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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 271-276

Effectiveness of additional Mulligan taping over conventional therapy in young female gymnasts with lateral ankle sprain


Department of Community Health, PES Modern College of Physiotherapy, Maharashtra University of Health Sciences, Pune, Maharashtra, India

Date of Submission24-Oct-2018
Date of Acceptance04-Nov-2019
Date of Web Publication28-Jul-2020

Correspondence Address:
Dr. Gauri Sudhakar Kulkarni
PES Modern College of Physiotherapy, Off, JM Road, Behind PDMBA Sports Complex, Shivaji Nagar, Pune - 411 005, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_84_18

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  Abstract 


BACKGROUND: Researchers found that ankle sprains accounted for sports-related injuries in twenty high school sports. Mulligan taping which is well known for ankle sprain and can be easily sustained by subjects. The study was conducted to determine the effect of Mulligan taping on the incidence and severity of ankle injury in women's gymnastics.
MATERIALS AND METHODS: Study design: Experimental study. Sample size: Sixty. Study setting: Gymnastics sports complexes in and around the city area. Sample distribution: Alternate allocation method. Study sampling: Purposive sampling. Inclusion criteria: Gymnasts diagnosed/ Prediagnosed with lateral ankle sprain (LAS)grade 2(sub acute) more than 2 weeks, vault and rhythmic gymnastics player of10–20 years of female practicing gymnastics more than 2 months and reporting minimum two episodes of giving away. Exclusion criteria: Recent surgeries on lower limbs, male gymnasts, recent fracture of the ankle and chronic ankle sprains. Procedure: Total sixty gymnasts' satisfying the inclusion–exclusion criteria and were divided into two equal groups by alternate allocation method i.e. Group A who underwent additional Mulligan taping with glides and Group B who underwent only conventional therapy. Post treatment data was collected and statistically analysed. Outcome measures: Visual Analog Scale (VAS) and Foot and Ankle Ability Measure (FAAM).
RESULTS: In Group A, t-value pre- and posttreatment for FAAM score was 48.346, which shows a significant change at P < 0.05. t-value of VAS score pre- and post-treatment was 66.880 at P < 0.05. In Group B, t-value pre- and post-treatment for FAAM score was 35.134 at P < 0.05.
CONCLUSION: Additional Mulligan taping has shown significant effects over conventional therapy in young female gymnasts with LAS.

Keywords: Ankle sprain, Mulligan taping, women gymnastics


How to cite this article:
Kulkarni GS, Desai A. Effectiveness of additional Mulligan taping over conventional therapy in young female gymnasts with lateral ankle sprain. Int J Health Allied Sci 2020;9:271-6

How to cite this URL:
Kulkarni GS, Desai A. Effectiveness of additional Mulligan taping over conventional therapy in young female gymnasts with lateral ankle sprain. Int J Health Allied Sci [serial online] 2020 [cited 2020 Sep 30];9:271-6. Available from: http://www.ijhas.in/text.asp?2020/9/3/271/290722




  Introduction Top


Gymnastics is a sport involving the performance of exercises requiring strength, flexibility, balance, agility, endurance, and control. Gymnastics originated in ancient Greece and was originally intended to military training, where it was used by soldiers to prepare for warfare. Gymnastics evolved from exercises used by ancient Greeks that included skills for mounting and dismounting a horse and from circus performance skills.[7]

There are two types of gymnastics Artistic and rhythmic gymnastics. Women's artistic gymnastics includes vaults, uneven bars, balance beam, and floor exercises.[8] Women's rhythmic gymnastics includes ropes, hoop, ball, clubs, and ribbons.[8]

Lateral ankle sprain (LAS) is one of the most common injuries experienced in sports. The recurrence rate for LAS among athletes has been reported to be as high as 80%. The ligaments which support the lateral aspect of the talocrural and subtalar joints are often sprained following hypersupination of the ankle complex. Recurrence of LAS is very common.

Patients report pain after having twisted an ankle. This usually occurs due to an inversion injury, which means the foot rolls underneath the ankle or leg. It commonly occurs during sports. Patients will complain of pain on the outside of their ankle and various degrees of swelling and bleeding under the skin (i.e., bruising). Technically, this bruising is referred to as ecchymosis. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot.[4]

There are three main ligaments involved in ankle sprain Anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament.[5] and Graded during sprain as follows: Grade 1 sprain (mild) slight stretching and microscopic tearing of the ligament fibers. Mild tenderness and swelling around the ankle. Grade 2 sprain (moderate) partial tearing of the ligament. Moderate tenderness and swelling around the ankle. If the doctor moves the ankle in certain ways, there is an abnormal looseness of the ankle joint Grade 3 sprain (severe) complete tear of the ligament.[24] On observation and palpation significant tenderness and swelling around the ankle is seen. If the doctor pulls or pushes on the ankle joint in certain movements, substantial instability occurs.

Mulligan taping is a renowned method of treatment. It works on the principle of postural fault corrections, which helps in pain relief even during painful movement. It proves and works wonders in subacute cases and also is based on fundamentals lead by Mulligan. Brian Mulligan discovered that treatment in some patients was enhanced when he utilizes taping to compliment the directional forces provided after the MWM treatment bout. Taping is applied in directions which complement the applied MWM passive force to a joint or a soft tissue. This study brings both these equally capable techniques on a single platform to compare their respective capabilities.[10],[15],[20]

Need of the study

Women's competitive gymnastics is a multifaceted sport that requires a high level of physical fitness and skill to succeed. Speed, strength, endurance, agility, flexibility, balance, and power are all physical abilities that play a role in the success of a competitive gymnast. In particular, the reinjure rate is alarming and points to the need for complete rehabilitation before return to full participation. The results of the analytic component of the study alluded to the potential role of competitive level and maturation rate in the profile of the injury-prone gymnast. Specifically, rapid periods of growth and advanced levels of training and competition appeared to be related to injury proneness.[9],[11],[12]

Analyzing data collected through the National High School Sports-Related Injury Surveillance System (RIO), an internet-based reporting system, researchers found that ankle sprains accounted for 16% of sports-related injuries in twenty high school sports serious enough to require medical attention by a certified athletic trainer or physician and restrict an athlete's participation for 1 or more days.[12]

Pain and functional disability is common following ankle sprain and a major problem in sports. Mulligan taping which is well known for ankle sprain and can be easily sustained by subjects. The objective of this study was to determine the effect of Mulligan taping on the incidence and severity of ankle injury in women's gymnastics.[13]


  Materials and Methods Top


Study design: Experimental study. Sample size: Sixty. Study setting: Gymnastics sports complexes on and around Pune area. Sample distribution: Alternate allocation method. Study sampling: Purposive sampling. Inclusion criteria: Gymnasts diagnosed with LAS for any one of the two lower limbs for more than 2 weeks,[3] vault as well as rhythmic gymnastics player,[5] age: 10–20 years of age,[10] sex: female,[2] duration – practicing gymnastics more than 2 months,[3] sprain more than 1 week (subacute) days 3–14,[2] prediagnosed with Grade 2 ankle sprain (subacute),[1],[2] tenderness Grade 1 and more [4] 1 year after age of menarche,[4] recent ankle sprains,[3] and minimum two episodes of giving away (ankle is suddenly and unexpectedly being unable to support the person and the leg just buckles leading to stumbling or falling).[3] Exclusion criteria: Recent surgeries on lower limbs,[5] male gymnasts,[2] recent fracture of ankle,[3] Grade 1 and 3 ankle sprain,[8] more than 3 weeks of injuries,[8] before age of menarche,[4] age more than 20 years,[10] chronic ankle sprains,[2] allergic to sticking material used in tapes,[10] any pathology of the knee and ankle,[3] medial ankle sprain,[2] and active menstruation.[3]

Materials and tools

Pen, paper, measuring tapes, consent form, ultrasound (US) machine, goniometer, rigid tapes, and exercise chart were used in this study.

Procedure

The study began with the presentation of synopsis to an ethical committee. The topic was thoroughly inspected from all the aspects, and ethical clearance was obtained from the committee. Various gymnastics sports complexes in and around Pune area were visited. For the study, total 60 gymnasts who were diagnosed with Grade 2 ankle sprain and who satisfied the inclusion and exclusion criteria were selected. A proper explanation of the procedure was given to the gymnasts, and consent forms were obtained. Gymnasts were divided into two equal groups of 30 gymnasts by random allocation method, namely Group A and Group B. The gymnasts in Group A underwent treatment with additional Mulligan taping along with glides for 10 reps/set, 3 sets/sessions, 3 sessions/week with 1 min of rest between each set along with conventional therapy for LAS. The gymnasts in Group B underwent only conventional therapy for a period of 2 weeks.

Group A (thirty players) – conventional ankle protocol.[6],[16],[17],[22] This will be given for 2 weeks that is for 14 days.[10] Group B (thirty players) – conventional ankle protocol [22] (for the 1st week, Rest, Ice, Compression, Elevation (RICE) protocol is to be given, and for the 2nd week, ankle exercises are to be given). US will be given for a period of 2 weeks once a day.[14],[23] Intensity is 0.2–0.5 W/cm 2, frequency – 1 MHz, and duration – 8 min.[25]

Conventional therapy protocol includes acute management such as rest, elevation of limb, ice, compression. Rehabilitation program day 1–14 was aimed for as follows- week 1: acute care strategies aimed at the reduction of swelling, commencement of balance training, isometric activation of muscle activity, and maintenance of generalised muscle tone. Week 2: return to modified fitness training, progress to balance training, increase muscle activity, and return to modified sports activity.

Conventional therapy protocol was followed as – Week 1: Day 1 rest, icing, and compression bandage elevation of the limb. Day 3–7 balance single leg balance with eyes closed. Standing on floor (2) standing on injured leg. Touchdown (but don't weight bear) on all. Strength training included double-leg calf raises (knees straight and bent) from the floor and within pain limits, calf stretches (pain free), knee-to-wall injured foot in front, keeping heel on floor continue with physiotherapy, ankle ice baths, compression, and elevation as often as possible. Week 2 day 8–14: Aim to progress balance retraining, increase strength, and return to modified training. The program should be completed twice on day 8, and ice should be applied afterward. Monitor pain and swelling. Balance training included double-leg wobble board balance with medicine ball catches above head, line walking with medicine ball lifts and twists, floor jumps. Strength training included walk on toes, return on heels, resisted eversion with concentric speed and eccentric control, single leg calf raises from the floor. Running was performed in a straight line 15 min 2 × per day if pain free. Progression is given per day of pain free.[21] US given for a period of 2 weeks once in a day [23] at the intensity 0.2–0.5 W/cm 2 and frequency 1 MHz for the duration of 8 min.

Taping materials were used for spray adhesive or hypoallergenic under tape 3.8-cm strapping tape. The gymnast was in supine lying on the plinth with the ankle in neutral position. The aim of taping was to glide the fibula dorsocranially and apply and maintain MWM to the distal fibula. As shown in [Figure 1], start with under wrap anterolaterally over the distal end of the fibula and lies obliquely. Direct the tape in a posterosuperior direction, making sure to lay the tape over the Achilles tendon, to end anteromedially on the tibia. The movement of ankle was checked for pain and range of motion. The pre- and 2-week post-treatment outcome measure scoring was noted for all the gymnasts.
Figure 1: Method of application. (a) Apply and maintain movement with mobilizations to the distal fibula. (b) Start anterolaterally over the distal end of the fibula and go obliquely. (c) Direct the tape in posterosuperior direction, making sure to lay the tape over the Achilles, to end anteromedially on the tibia. (d) Check the movement of the ankle for pain and range of motion

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The outcome measures used were the Visual Analog Scale (VAS)[19] and the Foot and Ankle Ability Measure (FAAM).[18]


  Results Top


The statistical analysis was done using SPSS software.IBM SPSS Statistics 25.0. Within the group i.e.pre and post readings for outcome measures, a paired t-test was used. Between the groups i.e. post readings of outcome measures, an unpaired t-test was used.

In Group A, t-value pre- and post-treatment for FAAM score was 48.346, which shows a significant change at P < 0.05. t-value of VAS score pre- and post-treatment was 66.880 at P < 0.05. In Group B, t-value pre- and post-treatment for FAAM score was 35.134 at P < 0.05.


  Discussion Top


Total 60 samples fulfilling the inclusion criteria were selected for the study. Female gymnasts diagnosed with LAS for any one of the two lower limbs for more than 2 weeks,[3] vault as well as rhythmic gymnastics player,[5] age: 10–20 years of age,[10] sex: female,[2] duration – practicing gymnastics more than 2 months,[3] sprain more than 1 week (subacute) days 3–14,[2] prediagnosed with Grade 2 ankle sprain (subacute),[1],[2] tenderness Grade 1 and more,[4] 1 year after age of menarche,[4] recent ankle sprains,[3] and minimum two episodes of giving away (ankle is suddenly and unexpectedly being unable to support the person and the leg just buckles leading to stumbling or falling)[3] were included in the study. Gymnasts with recent surgeries on lower limbs,[5] male gymnasts,[2] recent fracture of ankle,[3] Grade 1 and 3 ankle sprain,[8] more than 3 weeks of injuries,[8] before age of menarche,[4] age more than 20 years,[10] chronic ankle sprains,[2] allergic to sticking material used in tapes,[10] any pathology of the knee and ankle,[3] medial ankle sprain,[2] and active menstruation were excluded from the study.[3] Hence, the sampling was purposive sampling. The selected samples were divided into two groups of thirty samples each by random allocation by even–odd method. As shown in [Table 1], out of total 60 gymnasts, maximum gymnasts were 11 years old and minimum gymnasts were 14 years old.
Table 1: Age-wise distribution

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Group A received conventional therapy as well as Mulligan taping. It works on the principle of postural fault corrections, which helps in pain relief even during painful movement. During the development of MWMs, Brian Mulligan discovered that treatment in some patients was enhanced when he utilizes taping to compliment the directional forces provided after the MWM treatment bout. Taping is applied in directions that complement the applied MWM passive force to a joint or a soft tissue. This study brought both these equally capable techniques on a single platform to compare their respective capabilities. Pain and functional disability is common following ankle sprain and a major problem in sports. The objective of this study was to determine the effect of Mulligan taping on the incidence and severity of ankle injury in women's gymnastics. Marjan Someeh (2014) observed that the immediate effects of Mulligan's fibular repositioning taping on postural control in athletes with and without chronic ankle instability showed a significantly improved postural control in athletes with chronic ankle instability and healthy athletes. Therefore, fibular repositioning technique can be an effective management for athletes who suffer from chronic ankle injuries. Furthermore, Gopal Nambi S. and Bijal Tarun Shah (2012) studied Kinesiotaping versus Mulligan's mobilization with movement in subacute LAS in secondary school hockey players. This study demonstrated an effect of Mulligan's mobilization with movement technique on subacute LAS in secondary hockey players. The results of the study suggest that this technique should be considered in rehabilitation program following subacute LAS. This study provides justification for follow-up research of the long-term effect of Mulligan's mobilization with movement on subacute LAS.

Group B received only conventional therapy which included exercises and US. Pain and functional disability is common following ankle sprain and a major problem in sports. The conventional exercise protocol included traditional ankle exercise protocol. Ankle sprain correlated to strength; therefore, strengthening exercises have been incorporated in the conventional exercise protocol. US is an electrotherapeutic modality working on the principle of piezoelectric effect, producing high-frequency sound waves (1–3 MHZ) is used to help in reducing inflammation and promote healing. US has been proven to be very effective in acute and subacute stages of inflammation. US is a form of acoustic rather than electromagnetic energy.

Both of these protocols were given for the period 2 weeks to young female gymnasts with LAS to compare the effectiveness of one over the other. The outcome measures used were VAS to measure pain; this is a horizontal 10-cm line with word anchors, such as “no pain” on one end and “worst pain that the patient can bear” on the other end. The scale is a reliable and valid tool to measure pain in various musculoskeletal conditions including ankle sprain. Reliability of this scale is intraclass correlation coefficient (ICC) = 0.97 (95% confidence interval = 0.96–0.98). FAAM scoring is a self-report outcome instrument developed to assess physical function for individuals with foot and ankle related impairments. The FAAM is a 29-item questionnaire divided into two subscales: the FAAM has 21-item activities of daily living (ADL) subscale and the FAAM, 8-item sports subscale. The sports subscale assesses more difficult tasks that are essential to sports, and it is a population-specific subscale designed for athletes. Evidence for reliability was obtained using the group that was expected to remain stable.

The ADL and sports subscales demonstrated strong relationships with the SF-36 Physical Functioning Subscale (r = 0.84, 0.78) and Physical Component Summary score (r = 0.78, 0.80) and weak relationships with the SF-36 Mental Functioning Subscale (r = 0.18, 0.11) and Mental Component Summary score (r = 0.05, −0.02).[18]

The paired t-test was used for intragroup pre- and posttreatment data comparisons and the unpaired t-test for intergroup data comparisons. The details are given in [Table 2] and [Table 3]. The pre and post treatment values of FAAM and VAS showed a significant improvement in both the groups (Group A – FAAM: P < 0.05 and t = 48.346 and VAS: P < 0.05 and t = 66.880 and Group B – FAAM: P < 0.05 and t = 35.134 and VAS: P < 0.05 and t = 92.320, but the improvement observed from conventional therapy as well as Mulligan taping was significantly more than that of only conventional exercises (FAAM: P < 0.0001 and t = 10.178 and VAS: P < 0.0001 and t = 9.532). The comparison between pre- and posttreatment values of each component of FAAM revealed that the pain relief observed after Mulligan taping, and conventional therapy was more than the pain relief after only conventional therapy. Components such as standing, jumping, landing, and lateral movements have shown more improvement in Group A as compared to Group B as shown in [Graph 1] (h, i) and [Table 4] in detail. Hence, Mulligan taping was effective than conventional therapy to improve gymnasts' performance. The acquired results showed that the additional Mulligan taping over conventional therapy was superior to conventional therapy in reducing pain and function in young female gymnasts with LAS.
Table 2: Group A and Group B intergroup Foot and Ankle Ability Measure and Visual Analog Scale

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Table 3: Intragroup comparison posttreatment Group A and Group B

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Table 4: Comparing Group A and Group B between components of Foot and Ankle Ability Measure

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  Conclusion Top


Additional Mulligan taping has shown significant effects over conventional therapy in young female gymnasts with LAS. The study was having a small sample size; a bigger study with a larger sample size could be done. Only female gymnasts were taken as a sample. Only one taping technique was performed. The study has a future scope by including more cities and more physiotherapists. The study could be done on male gymnasts and other sports players or other occupations. The effect on different age groups could be evaluated. The study can be done other types of taping with a larger study sample size.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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