When you tape your patient's ankle, either after an injury or prophylactically to prevent ankle injuries, do you just shift the stress up the chain and make the patient more likely to develop knee injuries (like knee pain, ACL injuries, or other types of injuries)?
Is running around with ankles taped for more stability or rigidity like driving a 4WD on a rough track with the suspension locked out, getting bounced around until you've smacked your knees into the dashboard, and you can't turn your neck from whiplash and hitting your head on the roof?
Is this what taping an ankle does to your knees in change of direction sports? Are you putting your patient's knees at risk with ankle taping?
In this blogpost I want to explore a recent research study that will help us understand whether ankle taping has negative impacts on the knee or other joints, or could lead to an ACL injury, plus share the new Clinical Edge member presentation "Taping masterclass - Essential knowledge with Zoe Russell".
Utku et al. 2024 reviewed 25 healthy participants, including 10 females, and got them to perform sports-specific movements, including running, drop jumping, and 180° change of direction, with their ankle untaped then taped, while barefoot to avoid the shoes impacting the measurements and end results.
They assessed each participant before and after applying standard stirrups, horseshoe strips, heel locks, figure-eight locks, and circumferential strip locks with rigid tape.
There were a number of findings in this study that I'll break down over this blogpost and the next couple of posts, including which movement the tape actually changed, how long the tape was effective for, and whether the effectiveness of the tape changed as they went through their training and sport-specific skills and movements. To keep things short and sweet, today I want to focus on the risks and changes in movement up the chain.
What loads the ACL, knee and other proximal structures?
First off we need to figure out what the risk factors for ACL and other injuries are, then identify if ankle taping changes these risk factors positively or negatively.
Some of the factors referenced as increasing the risk of ACL injury (Hewett et al. 2005) are:
- Increased knee abduction angles (knee valgus) at landing, (8° greater in anterior cruciate ligament-injured than in uninjured athletes) and
- Increased knee abduction moments/loads (which Utku et al. called "internal knee adduction moments") - think of it as the force pulling the lower leg/foot out into abduction, or the knee inwards when the foot is fixed. e.g. with some knee valgus when landing from a jump, this "moment" is the force or load driving the knee inwards. This had the highest correlation and the one they focused most on in Hewett et al. 2005.
Now we've identified the potential risk factors, we can dive into whether taping changes these.
Did taping make people more at risk of an ACL or knee injury?
In Hewett's study, the difference between those who had an ACL injury and those who didn't was 8° of knee abduction angle. There are a number of limitations with Hewett's study, but for now, let's just compare the taping results to this 8° figure, as per our taping article.
Did knee abduction angles get worse by 8°?
In the drop jump test, peak knee abduction angle and peak internal knee adduction moment changed from 5.7° to 6.1°, an insignificant and clinically indistinguishable amount.
After 15 minutes of running around doing training drills while wearing the tape, this angle was still just 7.2° (p=.014).
This amount of change (1.5° in total) is not clinically significant, and is not close to the 8° that Hewett et al. identified as an increased risk of an ACL injury, or anything you could possibly identify in clinical practice.
Conclusions
Vertical drop jump is a commonly used test to look at biomechanics and identify if your patient is at risk of an ACL injury.
When you tape a patient's ankle, this study found it did not increase their knee valgus/knee abduction angles, knee abduction moments, or risk of ACL injury.
Just like you may love bananas and your best friend can't stand them, we know that individual patients will respond differently to treatments, including taping, and it's important to assess the response in your patients.
However, it is nice to know from this study, that in the population tested, taping does not appear to increase the risk of a potential ACL or knee injury.
Increased risk of a different injury?
Ankle taping was associated with patients having worse results in one particular assessment test, which may increase the risk of a different, non-knee related injury. I'll explore this in my next article.
References
Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492-501. doi:10.1177/0363546504269591
Utku B, Bähr G, Knoke H, Mai P, Paganini F, Hipper M, et al. The effect of fresh and used ankle taping on lower limb biomechanics in sports specific movements. J Sci Med Sport. 2024;27(11):772-8. doi:10.1016/j.jsams.2024.07.002
What essentials do you need to know before taping your patients?
Find out in our new Clinical Edge member presentation "Taping masterclass - Essential knowledge with Zoe Russell".
Zoe Russell (Specialist Sports and Exercise Physiotherapist, Olympic and Commonwealth Games Physio and Clinical Edge educator) reveals the clinical reasoning, safety principles and practical knowledge that are essential for effective taping, including which tape to use, how to prepare the skin, contraindications and precautions, safety checks and the removal instructions every taped patient needs.
Click here for your access to the taping masterclass with a Clinical Edge membership, or watch it here if you're a Clinical Edge member.