THE RELATEONSIHW BETWEEN ANKLE TAPENG AND KNEE iNjUEEES EN HIGH SCHOOL FOQTBALL Thesis {or “19 Degree of M. A. MICHIGAN STATE UNIVERSHY Clyde J. Stretch 1966 Michigan State [J LIBRARY Univel‘SitY -91‘—w.'-,> . “.9 rM-3A “-4 . Q ~'— ‘..l .. “i -,: nl'=!_" "_‘;;‘ ’: ‘1‘"? v 'O‘LAn-r‘5: mnvfia ._ 1;" 9'" _?a“-.:$ . INK-12...»... .1}, ;;..~.. ' ' . 4 a. QMHRMVAXJER ' ‘ ; ‘- .l THE RELATIONSHIP BETWEEN ANKLE TAPING AND KNEE INJURIES IN HIGH SCHOOL FOOTBALL By Clyde J. Stretch AN ABSTRACT OF A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Health, Physical Ed cation a d Recreation @WA Approved : flflfl/ijm // ABSTRACT THE RELATIONSHIP BETWEEN ANKLE TAPING AND KNEE INJURIES IN HIGH SCHOOL FOOTBALL by Clyde J. Stretch The purpose of this study was to determine the re- lationship between the support of the ankle by adhesive strappings or cloth wrappings and the incidence of knee injuries in football players. Following the 1956 football season, the coaches of ninety—five Michigan high schools were interviewed, with the remaining schools that were members of the Michigan High School Athletic Association being sent questionnaires. The responses to the questionnaires resulted in data from 516 of the 532 possible high schools. Chi—square was used for analysis of the data, allowing the following conclusions to be drawn: 1. No relationship existed between the incidence of knee injuries and the use or method of supporting the ankles artificially. 2. Schools with populations ranging from 375 to 899 students had the greatest incidence of knee injuries. 3. SChOOlSwith populations of under 175 students had the smallest incidence of knee injuries. Clyde J. Stretch A. Schools located in communities termed as urban- industrial had the highest incidence of knee injuries. 5. Schools located in communities termed as rural- agricultural had the lowest incidence of knee injuries. 6. The backfield positions were found to have incurred the most knee injuries, followed by the end and internal line positions, respectively. 7. No relationship existed between the incidence of knee injuries and the playing of football under game or practice conditions. THE RELATIONSHIP BETWEEN ANKLE TAPING AND KNEE INJURIES IN HIGH SCHOOL FOOTBALL By Clyde J. Stretch A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Health, Physical Education and Recreation 1966 Approved: DEDICATION This thesis is dedicated to my wife, Missy, without whose patience and understanding this study would not have been possible. ii ACKNOWLEDGMENTS The author would like to express his gratitude to Dr. Wayne Van Huss, without whose advice and assistance this study would not have been possible. iii TABLE OF CONTENTS DEDICATION ACKNOWLEDGMENT. TABLE OF CONTENTS. LIST OF TABLES. Chapter I. “THE PROBLEM . . . . . . . . ,Introduction. . ,Statement of the Problem. oNeed for Study SCOpe of Study . . -Limitations of Study uDefinition of Terms II. REVIEW OF RELATED LITERATURE III. METHODOLOGY . . . . . Interview Method Questionnaire Method Deletion of Schools Preliminary Statistical Procedure. Final Statistical Methodology IV. ANALYSIS AND PRESENTATION OF DATA Introduction. The Data Discussion V. SUMMARY, CONCLUSIONS, AND REC OW IENDA TI ON S. Summary Conclusions . . Recommendations. . BIBLIOGRAPHY . . . . . . . . . . iv Page ii iii iv vi H l—‘l—‘H HOOKOKO \Q U“! wwwmmw ,__J R.) MFJHJ n>mro 26 26 26 27 28 Chapter APPENDICES P38 0 o o o o r re APPENDIX A . . . O . . . . 29 . . . . . 3o APDENDIX 5 APPENDIX C ° ° ' ° ' C . U . . I O . . . . 3/) . . 34 v LIST OF TABLES Table Page I. The Relationship between School Size and Knee Injuries . . . . . . . . 13 II. The Relationship between Type of Community and Knee Injuries . . . . . . . 15 III. The Relationship between School Size and Type of Community . . . . . . . 16 \IV. The Relationship between Position Played and Knee Injuries . . . . . . . . . 17 NV. The Relationship between Incidences of Injury in Game and Practice . . . . . . 1? AVI. The Relationship between Ankle Taping Policy and Knee Injuries Incurred in Practice. 19 3 ‘VII. The Relationship between Ankle Taping Policy and Knee Injuries Incurred in Games . 21 \VIII. The Relationship between Knee Injuries with Ankles Taped and the Taping Technique . 23 Jlx. The Relationship between the Person Who Tapes the Ankles and the Number of Knee Injuries. . . . . . . . . . . 2A vi CHAPTER I THE PROBLEM Introduction The problem that has been under study was originated in 1956. At that time, an article by Joseph Dollerl caused a great deal of concern to coaches and trainers; as it hypothesized, with some emperical evidence, that there was a relationship between adhesively strapped ankles and the incidence of knee injuries. Hobart,2 in 1936, expressed this same hypothesis, however, it was mentioned in passing and generally ignored. Slocum,3 in 1959, supported this position, but added that he felt that this was not dangerous to a prOperly trained player. The influence of Doller's article showed itself in the hypothetical basis of the data collected for this study. That basis was that there would be greater incidence of knee injuries when the ankle was reinforced Y w —-— lJoseph Doller, "Reducing Knee Injuries by PrOper Ankle Strapping,” ScholasticCoach, 25:40-41, May, 1956. 2Marcus H. Hobart, "Athletic Injuries," Journal of the American Medical Association, 107:488-491, 15 August, 1935. 3Donald B. Slocum, "The Mechanics of Football Injuries,” Journal of the American Medical Association, l7o:l6AO—l6A6, 1 August, 1959. l by adhesive tapes or cloth wraps. The passing of ten years, however, provided a retrospective view which resulted in an alteration of the original hypothesis. A review of Thorndike's data at Harvard showed that the most commonly injured portion of the knee was that of the internal lateral ligament.“ These same data also indicated that the primary structures yielding to trauma in the ankle were the anterior tibiofibular, the talofibular and the calcaneofibular ligaments. Thus two of the three most commonly injured ankle ligaments directly opposed the most commonly injured ligament of the knee. Statement of the Problem To determine the relationship between the support of the ankle by adhesive strappings or cloth wrappings and the incidence of knee injuries in football players. Need for this Study Injuries have been accepted as a part of football, but with a corresponding concern to keep them to a minimum. Protection of the player from serious injury has required that certain techniques be used. The fear that this protection could result in further, and perhaps more serious injury has left coaches and trainers with a serious dilemma. This study was undertaken as an attempt to “Augustus Thorndike, Athletic Injuries (Philadelphia: Lea and Febiger, 1962). 3 clarify the situation as to whether or not it is in the best interests of the general safety of the football player to apply artificial support to his ankles. Scope of this Study This study was restrictedtx>thflse SChOOlS partici— pating in high school interscholastic football under the sanction of the Michigan High School Athletic Association. Limitations of this Study 1. There were individual differences in the interpre- tation of the questionnaire used to gather the data. 2. Some of the responses in the questionnaire required the use of recall on the part of the responder. 3. The responses to the questionnaire were limited to those players who were considered to be within the first twenty-two players on the squad. 4. Portions of responses to the questionnaire occasionally required minor interpretations. Definition of Terms l. Knee Injury-—Any injury to the knee which resulted in the loss of the player for at least one game or one week of practice. 2. Ankle Tape--Adhesive tape applied in such a manner so as to provide support to the ankle. 3. Ankle Wrap-—A heavy cloth bandage 1 1/2 to 2 inches wide and 6 to 10 feet long, encircling the ankle in such a manner that support is provided. A. Qamg—-A Michigan High School Athletic Association sanctioned interscholastic contest in football. 5. Practice——The daily supervised preparation for a game. 6. Trainer—~An employee of a school whose only direct connection with that school's football program is in the area of prevention and treatment of injuries incurred in foot- ball. 7. Bare Ankle-~Ankles of football players which have no artificial means of support. 8. Double Football Taping--A method of adhesive strap— ping which restricts inversion and eversion of the ankle with relatively no effect upon dorsal and plantar flexion. 9. Basketweave Tapinge-A method of adhesive strapping utilizing intertwining horizontal and vertical strips of tape as a basis for covering the ankle to restrict inversion, eversion, dorsal flexion and plantar flexion. 1t. Gibney Taping——Using the same basis as the basket- weave, the anterior portion of the ankle is left open, limiting restriction primarily to inversion and eversion. 11. Figure of Eight Taping——A method of adhesive strapping in which the lower portion of the leg and the upper portion of the foot are encircled with a continuous strip of tape, providing limited restriction in inversion, eversion, dorsal flexion and plantar flexion. CHAPTER II REVIEW OF RELATED LITERATURE Aside from Doller'sl poorly substantiated statement that a relationship between ankle taping and knee injuries 2’3 there was does exist along with an occasional opinion, no literature dealing specifically with the subject of this study. The suceptability of the knee and ankle to injury, however, has been noted often. Burnett and O'Brien,“ collecting injury data from about 100 Massachusetts high schools during the football seasons from 1929 to 1932 found ankle injuries to be most common with injuries to the knee next in order. Neilson,5 studying high school football in California during the l93: season, found knee injuries contributing approximately 11% of all injuries, leading all other injuries. lDoller, op. cit., pp. 39—40. 2Hobart, 00. cit. .._A____..______ 3Slocum, go. cit. uJ. H. Burnett and F. J. O'Brien, ”Survey of Football Injuries in the High Schools of Massachusetts,” Research Quarterly, A:9l—98, October, 1933. 5N. P. Neilson, "The Nature, Frequency and Age on Incidence of Injuries in Interscholastic Football,” Research Quarterly, Az78—90, October, 1933. [I J Hobart's6 compilation of injury data at Northwestern University during the football seasons from 1930 to 1934 showed the knee leading all other parts of the anatomy with 15% of all injuries. Lillie, 7by studying insurance claims of 42 Oregon high schools during the 1939 football season, found knee sprains accounting for 10% of all injuries, with ankle sprains contributing 9%. McPhee,E3reviewing football injuries at Princeton University from 1933 to 1942, reported approximately 18% of all injuries occurred to the knee and about 12% to the ankle. Gallagher9 reported ligamentous knee injuries from football leading all other injuries in various sports re— quiring hospitalization at Phillips Academy, Andover, Mas- sachusetts during the years from 1940 to 1947, with ankle injuries in football being reported as the second most frequent. /. b , . Hooart, op. Clt. '7 {Jerome C. Lillie, ”A Study of Football Injuries in Forty—Two Oregon High Schools” (unpublished M.S. Thesis, University of Oregon, Eugene, 1941). Harry R. McPhee, "Football Injuries," Journal—Lancet, July, 1947, pp. 267—968. 9J. R. Gallagher, ”Athletic Injuries Among Adolescents,” Research Quarterly, 19:198—214, October, 1948. /\ Dolan,ld demonstrating an increase of knee injuries in football reported 12 knee injuries from 1930 to 1940 at Purdue University, with 60 knee injuries for the next decade. VanBrocklinll reported knee and ankle sprains resulted in close to 20% of all insurance claims from Oregon high school during the l948-season. Cathcart,12 quoting the Handbook of the National State High School Athletic Associations, reported knee injuries constituting 19.6% of all football injuries during the 1952 13 in a review of Oregon high football season. Krause, school football insurance claims for the 1955 football season stated that knee injuries led with 11.3% of all injuries with ankle injuries second with 7.3% of the injuries. Thorndike's14 data for injuries at Harvard University from 1932 to 1959 showed knee and ankle injuries leading all eothers. During that period of time there were a total of 1,303 knee injuries and 1,010 ankle injuries, or an average loJoseph Dolan, "Football Injuries Change, Too,” Safety Education, September, 1950, 30:1. 1 ! *lNorman VanBrocklin, 'The Nature and Frequency of Injuries Occurring in Oregon High School Interscholastic Football” (unpublished M.S. thesis, University of Oregon, 1951). ngack F- Cathcart, I'Football's Ounce of Prevention,” Journal of Health, Physical Education and Recreation, 28:8, October, 1953. l3Melvin A. Krause, "The Nature and Frequency of Injuries Occurring in Oregon High School Interscholastic Football” (unpublished M.S. thesis, University of Oregon, 1960). 14 . .. . TTMDF’NJIFGL, EII- C] t. of about 85 knee and ankle injuries per year. This data, however, included all intercollegiate sports at Harvard during those twenty—seven years. The high rate of injury to the knee and ankle under— scored the importance of proper protection for those joints. Misconceptions of proper protection have left only the athlete to suffer. CHAPTER III METHODOLOGY This study was inaugurated for the purpose of determi- ning the existence of a relationship between protective ad— hesive ankle strappings or cloth wrappings and the incidence of knee injuries in the sport of football. The data for this study was assembled through the use of personal interviews and a mailed questionnaire. Interview Method Personal interviews were conducted with football coaches of ninety-five high schools within a seventy—five mile radius of the Michigan State University campus. The selection of the interview pOpulation was based upon the convenience of the schools for interview. These interviews and information drawn from them served as the foundation from which the questionnaire was developed. Questionnaire Method A list of all high schools participating in inter- scholastic football within the state of Michigan was secured from the Michigan High School Athletic Association. A questionnaire and a letter of transmittal were sent to each of the schools listed, with the exception of those schools 0 ,/ IO previously interviewed. Follow-up letters were then sent three and six weeks subsequent to the original question— naire. Questionnaires were sent to a total of 437 schools. Deletion of Schools Two schools were deleted from final consideration. Freeport High School reported that its football coach was no longer a member of its faculty, leaving no one available to supply the desired information. The second deleted school, Michigan School for the Blind, although sent the original questionnaire, was not included in the follow—up letters due to the unique relationship between the sport and those participants.1 Preliminary Statistical Procedure The data from both the interviews and questionnaires were transposed to IBM cards. Compilation of the data was done with the use of an IBM Card Sorter, after which, because of the enumerative data, chi square was applied. Using the total number of schools reporting certain results as the basis for the chi square, the highest probability was re— ported for each portion of the data.2 ‘7’ 1This work done by James Folsum; April—June, 1957. 2This work done by Emerson Dromgold, 1963. 11 Final Statistical Methodology The raw data from the interviews and questionnaires was retabulated and transposed to IBM cards. This data was then programmed for a computer output of chi-square contingency tables for all reasonable relationships within the data. All data not pertaining to the specific problem of study was set aside. The contingency tables provided by the computer served as a basis for the com— pilation of the data reported here, with only one such table reported directly. In some cases the card sorting technique was used to clarify and verify data reported by the computer. The basis for the majority of the final tables was the use of the total number of player partici— pants (twenty-two per school). The probability level for acceptability was set at the .05 level.3 3This work done by the author, April-June, 1966. CHAPTER IV ANALYSIS AND PRESENTATION OF DATA Introduction The purpose of this study was to test the hypothesis that there was no direct relationship between the support of the ankle by adhesive strappings or cloth wrappings and the incidence of knee injuries in the football player. The Data A total of 516 schools responded either through interview or questionnaire. This was a ninety-six per cent response including some 11352 Michigan high school foot- ball players. Initially, the data were broken into school sizes following the guidelines set forth by the Michigan High School Athletic Association for interscholastic compe- tition. These school sizes were compared for the incidence of knee injuries. Table I indicated that the schools whose populations ranged from 375 to 899 provided a high schi square in terms of knee injuries, with the schools with populations below 175 contributing a high chi square with a lack of knee injuries, providing a significant final chi square. A possible reason for this difference in the incidence of 12 l3 .mfiw.s ”Ho>ma mo. pm Umpflsvoh mx .Eoeoopw go moohmoe moans mm.mm mmm o.ooH mmm mmmas mam Asses mo.s m m.m Hm oemfi on msfi pope: @H.: Hmm H.wm com ems: mam qsmumsa os.w owfi w.mm sow mwmm ema mmm-msm as.m mm m.mfi mm amps es +oom mmHNSmCH mocz Hoozom mmALSmCH newsman ho mfioonom Hoozom mx mo Loossz mo mmflm an omcz Hmpoe pheasz Hmooe @o honesz mo omflm popooqwm moALchH & .mmHASmcH hoax Ucm mmflm floozom cesspop Qflcmeoflpmfloh oEE»I.H mgmoa he _,LH500L x N .EoUooLw go moehmep cm>om 15 Hm.sa mmm 0.00H mmm mmmfia q0H 00. pm emsflsomh 0x .Eo000p0 00 0000000 :09 0.0sh 0.s 0.0 o.s s.m0 0.0H a.om 0.00 s.mm 0x 0.00H 0H0 em 00 mm 00H 00 00 00H 00 qaeoe 0.0: 0s m 0 0 ms 0 0 m H med sepes H.sm 0H0 0H 0H s mm H0 0 mm ma ssm-msa n.0m 00H 0H s 0H 0H s0 0H am am 000-0sm 0.00 AA A 0 H 0 m 0H am am +000 p0£00 0H mo. 00 00LH500L x .50000L0 so 000300 003 m . - H0.H s0: 00H 00: q<90e 0m. mmm S: mam memm 0E00 H0. 000 mm new memo seapomee x 00H0500H 00cm 00HhSmCH 00H0300H 00cm 000%0Hm 0 mo 000832 00am mo R wo 902802 00 L00E52 000000xm . .00H000LQ 0:0 0500 CH segmcfl 00 000000H00H c00200o QflhmcoHpmfl0p 0LBwn.> mqm<9 .H00.m ”H0>0H m0. 00 00LHSU0L x 0 .Eo000pm 0o m00h000 038 s.00 mmm 0.00H mmm mmmafi qH mam0H m0. #0 00Lfi500p x m .E000000 00 0000000 xflm 00.0H 000 0.00 new 0000 ems 0090B 0m.0 m 0.H 0 owfi m 0000. 00.0 mm 0.00 00 sfima s0 pessmen sHeo 0003 so 0008 00.0 a 0. H as m 0900 0000 M000302H 0 0000 .03000 0009 00.0 00H 0.Hs 00H 000: 000 open ewes m00LSmcH 0008 00.0 00 0.00 mm 0000 e0fi 0000 0003 M000300H 000B 00.; m 0.H m 00 0 0000 sets ”000300H 0 0000 .00009 000% 00.0 m 0.0 0 00m 0 HH0 000% 000300H 000500H 00ssmcH xowmog hoafiom mx mh0m0fim mm0m0am 00000Hm mean: 00000 howfl00 00000oxm 0o 0 000%0am l i.‘ ll .00 0000300H 00:0 000 zoflHOQ 00H000 Hpompa :H 00003000 0a maoozom It fltl. III.|'. .I Afll. .1!!! 3:0 000300; 0H0020w00a00 00911.9> mqm<8 20 of this study, however, upon studying the same type of re— lationship under a game situation the solution became less simple. This table, as was the previous table, was significant and excluded the interviewed schools because of the lack of data. Table VII seemed to confirm the conclusion indicated in Table VI since all of the policies which required some kind of support for all players had more injuries than expected, where the policies of taping a portion of the players and leaving the remainder uunsupported had fewer injuries than expected. If viewed alone, Tfibles‘VI and VII would have been misleading. The fact was that the relationship that was determined dealt only with the policy which governed the teams and the support for their ankles. Had this been a repre- sentative method of evaluating the ankle support—knee injury question, the two tables would have been important. Although data were not collected concerning the support or lack of support of each of the players' ankles. The following data were collected from those players directly involved with a knee injury. Of the 553 knee injuries occurring throughout the season, 283 or 51.1 percent of those players had no artificial support applied to their ankles; 136 or 2M.6 percent of those players had some sort of adhesive strapping applied to their ankles; and 134 or 24.3 percent of those players had ankle wraps supporting their ankles. 21 "H0>0H m0. 00 / .Eo00000 00 00003000 mx 0000000 000 00.00 000 0.000 000 0000 00: 00000 00.0 : 0.m 0 :00 0 00000 mm.: 00 0.0 0H mmafi :0 0000000 zflco 0003 0o 000B 00.m mm 3.0 :0 0000 00 0000 0000 00005000 0 0000 03000 0009 m0.0 00 0.00 00 0000 mma 0000 0000 00003m00 000E mm.a mm w.®fi H: mmma mm 0000 0003 00000000 0008 0m.© 0H w.MH 0m 0mm mm 0000 0003 00003000 0 0000 00000 000% 00.0 0: 0.00 m: 0000 up 000 000E 000500H 000300H 000000H 000000 0000O0 x 0000000 0000000 0000000 00000 00000 000~o0 0 0o R 0000000 0Hoogom 000000xm 00000000 0000 0:0 000000 m00000 .00E0m 00 00000000 00200 0003000 0000:0000000 0:93;.HHb mammB 22 With the evidence pointing to a lack of relationship between ankle support and the incidence of knee injuries, the question under study allowed the development of some details concerning it. Data was collected regarding the types of adhesive strappings applied and the person connected with the team who applied any artificial support to the ankles of the players. Table VIII examined the relationship between taping technique used on ankles with the incidence of knee injuries. The lack of significance indicated that there was no re- lationship between the two variables. The final table, although significant, could not be considered as important information due to the fact that almost 93 percent of the schools had their coaches doing all of the taping or wrapping. Discussion Relationships were established between the size of the school and the number of knee injuries as well as the type of community and the incidence of knee injuries. Although a relationship was established between the size of the school and the type of community, its importance to this study was questionable. The position played was found to be related to the incidence of knee injuries, but there was no relationship found between the incidence of knee injuries and the participation under game or practice conditions. 23 .00000 0003 00000 xoO0 00000000 000 00003 00 0Hoo000 000 00 0000000 000 00 HHO 0000 A00a0>00 00000000V 0ofl0000000 000 00000 00000 000% ”00oz .HH ”00>00 mo. 00 00000000 mx ..Eo00000 00 0000000 0>00 mm.m mma 0.00H mmfi mmam mm @0908 00.0 0 0.0 m 000 m 00000 NH.H m H.® Ha mma w H0000oom 0H0000 00.0 00 0.00 00 000 00 00000 00 000wH0 0>00300x00m QO.H H m.H m mm H 000000 00.0 OH 0.0 00 qma w 0000M 00 000000 00.0 00 0.00 00 000 00 0>002000000 0H 000M 00H0000H 0000300H 0000000 000000m 0000.000B x 000002 0000 000K 00 000002 00 000000 000005 m 000000xm 00 R 00 000502 .000000000 M00000 000 000 00000 000000 0003 00000000 0000 0003000 00000ofl00a00 009:-.HHH> @0009 24 .wq:.m "00>00 mo. 00 00003000 m0 .0000000 00 0000w00 0300 00.00 :mm 0.000 mmm mmM00 00m 04900 00.0 q 0. m 00 3 0000000 002 mm.: 00 m.m mm @mm m0 0000008 oo.m0 m 0.0 m 00 m 00000Q mm.m q 0. 0 mm 0 000000 m0.0 :00 0.00 m0m 00000 00: 00000 00 mmmmMHH 0003000 0003000 0000000 -0000000 00000 0 00000000 0000000 000032 00 000032 00 000532 .00003000 0000 00 000E30 000 000 000000 000 00000 003 000000 000 0003000 000000000000 00%|-.00 m0m