Accepted Manuscript

What is the effect and mechanism of kinesiology tape on muscle activity?

Rasool Bagheri, Mohammad Reza Pourahmadi, Ali Reza Sarmadi, Ismail Ebrahimi
Takamjani, Giti Torkaman, Seyyed Hamed Fazeli

PII: S1360-8592(17)30142-0
DOI: 10.1016/j.jbmt.2017.06.018
Reference: YJBMT 1565

To appear in: Journal of Bodywork & Movement Therapies

Received Date: 23 February 2017

Revised Date: 1 May 2017
Accepted Date: 13 June 2017

Please cite this article as: Bagheri, R., Pourahmadi, M.R., Sarmadi, A.R., Takamjani, I.E., Torkaman,
G., Fazeli, S.H., What is the effect and mechanism of kinesiology tape on muscle activity?, Journal of
Bodywork & Movement Therapies (2017), doi: 10.1016/j.jbmt.2017.06.018.

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 ACCEPTED MANUSCRIPT

Title:
What Is the Effect and Mechanism of Kinesiology Tape on Muscle Activity?

Authors:
Rasool Bagheri PT, PhD (Candidate) a,b, Mohammad Reza Pourahmadi PT, PhD (Candidate) a,

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Ali Reza Sarmadi PT, PhD c*, Ismail Ebrahimi Takamjani PT, PhD a, Giti Torkaman PT, PhD c,
Seyyed Hamed Fazeli PT, PhD (Candidate) a

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Affiliations and Institutions:

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aDepartment of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health
Services, Tehran, Iran.
bRehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation, Semnan University of

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Medical Sciences and Health Services, Semnan, Iran.
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cSchool of Medicine, Tarbiat Modares University, Tehran, Iran.

Conflict of Interest Disclosure: None.

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* Corresponding Author:
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Dr. Ali Reza Sarmadi, Ph.D. PT.

Department of Physiotherapy, School of Medicine, Tarbiat Modares University, Tehran, Iran.
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Address: Tarbiat Modares University, Jalal Ale Ahmad Highway, P.O.Box: 14115-111, Tehran, Iran. Phone, +98-21-
82880. Email address: sarmadi.alirezapt@gmail.com
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Abstract
Objective: This study aimed to evaluate the effects of kinesiology tape, anesthesia, and kinesiology tape along with
anesthesia on the motor neuron excitability.
Participants: Participants included 20 healthy men aged 20–35 years, who were examined over 5 sessions.
Intervention: The five experimental sessions included: control without applying the kinesiology tape or Eutectic

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Mixture of Local Anesthetics (EMLA); treatment only with EMLA; only kinesiology tape application; only sham tape
application; and treatment with kinesiology tape and EMLA.
Main outcome measures: The H-reflex recruitment curve of the soleus and lateral gastrocnemius was recorded by a

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blinded assessor in the 5 separate sessions randomly assigned with 48 h washout periods. The major H-reflex
parameters include: the Hmax/Mmax ratio, the H-reflex threshold stimulation intensity (Hth), the intensity of maximum H-

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reflex (IntensityHmax), the H-reflex ascending slope (Hslp), and the H-reflex ascending slope fixed into the first three
points (first Hslp).

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Results: The H-reflex parameters (H slope, first Hslp, Hth, and IntensityHmax) were facilitated by application of the
kinesiology tape with and without EMLA; however, EMLA inhibited the H-reflex parameters (Hmax/Mmax ratio, Hslp, first
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Hslp, and Hth) in both the soleus and lateral gastrocnemius. The sham tape did not alter the H-reflex recruitment curve
parameters. The statistical model revealed a significant difference between the kinesiology tape and the sham tape
and control sessions, between kinesiology tape–EMLA and EMLA, and between kinesiology tape–EMLA and control
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session.
Conclusions: Results suggest that the kinesiology tape facilitates the muscle activity and the underlying mechanism
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on the gastrosoleus motor neuron pool is the cutaneous receptors.

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Key words: Kinesiology tape, H-reflex recruitment curve, Gastrosoleus

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1. Introduction
Initially introduced by Dr. Kenzo Kase (1973), the kinesiology tape is widely used since the Beijing 2008 Olympics.
Recently, it is used by sportspersons and in clinical practice for patients with several musculoskeletal injuries (Bridget
et al., 2010). The kinesiology tape is used in: inhibition of overactive synergists or antagonists, facilitation of
underactive movement synergists, promotion of proprioception, optimization of joint alignment, pain reduction, and

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unloading of irritable neural tissue (Alexander et al., 2003; Alexander et al., 2008; Host, 1995; Morrisey, 2000; Tobin
& Robinson, 2000).
Studies revealed that taping can alter the muscle activity with direction-dependent effects (Christou, 2004;

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McConnell, 1986; Tobin & Robinson, 2000). Kinesiology taping is presumed to facilitate the muscle activity when it is
applied from the origin to the muscle insertion point, whereas reversing the direction of application will have an

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inhibitory effect (Kase et al., 2003); however, rigid tape applied under tension in the direction of the muscle fibers, is
considered to facilitate the underlying muscle activity. Alternatively, rigid tape applied across the belly of the muscle,

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is considered to inhibit the muscle activity (McConnell, 1986; Tobin & Robinson, 2000). Alexander et al. (2003)
investigated the facilitatory or inhibitory effects of taping along the lower fibers of the trapezius and found that taping
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inhibited the Hoffman (H-) reflex. In another study, Alexander et al. (2008) examined the effects of taping along or
across the triceps surae on motor neuron excitability, and reported that taping along the length of the triceps surae
inhibited the muscle’s H-reflex excitability. Thus, the results of the aforementioned studies proposed that the
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application of tape along the muscle may shorten it, and unload the intrafusal fibers of the muscle spindle (Alexander
et al., 2003; Alexander et al., 2008; Kase et al., 2003); however, certain studies have revealed that the tape cannot
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alter the muscle activity regardless of its direction on the muscle (Cools et al., 2002; Tieh-Cheng et al., 2008). Bridget
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et al. reported that calf muscles motor neuron excitability remained unaltered following the application of the
kinesiology tape (Bridget et al., 2010); however, removing the tape facilitated the H-reflex, and cutaneous afferent
stimulation was stated as a possible mechanism of the kinesiology tape (Bridget et al., 2010). Another recent study
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investigated the motor neuron excitability after the facilitatory and inhibitory taping techniques, and concluded that the
amplitude of H-reflex remained unaltered by both facilitatory and inhibitory techniques of the kinesiology taping
(Yoosefinejad et al., 2016). Therefore, the inhibitory and facilitatory effects of taping on motor neuron excitability and
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underlying neurophysiological mechanisms remain controversial. To the best of our knowledge, very few studies
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have evaluated the possible mechanisms. In general, some studies indicated that the cutaneous receptors act as
possible mechanism for the inhibition and/or facilitation of motor neuron (Bridget et al., 2010; Tobin & Robinson,
2000); however, other studies concluded that the muscle spindle is responsible for inhibition of motor neuron after
taping (Alexander et al., 2003; Alexander et al., 2008).
The effects of cutaneous afferent on spinal motor neuron excitability have been investigated by some
researchers for several years. For example, the effects of skin anesthesia on motor neuron excitability have been
also evaluated by various authors to reveal the role of the cutaneous receptors (Arsenault et al., 1993; Krause et al.,

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2000; Navid et al., 2003a; Sabbahi & De Luca, 1982; Sabbahi & Luca, 1981; Salehi et al., 2005; Salehi et al., 2006).
In general, the results of these studies indicated that topical anesthesia of the skin can inhibit the H-reflex, and a
facilitatory role was attributed for the cutaneous receptors (Navid et al., 2003a; Salehi et al., 2005; Salehi et al.,
2006); however, certain evidences demonstrated that topical anesthesia spraying on the skin can facilitate the motor
neuron pool (Sabbahi & De Luca, 1982; Sabbahi & Luca, 1981).

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Presumption states that if the tape has enough strength to shorten a muscle and inhibit the motor neuron
excitability, as defined by Alexander et al. (Alexander et al., 2003; Alexander et al., 2008), the effect of the
kinesiology tape on excitability should be independent of anesthetization of the skin; however, no published study

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has evaluated the effect and possible mechanism of taping on the anesthetized skin. Therefore, we have developed
an experiment to evaluate the kinesiology tape effects on the anesthetized skin overlying the gastrosoleus for the

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motor neuron excitability. The study questions were as follows:
1- How does kinesiology tape affect the gastrosoleus H-reflex recruitment curve?

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2- How does the local skin anesthesia affect the gastrosoleus H-reflex recruitment curve?
3- How does kinesiology taping of the anesthetized skin affect the gastrosoleus H-reflex recruitment curve?
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2. Method and Materials
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2.1. Participants
This study included 24 nonathletic healthy male participants (aged 22–45 years). During the initial H-reflex
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assessment, four subjects were excluded due to the unstable amplitude of the H-reflexes (≥10% deviation in 5
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maximum reflexes of the same intensity level) ; (Sarmadi et al., Spring 2009; Simorgh et al., Winter 2007). Only
nonathletic males were preferred because the motor neuron excitability could be modulated by regular exercise
(Trimble & Koceja, 1994) and influenced during the luteal phase of the menstrual cycle in females (Murata et al.,
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2014). This prospective double blind clinical trial study was approved by the Ethical Committee of Tarbiat Modares
University (ethical approval number: 5299424). Participants who suffered pain in any of their joints or muscles during
the previous 2 years or those who had neurological, rheumatological, or other lower extremity musculoskeletal
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disorders, were excluded from the study. The sample size was determined based on a previous similar study and
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was calculated by the formula . Salehi et al. reported the mean ± SD of the H threshold (Hth) equal
to 11 ± 1.6 and 12.4 ± 1.4 before and after the application of topical anesthesia, respectively (Salehi et al., 2005).
Minimum 20 participants were required to obtain 80% power, 95% confidence interval (CI), and an alpha
value of ≤0.05. Participants met the inclusion criteria and agreed to participate in the study via the convenience
sampling method; posters were displayed in the frequently visited areas of the University and surrounding locality. An
informed consent was obtained from all 20 subjects.

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2.2. Apparatus
This study was a test–retest design comprising 5 separate sessions 2 days apart to reduce the impact of
any possible carryover effect. The test sessions were randomly assigned by simple randomization (by application of
a computer-generated randomization) with no specific order and the participants were blinded from the order of the
test conditions. A physiotherapist with 10-year experience of taping intervened the study. The assessor was blinded

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by placing a towel on the patient’s leg during the taping or application of the Eutectic Mixture of Local Anesthetics
(EMLA). The H-reflex recruitment curve data were obtained by the blinded assessor who was PhD candidate in
physiotherapy and was uninvolved in the interventions (taping and anesthesia). The experiments comprised the

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following five sessions: (1) Control session, where the recruitment curve was recorded without any intervention
(kinesiology tape or EMLA); (2) EMLA (anesthesia) session, where the skin overlying the gasterosoleus muscle was

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anesthetized with topical lidocaine–prilocaine 5% cream (EMLA); (3) taping session, where the skin overlying the
gasterosoleus was covered by only kinesiology taped and without using the EMLA; (4) tape–EMLA session, where

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the kinesiology tape was applied on the anesthetized skin overlying the gasterosoleus; and (5) sham tape session,
where the kinesiology tape was applied under no tension on the triceps surae.
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2.3. H-reflex recruitment curve recording
The calf muscle excitability was evaluated by evoking the H-reflex of the soleus and lateral gastrocnemius
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muscles simultaneously. To record the H-reflexes, a computer-controlled stimulator with an isolator (Nihon Kohden
ss-104j, Japan) and a Neuro-MEP system (Neurosoft, Russia) were used. Bandwidth and sampling frequencies were
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set at 5 –10 kHz and 4 kHz, respectively. To obtain these reflexes, the electromyographic activity (EMG) of the lateral
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gastrocnemius and soleus was recorded using Ag/AgCl surface electrodes placed 2 cm apart (Sarmadi et al., 2004).
The skin was abraded with fine sandpaper and cleaned with alcohol. An imaginary line connecting the mid-popliteal
fossa to the central point of the medial malleolus was bisected to locate the recording electrode on the soleus
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(Alrowayeh & Sabbahi, 2008; Palmieri et al., 2002). In aforementioned imaginary line, from a quarter below the
popliteal fossa, the recording electrode was located about 4–6 cm lateral to the midline of the leg at an angle of 45°
and parallel to the lateral gastrocnemius fibers (Sarmadi et al., 2004). The ground electrode was placed between the
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stimulating electrode and the soleus recording electrodes (Alrowayeh et al., 2005). To ensure accurate stimulation, a
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roving electrode (a rectangular flat electrode) was utilized to find the position of the tibial nerve in the popliteal fossa.
After establishing this position by evoking a response in the calf muscles, the roving electrode was fixed with a strap
over the tibial nerve. The stimulus artifacts were removed using a custom made artifact-suppressing amplifier.
Initially, each experimental session created the soleus and lateral gastrocnemius H-reflex recruitment profiles
for every subject. These profiles determined the pulse intensity necessary for eliciting three H-reflex amplitudes: (1)
the final H-reflex when the maximum M-response was achieved (last intensity); (2) the maximum H-reflex amplitude
(intensity of Hmax); and (3) the H-reflex equal to 5% of the maximum H-reflex (threshold or Hth). These intensities were

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used throughout the latter part of the experiment to obtain the H-reflex recruitment curves. Crucially, we used a
stimulating protocol (steady increments of 0–2 mA) to obtain of at least 16 and 14 real data points for driving the
soleus and lateral gastrocnemius recruitment curves, respectively. Every 10 s, a 1-ms square wave pulse was
delivered from a computer through the isolator and was then applied percutaneously to the tibial nerve. Electrical
stimuli progressively increased from below the threshold level until the maximum motor responses (Mmax) were

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achieved and plateaued in both soleus and gastrocnemius.
Furthermore, to map the H-reflex recruitment curve, at least 48 stimuli in the 16 intensity levels (3 stimulations
for each intensity level), which included the 3 target intensity levels of both soleus and lateral gastrocnemius, were

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delivered to the nerve. A minimum of 24 H-reflexes for the upsloping portion and 24 H-reflexes for the descending
portion were obtained for the soleus recruitment curve. As the lateral gastrocnemius has a higher threshold and lower

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last intensity compared to the soleus, its recruitment curve is drawn within the soleus motor neuron recruitment
curve. To obtain 42 H-reflexes from the lateral gastrocnemius, 21 stimuli for the upsloping portion and 21 stimuli for

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the descending portion were imported. Eventually, the soleus and lateral gastrocnemius H-reflex recruitment curves
(H amplitudes and related intensity levels) were obtained using 16 and 14 points, respectively. The intensity
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stimulation was recorded and stored simultaneously with the EMG data. Moreover, the EMG data were converted
from an analog to a digital signal and stored for further analysis by CED Signal software. Room temperature was
maintained between 25°C–27 °C throughout the experimental conditions.
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2.4. Taping method

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As defined by Kase et al., a Y-strip kinesiology tape technique was applied from the insertion to the origin.
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This method is assumed to “stimulate” the central nervous system and inhibits the muscle activity (Kase et al., 2003).
The tape length was determined and the tape was prepared by estimating the muscle length and required tension.
The tape was positioned in a single direction parallel to the direction of the muscle fibers of the soleus over the
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Achilles tendon up to the medial and lateral heads of the gastrocnemius muscles (Fig. 1). While the participants lying
in a prone position and actively dorsiflex the ankle to the end of available range, the tape was applied to the end of
the Achilles tendon under no tension. Furthermore, the tape was tensed (50%–75% of the available tape) and
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adhered to the skin overlying the soleus and lateral and medial gastrocnemius, and finally, the two ends of the tape
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were applied under no tension. The tape was rubbed by the tester to improve its adherence to the skin. In the sham
taping session, a Y-strip piece of the kinesiology tape was prepared and applied under no tension from the insertion
point to the origin of the triceps surae as participants lied in the prone position just like the real kinesiology tape.
Similar to the previous studies utilized sham taping for comparison, tape application looks very similar but all the
therapeutic elements removed from the process (Parreira et al.; Thelen et al., 2008).

PLEASE PLACE FIGURE 1 ABOUT HERE

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2.5. Anesthesia method

A lidocaine–prilocaine 5% cream (2.5% lidocaine with 2.5% prilocaine) [EMLA] was applied for anesthesia.
In order to avoid cooling of the skin, a towel was placed over the area. Sensations of the underlying skin (cold, warm,
touch, five points needle pressure via a monofilament) were assessed according to the previous studies (Navid et al.,

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2003a; Salehi et al., 2005). In a pilot study, a preliminary assessment estimated the time limit for applying the
kinesiology tape on the anesthetized skin overlying the triceps surae; the results revealed that 6–10 g of EMLA for
10–20 min significantly decreased the sensory and pain thresholds. Cold and warm sensation thresholds were

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assessed using a metal plate whose temperature was adjusted using two water bowls with 15 ºC and 25 ºC,
respectively. Subjects were asked to score their warm and cold sensations between 0 and 10 (10 indicated sensation

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before applying EMLA and 0 indicated no sensation). Additionally, the touch sensation threshold was assessed using
a small piece of cotton, which was slowly rubbed on five points of the skin overlying the triceps surae. The subjects

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were asked to score the touch sensation between 0 and 10 and the mean of the 5 points was calculated as the touch
sense. Monofilament test was performed by a single, continuous strand (filament) with 10° difference on the five
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points of the skin overlying the triceps surae. When the examiner gradually pressed the strand, the sensation
threshold of the filament was recorded. Sensation was assessed thrice: before applying the EMLA and 10 and 20 min
after anesthesia. Prior to EMLA application, the area of the leg, which was supposed to be taped in the Tape–EMLA
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group, was marked and 6 g of EMLA was applied on the skin.

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2.6. Measurement
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All the measurements were evaluated on the dominant leg. Leg dominancy was determined by a modified
version of a test outlined in a study by Bridget et al. (Bridget et al., 2010). Two recruitment curves were recorded in
the kinesiology tape and sham tape sessions in the following order: first curve was recorded, then kinesiology tape
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was applied, and second curve was recorded after 5 min. In three other sessions, three recruitment curves were
recorded in the following order: first curve was recorded, then EMLA was applied and second curve was recorded
after 10 min, and then kinesiology tape was applied and third curve was recorded after 5 min. In the EMLA session,
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first curve was recorded, then EMLA was applied and second and third curves were recorded after 10 and 25 min,
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respectively. In the control session, three recruitment curves were recorded like the EMLA session.

2.7. Data analysis

For data analysis, all H-reflex recruitment curves data (peak to peak amplitude as Y-axis and related
intensity level as X-axis) were imported into a custom LabView software (National Instruments Corporation, Austin,
TX, USA). Each recruitment curve was mapped using 16 and 14 data points from the soleus and lateral
gastrocnemius, respectively. The upsloping portion of the recruitment curve was fixed to the seven points for the

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lateral gastrocnemius and eight points for the soleus from the first H-reflex, which appeared in EMG trace through the
maximum H-reflex. The descending portion was fixed to the seven points for the lateral gastrocnemius and eight
points for the soleus from the maximum H-amplitude through the last H-reflex amplitude. The 14th and 16th data
points represented the stimulus intensity that elicited Mmax of lateral gastrocnemius and soleus, respectively.
Furthermore, the peak to peak amplitudes of the Hmax and the Mmax were extracted from each recruitment curve data,

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and the Hmax/Mmax ratio was calculated from each test condition. Moreover, the Hth, ascending (Hslp) and descending
slopes of the H-reflex and the first (first Hslp) and last three points (last Hslp) fixed to the ascending slope of the H-

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reflex recruitment curve were extracted from the recruitment curve data. The Hth was defined as the value where the
recruitment curve exceeded 5% of the peak normalized reflex response (i.e., Hmax/Mmax). Three components of the
recruitment curve including Hth, ascending slope of the H-reflex, and the Hmax /Mmax ratio (functional components

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principal) had excellent intersession reliability in previous researches (Bagheri et al., 2013; Kipp et al., 2011). Other
recruitment curve parameters also reported good intersession reliability (Bagheri et al., 2013).

2.8. Statistical analysis

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Data was analyzed using SPSS version 17.0 (IBM Inc., Chicago, IL, USA). The data were further analyzed
to assess for normal distribution using the Kolmogorov–Smirnov (K–S) test. K–S showed that all H-reflex parameters
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were normally distributed. The H-reflex recruitment curve parameters were compared using repeated measures
ANOVA (session × tape state) to assess for differences between the combined pre/post taping condition, pre/post
anesthesia and pre/post sham tape in each session. Post hoc testing was completed using a Bonferroni index to
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compare the mean differences of the H-reflex between the sessions. A significance level of 0.05 was used as the
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critical value.

3. Results
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The participants included 20 healthy male subjects with mean ± SD age of 27.7 ± 3.4 years, height of 1.65
± 0.36 m, and weight of 68.77 ± 0.7 kg. One participant was excluded because he did not complete the experimental
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sessions due to unexpected traveling. H-reflex recruitment curve data was analyzed for 19 subjects.
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3.1. H-reflex recruitment curve in control session

No time-effect was observed on the H-reflex recruitment curve parameters in the control session (P > 0.05;
see Table 1 and 2). Repeated measures revealed no significant differences between the Hmax/Mmax ratio, ascending
and descending slope of H-reflex, Hth and first Hslp and last Hslp of the ascending part of the H-reflex recruitment
curve in both the soleus and lateral gastrocnemius during the three recruitment curves.
3.2. H-reflex recruitment curve in taping session

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The Hmax/Mmax ratio did not change significantly after applying the kinesiology tape in both the soleus and lateral
gastrocnemius.
Five minutes after the kinesiology tape application, the Hth (P = 0.001) and the intensity of Hmax (P = 0.01)
decreased significantly and the first Hslp (P = 0.03) in soleus H-reflex recruitment curve increased significantly. In the
lateral gastrocnemius, the Hth (P = 0.000) and intensity of Hmax (P = 0.01) decreased significantly and the Hslp and first

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Hslp increased significantly (P = 0.05).
No significant change was observed in other parameters such as the descending slope of the H-reflex and
the intensity required to achieve the last H-reflex after kinesiology tape application in both soleus and lateral

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gastrocnemius muscles. Figure 2 indicates that the H-reflex recruitment curve was displaced to the left (facilitate) and
the M-wave remained stable after the application of the kinesiology tape. This illustration reveals that the intensity of

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Hmax and the Hth were horizontally displaced to the left (X-axis), whereas the amplitude of the Hmax and also Mmax
remained unchanged (Y-axis) after the application of kinesiology tape. As illustrated in Figure 1, about 0.4–1 mA

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difference is recognizable for the Hth and the intensity of the Hmax that are placed within 95% CI.
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PLEASE PLACE FIGURE 2 ABOUT HERE
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3.3. H-reflex recruitment curve in sham tape session

In the sham tape session, no significant change was observed in the recruitment curve parameters,
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between the pre tape and post tape conditions (P > 0.05).
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3.4. H-reflex recruitment curve in anesthesia session

Ten minutes after the EMLA application, the Hmax/Mmax ratio (P = 0.02) and soleus ascending Hslp (P = 0.01)
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decreased significantly.
Twenty-five minutes after the EMLA application, the ascending Hslp and first Hslp (P = 0.01 and 0.04,
respectively) decreased significantly, and the Hth increased significantly (P = 0.04) in the soleus. In addition, the Hslp
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and first Hslp of the lateral gastrocnemius (P = 0.04 and P = 0.05, respectively) decreased significantly.
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Table 1 summarizes some essential variables extracted from the soleus H-reflex recruitment curve.

PLEASE INSERT THE TABLE 1 ABOUT HERE

3.5. H-reflex recruitment curve changes in Tape–EMLA session

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Ten minutes after the EMLA application, the soleus Hmax/Mmax ratio (P = 0.02) and the ascending Hslp of the
soleus and lateral gastrocnemius (P = 0.01 and P = 0.02, respectively) decreased significantly. The intensity of Hmax
increased significantly in the lateral gastrocnemius (P = 0.02).
Five minutes after the kinesiology tape application, The Hth and intensity of Hmax (P = 0.01 and P = 0.01,
respectively) decreased significantly. In addition, the ascending Hslp and the first Hslp of the soleus H-reflex

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recruitment curve (P = 0.01 and P = 0.04, respectively) increased significantly. In the lateral gastrocnemius
recruitment curve, the Hth and intensity of Hmax (P = 0.000 and P = 0.006, respectively) decreased significantly and
the Hslp and first Hslp (P = 0.007, P = 0.01) increased significantly after kinesiology tape application.

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Table 2 summarizes some essential variables extracted from the lateral gastrocnemius motor neuron
recruitment curve in the five test sessions (the Hslp, Hth, intensity of Hmax, first Hslp, and Hmax/Mmax).

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Figure 3 represents the Hth and Hmax/Mmax ratio changes in the four test conditions.

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PLEASE INSERT THE TABLE 2 ABOUT HERE
PLEASE INSERT THE FIGURE 3 ABOUT HERE
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3.6. Between-session analysis
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3.6.1. Control session versus four other sessions:

The H-reflex recruitment curve parameters were analyzed by a post hoc test using Bonferroni index to
reveal the differences between groups (or sessions) on application of the kinesiology tape to the triceps surae.
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Post hoc test revealed that the kinesiology tape significantly decreased the lateral gastrocnemius Hth (P =
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0.00) and the intensity of Hmax in the soleus and the lateral gastrocnemius (P = 0.00 and P = 0.04, respectively)
compared to the control session; however, the EMLA significantly increased the soleus Hth and the intensity of Hmax
(P = 0.00 and P = 0.05, respectively) compared to control session. This test also revealed that the soleus Hth and the
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intensity of Hmax in the lateral gastrocnemius (P = 0.03 and P = 0.003, respectively) were significantly decreased after
applying the kinesiology tape in the tape–EMLA session compared to control session.
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3.6.2. Between other interventions analysis:

In this investigation, no significant difference was observed in the H-reflex parameters between the tape and
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tape–EMLA sessions when the kinesiology tape was applied to the lower leg (P > 0.05); however, the post hoc test
revealed a significant difference in the soleus Hth and the first Hslp between the EMLA and tape–EMLA sessions when
the kinesiology tape was positioned on the leg (F = 9.252, P = 0.003 and F = 2.139, P = 0.04, respectively). The post
hoc test using Bonferroni index with a Greenhouse-Geisser correction indicated that the Hth of the lateral
gastrocnemius differed significantly among the tape and sham tape sessions (F = 7.112, P = 0.01). The mean
intensity of Hmax of the lateral gastrocnemius and the first Hslp of the soleus differed statistically significantly between
the tape and the sham tape conditions when the kinesiology tape was applied on the triceps surae (F = 5.16, P =

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0.03. and F = 2.21, P = 0.05, respectively; see Table 3); however, no significant difference was seen for the Hmax
/Mmax ratio and the ascending slope of the H-reflex and the mean differences of the first Hslp and the last Hslp of the H-
reflex recruitment curve, between the testing conditions.

PLEASE INSERT THE TABLE 3 ABOUT HERE

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3.7. Assessment of skin sensation

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During the anesthesia session,10 and 20 min after EMLA application, the skin sensations such as warm,
cold, light touch, and five points pain pressure sensation decreased significantly (P < 0.05; see Table 4).

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PLEASE INSERT THE TABLE 4 ABOUT HERE

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4. Discussion
Kinesiology taping has claimed both facilitatory and inhibitory effects on the muscle activity. We aimed to
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investigate the motor neuron excitability of the soleus and lateral gastrocnemius after an inhibitory Y-technique using
the H-reflex recruitment curve. First, the results of this study indicated that the Hslp and Hth reported significant
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increase and decrease, respectively, after kinesiology taping. Second, local skin anesthesia decreased the Hslp and
increased the Hth and intensity of Hmax. The results of this study indicated that the ratio between the H-reflex and M-
wave (Hmax/Mmax) decreased after applying EMLA on the skin; however, the Hmax/Mmax ratio did not change after
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kinesiology tape application with and without EMLA. The Hmax/Mmax reveals the percentage of the depolarized motor
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neurons in response to Ia-afferent activation (Kipp et al., 2011). We presume that kinesiology taping on leg cannot
alter the number of recruited motor neurons; however, the Hslp, Hth, and intensity of Hmax were altered after
kinesiology tape application in the tape–EMLA session. The Hth or H threshold represents the excitability of the
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lowest threshold motor neurons, and the peak slope of the H-reflex recruitment curve (Hslp) indicates the rate of
change in the motor neuron pool excitability in response to an increased Ia-afferent input to the motor neuron pool
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(Kipp et al., 2011; Sarmadi et al., Spring 2009; Simorgh et al., Winter 2007). The first Hslp of the H-reflex recruitment
curve is used to estimate the rate of change in excitability of the lower threshold motor neuron pool (Navid et al.,
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2003b; Pierrot-Deseilligny & Mazevet, 2000; Sarmadi et al., Spring 2009; Simorgh et al., Winter 2007). Variation of
the Hth and intensity of Hmax produces a horizontal shift in the recruitment curve, whereas altering the Hmax/Mmax ratio
produces a vertical shift in the recruitment curve (Kipp et al., 2011). Both horizontal and vertical shifts may arise due
to an increase in the Ia-afferent input to the motor neuron pool.
Based on the results presented in Table 3, the kinesiology tape facilitated the H-reflex in the tape and tape–
EMLA sessions compared to the control session; however, no change was observed in the H-reflex parameters

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during the sham tape session. The EMLA inhibited the H-reflex recruitment curve parameters when compared to the
control session.
According to Table 3, the H-reflex was facilitated in the tape versus sham tape and tape–EMLA versus
EMLA after kinesiology tape application; however, the effect of the kinesiology tape on the H-reflex parameters was
not statistically different in the tape versus tape–EMLA and tape–EMLA versus sham tape sessions. Notably, the

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EMLA inhibited the motor neuron excitability. Surprisingly, the H-reflex facilitation after the kinesiology tape
application was not significant in the tape group compared to the tape–EMLA group.
As reflected by a decrease of the Hth and an increase of the first Hslp, the kinesiology tape application

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causes more facilitatory effects on the slow motor neurons in both tape and tape–EMLA sessions. This could be due
to the efficacy of each cutaneous receptor (high and low threshold) on the motor neuron excitability (GARNETT &

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STEPHENS, 1980; Kukulka C, 1994; Navid et al., 2003a; Patton et al., 1989). Previous studies used only the H-
amplitude or the Hmax/Mmax ratio for the assessment of motor neuron pool excitability after taping (Alexander et al.,

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2003; Alexander et al., 2008; Bridget et al., 2010; Yoosefinejad et al., 2016). Facilitation of slow motor neurons after
kinesiology tape application could be clinically useful in several pathologic conditions.
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Previous studies that applied rigid tape along the line of fibers of the medial gastrocnemius and trapezius
muscles have revealed inhibition of the motor neuron pool of both muscles (Alexander et al., 2003; Alexander et al.,
2008). These studies reported that Ia drive was reduced from the muscle spindle to the motor neuron pool due to the
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tape placed on the muscle in a shortened position. One difference between our study and previous works is that in
the previous studies (Alexander et al., 2003; Alexander et al., 2008), the sport rigid tape was applied with enough
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tension to create crimping or puckering of the skin; however, in this study, we used a more elastic tape that could be
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stretched more than the sport tapes. In addition, we used the H-reflex recruitment curve technique in order to assess
the motor neuron pool excitability; however, two aforementioned studies examined only the amplitude of Hmax
(Alexander et al., 2003; Alexander et al., 2008). Another research group investigated the effect of kinesiology tape
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over the Achilles tendon for the motor neuron excitability (Bridget et al., 2010). Contradictorily, they found no changes
in the motor neuron excitability after applying the kinesiology tape but removal of the tape facilitated the H-reflex.
Differences in taping method may lead to differences in the results. Additionally, we used the H-reflex recruitment
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curve to assess the soleus and lateral gastrocnemius motor neuron excitability; however, the other studies used only
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the maximum amplitude of the H-reflex.

The local anesthesia in the Tape–EMLA session, similar to the EMLA session, inhibited the motor neuron
pool of the soleus and lateral gastrocnemius (according to the Hmax/Mmax ratio, Hslp of the soleus, and the intensity of
lateral gastrocnemius Hmax in Tables 1 and 2). It appears that EMLA induced skin receptor (types II and III lower
threshold) inhibition (Aimonetti et al., 2000; Navid et al., 2003a; Sabbahi & Luca, 1981; Salehi et al., 2005);
therefore, it decreased the α-motor neuron drive. This inhibition is in accordance with other previous researches
(Navid et al., 2003a; Salehi et al., 2005); however, the kinesiology tape application on the anesthetized skin

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facilitated the H-reflex (see Tables 1 and 2). Previous studies revealed that type II and III cutaneous receptors, which
have postsynaptic inhibitory effects on motor neurons (Patton et al., 1989), are inhibited by type IV deeper cutaneous
and facial receptors (Aimonetti et al., 2000; GARNETT & STEPHENS, 1980; Kukulka C, 1994; Schleip, 2003). In
fact, cutaneous afferents (presumably type IV higher threshold), which had been activated by taping reduced the Ia
presynaptic inhibition (Aimonetti et al., 2000). If kinesiology tape had enough strength to shorten the muscle spindle,

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inhibitory influence from the tape could be expected; however, the results were contradictory. Therefore, it is
plausible that the mechanism of kinesiology taping is due to the cutaneous receptors stimulation (Navid et al., 2003b;
Patton et al., 1989; Salehi et al., 2005).

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Notably, our study had certain limitations. Future studies are warranted to evaluate the effect of the opposite
direction of kinesiology taping techniques on motor neuron excitability. Our results were generalized only to the

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healthy people. One of the main strength of our study is the capability of EMG apparatus in concurrent recording of
H-reflex from both soleus and lateral gastrocnemius. Alternatively, we use H-reflex recruitment curve to assess the

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motor neuron pool excitability. In this method we can evaluate both the slow and fast motor neuronal behaviors in
response to the kinesiology tape; however, none of the previous studies have used the H-reflex recruitment curve to
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investigate the effects of taping on the motor neuron excitability. Eventually, other strength of our study is its repeated
test–retest design within the same individuals, which is known to be a statistically efficient approach with reduced
interindividual variability.
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5. Conclusions
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In conclusion, the results of this study reported that the H-reflex was inhibited after applying EMLA and then
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the gasterosoleus motor neurons were facilitated by the kinesiology tape application on the anesthetized skin;
however, there is a facilitation of calf muscle motor neuron excitability after Y-strip taping technique which applied
from the calf muscle insertion to the origin. Currently, the kinesiology tape is presumed to be physiologically effective
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when measurements were taken in static condition.

Conflict of interest
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The authors declare no conflict of interest.

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Acknowledgments
We gratefully acknowledge the participants for their time and dedication in this study. Dr Sakine Goljarian,
PhD, PT is gratefully acknowledged for her assistance in the study analysis.

Funding
Authors have not received any funding to write this manuscript.

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TABLE 1: the mean ± standard error of mean of the some variables in five test conditions extracted from soleus
recruitment curve data. P value was calculated and reported pre/post anesthesia, pre/post tape.
Mean difference Mean difference
Control session First H record 10 min after P 25 min after P
(95% CI) (95% CI)

H slope 1.7± 0.08 1.8±0.06 0.05 (-0.08 – 0.2) 1 1.7±0.05 -0.03 (-0.13 – 0.07) 1

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Hth 8.3± 2.1 8.1± 2.2 0.2 (-1.07 – 1.47) 0.2 8.15± 1.67 0.05 (-1.7 – 2.05) 0.5

Intensity of Hmax 9.55± 1.95 9.55±1.35 0.00 (-45.83 – 45.83) 1 9.52±1.37 -0.02 (-1.93 – 1.88) 1

First fitted up-slope 2.22±1.2 2.41±1.3 0.2 (-0.55 – 0.97) 1 2.34±1.3 0.07 (-0.91 – 0.75) 1

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Hmax/Mmax 0.46±0.01 0.47±0.01 0.00 (-0.01 – 0.02) 1 0.47±0.01 0.00 (-0.01 – 0.01) 1
Mean difference Mean difference
EMLA Before E 10 m after EMLA P 25 m after EMLA P
(95% CI) (95% CI)
2.43± 0.5 2.02±0.4 -0.41 (-3.81 - 3.19) 0.01* 1.89±0.4 -0.53 (-9.99 - 7.4) 0.01*
H slope

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8.3± 0.98 8.43± 0.92 0.13 (-.08 - 1.07) 0.1 8.83± 0.67 0.53 (-6.75-6.7) 0.04*
Hth
9.8±1.6 10±1.5 0.16 (-0.35 - 0.68) 0.3 9.8±2.9 -0.2 (-8.9 - 8.5) 0.9
Intensity of Hmax
2.62±0.2 2.26±0.2 -0.35 (-0.80 - 0.09) 0.09 1.92±0.1 -0.31 (-1.03 - 0.4) 0.04*
First fitted up-slope

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0.40±0.05 0.36±0.05 -3.75 (-6.93 - -0.56) 0.02* 0.38±0.06 1.34 (-3.14 - 5.82) 0.4
Hmax/Mmax
Mean difference Mean difference
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Tape-EMLA Before E 10 m After EMLA P 5 m after Tape P
(95% CI) (95% CI)
H slope 2.46±0.4 2.06±0.5 -0.4 (-0.83 - 0.05) 0.01* 2.76±0.6 0.7 (-.1.47 - 0.08) 0.01*

Hth 8.1±0.63 8.3±0.6 0.2 (-.06 - 0.4) 0. 2 7.97±0.62 -0.33 (-0.05 - 0.83) 0.01*

Intensity of Hmax 10.8±0.8 10.6±0.7 -0.2 (-0.84 - 0.54) 0.4 10.2±0.7 -0.4 (-1.05 - 0.23) 0.01*
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First fitted up-slope 1.94±0.3 2.1±0.4 0.16 (-1.28- 1.60) 0.7 2.87±0.4 0.77 (-0.38 - 1.92) 0.04*

Hmax/Mmax 0.45±0.05 0.43±0.05 -1.8 (-3.29 - -0.31) 0.02* 0.44±0.05 1.49 (-1.06 - 4.06) 0.2

Mean difference
Tape session No tape 5 min after tape P
(95% CI)
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H slope 2.2± 0.5 2.5± 0.5 0.25 (-0.05 - 0.55) 0.09

Hth 8.33±0.5 8.02±0.54 -0.31 (-0.47 - -0.15) 0.001*

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Intensity of Hmax 10.7±0.1 10.32±0.1 -0.42 (-0.75 - -0.08) 0.01*

First fitted up-slope 1.9±0.4 3.6±0.8 1.66 (-0.14 - 3.47) 0.03*

Hmax/Mmax 0.45±0.07 0.46±0.07 0.01 (-.4.91 - 6.61) 0.8

Mean difference
Sham session No tape 5 min after tape P
(95% CI)
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H slope 1.9±.0.4 1.8±0.3 -0.07 (-0.29 - 0.14) 0.3

Hth 8.03±.7 7.9±0.7 -0.13 (-0.33 - 0.06) 0.6

Intensity of Hmax 10.1±0.8 10.0±0.8 -0.1 (-.36 - 0.09) 0.2

2.2±.3 2.2±0.4 0.03 (-0.77 - 0.7) 0.5
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First fitted up-slope

Hmax/Mmax 0.42±0.2 0.44±0.26 -0.02 (-1.04 - 6.37) 0.2

Values are reported as mean ± standard error.

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* Statistically significant: (P-value ≤0.05).

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TABLE 2: the mean ± standard error of mean of the some variables in five test conditions extracted from lateral
gastrocnemius recruitment curve data. P value was calculated and reported by comparison among pre- and post-
anesthesia, pre- and post-tape.
Mean difference 25 min Mean difference
Control session First H record 10 min after P P
(95% CI) after (95% CI)

H slope 1.42±0.3 1.43±0.2 0.01 (-0.15 – 0.17) 1 1.46±0.2 0.03 (-0.15 – 0.21) 1

Hth 8.81±0.63 8.72±0.68 -0.08 (-0.38 –0.21) 1 8.78±0.68 0.05 (-0.14 – 0.26) 1

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Intensity of Hmax 9.32±0.43 9.39±0.46 0.07 (-0.07 – 0.2) 0.3 9.38±0.44 -0.008 (-0.26 – 0.25) 1
First 3 points fitted up-
1. 4±0.2 1.56±0.2 0.1 (-0.18 – 0.31) 0.9 1.6±0.2 0.09(-0.35 – 0.53) 1
slope
Hmax/Mmax 0.53±0.03 0.54±0.05 0.00 (-0.09 – 0.11) 1 0.53±0.05 0.003 (-0.08 – 0.07) 1

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Mean difference
EMLA 10 min after Mean difference 25 min
Before EMLA (95% CI)
Session EMLA (95% CI) P after EMLA P

H slope 1.31±0.2 1.27±0.2 -0.03 (-0.09 – 0.02) 0.7 1.02±0.2 -0.25 (-0.84 – -0.03) 0.04*

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Hth 8.04±0.63 8.13±0.68 0.09 (-0.02 – 0.1) 0.8 8.08±0.68 -0.05 (-0.01 – -0.09) 0.9

Intensity of Hmax 9.47± 0.9 9.45±1.6 0.01 (-6.2 – 6.2) 1 9.89±1.6 0.4 (-2.4 – 3.3) 1

first Hslp 1.64±0.2 1.56±0.2 -0.08 (-0.01 – 0.12) 0.6 1.33±0.2 -0.23 (-0.45 – 0.23) 0.05*

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Hmax/Mmax 0.50±0.03 0.49±0.1 -0.01 (-0.06 – 0.07) 0.7 0.48±0.14 -0.01 (-0.7 – 0.02) 0.4
Tape-EMLA 10 min after Mean difference 5 min after Mean difference
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Before EMLA P P
Session EMLA (95% CI) Tape (95% CI)
H slope 1.05±0.2 1.25±0.2 0.2 (0.03 –0.37) 0.02* 1.39±0.2 0.34 (0.1 – 0.57) 0.007*

Hth 8.46±0.63 8.43±0.61 -0.03 (-0.2 – 0.16) 0.7 7.92±0.59 -0.5 (-0.72 – -0.28) 0.000*

Intensity of Hmax 10.05±0.8 10.40±0.7 0.35 (0.06 – 0.65) 0.02* 9.92±0.7 -0.48 (-0.80 – -0.16) 0.006*
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first Hslp 1.02±0.1 0.97±0.2 -0.04 (-0.48 – 0.39 ) 0.8 1.41±0.2 0.43 (0.12 – 0.75) 0.01*

Hmax/Mmax 0.46±0.08 0.48±0.09 0.01 (-0.02 – 0.05 ) 0.4 0.49±0.10 0.01 (-0.01 – 0.05) 0.2

5 min after Mean difference

Tape session Before tape P
D

Tape (95% CI)

H slope 1.4±0.2 1.67±0.3 0.26 (-0.10 – 0.62) 0.05*

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Hth 8.54±0.55 8.10±0.55 -0.43 (-0.58 – -0.28) 0.000*

Intensity of Hmax 10.5±0.7 10.1±0.7 -0.39 (-0.6 – -0.10) 0.01*

first Hslp 1.08±0.2 1.7±0.3 0.61 (-0.02 – 1.25) 0.05*

Hmax/Mmax 0.46±0.1 0.52±0.1 0.05 (-0.08 – 0.19) 0.3

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5 min after Mean difference

Sham session Before tape P
sham Tape (95% CI)

H slope 1.3±.2 1.1±.2 -0.15 (-0.35 – 0.04) 0.9

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Hth 8.04±.6 8.1±.7 0.08 (-0.12 – 0.29) 0.4

Intensity of Hmax 10.9±0.4 10.8±0.7 -0.08 (-0.39 – 0.19) 0.6

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first Hslp 1.5±.2 1.3±.2 -0.23 (-0.56 – 0.10) 0.4

Hmax/Mmax 0.57±0.37 0.55±0.34 -0.01 (-0.08 – 0.04) 0.5

Values are reported as mean ± standard error.

* Statistically significant: (P-value ≤0.05).

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TABLE 3: the mean difference± SE mean of variables of the 5 experiments conditions when the Kinesiology Tape
was applied on the triceps surae.
Sham Tape VS Tape Tape VS Tape-EMLA EMLA VS Tape-EMLA Tape-EMLA VS Sham Tape
Mean P P
Mean Mean P
P value Difference(95% valu Mean Difference(95% CI) valu
Difference(95% CI) Difference(95% CI) value
Variable CI) e e
Sol 0.68 (-0.63 – 1.47) 1 0.23 (-0.43 – 0.96) 0.8 1.47 (0.16 – 1.97) 0.4 0.91 (-0.14 – 1.94) 0.4
H slope
Gastr 0.51(-0.26 – 1.28) 0.1 0.27 (-0.24 – 0.93) 0.3 0.37 (-0.51 – 1.27) 0.3 0.23 (-0.19 – 0.67) 0.2

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Sol 0.25 (-0.09 – 0.5) 0.08 0.22 (-0.04 – 0.4) 0.7 1.66 (-0.2 – 4.17) 0.003* 0.17 (-0.04 – 0.3) 0.3
Hth 0.05
Gastr 0.5 (-0.2 – 1.1) 0.01* 0.15 (-0.33 – 0.61) 0.5 0.16 (-0.35 – 0.58) 0.6 0.32 (-0.01 – 1.07)
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Sol 0.61 (-0.5 – 1.8) 0.08 0.3 (-0.1 – 0.43) 0.4 0.4 (0.1 – 0.7) 0.4 0.3 (-0.07 – 045) 0.1
Intensity of Hmax
Gastr 0.55 (0.02 – 1.11) 0.03* 0.3 (0.1 – 0.7) 0.3 0.12 (-0.37 – 0.8) 0.8 0.41 (-0.01 – 1.04) 0.08

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Sol -0.44 (-0.07 – -1.17) 0.05* 0.26 (-0.12 – 0.56) 0.9 - 0.73 (-0.3 – -3.37) 0.04* 0.71 (-0.6 – 1.17) 0.2
first Hslp
Gastr 0.17 (-0.2 – 0.51) 0.32 0.05 (-0.3 – 0.46) 0.4 -0.08 (-0.31 – 0.47) 0.64 0.16 (-0.1 – 0.56) 0.3
Sol 0.03 (-0.22 – 0.24) 0.8 0.02 (-1.4 – 1.6) 0.3 0.05 (-1.7 – 1.8) 0.3 0.014 (-0.21 – 0.23) 0.3
Hmax/Mmax ratio

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Gastr 0.05 (-0.03 – 0.12) 0.2 0.03 (-0.08 – 0.14) 0.5 0.07 (-0.1 – 0.25) 0.3 0.01 (- 0.16 – 0.2) 0.8
Control VS Tape Control VS Sham Tape Control VS Tape-EMLA Control VS EMLA
Sol -0.41(-1.05-0.22) 0.1 -0.14(-0.36-0.07) 0.1 -0.30(-0.4-1.1) 0.4 0.39(-1.3-2.1) 0.4
H slope
Gastr -0.39(-1.09-0.30) 0.2 -0.009(-0.1 - 0.1) 0.9 -0.04(-0.9-0.9) 0.9 -0.27(-4.5-3.9) 0.8

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Sol -0.02(-0.05-0.00) 0.1 -0.01(-0.04 - 0.00) 0.1 0.4(0.0-0.8) 0.03* -0.4(-0.7-0.1) 0.00*
Hth
Gastr 0.3(0.1- 0.6) 0.00* 0.003(-0.03 - 0.04) 0.8 0.03(-0.01-0.07) 0.1 -0.01(-0.06-0.02) 0.3
AN
Sol 0.2(0.1- 0.4) 0.00* 0.01(-0.004 - 0.03) 0.1 0.3(-0.1-0.7) 0.07 -0.3(-0. 7- 0.04) 0.05*
Intensity of Hmax
Gastr 0.3(0.0- -0.7) 0.04* 0.01(-0.01-0.04) 0.2 0.6(0.2-0.9) 0.003* -0.05(-0.1- 0.03) 0.1
Sol 0.55(-0.07- 1.17) 0.07 0.2(-0.1-0.5) 0.2 -1.1(-3.2-0.9) 0.2 -0.3(-1.6-0.9) 0.6
first Hslp
M

Gastr 0.61(-0.18- 1.42) 0.1 0.1(-0.2-0.5) 0.3 -1.4(-4.1-1.1) 0.2 -1.3(-3.8-1.2) 0.2
Sol 0.15(-0.6-0.9) 0.5 -0.05(-1.5-1.4) 0.8 0.1(-0.5-0.8) 0.5 0.02(-0.1-0.2) 0.8
Hmax/Mmax ratio
Gastr -0.03(-0.2-0.1) 0.7 0.03(-0.2-0.2) 0.7 0.05(-1.2-1.3) 0.6 0.1(-0.4-0.8) 0.1
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Values are mean difference (95% confidence interval).

* Statistically significant: (P-value ≤ 0.05).
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TABLE 4: Changes in skin sensation following anaesthetization (10 minute, 20 minute) compared to before applying
EMLA
The mean
Type of sense P-value
difference ± SE
*
10 min after anesthesia 0.59±0.23 0.007
warm *
20 min after anesthesia 0.88±0.34 0.000
*

PT
10 min after anesthesia 0.69±0.12 0.035
cold *
20 min after anesthesia 0.61±0.43 0.003
*
10 min after anesthesia 0.55±0.13 0.002
touch

RI
*
20 min after anesthesia 0.45±0.16 0.000
*
graded point pressure sense in 5 points of lower leg 10 min after anesthesia 3.66±0.86 0.002

SC
*
20 min after anesthesia 4.11±0.33 0.000
* significant at p≤0.05.

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PT
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Figure1: kinesiology taping of the gastrosoleus muscle. The tape was positioned in a single direction parallel to the

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direction of the muscle fibers of the soleus over the Achilles tendon up to the medial and lateral heads of the
gastrocnemius muscles. The tape was applied with approximately 50-75% of maximum tension.

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Figure2: A representation of the soleus H-reflex and M wave recruitment curves in pre/post tape in tape session. The
recruitment curve shifted horizontally from pre tape condition toward a left when the tape applied
M

(facilitation).
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Figure3: (A) Comparison of the soleus Hmax/Mmax ratio in pre/post tape and Pre/Post anesthesia. The graphs show
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that the Hmax/Mmax ratio of soleus recruitment curve was inhibited after the EMLA applied to the skin overlying the
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triceps surae in the EMLA and tape-EMLA conditions. However, there was no statistically difference in pre/post tape
Hmax/Mmax ratio. (B) Comparison of the soleus Hth in pre/post tape and Pre/Post anesthesia in the 4 conditions. The
graph represents that the threshold of soleus inhibited after the EMLA and facilitated after the kinesiology tape was
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added to the skin overlying the triceps surae. however, there was no statistically difference in pre/post tape Hth in the
Sham tape condition (* Statistically significant: P value ≤0.05).
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