Manual Therapy (2002) 7(3), 154162

# 2002 Elsevier Science Ltd. All rights reserved.

doi:10.1054/math.2002.0464, available online at http://www.idealibrary.com on

Original article

Does taping inuence electromyographic muscle activity in the scapular rotators

in healthy shoulders?
A. M. Cools, E. E. Witvrouw, L. A. Danneels, D. C. Cambier
Department of Rehabilitation Sciences and Physiotherapy & Postgraduate Education in Manual Therapy, Faculty
of Medicine and Health Sciences, University Hospital, Ghent, Belgium

SUMMARY. Although taping techniques are commonly used in addition to exercise programmes in the
rehabilitation of shoulder instability and secondary subacromial or internal impingement, few studies exist on the
eect of taping on the muscle activity of the scapular rotators. The purpose of our study was to examine the
inuence of one particular tape on muscular activity in scapular muscles. Twenty healthy shoulders were examined
with surface EMG recordings on the three parts of trapezius and serratus anterior muscle during dynamic full range
of motion abduction and forward exion. The movement direction, and tape and no-tape conditions were
randomized. The statistical analyses with ANOVA repeated Measures (GLM model) showed signicant dierences
among the means between the four muscles (Po0.05), two movement directions (Po0.05), applied resistance
(Po0.01), and movement period (Po0.01). However, no signicant dierence was observed based on the
application of tape. The results of our investigation revealed no signicant inuence of tape application on EMG
activity in the scapular muscles in healthy subjects. Future research will be necessary to examine other parameters
of neuromuscular control in order to determine possible proprioceptive changes in muscle recruitment with tape
application. r 2002 Elsevier Science Ltd. All rights reserved.

Most authors agree that the eect of tape can only

partially be explained by increased mechanical
stability (Wilkerson 1991; Bockrath et al. 1993;
Bennell & Goldie 1994, Larsen et al. 1995; Kowall
et al. 1996; Somes et al. 1997; Gilleard et al. 1998;
Lohrer et al. 1999; McCaw & Cerullo 1999). It is
suggested, however, that taping may have some
proprioceptive inuences. Therefore, if taping techniques do give joint protection, it is now thought that
they act by improving proprioception rather than by
restricting movement (Karllson & Andreasson 1992;
Heit et al. 1996; Robbins & Waked 1998).
The eectiveness of various taping techniques was
studied 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 (Wilkerson
1991; Karlsson & Andreasson 1992; Lohrer et al.
1999; McCaw & Cerullo 1999).
Although the inuence of taping on neuromuscular
function is often suggested, the underlying mechanism is still unclear. Some authors found changes in
the onset of muscle activity in the knee with tape
(Karlsson & Andreasson 1992; Gilleard et al. 1998).
They assumed that changes in latency times might
be the result of cutaneous stimulation eected by the

INTRODUCTION
The application of taping is widely used among
athletes both in the rehabilitation and in the
prevention of sports injuries (Engstrom & Renstrom
1998; Robbins & Waked 1998). The basic rationale
for taping is to provide protection and support for a
joint while permitting optimal functional movement.
It is assumed that external support increases joint
stability by reinforcing the ligaments and restricting
motions. However, various authors mention that the
support function of taping is lost within a relatively
short time after application (Greene & Wight 1990;
Gross et al. 1994; Lohrer et al. 1999).
Received: 28 January 2002
Revised: 13 May 2002
Accepted: 5 June 2002
Ann 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 Rehabilitation
Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
Correspondence to: AC, Department of Rehabilitation Sciences
and 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 11
E-mail: ann.cools@rug.ac.be
154

Taping and electromyographic muscle activity in shoulders 155

tape. This theory supposes that traction on the skin

or the pressure of the tape provides cutaneous
sensory cues, thus providing additional proprioceptive input to the central nervous system. Recently,
various taping techniques of the scapula have been
introduced into the conservative management of the
shoulder girdle (Host 1995; Mottram 1997; Hall 1999;
Schmitt & Snyder-Mackler 1999). The purpose of
these techniques is to normalize the scapulohumeral
rhythm by inuencing the scapular muscle activity
and correcting abnormal scapular position.
Scapulothoracic dysfunction is often seen in
patients with shoulder problems or cervicobrachial
pathologies (Glousman et al. 1988; Kamkar et al.
1993; Host 1995; Rupp et al. 1995; McMahon et al.
1996; Arrayo et al. 1997; Blevins 1997; Mottram
1997; Wadsworth & Bullock-Saxton 1997; Kibler
1998; Lukasiewicz et al. 1999; Schmitt & SnyderMackler 1999; Pink & Tibone 2000; Sahrmann 2002).
A current belief is that weakness of the scapular
musculature will aect normal scapular positioning.
It has been suggested that if excessive motion of the
scapula occurs, this may place increased stress on the
glenohumeral capsular structures and lead to increased glenohumeral instability. Malpositioning of
the scapula for any given arm conguration may also
inuence the instantaneous centre of shoulder rotation, which can signicantly alter moments of force
generation about the shoulder (McQuade et al. 1998).
Scapulothoracic muscle weakness, and hence the lack
of scapular stability, has also been identied as a
cause of secondary subacromial impingement syndrome (Kamkar et al. 1998; Kibler 1998; Schmitt &
Snyder-Mackler 1999). Although much of the conservative management of patients with shoulder
impingement is predicated upon correction of faulty
and aberrant scapular motion patterns, quantitative
evidence documenting specic patterns of abnormal
scapular motions in this patient group is still quite
limited (Lukasiewicz et al. 1999).
Some authors (Pink et al. 1991; Kelley 1995) state
that muscular imbalance in throwing athletes, frequently consist of overcompensation of the scapular
elevators. This increased upper trapezius activity can
lead to hypertrophy and constant tension overload in
these muscle bres. Others (Kamkar et al. 1993; Host
1995; Kibler 1998) suggest that insucient upward
rotation of the scapula, causing a lack of appropriate
acromial elevation during overhead shoulder motion
such as throwing, may contribute to secondary
subacromial impingement. A relative decrease in the
subacromial space due to functional scapulothoracic
instability would be the underlying mechanism.
According to Blevins (1997), limited upward rotation
of the scapula is a contributing factor to internal or
superior glenoid impingement. The pinching of the
posteriorsuperior rotator cu tendons between the
humerus and the posteriorsuperior glenoid rim may
# 2002 Elsevier Science Ltd. All rights reserved.

be caused by a lack of scapular elevation and

retraction in the cocking position.
Although taping techniques are commonly used in
addition to exercise programmes in the rehabilitation
of shoulder instability and secondary subacromial or
internal impingement, few studies exist on the eect
of taping on the muscle activity of the scapular
rotators. Therefore, the purpose of this study was to
examine the inuence of tape application on muscular activity in scapular muscles (three trapezius
parts and serratus anterior) during a dynamic
abduction and forward exion movement.

MATERIALS AND METHODS

Subjects
Twenty healthy male subjects volunteered to participate in this study. Exclusion criteria were current or
past history of shoulder pain, shoulder instability or
chronic cervicobrachial pain symptoms, and participation in overhead sports. The mean age of the group
was 22.15 years (range 2025), mean body weight
71.35 kg (range 6190), and mean height 180.74 cm
(range 169188). Fifteen subjects were right handed,
ve were left handed. The dominant shoulder was
tested in all subjects. All subjects signed an informed
consent before participating in the investigation.
The study was approved by the Ethical Committee
of Ghent University.
Materials
Prior to electrode application, the skin was prepared
with alcohol to reduce skin impedance (typically
o10 kO). Bipolar surface electrodes (Blue Sensors
Medicotest, Denmark) were placed with a 1 cm interelectrode distance over the upper, middle and lower
portions of the trapezius muscle and the lower
portion of the serratus anterior. All electrodes were
placed according to the protocol described by
Basmajian and De Luca (1985), although the
electrode position of the upper trapezius was slightly
medialized, thus allowing proper tape application on
the muscle belly (Fig. 1). Electrodes for the upper
trapezius were placed midway between the spinous
process of the seventh cervical vertebra and the
posterior tip of the acromion process along the line of
the trapezius. The middle trapezius electrode was
placed midway on a horizontal line between the root
of the spine of the scapula and the thoracic spine. The
lower trapezius electrode was placed obliquely
upward and laterally along a line between the
intersection of the spine of the scapula with the
vertebral border of the scapula and the seventh
thoracic spinous process. The serratus anterior
electrode was placed midway between the lateral,
Manual Therapy (2002) 7(3), 154162

156 Manual Therapy

Fig. 2
Fig. 1

inferior border of the scapula and the insertion of the

muscle on the anterio-lateral side of the thorax. A
reference electrode was placed over the clavicle. Each
set of bipolar recording electrodes on each of the four
muscles was connected to a Noraxon Myosystem
2000 electromyographic receiver (Noraxon USA,
Inc., Scottsdale, AZ). The sampling rate was
1000 Hz. All raw myo-electric signals were preamplied (overall gain = 1000, common rate rejection ratio 115 dB, signal-to-noise ratio o1 mV RMS
baseline noise, ltered to produce a bandwidth of
101000 Hz).
A strip of Fixomull stretch (Beiersdorfs) was
applied over the muscle belly of the upper trapezius,
starting anterior just proximal to the clavicle. The
tape was rmly pulled over the belly of the upper
trapezius, meanwhile giving a skin traction on the
soft tissue towards the cervical spine. On the posterior side of the trunk, the tape was attached towards
the thoracic spine, following the muscle bres of the
lower trapezius. The same procedure was repeated
with a leukotape P strip (Beiersdorfs) (McConnell
1999). All the taping applications were performed by
the same researcher, who is experienced in the
procedure (Fig. 2).
Testing procedure
The testing session started with a warm-up procedure, consisting of shoulder movements in all
directions, push-up-exercises against the wall and
stretching exercises for the rotator cu and scapular
muscles. Then verication of EMG signal quality was
completed for each muscle by having the subject
perform isometric contractions in manual muscle test
positions specic to each muscle of interest (Kendall
& Kendall 1983). Subjects performed three 5-s
maximum voluntary isometric muscle contractions
against manual resistance by the principal investigator. A 5-s pause occurred between muscle contracManual Therapy (2002) 7(3), 154162

tions (Hancock & Hawkins 1996, De Luca 1997). As

a normalization reference, EMG data were collected
during maximal voluntary contraction (MVC) for
each muscle. After signal ltering with a low-pass
lter (single pass, Butterworth, 6 Hz low-pass lter of
the 6th order) and visual inspection for artefacts, the
peak average EMG value over a window of 1 s was
calculated for each trial. Further calculations were
performed with the mean of the repeated trials as a
normalization value (100%) (Danneels et al. 2001).
To avoid alterations in muscle activity of the upper
trapezius caused by head position or movement, the
subjects were instructed to look in front of them while
testing. Two movements were performed during the
test: abduction in the frontal plane, and forward
exion in the sagittal plane. Each movement was
performed over the whole range of motion in a
rhythm of 4 s:2 s of concentric contraction and
upward movement, and 2 s of eccentric contraction
and downward movement, with 4 s of rest between
trials. The rhythm was set by a metronome and
controlled by the examiners counting. Prior to
starting collecting data, subjects were allowed ve
practice trials to ensure they completed the arm
movement in a 4 s rhythm, as set by the metronome.
Following the practice trials, the subject completed
three trials of each movement. The second movement
was used for further analysis.
Each movement was performed with and without
an external resistance, and in a tape and a no-tape
condition. The weight resistance was set at 2 kg for a
body weight between 50 and 60 kg, 2.5 kg for a body
weight between 70 and 80 kg, and 3 kg if the person
weighed more than 80 kg. The test conditions tape/
no-tape and abduction/forward exion were randomized.
Signal processing
All 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 157

were digitally full-wave rectied and low-pass ltered

(single pass, Butterworth, 6 Hz low pass lter of sixth
order). Results were normalized to the maximum
activity observed during the maximal voluntary trials.
After rectifying, ltering and normalization, further
analysis was performed on four periods during arm
movement, each of 1-s duration. Periods were dened
by markers, automatically placed on the EMG signal
with every metronome signal. The mean amplitude
EMG signal, expressed as a percentage of maximal
voluntary contraction, was used to assess the activity
of the three trapezius parts and serratus anterior
muscle in each condition and each period.
Statistical analysis
Dierences in EMG activity among the several
conditions were analysed with an univariate approach to repeated measures analysis of variance
(General Linear Model), in which the within-subject
factors were: (1) muscle, (2) movement direction (3)
resistance, (4) tape, and (5) period. The alpha-level
for the ANOVA was set as 0.05. In case of signicant
dierences, paired t-tests with Bonferroni correction
were used for post-hoc multiple pairwise comparisons. All statistical analysis was performed with
the Statistical Package for Social Sciences (SPSS),
version 9.0.

RESULTS
The results of the descriptive statistical analyses are
summarized in Table 1 for the abduction movement
with and without external resistance, and Table 2 for
the forward exion movement, with and without
external resistance.
The statistical analysis with ANOVA repeated
measures General Linear and Model (GLM) showed
signicant dierences in EMG activity based on the
factors muscle (Po0.01), movement direction
(Po0.01), resistance (Po0.01), and period (Po
0.01), but no signicant dierence based on the
application of tape (P = 0.578). The analysis of
interaction eects for the muscle factor revealed
signicant muscle  movement direction interaction
eect (Po0.05), and no signicant interaction for
muscle  period (P = 0.126) and muscle  resistance
(P = 0.720). There was no signicant interaction
between the tape factor and any other factor in the
GLM. The results show that the application of tape
has no inuence on EMG activity in all conditions,
and dierences in EMG activity based on all other
factors are independent of tape application (no
tape  other factor interaction).
Since the inuence of tape on EMG activity for the
four muscles was of particular interest, and the
ANOVA showed no signicant dierences based on
# 2002 Elsevier Science Ltd. All rights reserved.

the application of tape, further post-hoc analyses on

the factor tape were not performed.

DISCUSSION
Normal muscle activity of the scapular rotators
allows for normal kinematics of the scapular movement. The role of the scapular muscles is to promote
glenohumeral stability, to provide a stable basis from
which other muscles can operate in an optimal
lengthtension relationship, and to elevate the
acromion during arm elevation in order to prevent
impingement (Wilk & Arrigo 1993; Mottram 1997).
In addition, the scapula plays an important role of
being a link in the kinetic chain of proximal to distal
sequencing of velocity, energy and forces in many
shoulder activities such as throwing (Kibler 1998).
Anatomic and histochemical studies regarding
trapezius muscle composition found some functional
subdivisions within the trapezius muscle. Lindman
et al. (1990, 1991) found that the ascending portion of
the trapezius muscle (arising from the spinous
processes and interspinous ligaments of approximately the T4T12 vertebrae, and attaching in the
region of the tubercle at the medial end of the spine of
the scapula) had a predominance of type I bres,
whereas the most superior parts of pars descendens
(from the medial third of the superior nuchal line and
the ligamentum nuchae to the posterior border of the
lateral third of the clavicle) had a higher frequency of
type II bres. These dierences in bre type might
reect dierent functional demands on the trapezius
muscle parts in various head, neck, and shoulder
movements. The author concluded that the lower
trapezius seems best suited for postural and stabilizing functions in the shoulder and arm movements,
whereas the upper trapezius seems best suited for
phasic activities. Similar conclusions can be drawn
from a dissection study revealing the fascicular
anatomy of the trapezius (Johnson et al. 1994). Based
on the orientation of the bres of the lower trapezius,
it was suggested that the role of the lower part of the
trapezius is more consistent with maintaining horizontal and vertical equilibrium of the scapula rather
than generating net torque. In addition, Johnson
et al. (1994) hypothesized that the thoracic bres of
the trapezius muscle do not appreciably change
length throughout the entire range of upward
rotation of the scapula. Hence, the contribution of
the lower trapezius to net torque about the axis of
rotation of the scapula was thought to be limited. The
upper bres of trapezius exert an upward rotation
moment about this axis, complementing that of the
serratus anterior. Wadsworth and Bullock-Saxton
(1997) examined the temporal recruitment patterns
of the scapular rotator muscles during controlled
voluntary abduction in the scapular plane. Their
Manual Therapy (2002) 7(3), 154162

Upper trapezius

No resistance, no tape
No resistance, tape
Resistance, no tape
Resistance, tape

Middle trapezius

Lower trapezius

Serratus anterior

P1

P2

P3

P4

P1

P2

P3

P4

P1

P2

P3

P4

P1

P2

P3

P4

9.8
(74.3)
10.9
(76.4)
19.8
(711.1)
22.3
(711.2)

28.8
(710.5)
29.6
(711.3)
51.7
(716.6)
51.7
(717.9)

21.9
(710.9)
22.7
(78.6)
32.1
(711.7)
34.7
(713.3)

12.2
(75.5)
14.2
(76.3)
24.7
(77.9)
27.7
(711.2)

5.7
(73.7)
5.3
(73.2)
11.0
(78.0)
13.6
(712.2)

18.6
(712.3)
16.4
(78.3)
35.2
(720.7)
27.6
(713.8)

13.5
(77.9)
13.6
(77.6)
23.6
(712.5)
21.3
(79.1)

6.4
(74.1)
6.9
(73.4)
17.6
(710.7)
15.9
(79.5)

3.8
(72.7)
3.8
(72.7)
8.5
(76.6)
10.9
(713.1)

25.6
(712.7)
22.5
(713.1)
41.8
(716.0)
36.6
(721.1)

25.7
(715.1)
25.8
(718.7)
40.6
(722.1)
39.1
(724.8)

8.5
(76.4)
8.1
(74.6)
20.6
(713.9)
20.3
(710.7)

3.9
(71.7)
3.6
(72.0)
8.0
(75.1)
10.2
(710.0)

26.0
(713.5)
22.8
(713.8)
42.2
(715.6)
41.7
(718.2)

25.6
(710.7)
23.5
(712.1)
36.7
(715.3)
35.7
(715.4)

7.1
(72.7)
7.3
(72.6)
17.3
(78.7)
16.4
(75.7)

# 2002 Elsevier Science Ltd. All rights reserved.

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 of
Maximal Voluntary Contraction during dynamic forward exion 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

No resistance, no tape
No resistance, tape
Resistance, no tape
Resistance, tape

Middle trapezius

Lower trapezius

Serratus anterior

P1

P2

P3

P4

P1

P2

P3

P4

P1

P2

P3

P4

P1

P2

P3

P4

11.2
(76.1)
10.5
(76.0)
18.2
(78.1)
15.6
(76.8)

26.7
(713.4)
25.4
(712.7)
42.5
(714.3)
44.1
(716.7)

21.0
(79.2)
22.2
(712.9)
29.3
(711.8)
30.6
(712.2)

10.2
(74.4)
12.2
(77.0)
20.6
(79.2)
23.3
(711.4)

2.9
(72.3)
2.3
(71.8)
5.7
(74.3)
5.4
(74.5)

8.5
(77.1)
5.7
(74.0)
17.4
(712.2)
16.2
(711.6)

6.3
(74.9)
5.2
(73.2)
10.4
(76.9)
10.2
(78.0)

2.8
(72.1)
2.9
(72.3)
8.5
(76.4)
8.4
(76.7)

4.9
(72.8)
4.8
(72.7)
11.4
(79.5)
10.8
(76.8)

25.7
(712.8)
21.8
(712.9)
38.1
(715.8)
37.5
(720.8)

29.0
(726.3)
23.3
(717.6)
33.6
(726.4)
26.9
(718.5)

8.7
(78.1)
9.7
(78.7)
22.8
(715.5)
25.9
(718.2)

5.5
(72.9)
5.2
(73.3)
10.7
(78.6)
8.8
(75.6)

27.8
(712.3)
25.8
(710.7)
43.8
(716.9)
42.1
(716.4)

26.0
(711.1)
26.4
(714.4)
35.8
(717.2)
36.1
(714.3)

7.3
(73.9)
7.9
(73.8)
19.6
(711.9)
19.7
(78.5)

158 Manual Therapy

Manual Therapy (2002) 7(3), 154162

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 of
Maximal 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: 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)

Taping and electromyographic muscle activity in shoulders 159

results indicated that in non-injured shoulders, the

upper trapezius was activated prior to the movement,
whereas the lower trapezius was not recruited until
after the start of the shoulder movement. However, in
a recent study, we examined muscle latency times of
the dierent trapezius parts in response to a sudden
unexpected arm movement (Cools et al. 2001). Our
results showed no signicant dierences among the
trapezius parts in relation to deltoid onset, thus
suggesting that the trapezius reacted as a unit in
response to a sudden unexpected arm movement
(Cools et al. 2001).
Although the trapezius muscle is often considered a
major stabilizing muscle for the scapula (Johnson et
al. 1994; Kibler 1998; Cools et al. 2001), other
scapular muscles also contribute to the stability and
movement quality of the scapula (Pink & Tibone
2000; Sahrmann 2002). Impaired control of the
scapula by the serratus anterior muscle is common
in patients with shoulder problems (Pink & Tibone
2000). The levator scapulae and rhomboid muscles
are both synergists and antagonists of the trapezius
muscle. Their function is to adduct and internally
rotate the scapula. Shortness of these muscles may
restrict upward rotation of the acromial region,
necessary for normal shoulder function (Sahrmann
2002). Scapulohumeral muscles such as latissimus
dorsi and pectoralis major also contribute to shoulder
function. These muscles essentially bypass the scapula and are attached directly to the humerus, and can
contribute to disruption of scapulohumeral rhythm
(Sahrmann 2002).
Summarizing, it is clear that there are many diverse
roles the scapula must play to achieve appropriate
shoulder function. These roles are interrelated and
depend on the quality of muscle activity in the
scapular muscles. Therefore, restoration of normal
scapular muscle activity is one of the priorities in the
early phase of rehabilitation of the athlete with
functional shoulder instability.
The purpose of our study was to determine if EMG
activity in the scapular muscles was inuenced by the
application of tape over the muscle belly of the upper
trapezius and parallel to the direction of the lower
trapezius muscle. Based on previous investigations
and clinical assumptions (Morin et al. 1997; McConnell 1999), we hypothesized that with tape the upper
trapezius activity would decrease, and the lower
trapezius activity would increase. In addition, we
assumed that the taping would change the overall
recruitment pattern of all scapular rotators, and
therefore hypothesized changes in muscle activity of
the serratus anterior and middle trapezius.
Conrming this hypothesis would be clinically
relevant, since scapulothoracic dysfunction is often
seen in patients with shoulder problems or
cervicobrachial pathologies. In this muscular imbalance, an overactivity of the upper trapezius part is
# 2002 Elsevier Science Ltd. All rights reserved.

assumed (Pink 1991; Kelley 1995). The purpose of

this tape was to inhibit muscle activity in the upper
trapezius part, and to enhance muscle activity in the
lower trapezius, thus correcting muscle activity
around the scapula.
In contrast to the expectations, the results of our
investigation revealed no signicant changes in EMG
activity in the scapular muscles based on the
application of tape. Morin et al. (1997) examined
the inuence of taping on upper and middle trapezius
muscle activity during an isometric contraction in the
shoulder. Contrary to the results of our study, he
found a signicant decrease in muscle activity in the
upper trapezius muscle with tape application, and an
increase in EMG activity of the middle trapezius part.
However, looking at the results of both studies, it
must be mentioned that in the study of Morin et al.
(1997) EMG measurements were performed during
isometric muscle contractions, which usually give a
more stable EMG signal than dynamic contractions.
The dynamic character of the movements performed
in our study might give a less steady EMG signal.
However, in view of the nature of instability
problems and related injuries, dynamic movements
over a large range of motions are more functional,
and hence more clinically relevant than isometric
contractions. In addition, in Morins investigation,
the serratus anterior and lower bres of the trapezius,
known to play an important role in the scapulothoracic stability and movement, were not included. Two
issues regarding our methods should be discussed: the
use of surface electrodes to evaluate muscle activity
and the use of maximal voluntary contraction as a
normalization reference.
The current state of surface electromyography is
enigmatic. Although it provides many important and
useful applications, it has many limitations that must
be considered (De Luca 1997). A major problem
is the issue of the cross-talk when using surface
electrode in the shoulder region. However, in view of
the nature of our investigation, in which the same
muscle was examined during the same movement
under dierent circumstances, possible cross-talk
remained unchanged over the conditions, and therefore probably did not inuence our results. Moreover, investigating large muscle groups such as the
trapezius muscle, surface electrodes do give a more
global evaluation of muscle activity than ne wire
electrodes, which measure a rather small selection of
muscle bres. In addition, cross-talk is not likely in
our setting since Winter et al. (1994) estimated that
90% of a surface EMG signal has its origin within
12-mm distance from an electrode pair. According
to Jensen and Westgaard (1997), the depth of the
supraspinatus and levator scapulae muscles suggests
that cross-talk contributes a relative small fraction to
the total EMG signal using surface electrodes on the
upper trapezius muscle.
Manual Therapy (2002) 7(3), 154162

160 Manual Therapy

Although normalization of EMG signal to MVC

values is common in EMG studies, its reproducibility
and stability is often questioned (Yang & Winter
1983; Jensen et al. 1993; Aaras et al. 1996; Araujo
et al. 2000). Some authors state that MVC is an
unreliable measurement (Yang & Winter 1983;
Araujo et al. 2000), while others concluded that
under certain conditions, in which methodological
errors inuencing the recorded EMG signal from the
muscle are kept to a minimum, normalization to
MVC values gives reproducible results (Aaras et al.
1996; Danneels et al. 2001a,b). In our investigation,
we used guidelines for EMG recording during
maximal voluntary contraction proposed by De Luca
(1997).
Concluding on the basis of our data that taping has
no eect on the scapulothoracic muscle activity
would be premature. Possibly, taping may aect
other parameters of neuromuscular control, such as
the muscle reaction times. In recent literature, timing
of muscle activity is often mentioned in a neuromuscular context. Lohrer et al. (1999) investigated the
neuromuscular properties and functional aspects of
taped ankles. He found taping caused changes in
muscle latency times, in addition to mechanical
restriction of movement. This was interpreted as a
proprioceptively activated eect of tape. In addition,
the inuence of this tape on the biomechanical
behaviour of the scapular position was not considered in this study.
We must take into account that the use of healthy
subjects is a limitation to our study, and further
research should emphasize muscle recruitment patterns in patients with abnormal scapular kinematics.
Other proprioceptive inuences, such as cutaneous
stimulation due to tape application, enhanced awareness of shoulder girdle and upper trunk position, and
subjective parameters of comfort after tape application, may possibly explain a positive eect of the tape
on functional shoulder performance.

CONCLUSIONS
Tape is often used in functional rehabilitation of the
shoulder patient. Although various taping techniques
are used in clinical practice, description of these
application methods and clinical studies evaluating
the eects of tape are scarce.
The purpose of our study was to investigate the
eect of tape application over the trapezius muscle on
the amount of electromyographic muscle activity in
the scapular muscles in healthy, pain-free shoulders.
We hypothesized that application of this particular
tape would have a proprioceptive eect on muscle
activation around the scapula, resulting in a change
in intensity of muscle activity in the scapular muscles.
We found no signicant dierences in muscle activity
Manual Therapy (2002) 7(3), 154162

in the trapezius and serratus anterior muscle, based

on the application of tape. This scapular technique
apparently does not aect muscle function in normal
pain-free shoulders. The question arises if the
intensity of EMG activity, is a representative parameter for proprioceptive qualities of a muscle.
Further research is necessary to measure dierent
aspects of neuromuscular control, in order to
determine proprioceptive changes after the application of tape. Although we were unable to reveal
signicant changes in muscle activity with the
application of this tape, the use of the taping
techniques in the clinical practice often results in
enhanced subjective functional scapular stability.
Future research is also needed to determine the
neuromuscular mechanism of these functional improvements in patients with scapular instability.
Acknowledgements
The authors would like to thank Ms Sara Vandevelde and Ms
Christel Vangestel for their assistance in collecting the data.

References
Aaras A, Veierod MB, Larsen S, Ostergren R, Ro O 1996
Reproducibility and stability of normalized EMG
measurements on musculus trapezius. Ergonomics 39(2):
171185
Anderson DL, Sanderson DJ, Hennig EM 1995 The role of
external non-rigid ankle bracing in limiting ankle inversion.
Clinical Journal of Sports Medicine 5: 1824
Anderson K, Woitys EM, Loubert PV, Miller RE 1992 A
biomechanical evaluation of taping and bracing in reducing
knee joint translation and rotation. The American Journal of
Sports Medicine 20(4): 416421
Araujo RC, Duarte M, Amadio AC 2000 On the inter- and intrasubjects variability of the electromyographic signal in isometric
contractions. Electromyography and Clinical Neurophysiology
40(4): 225229
Arrayo JS, Hershon SJ, Bigliani LU 1997 Special considerations in
the athletic throwing shoulder. Orthopedic Clinics of North
America 28(1): 6978
Basmajian JV, De Luca CJ 1985 Muscles Alive: Their Functions
Revealed by Electromyography, 5th edn. Williams and Wilkins,
Baltimore
Bennell KL, Goldie PA 1994 The dierential eects of external
ankle support on postural control. Journal of Orthopedic and
Sports Physical Therapy 20(6): 287295
Blevins FT 1997 Rotator cu pathology in athletes. Sports
Medicine 24(3): 205220
Bockrath K, Wooden C, Worrell T, Ingersoll CD, Farr J 1993
Eects of patella taping on patella position and perceived pain.
Medicine and Science in Sports and Exercise 25(9): 989992
Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Willems
TM, Cambier DC, Voight ML 2002 Scapular muscle
recruitment pattern: electromyographic response of the
trapezius muscle to sudden arm movement before and after a
fatiguing exercise. J Orthop Sports Phys Ther 32(5):
221229
Danneels LA, Cagnie BJ, Cools AM, Vanderstraeten GG, Cambier
DC, Witvrouw EE, De Cuyper HJ 2001a Intra-operator and
inter-operator reliability of surface electromyography in the
clinical evaluation of back muscles. Manual Therapy 6(3):
145153
Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE,
Stevens VK, De Cuyper HJ 2001b A functional subdivision of
hip, abdominal and back muscles during asymmetric lifting.
Spine 26(6): E114E121
# 2002 Elsevier Science Ltd. All rights reserved.

Taping and electromyographic muscle activity in shoulders 161

Davies GL, Docko-Homan S 1993 Neuromuscular testing and
rehabilitation of the shoulder complex. Journal of Orthopedic
Sports Physical therapy 18(2): 210219
De Luca CJ 1997 The use of surface electromyography in
biomechanics. Journal of Applied Biomechanics 13: 135163
Engstrom BK, Renstrom PA 1998 How can injuries be prevented
in the world cup soccer athlete? Clinics in Sports Medicine
17(4): 755768
Feuerbach JW, Grabiner MD, Koh TJ, Weiker GG 1994 Eect of
an ankle orthosis and ankle ligament anaesthesia on ankle joint
proprioception. The American Journal of Sports Medicine
22(2): 223261
Gilleard W, McConnell J, Parsons D 1998 The eect of patellar
taping on the onset of vastus medialis obliquus and vastus
lateralis muscle activity in persons with patellofemoral pain.
Physical Therapy 78(1): 2531
Glousman R, Jobe F, Tibone J, Moynes D, Antonelli D, Perry J
1988 Dynamic electromyographic analysis of the throwing
shoulder with glenohumeral instability. The Journal of Bone
and Joint Surgery 70A(2): 220226
Greene TA, Wight CR 1990 A comparative support evaluation
of three ankle orthoses before, during and after exercise.
Journal of Orthopedic and Sports Physical Therapy 11:
453466
Gross MT, Batten AL, Lamm AL 1994 Comparison of Donjoy
ankle ligament protector and subtalar sling ankle taping in
restricting foot and ankle motion before and after exercise.
Journal of Orthopedic and Sports Physical Therapy 19(1):
3341
Hancock RE, Hawkins RJ 1996 Applications of electromyography
in the throwing shoulder. Clinical Orthopaedics and Related
Research 330: 8497.
Hall CM 1999 The shoulder girdle. In: Hall CM, Brody LT (eds)
Therapeutic Exercise: Moving Toward Function. Lippincott
Williams and Wilkins, Philadelphia
Heit EJ, Lephart SM, Rozzi SL 1996 The eect of ankle bracing
and taping on joint position sense in the stable ankle. Journal of
Sports Rehabilitation 5: 206213
Host HH 1995 Scapular taping in the treatment of anterior
shoulder impingement. Physical Therapy 75(9): 803812
Jensen C, Vasseljen O, Westgaard RH 1993 the inuence of
electrode position on bipolar surface electromyogram
recordings of the upper trapezius muscle. European Journal of
Applied Physiology 67: 266273
Jensen C, Westgaard R 1997 Functional subdivision of the upper
trapezius muscle during low-level activation. European Journal
of Applied Physiology 76: 335339
Johnson G, Bogduk N, Nowitzke A, House D 1994 Anatomy and
actions of the trapezius muscle. Clinical Biomechanics 9: 4450
Kamkar A, Irrgang JI, Whitney SL 1993 Non-operative
management of secondary impingement syndrome. Journal of
Orthopedic and Sports Physical Therapy 17(5): 212224
Karlsson J, Andreasson GO 1992 The eect of external ankle
support in chronic lateral ankle joint instability: An
electromyographic study. The American Journal of Sports
Medicine 20(3): 257261
Kelley MJ 1995 Anatomic and biomechanical rationale for
rehabilitation of the athletes shoulder. Journal of Sports
Rehabilitation 4: 122154
Kelly BT, Kadrmas WR, Speer KP 1996 The manual muscle
examination for rotator cu strength: An electromyographic
investigation. Journal of Orthopedic and Sports Physical
Therapy 24(5): 581588
Kendall FP, Kendall EK 1983 Muscles, Testing and Function.
Williams and Wilkins, Baltimore
Kibler WB 1998 The role of the scapula in athletic shoulder
function. The American Journal of Sports Medicine 26(2):
325337
Konradson L, Voight M, Hojsgaard C 1997 Ankle inversion
injuries: the role of the dynamic defence mechanism. The
American Journal of Sports Medicine 25(1): 5458
Kowall MG, Kolk G, Nuber GW, Cassisi JE, Stern SH 1996
Patellar taping in the treatment of patellofemoral pain:
A prospective randomized study. The American Journal of
Sports Medicine 24(1): 6165
Larsen B, Andreansen E, Urfer A, Mickeslon MR, Newhouse KE
1995 Patellar taping: A radiographic examination of the medial
# 2002 Elsevier Science Ltd. All rights reserved.

glide technique. The American Journal of Sports Medicine

23(4): 465470
Lindman R, Eriksson A, Thornell L-E 1990 Fiber type
composition of the human male trapezius muscle: Enzymehistochemical characteristics. American Journal of Anatomy
189: 236244.
Lindman R, Eriksson A, Thornell L-E 1991 Fiber type
composition of the human female trapezius muscle: Enzymehistochemical characteristics. American Journal of Anatomy
190: 385392.
Lohrer H, Alt W, Gollhofer A 1999 Neuromuscular properties and
functional aspects of taped ankles. The American Journal of
Sports Medicine 27(1): 6975
Ludewig PM, Cook TM, Nawocsenski DA 1996 Threedimensional scapular orientation and muscle activity at selected
positions of humeral elevation. Journal of Orthopedic and
Sports Physical Therapy 24(2): 5765
Lukasiewicz AC, McClure P, Michiner L, Pratt N, Sennett B 1999
Comparison of three dimensional scapular position and
orientation between subjects with and without shoulder
impingement. Journal of Orthopedic and Sports Physical
Therapy 29(10): 574586
McCann PD, Wootten ME, Kadaba MP, Bigliani LU 1993
A kinematic and electromyographic study of shoulder
rehabilitation exercises. Clinical Orthopedics and Related
Researches 288: 179188
McConnell J. The Mc Connell approach to the problem shoulder.
Taping: Inhibition of the upper trapezius muscle. 1999 Course
Notes, p 34.
McCaw ST, Cerullo JF 1999 Prophylactic ankle stabilizers aect
ankle joint kinematics during drop landings. Medicine and
Science in Sports and Exercise 31(5): 702707
McMahon PJ, Jobe FW, Pink MM, Brault JR, Perry J 1996
Comparative electromyographic analysis of shoulder muscles
during planar motions: Anterior glenohumeral instability
versus normal. Journal of Shoulder and Elbow Surgery 5:
118123
McQuade KJ, Dawson J, Smidt GL 1998 Scapulothoracic muscle
fatigue associated with alterations in scapulohumeral rhythm
kinematics during maximum resistive shoulder elevation.
Journal of Orthopedic and Sports Physical Therapy 28(2):
7480
Morin GE, Tiberio D, Austin G 1997 The eect of upper trapezius
taping on electromyographic activity in the upper and middle
trapezius region. Journal of Sports Rehabilitation 6: 309319
Mottram SL 1997 Dynamic stability of the scapula. Manual
Therapy 2(3): 123131
Pink M, Perry J, Browne A, Scovacco ML, Kerrigan J 1991
The normal shoulder during free style swimming: An
electromyographic and cinematographic analysis of
twelve muscles. The American Journal of Sports Medicine 19:
569576
Pink MM, Tibone JE 2000 The painful shoulder in the swimming
athlete. Orthopedic Clinics of North America 31(2): 247261
Robbins S, Waked E 1998 Factors associated with ankle injuries:
Preventive measures. Sports Medicine 25(1): 6372
Rupp S, Berninger K, Hopf T 1995 Shoulder problems in high level
swimmersFimpingement, anterior instability, muscular
imbalance? International Journal of Sports Medicine 16:
557562
Sahrmann SA 2002 Diagnosis and treatment of Movement
Impairment Syndromes, 1st edn., chapter 5, pp 193245,
Mosby, St.Louis
Schmitt L, Snyder-Mackler L 1999 Role of scapular stabilizers in
etiology and treatment of impingement syndrome. Journal of
Orthopedic and Sports Physical Therapy 29(1): 3138
Shamus JL, Shamus EC 1997 A taping technique for the treatment
of acromioclavicular joint sprains: A case study. Journal of
Orthopedic and Sports Physical Therapy 25(6): 390394
Somes S, Worrell TW, Corey B, Ingersol CD 1997 Eects of
patellar taping on patellar position in the open and closed
kinetic chain: A preliminary study. Journal of Sports
Rehabilitation 6: 299308
Wadsworth DJ, Bullock-Saxton JE 1997 Recruitment patterns of
the scapular rotator muscles in freestyle swimmers with
subacromial impingement. International Journal of Sports
Medicine 18: 618624
Manual Therapy (2002) 7(3), 154162

162 Manual Therapy

Weiser WM, Lee TQ, McMaster WC 1999 Eects of simulated
scapular protraction on anterior glenohumeral stability. The
American Journal of Sports Medicine 27(6): 801805
Wilk KE, Arrigo C 1993 Current concepts in the rehabilitation of
the athletic shoulder. Journal of Orthopedic and Sports
Physical Therapy 18(1): 365378
Wilkerson GB 1991 Comparative biomechanical eects of the
standard method of ankle taping and a taping method designed

Manual Therapy (2002) 7(3), 154162

to enhance subtalar stability. The American Journal of Sports

Medicine 19(6): 588595
Winter DA, Fuglevand AJ, Archer SE 1994 Crosstalk in surface
electromyography: Theoretical and practical estimates. Journal
of Electromyography and Kinesiology 4: 1526
Yang JF, Winter DA 1983 Electromyography reliability in
maximal and submaximal isometric contractions. Archives of
Physical Medicine and Rehabilitation 64: 417420

# 2002 Elsevier Science Ltd. All rights reserved.