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Accepted Manuscript
The Effect of Kinesio Tape Application on Hamstring and Gastrocnemius Muscles inHealthy Young Adults
Dedi Lumbroso, BPT Elad Ziv, BPT Elisha Vered, BPT, Med Leonid Kalichman, PT,PhD
PII: S1360-8592(13)00137-X
DOI: 10.1016/j.jbmt.2013.09.011
Reference: YJBMT 1055
To appear in: Journal of Bodywork & Movement Therapies
Received Date: 1 July 2013
Revised Date: 28 August 2013
Accepted Date: 18 September 2013
Please cite this article as: Lumbroso, D., Ziv, E., Vered, E., Kalichman, L., The Effect of Kinesio TapeApplication on Hamstring and Gastrocnemius Muscles in Healthy Young Adults, Journal of Bodywork &Movement Therapies (2013), doi: 10.1016/j.jbmt.2013.09.011.
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The Effect of Kinesio Tape Application on Hamstring and Gastrocnemius Muscles
in Healthy Young Adults
Dedi Lumbroso, BPT, Elad Ziv, BPT, Elisha Vered, BPT, Med,
Leonid Kalichman, PT, PhD*
Physical Therapy Department, Recanati School for Community Health Professions,
Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
*Corresponding author: Leonid Kalichman, PhD, Department of Physical Therapy,
Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-
Gurion University of the Negev, P.O.B. 653, Beer Sheva, 84105, Israel.
Tel.: 972-52-2767050, Fax: 972-8-6477683; e-mail: [email protected] ,
[email protected] .
There are no conflicts of interest.
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SUMMARY
Background: Scarce evidence exists about effectiveness and mechanisms of action of
Kinesio tape (KT) application.
Objectives: To evaluate the effect of KT application over the gastrocnemius or
hamstring on range of motion and peak force.
Methods: Thirty-six physical therapy students participated (18 per group). KT was
applied with 30% tension for 48 hours to: Group 1- the gastrocnemius; Group 2- the
hamstrings. The straight leg raise (SLR), knee extension angle (KEA), weight bearing
ankle dorsiflexion, gastrocnemius, quadriceps and hamstrings peak forces were
evaluated prior to application, 15 minutes and 48 hours after.
Results and conclusions: A significant increase of peak force in the gastrocnemius
group appeared immediately and two days later; no immediate change of peak force in
the hamstrings group, however, two days later, peak force significantly increased. SLR
and ankle dorsiflexion increased immediately in the gastrocnemius group; KEA
improved significantly only after two days. It is possible that certain muscles react
differently when KT is applied, and the effect may be subsequently detected.
KEYWORDS
Kinesio tape
Physiotherapy techniques
Range of motion
Muscle strength
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INTRODUCTION
For the past 30 years, Kinesio tape (KT), an elastic tape, has gained in popularity (Huang
et al. 2011). KT is comprised of a polymer elastic strand warped by 100% cotton fibers
and designed to allow a longitudinal stretch of 55-60% of its resting length. Its thickness
is approximately the same as the epidermis of the skin (Kase et al. 2003). Kinesio taping
has been suggested for corrections of soft tissue movement, fascia and muscle relaxation,
ligament and tendon support, movement rectification and lymphatic fluid circulation
(Huang et al. 2011). It is currently regarded by physiotherapists as a supportive method of
rehabilitation that modify certain physiological processes, such as improving muscle
elasticity and strength (Slupik et al. 2007).
In recent years the use of KT has been exponentially growing. One of the factors
that facilitate the popularity of KT is its wide use by elite athletes during various world
championships and Olympic Games. Although KT is widely used, scarce evidence exists
as to its effectiveness and mechanisms of action. Numerous studies have evaluated the
effect of KT on sports injuries (Akbas et al. 2011; Chang et al. 2010; Williams et al.
2012), pain reduction (Castro-Sanchez et al. 2012; Chang et al. 2012; Chen et al. 2012;
Gonzalez-Iglesias et al. 2009; Kalichman et al. 2010; Kaya et al. 2011; Koss and Munz
2010; Krajczy et al. 2012; Lee et al. 2012; Martín-Sánchez and Yuste-Rodríguez 2012;
Paoloni et al. 2011; Thelen et al. 2008), range of motion (ROM) change (An et al. 2012),
and muscle force (Callegari et al. 2012; Chang et al. 2012; Fratocchi et al. 2012a; Lee et
al. 2012; Vercelli et al. 2012). However, the results were contradictory. Additional studies
are warranted to corroborate this method.
Hamstring muscles play a crucial role in the performance of many daily activities,
such as walking, running, jumping and controlling movement of the trunk. During the gait
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cycle, the hamstrings mainly assist in stabilizing and generating movement in the knee.
During running, a faster contraction is needed for shock absorption and leg deceleration
(Yu et al. 2008). Research has shown that the hamstring muscles elongate by 50%-90%
during a gait cycle (Chumanov et al. 2011). The hamstring's lack of flexibility is one of
the risk factors of muscle stretch injuries (Cross and Worrell 1999; Hartig and Henderson
1999). Stretching injuries of the hamstrings are the most common injuries among athletes,
comprising 11% of all lower limb injuries and often causing significant loss of activity
(Orchard and Seward 2002). Moreover, a direct relationship was found between the lack
of flexibility in the hamstrings and low back pain (Li et al. 1996; Tafazzoli and
Lamontagne 1996).
The triceps surae (gastrocnemius and soleus) accounts for approximately 80-
90% of plantar flexion strength, with the gastrocnemius contributing about 40-43%
(Chimera et al. 2010). Gastrocnemius contracture limits the ankle ROM and may
decrease the strength of the triceps surae, which may affect walking (Chimera et al.
2010). The gastrocnemius is considered at high risk for strains since it crosses two joints
(the knee and ankle) and has a high density of type two fast twitch muscle fibers (Bryan
Dixon 2009). Injury to the gastrocnemius muscle is among the more common injuries
occurring in the lower leg (12%) (Armfield et al. 2006).
According to recent anatomical studies, myofascial continuity exists between the
gastrocnemius and the hamstrings (Myers 2008; Tuncay et al. 2007). Strain, increased
tension in one of the muscles, trauma, scar or other restrictions to the fascial glide could
cause movement restriction or decrease in strength in the structures along the fascial
continuity line. We hypothesized that KT, applied over the gastrocnemius muscle,
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would increase hamstring muscle strength, as well as ROM of adjacent joints through
the fascial connections between these muscles.
Only two studies have specifically evaluated the effect of KT application on
hamstrings (Merino-Marban et al. 2011; Merino et al. 2010) and one has evaluated the
effect on gastrocnemius (Huang et al. 2011). Considering the importance of these
muscles in sport and musculoskeletal medicine, the aim of the present study was to
evaluate the effect of the KT application on hamstrings and the gastrocnemius in terms
of hip, knee and ankle ROM and quadriceps, hamstrings and gastrocnemius strength.
METHODS
Design
Quasi-experimental, repeated measures study.
Setting
The study was performed at the Department of Physical Therapy, Recanati School for
Community Health Professions, Faculty of Health Sciences, Ben Gurion University of
the Negev, Beer Sheva, Israel.
Subjects
Subjects were recruited through announcements publicizing the aims and
inclusion/exclusion criteria of the study. Two groups of 18 apparently healthy students
volunteered. The study was approved by the Institutional Review Board of the Recanati
School for Community Health Professions.
Inclusion criteria
1. Ages 18-35.
2. Healthy.
3. Average or pure score of the Trunk Flexibility Test (unable to touch the floor
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with knees fully extended).
Exclusion criteria
1. Pregnancy.
2. Pelvis or lower limb surgery during the last 6 months.
3. History of trauma or injury of the hamstrings/triceps surae, knee or ankle.
4. Skin disease or self-reported hypersensitivity to tape (including scar tissue in the
acute phase).
5. Any current treatment or physical activity aimed at improving flexibility of the
lower limbs during the research period.
General procedure
All subjects received a detailed description of intended research and signed an
informed consent form. Subjects were then screened for inclusion-exclusion criteria and
performed the trunk flexibility test to ascertain suitability for inclusion. All volunteers
were found suitable. Basic demographic data were collected using a self-administered
questionnaire. Outcome measure tests were performed three times on each subject
(evaluations E1-E3). The first baseline evaluation (E1) took place during the initial
meeting, after confirmation of suitability. Immediately after performing the
E1evaluation, the KT was applied to the testing leg. Fifteen minutes later (time for
tape’s adhesive to be activated) the second evaluation (E2) was performed. Forty-eight
hours after applying the KT, the third evaluation (E3) was performed. Before each
evaluation, subjects performed standardized five minutes of warm-up walking to pre-
condition the lower extremity muscles. One tester performed all evaluations on the
gastrocnemius group and another on the hamstring group. Both testers were trained in
evaluations methods. At each evaluation, the tester was blinded to the outcomes of
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previous evaluations.
The gastrocnemius group consisted of subjects in whom KT was applied to the
gastrocnemius muscle. The following measurements were performed: passive SLR,
knee extension angle test (KEA), weight bearing ankle dorsiflexion measurement,
gastrocnemius peak force test and hamstring peak force test performed on the knee at a
90° and 45° flexion.
The hamstring group consisted of subjects in whom KT was applied to the
hamstring muscles. The following measurements were performed: passive SLR; knee
extension angle test (KEA); hamstring peak force test performed on the knee at 90° and
45° flexion; and the quadriceps peak force test performed on the knee at 90° and 45°
flexion.
In both groups, ROM measurements were performed prior to the strength
measurements. In peak force measurements, three trials were conducted for each subject
and the mean value of the three trials was recorded for analysis.
KT application
KT application was performed by senior class physical therapy students (DL and
EZ), who had received special training by an experienced certified instructor of the KT
method (EV). After the initial training, the researchers developed a detailed protocol of
KT applications. Then, using this protocol, the KT was applied by each student onto
both legs of five volunteers (10 applications) who were not part of the study sample.
These applications were supervised and if need be, corrected by a qualified instructor of
the KT method. The study began only after both students’ KT applications were
approved by instructor.
If the subject had substantial body hair, the area of application was shaved before
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applying the KT. Before applying the KT onto the gastrocnemius muscles, the subject
was asked to lie prone with the knee fully extended and feet hanging off the
examination table (Figure 1). The researcher then applied a strip of cotton non-elastic
sport tape (“white tape”) around the testing foot, just distal to the navicular tuberosity,
which helped anchor the KT. The subject's ankle was then held in full dorsiflexion and a
"Y strip" of KT was applied to the testing leg. The tape was applied from the “white”
tape anchor on the plantar surface of the foot to the insertion point of the Achilles
tendon. The medial "Y" tail was applied along the medial border of the gastrocnemius
and the lateral "Y" tail along the lateral border of the gastrocnemius with about 30 %
tension from resting length (distal to proximal). The end points were just above the
popliteal fold. Lastly, another strip of non-elastic white tape was applied around the
testing foot above the first white tape to complete anchoring of the KT. KT was applied
to one leg only.
In the hamstring group, the tape was applied to the subject in a standing position,
with trunk flexed in order to achieve initial hip flexion prior to tape application. The
researcher applied an “I” strip of KT from the ischial tuberosity to the lateral aspect of the
popliteal fossa on the lateral border of the hamstrings. A second “I” strip was placed from
the ischial tuberosity to the medial aspect of the popliteal fossa on the medial border of
the hamstrings (Figure 2). Tension of approximately 30% was applied to the tape during
application.
According to Dr. Kase (Kase et al. 2003), the inventor of the KT, distal-to-
proximal KT applications inhibit muscle function and proximal-to-distal applications
facilitate muscle function. A recent randomized-control trial (Vercelli et al. 2012)
comparing three different KT applications (distal to proximal, proximal to distal and
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sham) on the quadriceps muscles found no increase nor decrease in maximal muscle
strength compared to no taping. In our study, we chose the gastrocnemius application
with tension applied from distal to proximal, and the hamstring application with tension
applied from proximal to distal, since these applications are used most frequently.
Straight leg rising (SLR)
The subject lay supine on the examination table with both legs extended. The
non-testing leg was stabilized by strapping the upper thigh. The ankle of the tested leg
was stabilized in mid position by a gypsum splint. The subject was instructed to relax
his/her muscles, not to resist and to signal the tester to stop when the muscles stretch
became painful. The tester would then passively lift the testing leg by flexing the hip
joint and keeping the knee fully extended. The end of the available ROM was
determined by the subject’s tolerance to the stretch or by the tester who felt maximal
stretch resistance. At the end of the available ROM, the hip joint angle was measured
and recorded by the tester, who positioned the digital inclinometer on to the midpoint of
the tibia. Intra-tester reliability for this test was high (interclass correlation (ICC)>0.97)
(Davis et al. 2008).
Knee extension angle test (KEA)
The initial position and subject instructions were similar to the SLR test. While
the non-testing leg was strapped, the tester passively lifted the testing leg by flexing the
hip joint to a 90° flexion, knee freely flexed. The tester then positioned a digital
inclinometer on the anterior thigh just above the patella, asking the subject to grasp it.
While keeping a 90° flexion at the hip joint, the tester passively extended the testing
knee. The end of the available ROM was determined by the subject’s tolerance of the
stretch or by the tester who felt maximal stretch resistance. At the end of the available
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ROM, the tester positioned another digital inclinometer on the midpoint of the anterior
border of the tibia and recorded the KEA by subtracting the second inclinometer angle
from the first. Intra-tester reliability for this test was high (ICC>0.99) (Davis et al.
2008).
Weight bearing ankle dorsiflexion measurement
The subject was placed in a standing position with both hands on a wall in front
of him, positioning his testing leg behind the non-testing leg as far as possible. The
testing foot was positioned parallel to a line on the floor, perpendicular to the wall. The
subject then leaned forward until reaching a maximum stretch felt in the posterior area
of the testing leg, while keeping the testing knee fully extended and the testing heel in
contact with the ground. The non-testing leg remained in a comfortable position in order
to maintain balance and not restrict dorsiflexion of the testing ankle. Lastly, the tester
positioned the digital inclinometer on the midpoint of the anterior border of the tibia and
recorded the measurement (intra-tester reliability for this test was moderate to high: ICC
0.77-0.91)(Munteanu et al. 2009).
Quadriceps peak force evaluation
The subject sat on the side of the examination table with the tested knee in a 90°
flexion, strongly grasping the edge of the table for stability. The tester stood on the side of
tested legs and stabilized the hydraulic push dynamometer against the anterior aspect of
the inferior part of the tibia just above the malleoli. It was impossible for the tester to hold
a dynamometer against the quadriceps. The other side of the dynamometer was stabilized
by the wall of the room. The tester’s function was to hold the dynamometer at the correct
position and to give the instructions to the subject. The subject then pressed as hard as he
could on the dynamometer's pushing board, by extending his knee while gripping the bed
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to stabilize his body. The maximal peak force was then recorded. The same procedure was
executed again with the tested knee in a 45° flexion.
Gastrocnemius peak force evaluation
The examination table was placed between two walls with the headboard touching
one of the walls, thus stabilizing the table. The tester then placed a hydraulic push/pull
dynamometer (Baseline® hydraulic push/pull 500 lb. digital dynamometer) against the
other wall and stabilized it. The subject lay supine with both feet reaching over the
table. The testing leg was extended with maximal dorsiflexion of the ankle, while the
metatarsals heads were situated against the dynamometer's pushing board. The subject
then pushed the dynamometer pushing board as hard as he could, using the plantar
flexion of the ankle while grasping the bed to stabilize his body. Achieved maximal
force was recorded as gastrocnemius maximal peak force.
Hamstring peak force evaluation
The subject lay prone with the testing knee in a 90° flexion and stabilization
straps on pelvic and distal thigh. The tester stood on the testing leg side and placed the
hydraulic push dynamometer (microFET 2TM, Hoggan Health Industries, West Jordan,
UT, USA) against the superior aspect of the Achilles tendon just above the malleoli and
stabilized it. The subject then pushed the dynamometer’s pushing board as hard as
he/she could by flexing the knee while grasping the examination table to stabilize the
body. Achieved maximal force was recorded as hamstring 90° maximal peak force. The
same procedure was executed again with the testing knee in a 45° flexion. This method
showed excellent intra-tester reliability (Ferro 2011)
Data analysis
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Descriptive statistics were used to characterize the study sample. Repeated
measurement ANOVA had been used to compare the strength and ROM measurements
before, immediately after the KT application and two days later, still wearing the KT.
Statistical analyses were conducted at a 95% confidence level. A p-value <0.05 was
considered significant. To control for multiple comparison, the Bonferroni corrections
were performed.
RESULTS
Thirty-six individuals (18 in the hamstring and 18 in the gastrocnemius groups 21
females and 15 males) participated in the study (Table 1). Mean age in both sample
populations was 25.72±1.89 (range 22-29); and mean body mass index (BMI) was
21.73±2.10 (range 18.72-25.95). Nine individuals (25.00%) smoked and 22 (61.11%)
participated in regular physical activities (Table 1).
Mean values (±SE) of all measurements taken are presented in Table 2. For each
measurement and in both groups, follow up evaluations (E2and E3) were compared
(pairwise comparison in ANOVA) to the baseline evaluation (E1). P-values presented in
the Table 2 are Bonferroni corrected.
In the gastrocnemius group, SLR (p=0.006) and ankle dorsiflexion ROM
(p=0.006) measurements increased significantly 15 minutes after the KT application.
This effect became insignificant after two days of wearing the KT. In addition, at E3
KEA ROM significantly increased (p=0.003). An increase in ROM at each studied joint
was approximately 3°. In muscle peak force evaluations, only the gastrocnemius
showed a significant increase in force (p=0.032) 15 minutes after applying the KT.
However, two days after wearing the KT, both gastrocnemius and hamstrings (in a 45○
flexion) showed a significant force increase (p-values <0.001 and 0.028,
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correspondingly). The peak force increase of the gastrocnemius muscle ranged between
46 Newton 15 minutes after applying the KT to 137 Newton after two days of wearing
the tape. Increase of peak force in the hamstrings, at 90° and 45°, was less prominent
(between 12 and 20 Newton, respectively), after two days of wearing the tape.
In the hamstrings group, SLR significantly increased 15 minutes after KT
application (p=0.025) with the effect becoming insignificant after two days of wearing
KT (p=0.139). Total increase measured in SLR ROM was approximately 4.7°. KEA did
not change significantly at E2 an E3. Muscle peak force evaluation showed no
significant increase of hamstring force, at a 90° (p=1.000) and at a 45° flexion
(p=0.195) 15 minutes after KT application. However, two days after wearing the KT, a
significant increase in force (p=0.050 and p=0.010, correspondingly) was found in both
measured angles. Quadriceps showed no change in muscle force in all tests (Table 2).
DISCUSSION
Research studies investigating the effects of KT are scarce. Most studies
concentrate on KT’s effect on pain and other symptoms, or the uses of KT for treatment
of certain clinical conditions (Akbas et al. 2011; Gonzalez-Iglesias et al. 2009; Hwang-
Bo and Lee 2011; Kalichman et al. 2010; Kaya et al. ; Kaya et al. 2011; Saavedra-
Hernandez et al. 2012; Thelen et al. 2008). We believe that it is essential to understand
the effect of KT on the musculoskeletal system in normal in addition to pathological
conditions, in order to perfect the application of KT in the clinic. If the KT application
can influence the strength or flexibility of the healthy muscle, it can be used in cases of
muscular imbalance which is important in the treatment and prevention of
musculoskeletal pathology
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Evidence of KT’s effect on muscle strength is controversial. A recent, meta-
analysis (Williams et al. 2012) found that 7 out of 10 studies showed a beneficial effect of
KT application on muscle strength. Nevertheless, in three isokinetic studies, no significant
effect on muscle strength was found when KT was applied to the quadriceps of healthy
subjects (Fu et al. 2008; Lins et al. 2012; Vercelli et al. 2012). On the other hand, in a
recent study of healthy participants investigating KT application on the biceps brachii
(Fratocchi et al. 2012b), concentric elbow peak torque significantly increased even when
compared to placebo taping.
The results of our study on the effect of KT application on muscle peak force
can be divided into two parts: where KT was applied over the studied muscle and where
KT was applied over the body segment adjacent to evaluated muscles. KT application
over the gastrocnemius caused a significant immediate increase of its peak force. This is
in accord with Huang et al (Huang et al. 2011) who found that KT applied to the
gastrocnemius muscle immediately increased vertical ground reaction forces and EMG
activity of the gastrocnemius while performing a vertical jump. In addition, the results
of our study indicate for the first time, that the effects on muscle force increased two
days after wearing KT. KT application over the hamstrings did not cause an immediate
change of its peak force, in accord with Merino et al (Merino-Marban et al. 2011).
However, after two days of wearing KT, hamstring peak force significantly increased.
This effect should be replicated in other studies.
KT application on the gastrocnemius significantly increased hamstring peak
force (after two days of wearing KT). This increase in force can probably be explained
by the fascial connections between the gastrocnemius and hamstring muscles (Myers
2008; Tuncay et al. 2007).
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On the other hand, KT application on the hamstrings did not change the peak
force of the quadriceps. There are two possible explanations: 1) KT application does not
change the force of quadriceps; 2) KT application on the antagonist muscle does not
change the force of the muscle.
The majority of studies have evaluated only the immediate effect of kinesio
taping rather than later effects (Briem et al. 2011; Fratocchi et al. 2012a; Gonzalez-
Iglesias et al. 2009; Lins et al. 2013; Vercelli et al. 2012; Yoshida and Kahanov 2007).
Slupik et al (Slupik et al. 2007) found similar results, 24 and 72 hours, after applying
the KT on the vastus medialis of healthy subjects, which significantly increased
recruitment of the muscle's motor units. In our study, hamstring peak force showed a
tendency (non-significant) towards improvement immediately following KT
application, however, measured peak force significantly improved only after two days
of wearing the KT. Similarly, when KT was applied on the gastrocnemius, the change in
the peak force of the hamstrings was significant only after two days of wearing KT. On
the other hand, the significant effect of KT on gastrocnemius force was immediate and
also additional improvement was demonstrated after two days of wearing KT. It is
possible that different muscles react differently on KT application. This point should be
tested in a future studies.
Very few trials examining KT include ROM as an outcome measure. Two trials
[10, 18] involved pain-free ROM in an acute whiplash injury and shoulder pain,
respectively. Both trials found increasing ROM after applying the KT. Akbaz et al (Akbas
et al. 2011) evaluated the effects after applying additional KT versus exercise along in
treating patello-femoral pain, and found a faster improvement in hamstring flexibility.
However, the increase of ROM in patients with musculoskeletal morbidity can potentially
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be attributed to a pain relieving effect of the KT application. The circumstances differ
when healthy subjects are studied. Yoshida et al (Yoshida and Kahanov 2007), in a study
of 30 healthy subjects, found that when applying KT over the lower trunk, an increase in
active lower trunk flexion ROM may occur. Nelson et al. (Nelson 2011) in a study of 40
asymptomatic trained amateur cyclists found that the KT application above the rectus
femoris significantly increased knee flexion. A small number of studies have evaluated
the effect of KT application on the hamstrings (Merino-Marban et al. 2011; Merino et al.
2010). Merino et al (Merino et al. 2010) in a pilot study of 10 healthy triathletes found
that KT application on hamstrings and low back immediately, significantly improved
flexibility measured in the sit-and-reach test. However, in another study performed by the
same authors (Merino-Marban et al. 2011) on 43 healthy university students, no
difference was found in hamstring flexibility between no taping, immediately after
application of sham or active KT application. However, this study had several
methodological weaknesses. First, a manual goniometer, previously found to be an
unreliable tool for measuring hip flexion (Nussbaumer et al. 2010) was used to evaluate
the SLR angle. Second, during the SLR test, the pelvis was stabilized by a clinician not by
a strap, which may have caused variation in hip stabilization.
In our study, a significant increase in ROM was found in all measurements. The
SLR significantly increased immediately after the KT application on hamstrings or the
gastrocnemius. Similarly, ankle dorsiflexion significantly increased immediately after
the KT application on the gastrocnemius. These changes became insignificant after two
days of wearing the KT, not because of the change in the mean value, but because of the
high variance. Some insignificant improvement in KEA was seen immediately after KT
application on the gastrocnemius, but it became significant only after two days of
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wearing the KT. The mean ROM increase at the studied joint varied between 3.01° and
4.23°. However, there were seven subjects (19.4%) in whom SLR increased more than
10°. On the other hand, in some subjects, KT application did not change SLR or even
slightly decreased it. The clinical meaning of these findings is still uncertain and future
studies should examine its clinical impact.
One of the possible explanations accounting for the effect of KT application on
muscular peak force and ROM, found in our study and on force sense found by others
(Chang et al. 2010; Chang et al. 2012), is that the KTs provides continuous tension to
the skin, and thereafter to superficial and through skin ligaments, on deep fascia.
Recently, investigations have demonstrated myofascial continuity and force transferee
from muscle to muscle (Stecco et al. 2009; Turrina et al. 2013). In addition, it was
shown that approximately 30% of muscle fibers inserted in the fascia envelope the
muscle and inter-muscular septa (Stecco et al. 2007). The hypothesis that the effect of
KT is due to fascial unloading has been proposed and advocated (O’Sullivan and Bird
2011). In addition, KT has been shown to effectively treat plantar fasciitis (Tsai et al.
2010) and meralgia paresthetica (Kalichman et al. 2010). In both studies the effect, most
probably, can be attributed to fascial unloading. How the different changes in fascial
tension (e.g. amount and direction of tension) influence muscle strength and elasticity
should be established in future studies. It is also possible that different muscles (uni- vs.
bi-articular, tonic vs. phasic, etc.) will react differently to the change of fascial tension
by the KT application.
There were a few study limitations. Firstly, there was no comparison with a
sham taping. Therefore, part of the increase in muscle force and ROM at the follow up
evaluations (E2 or E3) can be due to a placebo effect. Second, the order of evaluations
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was not random; therefore, at least part of the effect can be attributed to a motor
learning of the task, so called “testing effect”. However, if the change in peak force and
ROM was attributed only to a placebo effect, we would most probably see more
significant improvements the in quadriceps force or in KEA ROM; if the change was
attributed only to “testing effect”, we would expect, for example, the more significant
increase in SLR and ankle dorsiflexion at E3. In addition, the researchers who
performed the outcome tests were not blinded to presence/absence of KT or to
evaluation order. Absence of blinding may potentially cause an expectancy bias, where
the researchers’ expectations/beliefs cause them to unconsciously influence the
participants . Although we tried to design the tests as objective and uniform as possible,
there was a risk of measurement bias.
CONCLUSIONS
In study, we found that KT application on the gastrocnemius caused a significant
increase of its peak force immediately and after two days of wearing the KT. KT
application over the hamstrings or gastrocnemius, did not cause an immediate change of
hamstring peak force, however, after two days of wearing KT, hamstring peak force,
significantly increased.
A significant increase in ROM was found in all measurements. SLR and ankle
dorsiflexion significantly increased immediately after application of KT, but KEA
improved significantly only after two days of wearing KT on the gastrocnemius. It is
possible that different muscles react differently when KT is applied; and on occasion,
the effect of KT application is detected only after some time.
Additional studies should be conducted to evaluate the effect of KT application on
the ROM and muscle force. The design of these studies should include sham taping
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application and randomization of KT application order. The subjects should wear
clothes above the area of KT application. This way the assessor will be blinded to the
presence or absence of KT or its application.
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Acknowledgements
The authors thank Mrs Phyllis Curchack Kornspan for her editorial services.
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Table 1 Descriptive statistics
Gastrocnemius group
(N=18)
Hamstrings
group (N=18)
Variables
Mean± SD Mean± SD
Age 25.56±2.09 25.89±1.71
BMI 21.68±1.93 21.77±2.31
N (%) N (%)
Sex (females) 12 (66.7%) 9 (50.0%)
Smoking 4 (22.2%)
5 (27.8%)
Regular physical activity 10 (55.6%) 12 (66.7%)
SD: standard deviation; BMI: body mass index
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Table 2 Comparison (ANOVA) of range of motion (ROM) and muscle strength parameters (Bonferroni corrected).
Hamstrings group (Mean ± SE) Gastrocnemius group(Mean ± SE) Measurements
Baseline (E1) E2 E3 Baseline (E1) E2 E3
SLR 62.82°±2.58 66.21°±2.46
p=0.025
66.32°±2.49
p=0.139
63.10°±2.50 66.12°±2.68
p=0.006
66.11°±3.10
p=0.108
KEA 39.68°±2.75 36.98°±1.96
p=0.656
35.22°±1.50
p=0.109
39.84°±2.22 36.90°±1.94
p=0.202
35.17°±2.37
p=0.003
Range of motion
(ROM)
Ankle
dorsiflexion
- - - 41.08°±1.85 44.52°±1.81
p=0.006
44.34°±2.01
p=0.057
Quadriceps
45° (N)
350.97±28.44 373.87±32.50
p=0.294
375.07±28.79
p=0.416
- - -
Quadriceps
90° (N)
435.35±36.74 448.59±34.87
p=1.000
456.20±37.87
p=0.587
- - -
Muscle strength
Hamstrings
45°(N)
227.97±21.70 243.18±24.18
p=0.195
250.19±22.02
p=0.010
216.06±20.99
219.84±18.86
1.000
237.32±20.16
0.028
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Hamstrings
90°(N)
181.81±15.82 180.87±14.06
p=1.000
204.79±19.10
p=0.050
173.54±17.64 179.82±17.72
0.802
185.63±15.85
0.193
Gastrocnemius (N) - - - 461.46±42.52 509.49±42.75
0.032
600.93±32.84
0.000
SLR: straight leg raising; KEA: knee extension angle; SE: standard error; E: evaluation
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Captions to illustrations
Figure 1. Kinesio tape application on the hamstrings.
Figure 2. Kinesio tape application on the gastrocnemius.
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