Effects of Ankle Eversion Taping on Muscle Activity in Chronic Ankle
Instability Adults during Sudden Inversion
JONGSUNG CHANG
Department of Physical Therapy, Yeungnam University Collage, Daegu,
SOUTH KOREA
SEUNGMIN NAM
Department of Sports Rehabilitation & Exercise Management, Yeungnam University Collage, Daegu,
SOUTH KOREA
Abstract: - Ankle sprain is an injury in which the ligament of the ankle is stretched or torn when a strong
external force is applied to the ankle joint. This study was conducted to investigate the effect of ankle eversion
taping on muscle activity in chronic ankle instability adults during sudden inversion. The subjects of this study
were forty subjects with ankle instability. The subjects performed sudden ankle inversion on the trapdoor with
and without taping applied. The application of taping was conducted randomly. The subjects performed the
trapdoor test three times using dominant feet with a 60 sec rest period between tests. This study assessed
muscle activity during sudden ankle inversion three times. The results of the ankle eversion taping showed a
significant difference of Tibialis Anterior, Peroneus Longus, Peroneus Brevis muscles activity than no taping
(p<.05). But, ankle eversion taping showed no significant difference of Gastrocnemius muscle activity than no
taping (p>.05). The application of taping can be used as a method of prevention and intervention of ankle
injury.
Key-Words: - Ankle Eversion Taping, Chronic Ankle Instability, Ankle Sudden Inversion, Muscle Activity.
Received: October 26, 2022. Revised: November 22, 2022. Accepted: December 19, 2022. Published: December 31, 2022.
1 Introduction
Ankle sprain is an injury in which a ligament of the
ankle is stretched or torn when a strong external
force is applied to the ankle joint, [1]. In particular,
ankle sprains account for 85% of lateral ankle
damage due to inversion. This is because the lateral
side of the ankle is composed of relatively weaker
structures and tissues than the medial side. Also,
since the range of motion (ROM) of inversion is
greater than that of the ankle joint, it is easily
damaged in inversion motion, [2]. According to
previous studies, the area where sport injuries
frequently occur is the lower extremity, and among
them, the ankle joint occupies the second highest
frequency. This ankle sprain is a very common
injury in sport activities, and it accounts for a high
frequency of injuries not only in athletes but also in
adults who participate in sport activities, [3].
Ankle sprain is the main cause of activity disorder,
and symptoms such as pain, edema, muscle
weakness, and instability appear, [4]. Anterior
talofibular ligament (ATFL) and calcaneofibular
ligament (CFL) injuries are common in most ankle
sprains. Due to this damage, the stability between
the talus and fibula and between the calcaneus and
fibula deteriorates, leading to chronic ankle
instability, [5]. Chronic ankle instability means that
ligament relaxation is confirmed through physical
tests such as talar tilt test and anterior drawer test. It
also means complaining of subjective feelings such
as repetitive ankle sprains and giving-way of ankle
joints in active daily life, [6]. There are two major
causes of chronic ankle instability. The first is
ankle joint muscle weakness. In particular, it has
been reported that the tibialis anterior and peroneus
muscles, along with other muscles around the ankle
joint, play a role in protecting the ankle sprain
during sudden ankle inversion and plantar flexion,
[7]. The second is a decrease in proprioceptor
function. It has been reported that this delays the
reaction time of the peroneus muscle during sudden
ankle inversion, [8]. As a result, the decline in
proprioceptor function makes it difficult to control
posture and causes ankle instability. In other words,
when the muscle strength and proprioceptor around
the ankle joint are normal, the stability of the ankle
joint can be obtained, and re-injury can be
prevented, [9].
Taping, balance training, proprioceptor
training, muscle strength training are applied
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clinically to improve ankle joint stability and
prevent ankle sprain. In particular, it has been
reported that taping is effective in reducing the
recurrence of ankle sprains and managing chronic
ankle instability, [10]. In addition, compared to
various training methods, it can be easily applied
and has the advantage of bringing an immediate
effect. Therefore, the application of taping can be
recommended as a primary treatment for patients
with chronic ankle instability. According to a
previous study, it was reported that taping applied
to the ankle joint improved the proprioceptor of the
ankle and assisted the muscle to be effective in
improving the balance function and range of
motion (ROM) of patients with chronic ankle
instability, [11].
Many studies have reported that such taping
has a positive effect in terms of prevention or
treatment of chronic ankle instability. However,
there is a lack of studies investigating the effect of
taping application on the ankle joint in the situation
of the mechanical process and damage mechanism
in which the ankle joint is actually sprained.
Therefore, this study used the trap door used for
kinematic analysis of ankle injury. In other words,
in a state where a dynamic situation in which the
ankle joint is sprained was artificially provided, the
effect of taping application on ankle joint muscle
activation was investigated. The purpose of this
study is to find out how ankle eversion taping
affects the ankle muscles in sudden inversion
situations, and to secure grounds for prevention and
intervention of ankle injury by taping.
2 Methods
2.1 Subjects
This study was conducted using a randomized
controlled design. Forty subjects with ankle
instability but no history of neurological or
psychiatric disease were recruited. Inclusion
criteria were as follows: no history of a neurologic
or psychiatric disease, no significant visual or
vestibular impairment, the ability to independently
support body weight during the task, experience of
ankle sprain at least once and of ‘giving way’ of the
ankle joint, and a Cumberland ankle instability tool
score of < 24. All subjects gave their informed
consent for inclusion before they participated in the
study. The study was conducted under the
Declaration of Helsinki, and the protocol was
approved by the Ethics Committee of Daegu
University (IRB 1040621-201511-HR-018-02).
2.2 Study Protocol
This study used kinesiology tape with elasticity. The
patient is seated in a comfortable position on a table
that is high enough to prevent the feet from touching
the ground, while the therapist applies the tape on
the damaged ankle stretched with a tension of 70 –
80%, [12]. Ankle Eversion Taping (AET) method
was used for taping. Ankle eversion taping was
applied while gliding the distal fibula. First, place
the hand on the anterior and inferior distal fibula,
and hold the distal leg with the opposite hand and fix
it. The therapist then glides the distal fibula posterior
and superior. With gliding applied, taping is applied
to the lateral malleolus, and the taping is applied
posterior and superior to the distal fibula (Fig. 1).
The subject performed sudden ankle inversion on the
trapdoor with and without taping applied. The
application of taping was conducted randomly, and
each measurement was performed three times
depending on whether taping was applied or not.
The subjects performed the trapdoor test three times
using dominant feet with a 60 sec rest period
between tests. Since the subjects could detect when
the trap door would open, visual and auditory
information was blocked.
Fig. 1: Ankle Eversion Taping
2.3 Measurement Tools and Measurement
Methods
2.3.1 Trap Door
For examination, a trap door was employed to
analyze the ankle injuries kinematically, [13]. The
trap door was a foothold designed specifically to
induce sudden ankle joint inversion, similar to a
lateral ankle joint strain. Once a patient stood on
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the trap door with bare feet, a rope connected to the
vertical supports at both sides was pulled, and the
trap door opened, thereby inducing sudden
inversion of ankle joints. The trapdoor platform
rotated in an inverted manner by 25° from the
neutral standing position. No resistance was applied
to restrict trap door movement other than hinge
friction. The subjects performed the trapdoor test
three times using dominant feet with a 60 sec rest
period between tests (Fig. 2).
Fig. 2 : Trap door
2.3.2 Electromyography
Muscle activity was measured by surface
electromyography (EMG) (MP35, Biopac, Goleta,
CA, USA). Signals were recorded using Biopac
student lab PRO 3.7.1 software (Biopac System,
USA). EMG electrode locations were as follows:
tibialis anterior (TA), peroneus longus (PL),
peroneus brevis (PB), and lateral gastrocnemius
(GAS). The electrodes were placed as described by
the surface EMG for non-invasive assessment of
muscles (SENIAM) protocol, [14]. A ground
electrode was placed on the lateral malleolus. For
statistical analysis, EMG signal data were sampled
at 1,000 Hz, bandpass filtered between 30 and 500
Hz, and converted to digital signals using Biopac
student lab PRO 3.7.1. A notch filter at 60 Hz was
employed to clean the power line noises. Root
mean square (RMS) values of EMG data were
calculated and were measured during trapdoor
landing in 3 sessions with a 60-second rest period
between repetitions. Maximum EMG signals were
acquired during maximum voluntary isometric
contractions (MVIC) for 2 seconds. %MVIC values
2.4 Statistical Analyses
The Shapiro-Wilk test was performed to check for
the normal distribution of each measurement item,
and the results for all items satisfied normality. The
data were presented as mean ± standard deviation
(Mean ± SD), and the general characteristics of the
subjects were presented as descriptive statistics.
One-way repeated ANOVA was used for the group
analysis. Mauchly's mauchly's sphericity test was
satisfied (p>0.05), and univariate analysis and within-
subject effect test were performed. The data collected
for this study were statistically processed using
SPSS 26.0 for Windows (IBM, New York, USA)
and the statistical significance level P value of <
0.05.
3 Results
The demographic statistics of a single group are
shown in Table 1. Forty subjects (gender: male 28,
female 12; age: 23.27±1.94 years; height:
171.82±7.79cm; weight: 66.15±14.76kg). Ankle
eversion taping showed a significant difference of
Tibialis Anterior, Peroneus Longus, Peroneus
Brevis muscle activity than no taping (p<.05).
When also Ankle eversion taping was applied,
muscle activity was improved compared to no
taping. But, ankle eversion taping showed no
significant difference of Gastrocnemius muscle
activity than no taping (p>.05) (Table 2).
Table 1. General characteristics of subjects
Group (N=40)
Gender (M/F)
28/12
Age (year)
23.27±1.94
Height (㎝)
171.82±7.79
Weight (㎏)
66.15±14.76
Weight (㎏)
21.21±3.41
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Table 2. Comparison of the ankle muscle activity between the taping and non-taping
MVIC%
AETa
(Mean±SD)
NTb
(Mean±SD)
p
post-hoc
Tibialis Anterior
38.95±18.75
27.14±12.78
.001*
a>b
Peroneus Longus
69.01±19.53
52.18±20.25
.000*
a>b
Peroneus Brevis
23.37±7.91
19.43±7.52
.013*
a>b
Gastrocnemius
63.23±23.86
57.93±22.03
.301
Mean±SD: Mean±Standard Deviation
AET: Ankle eversion taping; NT: No taping
*p<.05
4 Discussion
This study was conducted to investigate the effect
of ankle eversion taping on the muscle activity of
the ankle muscle in adults with chronic ankle
instability. As participation in sport activities
increases, ankle sprains caused by ankle inversion
are very common. In other words, the application
of taping was intended to prevent ankle sprain and
to present it as one of the appropriate intervention
methods for chronic ankle instability. In addition,
most of the previous studies simply applied taping,
followed by functional evaluation and simple
muscle activity evaluation. However, this study
aimed to investigate the effect of taping application
on ankle joint muscle activation in the state of
artificially providing a dynamic situation in which
the ankle joint is sprained.
As a result of this study, the muscle activity of
the tibialis anterior was 27.14±12.78% in no taping
and 38.95±18.75% when taping was applied,
showing a significant difference. The muscle
activity of the peroneus longus was 52.18±20.25%
with no taping and 69.01±19.53% with taping,
showing a significant difference. The muscle
activity of peroneus brevis was 19.43±7.52% with
no taping and 23.37±7.91% with taping, showing a
significant difference. The tibialis anterior is the
agonist of ankle dorsiflexion, and the peroneus
muscle is the agonist of ankle eversion. That is, the
application of taping in the ankle eversion direction
applied in this study assisted ankle dorsiflexion and
eversion. Therefore, it is considered that there was
a significant increase in muscle activity when
taping was applied.
In addition, according to a previous study,
when taping was applied to patients with
patellofemoral pain syndrome (PFPS), muscle
activity of the vastus medialis and vastus lateralis
muscles significantly increased, [15]. Also, when
taping was applied to soccer players and ankle
sudden inversion was performed, it was consistent
with the results of a study that showed a significant
increase in muscle activity of the peroneus longus
muscle, [16]. According to previous studies, the
application of taping serves as mechanical support
and proprioceptive feedback, and it has been
reported that it is effective in improving muscle
function, [17]. In other words, it improves the
elastic force of elastic muscle taping to assist
muscle force, and when the muscle is stretched, the
force increases as the feedback function of sensory
receptors in the skin increases. In this study, when
artificial sudden ankle inversion was performed, it
is considered that higher muscle activity was
measured compared to no taping because taping
increased the auxiliary and proprioceptive feedback
function of the muscle. Taping can be used as a
way to maximize athletic performance. It improves
the function of muscles and joints, and can be
recommended as a method of prevention and
intervention of injuries.
As a result of this study, the muscle activity of
gastrocnemius was 57.93±22.03% in no taping and
63.26±23.86 when taping was applied, but there
was no statistically significant difference. These
results were not consistent with the results of a
study showing that the gastrocnemius muscle had a
positive effect on dynamic ankle stability, [18]. In
other words, the gastrocnemius muscle affects
stability as a two-joint muscle that affects the
movement of the knee joint and ankle joint in a
dynamic environment. However, it is considered
that the gastrocnemius muscle did not play a role in
ankle stability when ankle sudden inversion, not a
dynamic environment, was applied in this study.
Also, the gastrocnemius muscle is an ankle plantar
flexion agonist. Since taping was applied in the
direction of ankle eversion and dorsiflexion, it is
considered that the presence or absence of taping
did not affect gastrocnemius muscle activity. In
addition, according to previous studies, it was
reported that the activity of the quadriceps and
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gluteus muscles was greater than that of the
gastrocnemius muscle due to the limitation of ankle
movement when taping was applied. In other
words, it is considered that there was no difference
in gastrocnemius muscle activity in this study as
taping provided ankle movement restriction, [19].
The limitations of the study are as follows. In
the first dynamic situation, ankle sudden inversion
was induced and was not measured. In fact, ankle
sprains often occur in dynamic situations.
However, in this study, ankle sudden inversion was
induced and measured in a static standing state. A
study considering the dynamic situation is needed
in the future. The measurement was limited to the
muscles around the ankle joint. It has been reported
that the knee and hip strategy is used more often
than the ankle strategy when a sudden posture
change occurs, [20]. It is necessary to measure
muscles around the knee and hip in future studies.
Third, the small number of subjects makes it
difficult to generalize. As a single group study,
further studies with a larger number of subjects are
needed.
5 Conclusion
Taping intervention is used for the purpose of
improving exercise performance and preventing
sport injury. Due to the advantage of being easily
applied without any special side effects, it is also
used by the general public as an intervention
method for acute or chronic musculoskeletal
patients. In summary, the application of taping had
a positive effect on the improvement of muscle
activity around the ankle during sudden ankle
inversion. Therefore, the application of taping can
be used as a method of prevention and intervention
of ankle injury.
Acknowledgement:
This research was supported by the Yeungnam
University College Research Grants in 2022.
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Contribution of Individual Authors to the
Creation of a Scientific Article (Ghostwriting
Policy)
-JongSung Chang has organized and executed the
experiments.
-SeungMin Nam was responsible for the Statistics.
Creative Commons Attribution License 4.0
(Attribution 4.0 International, CC BY 4.0)
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Creative Commons Attribution License 4.0
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