journal of sport rehabilitation - researchgate · journal of sport rehabilitation ... key words:...

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/304251847

Elastic Bandaging for Orthopedic and Sports Injuries Prevention and

Rehabilitation: A Systematic Review

Article in Journal of sport rehabilitation · May 2016

DOI: 10.1123/jsr.2015-0126

CITATIONS

0

READS

136

6 authors, including:

Some of the authors of this publication are also working on these related projects:

On "Capture the Fracture" Prevention Fragility Fractures View project

Electrophysiology & Brain Imaging View project

Konstantinos Fousekis

Technological Educational Institute of Western Greece

24 PUBLICATIONS 265 CITATIONS

SEE PROFILE

Evdokia Billis



SEE PROFILE

Charalampos Matzaroglou

Technological Educational Institute of Western Greece, Patras, Greece


SEE PROFILE

Constantinos Koutsojannis



SEE PROFILE

All content following this page was uploaded by Elias Tsepis on 05 July 2016.

The user has requested enhancement of the downloaded file.

https://www.researchgate.net/publication/304251847_Elastic_Bandaging_for_Orthopedic_and_Sports_Injuries_Prevention_and_Rehabilitation_A_Systematic_Review?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_2&_esc=publicationCoverPdf

https://www.researchgate.net/publication/304251847_Elastic_Bandaging_for_Orthopedic_and_Sports_Injuries_Prevention_and_Rehabilitation_A_Systematic_Review?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_3&_esc=publicationCoverPdf

https://www.researchgate.net/project/On-Capture-the-Fracture-Prevention-Fragility-Fractures?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_9&_esc=publicationCoverPdf

https://www.researchgate.net/project/Electrophysiology-Brain-Imaging?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_9&_esc=publicationCoverPdf

https://www.researchgate.net/?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_1&_esc=publicationCoverPdf

https://www.researchgate.net/profile/Konstantinos_Fousekis?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_4&_esc=publicationCoverPdf


https://www.researchgate.net/institution/Technological_Educational_Institute_of_Western_Greece?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_6&_esc=publicationCoverPdf


https://www.researchgate.net/profile/Evdokia_Billis?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_4&_esc=publicationCoverPdf




https://www.researchgate.net/profile/Charalampos_Matzaroglou?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_4&_esc=publicationCoverPdf



https://www.researchgate.net/profile/Constantinos_Koutsojannis?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_4&_esc=publicationCoverPdf




https://www.researchgate.net/profile/Elias_Tsepis?enrichId=rgreq-f9f54f3d373cc0ad15bedb7174fb32e3-XXX&enrichSource=Y292ZXJQYWdlOzMwNDI1MTg0NztBUzozODA0MzgzNTU5NTU3MTJAMTQ2NzcxNDk4MDQ0Ng%3D%3D&el=1_x_10&_esc=publicationCoverPdf

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al.

Journal of Sport Rehabilitation

© 2016 Human Kinetics, Inc.

Note: This article will be published in a forthcoming issue of

the Journal of Sport Rehabilitation. The article appears here in

its accepted, peer-reviewed form, as it was provided by the

submitting author. It has not been copyedited, proofed, or

formatted by the publisher.

Section: Systematic Review

Article Title: Elastic Bandaging for Orthopedic and Sports Injuries Prevention and

Rehabilitation: A Systematic Review

Authors: Konstantinos Fousekis1, Evdokia Billis1, Charalampos Matzaroglou1, Konstantinos

Mylonas2, Constantinos Koutsojannis, and Elias Tsepis1

Affiliations: 1Department of Physiotherapy, Technological Educational Institute (TEI) of

Western Greece, Egio, Greece. 2Clinical and Sports Physiotherapist, Egio, Greece.

Running Head: Elastic bandaging in sports and orthopedics

Journal: Journal of Sport Rehabilitation

Acceptance Date: May 24,2 016

©2016 Human Kinetics, Inc.

DOI: http://dx.doi.org/10.1123/jsr.2015-0126

http://dx.doi.org/10.1123/jsr.2015-0126




Elastic bandaging for orthopedic and sports injuries prevention and rehabilitation: a

systematic review.

Running title: Elastic bandaging usage in orthopedics

Konstantinos Fousekis PhD,1 Evdokia Billis PhD,1 Charalampos Matzaroglou MD,

PhD,3 Konstantinos Mylonas PT,2 Constantinos Koutsojannis, Elias Tsepis, PhD.4

1. Assistant Professor in Physiotherapy, Department of Physiotherapy, Technological

Educational Institute (TEI) of Western Greece. Egio 25100, Greece.

2. Clinical and Sports Physiotherapist, Egio 25100, Greece

3. Assistant Professor in Orthopedics and Traumatology, Department of

Physiotherapy, Technological Educational Institute (TEI) of Western Greece. Egio 25100,

Greece.

4. Associate Professor of Physiotherapy, Department of Physiotherapy, Technological

Educational Institute (TEI) of Western Greece. Egio 25100, Greece.

Author contributions: All authors contributed almost equally to this work; Konstantinos

Fousekis, Charalambos Matzaroglou, Evdokia Billis and Elias Tsepis designed the

research; Konstantinos Fousekis, Konstantinos Mylonas and Charalambos Matzaroglou

performed the research; Konstantinos Fousekis and Konstantinos Mylonas analyzed the

data and all authors together wrote the paper.

Correspondence to: Konstantinos Fousekis, PT, PhD, Assistant Professor in

Physiotherapy, Department of Physiotherapy, Technological Educational Institute (TEI)

of Western Greece , Egio, Psaron 6, PC:25100, Greece, e-mail: [email protected]

Telephone: +003 02691022058, Fax: +oo3 026910-61250




Abstract

Context: Elastic bandages are commonly used in sports to treat and prevent sports injuries.

Objective: To conduct a systematic review assessing the effectiveness of elastic bandaging in

orthopedic and sports injuries prevention and rehabilitation. Evidence Acquisition: We

searched the following electronic databases: MEDLINE, CINAHL, SPORTDiscus, EMBASE and

Physiotherapy Evidence Database (PEDro), with key words ‘elastic bandaging’ in combination,

respectively, with (1) first aid, (2) sports injuries, (3) orthopedic injuries and (4) sports injuries

prevention and rehabilitation. Research studies were selected based upon the use of the term

‘elastic bandaging’ in the abstract. Final selection was made by applying inclusion and exclusion

criteria to the full text. Studies were included if they were English, peer-reviewed clinical trials

on the effects of elastic bandaging for orthopedic injuries prevention and rehabilitation.

Evidence Synthesis: Twelve studies met the above criteria and were included in the final

analysis. Data collected included number of participants, condition being treated, treatment

used, control group, outcome measures and results. Studies were critically analyzed using the

PEDro scale. Conclusions: The studies in this review fell into two (2) categories: studies in

athletes (N=2) and non-athletes (N=10). All included trials had moderate-to-high quality, scoring

(≥5 on the PEDro scale). The PEDro scores for the studies in athletes and non-athletes ranged

from 5 to 6 out of 10 and from 5 to 8 out of 10, respectively. The quality of studies was mixed,

ranging from higher to moderate methodological quality clinical trials. Overall, elastic

bandaging can assist proprioceptive function of knee and ankle joint. Because of the moderate

methodological quality and insufficient number of clinical trials, further effects of the elastic

bandaging could not be confirmed.

Key words: Elastic bandaging, injury prevention and rehabilitation, orthopaedics, sports

physiotherapy




Context

The term sports taping is used to describe various techniques for supporting an

anatomic region of an athlete with the usage of a fabric tape which either wrapped around an

anatomical structure (e.g. joint) or is affixed on it (e.g. skin-muscle). The need for supporting an

anatomical region is based on creating conditions for orthopedic injuries prevention and

protection as well as for adequate control of an acute injury in terms of edema formation

reduction and joint immobilization. 1-5

The epidermal material used for sports taping is divided into three (3) types and

respective techniques: a) the ‘elastic non-adhesive bandaging’ (ENAB) using elastic bandages

(bandage), b) ‘taping’ using non-elastic adhesive bandage (tape), and c) ‘kinesiotaping’ using

elastic adhesive tape (kinesiotape-elastic adhesive tape). 6 All three (3) types of sports taping

are applied a) in joints with functional deficits due to previous injuries, and b) in myodermal

structures for better proprioceptive activation and neuromuscular control or better metabolic

function. In both cases, sports taping can increase the athlete’s sense of safety as it enhances

joints stability and reduces occurrence of injuries.6-8

Although taping and kinesiotaping are the predominant therapeutic techniques used in

orthopedic and sports rehabilitation, 9-12 ENAB is used a) for compression of an anatomic

region,13 b) for decreasing or accelerating the time needed to achieve maximal joint range of

motion (ROM),13 c) to support other rehabilitative equipments such as cold-packs,14 and d) for

partial or total joint immobilisation.15 ENAB is also extensively used in treating sports injuries in

the acute stage and particularly during the first 48 hours of an injury. Bandaging of the injured

area may limit damage only to the tissue already affected and prevent possible hypoxic damage




of surrounding tissues. Furthermore, compression produced by the elastic bandage increases

tissue pressure thereby reducing excessive oedema and hematoma formation. For this purpose

ENAB can also be used in combination with other therapeutic interventions such as

cryotherapy.16 Applications of ENAB are also common in post-operative rehabilitation because

of their contribution in intra-articular bleeding elimination and analgesia.17,18 Additionally,

compression of the extremities via elastic bandaging also increases venous return in patients

with abnormal flow. 19,20

Despite the clear supremacy of other taping techniques (taping-kinesiotaping) in terms

of improving joint neuromuscular control and stability, 9-12 ENAB is used by many athletes both

amateur and professional ones for injury prevention.13,21,22 On that basis, it has been reported

that ENAB can improve position sense of a) of the knee in non-athletes 23 and in healthy dance

athletes, 24 and b) the elbow in non-injured males. 25 Nevertheless, although a body of research

exists regarding the potential efficacy of ENAB for either prevention or treatment of sports

injuries, there has not yet been a systematic review of this literature, exploring ENAB's true

clinical efficacy.

Objective

The purpose of this systematic review was to critically analyze previously published

literature to determine the documented effectiveness of ENAB both as a preventative means

and as a treatment strategy for orthopedic and sports injuries.




Evidence Acquisition

Published studies relating to ENAB were identified using a computerized literature

search in PubMed, Sportdiscus, EMBASE, CINAHL and Physiotherapy Evidence Database

(PEDro). Three (3) reviewers (KF, KM,CM) performed independent searches in February 2015.

Keyword used in the search was “elastic bandaging” in combination with respectively “first-

aids”, “sports injuries”, “orthopedic injuries” and “sports injuries prevention and

rehabilitation”. Reference lists of identified studies were also evaluated for relevant literature.

The lists were compared, and articles identified by the three reviewers were collected in full

text. The initial search using multiple combinations of these key words resulted in 96 studies.

The three (3) reviewers (KF, KM and CM) screened the full-text articles for inclusion in

the review based on a set of inclusion and exclusion criteria. Inclusion criteria were as follows:

studies (1) published in a peer-reviewed journals, (2) containing sufficient data to critically

appraise the study according to PEDro criteria, (3) including, the use of ENAB as a treatment

method (4) being published in English, (5) addressing treatment for an orthopedic condition, (6)

involving adults. Pilots and case studies were not included in the analysis. A total of 12 research

articles 18,24-34 met the inclusion criteria and were reviewed (Figure 1).

The three reviewers assessed all selected studies for methodological quality according

to standardized PEDro scale (Table 1). The PEDro scale is an evaluation checklist developed for

the Physiotherapy Evidence Database by the Centre for Evidence-Based Physiotherapy. 35 This

scale examines quality based on 11 criteria, 10 of which are scored. Points were summed and

presented as a score out of 10. For this review, investigations with PEDro scores of 6 and over

out of 10 were considered of high quality, 4 to 5 of moderate quality, and 0 to 3 were

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718355/table/i1062-6050-48-4-522-t01/




considered of low quality. The PEDro scale examines mainly the internal validity and

interpretability of the studies and not their clinical utility. All reviewers were unaware of each

other’s results until all studies were independently assessed. Agreement upon the final score

was achieved through discussion amongst the 3 reviewers.

Levels of Evidence and Strength of Recommendation

The level of evidence for the included studies and strength of recommendation for the

use of ENAB in sports injuries prevention and rehabilitation was determined using the criteria

suggested by the Oxford Center for Evidence Based Medicine. 36

Evidence Synthesis

A total of 12 research articles were reviewed. 18,24-34 Summary of included studies is

presented in Table 2. The studies in this review included both, athletes 26,34 and non-athletes.

18,24,25,27-34 All included trials were of moderate-to-high quality, scoring an average PEDro score

of 5.6 on the PEDro scale (Table 3). The PEDro scores for the studies in athletes and non-

athletes ranged from 5 to 6 out of 10 and from 5 to 8 of out of 10, respectively.

RCT: Randomised Control Studies, CT:Clinical Trials, ENAB: Elastic non-adhesive

bandaging, IPC: Intermittent pneumatic compression, OA: Osteoarthritis, VAS: Visual analogue

scale, ACL: Anterior cruciate ligament, ROM: Range of motion

Effects of ENAB in functional outcome after musculoskeletal-sports injury

Four of the selected papers studied the effects of ENAB on functional outcomes in

patients after sports injuries. 18,26-28 Gunay et al 26 evaluated the effect of using Aircast®

orthosis and ENAB application on the physical performance of 60 elite male football players




with ankle injuries. Battery of tests used included examination of ankle ROM, one maximum

repetition test for the ankle dorsal and plantar flexors, fingertip rise test, jump tests and 10-

step/sec test. Their results showed that ENAB restricted non-weight bearing ankle dorsi/plantar

flexion ROM by 9.85±3.74 degrees (p<0.05) and inversion-eversion ROM by 10.70±4.14 degrees

(p<0.05) compared to no bandaging. The use of ENAB did not hinder performance in any of the

four aforementioned functional tests.

Similar results with those of Gunay et al 26 were found in Boyce et al’s study 18 in an

attempt to determine the functional outcome of the ankle of non-athletes after a moderate or

severe inversion injury. They compared the effects of a standard treatment with Aircast ankle

brace against ENAB application in a randomized control study (RCT) of high methodological

quality (7/10 PEDro). Their findings showed that the use of an Aircast ankle brace improved

ankle joint functional capacity at 10 days (Karlsson score : mean 50 v 35, p = 0.028, 95%

confidence interval 1.7 to 27.7) and at one month (Karlsson score mean 68 v 55, p = 0.029, 95%

confidence interval 1.4 to 24.8) compared to standard management procedure with ENAB.

Furthermore, it should be reported that there was no difference between the effects of the two

techniques in ankle joint swelling (mean ankle girth: elastic bandage 14.4 cm, Aircast ankle

brace 8.5 cm; p = 0.09) and pain (mean pain scores-VAS: elastic bandage 2.9, Aircast ankle

brace 1.8; p = 0.07). Nevertheless, due to the absence of a control group, it is not possible to

draw definite conclusions about whether the ENAB group fared better than no bandage at all.

Leanderson & Wredmark 28 also evaluated the effects of treatment with ENAB or an Air-

Stirrup® ankle brace in patients with severe ankle sprains. Their results showed that patients

treated with the Air-Stirrup® ankle brace were more mobile (Active range of motion in




dorsiflexion/plantarflexion in 10 weeks after injury: Air-Stirrup® ankle brace: 95% of the

uninjured ankle; ENAB: 87% of the uninjured ankle) in the initial phase of rehabilitation and

had shorter sick leave.

Airaksinen et al 27 showed that the decrease in edema in ankle sprains with ENAB

application was significantly exponential with time during the four-week follow-up (from 105mL

to22mL in the fourth week after ENAB application, r = 0.997, p < 0.001). However intermittent

pneumatic compression treatment applied together with ENAB accelerated ankle sprain

rehabilitation procedure (ankle edema, ROM, pain, limb dysfunction) compared to the

application of ENAB or IPC alone.

The findings of the above studies [18, 26-28] do not clearly determine the role of ENAB

against no bandage application on functional outcomes after musculoskeletal-sports injury.

Evidence to date suggests that rehabilitation with the use of ENAB may be inferior to braces in

achieving more effective edema reduction and an earlier return to optimal functional status

after ankle joint injuries.

Effect of ENAB in joint proprioception

Seven (7) research trials assessed the effects of ENAB in joint proprioception in

orthopaedic pathologies and in healthy individuals. 24,25,29,30-33 Three (3) of them investigated

the effect of ENAB in proprioception of patients with knee osteoarthritis. 29,30,33 Hassan et al 29

evaluated whether knee ENAB in subjects with knee osteoarthritis (OA) would decrease pain

and improve knee joint neuromuscular control. Their high quality (7/10 PEDro) study showed

that ENAB significantly reduced knee pain (pre-bandage application: median VAS 4.36, IQR 3.84

–4.90; after 20 minutes of bandage application: median VAS 3.80, IQR 3.3–4.3, p<0.001),




improved static postural sway (pre-bandage: median sway 4.50, IQ range 3.5–6.4; bandage

applied: median sway 4.45, IQ range 3.4–6.3, p=0.027), in subjects with OA. These findings are

supported from the results of Barrett, et al (1991), who indicated that ENAB improves position

sense of accuracy in OA knees by 40%. 30 In contrast to previous findings, Hewitt et al 33

reported that ENAB did not significantly affect movement detection in 10 women aged > 65

years with moderate to severe knee OA. In particular, in this study, the 70% detection level for

the OA group with ENAB application was 2.9±1.0o and without the bandage was 2.9±0.8o. In the

control group, movement detection levels after ENAB application was 2.1±0.6o and 2.4±0.6o

without a bandage.

The proprioceptive function of the knee after external stabilization with ENAB has also

been evaluated in patients with patellar pain syndrome 31 and anterior cruciate ligament

deficiency.32 Both studies although graded as having moderate quality (5/10 PEDro) they

reported that ENAB improved injured knee joint angle reproduction capability. 31,32

Similar positive findings to the influence of ENAB in knee proprioception are found in

the ankle’s neuromuscular function. 24,25 Khabie et al 25 in a RCT of high methodological quality

(6/10 PEDro) reported a significant improvement in elbow position sense (2.2° ± 1.2°, P <.004)

after elbow ENAB application in twenty healthy volunteers, thus, implying a proprioceptive

facilitative role of ENAB. Based on this finding authors concluded that tactile cues from

cutaneous or other extraarticular receptors may play a role in elbow proprioception.

Furthermore, Wong et al 24 reported that knee ENAB decreased significantly the absolute error

(mean absolute errors of blindfolded set angle reproduction: ENAB=4.38, No ENAB=9.37,




p<0.001) produced in joint angle reproduction test during passive knee motion compared to no

ENAB application in 26 non injured dance students.

Effects of ENAB in joint range of motion (ROM)

Yamamoto et al 34 in a study with a small number of participants (N=4) evaluated the

effectiveness of the ankle ENAB and taping on tallar tilt (TT) range of motion (ROM) in judo

athletes. Their results showed that talar tilt angles were decreased (1-9°) after ENAB, but after

90 min of judo training, the talar tilt ROM were again the same as those without support ankle.

As expected taping was more effective in decreasing talar tilt ROM than ankle ENAB in judo

athletes and this restrictive effect remained after 90 min of competitive judo training.

As mentioned before, Gunay et al 26 also reported that ENAB can decrease ankle ROM

in terms of eversion/inversion and dorsal/plantar flexion. Nevertheless it was also determined

that Aircast® orthosis created a statistically significant restriction in joint range of motion,

compared to the ENAB in terms of eversion and inversion.

Levels of Evidence and Strength of Recommendation

The quality of included clinical trials and randomized control studies was generally low

and their levels of evidence is limited to level 2-b and 3-b evidence. As a result of the

aforementioned methodological quality issues and poor strength of studies the strength of

recommendation for the use of ENAB for prevention and rehabilitation of injuries is of grade B,

thus indicating uncertainty for its use.




Discussion

This is the first study to systematically review moderate and high quality research

studies, in exploring the evidence for ENAB application for preventing or rehabilitating sports

injuries . The present review revealed initially that although the technique is widely used by

Medical Doctors, Sports Physiotherapists and athletes and various health professionals and

they have been written several books on ENAB application techniques, 5,37 relevant research is

extremely small. We reviewed six (6) randomized controlled trials 18, 25,27,28,31,32 and six (6)

clinical trials 24,26, 29, 30,33,34 which studied the effects of ENAB alone or compared with other

therapeutical techniques of joint mechanical support. The quality of these trials was moderate

with an average PEDro validity score of only 5.8. However, most studies had acceptable scores.

Surprisingly, there is no research on a) the effect of ENAB in acute stage of injuries and

b) the necessity of its usage as first aid technique for the reduction of edema and hematoma

formation. However, two studies have highlighted that, despite this lack of scientific evidence,

ENAB is currently used as first line treatment in more than 70% of British emergency

departments. 38,39 The usage of ENAB in Emergency departments and sports fields for

management of acute injuries is probably based on the theory that compression via ENAB

contributes to reduced edema accumulation and increased venous return. 40,41

Τhe scientific studies evaluated in this review do not give clear answers on the impact

of ENAB on either injury prevention or rehabilitation. More specifically, there are no studies

evaluating the effects of ENAB on injury prevention based on prospective trials and

examination of related parameters over time. Nevertheless, their findings regarding joint

proprioceptive adaptations and ROM after ENAB application can be of critical importance given




that kinaesthetic disorders (especially deficits in joint position sense and sense of efforts

following musculoskeletal injury) can alter normal kinetic patterns and thus lead to re-injuries.

For example, the deficient proprioceptive function (sense of position) of the ankle joint has

been connected with incorrect biomechanical kinetic patterns at foot landing (excessive foot

supination) and theoretically increased risk of ankle re-injury.42-44 Τhus, efforts for improvement

of the lower extremities neuromuscular control through specialized proprioceptive exercises

and probably external mechanical support (such as ENAB) can be of great importance in injury

prevention. In this direction, the current review found a small amount of evidence supporting

the idea that ENAB improves knee and ankle proprioception in in patients with OA, meniscal

problems and healthy individuals. 24,25,29,30-32 These positive effects after ENAB application in

joints neuromuscular and kinaesthetic function can be attributed on irritation of kinaesthetic

receptors and subsequent improvement of joint position. Moreover, although it is non-evident,

it seems reasonable to suggest that ENAB by skin compression (and hence a better activation of

sensory receptors of the skin and underlying tissues) 45,46 can activate faster muscular response.

For example, ankle ENAB probably reduces the reaction time of peroneal muscles thus

inhibiting dangerous loading of the ankle generated by violent supination.

Although supported indirectly from only two studies in this review, it seems that ENAB

has a minimal protective function in terms of reduction of injury risk through improvement of

joint stability. More specifically, ENAB can lead to a significant reduction in both passive and

active ROM. 26,34 This ROM reduction which is immediately observed after ENAB application

progressively decreases with exercise.34 The protective effects of joint ENAB application, though

have not been directly reported in relevant studies, can also be attributed to possible reduction




of medium and maximum speed within which joint ROM is achieved. This biomechanical

adaptation hypothetically can increase the period of time before dangerous loading of the joint

and can thus, provide sufficient time for joint protective mechanisms (proprioceptive

information and muscular response) to act for elimination or reduction of the injury risk. Such

protective biomechanical adaptations have been clearly reported in ankle and shoulder taping

studies,8,47-48 and, in theory, can be attributed to a lesser extent to ENAB.

The above results regarding neuromuscular adaptations after ENAB application though

derived from studies of moderate methodological quality seem logical. It is reasonable to

expect a ROM reduction and better stabilization of a joint after ENAB application (mechanical

compression and neuromuscular enhancement provided from the elastic material). Superiority

of non-elastic adhesive tape (taping) and of Aircast® orthosis compared to ENAB in joint ROM

control was also expected due to their specific characteristics (rigid-anelastic). Several other

studies have shown that anelastic taping of a joint or the application of an Aircast® orthosis will

lead to a significant reduction in both passive and active range of ankle motion. 8, 50,51

Literature regarding enhancement of sports injuries rehabilitation processes through

ENAB has been limited to the comparison between ENAB and semi-rigid ankle supports. 18, 26-28

Evidence to date suggests that rehabilitation with the use of ENAB may be useful in

terms of edema reduction and controlled ROM in non-weight bearing. Furthermore the use of

ENAB did not affect functional performance compared to rigid braces. Existing evidence reports

that ENAB is less effective than semi-rigid ankle supports in terms of a) time to return to work

or sports and b) subjective instability on short-term. 18, 26-28 This conclusion is supported by

several other studies 52,53 reporting that although no adverse results are connected with ENAB




applications, the use of ankle braces is superior to an elastic support or ENAB. Patients treated

with ENAB took longer to return to work 28,53 and reported increased subjective instability. 52

However, despite known limitations accompanying the use of ankle braces (reduced functional

capacity and reduced compatibility with sports shoes) there are no comparisons between ENAB

and other taping techniques (taping-kinesiotaping) concerning their effectiveness for injury

management.

The findings of this review are unable to fully support the use of ENAB against other

taping techniques for musculoskeletal injury prevention and rehabilitation. In particular, there

are no randomized controlled studies with satisfactory methodological quality to compare the

effects from the application of all three taping techniques on critical parameters, such as joint

mechanical support and improvement of stability (which is the dominant aim of a sports taping

application) as well as enhancement of athlete’s functional capacity.

It seems that clinical sports physiotherapists should probably limit the use of ENAB to

the acute stage of injuries and in reducing edema-hematoma procedures. In this case the

external mechanical compression must be based upon an elastic taping material to avoid the

risk of excessive arterial compression. The main objectives of the subacute phase of a

rehabilitation program for orthopaedic and sports injuries such as reduction or avoidance of

dangerous final parts of injured joint ROM in conjunction with neuromuscular control

enhancement seems better served by anelastic taping techniques and specific types of joint

orthosis. Nevertheless, even minimal positive effect of ENAB and the ease of implementation in

relation to the other sports taping techniques indicate the necessity of applying it in cases

where the anelastic taping cannot be applied.




The main limitations of this review relate to the scarcity of studies and the lack of

sufficient methodological quality scientific surveys. Specifically, although ENAB is a common

therapeutic procedure, research about its effects a) is minimal and b) is related

to several methodological issues, such as small number of participants and vague description of

critical data (p-values etc). Furthermore there are no studies testing the effects of ENAB versus

no ENAB application on injury rates or return to sport. As presenting studies evaluated only

proprioception and/or functional outcomes, definite conclusions regarding injury risk, re-injury

risk or return to sport are only inferential and not directly supported by the evidence presented

cannot be made. Additionally, reported reductions in active ROM were performed in non-

weight-bearing conditions and it is not clear whether these reductions could reflect weight

bearing situations or provide any meaningful protection in an athletic environment. The most

impressive of all was that there were only two studies which evaluated

the effect of ENAB in athletes. It is therefore evident the lack of data to extract definitive

conclusions about the value of ENAB clinical application. Furthermore, statistical comparisons

of data was not possible as the studies evaluated in this review examined completely

different variables and parameters regarding use of ENAB. Therefore, the survey

data evaluated in this review could not critically appraised by categories, i.e. by outcome

measures, body region, injury type, prevention, or treatment outcomes and examined

independently. On this basis, this review was based clearly on the qualitative

evaluation of the studies through PEDRo scale rather than on the comparative quantitative

evaluation of the studies’ results.




Future research should focus on the effects of ENAB on injury prevention by conducting

prospective injury prevention trials. Other scientific topics that need to be addressed include a)

quantification of ENAB true influence on swelling control and on active, passive and weight-

bearing joint ROM and b) consideration on whether ENAB is appropriate for all kinds of athletes

or whether kinesiological and sport-specific considerations require different interventions.

Research also should clarify which type of taping (ENAB, taping, kinesiotaping) is most effective

in terms of improving functional outcome after an injury (ROM, strength, neuromuscular

control and return to play times).

Conclusions

Consequently, it is difficult to draw definitive conclusions concerning the effects of ENAB

for prevention and rehabilitation of orthopedic and sports injuries. While there is moderate

evidence suggesting improved ankle proprioception in terms of enhancing kinesthesia and

neuromuscular control in subjects wearing elastic bandage there is insufficient evidence for the

effects of ΕΝ-ΑΒ application on other critical parameters such as joint ROM and stability and

functional outcome after injury.

Randomized controlled studies focusing on different aspects of ENAB application are

necessary to determine the effect of its application and establish its 'working context' in an

effort to create ideal conditions for prevention and rehabilitation of musculoskeletal and sports

injuries.




References

1. Olmsted LC, Vela LI, Denegar CR, Hertel J. Prophylactic Ankle Taping and Bracing: A Numbers-Needed-to-Treat and Cost-Benefit Analysis. J Athl Train. 2004; 39(1):95-100.

2. McGuine TA, Greene JJ, Best T, Leverson G. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sport Med. 2000; 10(4):239-44.

3. McKay G, Goldie P, Payne W, and Oakes B. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001; 35(2): 103–108.

4. Callaghan M. Role of ankle taping and bracing in the athlete. Br J Sports Med. 1997; 31:102-108.

5. Perrin, DH. Athletic taping and bracing. Human Kinetics, 2005:50-100.

6. Alt W, Lohrer H, Gollhofer A. Functional properties of adhesive ankle taping: neuromuscular and mechanical effects before and after exercise. Foot Ankle Int. 1999, 20:238-245.

7. Robbins S, Waked E, & Rappel R. Ankle taping improves proprioception before and after exercise in young men. Br J Sports Med. 1995; 29(4): 242-247.

8. Firer P. Effectiveness of taping for the prevention of ankle ligament sprains. Br J Sports Med. 1990; 24(1): 47-50.

9. Aminaka N & Gribble PA. A systematic review of the effects of therapeutic taping on patellofemoral pain syndrome. Journal of Athletic training. 2005; 40(4): 341-7.

10. Warden SJ, Hinman R S, Watson MA, Avin KG, Bialocerkowski AE, Crossley KM. Patellar taping and bracing for the treatment of chronic knee pain: A systematic review and meta‐analysis. Arthritis Care & Research. 2008; 59(1): 73-83.

11. Mostafavifar M, Wertz J, Borchers J. A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. The Physician and sportsmedicine. 2012; 40(4): 33-40.

12. Williams S, Whatman C, Hume PA, Sheerin K. Kinesio taping in treatment and prevention of sports injuries. Sports Medicine. 2012; 42(2): 153-164.

13. Pape H. Sports management. In Tidy's Physiotherapy15: Tidy's Physiotherapy, 2013: 369-377.

14. Whitelaw GP, DeMuth KA, Demos HA, Schepsis A, Jacques E. The use of the Cryo/Cuff versus ice and elastic wrap in the postoperative care of knee arthroscopy patients. Am J Sports Med 1994; 8(1), 28-30.

15. Gray SD. Sports strapping and bandaging. Australian family physician. 1991; 20(3): 273-276.

http://www.ncbi.nlm.nih.gov/pubmed/?term=McKay%20G%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Goldie%20P%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Payne%20W%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Oakes%20B%5Bauth%5D




16. Boyce SH, Quigley MA, Campbell S. Management of ankle sprains: a randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace. Βr J Sports Med. 2005;39:91-96.

17. Andersen LØ, Husted H, Otte KS, Kristensen BB, Kehlet, H. A compression bandage improves local infiltration analgesia in total knee arthroplasty. Acta orthopaedic. 2008, 79(6): 806-811.

18. Charalambides C, Beer M, Melhuish J, Williams RJ, Cobb AG. Bandaging technique after knee replacement. Acta Orthopaedica. 2005, 76(1): 89-94.

19. Hampton S. Venous leg ulcers: Short stretch bandage compression therapy. Br J Nursing. 1997; 6(17): 990-998.

20. Jones NAG, Webb PJ, Rees RI, Kakkar VV. A physiological study of elastic compression stockings in venous disorders of the legs. Br J Surg. 1980;67:569–573.

21. Kofotolis ND, Kellis E, Vlachopoulos SP. Ankle sprain injuries and risk factors in amateur soccer players during a 2-year period. Am J Sports Med 2007; 35(3):458-466.

22. Gersho R, Peer K. Program and Facility Emergencies in Youth Sports, Part II: 15. Dealing with the Event. The Sport Journal. 2008, 11(3):13-47.

23. Perlau R, Frank C, Fick G. The effect of elastic bandages on human knee proprioception in the uninjured population. Am J Sports Med. 1995;23:251-5.

24. Wong MWN,Το WWK,Lam IYL. Effect of elastic bandages and ankle weights on knee proprioception inuninjured female dancers: a prospective study. Hong Kong Journal of Orthopaedic Surgery. 2001;5(1):52-57.

25. Khabie V, Schwartz MC, Rokito AS, Gallagher MA, Cuomo F, Zuckerman JD. The effect of intraarticular anesthesia and elastic bandage on elbow proprioception. Journal of Shoulder and Elbow Surgery. 1998; 7(5): 501-504.

26. Gunay S, Karaduman A, Ozturk BB. Effects of Aircast brace and elastic bandage on physical performance of athletes after ankle injuries. Acta orthopaedica et traumatologica turcica. 2014; 48(1):10-16.

27. Airaksinen O, Kolari P J, Miettinen H. Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains. Arch Phys Med Rehabil. 1990; 71(6): 380-3.

28. Leanderson J, Wredmark T. Treatment of acute ankle sprain: comparison of a semi-rigid ankle brace and compression bandage in 73 patients. Acta Orthopaedica. 1995; 66(6): 529-531.

http://bjsportmed.com/search?author1=S+H+Boyce&sortspec=date&submit=Submit

http://bjsportmed.com/search?author1=M+A+Quigley&sortspec=date&submit=Submit

http://bjsportmed.com/search?author1=S+Campbell&sortspec=date&submit=Submit




29. Hassan BS, Mockett S, Doherty M. Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis. Annals of the rheumatic diseases. 2002; 61(1), 24-28.

30. Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. Journal of Bone & Joint Surgery. 1991; 73(1):53-56.

31. Jerosch J, Schmidt K, Prymka M. Proprioceptive abilities of patients with a patellar pain syndrome with special reference to the effect of an elastic knee bandage. Der Unfallchirurg. 1997; 100(9):719-723.

32. Jerosch J, Prymka M. Knee joint proprioception in normal volunteers and patients with anterior cruciate ligament tears, taking special account of the effect of a knee bandage. Archives of orthopaedic and trauma surgery. 1996; 115 (3-4): 162-166.

33. Hewitt BA, Refshauge KM, Kilbreath SL. Kinesthesia at the knee: the effect of osteoarthritis and bandage application. Arthritis Care & Research 2002; 47(5): 479-483.

34. Maher CG, Sherrington C, Herbert R, Moseley A, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical Therapy. 2003; 83 (8): 713-721.

35. OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence". Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653

36. Abell BA. Taping and wrapping made simple. Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010.

37. Cooke MW, Lamb SE, Marsh J, Dale J. A survey of current consultant practice of treatment of severe ankle sprains in emergency departments in the United Kingdom. Emerg Med J. 2003;20:505–7.

38. Bridgman SA, Clement D, Downing A, Walley G, Phair I, Maffulli, N. Population based epidemiology of ankle sprains attending accident & emergency units in theWest Midlands of England, and a survey of UK practice for severe ankle sprains. Emerg Med J. 2003;20:508–10.

39. Hampton S. Venous leg ulcers: Short stretch bandage compression therapy. Br J Nursing. 1997, 6(17), 990-998.

40. Jones NAG, Webb PJ, Rees RI, Kakkar VV. A physiological study of elastic compression stockings in venous disorders of the legs . Br J Surg 1980;67:569–573.

41. Robbins S, Waked E, Rappel R. Ankle taping improves proprioception before and after exercise in young men. Br J Sports Med. 1995; 29:242-247.

42. Wright IC, Neptune RR, Van Den Bogert AJ, Nigg BM. The influence of foot positioning on ankle sprains. Journal of biomechanics. 2000; 33(5): 513-519.




43. Tropp H, Eckstrand J, Gillquist J. Stabilometry in functional instability of the ankle and its value in predicting injury. Med Sci Sports Exe.r 1984; 16: 64-6.

44. Wilkerson G. B. Biomechanical and neuromuscular effects of ankle taping and bracing. Journal of Athletic trainin., 2002; 37(4), 436.

465. Hopper D.M, McNair P & Elliott B. C. Landing in netball: effects of taping and bracing the ankle. Br J Sports Med.1999;33(6),409-413.

46. Ricard M, Sherwood S, Schulthies S, Knight K. Effects of tape and exercise on dynamic ankle inversion. J Athl Train. 2000; 35:31-37.

47. McConnell J, Donnelly C, Hamner S, Dunne J, Besier T. Passive and dynamic shoulder rotation range in uninjured and previously injured overhead throwing athletes and the effect of shoulder taping. PM&R. 2012; 4(2): 111-116.

48. Spanos S, Brunswic M, Billis E. The effect of taping on the proprioception of the ankle in a non-weightbearing position, amongst injured athletes. The Foot. 2008; 18: 25-33.

49. Gross M, Batten A, Lamm A, Lorren J, Stevens J, Davis J, Wilkerson G. Comparison of Donjoy ankle ligament protector and Subtalar Sling ankle taping in restricting foot and ankle motion before and after exercise. J Orthop Sports Phys Ther. 1994; 19:33-41 39.Larsen E. Taping the ankle for chronic instability. Acta Orthop Scand. 1984; 55:551-553.

50. Lohrer H, Alt W, Gollhofer A. Neuromuscular properties and functional aspects of taped ankles. Am J Sports Med. 1999; 27:69-75.

51. Kerkhoffs GM, Struijs PA, Marti RK, et al. Different functional treatment strategies for acute lateral ankle ligament injuries in adults (Cochrane Review). Cochrane Library. Issue 2. Oxford: Update Software, 2003.

52. Dettori JR, Pearson BD, Basmania CJ, Lednar, WM. Early ankle mobilization, Part I: The immediate effect on acute, lateral ankle sprains (a randomised clinical trial). Mil Med. 1994;159:15–20.




Figure 1. Consort diagram showing flow of studies through the review




Table 1. Physiotherapy Evidence-Based Database Scale [35]

PEDro Criteria

1. Participants were randomly allocated to groups (in a crossover study, participants were

randomly allocated to the order in which the interventions were received).

2. Allocation was concealed.

3. The groups were similar at baseline with regard to the most important prognostic indicators.

4. There was blinding of all participants (as per wording of original guidelines).

5. There was blinding of all therapists who administered the intervention.

6. There was blinding of all assessors who measured at least one key outcome.

7. The follow-up of all participants entered into the trial was adequate.

8. All participants for whom outcome measures were available received the intervention or

control condition as allocated or, when this was not the case, data for at least one key

outcome were analyzed on the basis of ’’intention to treat.‘‘

9. The results of between-group statistical comparisons were reported for at least one key

outcome.

10. The study provided both point measures and measures of variability for at least one key

outcome.




Table 2. Overview and summary of included studies

Reference Objectives Subjects Design Primary outcome

measure Results

Effects of elastic bandaging in functional outcome after ankle sprains

Boyce et al 18 To determine the effect of

ENAB and bracing in

functional outcome of the

ankle joint after a moderate

or severe inversion injury,

50 patients

(non

athletes)

RCT Modified Karlsson

scoring method

(maximum score 90).

Swelling Pain score

(at 10 days)

Aircast® orthosis for the

treatment of lateral ligament

ankle sprains produces a

significant improvement in

ankle joint function at both 10

days and one month compared

ENAB

Gunayet al 26 To evaluate the effect of

using an Aircast® orthosis

and ENAB application on

the physical performance of

athletes with ankle injuries.

60 elite

male

football

players

CT Ankle range of

motion Tibialis

anterior strength,

tibialis posterior and

peroneal muscles;

fingertip rise test,

Single- and double-

feet vertical jump

tests 10-step/sec test

for the gastrosoleus

The Aircast® orthosis was m

ENAB ore effective than the

ENAB in reducing injury risk,

preventing repetitive injuries

and providing an early return to

sports.

Airaksinen,

et al 27

To evaluate ENAB alone

and with intermittent

pneumatic compression

(IPC) therapy for the

rehabilitation of acute ankle

sprains

44 patients

(non

athletes)

RCT Edema Degree of

ankle motion Pain

Limb dysfunction

ENAB together with IPC

treatment resulted in faster

rehabilitation during the four-

week follow-up than did

bandaging alone

Leanderson

& Wredmark 28

To evaluate the effects of

treatment with an Air-

Stirrup® ankle brace or a

compression bandage in

73 patients

with grades

II and III

ankle sprain

RCT Clinical examination

Sickness Impact

Profile questionnair,

Karlsson's scoring

Patients treated with the Air-

Stirrup® ankle brace was more

mobile in the initial phase of

rehabilitation and had a shorter





measure Results

patients with severe ankle

sprains

scale Recording of

sick leaves

sick leave.

Effect of Bandaging on proprioception

Wong et al 24

To determine the effects of

ENAB and ankle weight in

ankle joint proprioception

(joint position sence)

26 non

injured

dance

students

CT Reproduction of an

ankle set angle

ENAB and ankle weights

improve ankle proprioception

Hassan et al 29

To investigate whether

ENAB of the knee in

patients subjects with knee

osteoarthritis (OA) would, in

the short term (a) reduce

pain, (b) improve knee joint

proprioception, and (c)

decrease sway

68 patients

with knee

OA

Cross

over,

within-

subject

study

Knee pain (VAS)

Knee proprioception

Static postural sway

Knee ENAB reduces knee

pain and improves static

postural sway in patients with

OA

Barrettet al 30 To inestiaget joint position sense in OA knees with and without ENAB

Eighty-one

normal and

45 OA

knees

CT Perception of the

position

ENAB improves position sense

accuracy in subjects with OA

by 40%

Khabie et al 25

To investigate the effect of

ENAB and injection of an

intra-articular anesthetic on

both elbow position sense

and detection of motion

Twenty

uninjured

male

volunteers

RCT Reproduction of an

ankle set angle (with

Biodex

dynamometer).

The application of ENAB

improves position sense

Jerosch et al 31

To investigate the effects of

ENAB on knee joint

proprioception of patients

43 patients

with a

patellar pain

RCT Passive angle

reproduction test

ENAB improves injured knee

joint angle reproduction

capability





measure Results

with patellar pain syndrome

syndrome–

Control

group: 30

healthy

volunteers

Jerosch et al 32

To investigate the effects of

ENAB in proprioception of

the ACL-deficient knees

25 patients

with an

rupture of

the ACL

Controls: 30

healthy

volunteers

RCT Angle reproduction

test

ENAB has positive influence

on acl-deficient knees

proprioception

Hewitt et al 33

To investigate whether OA

or ENAB of the knee affects

movement detection.

10 women

aged > 65

years with

knee OA

and 10

healthy

women as

controls

CT Movement detection

levels at 0.5°/second,

ENAB did not affect

movement detection

Effect of bandaging on sports injury prevention

Yamamoto et

al 34

To compare the effects of

ankle ENAB and taping in

ankle talar tilt ROM in judo

athletes .

4 University

judo

athletes

with ankle

instability

CT Talar tilt (TT) angles Ankle taping was more

effective than ENAB in

eliminating the talar tilt during

judo practice

RCT: Randomised Control Studies, CT:Clinical Trials, ENAB: Elastic non-adhesive bandaging, IPC: Intermittent pneumatic compression, OA: Osteoarthritis,

VAS: Visual analogue scale, ACL: Anterior cruciate ligament, ROM: Range of motion




Table 3. Physiotherapy Evidence Database (PEDro) Scale Scores

PEDro Scale Boyce et

al [18]

Wong et al [24]

Airaksinen et al. [27]

Leanderson &

Wredmark [28]

Hassan et al

[29]

Barrett, et al [30]

Khabie et al [25]

Jerosch et al

[31]

Jerosch et al

[32]

Yamamoto et al [34]

Hewitt et al [33]

Gunay et al [26]

Subjects were randomly allocated

to groups Y N Y Y Y N Y N N N N N

Allocation was concealed

Y N N N N N N N N N N N

The groups were similar at baseline regarding the most

important prognostic indicators

Y Y Y Y Y Y Y Y Y Y Y Y

There was blinding of all subjects

N N N Y N N N N N N N N

There was blinding of all therapists who

administered the therapy

N N N N Y N N N N N N N

There was blinding of all assessors who measured at least one key outcome

N N Ν N Ν N N N N N N Ν

Measures of at least one key outcome

were obtained from more than 85% of

the subjects initially





PEDro Scale Boyce et

al [18]

Wong et al [24]

Airaksinen et al. [27]

Leanderson &

Wredmark [28]

Hassan et al

[29]

Barrett, et al [30]

Khabie et al [25]

Jerosch et al

[31]

Jerosch et al

[32]

Yamamoto et al [34]

Hewitt et al [33]

Gunay et al [26]

allocated to groups

All subjects for whom outcome measures were

available received the treatment or

control condition as allocated


The result of between-group comparisons are

reported for at least one key outcome


The study provides both point measures

and measures of variability for at least

one key outcome


Total score 7 5 5 7 7 5 6 5 5 5 5 5

Y=Yes, N=No

View publication statsView publication stats

https://www.researchgate.net/publication/304251847

journal of sport rehabilitation - researchgate · journal of sport rehabilitation ... key words:...

Documents