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Functional Taping and Muscle Dysfunction

Solecki, Thomas J. DC, DACBSP DACRB, ICSSD
Grzeszkowiak, Konrad DC, PAK, CES, PES, FMT, PMT
Kramer, Abby BS, PAK, CPT, FMT, PMT
Froberg, Collene BS, FMT

Introduction

Kinesiology taping is a commonly used method to treat various conditions and aid in rehabilitation. Many research studies to date analyze the effects of kinesiology taping around the ankle joint. Kinesiology taping is proposed to: normalize muscular tone1; increase range of motion2; increase endurance3; and improve functional movement4.

Kinesiology taping is a relatively new technique, which differs from using standard white athletic tape. It contains elasticity and can be stretched up to 180% of its original length before applying to the skin.5 The tape then provides a constant pull or shear force to the skin. Kinesiology tape can be worn for several days and remain intact as it is air permeable and water resistant. Standard athletic tape can be restrictive while kinesiology taping can be therapeutically effective and useful following injury and rehabilitation.6 Dr. Kenzo Kase, founder of the kinesiology taping method, proposed the following mechanisms for the effects of kinesiology tape: 1. Altered muscle function by the tapes effects on weakened muscles, 2. Improved circulation of blood and lymph by eliminating tissue fluid or bleeding beneath the skin, 3. Decreased pain through neurological suppression, and 4. Repositioning of subluxed joints by relieving abnormal muscle tension, and helping to affect the function of fascia and muscle. A fifth mechanism has been suggested by Murray, which is that kinesiology tape increases proprioception through increased stimulation to cutaneous mechanoreceptors.7 8

The purpose of this study is to address the immediate and 48 hour effect of kinesiology taping on muscle strength, range of motion, functional movement, and endurance. It appears that only one study has addressed the effect of kinesiology tape on muscle tone, thus increasing functionality, which yielded no statically significant result.9 This could be potentially due limited stretch of the tape used (120%). Rocktape© kinesiology tape contains 180% stretch, which has been hypothesized to have a stronger effect on muscle tone and function. We have hypothesized that taping specific muscles, during a specific vector of movement may increase muscle response. To date, no research study to our knowledge has tested the validity of this hypothesis.

Methods:

Participants: Twenty-one male and female gymnasts between the ages of 12 and 18 volunteered to participate in this study. Informed consent was obtained from all subjects and all subjects were eligible to participate. Criteria for participation included no current ankle injury that is being treated professionally or conservatively. Participants verbally acknowledged no current pain in bilateral lower extremities. No mentions of previous injury to lower extremities were assessed. No one was harmed during this experiment.

Test Procedures: The subjects were tested using manual muscle testing (MMT) of six muscles surrounding the ankle joint: tibialis anterior, tibialis posterior, fibularis longus and brevis, fibularis tertius, and gastrocnemius. All muscles were scaled on a 0-5 scale. The standard references for muscle testing evaluation are based on the original work of Kendall and Kendall, Muscles: Testing and Function.10 Ankle range of motion (active dorsiflexion) was measured weight bearing and non-weight bearing using a digital inclinometer. A functional squat was performed and knee valgosity was recorded and measured in degrees with software from Spark Motion. Ankle agility and neuromuscular control was assessed using the Shark Test.11 Subjects were then kinesiology taped to increase tone for any neurologically inhibited muscles found. All assessments were repeated and reevaluated immediately following specified taping protocols. All assessments were also reevaluated in a 48-hour follow-up assessment.

Manual Muscle Test: Manual muscle testing began with the technique created by Lovett in 1912. Muscle testing is a system for grading muscle strength and was used for disability evaluation in polio and other diseases by the Kendall’s in 1936 and was first published in 1949. Techniques for manual muscle testing were expanded upon outside of conditions like polio and are now used to diagnose and treat muscle inhibition. Dr. Goodheart, founder of applied kinesiology, introduced his method of manual muscle testing to the Chiropractic profession in 1964, which have been further developed by the International College of Applied Kinesiology (I.C.A.K.).12 In this study, manual muscles testing of 5 muscles surrounding the ankle were used to assess neurological facilitation or inhibition. The five muscles around the ankle were all tested bilaterally before taping, immediately after taping, and 48 hours following the initial assessments. Certified Professional Applied Kinesiologists through the ICAK performed all manual muscle testing.

Tibialis Anterior

To test the tibialis anterior the athlete was seated with the leg to be tested extended and neutral. The tester dorsiflexes and inverts the ankle, having the athlete resist fully against the testers hand. The testers stabilization hand was resting on the distal leg laterally, superior to the ankle while the testing hand cupped the medial foot.

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1. Tibialis Anterior Manual Muscle Test

Tibialis Posterior

To test the tibialis posterior the athlete was seated with the leg to be tested extended and neutral. The tester plantar flexed and inverted the ankle, having the athlete resist fully against the testers hand. The testers stabilization hand was resting on the distal leg laterally, superior to the ankle while the testing hand cupped the medial foot.

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2. Tibialis Posterior Manual Muscle Test

Fibularis Longus/Brevis

To test the fibularis longus and brevis muscles, the athlete was seated with the leg to be tested extended and neutral. The tester plantar flexed and everted the ankle, having the athlete resist fully against the testers hand. The testers stabilization hand was resting on the distal leg medially, superior to the ankle while the testing hand cupped the medial foot.

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3. Fibularis Longus/Brevis Manual Muscle

Fibularis Tertius

To test the fibularis tertius the athlete was seated with the leg to be tested extended and neutral. The tester dorsiflexed and everted the ankle, having the athlete resist fully against the testers hand. The testers stabilization hand was resting on the distal leg medially, superior to the ankle while the testing hand cupped the medial foot.

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4. Fibularis Tertius Manual Muscle Test

Gastrocnemius

To test the gastrocnemius the athlete was seated with the leg to be tested extended and neutral. The tester bent the knee so the foot was off of the testing surface and plantar flexed the foot. The tester placed the stabilization hand on the athlete’s knee laterally and the testing hand cupping the calcaneal surface of the foot. The athlete resisted the testers pull which is posterior to anterior in a caudal direction.

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5. Gastrocnemius Manual Muscle Test

Digital Inclinometer:

Ankle range of motion was measured both weight bearing and non-weight bearing. To measure range of motion non-weight bearing the subjects started in a seated position and barefoot with the ankle to be tested extended and in neutral position. The inclinometer was placed on the dorsal surface of the foot and then zeroed. Upon starting the test the subject dorsiflexes the foot to maximal active dorsiflexion and the angle is measured. This measurement is repeated on the opposite leg. All measurements were taken before taping, immediately after tape application, and at a 48-hour follow up visit.

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6. Starting Position of ROM Testing Seated 7. Ending Position of ROM Testing Seated

To measure weight bearing ankle range of motion the subjects stood on a flat surface barefoot with the feet shoulder width apart and hands resting on the hips. The inclinometer was placed vertically along the anterior surface of the tibia and then zeroed. Upon starting the test the subject dorsiflexed the ankle by performing a squat until maximal active dorsiflexion was achieved. The final angle at end range of motion was measured. This assessment was repeated on the opposite leg. All measurements were taken before taping, immediately after tape application, and at a 48-hour follow up visit.

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8. Starting Position of ROM Testing Standing 9. Ending Position of ROM Standing

Functional Squat Assessment:

Athletes were instructed to stand barefoot with feet comfortably shoulder width apart with hands on hips. Athletes performed a squat passed 90 degree of knee flexion. Athletes were video recorded using an IPad© 3 with motion analysis software by Spark Motion©. Athletes were recorded prior to kinesiology taping, immediately post kinesiology taping, and 48 hours after kinesiology taping. Analysis of squat was done using Spark Motion© software. Bilateral knee valgosity was measured in degrees at 90 degrees of knee flexion during all three squats in all three videos.

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10. Beginning of Over Head Squat 11. Ending Position of Over Head Squat

Shark Skill Test:

The Shark Skill Test was performed as described by Michael Clark, DPT in NASM’s Essentials of Sports Performance Training. The test is designed to assess lower-extremity agility and neuromuscular control. Increased agility and neuromuscular control leads to improved function and increased endurance. The athlete was positioned in the center box of a grid, with hands on hips and standing on one leg barefoot. The athlete was instructed to hop to each box starting from their top left, always returning to the center box, only hopping into each box once. The athlete performed one practice run through the boxes with each foot. The athlete was then timed while performing the test one time for each leg. .01 seconds were added for each of the following deductions when they occurred each time: non-hopping leg touches ground; hands come off hips; foot goes into wrong square; foot does not return to center square. Athlete repeated same procedure after being kinesiology taped. 48 hours after being taped, athletes performed the same Shark Skill Test procedure with no initial practice trial.

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12. Beginning of Shark Skill Test 13. First Box Jump of Shark Skill Test

Kinesiology Taping Procedure:

Kinesiology tape was applied towards specific muscles in a specific vector of movement. The specific vector of movement corresponded to the facilitation of
that specific muscle as demonstrated by a manual muscle test described by Kendall. Kinesiology taping was administered by practitioners certified in
Fascial Movement Taping (FMT)© and Performance Movement Taping (PMT)©. This method of movement taping consists of the athlete maximally stretching the
specified muscle that is to be taped. Tape is then applied from insertion of the muscle to the origin of the muscle as the athlete maximally contracts the
specified muscle. Kinesiology taping was applied to only the muscle(s) that demonstrated ⅘ MMT. If no muscles demonstrated a ⅘ MMT, posterior tibialis was
bilaterally taped.

Gastrocnemius

For the gastrocnemius muscle kinesiology tape application, the athlete’s position was prone. The base of the kinesiology tape was applied to the dorsal
surface of the base of the calcaneus with no tension as the ankle in full dorsiflexion. The tape was then rolled out with 25% stretch over the path of the
Achilles tendon and up the middle of the gastrocnemius muscle belly, ending inferior to the popliteal fossa. While the tape was rolled out, the athlete
moved the ankle into maximal plantar flexion, activating the gastrocnemius muscle, along with the rest of the triceps surae complex.

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14. Beginning of Gastrocnemius Taping 15. Taping of Gastrocnemius with Movement 16. Finished Taping of Gastrocnemius

Fibularis Longus/Brevis

For the fibularis longus and brevis muscle kinesiology tape application, the athlete’s position was seated. The base of the kinesiology tape was applied to the plantar surface of the base of the 1st metatarsal with no tension, as the ankle was plantar flexed and inverted. Tape was then rolled out with 25% stretch over the path of the fibularis longus tendon, passing behind the lateral malleolus and ending on the fibular head. While the tape was rolled out, the athlete moved the ankle into the plantar flexed and everted position activating the fibularis longus and brevis muscles.

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17. Beginning of Fibularis Longus/Brevis 18. Taping Fibularis Longus/Brevis with Movement
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19. Continued Taping of Fibularis Longus/Brevis 20. Finished Taping of Fibularis Longus/Brevis

Fibularis Tertius

For the fibularis tertius muscle kinesiology tape application, the athlete’s position was seated. The base of the kinesiology tape was applied to the dorsal surface of the foot on the fifth metatarsal with no tension, as the ankle was dorsiflexed and inverted. The tape was then rolled out with 25% stretch over the path of the fibularis tertius tendon, passing anterior to the lateral malleolus and ending on the fibular head. While the tape was rolled out, the athlete moved the ankle into the dorsiflexed and everted position activating the fibularis tertius muscle.

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21. Beginning Taping of Fibularis Tertius 22. Taping of Fibularis Tertius with Movement
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23. Finished Taping of Fibularis Tertius

Tibialis Anterior

For the tibialis anterior muscle kinesiology tape application, the athlete’s position was seated. The base of the kinesiology tape was applied to the base of the 1st metatarsal head with no tension, as the ankle was in the plantar flexed and everted position. The tape was then rolled out with 25% stretch over the path of the tibialis anterior muscle crossing over to the lateral leg and ending near the fibular head. While the tape was rolled out, the athlete moved the ankle into the dorsiflexed and inverted position activating the tibialis anterior muscle.

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24. Beginning of Tibialis Anterior Taping 25. Taping of Tibialis Anterior with Movement
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26. Finished Tibialis Anterior Taping

Tibialis Posterior

For the tibialis posterior muscle kinesiology tape application, the athlete’s position was seated. The base of the kinesiology tape was applied to the base of the 5th metatarsal for added stabilization with no tension, as the ankle was in the plantar flexed and everted position. The tape was then rolled out with 25% stretch over the path of the tibialis posterior muscle along the medial border of the tibia just distal to the knee. While the tape was rolled out, the athlete moved the ankle into the plantar flexed and inverted position activating the tibialis posterior muscle.

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27. Beginning of Tibialis Posterior Taping 28. Taping of Tibialis Posterior with Movement
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29. Taping Tibialis Posterior with Movement 30. Finished Taping of Tibialis Posterior

 

Results:

Immediate Results Post Taping

16 out of 21 subjects were found to have muscle(s) demonstrating a 4/5 MMT. All 4/5 inhibited muscles that were taped demonstrated facilitation to a 5/5 MMT post taping. 4 out 21 subjects originally demonstrated a 5/5 MMT in all ankle muscles bilaterally. Post taping of posterior tibialis muscles bilaterally demonstrated to maintain a 5/5 MMT. Left and right non weight bearing ROM both resulted in a 0.58 P value post taping for a 5 degree decrease in ROM. Left weight bearing ROM resulted in a 0.66 P value and right weight bearing ROM resulted in a 0.68 P value for a 5 degree decrease in ROM. Left Shark skill test resulted in a 0.35 P value and right Shark skill test resulted in a 0.44 P value. Left squat knee angle assessment resulted in a 0.57 P value and the right squat angle assessment resulted in a 0.59 P value.

p-values-chart
31. Resulted P-Values From Performed Functional Tests After Tape Application

48-Hour Follow Up Post Taping

All 16 out of 21 subjects that originally demonstrated muscle(s) graded a 4/5 and that facilitated to 5/5 immediately post taping, demonstrated to maintain a 5/5 MMT 48 hours post taping. Left non-weight bearing ROM resulted in 0.62 P value and right non-weight bearing ROM resulted in a 0.65 P value. Left weight bearing ROM resulted in a 0.58 P value and right weight bearing ROM resulted in a 0.54 P value. Left Shark skill test resulted in a 0.31 P value and right Shark skill resulted in a 0.35 P value. Left squat angle assessment resulted in a 0.62 P value and the right squat angle assessment resulted in a 0.60 P value.

p-values-chart2
32. Resulted P-Values of Performed Functional Tests upon 48-hour Follow Up

Discussion:

In order to minimize any potential bias, we used a sample population that was near the same age range, activity level, and that performed similar movements through out the day and during their training. We also assessed our sample population at same time of day to limit daily activity variables. At no time during the study did any of the participants experience any discomfort or pain, either from the assessment, or from the taping application. Participants may have demonstrated a 4/5 MMT due to previous injury (not assessed), overuse injuries with no subjective measures (not assessed), and/or potential muscle imbalances due to compensation or improper biomechanics (not assessed).

The results of this study confirm that kinesiology taping did not decrease the subjects’ performance on any assessments. This agrees with the current literature on the topic of kinesiology taping.13 14 15

In the range of motion, shark skills test, and overhead functional squat assessment there was not a significant difference in the subjects’ performance before taping, after taping, and in the 48 hour follow up study. However, the athlete’s performance for these assessments were not diminished either.

The results for the MMT portion of the study were very significant. 16 of the 21 subjects demonstrated muscle(s) of 4/5 strength. All 16 of the subjects with muscle(s) of 4/5 strength, post taping demonstrated 5/5 strength of those muscle(s). During the 48-hour follow up assessment, all muscles that were taped demonstrated a maintained 5/5 strength with the MMT. The kinesiology tape, taped in the specific application as explained above to a muscle displaying a 4/5 MMT, demonstrated an increase in muscle tone and did not appear to have a negative effect subjectively or objectively in the surrounding musculature. This could prove to be a very effective technique to use for athlete rehabilitation and retraining of faulty firing patterns, as there were no negative effects from this taping technique.

4 out of the 21 subjects originally had all ankle muscles bilaterally test for 5/5 strength and tape was applied to the tibialis posterior muscle bilaterally to look for any change in the muscle facilitation. All of these subjects maintained 5/5 strength of the tibialis posterior muscle. This again demonstrates that the kinesiology tape did not provide a negative affect to muscles demonstrating 5/5 strength.

This effect can be explained by the elastic properties of kinesiology tape enhancing the function of muscle fibers and tendons. Myofascial units16 and muscle spindle fibers have the ability to act synergistically and antagonistically. Myofascial units are specialized mechanoreceptors at the musculotendinous junction. Ib afferent fibers are entangled within the myofascial unit and innervate it. The afferent fiber receptor depolarizes as weight and tension compresses the myofascial unit. This depolarization stimulates the Ib interneuron, which inhibits the corresponding alpha motor neuron that is normally stimulated by the neuromuscular spindle.17 Using kinesiology tape to decompress the weight on a myofascial unit by “lifting” the skin and affecting the fascia, may decrease depolarization of the Ib afferent fibers, decreasing stimulation of the Ib interneuron, allowing increased firing of the alpha motor neuron and facilitation of muscle fibers. Through these mechanisms by applying kinesiology tape (with tension) to a muscle, one can affect a muscle on a neurologic level. 18 One previous study found that kinesiology tape did not evoke this response, but was explained that their findings could be potentially due limited stretch of the tape used (120%). 19 Rocktape© kinesiology tape contains 180% stretch, which has been hypothesized to have a stronger effect on muscle tone and function. In this study, using kinesiology tape with a stronger adhesive and stretch has shown evidence in facilitation of muscles when they were specifically taped in the manor described above.

Two testers participated in this study, both certified in muscle testing through the International College of Applied Kinesiology. Both testers used the muscle testing technique from original work by Kendall and Kendall. When using a correct and specific technique, there are significantly less problems with inter-tester reliability.20

In further studies, it would be of interest to address hyper tonicity of muscles. Since the muscles are being facilitated, it would be important to note if the muscles are in a hypertonic or normotonic state while the tape is applied to the skin. Another issue to address would be how long the result of a 5/5 muscle lasts for. This study assessed muscle strength before taping, immediately after taping, and 48 hours later with the tape still applied to the skin. In further studies, one could examine subjects after the tape has been removed for muscle strength.

The results for non-weight bearing and weight bearing range of motion were not significant before and after taping. For some athletes the tape increased their range of motion. However, results for range of motion testing could be subjective for several reasons. In a further study for more accurate results, range of motion should be taken bilaterally 3 times and the scores averaged. This was not performed during this study in the interest of time, as the subjects were studied during their training hours. Results for ROM in the 48-hour follow up study were similar. The sample population used for the study may also have contributed to why statistical significance in range of motion was not observed. The sport of gymnastics requires extreme flexibility and potentially hypermobility. Because of this requirement, subjects may have already attained their maximal range of motion in the ankle mortise joint and were physically not able to gain further range of motion. The subject’s age may have been a factor as well. At such a young age, range of motion may be increased due to the natural occurrence of hypermobility in non-calcified joints. Again, the kinesiology tape did not significantly change ROM, however it did not negatively affect it either.

Results for the shark skills test were not statistically significant. No scores were necessarily diminished, and many of the subjects’ scores did improve, just not enough to show statistical significance. There is currently no normative baseline for the shark skills test. Therefore, in future studies there may be a better test, which could be used to assess muscular endurance. This test was solely used to measure the difference in endurance pre and post taping application. If scores improved, it could be implied that the tape helped with efficiency of muscle firing patterns, thus improving endurance. This improvement could also be due to the fact that for many of the subjects, it was their first time performing this assessment, so naturally each additional time the assessment is performed their score improved. In the 48 hour follow up many of the subjects scores also improved, however whether this improvement was due to the kinesiology tape or not remains unclear. It can be hypothesized that if the participants were re-taped every 48-72 hours, and were instructed to train with rehabilitation exercises for the ankle, that increased performance (decrease in time for the Sharks Skill Test) may be seen. A further study may be developed to explore this hypothesis.

Results from the overhead functional squat assessment were not statistically significant. It was noted to be rather difficult to get an accurate reading for measuring the angle of knee valgosity for the subject. In a further study it would be helpful to mark the points of interest on the subject before using the video analysis software. If the ASIS, patella, and talocrural joint were marked, one could expect a more accurate measure of knee valgosity. Also, in the interest of time these measurements were taken once before taping, after taping, and in the 48 hour follow up. For a more accurate reading it would be of interest to measure each knee angle 3 times and use the average of the 3 angles for assessment.

In future studies there are a few things to consider. When working with an athletic population, the subjects were very active over the 48 hours in whih the study took place. It is unclear at this time how that affected the outcome of the study, but one may note that the function of the kinesiology tape could have been affected as all of the subjects were training during the time of the study. As mentioned before, it would be of interest to look at the results from taping once the tape has been removed to see if the increase in muscle strength was sustained for a longer period of time without tape. This study addressed taping of individual muscles, however, one could examine other taping methods such as taping a functional movement instead of isolated muscles and that effect on specific assessments. Lastly, although for many assessments the results were not statistically significant, one could address feelings of confidence and stability. Other studies have demonstrated that even if the kinesiology tape does not change functional assessments, the subjects have increased sense of confidence, reassurance, and stability when tape is applied.21

Limits of this study include a small sample size (n=21) and a very specific population of young competitive gymnasts. While this was ideal to see how the kinesiology tape produced results in a specific population, it would be of interest to examine a larger sample size and population. Time was also a limitation, and an average of 3 assessments per type of assessment were not done. Having participants not be assessed during their training period may allow more time for multiple assessments.

Conclusion:

Kinesiology tape showed no statistical functional changes positive or negative for effects on ankle range of motion, endurance, or an overhead squat. It would be worthwhile to study long-term effects (2 weeks or more) of kinesiology taping of muscles and introduction of rehabilitation exercises, to increase performance and endurance. In addition, it would be of interest to study different brands of kinesiology tape, with different amounts of stretch, in order to assess just how important the amount of built-in stretch in the tape is to a positive outcome. Kinesiology tape did provide very significant results for muscle strength via the manual muscle test. This displays that the kinesiology tape does impact muscle strength and would be a valuable tool to use when assessing subject’s muscle imbalances and facilitating rehabilitation. This study offers valuable information in how the use of kinesiology taping can help facilitate neurologically inhibited muscles, thus helping to aide in correction of imbalance and dysfunction.

Acknowledments:

All kinesiology tape was provided by Rocktape©

1610 Dell Ave
Campbell, CA 95008
www.rocktape.com

Video Analysis software was provided by SparkMotion©

www.sparkmotion.com

Digital Goniometer used was manufactured by Baseline©

Funding sources and conflicts of interest:

All kinesiology tape was provided by Rocktape©. Video Analysis software was provided by SparkMotion©.

References:

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19 Tieh-Cheng Fu, Alice M.K. Wong, Yu-Cheng Pei, Katie P. Wu, Shih-Wei Chou, Yin-Chou Lin. “Effect of Kinesio taping on muscle strength in athletes – A pilot study.” Sports Medicine Australia doi:10.1016/j.jsams.2007.02.011
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