medicina

Review
Is Kinesio Taping Effective for Sport Performance and Ankle
Function of Athletes with Chronic Ankle Instability (CAI)? A
Systematic Review and Meta-Analysis
Carlo Biz 1, *,† , Pietro Nicoletti 1,2,† , Matteo Tomasin 1,2 , Nicola Luigi Bragazzi 3 , Giuseppe Di Rubbo 1
and Pietro Ruggieri 1

1 Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG),
University of Padova, 35128 Padova, Italy; [email protected] (P.N.);
[email protected] (M.T.); [email protected] (G.D.R.);
[email protected] (P.R.)
2 Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35128 Padova, Italy
3 Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM),
York University, Toronto, ON M3J 1P3, Canada; [email protected]
* Correspondence: [email protected]; Tel.: +39-0498213239
† These authors contributed equally to this work.

Abstract: Background and Objectives: Ankle injuries are the most common type of injury in healthy
active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle
instability (CAI). The aim of the present review is to evaluate the effects of Kinesio Taping (or KT) on
sports performances and ankle functions in athletes with CAI. Materials and Methods: This systematic
Citation: Biz, C.; Nicoletti, P.; review with meta-analysis was carried out following the criteria of the Prisma Statement system
Tomasin, M.; Bragazzi, N.L.; Di
(registered on Open Science Framework, number: 10.17605/OSF.IO/D8QN5). For the selection of
Rubbo, G.; Ruggieri, P. Is Kinesio
the studies, PubMed, Scopus and Web of Science were used as databases in which the following
Taping Effective for Sport
string was used: (“kinesiology tape” OR “tape” OR “taping” OR “elastic taping” OR “kinesio taping”
Performance and Ankle Function of
OR “neuro taping”) AND (unstable OR instability) AND (ankle OR (ankle OR “ankle sprain” OR
Athletes with Chronic Ankle
Instability (CAI)? A Systematic
“injured ankle” OR “ankle injury”)). The Downs and Black Scale was used for the quality analysis.
Review and Meta-Analysis. Medicina The outcomes considered were gait functions, ROM, muscle activation, postural sway, dynamic
2022, 58, 620. https://doi.org/ balance, lateral landing from a monopodalic drop and agility. Effect sizes (ESs) were synthesised as
10.3390/medicina58050620 standardized mean differences between the control and intervention groups. Calculation of the 95%
confidence interval (CI) for each ES was conducted according to Hedges and Olkin. Results: In total,
Academic Editors: Massimiliano
Mosca, Carlo Perisano and
1448 articles were identified and 8 studies were included, with a total of 270 athletes. The application
Tommaso Greco of the tape had a significant effect size on gait functions, ROM, muscle activation and postural sway.
Conclusions: The meta-analysis showed a significant improvement in gait functions (step velocity,
Received: 27 March 2022
step and stride length and reduction in the base of support in dynamics), reduction in the joint ROM
Accepted: 27 April 2022
in inversion and eversion, decrease in the muscle activation of the long peroneus and decrease in the
Published: 29 April 2022
postural sway in movement in the mid-lateral direction. It is possible to conclude that KT provides a
Publisher’s Note: MDPI stays neutral moderate stabilising effect on the ankles of the athletes of most popular contact sports with CAI.
with regard to jurisdictional claims in
published maps and institutional affil- Keywords: kinesio taping; chronic ankle instability; ankle sprain; ankle injuries; elastic taping
iations.

1. Introduction
Copyright: © 2022 by the authors.
Licensee MDPI, Basel, Switzerland. Ankle injuries are the most common injury in healthy active individuals [1–3], affecting
This article is an open access article women more frequently than men (13.6 vs. 6.94 per 1000 exposures), children more
distributed under the terms and frequently than adolescents (2.85 vs. 1.94 per 1000 exposures) and adolescents more
conditions of the Creative Commons frequently than adults (1.94 vs. 0.72 per 1000 exposures) [4]. These high incidence rates
Attribution (CC BY) license (https:// show that these injuries can cause high costs for health care systems; Gribble et al. showed
creativecommons.org/licenses/by/ that ankle injuries cost USD 6.2 billion in high school athletes in the US and EUR 208 million
4.0/). in the Netherlands annually [5,6].

Medicina 2022, 58, 620. https://doi.org/10.3390/medicina58050620 https://www.mdpi.com/journal/medicina

Medicina 2022, 58, 620 2 of 15

The sports in which ankle injuries are most common are indoor and court sports [7,8],
with an incidence rate of 7 per 1000 exposures, compared to water/ice sports
(3.7/1000 exposures), field-based sports (1.0/1000 exposures) and outdoor pursuits sports
(0.88/1000 exposures) [4]. About 30% of ankle injuries occur during training sessions and
the remaining 70% during matches, where performance becomes much more demand-
ing [9–12].
Chronic ankle instability (CAI) is the process caused by repetitive ankle sprains and
multiple episodes of the ankle “giving way” with persistent symptoms [13–15]. It mainly
affects the sports population and is related to multiple inversion injuries [16,17]. The
prevalence of CAI in a population with a history of ankle injuries is 46%, ranging from 9
to 76% [2]. The wide range in prevalence data is influenced by multiple factors, such as
gender and age, which can have a very important impact on the development of this type
of injury [18]. As mentioned above, women and young people are more likely to develop
ankle injuries and CAI [19,20]. The meta-analysis by Chiao-I Lin et al. showed that the
prevalence of CAI was much higher in subjects under 18 years old, with a rate of 63%
compared to the entire population considered [2].
In the study by Chiao-I Lin et al., recurrent ankle sprain (61%) was most prevalent in
soccer athletes, and the highest rate of perceived ankle instability (41%) was in track and
field athletes with a history of ankle sprain [2].
This type of instability can be related not only to mechanical instability or ligamentous
laxity but also to functional instability, with frequent “giving way” during normal daily
activities [21–23]. If the soft tissues are not damaged despite repeated injuries, then the
clinical condition is identified as functional ankle instability (FAI) [24]. The risk factors
underlying CAI are not exclusively linked to ligament laxity but also to a proprioceptive
deficit, to muscle weakness of the lateral compartment of the leg, mainly the peroneus
brevis and longus, to their delayed neuromuscular activation and to a loss of static and
dynamic balance in a monopodalic load [25–30]. Other risk factors are related to high
BMI, participation in sports, having an increased talar curvature and not using external
supports [31].
To establish the severity of ankle instability in people affected, three scores with a
defined cutoff score are recommended by the International Ankle Consortium: The Ankle
Instability Instrument (AII), answering “yes” to at least five questions; The Cumberland
Ankle Instability Tool (CAIT), with <24 points and The Identification of Functional Ankle
Instability (IdFAI), with >11 points [32].
Since CAI can become a demanding issue for athletes who are forced to stop at every
episode of sensation of “giving way” of their ankle, it is important to look for prevention
strategies and methods that improve the condition and performance of athletes. Given
this background and the incidence of these injuries, it was important to evaluate how the
kinesio taping (KT) acts on the injured ankle [33]. This elastic bandage was introduced in
the 1970s by Kenzo Kase and has become very popular over the last few decades, used
widely in physiotherapy for musculoskeletal disorders affecting both the upper and lower
limbs. In particular, it has become more widespread in sports and other rehabilitation fields
due to its intrinsic stretching capacity, which allows it to maintain sufficient mobility in the
areas where it is applied compared to inelastic bandages [34,35]. A very important aspect of
KT is its ability to retract after being applied due to its surface texture, which allows a slight
traction of the underlying tissues, granting greater stability to the targeted area [36,37].
As KT is widely used for multiple dysfunctions with debated effect reported in the
literature, and the several studies published over the years seem to contradict one another,
the aim of this review was to investigate the real effectiveness of KT in improving the
specific performance and the ankle function of athletes with CAI during sports activities
such as soccer, basketball, volleyball, baseball and badminton in which this disorder is
frequent and challenging to treat [38–40].
Medicina 2022, 58, 620 3 of 15

2. Materials and Methods

2.1. Data Sources and Search Strategy
Findings of the present systematic review and meta-analysis are reported according
to the “Preferred Reporting Items for Systematic Reviews and Meta-Analysis” (PRISMA)
guidelines [41]. The study protocol has been registered within the Open Science Framework
depository (Identifier code: DOI:10.17605/OSF.IO/D8QN5).
A search string related to KT was devised based on three major components: kinesiol-
ogy taping, ankle and instability. For each component, an exhaustive list of keywords and
relevant synonyms were generated, using proper Boolean connectors. The following string
was used: (“kinesiology tape” OR “tape” OR “taping” OR “elastic taping” OR “kinesio
taping” OR “kinesiotape” OR “neuro taping”) AND (unstable OR instability) AND (ankle
OR (ankle OR “ankle sprain” OR “injured ankle” OR “ankle injury”)).
The existing literature was systematically searched from 2010 to December 2021 using
the databases PubMed/MEDLINE20, ISI/Web of Science (WoS) and Scopus. A language
filter was also applied, searching in English only.

2.2. Inclusion Criteria

Only articles written in English and designed as original studies were included. Only
randomised clinical trials (either cross-sectional or cross-over), cohort studies, case-control
studies and case series were selected that met the following criteria: the participants were
adults, both females and males, with a diagnosis of chronic ankle instability (CAI); the
participants were athletes; there was at least one intervention group; there was at least
one group who had KT applied to their ankle; at least one ankle function was analysed in
the groups.

2.3. Exclusion Criteria

All studies that included non-athletic patients or those who underwent ankle surgery
or had an ankle fracture of at least 6 months were excluded. Non-English-language articles,
review articles, meta-analyses, editorials, letters, comments, conference abstracts or case
reports, duplicate or non-full-text articles were also excluded.

2.4. Screening
This systematic procedure, according to PRISMA guidelines, consists of identification,
screening, assessment and inclusion of those studies and the relative patients included that
were suitable for the review aims [41]. Hence, the screening was carried out by reading
first the abstracts of all of the articles found. If the abstracts met the inclusion criteria, the
full-text manuscript was retrieved and assessed. A cross-reference search of the selected
articles was also performed to obtain other relevant articles for the study.
After this initial process, the selected articles and references were reviewed and
assessed independently by two reviewers (GDR and MT), and all queries were discussed
and resolved by the supervisory team (CB and PN) during regular meetings. If there was
disagreement among the investigators regarding the inclusion or exclusion criteria, the
senior investigator (PR) made the final decision. The level of agreement was high, with
kappa statistics ≥ 0.80 [42,43].

2.5. Data Collection

Finally, data extraction was completed by an independent assessor (NLB). The studies
that were selected as includible were ordered in an Excel file in which the data extraction
was completed independently. Data were extracted for the various studies, (authors,
publication date, study design, level of evidence, outcome measurements) and for the
patients included: numbers, sex, age, type of sport.
Medicina 2022, 58, 620 4 of 15

2.6. Quality Appraisal

The quality analysis was carried out using the Downs and Black Scale [44], attributing
to each item 1 point if the study fully complied with the criteria and if not, 0 points. The
only exception was made for item 5 of the scale where 1 point was awarded even if the
criteria was not fully met or was partially met, and 2 points instead if the criteria was fully
met. The average value was calculated among the total scores to define the average quality
of the articles included in the systematic review and meta-analysis.

2.7. Meta-Analysis
Effect sizes (ESs) were synthesised as standardized mean differences between the con-
trol and intervention groups, correcting for the small sample size when necessary (Hedges’
g). Calculation of the 95% confidence interval (CI) for each ES was conducted according
to Hedges and Olkin (1985) [45]. For studies with a pre- and post-design, overall ES was
computed both sensu Morris (2002) and sensu Klauer (2001) [46]. While the latter computes
the overall ES simply subtracting the pre-ES from the post-ES, Morris (2002) weighs the
pre–post mean differences using the pooled pre-test standard deviation [46]. Using Cohen’s
rule of thumb, the magnitude and meaning of the computed ES was interpreted as follows:
small = 0.20, moderate = 0.50 and large ≥ 0.80 [47]. Fixed-effect models were applied when
heterogeneity among studies was not significant according to the I2 statistics; otherwise,
a mixed-effect model was applied. All statistical analyses were conducted by means of
the commercial software “Statistical Package for Social Sciences” (SPSS version 28.00, IBM
Corporation, Armonk, NY, USA). Graphs were generated by means of the commercial
software MedCalc® version 20.011 (MedCalc Software Ltd., Ostend, Belgium).

3. Results
3.1. Search Yield
The literature search yielded a pool of 1448 items: 1123 from Scopus, 200 from5 ISI/Web
Medicina 2022, 58, x FOR PEER REVIEW of 18
of Science and 125 from PubMed, as shown pictorially in Figure 1. Included studies are
reported in Table 1.

Figure 1. Systematic
Figure 1. Systematic Reviews Reviews and Meta-Analyses
and Meta-Analyses (PRISMA) flow
(PRISMA) flowchart
chartshowing the process
showing for in- for
the process
clusion of papers. For this study, 14 articles were assessed for eligibility after screening: among
inclusion of papers. For this study, 14 articles were assessed
these, 8 new studies were included in the analysis [41]. for eligibility after screening: among
these, 8 new studies were included in the analysis [41].
Table 1. Study Characteristics.

Author Level of
Type of Study n (m/f) Age (Years *) Sport
(Publication Year) Evidence
Kim et al. (2017) [48] Cross-Over Randomised Design I 22 (m) 17.72 ± 0.76 Football
Sarvestan et al. (2018) Cross-Sectional Randomised University
II 26 (13 m/13 f) 23.9 ± 1.6
Medicina 2022, 58, 620 5 of 15

Table 1. Study Characteristics.

Author Level of
Type of Study n (m/f) Age (Years *) Sport
(Publication Year) Evidence
Kim et al. (2017) [48] Cross-Over Randomised Design I 22 (m) 17.72 ± 0.76 Football
Sarvestan et al. (2018) [49] Cross-Sectional Randomised Design II 26 (13 m/13 f) 23.9 ± 1.6 University Athletes
Souza et al. (2018) [50] Cross-Sectional Randomised Trial II 13 (9 m/4 f) 23.2 ± 3.2 Basketball
Gehrke et al. (2018) [51] Cross-Sectional Randomised Trial II 21 (14 m/7 f) 23.7 ± 3.2 Basketball
Sarvestan et al. (2019) [52] Cross-Sectional Randomised Design II 25 (13 m/12 f) 23.8 ± 1.62 College Athletes
Alawna et al. (2020) [53] Randomised Controlled Trial I 100 (56 m/44 f) 22.25 ± 2.96 Volleyball
Basketball, volleyball,
Lin et al. (2020) [54] Randomised Controlled Trial I 33 (25 m/8 f) 22.0 ± 2.8
baseball and badminton
Sarvestan et al. (2020) [55] Case-Control Study III 30 (19 m/11 f) 23.91 ± 2.58 College Athletes
TOTAL 270 (171 m/99 f)
* age = mean ± SD.

3.2. Study Characteristics

A total of 270 athletes were included in the review: 171 were male (63.33%) and
99 female (36.66%). The sports of the various groups of athletes were football, basketball,
volleyball, baseball and badminton, and college athletes were also present (81 in total).
More details of study characteristics are reported in Table 1.

3.3. Outcome Measurements

The outcome measurements included were as follows: gait functions including stride
velocity, step length, stride length and Heel-Heel (H-H) distance of base of support, mea-
sured by the GAITRite Portable Walkaway SystemC; agility through different tests, such
as the Illinois Test, 5-0-5, Shuttle Test, Compass Drill Test, T-Agility Test and Figure of 8;
dynamic balance by the SEBT and the Y Balance Test; joint ROM; electromyographic muscle
activation; lateral landing from a monopodalic drop with the Kistler Force Plate. All of
the outcome measurements mentioned above are reported in Table 2 with the tests used to
assess them.

Table 2. Outcome measurements.

Author
n (m/f) Outcome Measurements Test
(Publication Year)
GAITRite PORTABLE WALKAWAY
Kim et al. (2017) [48] 22 (m) Gait Functions
SYSTEMc (cm)
Illinois, 5-0-5, 10-m Shuttle, Hexagon,
Sarvestan et al. (2018) [49] 26 (13 m/13 f) Agility
Compass Drill, T-Agility Test (*s)
Souza et al. (2018) [50] 13 (9 m/4 f) Dynamic Balance SEBT (*cm)
Dynamic Balance
Gehrke et al. (2018) [51] 21 (14 m/7 f) SEBT (cm) Figure-of-8 (s)
Agility
Illinois, 5-0-5, 10-m Shuttle, Hexagon,
Sarvestan et al. (2019) [52] 25 (13 m/12 f) ROM during Agility tests
Compass Drill, T-Agility Test (s)
Dynamic Balance Y Balance Test (inches)
Alawna et al. (2020) [53] 100 (56 m/44 f) *ROM ROM (degrees)
Vertical Jump Vertical Jump (inches)
KISTLER FORCE PLATE
PEAK *vGRF (%BW), Loading Rate
Lin et al. (2020) Lateral landing performance in
33 (25 m/8 f) (N/ms), Loading Time (ms),
[54] single-leg drop
Difference of *CoP-range, Difference
of CoP-velocity
KISTLER FORCE
Postural sway parameters
PLATE PEAK (cm)
Sarvestan et al. (2020) [55] 30 (19 m/11 f) ROM
ROM (degrees)
Muscle Activation
EMG (% peak)
TOTAL 270 (171 m/99 f)
*s = seconds, *cm = centimetres, *ROM = range of movement, *vGRF = ground reaction forces, *CoP = centre
of pressure.
Medicina 2022, 58, 620 6 of 15

3.4. Quality Assessment

For the quality appraisal, the Downs and Black scale was used; the studies achieved
an average score of 19.25/28, with values ranging from 16 to 22. All items are shown in
Table 3.

Table 3. Quality Assessment with Downs and Black Scale.

Kim et al. Sarvestan et al. Souza et al. Gehrke et al. Sarvestan et al. Alawna et a.l Lin et al. Sarvestan et al.
ITEM
(2017) [48] (2018) [49] (2018) [50] (2018) [51] (2019) [52] (2020) [53] (2020) [54] (2020) [55]
1. 1 1 1 1 1 1 1 1
2. 1 1 1 1 1 1 1 1
3. 1 1 1 1 1 1 1 1
4. 1 1 1 1 1 1 1 1
5. 2 1 2 2 0 2 2 0
6. 1 1 1 1 0 1 1 1
7. 1 1 1 1 1 1 1 1
8. 0 0 0 0 0 1 1 1
9. 0 0 0 0 0 0 0 0
10. 0 0 1 1 1 0 0 1
11. 1 1 1 1 1 1 1 1
12. 1 1 1 1 1 1 1 1
13. 1 1 1 1 1 1 1 1
14. 1 0 1 0 0 1 0 0
15. 1 0 1 1 0 0 0 0
16. 0 0 0 0 0 0 0 0
17. 1 1 1 1 1 1 1 1
18. 1 1 1 1 1 1 1 1
19. 1 1 1 1 1 1 1 1
20. 1 1 1 1 1 1 1 1
21. 1 1 1 1 1 1 1 1
22. U/D U/D U/D U/D U/D U/D U/D U/D
23. 1 0 1 1 0 1 1 0
24. 1 0 1 1 0 1 1 0
25. 1 1 1 1 1 1 1 0
26. 0 0 0 0 0 0 0 0
27. 0 1 0 0 1 0 0 0
TOTAL 21/28 17/28 22/28 21/28 16/28 21/28 20/28 16/28
U/D = undetermined.

3.5. Meta-Analysis
The effect of KT on dynamic balance was expressed in terms of SEBT. Pooled ES was
0.20 for SEBT (ranging from 0.08 for SEBT-AL to 0.29 for SEBT-L), indicating no significant
impact of KT on dynamic balance. Significant large effects could be found for the following:
lateral landing in loading time with an ES of 0.717 and a p-value of 0.050; gait functions
with ES ranging from 1.92 for H-H base support to 2.28 for stride and a p-value of 0.000;
ROM, only in ankle inversion–eversion angle peak, with an ES of 0.52 and a p-value of
0.048; sway parameters, with a relevant ES for sway velocity in medio-lateral direction,
with a p-value of 1.25; ES for average muscle activity, peroneus longus contraction, with an
ES of 0.55 and a p-value of 0.042. Further details are reported in Table 4.

Table 4. Results.

Parameter Effect Size or ES (SMD) Standard Error 95% CI p-Value I2

Dynamic Balance
SEBT 0.197 0.237 −0.268 to 0.662 0.406 0.00%
SEBT-A 0.0979 0.237 −0.375 to 0.571 0.681 0.00%
SEBT-AM 0.269 0.238 −0.206 to 0.744 0.263 0.00%
SEBT-M 0.199 0.237 −0.275 to 0.673 0.405 0.00%
SEBT-PM 0.211 0.237 −0.263 to 0.685 0.377 0.00%
SEBT-P 0.187 0.237 −0.286 to 0.661 0.433 0.00%
SEBT-PL 0.250 0.238 −0.224 to 0.725 0.296 0.00%
SEBT-L 0.286 0.238 −0.189 to 0.761 0.234 0.00%
SEBT-AL 0.0753 0.237 −0.398 to 0.548 0.752 0.00%
Lateral Landing
0.09 (overall ES sensu Morris)
Kistler force plate peak vGRF—ground 0.134 (overall ES sensu Klauer)
reaction forces 0.588 (pre) 0.246 0.095 to 1.081 0.017 0.00%
0.455 (post) 0.249 −0.034 to 0.943 0.068 0.00%
Medicina 2022, 58, 620 7 of 15

Table 4. Cont.

Parameter Effect Size or ES (SMD) Standard Error 95% CI p-Value I2

0.243 (overall ES sensu Morris)
0.233 (overall ES sensu Klauer)
Loading Rate
0.127 (pre) 0.246 −0.356 to 0.61 0.606 0.00%
0.360 (post) 0.248 −0.126 to 0.846 0.147 0.00%
0.760 (overall ES sensu Morris)
0.836 (overall ES sensu Klauer)
Loading Time
0.119 (pre) 0.246 −0.364 to 0.602 0.629 0.00%
0.717 (post) 0.366 −0.22 to 1.215 0.050 0.00%
Gait Functions
Velocity 1.978 0.368 1.257 to 2.699 0.000 0.00%
Step 2.271 0.387 1.513 to 3.029 0.000 0.00%
Stride 2.277 0.387 1.519 to 3.036 0.000 0.00%
H-H Base support 1.920 0.365 1.205 to 2.634 0.000 0.00%
Agility
Male: 0.213 (overall ES sensu Morris) 0.410 −0.59 to 1.02 0.603 0.00%
0.254 (overall sensu Klauer); 0.410 −0.55 to 1.06 0.536 0.00%
Illinois Female: −0.136 (overall ES sensu Morris) 0.409 −0.94 to 0.67 0.739 0.00%
−0.186 (overall sensu Klauer) 0.409 −0.99 to 0.62 0.649 0.00%
Male: −0.329 (overall ES sensu Morris) 0.411 −1.14 to 0.48 0.424 0.00%
−0.425 (overall sensu Klauer); 0.413 −1.23 to 0.38 0.304 0.00%
5-0-5 Female: −0.412 (overall ES sensu Morris) 0.413 −1.22 to 0.40 0.318 0.00%
−0.481 (overall sensu Klauer) 0.415 −1.29 to 0.33 0.246 0.00%
Male: −0.351 (overall ES sensu Morris) 0.412 −1.16 to 0.46 0.394 0.00%
−0.525 (overall sensu Klauer); 0.416 −1.34 to 0.29 0.207 0.00%
10-m Shuttle Female: −0.56 (overall ES sensu Morris) 0.417 −1.38 to 0.26 0.179 0.00%
−0.456 (overall sensu Klauer) 0.414 −1.27 to 0.36 0.271 0.00%
Male: 0.127 (overall ES sensu Morris) 0.409 −0.67 to 0.93 0.756 0.00%
0.253 (overall sensu Klauer); 0.410 −0.55 to 1.06 0.537 0.00%
Hexagon
Female: 0.312 (overall ES sensu Morris) 0.411 −0.49 to 1.12 0.448 0.00%
0.252 (overall sensu Klauer) 0.410 −0.55 to 1.06 0.539 0.00%
Male: −0.055 (overall ES sensu Morris) 0.408 −0.86 to 0.75 0.893 0.00%
−0.061 (overall sensu Klauer); 0.408 −0.86 to 0.74 0.881 0.00%
Compass Drill
Female: −0.067 (overall ES sensu Morris) 0.408 −0.87 to 0.73 0.870 0.00%
−0.092 (overall sensu Klauer) 0.408 −0.89 to 0.71 0.822 0.00%
Male: 0.339 (overall ES sensu Morris) 0.411 −0.47 to 1.15 0.410 0.00%
0.341 (overall sensu Klauer); 0.411 −0.47 to 1.15 0.407 0.00%
T-Agility Test
Female: −0.402 (overall ES sensu Morris) 0.413 −1.21 to 0.41 0.330 0.00%
−0.415 (overall sensu Klauer) 0.413 −1.22 to 0.39 0.315 0.00%
Figure of 8 0.302 0.310 −0.307 to 0.910 0.331 0.00%
ROM
Ankle angle peak Dorsi—Plantar flexion 0.03 0.258 −0.48 to 0.54 0.908 0.00%
Ankle angle Inversion–Eversion 0.52 0.263 0.00 to 1.04 0.048 0.00%
Knee angle peak Flexion–Extension 0.01 0.258 −0.50 to 0.52 0.978 0.00%
Hip angle Peak Flexion–Extension 0.05 0.258 −0.46 to 0.56 0.831 0.00%
Hip angle Peak Abduction–Adduction 0.12 0.258 −0.39 to 0.63 0.794 0.00%
Sway parameters
Sway length 0.14 0.259 −0.37 to 0.65 0.436 0.00%
Sway area 0.37 0.261 −0.14 to 0.88 0.499 0.00%
Sway displacement anterior–posterior 0.15 0.259 −0.36 to 0.66 0.433 0.00%
Sway displacement medial–lateral 0.46 0.262 −0.05 to 0.97 0.162 0.00%
Total velocity 0.16 0.259 −0.35 to 0.67 0.436 0.00%
Sway velocity anterior–posterior 0.17 0.259 −0.34 to 0.68 0.433 0.00%
Sway velocity medial–lateral 1.25 0.284 0.69 to 1.81 0.029 0.00%
Average muscle activity (% Peak)
Lateral Gastrocnemius 0.01 0.258 −0.50 to 0.52 0.963 0.00%
Medial Gastrocnemius 0.01 0.258 −0.50 to 0.52 0.901 0.00%
Tibialis Anterior 0.06 0.258 −0.45 to 0.57 0.674 0.00%
Peroneus Longus 0.55 0.263 0.03 to 1.07 0.042 0.00%

4. Discussion
CAI is a frequent complication of ankle sprains that may be associated with long-term
consequences in athletes. Although taping is a common intervention that is widely used
by clinicians and athletic trainers for the treatment of sports injuries and various neuro-
musculoskeletal disorders, no studies have evaluated its effectiveness specifically for sports
performance and ankle function in athletes affected by chronic ankle instability.
Medicina 2022, 58, 620 8 of 15

This is the first systematic review and meta-analysis to investigate only the effect
of KT on the sports performances and ankle functions of athletes with CAI. In all of the
studies included, KT was analysed as the only treatment implemented on athletes, without
concomitant physiotherapy or other types of exercises, so that the potential improvement
parameters registered were exclusively attributed to KT. Nevertheless, the recent literature
supports a multifactorial approach as the most effective on CAI using multiple interventions
such as KT associated with specific proprioceptive exercises [56].
Among the most popular contact sports (football, basketball, volleyball, baseball),
the ankle is the joint district most prone to injury [1–3]. Without recovering sufficient
stability of the ankle, athletes can suffer multiple sprains and relapses during sports
seasons, potentially reaching a condition of chronic instability [57–60].
Many articles have been published in the literature about the application of KT in
athletes [2,18,19], most of them concerning the upper limb and generally the shoulder
complex. In contrast, the available articles about KT and CAI have been very limited and
quite recent [48]. This can be explained by the increasing use of KT in recent years and
the large interest in evaluating its real effectiveness, even though it is an elastic bandaging
technique that was proposed in the early seventies.
Among the eight articles included in this review, the sports performance and ankle
functions that could be meta-analysed were (1) gait functions, (2) joint ROM, (3) muscle
activation, (4) sway parameters, (5) dynamic balance, (6) lateral landing from a monopodalic
drop and (7) agility. The main finding of this review, as reported in Table 4, is that KT
had a significant impact only on the following outcomes: (1) gait functions, as reported
by Kim et al. [48], who included gait velocity, step length, stride length and Heel-Heel
(H-H) distance of the base of support; (2) reducing ankle joint ROM in inversion–eversion;
(3) decreasing muscle activation of the peroneus longus; (4) decreasing postural sway in
mid-lateral movements, as reported by Sarvestan et al. (2020 [55]).

4.1. Gait Functions

In patients with CAI, the entire gait cycle can be altered by an increase in ankle
inversion, which can cause both a shorter step length and an increase in the base of support
and a reduction in gait speed [61,62]. In our review, the gait functions on which the tape
had the greatest impact were the increase in step length and stride length with a relative ES
of 2.27 and 2.28, respectively, an increase in speed, with an ES of 1.98 and the reduction in
H-H base distance, with an ES of 1.92.
The increase in stride velocity, expressed in m/s, corresponds to a greater looseness
during the phases of gait, which, associated with a smaller width of the base of support
in dynamics, indicates a greater sense of stability of the athlete during movement [63–66].
A wider base of support in dynamics usually allows lowering the centre of mass (COM),
increasing the body’s stability [67,68].
In the 22 athletes included in the study, the width of the base of support decreased
because taping seems to have provided greater stabilisation during walking. The main
problem with the study by Kim et al. [48] is the wide range of the confidence interval (95%
C.I.) of the gait functions, with values between 1.21 and 3.33; these can be justified by the
low number of athletes included in the study, i.e., a very limited sample size, although the
methodology of the study was of good quality (21/28).

4.2. Ankle Joint ROM

Ankle joint motion has also been found to influence the lower extremity landing
pattern in people with CAI [69]. It has been repeatedly confirmed to have a great influence
on bilateral postural stability [69,70]. For joint ROM, the only parameter in which taping
had a significant impact was in the post-tape reduction in inversion–eversion ankle range, as
shown by Sarvestan et al. [55], with an ES of 0.52 and a p-value of 0.05, while no substantial
change was found in all other joint parameters of the ankle, knee and hip. During the
agility tests evaluated by Sarvestan et al. in a previously included study [52], the change
Medicina 2022, 58, 620 9 of 15

in grades in dorsi–plantar flexion during movement was assessed. The results were not
included in the meta-analysis because they were not comparable, although Sarverstan et al.
reported an improvement in ankle sagittal ROM during linear sprinting. An increase in
ankle ROM could reduce the vertical ground reaction forces and the impact on the entire
lower limb [30,71].
Sarvestan et al. measured the peak joint movement in dorsiflexion and plantar flexion
in the sagittal plane and in inversion–eversion in the frontal pllane [55]. It was shown that,
after the use of the tape, the joint peak in the frontal plane decreased drastically, limiting
excessive rotation of the calcaneus and consequently reducing the oscillations in inversion
and eversion during walking, favouring greater stability. Similar results regarding gait
functions were also found by Kim et al. [48].
Inversion–eversion tilt is a movement that, both in a mechanical and perceptive sense,
reduces the feeling of ankle stability [72]. According to Smith et al. [72], application of the
tape decreased the sensation of instability in inversion–eversion, suggesting an effect that
contributes to preventing recurrent ankle sprains.

4.3. Muscle Contraction

In the literature, the possible action of KT in improving muscle contraction is much
debated. Some authors speculate that cutaneous stimulation of the tape may induce a
greater sensitisation of type 2 mechanoreceptors and improve the recruitment of motor
units [73,74]. Other possible explanations may be related to a concentric traction that the
tape exerts on the fascia, which may improve muscle contraction by shortening the distance
between the origin and insertion of the muscle [75–77].
In contrast, Sarvestan et al. [55] analysed whether the tape could modify muscle
contractions using an electromyographic examination, and an opposite effect was found
after application of the KT on the lateral leg muscles. The only muscle among those
considered on which the KT had a considerable impact was the peroneus longus with an
ES of 0.55 and a p-value of 0.05. In the leg with the KT applied, there was a strong decrease
in muscle activation justified by a supporting action that the tape provided when applied
laterally along the ankle, partially reducing activity of the eversion muscles, especially the
peroneus longus. However, this element has both a positive aspect in a phase in which the
athlete is looking for an external element of support that allows him to have a more stable
ankle during sport performance, but can also have a negative effect on active stabilisation
from lateral muscles, which risk being partially lacking and inhibited with the tape on, as
demonstrated in Sarvestan et al. [55].

4.4. Postural Sway during Movement

Athletes with CAI often do not have instant and corrective ankle reactions when they
make contact with the ground. A lack of corrections during movements greatly accentuate
body postural sway [72]. Some studies conclude that postural sway depends on a loss of
balance, which is an important indicator of possible falls during dynamic performances
and in pre-fatigue conditions [78–80].
Sarvestan et al. [55] showed that in the mid-lateral direction, KT significantly reduced
sway speed and reduced peak acceleration with an ES of 1.25 and a p-value of 0.03. In
contrast, there were no significant changes in speed and sway area in the anterior–posterior
direction. Many studies in the literature have confirmed the effectiveness of KT in im-
proving postural sway parameters, both in relation to speed and sway area, especially in
mid-lateral directions [81,82]. Reducing sway velocity in the mid-lateral direction suggests
better control in prone-supination movement, corresponding to greater overall stability [82].

4.5. Dynamic Balance

The meta-analysis for dynamic balance was carried out on the studies of Souza et al.
and Gehrke et al. [50,51], which had in common the use of the SEBT test. Data relating
to dynamic balance of Alawna et al. [53], in which the Y Balance Test was used, were
Medicina 2022, 58, 620 10 of 15

not meta-analysed, as they were not comparable. Table 4 shows that the ES did not
reveal a statistically significant impact, with p-values between 0.26 and 0.75. However,
both studies only evaluated 34 athletes in total. In the general population with CAI,
Hadadi et al. [83] showed that KT had a significant effect on both static and dynamic
balance. Other researchers, however, found no improvement in dynamic balance after the
application of KT [84,85].

4.6. Lateral Landing from Monopodalic Drop

Lateral landing is very difficult, having an impact on the entire lower limb due to
the dissipation of energy that is required [86]. For this reason, an alteration in the motor
patterns or in the joints involved, such as CAI, can adversely affect the ability to land, even
more so if the landing is performed after a monopodalic drop, which is a more challenging
function [87,88].
In this review, lateral landing from a monopodalic drop was only assessed by Lin et al. [54]
who considered ground reaction forces, loading rate and loading time. The p-values of the
loading rate and the loading time were between 0.15 and 0.63. Therefore, it was not possible
to define a significant impact of the KT on these functions. For the ground reaction forces,
although the p-values were <0.05 and therefore statistically significant, they had an overall
ES—including both the measurements before and after the application of the tape—that
did not show a real effectiveness in improving the performance of lateral landing from a
monopodalic drop. The values on the CoP (centre of pressure) were not considered for
the purposes of the meta-analysis because they did not include interquartile ranges, only
median values.
In another study [71], Lin et al. also concluded that KT was not sufficient to improve
both frontal and sagittal postural control during landing, while Mason-Mackay et al. [89]
added that KT must be combined with specific training to improve landing techniques
and strategies.

4.7. Agility
Agility is an athletic condition that is essential in sports such as those included in
this review (football, basketball, volleyball, baseball). This skill allows players to make
heterogeneous movements in rapid succession, such as changing direction, turning quickly
and cutting, all activities that have a significant impact on the ankle [49,51].
In our analysis, agility was assessed by Sarvestan et al. [49] and Gehrke et al. [51] by
measuring the time used to perform on tests such as Illinois, 5-0-5, 10-m Shuttle and Figure
of 8. No significant improvement was shown, with ES values ranging between −0.35 and
0.34 for males and between −0.53 and 0.31 for females.

4.8. Time of Application

In all of the included studies, only Sarvestan et al. [55] reported the time of application
of the KT before tests and measurements were carried out. They waited 25 min between
application of the tape and the start of the tests.
Some authors have found a positive effect of KT to increase balance and proprioception
in patients with CAI between 48 and 72 h [90]. Assessing the effectiveness of KT in the tests
seen in this review with a longer application time could be an important aspect to evaluate
in future studies.

4.9. Limitations and Strengths

There are several limitations in this review. First, since the studies included in the
meta-analysis did not evaluate identical outcome variables, there is potential for bias in
the validity of our results. However, if multiple data not representing the same outcome
of one study were included in the meta-analysis, the weight of that study would increase
in proportion. As a result, the total effect would not deviate towards the study with more
outcome data. Second, there is no specific technique for KT application: it usually varies
Medicina 2022, 58, 620 11 of 15

according to the symptoms of the patient, the therapist’s experience and intended purpose.
This heterogeneity, such as different tensions of the tape or applying KT in different
directions and shapes, may have caused inconsistent results and led to non-significant total
effects. Furthermore, the taping technique seems to have been kept consistent across the
participants in the different studies during activity; however, it was not possible to know
how long the taping was kept on during sports performances and the time from taping and
injury; this may be affected by variation in the injury mechanisms of the sports. Therefore,
it remains to be investigated whether a different taping technique could achieve a better
outcome for a specific sport or injury. Finally, KT is not typically used as a single treatment
tool but is combined with other treatments such as physical therapy and exercise therapy,
aspects influencing the final outcomes that were not possible to evaluate separately.
Our literature review also has strengths. First, it is the first meta-analysis of ran-
domised controlled trials (7/8) that focuses specifically on the effectiveness of KT. In all
studies, except in Sarvestan et al. [55], participants were randomised, which guarantees a
more accurate methodology. The eight studies included reported a high level of quality and
scientific evidence: an average score of 19.25/28, according to the Downs and Black Scale,
and a level of evidence between I and II (three studies I; four level II). Second, the studies
included in this review were published recently and very close to each other (from 2017 to
2020), including different sports population groups to guide clinical judgements. Hence,
our meta-analysis represents a synthesis of the most current knowledge on this subject in
the literature since the seventies. Third, even though this study included ankle function and
athletes’ functional performance testing as outcomes to provide more evidence for clinical
practice, it was designed with a different approach with respect to previous meta-analyses
that reported non-significant results for the effectiveness of KT.
Finally, since the sports performances and ankle functions analysed among the in-
cluded studies were heterogeneous, several independent meta-analyses were carried out,
stratifying the outcomes according to subgroups to avoid comparing outcomes considering
different parameters. There may be disparate ankle functions and performances that re-
quire very specific skills and ad hoc evaluation tests, especially when comparing different
sports and related parameters. Through the meta-analysis of each outcome, it was possible
to evaluate the efficacy of KT for every single item, avoiding overall conclusions that did
not give significance to single parameters for which KT was effective, without omitting any
of them. This should be considered as a strength of our study since it ensures the quality,
consistency and generalisability of our findings. Furthermore, seven out of eight studies
had a sample size of fewer than 35 athletes, which would have increased the risk of bias in
a large-scale comparative analysis with heterogeneous data.
Certainly, future studies maintaining the same level of quality of those included in this
review but increasing the number of participants and standardized outcome measurements
are required to better clarify the role of KT in CAI. In addition, further investigation is
necessary to define the influence of psychological aspects on the athletes’ performances
during KT application [9–11,71]. It is possible that individuals with CAI perceive their
ankle to be more stable and have more confidence in their ankle and their ability to perform
challenging tasks because of factors such as increased mechanical stability or a placebo
effect of the tape [91–93]. Although not sufficient, there is considerable evidence in the
current literature for the psychological effects of taping.

5. Conclusions
The present systematic review and meta-analysis shows that KT, used on athletes
with CAI (playing football, basketball, volleyball, baseball and badminton), is effective
only on some of the performances and ankle functions analysed. It was not possible to
define the precise time of the application of KT to the ankle joint of the athletes included
to see the benefit in performing sports. However, the meta-analysis showed a significant
improvement particularly on the following: gait functions (step velocity, step and stride
length and reduction in the base of support in dynamics); reduction in the joint ROM in
Medicina 2022, 58, 620 12 of 15

inversion–eversion; decrease in the muscle activation of the long peroneus; decrease in the
postural sway in movement in the mid-lateral direction.
In contrast, other aspects such as dynamic balance, lateral landing from a monopodalic
jump and agility tests did not improve significantly by applying KT to the ankle joint.
Finally, as the improvement achieved by some of the parameters analysed reflects an
increased stabilisation of the ankle joint of these athletes during sports performance, it is
possible to conclude that KT has a moderate stabilising effect on the ankles of the athletes
of the most popular contact sports with CAI.

Author Contributions: Conceptualization, C.B. and P.N.; methodology, C.B., P.N. and N.L.B.; val-
idation, C.B., P.N. and N.L.B.; formal analysis, N.L.B.; investigation, P.N., G.D.R. and M.T..; data
curation, P.N., N.L.B. and M.T.; writing—original draft preparation, C.B., P.N., G.D.R. and M.T.;
writing—review and editing, C.B. and G.D.R.; visualization, G.D.R.; supervision, C.B. and P.R.;
project administration, C.B. and P.R. All authors have read and agreed to the published version of
the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.

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