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THE EFFECTS OF SPATTING ON VERTICAL GROUND REACTION FORCE PEAK
VALUES DURING LANDING
A THESIS
Submitted to the Faculty of the School of Graduate Studies and
Research
of
California University of Pennsylvania in partial fulfillment
of the requirements for the degree of
Master of Science
by
Benjamin A. Galley, ATC, PES
Research Advisor, Dr. Shelly DiCesaro
California, Pennsylvania
2009
i
ii
AKNOWLEDGEMENTS
I would first like to thank my parents for
supporting me throughout my entire life, especially this
past year. Thank you Mom and Dad for never telling me
that I couldn’t and always letting me know how proud you
are of me. Thank you for supporting me financially
throughout my years at Liberty and now at Cal U. Thank
you for a warm bed to sleep in, a car to drive, and warm
meals.
Thank you, Katherine, for always encouraging me.
Thank you for being so patient and never complaining
about waiting for me to finish school before marrying me.
Even though we were far a way for so long, thank you for
your sacrifice and love that you truly showed me through
this past year.
Thank you, siblings, for keeping my head up. Thank
you for telling me that you are proud of me and
encouraging me through the process. Thank you, Josh and
Nicole, for supporting me through my years at Liberty and
your continued support, it means so much to me. Thank
you, Stacey and Tim, for your prayers and conversations
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all the way from China. Thank you for always giving me
encouraging words.
Thank you, God, for being my Rock and Firm
Foundation that I could stand on. Thank you for being my
Shelter in rough times that I could run to and count on.
Thank you for always being faithful.
Thank you also, Ruth, Mr. Zigger, and Julie, for
always being supportive of me and working with me through
this tough process while at Southmoreland. Thank you,
Julie, for always working with my schedule. Thank you to
the athletes at Southmoreland who made my experience
there enjoyable, I will never forget it.
Lastly, thank you to all the staff at Cal U who made
this possible for me. Thank you, Shelly, for sticking it
out with me and encouraging me to finish strong. Thank
you, Bob and Jamie, for being a part of this journey with
me and making this thesis project better. Thank you Tom,
for all you taught me and for all of the unselfish
support you show to all of us.
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TABLE OF CONTENTS
Page
SIGNATURE PAGE
. . . . . . . . . . . . . . .
i
Acknowledgements . . . . . . . . . . . . . . .
ii
TABLE OF CONTENTS
iv
LIST OF TABLES
INTRODUCTION
. . . . . . . . . . . . . .
. . . . . . . . . . . . . . .
vii
. . . . . . . . . . . . . . . .
1
. . . . . . . . . . . . . . . . . .
6
Research Design. . . . . . . . . . . . . . .
6
Subjects
7
METHODS
. . . . . . . . . . . . . . . . .
Preliminary Research
. . . . . . . . . . . .
8
Instruments . . . . . . . . . . . . . . . .
8
Procedures
. . . . . . . . . . . . . . . .
9
Hypothesis
. . . . . . . . . . . . . . . .
12
Data Analysis
. . . . . . . . . . . . . . .
12
. . . . . . . . . . . . . . . . . .
13
Demographics Information . . . . . . . . . . .
13
Hypothesis Testing
. . . . . . . . . . . . .
15
Additional Findings . . . . . . . . . . . . .
16
DISCUSSION . . . . . . . . . . . . . . . . .
17
Discussion of Results . . . . . . . . . . . .
17
Conclusion
20
RESULTS
. . . . . . . . . . . . . . . .
v
Recommendation . . . . . . . . . . . . . . .
21
REFERENCES . . . . . . . . . . . . . . . . .
23
APPENDIX A: Review of Literature
. . . . . . . .
26
Introduction . . . . . . . . . . . . . . . .
27
Functional anatomy of the ankle . . . . . . . .
28
Prophylactic ankle support and ROM . . . . . . .
33
The effect of prophylactic ankle support on athletic
performance . . . . . . . . . . . . . . . .
Speed
Agility
38
. . . . . . . . . . . . . . . . .
38
. . . . . . . . . . . . . . . .
40
Vertical Jump
. . . . . . . . . . . . . .
42
The effects of prophylactic ankle support on vertical
ground reaction force.
. . . . . . . . . . . .
44
Take off
. . . . . . . . . . . . . . . . .
44
Landing
. . . . . . . . . . . . . . . . .
45
Other factors that contribute to vertical ground
reaction force values.
. . . . . . . . . . . .
47
Summary . . . . . . . . . . . . . . . . . .
48
APPENDIX B: The Problem . . . . . . . . . . . .
50
Definition of Terms . . . . . . . . . . . . .
51
Basic Assumptions . . . . . . . . . . . . . .
52
Limitations of the Study . . . . . . . . . . .
53
Significance of the Study . . . . . . . . . . .
53
APPENDIX C: Demographics Survey . . . . . . . . .
56
vi
APPENDIX D: Informed Consent Form . . . . . . . .
58
APPENDIX E: Institutional Review Board Approval
. .
62
REFERANCES . . . . . . . . . . . . . . . . .
76
Abstract . . . . . . . . . . . . . . . . . .
79
vii
LIST OF TABLES
Page
1.
Descriptive Statistics of PFGRF Values and
Significance Level . . . . . . . . . . . . . .
16
1
INTRODUCTION
Numerous braces and methods of taping have been
created to limit the ROM of the ankle and to help
decrease the rate of acute ankle injury. In conjunction
with taping and bracing, many football players use the
method of spatting in hopes to further limit the range of
motion (ROM) and increase the stability of the ankle.
Spatting is a form of prophylactic ankle bracing
that is commonly used among athletes of all levels of
competition.1 Many studies have been conducted examining
the effects of popular prophylactic ankle bracing and
taping conditions on athletic performance, however very
little research has been conducted on the effects of
spatting on athletic performance.
A review of the literature on the effects of
prophylactic ankle braces on athletic performance focused
mostly on speed, agility, and vertical jump height.
2-11
Most research suggests that speed is not affected by most
prophylactic ankle braces, however research is
inconsistent on the effects that prophylactic ankle
bracing has on agility.3,5,6,9,11 Research conducted by
2
Metcalf et. al.2 and Rosenbaum et. al.7 showed a decrease
in performance in linen taped ankles, linen taped ankles
with moleskin reinforcement, Sweed-O-Universal braces,
and ridged ankle supports in agility testing, but no
significant decrease in agility when braced with semiridged or soft ankle braces.
Research has mostly shown that vertical jump height
is significantly decreased by most prophylactic ankle
devices.2,5-11 The research shows that prophylactic ankle
braces that produced no difference in vertical jump
height were mainly soft, semi-rigid, or lace up ankle
braces. In the study conducted by Rosenbaum et. al.,7
five semi-rigid and four soft braces showed no
significant difference in vertical jump height. In
contrast, the one rigid brace studied did have a
significant negative difference as previously stated,
while taped conditions also produced significant negative
effects on vertical jump height.6,7,12 Research seems to
neglect the study of spatting on athletic performance.
Research has also been conducted on the effects of
prophylactic ankle devices on ankle ROM. Research agrees
that when an ankle is fitted with a prophylactic ankle
brace, be it a braced, taped, or spatted condition, the
ankle’s ROM was significantly limited.
3
The minimal amount research that has been conducted
on spatting has examined its effects on ROM and this was
conducted by Pederson et. al.1 This research found that a
taped condition, taped and spatted condition, and only
spatted condition all limit the ankles ROM
significantly.1
Some researchers suggest that a decrease in ROM of
the ankle provided by prophylactic ankle bracing leads to
a decreased rate of injury due to added support of the
ankle joint.1,2,6 Others suggest that a decrease in ROM of
the ankle provided by prophylactic ankle devices,
including spatting, would increase the peak vertical
ground reaction forces (PVGRF)values upon landing from a
jump, and therefore may increase the rate of acute ankle
injury.12-14 Additional research suggests that a decrease
in ROM at the ankle joint was compensated for through an
increase in knee flexion to absorb force along the
kinetic chain upon landing from a jump.15
Along with athletic performance and ROM, the effects
of prophylactic ankle devices have been examined in PVGRF
values during take-off and landing.11-16 While some
researchers have found that peak values were higher among
braced conditions upon landing, others found no
significant change in peak values.15,16
4
DiStefano et. al.15 found significant changes in
joint flexion throughout the kinetic chain, specifically
in the knee, when subjects landed from a jump in a braced
condition, even though the PGRF values were not
significantly different among the braced group and the
control group. This suggests that if an athlete wants to
land with the same amount of force in a braced condition,
compensations must be made somewhere along the kinetic
chain when ROM of the ankle is limited.
Some researchers suggest that a decrease in ROM
provided by a prophylactic ankle brace may cause an
increase in PVGRF and therefore increase the rate of
injury12, while others suggest that a decrease in ROM may
also decrease the rate of injury.3 Finally researchers
have also found that prophylactic ankle bracing does not
impair PVGRF values, but that it may be due to
compensation along the kinetic chain. However, no
research has been conducted on the effects that spatting
has on PVGRF values.11
The purpose of this study was to examine whether
spatting has an effect on PVGRF values during landing.
The following question was addressed: Will PVGRF be
significantly different depending upon the braced
condition? This study will provide information to the
5
sports medicine community as to the effects spatting may
have on the kinetic chain when force is applied to the
ground.
6
METHODS
The purpose of this study was to determine the
effects of spatting on peak vertical ground reaction
force (PVGRF) values during landing. This section
includes the following subsections: Research Design,
Subjects, Preliminary research, Instruments, Procedures,
Hypotheses, and Data Analysis.
Research Design
A quasi-experimental within-subject research design
was used for this study. The independent variables were
the braced condition of the ankle, which will include the
following: non-braced control; taped only; spatted only;
taped and spatted. The dependent variables include
vertical ground reaction force peak values upon landing.
The study was conducted with each subject tested in all
four braced conditions. The within-subjects research
design allowed the subjects to serve as their own
control, increasing the strength of the study.
7
Subjects
Fifteen (n=15) male division II soccer and football
players from California University of Pennsylvania were
included as subjects in this research study. Based upon
previous research, the minimum number of subjects who
were accepted to be sufficient for the study was 15.11-16
Prior to testing each subject was screened for previous
lower leg, foot, and ankle injury. Subjects who had had a
previous ankle, foot, or lower leg (including the knee)
injury within the past year, or have been diagnosed with
any nerve or balance disorders have been excluded from
participating in the study. The subjects were a sample of
convenience.
Each subject completed an informed consent form
(Appendix D)and demographics survey (Appendix C) before
the study was conducted. The demographics survey included
information on sport; years of participation; position;
age; height; previous traumatic injury to the lower leg,
foot, or ankle; and previous braced (taped, spatted, or
tapped and spatted) experience.
The study was approved by the California University
of Pennsylvania Institutional Review Board.
Each
8
participant’s identity remained confidential and was not
included in the study.
Preliminary Research
Preliminary research was conducted to determine the
amount of time needed to complete the testing protocol
and taping of each braced condition for each subject. The
subject was instructed orally on testing procedure,
taped, and tested in each braced condition (non-taped,
spatted only, taped only, spatted and taped).
The preliminary research helped determine the length
of time needed to test one subject in all braced
conditions, as well as allowed the researcher to become
familiar with the testing procedures.
Instruments
The following instruments to collect data were used
in this study. A demographics survey (Appendix C)was used
to document each subject’s sport, years of participation,
position, age, height, previous traumatic injury to the
lower leg, foot, or ankle, and previous braced (taped,
spatted, or tapped and spatted) experience. A force
9
platform (AMTI OR6-7, Watertown, MA) was used to collect
data on vertical jump height and PVGRF upon landing.
NetForce software was used for the PVGRF data collection.
The data was analyzed statistically using SPSS 17.0.
Procedure
Prior to data collection, each subject will sign an
informed consent form (Appendix D). After signing the
informed consent form, the study was briefly explained to
each subject and any questions were answered.
Next, each subject was randomly assigned the braced
condition order, in which they were tested. Each subject
would perform in all 3 braced conditions. Each condition
was assigned a number to represent it and they are as
follows: (1) non-braced control; (2) taped only; (3)
spatted only; (4) taped and spatted. All possible
combinations were placed into a hat and randomly selected
by each subject until all possible combinations had been
selected. Once all possible combinations had been
exhausted, all combinations were placed back into the hat
and the process was repeated as many times as necessary.
The order selected was recorded.
10
The taping procedures were the same with each
subject to maintain consistency throughout the study. All
subjects wore tennis shoes in each condition. The
researcher used pre-wrap and white inch and one half
coach athletic speed tape for the taped only condition.
The researcher used the closed basket-weave technique
over pre-wrap utilizing two continuous heal locks and one
figure eight.
The researcher used two inch power-flex to spat the
subjects. The spatting procedure was a continues method
in which the researcher used at least one whole roll of
power-flex per ankle, covering the subjects shoe and two
inches above the top of the shoe. The researcher used two
continuous heal locks and one figure eight on each
spatted condition. For the taped and spatted condition
the researcher used the same procedures and methods used
for the taped only and spatted only condition, while
combining the two into a taped and spatted condition.
The subjects were then instructed on proper jumping
technique for this study. Subjects were verbally
instructed to place both hands on their hips at all times
in order to maintain consistency among subjects in the
method of jumping. Subjects were allowed a “loading
phase” prior to take-off with a preparatory squat before
11
the jump. Subjects were instructed to jump as high as
possible while keeping their hands on their hips and
return to the force platform with both feet and looking
directly ahead.
Subjects performed three jumps in each braced
condition in the same day in the order that they randomly
chose. The average of the three jumps in each braced
condition was recorded. The subjects were allowed 15
attempts to land three vertical jumps with both feet
simultaneously before requiring an additional rest period
and re-taping.
Ten minutes of rest was given to each subject
between braced conditions to limit fatigue as a possible
variable, and to give the researcher time to prepare the
subject in the next braced condition. All taping was
performed by the researcher as to maintain consistency
among subjects.
12
Hypothesis
The following hypothesis is based on previous
research and the researcher’s intuition based on a review
of the literature.
1). There will be a difference in vertical ground
reaction force peak values, upon landing from a jump, in
the three braced conditions compared to the control
condition with the taped and spatted condition having the
greatest difference from the control condition.
Data Analysis
The data was analyzed using a repeated measures
analysis of variance (ANOVA) comparing each independent
variable to each other, and their effects on the
dependent variable (PVGRF). The data was analyzed using
SPSS 17.0. The level of significance was set at ≤ .05.
13
Results
The purpose of this study was to determine whether
spatting has an effect on PVGRF during landing from a
vertical jump. The following section includes data
collection through the study and is divided into the
following three sections: Demographics Information,
Hypothesis Testing, and Additional Findings.
Demographics Information
A demographics sheet was created to retrieve basic
information about each subject and was completed along
with the informed consent form during the oral
instruction. The subjects age, height, current sport,
years of participation, past ankle injury to the subjects
knee, lower leg, ankle, or foot history within the past
year, and previous bracing experience, were recorded on
the demographics sheet.
Fifteen (n=15) subjects were included in this study
and consisted of male division II soccer and football
players from California University of Pennsylvania. Out
of fifteen athletes, the study included five soccer
14
players (33.33%) and ten (66.67%) football players. The
subjects ranged of age 19 to 24 years old (20.6 ± 1.24)
and height ranged from 175.62 to 190.5 (72.6 ± 2.13
inches). The subject’s years of participation at the
collegiate level ranged from 1 to 4 years (2.73 ± 0.79).
Nine subjects reported having previous ankle bracing
experience and six reported having no previous ankle
bracing experience. Out of the nine who reported previous
ankle bracing experience six reported having experience
in a braced only condition, eight reported having
experience in a taped only condition, and three reported
having experience in a spatted only condition.
15
Hypothesis Testing
The following hypothesis was tested for this study
using an alpha level of ≤ .05.
Hypothesis: There will be a difference in peak
vertical ground reaction force (PVGRF) values, upon
landing from a jump, in the three braced conditions
compared to the control condition with the taped and
spatted condition having the greatest difference from the
control condition.
Conclusion: The PVGRF values for each prophylactic
ankle device were compared using a repeated measures
ANOVA. Means and standard deviations are presented in
Table 1. No significant difference was found between any
prophylactic ankle brace condition compared to the
control condition (F3,42= 0.628, p>.05)(Table 1).
16
Table 1. Descriptive Statistics of PFGRF Values and
Significance Level
Condition
Mean (N)
Standard Deviation
P Value
Control
7674.19
2118.780
.601
Spatted Only
7706.58
2056.767
Taped Only
7507.17
1905.029
Taped and Spatted
7985.93
2069.842
Additional Findings
After testing the hypothesis, statistical tests were
conducted on additional remaining data that was collected
on the demographics sheet, including sport played and
previous braced experience.
A repeated measures ANOVA was used to calculate the
effects of each braced condition on the sport played. No
significant data was found between soccer and football
players (F3,39= .215, p>.05) (Table 1).
A repeated measures ANOVA was used to calculate the
effects of each braced condition on previous braced
experience. No significant difference was found between
previous braced experience and no previous braced
experience (F3,39= .744, p>.05) (Table 1).
17
DISCUSSION
The following section is divided into the following
three subsections: Discussion of Results, Conclusion, and
Recommendations.
Discussion of Results
The purpose of this study was to determine if
spatting has an effect on PVGRF upon landing from a
vertical jump. Spatting is a form of prophylactic ankle
support that has been proven to significantly limit the
ROM of the ankle in four directions.1 The literature is
mixed on the effects of prophylactic ankle bracing on
PVGRF.12-16 Two studies conducted by Cordova et. al. and
DiStefano et. al. found no significant differences in
PVGRF between braced and non-braced subjects.15,16 However,
three studies conducted by Abián-Vicén et. al., Reiman
et. al., and Hodgson et. al., all found significant
differences in PVGRF between subjects.12-14 The researcher
investigated this topic because no research has been
conducted on the effects of spatting on PVGRF.
18
No significant difference was found when comparing
the three braced conditions (spatted only, taped, only,
and taped and spatted) to the control condition. It was
originally hypothesized that there would be a difference
in PVGRF between braced conditions with the taped and
spatted condition having the greatest difference among
conditions. These findings are similar to that of
DiStefano et. al. and Cordova et al., in that they also
found no significant difference in PVGRF values upon
landing in prophylactic braced conditions.15,16 However,
both studies also measured other variables, such as knee
flexion and muscle activity upon landing, in which they
did find significant differences among braced conditions
when compared to the control condition.
However, these findings disagree with Abián-Vicén
et. al., Reiman et. al. and Hodgson et. al., who all
found a significant differences in prophylactic ankle
bracing conditions, specifically taped and Active Ankle
Bracing, when compared to the control conditions. Reiman
et al., however, also stated that stiff landings have a
greater effect than soft landings in PVGRF when fitted
with the ankle braced condition.14 While the findings of
this study are similar to some, and not others, it is the
first to study the effects of spatting on PVGRF values.
19
After testing the hypothesis, additional statistical
tests were conducted on remaining data collected from the
demographics sheet. The sport played by the athletes was
one of the additional investigations of the study. No
significant difference was found between soccer players
and football players. While no significant difference was
found, the significance value was much closer to the
predetermined p value of .05, for the soccer players than
the total significance value when the groups are
combined. The subject size was small, and only five of
the fifteen subjects that were tested were soccer
players. If the trend were to continue, a researcher may
potentially see a significant difference between groups
in a larger sample size.
The other additional investigation was conducted
between subjects who have previous braced experience
compared to those who have no previous braced experience.
No significant difference was found between groups. The
researcher expected to see this result as no significant
difference was found among PVGRF values in the combined
groups.
20
Conclusion
Based on the results it may be concluded that
spatting has no effect on PVGRF values upon landing from
a vertical jump. The results support some of the
literature.15,16 This study supports some of the results
from the DiStefano et. al. and Cordova et. al. studies
which found
PVGRF values had no significant difference
between prophylactic ankle supported groups and the
control condition. However DiStafano et. al. found a
significant difference in knee flexion upon landing in
the prophylactic ankle braced condition, suggesting that
compensations must be made along the kinetic chain in
order to absorb the force upon landing in a braced
condition. The results did not support some literature
such as that conducted by Abián-Vicén et. al. that showed
a significant increase in PVGRF in a prophylactic braced
condition when compared to the control group.12-16
The mixture of results may be due to the difference
in subject selection. Abián-Vicén et. al. used 15
subjects all of whom have had no previous prophylactic
ankle bracing experience of any kind. Additional findings
of this study showed no significant difference between
subjects who have had no previous prophylactic ankle
21
bracing experience and those who have had previous
experience. However, Abián-Vicén et. al. suggests that if
the subjects studied have had previous ankle taping
experience, the results may have been different.13
Although the results from this study are not what
the researcher predicted, this study contributes to the
literature on ankle taping and spatting. This study does
suggest that ankle spatting has no more significant
difference in PVGRF than taping, taping and spatting, or
a controlled condition, and therefore may not contribute
to an increased chance in ankle injury.
Recommendations
It is important that Certified Athletic Trainers
understand that spatting, spatting and taping, and taping
the ankle were not found to change PVGRF values. This is
of interest to those Athletic Trainers’s that are
concerned that spatting may increase the risk of ankle
injury upon landing. Further testing should be conducted
on spatting to examine the effects of spatting on knee
flexion upon landing from a jump to determine if spatting
may have an effect on the kinetic chain upon landing.
While many studies have been conducted on prophylactic
22
ankle bracing on athletic performance, none have been
conducted on the effects of spatting on athletic
performance. It is recommended that further research be
conducted on the effect of spatting on speed, agility,
and vertical jump height. Another recommendation is to
test the durability of spatting on limiting ROM during
activity since other studies have researched this on
other forms of prophylactic ankle bracing.
While the results of this study did not show a
significant difference in PVGRF in spatting when compared
to the control condition, spatting has been found to have
significant differences from the control condition in ROM
of the ankle in a study conducted by Pederson et. al.1 As
this study adds to the literature on spatting, hopefully
it will also add to the legitimacy of spatting as a form
of prophylactic ankle bracing among the athletic training
profession, and not only as a cosmetic adornment.
23
REFERENCES
1.
Pederson TS, Ricard MD, Merril G, Schulthies SS,
Allsen PE. The Effects of Spatting and Ankle Taping on
Inversion Before and After Exercise. Journal of
Athletic
Training. March 1997;32(1):29-33.
2.
Metcalfe RC, Schlabach GA, Looney MA, Renehan EJ. A
Comparison of MoleskinTape, Linen Tape, and Lace-Up
Brace on Joint Restriction and Movement Performance.
Journal Of Athletic Training. June 1997; 32(2): 136140.
3.
Paris DL, Vardaxis V, Kokkaliaria J. Ankle Ranges of
Motion During Extended Activity Periods While Taped
and Braced. Journal Of Athletic Training. September
1995; 30(3). 223-228.
4.
Pederson TS, Ricard MD, Merril G, Schulthies SS,
Allsen PE. The Effects of Spatting and Ankle Taping on
Inversion Before and After Exercise. Journal of
Athletic Training. March 1997;32(1):29-33.
5.
Verbrugge JD. The effects of semirigid Air-Stirrup
bracing vs. adhesive ankle taping on motor
performance. The Journal Of Orthopaedic And Sports
Physical Therapy. May 1996;23(5):320-325.
6.
Paris DL. The Effects of the Swede-O, New Cross, and
McDavid Ankle Braces, and
Adhesive Ankle Taping on
Speed, Balance, Agility, and Vertical Jump. Journal of
Athletic Training. 1992;27(3)253-256.
7.
Rosenbaum D, Kamps N, Bosch K, Thorwesten L, Völker K,
Eils E. The influence of external ankle braces on
subjective and objective parameters of performance in
a sports-related agility course. Knee Surgery, Sports
Traumatology, Arthroscopy. July 2005;13(5):419-425.
8.
Yaggie J, Kinzey S. A Comparative Analysis of Selected
Ankle Orthoses During Functional Tasks. Journal of
Sport Rehabilitation. August 2001;10(3):174-183.
24
9.
Bocchinfuso C, Sitler MR, Kimura IF. Effects of Two
Semirigid Prophylactic Ankle Stabilizers on Speed,
Agility, and Vertical Jump. Journal of Sport
Rehabilitation. 1994;3:125-1 34.
10.
MacKean LC, Bell G, Burnham RS. Prophylactic Ankle
Bracing Vs. Taping: Effects on Functional Performance
in Female Basketball Players. The Journal Of
Orthopaedic And Sports Physical Therapy. August 1995;
22(2):77-81.
11.
Pienkowski
Stayton J.
Antithetic
for Sports
12.
Hodgson B, Tis L, Cobb S, Higbie E. The Effect of
External Ankle Support on Vertical Ground-Reaction
Force and Lower Body Kinematics. Journal of Sport
Rehabilitation. 2005;14:301-312.
13.
Abian-Vicen J, Alegre LM, Fernandez-Rodriguez JM, Lara
AJ, Meana M, Aguado X. Ankle taping does not impair
performance in jump or balance tests. Journal of
Sports Science and Medicine. 2008; 7:350-356.
14.
Reimann BL, Schmitz RJ, Gale M, McCaw ST. Effects of
Ankle Taping on Vertical
Ground Reaction Forces
During Drop Landings Before and After Treadmill
Jogging. Journal of Orthopaedic & Sports Physical
Therapy. December 2002; 32(12):628-635.
15.
DiStefano LJ, Padua DA, Brown CN, Guskiewicz KM. Lower
Extremity Kinematics and Ground Reaction Forces After
Prophylactic Lace-Up Ankle Bracing. Journal of
Athletic Training. 2008;43(3):234-241.
16.
Cordova ML, Armstrong CW, Rankin JM, Yeasting RA.
Ground reaction forces and EMG activity with ankle
bracing during inversion stress. Medicine & Science in
Sports & Exercise. September 1998;30(9):1363-1370.
D, McMorrow M, Shapiro R, Caborn DNM,
The Effects of Ankle Stabilizers on
Performance. American Orthopaedic Society
Medicine. 1995;23(6):757-762.
25
APPENDICES
26
APPENDIX A
Review of Literature
27
REVIEW OF LITERATURE
Athletes have been known to utilize spatting methods
to limit ROM of the ankle in the hopes of increasing
stability and decreasing rate of injury.
Prophylactic
ankle supports such as bracing, taping, and spatting may
have a performance effect on the ankle’s ROM and
functional and athletic performance.
Certain functional
abilities such as speed, agility, vertical jump height,
and vertical ground reaction force are commonly tested
functional abilities on the effects of prophylactic ankle
support.
The following is a review of the literature on
the effects of prophylactic ankle support on ROM of the
ankle, and functional and athletic performance.
This literature review was divided into five major
sections and subsections 1) A review of the functional
anatomy and physiology of the ankle 2) The effects of
prophylactic ankle support on ankle ROM 3) The effects of
prophylactic ankle bracing on functional and athletic
performance, including the following subheadings:
a)
Speed; b) Agility; c) Vertical jump height 4) The effects
of prophylactic ankle bracing on vertical ground reaction
28
force with the following subheadings:
a) Take off; b)
Landing; c) Other factors that contribute to vertical
ground reaction force values.
Functional Anatomy of the Ankle
Anatomically speaking, the ankle is a stable joint.
The most anterior and proximal portion of the ankle is
made up of the distal ends of the tibia and the fibula.
The thickened distal portions of both the tibia and the
fibula are referred to as the medial malleolus, formed by
the distal end of the tibia, and the lateral malleolus,
formed by the distal end of the fibula.
The lateral
malleolus forms greater bony stability than the medial
malleolus as the fibula extends further distally.1
The ankle is a synovial hinge joint. The main
movements of the ankle are dorsiflexion and
planterflexion. Dorsiflexion is produced by the anterior
compartment muscles of the leg.2 The muscles of the
anterior compartment of the lower leg include the
following: tibialis anterior, extensor hallucis longus,
extensor digitorum longus, and fibularis tertius.3
Planterflexion is produced by the posterior compartment
muscles of the lower leg.2 The posterior compartment of
29
the leg includes a deep group and a superficial group.
The deep group that has an influence on the motion of the
foot includes the following muscles: flexor hallucis
longus, flexor digitorum longus, tibialis posterior. The
muscles superior compartment of the leg include the
gastrocnemius, plantaris, and soleus.3 Prophylactic ankle
bracing is often used to limit these two motions, along
with inversion and eversion.
Distal to the tibia and fibula is the talus bone.
The superior portion of the talus (trochlea) articulates
with the medial and lateral malleoli.
As well as serving
as a connection between the lower leg and the foot, the
talus is the main weight bearing bone of the ankle, and
is wider in the anterior portion than the posterior
portion.1
When the foot is in dorsiflexion, it is in its most
stable position.
The widest part of the talus
articulates with the narrow portion between tibia and
fibula, forming a closed compact position.
When the foot
is moved into plantarflexion, the narrower portion of the
talus articulates between the tibia and fibula causing a
more unstable position for the ankle.1
The inferior surface of the talus known as the
posterior calcaneal facet corresponds with the posterior
30
talar facet upon the superior surface of the calcaneus to
form the sub talar joint. The two motions of the subtalar joint are gliding and rotation. The gliding and
rotation allows for inversion and eversion motion of the
foot.3
Most lateral supporting ligaments of the ankle
attach to the malleolus of the fibula.
The anterior and
posterior tibiofibular ligaments connect the distal
portions of the tibia and fibula forming an oblique
pattern. This oblique pattern is designed to diffuse the
forces placed on the leg.1 The anterior talofibular (ATF)
ligament attaches from the anterior aspect of the lateral
malleolus to the lateral aspect of the talar neck. The
ATF ligament is often sprained because it is the first
ligament to undergo stress upon ankle inversion.
The
calcaneofibular (CF) ligament attaches from the lateral
malleolus and stretches downward to attach also to the
medial aspect of the calcaneus.
The CF ligament may also
be torn or sprained, but only after damage has been done
to the ATF.
The posterior talofibular (PTF) ligament
attaches from the posterior aspect of the fibular lateral
malleolus to the posterior aspect of the talus.
The main
function of PTF if to prevent forward slipping of the
31
fibula into the talus, and is only injured in severe
ankle trauma such as in dislocations.4
The lateral compartment of the lower leg contain two
muscles of who’s tendons travel behind the lateral
malleolus on their way to their insertion; fibularis
longus and fibularis brevis. The fibularis longus inserts
to the medial cuneiform and base of the first metarsal on
the medial aspect of the foot and is the prime mover in
foot eversion. The fibularis brevis tendon attaches to
the base of the fifth metarasal and assists in eversion
of the foot.3
The ligaments that support the medial ankle are
collectively known as the deltoid ligament.
The deltoid
ligament attaches from the medial malleolus, to the
medial surface of the talus, and to the sustentaculum
tali of the calcaneus.
Although the medial malleolus is
shorter distally than the lateral malleolus, the
additional ligamentous support helps make up for the lack
of bony structural support in preventing ankle eversion.1
The medial ankle also contains tendons of muscles
that produce ankle inversion, adduction, and supination.
These muscles include the tibialis posterior, flexor
digitorum longus, and flexor hallicus longus which all
pass posterior to the medial malleolus.
Muscles passing
32
anterior to the medial malleolus include tibialis
anterior and flexor hallicus longus.
1
It is important to note also, that the muscles that
cross anterior to the malleoli will collectively produce
dorsiflexion of the ankle and toe extension.
Muscles
that pass posterior to the malleoli collectively produce
plantar flexion and toe flexion.
1
During jumping the ankle is first placed into
dorsiflexion in the loading phase of the jump as the
subject flexes the hips and knees as well as moving into
ankle dorsiflexion in preparation for the jump.
In this
position, the ankle is in its most stable position.1
When the subject begins the jump and the hips and knees
move into extension, the force produced by the posterior
muscle group of the lower leg moves the ankle into
plantar flexion, a more unstable position of the ankle.1
When the subject is in the air during the jump the ankles
remain in plantarflexion, and are forced into
dorsiflexion as the subject begins to absorb the force of
their body weight upon landing.
It is reasonable to assume that the ankle is in its
most vulnerable position just as load is beginning to be
applied to the talus upon landing and continues to move
33
into a more stable position as the subject continues to
absorb the force of their landing.
Prophylactic Ankle Support and ROM
Numerous studies have been conducted to determine
the effects of prophylactic ankle devices on ROM (ROM) of
the ankle.
It is thought that when ROM is limited,
athletic performance may also be limited.5
Many studies
have been conducted to determine the effects of
prophylactic ankle braces in athletic performance.4,7-13
Over the years, it has been a widely accepted practice to
use prophylactic ankle bracing in athletic training to
restrict ROM and in hopes to reduce the risk of injury to
the ankle.5
In a study conducted my Metcalfe et. al.,5 research
was conducted on the restriction of three prophylactic
ankle braces on ROM, as well as their effects on athletic
performance in vertical jump height and agility. The
three braced conditions were tape, tape with moleskin
reinforcement, and Sweed-O ankle brace. The results
confirmed what is commonly practiced in the athletic
training profession, which is the tape with moleskin
significantly restricted ankle ROM in planter flexion,
34
dorsiflexion, ankle inversion, and ankle eversion.5
The
taped condition restricted ROM in all directions except
for planter flexion, while the brace restricted ROM in
all directions but ankle eversion.5
Metcalf et. al.5 also studied how this decrease in
ROM would affect athletic performance. It was found that
all three braced conditions produced significantly lower
vertical jump heights in subjects, and slower times in
the agility test.
It may be argued that the decrease in
ROM and decrease in athletic performance are positively
correlated in this study.
It is reasonable to assume that an ideal condition
is when a prophylactic ankle brace can reduce the rate of
injury by limiting ROM without impeding on athletic
performance.
Studies have also been conducted on the lasting
durability of the limited ROM of different prophylactic
ankle braced conditions. Paris et. al.6 studied the
lasting effects on ROM of three prophylactic ankle braces
(Swede-O, SubTalar Support brace, and non-elastic
athletic tape) before and after a period of exercise.6
Significant ROM reductions were found between the
unsupported control group and all three braced conditions
pre-activity in inversion, eversion, plantarflexion, and
35
dorsiflexion. Pre-activity inversion ROM was limited as
follows:
both Swede-O and SubTalar Support conditions
were limited by 12.3 degrees, and tape was limited by
12.8 degrees. Postactivity results showed a significant
increase in inversion ROM in all three braced conditions
from 0-15 minutes postactivity (Swede-O: 2.3 degrees,
SubTalar Support:
4.2 degrees: tape: 3.8 degrees).
A
further significant increase in postactivity inversion
ROM was seen in SubTalar Support braced condition between
the 15 and 30 minute intervals by 1.6 degrees.6
Significant eversion ROM reductions were also
reported between the control group and all three braced
conditions preactivity (Swede-O by 11.9 degrees, SubTalar
Support by 4.3 degrees, and tape by 11.4 degrees).
A
significant increase in eversion ROM of the taped group
was found after only 15 minutes of activity by 3.8
degrees.
Significant increases in eversion ROM of the
Swede-O braced condition did not appear until after 60
minutes of exercise, and no significant increase in
eversion ROM was seen in the SubTalar ankle supported
condition.6
Paris et. al.6 also found that all three braced
conditions provided significant restrictions in ROM in
plantarflexion preactivity, when compared to the control
36
group (Swede-O by 17.3 degrees, SubTalar Support by 12.2
degrees, and tape by 19.4 degrees).
In regards to
plantarflexion ROM, the SubTalar Support braced condition
and taped ankle condition both showed significant
increases in ROM after 15 minutes of activity (Subtalar
Support by 2.2 degrees and tape by 2.4 degrees).
Additionally, initial significant increase in ROM was
seen in the Swede-O ankle braced condition at 30 minutes
by 2.2 degrees. It is important to note that tape also
showed significant increases in plantarflexion ROM in 15
minute intervals at 30,45, and 60 minutes of activity.6
In regards to dorsiflexion, Paris et. al.6 found
that all three braced conditions provided significant
restriction in ROM preactivity when compared to the
control group (Swede-O by 5.6 degrees, SubTalar Support
by 0.7 degrees.
The researchers found that the taped
ankle condition showed a significant increase in
dorsiflexion ROM after 45 minutes of activity, while
neither Swede-O nor SubTalar braced condition showed any
significant increase in dorsiflexion ROM.6
Few studies have been conducted on the effects of
ankle spatting, despite spatting being a common practice
especially in sports where cleats are worn.7 Pederson et.
al.7 studied the effects of spatting and ankle taping on
37
ankle inversion and rate of inversion before and after
exercise.
The independent variables studied by Pederson
et. al.7 were non-taped control, taped ankle only,
spatted ankle only, and taped and spatted ankle.
The
researchers found that all braced conditions
significantly limited ankle inversion before a 30 minute
exercise bout when compared to the control group (taped:
11.4 degrees, spatted and taped: 17.3 degrees, and
spatted: 12.8 degrees).
After the 30 minute bout of
exercise, the researchers found that inversion ROM
significantly increased in all three braced conditions
(taped: 5.5 degrees, spatted and taped: 2.4 degrees, and
spatted: 2.2 degrees).7
Pederson’s study also found that all three braced
conditions significantly reduced the rate of ankle
inversion before and after exercise with the combination
of spatting and taping being the most effective, then
spatting only, followed by tape only being the least
effective.
Although tape was the least effective of the
three braced conditions, the Pederson study found that
the rate of inversion of all three braced conditions was
significantly less that the non-taped control group.7
38
The Effects of Prophylactic Ankle Support on Athletic
Performance
Speed, agility, and vertical jump tests are often
used to subjectively measure an individual’s athletic and
functional ability.
Therefore, when researchers want to
measure the effects of a variable on functional or
athletic ability, they often utilize some form of speed,
agility, and vertical jump tests individually, or in
combination with each other.
Speed
Speed is an important functional ability in
practically every sport.
Several studies have been
conducted that investigate the effects of various
prophylactic ankle braces on speed.
Many different
functional tests were employed in these studies to
determine the effect of a prophylactic ankle brace on
speed.
These tests included the shuttle run, 80 foot
sprint, 40 yard sprint, 50 yard sprint, a combination of
straight ahead and slalom sprinting, and a predetermined
“sprint drill.”
8-13
Many studies compared multiple types of prophylactic
ankle braces to another, such as tape, soft brace, lace-
39
up brace, air cast, rigid, and semi-rigid braces, and to
a non-braced control group.8-13
Most researchers found no
significant difference in sprint speed between the nonbraced control group when compared to any braced group.712
Furthermore, in studies that examined more than one
braced condition to another, researchers also found that
no significant differences occurred between braced
groups.8-16
Although it may be difficult to compare the results
of these studies to one another, the overall effect that
prophylactic ankle braces have on speed may still be
seen. The majority of studies showed that prophylactic
ankle bracing (regardless of the type) had no significant
effect on speed performance.
For example, research conducted by MacKean et. al.13
studies Prophylactic Ankle Bracing Vs. Taping: Effects on
Functional Performance in Female Basketball Players, and
examined the effects of Aircast Air-Stirrup Ankle
Training Brace (Aircast, Inc.), Swede-O-Universal Ankle
Brace (Swede-0-Universal), Active Ankle Training Brace
(Active Ankle Systems. Inc.), and tape (Dr. Scholl's
double seal 1 VG adhesive) on speed in young female
subjects with a sprint test across a basketball court
with a set of four lines that progressively moved further
40
apart.
MacKean et. al.13 found that there was no
significant difference in speed in any braced condition
when compared to the non-braced control group. Since most
of the studies used different speed tests, and results
varied, it is hard to make a conclusion of the effects of
prophylactic ankle devices on speed.
Agility
Agility is another characteristic commonly used to
assess an athlete’s ability.
The effect of prophylactic
ankle bracing on agility has also been researched. The
same issue arises when comparing studies of agility that
arose when comparing studies of speed, namely many
researchers use different tests to determine an athletes
level of agility.
Tests commonly used are the Southeast
Missouri (SEMO) agility test, four-point agility run,
“cone running” drill, Barrow and McGee’s agility run, and
a “side-cut” drill.5,8,9,12,14
Multiple studies compared more than one type of
prophylactic ankle brace to other prophylactic braces and
to a non-braced control group such as moleskin tape,
linen tape, adhesive tape, soft brace, lace-up brace, air
cast, rigid, and semi-rigid.5,8,9,12,14
Research results
are mixed among studies that examine the effects that
41
prophylactic ankle bracing has on agility.
While some
researchers found no significant differences between
agility times, others did find significant differences in
agility times between the non-braced control and certain
braced conditions.
When a significant difference between
the non-braced control and the braced conditions was
found, the braced condition always produced slower
agility times.5,10
Two studies that found significant negative
differences in agility were conducted by Matcalf et. al.5
and Rosenbaum et. al.10
In Matcalf’s study the results
showed that braced conditions that produced a significant
negative difference in agility times in the SEMO agility
test from the non-braced control, were moleskin
reinforced ankle tape, normal basket weave linen ankle
tape, and Swede-O-Universal Ankle Brace (Swede-0Universal).5
Furthermore, it was found by Rosenbaum et.
al.10 that the rigid ankle support (Caligamed) that was
tested had a significant negative effect on agility times
when compared to the non-braced control.
Metcalf et.
al.5 also found that the semi-rigid and soft ankle braces
had no significant effect on agility.10
Moleskin, linen tape, and the Swede-O-Universal
ankle braces were tested in the same study and therefore
42
the results that they produced can be compared with no
significant differences found between them.
No
comparison can be made however between the moleskin,
linen tape, and Swede-O-Universal to the rigid braced
condition that also negatively affected agility because
different testing procedures were used.
Some results have shown that certain prophylactic
ankle devices have a significant negative effect on
agility.5,10
But again, since most of the studies used
different agility tests, it is hard to make a definite
conclusion of the effects of prophylactic ankle devices
on agility.
Vertical Jump
Jumping is a skill that is required for most sports.
Sports such as football, basketball, softball,
volleyball, baseball, various track events, soccer, even
tennis and swimming require the athlete to jump.
For
this reason it is important to study the effects of
prophylactic ankle support on vertical jump height.
In
the studies reviewed, only two vertical jump height tests
were used; Vertec test, and chalk test.5,8-14 Since only
two tests were used it is easier to make a conclusion on
43
the effects of prophylactic ankle support on vertical
jump height when comparing study to study.
Similar to speed and agility, many studies compared
more than one type of prophylactic ankle brace to other
prophylactic braces and to a non-braced control group
such as moleskin tape, linen tape, adhesive tape, soft
brace, lace-up brace, air cast, rigid, and semi-rigid.5,814
Research results are mixed among studies that examine
the effects that prophylactic ankle bracing has on
vertical jump height.
While some researchers found no
significant differences between the non-braced control
group and the braced group in vertical jump heights.
Others did find significant differences in vertical jump
heights between the non-braced control and certain braced
conditions.
In a study conducted by Metcalf et. al.5 on the
effects of moleskin tape, linen tape, and Swede-0
Universal brace on athletic performance, all three braced
conditions had a significant negative effect on vertical
jump height, similar to agility.5
It was also found by
MacKean et. al.13 that a taped ankle had significantly
lower values in vertical jump height than the other
braced conditions which included: Aircast Air-Stirrup
Ankle Training Brace (Aircast, Inc.); Swede-0-Universal
44
Ankle Brace (Swede-0-Universal); Active Ankle Training
Brace (Active Ankle Systems Inc.).
Another braced
condition that had a significant negative effect on
vertical jump height was a rigid (Caligamed) ankle
support found by Rosenbaum et al.13
The research shows that prophylactic ankle braces
that produced no difference in vertical jump height were
mainly soft, semi-rigid, or lace up ankle braces.
study conducted by Rosenbaum et. al.11
In the
Five semi-rigid
and 4 soft braces showed no significant difference in
vertical jump height, while the 1 rigid brace studied did
have a significant negative difference as previously
stated, while taped conditions also produced significant
negative effects on vertical jump height.5,10,13
The Effects of Prophylactic Ankle Support on Vertical
Ground Reaction Force
Take Off
Abián-Vicén et. al.15 studied the effects of ankle
taping on peak vertical ground reaction forces and peak
power values during the take off phase of a jump test
utilizing a force platform.
They reported that ankle
45
taping does not impair performance in the push-off phase
of the vertical jump test.15
Landing
In the same study that Abián-Vicén et. al.15 studied
the effects of taping on take-off, the researchers also
investigated the effects that taping had on the landing
phase of a jump.
They found that there was a significant
increase in the second peak force value by 12% upon
landing in the taped group when compared to the non-taped
control group.15 This increase in peak vertical ground
reaction force agrees with similar studies conducted on
the effects of prophylactic ankle braces on vertical
ground reaction force.15-17
An increase in force may imply that the subjects
absorb less of the force of their own body weight upon
landing.
This may also lead to an increased risk of
injury in the landing phase of a jump in taped athletes.15
Conversely, the literature suggests that most
prophylactic ankle braces restrict ROM, at least for a
certain period of time.
With this decrease in ROM, it is
also suggested that the prophylactic ankle brace would
decrease risk of injury to an athlete.5
46
DiStefano et. al.18 conducted a study that examined
knee flexion, ROM (dorsiflexion), and peak values in the
landing phase of a jump.
The researchers found that
ankle dorsiflexion in the sagittal plane were
significantly limited when compared to the non-braced
condition.
Although ROM was significantly different, no
significant difference was found in peak values upon
landing, or in time to reach maximum dorsiflexion of the
ankle.
Researchers suggest that this is due to the
increase in knee flexion angle upon initial contact of
the landing phase.18 Research conducted by Cordova et.
al.19 studied the peak vertical ground reaction forces of
braced and non-braced ankles during dynamic inversion
stress, while also looking at EMG activity of muscles of
the lower leg.
The independent variables of this study
were the braced condition of the ankle (no brace-control,
Aircast Sport-Stirrup, Active Ankle).
No significant
differences in peak values in any braced conditions were
found when compared to the control. However it was found
that, during peak impact force, EMG activity of the
peroneus longus was reduced in the Aircast and Active
Ankle braces when compared to the control, but no
difference was found between braces.19 This evidence also
47
supports the idea the restricting the ROM of the ankle
can have an effect along the kinetic chain.
Other factors that contribute to vertical ground reaction
force values
Many other studies have been conducted in order to
determine the effects of a variable on vertical ground
reaction force.
The following variables have been found
to have significant effects on vertical ground reaction
force values: heal-toe landings when compared to forefooted landings; surface in which the force platform is
fixed; absorption properties of the surface in which the
subjects land; tibial axial acceleration; development of
life stages; augmented feedback given to subjects.
This
is important information to know when studying the
effects of a variable on vertical ground reaction force
in order that the researcher can know what other
variables have been found to have a significant effect on
vertical ground reaction force values, as to not
replicate such variables unless intended to.20-25
48
Summary
Most research agrees that ROM is significantly
limited by most prophylactic ankle braces, at least
during pre-activity.5-7 What researchers may still not
agree upon is the effectiveness of reducing the rate of
injury among the braced population.
While research shows
that most prophylactic ankle bracing significantly limits
ROM, it is hard to research the correlation between
limited ROM and rate of ankle injury, although it is
commonly assumed that limited inversion ROM also
decreases rate of inversion ankle injuries.5
The effect that prophylactic ankle bracing has on
athletic performance is also unclear.
Although much
research has been conducted on speed, agility, and
vertical jump height, in a variety of braced conditions
studies have been inconclusive.5,8-14
Furthermore,
limitations apply to the study of prophylactic ankle
braces on athletic performance when reviewing the
literature such as the variety of different tests used to
assess speed, agility, and vertical jump height.
With
all of these factors at play, most literature seems to
suggest that prophylactic ankle devices had no effect on
49
an athlete’s speed.8-13 While some studies showed a
significant difference in an athlete’s agility, others
did not.5,8-10,12,14
Research also shows that the braced
conditions that had the most effect on vertical jump
height were taped conditions and rigid braced
conditions.5,13
Some researchers have suggested that a decrease in
ROM provided by a prophylactic ankle brace may cause an
increase in vertical ground reaction force and therefore
increase the rate of injury19, while others suggest that a
decrease in ROM may also decrease the rate of injury.5
Other researchers have found that prophylactic ankle
bracing does not impair vertical ground reaction force
values, but may have an effect on the kinetic chain up
the leg.18
By understanding how the lower extremity reacts to
prophylactic ankle bracing on peak vertical ground
reaction forces, we may be able to predict how the body
may react to spatting when landing from a jump.
With the
information on the effects of spatting on peak vertical
ground reaction force, athletic trainer may be able to
determine if spatting is a safe and practical form of
prophylactic ankle bracing.
50
APPENDIX B
The Problem
51
The Problem
Spatting is a form of prophylactic ankle bracing
that is commonly used among athletes of all levels of
competition. Many studies have been conducted examining
the effects of popular prophylactic ankle bracing, such
as braced and taped conditions on athletic performance,
however very little research has been conducted on the
effects of spatting on athletic performance. The purpose
of this study was to examine the effects of spatting on
peak vertical ground reaction force values.
Definition of Terms
The following Terms were operationally identified
for this study:
1)
Vertical ground reaction force- The force that is
produced by the ground upon the body upon landing.
2)
Peak Vertical Ground Reaction Force- The point in
time at which the ground reaction force is maximally
applied.
3)
Prophylactic ankle device- a device applied to the
ankle to potentially prevent injury and improve
support and stability.
52
4)
Spatting- A type of prophylactic ankle device that
consists of taping over the athletes shoe and distal
aspect of the lower leg.
5)
Kinetic chain- the sequence of anatomical structures
within the body
Basic Assumptions
The following are basic assumptions of this study:
1)
The subjects used in this study was honest when
reporting the absence of ankle or lower leg injury
or neurological or balance disorders in the past
year.
2)
All subjects will participate voluntarily and
without coercion.
3)
All subjects will give their best effort in each
performance test.
4)
All braces used was fitted sufficiently in
accordance to each subject.
5)
All ankle taping was sufficient and done with the
same technique.
6)
The AMTI force platform and Netforce software was a
valid and reliable tool to measure vertical ground
reaction peak force values.
53
Limitations of the Study
The following are possible limitations to the study:
1)
ROM limitations of the tape and spat may not
simulate real training and game situations because
of the limit of activity required by each subject
and braced condition.
2)
Testing was conducted in a laboratory in a
controlled setting; therefore results may not apply
to a real training or game time setting.
3)
A sample of convenience was used for this study.
4)
External validity may be of concern because the
study was limited to Division II football and soccer
athletes of California University of Pennsylvania.
5)
Only one method of taping and one method of spatting
was used in this study.
6)
The study will not include any prophylactic
conditions that tested the effects of any ankle
brace devices.
Significance of the Study
Many prophylactic ankle devices have been
constructed over the years to reduce the ROM of the ankle
joint in hopes to reduce the rate of ankle injury, even
when landing from a jump. When landing, the primary goal
54
of a prophylactic ankle device is to restrict inversion
and eversion of the ankle in order to keep the ankle in a
neutral position.4 However, most prophylactic ankle
devices also restrict dorsiflexion and plantarflexion ROM
as well.4
The force reproduced by the ground (vertical ground
reaction force) is absorbed through the kinetic chain,
starting distally and dissipating proximally throughout
the joints of the lower extremity.17 Studies have shown an
increase in peak values of vertical ground reaction
forces when prophylactic ankle devices were used,
14-16
while others have shown an increase in knee flexion upon
landing while wearing a prophylactic ankle device.
17
This
evidence suggests that when the ROM of the ankle is
limited in the sagittal plane by a prophylactic device,
it will have an effect on force absorption upon landing
from a jump, which may lead to an increased risk of
injury to the lower extremity.17
While spatting is a common prophylactic ankle device
used in athletics today, specifically in football, no
study has been found examining the effects of spatting on
athletic performance on vertical ground reaction forces.
By investigating the effects that spatting has on
vertical ground reaction forces upon landing, athletic
55
trainers are better able to determine if spatting is a
safe and beneficial form of ankle stabilization, in
absorbing force, when landing from a jump.
56
APPENDIX C
Demographic Information
57
Demographic Information
-Subject Number: ______________
-Age: __________________________
-Height: __________________________
-Current Sport: __________________________
-Position: ________________________
-Years of Participation at this level: ________
-Have you incurred any injury to your knee, lower leg,
ankle, or foot within the past year that has prevented
you from playing:
Yes: If Yes, what was the injury ______________
No
-Do you have any experience with any type of ankle
bracing or taping:
Yes
No
-If the answer to the previous question was “Yes,” circle
all that apply
Braced
Taped only
Spatted only
Taped and Spatted together
58
APPENDIX D
Informed Consent Form
59
Informed Consent Form
1. Benjamin Galley, ATC, who is a Graduate Athletic
Training Student at California University of
Pennsylvania, has requested my participation in a
research study at California University of Pennsylvania.
The title of the research is The Effects of Spatting on
Vertical Ground Reaction Force Peak Values During
Landing.
2. I have been informed that the purpose of this
study is to The Purpose of this study is to examine
whether spatting has an effect on vertical ground
reaction force peak values during landing. I understand
that I must be 18 years of age or older to participate.
I understand that I have been asked to participate along
with subjects who have not suffered any lower leg
(including knee), ankle, or foot injury within the past
year and/or have not been diagnosed with neurological or
balance disorders prior to the test that have caused the
athlete to cease participation from their sport.
3. I have been invited to participate in this
research project. My participation is voluntary and I
can choose to discontinue my participation at any time
without penalty or loss of benefits. My participation
will involve randomly choosing the order in which I was
braced. I will perform three jumps on the AMTI OR 6-7
force platform in three braced ankle conditions (taped
only, spatted only, taped and spatted) with sufficient
rest between each tested condition as to limit fatigue. I
was instructed as to how to jump. The testing procedure
will take approximately one hour.
4. I understand there are foreseeable risks or
discomforts to me if I agree to participate in the study.
With participation in a research program such as this
there is always the potential for unforeseeable risks as
well. The possible risks and/or discomforts include
possibly falling during the landing phase of the jump. To
minimize this risk, the researcher will place a wooden
adaptor around the force plate to increase the landing
surface area.
60
5. I understand that, in case of injury, I can
expect to receive treatment or care in Hamer Hall’s
Athletic Training Facility. This treatment was provided
by the researcher, Benjamin Galley, under the supervision
of the CalU athletic training faculty, all of which can
administer emergency care. Additional services needed for
prolonged care was referred to the attending staff at the
Downey Garofola Health Services located on campus.
6. There are no feasible alternative procedures
available for this study.
7. I understand that the possible benefits of my
participation in the research is to help determine the
risk effects that spatting may have on an athlete’s
performance and body upon landing from a jump in the
aforementioned ankle braced conditions. This study can
help athletic trainers determine if spatting is a safe,
effective, or efficient form of ankle bracing.
8. I understand that the results of the research
study may be published but my name or identity will not
be revealed. Only aggregate data was reported. In order
to maintain confidentially of my records, Benjamin Galley
will maintain all documents in a secure location on
campus and password protect all electronic files so that
only the student researcher and research advisor can
access the data. Each subject was given a specific
subject number to represent his or her name so as to
protect the anonymity of each subject.
9. I have been informed that I will not be
compensated for my participation.
10. I have been informed that any questions I have
concerning the research study or my participation in it,
before or after my consent, was answered by:
Benjamin A. Galley, ATC
STUDENT/PRIMARY RESEARCHER
GAL4846@calu.edu
724-972-3124
Dr. Shelly DiCesaro, PhD, ATC
RESEARCH ADVISOR
dicesaro@calu.edu
61
724-938-4342
11. I understand that written responses may be used
in quotations for publication but my identity will remain
anonymous.
12. I have read the above information and am
electing to participate in this study. The nature,
demands, risks, and benefits of the project have been
explained to me. I knowingly assume the risks involved,
and understand that I may withdraw my consent and
discontinue participation at any time without penalty or
loss of benefit to myself. In signing this consent form,
I am not waiving any legal claims, rights, or remedies. A
copy of this consent form was given to me upon request.
13. This study has been approved by the California
University of Pennsylvania Institutional Review Board.
from:
14. The IRB approval dates for this project are
03/25/10 to 03/25/11.
Subject's signature:___________________________________
Date:____________________
Witness signature:___________________________________
Date:____________________
62
APPENDIX E
Institutional Review Board Approval
63
Proposal Number
Date Received
PROTOCOL for Research
Involving Human Subjects
Institutional Review Board (IRB) approval is required before
beginning any research and/or data collection involving human
subjects
Project Title The Effects of Spatting on Vertical Ground Reaction Force Peak Values
During Landing
Researcher/Project Director
Benjamin A. Galley
Phone # 724-972-3124
E-mail Address GAL4846@calu.edu
Faculty Sponsor (if required) Dr. Shelly DiCesaro
Department
Health Science
Project Dates
to December 1, 2010
Sponsoring Agent (if applicable) Project to be Conducted at California University of Pennsylvania
Project Purpose:
Thesis
Research
Class Project
Other
(Reference IRB Policies and Procedures for clarification)
64
Please attach a typed, detailed summary of your project AND complete items 2 through
6.
1.
Provide an overview of your project-proposal describing what you plan to do and
how you will go about doing it. Include any hypothesis(ses)or research questions that might
be involved and explain how the information you gather will be analyzed. For a complete list
of what should be included in your summary, please refer to Appendix B of the IRB Policies
and Procedures Manual.
The purpose of this study will be to examine whether spatting has an effect on vertical ground
reaction force peak values during landing. Healthy National Collegiate Athletic Association
(NCAA) Division II male football and soccer players will be asked to participate in this study
(N~20). Only athletes from the football and men's soccer teams will be asked to participate
because spatting is only utilized in sports where cleats are worn. Males will only be asked to
participate to limit the variable of gender. Subjects who have suffered any lower leg
(including knee), ankle, or foot injury within the past year, or who have been diagnosed with
neurological or balance disorders prior to the test, and/or currently suffering from any of the
aforementioned injuries, that have caused the athlete to cease participation from their sport,
will be excluded from participating in the study. Each subject who signed the informed
consent (attached) will have their vertical ground reaction force peak values measured upon
landing from a jump in three prophylactic ankle braced conditions and a control condition.
Subjects will act as their own control in this quasi-experimental within-subjects research
design. The prophylactic braced conditions include a taped only condition, spatted only
condition, and a taped and spatted condition, where the control condition will be natural (nonbraced). Each subject will report only one day for testing in all braced conditions. The testing
procedure will last no longer than three hours per subject.
The subjects will randomly choose the order in which they will be braced. Each subject will
perform three vertical jumps on the AMTI OR 6-7 force platform in each braced condition,
with ten minutes of rest between each tested condition as to limit fatigue. Each subject will be
instructed to place their hands on their hips and jump as high as possible, landing on the force
platform with both feet. A wooden platform will be placed around the force plate to extend
the landing area to limit the possibility of injury.
The research question seeking to be answered is, "Will spatting have an effect on vertical
ground reaction force peak values." The hypothesis is stated as the following: "There will be
a difference in vertical ground reaction force peak values in the three braced conditions when
compared to the control condition, where the tapped and spatted condition will have the most
significant difference."
The vertical ground reaction force peak values will be compared to each condition including
the controlled condition using a multivariate analysis of variance (MANOVA) with a
significance value set at .05
(P ≤ 0.05). The data will be analyzed by the latest version of SPSS software.
2.
Section 46.11 of the Federal Regulations state that research proposals involving
human subjects must satisfy certain requirements before the IRB can grant approval. You
should describe in detail how the following requirements will be satisfied. Be sure to address
each area separately.
65
a. How will you insure that any risks to subjects are minimized? If there are potential risks,
describe what will be done to minimize these risks. If there are risks, describe why the risks
to participants are reasonable in relation to the anticipated benefits.
There is a small possibility that when the subjects land from their jump, they may miss the
platform with both feet. A wooden platform the same height will be placed on the ground to
completely surround the force platform in increase the landing area. The wooden adaptor will
increase the landing surface in order to minimize the risk for potential injury. Another
potential risk that may be present is the potential risk for general muscle soreness.
b. How will you insure that the selection of subjects is equitable? Take into account your
purpose(s). Be sure you address research problems involving vulnerable populations such as
children, prisoners, pregnant women, mentally disabled persons, and economically or
educationally disadvantaged persons. If this is an in-class project describe how you will
minimize the possibility that students will feel coerced.
All subjects will be volunteers who are eighteen years of age or older, male, NCAA division
II collegiate football or soccer athletes from California University of Pennsylvania. Prior to
the research, each potential subject will be review and sign an informed consent form, absent
of their coaches, the will describe the concept of the study. Any athlete who currently suffers
from, or has suffered from a lower leg (including knee), ankle, or foot injury within the past
year, or who have been diagnosed with neurological or balance disorders prior to the test,
and/or currently suffering from any of the aforementioned injuries, that have caused the
athlete to cease participation from their sport, will be excluded from participating in the study
as these conditions may interfere with the subjects ability to absorb force. This exclusion due
to these medical conditions will be performed by the supervising Certified Athletic Trainer in
order to maintain patient confidentiality.
Only athletes from the football and men's soccer teams will be asked to participate because
spatting is only utilized in sports where cleats are worn. Males will only be asked to
participate to limit the variable of gender.
c. How will you obtain informed consent from each participant or the subject’s legally
authorized representative and ensure that all consent forms are appropriately documented?
Be sure to attach a copy of your consent form to the project summary.
An informed consent form (attached) will be reviewed, completed, and signed by all subjects
prior to participating in the study on the day of testing. Each signed form will be kept by the
researcher in a locked filing cabinet located in the program directors office in Hammer Hall
on the campus of California University of Pennsylvania. Only the program director,
researcher, and research advisor will have access to the data.
d. Show that the research plan makes provisions to monitor the data collected to insure the
safety of all subjects. This includes the privacy of subjects’ responses and provisions for
maintaining the security and confidentiality of the data.
All data will be recorded during the spring semester. All subjects will report to the testing site
once for testing and the secession will take no longer than 3 hours. All electronic files will be
password protected and only be accessible by the researcher and research advisor. All hard
copy files will be stored in a locked filing cabinet on campus in the program directors office
in Hammer Hall that will only be able to be accessed by the program director, researcher, and
66
research advisor. Also, all collected data will be identified by subject number, not name, to
ensure patient data confidentiality.
3.
Check the appropriate box(es) that describe the subjects you plan to use.
Adult volunteers
CAL University Students
Other Students
Prisoners
Mentally Disabled People
Economically Disadvantaged
People
Educationally Disadvantaged
People
Pregnant Women
Fetuses or fetal material
Physically Handicapped
People
Children Under 18
Neonates
4.
Is remuneration involved in your project?
5.
Is this project part of a grant?
information:
Yes or
Yes or
No
No. If yes, Explain here.
If yes, provide the following
Title of the Grant Proposal
Name of the Funding Agency
Dates of the Project Period
6.
Does your project involve the debriefing of those who participated?
Yes or
If Yes, explain the debriefing process here.
7.
If your project involves a questionnaire interview, ensure that it meets the
requirements of Appendix
in the Policies and Procedures Manual.
No
67
California University of Pennsylvania Institutional Review Board
Survey/Interview/Questionnaire Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview or questionnaire?
YES—Complete this form
NO—You MUST complete the “Informed Consent Checklist”—skip the
remainder of this form
Does your survey/interview/questionnaire cover letter or explanatory statement
include:
(1) Statement about the general nature of the survey and how the data will be
used?
(2) Statement as to who the primary researcher is, including name, phone, and
email address?
(3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information
provided?
(4) Statement that participation is voluntary?
(5) Statement that participation may be discontinued at any time without penalty
and all data discarded?
(6) Statement that the results are confidential?
(7) Statement that results are anonymous?
(8) Statement as to level of risk anticipated or that minimal risk is anticipated?
(NOTE: If more than minimal risk is anticipated, a full consent form is required—and
the Informed Consent Checklist must be completed)
(9) Statement that returning the survey is an indication of consent to use the data?
(10) Who to contact regarding the project and how to contact this person?
(11) Statement as to where the results will be housed and how maintained? (unless
otherwise approved by the IRB, must be a secure location on University premises)
(12) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)?
68
(13) FOR ELECTRONIC/WEBSITE SURVEYS: Does the text of the cover letter
or
explanatory statement appear before any data is requested from the participant?
(14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue
participation at any point in the process and all data is immediately discarded?
California University of Pennsylvania Institutional Review Board
Informed Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview, or questionnaire?
YES—DO NOT complete this form. You MUST complete the
“Survey/Interview/Questionnaire Consent Checklist” instead.
NO—Complete the remainder of this form.
1.
Introduction (check each)
(1.1) Is there a statement that the study involves research?
(1.2) Is there an explanation of the purpose of the research?
2. Is the participant. (check each)
(2.1) Given an invitation to participate?
(2.2) Told why he/she was selected.
(2.3) Told the expected duration of the participation.
(2.4) Informed that participation is voluntary?
(2.5) Informed that all records are confidential?
(2.6) Told that he/she may withdraw from the research at any time without
penalty or loss of benefits?
(2.7) 18 years of age or older? (if not, see Section #9, Special Considerations
below)
3. Procedures (check each).
(3.1) Are the procedures identified and explained?
(3.2) Are the procedures that are being investigated clearly identified?
(3.3) Are treatment conditions identified?
4. Risks and discomforts. (check each)
(4.1) Are foreseeable risks or discomforts identified?
(4.2) Is the likelihood of any risks or discomforts identified?
(4.3) Is there a description of the steps that will be taken to minimize any risks or
discomforts?
(4.4) Is there an acknowledgement of potentially unforeseeable risks?
(4.5) Is the participant informed about what treatment or follow up courses of
action are available should there be some physical, emotional, or psychological harm?
69
(4.6) Is there a description of the benefits, if any, to the participant or to others
that may be reasonably expected from the research and an estimate of the likelihood
of these benefits?
(4.7) Is there a disclosure of any appropriate alternative procedures or courses of
treatment that might be advantageous to the participant?
5. Records and documentation. (check each)
(5.1) Is there a statement describing how records will be kept confidential?
(5.2) Is there a statement as to where the records will be kept and that this is a
secure location?
(5.3) Is there a statement as to who will have access to the records?
6. For research involving more than minimal risk (check each),
(6.1) Is there an explanation and description of any compensation and other
medical or counseling treatments that are available if the participants are injured
through participation?
(6.2) Is there a statement where further information can be obtained regarding the
treatments?
(6.3) Is there information regarding who to contact in the event of researchrelated injury?
7. Contacts.(check each)
(7.1) Is the participant given a list of contacts for answers to questions about the
research and the participant’s rights?
(7.2) Is the principal researcher identified with name and phone number and
email address?
(7.3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact
information provided?
8. General Considerations (check each)
(8.1) Is there a statement indicating that the participant is making a decision
whether or not to participate, and that his/her signature indicates that he/she has
decided to participate having read and discussed the information in the informed
consent?
(8.2) Are all technical terms fully explained to the participant?
(8.3) Is the informed consent written at a level that the participant can understand?
(8.4) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)
9. Specific Considerations (check as appropriate)
70
(9.1) If the participant is or may become pregnant is there a statement that the
particular treatment or procedure may involve risks, foreseeable or currently
unforeseeable, to the participant or to the embryo or fetus?
(9.2) Is there a statement specifying the circumstances in which the participation
may be terminated by the investigator without the participant’s consent?
(9.3) Are any costs to the participant clearly spelled out?
(9.4) If the participant desires to withdraw from the research, are procedures for
orderly termination spelled out?
(9.5) Is there a statement that the Principal Investigator will inform the participant
or any significant new findings developed during the research that may affect them
and influence their willingness to continue participation?
(9.6) Is the participant is less than 18 years of age? If so, a parent or guardian must
sign the consent form and assent must be obtained from the child
Is the consent form written in such a manner that it is clear that the parent/guardian
is giving permission for their child to participate?
Is a child assent form being used?
Does the assent form (if used) clearly indicate that the child can freely refuse to
participate or discontinue participation at any time without penalty or coercion?
(9.7) Are all consent and assent forms written at a level that the intended
participant can understand? (generally, 8th grade level for adults, age-appropriate for
children)
71
California University of Pennsylvania Institutional Review Board
Review Request Checklist (v021209)
This form MUST accompany all IRB review requests.
Unless otherwise specified, ALL items must be present in your review request.
Have you:
(1.0) FOR ALL STUDIES: Completed ALL items on the Review Request Form?
Pay particular attention to:
(1.1) Names and email addresses of all investigators
(1.1.1) FOR ALL STUDENTS: use only your CalU email address)
(1.1.2) FOR ALL STUDENTS: Name and email address of your faculty research
advisor
(1.2) Project dates (must be in the future—no studies will be approved which have
already begun or scheduled to begin before final IRB approval—NO EXCEPTIONS)
(1.3) Answered completely and in detail, the questions in items 2a through 2d?
2a: NOTE: No studies can have zero risk, the lowest risk is “minimal risk”. If more
than minimal risk is involved you MUST:
i. Delineate all anticipated risks in detail;
ii. Explain in detail how these risks will be minimized;
iii. Detail the procedures for dealing with adverse outcomes due to these risks.
iv. Cite peer reviewed references in support of your explanation.
2b. Complete all items.
2c. Describe informed consent procedures in detail.
2d. NOTE: to maintain security and confidentiality of data, all study records must
be housed in a secure (locked) location ON UNIVERSITY PREMISES. The actual
location (department, office, etc.) must be specified in your explanation and be listed
on any consent forms or cover letters.
(1.4) Checked all appropriate boxes in Section 3? If participants under the age of
18 years are to be included (regardless of what the study involves) you MUST:
(1.4.1) Obtain informed consent from the parent or guardian—consent forms must
be written so that it is clear that the parent/guardian is giving permission for their
child to participate.
(1.4.2) Document how you will obtain assent from the child—This must be done
in an age-appropriate manner. Regardless of whether the parent/guardian has given
permission, a child is completely free to refuse to participate, so the investigator must
document how the child indicated agreement to participate (“assent”).
(1.5) Included all grant information in section 5?
(1.6) Included ALL signatures?
(2.0) FOR STUDIES INVOLVING MORE THAN JUST SURVEYS,
INTERVIEWS, OR QUESTIONNAIRES:
(2.1) Attached a copy of all consent form(s)?
(2.2) FOR STUDIES INVOLVING INDIVIDUALS LESS THAN 18 YEARS OF
AGE: attached a copy of all assent forms (if such a form is used)?
72
(2.3) Completed and attached a copy of the Consent Form Checklist? (as
appropriate—see that checklist for instructions)
(3.0) FOR STUDIES INVOLVING ONLY SURVEYS, INTERVIEWS, OR
QUESTIONNAIRES:
(3.1) Attached a copy of the cover letter/information sheet?
(3.2) Completed and attached a copy of the Survey/Interview/Questionnaire
Consent Checklist? (see that checklist for instructions)
(3.3) Attached a copy of the actual survey, interview, or questionnaire questions in
their final form?
(4.0) FOR ALL STUDENTS: Has your faculty research advisor:
(4.1) Thoroughly reviewed and approved your study?
(4.2) Thoroughly reviewed and approved your IRB paperwork? including:
(4.2.1) Review request form,
(4.2.2) All consent forms, (if used)
(4.2.3) All assent forms (if used)
(4.2.4) All Survey/Interview/Questionnaire cover letters (if used)
(4.2.5) All checklists
(4.3) IMPORTANT NOTE: Your advisor’s signature on the review request form
indicates that they have thoroughly reviewed your proposal and verified that it meets
all IRB and University requirements.
(5.0) Have you retained a copy of all submitted documentation for your records?
73
Project Director’s Certification
Program Involving HUMAN SUBJECTS
The proposed investigation involves the use of human subjects and I am submitting the
complete application form and project description to the Institutional Review Board for
Research Involving Human Subjects.
I understand that Institutional Review Board (IRB) approval is
required before beginning any research and/or data collection
involving human subjects.
If the Board grants approval of
this application, I agree to:
1.
Abide by any conditions or
changes in the project required by the Board.
2.
Report to the Board any
change in the research plan that affects the method of using human subjects before such
change is instituted.
3.
Report to the Board any
problems that arise in connection with the use of human subjects.
4.
Seek advice of the Board
whenever I believe such advice is necessary or would be helpful.
5.
Secure the informed, written
consent of all human subjects participating in the project.
6.
Cooperate with the Board in
its effort to provide a continuing review after investigations have been initiated.
I have reviewed the Federal and State regulations concerning the use of human subjects in
research and training programs and the guidelines. I agree to abide by the regulations and
guidelines aforementioned and will adhere to policies and procedures described in my
application. I understand that changes to the research must be approved by the IRB before
they are implemented.
Professional Research
Project Director’s Signature
Department Chairperson’s
Signature
74
Student or Class Research
Student Researcher’s Signature
Supervising Faculty Member’s
Signature if required
Department Chairperson’s
Signature
ACTION OF REVIEW BOARD (IRB use only)
The Institutional Review Board for Research Involving Human Subjects has reviewed this application
to ascertain whether or not the proposed project:
1.
provides adequate safeguards of the
rights and welfare of human subjects involved in the investigations;
2.
uses appropriate methods to obtain
informed, written consent;
3.
indicates that the potential benefits of
the investigation substantially outweigh the risk involved.
4.
provides adequate debriefing of human
participants.
5.
provides adequate follow-up services to
participants who may have incurred physical, mental, or emotional harm.
Approved[_________________________________]
Disapproved
___________________________________________
_________________________
Chairperson, Institutional Review Board
Date
75
Institutional Review Board
California University of Pennsylvania
Psychology Department LRC, Room 310
250 University Avenue
California, PA 15419
instreviewboard@cup.edu
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair
Benjamin Galley,
Please consider this email as official notification that your
proposal titled “ The Effects of Spatting on Vertical Ground
reaction Force Peak Values During Landing” (Proposal #09-073)
has been approved by the California University of Pennsylvania
Institutional Review Board as amended, with the following
stipulation:
The “laymen’s terms” definition of spatting
submitted to the board must be added to the consent form.
Once you have made this revision, you may immediately begin
data collection. You do not need to wait for further IRB
approval. [At your earliest convenience, you must forward a
copy of the revised consent form for the Board’s records].
The effective date of the approval is 3-25-2010 and the
expiration date is 3-25-2011. These dates must appear on the
consent form .
Please note that Federal Policy requires that you notify the
IRB promptly regarding any of the following:
(1) Any additions or changes in procedures you might wish for
your study (additions or changes must be approved by the IRB
before they are implemented)
(2) Any events that affect the safety or well-being of
subjects
(3) Any modifications of your study or other responses that
are necessitated by any events reported in (2).
(4) To continue your research beyond the approval expiration
date of 3-25-2011 you must file additional information to be
considered for continuing review. Please contact
instreviewboard@cup.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board
76
REFERENCES
1.
Prentice W. Arnheim’s Principles of Athletic
Training A Competency-Based Approach. 11th ed.
New York, NY: McGraw –Hill Companies, Inc.; 2003.
2.
Moore KL, Dalley AF. Clinically Oriented Anatomy
Forth Edition. Baltimore, MD: Lippincott
Williams & Wilkins; 1999.
3.
Drake RL, Vogl AW, Mitchell AWM. Gray’s Anatomy
for Students. 2nd ed. Philadelphia, PA: Churchill
Livingstone, Elsevier Inc.; 2010.
4.
Hoppenfeld S. Physical Examination of the Spine
and Extremities. Upper Saddle River, NJ: Prentice
Hall, INC.; 1976.
5.
Metcalfe RC, Schlabach GA, Looney MA, Renehan EJ.
A Comparison of MoleskinTape, Linen Tape, and
Lace-Up Brace on Joint Restriction and Movement
Performance. Journal Of Athletic Training. June
1997; 32(2): 136-140.
6.
Paris DL,
of Motion
Taped and
September
7.
Pederson TS, Ricard MD, Merril G, Schulthies SS,
Allsen PE. The Effects of Spatting and Ankle
Taping on Inversion Before and After Exercise.
Journal of Athletic Training. March
1997;32(1):29-33.
8.
Verbrugge JD. The effects of semirigid AirStirrup bracing vs. adhesive ankle taping on
motor performance. The Journal Of Orthopaedic And
Sports Physical Therapy. May 1996;23(5):320-325.
9.
Paris DL. The Effects of the Swede-O, New Cross,
and McDavid Ankle Braces, and Adhesive Ankle
Taping on Speed, Balance, Agility, and Vertical
Jump. Journal of Athletic Training.
1992;27(3)253-256.
Vardaxis V, Kokkaliaria J. Ankle Ranges
During Extended Activity Periods While
Braced. Journal Of Athletic Training.
1995; 30(3). 223-228.
77
10.
Rosenbaum D, Kamps N, Bosch K, Thorwesten L,
Völker K, Eils E. The influence of external ankle
braces on subjective and objective parameters of
performance in a sports-related agility course.
Knee Surgery, Sports Traumatology, Arthroscopy.
July 2005;13(5):419-425.
11.
Yaggie J, Kinzey S. A Comparative Analysis of
Selected Ankle Orthoses During Functional Tasks.
Journal of Sport Rehabilitation. August
2001;10(3):174-183.
12.
Bocchinfuso C, Sitler MR, Kimura IF. Effects of
Two Semirigid Prophylactic Ankle Stabilizers on
Speed, Agility, and Vertical Jump. Journal of
Sport Rehabilitation. 1994;3:125-1 34.
13.
MacKean LC, Bell G, Burnham RS. Prophylactic
Ankle Bracing Vs. Taping: Effects on Functional
Performance in Female Basketball Players. The
Journal Of Orthopaedic And Sports Physical
Therapy. August 1995; 22(2):77-81.
14.
Pienkowski D, McMorrow M, Shapiro R, Caborn DNM,
Stayton J. The Effects of Ankle Stabilizers on
Antithetic Performance. American Orthopaedic
Society for Sports Medicine. 1995;23(6):757-762.
15.
Abian-Vicen J, Alegre LM, Fernandez-Rodriguez JM,
Lara AJ, Meana M, Aguado X. Ankle taping does not
impair performance in jump or balance tests.
Journal of Sports Science and Medicine. 2008;
7:350-356.
16.
Reimann BL, Schmitz RJ, Gale M, McCaw ST. Effects
of Ankle Taping on Vertical Ground Reaction Forces
During Drop Landings Before and After Treadmill
Jogging. Journal of Orthopaedic & Sports Physical
Therapy. December 2002; 32(12):628-635.
17.
Hodgson B, Tis L, Cobb S, Higbie E. The Effect of
External Ankle Support on Vertical GroundReaction Force and Lower Body Kinematics. Journal
of Sport Rehabilitation. 2005;14:301-312.
18.
DiStefano LJ, Padua DA, Brown CN, Guskiewicz KM.
Lower Extremity Kinematics and Ground Reaction
78
Forces After Prophylactic Lace-Up Ankle Bracing.
Journal of Athletic Training. 2008;43(3):234-241.
19.
Cordova ML, Armstrong CW, Rankin JM, Yeasting RA.
Ground reaction forces and EMG activity with
ankle bracing during inversion stress. Medicine &
Science in Sports & Exercise. September
1998;30(9):1363-1370.
20.
Kovacs I, Tihanyi J, Devita P, Racz L, Barrier J,
Hortobagyi T. Foot placement modifies kinematics
and kinetics during drop jumping. Medicine &
Science in Sports & Exercise. May1999;31(5):708716.
21.
Fritz M, Peikenkamp K. Simulation of the
influence of sport surfaces on vertical ground
reaction forces during landing. Medical and
Biological Engineering & Computing. 2003;41:1117.
22.
Peikenkamp K, Fritz M, Nicol K, Wilhelm W.
Simulation of the Vertical Ground Reaction Force
in Sport Surfaces During Landing. Journal of
Applied Biomechanics. 2002; 18:122-134.
23.
Elvin NG, Elvin AA, Arnoczky SP. Correlation
Between Ground Reaction Force and Tibial
Acceleration in Vertical Jumping. Journal of
Applied Biomechanics. 2007;23:180-189.
24.
Swartz EE, Decoster LC, Russell PJ, Croce RV.
Effects of Developmental Stage and Sex on Lower
Extremity Kinematics and Vertical Ground Reaction
Forces During Landing. Journal of Athletic
Training. 2005;40(1):9-14.
25.
Cronin JB, Bressel E, Finn L. Augmented Feedback
Reduces Ground Reaction Forces in the Landing
Phase of the Volleyball Spike Jump. Journal of
Sport Rehabilitation. 2008;17:148-159.
79
ABSTRACT
Title:
THE EFFECTS OF SPATTING ON VERTICAL GROUND
REACTION FORCE PEAK VALUES DURING LANDING
Researcher:
Benjamin A. Galley, ATC, PES
Advisor:
Dr. Shelly DiCesaro, ATC
Date:
May 2010
Research Type: Master’s Thesis
Purpose:
The purpose of this study was to determine
the effects of prophylactic ankle taping,
spatting, and taping and spatting on peak
vertical ground reaction force (PVGRF)
values during landing.
Problem:
Spatting is a common form of prophylactic
ankle bracing, however very little
research has been conducted on its effect
on athletic performance.
Methods:
Fifteen California University NCAA
Division II football and male soccer
players participated in this study (10
football; 5 male soccer). Subjects
preformed three vertical jumps on a force
plate in each prophylactic ankle braced
condition. The braced conditions included
control, taped only, spatted only, and
taped and spatted conditions. The highest
PVGRF value of each condition was
recorded. The results were analyzed using
a repeated measures analysis of variance
test using a significance level of ≤ .05.
Findings:
No significant difference was found
between any prophylactic ankle brace
condition compared to the control
condition (F3,42= 0.628, p>.05.)
Conclusion:
Based on the results it may be concluded
that spatting has no effect on PVGRF
values upon landing from a vertical jump.
80
This study suggests that ankle spatting
has no more significant difference in
PVGRF than taping, taping and spatting, or
a controlled condition, and therefore may
not contribute to an increased chance of
ankle injury, especially when landing from
a jump.
Word Count:
214
VALUES DURING LANDING
A THESIS
Submitted to the Faculty of the School of Graduate Studies and
Research
of
California University of Pennsylvania in partial fulfillment
of the requirements for the degree of
Master of Science
by
Benjamin A. Galley, ATC, PES
Research Advisor, Dr. Shelly DiCesaro
California, Pennsylvania
2009
i
ii
AKNOWLEDGEMENTS
I would first like to thank my parents for
supporting me throughout my entire life, especially this
past year. Thank you Mom and Dad for never telling me
that I couldn’t and always letting me know how proud you
are of me. Thank you for supporting me financially
throughout my years at Liberty and now at Cal U. Thank
you for a warm bed to sleep in, a car to drive, and warm
meals.
Thank you, Katherine, for always encouraging me.
Thank you for being so patient and never complaining
about waiting for me to finish school before marrying me.
Even though we were far a way for so long, thank you for
your sacrifice and love that you truly showed me through
this past year.
Thank you, siblings, for keeping my head up. Thank
you for telling me that you are proud of me and
encouraging me through the process. Thank you, Josh and
Nicole, for supporting me through my years at Liberty and
your continued support, it means so much to me. Thank
you, Stacey and Tim, for your prayers and conversations
iii
all the way from China. Thank you for always giving me
encouraging words.
Thank you, God, for being my Rock and Firm
Foundation that I could stand on. Thank you for being my
Shelter in rough times that I could run to and count on.
Thank you for always being faithful.
Thank you also, Ruth, Mr. Zigger, and Julie, for
always being supportive of me and working with me through
this tough process while at Southmoreland. Thank you,
Julie, for always working with my schedule. Thank you to
the athletes at Southmoreland who made my experience
there enjoyable, I will never forget it.
Lastly, thank you to all the staff at Cal U who made
this possible for me. Thank you, Shelly, for sticking it
out with me and encouraging me to finish strong. Thank
you, Bob and Jamie, for being a part of this journey with
me and making this thesis project better. Thank you Tom,
for all you taught me and for all of the unselfish
support you show to all of us.
iv
TABLE OF CONTENTS
Page
SIGNATURE PAGE
. . . . . . . . . . . . . . .
i
Acknowledgements . . . . . . . . . . . . . . .
ii
TABLE OF CONTENTS
iv
LIST OF TABLES
INTRODUCTION
. . . . . . . . . . . . . .
. . . . . . . . . . . . . . .
vii
. . . . . . . . . . . . . . . .
1
. . . . . . . . . . . . . . . . . .
6
Research Design. . . . . . . . . . . . . . .
6
Subjects
7
METHODS
. . . . . . . . . . . . . . . . .
Preliminary Research
. . . . . . . . . . . .
8
Instruments . . . . . . . . . . . . . . . .
8
Procedures
. . . . . . . . . . . . . . . .
9
Hypothesis
. . . . . . . . . . . . . . . .
12
Data Analysis
. . . . . . . . . . . . . . .
12
. . . . . . . . . . . . . . . . . .
13
Demographics Information . . . . . . . . . . .
13
Hypothesis Testing
. . . . . . . . . . . . .
15
Additional Findings . . . . . . . . . . . . .
16
DISCUSSION . . . . . . . . . . . . . . . . .
17
Discussion of Results . . . . . . . . . . . .
17
Conclusion
20
RESULTS
. . . . . . . . . . . . . . . .
v
Recommendation . . . . . . . . . . . . . . .
21
REFERENCES . . . . . . . . . . . . . . . . .
23
APPENDIX A: Review of Literature
. . . . . . . .
26
Introduction . . . . . . . . . . . . . . . .
27
Functional anatomy of the ankle . . . . . . . .
28
Prophylactic ankle support and ROM . . . . . . .
33
The effect of prophylactic ankle support on athletic
performance . . . . . . . . . . . . . . . .
Speed
Agility
38
. . . . . . . . . . . . . . . . .
38
. . . . . . . . . . . . . . . .
40
Vertical Jump
. . . . . . . . . . . . . .
42
The effects of prophylactic ankle support on vertical
ground reaction force.
. . . . . . . . . . . .
44
Take off
. . . . . . . . . . . . . . . . .
44
Landing
. . . . . . . . . . . . . . . . .
45
Other factors that contribute to vertical ground
reaction force values.
. . . . . . . . . . . .
47
Summary . . . . . . . . . . . . . . . . . .
48
APPENDIX B: The Problem . . . . . . . . . . . .
50
Definition of Terms . . . . . . . . . . . . .
51
Basic Assumptions . . . . . . . . . . . . . .
52
Limitations of the Study . . . . . . . . . . .
53
Significance of the Study . . . . . . . . . . .
53
APPENDIX C: Demographics Survey . . . . . . . . .
56
vi
APPENDIX D: Informed Consent Form . . . . . . . .
58
APPENDIX E: Institutional Review Board Approval
. .
62
REFERANCES . . . . . . . . . . . . . . . . .
76
Abstract . . . . . . . . . . . . . . . . . .
79
vii
LIST OF TABLES
Page
1.
Descriptive Statistics of PFGRF Values and
Significance Level . . . . . . . . . . . . . .
16
1
INTRODUCTION
Numerous braces and methods of taping have been
created to limit the ROM of the ankle and to help
decrease the rate of acute ankle injury. In conjunction
with taping and bracing, many football players use the
method of spatting in hopes to further limit the range of
motion (ROM) and increase the stability of the ankle.
Spatting is a form of prophylactic ankle bracing
that is commonly used among athletes of all levels of
competition.1 Many studies have been conducted examining
the effects of popular prophylactic ankle bracing and
taping conditions on athletic performance, however very
little research has been conducted on the effects of
spatting on athletic performance.
A review of the literature on the effects of
prophylactic ankle braces on athletic performance focused
mostly on speed, agility, and vertical jump height.
2-11
Most research suggests that speed is not affected by most
prophylactic ankle braces, however research is
inconsistent on the effects that prophylactic ankle
bracing has on agility.3,5,6,9,11 Research conducted by
2
Metcalf et. al.2 and Rosenbaum et. al.7 showed a decrease
in performance in linen taped ankles, linen taped ankles
with moleskin reinforcement, Sweed-O-Universal braces,
and ridged ankle supports in agility testing, but no
significant decrease in agility when braced with semiridged or soft ankle braces.
Research has mostly shown that vertical jump height
is significantly decreased by most prophylactic ankle
devices.2,5-11 The research shows that prophylactic ankle
braces that produced no difference in vertical jump
height were mainly soft, semi-rigid, or lace up ankle
braces. In the study conducted by Rosenbaum et. al.,7
five semi-rigid and four soft braces showed no
significant difference in vertical jump height. In
contrast, the one rigid brace studied did have a
significant negative difference as previously stated,
while taped conditions also produced significant negative
effects on vertical jump height.6,7,12 Research seems to
neglect the study of spatting on athletic performance.
Research has also been conducted on the effects of
prophylactic ankle devices on ankle ROM. Research agrees
that when an ankle is fitted with a prophylactic ankle
brace, be it a braced, taped, or spatted condition, the
ankle’s ROM was significantly limited.
3
The minimal amount research that has been conducted
on spatting has examined its effects on ROM and this was
conducted by Pederson et. al.1 This research found that a
taped condition, taped and spatted condition, and only
spatted condition all limit the ankles ROM
significantly.1
Some researchers suggest that a decrease in ROM of
the ankle provided by prophylactic ankle bracing leads to
a decreased rate of injury due to added support of the
ankle joint.1,2,6 Others suggest that a decrease in ROM of
the ankle provided by prophylactic ankle devices,
including spatting, would increase the peak vertical
ground reaction forces (PVGRF)values upon landing from a
jump, and therefore may increase the rate of acute ankle
injury.12-14 Additional research suggests that a decrease
in ROM at the ankle joint was compensated for through an
increase in knee flexion to absorb force along the
kinetic chain upon landing from a jump.15
Along with athletic performance and ROM, the effects
of prophylactic ankle devices have been examined in PVGRF
values during take-off and landing.11-16 While some
researchers have found that peak values were higher among
braced conditions upon landing, others found no
significant change in peak values.15,16
4
DiStefano et. al.15 found significant changes in
joint flexion throughout the kinetic chain, specifically
in the knee, when subjects landed from a jump in a braced
condition, even though the PGRF values were not
significantly different among the braced group and the
control group. This suggests that if an athlete wants to
land with the same amount of force in a braced condition,
compensations must be made somewhere along the kinetic
chain when ROM of the ankle is limited.
Some researchers suggest that a decrease in ROM
provided by a prophylactic ankle brace may cause an
increase in PVGRF and therefore increase the rate of
injury12, while others suggest that a decrease in ROM may
also decrease the rate of injury.3 Finally researchers
have also found that prophylactic ankle bracing does not
impair PVGRF values, but that it may be due to
compensation along the kinetic chain. However, no
research has been conducted on the effects that spatting
has on PVGRF values.11
The purpose of this study was to examine whether
spatting has an effect on PVGRF values during landing.
The following question was addressed: Will PVGRF be
significantly different depending upon the braced
condition? This study will provide information to the
5
sports medicine community as to the effects spatting may
have on the kinetic chain when force is applied to the
ground.
6
METHODS
The purpose of this study was to determine the
effects of spatting on peak vertical ground reaction
force (PVGRF) values during landing. This section
includes the following subsections: Research Design,
Subjects, Preliminary research, Instruments, Procedures,
Hypotheses, and Data Analysis.
Research Design
A quasi-experimental within-subject research design
was used for this study. The independent variables were
the braced condition of the ankle, which will include the
following: non-braced control; taped only; spatted only;
taped and spatted. The dependent variables include
vertical ground reaction force peak values upon landing.
The study was conducted with each subject tested in all
four braced conditions. The within-subjects research
design allowed the subjects to serve as their own
control, increasing the strength of the study.
7
Subjects
Fifteen (n=15) male division II soccer and football
players from California University of Pennsylvania were
included as subjects in this research study. Based upon
previous research, the minimum number of subjects who
were accepted to be sufficient for the study was 15.11-16
Prior to testing each subject was screened for previous
lower leg, foot, and ankle injury. Subjects who had had a
previous ankle, foot, or lower leg (including the knee)
injury within the past year, or have been diagnosed with
any nerve or balance disorders have been excluded from
participating in the study. The subjects were a sample of
convenience.
Each subject completed an informed consent form
(Appendix D)and demographics survey (Appendix C) before
the study was conducted. The demographics survey included
information on sport; years of participation; position;
age; height; previous traumatic injury to the lower leg,
foot, or ankle; and previous braced (taped, spatted, or
tapped and spatted) experience.
The study was approved by the California University
of Pennsylvania Institutional Review Board.
Each
8
participant’s identity remained confidential and was not
included in the study.
Preliminary Research
Preliminary research was conducted to determine the
amount of time needed to complete the testing protocol
and taping of each braced condition for each subject. The
subject was instructed orally on testing procedure,
taped, and tested in each braced condition (non-taped,
spatted only, taped only, spatted and taped).
The preliminary research helped determine the length
of time needed to test one subject in all braced
conditions, as well as allowed the researcher to become
familiar with the testing procedures.
Instruments
The following instruments to collect data were used
in this study. A demographics survey (Appendix C)was used
to document each subject’s sport, years of participation,
position, age, height, previous traumatic injury to the
lower leg, foot, or ankle, and previous braced (taped,
spatted, or tapped and spatted) experience. A force
9
platform (AMTI OR6-7, Watertown, MA) was used to collect
data on vertical jump height and PVGRF upon landing.
NetForce software was used for the PVGRF data collection.
The data was analyzed statistically using SPSS 17.0.
Procedure
Prior to data collection, each subject will sign an
informed consent form (Appendix D). After signing the
informed consent form, the study was briefly explained to
each subject and any questions were answered.
Next, each subject was randomly assigned the braced
condition order, in which they were tested. Each subject
would perform in all 3 braced conditions. Each condition
was assigned a number to represent it and they are as
follows: (1) non-braced control; (2) taped only; (3)
spatted only; (4) taped and spatted. All possible
combinations were placed into a hat and randomly selected
by each subject until all possible combinations had been
selected. Once all possible combinations had been
exhausted, all combinations were placed back into the hat
and the process was repeated as many times as necessary.
The order selected was recorded.
10
The taping procedures were the same with each
subject to maintain consistency throughout the study. All
subjects wore tennis shoes in each condition. The
researcher used pre-wrap and white inch and one half
coach athletic speed tape for the taped only condition.
The researcher used the closed basket-weave technique
over pre-wrap utilizing two continuous heal locks and one
figure eight.
The researcher used two inch power-flex to spat the
subjects. The spatting procedure was a continues method
in which the researcher used at least one whole roll of
power-flex per ankle, covering the subjects shoe and two
inches above the top of the shoe. The researcher used two
continuous heal locks and one figure eight on each
spatted condition. For the taped and spatted condition
the researcher used the same procedures and methods used
for the taped only and spatted only condition, while
combining the two into a taped and spatted condition.
The subjects were then instructed on proper jumping
technique for this study. Subjects were verbally
instructed to place both hands on their hips at all times
in order to maintain consistency among subjects in the
method of jumping. Subjects were allowed a “loading
phase” prior to take-off with a preparatory squat before
11
the jump. Subjects were instructed to jump as high as
possible while keeping their hands on their hips and
return to the force platform with both feet and looking
directly ahead.
Subjects performed three jumps in each braced
condition in the same day in the order that they randomly
chose. The average of the three jumps in each braced
condition was recorded. The subjects were allowed 15
attempts to land three vertical jumps with both feet
simultaneously before requiring an additional rest period
and re-taping.
Ten minutes of rest was given to each subject
between braced conditions to limit fatigue as a possible
variable, and to give the researcher time to prepare the
subject in the next braced condition. All taping was
performed by the researcher as to maintain consistency
among subjects.
12
Hypothesis
The following hypothesis is based on previous
research and the researcher’s intuition based on a review
of the literature.
1). There will be a difference in vertical ground
reaction force peak values, upon landing from a jump, in
the three braced conditions compared to the control
condition with the taped and spatted condition having the
greatest difference from the control condition.
Data Analysis
The data was analyzed using a repeated measures
analysis of variance (ANOVA) comparing each independent
variable to each other, and their effects on the
dependent variable (PVGRF). The data was analyzed using
SPSS 17.0. The level of significance was set at ≤ .05.
13
Results
The purpose of this study was to determine whether
spatting has an effect on PVGRF during landing from a
vertical jump. The following section includes data
collection through the study and is divided into the
following three sections: Demographics Information,
Hypothesis Testing, and Additional Findings.
Demographics Information
A demographics sheet was created to retrieve basic
information about each subject and was completed along
with the informed consent form during the oral
instruction. The subjects age, height, current sport,
years of participation, past ankle injury to the subjects
knee, lower leg, ankle, or foot history within the past
year, and previous bracing experience, were recorded on
the demographics sheet.
Fifteen (n=15) subjects were included in this study
and consisted of male division II soccer and football
players from California University of Pennsylvania. Out
of fifteen athletes, the study included five soccer
14
players (33.33%) and ten (66.67%) football players. The
subjects ranged of age 19 to 24 years old (20.6 ± 1.24)
and height ranged from 175.62 to 190.5 (72.6 ± 2.13
inches). The subject’s years of participation at the
collegiate level ranged from 1 to 4 years (2.73 ± 0.79).
Nine subjects reported having previous ankle bracing
experience and six reported having no previous ankle
bracing experience. Out of the nine who reported previous
ankle bracing experience six reported having experience
in a braced only condition, eight reported having
experience in a taped only condition, and three reported
having experience in a spatted only condition.
15
Hypothesis Testing
The following hypothesis was tested for this study
using an alpha level of ≤ .05.
Hypothesis: There will be a difference in peak
vertical ground reaction force (PVGRF) values, upon
landing from a jump, in the three braced conditions
compared to the control condition with the taped and
spatted condition having the greatest difference from the
control condition.
Conclusion: The PVGRF values for each prophylactic
ankle device were compared using a repeated measures
ANOVA. Means and standard deviations are presented in
Table 1. No significant difference was found between any
prophylactic ankle brace condition compared to the
control condition (F3,42= 0.628, p>.05)(Table 1).
16
Table 1. Descriptive Statistics of PFGRF Values and
Significance Level
Condition
Mean (N)
Standard Deviation
P Value
Control
7674.19
2118.780
.601
Spatted Only
7706.58
2056.767
Taped Only
7507.17
1905.029
Taped and Spatted
7985.93
2069.842
Additional Findings
After testing the hypothesis, statistical tests were
conducted on additional remaining data that was collected
on the demographics sheet, including sport played and
previous braced experience.
A repeated measures ANOVA was used to calculate the
effects of each braced condition on the sport played. No
significant data was found between soccer and football
players (F3,39= .215, p>.05) (Table 1).
A repeated measures ANOVA was used to calculate the
effects of each braced condition on previous braced
experience. No significant difference was found between
previous braced experience and no previous braced
experience (F3,39= .744, p>.05) (Table 1).
17
DISCUSSION
The following section is divided into the following
three subsections: Discussion of Results, Conclusion, and
Recommendations.
Discussion of Results
The purpose of this study was to determine if
spatting has an effect on PVGRF upon landing from a
vertical jump. Spatting is a form of prophylactic ankle
support that has been proven to significantly limit the
ROM of the ankle in four directions.1 The literature is
mixed on the effects of prophylactic ankle bracing on
PVGRF.12-16 Two studies conducted by Cordova et. al. and
DiStefano et. al. found no significant differences in
PVGRF between braced and non-braced subjects.15,16 However,
three studies conducted by Abián-Vicén et. al., Reiman
et. al., and Hodgson et. al., all found significant
differences in PVGRF between subjects.12-14 The researcher
investigated this topic because no research has been
conducted on the effects of spatting on PVGRF.
18
No significant difference was found when comparing
the three braced conditions (spatted only, taped, only,
and taped and spatted) to the control condition. It was
originally hypothesized that there would be a difference
in PVGRF between braced conditions with the taped and
spatted condition having the greatest difference among
conditions. These findings are similar to that of
DiStefano et. al. and Cordova et al., in that they also
found no significant difference in PVGRF values upon
landing in prophylactic braced conditions.15,16 However,
both studies also measured other variables, such as knee
flexion and muscle activity upon landing, in which they
did find significant differences among braced conditions
when compared to the control condition.
However, these findings disagree with Abián-Vicén
et. al., Reiman et. al. and Hodgson et. al., who all
found a significant differences in prophylactic ankle
bracing conditions, specifically taped and Active Ankle
Bracing, when compared to the control conditions. Reiman
et al., however, also stated that stiff landings have a
greater effect than soft landings in PVGRF when fitted
with the ankle braced condition.14 While the findings of
this study are similar to some, and not others, it is the
first to study the effects of spatting on PVGRF values.
19
After testing the hypothesis, additional statistical
tests were conducted on remaining data collected from the
demographics sheet. The sport played by the athletes was
one of the additional investigations of the study. No
significant difference was found between soccer players
and football players. While no significant difference was
found, the significance value was much closer to the
predetermined p value of .05, for the soccer players than
the total significance value when the groups are
combined. The subject size was small, and only five of
the fifteen subjects that were tested were soccer
players. If the trend were to continue, a researcher may
potentially see a significant difference between groups
in a larger sample size.
The other additional investigation was conducted
between subjects who have previous braced experience
compared to those who have no previous braced experience.
No significant difference was found between groups. The
researcher expected to see this result as no significant
difference was found among PVGRF values in the combined
groups.
20
Conclusion
Based on the results it may be concluded that
spatting has no effect on PVGRF values upon landing from
a vertical jump. The results support some of the
literature.15,16 This study supports some of the results
from the DiStefano et. al. and Cordova et. al. studies
which found
PVGRF values had no significant difference
between prophylactic ankle supported groups and the
control condition. However DiStafano et. al. found a
significant difference in knee flexion upon landing in
the prophylactic ankle braced condition, suggesting that
compensations must be made along the kinetic chain in
order to absorb the force upon landing in a braced
condition. The results did not support some literature
such as that conducted by Abián-Vicén et. al. that showed
a significant increase in PVGRF in a prophylactic braced
condition when compared to the control group.12-16
The mixture of results may be due to the difference
in subject selection. Abián-Vicén et. al. used 15
subjects all of whom have had no previous prophylactic
ankle bracing experience of any kind. Additional findings
of this study showed no significant difference between
subjects who have had no previous prophylactic ankle
21
bracing experience and those who have had previous
experience. However, Abián-Vicén et. al. suggests that if
the subjects studied have had previous ankle taping
experience, the results may have been different.13
Although the results from this study are not what
the researcher predicted, this study contributes to the
literature on ankle taping and spatting. This study does
suggest that ankle spatting has no more significant
difference in PVGRF than taping, taping and spatting, or
a controlled condition, and therefore may not contribute
to an increased chance in ankle injury.
Recommendations
It is important that Certified Athletic Trainers
understand that spatting, spatting and taping, and taping
the ankle were not found to change PVGRF values. This is
of interest to those Athletic Trainers’s that are
concerned that spatting may increase the risk of ankle
injury upon landing. Further testing should be conducted
on spatting to examine the effects of spatting on knee
flexion upon landing from a jump to determine if spatting
may have an effect on the kinetic chain upon landing.
While many studies have been conducted on prophylactic
22
ankle bracing on athletic performance, none have been
conducted on the effects of spatting on athletic
performance. It is recommended that further research be
conducted on the effect of spatting on speed, agility,
and vertical jump height. Another recommendation is to
test the durability of spatting on limiting ROM during
activity since other studies have researched this on
other forms of prophylactic ankle bracing.
While the results of this study did not show a
significant difference in PVGRF in spatting when compared
to the control condition, spatting has been found to have
significant differences from the control condition in ROM
of the ankle in a study conducted by Pederson et. al.1 As
this study adds to the literature on spatting, hopefully
it will also add to the legitimacy of spatting as a form
of prophylactic ankle bracing among the athletic training
profession, and not only as a cosmetic adornment.
23
REFERENCES
1.
Pederson TS, Ricard MD, Merril G, Schulthies SS,
Allsen PE. The Effects of Spatting and Ankle Taping on
Inversion Before and After Exercise. Journal of
Athletic
Training. March 1997;32(1):29-33.
2.
Metcalfe RC, Schlabach GA, Looney MA, Renehan EJ. A
Comparison of MoleskinTape, Linen Tape, and Lace-Up
Brace on Joint Restriction and Movement Performance.
Journal Of Athletic Training. June 1997; 32(2): 136140.
3.
Paris DL, Vardaxis V, Kokkaliaria J. Ankle Ranges of
Motion During Extended Activity Periods While Taped
and Braced. Journal Of Athletic Training. September
1995; 30(3). 223-228.
4.
Pederson TS, Ricard MD, Merril G, Schulthies SS,
Allsen PE. The Effects of Spatting and Ankle Taping on
Inversion Before and After Exercise. Journal of
Athletic Training. March 1997;32(1):29-33.
5.
Verbrugge JD. The effects of semirigid Air-Stirrup
bracing vs. adhesive ankle taping on motor
performance. The Journal Of Orthopaedic And Sports
Physical Therapy. May 1996;23(5):320-325.
6.
Paris DL. The Effects of the Swede-O, New Cross, and
McDavid Ankle Braces, and
Adhesive Ankle Taping on
Speed, Balance, Agility, and Vertical Jump. Journal of
Athletic Training. 1992;27(3)253-256.
7.
Rosenbaum D, Kamps N, Bosch K, Thorwesten L, Völker K,
Eils E. The influence of external ankle braces on
subjective and objective parameters of performance in
a sports-related agility course. Knee Surgery, Sports
Traumatology, Arthroscopy. July 2005;13(5):419-425.
8.
Yaggie J, Kinzey S. A Comparative Analysis of Selected
Ankle Orthoses During Functional Tasks. Journal of
Sport Rehabilitation. August 2001;10(3):174-183.
24
9.
Bocchinfuso C, Sitler MR, Kimura IF. Effects of Two
Semirigid Prophylactic Ankle Stabilizers on Speed,
Agility, and Vertical Jump. Journal of Sport
Rehabilitation. 1994;3:125-1 34.
10.
MacKean LC, Bell G, Burnham RS. Prophylactic Ankle
Bracing Vs. Taping: Effects on Functional Performance
in Female Basketball Players. The Journal Of
Orthopaedic And Sports Physical Therapy. August 1995;
22(2):77-81.
11.
Pienkowski
Stayton J.
Antithetic
for Sports
12.
Hodgson B, Tis L, Cobb S, Higbie E. The Effect of
External Ankle Support on Vertical Ground-Reaction
Force and Lower Body Kinematics. Journal of Sport
Rehabilitation. 2005;14:301-312.
13.
Abian-Vicen J, Alegre LM, Fernandez-Rodriguez JM, Lara
AJ, Meana M, Aguado X. Ankle taping does not impair
performance in jump or balance tests. Journal of
Sports Science and Medicine. 2008; 7:350-356.
14.
Reimann BL, Schmitz RJ, Gale M, McCaw ST. Effects of
Ankle Taping on Vertical
Ground Reaction Forces
During Drop Landings Before and After Treadmill
Jogging. Journal of Orthopaedic & Sports Physical
Therapy. December 2002; 32(12):628-635.
15.
DiStefano LJ, Padua DA, Brown CN, Guskiewicz KM. Lower
Extremity Kinematics and Ground Reaction Forces After
Prophylactic Lace-Up Ankle Bracing. Journal of
Athletic Training. 2008;43(3):234-241.
16.
Cordova ML, Armstrong CW, Rankin JM, Yeasting RA.
Ground reaction forces and EMG activity with ankle
bracing during inversion stress. Medicine & Science in
Sports & Exercise. September 1998;30(9):1363-1370.
D, McMorrow M, Shapiro R, Caborn DNM,
The Effects of Ankle Stabilizers on
Performance. American Orthopaedic Society
Medicine. 1995;23(6):757-762.
25
APPENDICES
26
APPENDIX A
Review of Literature
27
REVIEW OF LITERATURE
Athletes have been known to utilize spatting methods
to limit ROM of the ankle in the hopes of increasing
stability and decreasing rate of injury.
Prophylactic
ankle supports such as bracing, taping, and spatting may
have a performance effect on the ankle’s ROM and
functional and athletic performance.
Certain functional
abilities such as speed, agility, vertical jump height,
and vertical ground reaction force are commonly tested
functional abilities on the effects of prophylactic ankle
support.
The following is a review of the literature on
the effects of prophylactic ankle support on ROM of the
ankle, and functional and athletic performance.
This literature review was divided into five major
sections and subsections 1) A review of the functional
anatomy and physiology of the ankle 2) The effects of
prophylactic ankle support on ankle ROM 3) The effects of
prophylactic ankle bracing on functional and athletic
performance, including the following subheadings:
a)
Speed; b) Agility; c) Vertical jump height 4) The effects
of prophylactic ankle bracing on vertical ground reaction
28
force with the following subheadings:
a) Take off; b)
Landing; c) Other factors that contribute to vertical
ground reaction force values.
Functional Anatomy of the Ankle
Anatomically speaking, the ankle is a stable joint.
The most anterior and proximal portion of the ankle is
made up of the distal ends of the tibia and the fibula.
The thickened distal portions of both the tibia and the
fibula are referred to as the medial malleolus, formed by
the distal end of the tibia, and the lateral malleolus,
formed by the distal end of the fibula.
The lateral
malleolus forms greater bony stability than the medial
malleolus as the fibula extends further distally.1
The ankle is a synovial hinge joint. The main
movements of the ankle are dorsiflexion and
planterflexion. Dorsiflexion is produced by the anterior
compartment muscles of the leg.2 The muscles of the
anterior compartment of the lower leg include the
following: tibialis anterior, extensor hallucis longus,
extensor digitorum longus, and fibularis tertius.3
Planterflexion is produced by the posterior compartment
muscles of the lower leg.2 The posterior compartment of
29
the leg includes a deep group and a superficial group.
The deep group that has an influence on the motion of the
foot includes the following muscles: flexor hallucis
longus, flexor digitorum longus, tibialis posterior. The
muscles superior compartment of the leg include the
gastrocnemius, plantaris, and soleus.3 Prophylactic ankle
bracing is often used to limit these two motions, along
with inversion and eversion.
Distal to the tibia and fibula is the talus bone.
The superior portion of the talus (trochlea) articulates
with the medial and lateral malleoli.
As well as serving
as a connection between the lower leg and the foot, the
talus is the main weight bearing bone of the ankle, and
is wider in the anterior portion than the posterior
portion.1
When the foot is in dorsiflexion, it is in its most
stable position.
The widest part of the talus
articulates with the narrow portion between tibia and
fibula, forming a closed compact position.
When the foot
is moved into plantarflexion, the narrower portion of the
talus articulates between the tibia and fibula causing a
more unstable position for the ankle.1
The inferior surface of the talus known as the
posterior calcaneal facet corresponds with the posterior
30
talar facet upon the superior surface of the calcaneus to
form the sub talar joint. The two motions of the subtalar joint are gliding and rotation. The gliding and
rotation allows for inversion and eversion motion of the
foot.3
Most lateral supporting ligaments of the ankle
attach to the malleolus of the fibula.
The anterior and
posterior tibiofibular ligaments connect the distal
portions of the tibia and fibula forming an oblique
pattern. This oblique pattern is designed to diffuse the
forces placed on the leg.1 The anterior talofibular (ATF)
ligament attaches from the anterior aspect of the lateral
malleolus to the lateral aspect of the talar neck. The
ATF ligament is often sprained because it is the first
ligament to undergo stress upon ankle inversion.
The
calcaneofibular (CF) ligament attaches from the lateral
malleolus and stretches downward to attach also to the
medial aspect of the calcaneus.
The CF ligament may also
be torn or sprained, but only after damage has been done
to the ATF.
The posterior talofibular (PTF) ligament
attaches from the posterior aspect of the fibular lateral
malleolus to the posterior aspect of the talus.
The main
function of PTF if to prevent forward slipping of the
31
fibula into the talus, and is only injured in severe
ankle trauma such as in dislocations.4
The lateral compartment of the lower leg contain two
muscles of who’s tendons travel behind the lateral
malleolus on their way to their insertion; fibularis
longus and fibularis brevis. The fibularis longus inserts
to the medial cuneiform and base of the first metarsal on
the medial aspect of the foot and is the prime mover in
foot eversion. The fibularis brevis tendon attaches to
the base of the fifth metarasal and assists in eversion
of the foot.3
The ligaments that support the medial ankle are
collectively known as the deltoid ligament.
The deltoid
ligament attaches from the medial malleolus, to the
medial surface of the talus, and to the sustentaculum
tali of the calcaneus.
Although the medial malleolus is
shorter distally than the lateral malleolus, the
additional ligamentous support helps make up for the lack
of bony structural support in preventing ankle eversion.1
The medial ankle also contains tendons of muscles
that produce ankle inversion, adduction, and supination.
These muscles include the tibialis posterior, flexor
digitorum longus, and flexor hallicus longus which all
pass posterior to the medial malleolus.
Muscles passing
32
anterior to the medial malleolus include tibialis
anterior and flexor hallicus longus.
1
It is important to note also, that the muscles that
cross anterior to the malleoli will collectively produce
dorsiflexion of the ankle and toe extension.
Muscles
that pass posterior to the malleoli collectively produce
plantar flexion and toe flexion.
1
During jumping the ankle is first placed into
dorsiflexion in the loading phase of the jump as the
subject flexes the hips and knees as well as moving into
ankle dorsiflexion in preparation for the jump.
In this
position, the ankle is in its most stable position.1
When the subject begins the jump and the hips and knees
move into extension, the force produced by the posterior
muscle group of the lower leg moves the ankle into
plantar flexion, a more unstable position of the ankle.1
When the subject is in the air during the jump the ankles
remain in plantarflexion, and are forced into
dorsiflexion as the subject begins to absorb the force of
their body weight upon landing.
It is reasonable to assume that the ankle is in its
most vulnerable position just as load is beginning to be
applied to the talus upon landing and continues to move
33
into a more stable position as the subject continues to
absorb the force of their landing.
Prophylactic Ankle Support and ROM
Numerous studies have been conducted to determine
the effects of prophylactic ankle devices on ROM (ROM) of
the ankle.
It is thought that when ROM is limited,
athletic performance may also be limited.5
Many studies
have been conducted to determine the effects of
prophylactic ankle braces in athletic performance.4,7-13
Over the years, it has been a widely accepted practice to
use prophylactic ankle bracing in athletic training to
restrict ROM and in hopes to reduce the risk of injury to
the ankle.5
In a study conducted my Metcalfe et. al.,5 research
was conducted on the restriction of three prophylactic
ankle braces on ROM, as well as their effects on athletic
performance in vertical jump height and agility. The
three braced conditions were tape, tape with moleskin
reinforcement, and Sweed-O ankle brace. The results
confirmed what is commonly practiced in the athletic
training profession, which is the tape with moleskin
significantly restricted ankle ROM in planter flexion,
34
dorsiflexion, ankle inversion, and ankle eversion.5
The
taped condition restricted ROM in all directions except
for planter flexion, while the brace restricted ROM in
all directions but ankle eversion.5
Metcalf et. al.5 also studied how this decrease in
ROM would affect athletic performance. It was found that
all three braced conditions produced significantly lower
vertical jump heights in subjects, and slower times in
the agility test.
It may be argued that the decrease in
ROM and decrease in athletic performance are positively
correlated in this study.
It is reasonable to assume that an ideal condition
is when a prophylactic ankle brace can reduce the rate of
injury by limiting ROM without impeding on athletic
performance.
Studies have also been conducted on the lasting
durability of the limited ROM of different prophylactic
ankle braced conditions. Paris et. al.6 studied the
lasting effects on ROM of three prophylactic ankle braces
(Swede-O, SubTalar Support brace, and non-elastic
athletic tape) before and after a period of exercise.6
Significant ROM reductions were found between the
unsupported control group and all three braced conditions
pre-activity in inversion, eversion, plantarflexion, and
35
dorsiflexion. Pre-activity inversion ROM was limited as
follows:
both Swede-O and SubTalar Support conditions
were limited by 12.3 degrees, and tape was limited by
12.8 degrees. Postactivity results showed a significant
increase in inversion ROM in all three braced conditions
from 0-15 minutes postactivity (Swede-O: 2.3 degrees,
SubTalar Support:
4.2 degrees: tape: 3.8 degrees).
A
further significant increase in postactivity inversion
ROM was seen in SubTalar Support braced condition between
the 15 and 30 minute intervals by 1.6 degrees.6
Significant eversion ROM reductions were also
reported between the control group and all three braced
conditions preactivity (Swede-O by 11.9 degrees, SubTalar
Support by 4.3 degrees, and tape by 11.4 degrees).
A
significant increase in eversion ROM of the taped group
was found after only 15 minutes of activity by 3.8
degrees.
Significant increases in eversion ROM of the
Swede-O braced condition did not appear until after 60
minutes of exercise, and no significant increase in
eversion ROM was seen in the SubTalar ankle supported
condition.6
Paris et. al.6 also found that all three braced
conditions provided significant restrictions in ROM in
plantarflexion preactivity, when compared to the control
36
group (Swede-O by 17.3 degrees, SubTalar Support by 12.2
degrees, and tape by 19.4 degrees).
In regards to
plantarflexion ROM, the SubTalar Support braced condition
and taped ankle condition both showed significant
increases in ROM after 15 minutes of activity (Subtalar
Support by 2.2 degrees and tape by 2.4 degrees).
Additionally, initial significant increase in ROM was
seen in the Swede-O ankle braced condition at 30 minutes
by 2.2 degrees. It is important to note that tape also
showed significant increases in plantarflexion ROM in 15
minute intervals at 30,45, and 60 minutes of activity.6
In regards to dorsiflexion, Paris et. al.6 found
that all three braced conditions provided significant
restriction in ROM preactivity when compared to the
control group (Swede-O by 5.6 degrees, SubTalar Support
by 0.7 degrees.
The researchers found that the taped
ankle condition showed a significant increase in
dorsiflexion ROM after 45 minutes of activity, while
neither Swede-O nor SubTalar braced condition showed any
significant increase in dorsiflexion ROM.6
Few studies have been conducted on the effects of
ankle spatting, despite spatting being a common practice
especially in sports where cleats are worn.7 Pederson et.
al.7 studied the effects of spatting and ankle taping on
37
ankle inversion and rate of inversion before and after
exercise.
The independent variables studied by Pederson
et. al.7 were non-taped control, taped ankle only,
spatted ankle only, and taped and spatted ankle.
The
researchers found that all braced conditions
significantly limited ankle inversion before a 30 minute
exercise bout when compared to the control group (taped:
11.4 degrees, spatted and taped: 17.3 degrees, and
spatted: 12.8 degrees).
After the 30 minute bout of
exercise, the researchers found that inversion ROM
significantly increased in all three braced conditions
(taped: 5.5 degrees, spatted and taped: 2.4 degrees, and
spatted: 2.2 degrees).7
Pederson’s study also found that all three braced
conditions significantly reduced the rate of ankle
inversion before and after exercise with the combination
of spatting and taping being the most effective, then
spatting only, followed by tape only being the least
effective.
Although tape was the least effective of the
three braced conditions, the Pederson study found that
the rate of inversion of all three braced conditions was
significantly less that the non-taped control group.7
38
The Effects of Prophylactic Ankle Support on Athletic
Performance
Speed, agility, and vertical jump tests are often
used to subjectively measure an individual’s athletic and
functional ability.
Therefore, when researchers want to
measure the effects of a variable on functional or
athletic ability, they often utilize some form of speed,
agility, and vertical jump tests individually, or in
combination with each other.
Speed
Speed is an important functional ability in
practically every sport.
Several studies have been
conducted that investigate the effects of various
prophylactic ankle braces on speed.
Many different
functional tests were employed in these studies to
determine the effect of a prophylactic ankle brace on
speed.
These tests included the shuttle run, 80 foot
sprint, 40 yard sprint, 50 yard sprint, a combination of
straight ahead and slalom sprinting, and a predetermined
“sprint drill.”
8-13
Many studies compared multiple types of prophylactic
ankle braces to another, such as tape, soft brace, lace-
39
up brace, air cast, rigid, and semi-rigid braces, and to
a non-braced control group.8-13
Most researchers found no
significant difference in sprint speed between the nonbraced control group when compared to any braced group.712
Furthermore, in studies that examined more than one
braced condition to another, researchers also found that
no significant differences occurred between braced
groups.8-16
Although it may be difficult to compare the results
of these studies to one another, the overall effect that
prophylactic ankle braces have on speed may still be
seen. The majority of studies showed that prophylactic
ankle bracing (regardless of the type) had no significant
effect on speed performance.
For example, research conducted by MacKean et. al.13
studies Prophylactic Ankle Bracing Vs. Taping: Effects on
Functional Performance in Female Basketball Players, and
examined the effects of Aircast Air-Stirrup Ankle
Training Brace (Aircast, Inc.), Swede-O-Universal Ankle
Brace (Swede-0-Universal), Active Ankle Training Brace
(Active Ankle Systems. Inc.), and tape (Dr. Scholl's
double seal 1 VG adhesive) on speed in young female
subjects with a sprint test across a basketball court
with a set of four lines that progressively moved further
40
apart.
MacKean et. al.13 found that there was no
significant difference in speed in any braced condition
when compared to the non-braced control group. Since most
of the studies used different speed tests, and results
varied, it is hard to make a conclusion of the effects of
prophylactic ankle devices on speed.
Agility
Agility is another characteristic commonly used to
assess an athlete’s ability.
The effect of prophylactic
ankle bracing on agility has also been researched. The
same issue arises when comparing studies of agility that
arose when comparing studies of speed, namely many
researchers use different tests to determine an athletes
level of agility.
Tests commonly used are the Southeast
Missouri (SEMO) agility test, four-point agility run,
“cone running” drill, Barrow and McGee’s agility run, and
a “side-cut” drill.5,8,9,12,14
Multiple studies compared more than one type of
prophylactic ankle brace to other prophylactic braces and
to a non-braced control group such as moleskin tape,
linen tape, adhesive tape, soft brace, lace-up brace, air
cast, rigid, and semi-rigid.5,8,9,12,14
Research results
are mixed among studies that examine the effects that
41
prophylactic ankle bracing has on agility.
While some
researchers found no significant differences between
agility times, others did find significant differences in
agility times between the non-braced control and certain
braced conditions.
When a significant difference between
the non-braced control and the braced conditions was
found, the braced condition always produced slower
agility times.5,10
Two studies that found significant negative
differences in agility were conducted by Matcalf et. al.5
and Rosenbaum et. al.10
In Matcalf’s study the results
showed that braced conditions that produced a significant
negative difference in agility times in the SEMO agility
test from the non-braced control, were moleskin
reinforced ankle tape, normal basket weave linen ankle
tape, and Swede-O-Universal Ankle Brace (Swede-0Universal).5
Furthermore, it was found by Rosenbaum et.
al.10 that the rigid ankle support (Caligamed) that was
tested had a significant negative effect on agility times
when compared to the non-braced control.
Metcalf et.
al.5 also found that the semi-rigid and soft ankle braces
had no significant effect on agility.10
Moleskin, linen tape, and the Swede-O-Universal
ankle braces were tested in the same study and therefore
42
the results that they produced can be compared with no
significant differences found between them.
No
comparison can be made however between the moleskin,
linen tape, and Swede-O-Universal to the rigid braced
condition that also negatively affected agility because
different testing procedures were used.
Some results have shown that certain prophylactic
ankle devices have a significant negative effect on
agility.5,10
But again, since most of the studies used
different agility tests, it is hard to make a definite
conclusion of the effects of prophylactic ankle devices
on agility.
Vertical Jump
Jumping is a skill that is required for most sports.
Sports such as football, basketball, softball,
volleyball, baseball, various track events, soccer, even
tennis and swimming require the athlete to jump.
For
this reason it is important to study the effects of
prophylactic ankle support on vertical jump height.
In
the studies reviewed, only two vertical jump height tests
were used; Vertec test, and chalk test.5,8-14 Since only
two tests were used it is easier to make a conclusion on
43
the effects of prophylactic ankle support on vertical
jump height when comparing study to study.
Similar to speed and agility, many studies compared
more than one type of prophylactic ankle brace to other
prophylactic braces and to a non-braced control group
such as moleskin tape, linen tape, adhesive tape, soft
brace, lace-up brace, air cast, rigid, and semi-rigid.5,814
Research results are mixed among studies that examine
the effects that prophylactic ankle bracing has on
vertical jump height.
While some researchers found no
significant differences between the non-braced control
group and the braced group in vertical jump heights.
Others did find significant differences in vertical jump
heights between the non-braced control and certain braced
conditions.
In a study conducted by Metcalf et. al.5 on the
effects of moleskin tape, linen tape, and Swede-0
Universal brace on athletic performance, all three braced
conditions had a significant negative effect on vertical
jump height, similar to agility.5
It was also found by
MacKean et. al.13 that a taped ankle had significantly
lower values in vertical jump height than the other
braced conditions which included: Aircast Air-Stirrup
Ankle Training Brace (Aircast, Inc.); Swede-0-Universal
44
Ankle Brace (Swede-0-Universal); Active Ankle Training
Brace (Active Ankle Systems Inc.).
Another braced
condition that had a significant negative effect on
vertical jump height was a rigid (Caligamed) ankle
support found by Rosenbaum et al.13
The research shows that prophylactic ankle braces
that produced no difference in vertical jump height were
mainly soft, semi-rigid, or lace up ankle braces.
study conducted by Rosenbaum et. al.11
In the
Five semi-rigid
and 4 soft braces showed no significant difference in
vertical jump height, while the 1 rigid brace studied did
have a significant negative difference as previously
stated, while taped conditions also produced significant
negative effects on vertical jump height.5,10,13
The Effects of Prophylactic Ankle Support on Vertical
Ground Reaction Force
Take Off
Abián-Vicén et. al.15 studied the effects of ankle
taping on peak vertical ground reaction forces and peak
power values during the take off phase of a jump test
utilizing a force platform.
They reported that ankle
45
taping does not impair performance in the push-off phase
of the vertical jump test.15
Landing
In the same study that Abián-Vicén et. al.15 studied
the effects of taping on take-off, the researchers also
investigated the effects that taping had on the landing
phase of a jump.
They found that there was a significant
increase in the second peak force value by 12% upon
landing in the taped group when compared to the non-taped
control group.15 This increase in peak vertical ground
reaction force agrees with similar studies conducted on
the effects of prophylactic ankle braces on vertical
ground reaction force.15-17
An increase in force may imply that the subjects
absorb less of the force of their own body weight upon
landing.
This may also lead to an increased risk of
injury in the landing phase of a jump in taped athletes.15
Conversely, the literature suggests that most
prophylactic ankle braces restrict ROM, at least for a
certain period of time.
With this decrease in ROM, it is
also suggested that the prophylactic ankle brace would
decrease risk of injury to an athlete.5
46
DiStefano et. al.18 conducted a study that examined
knee flexion, ROM (dorsiflexion), and peak values in the
landing phase of a jump.
The researchers found that
ankle dorsiflexion in the sagittal plane were
significantly limited when compared to the non-braced
condition.
Although ROM was significantly different, no
significant difference was found in peak values upon
landing, or in time to reach maximum dorsiflexion of the
ankle.
Researchers suggest that this is due to the
increase in knee flexion angle upon initial contact of
the landing phase.18 Research conducted by Cordova et.
al.19 studied the peak vertical ground reaction forces of
braced and non-braced ankles during dynamic inversion
stress, while also looking at EMG activity of muscles of
the lower leg.
The independent variables of this study
were the braced condition of the ankle (no brace-control,
Aircast Sport-Stirrup, Active Ankle).
No significant
differences in peak values in any braced conditions were
found when compared to the control. However it was found
that, during peak impact force, EMG activity of the
peroneus longus was reduced in the Aircast and Active
Ankle braces when compared to the control, but no
difference was found between braces.19 This evidence also
47
supports the idea the restricting the ROM of the ankle
can have an effect along the kinetic chain.
Other factors that contribute to vertical ground reaction
force values
Many other studies have been conducted in order to
determine the effects of a variable on vertical ground
reaction force.
The following variables have been found
to have significant effects on vertical ground reaction
force values: heal-toe landings when compared to forefooted landings; surface in which the force platform is
fixed; absorption properties of the surface in which the
subjects land; tibial axial acceleration; development of
life stages; augmented feedback given to subjects.
This
is important information to know when studying the
effects of a variable on vertical ground reaction force
in order that the researcher can know what other
variables have been found to have a significant effect on
vertical ground reaction force values, as to not
replicate such variables unless intended to.20-25
48
Summary
Most research agrees that ROM is significantly
limited by most prophylactic ankle braces, at least
during pre-activity.5-7 What researchers may still not
agree upon is the effectiveness of reducing the rate of
injury among the braced population.
While research shows
that most prophylactic ankle bracing significantly limits
ROM, it is hard to research the correlation between
limited ROM and rate of ankle injury, although it is
commonly assumed that limited inversion ROM also
decreases rate of inversion ankle injuries.5
The effect that prophylactic ankle bracing has on
athletic performance is also unclear.
Although much
research has been conducted on speed, agility, and
vertical jump height, in a variety of braced conditions
studies have been inconclusive.5,8-14
Furthermore,
limitations apply to the study of prophylactic ankle
braces on athletic performance when reviewing the
literature such as the variety of different tests used to
assess speed, agility, and vertical jump height.
With
all of these factors at play, most literature seems to
suggest that prophylactic ankle devices had no effect on
49
an athlete’s speed.8-13 While some studies showed a
significant difference in an athlete’s agility, others
did not.5,8-10,12,14
Research also shows that the braced
conditions that had the most effect on vertical jump
height were taped conditions and rigid braced
conditions.5,13
Some researchers have suggested that a decrease in
ROM provided by a prophylactic ankle brace may cause an
increase in vertical ground reaction force and therefore
increase the rate of injury19, while others suggest that a
decrease in ROM may also decrease the rate of injury.5
Other researchers have found that prophylactic ankle
bracing does not impair vertical ground reaction force
values, but may have an effect on the kinetic chain up
the leg.18
By understanding how the lower extremity reacts to
prophylactic ankle bracing on peak vertical ground
reaction forces, we may be able to predict how the body
may react to spatting when landing from a jump.
With the
information on the effects of spatting on peak vertical
ground reaction force, athletic trainer may be able to
determine if spatting is a safe and practical form of
prophylactic ankle bracing.
50
APPENDIX B
The Problem
51
The Problem
Spatting is a form of prophylactic ankle bracing
that is commonly used among athletes of all levels of
competition. Many studies have been conducted examining
the effects of popular prophylactic ankle bracing, such
as braced and taped conditions on athletic performance,
however very little research has been conducted on the
effects of spatting on athletic performance. The purpose
of this study was to examine the effects of spatting on
peak vertical ground reaction force values.
Definition of Terms
The following Terms were operationally identified
for this study:
1)
Vertical ground reaction force- The force that is
produced by the ground upon the body upon landing.
2)
Peak Vertical Ground Reaction Force- The point in
time at which the ground reaction force is maximally
applied.
3)
Prophylactic ankle device- a device applied to the
ankle to potentially prevent injury and improve
support and stability.
52
4)
Spatting- A type of prophylactic ankle device that
consists of taping over the athletes shoe and distal
aspect of the lower leg.
5)
Kinetic chain- the sequence of anatomical structures
within the body
Basic Assumptions
The following are basic assumptions of this study:
1)
The subjects used in this study was honest when
reporting the absence of ankle or lower leg injury
or neurological or balance disorders in the past
year.
2)
All subjects will participate voluntarily and
without coercion.
3)
All subjects will give their best effort in each
performance test.
4)
All braces used was fitted sufficiently in
accordance to each subject.
5)
All ankle taping was sufficient and done with the
same technique.
6)
The AMTI force platform and Netforce software was a
valid and reliable tool to measure vertical ground
reaction peak force values.
53
Limitations of the Study
The following are possible limitations to the study:
1)
ROM limitations of the tape and spat may not
simulate real training and game situations because
of the limit of activity required by each subject
and braced condition.
2)
Testing was conducted in a laboratory in a
controlled setting; therefore results may not apply
to a real training or game time setting.
3)
A sample of convenience was used for this study.
4)
External validity may be of concern because the
study was limited to Division II football and soccer
athletes of California University of Pennsylvania.
5)
Only one method of taping and one method of spatting
was used in this study.
6)
The study will not include any prophylactic
conditions that tested the effects of any ankle
brace devices.
Significance of the Study
Many prophylactic ankle devices have been
constructed over the years to reduce the ROM of the ankle
joint in hopes to reduce the rate of ankle injury, even
when landing from a jump. When landing, the primary goal
54
of a prophylactic ankle device is to restrict inversion
and eversion of the ankle in order to keep the ankle in a
neutral position.4 However, most prophylactic ankle
devices also restrict dorsiflexion and plantarflexion ROM
as well.4
The force reproduced by the ground (vertical ground
reaction force) is absorbed through the kinetic chain,
starting distally and dissipating proximally throughout
the joints of the lower extremity.17 Studies have shown an
increase in peak values of vertical ground reaction
forces when prophylactic ankle devices were used,
14-16
while others have shown an increase in knee flexion upon
landing while wearing a prophylactic ankle device.
17
This
evidence suggests that when the ROM of the ankle is
limited in the sagittal plane by a prophylactic device,
it will have an effect on force absorption upon landing
from a jump, which may lead to an increased risk of
injury to the lower extremity.17
While spatting is a common prophylactic ankle device
used in athletics today, specifically in football, no
study has been found examining the effects of spatting on
athletic performance on vertical ground reaction forces.
By investigating the effects that spatting has on
vertical ground reaction forces upon landing, athletic
55
trainers are better able to determine if spatting is a
safe and beneficial form of ankle stabilization, in
absorbing force, when landing from a jump.
56
APPENDIX C
Demographic Information
57
Demographic Information
-Subject Number: ______________
-Age: __________________________
-Height: __________________________
-Current Sport: __________________________
-Position: ________________________
-Years of Participation at this level: ________
-Have you incurred any injury to your knee, lower leg,
ankle, or foot within the past year that has prevented
you from playing:
Yes: If Yes, what was the injury ______________
No
-Do you have any experience with any type of ankle
bracing or taping:
Yes
No
-If the answer to the previous question was “Yes,” circle
all that apply
Braced
Taped only
Spatted only
Taped and Spatted together
58
APPENDIX D
Informed Consent Form
59
Informed Consent Form
1. Benjamin Galley, ATC, who is a Graduate Athletic
Training Student at California University of
Pennsylvania, has requested my participation in a
research study at California University of Pennsylvania.
The title of the research is The Effects of Spatting on
Vertical Ground Reaction Force Peak Values During
Landing.
2. I have been informed that the purpose of this
study is to The Purpose of this study is to examine
whether spatting has an effect on vertical ground
reaction force peak values during landing. I understand
that I must be 18 years of age or older to participate.
I understand that I have been asked to participate along
with subjects who have not suffered any lower leg
(including knee), ankle, or foot injury within the past
year and/or have not been diagnosed with neurological or
balance disorders prior to the test that have caused the
athlete to cease participation from their sport.
3. I have been invited to participate in this
research project. My participation is voluntary and I
can choose to discontinue my participation at any time
without penalty or loss of benefits. My participation
will involve randomly choosing the order in which I was
braced. I will perform three jumps on the AMTI OR 6-7
force platform in three braced ankle conditions (taped
only, spatted only, taped and spatted) with sufficient
rest between each tested condition as to limit fatigue. I
was instructed as to how to jump. The testing procedure
will take approximately one hour.
4. I understand there are foreseeable risks or
discomforts to me if I agree to participate in the study.
With participation in a research program such as this
there is always the potential for unforeseeable risks as
well. The possible risks and/or discomforts include
possibly falling during the landing phase of the jump. To
minimize this risk, the researcher will place a wooden
adaptor around the force plate to increase the landing
surface area.
60
5. I understand that, in case of injury, I can
expect to receive treatment or care in Hamer Hall’s
Athletic Training Facility. This treatment was provided
by the researcher, Benjamin Galley, under the supervision
of the CalU athletic training faculty, all of which can
administer emergency care. Additional services needed for
prolonged care was referred to the attending staff at the
Downey Garofola Health Services located on campus.
6. There are no feasible alternative procedures
available for this study.
7. I understand that the possible benefits of my
participation in the research is to help determine the
risk effects that spatting may have on an athlete’s
performance and body upon landing from a jump in the
aforementioned ankle braced conditions. This study can
help athletic trainers determine if spatting is a safe,
effective, or efficient form of ankle bracing.
8. I understand that the results of the research
study may be published but my name or identity will not
be revealed. Only aggregate data was reported. In order
to maintain confidentially of my records, Benjamin Galley
will maintain all documents in a secure location on
campus and password protect all electronic files so that
only the student researcher and research advisor can
access the data. Each subject was given a specific
subject number to represent his or her name so as to
protect the anonymity of each subject.
9. I have been informed that I will not be
compensated for my participation.
10. I have been informed that any questions I have
concerning the research study or my participation in it,
before or after my consent, was answered by:
Benjamin A. Galley, ATC
STUDENT/PRIMARY RESEARCHER
GAL4846@calu.edu
724-972-3124
Dr. Shelly DiCesaro, PhD, ATC
RESEARCH ADVISOR
dicesaro@calu.edu
61
724-938-4342
11. I understand that written responses may be used
in quotations for publication but my identity will remain
anonymous.
12. I have read the above information and am
electing to participate in this study. The nature,
demands, risks, and benefits of the project have been
explained to me. I knowingly assume the risks involved,
and understand that I may withdraw my consent and
discontinue participation at any time without penalty or
loss of benefit to myself. In signing this consent form,
I am not waiving any legal claims, rights, or remedies. A
copy of this consent form was given to me upon request.
13. This study has been approved by the California
University of Pennsylvania Institutional Review Board.
from:
14. The IRB approval dates for this project are
03/25/10 to 03/25/11.
Subject's signature:___________________________________
Date:____________________
Witness signature:___________________________________
Date:____________________
62
APPENDIX E
Institutional Review Board Approval
63
Proposal Number
Date Received
PROTOCOL for Research
Involving Human Subjects
Institutional Review Board (IRB) approval is required before
beginning any research and/or data collection involving human
subjects
Project Title The Effects of Spatting on Vertical Ground Reaction Force Peak Values
During Landing
Researcher/Project Director
Benjamin A. Galley
Phone # 724-972-3124
E-mail Address GAL4846@calu.edu
Faculty Sponsor (if required) Dr. Shelly DiCesaro
Department
Health Science
Project Dates
to December 1, 2010
Sponsoring Agent (if applicable) Project to be Conducted at California University of Pennsylvania
Project Purpose:
Thesis
Research
Class Project
Other
(Reference IRB Policies and Procedures for clarification)
64
Please attach a typed, detailed summary of your project AND complete items 2 through
6.
1.
Provide an overview of your project-proposal describing what you plan to do and
how you will go about doing it. Include any hypothesis(ses)or research questions that might
be involved and explain how the information you gather will be analyzed. For a complete list
of what should be included in your summary, please refer to Appendix B of the IRB Policies
and Procedures Manual.
The purpose of this study will be to examine whether spatting has an effect on vertical ground
reaction force peak values during landing. Healthy National Collegiate Athletic Association
(NCAA) Division II male football and soccer players will be asked to participate in this study
(N~20). Only athletes from the football and men's soccer teams will be asked to participate
because spatting is only utilized in sports where cleats are worn. Males will only be asked to
participate to limit the variable of gender. Subjects who have suffered any lower leg
(including knee), ankle, or foot injury within the past year, or who have been diagnosed with
neurological or balance disorders prior to the test, and/or currently suffering from any of the
aforementioned injuries, that have caused the athlete to cease participation from their sport,
will be excluded from participating in the study. Each subject who signed the informed
consent (attached) will have their vertical ground reaction force peak values measured upon
landing from a jump in three prophylactic ankle braced conditions and a control condition.
Subjects will act as their own control in this quasi-experimental within-subjects research
design. The prophylactic braced conditions include a taped only condition, spatted only
condition, and a taped and spatted condition, where the control condition will be natural (nonbraced). Each subject will report only one day for testing in all braced conditions. The testing
procedure will last no longer than three hours per subject.
The subjects will randomly choose the order in which they will be braced. Each subject will
perform three vertical jumps on the AMTI OR 6-7 force platform in each braced condition,
with ten minutes of rest between each tested condition as to limit fatigue. Each subject will be
instructed to place their hands on their hips and jump as high as possible, landing on the force
platform with both feet. A wooden platform will be placed around the force plate to extend
the landing area to limit the possibility of injury.
The research question seeking to be answered is, "Will spatting have an effect on vertical
ground reaction force peak values." The hypothesis is stated as the following: "There will be
a difference in vertical ground reaction force peak values in the three braced conditions when
compared to the control condition, where the tapped and spatted condition will have the most
significant difference."
The vertical ground reaction force peak values will be compared to each condition including
the controlled condition using a multivariate analysis of variance (MANOVA) with a
significance value set at .05
(P ≤ 0.05). The data will be analyzed by the latest version of SPSS software.
2.
Section 46.11 of the Federal Regulations state that research proposals involving
human subjects must satisfy certain requirements before the IRB can grant approval. You
should describe in detail how the following requirements will be satisfied. Be sure to address
each area separately.
65
a. How will you insure that any risks to subjects are minimized? If there are potential risks,
describe what will be done to minimize these risks. If there are risks, describe why the risks
to participants are reasonable in relation to the anticipated benefits.
There is a small possibility that when the subjects land from their jump, they may miss the
platform with both feet. A wooden platform the same height will be placed on the ground to
completely surround the force platform in increase the landing area. The wooden adaptor will
increase the landing surface in order to minimize the risk for potential injury. Another
potential risk that may be present is the potential risk for general muscle soreness.
b. How will you insure that the selection of subjects is equitable? Take into account your
purpose(s). Be sure you address research problems involving vulnerable populations such as
children, prisoners, pregnant women, mentally disabled persons, and economically or
educationally disadvantaged persons. If this is an in-class project describe how you will
minimize the possibility that students will feel coerced.
All subjects will be volunteers who are eighteen years of age or older, male, NCAA division
II collegiate football or soccer athletes from California University of Pennsylvania. Prior to
the research, each potential subject will be review and sign an informed consent form, absent
of their coaches, the will describe the concept of the study. Any athlete who currently suffers
from, or has suffered from a lower leg (including knee), ankle, or foot injury within the past
year, or who have been diagnosed with neurological or balance disorders prior to the test,
and/or currently suffering from any of the aforementioned injuries, that have caused the
athlete to cease participation from their sport, will be excluded from participating in the study
as these conditions may interfere with the subjects ability to absorb force. This exclusion due
to these medical conditions will be performed by the supervising Certified Athletic Trainer in
order to maintain patient confidentiality.
Only athletes from the football and men's soccer teams will be asked to participate because
spatting is only utilized in sports where cleats are worn. Males will only be asked to
participate to limit the variable of gender.
c. How will you obtain informed consent from each participant or the subject’s legally
authorized representative and ensure that all consent forms are appropriately documented?
Be sure to attach a copy of your consent form to the project summary.
An informed consent form (attached) will be reviewed, completed, and signed by all subjects
prior to participating in the study on the day of testing. Each signed form will be kept by the
researcher in a locked filing cabinet located in the program directors office in Hammer Hall
on the campus of California University of Pennsylvania. Only the program director,
researcher, and research advisor will have access to the data.
d. Show that the research plan makes provisions to monitor the data collected to insure the
safety of all subjects. This includes the privacy of subjects’ responses and provisions for
maintaining the security and confidentiality of the data.
All data will be recorded during the spring semester. All subjects will report to the testing site
once for testing and the secession will take no longer than 3 hours. All electronic files will be
password protected and only be accessible by the researcher and research advisor. All hard
copy files will be stored in a locked filing cabinet on campus in the program directors office
in Hammer Hall that will only be able to be accessed by the program director, researcher, and
66
research advisor. Also, all collected data will be identified by subject number, not name, to
ensure patient data confidentiality.
3.
Check the appropriate box(es) that describe the subjects you plan to use.
Adult volunteers
CAL University Students
Other Students
Prisoners
Mentally Disabled People
Economically Disadvantaged
People
Educationally Disadvantaged
People
Pregnant Women
Fetuses or fetal material
Physically Handicapped
People
Children Under 18
Neonates
4.
Is remuneration involved in your project?
5.
Is this project part of a grant?
information:
Yes or
Yes or
No
No. If yes, Explain here.
If yes, provide the following
Title of the Grant Proposal
Name of the Funding Agency
Dates of the Project Period
6.
Does your project involve the debriefing of those who participated?
Yes or
If Yes, explain the debriefing process here.
7.
If your project involves a questionnaire interview, ensure that it meets the
requirements of Appendix
in the Policies and Procedures Manual.
No
67
California University of Pennsylvania Institutional Review Board
Survey/Interview/Questionnaire Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview or questionnaire?
YES—Complete this form
NO—You MUST complete the “Informed Consent Checklist”—skip the
remainder of this form
Does your survey/interview/questionnaire cover letter or explanatory statement
include:
(1) Statement about the general nature of the survey and how the data will be
used?
(2) Statement as to who the primary researcher is, including name, phone, and
email address?
(3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information
provided?
(4) Statement that participation is voluntary?
(5) Statement that participation may be discontinued at any time without penalty
and all data discarded?
(6) Statement that the results are confidential?
(7) Statement that results are anonymous?
(8) Statement as to level of risk anticipated or that minimal risk is anticipated?
(NOTE: If more than minimal risk is anticipated, a full consent form is required—and
the Informed Consent Checklist must be completed)
(9) Statement that returning the survey is an indication of consent to use the data?
(10) Who to contact regarding the project and how to contact this person?
(11) Statement as to where the results will be housed and how maintained? (unless
otherwise approved by the IRB, must be a secure location on University premises)
(12) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)?
68
(13) FOR ELECTRONIC/WEBSITE SURVEYS: Does the text of the cover letter
or
explanatory statement appear before any data is requested from the participant?
(14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue
participation at any point in the process and all data is immediately discarded?
California University of Pennsylvania Institutional Review Board
Informed Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview, or questionnaire?
YES—DO NOT complete this form. You MUST complete the
“Survey/Interview/Questionnaire Consent Checklist” instead.
NO—Complete the remainder of this form.
1.
Introduction (check each)
(1.1) Is there a statement that the study involves research?
(1.2) Is there an explanation of the purpose of the research?
2. Is the participant. (check each)
(2.1) Given an invitation to participate?
(2.2) Told why he/she was selected.
(2.3) Told the expected duration of the participation.
(2.4) Informed that participation is voluntary?
(2.5) Informed that all records are confidential?
(2.6) Told that he/she may withdraw from the research at any time without
penalty or loss of benefits?
(2.7) 18 years of age or older? (if not, see Section #9, Special Considerations
below)
3. Procedures (check each).
(3.1) Are the procedures identified and explained?
(3.2) Are the procedures that are being investigated clearly identified?
(3.3) Are treatment conditions identified?
4. Risks and discomforts. (check each)
(4.1) Are foreseeable risks or discomforts identified?
(4.2) Is the likelihood of any risks or discomforts identified?
(4.3) Is there a description of the steps that will be taken to minimize any risks or
discomforts?
(4.4) Is there an acknowledgement of potentially unforeseeable risks?
(4.5) Is the participant informed about what treatment or follow up courses of
action are available should there be some physical, emotional, or psychological harm?
69
(4.6) Is there a description of the benefits, if any, to the participant or to others
that may be reasonably expected from the research and an estimate of the likelihood
of these benefits?
(4.7) Is there a disclosure of any appropriate alternative procedures or courses of
treatment that might be advantageous to the participant?
5. Records and documentation. (check each)
(5.1) Is there a statement describing how records will be kept confidential?
(5.2) Is there a statement as to where the records will be kept and that this is a
secure location?
(5.3) Is there a statement as to who will have access to the records?
6. For research involving more than minimal risk (check each),
(6.1) Is there an explanation and description of any compensation and other
medical or counseling treatments that are available if the participants are injured
through participation?
(6.2) Is there a statement where further information can be obtained regarding the
treatments?
(6.3) Is there information regarding who to contact in the event of researchrelated injury?
7. Contacts.(check each)
(7.1) Is the participant given a list of contacts for answers to questions about the
research and the participant’s rights?
(7.2) Is the principal researcher identified with name and phone number and
email address?
(7.3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact
information provided?
8. General Considerations (check each)
(8.1) Is there a statement indicating that the participant is making a decision
whether or not to participate, and that his/her signature indicates that he/she has
decided to participate having read and discussed the information in the informed
consent?
(8.2) Are all technical terms fully explained to the participant?
(8.3) Is the informed consent written at a level that the participant can understand?
(8.4) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)
9. Specific Considerations (check as appropriate)
70
(9.1) If the participant is or may become pregnant is there a statement that the
particular treatment or procedure may involve risks, foreseeable or currently
unforeseeable, to the participant or to the embryo or fetus?
(9.2) Is there a statement specifying the circumstances in which the participation
may be terminated by the investigator without the participant’s consent?
(9.3) Are any costs to the participant clearly spelled out?
(9.4) If the participant desires to withdraw from the research, are procedures for
orderly termination spelled out?
(9.5) Is there a statement that the Principal Investigator will inform the participant
or any significant new findings developed during the research that may affect them
and influence their willingness to continue participation?
(9.6) Is the participant is less than 18 years of age? If so, a parent or guardian must
sign the consent form and assent must be obtained from the child
Is the consent form written in such a manner that it is clear that the parent/guardian
is giving permission for their child to participate?
Is a child assent form being used?
Does the assent form (if used) clearly indicate that the child can freely refuse to
participate or discontinue participation at any time without penalty or coercion?
(9.7) Are all consent and assent forms written at a level that the intended
participant can understand? (generally, 8th grade level for adults, age-appropriate for
children)
71
California University of Pennsylvania Institutional Review Board
Review Request Checklist (v021209)
This form MUST accompany all IRB review requests.
Unless otherwise specified, ALL items must be present in your review request.
Have you:
(1.0) FOR ALL STUDIES: Completed ALL items on the Review Request Form?
Pay particular attention to:
(1.1) Names and email addresses of all investigators
(1.1.1) FOR ALL STUDENTS: use only your CalU email address)
(1.1.2) FOR ALL STUDENTS: Name and email address of your faculty research
advisor
(1.2) Project dates (must be in the future—no studies will be approved which have
already begun or scheduled to begin before final IRB approval—NO EXCEPTIONS)
(1.3) Answered completely and in detail, the questions in items 2a through 2d?
2a: NOTE: No studies can have zero risk, the lowest risk is “minimal risk”. If more
than minimal risk is involved you MUST:
i. Delineate all anticipated risks in detail;
ii. Explain in detail how these risks will be minimized;
iii. Detail the procedures for dealing with adverse outcomes due to these risks.
iv. Cite peer reviewed references in support of your explanation.
2b. Complete all items.
2c. Describe informed consent procedures in detail.
2d. NOTE: to maintain security and confidentiality of data, all study records must
be housed in a secure (locked) location ON UNIVERSITY PREMISES. The actual
location (department, office, etc.) must be specified in your explanation and be listed
on any consent forms or cover letters.
(1.4) Checked all appropriate boxes in Section 3? If participants under the age of
18 years are to be included (regardless of what the study involves) you MUST:
(1.4.1) Obtain informed consent from the parent or guardian—consent forms must
be written so that it is clear that the parent/guardian is giving permission for their
child to participate.
(1.4.2) Document how you will obtain assent from the child—This must be done
in an age-appropriate manner. Regardless of whether the parent/guardian has given
permission, a child is completely free to refuse to participate, so the investigator must
document how the child indicated agreement to participate (“assent”).
(1.5) Included all grant information in section 5?
(1.6) Included ALL signatures?
(2.0) FOR STUDIES INVOLVING MORE THAN JUST SURVEYS,
INTERVIEWS, OR QUESTIONNAIRES:
(2.1) Attached a copy of all consent form(s)?
(2.2) FOR STUDIES INVOLVING INDIVIDUALS LESS THAN 18 YEARS OF
AGE: attached a copy of all assent forms (if such a form is used)?
72
(2.3) Completed and attached a copy of the Consent Form Checklist? (as
appropriate—see that checklist for instructions)
(3.0) FOR STUDIES INVOLVING ONLY SURVEYS, INTERVIEWS, OR
QUESTIONNAIRES:
(3.1) Attached a copy of the cover letter/information sheet?
(3.2) Completed and attached a copy of the Survey/Interview/Questionnaire
Consent Checklist? (see that checklist for instructions)
(3.3) Attached a copy of the actual survey, interview, or questionnaire questions in
their final form?
(4.0) FOR ALL STUDENTS: Has your faculty research advisor:
(4.1) Thoroughly reviewed and approved your study?
(4.2) Thoroughly reviewed and approved your IRB paperwork? including:
(4.2.1) Review request form,
(4.2.2) All consent forms, (if used)
(4.2.3) All assent forms (if used)
(4.2.4) All Survey/Interview/Questionnaire cover letters (if used)
(4.2.5) All checklists
(4.3) IMPORTANT NOTE: Your advisor’s signature on the review request form
indicates that they have thoroughly reviewed your proposal and verified that it meets
all IRB and University requirements.
(5.0) Have you retained a copy of all submitted documentation for your records?
73
Project Director’s Certification
Program Involving HUMAN SUBJECTS
The proposed investigation involves the use of human subjects and I am submitting the
complete application form and project description to the Institutional Review Board for
Research Involving Human Subjects.
I understand that Institutional Review Board (IRB) approval is
required before beginning any research and/or data collection
involving human subjects.
If the Board grants approval of
this application, I agree to:
1.
Abide by any conditions or
changes in the project required by the Board.
2.
Report to the Board any
change in the research plan that affects the method of using human subjects before such
change is instituted.
3.
Report to the Board any
problems that arise in connection with the use of human subjects.
4.
Seek advice of the Board
whenever I believe such advice is necessary or would be helpful.
5.
Secure the informed, written
consent of all human subjects participating in the project.
6.
Cooperate with the Board in
its effort to provide a continuing review after investigations have been initiated.
I have reviewed the Federal and State regulations concerning the use of human subjects in
research and training programs and the guidelines. I agree to abide by the regulations and
guidelines aforementioned and will adhere to policies and procedures described in my
application. I understand that changes to the research must be approved by the IRB before
they are implemented.
Professional Research
Project Director’s Signature
Department Chairperson’s
Signature
74
Student or Class Research
Student Researcher’s Signature
Supervising Faculty Member’s
Signature if required
Department Chairperson’s
Signature
ACTION OF REVIEW BOARD (IRB use only)
The Institutional Review Board for Research Involving Human Subjects has reviewed this application
to ascertain whether or not the proposed project:
1.
provides adequate safeguards of the
rights and welfare of human subjects involved in the investigations;
2.
uses appropriate methods to obtain
informed, written consent;
3.
indicates that the potential benefits of
the investigation substantially outweigh the risk involved.
4.
provides adequate debriefing of human
participants.
5.
provides adequate follow-up services to
participants who may have incurred physical, mental, or emotional harm.
Approved[_________________________________]
Disapproved
___________________________________________
_________________________
Chairperson, Institutional Review Board
Date
75
Institutional Review Board
California University of Pennsylvania
Psychology Department LRC, Room 310
250 University Avenue
California, PA 15419
instreviewboard@cup.edu
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair
Benjamin Galley,
Please consider this email as official notification that your
proposal titled “ The Effects of Spatting on Vertical Ground
reaction Force Peak Values During Landing” (Proposal #09-073)
has been approved by the California University of Pennsylvania
Institutional Review Board as amended, with the following
stipulation:
The “laymen’s terms” definition of spatting
submitted to the board must be added to the consent form.
Once you have made this revision, you may immediately begin
data collection. You do not need to wait for further IRB
approval. [At your earliest convenience, you must forward a
copy of the revised consent form for the Board’s records].
The effective date of the approval is 3-25-2010 and the
expiration date is 3-25-2011. These dates must appear on the
consent form .
Please note that Federal Policy requires that you notify the
IRB promptly regarding any of the following:
(1) Any additions or changes in procedures you might wish for
your study (additions or changes must be approved by the IRB
before they are implemented)
(2) Any events that affect the safety or well-being of
subjects
(3) Any modifications of your study or other responses that
are necessitated by any events reported in (2).
(4) To continue your research beyond the approval expiration
date of 3-25-2011 you must file additional information to be
considered for continuing review. Please contact
instreviewboard@cup.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board
76
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78
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79
ABSTRACT
Title:
THE EFFECTS OF SPATTING ON VERTICAL GROUND
REACTION FORCE PEAK VALUES DURING LANDING
Researcher:
Benjamin A. Galley, ATC, PES
Advisor:
Dr. Shelly DiCesaro, ATC
Date:
May 2010
Research Type: Master’s Thesis
Purpose:
The purpose of this study was to determine
the effects of prophylactic ankle taping,
spatting, and taping and spatting on peak
vertical ground reaction force (PVGRF)
values during landing.
Problem:
Spatting is a common form of prophylactic
ankle bracing, however very little
research has been conducted on its effect
on athletic performance.
Methods:
Fifteen California University NCAA
Division II football and male soccer
players participated in this study (10
football; 5 male soccer). Subjects
preformed three vertical jumps on a force
plate in each prophylactic ankle braced
condition. The braced conditions included
control, taped only, spatted only, and
taped and spatted conditions. The highest
PVGRF value of each condition was
recorded. The results were analyzed using
a repeated measures analysis of variance
test using a significance level of ≤ .05.
Findings:
No significant difference was found
between any prophylactic ankle brace
condition compared to the control
condition (F3,42= 0.628, p>.05.)
Conclusion:
Based on the results it may be concluded
that spatting has no effect on PVGRF
values upon landing from a vertical jump.
80
This study suggests that ankle spatting
has no more significant difference in
PVGRF than taping, taping and spatting, or
a controlled condition, and therefore may
not contribute to an increased chance of
ankle injury, especially when landing from
a jump.
Word Count:
214