Effect of kinesio taping on shoulder maximal voluntary contraction,proprioception and upper limb reaction time in recreational badminton players: A randomized placebo controlled trial

Abstract

BACKGROUND:

Despite recent gain in popularity and the proposed theories of effectiveness of kinesio taping (KT), there remains a lack of sufficient literature on the effect of kinesio taping on maximal voluntary contraction, proprioception and upper limb reaction time.

OBJECTIVE:

To assess the effect of kinesio taping and fatigue on maximal voluntary contraction, proprioception of the shoulder and upper limb reaction time in recreational badminton players.

PARTICIPANTS:

40 recreational badminton players were included in the study.

METHODS:

The subjects were randomly allocated into–1) the KT group and 2) Placebo group. Maximal voluntary contraction, proprioception and reaction time was measured before the application of KT to the shoulder and after 35 minutes of playing badminton with KT.

ANALYSIS:

Wilcoxin signed rank test was used for within group comparison and Mann Whitney U test was used for between group comparison.

RESULTS:

For proprioception within group comparison showed a significant difference at 60° of flexion and 120° of abduction in the control group. On comparison of change in effect size, a significant difference was seen at 60°, 90° of flexion and at 90° of external rotation. For maximal voluntary contraction, between group comparison showed a significant difference in all muscle groups except for the internal rotators.For reaction time, a significant difference was seen on between group comparison. (p < 0.05)

CONCLUSION:

Kinesio taping may help in maintaining proprioception and strength of the shoulder and improving reaction time in badminton players even after a fatiguing game.

Keywords

Kinesio taping shoulder maximal voluntary contraction proprioception upper limb reaction time recreational badminton players

1 Introduction

Badminton is a high intensity sport consisting of rapid arm movement, lunges, jumps and quick changes in direction which are important components required during a match. The game mainly consists of overhead, underhand and sidestrokes [1].

In overhead sports, like badminton shoulder muscles appear to be particularly susceptible to fatigue [2], due to aggressive and powerful strokes such as smash and net shots [1]. Fatigue is characterized by a decline in muscle tension or force capacity due to repetitive activity [3]. During a game of badminton, repetitive activity with incomplete recovery periods lead to sodium potassium downregulation which alters myofilament activity [4]. Besides reduced glycogen content of the active muscles, depletion of phosphocreatinine, oxygen reduction and increase in blood lactate leads to muscle fatigue which impairs muscular performance i.e maximal voluntary contraction [3], proprioception [2] and reaction time [5].

Proprioception in simplest terms is explained as awareness of the body in space [4]. Proprioceptors play a vital role in providing sensory input to the CNS through the afferent pathway which help in maintaining joint stability via activation of the dynamic stabilizers [6].

Reaction time is defined as the time lapse between presence of a stimulus and occurrence of the response of an individual [5]. Reaction time is an important component which enables the player to quickly and accurately pick up sensory information needed and reduce time required for decision making [7].

Impaired muscular performance [3], altered proprioception [2] and reaction time [5] may lead to loss of stability and increase the risk of injuries [6]. In a retrospective study conducted by Shariff A H., 469 musculoskeletal injuries were diagnosed among Malaysian badminton players in a period of 2.5 years. Out of these injuries, shoulder injuries accounted for 36.9 of all injuries in these players [8].

In a RCT performed by Shen Zhang et al., kinesio tape was applied to the forearm of 14 trained tennis players. Kinesio taping helped in delaying the onset of fatigue in prolonged sporting activities in these players [9]. Kinesio tapes have been extensively used for the prevention and rehabilitation of sports injuries. Taping can improve proprioception, which is believed to play a role in preventing acute injury and in the evolution of chronic injury [10]. We assume that kinesio tapes may also play a role in improving strength and reducing reaction time.

Studies on the effect of kinesio taping to assess maximal voluntary contraction and proprioception have had contradictory results in the past literature. However, most of these studies have been carried out without an exercise bout [11, 12]. To our knowledge no retrievable data was found which studied the influence of kinesio taping on reaction time. Hence, this study adds to the current literature on the influence of kinesio taping on maximal voluntary contraction, proprioception and reaction time in recreational badminton players.

2 Methods

The study protocol with reference no: IEC KMC MLR 11-17/231 was approved by the Institutional Ethics Committee, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka. Study was also registered under The Clinical Trials Registry- India (CTRI) with Registration no: (CTRI/2018/01/011399)

This study was a randomized controlled trial conducted in two sports complexes from July 2018 to February 2019. The sample size was 20 in each group and was calculated using 95% confidence tool and 80% power [2].

The inclusion criteria were male and female recreational badminton players of the age group of 18–40 years who have been playing badminton for more than six months. The players were excluded if they presented with any of the following–recent shoulder injury in the past six months, shoulder pain, shoulder surgery in the past 12 months affecting performance, presence of muscle soreness, skin allergy to adhesive material, any musculoskeletal problems affecting the performance.

Informed consent was obtained from each participant in writing. The 40 players were randomly allocated into two groups by chit method. 20 chits were prepared with the letter E written on them (for experimental group). The other 20 chits had P written on them (for placebo group). After folding the chits, they were put in a box and mixed well. Each player was then asked to pick up one chit and were allocated to one of the two groups, based on the letter written on the chit [13]

The participants were asked not to consume any sports drinks or caffeine before the game. On the day of testing, all baseline parameters were tested after which kinesio taping was done for one group and placebo taping for the other group. The players played badminton for 35 mins after which all baseline parameters were measured again [14]. Figure 1 depicts the methodology.

Fig. 1

Consort flow chart.

2.1 Method to test shoulder strength

The maximum isometric voluntary contraction was measured according to–by asking the participants to push against the hand held dynamometer (baseline – Hydraulic LCD Push – Pull Dynamometer. Fabrication Enterprises Inc, White Plains, New York, USA) for approximately three seconds for shoulder flexor, extensor, abductor, adductor, lateral rotators and medial rotators. This was tested with the participant in sitting, before and after the game. The best result out of three trials was considered which was preceded by a practice trail [15].

2.2 Procedure for measurement of proprioception

The joint position sense of the shoulder was measured using a bubble inclinometer (baseline – bubble inclinometer. Fabrication enterprises INC. White Plains, New York 10602, U.S.A) which was attached to the upper arm using an adhesive strapping tape. The participant were asked to keep the arm in zero position [2].

Predetermined reference angles of 60°, 90° and 120° for flexion and abduction, 30°, 45° and 90° of external rotation were used [2, 16]. The participants completed three trials for each angle. Initially the arm was placed passively at the reference angle. The participant was then asked to close their eyes and to actively place the arm at the reference position and hold the position for five seconds [3 , 17]. Position errors were calculated as the relative angular error (RAE). RAE = (target angle – 1st trial) + (target angle – 2nd trial) + (target angle – 3rd trial)/3[18].

2.3 Reaction time

The participant were made to sit on a chair with forearm rested on a flat horizontal table. The elbow was flexed to 90° and wrist was outside the table. The ruler was held in between the thumb and index finger of the participant by the examiner such that five cm gradation is at the web space. The participant were then instructed to catch the ruler as soon as it was released. The distance travelled by the ruler past five cm was recorded. The best of three trials was considered and then converted to time using the formula t = (2d/g)^1/2 . where, $\begin{matrix} t = reaction time, d = distance travelled, \\ g = 9.81 m / s^{2} (gravity acceleration) [19] . \end{matrix}$

2.4 Method to apply kinesio tape to the shoulder

I and Y strip application of taping from origin to insertion was used in this study with the muscle placed in a stretched position. The base was applied at the origin with no tension. Once the base was fixed, about 50–55% tension was applied evenly along the length of the strip. Once the strip reached approximately one to two inches from the insertion, tape was applied to the insertion with no tension. The tape was rubbed along its length in order to ensure proper fixation [20]. The muscles taped in experimental group were supraspinatus, deltoid, infraspinatus and pectoralis minor, Fig. 2 demonstrated experimental taping technique and Fig. 3 demonstrated placebo taping.

Fig. 2

Depicts Kinesio taping done in Group A (Experimental group).

Fig. 3

Depicts placebo taping done in group B (Control group).

3 Results

In our study,40 subjects with a mean age of 26.15±7.59 in the experimental group and 24.55±5.49 in the control group were recruited. Wilcoxin signed rank test and Mann Whitney U test was used for with and between group analysis at baseline. Both the groups were similar at baseline in terms of age, gender, dominance and years of playing badminton, shoulder proprioception, maximal voluntary contraction and upper limb reaction time at baseline.

Statistical analysis was done using statistical package for social science (SPSS)–IBM SPSS Statistics for windows, Version 25.0. Armonk, NY: IBM Corp. The level of significance was set at < 0.05 with 95% confidence interval.

Wilcoxin signed rank test was used for within group comparison of all three parameters whereas Mann Whitney U test was used between group comparison.

Table 2 – For Maximal Voluntary Contraction (N = 20 in each group), a significant fall in strength was seen in all muscle groups in the control group (p < 0.05). The experimental group showed a significant improvement in the extensors (p = 0.014) and external rotators (p = 0.017). A significant difference was seen in all muscle groups except the internal rotators.

Table 1
Represents the position of the dynamometer [15]

Muscles being tested Limb position Placement of dynamometer

Shoulder flexors 90° of shoulder flexion, elbow extension Approximately 5 cms above the elbow joint

Shoulder extensors Arm by the side of the body with neutral rotation Distal end of humerus on the posterior aspect approximately 5 cm above elbow joint

Shoulder abductors 80° of shoulder abduction along with full elbow flexion Lateral aspect of arm, approximately 5 cm above elbow joint

Shoulder adductors 80° shoulder flexion with elbow extension Medial aspect of arm, approximately 5 cm above the elbow joint

External rotators Arm by the side of the body, elbow flexed to 90° with forearm in mid prone position Dorsal aspect of forearm, approximately 5 cm above wrist joint.

Internal rotators Arm by the side of the body, elbow flexed to 90° with forearm in mid prone position Volar aspect of forearm, approximately 5 cm above wrist joint.

Muscles being tested	Limb position	Placement of dynamometer
Shoulder flexors	90° of shoulder flexion, elbow extension	Approximately 5 cms above the elbow joint
Shoulder extensors	Arm by the side of the body with neutral rotation	Distal end of humerus on the posterior aspect approximately 5 cm above elbow joint
Shoulder abductors	80° of shoulder abduction along with full elbow flexion	Lateral aspect of arm, approximately 5 cm above elbow joint
Shoulder adductors	80° shoulder flexion with elbow extension	Medial aspect of arm, approximately 5 cm above the elbow joint
External rotators	Arm by the side of the body, elbow flexed to 90° with forearm in mid prone position	Dorsal aspect of forearm, approximately 5 cm above wrist joint.
Internal rotators	Arm by the side of the body, elbow flexed to 90° with forearm in mid prone position	Volar aspect of forearm, approximately 5 cm above wrist joint.

Table 2

A–experimental group, B–control group, Diff–difference G–group, IQR–interquartile range, M- median, N- sample size

Muscle Group	G		N	M (IQR)	Diff of M	Change %	Pre–post	Post–post
							p value	p value
Flexors	A	Pre	20	8 (7–10)
		Post		10 (7–11)	0.5	8.28	0.116
	B	Pre	20	8 (6–10)
		Post		7 (6–8)	–1	8.86	0.022^*	0.028^*
Extensors	A	Pre	20	6 (5–7)
		Post		6.5 (5.25–8.75)	1	20.69	0.014^*
	B	Pre	20	5 (4–7)
		Post		4.5 (3.25–6)	–0.5	10.28	0.019^*	0.001^*
Abductors	A	Pre	20	8.5 (7–10.75)
		Post		9 (7.25–11.5)	0.5	3.87	0.430
	B	Pre	20	7 (6–8.75)
		Post		6.5 (5–8)	–1	14.65	0.038^*	0.043^*
Adductors	A	Pre	20	5 (4.25–6)
		Post		5 (4 –6.75)	0	0.96	0.949
	B	Pre	20	5 (4 – 6)
		Post		4 (3 – 5)	–1	16.49	0.004^*	0.049^*
Internal Rotators	A	Pre	20	6 (4–7)
		Post		6.5 (4.25–8)	0.5	0.82	0.916
	B	Pre	20	5 (4.25–7)
		Post		4 (3–6)	–1	15.18	0.049^*	0.086
External Rotators	A	Pre	20	5 (4.25–8.75)
		Post		7 (5 – 9.75)	1	15.57	0.017^*
	B	Pre	20	6 (5–7)
		Post		4.5 (3.25–5.75)	–1	17.65	0.008^*	0^*

Table 3 – Within group comparison for proprioception showed an alteration at 60° of flexion and 120° of abduction in the control group. On comparison of change in effect size of proprioception (N = 20 in each group), a significant difference was found at 60° of flexion (p = 0.012), 90° of flexion (p = 0.041) and 90° of external rotation (p = 0.045).

Table 3

Abd–abduction, A–experimental group, B–control group, Diff–difference, ER–external rotation, Flex–flexion, G–group, IQR–interquartile range, M- median, N- sample size

Parameter	G	N	M (IQR)	Diff of M	Change %	Pre–post	Post–post
							p value	p value
Flex 60°	A	Pre	20	5.330 (3.33–892)
		Post		3.495 (1.66–6.66)	–6.70	32.45	0.79
	B	Pre	20	5.165 (2.91–8.08)
		Post		8 (5–11.58)	2.170	53.03	0.25^*	0.12^*
Flex 90°	A	Pre	20	4.665 (3.08–6.33)
		Post		2.830 (0.66–4.92)	2.665	36.89	0.95
	B	Pre	20	5.165 (3.75–7.41)
		Post		6.660 (4.41–10)	1.495	35.94	0.191	0.041^*
Flex 120°	A	Pre	20	5 (3.41–8.33)
		Post		4.330 (3.08–5.83)	1.505	25.44	0.70
	B	Pre	20	5.330 (3.33–7.91)
		Post		5.330 (3.41–8.08)	–0.665	5.04	0.968	0.185
Abd 60°	A	Pre	20	4.165 (3–6.58)
		Post		3.330 (2.41–5)	–6.70	20.62	0.167
	B	Pre	20	3.665 (1.41–8.91)
		Post		6.160 (3.33–10.25)	0.500	26.34	0.266	0.133
Abd 90°	A	Pre	20	2.995 (2–4.58)
		Post		3.830 (2.41–5.92)	1.335	19.80	0.198
	B	Pre	20	3.160 (2–5.25)
		Post		5.660 (2.66–9.83)	1.995	56.89	0.126	0.107
Abd 120°	A	Pre	20	5.330 (3.33–7.16)
		Post		4 (3.08–6.5)	0.835	1.26	0.955
	B	Pre	20	4.495 (2.66–7.41)
		Post		7.830 (4.41–10.5)	2.665	64.38	0.025^*	0.107
ER 30°	A	Pre	20	3.330 (2.06–5.5)
		Post		3.665 (1.75–8.16)	1	19.95	0.455
	B	Pre	20	4.660 (2.75–5.66)
		Post		5.330 (2.75–8.92)	0.830	36.52	0.269	0.797
ER 45°	A	Pre	20	3.995 (2.08–6.33)
		Post		3.330 (1.66–5)	–0.335	7.29	0.732
	B	Pre	20	4.165 (2.41–5.58)
		Post		5.660 (3.5–8.33)	1.005	43.26	0.116	0.172
ER 90°	A	Pre	20	7.160 (2.5–13.83)
		Post		6.495 (2.5–8.83)	2.670	16	0.232
	B	Pre	20	8.660 (3.66–12.16)
		Post		11.330(7.08–14.08)	3.005	32.87	0.073	0.045^*

Table 4. – A significant improvement in reaction time was seen in the experimental group (p = 0.003). A significant difference between the groups was also seen for reaction time. (N = 20 in each group).

Table 4

A–experimental group, B–control group, Diff–difference G–group, IQR–interquartile range, M- median, N- sample size, REACT^N- reaction

REACT ^N TIME			N	M (IQR)	Diff of M	Change %	Pre to post	Post to post
							p value	p value
	A	Pre	20	1.942 (1.75–2.2)
		Post		1.688 (1.45–1.86)	0.264	12.56	0.003^*
	B	Pre	20	1.968 (1.64–2.25)
		Post		1.942 (1.68–2.32	0	1.25	0.554	0.003^*

4 Discussion

Our results in terms of effect of kinesio taping on proprioception, showed an alteration in proprioception at 60° of flexion and 120° of abduction in the control group when the pre and post values were compared. i.e. on within group analysis. In the experimental group, we found that there was no significant difference in within group analysis. On comparing the change percent of effect between the experimental and control group, we found a significant difference at 60°, 90° of flexion and 90° of external rotation. These results suggest that there might be a relationship between the effectiveness of kinesio tape on proprioception.

The knowledge of one’s body in space is known as proprioception—the action of mechanoreceptors in muscles, joint tissues, and skin cause proprioceptive sensations [4]. Along with age, gender, hand dominance, and injury, fatigue is one of the factors that can affect proprioception [6, 17]. Hence, while Kinesio taping did not increase proprioception, it may have assisted the experimental group in maintaining proprioception even after a vigorous (fatiguing) game of badminton.

The significant difference between both the groups at 60°, 90° of flexion and 90° of external rotation, implies that the efficiency of Kinesio tape and proprioception may be linked. Notably, the Kinesio tape group’s decreased variability in flexion joint reposition sensing errors after playing badminton shows that Kinesio tape may retain or enhance proprioception.

A study found that the glenohumeral joint ligaments are lax at 90 degrees and lower, which is consistent with our findings. At these angles, gravitational forces have the most significant influence. To provide stability, precise muscular co-contraction, reflex activity, and force couple coordination are necessary [21]. The amount of gravitational torque increases as the elevation angle approaches 90°, promoting muscular activation and increasing activity from musculotendinous mechanoreceptors, helping to improve JPS [22]. This better JPS, combined with higher cutaneous input provided by Kinesio tapes, may have resulted in decreased fluctuation in external rotation at 90 degrees.

Muscle fatigue is believed to desensitize muscle spindle threshold, affecting joint position sense and the neuromuscular responses vital to joint stability [6, 17]. Together with those of other studies [17 , 25], our findings imply that Kinesio tape may help with fatigue-related joint position awareness. In contrast to our findings, Zanca GG. et al. (2015), conducted a study on 24 healthy subjects and reported that Kinesio tape did not ameliorate fatigue-induced proprioceptive deficits at the shoulder in their study. They suggested that receptors adapt to cutaneous stimuli over time, and therefore Kinesio taping’s effect on boosting blood flow during dynamic contractions may be ineffective because blood flow is not a limiting factor [26].

The present study also looked at the influence of Kinesio taping on maximum voluntary contraction. For all of the muscle groups evaluated, there was a significant difference in the control group. This difference in the control group implies that there was a change in muscle strength after playing badminton. In the experimental group, there was a considerable alteration in the strength of the extensors and external rotators, indicating a reduction in muscle strength. However, no significant differences were observed in the other muscle groups, suggesting that Kinesio taping may have aided in postponing the effects of tiredness and maintaining muscle strength in other areas.

Except for the internal rotators that were not taped, all the other muscle groups demonstrated statistical significance when compared between groups. The considerable shift in all other muscle groups was similar to the findings of Konishi Y., examined whether the effect of tactile stimulation in the form of Kinesiology tape on muscle weakness attributed to attenuation of afferent feedback on 10 participants [27]. Similarly, Lumbroso D et al. [11], found significant improvement in the strength to gastrocnemius and hamstring muscles, when kinesio tape was applied to 36 students. One probable explanation is that, as a muscle is stretched, the spindles are also stretched which set up an action potential, stimulating the–γ efferent fibers, which causes the contractile ends of intrafusal fibers to shorten, causing a stretch of the central region of the spindle to generate impulses in the sensory nerve, which then leads to reflex muscle contraction [28].

Another theory is that KT improves intramuscular blood flow, which delays the formation of lactic acid in the muscle and increases the muscle’s resistance to fatigue [9]. By exerting a concentric draw on the fascia and encouraging an increase in muscular contraction, KT may also result in an instant increase in muscle strength and aid in muscular alignment, contributing to a minor increase in muscle strength [29].

However, when compared to placebo taping and no taping, Zhang S found no effect of KT in improving wrist flexor and extensor strength in 14 volunteers, which could be due to the differences in the muscle’s response to the cutaneous stimulation and the mechanical assistance provided by the tape might not be strong enough to modulate the strength of athletes [9]. Jesus JF concluded that KT did not affect quadriceps strength after conducting a study on 130 healthy people. This could be because KT was applied without tension and also indicated that muscle recruitment differs in athletes from that of healthy people [12].

We also looked at how Kinesio taping affected upper-limb reaction time in our research. In the control group, there were no significant changes for within-group analyses. For within-group comparisons, the experimental group demonstrated a substantial change in the form of an improvement in reaction time. Compared to before the game, the IQR decreased after playing badminton, showing an improvement in reaction time. There was also a significant difference in upper-limb reaction time on comparing the two groups. According to one study, KT causes an increase in sensory input to the central nervous system, which leads to higher information integration, resulting in increased muscle fiber recruitment and improved muscular response. In addition, KT’s ability to promote lymphatic and vascular flow while also reducing discomfort may increase muscle responsiveness [29].

Sant’Ana J et al., in their study, which investigated the effect of a specific fatigue protocol on reaction time, response time, performance time, and kick impact on 7 male athletes, claimed that fatigue caused reaction time to increase [5]. According to Bruce SL et al, when the effectiveness of rock taping and sham taping was compared to kinesio taping in 23 male and 33 female volunteers, kinesio taping did not increase shoulder reaction speed [30].

However, as previously stated, KT may improve fatigue resistance [17]. As a result, we believe that KT may aid in postponing the negative consequences of fatigue by increasing cutaneous proprioceptive input, perhaps improving reaction time.

4.1 Limitations

Nevertheless, this study had some limitations. First, Measurements were not taken immediately after taping. Second, our study used a handheld dynamometer that measured the isometric strength instead of an isokinetic dynamometer as it was portable. Third, none of the internal rotators were taped, and finally, no blinding was done.

4.2 Future implication

Further work is warranted to investigate the effect of Kinesio tape in different populations and at different angles after a bout of fatigue. Further studies should also consider using an isokinetic dynamometer for strength assessment.

5 Conclusion

KT might help maintain proprioception, improve the strength of the shoulder joint, and enhance upper limb reaction time. The application of Kinesio tapes may also enable a player to play for longer with more efficacy and help prevent injuries by delaying the effect of fatigue on proprioception, maximal voluntary contraction, and reaction time.

Author contributions

CONCEPTION: All authors.

DATA COLLECTION: Payal S. Mehta.

DATA ANALYSIS AND INTERPRETATION: Payal S. Mehta, Ashish Prabhakar and Charu Eapen.

WRITING OF THE MANUSCRIPT: Payal S. Mehta, Ashish Prabhakar and Charu Eapen.

REVISION FOR IMPORTANT INTELLECTUAL CONTENT: All authors.

Conflict of interest

The authors have no conflict of interest relevant to this paper.

Ethical considerations

Name of registry: The Clinical Trials Registry- India (CTRI)

CTRI Registration no: (CTRI/2018/01/011399)

URL of registry: https://ctri.nic.in

Funding

The Manipal Academy of Higher Education provided partial financial support for the work discussed in this paper.

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