Influence of Mulligan Ankle Taping on Functional ...

Original Clinical Research

Influence of Mulligan Ankle Taping on Functional Performance Tests in Healthy Athletes and Athletes With Chronic Ankle Instability Marjan Someeh, PT, MSc, Ali Asghar Norasteh, PT, PhD, Hassan Daneshmandi, PhD • University of Guilan; and Abbas Asadi, MSc • Roudbar Branch, Islamic Azad University, Roudbar, IRAN

Context: Ankle sprains or chronic ankle instability (CAI) is common in athletes and a common method for decreasing the effects of ankle instable is using tape. Objective: To determine whether Mulligan ankle taping (MAT) influenced the functional performance (FP) tests in athletes with and without CAI. Design: A cross-sectional study using a within-subject experimental design between four ankle conditions (taped and untaped, athletes with and without CAI). Setting: Research laboratory. Participants: Sixteen professional athletes with unilateral CAI (10 men and 6 women; age 23.2 ± 3 years, height 175.4 ± 10.3 cm, weight 73 ± 14.5 kg, and body mass index 23.8 ± 3.6%) and 16 uninjured professional athletes (10 men and 6 women; age 22.8 ± 1.7 years, height 173.6 ± 12.2 cm, weight 66.4 ± 11.4 kg, and body mass index 22.2 ± 3.3%) volunteered to participant in this study. Intervention: Mulligan ankle taping. Main Outcome Measures: FP tests including single leg hopping course, Figure-of-8 hop and side hop were measured for both the groups in two conditions: taped and untaped. Results: There were significant differences between injured and uninjured athletes in all FP tests (P < .05). MAT significantly improved FP tests in both groups (P < .05). Conclusion: We found that MAT can improve FP tests in athletes with CAI and uninjured athletes. Therefore, it seems that MAT can be an effective method for enhancing athletes’ performance in sports that require lateral movements. Key Words: ankle sprain, taping, functional performance

A

nkle sprains are one of the most common lower extremity injuries that lead to the longest absence from athletic activity.1 With regard to the athletes with the National Collegiate Athletic Association, ankle sprains are the most common injury in men and women who participate in competitive sports.2 A common result of reoccurring ankle sprain is the development of functional instability at the ankle, resulting in chronic

ankle instability (CAI).3 When CAI occurs, damage not only occurs to the structural integrity of the ligaments and tendons, but also to various mechanoreceptors in the joint capsules, ligaments, and tendons around the ankle complex.4–6 It appears that CAI induces impairment in proprioception, neuromuscular control, and deficits in strength and functional performance (FP).7–10 Previous studies noted that FP is impaired in subjects with CAI.7,8,10 Therefore, FP deficits may be a casual © 2015 Human Kinetics - IJATT 20(1), pp. 39-45 http://dx.doi.org/10.1123/ijatt.2014-0050

international journal of Athletic Therapy & training

January 2015  39

mechanism of CAI and an appropriate component of a classification scheme designed to predict those more likely to develop CAI. One successful method of supporting a weakened ankle from undergoing a further sprain and reducing the occurrence of ankle joint injury is through the use of external prophylactic ankle support, such as tape.11–18 It has been well documented that taping can increase joint stability by neuromuscular proprioceptive and physiological processes, increasing the skin proprioceptive receptors which offer additional awareness of the foot position and the direction of motion.12–18 There are a large number of methods of ankle taping, such as heel lock, lateral subtalar sling, basket weave, and others, and researchers have found both positive and negative effects of these methods on FP. According to some previous studies, vertical jump was decreased in athletes using various forms of ankle support,19–21 while no significant effect was found by others.22,23 A significant decrease in performance on multidirectional agility tests for uninjured subjects wearing ankle support was observed by some researchers,19,24 whereas other researchers demonstrated no difference between supported and unsupported conditions. Recently, Bicici, Karatas, and Baltaci17 examined the effects of athletic taping and Kinesio Taping® on FP in basketball players with and without ankle sprains and found improvements in performance time with taping. Mulligan ankle taping (MAT), or fibular repositioning tape, is a relatively new taping technique which requires two ~20 cm rigid tape pieces that can be worn for several days and can be applied by a physiotherapist with minimal time. In addition, Mulligan25 has proposed that individuals with CAI experience an anterior positional fault of the distal fibula on the tibia. It seems that MAT may correct this fault; however, no direct study examined this. Unfortunately, information within the literature is scarce, and little attention has been given to fibular repositioning taping or the MAT mechanism.13,14 To our knowledge, no study has examined the influence of MAT on FP in subjects with and without

CAI. Previous studies only examined FP tests in participants with CAI and with a healthy group and found that FP deficits are greater for CAI subjects when compared with the healthy group.7,8,10 Although previous authors have explored the FP deficits in subjects with and without CAI,7,8,10 no study has examined the influence of MAT on FP in athletes with and without CAI. In the present investigation we used MAT, because previous studies suggested that this taping technique can correct an anterior positional fault of the fibula and also maintain correct fibular alignment,15,16 and perhaps improve FP; however, there is no research evidence to support this. Therefore, it is important to understand the effects of MAT on FP in athletes since many assumptions have been made based on studies using this technique or FP tests. Thus, the aim of this investigation was to examine the influence of MAT on FP in professional athletes with and without CAI.

Procedures and Findings Sixteen athletes with CAI (10 men and 6 women) and 16 healthy athletes (10 men and 6 women) volunteered to participate in this study and were matched based on sex, limb dominance, foot curvature, sport experience level, and ± 10% of age, weight, and height (Table 1). Thus, there were no significant differences between groups in demographic data (P > .05). An estimated sample size for β = 0.80 with α = .05 was calculated a priori based on tabled data from previous research.26 Once the participants understood and signed the informed consent form approved by the institutional review board, all subjects completed the Foot and Ankle Disability Index (FADI; ICC 0.89) and the FADI-Sport (ICC 0.84).27 These two questionnaires are designed to reflect the current state of stability of the ankle during activities of daily living, as well as during sporting activity. Subjects were included in the study if they had less than 90% and 75% scores for the FADI and FADI-Sport questionnaires, respectively. Healthy subjects did not have a history of ankle sprains and scored 100% on the FADI and FADI-Sport instru-

Table 1. Participant Characteristics (Mean ± SD) Group CAI athletes Uninjured athletes

Age (years)

Height (cm)

Weight (kg)

BMI (%)

FADI Score (%)

FADI-Sport Score (%)

23.2 ± 3 22.8 ± 1.7

175.4 ± 10.3 173.6 ± 12.2

73.06 ± 14.5 66.4 ± 11.4

23.8 ± 3.6 22.2 ± 3.3

74.5 ± 8.62 100 ± 0

63.5 ± 7.68 100 ± 0

Note. CAI = chronic ankle instability.

40  January 2015


ments. Both groups consisted of professional athletes involved in ball sport events such as football, volleyball, and handball, and who trained at least three times a week for 90 min. Procedures and the study were conducted in accordance with ethical standards in sport and exercise science research28 and approved by the local ethics committee. A cross-sectional study consisting of within-subject experimental design between four ankle conditions (taped and untaped, CAI and uninjured) was used in the current study. CAI was defined by a history of at least two acute ankle sprains that resulted in pain and swelling, and a history of multiple episodes of the ankle giving way in the past six months. Participants were excluded if they had a previous injury such as a muscle injury or fractures in the lower extremity, lower back pain, a previous record of surgery in the lower extremity, disease experience such as neuropathy, an acute sprain within the past six weeks, and bilateral CAI.29 On examination day, each subject’s height was measured using a wall-mounted stadiometer (Seca 222, Terre Haute, IN), recorded to the nearest centimeter. Body mass was measured to the nearest 0.1 kg using a medical scale (Tanita, BC-418MA, Tokyo, Japan). In addition, foot curvature was determined using Feiss line orthopedic examination.30,31 After measurement of weight and height, participants completed a 10-min warm-up that included 5 min of cycling and 5 min of stretching and ballistic movements. Then participants performed FP tests (single leg hopping course, figure of-8-hop, and side hop) with and without MAT. Before each condition (taped and untaped), the subjects performed tests for three times for familiarization, warm up, and to decrease any bias. After performing each FP test, the stability and confidence of the ankle joint were assessed. The order of condition (with or without MAT) was randomized and there was a ~10-min interval between condition and FP testing. Five- and 10-min breaks between tests and conditions were allowed for rest. In this study we used the single leg hopping course, figure-of-8-hop, and side hop for assessing FP in athletes. The order of FP tests were random and were determined by participants. On one day following a 10-min warm-up (including 5-min cycling and 5-min stretching movements), subjects performed three trials of each FP test with a 30-s rest between trials and a 2-min rest between tests to minimize fatigue. After completing the warm-up period, each participant performed each test procedure three times with maximum international journal of Athletic Therapy & training

effort, and the best of these three trials was recorded as the final score for each individual test. A 2-min rest was given in between each trial to decrease the chance of fatigue. To determine the reliability of the FP tests, two measurements of FP tests were made in 15 subjects. The reliability of the measurement was tested in two sessions 48 hr apart from each other in the same 15 subjects (single leg hopping course: ICC = 0.92; figure-of-8 hop: ICC = 0.92; side hop: ICC = 0.93). All testing was performed with each subject barefoot. If the participants fell or were unable to perform test, the trial was discarded and repeated. The single leg hopping course was constructed of hardwood and consisted of 33.02 cm × 33.02 cm squares positioned in two rows of four. The jumping course consists of eight squares: four of them were even, one had a 15° increase, one had a 15° decrease, and two showed a lateral inclination. The participants were asked to jump across this course on one leg by touching each area once as fast as possible without leaving the course. The test result is quantified by seconds used to pass the course. Each failure adds an extra second to the time taken to complete the course (Figure 1).7 The figure-of-8 hop test was reproduced using the measurements and picture provided by Docherty et al.8 For the figure-of-8 hop test, a 5-m course outlined with cones was used. Each participant was instructed to hop on one limb twice around the course as fast as possible (Figure 2). The side hop test was reproduced using the measurements and picture provided by Docherty et al.8 For the side hop test, all participants were instructed to hop on one limb laterally over a 30-cm distance. One repetition constituted hopping laterally 30 cm and back to the starting location. Each participant completed 10 repetitions and was instructed to do so as quickly as possible (Figure 3).

Figure 1

Single leg hopping course procedure.

January 2015  41

Figure 2

Figure-of-8 hop procedure.

Figure 3

Side hop procedure.

After completion of each of the FP tests, the participants were questioned regarding their perceived levels of stability and confidence: “How was your ankle during the test and do you feel unstable during that activity?” Each participant with CAI was required to answer with either a score of 1 if they felt instability of the ankle or a score of 0 if they felt stability and confidence of the ankle during the two conditions (taped and untaped).15 All taping procedures were performed by the same trained physiotherapist. Each subject’s skin was shaved with a specific razor and cleaned with an alcohol swab. Taping-specific spray (Q.D.A. Tape Adherent Spray, Cramer, USA) was used for increasing adhesiveness and decreasing skin sensitivity. The MAT was applied when the participants were in a supine position on a plinth. A 20-cm length of nonstretch tape (Euro Tape, Muiler, USA) was applied with the ankle in neutral 42  January 2015

position, starting obliquely at the distal end of the lateral malleolus, while a pain-free posterolateral-superior glide was applied to the fibula at the level of the inferior tibiofibular joint and then wrapped slightly diagonal around the tendoachilles and anchored above the initial tape attachment. A pain-free posterolateral force was applied to the distal fibula while tape was applied. A second reinforcing strip was then applied in the same manner. The MAT application is shown in Figure 4 and further detailed in an article by Moiler, Hall, and Robinson.16 To determine the influence of MAT on FP tests, we used a two-way ANOVA with repeated measurements. When a significant F value was achieved across time or between groups, Tukey post hoc tests were performed to locate the pairwise differences between the means. Furthermore, we used the Wilcoxon signed-rank test to determine participants’ responses to questions relating to perceptions of stability and confidence. In addition, the calculation of effect size (the difference between pretest and posttest scores divided by the pretest standard deviation) was used to examine the magnitude of any treatment effect. The alpha level was set at P < .05 for all analyses. The FADI score for CAI athletes and uninjured athletes was 74.5 ± 5.62 and 100 ± 0%, and the FADI-Sport score for CAI athletes and uninjured athletes was 63.5 ± 7.68 and 100 ± 0%. We found significant differences between the CAI athletes and uninjured athletes in the time to completion for the single leg hopping course (P = .001), figure-of-8 hop (P = .001), and side hop (P = .001) tests before the taped condition. Likewise, both the groups indicated significant improvements in FP tests after taping (single leg hopping course test: CAI from 10.07 ± 2.45 to

Figure 4

Mulligan ankle taping procedure.


8.99 ± 2.01 s, P = .014, 10.7%, effect size [ES] = 0.44; uninjured from 7.43 ± 0.99 to 6.91 ± 1 s, P = .001, 7%, ES = 0.52; figure-of-8 hop: CAI from 5.36 ± 0.79 to 4.97 ± 0.59 s, P = .005, 7.2%, ES = 0.49; uninjured from 4.36 ± 0.5 to 4.14 ± 0.4 s, P = .001, 5%, ES = 0.44; side hop: CAI from 9.23 ± 1.16 to 8.41 ± 1.16 s, P = .001, 8.8%, ES = 0.70; uninjured from 7.6 ± 1.18 to 7.22 ± 1.09 s, P = .001, 5%, ES = 0.32) (Figure 5). We also found significant improvement in perceptions of stability and confidence and decreases in feelings of instability of the ankle for CAI athletes following the MAT during FP tests (single leg hopping course test: 0.625 ± 0.71 to 0.125 ± 0.34, P = .023, 80%, ES = 0.70; figure-of-8 hop: 0.562 ± 0.72 to 0.128 ± 0.24, P = .038, 77.2%, ES = 0.60; side hop: 0.937 ± 0.85 to 0.375 ± 0.5, P = .048, 60%, ES = 0.66) (Figure 6).

Figure 5

Functional performance tests in athletes with chronic ankle instability (CAI) and uninjured athletes. Values are mean ± standard deviation. *Significant differences (P < .05) compared with untaped. †Significant differences (P < .05) compared with CAI at baseline.

Figure 6

Participants’ perceptions of instability at the ankle at pre and post taping conditions. Values are mean ± standard deviation. *Significant differences (P < .05) compared with untaped.


Discussion Our findings suggest that those athletes who had CAI showed performance deficits on the single leg hopping course, figure-of-8 hop, and side hop tests when compared with uninjured athletes. Our results are in agreement with that of three other investigations.7,8,10 Docherty et al.8 compared FP deficits in subjects with and without ankle instability using figure-of-8 hop, side hop, up-down hop, and single leg hop tests. They reported significant relationships between figure-of-8 hop and side hop with ankle instability.8 Additionally, they suggest that the figure-of-8 hop and side hop tests are more sensitive than other FP tests to determine ankle instability because the performance deficits are present during tests that include lateral movement and require the participants to move laterally, placing stress on the structures on the lateral aspect of the leg, including the lateral ligaments and peroneus muscle complex.8 In contrast, up-down hop and single leg hop tests are done in the sagittal plane and related to muscular strength and are not sensitive for determining FP deficits in CAI subjects.8 Buchanan, Docherty, and Schrader7 investigated FP deficits in participants with and without ankle instability using the single leg hopping course and single leg hurdle tests and found that the single leg hopping course is an appropriate test to determine FP deficits in subjects with ankle instability. Since lateral ankle sprains induce injury to the lateral ligament of the ankle, to determine FP deficits in CAI subjects we must use tests that involve the lateral side of the ankle. It has been well documented that the single leg hopping course includes lateral and up and down movements10 and is sensitive in detecting FP deficits in participants with ankle instability. In support of our findings, Jerosch and Bischof32 reported that when rotational stress was placed on the structures around the ankle, subjects with CAI had performance deficits. They used the single leg hopping course and found that this test could be an effective tool for determining performance deficits in participants with CAI.32 In contrast of our findings, Demeritt et al.33 did not find significant differences between subjects with and without ankle instability in performance tests. Previous authors used cocontraction, shuttle run, and agility hop tests for determining FP deficits; however, it is well known that these tests are not sensitive enough to evaluate FP deficits because these tests need muscular strength and are performed on two legs and thus cannot show performance deficits in an injured January 2015  43

ankle.33 Although other studies explored FP deficits in CAI subjects and did not find differences between injured and uninjured subjects,33–35 it was difficult to compare our findings with the results of other studies due to differences in research methodology and FP tests. Moreover, previous studies did not use FADI and FADI-Sport questionnaires for selecting subjects for their study, whereas we used these questionnaires. Previous investigators only selected CAI subjects with a history of ankle inversion based on self-reports, but in the current study, standard questionnaires were used for selecting CAI subjects. It seems that differences in selecting CAI subjects should be noted when considering the difference in results between our findings and previous author results. With regard to previous studies and our findings, we can say that FP tests with emphasis on lateral movements and rotational stress are appropriate tests for determining FP deficits in athletes with CAI. Our purpose of this investigation was to examine the influence of MAT on FP in athletes with and without CAI. Our data suggests that MAT improved FP for both groups, whereas the percent of these improvements was greater for CAI subjects. To our knowledge, no study has directly examined the influence of taping, especially MAT, on FP. Previous authors only examined the influence of bracing on performance in subjects with ankle instability and found that bracing could improve shuttle run and vertical jump performance.13 In addition, Bicici et al.17 examined the effects of athletic taping and Kinesio Taping® on FP in basketball players with and without ankle sprains, and found improvements in performance time with taping. In contrast, Gross et al.36 examined the effects of an orthesis device on 40-m sprint, figure-8 running, and vertical jump in subjects with ankle instability and found no “orthesis effect” on performance. In this study we used the single leg hopping course, figure-of-8 hop, and side hop tests. It is well known that these FP tests involved lateral aspects of the ankle and are more sensitive than other FP tests such as up-down hop, agility hop, shuttle run, and others, because during these tests lateral movements occur, which affects the lateral side of the ankle.7,10 It appears that CAI induces anterior fault of the fibula, and this translation may be one of the mechanisms for the deficits of FP in subjects with CAI.36 Some studies addressed that CAI can induce impairment in FP.7,8,32 In addition, it appears that CAI impaired proprioception and neuromuscular control, and caused deficits in strength resulting in impair44  January 2015

ment in FP.9,15,16 One of the most popular methods of supporting a weakened ankle is by applying external support by means of ankle tape.13,15 In this study we used MAT because previous authors suggest that this taping method can correct an anterior positional fault of the fibula in CAI subjects and also maintain correct fibular alignment in uninjured subjects.15,16 This may be one of the key mechanisms for improving FP in participants with CAI. Moreover, increases in skin proprioceptive receptors, which offer additional awareness of the foot position and the direction of motion,13,16,37 could be another reason for enhancing FP in athletes with and without CAI. Additional research is necessary to evaluate the effects of taping, such as MAT, on FP in athletes in order to increase data and information about this aspect. Our study indicated that MAT improved stability and confidence and decreased feelings of instability in subjects with CAI. The potential mechanisms for the increased confidence and stability could be the influence of taping on enhancing proprioception and neuromuscular control.4,25 Increases in the skin proprioceptive receptors also offers additional awareness of the foot position and the direction of motion, resulting in increases in confidence and stability at the unstable ankle during FP tests.13,16,36,37 The results of this study suggest that there were differences between athletes who had CAI and healthy athletes in FP tests. In addition, we found that immediate effects of MAT can increase FP tests in subjects with and without CAI, and that these increases were greater for CAI subjects. Based on results, MAT may improve short-term FP. Further research should look at real-time performance. The positive effects of MAT for enhancing confidence and stability in an injured ankle during FP tests were supported via results of this study. Moreover, this taping method has some benefits in comparison with traditional taping, such as facilitation of delivery efficiency, reduction in physiotherapist time, and minimization of time lost by athletes in training and competition. 

References 1. Garrick JG, Requa RK. The epidemiology of foot and ankle injuries in sports. Clin Sports Med. 1988;7:29–36. PubMed 2. Brown CN, Mynark R. Balance deficits in recreational athletes with chronic ankle instability. J Athl Train. 2007;42:367–373. PubMed 3. Caulfield B. Functional instability of the ankle joint. Physiotherapy. 2000;86:401–411. doi:10.1016/S0031-9406(05)60829-2 4. Freeman MAR, Wyke BD. Articular reflexes at the ankle joint: an electromyographic study of normal and abnormal influences of ankle-joint


mechanoreceptors upon reflex activity in the leg muscles. Br J Surg. 1967;54:990–1001. PubMed doi:10.1002/bjs.1800541204 5. Freeman MAR, Dean MRE, Hanham IWF. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br. 1965;47:678–685. PubMed 6. Michelson JD, Hutchins C. Mechanoreceptors in human ankle ligaments. J Bone Joint Surg Br. 1995;77:219–224. PubMed 7. Buchanan AS, Docherty CL, Schrader J. Functional performance testing in participant with functional ankle instability and in a healthy control group. J Athl Train. 2008;43:342–346. PubMed doi:10.4085/10626050-43.4.342 8. Docherty CL, Arnold BL, Gansneder BM, Hurwitz S, Gieck J. Functional performance deficits in volunteers with functional ankle instability. J Athl Train. 2005;40:30–34. PubMed 9. Refshauge KM, Kilbreath SL, Raymond J. The effect of recurrent ankle inversion sprain and taping on proprioception at the ankle. Med Sci Sports Exerc. 2000;32:10–15. PubMed doi:10.1097/00005768200001000-00003 10. Sekir U, Yildiz Y, Hazneci B, Ors F, Saka T, Aydin T. Reliability of a functional test battery evaluating functionality, proprioception and strength in recreational athletes with functional ankle instability. Eur J Phys Rehabil Med. 2008;44:407–415. PubMed 11. Dizon JMR, Reyes JJB. A systemic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. J Sci Med Sport. 2010;13:309–317. PubMed doi:10.1016/j.jsams.2009.05.002 12. Stanek JM, McLoda TA, McCaw S, Launder K. The effects of external support on electromechanical delay of the peroneus longus muscle. Electromyogr Clin Neurophysiol. 2006;46:349–354. PubMed 13. Hopper D, Samsson K, Hulenik T, Hall T, Robinson K. The influence of mulligan ankle taping during balance performance in subjects with unilateral chronic ankle instability. Phys Ther Sport. 2009;10:125–130. PubMed doi:10.1016/j.ptsp.2009.07.005 14. Mulligan RF. Self treatments for backs, necks, limbs: a new approach. Wellington, New Zealand: Plane View Services; 2003. 15. Delahunt E, McGrath A, Doran N, Coughlan GF. Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability. Arch Phys Med Rehabil. 2010;91:1383–1389. PubMed doi:10.1016/j.apmr.2010.06.023 16. Moiler K, Hall T, Robinson K. The role of fibular tape in the prevention of ankle injury in Basketball: A Pilot Study. J Orthop Sports Phys Ther. 2006;36:661–668. PubMed doi:10.2519/jospt.2006.2259 17. Bicici S, Karatas N, Baltaci G. Effect of athletic taping and kinesiotaping® on measurements of functional performance in basketball players with chronic inversion ankle sprains. Int J Sports Phys Ther. 2012;7:154–166. PubMed 18. Sawkins K, Refshauge K, Kilbreath S, Raymond J. The placebo effect of ankle taping in ankle instability. Med Sci Sports Exerc. 2007;39:781– 787. PubMed doi:10.1249/MSS.0b013e3180337371 19. Metcalfe RC, Schlabach GA, Looney MA. A comparison of moleskintape, linentape, and lace-up brace on joint restriction and movement performance. J Athl Train. 1997;32:136–140. PubMed 20. Juvenal JP. The effects of ankle taping on vertical jumping ability. Athl Train J Natl Athl Train Assoc. 1972;7:146–149. 21. Mayhew JL. Effects of ankle taping on motor performance. Athl Train J Natl Athl Train Assoc. 1972;7:10–11. 22. Greene TA, Hillman SK. Comparison of support provided by a semirigid orthosis and adhesive ankle taping before, during,


and after exercise. Am J Sports Med. 1990;18:498–506. PubMed doi:10.1177/036354659001800509 23. Bocchinfuso C, Sitler MR, Kimura I. Effects of two semirigid prophylactic ankle stabilizers on performance involving speed, agility, and vertical jump. J Sport Rehabil. 1994;3:125–134. 24. Burks RT, Bean BG, Marcus R, et al. Analysis of athletic performance with prophylactic ankle devices. Am J Sports Med. 1991;19:104–106. PubMed doi:10.1177/036354659101900202 25. Mulligan BR. Manual therapy: NAGS, SNAGS, MWMS, etc. 3rd ed. Wellington, New Zealand: Plane View Services LTD; 1995. pp. 95–101. 26. Hertel J, Olmsted-Kramer LC. Deficits in time to boundary measures of postural control with chronic ankle instability. Gait Posture. 2007;25:33–39. PubMed doi:10.1016/j.gaitpost.2005.12.009 27. Gribble PA, Brittany L, Taylor J, Shinohara U. Bracing does not improve dynamic stability in chronic ankle instability subjects. Phys Ther Sport. 2010;11:3–7. PubMed doi:10.1016/j.ptsp.2009.11.003 28. Harriss DJ, Atkinson G. Ethical standards in sports and exercise science research. Int J Sports Med. 2013;34:1025–1028. PubMed doi:10.1055/s-0033-1358756 29. Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the international ankle consortium. J Orthop Sports Phys Ther. 2013;43:585–591. PubMed doi:10.2519/jospt.2013.0303 30. Magee DJ. Orthopedic physical assessment. 4th ed. Amsterdam, Netherlands: Elsevier Sciences; 2002. 31. Sporndly-Ness S, Dasberg B, Nielson RO, Boesen MI, Langberg H. The navicular position test-a reliable measure of the navicular bone position during rest and loading. Int J Sports Phy Ther. 2011;6:199–205. 32. Jerosch J, Bischof M. Proprioceptive capabilities of the ankle in stable and unstable joint. Sports Exerc Inj. 1996;2:167–171. 33. Demeritt KM, Shultz SJ, Docherty CL, Gansneder BM, Perrin DH. Chronic ankle instability does not affect lower extremity functional performance. J Athl Train. 2002;37:507–511. PubMed 34. Munn JS, Beard J, Refshauge KM, Lee RWY. Do functional performance tests detect impairment in subjects with ankle instability. J Sport Rehabil. 2002;11:40–50. 35. Worrell TW, Booher LD, Hench KM. Closed kinetic chain assessment following inversion ankle sprain. J Sport Rehabil. 1994;3:197–203. 36. Gross MT, Clemence LM, Cox BD, et al. Effect of ankle orthoses on functional performance for individuals with recurrent lateral ankle sprains. J Orthop Sports Phys Ther. 1997;25:245–252. PubMed doi:10.2519/jospt.1997.25.4.245 37. Hals TM, Sitler MR, Mattacola CG. Effect of a semi-rigid ankle stabilizer on performance in persons with functional ankle instability. J Orthop Sports Phys Ther. 2000;30:552–556. PubMed doi:10.2519/ jospt.2000.30.9.552

Marjan Someeh, Ali Asghar Norasteh, and Hassan Daneshmandi are with the Department of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran. Abbas Asadi is with Roudbar Branch, Islamic Azad University, Roudbar, Iran. Address author correspondence to Asadi at abbas_asadi1175@ yahoo.com Tricia Turner, PhD, ATC, University of North Carolina at Charlotte, is the report editor for this article.

January 2015  45