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Content uploaded by Gul Baltaci
Author content
All content in this area was uploaded by Gul Baltaci on Jul 26, 2019
Content may be subject to copyright.
The Effectiveness of Kinesio Taping in Recovering From Delayed
Onset Muscle Soreness: A Crossover Study
Berkiye Kirmizigil, Jeffry Roy Chauchat, Omer Yalciner, Gozde Iyigun, Ender Angin, and Gul Baltaci
Context:Kinesio taping (KT) is a popular taping technique used in the recovery process; however, in the relevant literature, there
is no real consensus on its efficacy. Objective:To investigate whether rectus femoris KT application after delayed onset muscle
soreness enhances recovery of muscle soreness, edema, and physical performance. Participants:A total of 22 healthy amateur
male athletes participated in this study. Design:Randomized, crossover study. Setting:Human performance laboratory of the
university. Interventions:Participants performed an exercise protocol inducing delayed onset muscle soreness. They accom-
plished 2 distinct trials, with or without KT. The washout period between trials was 6 weeks. For the KT condition, KT inhibition
technique was used and applied immediately after exercise bilaterally on rectus femoris. Main Outcome Measures:Range of
motion, muscle soreness, and edema were measured at baseline, 30 minutes, 24, 48, and 72 hours postexercise. Dynamic balance,
sprint, and horizontal jump were evaluated at similar time frame except for 30-minute postexercise. Results:The findings showed
that there were no significant differences between the KT group (KTG) and control group for all outcome variables (P>.05).
Muscle soreness returned to baseline values 72 hours postexercise only within the KTG (P>.05). Although the horizontal jump
performance decreased substantially from baseline to 24 and 48 hours postexercise only within the control group (P<.05), the
performance increased significantly from 24 to 72 hours postexercise within the KTG (P<.05). Balance increased significantly
from baseline to 48 hours postexercise (P<.05) in both groups. Balance also increased significantly from baseline to 72 hours
postexercise only within the KTG (P<.05). The effect size of soreness which is our primary outcome was large in both groups
(r>.5). Conclusions:KT is favorable in the recovery of muscle soreness after delayed onset muscle soreness. KT has beneficial
effects on horizontal jump performance and dynamic balance.
Keywords:recovery, pain, edema, physical performance, Kinesio tape
Unaccustomed physical activity with high intensity and eccen-
tric contractions may cause muscle damage that may present itself as
delayed onset muscle soreness (DOMS).
1,2
Indeed, DOMS is
accepted as a type I muscle strain.
3
Stiffness, soreness, and tenderness
of muscles are symptoms associated with DOMS.
3
These symptoms
generally appear within the first 24 hours postexercise,
3,4
peak 24 to
72 hours postexercise,
1,3,4
and disappear from 5 to 7 days postexer-
cise.
3,4
Recovery techniques may help to expedite the process.
3
There
are many causes for the psychological discomfort associated with
DOMS, including muscle spasm, connective tissue and muscle
damages, accumulation of metabolites, an increase in creatine kinase
activity, and other inflammatory markers (eg, tumor necrosis factor-
alpha).
3,5
In addition to the muscle soreness, the structural changes in
muscle and connective tissue due to DOMS may impair muscle
functions and joints’mechanical properties.
3
Consequently, muscle
soreness and structural changes in soft tissues cause a decrease in the
joints’range of motion (ROM), a swelling of muscles, and limited
functional movements.
6
Moreover, many researchers showed that
DOMS is associated with a substantial decline in strength and
power.
1,3,4,6
In conclusion, DOMS adversely affects physical
performance by reducing muscle function and ROM with a concom-
itant increase in psychological discomforts, such as muscle soreness.
Elastic taping is known to be a popular recovery method.
2,6
The Kinesio taping (KT) is a type of elastic taping which stretches
up to 140% of its original length.
7
Many studies showed that KT
would have beneficial effects on soreness by ameliorating muscle
function,
6
inhibiting muscle activity,
4
increasing blood and lymph
circulation,
6,8,9
and leading to neurological inhibition.
4,10
There are few studies that have investigated the potential
effects of KT on DOMS, which remained underresearched.
2,4,6,10,11
According to the relevant published studies, to date, there was no
consensus on how to apply KT. The KT cutting methods, amount
of stretch in the tape, and application techniques may vary.
2,4,6,10,11
For example, Boobphachart et al
2
used the KT facilitation tech-
nique before the exercise protocol on rectus femoris, vastus
medialis, and vastus lateralis muscles by stretching it up to 125%
of its original length. They found that elastic tape application on
quadriceps femoris recovered muscle strength and reduced muscle
soreness after 72 hours postintensive exercise. They proposed that
the reduction in muscle soreness might be due to blood and
lymphatic flow enhancement, and these 2 physiologic responses
along with increased stimulation of skin mechanoreceptors caused
by increased sensory feedback in the taped area might improve
muscle strength.
2
Similarly, Tajik et al
11
applied KT before fatigue
protocol, on the same muscles and direction. However, we should
note that the tension applied was different (stretched to 40% of
initial length). They showed that KT application did not have any
significant effects on balance just after fatigue intervention. How-
ever, the KT group (KTG) had better scores in dynamic balance
compared with the control group (CG). They postulated that KT
Kirmizigil, Iyigun, Angin, and Baltaci are with the Department of Physiotherapy and
Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University,
Famagusta, North Cyprus via Mersin 10, Turkey. Chauchat and Yalciner are
with the Department of Sports Sciences, Faculty of Health Sciences, Eastern
Mediterranean University, Famagusta, North Cyprus via Mersin 10, Turkey.
Kirmizigil (berkiye.kirmizigil@emu.edu.tr,berkiyekirmizigil@yahoo.com) is cor-
responding author.
1
Journal of Sport Rehabilitation, (Ahead of Print)
https://doi.org/10.1123/jsr.2018-0389
© 2019 Human Kinetics, Inc. ORIGINAL RESEARCH REPORT
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enhances fatigued muscles’proprioception, which may decrease
the joint error, and thereby positively affects balance.
11
Lee et al
6
applied tape perpendicularly to the biceps brachii muscle after an
intensive exercise. They demonstrated that KT is an effective
method in the recovery of biceps brachii muscle thickness and
strength after 72 hours post-DOMS protocol. According to them,
KT accelerates the recovery of muscle thickness by stimulating
γ-motor neurons. Furthermore, KT, by lifting the skin, facilitates
the removal of waste products and the increase of oxygen supply to
the muscle and thereby may induce a recovery of muscle strength.
6
Bae et al,
4,6
who used maximally lengthened Y-shaped KT on
biceps brachii muscle, and Lee et al
6
showed that KT decreases
soreness significantly from 24 to 72 hours after an exercise
inducing DOMS. Both authors indicated that increased metabolic
activity due to muscle contraction reduces soreness.
4,6
In addition,
applying stretched KT in muscles pulls them and causes stimula-
tion of Golgi tendon organ, which induces neurologic suppression
resulting in pain reduction.
4
In contrast to the findings of studies
reported previously, including Lee et al’s
6
findings, in a crossover
study conducted by Ozmen et al,
10
KT was found out to be useless
in the recovery of DOMS and short sprint performance 48 hours
postexercise. However, the same study showed that KT maintained
flexibility. They applied from origin to insertion of quadriceps
femoris muscle a Y-shaped KT with 25% tension on the tails
immediately before the exercise protocol. Ozmen et al
10
stated that
beneficial effects of KT, such as increase blood and lymphatic
circulation, and stimulation of cutaneous mechanoreceptors might
improve flexibility.
When we examined the relevant studies in the literature, we
noticed that the KT inhibition technique was not used on rectus
femoris muscle. This study aims to investigate whether the appli-
cation of rectus femoris KT inhibition technique after DOMS
enhances recovery of muscle soreness, edema, and physical per-
formance. Thus, we hypothesized that the perception of soreness,
level of edema, and athletic performance would be similar in KTG
and CG after an exercise inducing DOMS.
Methods
Participants
In this study, a priori sample size was calculated using statistical power
analysis by PASS 2005 software (NCSS Statistical Software, Kays-
ville, UT). The power analysis indicated that 20 participants were
needed for 80% power and 0.05 type 1 error (under the assumptions
lower limit = 0, upper limit = 10, true difference = 0.5, SD = 0.6,
alpha = .05, and beta = 0.20). In case of a potential dropout, the
estimated number of participants was increased by 30%. As a result,
the final sample size was calculated as 26. Participants were randomly
assigned into 2 groups by a simple randomization technique (14 in the
KTG and 12 in the CG). Although there were 26 participants at the
beginning of this study, only 22 of them (mean (SD): age 21.36
[1.68] y; body height 178.14 [6.57] cm; body weight 79.43 [10.07] kg;
body mass index 25.03 [2.85] kg/m
2
; and sport age 5.73 [3.27] y)
completed the whole study as planned (see Figure 1). All the
participants were recreational athletes (ie, they were participating in
sports activities to be healthy and/or to have fun), and they were
attending aerobic-based activities at least 2 sessions per week. They
were informed to abstain from doing any lower body strength training
or unaccustomed physical exercise at least 1 week before the begin-
ning of this study. Participants who had any neuromuscular, cardio-
respiratory, neurologic diseases, or underwent any musculoskeletal
injuries over the last 6 months were excluded from this study.
The participants were also advised not to consume alcohol, take
nutritional supplements, participate in physical activities, and call on
other recovery techniques, such as analgesic drugs and cryotherapy,
throughout this study. Moreover, they were asked to maintain their
usual nutritional and water intake over the course of this study. Both
written and verbal information was given to all participants, and their
written informed consent was requested. The ethical approval for this
study was obtained from the Eastern Mediterranean University Health
Subcommittee in February 2018 (approval number: 2018/53-04).
Procedures
This study was conducted in a randomized crossover design,
involving a KT intervention trial and a non-KT control trial with
a 6-week interval (washout) between the trials. While 14 of the
participants started this study in the KTG, the rest began the study
in the CG. Six weeks later, they crossed over to the other group.
Each trial lasted 5 days. To discard the potential effects of learning,
the first day at least 48 hours prior testing was reserved for a
familiarization session about the different tests. An exercise proto-
col inducing DOMS was held on the second day. The results related
to the evaluation of edema, pain intensity, and ROM were mea-
sured for each group at baseline, 30 minutes, 24, 48, and 72 hours
postexercise. Meanwhile, the outcome variables related to the
assessments of balance, speed, and explosive power were taken
at similar time frame except there was no measurement at
30-minute postexercise. Physical performance tests and DOMS
induction were conducted at the same time of day (2:00 PM) to
avoid fluctuations in physiological responses due to differences in
circadian rhythm. They also were conducted indoors in the human
performance laboratory of the university, which allowed for
climate and testing surfaces to remain more consistent. Verbal
encouragement was given to the participants during the physical
performance tests to ensure they were giving their best. All
measurements were performed by the same researcher.
Exercise Protocol Inducing DOMS
To generate DOMS, we used the drop jump that is an eccentric
exercise. Participants successively performed 5 sets of 20 drop
jumps from a 0.6 m high box with 10-second intervals between
each jump. The rest between sets were 2 minutes.
12
Taping Application
The 5-cm width Kinesio tape (Kinesio
®
Tex Gold
™
, Albuquerque,
NM) applied to the participants had a feature of being stretched to
140% of its original length. Moreover, due to its latex-free, cotton,
hypoallergenic, and porous characteristics, comfortable wear over a 3
to 5 days period was possible. Its water-resistant fabric insulated from
moisture and allowed the participants to bathe as usual.
7
Body hair
may prevent the tape from adhering directly to the skin. To avoid such
a case, the skin was shaved. Moreover, the skin was cleaned with
rubbing alcohol before applying the Kinesio tape. Similar to the study
conducted by Vercelli et al,
13
a certified physiotherapist applied KT
inhibition technique to the rectus femoris from the insertion to origin
with light tension (15%–25% of available tension), to inhibit muscle
tension. We preferred to use this taping technique which may prevent
muscle spasm, a reason of DOMS. To be clear, the tape was cut in a Y
shape. While the rectus femoris was held in the stretching position, it
was surrounded bilaterally with the tails.
13
The tape was applied
immediately after the DOMS inducing exercise.
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Outcome Measures
Demographic and Anthropometric Evaluation. On day 1, all
demographic and anthropometric assessments were done. Chro-
nological and training ages were asked. Body height was measured
with a tape measure. Body weight was measured by a scale. Body
mass index was calculated by using the following formula: weight
(kg)/height (m)
2
.
Perceived Soreness. A visual analog scale ranging from 0 (“no
pain”)to10(“unbearable/worst pain”) was used to assess pain level.
14,15
Range of Motion. The flexibility of quadriceps femoris muscle
was measured by using a goniometer.
10
The dominant knee
ROM was measured by using a goniometer, and the measure
was taken while the participant laid prone and held his knee at
full flexion. The goniometer was positioned so that the goniometer
axis stayed still over the lateral epicondyle of the femur. The
stationary goniometer arm was aligned parallel to the longitudinal
axis of the femur, aligned with the greater trochanter, while the
mobile arm was placed parallel to the longitudinal axis of the fibula,
aligned with the lateral malleolus.
16
Figure 1 —Consort flow diagram showing the flow of participants through each stage of the randomized crossover trial. CG indicates control group;
KTG, Kinesio taping group.
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Level of Edema. The level of edema was detected by measuring
the circumference of the middle of rectus femoris. As the described
in the study of Sellwood et al,
14
we palpated for the anterior
superior iliac spine and the superior margin of the patella, and then
marked with a pen to record the length of the femur by using a tape
measure. Next, we found the midpoint between the anterior super-
ior iliac spine and superior margin of the patella by using a tape
measure again and marked with a pen.
Sprint Performance. Sprint measurements were conducted using
photocells placed at 0 and 20 m (Newtest Oy 2007–2010, Oulu,
Finland). The participants stood 1 m behind the starting line, started
on a verbal signal, and then ran to complete the 20 m distance as
fast as they could.
10
All of them completed 3 runs. They rested
1 minute between each run. The mean sprint time was retained for
the analyses.
Horizontal Jump Performance. The horizontal jump perfor-
mance was assessed by using the double-leg hop test. The parti-
cipants started in a standing position with their toes just behind the
starting line. They began the jumping movement by swinging their
arms and bending their knees to provide maximal forward drive.
Subjects were asked to jump as far forward as possible and to land
on 2 feet. The jump-length measurement was determined using a
metric tape measure, from the takeoff line to the nearest point of
landing contact (ie, the back of the heels).
17
Each subject completed
3 attempts. The rest between attempts was 1 minute. The mean of
the 3 jump distances was taken.
Dynamic Balance. We used a computer-based balance device
(PK200WL; Prokin TecnoBody, Bergamo, Italy) such as the one
used by Birinci and Demirbas.
18
However, the disequilibrium
assessment was chosen to test dynamic balance on bipedal stance
for 30 seconds (see Figures 2and 3). In this test, the subject sees
some gates that come against, and the aim is to enter into those
gates and to maintain the board as firm as possible. Four difficulty
levels are available in the test (monoaxial, easy, medium, and hard).
As the participants were recreational athletes, an easy base was
chosen. This test provides us with the distance medium error
(DME), which shows the participants’ability to move themselves
correctly into the gates. If the participants moved away from the
gates, the DME (%) would be high.
19
Subjects were asked to
complete 3 attempts, interspersed by 1-minute intervals. The mean
of the 3 attempts was recorded.
Statistical Analysis. All statistical analysis was performed by
using IBM SPSS 22 package (SPSS Inc, Chicago, IL). Before
statistical tests were used, we checked potential outliers and missing
data. Normal distribution assumptions of the data were checked with
Shapiro–Wilk test. As P<.05 data were not normally distributed, we
used nonparametric tests. The Friedman test was used to detect
significant differences within the group. Meanwhile, for multiple
comparisons within the group, we used the post hoc Dunn test. The
Mann–Whitney Utest was used to detect significant differences
between groups. Statistical significance was set at P<.05.
The “r=z/p(n×2)”formula is used to determine the effect
size of the changes over time in the KTG and CG. Effect sizes were
interpreted as small (r≤.1), moderate (r= .30), and large (r≥.5).
20
Results
The characteristics of the participants were displayed in Table 1.
Figure 2 —Dynamic balance test (disequilibrium assessment).
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The results related to the evaluation of edema, pain intensity,
and ROM were displayed in Table 2. Meanwhile, the outcome
variables related to the assessments of balance, speed, and explo-
sive power were shown in Table 3.
Control group muscle soreness remained substantially ele-
vated 30 minutes, 24, and 48 hours postexercise compared with
baseline (P<.001, confidence interval [CI] = 1.7 [0.10 to 6.6];
P=<.001, CI = 1.9 [0.10 to 5.4]; P=<.001, CI = 2.7 [−0.3 to 9.2],
respectively). In the meantime, muscle soreness remained also
significantly elevated 24 and 48 hours postexercise compared
with baseline within the KTG (P=<.001, CI = 2.8 [0.2 to 6.2];
P=<.001, CI = 2.8 [0.1 to 6.4], respectively). Even if muscle
soreness remained significantly elevated 30-minute postexercise
Figure 3 —Dynamic balance test (disequilibrium assessment) results.
Table 1 Participants’Characteristics
N Mean (SD)
Age, y 22 21.36 (1.68)
Height, cm 22 178.14 (6.57)
Weight, kg 22 79.43 (10.07)
BMI, kg/m
2
22 25.03 (2.85)
Sport age, y 22 5.73 (3.27)
Training sessions per week (number) 22 3.77 (1.48)
Abbreviation: BMI, body mass index.
Table 2 Evaluation of Pain, Edema, and Range of Motion
Variables Groups Baseline Post 30 min Post 24 h Post 48 h Post 72 h
VAS (out of 10) CG 0.51 (0.34) 2.17 (1.50)
a
2.45 (1.84)
a
3.16 (2.36)
a
1.98 (2.00)
a
KTG 0.68 (0.67) 2.35 (1.82)
a
3.52 (2.02)
a,d
3.46 (1.84)
a
1.76 (1.52)
b,c
Mid-thigh circumference, cm CG 60.05 (4.27) 60.57 (4.51) 60.65 (4.20) 60.58 (4.53)
a
60.58 (4.25)
KTG 59.80 (4.16) 60.16 (4.25) 60.27 (4.28) 60.56 (4.08)
a,e
60.11 (4.22)
Knee flexion, deg CG 122.68 (6.12) 124.32 (6.23) 121.45 (7.24) 118.64 (8.59) 118.45 (9.47)
f
KTG 123.23 (7.86) 122.82 (7.29) 123.09 (8.28) 122.50 (8.08) 117.77 (24.87)
Abbreviations: CG, control group; KTG, Kinesio taping group; VAS, visual analog scale. Note: Data are represented by mean (SD).
a
Significant difference from baseline.
b
Significant difference from 48 to 72 hours postexercise.
c
Significant difference from 24 to 72 hours postexercise.
d
Significant
difference from 30 minutes to 24 hours postexercise.
e
Significant difference from 30 minutes to 48 hours postexercise.
f
Significant difference from 30 minutes to 72 hours
postexercise (P<.05).
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The Effectiveness of KT in Recovering From DOMS 5
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compared with baseline (P= .01) within KTG, CI was 1.7 (−0.3 to
4.3). Muscle soreness remained substantially elevated 72 hours
postexercise compared with baseline (P=<.001) within the CG but
CI was 1.5 (−0.8 to 6.7). On the other side, it returned to baseline
values 72 hours postexercise within the KTG. Although there was
a significant drop in muscle soreness from 24 to 72 hours postex-
ercise (P= .01) within the KTG, CI was −1.8 (−5.6 to 1.9). Other-
wise, there was a significant increase in muscle soreness from
30 minutes to 24 hours postexercise in the KTG (P= .03) but CI
was found 1.7 (−1.5 to 6.5).
Meanwhile, as shown in Table 2, there was a significant
increase in the level of edema from baseline to 48 hours postexer-
cise in both groups (P<.001 in CG and P= .01 in KTG). However,
from baseline to 48 hours postexercise, CI was 0.8 (−0.4 to 2.4) in
KTG and 0.53 (−4.3 to 2.6) in CG.
No significant time effect was found in the knee-flexion ROM
among the KTG (P>.05).
In both groups, speed decreased significantly only from baseline
to 24 hours postexercise (P= .02 in CG and P= .04 in KTG), but CI
was 0.01 (−0.3 to 5) in KTG and 0.1 (−0.1 to 0.7) in CG.
There were substantial decreases in the horizontal jump
performance from baseline to 24 and 48 hours postexercise
(P= .04 and P=<.001, respectively) within the CG. However,
CI values were −7(−46 to 10) and −7.7 (−26 to 2), respectively.
In addition, there was a significant increase in the horizontal
jump performance from 24 to 72 hours postexercise within the
KTG (P<.001); however, CI was 1.5 (−2.2 to 6.1).
The DME in the disequilibrium assessment decreased signifi-
cantly from baseline to 48 hours postexercise in both groups
(P= .03 in CG and P= .02 in KTG), but CI was −0.9 (−4.1 to
0.5) in CG and −0.6 (−1.8 to 0.8) in KTG.
There were no differences between the groups at all times, at
any parameters (P>.05). In addition, the effect size of our primary
outcome (ie, soreness) was found large in both groups (r= .72 in
both groups). Apart from the effect size of KT balance value which
is large (r= .53), all other parameters’effect size were moderate in
both groups (0.1 <r<.5).
Discussion
This study aimed to investigate the effectiveness of rectus femoris
KT application on muscle soreness, edema, and athletic perfor-
mance in recovery from a DOMS inducing exercise in young male
recreational athletes. The results of this study showed that signifi-
cant changes occurred in variables, such as muscle soreness;
explosive power (ie, horizontal jump); and balance, in both groups.
However, unlike the CG, recovery of muscle soreness occurred
72 hours postexercise compared with baseline in the KTG.
Although significant drops in the horizontal jump performance
occurred from baseline to 24 and 48 hours postexercise in CG,
no significant changes were identified in the KTG. In fact, a
substantial increase in the horizontal jump performance happened
from 24 to 72 hours postexercise in the KTG. While balance
performance increased significantly in both groups from baseline to
48 hours postexercise, balance performance increased significantly
from baseline to 72 hours postexercise only within the KTG.
There are different methods inducing DOMS (eg, plyometric
exercise, isokinetic dynamometry, running-based exercises, cycling,
free weight exercises, squat, drop jump, match, or training).
1,4
The
drop jump protocol was used as a method in this study. Many studies
related to DOMS showed that muscle soreness tended to increase
within 24 hours postexercise, peaked at 48 hours postexercise, and
started to decrease 72 hours postexercise.
1,3,4,6,10,15
The results of this
study are in line with the literature.
1,4,6,10,15
Muscle soreness began
30 minutes postexercise, gradually increased over time, and peaked
at 48 hours postexercise in both groups. While muscle soreness
returned to its baseline value 72 hours postexercise in the KTG, it
remained significantly elevated 72 hours postexercise compared
with baseline in the CG. Many studies in the literature investigated
the potential effects of KT on the level of tenderness after a high-
intensive exercise.
2,4,6,10
Few of the published studies, such as this
study, were about the lower-extremity. Ozmen et al,
10
who applied
Y-shaped KT on quadriceps femoris muscle from origin to insertion,
demonstrated that muscle soreness increased 48 hours postexercise
compared with baseline in the KTG. No changes were found in the
intergroups. Therefore, they concluded that KT was not an efficient
method to reduce muscle pain.
10
Likewise, Boobphachart et al,
2
who
used KT facilitation technique on superficial muscles of the quadri-
ceps femoris, found out that muscle soreness remained elevated
72 hours postexercise compared with baseline in the elastic taping
group. However, muscle soreness was lower at 72 hours postexercise
in the KTG compared with the placebo group.
2
In addition, studies
about the effects of KT on upper-extremity DOMS showed that
soreness did not diminish48 or 72 hours postexercise compared with
baseline; however, soreness decreased 72 hours postexercise com-
pared with 24 hours in KTG.
4,6
Unlike this study, other studies used
different KT techniques or application tension. Except us, in none of
the published studies, KT provided a recovery in muscle soreness
from baseline to 72 hours postexercise. Several explanations are put
forward to explain the favorable effects of KT on muscle soreness.
First , the accumulation of lymphatic fluids may cause increased
pressure on tissue that may consequently cause pain. KT enhances
lymphatic circulation in the application area by lifting the skin away
from the tissue beneath. This lifting action can help to relieve
pressure on nociceptors directly under the skin and to remove the
Table 3 Biomotor Abilities Performance Tests
Variables Groups Baseline Post 24 h Post 48 h Post 72 h
20-m sprint time, s CG 3.34 (0.15) 3.45 (0.20)
a
3.44 (0.21) 3.39 (0.18)
KTG 3.39 (0.16) 3.48 (0.25)
a
3.45 (0.20) 3.46 (0.20)
Horizontal jump, cm CG 211.00 (16.47) 204.05 (21.72)
a
203.32 (18.75)
a
205.23 (18.78)
KTG 206.41 (18.87) 202.41 (19.58) 205.91 (17.98) 209.59 (18.38)
b
Disequilibrium assessment/distance medium error, % CG 1.62 (1.84) 0.85 (0.73) 0.69 (0.71)
a
0.76 (0.82)
KTG 1.20 (0.83) 0.92 (0.68) 0.59 (0.55)
a
0.50 (0.44)
a
Abbreviations: CG, control group; KTG, Kinesio taping group. Note: Data are mean (SD).
a
Significant difference from baseline.
b
Significant difference from 24 to 72 hours postexercise (P<.05).
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accumulated metabolites. Thus, it could decrease muscle soreness
quicker in the early period of DOMS.
2
Second, the alteration of
muscle soreness could be attributed to the gate control theory. KT
increases the afferent stimulus to large diameter nerve fibers, and
therefore, the afferent input received by thin diameter nerve fibers,
such as nociceptors is reduced, and less pain is felt.
21
Third, KT
triggers the Golgi tendon organ by pulling the muscles, which causes
inhibition of the contraction which is called autogenic inhibition.
4
Fourth, KT is thought to increase blood circulation and muscle
temperature by stimulating the vasomotor reflex. This increased
metabolism may decrease pain.
4
KT stimulates the cutaneous fusi-
motor reflex which in turn generates muscle contraction. Lymphatic
and blood circulation is increased when muscle contraction occurs.
4
In this study, the recovery of muscle soreness occurred 72 hours
postexercise when KT inhibition technique and paper-off tension
were applied. This finding could be attributed to the increased blood
and lymphatic circulation generated by the cutaneous fusimotor and
vasomotor reflexes, which in turn increased the removal of meta-
bolites and increased muscle oxygenation. As KT was applied along
the muscle from insertion to the origin, the proprioceptors which are
sensitive to changes in muscle length are thought to be stimulated
and thereby generating inhibition of muscle which could also explain
the recovery of muscle soreness.
Edema limits mobility which is a significant biomotor ability
in sports. Inflammation due to micro tears occurring in muscle
fibers or connective tissue damage is likely to be present particu-
larly after the eccentric exercises inducing DOMS.
4,6
Accordingly,
the likelihood of muscle spasticity and swelling grows, and there-
fore, routine daily activities are adversely affected.
4
As shown in
the study conducted by Pop et al,
9
using their own KT method with
%10 tension had positive effects on the level of edema. In fact, KT
reduced by 55% lymphedema after mastectomy. Pop et al
9
showed
that direction of the tapes’application (ie, from the most distant part
of the edema limb to the proximal part) has an effect on the
reduction of the volume of lymphedema.
9
Likewise, ultrasound
muscle thickness measurements conducted by Lee et al
6
after an
exercise inducing DOMS showed that perpendicular KT applica-
tion was an effective method to decrease the level of edema. They
suggested that stimulation of γ-motor neurons by KT caused a
reduction of edema.
6
In contrast, the results of another study which
used KT facilitation technique indicated that KT application after
DOMS did not attenuate muscle swelling.
2
In this study, we used
the inhibition technique. However, KT application did not prevent
the development of edema. Different KT modality used to prevent
edema might be the reason for explaining the discrepancy in the
literature. We could also hypothesize that the amount of edema
generated after DOMS is not as much as lymphedema, which might
be the underlying reason why KT application was less beneficial in
the recovery of edema in this study.
Decreased flexibility is a relevant risk factor for musculoskel-
etal injuries. Various studies showed that acute KT application
improved the shoulder joint ROM in overhead athletes
22
and
healthy sedentary people,
23
and the ankle joint ROM in duath-
letes.
24
However, we should note that there is inconsistency in the
literature about the potential effects of KT application on ROM
after an exercise. Although Merino-Marban et al
24
showed that
I-shaped KT application with %10 tension did not affect ankle
ROM in duathletes after an exercise, Eom et al,
25
who used the
same KT application technique that we also used, indicated that KT
had beneficial effects in university students. Moreover, Boobpha-
chart et al
2
concluded that KT application was not effective in the
recovery of ROM immediately and 24 hours postexercise inducing
DOMS. However, ROM returned to baseline values 48 hours
postexercise. They evoked that lifting the skin in the taped area
reduces the loading of the underlying fascia or connective tissue,
and the circulation and cutaneous mechanoreceptors stimulation
may affect the ROM.
2
In this study, no significant effect over time
was observed for ROM in the KTG. In the meantime, even though
edema persisted, we noticed that ROM did not diminish in the
KTG. We applied the KT inhibition technique on rectus femoris
muscle while it was stretched. We thought that the maintenance or
improvement of ROM could be due to the neurologic suppression
generated by the stimulation of Golgi tendon organ. In addition, KT
improves blood and lymphatic circulation which may also improve
flexibility.
10
The proprioceptive system which is essential for balance is
affected adversely by inflammatory substances or metabolites.
11
Although the way about how KT affected balance was not yet fully
understood, a study demonstrated that KT induced changes in the
skin surface, dermis, and epidermis which could support physio-
logical pathways enhancing balance.
26
According to Bischoff
et al,
8
the development of proprioceptive skills might also be
due to this fact. Nonelite soccer players’balance decreased after
a protocol inducing fatigue in both CG and KTG. However, the
decrease in the KTG was significantly lower than the CG. Tajik
et al
11
attributed these results to the plausible effects of KT in
mitigating the adverse effects of fatigue on balance. To be more
precise, KT improves blood flow and thereby oxygen supply to the
tissues. Consequently, this situation helps the removal of metabo-
lites.
11
In this study, we noticed that a substantial decrease of DME
still occurred from baseline to 72 hours postexercise only in the
KTG. The same physiologic mechanism underlined by Tajik et al
11
may explain why KT had beneficial effects on balance in this study.
Delayed onset muscle soreness induced by unaccustomed
physical activities reduced explosive power.
15
In a study conducted
by Aktas and Baltaci,
7
the single-leg hop test performance
increased significantly and progressed the best in the group using
both quadriceps muscle technique and patellar mechanical correc-
tion technique (KT) compared with the brace group and the brace
plus KTG. They postulated that the favorable effects of KT on
performance were assignable to an increase of circulation and a
tactile input enhancement, which modulates the excitability of the
central nervous system resulting in an increase of motor unit firing.
7
We used the double-leg hop test to assess the horizontal jump
performance, and similarly to Aktas and Baltaci,
7
we found out that
performance did not decrease in any time frame compared with
baseline and increased significantly from 24 to 72 hours postexer-
cise only in the KTG. Applying KT on rectus femoris which are
known to generate power to thrust the body forward
27
may increase
the skin mechanoreceptors stimulation. The improvement of explo-
sive power may be explained by 2 following different reasons: the
mechanoreceptors stimulation first provides information about
joint position and movement to decrease joint error, and second
increases motor unit firing which is a physiologic mechanism
argued previously by Aktas and Baltaci.
7
Sprint is a complex sports task with different phases.
28
During
running, the highest power is generated by the ankle plantar flexors
for the complete stride cycle compared with other lower-extremity
joints. One of the main functions of knee extensors is to maintain
the center of mass height while running. However, the contribution
of knee extensors is negligible during the stance phase of the stride
cycle.
27
Instead, Y-shaped facilitation KT technique with paper-off
tension applied on quadriceps muscle improved the 30-yd sprint
performance in a study.
29
However, same KT cut and technique
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with 120% tension had no effect on 10-m sprint performance in
another study.
30
Likewise, Y-shaped facilitation KT technique
applied to male athletes’gluteal muscles and young healthy adult
women’s quadriceps femoris muscle did not have an effect on their
20-m sprint performance after an exhaustive exercise protocol.
10,28
In this study, KT application resulted in similar sprint time as the
CG compared with baseline. We thought that the underlying reason
why KT application did not improve sprint performance in this
study was due to the minimal contribution of the quadriceps muscle
group during this complex task.
Finally, there are some limitations in this study. First, the
sample size is small. Second, the findings of this study should only
be applied to young recreational athletes.
Implications for Practice, Education, and Future
Research
The findings obtained in this study suggest that KT could be
applied after an unaccustomed or eccentric physical exercise to
reduce muscle soreness. The application of KT can be worthy of
recommendation to improve performance during training based on
explosive power or balance.
Further studies are needed to find out whether the effects of KT
differ in professional athletes and athletes with chronic symptoms
accompanying knee problems due to the rectus femoris weakness.
Furthermore, additional research is needed to find out the most
convenient KT application technique for recovery.
Conclusions
Muscle soreness returned to baseline values 72 hours postexercise
only within the KTG. Balance improved from baseline to 72 hours
postexercise only in the KTG. KT had a favorable effect on horizontal
jump performance from 24 to 72 hours postexercise only in the KTG.
The KTG and CG had similar results related to the midbelly
circumference of quadriceps, sprint performance, and ROM.
Acknowledgments
The authors would like to thank Assist. Professor Levent Eker, MD for the
valuable guidance in statistics of this study. This project was supported by
Kinesio Taping Association International (KTAI) Research Committee.
The authors confirm that there is no conflict of interest, financial, and
personal relationship with other people or organizations that could inap-
propriately influence (bias) this study.
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