Kinesio and Ankle

KINESIOTAPING AND ANKLE SPRAIN

WHICH COMBINATION? ANNUAL KINESIOTAPING SYMPOSIUM

ORLANDO FL

JUNE 24-26

STEFANO FRASSINE DOTT. FT. CKTI

Kinesio and Ankle

Is it important to have a workshop about the use of kinesiotaping correlated to the treatment

of a sprained ankle?

Kinesio and Ankle

“ In total, 1055 injuries were reported, resulting in an incidence of 96.1 injuries per 1000 registered athletes. Half of the injuries (49.6%) were expected to prevent the athlete from participating in competition or training. The most prevalent diagnoses were ankle sprains and thigh strains. The majority (72.5%) of injuries were incurred in competition. One third of the injuries were caused by contact with another athlete, followed by overuse (22%) and noncontact incidences (20%). Injuries were reported from all sports, but their incidence and characteristics varied substantially. In relation to the number of registered athletes, the risk of incurring an injury was highest in soccer, taekwondo, hockey, handball, weightlifting, and boxing (all >or=15% of the athletes) and lowest for sailing, canoeing/kayaking, rowing, synchronized swimming, diving, fencing, and swimming”

Am J Sports Med. 2009 Nov;37(11):2165-72. Epub 2009 Sep 25.

Sports injuries during the Summer Olympic Games 2008.

Junge A, Engebretsen L, Mountjoy ML, Alonso JM, Renström PA, Aubry MJ, Dvorak J.

Kinesio and Ankle

“This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination.” Sports Med Arthrosc Rehabil Ther Technol. 2009 Jul 30;1:14.

«Understanding acute ankle ligamentous sprain injury in sports.»

Fong DT, Chan YY, Mok KM, Yung PSh, Chan KM.

Kinesio and Ankle

Statistically it is the most frequent injuriy that occurs during sports activities “Injury rates during games were higher than injury rate during practice sessions.”

Ankle sprain injuries: a 2-year prospective cohort study in female Greek professional basketball

players.Kofotolis N, Kellis E.

Jump sports and contact sports are, statistically, the most involved in this clinical condition Am J Sports Med. 2009 Nov;37(11):2165-72. Epub 2009 Sep 25.

Sports injuries during the Summer Olympic Games 2008.

Junge A, Engebretsen L, Mountjoy ML, Alonso JM, Renström PA, Aubry MJ, Dvorak J.

KINESIO AND ANKLE

Risk factors?

KINESIO AND ANKLE

Extrinsic risk factors:

- Sport shoes «impact sport and jump sport performed with specific shoes have a higher risk of ankle sprain than sports performed without shoes. (as beach volley f.i.)»

”Foot and ankle injuries in the barefoot sports.”

Vormittag K Calonje R Briner WW

Curr Sports Med Rep. 2009 Sep-Oct;8(5):262-6.

indoor).”

KINESIO AND ANKLE

“some data suggest that shoes may limit the adaptive pronation that occurs after footstrike during running gait. This pronation likely protects runners from injury.” Foot and ankle injuries in the barefoot sports.

Vormittag K Calonje R Briner WW

Curr Sports Med Rep. 2009 Sep-Oct;8(5):262-6.

KINESIO AND ANKLE

“RESULTS: No difference was noted in ankle sprain incidence between groups (chi(2) = 2.44, P = .20, relative risk = 1.47, 95% confidence interval [CI] = 0.32, 6.86). The incidence of ankle sprains was 1.33 per 1000 exposures in the cushioned column group (95% CI = 0.62, 3.51) and 1.96 per 1000 exposures in the noncushioned column group (95% CI = 0.51, 4.22). CONCLUSIONS: No increased incidence of ankle sprains was associated with shoe design.” J Athl Train. 2008 May-Jun;43(3):230-3.

“The role of shoe design in ankle sprain rates among collegiate basketball players.”

Curtis CK, Laudner KG, McLoda TA, McCaw ST.

KINESIO AND ANKLE

- Intensity of the sport activity:

“For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk.”

Sports Med Arthrosc Rehabil Ther Technol. 2009 Jul 30;1:14.

“Understanding acute ankle ligamentous sprain injury in sports.”

Fong DT, Chan YY, Mok KM, Yung PSh, Chan KM.

KINESIO AND ANKLE

INTRINSICK FACTORS:

- Width of the foot.

- Inversor muscles stronger than subversor muscles

- Plantar flexor muscles stronger than dorsal flexor muscles

- Dominant side. “Sports Med Arthrosc Rehabil Ther Technol. 2009 Jul 30;1:14.

Understanding acute ankle ligamentous sprain injury in sports.

Fong DT, Chan YY, Mok KM, Yung PSh, Chan KM.”

KINESIO AND ANKLE

Sensorimotor deficit: “The presence of sensorimotor deficits in patients who have suffered ankle sprains or who have chronic ankle instability has been recognized for several decades; however, a body of research literature has developed that elucidates potential physiologic explanations for these deficits. Alterations in a spectrum of sensorimotor measures make it apparent that conscious perception of afferent somatosensory information, reflex responses, and efferent motor control deficits are present with ankle instability. The specific origin of these deficits local to the ankle ligaments or at the spinal or supraspinal levels of motor control have yet to be fully elucidated. It is clear, however, that both feedback and feedforward mechanisms of motor control are altered with ankle instability.”

Clin Sports Med. 2008 Jul;27(3):353-70, vii.

Sensorimotor deficits with ankle sprains and chronic ankle instability.

Hertel J.

KINESIO AND ANKLE

- Fatigue:

“CONCLUSIONS: A significant decrease in median frequency of the peroneus longus muscle after plantar flexion fatigue and corresponding with a decreased firing rate, may be of importance, especially with regard to the role in countering the violent moment seen with inversion ankle sprains.” J Athl Train. 2008 May-Jun;43(3):230-3.

“The role of shoe design in ankle sprain rates among collegiate basketball players.”

Curtis CK, Laudner KG, McLoda TA, McCaw ST.

KINESIO AND ANKLE

PATHOGENETIC MECHANISM

KINESIO AND ANKLE

Anterior – Posterior stability It is insured by the gravity force which maintans the talus under the tibia’s surface. The tibia’s anterior and posterior edges prevent the anterior/posterior sliding of the talus.

This biomechanic condition depends by the integrity of the tibio-peoneal ligaments (both anterior and posterior)

KINESIO AND ANKLE

TRANSVERSAL STABILITY Both branches of the bi-malleolar pincers maintain the talus in the right position as long as the distance between tibia and fibula is maintained. This is strictly dependent by the integrity of the tibio-peroneal ligaments

KINESIO AND ANKLE

POSTERIOR VIEW

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IPERADDUCTION

- The top of the foot is pushed inside, the talus is rotated around its vertical axis

- The talus has been inclined with the lateral side donward and the medial side upward

- The talus is also projected ahead

KINESIO AND ANKLE

-this rotation combined with the aterior sliding of the talus provoke a diastase between tibia and fibula; the inferior tibio-fibular ligaments are stressed

- If this movement will continue the lateral ligaments of the ankle are also stressed.

KINESIO AND ANKLE

- The lateral rotation combined with the anterior sliding of the talus, pull the calcaneous in the same directions, so, the fibular- calcanear ligament is also stressed.

- If this movement is very marked the malleolar fracture could occur (sometimes a bi-malleolar fracture occur)

- (Kapandij; Boccardi)

KINESIO AND ANKLE

Muscle activity

- The tibialis posterioris pulls the scaphoid, uncovering the upper-external surface of the talus head

- The scaphoid pulls the cuboid thanks to the scapho-cuboid ligaments

- The cuboid pulls the calcaneous ahead and below the talus

KINESIO AND ANKLE

- The sinus of the talus is opened at maximum

- The pairs scaphoid-cuboid is pull medially and this condition pulls the forefoot ahead and inside

- At the same time the pairs scaphoid – cuboid rotate around an anterior-posterior axis passing through the chopart ligament. The combination between this rotation and the medially pulling determine the supination movement of the ankle.

KINESIO AND ANKLE

EXTERNAL LIGAMENTS OF THE ANKLE

- Ligament talus-peroneal anterioris: it runs from the anterior border of the malleolus peronealis to the antero-lateral border of the talus

- ligament peoneal-calcanear from the inferior apex of the malleolus to the posterior-external tuberculus of the calcaneus

- Ligament peroneal – talus posterioris frome the posterior border of the malleulus to the postero-external tuberculus of the talus

KINESIO AND ANKLE

KINESIO AND ANKLE

“Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle.”

Sports Med Arthrosc Rehabil Ther Technol. 2009 Jul 30;1:14.

Understanding acute ankle ligamentous sprain injury in sports.

Fong DT, Chan YY, Mok KM, Yung PSh, Chan KM.

KINESIO AND ANKLE

IPERABDUCTION

- The external side of the talus push against the peroneal malleolus that became a fulcrum because it is lower than the tibial one.

- The bimalleolar pincer is opened and, if the pressure will continuethat could provoke the anterior-inferior tibio-peroneal ligament.

- The talus is inclined with the lateral side upward and the medial side downword. Because of this the lateral igaments are damaged.

KINESIO AND ANKLE

MUSCLE ACTIVITY

- The proneus brevis pulls the cubouid outside and backword

- The cuboid pulls the scaphoid and the upper-internal surface of the talus head. The calcaneous it is pulled outside too.

- Scphoid and calcaneous are pulled outside and ahead. At the same time this pais of bones rotate producing a pronation

KINESIO AND ANKLE

MEDIAL LIGAMENTS OF THE ANKLE

- Deep lawier

Anterior: from the tibial malleolus to the internal side of the malleolus

Posterior: from the tibial malleolus to the internal side of the talus (posteriorly than the anterior one)

KINESIO AND ANKLE

- Superficial lawier

Ligament Deltoideus: from the tibial malleolus to the scaphoid (anterior bundle), and to the apophisis of the calcaneous (posterior bundle)

KINESIO AND ANKLE

KINESIO AND ANKLE

THE EVALUATION

The evaluation is the first step of the treattment.

Expecially in sport rehab it is really important to know as much as possible the sport-related foundmentals, inn order to restore the sport-specifics skills that the patient needs

KINESIO AND ANKLE

KINESIO AND ANKLE

THINGS TO CONSIDER:

- Pain: location (deep or superficial), intermittent/costant, type of pain (tension, burning, twinge pain, extc.), correlated symptoms (pince and needl)

All these factors give us a first idea of the structures involved.

KINESIO AND ANKLE

- 24hrs behaviour: night or early morning or evening? this point give us an information about the phase of the pathology and how the structures involved accept the load

- Provokative activities: these activities give us information about both the structures involved, the direction of the treattment, and the irritability of the joint

KINESIO AND ANKLE

- Past injuries: give us information about the «chronic instability» of the ankle.

“RESULTS: The ICCs for ankle functional and proprioceptive ability showed high reliability (ICCs ranging from 0.94 to 0.98). Additionally, isokinetic ankle joint inversion and eversion strength measurements represented good to high reliability (ICCs between 0.82 and 0.98). CONCLUSION: The functional test battery investigated in this study proved to be a reliable tool for the assessment of athletes with functional ankle instability. Therefore, clinicians may obtain reliable information from the functional test battery during the assessment of ankle joint performance in patients with functional ankle instability.”

Eur J Phys Rehabil Med. 2008 Dec;44(4):407-15.

Reliability of a functional test battery evaluating functionality, proprioception, and strength in recreational athletes with functional ankle instability.

Sekir U, Yildiz Y, Hazneci B, Ors F, Saka T, Aydin T

KINESIO AND ANKLE

TREATTMENT???

How to match-up patient’s clinical

condition and kinesio tape

application???? up

clinical condition and

kinesio tape

application????

clinical condition and

kinesio tape

application????

Patient condition

0 health 5 10 acute phase

Tension of the tape

0 % 50% 100%

clinical condition and

kinesio tape

application????

Patient condition

0 health 5 10 acute phase

Tension of the tape

0 % 50% 100%

HOW TO DECIDE THE CLINICAL CONDITION OF THE PATIENT?

4 PARAMETRES:

1. V.A.S. PAIN SCALE

2. QUALITY OF THE PAIN MECHANICAL/ CHEMICAL

3. IRRITABILITY

4. NEURODINAMIC TEST

clinical condition and

kinesio tape

application????

1. V.A.S. PAIN SCALE

0 5 10

0 = no pain

10 = the worst pain you have ever had

clinical condition and

kinesio tape

application????

2. QUALITY OF THE PAIN MECHANICAL/ CHEMICAL

MECHANICAL = pain is an “on-off pain”, so it is strictly correlated to the mechanical stimulation over the structure: no mechanical stimulation no pain. The pain appears just in the point of ROM where the wrong biomechanism is. Before and sometimes after this point the patient has no pain

clinical condition and

kinesio tape

application????

2. QUALITY OF THE PAIN MECHANICAL/ CHEMICAL

CHEMICAL = the pain is not strictly correlated with the amount of the mechanical stimulation, it is not an “on-off pain”, it stays for a long time after the stimulation even if the stimulation is removed

clinical condition and

kinesio tape

application????

3. IRRITABILITY

It is a combination between the VAS pain value and the quality of the pain,it is an index about the amount of load that a structure can accept(mechanical/chemical)

Higher the VAS is with a chemical pain, higher the irritability value is

Lower the VAS is with a mechanical pain, lower the irritability value is

clinical condition and

kinesio tape

application????

4. Neurodynamic tests

These are validated techniques to evaluate the ability of the periferal nerve to be stressed by a mechanical stimulation

When the neurodynamic test is positive and provoke the symptom more attention should be used applying the tension in the tape.

clinical condition and

kinesio tape

application????

clinical condition and

kinesio tape

application????

Patient condition

0 health 5 10 acute phase

VAS LOW HIGH

QTY MECHANICAL CHEMICAL

IRRITABILITY LOW HIGH

NEURODYNAMIC NEGATIVE POSITIVE + SYMPTOMS

clinical condition and

kinesio tape

application????

Patient condition

0 health 5 10 acute phase

Tension of the tape

0 % 50% 100%

clinical condition and

kinesio tape

application????

Patient condition

0 health 5 10 acute phase

0 % 50% 100%

Tension of the tape

LIMPH SPACE

INHIB

TENDON FACILITATION

FASCIA LIGAMENT

MECHANICAL

FUNCTIONAL

THIS IS NOT A RULE, BUT THIS ARE GOOD AND QUICK SUGGESTIONS FOR WHO STARTS TO

USE KINESIO TAPING METHOD

clinical condition and

kinesio tape

application????

CLINICAL

PROGRESSION

ANKLE SPRAIN

Acute phase

Several fan stripes that involes all the ankle, and

the leg.

CLINICAL

PROGRESSION

ANKLE SPRAIN

Post acute phase

fan stripes over the edhema (if is necessary).

Inhibition: gastrocnemius

Facilitation: peroneus, tibialis posterioris

CLINICAL

PROGRESSION

ANKLE SPRAIN

Post acute phase

ANKLE SPRAIN

15 giorni dopo

dolore:

tira, superficiale, intermittente

ROM, non irritabile

CLINICAL

PROGRESSION

ANKLE SPRAIN

Rehab phase

Facilitation: tibialis posterioris,peroneus,

extensor longus allucis.

Ligament correction: technique for the ligament

involved.

In recidivant ankle: functional correction for the

extensor retinaculuum

CLINICAL

PROGRESSION

ANKLE SPRAIN

Rehab phase

KINESIO AND ANKLE

ACCESSORY TAPINGS:

- Mechanical correction for fibula’s mal-alaignments

- Mechanical correction for calcaneouse’s mal-alaignments

- Ligaments - Mechanical correction for retinaculum extensoris, and retinaculum peronieris

- Ligaments - Mechanical correction for plantar arch