Does taping influence electromyographic muscle activity in the ...

Manual Therapy (2002) 7(3), 154–162# 2002 Elsevier Science Ltd. All rights reserved.doi:10.1054/math.2002.0464, available online at http://www.idealibrary.com onOriginal articleDoes taping influence electromyographic muscle activity in the scapular rotatorsin healthy shoulders?A. M. Cools, E. E. Witvrouw, L. A. Danneels, D. C. CambierDepartment of Rehabilitation Sciences and Physiotherapy & Postgraduate Education in Manual Therapy, Facultyof Medicine and Health Sciences, University Hospital, Ghent, BelgiumSUMMARY. Although taping techniques are commonly used in addition to exercise programmes in therehabilitation of shoulder instability and secondary subacromial or internal impingement, few studies exist on theeffect of taping on the muscle activity of the scapular rotators. The purpose of our study was to examine theinfluence of one particular tape on muscular activity in scapular muscles. Twenty healthy shoulders were examinedwith surface EMG recordings on the three parts of trapezius and serratus anterior muscle during dynamic full rangeof motion abduction and forward flexion. The movement direction, and tape and no-tape conditions wererandomized. The statistical analyses with ANOVA repeated Measures (GLM model) showed significant differencesamong the means between the four muscles (Po0.05), two movement directions (Po0.05), applied resistance(Po0.01), and movement period (Po0.01). However, no significant difference was observed based on theapplication of tape. The results of our investigation revealed no significant influence of tape application on EMGactivity in the scapular muscles in healthy subjects. Future research will be necessary to examine other parametersof neuromuscular control in order to determine possible proprioceptive changes in muscle recruitment with tapeapplication. r 2002 Elsevier Science Ltd. All rights reserved.INTRODUCTIONThe application of taping is widely used amongathletes both in the rehabilitation and in theprevention of sports injuries (Engstro¨ m & Renstro¨ m1998; Robbins & Waked 1998). The basic rationalefor taping is to provide protection and support for ajoint while permitting optimal functional movement.It is assumed that external support increases jointstability by reinforcing the ligaments and restrictingmotions. However, various authors mention that thesupport function of taping is lost within a relativelyshort time after application (Greene & Wight 1990;Gross et al. 1994; Lohrer et al. 1999).Received: 28 January 2002Revised: 13 May 2002Accepted: 5 June 2002Ann M. Cools, PT, candidate for a doctoral degree, Erik E.Witvrouw, PT, PhD, Lieven A. Danneels, PT, PhD, Dirk C.Cambier, PT, PhD, Director, Department of RehabilitationSciences and Physiotherapy, Ghent University, Ghent, Belgium.Correspondence to: AC, Department of Rehabilitation Sciencesand Physiotherapy & Postgraduate Education in Manual Therapy,University Hospital Ghent, De Pintelaan 185, 1B3, B9000 Ghent,Belgium. Tel.: +32/240 26 32; Fax: +32/240 38 11E-mail: ann.cools@rug.ac.beMost authors agree that the effect of tape can onlypartially be explained by increased mechanicalstability (Wilkerson 1991; Bockrath et al. 1993;Bennell & Goldie 1994, Larsen et al. 1995; Kowallet al. 1996; Somes et al. 1997; Gilleard et al. 1998;Lohrer et al. 1999; McCaw & Cerullo 1999). It issuggested, however, that taping may have someproprioceptive influences. Therefore, if taping techniquesdo give joint protection, it is now thought thatthey act by improving proprioception rather than byrestricting movement (Karllson & Andreasson 1992;Heit et al. 1996; Robbins & Waked 1998).The effectiveness of various taping techniques wasstudied extensively in the knee (Anderson et al. 1992;Bockrath et al. 1993; Larsen et al. 1995; Kowall et al.1996; Gilleard et al. 1998), and the ankle (Wilkerson1991; Karlsson & Andreasson 1992; Lohrer et al.1999; McCaw & Cerullo 1999).Although the influence of taping on neuromuscularfunction is often suggested, the underlying mechanismis still unclear. Some authors found changes inthe onset of muscle activity in the knee with tape(Karlsson & Andreasson 1992; Gilleard et al. 1998).They assumed that changes in latency times mightbe the result of cutaneous stimulation effected by the154

156 Manual TherapyFig. 2Fig. 1inferior border of the scapula and the insertion of themuscle on the anterio-lateral side of the thorax. Areference electrode was placed over the clavicle. Eachset of bipolar recording electrodes on each of the fourmuscles was connected to a Noraxon Myosystem2000 electromyographic receiver (Noraxon USA,Inc., Scottsdale, AZ). The sampling rate was1000 Hz. All raw myo-electric signals were preamplified(overall gain = 1000, common rate rejectionratio 115 dB, signal-to-noise ratio o1 mV RMSbaseline noise, filtered to produce a bandwidth of10–1000 Hz).A strip of Fixomull stretch (Beiersdorf s ) wasapplied over the muscle belly of the upper trapezius,starting anterior just proximal to the clavicle. Thetape was firmly pulled over the belly of the uppertrapezius, meanwhile giving a skin traction on thesoft tissue towards the cervical spine. On the posteriorside of the trunk, the tape was attached towardsthe thoracic spine, following the muscle fibres of thelower trapezius. The same procedure was repeatedwith a leukotape P strip (Beiersdorf s ) (McConnell1999). All the taping applications were performed bythe same researcher, who is experienced in theprocedure (Fig. 2).Manual Therapy (2002) 7(3), 154–162Testing procedureThe testing session started with a warm-up procedure,consisting of shoulder movements in alldirections, push-up-exercises against the wall andstretching exercises for the rotator cuff and scapularmuscles. Then verification of EMG signal quality wascompleted for each muscle by having the subjectperform isometric contractions in manual muscle testpositions specific to each muscle of interest (Kendall& Kendall 1983). Subjects performed three 5-smaximum voluntary isometric muscle contractionsagainst manual resistance by the principal investigator.A 5-s pause occurred between muscle contractions(Hancock & Hawkins 1996, De Luca 1997). Asa normalization reference, EMG data were collectedduring maximal voluntary contraction (MVC) foreach muscle. After signal filtering with a low-passfilter (single pass, Butterworth, 6 Hz low-pass filter ofthe 6th order) and visual inspection for artefacts, thepeak average EMG value over a window of 1 s wascalculated for each trial. Further calculations wereperformed with the mean of the repeated trials as anormalization value (100%) (Danneels et al. 2001).To avoid alterations in muscle activity of the uppertrapezius caused by head position or movement, thesubjects were instructed to look in front of them whiletesting. Two movements were performed during thetest: abduction in the frontal plane, and forwardflexion in the sagittal plane. Each movement wasperformed over the whole range of motion in arhythm of 4 s:2 s of concentric contraction andupward movement, and 2 s of eccentric contractionand downward movement, with 4 s of rest betweentrials. The rhythm was set by a metronome andcontrolled by the examiner’s counting. Prior tostarting collecting data, subjects were allowed fivepractice trials to ensure they completed the armmovement in a 4 s rhythm, as set by the metronome.Following the practice trials, the subject completedthree trials of each movement. The second movementwas used for further analysis.Each movement was performed with and withoutan external resistance, and in a tape and a no-tapecondition. The weight resistance was set at 2 kg for abody weight between 50 and 60 kg, 2.5 kg for a bodyweight between 70 and 80 kg, and 3 kg if the personweighed more than 80 kg. The test conditions tape/no-tape and abduction/forward flexion were randomized.Signal processingAll raw EMG signals were analogue/digital (A/D)converted (12-bit resolution) at 1000 Hz. Signals then# 2002 Elsevier Science Ltd. All rights reserved.

Taping and electromyographic muscle activity in shoulders 157were digitally full-wave rectified and low-pass filtered(single pass, Butterworth, 6 Hz low pass filter of sixthorder). Results were normalized to the maximumactivity observed during the maximal voluntary trials.After rectifying, filtering and normalization, furtheranalysis was performed on four periods during armmovement, each of 1-s duration. Periods were definedby markers, automatically placed on the EMG signalwith every metronome signal. The mean amplitudeEMG signal, expressed as a percentage of maximalvoluntary contraction, was used to assess the activityof the three trapezius parts and serratus anteriormuscle in each condition and each period.Statistical analysisDifferences in EMG activity among the severalconditions were analysed with an univariate approachto repeated measures analysis of variance(General Linear Model), in which the within-subjectfactors were: (1) muscle, (2) movement direction (3)resistance, (4) tape, and (5) period. The alpha-levelfor the ANOVA was set as 0.05. In case of significantdifferences, paired t-tests with Bonferroni correctionwere used for post-hoc multiple pairwise comparisons.All statistical analysis was performed withthe Statistical Package for Social Sciences (SPSS),version 9.0.RESULTSThe results of the descriptive statistical analyses aresummarized in Table 1 for the abduction movementwith and without external resistance, and Table 2 forthe forward flexion movement, with and withoutexternal resistance.The statistical analysis with ANOVA repeatedmeasures General Linear and Model (GLM) showedsignificant differences in EMG activity based on thefactors muscle (Po0.01), movement direction(Po0.01), resistance (Po0.01), and period (Po0.01), but no significant difference based on theapplication of tape (P = 0.578). The analysis ofinteraction effects for the muscle factor revealedsignificant muscle movement direction interactioneffect (Po0.05), and no significant interaction formuscle period (P = 0.126) and muscle resistance(P = 0.720). There was no significant interactionbetween the tape factor and any other factor in theGLM. The results show that the application of tapehas no influence on EMG activity in all conditions,and differences in EMG activity based on all otherfactors are independent of tape application (notape other factor interaction).Since the influence of tape on EMG activity for thefour muscles was of particular interest, and theANOVA showed no significant differences based onthe application of tape, further post-hoc analyses onthe factor tape were not performed.DISCUSSIONNormal muscle activity of the scapular rotatorsallows for normal kinematics of the scapular movement.The role of the scapular muscles is to promoteglenohumeral stability, to provide a stable basis fromwhich other muscles can operate in an optimallength–tension relationship, and to elevate theacromion during arm elevation in order to preventimpingement (Wilk & Arrigo 1993; Mottram 1997).In addition, the scapula plays an important role ofbeing a link in the kinetic chain of proximal to distalsequencing of velocity, energy and forces in manyshoulder activities such as throwing (Kibler 1998).Anatomic and histochemical studies regardingtrapezius muscle composition found some functionalsubdivisions within the trapezius muscle. Lindmanet al. (1990, 1991) found that the ascending portion ofthe trapezius muscle (arising from the spinousprocesses and interspinous ligaments of approximatelythe T 4 –T 12 vertebrae, and attaching in theregion of the tubercle at the medial end of the spine ofthe scapula) had a predominance of type I fibres,whereas the most superior parts of pars descendens(from the medial third of the superior nuchal line andthe ligamentum nuchae to the posterior border of thelateral third of the clavicle) had a higher frequency oftype II fibres. These differences in fibre type mightreflect different functional demands on the trapeziusmuscle parts in various head, neck, and shouldermovements. The author concluded that the lowertrapezius seems best suited for postural and stabilizingfunctions in the shoulder and arm movements,whereas the upper trapezius seems best suited forphasic activities. Similar conclusions can be drawnfrom a dissection study revealing the fascicularanatomy of the trapezius (Johnson et al. 1994). Basedon the orientation of the fibres of the lower trapezius,it was suggested that the role of the lower part of thetrapezius is more consistent with maintaining horizontaland vertical equilibrium of the scapula ratherthan generating net torque. In addition, Johnsonet al. (1994) hypothesized that the thoracic fibres ofthe trapezius muscle do not appreciably changelength throughout the entire range of upwardrotation of the scapula. Hence, the contribution ofthe lower trapezius to net torque about the axis ofrotation of the scapula was thought to be limited. Theupper fibres of trapezius exert an upward rotationmoment about this axis, complementing that of theserratus anterior. Wadsworth and Bullock-Saxton(1997) examined the temporal recruitment patternsof the scapular rotator muscles during controlledvoluntary abduction in the scapular plane. Their# 2002 Elsevier Science Ltd. All rights reserved. Manual Therapy (2002) 7(3), 154–162

Manual Therapy (2002) 7(3), 154–162 # 2002 Elsevier Science Ltd. All rights reserved.Table 1 Mean (7 Standard Deviation) for the electromyographic activity of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA), expressed as percentage ofMaximal Voluntary Contraction during dynamic abduction movements in a tape and no-tape condition, with and without external resistance, analysed for four periods of movement (period 1: concentricfrom 01 to 901 of abduction, period 2: concentric from 901 to 1801 of abduction, period 3: eccentric from 1801 to 901 of abduction, period 4: eccentric from 901 to 01 of abduction)Upper trapezius Middle trapezius Lower trapezius Serratus anteriorP1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4No resistance, no tape 9.8(74.3)28.8(710.5)21.9(710.9)12.2(75.5)5.7(73.7)18.6(712.3)13.5(77.9)6.4(74.1)3.8(72.7)25.6(712.7)25.7(715.1)8.5(76.4)3.9(71.7)26.0(713.5)25.6(710.7)7.1(72.7)No resistance, tape 10.9(76.4)29.6(711.3)22.7(78.6)14.2(76.3)5.3(73.2)16.4(78.3)13.6(77.6)6.9(73.4)3.8(72.7)22.5(713.1)25.8(718.7)8.1(74.6)3.6(72.0)22.8(713.8)23.5(712.1)7.3(72.6)Resistance, no tape 19.8 51.7 32.1 24.7 11.0 35.2 23.6 17.6 8.5 41.8 40.6 20.6 8.0 42.2 36.7 17.3(711.1)Resistance, tape 22.3(711.2)Table 2 Mean (7 Standard Deviation) for the electromyographic activity of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA), expressed as percentage ofMaximal Voluntary Contraction during dynamic forward flexion movements in a tape and no-tape condition, with and without external resistance, analysed for four periods of movement (period 1:concentric from 01 to 901 of abduction, period 2: concentric from 901 to 1801 of abduction, period 3: eccentric from 1801 to 901 of abduction, period 4: eccentric from 901 to 01 of abduction)Upper trapezius Middle trapezius Lower trapezius Serratus anteriorP1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4 P1 P2 P3 P4No resistance, no tape 11.2(76.1)26.7(713.4)21.0(79.2)10.2(74.4)2.9(72.3)8.5(77.1)6.3(74.9)2.8(72.1)4.9(72.8)25.7(712.8)29.0(726.3)8.7(78.1)5.5(72.9)27.8(712.3)26.0(711.1)7.3(73.9)No resistance, tape 10.5(76.0)25.4(712.7)22.2(712.9)12.2(77.0)2.3(71.8)5.7(74.0)5.2(73.2)2.9(72.3)4.8(72.7)21.8(712.9)23.3(717.6)9.7(78.7)5.2(73.3)25.8(710.7)26.4(714.4)7.9(73.8)Resistance, no tape 18.2 42.5 29.3 20.6 5.7 17.4 10.4 8.5 11.4 38.1 33.6 22.8 10.7 43.8 35.8 19.6(78.1)Resistance, tape 15.6(76.8)(716.6)51.7(717.9)(714.3)44.1(716.7)(711.7)34.7(713.3)(711.8)30.6(712.2)(77.9)27.7(711.2)(79.2)23.3(711.4)(78.0)13.6(712.2)(74.3)5.4(74.5)(720.7)27.6(713.8)(712.2)16.2(711.6)(712.5)21.3(79.1)(76.9)10.2(78.0)(710.7)15.9(79.5)(76.4)8.4(76.7)(76.6)10.9(713.1)(79.5)10.8(76.8)(716.0)36.6(721.1)(715.8)37.5(720.8)(722.1)39.1(724.8)(726.4)26.9(718.5)(713.9)20.3(710.7)(715.5)25.9(718.2)(75.1)10.2(710.0)(78.6)8.8(75.6)(715.6)41.7(718.2)(716.9)42.1(716.4)(715.3)35.7(715.4)(717.2)36.1(714.3)(78.7)16.4(75.7)(711.9)19.7(78.5)158 Manual Therapy

Taping and electromyographic muscle activity in shoulders 159results indicated that in non-injured shoulders, theupper trapezius was activated prior to the movement,whereas the lower trapezius was not recruited untilafter the start of the shoulder movement. However, ina recent study, we examined muscle latency times ofthe different trapezius parts in response to a suddenunexpected arm movement (Cools et al. 2001). Ourresults showed no significant differences among thetrapezius parts in relation to deltoid onset, thussuggesting that the trapezius reacted as a unit inresponse to a sudden unexpected arm movement(Cools et al. 2001).Although the trapezius muscle is often considered amajor stabilizing muscle for the scapula (Johnson etal. 1994; Kibler 1998; Cools et al. 2001), otherscapular muscles also contribute to the stability andmovement quality of the scapula (Pink & Tibone2000; Sahrmann 2002). Impaired control of thescapula by the serratus anterior muscle is commonin patients with shoulder problems (Pink & Tibone2000). The levator scapulae and rhomboid musclesare both synergists and antagonists of the trapeziusmuscle. Their function is to adduct and internallyrotate the scapula. Shortness of these muscles mayrestrict upward rotation of the acromial region,necessary for normal shoulder function (Sahrmann2002). Scapulohumeral muscles such as latissimusdorsi and pectoralis major also contribute to shoulderfunction. These muscles essentially bypass the scapulaand are attached directly to the humerus, and cancontribute to disruption of scapulohumeral rhythm(Sahrmann 2002).Summarizing, it is clear that there are many diverseroles the scapula must play to achieve appropriateshoulder function. These roles are interrelated anddepend on the quality of muscle activity in thescapular muscles. Therefore, restoration of normalscapular muscle activity is one of the priorities in theearly phase of rehabilitation of the athlete withfunctional shoulder instability.The purpose of our study was to determine if EMGactivity in the scapular muscles was influenced by theapplication of tape over the muscle belly of the uppertrapezius and parallel to the direction of the lowertrapezius muscle. Based on previous investigationsand clinical assumptions (Morin et al. 1997; McConnell1999), we hypothesized that with tape the uppertrapezius activity would decrease, and the lowertrapezius activity would increase. In addition, weassumed that the taping would change the overallrecruitment pattern of all scapular rotators, andtherefore hypothesized changes in muscle activity ofthe serratus anterior and middle trapezius.Confirming this hypothesis would be clinicallyrelevant, since scapulothoracic dysfunction is oftenseen in patients with shoulder problems orcervicobrachial pathologies. In this muscular imbalance,an overactivity of the upper trapezius part isassumed (Pink 1991; Kelley 1995). The purpose ofthis tape was to inhibit muscle activity in the uppertrapezius part, and to enhance muscle activity in thelower trapezius, thus correcting muscle activityaround the scapula.In contrast to the expectations, the results of ourinvestigation revealed no significant changes in EMGactivity in the scapular muscles based on theapplication of tape. Morin et al. (1997) examinedthe influence of taping on upper and middle trapeziusmuscle activity during an isometric contraction in theshoulder. Contrary to the results of our study, hefound a significant decrease in muscle activity in theupper trapezius muscle with tape application, and anincrease in EMG activity of the middle trapezius part.However, looking at the results of both studies, itmust be mentioned that in the study of Morin et al.(1997) EMG measurements were performed duringisometric muscle contractions, which usually give amore stable EMG signal than dynamic contractions.The dynamic character of the movements performedin our study might give a less steady EMG signal.However, in view of the nature of instabilityproblems and related injuries, dynamic movementsover a large range of motions are more functional,and hence more clinically relevant than isometriccontractions. In addition, in Morin’s investigation,the serratus anterior and lower fibres of the trapezius,known to play an important role in the scapulothoracicstability and movement, were not included. Twoissues regarding our methods should be discussed: theuse of surface electrodes to evaluate muscle activityand the use of maximal voluntary contraction as anormalization reference.The current state of surface electromyography isenigmatic. Although it provides many important anduseful applications, it has many limitations that mustbe considered (De Luca 1997). A major problemis the issue of the cross-talk when using surfaceelectrode in the shoulder region. However, in view ofthe nature of our investigation, in which the samemuscle was examined during the same movementunder different circumstances, possible cross-talkremained unchanged over the conditions, and thereforeprobably did not influence our results. Moreover,investigating large muscle groups such as thetrapezius muscle, surface electrodes do give a moreglobal evaluation of muscle activity than fine wireelectrodes, which measure a rather small selection ofmuscle fibres. In addition, cross-talk is not likely inour setting since Winter et al. (1994) estimated that90% of a surface EMG signal has its origin within12-mm distance from an electrode pair. Accordingto Jensen and Westgaard (1997), the depth of thesupraspinatus and levator scapulae muscles suggeststhat cross-talk contributes a relative small fraction tothe total EMG signal using surface electrodes on theupper trapezius muscle.# 2002 Elsevier Science Ltd. All rights reserved. Manual Therapy (2002) 7(3), 154–162

160 Manual TherapyAlthough normalization of EMG signal to MVCvalues is common in EMG studies, its reproducibilityand stability is often questioned (Yang & Winter1983; Jensen et al. 1993; Aaras et al. 1996; Araujoet al. 2000). Some authors state that MVC is anunreliable measurement (Yang & Winter 1983;Araujo et al. 2000), while others concluded thatunder certain conditions, in which methodologicalerrors influencing the recorded EMG signal from themuscle are kept to a minimum, normalization toMVC values gives reproducible results (Aaras et al.1996; Danneels et al. 2001a,b). In our investigation,we used guidelines for EMG recording duringmaximal voluntary contraction proposed by De Luca(1997).Concluding on the basis of our data that taping hasno effect on the scapulothoracic muscle activitywould be premature. Possibly, taping may affectother parameters of neuromuscular control, such asthe muscle reaction times. In recent literature, timingof muscle activity is often mentioned in a neuromuscularcontext. Lohrer et al. (1999) investigated theneuromuscular properties and functional aspects oftaped ankles. He found taping caused changes inmuscle latency times, in addition to mechanicalrestriction of movement. This was interpreted as aproprioceptively activated effect of tape. In addition,the influence of this tape on the biomechanicalbehaviour of the scapular position was not consideredin this study.We must take into account that the use of healthysubjects is a limitation to our study, and furtherresearch should emphasize muscle recruitment patternsin patients with abnormal scapular kinematics.Other proprioceptive influences, such as cutaneousstimulation due to tape application, enhanced awarenessof shoulder girdle and upper trunk position, andsubjective parameters of comfort after tape application,may possibly explain a positive effect of the tapeon functional shoulder performance.CONCLUSIONSTape is often used in functional rehabilitation of theshoulder patient. Although various taping techniquesare used in clinical practice, description of theseapplication methods and clinical studies evaluatingthe effects of tape are scarce.The purpose of our study was to investigate theeffect of tape application over the trapezius muscle onthe amount of electromyographic muscle activity inthe scapular muscles in healthy, pain-free shoulders.We hypothesized that application of this particulartape would have a proprioceptive effect on muscleactivation around the scapula, resulting in a changein intensity of muscle activity in the scapular muscles.We found no significant differences in muscle activityManual Therapy (2002) 7(3), 154–162in the trapezius and serratus anterior muscle, basedon the application of tape. This scapular techniqueapparently does not affect muscle function in normalpain-free shoulders. The question arises if theintensity of EMG activity, is a representative parameterfor proprioceptive qualities of a muscle.Further research is necessary to measure differentaspects of neuromuscular control, in order todetermine proprioceptive changes after the applicationof tape. Although we were unable to revealsignificant changes in muscle activity with theapplication of this tape, the use of the tapingtechniques in the clinical practice often results inenhanced subjective functional scapular stability.Future research is also needed to determine theneuromuscular mechanism of these functional improvementsin patients with scapular instability.AcknowledgementsThe authors would like to thank Ms Sara Vandevelde and MsChristel Vangestel for their assistance in collecting the data.ReferencesAaras A, Veierod MB, Larsen S, Ostergren R, Ro O 1996Reproducibility and stability of normalized EMGmeasurements on musculus trapezius. Ergonomics 39(2):171–185Anderson DL, Sanderson DJ, Hennig EM 1995 The role ofexternal non-rigid ankle bracing in limiting ankle inversion.Clinical Journal of Sports Medicine 5: 18–24Anderson K, Woitys EM, Loubert PV, Miller RE 1992 Abiomechanical evaluation of taping and bracing in reducingknee joint translation and rotation. The American Journal ofSports Medicine 20(4): 416–421Araujo RC, Duarte M, Amadio AC 2000 On the inter- and intrasubjectsvariability of the electromyographic signal in isometriccontractions. Electromyography and Clinical Neurophysiology40(4): 225–229Arrayo JS, Hershon SJ, Bigliani LU 1997 Special considerations inthe athletic throwing shoulder. Orthopedic Clinics of NorthAmerica 28(1): 69–78Basmajian JV, De Luca CJ 1985 Muscles Alive: Their FunctionsRevealed by Electromyography, 5th edn. Williams and Wilkins,BaltimoreBennell KL, Goldie PA 1994 The differential effects of externalankle support on postural control. Journal of Orthopedic andSports Physical Therapy 20(6): 287–295Blevins FT 1997 Rotator cuff pathology in athletes. SportsMedicine 24(3): 205–220Bockrath K, Wooden C, Worrell T, Ingersoll CD, Farr J 1993Effects of patella taping on patella position and perceived pain.Medicine and Science in Sports and Exercise 25(9): 989–992Cools AM, Witvrouw EE, Declercq GA, Danneels LA, WillemsTM, Cambier DC, Voight ML 2002 Scapular musclerecruitment pattern: electromyographic response of thetrapezius muscle to sudden arm movement before and after afatiguing exercise. J Orthop Sports Phys Ther 32(5):221–229Danneels LA, Cagnie BJ, Cools AM, Vanderstraeten GG, CambierDC, Witvrouw EE, De Cuyper HJ 2001a Intra-operator andinter-operator reliability of surface electromyography in theclinical evaluation of back muscles. Manual Therapy 6(3):145–153Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE,Stevens VK, De Cuyper HJ 2001b A functional subdivision ofhip, abdominal and back muscles during asymmetric lifting.Spine 26(6): E114–E121# 2002 Elsevier Science Ltd. All rights reserved.

Taping and electromyographic muscle activity in shoulders 161Davies GL, Dockoff-Hoffman S 1993 Neuromuscular testing andrehabilitation of the shoulder complex. Journal of OrthopedicSports Physical therapy 18(2): 210–219De Luca CJ 1997 The use of surface electromyography inbiomechanics. Journal of Applied Biomechanics 13: 135–163Engström BK, Renström PA 1998 How can injuries be preventedin the world cup soccer athlete? Clinics in Sports Medicine17(4): 755–768Feuerbach JW, Grabiner MD, Koh TJ, Weiker GG 1994 Effect ofan ankle orthosis and ankle ligament anaesthesia on ankle jointproprioception. The American Journal of Sports Medicine22(2): 223–261Gilleard W, McConnell J, Parsons D 1998 The effect of patellartaping on the onset of vastus medialis obliquus and vastuslateralis muscle activity in persons with patellofemoral pain.Physical Therapy 78(1): 25–31Glousman R, Jobe F, Tibone J, Moynes D, Antonelli D, Perry J1988 Dynamic electromyographic analysis of the throwingshoulder with glenohumeral instability. The Journal of Boneand Joint Surgery 70A(2): 220–226Greene TA, Wight CR 1990 A comparative support evaluationof three ankle orthoses before, during and after exercise.Journal of Orthopedic and Sports Physical Therapy 11:453–466Gross MT, Batten AL, Lamm AL 1994 Comparison of Donjoyankle ligament protector and subtalar sling ankle taping inrestricting foot and ankle motion before and after exercise.Journal of Orthopedic and Sports Physical Therapy 19(1):33–41Hancock RE, Hawkins RJ 1996 Applications of electromyographyin the throwing shoulder. Clinical Orthopaedics and RelatedResearch 330: 84–97.Hall CM 1999 The shoulder girdle. In: Hall CM, Brody LT (eds)Therapeutic Exercise: Moving Toward Function. LippincottWilliams and Wilkins, PhiladelphiaHeit EJ, Lephart SM, Rozzi SL 1996 The effect of ankle bracingand taping on joint position sense in the stable ankle. Journal ofSports Rehabilitation 5: 206–213Host HH 1995 Scapular taping in the treatment of anteriorshoulder impingement. Physical Therapy 75(9): 803–812Jensen C, Vasseljen O, Westgaard RH 1993 the influence ofelectrode position on bipolar surface electromyogramrecordings of the upper trapezius muscle. European Journal ofApplied Physiology 67: 266–273Jensen C, Westgaard R 1997 Functional subdivision of the uppertrapezius muscle during low-level activation. European Journalof Applied Physiology 76: 335–339Johnson G, Bogduk N, Nowitzke A, House D 1994 Anatomy andactions of the trapezius muscle. Clinical Biomechanics 9: 44–50Kamkar A, Irrgang JI, Whitney SL 1993 Non-operativemanagement of secondary impingement syndrome. Journal ofOrthopedic and Sports Physical Therapy 17(5): 212–224Karlsson J, Andreasson GO 1992 The effect of external anklesupport in chronic lateral ankle joint instability: Anelectromyographic study. The American Journal of SportsMedicine 20(3): 257–261Kelley MJ 1995 Anatomic and biomechanical rationale forrehabilitation of the athlete’s shoulder. Journal of SportsRehabilitation 4: 122–154Kelly BT, Kadrmas WR, Speer KP 1996 The manual muscleexamination for rotator cuff strength: An electromyographicinvestigation. Journal of Orthopedic and Sports PhysicalTherapy 24(5): 581–588Kendall FP, Kendall EK 1983 Muscles, Testing and Function.Williams and Wilkins, BaltimoreKibler WB 1998 The role of the scapula in athletic shoulderfunction. The American Journal of Sports Medicine 26(2):325–337Konradson L, Voight M, Hojsgaard C 1997 Ankle inversioninjuries: the role of the dynamic defence mechanism. TheAmerican Journal of Sports Medicine 25(1): 54–58Kowall MG, Kolk G, Nuber GW, Cassisi JE, Stern SH 1996Patellar taping in the treatment of patellofemoral pain:A prospective randomized study. The American Journal ofSports Medicine 24(1): 61–65Larsen B, Andreansen E, Urfer A, Mickeslon MR, Newhouse KE1995 Patellar taping: A radiographic examination of the medialglide technique. The American Journal of Sports Medicine23(4): 465–470Lindman R, Eriksson A, Thornell L-E 1990 Fiber typecomposition of the human male trapezius muscle: Enzymehistochemicalcharacteristics. American Journal of Anatomy189: 236–244.Lindman R, Eriksson A, Thornell L-E 1991 Fiber typecomposition of the human female trapezius muscle: Enzymehistochemicalcharacteristics. American Journal of Anatomy190: 385–392.Lohrer H, Alt W, Gollhofer A 1999 Neuromuscular properties andfunctional aspects of taped ankles. The American Journal ofSports Medicine 27(1): 69–75Ludewig PM, Cook TM, Nawocsenski DA 1996 Threedimensionalscapular orientation and muscle activity at selectedpositions of humeral elevation. Journal of Orthopedic andSports Physical Therapy 24(2): 57–65Lukasiewicz AC, McClure P, Michiner L, Pratt N, Sennett B 1999Comparison of three dimensional scapular position andorientation between subjects with and without shoulderimpingement. Journal of Orthopedic and Sports PhysicalTherapy 29(10): 574–586McCann PD, Wootten ME, Kadaba MP, Bigliani LU 1993A kinematic and electromyographic study of shoulderrehabilitation exercises. Clinical Orthopedics and RelatedResearches 288: 179–188McConnell J. The Mc Connell approach to the problem shoulder.Taping: Inhibition of the upper trapezius muscle. 1999 CourseNotes, p 34.McCaw ST, Cerullo JF 1999 Prophylactic ankle stabilizers affectankle joint kinematics during drop landings. Medicine andScience in Sports and Exercise 31(5): 702–707McMahon PJ, Jobe FW, Pink MM, Brault JR, Perry J 1996Comparative electromyographic analysis of shoulder musclesduring planar motions: Anterior glenohumeral instabilityversus normal. Journal of Shoulder and Elbow Surgery 5:118–123McQuade KJ, Dawson J, Smidt GL 1998 Scapulothoracic musclefatigue associated with alterations in scapulohumeral rhythmkinematics during maximum resistive shoulder elevation.Journal of Orthopedic and Sports Physical Therapy 28(2):74–80Morin GE, Tiberio D, Austin G 1997 The effect of upper trapeziustaping on electromyographic activity in the upper and middletrapezius region. Journal of Sports Rehabilitation 6: 309–319Mottram SL 1997 Dynamic stability of the scapula. ManualTherapy 2(3): 123–131Pink M, Perry J, Browne A, Scovacco ML, Kerrigan J 1991The normal shoulder during free style swimming: Anelectromyographic and cinematographic analysis oftwelve muscles. The American Journal of Sports Medicine 19:569–576Pink MM, Tibone JE 2000 The painful shoulder in the swimmingathlete. Orthopedic Clinics of North America 31(2): 247–261Robbins S, Waked E 1998 Factors associated with ankle injuries:Preventive measures. Sports Medicine 25(1): 63–72Rupp S, Berninger K, Hopf T 1995 Shoulder problems in high levelswimmersFimpingement, anterior instability, muscularimbalance? International Journal of Sports Medicine 16:557–562Sahrmann SA 2002 Diagnosis and treatment of MovementImpairment Syndromes, 1st edn., chapter 5, pp 193–245,Mosby, St.LouisSchmitt L, Snyder-Mackler L 1999 Role of scapular stabilizers inetiology and treatment of impingement syndrome. Journal ofOrthopedic and Sports Physical Therapy 29(1): 31–38Shamus JL, Shamus EC 1997 A taping technique for the treatmentof acromioclavicular joint sprains: A case study. Journal ofOrthopedic and Sports Physical Therapy 25(6): 390–394Somes S, Worrell TW, Corey B, Ingersol CD 1997 Effects ofpatellar taping on patellar position in the open and closedkinetic chain: A preliminary study. Journal of SportsRehabilitation 6: 299–308Wadsworth DJ, Bullock-Saxton JE 1997 Recruitment patterns ofthe scapular rotator muscles in freestyle swimmers withsubacromial impingement. International Journal of SportsMedicine 18: 618–624# 2002 Elsevier Science Ltd. All rights reserved. Manual Therapy (2002) 7(3), 154–162

162 Manual TherapyWeiser WM, Lee TQ, McMaster WC 1999 Effects of simulatedscapular protraction on anterior glenohumeral stability. TheAmerican Journal of Sports Medicine 27(6): 801–805Wilk KE, Arrigo C 1993 Current concepts in the rehabilitation ofthe athletic shoulder. Journal of Orthopedic and SportsPhysical Therapy 18(1): 365–378Wilkerson GB 1991 Comparative biomechanical effects of thestandard method of ankle taping and a taping method designedto enhance subtalar stability. The American Journal of SportsMedicine 19(6): 588–595Winter DA, Fuglevand AJ, Archer SE 1994 Crosstalk in surfaceelectromyography: Theoretical and practical estimates. Journalof Electromyography and Kinesiology 4: 15–26Yang JF, Winter DA 1983 Electromyography reliability inmaximal and submaximal isometric contractions. Archives ofPhysical Medicine and Rehabilitation 64: 417–420Manual Therapy (2002) 7(3), 154–162# 2002 Elsevier Science Ltd. All rights reserved.