An Exploratory Study On The Acute Effects Of .

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Asian J Sports Med. 2018 June; 9(2):e63020.doi: 10.5812/asjsm.63020.Published online 2018 June 1.Research ArticleAn Exploratory Study on the Acute Effects of Proprioceptive Exerciseand/or Neuromuscular Taping on Balance PerformanceLuca Russo,1 Paolo Bartolucci,1 Luca Paolo Ardigò,2, * Johnny Padulo,3,4 Jelena Pausic,4 and AntonioDello Iacono51Department of Applied Clinical Sciences and Biotechnologies, University of L’Aquila, L’Aquila, ItalyDepartment of Neurosciences, School of Exercise and Sport Science, Biomedicine and Movement Sciences, University of Verona, Verona, ItalyUniversity eCampus, Novedrate, Italy4Faculty of Kinesiology, University of Split, Split, Croatia5Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel23*Corresponding author: Luca Paolo Ardigò, Department of Neurosciences, School of Exercise and Sport Science, Biomedicine and Movement Sciences, University of Verona, ViaFelice Casorati, 43, 37131, Verona, Italy. Tel: 39-3477266814, Fax: 39-0458425131, E-mail: [email protected] 2017 October 18; Revised 2017 December 03; Accepted 2018 March 10.AbstractBackground: This study aimed at investigating the acute effects of combined EXERCISE and TAPING in comparison to isolated proprioceptive exercise (EXERCISE) and ankle neuromuscular taping (TAPING) on one - leg stability performance in rugby players.Methods: Stability tests, performed on a stabilometric platform, were assessed for stability before and after above interventions.Performed stability tests were one - leg static stance (dominant leg and non - dominant leg) each with eyes open and eyes closed. Theassessed dependent variables were: centre of pressure (CoP) path length; CoP speed; medio - lateral, and anterior - posterior sway.Sixteen male rugby players (27.3 3.3 years; 177.3 7.3 cm; 88.8 15.2 kg) from a non - professional rugby team were tested in allabove conditions, according to a cross - over study design.Results: Most of investigated variables improved following EXERCISE TAPING (CoP path length -18.2/ -15.6%, CoP speed -22.8/-17.7%,and anterior-posterior sway -21.0/ -16.3%), in comparison with the other two protocols. EXERCISE TAPING improved the stabilitycontrol by combining the effects of both proprioceptive exercise and neuromuscular taping.Conclusions: Such findings could suggest the benefits of planning long - term strategies using EXERCISE TAPING protocols forimproving the functional stability and for preventing re - occuring injuries.Keywords: Ankle, Exercise, Proprioception1. BackgroundHuman postural demands and balance control are ofprimary interest for both daily life and athletic motion.The ability to manage one’s own body in the environmentis controlled by a complex interaction between musculoskeletal and neural system activities involving the reception and interpretation of information about the positionof body parts, integration of sensorimotor inputs and execution of appropriate movement (1). Specifically for gaitand balance tasks, ankle joint and foot structures are identified as great contributors to performance, given that theyboth represent the starting point from whence kinestheticinformation arises and are the functional executors providing stability in response to the demanded skills (1). Infact, somatosensory inputs originate from three differentreceptors: pressure receptors in the skin, deep tendon sensory receptors, and joint receptors located in the distal partof the lower limb (2). In light of this background, the ankleand foot structures provide the propulsion for the wholebody, absorb impact, and perform the functions of keepingthe body upright against gravity and of maintaining posture during movement (3).In the clinical field, changes in the control and the stability of the ankle are chronically obtained by means ofproprioceptive exercises (4-7) and by applying both neuromuscular and rigid bandages to the joint (5, 8, 9). Several types of exercise are proposed to improve proprioception, designed as either acute - designed strategies (6) orlong - term training protocols. It has been widely reportedthat exercise groups involved in proprioceptive and neuromuscular training programs demonstrated significant improvement of passive and active ankle range of movement,better scores in most of the postural sway related variablesand higher muscle activations combined with shorter re-Copyright 2018, Asian Journal of Sports Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0International License ( which permits copy and redistribute the material just in noncommercial usages, provided theoriginal work is properly cited

Russo L et al.action times of the muscles surrounding the ankle joint (5,6, 10).Neuromuscular taping (i.e., with adjustable elasticity)has been proposed as an effective alternative to the functional bandage for the passive stabilization and blockage(i.e., stiffness) of joints (8). Neuromuscular taping hasa number of mechanical and neurophysiological advantages: it improves stability of the ankle joint and therefore has a positive effect on gait speed and balance ability in healthy adults (11) as well as positive effects on knee flexion range of movement, walking, and pain in patientswith knee osteoarthritis (12). Neuromuscular taping hasalso the ability to control the centre of pressure (CoP) swayspeed and lead to better performance in maintaining stability when a perturbation is applied (13). Studies havealso shown that neuromuscular taping facilitates the neuromuscular reflexes (13). This capability is the result of theincrease in sensory input caused by direct contact betweenthe tape and the skin (14). MRI evidence indicates that neuromuscular taping affects both underlying and targetedtissues, as well as distant ones (15). In addition, some systematic reviews (16, 17) found anecdotal support for the usage of neuromuscular tape. Overall, other authors indicatethe questionable potential advantages associated with itsapplication. Williams et al. (17) concluded that there islittle evidence to support the use of neuromuscular taping over other types of taping in the management or prevention of sports injuries and in improving strength andrange of motion; but further studies are needed to confirm these findings. Serrao et al. (18) did not show anyeffect of neuromuscular taping on thigh muscles surfaceelectromyography and perceived exertion during squat exercise in healthy subjects. The results of a meta - analysis (19) suggested that the effectiveness of neuromusculartaping is not muscle - group dependent. However, the reviewed studies investigated the potential effects of neuromuscular taping application on muscular outcomes butneglected the assessment of its well - known effects on postural control and joint stabilization. Indeed, both proprioceptive exercise and neuromuscular taping have been reported to enhance postural control by improving proprioception inputs; but investigations are lacking in the combined effects of these treatments, in order to select the beststrategy to manage proprioception deficit.Taping Applications in Kinesiology”] Method ) would bemore effective than the single strategy in inducing acuteeffects on balance ability. Therefore, this study comparedthe acute effects of using single or combined stabilizationstrategies on stability during a one - leg static balance task.3. Methods3.1. ParticipantsThis study involved 16 male rugby players (27.3 3.3years; 177.3 7.3 cm; 88.8 15.2 kg [mean SD]), members of a non - professional rugby team. All players trainedthree days per week for 90 min a day, performing technical, tactical, strength, and speed training (plus match onSunday). The three different experimental trials were administered on the same three days of week and at the sametime of the day, in order to reduce possible bias and anypotential effect of physical activities and diurnal variation.Players were asked to refrain from strenuous physical exercise during the 24 h before testing to limit residual effects due to previous effort. To identify which lower limbwas the dominant one, the participants were asked to indicate their preferred kicking foot: 100% of the participantswere identified as right - leg dominant. Written informedconsent was obtained from the participants after they weregiven an oral explanation of the purpose, benefits, and potential risks of participating in the study. This study was approved by the institution’s ethics committee in agreementwith the Declaration of Helsinki.The inclusion/exclusion criteria for the study participations were: To have participated in at least 90% of the training sessions with the same team. No history during the three months preceding the testof neuromuscular disease, vertigo, or any uncorrectedvisual problems. Absence of cardiovascular, neurologic, or pulmonarydisease, balance problems, rheumatoid disease, or psychological disease. Absence of any kind of ankle injury or lower limb2. ObjectivesTaking into consideration the scientific evidence inthe current literature, the main hypothesis of this studywas that the concurrent application of neuromuscular taping combined with proprioceptive exercise - based protocols (“Taping Elastico Chinesiologico”, T.E.CH. [i.e., “Elastic2surgery. No use of sedative medication.A randomized and crossover study design was used tocompare the effects of using either combined or isolatedstrategies on subsequent stability performance.Asian J Sports Med. 2018; 9(2):e63020.

Russo L et al.3.2. ProceduresThree experimental protocols were randomly administered on three different occasions. A subjects’ block randomization in three groups was performed and the following protocols were administered: Protocol 1. Proprioceptive exercises and balance exercises performed on unstable surfaces (EXERCISE). Protocol 2. Neuromuscular tape (TAPING). Following theapplication of neuromuscular tape, subjects were freeto move and walk, avoiding unstable surfaces, for about25min. Protocol 3. Both neuromuscular tape and proprioceptive exercises on unstable surfaces (EXERCISE TAPING)were applied/performed concurrently (i.e., taping wasoperated before proprioceptive exercises).Upon each visit, the subjects performed a baseline stabilometric test (20), followed by one of the three conditions, and were then re - tested. The tests consisted of a one- leg static balance assessment lasting 10 sec in the following conditions (3): alternate one - leg with open (OE) andclosed (CE) eyes in a random sequence. The assessmentswere carried out in the same room and same conditions oflight, temperature (23 C), and humidity (18%).For the stabilometric assessment, a sensor matrix platform (FreeMed 40 40, Sensor Medica, Guidonia, Italy)with sampling rate of 50 Hz (21) was used. The accuracyof the instrument was previously documented (22), while,for verifying the precision of the measures in our study, thestabilometric data recorded at each baseline point werecompared. For each test, quantitative measurements ofCoP path length, CoP path average speed, medio - lateral( X) and anterior - posterior sway amplitude ( Y) were assessed (23).The neuromuscular taping (Taping Elastico , ATS,Arezzo, Italy) was carried out according to the T.E.CH.Method recommendations (Figure 1A-C). Moreover, in allconditions the same operator operated the taping application, in order to avoid any bias effects due to inter-operatorvariability.The proprioceptive exercise protocol was performedon different unstable surfaces that were placed in a seriesto create a compulsory path for the subjects. The exercisesequence had the same duration of the protocol describedby Romero - Franco et al. (6, 22): 25 min of proprioceptiveexercise circuit with six balance exercises on unstable surfaces, lasting 30 s for each leg, with a 30 s recovery time, andrepeated five times (Figure 2A-F).Asian J Sports Med. 2018; 9(2):e63020.Figure 1. Placement of the Neuromuscular Tape on Subjects (A, B, and C).3.3. Statistical AnalysisDescriptive statistics are presented as mean (SD, 95%CI). Statistical analysis was performed by using SPSS software (version 21, SPSS Inc., Chicago, IL, USA). Assumptionof data normality was verified by Kolmogorov - Smirnovtest. A univariate ANOVA test with factor (each condition)post - hoc comparisons (LSD) was used to investigate differ3

Russo L et al.Figure 2. Proprioceptive exercise circuit’s 6 workstations: (A) unstable foam mat in static stance, (B) unstable foam mat guide in dynamic stance, (C) air cushion in staticstance, (D) stiff unstable tridimensional plate, (E) air cushion in lower - limb static stance and with ball movement around the trunk, (F) elastic trampoline with jump andstop task.ences between the baseline measures of each testing day.Measures in the different conditions were analyzed by using a separate two - way ANOVA (condition x time) with re-4peated measures and the paired t - test was used to compare pre- and post - treatment in the different conditions.The significance level was set at P 0.05. In case of sig-Asian J Sports Med. 2018; 9(2):e63020.

Russo L et al.nificance, Cohen’s d effect size (ES) was calculated. Theobtained ESs were shown and interpreted as proposed byHopkins ( with ES 0.2considered as trivial, 0.2-0.5 small, 0.6-1.1 moderate, 1.2-1.9large and 2 very large.4. ResultsANOVA showed no significant baseline stability performance differences between each testing day for all measurements in all conditions, with all P 0.05 (Table 1),therefore type 1 error was excluded. Two - way ANOVA didnot show any significant difference over conditions. The t- test between pre- and post - values showed significant differences in effect of time (Tables 2 and 3).For the non - dominant leg and OE condition, o