plantarflexor muscles play a critical role in ankle stabilization , and their combined 
 eccentric contraction decreases the rate of tibial advancement during midstance and causes 
 the foot and tibia to roll off over the forefoot rocker during terminal stance1 .
limited ankle dorsiflexion range of motion 
 ( rom ) is associated with various cumulative injuries and also causes compensatory changes 
 during walking2 . for normal
walking , 
 proper ankle dorsiflexion rom is necessary to absorb the body weight and contributes to the 
 forward body movement during the stance phase of the gait cycle1 .
ambulation on a sloped surface requires a shift towards 
 increased ankle dorsiflexion and more muscle activation of the knee and ankle joint for 
 stability3 .
deficits in ankle 
 dorsiflexion rom can come from restraints in contractile or noncontractile tissue , and 
 abnormal tissue flexibility requires greater force , which leads to energy dissipation1 , 4 . 

mobilization with movement ( mwm ) is widely used to improve the accessory motion of joints ; 
 however , it has a limitation in that it can only be applied by a therapist in a physical 
 therapy room7 .
recently , mwm has been 
 modified by using tape to provide a posterior inferior talar glide , which can cause passive 
 movement by substituting for a therapist 's force8 .
a lot of physical therapists have often employed mwm using tape to 
 increase ankle dorsiflexion , but how incline walking with modified mwm using tape influences 
 the foot and ankle biomechanics is still unclear , and no information has been gathered about 
 the muscle activities . an inclined surface is often used as a therapeutic intervention 
 because it requires additional muscle action and increases the concentric activity of the 
 plantarflexor muscles9 .
biomechanical 
 alterations resulting from clinicians ' utilization of modified mwm using tape have the 
 potential to change the plantarflexor and dorsiflexor muscle activities .
therefore , the 
 purpose of this study was to investigate the effect of modified mwm using tape on the talus 
 on the gcm and ta muscle activities during incline treadmill walking in women with limited 
 ankle dorsiflexion .
fifteen women ( a total of 22 feet with limited ankle dorsiflexion ) were recruited for this 
 study .
the mean age , height , and weight of the subjects were 28.13.0  years ( meansd ) , 
 161.96.9  cm , and 54.55.0  kg , respectively .
our eligibility criteria were as follows : 1 ) 
 passive ankle dorsiflexion rom of less than 8 degrees when measured in a non - weight - bearing 
 condition with the knee extended and ankle dorsiflexion rom with the knee flexed to at least 
 5 degrees greater than with the knee extended in the subtalar neutral position ; 2 ) leg 
 length discrepancy of less than 2  cm ; 3 ) no lower extremity injury within 6 months prior to 
 participation in the study ; 4 ) no history of neurological dysfunction ; and 5 ) ability to 
 ambulate without pain .
we chose experimental feet with a passive ankle dorsiflexion rom of 8 
 degrees or less with the knee extended6 . a vicon mx - t20 motion analysis system ( vicon motion system , ltd . ,
oxford , uk ) ( sampling 
 rate 100  hz ) with eight cameras was used to record the location of reflective skin markers 
 over the lateral calcaneus ; this was used to determine the time of heel strike and heel off . 

the activities of the medial gcm and ta muscles of the lower extremity with limited ankle 
 dorsiflexion were measured by a wireless electromyography ( emg ) system ( delsys , inc . , 
 boston , ma , usa ) using surface electrodes with a fixed interelectrode distance of 10  mm .
the 
 emg signals were rectified and low - pass filtered using a zero - lag butterworth filter with a 
 cutoff frequency of 10  hz . the data processing was controlled by the nexus software ( ver . 

gait cycle 
 events were used to determine heel strike , heel off , and toe off events for each gait trial . 
 prior to incline walking , electrodes were attached to the medial gcm and ta muscles .
a 
 sampling rate of 1,000  hz was used , and the root mean square ( rms ) values of the raw data 
 were calculated . for normalization ,
maximal emg signals were acquired during a maximal voluntary isometric 
 contraction ( mvic ) maneuver , which was performed for 5 seconds in the manual muscle - testing 
 position described by kendall et al10 . 

each subject was instructed to walk with and without modified mwm using tape on an inclined 
 treadmill ( model 1100 , hebb industries , inc . , tyler , texas , usa ) set to a grade of 6 degrees 
 at a speed of 1.25 m / s for 5 minutes .
the modified mwm using taping was applied by one examiner 's maximal 
 force using a piece of tape .
each participant placed their foot on a box and positioned 
 closed - packed dorsiflexion as tibia forward from the talus anterior progressing inferiorly 
 and posteriorly .
one examiner attached the tape ( a mueller kinesiological tape with a width 
 of 37  mm ) to the plantar surface of the calcaneus from the lateral to medial side .
the two 
 tasks ( incline walking with and without modified mwm using tape ) were administered randomly , 
 and each subject rested for 30 minutes between tasks in order to minimize any learning 
 effect .
statistical analysis was performed using a statistical package ( pasw statistics , 
 18.0 , ibm corporation , ny ) .
the paired t - test was used to examine differences in emg 
 activities of the gcm and ta muscles with and without modified mwm using tape , and 
 significance was defined as p<0.05 .
there were significant differences with and without the modified mwm using tape in terms of 
 the normalized mean emg activity of the gcm ( p=0.001 ) and ta ( p=0.049 ) between heel strike 
 and heel off .
the normalized mean emg activities of the gcm during incline walking with and 
 without the modified mwm using tape were 67.6321.48%mvic and 54.5617.68%mvic , 
 respectively .
the normalized mean emg activities of the ta during incline walking with and 
 without the modified mwm using tape were 24.8515.97%mvic and 27.5215.14%mvic , 
 respectively .
there were no significant differences among tasks in terms of the emg 
 activities of the gcm and ta between heel off and toe off .
the normalized mean emg 
 activities of the gcm during incline walking with and without the modified mwm using tape 
 were 56.2429.79%mvic and 52.5619.05%mvic , respectively .
the normalized mean emg activities 
 of the ta during incline walking with and without the modified mwm using tape were 
 26.8616.48%mvic and 24.9712.54%mvic , respectively .
this study investigated the effect of modified mwm using tape on muscle activities during 
 inclined walking in women with limited ankle dorsiflexion .
we found that modified mwm using 
 tape during incline walking increased the activity of the medial gcm muscle and decreased 
 the activity of the ta muscle between heel strike and heel off , while there was no 
 difference between heel off and toe off in the two muscles .
we consider that applying tape 
 to the talus during incline walking may make the talus move in the posterior and inferior 
 directions .
it is also possible that the force of the tape toward the posterior and inferior 
 directions on the talus and a repetitive activity involving 5 minutes of incline walking 
 performed additively could induce the talus to roll and glide posteriorly , which may affect 
 ankle arthrokinematics , resulting in a gain in the normal dorsiflexion rom .
active 
 physiological movements of the ankle joint under weight - bearing activity could increase 
 ankle dorsiflexion rom , while changed ankle mechanics could alter muscle activities11 . therefore , regaining of ankle 
 dorsiflexion rom by modified mwm using tape could change the flexibility of the gcm muscle ; 
 enhanced muscle flexibility , in turn , could allow more efficient movements , which might 
 increase the emg activity of the gcm .
incline walking with the modified mwm using tape 
 involves active physiological motion , and repetitive motion for 5 minutes could change gcm 
 muscle activity . we think that incline walking with the modified mwm using tape could be 
 applied for effects similar to those of dynamic stretching , which consists of performing 
 movements12 .
we observed that there was decreased emg activity of the ta muscle between heel strike and 
 heel off during inclined walking with modified mwm using tape compared with that without 
 using tape .
at least 10 degrees of ankle dorsiflexion is needed during the stance phase of 
 the gait cycle ; this contributes to forward body movement for normal walking .
the ta muscle 
 is active at heel strike and continues until the loading response ; initially , eccentric 
 activity and concentric activity in the second half of the loading response move the tibia 
 forward1 . to compensate for the limited 
 ankle dorsiflexion rom , the activity of the ta muscle may increase during the early stance 
 phase13 .
incline walking with the 
 modified mwm using tape could be helpful to in increasing ankle dorsiflexion rom , which may 
 contribute to controlling the compensatory strategy and preventing pronation , thereby 
 resulting in decreased activity of the ta muscle .
the emg activities in both the gcm and ta muscles did not change between heel off and toe 
 off in this study .
we focused on the mean emg activity of the gcm prior to the pre - swing 
 phase because plantarflexion primarily arises from the recoil of the tendon , and actually , 
 the gcm seldom moves between heel off and toe off1 .
our data were obtained from a small sample of only young women , so 
 it is difficult to standardize the change in the activities of the lower extremity muscles . 

further study with a larger number of subjects should be performed to analyze the kinetics 
 and kinematics during incline walking in a synchronous fashion .
in addition , we need to 
 investigate the long - term effect of modified mwm using tape through various exercise 
 frequencies .
we concluded that incline walking with modified mwm using tape increased the 
 emg activity of the medial gcm muscle and decreased the activity of the ta muscle between 
 heel strike and heel off .
therefore , our results suggest that modified mwm using tape during 
 incline walking could be an effective intervention for altering the emg activities of medial 
 gcm and ta muscle in people with limited ankle dorsiflexion .
   [ purpose ] this study compared the emg activities of the plantarflexor and dorsiflexor 
 muscles during inclined walking with and without modified mobilization with movement 
 ( modified mwm ) using tape in women with limited ankle dorsiflexion . [ subjects ] fifteen 
 women with limited dorsiflexion in their feet ( 22 feet in total ) were recruited for this 
 study . 
 [ methods ] the subjects walked with and without modified mwm using tape on a 
 treadmill at 6 degrees with a speed of 1.25 m / s for 5 minutes . 
 the emg activities of the 
 medial gastrocnemius ( gcm ) and tibialis anterior ( ta ) muscles were measured using a 
 surface emg system . [ results ] during incline walking with modified mwm using tape , the 
 mean emg activity of the gcm significantly increased , and that of the ta decreased between 
 heel strike and heel off . 
 there was no difference between heel off and toe off in the two 
 muscles . [ conclusions ] modified mwm 
 using tape on the talus during incline walking could 
 alter the muscle activities of the gcm and ta between heel strike and heel off in women 
 with limited ankle dorsiflexion . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION