Quadriceps Muscle Inhibition and the Effect of Kinesiotape: Fact or Fiction? Jay Hertel, PhD, ATC, FASCM, FNATA Department of Kinesiology Department of Orthopaedic Surgery Exercise & Sport Injury Laboratory
Disclosures Textbook Royalties – Wolters Kluwer Grant Support: National Institutes of Health
Purported Effects of Kinesio Tape • Lifts skin separating the dermis from underlying tissues • Reduce pain • Increase range of motion • Improve proprioception • Increase strength 3
Quadriceps Function after Knee Injury • Quadriceps Inhibition – Common following knee injury Joint Injury or surgery (Hart et al, 2010) Muscle AMI • Arthrogenic Muscle Inhibition (AMI) Immobilization weakness – Reflexive inhibition of surrounding musculature following joint injury (Hopkins et al, 2000; Rice et al, 2009) Muscle – Resistant to voluntary exercise atrophy The injury paradigm – Interventions to counter AMI? (Hopkins et al. 2000)
“Disinhibitory” Modalities – Cryotherapy (Hopkins et al, 2001; Pietrosimone et al, 2009 ) • 20 minute cryotherapy treatment decreased AMI up to 45 minutes after application – Transcutaneous electrical nerve stimulation (TENS) (Hopkins et al, 2001; Pietrosimone et al, 2009) • Decreased inhibition in both artificial joint effusion subjects and subjects with OA – Joint Manipulation (Grindstaff et al. 2008) • Significant increase in quadriceps activation/force after lumbopelvic manipulation.
Clinical Effects of Kinesio Tape in Knee-Injured Patients • Knee OA • PFP – Immediate decrease in pain – Immediate decrease in pain and improved strength and and some improved proprioception (Cho et al. 2015, function (Aghapour et al. 2017) Anandkumar et al. 2014, Aydogdu et – Slight improvements in al. 2017) function after 2 days (Kurt et – No difference in 3 week al. 2016) outcome compared to conventional treatment • ACLR (Aydogdu et al. 2017) – Knee braces associated – Improved function after 4 with better function than weeks in exercise group KT (Harput et al. 2016) with KT compared to exercise group alone in – No change in strength or elderly women with OA balance (Oliveira et al. 2016) (Kim & Lee, 2017)
Effect of Kinesio Tape on Quad Strength in Healthy Subjects – Effects on muscle function • Increased peak torque and bioelectrical activity after 24 hours use (Slupik et al. 2007) • Increased isokinetic muscular power and hop distance (Aktas et al. 2011) • Decreased VMO muscle onset timing while stepping (Chen et al. 2007) • May provide proprioception stimulus (Chang et al. 2010) – KT effects on specific neuromuscular activation is unknown
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Clinical Question • P: Patients with knee injuries • I: Kinesiotaping • C: Sham taping • O: Measures of quad inhibition – Pain, Self-reported function, performance 9
Study Design • Design: – Randomized – Single-blinded (assessor) – Parallel • Independent Variables: – Group (KT, sham) – Time (pre-, immediately post-, 20-min post-, and 24-48 hrs post- tape) • Dependent Variables: – Quadriceps Hmax/Mmax ratio – Isometric knee extension torque (Nm/kg) – Quadriceps central activation ratio (CAR)
Subject Demographics Kinesio Tape Sham Sex 7 Male/1 Female 2 Male/6 Female 25 ± 4.97 23 ± 3.45 Age, yr 178.13 ± 7.5 175.26 ± 11.74 Height, cm 78.88 ± 14.05 74.56 ± 16.02 Mass, kg 84.8 ± 8.76 88.39 ± 11 IKDC* score (0-100) 0.88 ± 7 0.63 ± 2.73 Pain VAS* (10cm) *IKDC = International Knee Documentation Committee *VAS = Visual Analogue Scale
Subject Demographics Type of knee injury/surgery KT Sham (n=8) (n=8) ACL reconstruction 4 3 Anterior knee pain 2 1 ACL sprain (<Grade III) 2 Meniscus tear 1 Combination MCL-LCL sprain (<Grade III) 1 Combination MCL sprain (<Grade III) 1 & meniscus tear PCL tear (Grade III) 1
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Superimposed Burst Technique (SIB) • Electrode Placement: – Proximal vastus lateralis (VL) – Distal vastus medialis oblique (VMO) • Dynamometer Positioning: Trunk at 85 ° of flexion – Knee positioned at 90 ° of knee – flexion • Subject Education: – Maximal voluntary isometric contraction (MVIC) – Super-imposed burst
Central Activation Ratio (CAR) • As MVIC plateaus – Electrical stimulus triggered T SIB Electrical Torque MVIC (T MVIC ) Stimulus • Superimposed Torque (T SIB ) • 100ms • Mean of 3 successful trials Mean T MVIC used for data analysis T MVIC Mean T MVIC CAR = Initiation of Mean T MVIC + T SIB contraction 3-4 sec MVIC
Hoffmann Reflex 15 ° knee flexion • EMG electrode placement • Recording electrodes - VMO Ground electrode Quad electrode • H-reflex electrode placement • Stimulating electrode - Femoral nerve Stimulating electrode • Dispersive electrode - Posterior thigh ASIS Dispersive pad
Eliciting H-reflex and M-wave – Electrical stimulus used to determine: • Maximum H-reflex • Maximum M-wave H-max – H:M ratio = M-max – Mean of 3 trials used for data analysis (Hopkins et al, 2003)
Tape Intervention Active Sham Intervention Intervention Ktape: 25% tension Athletic tape: No tension
Quadriceps H:M Ratio 0.5 Visit 2 Visit 1 0.4 0.3 KT Sham 0.2 0.1 0 Pre Tape Immediately Post Tape 20 Minutes Post Tape 24-48 Hours Post Tape Time Group Pre Tape Immediately Post Tape 20 Minutes Post Tape 24-48 Hours Post Tape .12 ± .10 .16 ± .14 .16 ± .14 .15 ± .14 KT .23 ± .15 .20 ± .19 .20 ± .14 .16 ± .14 Sham
Quadriceps Central Activation Ratio Visit 2 Visit 1 Time Group Baseline CAR Post CAR .77 ± .09 .81 ± .06 KT .74 ± .21 .77 ± .13 Sham
Knee Extension Torque Visit 2 Visit 1 Time Group Baseline MVIC Post MVIC 2.26 ± .63 2.26 ± .56 KT 2.05 ± 1.15 2.04 ± 1.11 Sham
Discussion: Does KT Work? • Kinesio Tape did not alter quadriceps neuromuscular function immediately post- or 24-48 hours after application – Spinal reflex excitability, volitional activation, and force • Stimulus provided by KT may not have been sufficient to evoke a change in quad neurophysiologic function. • If Kinesio Tape is an effective modality for knee dysfunction, it is not the result of alterations in quad NM activation. • Current study investigated KT in an acute, laboratory setting. • There is conflicting evidence to support use of KT in knee- injured patients – Tends to emphasize immediate effects – Concerns about methodological quality of clinical studies
Fact, Fiction, or Fad? 23
Thank You Jhertel@virginia.edu @Jay_Hertel 24
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