· Web viewIs there a place for kinesiotape in modern osteopathic practice? Author: Richard Moore, 07004959. Abstract. Background. Kinesiotaping …

Is there a place for kinesiotape in modern osteopathic practice?

Author: Richard Moore, 07004959

Abstract

Background

Kinesiotaping (KT) was developed by Kenso Kase in the 1970s as a method of assisting

physical treatment of damaged tissue whilst maintaining full range of motion. It works by lifting

the epidermis to reduce compression of underlying tissues and aid venous and lymphatic

movement. The aim of this paper was to identify evidence for the use of KT in the treatment of

musculoskeletal conditions and suggest how this could inform osteopathic treatment.

Method

A critical literature review was conducted to investigate the effect of KT on musculoskeletal

conditions. Five electronic databases (PUBMED, AMED, PEDRO, CINAHL, SPORTDiscus)

and five key websites were searched up to 19th November 2011. 9 randomised controlled trials

met specified inclusion criteria. The CASP RCT appraisal tool was used to assess validity and

quality of each trial.

Results

Three papers discussed use of KT in patello-femoral pain, three for shoulder impingement, one

for whiplash-affected disorder, one for plantar fasciitis and one for chronic low back pain.

Methodology was varied with taping protocols, comparison and measured outcomes

inconsistent across the studies. Positive effects were seen in muscle flexibility, pain, disability

and fascia thickness when compared to manual therapy and sham taping.

Conclusion

Despite considerable heterogeneity of study design, positive effects of KT have been identified

and could be utilised by osteopaths in the treatment of acute or chronic conditions. Further

research with larger study groups and homogeneous methodology should be undertaken to

provide definitive results in treatment of named conditions.

Keywords: kinesiotaping, osteopathy, patellofemoral pain, shoulder impingement (250 words)

Contents

INTRODUCTION...........................................................................................................3Aims........................................................................................................................................................7

METHODS.......................................................................................................................8

RESULTS.......................................................................................................................12Emergent Themes.................................................................................................................................17

DISCUSSION.................................................................................................................18Kinesiotaping as a viable alternative.....................................................................................................22

Limitations of studies assessing efficacy of kinesiotape........................................................................23

Limitations of this review......................................................................................................................24

CONCLUSION..............................................................................................................25Opportunities for future research.........................................................................................................25

ACKNOWLEDGMENTS.............................................................................................25

REFERENCES..............................................................................................................26

Introduction

Kinesiotaping was developed by Japanese chiropractor Kenso Kase in the 1970s as a method of

assisting physical treatment of damaged tissue whilst maintaining full range of motion, unlike

traditional taping methods, which restrict movement (Kinesio UK, 2011). Popular applications

include patellar or achilles tendinopathy, acute shoulder impingement and lower back strain

(Konin, 2010). The Kinesio Taping Association (KTA) has over 10,000 members worldwide

and is training professionals at a rate of over 800 per year in the UK alone (Slater, 2012).

Kinesiotape (KT) first gained widespread attention at the 1988 Seoul Olympics, where 50,000

rolls were donated to 58 countries, giving the product exposure on the world stage (Lowes,

2008). Since then, high profile athletes such as Lance Armstrong, Rory McIlroy and David

Beckham have popularised use of the tape (Wintle, 2012).

KT’s ability to longitudinally stretch and the direction that it is applied, offers the therapeutic

value (Kase et al, 2003). The tape works by lifting the epidermis, as the tape recoils after being

applied with tension (Figure 1). This lifting increases interstitial space between the skin and the

underlying connective tissues, vessels and muscles to reduce compression and aid lymphatic

and venous movement (Yoshida & Kahanov, 2007).

Figure 1: The effect of kinesiotape on the skin and underlying tissue (Hitech Therapy, 2012).

Taped/“Lifted” area= reduced compression on interstitial space

Non-Taped Area= blood and lymph vessels compressed beneath epidermis

The ‘lifting’ also has an effect on underlying fascia, reducing pain, decreasing susceptibility to

microtrauma and improving muscle performance (O'Sullivan & Bird, 2011).

The therapeutic effect is the same for all available colours and is dependant on how the tape is

applied. Figure 2 demonstrates a typical application to inhibit a strained muscle, tension being

applied distally to proximally along the muscle, with 15-25% tension. Figure 3 shows

application in the opposite direction to facilitate a weakened muscle, with 15-35% tension.

Figure 2: Muscle Inhibition. Figure 3: Muscle Facilitation(Biceps brachii) (Biceps brachii)

Application to aid oedema is shown in Figure 4. A single strip is cut into multiple tails placed

over the oedema with 0-20% tension. The ‘head’ of the tape is placed towards the target lymph

nodes.

KT can also be used to stabilise by placing it over the unstable joint, with all the stretch

removed, applying over 75% tension (Figure 5).

Figure 4: Lymphatic correction. Figure 5: Mechanical support (Acromioclavicular joint)

The effect on healthy individuals has been the subject of observational studies, focussed on a

range of outcomes, including muscle strength and motor nerve conduction. Of the fifteen trials

identified (Table 1) seven returned positive results in all or some of the outcomes measured,

whilst the remaining studies found nil or inconclusive results.

Where numerous trials have looked at the same outcome, results are contradictory. In the case

of grip strength, Chang et al (2010) found no positive effect from KT applied to the forearm,

compared to sham and no taping, whilst Lee et al (2010) found a clear improvement in grip

strength, albeit without a control group.

Similar contradiction is found in studies looking at effect on the quadriceps. Aktas & Baltaci

(2011) found a positive effect on jump height, Słupik et al (2007) noticed an increase in motor

unit recruitment after taping, whilst Vithoulkaa et al (2010) found that the overall effects of KT

mixed, with eccentric force improved but concentric force the same as control and Fu et al

(2008) found no positive effect.

Table 1: Studies investigating physiological effects of kinesiotaping in healthy individuals

StudyEffect tested / Application Sample size Outcome

Aktas & Baltaci, 2011 Muscle strengthJump height(quadriceps)

20 (9 male, 11 female)

Positive(jump & peak torque)

Chang et al, 2010 Grip strength(forearm flexors)

21 (all male). Nil

Firth et al, 2010 Single leg hop test, pain.(Achilles tendon)

48 (24 asymptomatic, 24 achilles tendonitis)

Nil

Fu et al, 2008 Muscle strength(quadriceps and hamstrings)

14 (7 male, 7 female).

Nil

Halseth et al, 2004 Proprioception(lateral & medial lower leg)

30 (15 male. 15 female)

Nil

Hombrados-Hernándeza et al, 2011

Sporting performance(diaphragm)

17 (10 male, 7 female)

Nil

Huang et al, 2011 Vertical jump(triceps surae)

31 (19 male, 12 female)

Nil

Lee et al, 2010 Grip strength(forearm flexors)

40 (20 male, 20 female)

Positive

Lee et al, 2011 Motor nerve conduction velocity

17 (9 male, 8 female)

Nil

Lee, Yoo & Hwang-Bo, 2011

Pelvic tilt (lumbar erector spinae)

40 (23 male, 17 female).

Positive

Lou, 2008 Motor perception(knee)

19 (9 male, 8 female)

Positive

Słupik et al, 2007 Muscle activity(Vastus medialis)

27 (15 male, 12 female)

Positive

Soylu et al, 2011 Muscle strength(masseter)

11 (7 male, 4 female)

Nil

Vithoulkaa et al, 2010 Muscle strength(quadriceps)

20 (all female) Positive (eccentric torque)

Yoshida & Kahanov, 2007

Trunk range of motion(lumbar erector spinae)

30 (15 male, 15 female)

Positive (flexion only)

Overall, studies involving healthy individuals found some positive effect on muscle strength

(Soylu et al 2011, Lee et al 2010, Vithoulkaa et al 2010), flexibility (Yoshida & Kahanov 2007,

Lee et al 2011) and motor nerve conduction (Lee et al 2011), suggesting that KT could be used

in the treatment of musculoskeletal conditions. Further examination of studies investigating the

use of KT is indicated along with how this information could successfully be used by osteopaths

in the treatment of common musculoskeletal conditions, adhering to established osteopathic

principles.

Aims

It is the aim of this paper to identify evidence for the use of kinesiotaping in the treatment of

musculoskeletal conditions and how this information could be used in an osteopathic setting.

Studies will be included if investigating the use of the KT in a pathological state through a

controlled trial, with observational studies or those conducted solely on healthy individuals

excluded. Based on these findings, the implications on osteopathic care will be discussed and

opportunities for further research suggested.

This is framed in the question: “Is there a place for kinesiotaping in modern osteopathic

practice?”

Methods

As an initial search of the Cochrane Library found no existing systematic or literature reviews,

PUBMED, AMED, CINAHL, PEDRO and SPORTDiscus databases were searched up to 19 th

November 2011, with the following string:

(kinesio tap*) OR (kinesiotap*) OR (k-tap*)

Additional to the database searching, the websites of the Osteopathic Research Web

(www.osteopathic-research.com), OSTMED (www.ostmed-dr.com), Journal Of American

Osteopathic Association (www.jaoa.org/), Chiropractic & Manual Therapies

(www.chiromt.com) and Open Grey (www.opengrey.eu) were also searched.

Once all duplicates had been removed, inclusion and exclusion criteria (Table 3) were applied to

these results. To focus results, all studies where kinesiotape was not the primary focus were

removed, as were treatments for non-musculoskeletal conditions such as cerebral palsy and

breast cancer. Observational studies on healthy individuals were also discarded. Only controlled

trials were selected for review.

Hand searching of the selected papers returned ten additional papers, one of which met all the

relevant inclusion and exclusion criteria. This gave a total of nine papers to be assessed (Figure

8).

The nine studies selected were then subjected to the CASP assessment tool (Table 4). All papers

submitted for CASP assessment were found to be of a high enough quality to be included in the

review.

Table 3: Selection criteria for papers investigating efficacy of kinesiotape in treatment of musculoskeletal conditions.

Inclusion criteria Exclusion criteria Reasoning

Population Human

Primary MSK condition being treated

Non-human

Healthy individuals

Non-MSK presentation e.g. cerebral palsy

To focus on conditions that may typically present to an osteopath to maximise relevance

To identify effect on pathological state rather than effect on healthy tissues

Intervention Kinesiotape only

Application by trained professionals using recognised techniques

Non-elastic tape

Multi-modal interventions/comparisons

Applications not specified, described or focussed on condition being treated

To identify studies looking at kinesiotape rather than traditional athletic tape / ‘McConnell’ tape

To focus on effect of kinesiotape

To ensure tape is used effectively

Control Control group receiving sham or no taping

Lack of control group To measure effect of tape against sham / no tape or alternative intervention rather than alternative taping applications

Outcome Studies using objective methods to identify change is muscle activity, range of motion in specific muscles/joints alongside subjective measures

Studies solely using subjective measures such as pain scales

Studies not relating findings to identified pathology

To reduce possibility of bias (Kane, 2004)

To identify effect of intervention on identified pathology

Study design

Randomised controlled clinical trials, controlled clinical trials, controlled pilot studies

Published in English language Independent from tape manufacturer, trainer or distributor

Published in past 10 years

Case reports

Observational studies on asymptomatic participants

Non-English language

Literature reviews, meta-analyses

Studies funded by tape manufacturers / trainers

Focus on highest form of evidence (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996)

Primary studies only (Aveyard, 2008, p. 23)

English language studies can only be used due to resource limitations

To reduce possibility of bias

Most recent material only

Searching electronic databases (n=117)

PubMed27Osteopathic Research Web 0PEDro17OSTMED 0CINAHL43JAOA 0AMED24Chiropractic & Manual Therapy 0SPORTDiscus6Open Grey 0

Abstracts retrieved (n=68)

Duplicates removed (n=49)

Papers reviewed(n=33)

Excluded (n=35)Case reports9Articles10Non-English16

Papers selected(n=8)

Excluded (n=25)Non-MSK3Healthy individuals8Non-controlled11Multimodal3

Reference list searches (n=10)Excluded (n=9)Non-English3Case reports2Healthy individuals3Non-controlled1Multimodal3Additional papers (n=1)

Papers selected for review (n=9)

Figure 8: Flowchart showing literature selection process for papers investigating efficacy of kinesiotape in treatment of musculoskeletal conditions.

Table 4: Critical appraisal results using CASP tool for selected papers investigating efficacy of kinesiotape in treatment of musculoskeletal conditions.

CASP Questions (P = Yes; ? = Unclear; O = No)1 2 3 4 5 6 7 8 9 10

Akbas et al (2011) P P P P ? P ? P P PAytar et al (2011) P P ? P P P ? P P PChen et al (2008) P P P ? P P ? P P OGonzalez-Iglesias et al (2009)

P P P P P P ? P P PHsu et al (2008) P P P P P P ? P P OKaya et al (2010) P P O O P P P P P PPaoloni et al (2011) P P P P P P ? P P PThelen et al (2008) P P P P P P O P P PTsai et al (2010) P P P P P P ? P P P

Results

Nine studies were identified with a total of 326 participants, investigating the effect of

kinesiotape (KT) on patellofemoral pain (n=3), shoulder impingement (SI) (n=3), whiplash

affected disorder (n=1), chronic lower back pain (n=1) and plantar fasciitis (n=1).

Table 5 summarises the results for the use of KT in patello-femoral pain (PFPS). Akbas et al

(2011) found that KT in conjunction with strengthening exercises and soft tissue massage

achieved faster improvements (significant at three weeks) in both pain and muscle flexibility

when compared to exercise and massage alone, although final outcome levels at six weeks were

similar in both groups.

The two remaining studies (Aytar et al, 2011 and Chen et al, 2008) looked at the effects of KT

immediately after application. Aytar et al (2011) examined the effect on pain alongside balance,

proprioception and muscle strength when compared to sham tape. Although there were no

statistically significant differences in pain and proprioception after application, positive effects

were seen on muscle strength and dynamic balance in the KT group.

Finally, Chen et al (2008) investigated the effects on stair climbing and found ground force

reaction reduced when descending and muscle firing improved in the symptomatic KT group.

No positive results were seen in the asymptomatic group despite identical application of KT.

Table 6 summarises the results for the use of KT in shoulder impingement. Hsu et al (2009)

adopted a pre-test and post-test model, comparing KT to sham tape applied across the lower

trapezius of symptomatic baseball players. Scapular movement improved in both groups, as did

activation of the upper trapezius and serratus anterior but the KT group also showed

improvements in activity and strength of the lower fibres of trapezius.

Thelan et al (2008) and Kaya et al (2010) both investigated the effects on pain and disability,

with a similar taping protocol across supraspinatus, deltoid and teres minor.

Table 5: Summary of results from selected papers investigating efficacy of kinesiotape in treatment of patello-femoral pain syndrome (PFPS).

Study Presenting condition

Outcomes measured Experimental group Control group Summary of results

Akbas et al, 2011 PFPS (n = 31)

1. Pain2. Soft tissue flexibility3. Patellar positioning

1. KT to facilitate quadriceps, ilio-tibial band (ITB) and hamstrings2. Strengthening exercises3. Soft tissue massage(n = 16)

1. Strengthening exercises2. Soft tissue massage(n = 15)

Pain, flexibility improved in both groups by end of trial

Flexibility of soft tissues (hamstrings and ITB) occurred faster and greater in KT group

Neither group saw positive change in patellar position

Aytar et al, 2011 PFPS (n = 22)

1. Pain2. Muscle strength3. Proprioception4. Balance

KT to quadriceps and around patella(n = 12)

Identical taping but with non-flexible sticking plaster(n = 10)

Strength improved in both groups (60° = both, 180° = KT only)

Balance improved in both groups (static = both, dynamic = KT only)

No significant changes in pain or proprioception in either group

Chen et al, 2008 PFPS (n = 25)

1. Ground force reaction (GRF)2. Muscle firing

KT to facilitate vastus medialis and inhibit vastus lateralis – PFPS sufferers(n = 15)

Identical taping in healthy individuals(n = 10)

No positive effect seen in healthy individuals

GRF reduced in descending stairs in KT group

Timing of activation of vastus medialis improved in KT group

Key: KT = Kinesiotaping ; PFPS = Patello-femoral Pain Syndrome

Kaya et al (2010) compared KT applied every three days, along with guided home exercises, to a daily

programme of ultrasound, TENS, heat pack and home exercise. Pain levels at the end of the two-week

trial were similar in both groups but the KT group improved faster with significant differences at the

end of week one. Disability scores were more improved (a drop from 57.5 to 18 compared with a drop

from 56 to 31 on the DASH 100-point score) in the KT group at the end of the trial.

Thelan et al (2008) compared KT to sham tape over a six-day period. By the end of the trial, both

groups achieved similar results for improvement of pain-free range of movement but the KT group

achieved results after just three days compared to six days for the control group. There was no

significant difference in pain or disability in either group by the end of the trial.

Table 7 summarises the results for the use of KT in chronic low back pain (CLBP), whiplash affected

disorder (WAD) and plantar fasciitis (PF).

Gonzalez-Iglesias et al (2009) investigated the effect of KT on pain and cervical range of motion

following WAD over a 24 hour period when compared to sham KT (applied with no tension).

Although there were statistically-significant improvements to both pain and range of motion in the KT

group at the end of the trial, both were at levels deemed not clinically relevant.

Paolini et al (2011) studied the effects on chronic low back pain across three groups; KT only, KT plus

home exercises and home exercises only. An immediate effect was seen on pain in all KT groups but it

was the home exercise group that showed most improvement in disability at the end of the 4-week

trial.

The last paper, Tsai et al (2010) focussed on plantar fasciitis, comparing KT with daily physical

therapy. Both pain and foot function improved more in the KT group and there was a significant

reduction in plantar fascia thickness, as measured by ultrasound, at the insertion site on the calcaneus

in the KT group. However, plantar fascia thickness at the site of most significant inflammation was

unchanged in both groups.

Table 6: Summary of results from selected papers investigating efficacy of kinesiotape in treatment of shoulder impingement (SI).

Study Presenting condition

Outcomes measured Experimental group Control group Summary of results

Hsu, et al, 2009 Shoulder impingement(n = 17)

1. Shoulder kinematics2. Muscle activity3. Muscle strength

KT to lower trapezius(n = 17)

Identical taping but with non-flexible 3M tape(n = 17)

Improved scapular posterior tilt at 30-60° in both groups

Increased lower trapezius activity at 60-30° in KT group

Decreased activity in same range in control group

Increase in serratus anterior and upper trapezius activity in both

Increase in strength of lower trapezius in KT group

Kaya et al, 2010 Shoulder impingement(n = 55)

1. Pain2. Disability

KT over supraspinatus, deltoid and teres minor+ home exercise program(n = 30)

Ultrasound, TENS, heat pack and exercise daily+ home exercise program(n = 25)

Pain improved equally by end of trial but improvement was initially faster in KT group

Disability scores lower in KT group than control group at end of trial

Thelen et al, 2008

Shoulder impingement(n = 42)

1. Pain2. Disability3. Range of movement (ROM)

KT over supraspinatus and deltoid and across coracoid process(n = 21)

KT applied with no tension in non-therapeutic areas(n = 21)

Immediate improvement in ROM in KT group but similar improvement in both groups at end of trial

No significant improvements to pain or disability in either group

Key: KT = Kinesiotaping ; SI = Shoulder Impingement

Table 7: Summary of results from selected papers investigating efficacy of kinesiotape in treatment of whiplash-affected disorder (WAD), chronic low back pain (CLBP) and plantar fasciitis (PF).

Study Presenting condition

Outcomes measured Experimental group Control group Summary of results

Gonzalez-Iglesias et al, 2009

WAD(n = 41)

1. Pain2. Cervical spine ROM

KT along posterior neck and across lower cervical spine(n = 21)

KT applied with no tension in similar position(n = 20)

Improvements to cervical ROM and pain in KT group were statistically but not clinically relevant

Paoloni, et al, 2011

CLBP(n = 39)

1. Pain2. Disability3. Muscle function (FR ability)

KT along lumber erector spinae and midline (3 strips total)(n = 13)

Note: All participants taped initially for immediate results on pain and FR(n = 39)

KT applied in same way + home exercises(n = 13)

Home exercises only(n = 13)

Immediate reduction in pain in all KT groups

Improved FR in 17/39 initially Pain improved in all groups at

end of trial Disability improved most in

non-KT group FR most improved at end of

trial in KT + Exercise group

Tsai et al, 2010 PF(n = 52)

1. Pain2. Foot function3. Thickness of plantar fascia in 2 positions

KT over gastrocnemius and plantar fascia+ daily physical therapy (ultrasound, TENS)(n = 26)

Daily physical therapy only(n = 26)

Immediate improvement in pain and foot function in KT group

Reduction in plantar fascia thickness in KT group in 1 of 2 designated sites only

Key: KT = Kinesiotaping ; PF = Plantar Fasciitis ; CLBP = Chronic Low Back Pain ; WAD = Whiplash Associated Disorder ; FR = Flexion-Relaxation

Emergent Themes

As described in the Methodology, a number of themes can be taken from the above results (Table 8).

The papers identified a number of conditions that KT could potentially be used to treat and there were

a number of recurring minor themes, namely the use of KT as a cost-effective alternative to traditional

interventions such as ultrasound, TENS and home exercise and the efficacy of KT on muscle tissue

and fascia in the immediate and short term.

Table 8: Themes drawn from selected papers investigating efficacy of kinesiotape in treatment of musculoskeletal conditions.

Major Themes Minor Themes

Kinesiotaping as a treatment for musculoskeletal pain, namely:

Patello-femoral pain Shoulder impingement Other conditions

o Chronic low back paino Whiplash affected disordero Plantar fasciitis

Kinesiotaping as a cost-effective alternative to ultrasound, exercise therapy or TENS

Kinesiotaping as a fast-acting/short-term treatment

Effect of kinesiotaping on muscle tissue and fascia

Discussion

The purpose of this literature review was to identify evidence for the use of kinesiotape (KT) in the

treatment of musculoskeletal conditions and its role in osteopathic practice. Nine papers satisfied

inclusion and exclusion criteria, with significant variability in study design, methodology and quality

(Table 9).

All three papers addressing the use of KT in treating patello-femoral pain (Akbas et al, 2011; Aytar et

al, 2011; Chen et al, 2008) hypothesised that pain is caused by maltracking of the patella, following

imbalance between vastus medialis and vastus lateralis due to the Q angle (Levangie & Norkin, 2001)

and taped accordingly (Figure 9).

Despite similar hypotheses, heterogeneity of methodology across the three studies makes direct

comparison difficult (Table 5). Both Akbas et al (2011) and Aytar et al (2011) were well-documented

trials, with clearly presented results focussed on PFPS as the presenting condition. Unfortunately,

differing control groups (sham taping and exercise/massage respectively) makes overall comparison

inconclusive. Chen et al (2008) focussed on biomechanical effects of KT on PFPS sufferers,

comparing its effects against sham taping, no taping and asymptomatic healthy participants. Although

the results are presented in great detail, a poorly documented methodology, makes this study less

meaningful to this review.

Figure 9: Taping protocols for Patello-Femoral Pain Syndromea) Akbas et al 2011, b) Aytar et al 2011, c) Chen et al 2008 (not illustrated in paper)

None of these studies included a power calculation and featured small (n=31, 25, 22) study groups,

though small groups can be expected from qualitative research (Aveyard, 2008, p. 100).

Table 9: Methodological quality of selected papers investigating efficacy of kinesiotape in treatment of musculoskeletal conditions.

Study Key Strengths/Weaknesses RatingAkbas et al (2011)

Strengths: Inclusion/exclusion criteria clear and relevant Clear protocol of group allocation &

randomisation Blinding of participants and examiners Outcomes measured are relevant & consistent

Weaknesses: KT mixed with exercise rather than alone Study groups small with no power calculation

High

Aytar et al (2011)

Strengths: Inclusion/exclusion criteria clear and relevant Blinding of participants and examiners Sham KT identical in design/application Outcomes measured are relevant & consistent

Weaknesses: Randomisation/allocation method unrecorded Study groups small with no power calculation

High

Chen et al (2008)

Strengths: Sham KT identical in design/application

Weaknesses: Inclusion/exclusion criteria undefined Blinding of participants only Mix of symptomatic and asymptomatic

participants Results predominantly biomechanical Study groups small with no power calculation

Low

Gonzalez-Iglesias et al (2009)

Strengths: Sham KT identical in design/application Blinding of participants and examiners Inclusion/exclusion criteria clear and relevant Results consistent, relevant and clearly presented

Weaknesses: KT used in both groups Randomisation/allocation method unrecorded Results measured in first 24 hours only Study groups small with no power calculation

High

Hsu et al (2008)

Strengths: Sham KT identical in design/application Blinding of participants and examiners Inclusion/exclusion criteria clear and relevant

Weaknesses:

Moderate

Extremely specific population studied Randomisation method unclear No assessment of pain or disability Study groups small with no power calculation

Key: KT = Kinesiotaping

Table 9 (cont): Methodological quality of selected papers investigating efficacy of kinesiotape in treatment of musculoskeletal conditions.

Study Key Strengths/Weaknesses RatingKaya et al (2010)

Strengths: Inclusion/exclusion criteria clearly defined Power calculation recorded and adequate group

size recorded Results clearly presented

Weaknesses: KT mixed with exercise rather than alone Allocation based on date of admission rather than

randomised model Examiner not blinded

Moderate

Paoloni et al (2011)

Strengths: Inclusion/exclusion criteria clearly defined Enrolment of subjects and progression of trial

very well presentedWeaknesses:

Central hypothesis (FR) not commonly accepted as cause of CLBP

Mixed intervention and assessment protocol Study groups small with no power calculation No assessment of speed of improvement, just

overall figures at end of trial

Moderate

Thelen et al (2008)

Strengths: Sham KT designed to blind participants

effectively Blinding of participants and examiners Inclusion/exclusion criteria clearly defined Enrolment of subjects very well presented Randomisation method clear Power calculation included

Weaknesses: Subjects recruited from military academy and all

aged 18-24 Groups smaller than required

High

Tsai et al (2010)

Strengths: Randomisation method clear Blinding of participants and examiners Inclusion/exclusion criteria clearly defined Testing method relevant and accurate

High

Results clearly presentedWeaknesses:

Study groups small with no power calculation

Key: KT = Kinesiotaping ; FR = Flexion/Relaxation ; CLBP = Chronic Low Back Pain

Positive results in pain, soft tissue flexibility (Akbas et al 2001), muscle activation (Chen et al 2008)

and strength (Aytar et al 2011) echo findings from trials featuring healthy individuals (Aktas &

Baltaci, 2011; Słupik et al 2007; Vithoulkaa et al, 2010), suggesting that KT may be effective in the

treatment of PFPS.

In treating shoulder impingement (SI) Thelen et al (2008) and Kaya et al (2010) taped in a similar

manner (Figure 10a, b) but comparison groups and study duration differed; Thelen at al (2008)

compared with sham KT and measured outcomes after weeks one and two, whilst Kaya et al (2010)

compared against ultrasound, TENS and heat packs and measured outcomes after day one, three and

six. Thelen et al (2008) was the only SI study to include a power calculation but failed to provide

enough participants (26 required in each group, 21 provided) to satisfy.

Hsu et al (2009) featured a taping protocol quite different to the previous two trials (Figure 10c) and

was peculiar in that it focussed on a small number (n=17) of baseball players only, a narrow

population with specific loads on the shoulder complex.

Figure 10 shows how the taping protocols differed and although Thelen at al (2008) and Kaya et al

(2010) have similarities, there are still fundamental differences in KT approach, including lack of KT

over the mid fibres of trapezius (10a) and KT over the lower fibres of trapezius only in Hsu et al

(2009) (10c). As a result, the efficacy of KT in the treatment of shoulder impingement is not clearly

identified by these three studies.

Figure 10: Kinesiotaping approaches to shoulder impingement.a) Thelen et al (2008), b) Kaya et al (2010), c) Hsu et al (2009)

Paolini et al (2011) addressed chronic lower back pain (CLBP), focusing on “Flexion-Relaxation”

(FR) of the lumbar erector spinae. In healthy individuals, muscle activity is reduced after forward

flexion whilst in CLBP sufferers it is hypothesised that these same muscles are held in a state of

contraction. Featuring a complex model of three intervention groups with testing in two phases, the

results are inconclusive for either KT or home exercise, with an immediate positive improvement in

FR in 33% of participants being the most significant result.

A study of healthy individuals (Yoshida & Kahanov, 2007) found positive results in increased

forward flexion immediately after using KT to facilitate lumbar erector spinae. Although no

assessment was made of pain and a direct connection between increased range of movement and

reduced pain not possible from these results alone, when combined with the results from Paolini et al

(2011) there is indication of how KT could be used in CLBP. Guidelines for the treatment of low back

pain (Koes et al, 2006; UK BEAM Trial, 2004; NICE, 2009) advise remaining active and maintaining

mobility, so KT could be used to increase range of movement and relieve muscle tension.

As each of the remaining papers (Gonzalez-Iglesias et al 2009, Tsai et al 2010) looked at different

conditions, with no additional studies to compare findings to, firm conclusions are difficult.

A unique finding from Tsai et al (2010) was the effect of KT on fascia thickness, as measured by

diagnostic ultrasound. Featuring one of the larger overall study groups (n=52), a mean reduction in

the thickness of plantar fascia of over 16% at the site of calcaneal attachment was one of the clearest

positive outcomes from any the studies.

Kinesiotaping as a viable alternative

Four of the identified studies (Akbas et al 2011, Kaya et al 2010, Paolini et al 2011, Tsai et al 2010)

compared the action of therapeutic KT against manual therapy. Akbas et al (2011) found

improvements in soft tissue flexibility appeared faster in the KT group, whilst a faster reduction in

pain was noted by Kaya et al (2010), Paolini et al (2011) and Tsai et al (2010. In all studies KT was

applied less frequently (typically every 3 days) than alternative treatment (daily in all but Paolini et al

2011, where exercise was three times a week).

This suggests that KT achieves results faster than US, TENS or exercise and can be supplied less

often with less specialist equipment.

Limitations of studies assessing efficacy of kinesiotape

One of the most important issues affecting the reliability of results from these trials is the manner in

which the tape is applied. KT can be applied in a number of ways, at the discretion of the therapist.

Although advantageous in the clinical setting, it makes direct comparison of trials difficult as the

taping protocol may differ greatly.

It is therefore difficult to categorically argue that KT does or does not work for a particular condition,

as success or failure is due to the manner in which the tape is applied, as much as the tape itself.

Clinical Implications and Relevance to Osteopathy

The proposed mechanism of action of KT, the lifting of the epidermis to reduce compression of

tissues and fluid beneath, directly follows one of the key osteopathic principles, the importance of

fluid movement in the maintenance of health (Figure 11, #6).

Figure 11: Osteopathic Principles (Sammut & Searle-Barnes, 1998)

Further to this, the ability of KT to improve muscle firing (Chen et al, 2008, Hsu et al 2009) improve

soft tissue flexibility and increase range of movement (Akbas et al 2011, Thelen et al 2008, Gonzalez-

Iglesias et al, 2009) suggests that it could be used to help improve the structure and function of the

body, better equipping it to promote repair.

1. The body is a unit

2. Structure and function are reciprocally interrelated

3. The body possesses self-regulatory mechanisms

4. The body has the inherent capacity to defend itself and repair itself

5. When normal adaptability is disrupted, or when environmental changes overcome the

body's capacity for self-maintenance, disease may ensue

6. Movement of body fluids is essential to the maintenance of health

7. The nerves play a crucial part in controlling the fluids of the body

8. There are somatic components to disease that are not only manifestations of disease but

also are factors that contribute to maintenance of the diseased state

Future treatment of chronic postural

conditions could be influenced by the

findings of Tsai et al (2010), which found

measurable effects of KT on fascia

thickness. Figure 12 shows a chronic,

slouched posture commonly observed, the

muscles held in a state of constant strain.

Myers (2007, p18) describes how collagen

fibres are laid down to support these

muscles, creating an inelastic, fibrous

network. This can be treated with manual

therapy, home exercise and postural

education but the addition of KT to reduce

thickness of this tissue alongside these interventions has great potential for success.

The very nature of KT means that application can be adapted for each individual, targeting specific

tissues. This is particularly relevant to the osteopathic approach of treating each patient as an

individual (DiGiovanna et al, 2005), suggesting it could work effectively alongside soft tissue

massage, mobilisation or manipulation.

Limitations of this review

There were numerous limitations to the design of this review, influenced by resources available and

the author’s experience. Due to the nature of this undergraduate study, only one researcher, relatively

inexperienced in research methodology, performed all searches, inclusion/exclusion of papers and

analysis of selected studies, allowing for individual bias (Kane, 2004).

Although a systematic approach was adopted (Aveyard, 2008, p. 13) and care taken to search all

appropriate databases with relevant search terms, the potential still exists for papers to be missed. No

meta-analysis was performed due to heterogeneity of methodology but themes were identified and

discussed.

To strengthen the quality of this review, a second researcher could be used to ensure that searches are

performed and recorded accurately and offer additional opinions relating to study selection and

assessment. This additional resource could also aid thorough searching of online databases, grey

literature, foreign language studies and relevant journals by hand.

Figure 12: The effect of chronic postural adaptations on muscle and fascia (Myers, 2007)

Conclusion

This study identified nine randomised controlled trials assessing the efficacy of kinesiotape (KT) in

the treatment of musculoskeletal pathology.

One study (Tsai et al, 2010) found compelling evidence for the positive effect of KT on fascia

thickness whilst four studies (Akbas et al 2011, Kaya et al 2010, Paolini et al 2011, Tsai et al 2010)

found KT to be as effective as ultrasound, TENS and home exercise in improving pain and disability,

when applied three times less frequently. Five papers (Akbas et al 2011, Kaya et al 2010, Thelan et al

2008, Paolini et al 2011, Tsai et al 2010) identified that KT provided faster improvements in pain and

flexibility than control groups, although final outcomes were similar in all but one (Akbas et al 2011).

Studies investigating effect on shoulder impingement and patello-femoral pain, found some positive

results but heterogeneity of methodology makes it difficult to categorically confirm efficacy. Further

research with consistent methodology is required.

The identified positive effects of KT on soft tissue flexibility, fascia thickness, pain and disability

indicate that KT can and should be used by osteopaths to treat both acute and chronic musculoskeletal

presentations.

Opportunities for future research

The application of the tape is as important as the tape itself, so future studies should follow standard

taping protocols and measure homogeneous outcomes to ensure that results can be combined and

conclusions drawn. At present no such protocols exist, so this would need to be established before

additional studies undertaken.

Future studies should aim to improve methodological quality and provide larger sample sizes, at

least large enough to satisfy power-calculated amounts.

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