Quadriceps Muscle Inhibition and the Effect of Kinesiotape: Fact or - - PowerPoint PPT Presentation

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

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Quadriceps Function after Knee Injury

• Quadriceps Inhibition

– Common following knee injury

• r surgery (Hart et al, 2010)
• Arthrogenic Muscle Inhibition (AMI)

– Reflexive inhibition of surrounding musculature following joint injury (Hopkins et al,

2000; Rice et al, 2009)

– Resistant to voluntary exercise – Interventions to counter AMI?

The injury paradigm

(Hopkins et al. 2000)

AMI

Joint Injury Immobilization Muscle weakness Muscle atrophy

“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

• PFP

– Immediate decrease in pain and some improved function (Aghapour et al. 2017) – Slight improvements in function after 2 days (Kurt et

• al. 2016)
• ACLR

– Knee braces associated with better function than KT (Harput et al. 2016) – No change in strength or balance (Oliveira et al. 2016)

• Knee OA

– Immediate decrease in pain and improved strength and proprioception (Cho et al. 2015,

Anandkumar et al. 2014, Aydogdu et

• al. 2017)

– No difference in 3 week

• utcome compared to

conventional treatment

(Aydogdu et al. 2017)

– Improved function after 4 weeks in exercise group with KT compared to exercise group alone in elderly women with OA

(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

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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 Age, yr 25 ± 4.97 23 ± 3.45 Height, cm 178.13 ± 7.5 175.26 ± 11.74 Mass, kg 78.88 ± 14.05 74.56 ± 16.02 IKDC* score (0-100) 84.8 ± 8.76 88.39 ± 11 Pain VAS* (10cm) 0.88 ± 7 0.63 ± 2.73

*IKDC = International Knee Documentation Committee *VAS = Visual Analogue Scale

Subject Demographics

Type of knee injury/surgery KT (n=8) Sham (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) & meniscus tear 1 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

• Torque MVIC (TMVIC)
• Superimposed Torque (TSIB)
• Mean of 3 successful trials

used for data analysis

TMVIC TSIB

Electrical Stimulus

100ms

Mean TMVIC

Initiation of contraction

CAR =

Mean TMVIC Mean TMVIC + TSIB

3-4 sec MVIC

Hoffmann Reflex

• EMG electrode placement
• Recording electrodes
• VMO
• H-reflex electrode placement
• Stimulating electrode
• Femoral nerve
• Dispersive electrode
• Posterior thigh

Quad electrode Ground electrode

ASIS Stimulating electrode

15°knee flexion

Dispersive pad

Eliciting H-reflex and M-wave

– Electrical stimulus used to determine:

• Maximum H-reflex
• Maximum M-wave

– H:M ratio =

– Mean of 3 trials used for data analysis

(Hopkins et al, 2003)

H-max M-max

Tape Intervention

Active Intervention

Ktape: 25% tension

Sham Intervention

Athletic tape: No tension

Quadriceps H:M Ratio

0.1 0.2 0.3 0.4 0.5 Pre Tape Immediately Post Tape 20 Minutes Post Tape 24-48 Hours Post Tape KT Sham

Group Time Pre Tape Immediately Post Tape 20 Minutes Post Tape 24-48 Hours Post Tape KT .12±.10 .16±.14 .16±.14 .15±.14 Sham .23±.15 .20±.19 .20±.14 .16±.14

Visit 1 Visit 2

Quadriceps Central Activation Ratio

Group Time Baseline CAR Post CAR KT .77±.09 .81±.06 Sham .74±.21 .77±.13

Visit 1 Visit 2

Knee Extension Torque

Group Time Baseline MVIC Post MVIC KT 2.26±.63 2.26±.56 Sham 2.05±1.15 2.04±1.11

Visit 1 Visit 2

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?

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Thank You

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Jhertel@virginia.edu @Jay_Hertel