Elsevier

Journal of Biomechanics

Volume 48, Issue 16, 16 December 2015, Pages 4262-4270
Journal of Biomechanics

MRI analyses show that kinesio taping affects much more than just the targeted superficial tissues and causes heterogeneous deformations within the whole limb

https://doi.org/10.1016/j.jbiomech.2015.10.036Get rights and content

Abstract

Kinesio taping (KT) is widely used in the treatment of sports injuries and various neuro-musculoskeletal disorders. However, it is considered as selectively effective on targeted tissues and its mechanical effects have not been quantified objectively. Ascribed to continuity of muscular and connective tissues, mechanical loading imposed can have widespread heterogeneous effects. The aim was to characterize the mechanical effects of KT objectively and to test the hypotheses that KT causes acutely, local deformations not necessarily (I) in agreement with tape adhering direction and (II) limited to the directly targeted tissues.

High-resolution 3D magnetic resonance image sets were acquired in healthy human subjects (n=5) prior to and acutely after KT application over the skin along m. tibialis anterior (TA). Hip, knee and ankle angles were kept constant. Demons image registration algorithm was used to calculate local tissue deformations within the lower leg, in vivo.

Mean peak tissue strains were significantly higher than strain artifacts. Only KT-to-TA region in part shows local deformations in agreement with tape adhering direction whereas, superficial skin, the rest of KT-to-TA and TA regions show deformations (up to 51.5% length change) in other directions. Non-targeted tissues also show sizable heterogeneous deformations, but in smaller amplitudes. Inter-subject variability is notable.

Magnetic resonance imaging analyses allow for a detailed assessment of local tissue deformation occurring acutely after KT application. The findings confirm our hypotheses and characterize how KT affects the underlying tissues, both immediately targeted and distant. This allows revealing mechanisms that can affect clinical outcomes of KT objectively.

Introduction

Kinesio taping (KT) (for a review see Bassett et al., 2010; Williams et al., 2012) has been increasingly used in the treatment of sports injuries and various neuro-musculoskeletal disorders. However, objective assessments of its effects have been sparse. Studied physiological outcome measures agree with the expected benefits such as improved muscle strength (Fratocchi et al., 2013, Hsu et al., 2009) and activity (Hsu et al., 2009, Slupik et al., 2007), increased range of motion (Gonzalez-Iglesias et al., 2009, Hsu et al., 2009, Thelen et al., 2008), better force sensing (Chang et al., 2010a), scar healing (Karwacinska et al., 2012), increased lymph flow (Shim et al., 2003) and reduced pain (Aguilar-Ferrandiz et al., 2013, Gonzalez-Iglesias et al., 2009, Thelen et al., 2008). Yet, other studies argue that the changes may be too small to be clinically beneficial (Gonzalez-Iglesias et al., 2009), or even show no changes e.g., in muscle strength (Chang et al., 2010a) and activity (Alexander et al., 2008, Alexander et al., 2003, Briem et al., 2011), nerve conduction (Lee et al., 2011) and joint position sense (Fratocchi et al., 2013, Halseth et al., 2004).

Alexander et al., 2008, Alexander et al., 2003 showed an inhibitory effect of taping on trapezius and gastrocnemius muscles. This suggests that taping causes deformations within the target muscle, a component of which affects muscle fibers. For this to occur, forces applied by the tape over the skin must be transmitted to deeper layers of muscle tissue. On the other hand, KT effects outside the target muscle are often ascribed to neurological mechanisms triggered by the effects on the target muscle (Kase et al., 2003, Tamburella et al., 2014). Mechanical effects of KT beyond the targeted tissues are not known objectively. Muscles packed within a limb can impose loads on each other via their contacting surfaces. This can reflect particularly normal forces originating from KT inside the limb. Additionally, continuity of the extracellular matrix (ECM) with epimuscular connective tissues (Huijing, 2009, Yucesoy et al., 2003) and muscle fibers (Berthier and Blaineau, 1997, Huijing, 1999, Street, 1983) allows myofascial force transmission (MFT) (for details see Yucesoy, 2010; Yucesoy and Huijing, 2007). Animal experiments showed major inter-synergistic (Maas et al., 2001) and inter-antagonistic (Rijkelijkhuizen et al., 2007) MFT, within an entire limb (Yucesoy et al., 2010). This can reflect both normal and tangential forces originating from KT to the targeted tissues and from there, to other tissues elsewhere within the limb. Recent magnetic resonance imaging (MRI) studies indicate heterogeneous local deformations, upon changing exclusively the knee angle, not only within m. gastrocnemius, but also within its synergistic (Huijing et al., 2011) and antagonistic muscles (Yaman et al., 2013). Therefore, mechanical loading imposed selectively can have widespread heterogeneous effects.

We consider that by operationalizing such mechanisms, KT initiates mechanical effects distributed within a limb. Proposed benefits may rely directly on local deformations (e.g., in tissue alignment), or on their translation into sensory (e.g., by increasing space over the area of pain, or directing the exudate to a lymph duct) or proprioceptive (e.g., by loading or unloading of mechanoreceptors) effects. However, comprehensive assessments of mechanical effects of KT are lacking which obscures understanding of the mechanism of imposed effects on the underlying tissues. Therefore, our goal was to characterize the mechanical effects of KT objectively using MRI analyses. Specifically, we aimed at testing the hypotheses that KT causes acutely local deformations not necessarily (I) in agreement with tape adhering direction and (II) limited to the directly targeted tissues.

Section snippets

Subjects

Experimental procedures were in strict agreement with guidelines and regulations concerning human welfare and experimentation set forth by Turkish law, and approved by a Committee on Ethics of Human Experimentation at Istanbul University, Istanbul School of Medicine, Istanbul.

Five healthy woman subjects ((mean±SD): age=25.6±1.8 years, height=160.4±5.5 cm, body mass=51.4±7.8 kg) volunteered (Table 1). After a full explanation of the purpose and methodology, the subjects provided an informed

Results

After KT application, mean peak tissue strains in directly targeted tissues and non-targeted tissues were significantly higher than algorithm and subject repositioning artifacts (Table 3). For a majority of the comparisons, subject repositioning artifacts were significantly higher than algorithm artifacts.

Fig. 4 shows pooled local tissue deformations data across all subjects. For KT-to-TA and TA regions respectively, maximal local lengthening and shortening equals 51.5% and 27.5%, and 41.4% and

Discussion

Demons algorithm has been utilized for calculating deformations in various tissues including pelvic floor (Wang et al., 2005), lung (Latifi et al., 2013), myocardium (Gao et al., 2014) and finger flexor muscles (Shi et al., 2012). In those studies, good agreements were shown among strains calculated using Demons algorithm and those determined by other registration methodologies and imaging modalities. A commonly used reliable method to test algorithm success is to use synthetic image sets with

Conflict of interest statement

The authors confirm that there exists no conflict of interest.

Acknowledgments

This work was supported by (1) The Scientific and Technological Research Council of Turkey (TÜBĐTAK) under grant 111E084 to Can A. Yucesoy and (2) The Turkish Academy of Sciences (TÜBA) under Distinguished Young Scientist Award to Can A. Yucesoy. The authors would like to acknowledge the following people at Boğaziçi University, Istanbul: Cengizhan Ozturk and Onur Ozyurt for their help in acquisition of MRI images, Ayça Aklar Çörekçi for applying the kinesio tape on the subjects and Arda Arpak

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