questions for Discussion: How do you treat a patient with CAI? Have you used fibular taping with a patient with CAI? Do you believe fibular taping has a psychological effect on the patient to makes them feel more stable in their ankle? Do you think fibular taping should be used as a treatment option for patients suffering from CAI?

Written by: Callie Jedrzejek
Reviewed by: Lisa Chinn and Jeffrey Driban

Related Posts:
Hip Kinematics in Patients with Chronic Ankle Instability

Wheeler TJ, Basnett CR, Hanish MJ, Miriovsky DJ, Danielson EL, Barr JB, Threlkeld AJ, & Grindstaff TL (2013). Fibular taping does not influence ankle dorsiflexion range of motion or balance measures in individuals with chronic ankle instability. Journal of Science and Medicine in Sport, 16 (6), 488-92 PMID: 23537695


Todd Lazenby MA, ATC, Ithaca College said...

Brian Mulligan, a physiotherapist from New Zealand who has taught his mobilization techniques worldwide, introduced and has been teaching this taping technique for years. As an athletic trainer I can state that clinically it makes a difference in the athlete's perception and confidence in their ankle stability. I have utilized this technique frequently and with great success in conjunction with rehab to provide increased proprioceptive feedback while performing exercises. In addition, the technique is great to incorporate under a regular ankle taping to enhance stability when the athlete is ready to perform functional, sport specific rehab and return to play. The video link that is provided in the post doesn't demonstrate the proper taping technique as described by Mulligan and his Mulligan Concept Instructors. The technique is usually performed with the foot in a relaxed position, utilizing both hands to create the fibular glide obliquely back up on the tibia. One hand stabilizes the medial malleolus, creating a counterforce to the movement as the other hand, with the lateral malleolus sitting in between the thenar and hypothenar eminence creates the glide of the fibula in a poster-superior direction. If the glide is performed correctly, the forefoot should evert. While holding this position repeat the painful motion to make sure the range has improved and if so, then repeat the procedure with leukotape. If the ROM has not improved both in range and pain, then an alteration in the direction should be attempted and re-tested to see if improvement occurs. The tape should be started on the skin just inferior and anterior to the lateral malleolus going into the direction of the appropriate fibular glide. The glide is then re-applied and the tape is tensioned into that direction and spiraled up the lower leg. A second strip is repeated over the first. If the tape is applied in the correct direction and with enough tension, the athlete should notice significant improvement in their symptoms when they ambulate and they should feel an improved sense of stability.
Mulligan has produced videos on the taping technique and I would encourage anyone interested to seek these clips on youtube (search Mulligan ankle taping). The clip shows the taping being performed with 2 clinicians, but it can easily be done by yourself if you utilize your leg to aid in holding the foot position while your gliding hand maintains the corrected fibular position. The hand that was providing the counterforce when performing the glide, then grabs the other end of the tape and places the correct amount of tension and spirals the tape up the lower leg.

Colby Mangum said...

As Todd mentioned above, I have also used the Mulligan technique for a distance runner who had a history of recurrent ankle sprains as well as subluxing peroneal tendon. I used leukotape pulling posteriorly while gliding the fibula into the correct position. With this tape, he was able to increase his mileage without having another sprain or subluxation of tendon around his lateral malleolus. He also reported feeling "more secure" with this tape as opposed to a standard ankle tape or brace, which were both tried with this particular patient. I believe that if the clinician properly applies the tape with the glide and the patient has "bought into" the tape and understands its purpose; this can be a great tool to use. The psychological effect is huge and I personally believe that was probably 80% of why it was a success with the runner that I treated. The fibular taping is not a stand-alone treatment, but is a great addition especially if the patient believes that it is stabilizing and beneficial.

Patrick McKeon said...

Excellent commentary Callie. Wheeler et al. bring up very good points with regard to the effects of fibular taping on those with ankle instability. Perhaps there are responders and non-responders to this type of taping technique. One way of determining this might be to take the approach of Caffrey et al. JOSPT 2009;39(11):799-806 in determining whether those who perform functional tests feel unstable in their performance. With the application of the fibular taping technique, determining changes in a patient's confidence, perception of stability, and changes in performance outcomes may be an appropriate way to explore these interventions from a patient-oriented perspective. Changes in functional impairments such as balance or dorsiflexion are important as well, but this is more directed toward disease-oriented evidence. Finding the interaction between the two types of evidence across multiple treatments of fibular taping makes a great deal of sense from both clinician-oriented and laboratory-oriented perspectives.

Shannon Snell said...

I agree with everything that Todd and Colby said. I have recently used the fibular taping technique on one of my track and field athletes. At first I tried the traditional ankle taping but she did not like it. She felt the taping was too restricting. The next day I tried the fibular taping on her and she liked it. She told me that she finally felt confident she would not re-injure her ankle while practicing her high jump. The confidence the athletes gain from the taping will allow for them to perform their sport fully without worrying about injury. Another benefit is that the athlete would be able to partake in more rehabilitative exercises which would hopefully help to prevent any re-injuries.

Jake Marshall ATC CES said...

I have had one of the PTs I work with apply the posterior glide tape on me before I personally went to the gym for a lower body work out after my most recent sprain. I have never had full dorsiflexion ROM but I have even less on my left side after two serious sprains of my left ankle. I was able to achieve a deeper squat with proper form and less pain while wearing the tape than I was without it. I still use the posterior glidde technique from time to time if I know I am going to be doing weighted squats at the gym. I did not feel any more "stable" with this particular taping techinque but it did help with ROM and maintaining appropriate form throughout the movement.

I have not used it on any of my athletes. In my current position all the off the field rehab is done by the PTs so I am just taping for practice and game stability and injury prevention.

Zach Johnson said...

I have used fibular taping on collegiate soccer athletes and have had limited but mixed results so this article was very helpful to me to help learn more about the effects and changes in dorsiflexion range of motion. I agree with Patrick that functional tests would be great as a next step. Thinking clinically, I also believe that patient reported outcomes for athletes after a practice or game would be a great way to understand how athletes feel after using a fibular taping technique for a long period of time. I personally have had athletes tell me that this tape job is working great, but come to me near the end of a game/practice and complain that the tape is not working anymore and is irritating them, so I would like to see larger outcomes of this type moving forward as well.

Maddy said...

Excellent summary provided regarding fibular taping versus traditional taping!! I've used fibular taping in my college sporting period and really have great time while doing some athletic movement. Although I'm pleased to learn some different types of benefits of using such taping process. Thanks.

Kaitlyn Grossman ATC said...

I find this article quite interesting. As a clinician I have not learned about or used this tape much, but as a CAI patient myself, I had this done in high school. I can understand the theoretical idea behind it all, and I can say as an athlete in who had this done, it does improve confidence and a feeling of support to the ankle joint. This resurfaces a useful taping technique, not necessarily to increase dorsiflexion, but to prevent ankle sprains and provide the mental support to the athlete. I will try to make it a point to try this technique this upcoming year, and I look forward to hearing the feedback. Great article!

Jeffrey Driban said...

Kaitlyn, thanks for sharing your experience. Keep us posted on how the taping works for you this coming year.

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