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Abstract

BACKGROUND:

Kinesio Tape (KT) is one of the most common taping methods used to prevent injuries, rehabilitate injured athletes, and improve muscle performance. But there are no studies investigating the acute effect of reverse taping on the isokinetic muscle strength.

OBJECTIVE:

To investigate the effects of KT applied to quadriceps (Q) and hamstring (H) muscles on knee extension (Ex) and flexion (Flx) strength, H/Q ratio, and fatigue index (FI).

METHODS:

In total, 17 healthy male subjects with a history of regular physical activity for at least 3 years participated in the study voluntarily. The muscle facilitation and muscle inhibition techniques of KT were applied in reverse direction to the Q and H muscles, and concentric/concentric isokinetic Ex and Flx strengths of the knee were measured at 60, 180, and 240 ${}^{\circ}$ /s. Isokinetic Ex and Flx strengths were measured without any application of KT, in trial 1 (T1). In trial 2 (T2), muscle facilitation was applied to Q, and muscle inhibition was applied to H. In trial 3 (T3), muscle facilitation was applied to H, and muscle inhibition was applied to Q. A body analyzer was used for height, weight, and body mass index (BMI) values.

RESULTS:

As for the strength, T2 showed higher scores compared to T1 and T3 at all angular velocities ( $P<$ 0.05). The values of the H/Q ratio at T2 were higher than at T1 at 180 and 240 ${}^{\circ}$ /s ( $P<$ 0.05). No significant difference was found in the mean FI values between the trials at any of the test velocities.

CONCLUSIONS:

Simultaneous facilitation and inhibition, applied to Q and H, respectively, had a positive effect on both the Ex and Flx strengths and also on H/Q ratio at high angular velocities (180 ${}^{\circ}$ and 240 ${}^{\circ}$ ) in healthy individuals. The mechanism responsible for this improvement is probably associated with creating different tensions in Q and H muscle groups by the reverse application of KT.

Keywords

Isokinetic knee strength Kinesio Tape reverse taping H/Q ratio

1. Introduction

Kinesio Tape (KT), developed by Kase in 1973, is one of the most common taping methods used to prevent sports injuries, rehabilitate injured athletes, and improve muscle performance [37, 43]. Currently, KT is being intensively used by athletes, physiotherapists, and researchers, and researchers have shown that KT affects the inflammation by increasing blood and lymph circulation, and thereby, stimulates movement through intense contraction in the muscle, reduces pain via decreasing the pressure on subcutaneous nociceptors, and facilitates movement in joint and muscle functions by muscle alignment and activation methods [14, 28, 42, 48]. KT has a structure that can have a high degree of tension (up to 50%–75% of its original length) based on the contraction and direction of movement of the muscle group to which it is applied, and two types of applications of KT techniques have been reported for its effect on muscle strength [22, 39]. One of these is the “muscle facilitation” technique, which is applied to the insertion of the muscle from its origin with a KT tension of 50%–75%, increasing the contraction of the muscle. Second is the “muscle inhibition” technique, which is applied to the origin of the muscle from its insertion with a KT tension of 15–25%, decreasing the contraction of the muscle. Although researchers have studied the effects of KT on muscle strength and endurance with different muscle and experimental groups [3, 19, 30, 31, 32, 39, 41, 46, 48], there is still no consensus on whether KT has positive effects in terms of performance [48]. This has led to a lack of clear scientific consensus.

Recently, different applications of KT to Q and H muscle groups have been reported [10, 14, 28, 30, 31, 37, 43, 46]. It emerges that in spite of a large number of studies dealing with the acute and chronic effects of KT on Q and H using different taping methods [14, 36, 43, 48], there are no studies investigating the acute effect of reverse taping on the isokinetic strength of these muscles.

Thus the aim of our study was to investigate the effects of KT facilitation and inhibition techniques applied to the vastus medialis (VM) and biceps femoris (BF) and semimembranosus (SM) on the isokinetic knee strength, H/Q ratio, and fatigue index (FI). It was hypothesized that the facilitation method applied to Q and H muscles would positively affect isokinetic knee strength, and the inhibition technique applied to the antagonist of the muscle to which facilitation was applied would increase the strength of these muscle groups.

2. Method

2.1 Subjects

In total, 17 healthy male subjects (mean age, 20.47 years; mean height, 1.77 m; and mean weight, 75.35 kg) with a history of regular physical activity for at least 3 years participated in the study voluntarily. Inclusion criteria were regular physical activity for at least 3 years and no previous knee injuries.

Table 1
Descriptive parameters of subjects ( $N=$ 17)

	Minimum	Maximum	Mean	Std. deviation
Age (years)	19.00	24.00	20.47	1.18
Height (m)	1.67	1.83	1.77	0.05
Weight (kg)	62.00	92.00	75.35	6.84

2.2 Procedure

This study was designed as a randomized controlled cross-experimental trial. With this design, the effect of KT on isokinetic knee extension (Ex) and flexion (Flx) strength was investigated by muscle facilitation and muscle inhibition techniques via reverse taping. The effect of KT on H/Q ratios was also investigated through the peak moments obtained. Subjects visited the laboratory four times at 24-hour intervals.

During the first visit, the aim of the study was explained to all subjects, subjects were informed about the test protocols to be applied, and the written informed consent was obtained from all subjects. Height, weight, and body mass index (BMI) measurements were obtained, and then pilot trial was performed on all subjects to measure knee Ex and Flx strength at concentric/concentric contraction at specific angular velocities (60 ${}^{\circ}$ sec ${}^{-1}$ , 180 ${}^{\circ}$ sec ${}^{-1}$ , and 240 ${}^{\circ}$ sec ${}^{-1}$ ) on the isokinetic dynamometer. During the second visit, the isokinetic knee Ex and Flx strengths were measured without any application of KT [trial 1 (T1)]. During the third and fourth visits, the patients were randomly divided into two groups and received two different applications of KT [trial 2 (T2) and trial 3 (T3)], and then isokinetic test was applied. In T2, muscle facilitation was applied on the VM muscle, muscle inhibition was applied on the BF and SM muscles via KT, and the isokinetic knee Ex and Flx strengths were measured at the designated velocities. In T3, muscle inhibition was applied on the VM muscle, muscle facilitation was applied on the BF and SM muscles via KT, and the isokinetic knee Ex and Flx strengths were measured likewise. A general warm-up was performed before the isokinetic tests. The subjects were warned not to perform any exercise or physical activity during the trials. Trials were performed at the same time of the day (14:00–16:00). The present study was designed and implemented in accordance with the Declaration of Helsinki [44].

2.2.1 Warm-up procedure

Before the tests, the subjects undertook 5 minutes of low intensity aerobic run and 10 minutes of dynamic and static stretching of lower extremity muscles for general warm-up [2].

2.2.2 Determination of descriptive information

A Gaia 359 Plus Body Pass analyzer was used to record the height, weight, and BMI parameters of the subjects. Before the measurements, the device was introduced to all the subjects and they were asked to stay as quiet and as immobile as possible during the test. An individual demonstrated the test with the analyzer to help the subjects understand it. The subjects stood on the analyzer with bare feet, wearing a t-shirt and shorts, and their height (cm), weight (kg), and BMI (kg/m ${}^{2}$ ) values were recorded.

2.2.3 Determination of isokinetic knee strength

Isokinetic knee strength was determined via peak moment parameter [26, 35]. Before isokinetic knee strength, isokinetic dynamometer was calibrated as advised by CSMI (2003). Subject’s moments for knee extension and flexion were determined as 60 ${}^{\circ}$ sec ${}^{-1}$ , 180 ${}^{\circ}$ sec ${}^{-1}$ , and 240 ${}^{\circ}$ sec ${}^{-1}$ . The tests were conducted with computer controlled isokinetic dynamometer (Humac Norm Testing and Rehabilitation System, CSMI, USA).

Subjects were asked to exert five maximum efforts and the highest values displayed per angular speed were accepted as peak moment values. To protect them from injuries, three practice repetitions of all angular speeds were made before the test, and the test was started after 30 seconds of rest. Each subject was informed about basic push/pull and the number of remaining repetitions, and received loud verbal encouragement were given continuously to help the peak moment (PM) values of the subjects to be the highest level during testing [9]. At all angular speeds, PM values were recorded in Newton meter (Nm).

2.2.4 Application of KT

In order to investigate the effects of the muscle facilitation and muscle inhibition techniques of KT on isokinetic knee Ex and Flx strengths, two different taping methods were applied and isokinetic knee strengths were measured immediately after each taping. In the first application method, muscle facilitation of KT was applied on the VM from its origin to its insertion at high tension (50%–75%), muscle inhibition of KT was applied on the BF and SM from their insertion to their origin at low tension (25%), and isokinetic knee-strength measurements were performed. In the second application method, muscle facilitation of KT was applied on the BF and SM from their origin to their insertion at high tension (50%–75%), muscle inhibition of KT was applied on the VM from its insertion to its origin at low tension (25%), and isokinetic knee-strength measurements were performed. Prior to the application of KT, the Q and H regions of the subjects were shaven and cleaned, and the application was performed in the most appropriate way [22, 39].

2.2.5 Statistical analysis

The SPSS 22.0 version was used for statistical analyses. The data were presented as minimum, maximum, mean, standard deviation, standard error, 95% confidence interval and partial eta (effect size). Shapiro-Wilk test was used to check normality of the data. Repeated measures one-way ANOVA and LSD test were used to analyze the differences between trials. For statistical results, a $P$ value $<$ 0.05 was considered to be statistically significant.

Table 2
Analysis of isokinetic knee strength parameters of subjects between trials

	Mean	SD	Partial	SE	95% CI
			eta		LB	UB
PM 60 ${}^{\circ}$ Ex (Nm)
T1	206.65	25.68	0.638	6.227	193.446	219.848
T2	248.94 ${}^{\text{ac}}$	27.56		6.671	234.799	263.083
T3	206.29	30.55		7.409	190.587	222.001
PM 60 ${}^{\circ}$ Flx (Nm)
T1	104.12	19.53	0.485	4.736	94.079	114.157
T2	126.53 ${}^{\text{ac}}$	21.51		5.217	115.470	137.588
T3	103.53	16.35		3.965	95.124	111.935
PM 180 ${}^{\circ}$ Ex (Nm)
T1	131.12	16.42	0.442	3.982	122.675	139.560
T2	150.88 ${}^{\text{ac}}$	19.09		4.630	141.068	160.697
T3	137.94	21.06		5.107	127.114	148.768
PM 180 ${}^{\circ}$ Flx (Nm)
T1	67.06	14.68	0.543	3.560	59.512	74.605
T2	84.82 ${}^{\text{ac}}$	14.06		3.410	77.595	92.052
T3	73.41	10.28		2.494	68.124	78.699
PM 240 ${}^{\circ}$ Ex (Nm)
T1	115.47	15.90	0.381	3.857	107.294	123.647
T2	132.29 ${}^{\text{ac}}$	16.29		3.950	123.921	140.667
T3	120.29	19.52		4.734	110.259	130.330
PM 240 ${}^{\circ}$ Flx (Nm)
T1	55.71	9.63	0.564	2.335	50.755	60.657
T2	74.18 ${}^{\text{ac}}$	14.98		3.633	66.474	81.879
T3	60.88	9.10		2.208	56.202	65.563

${}^{\text{a}}$ Significant difference between T1 and T2; ${}^{\text{b}}$ significant difference between T1 and T3; ${}^{\text{c}}$ significant difference between T2 and T3; SD standard deviation; SE standard error; CI confidence of interval; LB lower bound; UB upper bound; PM peak moment; Ex extension; Flx flexion; Nm Newton meter.

Table 3

Analysis of H/Q ratios of subjects between trials

	Mean	SD	Partial	SE	95% CI
			eta		LB	UB
H/Q ratio 60 ${}^{\circ}$ (%)
T1	50.47	9.51	0.005	2.306	45.582	55.359
T2	51.35	7.27		1.763	47.615	55.091
T3	50.94	5.78		1.402	47.968	53.914
H/Q ratio 180 ${}^{\circ}$ (%)
T1	51.06	8.41	0.185	2.041	46.732	55.385
T2	56.35 ${}^{\text{a}}$	6.34		1.539	53.091	59.615
T3	53.41	5.49		1.331	50.589	56.234
H/Q ratio 240 ${}^{\circ}$ (%)
T1	48.24	5.70	0.289	1.381	45.307	51.164
T2	56.12 ${}^{\text{a}}$	8.99		2.179	51.498	60.737
T3	52.18	7.15		1.735	48.499	55.854

Table 4

Analysis of fatigue index of subjects between trials

	Mean	SD	Partial	SE	95% CI
			eta		LB	UB
FI (Ex)
T1	32.0588	7.62	0.159	1.848	28.141	35.976
T2	28.5882	4.78		1.160	26.129	31.048
T3	28.7059	4.47		1.084	26.408	31.004
FI (Flx)
T1	31.8824	8.07	0.107	1.957	27.734	36.031
T2	36.6471	13.00		3.153	29.963	43.331
T3	29.9412	8.47		2.053	25.588	34.294

SD standard deviation; SE standard error; CI confidence of interval; LB lower bound; UB upper bound.

3. Results

When the isokinetic knee strengths between trials were examined statistically, it was found that T2 showed higher results compared to T1 and T3 at all angular velocities ( $P<$ 0.05). There was no significant difference between T3 and T1 ( $P>$ 0.05). The application of KT performed in T2 (muscle facilitation on VM and muscle inhibition on BF and SM) was found to have a positive effect on both the Ex and Flx strengths at all angular velocities. In addition, it was observed that the application of KT performed in T3 (muscle inhibition on VM and muscle facilitation on BF and SM) did not positively affect Flx strength at 60 ${}^{\circ}$ /s, but there were minor improvements at 180 and 240 ${}^{\circ}$ /s, although these were not statistically significant (Table 2).

When the H/Q ratios between the trials were examined statistically, T2 was found to have higher ratios compared to T1 at 180 ${}^{\circ}$ and 240 ${}^{\circ}$ /s ( $P<$ 0.05). Although there was no statistical significance, T3 was associated with increased H/Q ratios compared to T1. At 60 ${}^{\circ}$ /s, no significant difference was observed between the trials ( $P>$ 0.05). KT was found to have a positive effect on H/Q ratio at 180 and 240 ${}^{\circ}$ /s in both T2 (muscle facilitation on VM and muscle inhibition on BF and SM) and T3 (muscle inhibition on VM and muscle facilitation on BF and SM) trials. However, at 60 ${}^{\circ}$ /s, KT had no effect (Table 3).

Mean FI values obtained during the isokinetic knee Ex and Flx strength measurements at 60, 180, and 240 ${}^{\circ}$ /s applied successively with specific resting intervals are given in Table 4. According to the results, in both T2 and T3, the applications of KT showed no statistical significance compared to T1 in the Ex and Flx phases during isokinetic knee-strength measurements ( $P>$ 0.05). However, the application of KT in T2 and T3 reduced FI in the Ex phase, and FI in T2 increased compared to T1, but showed a minor decrease in T3.

4. Discussion

Two major findings emerge from this study: (1) the application of KT in T2 increased isokinetic knee strength both in the Ex and Flx phases at all angular velocities; (2) the application of KT in T2 increased H/Q ratio at 180 and 240 ${}^{\circ}$ /s.

However, the muscle inhibition of KT on VM and muscle facilitation on BF and SM in T3 did not have any effect on the isokinetic knee Ex and Flx strengths ( $P>$ 0.05) (Table 2). Similar to our study, there were several studies that investigated the application of KT on VM in the Q muscle group, and others investigating the vastus lateralis muscle in addition to VM. These studies reported that KT had no acute effect on muscle strength in different contraction types and angular velocities [19, 36, 41, 43, 46]. Similarly, researchers reported that KT applied to muscle groups in different joints did not have an acute effect on isokinetic strength [5, 33, 48]. However the application of KT did shorten the time to PM and increased muscle activation [14, 36, 43]. Studies conducted on different patient groups reported that the application of CT had a positive effect on strength and pain level [17]. However, these studies included only one-directional application of KT on the Q muscle group. Jones et al. [20] stated that the application of KT had no acute effects, but the application of specific and high load training methods at certain periods to facilitate muscle strength, neural activation, and renewal of muscle fibers via the application of KT could have a positive effect on muscle strength in addition to the effects of training. Some studies showed that the application of KT at certain periods together with specific training methods had a positive effect on muscle strength [18], and this validated the hypothesis of Jones et al. [20].

We believe that the isokinetic strength increases observed in both the Ex and Flx phases in T2 measurements were due to muscle facilitation technique applied to the VM to increase muscle strength in the Ex phase and also due to the muscle inhibition technique applied to BF and SM muscles in H to increase muscle strength in the Flx phase. In our study, the effect of KT reverse taping on the increase of strength was thought to be due to increased stimulation of motor unit with the stimulation of both central and peripheral nervous system by cutaneous afferent applications and increased stimulation of motor cortex resulting in increased muscle activation, as stated by Ridding et al. [34]. In addition, researchers demonstrated that motor units were stimulated more quickly and easily by reducing the neural threshold with cutaneous applications [21]. Hsu et al. [17] reported that the increase in muscle activation could increase the tension in the taped muscle and increase muscle reflex, and thereby, muscle activation. However, some researchers argued that cutaneous application of KT may increase muscle activity by altering motor neuron stimulation, but was not a potent stimulant to affect strength [43]. In the current study it was thought that the resulting strength increase by the reverse application of KT affected muscle strength by creating different tensions in Q and H muscle groups.

Asymmetric strength ratio and strength balance may play some role in predisposition to injuries [25]. The asymmetric force for the lower extremity can be defined as the inability of Q and H muscles in both the right and left sides to produce a self-balancing, mutual moment in similar contraction types [23]. In our study, H/Q ratio differences between the application of KT in T2 and T1 were statistically significant ( $P<$ 0.05) (Table 3). The application of KT in T3 caused an increase in H/Q ratio, but this increase was not significant ( $P>$ 0.05) (Table 3). Based on the H/Q ratios obtained in this study, we suggest that the application of KT may have a positive effect on asymmetric strength imbalance. In the studies that examined the effect of KT on knee extension and flexion strengths, PM results revealed that the application did not have any adverse effects on asymmetric strength ratio and strength balance [6, 11, 14, 15, 17, 41, 43]. The studies investigating the effect of KT on strength ratios between H and Q were generally of the therapeutic application of KT on individuals with patellafemoral pain syndrome. These studies showed that the application of KT positively affected the pain levels of individuals measured using a visual analogue scale [8, 27, 29].

In our study, it was found that the FI levels of the isokinetic knee Ex and Flx strength tests performed at 3 all velocities did not show any difference between the trials ( $P>$ 0.05) (Table 4). However, the muscle facilitation technique applied to VM in T2 decreased the FI level of the Q muscle group in the Ex phase, and the muscle inhibition technique applied to the BF and SM in T2 increased FI levels. These results may indicate that the muscle facilitation technique applied to increase muscle strength have a positive effect on FI index, whereas the muscle inhibition technique simultaneously applied on the antagonist muscle to reduce muscle strength had a negative effect on FI index. It was found that KT applied in T3 on VM in the Q muscle group had no negative effect on FI index even though it was applied as muscle inhibition while muscle facilitation applied on BF and SM in the H muscle group reduced FI index. There are a few studies investigating the effect of KT on FI levels. Zhang et al. [48] looked into the effect of KT applied on shoulder muscles of tennis players on muscle strength and reported it had a positive effect on FI level in the Flx phase, and had no effect in the Ex phase. Ebersole et al. [13] argued that the decreases in PM during repeated muscle strength measurements could be due to the contribution of type 1 and type 2 muscle groups to strength, and the low FI level could result from the fact that the movement was primarily obtained by type 1 muscle fibers instead of type 2 fibers during repeated measurements. Theoretically, this is consistent with our results. In all, these results allow us to conclude that the application of KT may change the time to reach PMby increasing its contribution to type 1 and type 2 muscle fibers, a conclusion reached by Zhang et al. [48] as well.

5. Conclusion

The current results showed that muscle facilitation applied to the VM simultaneously with inhibition applied to BF and SM may have a positive effect on both the Ex and Flx strengths and the H/Q ratio in healthy individuals at high angular velocities (180 ${}^{\circ}$ and 240 ${}^{\circ}$ ). Especially, muscle facilitation technique applied to VM contributes to strength production in the Ex phase. This strength increase in the Ex phase is thought to be due to the fact that strength generation of the Q muscle group is facilitated by the muscle inhibition technique applied to the antagonist muscle group. Strength increase was detected in the Flx phase even though muscle inhibition technique was applied to BF and SM muscles in T2; however, the strength increase observed in the muscle facilitation technique applied to H in T3 was not statistically significant. This leads to the conclusion that the strength increase during the Ex phase obtained by muscle facilitation technique applied on the Q muscle group facilitated the transition to the Flx phase and had a positive effect on H strength. On the other hand, the application of KT did not have a significant effect on the H muscle group strength, which is comparably weaker than the Q muscle group. Thus, future studies investigating the effects of KT on the H muscle groups strength by applying KT on H alone while deliberately reducing strength generation of the Q muscle group will make a significant contribution to the field.

Footnotes

Conflict of interest

None to report.

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Acute effects of reverse Kinesio Taping on knee muscle strength,fatigue index and H/Q ratio in healthy subjects

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1. Introduction

2. Method

2.1 Subjects

Table 1 Descriptive parameters of subjects ( N = 17)

2.2.1 Warm-up procedure

2.2.2 Determination of descriptive information

2.2.3 Determination of isokinetic knee strength

2.2.4 Application of KT

2.2.5 Statistical analysis

Table 2 Analysis of isokinetic knee strength parameters of subjects between trials

4. Discussion

5. Conclusion

Footnotes

Conflict of interest

References

Table 1
Descriptive parameters of subjects ( $N=$ 17)

Table 2
Analysis of isokinetic knee strength parameters of subjects between trials