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Original article

What is the effect of taping along or across a muscle on motoneurone

excitability? A study using Triceps Surae
Caroline M. Alexandera,b,, Marie McMullana, Philip J. Harrisona
a

Department of Physiology, University College London, Gower St, London WC1E 6BT, UK
Department of Physiotherapy, Hammersmith Hospitals NHS Trust, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK

Received 9 August 2005; received in revised form 17 July 2006; accepted 27 August 2006

Abstract
Taping along the skin overlying lower trapezius reduces motoneurone excitability in healthy subjects [Alexander, C.M., Stynes, S.,
Thomas, A., Lewis, J., Harison, P.J., 2003. Does tape facilitate or inhibit the lower bres of trapezius? Manual Therapy 8, 3741]. It
remains unclear whether this effect is: (a) specic to trapezius and (b) specic to the direction of application of the tape. In light of
this, the excitability of another muscle was measured in order to see if these results were repeatable and independent of the muscle
taped. Thus, the excitability of the medial and lateral gastrocnemius (MG and LG) and soleus (Sol) motoneurone pool was assessed
using the Hoffman reex (H reex). The amplitude of this reex was measured with the tape aligned across and then along the
direction of the MG muscle bres. Tape aligned across the bres failed to affect motoneurone excitability (MG P 0.61, LG
P 0.69, Sol P 0.17). Under tape and sports tape applied together aligned along the MG muscle reduced the excitability of both
MG and LG (19% (P 0.01) and 13% (P 0.01), respectively). These observations suggest that any change to movement patterns
with tape application cannot be explained by facilitation of the motoneurone excitability.
r 2006 Elsevier Ltd. All rights reserved.
Keywords: Tape; Gastrocnemius; Muscle

1. Introduction
The application of tape has been widely used for many
years by physiotherapists as a useful adjunct to prophylactic or rehabilitation programmes in the management of
a wide variety of neuromusculoskeletal disorders. The
effects of taping which are most commonly described
include: inhibition of overactive synergists or antagonists,
facilitation of underactive movement synergists, promotion of proprioception, optimisation of joint alignment,
pain reduction and unloading of irritable neural tissue
(Host, 1995; Morrisey, 2000). The technique of tape
application is widely anecdotal and varies depending
Corresponding author. Hammersmith Hospitals NHS Trust,
Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK.
Tel.: +44 0207 679 0855; fax: +44 0208 846 7783.
E-mail address: CMAlexander@hhnt.nhs.uk (C.M. Alexander).

upon the therapist applying it and the desired effect. The

technique normally involves preparation of the skin, the
application of a protective undertape followed by a nonelastic, rigid overtape which is used to apply tension over
the underlying soft tissues. One common presumption,
based in the main upon anecdotal evidence, is that tape
facilitates and inhibits muscles depending upon the way it
is applied. For example, tape applied under tension in the
direction of the muscle bres, is thought to facilitate the
underlying muscle (Morrisey, 2000). However, tape
applied across the belly of the muscle, is thought to
inhibit the muscle (Tobin and Robinson, 2000). The
mechanisms by which these taping effects are achieved
have limited scientic support and as yet, are inconclusive
though most theories highlight the proprioceptive and
mechanical effects with lesser effects hypothesized to be
placebo (Simoneau, 1997; Hume and Gerrard, 1998,
Alexander et al., 2003).

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doi:10.1016/j.math.2006.08.003
Please cite this article as: Alexander CM, et al. What is the effect of taping along or across a muscle on motoneurone excitability? A study using
Triceps Surae. Manual Therapy (2007), doi:10.1016/j.math.2006.08.003

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If tape does act by causing a change to afferent input,

then motoneurone excitability must be affected. One way
in which changes to motoneurone excitability can be
explored is by measuring changes in spinal reex
amplitude. Indeed, if reex amplitude were reduced with
application of tape, then this would reect a reduction of
motoneurone excitability. Conversely, if reex amplitude
increases this would reect a facilitation of motoneurone
excitability. A spinal reex that is commonly used to
investigate motoneurone excitability is the H reex.
Indeed, this reex has been previously used in healthy
subjects to show that taping along the direction of the
bres of lower trapezius decreases the amplitude of the
lower trapezius H reex (Alexander et al., 2003) and
therefore produces an inhibition of motoneurone excitability. These investigations have been extended here to
examine the generality of these ndings. Thus, can these
observations be extended to other muscles? To be specic,
is this a rule that is independent of the muscle but
dependant upon the direction of application of tape? To
explore these questions, a muscle that is not commonly
taped in this way was chosenthe triceps suraein order
to focus upon (a) the effect of the direction of the tape
and (b) a muscle where no expectations of this application of tape pre-exist. The triceps surae are a muscle
group for which the H reex has been extensively used in
neurophysiological testing and its behaviour is well
understood (Pierrot-Deseilligny and Mazevet, 2000). To
evoke its H reex, the nerve supply to gastrocnemius is
electrically stimulated. This has a number of effects (see
Fig. 1). One effect is that the efferents to the muscle are
stimulated. This efferent volley causes the muscle to
contract resulting in a short latency motor response or M
response. This is not a reex. Another effect of the
stimulus is that the afferents from the muscle are
stimulated. This results in an impulse that monosynaptically connects to the motoneurones in the spinal cord.
When these motoneurones re, the muscle will contract a
second time, resulting in the H reex. Thus, the aim of
this study was to examine whether tape would affect the
triceps surae H reex in the same way as it affects the
trapezius H reex. Finally, the effect of taping along the
muscle bres has been contrasted with those effects of
taping across the muscle bres.

2. Method
Subjects were recruited from the staff and students of
the Department of Physiology, UCL. However, those
who had suffered pain from any of their joints or
muscles during the previous 2 years or those who had a
rheumatological or neurological problem were excluded.
With local ethical approval (University College London
Ethics Committee) and informed consent, recordings
were made from a group of 14 healthy subjects. 11

Fig. 1. A diagrammatic representation of the H reex pathway (top)

and the Soleus H reex (bottom). This is a modication of the diagram
seen in Alexander et al. (2003): (A) electrical stimulation of a mixed
peripheral nerve evokes two responses from the muscle it supplies. The
rst response is the motor response (M response). This is from the
direct stimulation of the motor axons. The second response (or H
reex) is evoked by stimulation of the afferent supply, which
monosynaptically activates the efferent axons. (B) The soleus
responses to electrical stimulation of the tibial nerve. This average is
the result of 10 stimuli.

women and three men were recruited (age range:

between 24 and 48 years). The excitability of the
gastrocnemius motoneurone pool was measured using
the gastrocnemius H reex. Electrical 1 ms square wave
pulses were delivered percutaneously every ve seconds
(Digitimer DS7A stimulator) to the tibial nerve. The
anode (a metal plate smeared with electrode gel) was
strapped over the distal surface of the quadriceps. The
cathode (a Medicotest disc, pre-gelled electrode) was
adhered to the skin over the tibial nerve in the popliteal
fossa. Whilst sitting, surface EMG was recorded using
adhesive electrodes placed edge to edge with the
recording area 3 cm apart and positioned over the
medial gastrocnemius (MG), lateral gastrocnemius (LG)
and soleus (Sol) muscles (Williams et al., 1989;
Simonsen and Dyhre-Poulsen, 1999) The EMG was
amplied (Digitimer NL824) and ltered (Neurolog
NL125) with a bandwidth of 30 Hz3 kHz. The data
were converted from an analogue to a digital signal at a
sampling frequency of 4 kHz (CED 1401) and stored for
later analysis by CED Signal software (see Fig. 2; for
details of the H reex as an investigative tool see PierrotDeseilligny and Mazevet, 2000).

Please cite this article as: Alexander CM, et al. What is the effect of taping along or across a muscle on motoneurone excitability? A study using
Triceps Surae. Manual Therapy (2007), doi:10.1016/j.math.2006.08.003

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Fig. 2. A diagrammatic representation of the recording (dashed

arrows) and stimulating (full arrows) methods.

Using a single investigator who was not blinded

during the procedure or investigation of the data, the
tape was attached to the skin overlying MG in two ways.
In one way the tape was positioned so that it was aligned
to go across the direction of the muscle bres of MG. In
the other way the tape was positioned so that it was
aligned to go along the direction of these muscle bres.
As the MG muscle bres descend with a lateral
inclination, the tape was always at an angle to the
horizontal or vertical (see Fig. 3). Two different types of
tape were applied. Firstly, a protective elastic under tape
was carefully applied to the skin overlying MG without
creating tension or distortion of the skin. Secondly, a
rigid non-elastic zinc oxide tape (sports tape) was
applied directly over the under tape with enough tension
to create crimping or puckering of the skin. The
investigator was a senior physiotherapist experienced
in the use of tape.
In both variations of tape placement, the stimulus
intensity was varied until a mid-amplitude H reex was
evoked with its accompanying M response. At this
stimulus intensity a minimum of 40 stimuli were evoked:
(i) before taping, (ii) with under tape aligned across or
along the direction of the MG bres, (iii) with the
addition of rigid tape positioned over the under tape and
nally (iv) with both tapes removed. The peak to peak
amplitude of all the M responses and the H reexes were
measured. The amplitude of these responses can be
variable. One cause of this variability is that the
stimulating probe can move in relation to the nerve.
However, the M response is a useful measure of the
stability of this effective stimulus. In particular, any
variability of the amplitude of the M response reects a
change in the position of the stimulating electrode upon
the nerve rather than a change to motoneurone
excitability. Conversely, if the stimulating electrode is
in a steady position to the nerve and the amplitude of
the M response is steady, then any changes to the H
reex amplitude are due to the changing motoneurone
excitability (Alexander et al., 2003). Thus, to ensure
that any alteration in reex amplitude was in response
to the tape and not to uctuations in the effectiveness
of the stimulus, only series of recordings in which the

Fig. 3. The location and orientation of tape applied to the skin

overlying medial gastrocnemius. The picture to the left shows tape
applied along the direction of muscle bres, while the picture to the
right shows tape applied across the direction of the muscle bres.

M response was consistent were used. As the M

responses were inconsistent in four subjects, the data
from these subjects was discarded. The data from the
remaining 10 subjects were analysed further. The
amplitude of the M responses across all four conditions
was measured and a one way analysis of variance
was used to assess whether the M response was
consistent throughout the recording period. If the M
response varied such that the amplitude was signicantly
different between tape conditions, the variable M
responses along with the accompanying H reex were
ltered out until the ANOVA demonstrated nonsignicant uctuations in amplitude of the M response.
After ltering out any erroneous M responses and their
accompanying H reexes, the EMG from the remaining
subjects was averaged. This provided an average
H reex amplitude collected: (i) before application of
tape; (ii) with under tape aligned along or across the
muscle bres; (iii) with sports tape overlying the
undertape; and (iv) after both tapes were removed.
These amplitudes were then compared across the
different experimental conditions both whilst taping
along MG and then whilst taping across MG using a
two-way ANOVA without replication. Where a paired
Students t-test revealed no signicant difference between pre and post tape results, the amplitudes were
averaged and a two-way ANOVA without replication
was used to assess for differences between the combined
pre/post taping condition, the under tape condition and
with both tapes in place. A post hoc Tukey test revealed
any signicant differences across these different experimental regimes. Finally, power calculations were performed (signicance set at 5%) to ensure that the data
set was sufciently extensive to support the conclusions
being made.

Please cite this article as: Alexander CM, et al. What is the effect of taping along or across a muscle on motoneurone excitability? A study using
Triceps Surae. Manual Therapy (2007), doi:10.1016/j.math.2006.08.003

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3. Results
3.1. Taping along the fibres of MG
Fig. 4 shows the effects of taping along the bres of
MG. As can be seen in Fig. 4A the dominant feature of
the recording is the large M response, which is then
followed by the H reex. The amplitude of the H reex
is indicated using the dashed horizontal lines. Upon
application of the under tape the M response remains
the same amplitude but, in this record, the H reex
appears to get smaller (Fig. 4B). Application of the
sports tape reduces the amplitude of the H reex
substantially (75%, Fig. 4C). Removal of both tapes
then results in the H reex reverting back to its control
amplitude (Fig. 4D). Note the M response remained
constant throughout indicating that the effective stimulus remained stable throughout the recording period
(Alexander et al., 2003). Thus, any change in reex
excitability was dependant on the application of tape.
Results from another experiment can be seen graphically in Fig. 5 where the amplitude of each individual H

reex has been plotted sequentially during the four

conditions of taping. As can be seen, the application of
sports tape along the muscle systematically inhibits the
H reex (open symbols). Thus, as was expected from
previous investigations, taping along the bres of MG
inhibited the H reexes of MG.
Fig. 6 summarizes the data from all 10 subjects. As
indicated in Fig. 6, the application of under tape
reduced the H reex amplitude by 7%. However, this
is not statistically signicant. On the other hand,
application of the rigid sports tape produced a much
more dramatic reduction in reex amplitude which is
statistically signicant (P 0.01). On average, the
application of both under tape and rigid sports tape
inhibited the reex by 19714% (mean7SEM). Removal of both tapes produced a reversal of this
inhibition. The amplitude of the H reex was then not
signicantly different when compared before and after
application of the tape (P 0.25).
Recordings were also made of LG and Sol H reexes
whilst taping MG. The LG H reex reacted in a very
similar way to the MG reex, albeit in a reduced

Fig. 4. Averaged electromyograms from one individual illustrating the M response and H reex evoked under four conditions: (A) the M response
and H reexes evoked before the application of tape; (B) with the under tape applied along the bres of medial gastrocnemius; (C) with the addition
of sports tape; and (D) with both tapes removed. The downward arrows mark the H reexes. The upward arrows mark the stimulus artefact. Note
that the average H reex amplitude varies while the M response amplitude remains constant.

Fig. 5. The effect of tape aligned along the bres of medial gastrocnemius in one individual. The amplitude of the M responses (closed symbols)
remain stable whilst the H reex amplitudes (open symbols) vary.
Please cite this article as: Alexander CM, et al. What is the effect of taping along or across a muscle on motoneurone excitability? A study using
Triceps Surae. Manual Therapy (2007), doi:10.1016/j.math.2006.08.003

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Fig. 6. The mean amplitude of the medial gastrocnemius H reex across four different conditions (7the average SEM for each condition, n 10).
The amplitude of the H reex was signicantly different with the application of the sports tape aligned along the bres of medial gastrocnemius
compared to the pre and post tape conditions. The * indicates signicant results (where Po0.05).

Fig. 7. The effect of tape aligned across the bres of medial gastrocnemius upon the LG H reex in one individual. The amplitude of the M responses
(closed symbols) and H reexes (open symbols) remain constant.

manner. That is, the reex was inhibited by the

application of the under tape and sports tape by
13712% (mean7SEM, P 0.01). The H reex of Sol
showed a similar trend but did not reach signicance
(P 0.06).
3.2. Taping across the fibres of MG
When taping across the bres of MG the tape failed to
have an effect upon H reex amplitude. Fig. 7 illustrates
a typical result of taping across the MG upon the LG H
reex amplitude. The population data emphatically
support this result. Thus, taping across the bres of

MG did not affect motoneurone pool excitability (MG

P 0.61, LG P 0.69, Sol P 0.17).

4. Discussion
The results of this study conrm and extend previous
observations that taping along the length of a muscle
inhibits that muscles reex excitability (Alexander et al.,
2003). While the results of previous work are based on
reexes evoked in the trapezius muscle, the present work
has extended this to a completely different group of
muscles, triceps surae. In addition, the effects of taping

Please cite this article as: Alexander CM, et al. What is the effect of taping along or across a muscle on motoneurone excitability? A study using
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6

C.M. Alexander et al. / Manual Therapy ] (]]]]) ]]]]]]

along and across the direction of the bres of MG have

been assessed.
In assessing the excitability of the motoneurones of
triceps surae, changes in the amplitude of H reexes of
MG, LG and Sol were monitored. It has been assumed
previously that the taping along or across the direction
of the muscle bres would facilitate or inhibit H reexes,
respectively (Morrisey, 2000; Tobin and Robinson,
2000), as reected by an increase or a decrease in H
reex amplitude. Contrary to these expectations, the
results of this study indicate that taping along the
direction of the bres of MG actually reduces the
amplitude of the H reex and thus inhibits triceps surae.
However, taping across the direction of the bres of MG
produces no change in excitability as reected by no
change in H reex amplitude. On removal of both tapes,
the H reex reverts back to its original amplitude.
Taping along the direction of the bres of a muscle
has now been explored in both trapezius and gastrocnemius. In both studies taping inhibits both trapezius
(Alexander et al., 2003) and gastrocnemius. While it is
true that this has been found in only two muscles it
cannot be claimed to be universally applicable. However, it is likely to be more wide spread in occurrence
than merely the two muscles studied. As taping across
the gastrocnemius muscle fails to alter reex amplitude
it seems reasonable to suggest that taping across the
muscle does not have an effect upon motoneurone
excitability in this muscle in healthy subjects. However,
this does not suggest that the application of tape is not a
useful technique in physiotherapy. Indeed, recently
Lewis et al. (2005) demonstrated that taping altered
posture, increased the range of movement of the
shoulder and in patients with shoulder impingements,
pain was experienced further into range. The results of
the present investigations do however suggest that
previous explanations of the mechanisms involved may
need to be revised.
Just how tape affects its inuence upon motoneurone
excitability remains open to speculation. Biomechanical
and various neural mechanisms have been discussed
(Host, 1995; Robichaud and Agostinucci, 1996; Morrisey, 2000). Indeed, in a previous investigation of the effect
of tape upon trapezius excitability, possible mechanisms
were also discussed (Alexander et al., 2003). One
suggested mechanism is that tape along the muscle may
shorten it, thus unloading the intrafusal muscle bres of
the spindle. If tape does indeed shorten the intrafusal
bres, this might result in a decrease in the tonic
discharge rate of the spindle leading to a reduced
facilitation of the motoneurone pool and subsequent
reduction in the H reex amplitude seen here. In addition
in this case, as both LG and Sol share common Ia input
from MG (Eccles et al., 1957), a reduction in Ia activity
from the MG spindle should and did result in a decrease
in H reex amplitude of LG and Sol. Moreover, taping

across the muscle is unlikely to signicantly change

muscle length and therefore is unlikely to alter muscle
spindle ring rates. In accordance with this, taping across
the muscle does not change H reex amplitude.
The activation of cutaneous receptors has also been
cited as another possible mechanism driving the effect of
tape (Robichaud and Agostinucci, 1996). However, with
the application of tape, one might expect that the
inhibition seen here might also be present irrespective of
the direction in which the tape is positioned. In addition,
while some cutaneous receptors may be sensitive to the
direction of pull of the tape, it seems unlikely that this
directional sensitivity would be associated with the
direction of the underlying muscle bres.
In conclusion, while these experiments were not
designed to study the mechanisms underlying the results
described here, it is clear that the results are consistent
with the hypothesis that the inhibition observed may be
related to the unloading of muscle spindles during the
muscle shortening that may occur during taping along the
length of the muscle. However, this is not to deny that
other factors may be involved, particularly in patients
with different pathologies. It would therefore clearly be of
interest to extend this work to different patient groups.
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Please cite this article as: Alexander CM, et al. What is the effect of taping along or across a muscle on motoneurone excitability? A study using
Triceps Surae. Manual Therapy (2007), doi:10.1016/j.math.2006.08.003