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Original Article
Short-term eect of spiral taping on the pain and
walking performance of individuals with
chronic ankle instability
Chae-gil lim, PT, PhD1)
1) Department of Physical Therapy, College of Health Science, Gachon University: 191 Hambangmoe-ro,
Yeonsu-gu, Incheon 406-799, Republic of Korea
Abstract. [Pur pose] This study was designed to investigate the effects of spiral taping (ST) on the pain and
walking performance of individual with chronic ankle instability (CAI). [Subjects and Methods] 12 men and 13
women (mean: 21.52 years; range: 20–31 years) with unilateral CAI (Cumberland ankle instability score: ≤24)
were included. All the participants received 3 mm-wide ST. The latter was applied in a 3 × 4 cross shape onto the
medial malleolus, the lateral malleolus, and the anterior talotibial joint of the unstable an kle. The pain and walking
performance were measured on the visual analogue scale (VAS) and with a timed up and go test (TUGT) at the
baseline and 30 minutes after the intervention. [Results] VAS and TUGT scores were signicantly improved after
application of the ST. [Conclusion] The results indicated that ST can improve the pain and walking performance of
CAI individuals.
Key words: Chronic ankle instability, Walking perfor mance, Spiral taping
(This article was submitted Jan. 13, 2017, and was accepted Mar. 20, 2017)
INTRODUCTION
In chronic ankle instability (CAI), 55–75% of patients experience symptoms such as pain and sensations of giving way
that last for 6–18 months and that limit their daily and physical activities, such as walking and running1, 2), thereby decreasing
their quality of life3). Therefore, it is important to focus on the prevention and treatment of ankle instability in the clinical
approach to CAI, and 42–70% of patients require help with the management of physical activities4). Ankle joint taping is the
most effective and alternative treatment modality for the prevention of ankle joint re-injury and the promotion of stability5, 6).
Several types of elastic and non-elastic ankle tapes can be used. Non-elastic tapes include athletic tape, Mulligan’s tape, and
the spiral tape (ST). Among them, taping method used widely for ankle injury7), ST is commonly used in clinical practice
despite the insufcient evidence for its effects. Therefore, this study was designed to verify the short-term effects of ST
application on the pain and walking performance of CAI individuals.
SUBJECTS AND METHODS
The study adopted a single-group pre-post measures experimental design. The participants were 21- to 30 year-old stu-
dents recruited at a university. A pilot study of 6 patients was conducted to determine the appropriate sample size. The
G-power 3.1.9.2 software computed a required sample size of 25 participants, with a 0.05 signicance level, a power of
0.08, and an effect size of 0.8 (as calculated from the mean and standard deviation of the pilot study). The inclusion criteria
were as follows: (1) pain and discomfort during walking in one ankle with no treatment for the pain; (2) a Cumberland ankle
instability (CAIT) score of or below 24 (CAIT is a simple, valid, and reliable tool to measure the severity of ankle instability
J. Phys. Ther. Sci. 2 9: 1040 –1042, 2017
Corresponding author. Chae-gil Lim (E-mail: jgyim@gachon.ac.kr)
©2017 The Societ y of Physical Therapy Science. Published by IPEC Inc.
This is an open-access article distributed under the terms of the Creative Com mons Att ribut ion Non-Commercial No Derivatives (by-nc-nd)
License <https://creativecommons.org/licenses/by-nc-nd/4.0/>.
The Journal of Physical Therapy Science The Journal of Physical Therapy Science
1041
[validity, α=0.83; reliability=0.99], and a CAIT score of or below 24 indicates CAI)8); and (3) ability to walk independently.
The exclusion criteria were as follows: (1) surgical experience; (2) previous neurologic impairment; and (3) contraindications
to any of the measurement procedures. Participants signed a written consent form approved by the local ethics committee.
The general characteristics of the participants were recorded; pain and walking performance were measured at baseline and
30 minutes after the intervention.
The ST was applied by a single physical therapist with>3 years of experience. Physical therapist was blinded to the
purpose of applied the spiral taping, and the participants were blind to the type of tape used. The size of the ST is width of
3 mm was used (SPX-50H, Nichiban Inc., Japan), ST is adhesive non-elastic tape. In this study, ST was applied at the medial
malleolus, the lateral malleolus, and the anterior talotibial joint9). The ST was applied that tape was attached 3 cm above the
medial malleolus; it then passed below the sole and was xed 3 cm above the center line of the lateral malleolus. Then, medial
malleolus application: The tape was attached to the center of the medial malleolus, and then above and below it. It was rst
applied in a diagonal direction toward the right at a 30°–35° angle with an 8-mm interval, and then in a diagonal direction
toward the left at a 30°–35° angle with an 8-mm interval, and was xed with four tapes (Fig. 1A). The lateral malleolus (Fig.
1B) and anterior talotibial joint (Fig. 1C) applications were similar to that at the medial malleolus During the application, the
ankle was placed in a neutral position to avoid stretching the tape.
The pain was measured on the visual analogue scale (VAS) in order to determine the intensity of the pain while the sub-
jects performed the timed up and go test (TUGT). The VAS is a 100 mm line that ranges from “0 − no pain” to “100 − most
severe pain”. Walking performance was measured TUGT. The physical mobility at the level of the musculoskeletal injury in
the lower limbs was measured with the TUGT (ICC=0.80), which offers high validity and reliability10). The subjects were
made to get up from a chair and walk 3 m forward, before returning to the chair to sit down. The unit was seconds.
All statistical analyses were performed with the SPSS 21.0 Analysis software. The changes between the pre- and post-
intervention values were compared with a paired t-test. All values are expressed as mean ± standard deviations (SDs). The
effect size (ES) was calculated with the following equation: (mean after intervention-mean before intervention)/base SD. The
signicance level was set at p<0.05.
RESU LT S
Table 1 shows the general characteristics of the 25 participants (12 men and 13 women). The pain had signicantly de-
creased after the intervention (p<0.01, ES=1.37). The TUGT score also showed a signicant change after the ST application
(p<0.01, ES=0.76) (Table 2).
Fig. 1. Spiral taping method
A: medial malleolus; B: lateral malleolus; C: anterior tibiotalar
joint application
Tab le 1. General characteristics of the subjects
Gender (male/female) 25 (12/13)
Age (years) 21.5 ± 1.9 2
Height (cm) 167.7 ± 7.8 6
Weight (kg) 62.2 ± 8.94
Affected leg (left/right) 10/15
CAI duration (Months) 10.4 ± 7.75
CAIT score 20.1 ± 3.07
CAIT: Cumberland ankle instability test
Tab le 2 . Change in pain, TUGT before and after the inter vention
Before After Change (95% CI) Effect si ze
VAS (score) 4.03 ± 1.42 1.98 ± 1.56* −2.06 ± 0.90 (−2.4286 to −1.683) 1.37
TU GT (se c) 9.23 ± 0.63 8.75 ± 1.02* −0.49 ± 0.30 (−0.613 to −0.360) 0.76
*p<0.01 Signicance difference in compared to before
J. Phys. Ther. Sci. Vol. 29, No. 6, 2017
1042
DISCUSSION
Taping is commonly done to prevent re-injury in patients with ankle sprain and CAI. Non-elastic adhesive tape is consid-
ered to provide greater ankle support than elastic tape11). Movement-evoked pain injuries lead to the deterioration of walking
and physical activity12), and CAI pain may also compromise walking ability. A previous research has shown that ankle taping
reduces joint apprehension and enables physical activity7). The present study found that application of ST not only decreased
pain effectively but also improved walking performance. Also, this study showed the large ESs in terms at attenuating the
pain during walking after the ST application. These results suggest that ST application increased ankle support in individuals
with CAI. Pain attenuation is considered an important factor. The previous studies also proved that ST application reduced
back and neck pain13). Therefore, it can be deduced that ST has a positive effect on musculoskeletal pain. The results of this
study suggest that ST effect reduced pain and improving walking performance, therefore ST be a suitable clinical intervention
for individuals with CAI.
There are limitations to this study. This experiment was conducted over a short time period (30 minutes); therefore, the
results could only indicate short-term effects; the long-term effects of ST remain unclear. And this study was conducted
single group pre and post-test design. Therefore further study should be conducted to compare with the control group and
other taping methods. Additionally, CAI has an impact on muscle strength and balance14). The author recommends that the
mechanism of ST-related pain attenuation be identied and will investigate the relationship between the changes in pain and
functional activities after ST application in CAI in a future study.
REFERENCES
1) Hiller C E, Kilbreath SL , Refshauge KM: Ch ronic an kle in stability: evolut ion of the mod el. J Athl Trai n, 2011, 46: 133–141. [Medli ne] [C ros sRe f ]
2) van Rijn RM, van Os AG, Bernsen RM , et al.: What is the clinical course of acute ankle sprains? A systemat ic literat ure review. Am J Med, 2008, 121: 324–331.
e6. [M ed li ne] [C ro ssR ef ]
3) Anand acoom arasamy A, Bar nsley L: Long term out comes of inversion an kle injuries . Br J Sport s Med, 20 05, 39: e14, discu ssion e14. [Medline] [Cr oss Ref ]
4) Smith RW, Reischl SF: Treatme nt of ank le sprai ns in you ng athletes. Am J Sp orts Me d, 1986, 14: 465–471. [M ed li ne] [C ros sRe f ]
5) Lee BG, Lee J H: Immediate effects of a nkle ba lance t aping wit h kine siology ta pe on the dy namic balance of you ng players w ith fu nction al ank le inst abilit y.
Technol Health Care, 2015, 23: 333–341. [Me dl in e] [Cr os sRef ]
6) Jackson K , Simon JE, Docherty CL: Extended use of kin esiology t ape and ba lance in part icipant s with ch ronic ankle i nstabi lity. J Athl Train, 2016, 51: 16–21.
[Me dl ine] [Cros sRe f]
7) Hali m-Kertane gara S, Raymond J, H iller CE, et al.: The e ffect of ankle t aping on funct ional perfor mance in par ticipants with f unctional a nkle insta bility. Phys
Ther Sport, 2017, 23: 162–167. [Me dl in e] [Cr ossRef ]
8) Donahue M, Simon J, Do chert y CL: Crit ical review of self-repor ted func tional ankle i nstability measures. Foot A nkle Int, 2011, 32: 1140–1146. [ Me dl in e]
[Cro ssR ef ]
9) Danak a N: Spiral ba lance taping therapy. Gang ju: Py ungwha ME Co., 1997.
10) Yeung TS, Wessel J, Stratford PW, et al.: The ti med up and go t est for use o n an inpatient or thopaedic reha bilita tion ward . J Ort hop Spor ts Phys Ther, 2008,
38: 410– 417. [Medl ine] [Cross Ref ]
11) Briem K, Ey thörsdötti r H, Magn úsdóttir RG, et al.: Effects of ki nesio ta pe compa red with nonelast ic spor ts tape a nd the untaped a nkle durin g a sudden i nver-
sion per turb ation in m ale athletes. J Or thop Sports Phys T her, 2011, 41: 328–335. [Med li ne] [C ros sRe f ]
12) Hurw itz DE, Ryals A R, Block JA, et al.: Knee pain and joi nt loadi ng in subje cts wit h osteoa rth ritis of the kne e. J Ort hop Res, 20 00, 18: 572–579. [Med li ne]
[Cro ssR ef ]
13) Choi SH, Ko K M, Ki m KW, et al.: The effect s of spira l taping t herapy- a random izat ion contr olled tr ial. J Kore an Acu Moxi Soc i, 2006, 23: 165–172.
14) Hert el J: Sensor imotor decits wit h ank le sprai ns and ch ronic a nkle i nstability. Clin Sport s Med, 200 8, 27: 353–370, vii. [Me dl i ne] [C ros sRe f ]
