Effective Ankle Taping Study for Fast Bowlers with Posterior Ankle Impingement

GUIDE: Prof. M.SUKUMAR,M.P.T (Sports), M.I.A.P Jaya College of Paramedical Sciences, College of Physiotherapy, MTH Road, Thiruninravur 602 024. Thiruvallur District, Tamilnadu. Presented By: Register No: 271850202 Mr. D.KRISHNA PRABHU

BACKGROUND Posterior ankle impingement syndrome (PAIS) is a common disorder being reported increasingly in fast bowler s . In cricket players, it is caused by the repetitive stress of ankle plantar flexion due to longer delivery stride on front foot landing. Protective ankle dorsal flexion taping is recommended with the belief that it prevents s posterior ankle impingement. How ever the relationship between the ankle taping and the bowling performance/ speed remains unclear.

INTRODUCTION Posterior ankle impingement syndrome (PAIS) is the term attributed to the clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. Soft tissues, bony process unfused ossicles or osseous fragments entrapped between the posterior tibial plafond and the superior calcaneus lead to the symptoms. (2) Posterior ankle pain has been associated with athletes who engage in activities involving heavy landings or springing off the foot. It is a collection of conditions that include flexor hallucis longus tenosynovitis, peroneal tenosynovitis and tendinitis, intra-articular loose bodies, ankle synovitis and disorders with an os trigonum. This clinical syndrome is well recognized in fast bowlers in cricket.(3, 20, 28)

INTRODUCTION Taping can be a very effective means of reducing the range plantar flexion forces that typically aggravate the condition during in competition and in acute or irritable cases. (7). Also taping provides mechanical support, and the tape may enhance proprioception. (8)

NEED FOR THE STUDY None of the studies have focused on plantar flexion restriction taping correction in managing posterior ankle Impingement syndrome. So this study aims at finding the effectiveness of ankle taping by restricting plantar flexion at an angle to avoid Posterior Ankle Impingement Syndrome in fast bowlers during their front foot impact.

OBJECTIVE OF THE STUDY The objectives of this study were to evaluate the effectiveness between the restriction of ankle taping at 15 degree of plantar flexion, restriction of ankle taping at 30 degree of plantar flexion and no ankle taping for the fast bowlers with the posterior ankle impingement syndrome.

HYPOTHESIS NULL HYPOTHESIS: There is no significant difference between ankle taping at 15 degree (group A) and ankle taping at 30 degree (Group B) and no taping (group C) in fast bowlers with posterior ankle impingement syndrome. ALTERNATIVE HYPOTHESIS: There is significant difference between ankle taping at 15 degree (group A) and ankle taping at 30 degree (Group B) and no taping ( Group C) in fast bowlers with posterior ankle impingement syndrome.

OPERATIONAL DEFINITION PAIS - Posterior ankle impingement syndrome is the term attributed to the clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. NPRS- Numerical Pain Rating Scale measure the subjective intensity of pain, is an 11 point scale 0-10. FAAM- Sports Sub Scale- Foot and ankle ability measure is a self report measure that assesses physical function of individuals with lower leg, foot and ankle musculoskeletal disorders.

DESIGN & METHODOLOGY STUDY DESIGN: Experimental Study Design. STUDY SETTING: Cricket Nets : SRMC-Cricket Ground (Porur), Nagaland Cricket Academy (Dimapur, Nagaland), SSN College of Engineering (Kalpathi- AGS Cricket Ground).

DESIGN & METHODOLOGY SOURCE OF DATA: Young star cricket club, Crombest Recreation Club Nagaland Cricket Association State Cricket team. SAMPLE SIZE: 30 subjects STUDY DURATION: Subjects were tested on a 3 occasion and were tested across 3 taping conditions in a randomized order with rest period of 3 days between each taping condition. TREATMENT DURATION: Subjects attended a 1-hour testing session at the nets

DESIGN & METHODOLOGY INCLUSION CRITERIA: Cricket Players - Pace/Fast Bowlers. Male Cricketers. Both left and right arm fast bowlers. Age between 16 to 35. Positive Hyper plantar Flexion Test Pain on their front foot impact while bowling. Bowling in turf wickets. Fast Bowlers playing State level. EXCLUSION CRITERIA: History of Surgery. Allergic to tape. Players who received steroid injection last 30 days before. Pain while running and jogging. Bowling in indoor areas.

DESIGN & METHODOLOGY METHODOLOGY: Data will be collected from cricket players with specialization of fast bowling in India from different state who were played and playing for their respective state. Subjects who were clinically diagnosed as PAIS will be included in the study. Subjects will be selected based upon inclusion criteria. The purpose of the study explained to the players and volunteered to participate in the study after providing written informed consent.

DESIGN & METHODOLOGY MATERIALS USED: Physio Table. Goniometer. Pre wrap - 38mm Fixomull tape/Stretch o- Fix 50mm Brown Rigid Adhesive Tape. Tape Remover Spray. Bushnell Speed radar gun. Taping Scissor. Tape Cutter. Foot And Ankle Ability Measure (FAAM)- Sports sub Scale NPRS-Numeric Pain rating Scale.

DESIGN & METHODOLOGY Variables: Dependent variables: Pain Functional ability. Average Bowling Speed. Independent variables: Ankle Taping @ 15degree & 30 Degree & No taping. PARAMETER MEASUREMENTS: Primary outcome measures of treatment with relative parameters such as: Pain- Numerical Pain Rating scale (NPRS). Foot ankle ability measure (FAAM) Sports Sub Scale Bowling Speed Bushnell radar Speed Gun.

PROCEDURE

PROCEDURE Anchor A strip of tape around the lower 1/3 of the shin and another one around the forefoot, just before the toes over the metatarsal heads. Subject s plantar flexion range is restricted at an angle which is measured through Goniometer.

PROCEDURE Straight line: Start the tape at the level of the lower leg anchor and conclude this taping technique at the level of the forefoot anchor by firmly. 1 straight line either centrally or slightly adjacent to each other depending on the size of the ankle and the amount of support required.

PROCEDURE Crosses: Begin this taping technique at the level of the lower leg anchor on the inner aspect of the lower leg and conclude this taping technique by firmly following the white arrow to the outer aspect of the forefoot anchor. Repeat this process beginning from the outer aspect of the lower leg and moving to the inner aspect of the forefoot so we form a cross. Overlay 3 or 4 strips over the anterior ankle in an X shape following the contours of the ankle and including another couple of check reins.

PROCEDURE Ball release speed was measured using a cordless Bushnell Velocity Speed Gun, which was positioned / Hold behind the nets and bowling speed noted in KMPH for each delivery.

DATA ANALYSIS & STATISTICS Statistics Methodology Descriptive Statistics Mean & Standard deviation for Continuous variables like NPRS, FAAM, and AVERAGE BOWLING SPEED Inferential Statistics One-Way Repeated Measures ANOVA One-Way Repeated measures ANOVA A repeated measure ANOVA is the extension of the dependent t-test or Paired Samples t-test. Repeated measures ANOVA can be applied to analyze data that comes from two types study design (1) to examine whether there is significant changes in mean scores over three or more time points, or (2) to examine whether there is significant differences in mean scores under three or more different treatment conditions.

DATA ANALYSIS & STATISTICS Hypotheses: Null hypothesis, H0: There is no significant difference between related population means (i.e. _1= _2= _3= = _k) Alternate hypothesis, H1: At least two means are significantly different Test Statistic: F= (Mean Square under different conditions / Mean Square Error)

DESCRIPTIVE STATISTICS -MEAN 116.80 120 106.80 106.70 94.60 100 70.20 80 63.70 MEAN NPRS (no taping) 60 FAAM (no taping) 40 BOWLING_SPEED (no taping) NPRS_15* OF Taping 20 7.20 4.50 1.20 FAAM_15* OF Taping 0 BOWLING_SPEED_15* OF Taping NPRS_30* OF Taping FAAM_30* OF Taping BOWLING_SPEED_30* OF Taping VARIABLES