TITLE: The effects of kinesio taping on architecture, strength and pain of muscles
in delayed onset muscle soreness of biceps brachii

  ABSTRACT:
[Purpose] This study aimed to confirm the effects of kinesio taping (KT) on muscle
function and pain due to delayed onset muscle soreness (DOMS) of the biceps brachii.
[Subjects and Methods] Thirty-seven subjects with induced DOMS were randomized into either
Group I (control, n=19) or Group II (KT, n=18). Outcome measures were recorded before the
intervention (application of KT) and at 24, 48, and 72 hours after the intervention. DOMS
was induced, and muscle thickness was measured using ultrasonic radiography. Maximal
voluntary isometric contraction (%MVIC) was measured via electromyography (EMG).
Subjective pain was measured using a visual analogue scale (VAS). [Results] Group I
exhibited a positive correlation between muscle thickness and elapsed time from
intervention (24, 48, and 72 hours post induction of DOMS); they also showed a significant
decrease in MVIC(%). Group II showed significant increases in muscle thickness up to the
48-hour interval post induction of DOMS, along with a significant decrease in MVIC (%).
However, in contrast to Group I, Group II did not show a significant difference in muscle
thickness or MVIC (%) at the 72-hour interval in comparison with the values prior to DOMS
induction. [Conclusion] In adults with DOMS, activation of muscles by applying KT was
found to be an effective and faster method of recovering muscle strength than rest
alone.

BODY.INTRODUCTION:
Delayed onset muscle soreness (DOMS) is defined as muscle injury caused by movements people
are unaccustomed to, by intensive physical activity, etc1). DOMS is usually experienced within 12 hours of the offending
activity, with the pain reaching a maximum in the following 48 to 72 hours, and it commonly
resolves within 5 to 7 days2).  Eccentric exercises are more likely to induce DOMS, movements which are rarely used in
daily activities3). Muscle pain and loss of
strength occur due to excessive eccentric contractions, which produce pools of intramuscular
lactic acid4). Increases in muscle resting
tension also temporarily alter muscle function5). DOMS manifests as limitations of range of motion (ROM), swelling,
reduced muscle strength, increased muscle thickness, and limited functional movement6,7,8).  Taping has been used in general to protect joints, reduce swelling, and stabilize joints
following acute injuries9). Elastic kinesio
taping (KT) of muscle is effective for pain control due to increases in both blood and lymph
circulations10). It is used for earlier
recovery of muscle strength after exercise11).  Muscle thickness is a measure of muscle function that is taken using ultrasound while the
muscle is actively contracting12).
Electromyography (EMG) is used to assess the functional changes in muscle7, 13).
A visual analogue scale (VAS) is also used to assess subjective changes in pain
experienced14).  The objective of this study, therefore, was to ascertain how KT affects the thickness and
%MVIC of muscle, and subjective pain experienced, as caused by induced DOMS, at different
times of measurement.

BODY.SUBJECTS AND METHODS.SUBJECTS:
This study was conducted with male participants in their twenties. The inclusion criteria
were as follows: no orthopedic problems in the preceding 6 months, no cardiovascular
problems, no medications that may affect performance or measurement, no limitation in ROM,
andright-handed dominant side. All of the subjects voluntarily consented to participate in
this study. Data collection was initiated after approval was obtained from the Dongshin
University Institutional Review Board (BM-006-01). The general characteristics of the
subjects are shown in Table 1Table 1.Characteristics of study participantsParametersGroup I (n=19)Group II (n=18)Age (years)23.5±1.222.5±1.4Height (cm)169.1±3.1171.4±3.6Weight (kg)65.1±3.766.5±5.0All data are expressed as means with standard deviations (SDs). Group I, control;
Group II, kinesio taping.

BODY.SUBJECTS AND METHODS.METHODS:
Out of the 50 participants, only 37 experienced DOMS following the procedure outlined
below. These 37 were then grouped into Group I (control, no treatment, n=19) and Group II
(KT, n=18) by picking up a ball with either group labeled on it. Dumbbells to elicit 70%
of maximal isometric muscle strength (1 RM) of each subject were used to induce DOMS in
the following way. With their nondominant arms on a table, the subjects were asked to flex
their shoulders to 45 degrees, and elbows to 90 degrees and to maintain this position for
3 seconds. Following this, they slowly extended their elbows to the fully extended
position. After full extension, they were passively returned to the starting position of
90 degrees of elbow flexion. This exercise was performed for 7 sets of 10 repetitions per
set. The subjects were rested for 1 minute between sets15). In Group II, KT was applied to the biceps brachii on the
nondominant side in a direction perpendicular to the muscle fibers. Ultrasonography
(Sonoace X49900, Medison, Seoul, South Korea) was used to measure muscle thickness. This
was measured at the midpoint of the muscle belly, which was calculated to be at a point
30% of the way along the biceps muscle and proximal to the elbow joint. The measurement
was taken with the subject sitting and the elbow fully extended. For measurement of the
maximal voluntary isometric contraction (%MVIC), a surface EMG (BTS Pocket EMG, BTS
S.p.A.,Milan, Italy) was used. Data were collected with subjects sitting and the elbow
flexed to 90 degrees against resistance. The sample collection rate was 1,000 Hz, and
filtering was 20 to 500 Hz. A VAS was used to assess subjective pain level. Each session
was repeated 3 times with a 1 minute break between sessions. Outcome measures were
collected a total of 4 times, before the intervention and at 24, 48, and 72 hour
postintervention.  For statistical analysis, SPSS 12.0 for Windows was used. Comparison between groups at
different times was performed by one-way repeated measure ANOVA. When a significant
difference was found, a contrast test was performed. The statistical significance level
was set at α=0.05.

BODY.RESULTS:
Upon analysis of muscle thickness and MVIC (%) before and after induced DOMS, Group I
showed increases in muscle thickness and decreases in MVIC (%) over time (p<0.001). Group
II mirrored the increase in muscle thickness and decrease in MVIC (%) up to the 48 hour
interval post induction of DOMS (p<0.001), but at the 72 hour interval, the measurements
obtained showed no significant difference in muscle thickness and MVIC (%) for Group II when
compared with those from before induction of DOMS (p>0.05) (Tables 2 and
3Table 2.The changes of muscle thickness (cm)−24 h24 h48 h72 hGroup I1.20±0.181.48±0.11a)***1.50±0.12b)***1.41±0.11c)***Group II1.30±0.971.51±1.56a)***1.58±0.4b)***1.31±0.11All values are shown as the mean±SD. Group I, control; Group II, kinesio taping.
a) −24 h vs. 24 h, b) −24 h vs. 48 h, and c) −24 h
vs. 72 h by one-way repeated measures ANOVA and post hoc testing with a contrast test
(***; p<0.001)Table 3.The changes of MVIC (%)−24 h24 h48 h72 hGroup I33.1±1.328.1±1.5a)***28.8±1.3b)***29.5±1.8c)***Group II31.1±1.026.2±1.8a)***27.9±1.3b)***30.9±1.8All values are shown as the mean±SD. GroupI, control; Group II, kinesio taping.
a) −24 h vs. 24 h, b) −24 h vs. 48 h, and c) −24 h
vs. 72 h by one-way repeated measures ANOVA and post hoc testing with a contrast test
(***; p<0.001)).

BODY.DISCUSSION:
Delayed onset muscle soreness (DOMS) after excessive or unaccustomed use of muscles can
occur in anyone16). It is related to
inflammation resulting from damage to muscle and connective tissue17). KT reduces pain via mechanical stimulation18). It is also known to be effective in the
restoration of ROM and muscle strength19).
KT maintains consistent muscle tension and further improves muscle function by enhancing
stability20). The aim of this study was
to find out how KT influences muscle thickness, MVIC (%), and subjective pain in adults with
deliberately induced DOMS 24 hours, 48 hours, and 72 hours postintervention.  To properly assess muscle function, it is important to compare and analyze muscle with
ultrasound21). This makes it possible to
assess characteristics of muscle such as size, thickness, shape, and function8). Muscle thickness is an especially important
gauge of the mechanical properties of muscle and the changes that are occurring to inner
structures22).  After induction of DOMS, muscle thickness in both Group I and II showed increases at the 24
hour and 48 hour intervals. At the 72 hour interval, Group II showed a muscle thickness that
was similar to the measurements obtained before induced DOMS. We believe this to be due to
KT stimulating γ-motor neurons within skeletal muscle with a subsequent effect on resting
muscle tension.  DOMS causes reduced muscle function and damages muscle fibers more in eccentric
contractions than concentric ones23).
Surface EMG analyzes the electrical activity of individual muscles and provides information
about changes in motor control24).  Changes in muscle function are measured via %MVIC7). Following induction of DOMS, Group II had decreases in MVIC (%) at
24 and 48 hours intervals, although MVIC (%) recovered by the 72 hour interval. Group I
showed significant decreases in MVIC (%) at all intervals. We believe this to be due to
metabolic problems occurring within the muscle due to the increase in muscle thickness, the
buildup of cellular waste products, and to a decrease in contractility as a result of
myofiber microtrauma. We also believe that the recovery of altered tissues in Group II was
facilitated by KT due to its elastic nature, which raises the skin and muscle fascia.  Changes in subjective pain levels were measured by VAS15). Both Group I and Group II with induced DOMS showed increased pain
levels 24 hours after the intervention, reaching a maximum 48 hours post intervention and
decreasing at the 72 hour mark. We propose that this proves that elastic KT is effective in
reducing pain. We further suggest that this will have a positive psychological effect and
hasten the return to daily routine (Table
4Table 4.The changes of VAS (scores)−24 h24 h48 h72 hGroup I05.29±1.375.86±0.134.52±1.36Group II05.07±1.285.74±0.172.19±0.23a)***All values are shown as the mean±SD. GroupI, control; Group II, kinesio taping.
a)24 h vs. 72 h by one-way repeated measures ANOVA and post hoc testing
with a contrast test (***; p<0.001)).  In conclusion, elastic KT was found to reduce pain by improving muscle function and
strength, as it provides an environment conducive to recovery. It achieves this by
activating muscles with DOMS. KT was found to be an important modality in the treatment of
musculoskeletal disorders.

Question: Compared to baseline what was the result of Group I - control on Maximal voluntary isometric contraction (MVIC)?
Evidence: Upon analysis of muscle thickness and MVIC (%) before and after induced DOMS, Group I
showed increases in muscle thickness and decreases in MVIC (%) over time (p<0.001). 
Answer: significantly decreased