Effects of kinesio taping on biomechanics characteristics of ankle joint: theoretical research and application advances

doi:10.3969/j.issn.2095-4344.2017.28.023

Abstract

Abstract:

BACKGROUND: Kinesio taping is commonly used, but there is a lack of rigorous and scientific research, especially in biomechanics and exercise.
OBJECTIVE: To overview the biomechanics characteristics of the ankle joint after treatment with kinesio taping, and to summarize the biomechanics difference in kinematics, kinetics, and electromyography of the ankle joint between non-kinesio and kinesio taping.
METHODS: Ovid Medline, Elsevier SDOL, PubMed and CNKI databases were retrieved for the Chinese and English literatures concerning the biomechanics and exercise performance of kinesio taping published before December 2015. Subsequently, all literatures were classified according to the Oxford Centre for Evidence-based Medicine Levels of Evidence.
RESULTS AND CONCLUSION: Most of literatures support the viewpoint that kinesio taping can improve ankle joint stability, increase the arch height and decrease the external load of key muscles of the ankles and feet. Some studies have suggested that during landing, kinesio taping shortened the duration of the peak of support reaction forces, reduced the flexion force, and increased the loading rate of lower extremities, thereby resulting in an increased risk for injury. Other studies have shown that kinesio taping increases the recruitment of motor units and changes the order of neuromuscular contraction, but it cannot improve the athletic performance, and even decrease the athletic performance in most cases. Whether kinesio taping improves muscular force, increases the muscular performance, and increases the power of lower extremities is under discussion; hence, in-depth studies are needed in the future.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Ankle Joint, Biomechanics, Review Literature as Topic, Tissue Engineering

CLC Number:

R318

Luo Jiong, Zheng Bing, Xie Hao-dong. Effects of kinesio taping on biomechanics characteristics of ankle joint: theoretical research and application advances[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(28): 4570-4576.

Figures/Tables 3

踝关节由于外踝一直延伸到距骨下端，使外踝的结构比内踝稳定，而且内侧的三角韧带比较强韧使踝关节外翻受到限制，于是使足踝内翻、外翻活动度不平衡。许多运动专项体能测试中，跑、跳的动作占大部分比率，如垂直跳、立定三次跳、立定跳远、连续原地跳、五级蛙跳、助跑起跳摸高、100 m跑、9 m三次折返跑、3 m反应移动、6 m四次横移动、V字形移位跑、30 m跑、1 500 m跑及800 m跑等，都是与下肢有关的体能项目。这些动作的产生，都必须依靠足部与场地接触来完成，故此，足部所受的压力可想而知。不论日常生活中作息的动作或运动场上的竞技活动，足部一次所承受的力量最大可达体质量的三至四倍。除非人体下肢不接触地面，否则每次活动都必须使用到足部。因此足部关节在人体上是使用率最高的关节之一，特别是踝关节，同时也是非常重要的关节。足部伤害有许多种类，大部分都发生在踝关节，如踝关节骨折、挫伤、脱臼、外生骨赘、软骨破裂、拉伤、滑膜炎、腱鞘炎及扭伤等。从解剖学结构来看，踝关节外侧具有较佳的稳定性，使外翻和内翻的角度有相当大的差距。Root测量了内、外翻动作角度[9]，其内翻角度约为 20°-30°，外翻角度为10°-15°。踝关节属单轴屈戍关节，它让足部可以在矢状面作跖屈与背屈动作，其主要作用肌肉为腓肠肌、比目鱼肌与胫前肌。踝关节在矢状面的活动角度约为70°(跖曲约40°，背曲约30°)。踝关节下方的距下关节由距骨与跟骨构成，使脚踝作出内翻与外翻动作的主要肌肉为胫后肌、胫前肌、腓骨长肌及腓骨短肌。跖屈、背屈、外翻及内翻四个动作可协同，从而形成近似三轴关节的三度空间动作，同时执行跖屈与内翻时，形成的内旋动作，执行足背屈与外翻时形成外旋动作。外踝相比于内踝的位置相对较远且偏后方，这使得踝关节动作轴心不平衡且侧倾约10°，这限制了踝关节外翻的角度，使足踝内翻及外翻活动度不平衡，当内翻动作过大易导致脚踝扭伤[10]。踝关节扭伤85%是由于内翻足造成外侧韧带受伤，特别是前距腓骨韧带，其发生率约是另外两条外侧韧带的2倍，造成踝关节扭伤发生的原因是由于压力施于踝关节一侧，它的垂直力使得踝关节脱出原来的接合处，而造成这种现象的可能是踝关节的旧伤，激烈的运动使得踝节容易脱离原有位置，同时不合脚的鞋子、太过疲劳、肌力不足及在不平整的场地上运动等也是重要诱因[11]。通常情况下，踝关节扭伤都发生在内翻动作，因此防止踝扭伤的最重要课题往往放在避免踝关节内翻的发生。 2.1.2 踝关节贴扎及使用方式近年来，足踝关节损伤及预防的辅助工具中，贴内效贴扎技术逐渐受到重视。该技术是按照一定的要求，将肌内效贴布施加到人体的皮肤表面，并借其弹性回缩而发挥功效的一种医学治疗技术。贴扎是属于非常专业的技巧活，贴布剪裁的不同、贴布起始点(也称为锚点)、弹性延展度的调整、应用力学原理的差异、力矩立体架构的概念、采用单层还是多层、关节伸展与屈曲的姿势等，都是贴扎技巧必须审慎去评估的部分。贴扎的思考流程必须合并基础知识与临床病征的整合过程，甚至融入各专业领域的理论与技术，才能将贴扎技巧的运用做到正确无误。贴布一般选定5 cm宽比较适合，使用技巧是利用贴扎贴布拉扯张力，以平行贴扎模式，提供力量大小为全张力(贴布完全延展下所产生的张力)为宜。因贴布长度选择上，不同个体其小腿长度及足长皆不相同，为使个体能达到全张力的贴布伸展长度，并易于贴布长度测量，使用腓肠肌贴布原长度约为小腿长的1/2，而足底筋膜贴布原长度为足长的1/2。依人体结构测量小腿长度，为从腓骨头至外侧踝的长度。足长测量长度，以足跟至脚趾顶端。目前足踝贴扎的使用目的看：其一是运用于运动训练及比赛。以增加踝关节的稳定性，提升本体感觉及下肢力量，贴扎方式集中于两类：①顺从肌肉收缩方向贴，由肌肉止端往起端贴扎，目的在协助保护受伤肌肉收缩；②逆向肌肉收缩方向贴，在肌肉群处由肌肉往止端贴扎，目的在防止肌肉过度使用，产生过大张力。此外，还有传统式贴扎(low-dye tapping)，它是利用无弹性或弹性较差的运动绷带，对关节采用固定方式，减少关节的使用及增加对受伤组织的压迫[12]。步行、跑步及跳跃是最常使用踝关节贴扎，且以开放性编篮贴扎法(open basket)及闭锁性编篮贴扎法(close basket)两种，有时在闭锁式编篮贴扎法基础上，加上8字型贴扎法及锁根贴扎法(综合贴扎)[13-14]。其二是足踝贴扎用于损伤治疗方面。治疗效果取决于两方面：①患者状况的合适评估，即确定在合适的组织上贴扎肌内效贴；②合适肌内效贴扎技术的运用。只有两者处于最合适的结合状态时，才能有效发挥其作用功效。因此，方法设计、贴布长度及张力是需要考虑的重要因素。针对足踝及足底筋膜的生物力学综合考虑，足踝贴扎一般选定贴布5 cm宽比较适合，足底筋膜及腓肠肌贴扎皆使用相同宽度的贴布。使用技巧是利用贴布拉扯的张力，以平行贴扎及全张力(贴布完全延展下所产生的张力)粘贴为宜。由于贴布长度选择上，不同个体其小腿长度及足长皆不相同，为使个体能达到全张力的贴布伸展长度，并易于贴布长度测量，使用腓肠肌贴布原长度约为小腿长的1/2，而足底筋膜贴布原长度为足长的1/2。依人体结构测量小腿长度，为从腓骨头至外侧踝的长度。足长测量长度，以足跟至脚趾顶端。目前而言，足踝贴扎用于损伤最常见也有两类：①腓肠肌贴扎方式：腓肠肌为小腿后侧肌群中最大的肌肉，因为较靠近皮肤表面，较易进行贴扎(见图2)。使用Y字型贴法[15]，目的为使腓肠肌放松降低对足踝及足底筋膜拉扯力；使用伸缩度为33%的贴布(伸长为原长的1/3)，撕开Y字型底端(5 cm，为贴布的固定端)，定点粘贴固定于足踝内、外髁中间及跟腱上，然后全张力拉开贴布，定点粘至腓骨头下方1/4腿长处，Y字型头端粘至腓肠肌肌肉肥大处，由起端往止端平顺粘贴；②足底筋膜贴扎方式：采用平行及全张力方式贴扎，选用手掌状型贴法，将贴布预留2 cm，平均剪开四等分，目的用贴布的伸展性协助取代足底筋膜，减少筋膜承重时拉扯，同样使用伸缩度为33%的贴布强度[15]。撕开手掌状形底端(2 cm，为贴布的固定端)，定点粘贴固定于后足区中段，跟骨粘接处，接着全张力拉开贴布，定点粘至前足区，内段对准第一根脚趾，外段对准第五根脚趾，中间两段分别对准第二、四根脚趾，然后由起端往止端平顺粘贴(见图3)。"

2.2 贴扎对足踝生物力学的影响见表1。 2.2.1 贴扎对踝关节运动学特征的影响有研究认为踝关节贴扎对踝关节活动范围有显著的限制作用[16-19]，特别是反旋贴扎不仅降低了胫骨前肌和胫骨后肌的肌肉活性，而且明显提高了足弓高度，降低了踝及足部关键肌群的外部负荷；加强low-dye贴扎后的踝内侧其纵弓高度均值显著增加，且改良式low-dye内侧纵弓贴扎可使距下关节置于中立位附近。贴扎虽然能限制踝关节的活动范围，但研究认为这种限制作用随运动时间延长而下降，且多数研究都支持贴扎对踝关节限制时间20-30 min[20-21]。Karadag-Saygi等[22]以半边瘫痪的患者进行下肢肉毒杆菌注射加踝肌内效贴扎及下肢肉毒杆菌注射加踝假性贴扎来评估走路步态速度及步长，结果发现，1个月后肌内效贴扎组的步长及步速显著高于假性贴扎组。Cortesi等[23]以15例多发性硬化症患者贴扎肌内效贴布于两侧的小腿肌肉，结果显示受试者内、外侧身体晃动无显著差异，而前、后侧身体晃动上肌内效贴扎组有显著改善。侯世伦等[24]对男子篮球运动员踝关节采用闭锁式贴扎，结果发现，随着时间延长踝关节主动和被动内翻的限制作用呈显著下降，30 min后几乎失限。Fumich等[25]发现，贴扎后进行2.5-3.0 h足球训练，踝关节中立位内翻、跖屈内翻和中立位外翻角度限制下降50%，跖屈、背屈和跖屈外翻角度减少超过50%。张博涵等[26]以高速摄影机及测力板分析6位女性运动员接受未贴扎、运动贴扎及肌内效贴扎对急停跳投的生物力学分析中显示，肌内效贴扎对膝关节着地时的运动学参数并无影响，只有重心位移量与无贴扎者有显著差异。Karlsson等[27]研究发现，贴扎导致腓骨短肌的反应时间缩短、踝关节外翻肌群的肌力显著增大。McCaw等[28]发现，贴扎后在高处着地时，踝关节足背弯曲角度和角速度减少。SaccoIde等[29]研究发现，踝关节贴扎能减少了足部垂直地面反作用力达到峰值时的作用时间。"

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