Wednesday, August 20, 2008

Kinesiotape- part II, and some related thoughts on doping

A reader posted a follow-up question regarding my post on kinesiotape:

"Let's say I'm a perfectly healthy athlete who decides to put kinesiotape on my shoulder to help with proprioception during my tennis match against Lindsay Davenport. Would you say this is more equivalent to me (a) wearing an Ace bandage around my prone-to-spraining ankle, (b) wearing a sweatband to keep my hair, sweat, etc. out of my face, or (c) me taking steroids to help improve my performance? Or (d) none of the above. I guess my more general question is, could kinesiotape be used to give injured and/or non-injured users any kind of advantage (beyond the band-aid type functionality)?"


I'll address the specific question asked here at the end of this post.

As for the more general question, and it's a good one- how should we view the benefits of kinesiotape- is it within the realm of clothing, or should it be considered a form of doping. These types of questions are tricky to answer, but they are becoming more important in the realm of sports. Before I give an answer, I'll provide a few more examples of things like kinesiotape, that are things that athletic boards need to consider:

1. Carbon fiber or other alloys in athletic equipment (including obvious things like bikes and tennis racquets, but also less obvious things like the soles of athletic shoes, where it could augment the propulsion of runners)

2. Nutritional supplements

3. Sleeping chambers to simulate sleeping at altitude

4. Anabolic steroids

5. Birth control pills and corticosteroids- both are also forms of steroids, also with multiple systemic effects, including some significant side effects, and both which are sometimes prescribed for athletic performance. For example, birth control pills are sometimes prescribed to help with menstrual irregularities associated with the training from female endurance athletes. As another example, corticosteroids are amongst the most commonly prescribed drugs in athletes, such as in inhalers for asthmatics, or joint injections for joint pain. These are interventions that are not without significant risks.

6. Prosthetics for lost limb segments.

7. Caffeine

8. Water- this may seem obvious, but some sporting events used to ban water, and it does offer some performance advantage. Should this be banned?

9. Weight training

These are just a few examples. I think it is valuable, before making an arbitrary decision on whether to allow something like kinesiotape in recreational tennis matches or Olympic beach volleyball matches, to have a set of criteria by which that decision would be reached.

In my opinion, in order to ban an intervention, it should be meet both of the following criteria:

A. The intervention confers a definite performance advantage
B. The intervention causes a reasonable expectation of harm to the athlete who uses it

In my opinion, an intervention needs to meet both of these criteria for it to be banned. This discussion is explicity assuming that the reason to ban something is for the safety of the athlete (below, I will discuss other aesthetic considerations). To give a few examples:

1. Water. Water almost certainly meets critieria A (confers benefit), but doesn't meet criteria B (reasonable expectation of harm). Therefore, there is no need to ban it, since there is no significant harm in athletes using water. Athletes should use water. I would probably make a similar argument for caffeine.

2. Beer. Beer probably meets criteria B (reasonable expectation of harm), but it is unlikely to meet criteria A (confers benefit), so there is no reason to ban it, since athletes aren't going to use it anyway.

3. Cutting off your nose. I use this as a trivial example. Some may argue that for beer- "well, it's not likely to be beneficial, but since it can harm athletes, we want to ban it to protect the athletes." But it's not reasonable to ban everything that can harm athletes- the purpose of governing athletic bodies is to protect athletes within the context of their sport, not life in general. It may seem obvious that athletes shouldn't have to be reminded not to cut off their nose, but athletic bodies frequently ban interventions with no proven benefit, and in my opinion they are extending themselves into the personal lives of the athletes and no longer protecting the sport. As an example, I don't think regulatory agencies have any business regulating marijuana or alcohol consumption, since they are not directly related to athletic performance.

4. Cocaine. Cocaine probably does meet criteria A (it is a stimulant, and probably confers a performance advantage) and also meets criteria B (it has many well documented harmful side effects). This, to me, is the very kind of substance that should be banned- if it was not banned, athletes might feel a selective pressure to take cocaine in order to compete, and therefore put themselves in harms way.

Getting back to the initial question regarding kinesiotape- it is possible that it meets criteria A (offers a performance advantage), but it is highly unlikely that it meets criteria B (reasonably would expect harmful side effects), so I can see no reason to ban it for players, whether they are injured or otherwise.


The other reason for banning an intervention, beyond protecting the safety of the athletes (which is what I was really getting to above) is protecting the aesthetic and performance standards of the sport. There are certain equipment changes which have fundamentally altered the nature of their sports. These include:

1. Composite materials. Materials such as graphite, titanium, and carbon fiber have revolutionized sports like tennis, golf, and cycling. There is frequent discussion about whether these changes have ruined their sports. I think the difference is most striking in tennis, where the advent of new materials has probably been the dominant factor in the shift from serve-and-volley to power baseline as the dominant playing styles. I happen to like this shift, but some people hate it.

2. Aerodynamics/hydrodynamics. Examples include aerobars and disk wheels in cyling and the much-talked about LAZR swimsuit from Speedo have played large roles in rewriting the record books.

3. Altered techniques. Probably the best examples I can think of are the Fosbury Flop in high-jumping (the technique of going over backwards, developed by Dick Fosbury) and the Berkoff Blastoff in swimming (David Berkoff would swim nearly the entire lap of backstroke underwater using a dolphin kick. This has since been banned- an example of outlawing a technique to preserve the aesthetic of a sport, even if the new technique is faster).

As an aside, the concept of altered techniques altering a sport became very apparent to me in my marginal high school swimming career. When I was in high school, one of my teammates was a guy named Keith Rizzi. We came up swimming together in youth programs, and while he was always good when we were younger, he didn't become truly outstanding until late in our high school careers.

I think two things occured during our junior year that led to rapid improvements. The first factor was puberty, which is always a difference maker in high school sports. The second is that when we were juniors, they made a seemingly small change in the rule for backstroke flip turns, allowing what was called the cross-over turn. Until our sophomore year, it used to be required that a swimmer touched the wall while still on their back before starting their turn. They changed the rule to allow a "cross-over" turn, where the swimmer was allowed to flip onto their stomach for one stroke prior to initiating their turn. This allowed the swimmer to gain momentum from twisting from their back onto their stomachs and use that to propel their turns, which was faster for everybody.

However, Keith Rizzi was better at this turn than anybody else, and it made him unbeatable. Furthermore, he was able to use the technique he refined on his turns in backstroke and use that on his freestyle flip turns, and he became unbeatable in freestyle sprints as well. This made a big impression on me as a young swimmer, because I was overwhelmed with how a seemingly small change in a rule could make such a large impact in the outcome of the race. I think about this often when assessing the biomechanics of athletes or my patients- small changes in movement can make dramatic changes in outcome.

4. Altered equipment. Sometimes equipment dramatically alters. Examples include shapes of the modern putter in golf. Another example, which hasn't particuarly caught on, is two-handed tennis racquets.


So, should kinesiotape be banned from volleyball, tennis, or other sports for aesthetic grounds?

In my personal opinion, no.

Beach volleyball and tennis, though, provide interesting counterpoints to the extent to which they regulate their aesthetics. Beach volleyball promotes the aesthetics of their athletes more avidly than any other sport. Tennis, particuarly the women's game, probably goes more out of their way to downplay the aesthetics of their athletes than any other game. It wouldn't surprise me if tennis outlawed kinesiotape because they found it "off-putting." At the very least, I would imagine that at Wimbledon players would have to make sure their kinesiotape was white.

Anyway, let me get back to directly answering the readers original question. I would consider using kinesiotape most equivalent to using an ACE bandage on your prone-to-spraining ankle. And I still don't think you'd have any chance of beating Lindsay Davenport.


Anonymous said...

I may not be able to beat Lindsay, but I could at least beat Julie Coin (#188)>

Gary P. Chimes, MD, PhD said...

Yeah- Ana's been playing pretty awful since the French Open. At least my Safina pick is looking ok right now.