Accepted Manuscript

Multidimensional impact of low-Dye taping on low-load hopping in individuals with and

without plantar fasciitis

Tarbie Van Tonder, Garry T. Allison, Diana Hopper, Tiffany L. Grisbrook

PII: S1466-853X(17)30152-9
DOI: 10.1016/j.ptsp.2017.11.001
Reference: YPTSP 847

To appear in: Physical Therapy in Sport

Received Date: 13 April 2017

Revised Date: 19 October 2017
Accepted Date: 3 November 2017

Please cite this article as: Van Tonder, T., Allison, G.T., Hopper, D., Grisbrook, T.L., Multidimensional
impact of low-Dye taping on low-load hopping in individuals with and without plantar fasciitis, Physical
Therapy in Sports (2017), doi: 10.1016/j.ptsp.2017.11.001.

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 ACCEPTED MANUSCRIPT
Title: Multidimensional impact of low-Dye taping on low-load hopping in individuals with

and without plantar fasciitis.

Authors: Tarbie Van Tonder, BSc (Physiotherapy, Hons)1, Garry T. Allison, PhD1, Diana

Hopper, PhD1 and Tiffany L. Grisbrook, PhD1

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School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia

6845

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Address correspondence to:
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Tiffany Grisbrook
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School of Physiotherapy and Exercise Science, Curtin University

GPO Box U1987, Perth, WA 6845.

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E-mail: tiffany.grisbrook@curtin.edu.au
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Word Count: 3655 words (including Figures and Tables)

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Abstract Word Count: 250 words

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1 Multidimensional impact of low-Dye taping on low-load hopping in individuals with and

2 without plantar fasciitis.

4 ABSTRACT

5 Objectives: Evaluate the acute effect of low-Dye, placebo and no tape on motor behaviour in

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6 individuals with plantar fasciitis (PF).

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7 Design: Prospective, experimental.

8 Setting: Motion analysis laboratory

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9 Participants: Ten participants with PF and ten matched controls.

10 Main Outcome Measures: Hopping behaviour (lower-limb stiffness and ankle angle at peak

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loading) were evaluated during low-load sleigh hopping, during three taping conditions.
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12 Stiffness and ankle angle were determined using three-dimensional motion analysis. Pain
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13 during submaximal loading was assessed with a numeric pain rating scale.

14 Results: The lower-limb stiffness response to therapeutic taping was modulated by the
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15 presence of PF (interaction, F=4.48, p=0.018). Matched controls demonstrated a significant

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16 increase in stiffness post application of low-Dye taping (p=0.001),. stiffness was unchanged

17 in the PF group. In the PF group, low-Dye taping decreased hopping pain in comparison to
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18 placebo (p=0.037) and no-tape (p=0.024). There was no difference in ankle angle at peak
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19 loading between the groups or across taping conditions.

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20 Conclusions: Low-Dye taping reduces nociceptive inputs more than placebo in the presence

21 of PF pain. Low-Dye tape alters stiffness in the control group but not the PF group. The

22 motor behavioural outputs such as stiffness, during low-load hopping is modulated by both

23 pathology and therapeutic taping.

24

25 Key Words: stretch-shortening cycle; kinematics; pain

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26 1. INTRODUCTION

27 Therapeutic taping is widely used in the sports and therapy context. Many studies have

28 examined the impact of various forms of taping on motor performance, lower-limb

29 mechanics and sensory inputs (Aminaka and Gribble, 2005; van de Water and Speksnijder,

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30 2010). While it is acknowledged that therapeutic taping may induce changes in motor

31 performance via various mechanistic domains such as altered: motor behaviour, mechanical

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32 loading, nociception and changes in sensory inputs, few studies have examined the effects of

33 taping outside a specific domain. This study examines the impact of therapeutic taping in

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34 both control subjects and a pathological population assessing behaviour, biomechanics and

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35 pain.
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36
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37 Heel pain has a lifetime prevalence of approximately 10% of the population; the most

38 common cause of heel pain is plantar fasciitis (PF) (Crawford and Thomson, 2003; Thomas
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39 et al., 2010). Plantar fasciitis presents as severe sharp stabbing pain localising around the area
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40 of the medial calcaneal tubercle (Glazer, 2009; Thomas et al., 2010) and stiffness of the

41 medial arch of the foot’s plantar surface (Bennett et al., 2001; Bennett et al., 1998). Clinically
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42 the patient would report an alleviation of their heel pain and stiffness with activity, however
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43 these symptoms may return after prolonged weight-bearing (Covey and Mulder, 2013). This
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44 condition is thought to occur due to chronic overload of the plantar fascia, leading to

45 repetitive micro-tearing near the medial calcaneal tubercle origin (D'Ambrosio and Drez,

46 1982). It was previously suggested that chronic micro-tearing of the plantar fascia led to an

47 inflammatory response (D'Ambrosio and Drez, 1982). More recent histological findings

48 suggest this condition is more of a degenerative fasciosis of the plantar fascia without

49 inflammation (Lemont et al., 2003). Thus certain therapies, such as corticosteroid injections,

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50 which treat the inflammatory component of the disorder may be outdated.(Lemont et al.,

51 2003) Instead, therapies which modify load and assist in the regeneration of the plantar

52 fascia should be employed.

53

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54 One treatment option which may alter loading of the plantar fascia is low-Dye taping, an

55 effective therapy in the short term management of PF (Radford et al., 2006a; Radford et al.,

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56 2006b). This technique, developed by Dye (Dye, 1939) in 1939 and since modified by several

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57 authors (Boergers, 2000; Del Rossi et al., 2004; Lange et al., 2004; Russo and Chipchase,

58 2001) is purported to support the medial longitudinal arch of the foot to limit pronation

59

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(Radford et al., 2006a), reduce peak plantar pressures (Lange et al., 2004; Russo and
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60 Chipchase, 2001;) and reduce pain by offloading the plantar fascia (Yoho et al., 2012). Many

61 studies have examined the effect of low-Dye taping on lower-limb biomechanics, although
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62 there is still a lack of conclusive evidence as to the mechanism by which this taping technique
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63 offloads the plantar fascia (Radford et al., 2006a). A systematic review by Radford et al
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64 (Radford et al., 2006a) evaluated several studies which examined navicular height (Del Rossi

65 et al., 2004; Vicenzino et al., 1997), navicular drop (Del Rossi et al., 2004), rear-foot eversion
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66 (Keenan and Tanner, 2001) and plantar pressures (Lange et al., 2004). Of these studies,

67 which were mostly conducted in young pain-free populations, no clinically significant

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68 changes were found in kinematic or kinetic variables to explain the mechanism by which
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69 low-Dye taping modifies loading of the plantar fascia (Boergers, 2000; Del Rossi et al., 2004;

70 Keenan and Tanner, 2001; Lange et al., 2004; Radford et al., 2006a; Russo and Chipchase,

71 2001). No studies have examined the effect of this taping technique on lower-limb loading

72 behaviours during a functional task in a pathological population.

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74 Lower-limb stiffness is the amount of angular displacement the joints of the lower-limb

75 undergo during a loaded ground contact phase (Farley and Morgenroth, 1999). Excessive

76 stiffness may result in increased peak-forces up the kinetic chain while inadequate stiffness

77 may overload structures which attenuate force (Butler et al., 2003). Both of these extremes

78 may lead to injury (Butler et al., 2003; Williams et al., 2004). It has been demonstrated that

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79 individuals with Achilles tendinopathy (AT) have significantly increased lower-limb stiffness

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80 compared to controls (Debenham et al., 2016b). However, it is unknown if individuals with

81 PF have altered lower-limb stiffness.

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83

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Hopping is often used to study lower-limb stiffness as it utilises the stretch-shortening cycle,
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84 which is integral to efficient locomotion (Kramer et al., 2010), however upright hopping is

85 not always feasible, particularly in a PF population where repetitive weight-bearing activities

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86 are often painful (Thomas et al., 2010). Low-load hopping is studied via a sleigh, where the
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87 participant is able to jump with only a percentage of their body weight while maintaining a
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88 similar movement pattern to upright hopping and eliminating extraneous variables such as

89 fatigue, vestibular and balance control, upper body contributions and muscle capacity
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90 (Furlong and Harrison, 2013). Individuals with AT were able to low-load hop for an extended

91 period without exacerbation of symptoms (Debenham et al., 2016b).

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93 The objective of this study was to examine the interaction effects of therapeutic low–Dye

94 taping in both controls and individuals with PF, across multiple domains of behaviour, pain

95 and stiffness. It was hypothesised that low-Dye taping would decrease pain in individuals

96 with PF during low-load hopping. Secondly, that low-Dye taping would correct suboptimal

97 loading behaviours in individuals with PF by increasing lower-limb stiffness without altering

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98 ankle angle at peak loading during low-load hopping. Thirdly, that lower-limb stiffness

99 would remain unchanged with and without low-Dye taping in controls. This is a mechanistic

100 study examining the different domains of behaviour during low-load hopping and was not a

101 clinical trial.

102

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103 2. METHODS

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104 2.1 Participants

105 Participants with PF were recruited from posters placed in podiatry clinics and were included

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106 if they were aged 18 to 80 years, and presented with more than one month of unilateral

107 plantar surface heel pain originating from the medial calcaneal tubercle with a consistent

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history of PF as diagnosed by a podiatrist. To be included in this study individuals with PF
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109 had to clinically present with pain on first weight bearing and pain over the medial calcaneal
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110 tubercle on palpation. Using a two-way analysis of variance (ANOVA) (group by condition)

111 with 10 samples in each cell (i.e. 10 matched participants) there is a 95% chance of detecting
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112 an effect size of 0.74 standard deviations for each contrast with a power of 80%, therefore 20
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113 participants were recruited for this study (Bausell and Li, 2002).
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115 The control group (CG) were recruited via word of mouth from Perth, Western Australia. The
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116 CG participants were in good general health, and matched to the PF participants according to;
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117 age (±5 years) and body mass index (BMI) (±5 units of BMI [kg/m2]). Participants were

118 excluded if they had a reported neurological condition, known tape allergy, history of other

119 lower-limb pathology, pain within the past six weeks, or lower-limb trauma or surgery within

120 the past two years.

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122 This study was approved by the university’s Human Research Ethics Committee,

123 (PT024/2014). All participants provided written informed consent prior to participation.

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125 2.2 Instrumentation

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126 Three-dimensional kinematic data were obtained using an 18-camera Vicon MX motion

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127 analysis system (250Hz) (Oxford Metrics Group, Oxford, UK) and instrumented sleigh

128 (Gibson et al., 2013). The sleigh was instrumented with a force plate (1000 Hz) (Advanced

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129 Mechanical Technology, Inc, Watertown, MA) interfaced with the Vicon Nexus system (Fig

130 1), which was utilised to collect hopping frequency variables.

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134 FIG 1. Custom built sleigh apparatus (adapted from Gibson et al 2013).

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137 2.3 Procedures

138 All data were collected between February and April 2015. Participant demographics

139 including: sex, age, body mass, height, leg dominance, foot length and history of PF or lower-

140 limb injuries were recorded. Testing order of the three taping conditions: low-Dye, placebo

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141 and no-tape, were randomised via a balanced Latin square. This study utilised the low-Dye

142 taping technique employed by Osborne & Allison (2006) (Osborne and Allison, 2006) (Fig

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143 2). The placebo taping condition covered the same surface area as low-Dye taping but with

144 minimal tension applied to the tape (Fig 3). All participants were asked if both taping

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145 conditions felt comfortable (not too tight etc). ,Rigid strapping tape (38mm) was used for

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146 both taping conditions and was always applied by the same researcher.
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a) b) c) d)

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FIG 2. Low-Dye tape according to Osborne and Allison 2006.

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a) The foot is placed in the neutral position (the ankle relative to the leg was at 90
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degrees and the subtalar joint was placed in neutral), and a stirrup and anchor is

applied. b) The tape is applied in diagonal with tension in the direction of the
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arrows. c) The tape is applied transversely across the plantar surface of the foot
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with tension in direction of arrows. d) The stirrup and anchor are reapplied to keep
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the tape in position. The tape was applied up to the first metatarsophalangeal joint.

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a) b)

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FIG 3. Placebo tape

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a) The foot is place in the neutral position and a stirrup and anchor is applied. b) Tape is
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applied transversely across the plantar surface of the foot with no tension.

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After the first taping condition was applied, participants were fitted with retroreflective
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157 markers (16mm) according to a customised version of a standard lower-limb marker

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158 nomenclature (Besier et al., 2003; Debenham et al., 2016b). Participants performed a static

159 standing trial for kinematic data calibration. For the single leg low-load hopping task
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160 participants were instructed to hop at a continuous, comfortable pace while keeping their
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161 knee as straight as possible (in an attempt to mimic upright hopping) (Debenham et al.,

162 2016b) and were allowed a standardised five minute familiarisation period on the sleigh.

163 Participants in the PF group were required to hop on their affected foot, whereas side was

164 randomised in the CG via a balanced Latin square. A hopping frequency trial was recorded

165 for each participant and used to calculate self-selected hopping frequency. Although self-

166 selected low-load hopping frequency has been shown to be reliable between trials and

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167 sessions (Travers et al., 2013), the participant’s hopping frequency was recorded and played

168 back via a metronome to maintain a constant hopping frequency throughout the remainder of

169 the trials. Five 10 second trials were recorded for each participant, for each taping condition,

170 with a standardised 30 second rest interval between each trial. The remaining two taping

171 conditions were tested in the same manner, with the static data calibration repeated between

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172 each condition as retroreflective markers on the tested foot were removed and replaced due to

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173 placement of the tape. Participants were allowed a five minute rest interval between each

174 condition.

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175

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Participants in the PF group were asked to rate the pain in their tested foot according to the
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177 numeric pain rating scale (NPRS) for each hopping trial. The NPRS (0-10) has been shown to

178 be a valid and reliable tool for assessing pain (Jensen et al., 1986; Jensen et al., 1994; Price et
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179 al., 1994) and has been used in previous PF studies (Cleland et al., 2009; Drake et al., 2011;
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180 Young et al., 2004). Although this is a mechanistic study this scale sets a change of 1 point to
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181 be considered of minimal clinical importance in musculoskeletal pain (Salaffi et al., 2004).

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183 2.4 Data Management

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184 Kinematic data were labelled and inspected for gaps within the Vicon Nexus 2.0 software
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185 (Nexus; Oxford Metrics, Inc.). Residual analysis was performed, using a customised

186 LabVIEW v2014 SP1 program (National Instruments, Texas, US), to determine an optimal

187 filtering frequency. Data were filtered using a Butterworth low-pass filter, with a cut off

188 frequency of 12 Hz. All kinematic and force plate data were calculated using the Curtin-

189 UWA lower-limb model. A custom written program developed in LabVIEW v2014 SP1

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190 (National Instruments, Texas, US) was used to output the variables of interest: lower-limb

191 stiffness, ankle flexion-extension angle at peak loading and hopping frequency. This program

192 calculated all variables for each hop, during each 10 second hopping trial, for all taping

193 conditions. Lower-limb stiffness was calculated using the method described by Dalleau et

194 al(Dalleau et al., 2004) (2004), which uses flight time and contact time modelling. This

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195 method has been demonstrated to be a valid method of lower-limb stiffness estimation on the

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196 sleigh apparatus (Grisbrook et al., 2014).

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197

198 2.5 Data Analysis

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Means and standard deviations (SD) were determined for each hopping variable across each
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200 trial for each taping condition for all participants. Data were analysed using IBM SPSS
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201 Statistics for Windows version 22 (IBM Corp, 2013, Armonk, NY). Data were assessed for

202 outliers using box and whisker plots and then assessed for normality using the Shapiro-Wilk
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203 test, and all data were normally distributed.

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204
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205 Independent samples t-tests were used to determine any differences in age, BMI and hopping

206 frequency between groups. A Chi-Square was conducted to examine differences in gender
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207 between groups. A repeated measures ANOVA was used to determine differences in pain
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208 between the taping conditions for the PF group. Two-factor (one within – taping condition

209 and one between - group) ANOVAs were used to determine differences in lower-limb

210 stiffness and ankle angle at peak loading across the different taping conditions and between

211 groups. Post-hoc analyses were completed using the Bonferroni post-hoc test, and effect sizes

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212 of the post-hoc comparisons were determined using a partial Eta squared (ƞp2). Statistical

213 significance was set at a 95% confidence interval.

214 3. RESULTS

215 Ten PF participants and ten control participants were recruited. There were no significant

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216 differences in age, BMI, hopping frequency or gender between the PF and CG groups (Table

217 1). Mean values for pain, stiffness and ankle angle at peak loading are presented in Table 2.

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218

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219 TABLE 1. Baseline comparison of participant demographics for both groups

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Variable
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PF (n = 10) CG (n = 10) p value
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Age (years); mean (SD) 58 (11) 59 (11) 0.837
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Female; n (%) 7 (70) 6 (60) 0.639

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Body mass index (kg/m2); mean 28.6 (4.4) 26.1 (3.4) 0.170
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(SD)
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Hopping frequency (Hz); mean (SD) 1.32 (0.20) 1.26 (0.17) 0.875

Abbreviations: PF, plantar fasciitis group; CG, control group; SD, standard deviation; n,
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number; kg/m2, kilogram per meter squared; Hz, Hertz.

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227 TABLE 2. Mean values for pain, stiffness and ankle angle at peak loading; presented as

228 means (SD).

Variable Group No-tape Placebo Tape Low-Dye

Pain PF 2.79 (1.83) 2.04 (1.32) 1.57 (1.27)

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Stiffness (kN/m) PF 6.60 (2.29) 6.86 (2.35) 6.87 (2.40)

CG 6.50 (2.67) 6.41 (2.74) 7.12 (2.95)

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Ankle angle at peak PF 3.8 (5.1) 3.8 (5.6) 4.0 (5.0)

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loading (˚) CG 5.4 (3.8) 2.5 (4.3) 3.9 (4.2)

229 Abbreviations: SD, standard deviation; PF, plantar fasciitis group; CG, control group.

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231 3.1 Pain
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232 There was a significant main effect of taping condition on pain for the PF group (F (1.20,
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233 10.83) = 9.95, p=0.007). The Bonferroni post-hoc test demonstrated there was a significant
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234 difference in pain between low-Dye and no-tape (mean difference: 1.22, 95% confidence

235 interval [CI]: -2.28 to -0.16, p=0.024), and between low-Dye and placebo tape (mean
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236 difference 0.47, 95%CI: -0.91 to -0.03, p=0.037). There was no difference in pain between

237 the placebo tape and no-tape conditions (p=0.070) (Fig 4).
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10

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Pain (NPRS 0-10)

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p=0.024

3 p=0.037

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No Tape Placebo Tape Low-Dye Tape
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FIG 4. Change in mean (SE) pain (maximal scale 10) during low-load hopping for the PF
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241 group; Main effect for condition (p=0.007) with post hoc pairwise comparison shown. n = 10
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242 Abbreviations: SE, standard error; PF, plantar fasciitis; n, number; NPRS. Numeric pain

243 rating scale (0-10).

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244

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245 3.2 Lower-limb Stiffness

246 There was a statistically significant interaction (F(2, 36)=4.48, p=0.018, ƞ2=0.20) between

247 taping condition and group for hopping stiffness. The simple main effects for taping

248 condition demonstrated there was no significant difference in stiffness between the groups

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249 during the low-Dye (F(1, 18)=0.05, p=0.835), no-tape (F(1, 18)=0.01, p=0.929) and placebo

250 (F(1, 18)=0.16, p=0.697, ƞp2=0.01) taping conditions. The simple main effect for group

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251 demonstrated there was a significant effect of taping condition on stiffness for the CG (F (2,

252 18)=10.19, p=0.001). Post-hoc comparisons demonstrated in the CG low-Dye taping

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253 increased stiffness when compared to placebo (mean difference 0.71, 95%CI: 0.15 to 1.27,

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254 p=0.014) and no-tape (mean difference: 0.63, 95%CI: 0.14 to 1.11, p=0.013). There was no
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255 significant systematic difference in stiffness between the placebo tape and no-tape conditions,

256 for the CG (p=1.000). In contrast, the PF group did not demonstrate any systematic changes
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257 in stiffness between any taping conditions (Fig 5).

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p=0.013
8.5
p=0.014
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Lower Limb Stiffness (kN/m)

7.5
Plantar
7 Fasciitis

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Group
6.5
Control

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Group
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5.5

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5
No Tape Placebo Tape Low-Dye Tape

259
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260 FIG 5. Change in mean (SE) lower-limb stiffness during low-load hopping for the PF and
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261 CG; n = 10 in each group. Significant interaction (Condition by Group p<.0018) with

262 significant post-hoc pairwise comparisons shown for the CG. Other post-hoc comparisons
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263 did not reach significance.

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264 Abbreviations: SE, standard error; PF, plantar fasciitis; CG, control group; n, number
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3.3 Ankle Angle at Peak Loading

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267

268 There was no significant interaction between taping condition and group, for ankle angle at

269 peak loading (F(2, 32)=2.51, p=0.098, ƞp2=0.14). The main effects demonstrated there to be

270 no significant main effect on ankle angle at peak loading between groups or across taping

271 conditions (Table 2).

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273 4. DISCUSSION

274 This study aimed to assess the acute effects of low-Dye taping in individuals with PF and

275 demonstrated that there was a statistically significant decrease in pain after the application of

276 low-Dye taping in this population. Although this supports current literature that low-Dye

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277 taping is an effective intervention for decreasing pain in a PF population (Osborne and

278 Allison, 2006; Yoho et al., 2012), this study is not a clinical efficacy trial. There was also a

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279 significant difference in pain between placebo and low-Dye taping, indicating low-Dye

280 taping has a greater effect on pain than the effect of placebo tape via cutaneous stimulation

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281 alone.

282

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283 The findings for lower-limb stiffness were contrary to the hypotheses, as there were no
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284 systematic significant changes in the PF group across taping conditions or a significant

285 difference between groups. These results contrast to the literature, as Debenham et al
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286 (Debenham et al., 2016b) found individuals with AT to have increased lower-limb stiffness
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287 during low-load hopping in comparison to controls. However, participants with AT did not

288 experience any pain during testing whereas during this study participants with PF had a
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289 history of pain and most experienced some pain during the experimental protocol. This could
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290 suggest that an element of the increased stiffness behaviour observed in the AT population
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291 could be an adaptive strategy in response to chronic pain or a dysfunctional response to

292 loading (Debenham et al., 2016b). A decrease in pain without a concomitant reduction in

293 stiffness in the PF cohort of this study may suggest that lower-limb stiffness is not overtly

294 modulated in the pathology of PF. However, contrary to our hypothesis, there was a change

295 in loading behaviour in the CG, with a significant increase in stiffness post application of

296 low-Dye taping in comparison to placebo and no-tape. Therefore the findings of the study in

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297 combination suggest that low-Dye taping may tighten the plantar fascia via the windlass

298 mechanism (Fuller, 2000; Hicks, 1954) and result in increased stiffness in the absence of a

299 pain modulation. In the presence of pathology the low-Dye taping technique may provide a

300 mechanical driver for increased stiffness but a sensory (nociceptive driver) for a decrease in

301 stiffness (protective muscle activation) possibly leading to a washout effect and no systematic

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302 change in stiffness in the PF population being observed. Further evidence to identify the

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303 underlying mechanisms of how low-Dye taping alters pain and loading behaviour is required.

304

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305 These findings highlight the importance of understanding both sensory and mechanical

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factors in human motor control. Future research on the effects of therapeutic taping on
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307 clinical populations and not just normal controls is warranted as the dominant mechanism

308 may be profoundly different in the presence of pain or pathology.

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310 Ankle angle at peak loading remained stable between groups and across taping conditions. In
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311 the presence of a maintained hopping frequency, this suggests that the overall hopping
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312 biomechanics were not systematically altered between conditions. Ankle angle at peak

313 loading was selected as a marker of behaviour as this has been shown to be a sensitive change
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314 in behaviour during a sleigh hopping task. However, in contrast to the findings of this study,
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315 Debenham et al (Debenham et al., 2016b) found individuals with AT to hop with greater peak

316 dorsiflexion than controls. This contrast is possibly due to the plantar fascia not crossing the

317 ankle joint whereas the Achilles tendon does and is part of a musculotendinous unit that can

318 be influenced by eccentric loading and muscle fatigue (Debenham et al., 2015; Debenham et

319 al., 2016a). Examining foot mechanics in individuals with PF during the hopping tasks could

320 be an avenue of future research. Additionally classifying foot types or foot posture before and

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321 after taping could provide further insight into the mechanism of low-dye taping, as it may be

322 more effective in individuals with a low arch, however this required further investigation.

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324 A previous study (Debenham et al., 2016b) using low-load hopping in AT found delayed

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325 soleus muscle activity onset in individuals with AT during low-load hopping, possibly due to

326 an adaptive anticipatory strategy associated with chronic pain condition. In this study

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327 individuals with PF experienced a decrease in pain post application of low-Dye taping,

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328 however loading behaviour (peak ankle angle) and mechanical behaviour (stiffness) remained

329 unchanged. Muscle activation changes during low-load hopping in the PF cohort may have

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changed and therefore future research could examine muscle activity profiles during low-load
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331 hopping with different taping conditions and pain levels.
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The findings that there were fundamental differences observed between the control and PF
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334 group suggest that the pathology of the PF may have mediated the response to the low-Dye
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335 taping in terms of altered stiffness. The characteristics of the PF sample mirror the literature;
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336 a BMI of greater than 25 kg/m2 (Riddle and Schappert, 2004) and age of greater than 40 years

337 (Buchbinder, 2004; Irving et al., 2007) are identified as a risk factors for developing PF. On
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338 palpation, all participants in the PF group had tenderness over the medial calcaneal tubercle.
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339 Insertional PF with tenderness over the medial calcaneal tubercle, as opposed to non-

340 insertional PF, may be more common in older populations (Ieong et al., 2013). Participants

341 with PF reported low levels of pain according to the NPRS during the study. This was

342 possibly due to testing not occurring early in the mornings or after prolonged periods of

343 weight-bearing, both considered as times when pain is most exacerbated in individuals with

344 PF (Furey, 1975; Glazer, 2009; Paige and Nouvong, 2006). That said, the participants had

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345 long-term chronic pain responses associated with the PF and although the pain during low-

346 load hopping was low, it is reasoned that the motor control strategies associated with the

347 history of pain were likely to be maintained even at low magnitude of pain. These low levels

348 of pain however may limit the findings of this study and future research can examine changes

349 in pain in a PF population during maximal loading where higher levels of pain may be

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350 reported. Although statistically significant changes were observed, this study is also limited

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351 by the small sample size and the fact that groups were not matched on physical activity

352 levels, which has the potential to influence the results.

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353

354 5. CONCLUSIONS
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355 This study shows that the acute response to low-Dye taping alters pain but not stiffness in a
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356 pathological PF cohort and stiffness behaviours in a CG. These changes are achieved over

357 and above the changes observed with no-tape and placebo tape. The findings of this study
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358 suggest that although the taping technique shows a clinical benefit (reduced pain) the
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359 underlying mechanism observed in control subjects (increased stiffness) may occur

360 independently to changes in the pathological cohort. Therefore, it would seem that future
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361 experimental protocols examining the underlying mechanisms of therapeutic taping should
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362 consider the mediating influence of pain and pathology. Observing mechanical changes in
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363 pain free controls may not be replicated in the clinical setting with pathological populations.

364 Furthermore, any observable clinical benefit cannot necessarily be attributed to changes

365 observed in control cohort studies. This causative link is common in the therapeutic literature

366 and may be a threat to external validity for clinical reasoning.

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Highlights

• Low-Dye tape reduces pain in people with plantar fasciitis during low-load hopping

• Lower limb stiffness is not altered in individuals with plantar fasciitis

• Low-Dye taping increases lower limb stiffness during low-load hopping in controls

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Ethical Approval

This study was approved by Curtin University’s Human Research Ethics Committee
(PT024/2014) and all participants provided written informed consent prior to participation.

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