Chris Whatman

Kinesio Taping in Treatment and Prevention of Sports Injuries A Meta-Analysis of the Evidence for its Effectiveness

Kinesio tape (KT) is an elastic therapeutic tape used for treating sports injuries and a variety of other disorders. Chiropractor, Dr Kenso Kase, developed KT taping techniques in the 1970s. It is claimed that KT supports injuredmuscles and joints and helps relieve pain by lifting the skin and allowing improved blood and lymph flow. The profile of KT rose after the tape was donated to 58 countries for use during the 2008 Olympic Games, and was seen on high-profile athletes. Practitioners are asking whether they should use KT over other elastic adhesive tapes. The aim of this review was to evaluate, using meta-analysis, the effectiveness ofKT in the treatment and prevention of sports injuries. Electronic databases including SPORTDiscus®, Scopus,MEDLINE, ScienceDirect and sports medicine websites were searched using keywords ‘kinesio taping/tape’. From 97 articles, ten met the inclusion criteria (article reported data for effect of KT on a musculoskeletal outcome and had a control group) and were retained for meta-analyses.Magnitude-based inferences were used to assess clinical worth of positive outcomes reported in studies. Only two studies investigated sports-related injuries (shoulder impingement), and just one of these involved injured athletes. Studies attending to musculoskeletal outcomes in healthy participants were included on the basis that these outcomes may have implications for the prevention of sporting injuries. The efficacy of KT in pain relief was trivial given there were no clinically important results. There were inconsistent range-of-motion outcome results, with at least small beneficial results seen in two studies, but trivial results in two other studies across numerous joint measurements. There was a likely beneficial effect for proprioception regarding grip force sense error, but no positive outcome for ankle proprioception. Seven outcomes relating to strength were beneficial, although there were numerous trivial findings for quadriceps and hamstrings peak torque, and grip strength measures. KT had some substantial effects on muscle activity, but it was unclear whether these changes were beneficial or harmful. In conclusion, there was little quality evidence to support the use ofKT over other types of elastic taping in themanagement or prevention of sports injuries. KT may have a small beneficial role in improving strength, range of motion in certain injured cohorts and force sense error compared with other tapes, but further studies are needed to confirm these findings. The amount of case study and anecdotal support for KT warrants well designed experimental research, particularly pertaining to sporting injuries, so that practitioners can be confident that KT is beneficial for their athletes.

The reliability and validity of physiotherapist visual rating of dynamic pelvis and knee alignment in young athletes

PURPOSE To investigate visual rating of pelvis and knee position in young athletes during lower extremity functional tests. METHODS Pelvis and knee alignment, in 23 athletes, was visually rated by 66 physiotherapists. Peak two-dimensional (2D) and three-dimensional (3D) kinematics were also quantified. Ratings were compared to consensus visual ratings of an expert panel. The consensus ratings were also compared to peak kinematics. Reliability was determined using percentage agreement (PA) and the first order agreement coefficient (AC1). Sensitivity, specificity, diagnostic odds ratio (DOR) and differences in kinematics between groups based on the expert visual ratings were calculated to assess rating validity. RESULTS Mean intra-rater agreement was substantial (PA: 79-88%, AC1: 0.60-0.78). Inter-rater agreement ranged from fair to substantial (PA: 67-80%; AC1: 0.37-0.61). Sensitivity (≥80%) and specificity (≥50%) were acceptable for all tests except the Drop Jump. Experience (DOR 1.6-2.8 times better) and slower movement (4.9 times better) improved rating accuracy. Peak 3D and 2D kinematics were different between groups rated as having good versus poor alignment by the experts. CONCLUSIONS Visual rating by physiotherapists is a valid tool for identifying young athletes with poor frontal plane dynamic pelvis and knee alignment.

Acute changes in passive stiffness and range of motion post-stretching

PURPOSE To investigate the change in passive hamstring stiffness and knee joint range of motion (ROM) following a single bout of passive hamstring stretching with or without active movement post-stretch. METHODS A Kincom dynamometer was used to measure knee joint ROM and passive stiffness in nine participants. Each participant completed three conditions: (1) a baseline test of knee extension ROM and passive stiffness, 4×20 second static stretches of the hamstring muscles and repeat testing immediately post-stretch and at 5min intervals for 20min; (2) the same procedure with the addition of 90s of isotonic knee flexion and extension between tests over the 20min post-stretching period; (3) the control condition involving repeat tests only over 20min. RESULTS Knee joint ROM increased by 4-5° post-stretch in both intervention conditions, relative to the control condition, but there was no clear evidence of the ROM increase lasting longer than 5min. Both intervention conditions showed a small decrease in passive stiffness post-stretch and it is likely this effect lasted for at least 20min. CONCLUSIONS An isolated bout of stretching produced a small, short-lived change in ROM and stiffness. This has implications for the design of warm-up protocols.

The acute effects of hamstring stretching and vibration on dynamic knee joint range of motion and jump performance

OBJECTIVES To investigate dynamic knee joint range of motion (ROM) and jump performance following a single bout of passive hamstring stretching, hamstring vibration or a combination of both. DESIGN Knee joint dynamic ROM and jump performance were assessed prior to, immediately following and 10 min following stretching and vibration of the hamstring muscles. The study was a crossover design with all participants completing three interventions: (1) 3 x 30s static stretches of the hamstring muscles, (2) 3 x 30s bouts of vibration applied to the hamstring muscles, (3) a combination of the stretching and vibration protocols. SETTING The study was conducted in the muscle performance laboratory of Auckland University of Technology. PARTICIPANTS Ten male participants (mean+/-SD, age 22.7+/-3.6 yr, height 181.2+/-6.51 cm, mass 84.9+/-12.3 kg) with no musculoskeletal problems volunteered to participate in this study. MAIN OUTCOME MEASURES Dynamic knee joint ROM and jump height. RESULTS The only increase in dynamic knee joint ROM was between the pre and immediate post assessments in the stretching intervention (mean change 3 degrees or 2%, ES=0.4, p=0.011). There was no statistically significant interaction between intervention and time for any of the jump performance assessments. CONCLUSIONS A single bout of stretching produced a small, short-lived change in dynamic knee joint ROM but did not change jump performance. The addition of vibration alone or in combination with stretching did not influence dynamic knee joint ROM or jump performance.

Kinematics during lower extremity functional screening tests - are they reliable and related to jogging?

PURPOSE To investigate the within-day and between-day reliability of 3D lower extremity kinematics during five lower extremity functional screening tests and to assess the association between these kinematics and those recorded during jogging. METHODS Peak three-dimensional lower extremity kinematics were quantified in 25 uninjured participants during five lower extremity functional tests and jogging. A nine camera motion analysis system (Qualysis Medical AB, Sweden) was used to capture three trials of all tests. All functional tests were repeated by 10 participants one to two days later. Visual 3D (C-Motion Inc, USA) and Labview were used to process all data. Intraclass correlation coefficients (ICC) and typical errors (TE) were used to assess within- and between-day reliability of all variables. Pearson correlation coefficients were used to evaluate the association between peak joint kinematics during the functional tests and jogging. RESULTS For the majority of kinematic variables the within-day reliability was excellent (ICC ≥ 0.92) and the between-day reliability was excellent to good (ICC ≥ 0.80). The correlation between kinematics of the functional tests and jogging was generally large to very large (r = 0.53 to 0.93). CONCLUSIONS These results suggest these lower extremity functional screening tests should prove a useful clinical tool when assessing dynamic lower extremity alignment.

Gluteus Medius: Applied Anatomy, Dysfunction, Assessment, and Progressive Strengthening.

ONE OF THE MORE COMMON DEFICITS IDENTIFIED BY REHABILITATION SPECIALISTS AND STRENGTH AND CONDITIONING PRACTITIONERS IS WEAKNESS OF THE GLUTEI MUSCLES, PARTICULARLY THE GLUTEUS MEDIUS (GM). GLUTEAL WEAKNESS CAN REDUCE ATHLETIC PERFORMANCE AND PRECIPITATE A NUMBER OF LOWER EXTREMITY INJURIES. IN THIS ARTICLE, WE DISCUSS THE ANATOMY AND FUNCTION OF THE GM MUSCULATURE, PRESENT A REVIEW OF THE CURRENT LITERATURE PERTAINING TO GM CONDITIONING, AND RECOMMEND AN EXERCISE MODEL BASED ON CURRENT STRENGTHENING GUIDELINES.

Biomechanics Associated with Patellofemoral Pain and ACL Injuries in Sports

BackgroundKnee injuries are prevalent among a variety of competitive sports and can impact an athlete’s ability to continue to participate in their sport or, in the worst case, end an athlete’s career.ObjectiveThe aim was to evaluate biomechanics associated with both patellofemoral pain syndrome (PFPS) and anterior cruciate ligament (ACL) injuries (in sports involving landing, change in direction, or rapid deceleration) across the three time points frequently reported in the literature: pre-injury, at the time of injury, and following injury.MethodsA search of the literature was conducted for research evaluating biomechanics associated with ACL injury and PFPS. The Web of Science, SPORTDiscus, EBSCO, PubMed, and CINAHL databases, to March 2015, were searched, and journal articles focused on ACL injuries and PFPS in sports that met the inclusion criteria were reviewed. The search methodology was created with the intent of extracting case–control, case, and cohort studies of knee injury in athletic populations. The search strategy was restricted to only full-text articles published in English. These articles were included in the review if they met all of the required selection criteria. The following inclusion criteria were used: (1) The study must report lower extremity biomechanics in one of the following settings: (a) a comparison of currently injured and uninjured participants, (b) a prospective study evaluating risk factors for injury, or (c) a study reporting on the injury event itself. (2) The study must include only currently active participants who were similar at baseline (i.e. healthy, high school level basketball players currently in-season) and include biomechanical analysis of either landing, change in direction, or rapid deceleration. (3) The study must include currently injured participants. The studies were graded on the basis of quality, which served as an indication of risk of bias. An adapted version of the ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) guidelines was used to rate observational research.ResultsFifteen journal articles focusing on ACL injuries and PFPS in sports met the inclusion criteria. These included three associated with both ACL injuries and PFPS across multiple time points. There was limited evidence for an association between ankle biomechanics and knee injury, with only one ACL injury study identifying decreased plantar flexion in association with injury.LimitationsOnly prospective studies can determine biomechanical risk factors associated with ACL injuries and PFPS. Case studies and case–control studies do not allow for the determination of risk factors associated with both ACL injuries and PFPS as there is no certainty regarding the presence of the observed biomechanics prior to the onset of injury. Further, each study design has its own set of limitations. Lastly, the majority of the studies included in this review had adult female participants.ConclusionBy evaluating several different study designs looking at knee injuries during high-risk manoeuvres, we were able to obtain a holistic perspective of biomechanics associated with PFPS and ACL injuries. Looking at different biomechanical research approaches allowed us to assess not only the mechanism of injury, but also to look for commonalities in biomechanics (in particular, altered frontal plane mechanics at the knee and altered sagittal plane mechanics at the knee and hip) between injured and uninjured participants pre-injury, at the time of injury, and following injury, to better understand potential causes of PFPS and ACL injury. Development of injury prevention programmes should focus on correcting these mechanics observed across the three time points during high-risk manoeuvres as this may help decrease the prevalence of ACL injury and PFPS. Programmes focusing not only on neuromuscular training, but also skill-specific training focused on correcting mechanics during these high-risk manoeuvres may be of greatest benefit regarding prevention. Future research should consider the impact of cumulative loading on knee injury risk. Additionally, better techniques for assessing mechanics in-game are needed in order to facilitate injury prevention and screening strategies.

A review of the risk factors for lower extremity overuse injuries in young elite female ballet dancers.

The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.

Assessing dynamic knee joint range of motion using siliconcoach

OBJECTIVE Compared to measuring static range of motion (ROM) the assessment of dynamic ROM has received very little research attention. The purpose of this study therefore was to determine the reliability of the siliconCOACH motion analysis system for assessing dynamic ROM of the knee joint. DESIGN Test-retest reliability. SETTING Laboratory. PARTICIPANTS Ten male subjects unable to fully extend their knee at 90° of hip flexion. MAIN OUTCOME MEASURES Static and dynamic ROM over four separate occasions using a video camera and siliconCOACH digitized footage. RESULTS The variation between days for both static and dynamic measurements was minimal (CV<2.1%). With regards to test-retest reliability, the ICC values, were high (ICC⩾0.89) for both assessment techniques and the static and dynamic ROM measurements did not differ significantly (p<0.05) on any given testing occasion. CONCLUSIONS The high ICC and low CVs indicate a high degree of stability between testing days for the procedures used in this study to assess dynamic ROM. Software programmes such as siliconCOACH seem ideal for determining the end range of a movement for both static and dynamic ROM and would seem to offer a functional and cost effective assessment strategy for those practitioners and clinicians interested in the effects of various interventions on ROM.

The effect of reduced ankle dorsiflexion on lower extremity mechanics during landing: A systematic review.

OBJECTIVES To examine the evidence for effect of restricted ankle dorsiflexion range of motion on lower-extremity landing mechanics. DESIGN Literature review. METHODS Systematic search of the literature. Articles critiqued by two reviewers. RESULTS Six studies were identified that investigated the effect of restricted DF ROM on landing mechanics. Overall, results suggest that landing mechanics are altered with restricted DF ROM, but studies disagree as to the particular mechanical variables affected. CONCLUSIONS There is evidence that restricted dorsiflexion range of motion may alter lower-extremity landing mechanics in a manner, which predisposes athletes to injury. Interpretation of results was made difficult by the variation in landing tasks investigated and the lack studies investigating sport-specific landing tasks. The focus of studies on specific mechanical variables rather than mechanical patterns and the analysis of pooled data in the presence of different compensation strategies between participants also made interpretation difficult. These areas require further research.