Type effect of inhibitory KT tape on measured vs. perceived maximal grip strength

Type effect of inhibitory KT tape on measured vs. perceived maximal grip strength

Journal of Bodywork & Movement Therapies xxx (2017) 1e4 Contents lists available at ScienceDirect Journal of Bodywork & Movement Therapies journal h...

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Journal of Bodywork & Movement Therapies xxx (2017) 1e4

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Single-blinded crossover study

Type effect of inhibitory KT tape on measured vs. perceived maximal grip strength Aislinn Joan Campbell MacPhail a, *, Ivan Pui-Hung Au a, Mavis Chan a, Dominic Ngo-Tung Mak b, Winko Wenkang An a, Zoe Yau-Shan Chan a, Janet Hanwen Zhang a, Kenny Wong a, Ann So a, Nora Chan a, Chris Kwok a, Patrick Lau a, David Draper c, Roy Tsz-Hei Cheung a a

Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong c College of Life Sciences, Brigham Young University, Utah, USA b

a r t i c l e i n f o

a b s t r a c t

Article history: Received 15 June 2017 Received in revised form 18 October 2017 Accepted 23 October 2017

This study examined the effects of KT tape (KT) applied in an inhibitory manner on muscle activity, measured maximal grip strength, and perceived maximal grip strength in regular KT-users and nonusers. This study was a single-blinded crossover study with sixty participants including 27 kT-users and 33 non-users. Participants underwent maximal grip strength tests with and without inhibitory KT applied across the wrist extensors. Muscle activity and maximal grip strength were measured, while perceived maximal grip strength was rated using a visual analogue scale. No significant interaction effect was found between taping conditions and participant KT-experience for muscle activity (F ¼ 0.825, p ¼ 0.367), measured grip strength (F ¼ 1.018, p ¼ 0.317) or perceived grip strength (F ¼ 0.122, p ¼ 0.728). No significant differences were observed in the EMG activity between taping conditions for either KTusers (p ¼ 0.367) or non-users (p ¼ 0.215). A similar trend was found in the measured grip strength (KT-users: p ¼ 0.317; non-users: p ¼ 0.294) and perceived grip strength (KT-users: p ¼ 0.728; non-users: p ¼ 0.063). KT applied in an inhibitory manner does not impede EMG activity, measured maximal grip strength, or perceived maximal grip strength in adults, regardless of their preconceived notions of KT. © 2017 Elsevier Ltd. All rights reserved.

1. Introduction The creators of the controversial sports intervention Kinesio Tape claim that, with specialized application techniques, the tape can elicit short and long-term effects on muscle strength, tissue edema, pain, and lymphatic drainage (Kase et al., 2003). However, previous research on the effects of elastic therapeutic tape in a clinical setting has provided mixed results. Some studies have found the tape to be effective in increasing muscle activity (Hsu et al., 2009; Słupik et al., 2006) reducing pain (Kalron and BarSela, 2013; Montalvo et al., 2014) and increasing lymphatic flow (Białoszewski et al., 2008). However, the mechanisms behind the tape are still poorly understood, particularly in regards to the

* Corresponding author. Gait and Motion Analysis Lab, Block S, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. E-mail address: [email protected] (A.J.C. MacPhail).

inhibitory application of KT, which few previous studies have examined. Furthermore, multiple meta-analyses have concluded that insufficient evidence currently exists for the use of KT over other clinical practices (Morris et al., 2013; Williams et al., 2012). Additionally, recent research in to the effects of KT, which controlled for any potential placebo effect, has failed to see any clinically significant results (Cai et al., 2016; Poon et al., 2015; Vercelli et al., 2012). This suggests that previously witnessed clinically significant effects with KT may be partially or fully due to an active placebo effect and this idea must be explored. Despite years of research, the placebo effect is still a minimally understood phenomenon. Considerable study of the effect in sport and exercise has been carried out to explore the potential of enhancing athlete performance, as well as reducing their fatigue €teles et al., 2011; Wallman et al., 2015). A recent perception (Ko meta-analysis concludes that, from the majority of athletes believe in the power of placebo to improve their performance in sport rdi et al., 2015). Furthermore, the results of a number of studies (Be

https://doi.org/10.1016/j.jbmt.2017.10.011 1360-8592/© 2017 Elsevier Ltd. All rights reserved.

Please cite this article in press as: MacPhail, A.J.C., et al., Type effect of inhibitory KT tape on measured vs. perceived maximal grip strength, Journal of Bodywork & Movement Therapies (2017), https://doi.org/10.1016/j.jbmt.2017.10.011

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A.J.C. MacPhail et al. / Journal of Bodywork & Movement Therapies xxx (2017) 1e4

have shown evidence of an active placebo effect and that said phenomenon has the potential to work positively and negatively i.e. both enhance and reduce performance (Beedie and Foad, 2009; Zhang et al., 2016). The purpose of this study was to investigate the potential role of placebo when utilizing KT, specifically the inhibitory application of KT. This study sought to determine how KT applied in a supposedly inhibitory manner would affect muscle activity, measured maximal grip strength and perceived maximal grip strength in regular KTusers and non-users. We hypothesized that muscle activity, measured and/or perceived grip strength in KT-users would be more affected by KT applied in an inhibitory manner than in nonusers, due to their preconceived notions of KT. 2. Methods A total of 60 adults were recruited for this study through convenient sampling. Subjects were split into two groups with 27 kT-users (12 females, 15 males) and 33 non-users (16 females, 17 males), according to their previous experience with KT (Table 1.). To be considered a KT-user, participants should have utilized KT at least once per week for the preceding 3 months. Non-users are participants who have never utilized KT, but may be aware of its existence. The elastic therapeutic tape utilized in this study is titled KT Tape (KT Health, LLC, UT, USA). All participants in the study were free from any known cardiopulmonary conditions as well as previous surgical procedures on the tested extremity (Table 2). The concerning ethical review committee reviewed and approved the experimental procedures and written consent was collected from each participant. Participants underwent testing in a randomly assigned order of “tapeless condition” (NKT) and “inhibitory KT condition” (IKT). In the IKT condition, KT was applied along the surface of the wrist extensor muscles (Extensor carpi radialis brevis, Extensor digitorum) of the dominant arm (Fig. 1a). Arm dominance was defined as that which was preferred for writing (Powers et al., 2005). The tape was applied from insertion to origin, which is proposed to have an inhibitory muscle effect (Kase et al., 2003). The tension of the tape during application was 25% for both conditions, as recommended for origin to insertion application (Kase et al., 2003). The tension was maintained through anthropometric measurement of the tape i.e. measuring the change in length of tape before and after stretching (Poon et al., 2015). A certified physical therapist was present to apply the KT on each participant. In the NKT condition, no tape was applied on the participants. To allow for any placebo effect to occur, participants were made aware of each condition and the supposed effects. Participants were then asked to carry out a maximal power grip three times in each condition with a 30-second rest in between each attempt. A three-minute rest was given between each taping condition. Grip strength was quantified using a digital dynamometer (Model J00105, Lafayette Instrument, IN, USA). Positioning of the instrumentation and participants was standardized according to a past study (Trampisch et al., 2012). Surface EMG of the wrist extensor muscles was measured using an Ag/AgCl electrode

Table 1 Subject Demographics Demographic data of participants (mean ± standard deviation) split by previous Kinesio tape (KT) experience. KT-users Age (Years) Weight (Kg) Height (m) BMI

22.3 59.6 1.69 20.8

± ± ± ±

1.2 10.2 0.09 2.3

Non-users 26.0 62.6 1.69 21.7

± ± ± ±

6.5 9.5 0.08 2.1

P-value 0.006 0.255 0.793 0.115

(SX230, Biometrics Limited, Newport, UK). To reduce skin-electrode interference, the testing area was cleaned with alcohol and gently abraded with sandpaper so that the skin impedance was lower than 5 kU. To maintain a constant contact surface area between participants and conditions, a hole-puncher was used to cut two circular holes in each piece of KT. After the application of conductive gel, the electrode was positioned longitudinally along the muscle belly of the wrist extensor muscles (Fig. 1b). The EMG signal was preamplified (330), band-pass filtered (50e300 Hz), and sampled at 1000 Hz. The middle 1-second time window of the maximum grip strength test was utilized to calculate the root mean square (RMS) of the EMG data. Maximal grip strength and RMS EMG data from each of the three trials was averaged for further analysis. After each test condition, participants were asked for feedback about their performance. This subjective feedback was collected using a visual analogue scale (VAS: 0 e Worst performance; 10 e best performance). All data was analysed using SPSS version 22 (SPSS Software, Chicago, IL, USA). Due to the significant difference in age between regular KT-users and non-users, a repeated measures ANCOVA was used to test the effects (RMS-EMG activity, measured grip strength, and perceived grip strength) of each taping condition (NKT vs. IKT) in KT-users and non-users with age as a covariate. Paired t-tests were also conducted for pairwise comparisons, when necessary. The global alpha level was set at 0.05. 3. Results RMS-EMG activity, measured grip strength, and perceived grip strength of KT-users and non-users are presented in Fig. 2. A repeated measures ANCOVA demonstrated that age was not a significant confounding factor in the comparisons of muscle activity (p ¼ 0.701) measured grip strength (p ¼ 0.474), or perceived grip strength (p ¼ 0.534). There was no significant interaction effect between taping conditions and subject KT-experience for muscle activity (F ¼ 0.825, p ¼ 0.367), measured grip strength (F ¼ 1.018, p ¼ 0.317), or perceived grip strength (F ¼ 0.122, p ¼ 0.728). Furthermore, there was no significant taping effect on muscle activity in both KT-users (p ¼ 0.367, Cohen's d ¼ 0.04) and non-users (p ¼ 0.215, Cohen's d ¼ 0.28). A similar trend was observed in the measured grip strength (KT-users: p ¼ 0.317, Cohen's d ¼ 0.00; non-users: p ¼ 0.294, Cohen's d ¼ 0.15) and perceived grip strength (KT-users: p ¼ 0.728, Cohen's d ¼ 0.07; non-users: p ¼ 0.063, Cohen's d ¼ 0.29). 4. Discussion The study examined the effects of the inhibitory application of KT on the muscle activity of the wrist extensor muscle, measured grip strength, and perceived grip strength in two groups of health adults; regular KT-users and non-users. The results of this study showed no significant interaction between taping condition and experience for any of the measured parameters. This suggests that muscle activity, measured grip strength, and perceived grip strength in KT-users and non-users did not differ based on taping conditions. Although a few studies have recorded significant changes in muscle activity when utilizing KT (Hsu et al., 2009), others have failed to do so. For example, Cai et al. found that muscle activity and grip strength were not significantly different between the inhibitory tape condition, facilitatory tape condition, and tapeless condition, when subjects were ignorant of KT and its supposed effects. Additionally, recent meta-analytical reviews conclude that, despite previous studies, there is not enough evidence to support the claims surrounding KTe including its effects and that further research is needed (Morris et al., 2013; Williams et al., 2012).

Please cite this article in press as: MacPhail, A.J.C., et al., Type effect of inhibitory KT tape on measured vs. perceived maximal grip strength, Journal of Bodywork & Movement Therapies (2017), https://doi.org/10.1016/j.jbmt.2017.10.011

A.J.C. MacPhail et al. / Journal of Bodywork & Movement Therapies xxx (2017) 1e4

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Table 2 Inclusion and exclusion criteria. Inclusion

Exclusion

- Participants should have utilized therapeutic tape at least once per week for the past 3 months (KT users only) - Participants should never have used therapeutic tape, but may be aware of its existence (non-KT users only)

- Cardiopulmonary disease - Previous surgery on affected arm

Fig. 1. (a) Placement of KT tape positioned longitudinally along the muscle belly of the wrist extensor muscles. Circular holes for electrodes shown. (b) Arrangement of electrode placement and KT tape along wrist extensor muscles.

However, inconsistent with our hypotheses was the lack of significant difference in the perceived maximal grip strength between taping conditions for KT-users. It is possible that the placebo mechanism is not active for the participants in this study. However, an alternative explanation is that the participants did not expect any changes in the measured parameters therefore; no changes in perception were measured. According to the creators of a similar product, Kinesio Tape, the tape should only be applied in an inhibitory manner when the muscles are acutely over-used or over-stretched (Kase et al., 2003). Since the participants in this study were and injury free at the time of measurement, the inhibitory application may have been deemed unnecessary and ineffective, particularly by those who are cognoscente of the theory behind KT. Additionally, past research suggests that interplay of situation and personality can play a role in an individual's susceptibility to the placebo effect. For example, a study by Geers et al. (2005) demonstrated that the placebo effect is more likely to occur when individuals have a goal to be achieved through validation of the placebo expectation. Uninjured individuals, as utilized in the present study, should have no motivation to inhibit their muscle strength, which could explain the lack of placebo effect observed in this study. Overall, KT-users were found to be significantly older than nonusers in this cohort (Table 1). However, this information is not pertinent to the results of this study, as the main focus of this research was to investigate the within-subjects differences between taping conditions, and not the differences between KT-users and non-users.

Fig. 2. Root mean square electromyographic activity (a), measured grip strength (b), and perceived grip strength (c) of users and non-users for Inhibitory KT Tape (IKT) and No KT Tape (NKT) conditions. Error bars represent ± SD.

A few limitations exist for this study. One limitation of this study is that the data was collected from young adults therefore; the results may not be applicable to all populations such as injured athletes, children or the elderly. However, recent evidence exploring the potential effects of KT use to treat lateral epicondylitis found that neither facilitatory or inhibitory effects were observed with different application techniques, supporting our results and the potential for an active placebo effect with KT use (Au et al., 2017). Another limitation of this study is the circular electrode holes punched into the tape, which may have affected the

Please cite this article in press as: MacPhail, A.J.C., et al., Type effect of inhibitory KT tape on measured vs. perceived maximal grip strength, Journal of Bodywork & Movement Therapies (2017), https://doi.org/10.1016/j.jbmt.2017.10.011

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A.J.C. MacPhail et al. / Journal of Bodywork & Movement Therapies xxx (2017) 1e4

structural integrity of the KT. Alternatively, we believe that the duration of KT wear time pre-measurement is not a limitation in this study. The tape's effect on muscle strength should be immediate as it is theorized to function via tactile stimulation based on the tension of the tape during application and the resultant effect on motor unit firing (Kase et al., 2003). Furthermore, a past research comparing the immediate and long-term effects of tape application have shown that wear-time did not lead to significant differences in balance, functional performance, or neuromuscular performance (Lins et al., 2016; Wilson et al., 2016). 5. Conclusion The results of this study lead us to conclude that KT applied in an inhibitory manner does not impede EMG activity, measured maximal grip strength, or perceived maximal grip strength in health adults, regardless of their preconceived notions of KT. It is recommended that further study of the placebo effect with inhibitory KT be explored with injured individuals i.e. those who fit the stated criteria for inhibitory KT application. Acknowledgements The authors declare no conflicts of interest. This study was reviewed and approved by the relevant ethical committee. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector. References Au, I.P.H., Fan, P.C.P., Lee, W.Y., Leong, M.W., Tang, O.Y., An, W.W., Cheung, R.T., 2017. Effects of Kinesio tape in individuals with lateral epicondylitis: a deceptive crossover trial. Physiother. Theory Pract. 1e6. https://doi.org/10.1080/ 09593985.2017.1359871. Beedie, C.J., Foad, A.J., 2009. The placebo effect in sports performance. Sport. Med. 39, 313e329. https://doi.org/10.2165/00007256-200939040-00004. rdi, M., Ko €teles, F., Hevesi, K., Ba rdos, G., Szabo, A., 2015. Elite athletes' attitudes Be towards the use of placebo-induced performance enhancement in sports. Eur. J. Sport Sci. 15, 315e321. https://doi.org/10.1080/17461391.2014.955126. Białoszewski, D., Wo zniak, W., Zarek, S., 2008. Clinical efficacy of kinesiology taping in reducing edema of the lower limbs in patients treated with the ilizarov methodepreliminary report. Ortop. Traumatol. Rehabil. 11, 46e54. Cai, C., Au, I.P.H., An, W., Cheung, R.T.H., 2016. Facilitatory and inhibitory effects of Kinesio tape: fact or fad? J. Sci. Med. Sport 19, 109e112. https://doi.org/10.1016/ j.jsams.2015.01.010. Geers, A.L., Weiland, P.E., Kosbab, K., Landry, S.J., Helfer, S.G., 2005. Goal activation, expectations, and the placebo effect. J. Pers. Soc. Psychol. 89, 143e159. https:// doi.org/10.1037/0022-3514.89.2.143. Hsu, Y.-H., Chen, W.-Y., Lin, H.-C., Wang, W.T.J., Shih, Y.-F., Ackermann, B., Adams, R., Marshall, E., Alexander, C.M., Stynes, S., Thomas, A., Lewis, J., Harrison, P.J., Bao, S., Mathiassen, S.E., Winkel, J., Christou, E.A., Clarys, J.P., Cools, A.M., Declercq, G.A., Cambier, D.C., Mahieu, N.N., Witvrouw, E.E., Cools, A.M., Witvrouw, E.E., Danneels, L.A., Cambier, D.C., Cools, A.M., Witvrouw, E.E., Declercq, G.A., Danneels, L.A., Cambier, D.C., Ekstrom, R.A., Bifulco, K.M., Lopau, C.J., Andersen, C.F., Gough, J.R., Endo, K., Ikata, T., Katoh, S., Takeda, Y.,

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Please cite this article in press as: MacPhail, A.J.C., et al., Type effect of inhibitory KT tape on measured vs. perceived maximal grip strength, Journal of Bodywork & Movement Therapies (2017), https://doi.org/10.1016/j.jbmt.2017.10.011