Zonas vs K Tape

image source: https://commons.wikimedia.org/wiki/File:Kinesio_Taping_for_Soleus_and_Achilles_tendon.jpg

In this case, flexibility and an elastic component (K Tape), which adds proprioception, rather than rigid (Zonas), which takes it away, seems to work better. 

"Compared to Athletic Tape, Kinesio Tape (KT)  provides a flexible pulling force that facilitates foot eversion during early stance, while not restricting normal inversion in late stance during walking. KT may be a useful clinical tool in correcting aberrant motion while not limiting natural movement in sports."

Yen SC, Folmar E, Friend KA, Wang YC, Chui KK. Effects of kinesiotaping and athletic taping on ankle kinematics during walking in individuals with chronic ankle instability: A pilot study. Gait Posture. 2018 Aug 28;66:118-123. doi: 10.1016/j.gaitpost.2018.08.034. [Epub ahead of print]

What specific movement pattern(s) does a person with chronic ankle instability have?

image source: https://en.wikipedia.org/wiki/Ligament

...it is unique and depends on their compensation

"The researchers concluded that multiple distinct movement patterns were found in a high percentage of CAI subjects and each person likely incorporates unique positions and loads that contribute to the chronic nature of instability. Additionally, the data revealed distal joint stiffness was lower in those with CAI than controls generally, while proximal joint stiffness was greater than controls. These data support the theory that the hop plays a vital role in controlling lower extremity movement in CAI subjects."

Hopkins JT, Son SJ, Kim J, et al. Joint Stiffness Alterations, Grouped by Movement Strategy, in Chronic Ankle Instability.

http://lermagazine.com/special-section/conference-coverage/identifying-cai-through-specific-movement-patterns

Acupuncture/Dry Needling and Proprioception. A Winning combination.

What a great combination of therapies for folks with chronic ankle instability, or almost any injury for that matter! Taking 2 modalities that emphasize afferent input from the peripheral mechanoreceptor system, which has such a large influence on the cerebellum as well as the segmental and descending pain inhibition pathways.

Did you notice they used the trigger points in the peroneus longs muscle to needle? Though they didn't say it, did you remember that that the point correlates to a great point: Gallbladder 34, which is an empirical point for musculoskeletal pain? Interesting how this muscle influences both frontal and saggital plan stability. 

Though the techniques of exercise could use some refinement (check out the gents posture in the photo, sure looks like he could use some gluteus medius work!), this is a good overview that provides evidence that utilizing spacial summation (combining multiple techniques that provide afferent input to more than one modality to cause an effect) has better outcomes than one alone. Put this one on your reading list : )

Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, Sánchez-Milá Z, Fernández-de-Las-Peñas C, Alburquerque-Sendín F.Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. Evid Based Complement Alternat Med. 2015;2015:790209. doi: 10.1155/2015/790209. Epub 2015 Apr 30.

link to FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430654/

Who’d a thought? Can someone make an “app” for that?

Interesting study that we just found out about in the June 15th LER journal titled “Patients with ankle instability respond to auditory feedback by changing gait”

In this study they put a sensor under the head of the 5th metatarsal in 10 folks with chronic ankle instability that would emit a sound in respose to excessive lateral ankle pressure. They were told to “walk quietly” and not let the beeper beep. After a short time, the people in the study were able to walk with decreased pressures in the lateral forefoot, in addition to the midfoot and central forefoot. EMG showed increase in peroneal and medial gastroc activity.

Interesting implications and also some questions.

This study shows that auditory feedback can alter behavior and gait. Is this a good thing? We suppose this depends on what you are trying to accomplish and does it ultimately benefit the patient?

this sensor could be made into an “app” that has some cool rehabilitation implications. Imagine a moveable sensor or multiple sensors that could track patterns over time and plot them for you? The auditory could be used to discourage some bevaiors/characteristics of gait and the “tracking” feature could provide progress information. Or maybe is it hooked up to some of your favorite music and it stops playing when you are not weighting appropriately. Wondering if your patient is loading the head of the 1st metatarsal? This could provide some feedback.

Check it out:

Donovan l, Hart JM, Saliba S et al. Effects of an auditory feedback device on plantar pressure in participants with chronic ankle instability. Med Sci Sports Exerc 2015; 46(5 suppl); S104