Running head: KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
THE EFFECT OF KINESIO® TAPE ON THE ECCENTRIC FORCE PRODUCTION
OF THE QUADRICEPS FEMORIS IN HEALTHY, NON-INJURED INDIVIDUALS
_____________________________________________________________
An Independent Research
Presented to
The Faculty of the College of Health
Professions & Social Work
Florida Gulf Coast University
In Partial Fulfillment of the Requirement
for the Degree of Doctor of Physical Therapy
_____________________________________________________________
By
Matthew Cerone and Jeffrey Lamar
2015
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
APPROVAL SHEET
This independent research is submitted in partial fulfillment of
the requirements for the degree of
Doctor of Physical Therapy
Matthew Cerone and Jeffrey Lamar
Approved: November 2014
____________________________
Dr. Mollie Venglar, DSc, MSPT, NCS
____________________________
Dr. Jason Craddock, EdD, ATC, LAT
The final copy of this independent research has been examined by the signatories, and we
find that both the content and the form meet acceptable presentation standards of
scholarly work in the above mentioned discipline.
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
Acknowledgments
First and foremost, we would like to acknowledge and thank our exceptional
committee members: Dr. Mollie Venglar, our committee chair; and Dr. Jason Craddock.
This process could have been so much more difficult if not for their support and
professionalism. It has been a pleasure to work with you both.
We would also like to thank our friends, families, and colleagues, for their
continued encouragement throughout our time in graduate school. Lastly, thank you to
Florida Gulf Coast University and the College of Health Professions and Social Work for
their contributions to our education.
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
1
TABLE OF CONTENTS
ABSTRACT ...................................................................................................................2
INTRODUCTION .........................................................................................................3
LITERATURE REVIEW..............................................................................................3
PLACEBO EFFECT ......................................................................................................... 13
THE BIODEX................................................................................................................. 14
METHODS .................................................................................................................. 17
PARTICIPANTS ............................................................................................................. 17
PROCEDURE................................................................................................................. 18
DATA ANALYSIS .......................................................................................................... 20
RESULTS .................................................................................................................... 20
TABLE 1, RECTUS FEMORIS PAIRED SAMPLE STATISTICS – TAPE VS. NO TAPE .............. 21
TABLE 2, FIRST TRIAL VS. SECOND TRIAL DATA .......................................................... 22
DISCUSSION .............................................................................................................. 23
SUMMARY ................................................................................................................. 26
REFERENCES ............................................................................................................ 27
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
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Abstract
CONTEXT: Kinesio® Tape is a therapeutic elastic tape that has been used in a wide
variety of populations to decrease pain, support the muscles and joints, improve
circulation, and to strengthen muscles. However, there is limited clinical research to
determine if Kinesio® Tape has an effect on eccentric force production of the rectus
femoris in healthy populations.
OBJECTIVE: To determine if Kinesio® Tape has an effect on eccentric force production
of the rectus femoris in healthy, non-injured individuals as measured by the Biodex
System 4 Pro Isokinetic Dynamometer.
STUDY DESIGN: Randomized controlled trial.
SETTING: Testing took place in the Florida Gulf Coast University Sports Medicine Lab.
PARTICIPANTS: 51 healthy individuals ages 18-40 years. No knee injury or surgery in
the past 6 months, no lower extremity rehabilitation in the last 6 months, no use of
Kinesio® Tape around the knee within the past month, medically cleared PAR-Q and
Health History Questionnaire.
INTERVENTIONS: Kinesio® Tex Tape Gold with a “Y” cut for muscle facilitation
technique for the rectus femoris.
MAIN OUTCOME MEASURES: Muscle peak torque (ft-lbs), time to peak torque
(milliseconds), average peak torque (ft-lbs) measured at 60 degrees per second and 180
degrees per second for the rectus femoris on the Biodex Isokinetic Dynamometer.
RESULTS: For the condition of tape vs. no tape there were no statistical differences
found regardless of the speed of the eccentric contraction. The comparison of first trial
versus second trial regardless of the tape condition resulted in a statistically significant
greater average power for the second trial.
CONCLUSION: This study’s findings were inconclusive as to the ability of Kinesio®
Tape to affect the eccentric force production of the quadriceps. Further research should
include sham tape and mitigating the learning effect of the Biodex Isokinetic
Dynamometer in eccentric mode.
KEYWORDS: Kinesiotape, eccentric, force production, torque, Biodex, quadriceps
femoris, knee, power, randomized controlled trial, Florida Gulf Coast University.
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
3
Introduction
Kinesio® Tape is a therapeutic elastic tape created to simulate the elasticity of
human skin, and is used for a multitude of applications ranging from rehabilitation to
optimization of performance. While there are anecdotal claims that suggest Kinesio®
Tape has beneficial properties, limited research has been conducted on the effects of
Kinesio® Tape. The purpose of this study is to determine if Kinesio® Tape has an effect
on eccentric force production as measured by the Biodex® System 4 Pro Isokinetic
Dynamometer. The question to be answered in this study is does Kinesio® Tape produce
an effect in eccentric force production of the quadriceps femoris in healthy, non-injured
individuals?
Literature Review
In 1976, Kenzo Kase invented Kinesio® Tape, and it was designed to have
approximately the same thickness as the epidermis and can be stretched between 120140% of its resting length longitudinally (Fu, Wong, Pei, Wu, Chou, and Lin, 2008).
Kinesio® Tape derives its name from the field of kinesiology, and differs from other
elastic tapes because it is manufactured with a special weave and viscosity, which allows
ventilation and water resistance, with more expanded elasticity and a minimization of
skin discomfort (Huang, Hsieh, Lu, & Su, 2011).
Kinesio® Tape was engineered for a variety of uses including providing a
positional stimulus through the skin: to align fascial tissues, to create more space by
lifting fascia and skin above the area of pain/inflammation, to provide sensory
stimulation to assist or limit motion, and to assist in the removal of edema by directing
exudates towards a lymphatic duct (Kase, Wallis, & Kase, 2003). Particular properties of
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
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Kinesio® Tape that are desirable to the athletic population include: high water resistance,
freedom of motion, and a smooth feeling (Huang, Hsieh, Lu, & Su, 2011). There are a
number of clinicians, including physical therapists, who have begun incorporating
Kinesio® Tape during or after treatment and rehabilitation. In fact, Kinesio® Tape
continuing education courses are also quite popular among many practicing physical
therapists and occupational therapists. Despite this, there is limited and conflicting
evidence on the clinical efficacy of Kinesio® Tape application.
A study by Aktas and Baltaci (2011) tried to determine if using a knee brace or
Kinesio® Tape, or a combination of the two, would improve muscle strength during
jumping. The study used twenty healthy participants (11 female, 9 male), with no
previous history of knee injuries. Kinesio® Tape application was significantly correlated
to increased hop distance (p=0.015, P=0.018) in both lower extremities, and in isokinetic
knee extension peak torque (p=. 034) at 180 degrees per second. The researchers
concluded that Kinesio® Tape application was more effective for increasing muscle
strength and jump distance than knee braces (Aktas and Baltaci, 2011).
The effect of forearm Kinesio® Tape on handgrip strength was researched by
Mohammadi, et al. (2010). Forty subjects, 20 males and 20 females with a mean age of
22.3 ±2 years, had Kinesio® Tape applied to their forearm and used a grip-meter device
to measure grip strength every half an hour for two hours. The results of this study
revealed that Kinesio® Tape increased handgrip strength in males from 38.33 ±6.5 to
42.4±7.3kg (P< 0.05) and females increased from 19.3±4.5 to 23.54.3 kg (P< 0.05)
(Mohammadi, et al. 2010).
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
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Conversely, there are also studies which have shown Kinesio® Tape to be
ineffective at increasing muscular strength. Fu et al. (2008) conducted a study
investigating the effects of Kinesio® Tape when applied to the quadriceps and hamstring
musculature in healthy athletes. The study utilized fourteen college kickboxing athletes,
seven males and seven females, who had no prior knee problems. The strength was
assessed by an isokinetic dynamometer under three separate conditions: (1) without
taping; (2) immediately after taping; (3) 12 hours after taping. Muscle strength was
measured with a Cybex NORM, and the following trials were performed: concentric
quadriceps contractions at 60 degrees per second; eccentric quadriceps at 60 degrees per
second; concentric quadriceps contractions at 180 degrees per second and eccentric
quadriceps contraction at 180 degrees per second. The study found that kinesiotape
application on the anterior thigh did not increase or decrease strength in any of the trials
(Fu et. al, 2008).
Janwantakul and Gaogasigam (2005), investigated the effect of inhibition and
facilitation Kinesio® taping techniques on the activity of vastus lateralis and vastus
medialis obliquus. This research had thirty healthy female participants, between ages 1823, descending stairs while the electromyogaphic activity of the vastus lateralis and
vastus medialis obliquus were recorded through bipolar surface electrodes. The results of
the study found that Kinesio® Tape was not effective in inhibiting or facilitating muscle
activity (Jawantanakul and Gaogasigam, 2005). Nyugen (2013) conducted a study which
investigated the effects Kinesio® Tape when applied to the biceps brachii during bicep
curls. Twenty healthy subjects participated, 9 males and 11 females with a mean age of
25 ± 6.2 years, and an isokinetic dynamometer measured concentric elbow flexion at an
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
6
angular velocity of 90 degrees per second. The study was completed over the course of
two days, and subjects flipped a coin to determine if they would use placebo tape or
Kinesio® Tape the first day of testing; the second day the participants used the tape they
did not use during the first day. Through the 3-repetition strength protocol, t-test
outcomes showed that Kinesio® Tape had no noticeable effect on elbow peak torque
generation (Nyugen, 2013). In order to establish Kinesio® Tape as evidence-based
physical therapy practice, more randomized control trials with a high level of evidence
need to be conducted.
One of the proposed effects of Kinesio® Tape is its ability to reduce the pain of
musculoskeletal injuries. When an injury causes the tissue to compress, the subcutaneous
nociceptors (pain receptors) will start to elicit pain signals to the brain. The gate control
theory of pain may explain the pain relieving effects of Kinesio® Tape. Melzack and
Wall originally proposed the gate control theory in 1965. They suggested that the spinal
cord has a neurological gate mechanism that allows or limits pain signals travelling to the
brain. The stimulation of small diameter nerve fibers (pain pathway fibers) will open the
neurological gate, subsequently allowing the transmission of pain signals. However,
stimulation of large-diameter fibers (sensory pathways such as vibration, touch, pressure)
inhibits the transmission of pain, which closes the gate. During the period in which the
gate is closed, the transmission of pain signals from smaller diameter fibers (pain
pathway fibers) will be prevented. The stimulation of sensory pathways in the nervous
system will increase afferent stimulus to large-diameter nerve fibers, or sensory pathway
fibers, and will reduce the input from smaller diameter nerve fibers, or pain pathway
fibers, which conduct pain. By applying the tape on top of the injured area, Kinesio®
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
7
Tape will reduce the tissue compression as it applies an elevating force to the skin
(Williams, 2012). Due to the pressure sparing effects on the skin upon application,
Kinesio® Tape will provide sensory stimulation to the mechanoreceptors in the skin,
typically the Meissner’s corpuscles and Pacinian corpuscles. Meissner’s corpuscles,
which are located near the surface of the skin, respond to discriminative touch. Pacinian
corpuscles, located in the subcutaneous tissue, respond to vibration and pressure. By
activating these touch and pressure receptors, the descending inhibitory system of the
spine will decrease pain via the Gate Control Theory (Schoene, 2009).
In 2008, Thelen, Dauber, and Stoneman examined the clinical efficacy of
Kinesio® Tape when applied to college students with shoulder pain. The design of the
study utilized a randomized double-blinded clinical trial that used 42 subjects, between
ages of 18 and 24, who were clinically diagnosed with rotator cuff tendonitis. Kinesio®
Tape was applied on the supraspinatus, deltoid, and from the coracoid process around to
the posterior deltoid of the first group. Sham Kinesio® Tape was applied on the
shoulders of the other participants, and the outcomes were measured by the Shoulder Pain
and Disability Index, pain-free active range of motion, and a 100-mm visual analogue
scale which was used to assess pain at the endpoint of the active shoulder range of
motion. The results of the study found that the group who wore Kinesio® Tape showed
immediate improvement in pain-free shoulder abduction (mean +/- SD increase, 16.9
degrees +/- 23.2 degrees; P = .005) after the tape was applied. However, over time,
Kinesio® Tape had no advantages in decreasing shoulder pain and intensity compared to
the placebo tape group (Thelen, Dauber and Stoneman, 2008).
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
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It is also suggested that Kinesio® Tape can be used to improve circulation and the
drainage of lymphatic fluids. It is hypothesized that the application of Kinesio® Tape on
the surface of the epidermis will increase the interstitial space between the skin and
connective tissues, which will result in a larger flow of lymphatic fluids. Kinesio® Tape
may provide a directional pull that may guide lymphatic fluid to the chosen location of
drainage (Frid, Strang, Friedrichsen, and Johansson, 2006). A case report by Psyzora and
Krajnik (2011) examined if Kinesio® Tape could be useful for advanced cancer
lymphedema treatment. The patient of the case report was a 56-year-old woman, with a
malignant pancreatic tumor, that was admitted to palliative home care. The patient also
suffered from lower extremity lymphedema, primarily located in the region of the shins,
and subcutaneous tissue pressure pain. Classic decongestive therapy uses multi-layer
compression bandaging and manual lymphatic drainage, but the physical therapist
determined that it was not a suitable approach for this patient, as she was experiencing a
great deal of pain. Kinesio® Tape was applied on the anterolateral lower leg with a fan
tape anchor at the knee, and three tails (anterior, posterior, and medial) travelling distally
down the lower limb with 15% tension. The Kinesio® Tape remained applied to the
patient for three days. Upon removal, the therapist reported that the patient’s edema, pain,
and feelings of heaviness had decreased (Psyzora and Krajnik, 2011). While these results
are promising, this is another area of study for using Kinesio® Tape that will benefit
from a higher level of evidence in the future.
Kinesio® Tape is also thought to have an effect on range of motion. A study, by
Yoshida and Kahanov (2007), investigated the effects Kinesio® taping would have on
range of motion in trunk extension, lateral flexion, and extension. The sample was 30
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
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participants, half male and half female with an average age of 26.9±5.9, who had no
history of lower trunk or back issues. Each participant had trunk range of motions
(extension, lateral flexion, extension) measured, both with and without Kinesio® Tape, in
centimeters by a tape measure. The origin point of the Y-shaped Kinesio® Tape was
applied in the middle of the sacrum, and the other end of the tape was applied from the
origin of the sacrospinalis towards the insertion. The results of the study found that trunk
flexion improved (t (29) = 2.51 p < 0.05) while no differences were found in lateral
flexion (3cm; t(29) = -1.25, p> 0.05), and extension (-2.9cm; t (29) = -0.55, p > 0.05)
(Yoshida and Kahanov, 2007).
Studies on eccentric, or muscle lengthening, forces have many factors to consider
including: a higher risk of muscle and joint injury; more difficult for participants to
understand; and a higher coefficient of variability (Brech, Ciolac, Secchi, Alonso, and
Greve, 2011). While these are legitimate concerns, eccentric exercises also have a
multitude of positive attributes. Numerous studies have demonstrated that eccentric
contractions can maximize the force exerted and the work performed by the muscle.
Eccentric contractions are associated with a greater mechanical efficiency, can be 40%
stronger than concentric contractions, that can attenuate the mechanical effects of impact
forces, and can enhance the tissue damage associated with exercise (Enoka, 1996). In
addition to that, exercises that incorporate both eccentric and concentric contractions can
produce more improvements in strength than concentric contractions.
Eccentric contractions happen frequently in the activities of daily living and in
athletics. An eccentric contraction is one in which the muscle elongates while under
tension from an antagonistic force larger than the muscle can generate; thus, the activated
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
10
muscles are forcibly lengthened (Enoka, 1996). Muscles operate eccentrically to either
dissipate energy for decelerating the body or to store elastic recoil energy in preparation
for a shortening (concentric) contraction. The benefits of eccentric exercise are
numerous. Eccentric exercises are thought to be more efficient than concentric exercises;
eccentric contractions are capable of producing superior forces at approximately 20% less
oxygen utilization, carbon dioxide production, and energy expenditure when compared to
equal sessions of concentric work (Kaminski, Wabbersen, and Murphy, 1998). Koni and
Buskirk (1972) investigated strength gains of the elbow flexors after 12 weeks of
isotonic, concentric, or eccentric training programs. The study found that the subjects
who participated in eccentric exercise improved their strength to a greater degree than the
other two groups. Most muscle strains happen during eccentric contractions;
consequently, improving eccentric strength can help to lessen risk of injury. Garret
(1990) elaborated on how the muscle has the ability to act as energy absorbers in
preventing injury to muscles, bones, and joints. The study detailed that increased
eccentric strength can improve a muscle’s ability to withstand force/strain without failing.
Eccentric exercises also have a role in strength and conditioning. A study utilizing
27 healthy participants looked at the effects of concentric versus enhanced eccentric
hamstring strength training. Participants were split into three groups: control, eccentric
strength training, and concentric strength training. Subjects participated in a one
repetition maximum pretest, followed by training 2 days per week for 6 weeks, and then a
one-repetition maximum posttest. The results found that the concentric group improved
19% while the eccentric group improved 29% (Kaminski, Wabbersen, and Murphy,
1998).
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
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A unique characteristic of eccentric exercise is that untrained individuals are stiff
and sore due to muscular fiber damage (Proske and Morgan, 2001). This is important to
note that the muscle forces produced by this lengthening behavior can be extremely high,
despite the requisite low energetic cost, and can lead to larger amounts of muscular
damage at the level of the sarcomeres.
Sarcomeres are the basic structural units of muscles. Figure 1, pictured below,
details a suggested hypothesis for the process of sarcomere disruption in eccentric
contractions. During the active stretch of a muscle, the weakest sarcomeres in myofibrils
will accommodate for the majority of the length change in that muscle. Sarcomeres will
continually weaken over time, during the stretch, and will eventually reach a yield point.
Figure 1. Postulated series of events leading to muscle damage from eccentric exercise. Adapted from U. Proske and D. L. Morgan.
2001.
The sarcomeres will quickly stretch until no myofilament overlap exists; the next weakest
sarcomere will continue this process. During muscular relaxation, most of the overtaxed
sarcomeres will re-interdigitate and resume functioning. However, some sarcomeres will
not be able to accommodate and become disrupted. Repeated eccentric contractions will
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
12
exponentially increase the amount of disrupted sarcomeres until damage to the muscle
occurs (Proske and Morgan, 2001). As a result, the implementation of eccentric exercises
into training protocols has been found to cause delayed onset muscle soreness (Boone, et
al., 2011).
Currently, the literature on the effects of Kinesio® Tape on force production is
limited, especially when focusing on eccentric contractions. A study conducted by
Vithoulka et. al., (2010) looked at the effects of Kinesio® Tape on quadriceps strength
during isokinetic exercise in healthy non-athlete women. The study used 20 randomly
selected female volunteers, who met the criteria for being inactive prior to the study. The
Kinesio® Tape was applied three different ways to the quadriceps, each method
emphasizing a different muscle: 1) the medial tail of the Y tape was applied to the
anterior inferior iliac spine and the lateral tail was applied three finger lengths lateral to
the medial tail, the tape was then stretched across the patella and placed on the tibia
tuberosity (rectus femoris); 2) one end of the Kinesio® Tape was applied to the lower
intertrochanteric line, the patella, and the pes anserine (vastus medialis); 3) Kinesio®
Tape was applied to the greater trochanter of the femur, lateral aspect of the patella, and
the lateral head of the fibula (vastus lateralis). The participants performed five concentric
maximal knee extension/flexion repetitions at 60 and 240 degrees per second and one
bout of three eccentric maximal knee flexion repetitions at 60 degrees per second; all
tests were performed in the seated position with an isokinetic dynamometer. The results
showed no differences in peak concentric torque at 60 degrees per second or at 240
degrees per second. However, analysis revealed increased performance in maximum
eccentric torque at 60 degrees per second in all three taping methods [F (1,20)= 6.892,
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
13
p<0.05, F (1,20) = 5.184, p<0.05] (Vithoulka et al., 2010). Fu et al. (2008) investigated
the effect of Kinesio® Tape on muscle strength in athletes. The study utilized a sample of
14 healthy male and female athletes. Subjects performed knee extensions, on the Cybex®
NORM isokinetic dynamometer, at 60 degrees per second and at 180 degrees per second.
This was used to find peak torque and total work of the quadriceps and hamstrings. The
study found that that Kinesio® Tape did not enhance nor inhibit muscular strength in the
quadriceps or hamstring musculature. The study suggested that Kinesio® Tape may not
be strong enough to modulate muscle power in healthy athletes (Fu et. al., 2008).
Placebo Effect
Kinesio® Tape has risen in popularity over the past decade. Popular athletes have
worn it during the Olympics and televised sporting events such as tennis, soccer, and
volleyball. Kinesio® Tape also comes in a variety of bright colors which makes it more
visible during these events, or whatever setting in which it is used. Due to this popularity,
users of Kinesio® Tape may experience a placebo effect, by thinking that the tape is
helping regardless of scientific truth. The placebo effect is the belief that a medically
inert substance that people believe to have a beneficial effect will give beneficial results
(Miller and Rosenstein, 2006). This phenomenon is well documented. This is also a
potential limiting factor of any study that utilizes Kinesio® Tape. To combat these effects
many studies use a placebo tape in their trials. A recent study, which looked at the effects
of Kinesio® Tape on the quadriceps during isokinetic exercise in healthy non-athlete
women, found no significant difference in peak torque produced during concentric
contraction of quadriceps musculature (60/sec, 240/sec) with Kinesio® Tape applied
when compared with the peak torque produced by the placebo application or without
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
14
Kinesio® Tape application with the same settings on the Biodex® System 4 Pro
Dynamometer (Vithoulka et. al., 2011). A meta-analysis on 97 Kinesio® Tape articles
found that only 10 of these studies included a control group and a reported effect on
outcome. The analysis concluded that there was little quality evidence to support the use
of Kinesio® Tape over other types of elastic taping in the management or prevention of
sports related injuries, and that Kinesio® Tape may have placebo-like effects on the user
(Williams et. al., 2012).
The Biodex®
The Biodex® provides a large amount of tester control for a study of this nature.
The Biodex® has many uses clinically and in research including allowing for objective
measures of work, peak torque and power. It can be used for testing and training muscle
contractions concentrically, isometrically, and eccentrically in specific ranges of motion,
varying degrees of resistance, and easily allows for the isolation of almost any desired
muscle group (Biodex Pro Operation Manual, 2011).
Several studies have examined the reliability of dynamometers, including the
Biodex® system in isokinetic mode, and have shown excellent reliability for peak torque
measurements (Derscheid, Ellenbecker, & Feiring, 1990; Frisiello, Gazaille, O'Halloran,
Palmer, & Waugh, 1994; Treddinnick & Duncan, 1988; Gross, Huffman, Phillips, &
Wray, 1991; Buckley, Grimshaw, Shield, & Tsiros, 2011). Isokinetic mode on the
Biodex® allows for contractions to occur at a constant speed, meaning that a joint can be
moved through a predetermined amount of degrees per second allowing for replication
across subjects and test sessions. The following studies show the reliability of using the
Biodex® clinically and for research purposes. Derscheid, et al., (1990) tested the
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
15
Biodex® concentrically for test-retest reliability at speeds ranging from 60 degrees per
second to 300 degrees per second for knee flexion and extension. The data was analyzed
to be significant at a level of 0.05 with all ICC values being 0.95 or greater for
measurements of peak torque and work making it a reliable measure of force production
(Derscheid, Ellenbecker, and Feiring, 1990). A study by Frisiello, et al., (1994) examined
the peak torque of the shoulder during eccentric medial and lateral rotation with 0 degrees
of shoulder abduction in healthy subjects. They measured peak torque in the shoulder at
speeds of 90 and 120 degrees per second with all intraclass correlation coefficients (ICC)
ranging from 0.77-0.86. An ICC measure of >0.75 shows excellent reliability and in this
case it demonstrates that the Biodex® is reliable during eccentric contractions in a
healthy population (Frisiello, Gazaille, O'Halloran, Palmer, & Waugh, 1994). Treddinick
and Duncan (1998) focused on the eccentric and concentric contractions of the
quadriceps femoris muscles in knee extension at three different velocities of 60 degrees
per second, 120 degrees per second, and 180 degrees per second. They tested a
KIN/COM dynamometer for peak torque and total work with results of good reliability at
120 degrees per second and excellent reliability at 180 degrees per second with ICC
values ranging from 0.75 to 0.97. However, at 60 degrees per second eccentric torque
was not as reliable as the other measurements with an ICC of 0.47. They explain that the
slower speeds allow for a greater number of eccentric force oscillations that can affect the
reliability of torque measurements taken at those speeds (Treddinnick & Duncan, 1988).
A comparison study done by Gross, et al., demonstrated that the Biodex® has excellent
intramachine reliability with ICC values of 0.97 for concentric knee extension peak
torque (Gross, Huffman, Phillips, and Wray, 1991). Buckley, et al., used a Biodex®
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
16
System 4 Isokinetic Dynamometer and achieved ICC values of 0.96 for concentric knee
flexion and extension in a pediatric population of children 10 to 13 years old (Buckley,
Grimshaw, Shield, & Tsiros, 2011).
Special considerations for testing force production must be taken into account.
First, the Biodex® accounts for the weight of the test limb and the apparatus attachments
because they add to the force of gravity and the force of the machine that the knee
extensor muscles are eccentrically working against. This is called the Gravity Effect
Torque (GET) and is a measurement that is added to the resistance provided by the
machine. This measurement is taken by the Biodex® software and is recommended to be
universally recorded at 30 degrees of flexion to allow for standardized data recording
(Biodex Pro Operation Manual, 2011). Second, another consideration proposed by Gross,
et al., is that every degree of possible motion may not be accounted for during testing due
to subject variance. This study suggests that the only data that should be analyzed is the
data that falls within a specified window, meaning that each repetition performed by the
subject has data for each degree of motion that falls within that window. Gross, et al.,
notes that this will increase the reliability of the data by allowing for measurements of
total work in a specific range of motion, which is a better indicator of overall muscular
performance than peak torque (Gross, Huffman, Phillips, and Wray, 1991). Third, the
angular velocities under which testing is performed must be taken into consideration to
achieve the best results. Treddinnick and Duncan showed that eccentric peak torque
reliability was significantly reduced at slower test speeds of 60 degrees per second as
compared to 120 and 180 degrees per second (Treddinnick & Duncan, 1988). Buckley, et
al., adopted previous research methods stating that children are stronger at a slower speed
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
17
of 60 degrees per second (2011). The Biodex® manufacturer suggests that strength
speeds are measured in the range of 60 to 120 degrees per second and endurance speeds
are measured in the range of 180 to 300 degrees per second with no distinction being
made between concentric and eccentric contractions (Biodex Medical Systems, Isokinetic
Testing and Data Interpretation). A fourth consideration is that the Biodex® requires a
predetermined force in order to elicit movement of the machine during eccentric
contractions. This is a safety precaution for the subject to prevent injury due to the
forceful nature of eccentric contractions. A maximal torque production limit is set by the
tester to prevent injury to the subject. The subject must maintain at least a minimum force
equal to 10% of the torque limit otherwise the Biodex® will automatically halt
movement to prevent injury (Biodex Pro Operation Manual, 2011). Suggested norms for
these values have not been found in the literature concerning the Biodex® dynamometer.
Methods
Participants
Participants were comprised of both men and women ages 18-40 years of age.
Participants were recruited from Florida Gulf Coast University (FGCU) students and
faculty in the College of Health Professions and Social Work. Testing was performed on
the FGCU campus in the Sports Medicine laboratory where the Biodex® System 4 Pro
Dynamometer is housed. Convenience sampling was used to find 50 participants for this
study. Volunteers were solicited through email and classroom visits. The research was
conducted as an experimental research design with two independent variables and one
dependent variable. The independent variables are the Kinesio® Tape and eccentric
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
18
velocity of the Biodex®. The dependent variable is the force produced by the quadriceps
femoris.
The inclusion criteria were: ages 18-40 with no active or chronic lower knee
injury/surgery in the past year, no prior lower extremity rehabilitation in the last year, no
active use of Kinesio® Tape for muscle facilitation around the knee within the past
month, must be in good health, and medically cleared PAR-Q and Health History
Questionnaire. The exclusion criteria included potential participants who: are out of the
18-40 range due to liability issues related to being a minor and the possibility of
including a population with decreased or inhibited muscle function due to age, have had
acute or chronic knee injuries or surgeries within the past year, had any participation in
knee rehabilitation within the past year, anyone using Kinesio® Tape on or around the
knee in the previous month, do not have at least 90 degrees of knee flexion and 0 degrees
of knee extension, and are not medically cleared to participate.
Procedure
Upon arrival to the testing site each participant filled out a PAR-Q, Health History
Questionnaire and signed an informed consent for the Institutional Review Board (IRB).
A six-sided di was rolled to determine if the subject would perform the protocol with or
without the Kinesio® Tape for the first testing. At this time each participant’s vital signs
were taken to assure their physical ability to perform the testing without personal harm.
Height, weight and thigh circumference at mid-thigh were recorded as well. If tape was
indicated first, a professor from the Department of Physical Therapy, certified in the
application of Kinesio® Tape, applied the tape appropriately to the quadriceps femoris
muscles in order to facilitate increased muscle contraction via the muscle facilitation
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
19
technique. The tape was applied with a Y-cut in order to cross the knee joint by
circumventing the patella. A 30-minute activation time was allowed for according to
manufacture specifications (Kase, Wallis, and Kase, 2003).
Figure 2. Kinesio® Tape application to the right rectus femoris.
Figure 3. Subject in resting test position on the Biodex.
Each participant was seated and stabilized according to Biodex manufacturer protocols
for knee flexion which include a seventy degree tilt of the seat back and the fulcrum of
the dynamometer being aligned with the femoral condyles. Active range of motion
(AROM) assessment of the right knee on the Biodex® was made in order to make sure
each participant could actively move from 90 degrees of knee flexion to 0 degrees of
knee extension (Lund, et al., 2005; Pincivero, Salfetnikov, Campy, and Coelho, 2004). A
trial run was performed on the Biodex® at either a velocity of 60 degrees per second or
180 degrees per second for eccentric knee extension respective to the testing sequence.
Measurements for force output were recorded by the Biodex® for eccentric right knee
extension at a velocity of 60 degrees per second for 5 repetitions. Each participant had a
rest time of 3 minutes between trials to ensure uniformity and full muscle recovery
(Baechle and Earle, 2008). Testing was repeated at a velocity of 180 degrees per second
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
20
for 5 repetitions. At this time the protocol was repeated with or without Kinesio® Tape as
indicated.
Data Analysis
IBM SPSS Statistics (version 22) was utilized in our study for data analysis. Data
collected from the Biodex® was manually input into Microsoft Excel and then imported
into SPSS. The data analysis appropriate for this study was the Paired t-Test for
dependent samples. The following eight variables were compared with and without
Kinesio® Tape: peak torque (ft-lbs); time to peak torque (milliseconds); angle of peak
torque (degrees); max repetition total work (ft-lbs); total work (ft-lbs); average power
(watts); acceleration time (milliseconds); deceleration time (milliseconds). The means of
each variable were compared to determine their significance.
Results
Recruitment of participants occurred from March 2014 until April 2014. The
study was able to meet the projected sample size in this timeframe. Participants were not
required to follow up after the initial testing.
When wearing Kinesio® Tape during testing at 60 degrees per second the paired
samples statistics for the condition of tape vs. no tape resulted in larger mean values for
peak torque, time to peak torque, angle of peak torque, max rep total work, acceleration
time, deceleration time, and average peak torque; while average power and total work
had smaller values. The paired samples test for the condition of tape vs. no tape resulted
in p-values ranging from 0.343 - 0.984 meaning that there was no significant difference
recorded at 60 degrees per second with or without Kinesio® Tape being worn.
21
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
Table 1. Rectus Femoris Paired Sample Statistics – Tape vs. No Tape
Velocity
Mean
Measure
Mean
95% C. I.
Difference
(deg/sec)
60
147.24
-7.797 0.845
Peak
9.487
60*
146.4
Torque (ft180
151.74
-25.632lbs)
-2.62
20.393
180*
154.35
60
1479.41
-357.791Time to
3.722
365.234
60*
1475.69
Peak
Torque
180
1255.88
-922.62157.451
(msec)
1237.522
180*
1098.43
60
143.39
-6.9222.41
Max Rep
11.742
60*
140.98
Total Work
180
151.27
-24.61(ft-lbs)
-1.48
21.681
180*
152.75
60
681.03
-59.999-1.18
57.638
60*
682.21
Total Work
(ft-lbs)
180
721.16
-123.2572.382
128.022
180*
718.77
60
70.66
-0.375
-6.833-6.084
Average
60*
71.04
Power
180
125.05
-18.754(watts)
6.147
31.048
180*
118.9
60
128.6
Average
0.376
-7.729-8.482
60*
128.23
Peak
Torque (ft180
140.34
-19.361.127
lbs)
21.615
180*
139.21
P-value
.845
0.82
0.984
0.771
0.606
0.898
0.968
0.97
0.908
0.622
0.926
0.912
* indicates data when Kinesio Tape was not worn.
When wearing Kinesio® Tape during testing at 180 degrees per second the paired
samples statistics for the condition of tape vs. no tape resulted in larger mean values for
time to peak torque, total work, average power, and acceleration time; while peak torque,
angle of peak torque, max rep total work, and deceleration time had smaller values. The
paired samples test for the condition of tape vs. no tape resulted in p-values ranging from
0.622 - 0.970 meaning that there was no significant difference recorded at 180 degrees
per second with or without Kinesio® Tape being worn.
22
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
Table 2. First Trial vs. Second Trial Data
Measure
Peak Torque
(ft-lbs)
Time to Peak
Torque
(msec)
Max Rep
Total Work
(ft-lbs)
Total Work
(ft-lbs)
Average
Power
(watts)
Deceleration
Time (msecs)
Average
Peak Torque
(ft-lbs)
Velocity
(deg/sec)
60
60*
180
180*
60
60*
180
180*
60
60*
180
180*
60
60*
180
180*
60
60*
180
180*
60
60*
180
180*
60
60*
180
180*
Mean
146.01
147.63
149.69
156.41
1622.35
1332.74
1488.43
865.88
142.78
141.6
150.15
153.87
672.37
690.87
702.5
737.43
66.43
75.27
111.68
132.27
396.86
303.92
428.2
407.4
126.95
129.88
137.37
142.18
Mean
Difference
95% C. I.
P-value
-1.622
-10.2557.011
0.708
-6.725
-14.525 1.074
0.890
289.612
-62.418641.642
0.105
622.549
-456.203 1701.301
0.252
1.178
-8.17310.529
0.801
-3.724
-10.6923.245
0.288
-18.498
-77.08240.086
0.529
-34.935
-74.6294.758
0.083
-8.845
-14.796- 2.894
0.002
-20.582
-32.490 - 8.675
0.001
92.941
19.678166.204
0.014
20.8
-21.29 62.89
0.326
-2.929
-10.9925.134
0.469
-4.814
-10.265.637
0.082
* indicates data taken from the 2nd trial regardless of tape condition.
When tested at 180 degrees per second the paired samples statistics for 1 st trial vs.
2nd trial resulted in larger mean values for peak torque, max rep total work, total work,
average power, and average peak torque for the 2nd trial. This comparison also showed
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
23
lower means for all time dependent data of the 2nd trial including time to peak torque,
acceleration time, and deceleration time. The paired samples test resulted in p-values
ranging from 0.001 - 0.326 showing a significant difference at p=0.001 with average
power being statistically greater for the 2nd trial regardless of the condition of Kinesio®
Tape or no tape.
When tested at 60 degrees per second the paired samples statistics for 1 st trial vs.
2nd trial resulted in larger mean values for peak torque, total work, average power, and
average peak torque for the 2nd trial. This comparison also showed lower means for all
time dependent data of the 2nd trial including time to peak torque, acceleration time,
deceleration time, and also max rep total work. The paired samples test resulted in pvalues ranging from 0.004 - 0.801. There was a significant difference at p=0.004 with
average power being statistically greater for the 2nd trial regardless of the condition of
Kinesio® Tape or no tape. There was also a significant difference at p=0.014 with
deceleration time being statistically greater for the 1st trial regardless of the condition of
Kinesio® Tape or no tape, meaning that subjects took a greater amount of time to slow
the Biodex® arm in the 1st trial as compared to the 2nd trial.
Discussion
Theoretically, Kinesio® Tape, when applied from origin to insertion, improves
muscle strength. Wrinkles in the skin created by application of the tape, and the direction
in which the tape is applied helps to pull the insertion of the muscle towards the direction
of the contraction and improves muscle tone (Vithoulka, 2010). However, the results of
this study are inconclusive in determining whether the application of Kinesio® Tape to
the anterior thigh can improve eccentric force production. Studies by researchers Fu et al.
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
24
(2008) and Nyugen (2013), both of which examined Kinesio® Tape’s effects on peak
torque, had similar inconclusive results. A study by Lin et al., (2013) found no significant
difference in the peak torque of the vastus lateralis muscle with or without tape both
concentrically and eccentrically at 60 degrees per second using the Biodex® System 3
Dynamometer. Fu et. al (2008) stated that the inconclusive results of their study might
have been due to the fact that magnitude of cutaneous afferent stimulation generated by
Kinesio® Tape may not be strong enough to modulate muscle power of healthy athletes.
The short-term application of Kinesio® Tape was tested in this study, but future
researchers should consider investigating the effects of long-term application as well. A
study by Chang et al (2006), found significantly improved effectiveness of Kinesio®
Taping on force production when it was applied for 24-48 hours, even after removal of
the tape (Chang, Kao, Ho, Chou & Wang, 2006).
There are several potential limitations in this study. To begin with, the
participants (n=51) of our study were college-aged (mean age = 25) with no recent
history of injury. In addition, some participants stated that they had previous experience
with Kinesio® Tape, which may have introduced bias. Future researchers may benefit
from collecting data from a wider variety of subjects who have limited experience with
Kinesio® Tape as well as an older population or those who have had recent history of
injury.
Another limitation in our methodology was not properly accounting for the
placebo effect. Williams et. al (2012) conducted a meta-analysis on Kinesio® Tape
which identified the following criteria that have been fundamental in reducing bias in
clinical trials: (i) randomization of subject allocation; (ii) blinding of subjects; and (iii)
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
25
blinding of all assessors (Williams, Whatman, Hume, and Sheerin, 2012). Without a
placebo tape group we are unable to determine whether any statistical differences were
due to Kinesio® Taping or from taping alone. The use of a placebo group with sham tape
should be considered to minimize potential bias resulting from Kinesio® Tape
intervention. It is notable to mention that another study by Vithoulka et al. found
significant statistical increase in peak muscle torque during eccentric contraction of the
quadriceps musculature with Kinesio Tape application compared to placebo tape
(Vithoulka, Beneka, Malliou, Aggelousis, Karatsolis, & Diamantopoulos, 2010). For the
purposes of this study each participant served as their own control. However, having a
separate control group could have increased the internal validity of this study. A study by
Lins, et al. (2012) used a control, sham, and intervention group to test the ability of
Kinesio® Tape to alter neuromuscular performance of the quadriceps musculature with
no statistical difference found between the different groups. To ensure methodological
quality, the appropriate blinding of subjects and assessors as well as a control and
placebo tape group is necessary.
There did appear to be a learning effect, as none of the participants had
experience with a strength dynamometer for eccentric motions. Observations during data
collection, which were made by both researchers, revealed that many participants had
difficulty understanding how to perform an eccentric contraction on the Biodex®, and
occasionally required multiple attempts to progress through the practice trials. This may
help to reinforce the idea from a previous study that suggests eccentric exercises are more
difficult for participants to understand (Brech, Ciolac, Secchi, Alonso, and Greve, 2011).
The study by Vithoulka et. al (2010) incorporated a pretrial practice in order to
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
26
familiarize subjects with the Biodex® eccentrically and recorded trials were not done on
the same day. This study showed an excellent test re-test reliability of the Biodex® but it
did not indicate whether the performance at the pretrial practice was similar to the
performance of the trials, so we can not extrapolate if a learning effect was avoided in
that instance. A learning effect for strength dynamometers has been theorized but not
consistently demonstrated in experimentation. Sole et al.(2007) demonstrated excellent
test-retest reliability of concentric and eccentric knee flexion and extension using the
Kinetic Communicator (KinCom) 500H isokinetic dynamometer. They, however, did not
employ a training session previous to the day of initial testing and eccentric knee extensor
contractions showed no significant difference from day 1 to day 2 of testing. No learning
effect was apparent in this study by Sole et al. (2007).
Summary
These limitations should be addressed in future studies by incorporating: a
practice session on days previous to testing to avoid a possible learning effect, blinding
assessors and subjects to test conditions, including a sham tape condition, and a control
group. Of importance would also be the testing of Kinesio® Tape eccentrically in an
unhealthy and/or older population for its ability to alter neuromuscular input when there
is an underlying deficit. This study’s findings were inconclusive as to the ability of
Kinesio® Tape to affect the eccentric force production of the rectus femoris in a healthy
population on the Biodex® System 4 Pro Dynamometer.
KINESIO® TAPE EFFECT ON ECCENTRIC FORCE PRODUCTION
27
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