Muscular injuries are a major problem in football, with 47% of players being absent from play for up to 28 days each season (Ekstrand, et al., 2011). Therefore, injury rehabilitation is vital aspect which all, therapists and medical professions should possess, in order to understand the best recovery method for their clients. In addition, to the first statement, Ekstrand, et al., (2013) found that in a study that lasted over eleven seasons (2001-2012) in ten countries, with 1,743 elite professional football players, that hamstring muscle injuries are the most common injuries. To quantify how common they occur, hamstring injuries count for 12-16% of injuries in football, in comparison to lateral ankle sprains only contribute to about 6-9% of all injuries in football (Ekstrand, et al., 2013; Beijsterveld, et al., 2013).
The normative recovery time period for hamstring injuries range between eight and twenty-five days, causing long periods of time out of action, Heiderscheit, et al., (2010) adds to his statement by explaining that there is a higher risk of reoccurring injury during the first two weeks returning back to sport due to inadequate rehabilitation programs, returning to the sport too quickly, or a combination of both. To quantify the likelihood of a reoccurrence injury to the hamstrings, Petersen and Hölmich (2005) found that there was up to 31% chance of suffering another injury to the hamstring site.
1.2 Alternative Treatment Method.
Therapists and medical professionals will use a number of different treatment styles on their different clients to suit their individual needs. Practitioners aim to use their own knowledge, experiences, and current peer-reviewed evidence to best treat each client individually. Traditional techniques like; ultrasound, massage, mobilisations, athletic taping and braces are common methods to aid in rehabilitation. On the other hand, new alternative treatment methods are being increasingly popular amongst therapists.
One Increasingly popular new treatment technique is Kinesiology Tape. The popularity of this elastic adhesive tape ballooned after gaining huge television exposure at the 2008 Beijing Olympic Games (Drouin, et al., 2013; Mo An, et al., 2012; Lumbroso, et al., 2014), and has now got numerous different companies producing alternative versions of Kinesio tape and over one hundred, thousand practitioners regularly use kinesio tape in their practices (Mo An, et al., 2012).
Kinesio tape is an elastic adhesive tape which is covered by cotton fibres; the elastic stand has the adhesive substance applied in wave longitudinal format to aim to mimic the waves of a fingerprint (Kase, et al., 2013). This pattern allows the tape to pull the Fascia in the direction of the origin of the tape, this has been hypothesised to lift the fascia and epidermis to reduce pressure, improve circulation and lymph flow (Lumbroso, et al., 2014; Drouin, et al., 2013; and Hoyo, et al., 2013). Over the duration of application of three to five days (Kase, 2008) Kinesio tape theoretically lifts the fascia and epidermis away from the soft tissue is explained by Kase, et al., (2013) and Morris, et al., (2013), who collectively explain that due to the thickness of the tape being similar to the epidermis itself, the lightweight properties, and the recoil effect of the tape allows for the lifting of the superficial structures. This allows increased space for circulation of blood as well as increasing lymph flow to reduce edema or hematomas (Drouin, et al., 2013).
Drouin, et al., (2013) adds to this by stating that Kinesio tape improves the realignment of fascia tissues, normalising muscular tension and aids in strengthening musculature weaknesses. Kinesio tape also affects an athletes’ pain level, due to the continuous proprioception with the tape, allowing the mechanoreceptors will continuously be firing due to the stimuli of having the Kinesio tape on the body, this will therefore affect the gate theory and reduce the athletes pain levels (Lins, et al., 2013)
There are four main types of Kinesio application, shown in figure 1, which are; an I strip, a Y strip, an X strip and a Fan. General rules for application are; check application for allergies, clean the treatment area from any oil, cream or wax, measure the tape and round the corners for better application, and always ensure there is an anchor at the end of the tape where no stretch is applied (Gibbons, 2014).
1.3 Measuring and analysing the Data
The reliability and accuracy of measuring time are becoming more and more relevant in sport due to more athletes being able to travel shorter and longer distances faster, allowing for smaller time differences. Therefore, advanced equipment like timing gates and 5 Hz Global positioning system (GPS) are becoming popular methods to accurately measure speed and distance travelled. Waldron, et al., (2011) compared reliability of the timing gates with the 5Hz GPS over ten, twenty and thirty meters. This paper had a direct impact of this study due to similar sprint distances measured in comparison to the distance Waldron, et al., (2011) tested. Waldron, et al., (2011) found that the coefficient of variation (CV) for timing gates was more reliable (CV=1%-1.54%) in comparison to the reliability of the 5Hz GPS (CV=4.69%-5.16%), this was due to the GPS system being more susceptible to technical errors rather than the timing gates. The timing gates are set up in pairs parallel to each other at the chosen distances. In addition, the pairs of timing gates are set on tripods to allow laser to accurately measure the participants’ time lapses and record the timings.
1.4 Aims and objectives
The purpose of the study is to examine and analyse the effect of applying Kinesio tape to the hamstring’s recovery time. The null hypothesis was that there will be no difference between normal recovery time and recovery time with the assistance of Kinesio tape. Whilst, the experimental hypothesis stated that there will be a difference between normal recovery time and recovery time with the assistance of Kinesio tape, with the Kinesio tape reducing the effects of the fatiguing protocol.
Figure 1. Four types of Kinesio tape application ‘I’, ‘Y’, ‘X’ and ‘Fan shaped’ applications and the templates for cutting the shapes.
2. Literature Review
This literature review will review and examine the current evidence about Kinesio tape’s claimed benefits, the theoretical underpinning, as well as to see whether the current literature supports or opposes the clinical usage of Kinesio tape. The real effect of kinesio tex tape are still being explored and examined to aim to find the extent of kinesio tape’s effect on the human body. In addition to Kinesio tape, the literature review will engage in understanding how current literature views hamstring injuries; their main cause for injury, expected period time absent from play and current treatment methods. Furthermore, analyse how effective the fatiguing and testing protocols are. The literature found was sourced using Google Scholar, SPORTDiscus, Scopus, MEDLINE, ScienceDirect, and PEDro, searching a combination of the keywords; Kinesio Tape, Range of Motion, Muscular Activity, Application, pain gate theory, blood flow, lymph, literature review, hamstrings, injuries, Yo-yo intermittent recovery, GPS, Timing gate, Reliability, Validity, and physiological demands. The sourced literature was then read, and split into different categories. Exclusion of literature was done paper-by-paper, analysing the articles relevance to the topic areas.
Kinesio tex tape is fast becoming a popular alternative taping method; due to its thin, lightweight and breathable structure, it allows the musculature the ability to have an increased range of motion in comparison to alternative taping methods such as athletic taping (Lins, et al., 2012). Due to its recent popularity there are numerous practitioners whom are very sceptical on their claimed benefits. The claimed benefits of Kinesio tape are; prevention of over contraction of musculature or to increase the muscular activity at under activated muscles, reduction of pain via the gate control theory, increase of range of motion in unhealthy patients, and to be able to improve lymphatic and cardiovascular flow which would aid the reduction of inflammation and increase the speed of recovery (Wong, et al., 2012; Lins, et al., 2012). Therefore, what evidence is there to support or reject the claims?
2.1.1 The effect of muscular activity with the application of Kinesio tape.
Lins, et al., (2013) studied the immediate effects of Kinesio tape on neuromuscular on the quadriceps, they found that there was no significant difference between the control group and the Kinesio tape group. The study consisted of sixty healthy, recreationally active females with no history of any trauma to the lower limbs, therefore are unlikely to find major differences due to Kinesio tape’s main target population is unhealthy athletes. Lee, et al., (2012) used patients suffering from patellofemoral pain syndrome (PFPS), whom have; not received treatment for their current injury, have no signs of a secondary injury, or have previous knee injuries or surgery to the knee joint. The study found that there was a reduction in neurological activity during ascent and descent when using Kinesio tape. Although on the surface it may seem that Kinesio tape cause a detrimental effect, Lee, et al., (2012) hypothesised that the Kinesio tape may have reduced the pressure on the soft tissue by increasing the quality of the musculature contraction, which leads to a reduction in neuromuscular activity, and therefore a reduced amount of force being applied through the joint to create the same force as no-tape.
On the other hand, Lins, et al., (2013) stated that, they only recorded the best results and disregarded the other data. This leads inaccurate data due as they are not using all the recorded data. As the study only took the best scores from each test it stops the ability to rule out outliers and to gain accurate mean scores, this leads to a reduction of the reliability of the study.
Another study by, Hoyo, et al., (2013) analysed eight-teen elite youth football players, the study analysed the effect of kinesio tape on muscle response. The subjects were randomly assigned into one of two groups (kinesio and control). The study found that there was no significant difference between the two groups in affecting short term muscular improvement. Between each experimental condition the participants were allocated a rest period which aimed to reduce carryover effects, in addition the data collection were taken part under the same conditions each time reducing the effect of external factors. The study follows a reproductive methodology, which enables additional research to expand on their findings and aim to gain a greater mean population sample size.
Furthermore, a study conducted by Strutzenberger et al., (2015) looked at the fatiguing effect on the gluteal musculature pre and post a fatiguing protocol. The ten participants completed each of the different interventions (control, kinesio tape and sham tape), the order of protocol was randomised to ensure that there was equalise the effects of demand characterises between the protocols. In addition, the participants had a week rest between each protocol to reduce the effects from the previous session. The study used timing gates to measure the 20meter sprint time as well as recording Counter-movement jumps and Drop-jumps. The study found that there was no immediate improvements in sprint time after the fatiguing protocol, but found that kinesio tape had a reduced increase in sprint time over the control group. The fatiguing protocol had evidence to back it use in, although the methods did not tell how long the kinesio tape was on the participant for, as Kase, et al., (2013) recommends that the application needs a minimum of thirty minutes of no activity to allow the best results for application on durability and effectiveness.
Furthermore, Lins, et al., (2013) study agreed that they did not use the correct population to test the effects of Kinesio tape on the neuromuscular performance of the quadriceps. This lead to both, Lins, et al., (2013) and Morris, et al., (2013) concluding that Kinesio tape’s main aim is to treat unhealthy and damaged tissues, rather than improvement of musculoskeletal performance. To add to the summary, Moore (2012, pg.56) reviewed numerous journal articles and concluded that “Kinesio taping assists the treatment of damaged tissues whilst maintaining the full range of motion.” This links to the above literature which concludes that healthy populations are unlikely to have a significant effect when Kinesio tape is applied.
2.1.2 The effect on the pain gate theory with the application of Kinesio tape.
Another claimed benefit of Kinesio tape is that; it lifts the skin and fascia off the musculature, which causes a reduction in pressure on the underlying structures. This is thought to cause an increase of the lymph and circulatory system, which can aid to reduce chronic and acute edema (Lumbroso, et al., 2014; Drouin, et al., 2013; and Hoyo, et al., 2013).
This hypothesized reduction in pressure is alleged to cause a decrease in compression on the nerve endings; leading to a reduction of nociceptive stimuli travelling towards the dorsal horn. The reduction in nociceptive stimuli, is enhanced by the sensory feedback given from the application of the kinesio tape (Williams, et al., 2012). The tape stimulates the mechanoreceptors. Melzack, (1993) and Melzack and Wall (1996) states that mechanoreceptors travel on A-Beta fibres; these fibres at stimulated when movement occurs to allow your brain to know where your body is in space. In comparison, when a nociceptive pain occurs, the pain travels on two different fibres, C-fibres and A-Delta fibres. C-fibres have a small diameter and are unmyelinated, causing a slow transmission of the pain signal, whereas, sharp pain like a pin prick travel of larger myelinated A-Delta fibres. When the two signals meet at the substantia-gelatinosa in the dorsal horn only one signal is transmitted through and sent up the spinal cord via spinal T-cells. Due to the greater signal from the A-Delta fibres the dull pain stimuli does not pass through, and the sharp pain gets transmitted.
Furthermore, when the kinesio tape is applied, Kase (2008) argues that the tape stimulates the mechanoreceptors and therefore blocking the pain signals (Melzack, 1993; Melzack and Wall,1996). The pain singal is blocked due to the A-Beta Fibres transmitting greater signals to the dorsal horn, stopping the progression of the A-Delta or C-Fibres from firing.
Freedman, et al., (2014) found that patients with PFPS had a significant reduction in pain when Kinesio tape was applied in comparison to a sham method (t(49) = −3.18, P = 0.003, d = 0.45). To measure pain Freedman, et al., (2014) used the numeric pain rating score (NPRS). NPRS has been found to have more compliance, accuracy and sensitivity in comparison to the visual analogue scale, the faces pain scale-revised and the verbal rating scale, but the literature has also stated that all four measurements had good intrapatient reliability (Ferrerira-Valente, et al., 2011; Hjermstad, et al., 2011). Although Kinesio tape produced a significant reduction of pain, the results show that they had a low to medium confidence interval; this shows that the study’s results would be unlikely to have occurred by chance.
Morris, et al., (2013) looked at recent randomised controlled trials and review their clinical applicability, limited to moderate studies, they found that there was limited evidence to suggest that kinesio tape improved participants’ pain levels. On the other hand, one study looking at effects of kinesio tape on plantar fasciitis found there was a large consistent reduction in pain in comparison against a control group. Morris, et al., (2013) analysed the journal by stating that due to poor method validity the study, was limited in its application means that the results found may not represent the true outcome of the study.
Morris, et al., (2013) scrutinised a high-quality article by Thelen, et al., (2008), which compared kinesio tape with a sham kinesio tape group, they found that there was an immediate effect in improving pain free range of motion, lasting three days. This is clinically significant as a client and therapist can work on improving the client’s range of motion over the three days, whereas without the kinesio tape the rehabilitation process would have been prolonged.
To summarise, there is little strong evidence that kinesio tape improves pain, whereas Thelen, et al., (2008) gives a good indication that kinesio tape can improve the pain levels during the application of the tape.
2.1.3 The effect on blood flow with the activation of kinesio tape.
As discussed before, the application kinesio tape stimulates the mechanoreceptors, this causes another reaction along with pain reduction. Therefore, when the kinesio tape pulls on the musculature with its recoil effect, it is hypothesized to cause the a continuous increase in blood flow and lymphatic flow (Bae, et al., 2014). This increase in blood flow theoretically means that there would be in increased metabolism and therefore, improved muscle function (Stadge, et al., 2012). Stadge, et al., (2012) measured blood flow of the gastrocnemius muscle in sixty-one healthy athletes, this found no significant difference in blood flow levels. The methodology of the study ensured that the measurement of blood flow was taken from the same place, time and duration. This is vital to ensure the same location is tested to check the differences over time. Although, the validity and reliability of the equipment is questionable due to no published information on the equipment’s reliability and validity. The measurement of blood flow was reinforced with recording the subjects’ circumference at 10 points between the malleoli and the head of fibula, as well as recording the volume, via water displacement in ml. Therefore overall, the methodology has a moderate to low score due to unknown reliability, validity and normative data for the measurement of blood flow.
In addition, the study recognised that their main limitation was using healthy active participants, as kinesio tape main target population is unhealthy patients to enable the effect of recovery (Kase, 2008). This shows that there is a great uncertainty if kinesio tape recoil effect actually increases localised blood flow, as Stadge, et al., (2012) suggested there needs to be research conducted on how kinesio tape affects populations with acute swelling and chronic swelling.
2.1.4 The Effect on range of motion with the application of kinesio tape.
Williams, et al., (2012) states that due to the hypothesised effects of kinesio tape on pain reduction, as well as the increasing localised blood flow should cause an improvement in unhealthy athletes pain-free range of motion.
Thelen, et al., (2008) studied thirty-six subjects were split into two different groups, which consisted of two different taping techniques (kinesio and Sham). The subjects were assessed before, and after the application of the tape. To limit the amount of physical exercise the subjects underwent the subjects were issued a limited-duty physical profile whilst at work, ensuring low amounts of exercise in the upper extremities. Another strong point to this methodology is the subjects were constantly reassessed after each application of the tape, this ensures that the researchers can tract the subjects progress.
As stated before Thelen, et al., (2008) found that kinesio tape improve range of shoulder abduction in patients suffering from a rotator cuff impingement. Williams, et al., (2012) reported that the study by Thelen, et al., (2008), found that kinesio tape has a 58% likelihood of being beneficial after three days. This relates to the durability of the application which lasts for up to three to five days (Kase, 2008). Therefore the application is likely to have a positive effect on the client’s range of motion during application, which should be maintained with other manual therapy techniques. Williams, et al., (2012) concluded despite analysing two high quality studies, which found that kinesio tape increases range of motion in unhealthy athletes. That due to the low quality studies there is not enough evidence to state that kinesio tape improves or reduces range of motion in all joints. This leads to the need of more high quality studies looking at the effect of kinesio tape on range of motion in unhealthy subjects which include a sham application.
2.2 Hamstring injuries
In football hamstring injuries are related to fatigue, resulting in a neurological imbalance when performing high speeds running and acceleration movements (Schuermans, et al., 2014). Therefore, this section will aim to analyse the importance fatigue plays in the risk of hamstring injuries. As well as analysing the fatiguing and testing protocols.
2.2.1 The role fatigue plays in Hamstring injuries
Schuermans, et al., (2014) assessed the effect of exercise has on the hamstring muscle group between football players who have and haven’t suffered from a hamstring injury. The study used a fMRI to assess the differences pre and post exercise to aim to evaluate the effect fatigue plays in the muscle co-ordination as well as a re-injury risk. The study found that players with previous hamstring injuries had a quicker time to exhaustion as well as a significant increase (p<0.01) in metabolic activity in all the hamstring muscles (ST, Semitendinosus; BF, Biceps Femoris; SM, Semimembranosus). Schuermans, et al., (2014) discovered that there was an increase in similar activation patterns in the injured hamstrings. This was analysed to have been caused to be a neurological compensatory activation of the hamstring muscles with a history of hamstring injuries; leading to an increase in fatigue and higher risk of re-injury in high speed movement and eccentric loading. The author’s study links to Greig and Siegler (2009) which found that over a period of a simulated football match that eccentric hamstring strength decreased over the duration of a simulated match, which replicates current literature on the time period of hamstring injuries in football.
These articles link together as, Schumermans, et al., (2014) shows how the effect of previous injury and fatigue affects the activation of the neuromuscular activity, which is added to by Greig, et al., (2009) which supports and quantifies the effect fatigue in football; showing that the lowest eccentric hamstring torque scores being prevalent at 90 and 105 minutes.
These findings show that both fatigue as well as previous injury are major causes of hamstring injuries. Therefore, efforts to reduce the effect fatigue has over a busy schedule will allow the players to perform more bouts of high intensity sessions, or assist in the recovery in between two close matches will reduce the risk of injury. This lead to this study looking at the effects kinesio tape has on the recovery period after the effect of fatigue.
2.3 How does the Yo-Yo Intermittent Recovery Test Level 2 Replicate a Football Match.
Football players cover between 10-13km, with players in the English Championship and Premier League sprinting for 308m, and 248m respectively with high speed running (>19km/h) covering 803m and 601m respectively (Bangsbo, 2014). This shows that on average only 8.67% (6.53%-11.11%) of a match is spent doing high intensity movements, where low intensity movements makes up for the rest.
Furthermore, due to the low percentage of time spent performing movements at high intensities the ability to recover from continuous is vital. Therefore, the Yo-Yo Intermittent Recovery Test Level Two (YYIR2) aims to evaluate the players’ anaerobic and aerobic system’s ability to perform repeated high intensity movement. Mohr and Krustrup (2013) states that the validity of the test is team dependent, this is due to team playing style, team’s position in the football pyramid, as well as average number of games a season. Although the intra-player score is very sensitive to change in players fitness levels. Krustrup, et al., (2006) found that there was no significant differences when two YYIR2 tests were perform one week apart, as well no significant difference found pre and post football season. This shows that the retest reliability is high and therefore gives an accurate performance indicator.
Bangsbo, (2014) found that the YYIR2 accumulates greater levels of lactate acid and a faster increase of heart rate. Due to the YYIR2 protocol, the participants face a faster increase in sprint speed with the same recovery time as the YYIR1 (Yo-yo Intermittent recovery test level one). This faster increase in speed results in a faster build up in lactic acid, as well as the utilization of glycogen (Bangsbo, 2014). Therefore, the increase in usage of glycogen and the greater build-up of lactic acid in the musculature will cause the participants to be fatigued; this was shown in a study done by Krustrup, et al., (2006) which found that participants had a significant increase in lactic acid build up, post YYIR2. Post exhaustion, the athlete’s lactic acid levels increased, this leads to the tissues becoming unhealthy providing the rational for the use of the test for the fatiguing protocol.
2.4 How reliable is the testing protocol.
Jennings, et al., (2010) comments on the physiological demands of football; the study states that there is an increased link between repeated 20 meter sprint performance and team performance, this relates to the ability for the players’ to be able to recover from high intensity work to allow them to perform at a high level.
There are two main ways of tracking players’ 20meter sprint times; Global Positioning System (GPS) and Timing gates. GPS devices are used to tract a players’ activity levels in training sessions and can also be used on match day. Waldron, et al., (2011) tested the concurrent validity and reliability of the timing gate and 5Hz GPS. The study used nineteen youth rugby league players, aimed to assess the difference between the two systems. The GPS system underestimated the distance between the timing gates; this translated to a worse case error score of 39% (95% ratio limits of agreement= 1.05-1.12×/÷1.11-1.29). This leads to the incorrect distance being recorded, resulting in the incorrect sprint time being recorded, whereas timing gates are stationary in the correct distances which leads to greater re-test reliability.
Waldron, et al., (2011) also found that the timing gate was the most reliable method of recording speed (CV=1-1.54%) compared to the GPS which had a reliability rating of CV=1.62-2.3%. This finding shows that, in comparison of the most popular methods of testing and recording sprint speed show that; timing gates are have greater test-retest reliability and have a better concurrent validity, when testing sprinting performance. Furthermore, the study by Waldron, et al., (2011) discovered that the GPS systems have individual errors in the system causing measurement errors. Therefore, when conducting research, the GPS would not be the recommended equipment to use to measure the difference between difference devices as well as technical difficulties in comparison to timing gates.
Based on the literature above there is inconclusive evident to whether kinesio tape could cause a positive impact on recovery. Kinesio tape is becoming increasingly popular with practitioners, as well as researchers to discover is true effects on different populations, as well as pathologies. Researchers have been aiming to find out how kinesio tape affects different structures in the body. Lins, et al., (2013) and Lee, et al., (2012) aimed to discover how the tape affects the muscular activity in healthy patients and unhealthy patients respectively. As supported by Moore, et al., (2012), Lee, et al., (2012) found that there was a difference in the injured patients where as Lins, et al., (2013) found no difference.
One main effect kinesio tape research is focusing on is the application of tape in correlation with pain reduction; due to one of Kase, et al., (2013) main claims that the constant stimulation of the mechanoreceptors leading to a pain reduction has led to a number of studies aiming to understand and quantify the claim made; the current studies found in the literature have produced moderate quality studies finding limited evidence, with one study causing an interesting high effect whilst having a poor methodological validity. Furthermore, the application of range of motion and blood flow have limited research which is inconclusive to whether kinesio tape affects the underlying structure.
Furthermore, the high injury occurrence and re-occurance of hamstring injuries show a great need for alternative methods to treat and maintain hamstring ability. This lead to this study aiming to manipulate the fatiguing effects of football using the YYIR2, whilst aiming to improve recovery time in the kinesio group.
Twenty healthy male outfield football players were used in the study (20 males, mean age 21±1.34). All subjects were a part of the University of Teesside’s football teams. Table 1 shows the participants demographics, this includes; age, height, weight, and football position. The subjects where were collected through speaking them face to face at a training session. Interested subjects were then contacted through email, informing them of the study and inquiring if they would like to take part in the study. Participation in the study was completely voluntary with no penalty for people declining to participate or dropping out at any stage of the research study.
3.2 Preliminary Measures
Prior to commencement of the present study, ethical approval was obtained from the Human Ethics Committee, Faculty of Social Sciences and Law, Teesside University. Before participating each participant was given an information document which outlined the purpose and procedure of the study (appendix one), written consent was obtained (appendix two) and the participants were informed about their rights to withdraw from the study at any time. Each participant completed a Pre activity readiness and Medical Questionnaire (appendix three) before taking part in the experimental study. All the obtained participant data information was recorded and stored confidentially under the 1998 Data Protection Act.
The materials used for the study are Kinesio Tex Tape (Kinesio TEX; Kinesio Taping Co. Ltd. Japan) , scissors, portable massage couches, Two pairs of timing gates (Brower Timing Gates, Speed Trap 2: Brower Timing System, Draper, UT, USA), Stereo system with Cd player, CD copy of the Yo-Yo intermittent recovery level two test (Yo-Yo Intermittent recovery level 2, Bangsbo(1994) Intermittent Recovery Level 2, Copenhagen University, Denmark). To ensure correct application, the researcher has completed a Kinesio Tape level two qualification. In addition, all the equipment was checked, to ensure was working correctly, battery level and to ensure no parts were damaged. Furthermore, checking the Yo-Yo intermittent endurance level two test played fully without any faults.
3.4 Design of the experimental study
The study was a between subjects – repeated measures design. Subjects were randomly allocated into their groups. The independent variables for the study were condition, Kinesio Tex tape and control, and time. The time points were; Baseline measure, one hour post and twenty-four hours post. The measurements taken were three 20meter sprint times for each participant at each time point. Significance was set at p ≤ 0.05.
Interested subjects whom read the information sheet about the study and voluntarily returned an informed consent form, signed and therefore, agreed to take part in the study. The subjects then filled in the medical questionnaire to ensure they were able to take part in the study (appendix three). During the familiarisation session, the subjects sampled the Kinesio tape applied on their hamstrings, this allows the subjects to adjust to how the tape feels on their skin, as well as, check for an allergic reaction, and gain education about how prolong the life of the Kinesio tape application; Kase, et al., (2013) recommends that, no physical exercise should be done 30minutes after application. Another guideline is that post bathing or swimming the subjects were taught that the Kinesio tex tape should only be patted dry, that the subjects should allow the tape to breath to allow it to dry. If the subject uses any form of heat it could cause the tape to become very difficult to remove (Kase, et al., 2013).
In addition, the subjects sampled the YYIR2, subjects were told about the protocol and completed a maximum of five minutes of the test, this allows the subjects to learn and get used to the layout and method of test. Furthermore the subjects were showed and performed twentymeter sprint protocols to reduce the effect of practice during the study. The familiarization is key to ensure the subjects know the procedure, what is expected and to gain a taste of that the testing protocol involves, plus what the kinesio tape application feels like (Impellizzeri, 2008).
On the first day of testing, baseline measures were taken. These included; the subjects’ height, weight, age, and playing position (Table 1.). The subjects then warmed up for five minutes, the researcher took the participants on a warm up consisting of jogging, sprinting, walking and dynamic stretches to the lower limb. Afterwards, the subjects took it in turn to complete three, twenty-meter sprints. Subjects set themselves in a standing position behind the line and when they were ready, sprinted through the two timing gates which record the time taken, to the third decimal place, after each sprint the participant would have a minute rest before completing the next sprint. Lockie, et al., (2013) assessed the 20-meter sprint protocol’s reliability (ICC, Intra-class correlation coefficient), typical error (TE) as well as the CV. Using eighteen football players Lockie, et al., (2013) found that a three time repeated 20-meter sprint had a strong rating (90% CL; ICC= 0.96, TE, 0.06seconds; CV, 1.9%), this means that the testing protocol has a good ability to determine a players sprinting ability.
The subjects were given a five minute active recovery, before they completed the Yo-Yo intermittent recovery level 1 test, with encouragement from the researcher to ensure they performed to their maximal level. The Yo-Yo intermittent recovery level one test consists of two, twenty meter sprints followed by a ten second rest period. The Yo-Yo intemittent recovery level two protocol starts at an average running speed of 10 km.h-1 (Ingebrigtsen, et al., 2013; Mohr and Krustrup, 2012) the speed gradually increases with every level the subjects complete. Subjects will continue until they have reached felt too physically exhausted to continue to at the required speed to meet the finish line, or failed to reach the finish line of the sprint bout twice.
Afterwards, subjects were randomly assigned to no tape or Kinesio Tex tape. Therefore the subjects who were in the control (no Tape) group were invited back after one hour for retesting. After the fatiguing protocol was completed in the Kinesio group the Kinesio Tex tape would be applied five minutes afterwards to allow the participants a rest period before the tape was applied. An ‘I’ Strip (figure 1.) was applied from the ischual tuberosity to 3 cm parallel to the medial the lateral epicondyle. The Kinesio needs approximately thirty minutes for the full adhesive strength to take effect before any exercise should take place (Kase, et al., 2013). Figure 2 shows the application of the kinesio tape. The participant stretches their hamstrings when the anchor is applied. The kinesio tape is applied with 10% stretch to the ischual tuberosity, where the second anchor is applied.
Kinesio and Control Total 20 21(±1.34) 183.9(±7.75) 82.7(±11.40)
Table 1. shows the subjects demographics which participated in the study. 20 subjects took part in the study. All Subjects were active members of the University of Teesside’s Football Teams. Subjects’s levels ranged from Seven-a-Side football to the 1st team squad, with testing occurring mid-season.
The main differences between the group demographics is the subjects’ average height and weight. In the control group there was one participant who increased the overall height and weight, taking the player out would have caused a closer difference the mean height and weight (182.89±4.37cm, 84.22±10.98). Furthermore, two subjects had to be retested due to the tape application coming off half way through the investigation.
Table 2 looks at the mean sprint times. Both groups average sprint speed was slower one hour after the YYIR2. In total the average score on the YYIR2 was 687meters with a range of 560-800meters. In comparison to other studies, the scores lay between elite professionals and sub-elite, and greater results in comparison to amateurs (Rampinini, et al., 2009; Ingebrigtsen, et al., 2012)
This shows that the participants had a very good level of fitness in comparison to their age range in football. Furthermore, the subjects’ mean sprint speed is 3.150s (±0.156, 2.754-3.628seconds), this relates to a study by Meckel, et al., (2009) which assessed a similar population group had a similar mean sprint time of 3.233 seconds. Whilst in comparison to English Premiership players (2.94±0.11seconds) the subjects were on average 0.21 seconds slower. This shows the difference between elite professionals in comparison to University athlete levels isn’t big on sprint speeds, whereas the difference would be in other physiological factors and technical ability.
Table 2 shows the average (mean±standard deviation) 20meter sprint times before the fatiguing protocol and, one and twenty-four hours post, as well as the Yo-Yo Intermittent Recovery Level 2(YYIR2).
Group Baseline (seconds) 1Hour Post (seconds) 24Hour Post (seconds) % of recovery YYIR2 (meters)
Control 3.203(±0.133) 3.299(±0.116) 3.229(±0.127) 99.1% 856(±115.1)
Kinesio Tape 3.073(±0.149) 3.118(±0.108) 3.068(±0.112) 100.1% 824(±142.3)
Table 2 also shows that the kinesio group had an improved recovery time in comparison to the control group. As the kinesio group did not just fully recover from the exercise, they also exceeded the baseline score; it could be assumed that the kinesio tape allows for greater recovery. In addition, the difference of recovery would have been affected by the YYIR2 score.
Table 2 shows that the fatiguing protocol affected both groups, the fatiguing protocol slowed the control group by; 0.096seconds, whereas, the kinesio group was affected by fatigue less (0.045seconds slower). This could have been the result of the difference in the YYIR2 score.
The YYIR2 scores are between what is found by Rampinini, et al., (2009) which tested amateurs and professional football players. They found that professionals had a YYIR2 score of 958±99m whereas amateurs scored 613±125m. This shows that, the subjects’ score was within range of recreational-professional footballers. In addition, Fanchini, et al., (2014) found that young footballers had an YYIR2 score of 747±181m. This also supports the fatiguing protocol as it shows that the players performed the fatiguing protocol correctly and to the best of their ability.
Figure 2 shows a comparison between the two groups over time. The main points of the graph show that the effect of the fatiguing exercise is greater in the control group.
Additionally, there is a greater range of scores in the control group in comparison to the kinesio group; this shows that there is a greater variance in the control group in comparison to the kinesio group.
4.2 Statistical analysis
All the subjects’ results gained from the 20 subjects’ sprint speeds. All the data from the assessment was imputed into SPSS (IBM SPSS Statistics for Windows Version 22.0. Armonk, NY: IBM Corp.). The data was then formatted into a frequency graph (appendix five). After standardising skewness and kurtosis outputs, by dividing the kurtosis and skewness by the standard error of kurtosis and skewness (appendix four), it was formulated that the data was normally distributed around the mean and the values are formulated ±2 within the mean value. This is highlighted in appendix five which shows the Baseline measurement as well as the 24hours post fatiguing protocol both having bell-shaped normal distribution. Whereas the 1hour post fatigue shows that the data is positively skewed.
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