Sports Medicine Research: In the Lab & In the Field: Guest Post: Kinesio Taping Improves Shoulder Symptoms Better than Modalities (Sports Med Res)
Wednesday, June 1, 2011

Guest Post: Kinesio Taping Improves Shoulder Symptoms Better than Modalities

Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome

Kaya E, Zinnuroglu M, Tugcu I. Clin Rheumatol. (2011) 30;201-207.

Kinesio taping (KT) has been around since 1973, but only recently become more popular since its appearance at the 2008 summer Olympic Games in China. Despite its recent popularity, there is limited evidence regarding its effectiveness. The purpose of this study was to explore the short-term effects of KT applications on shoulder pain and compare them to commonly used therapeutic modalities, such as transcutaneous electrical nerve stimulation (TENS) and ultrasound (1 MHz, 1 Watt/cm2 for 5 minutes). 60 consecutive patients, demonstrating symptoms of subacromial impingement as seen with clinical examination (e.g., positive empty can test, positive Hawkins-Kennedy tests), were enrolled in this study and assigned to a modality or KT group. The KT group received 3 separate tapings, described as space and lymphatic correction techniques (15 to 25% tension on the tape). It was applied to the supraspinatus, deltoid, and teres minor muscles. The modality group received daily modalities including TENS, moist heat, and ultrasound. Both groups were given the same HEP including rotator cuff and periscapular strengthening exercises, posterior shoulder stretching, and range of motion exercises. Both groups completed this protocol for two weeks. Outcome measures were self-reported upper limb physical function and symptom score (DASH) as well as pain at night, rest, and with active shoulder movements (visual analog scale; VAS). Both groups had significantly lower DASH and VAS scores after 2 weeks of treatment compared to baseline. The KT group had significantly lower DASH scores at two weeks compared to the modality group. Furthermore, the KT group had significantly lower VAS pain scores at week one but not at week two compared to the modality group. While no adverse outcomes were reported the modality group lost 5 patients to follow-up (3 had persistent pain requiring myofascial trigger point injections, 1 stopped attending, and 1 was found to have concomitant labral tear).

These findings are interesting because they suggest that KT is a beneficial modality acutely for this patient population. Clinically, a rapid reduction in pain symptoms will allow for therapeutic interventions to be implemented sooner. Ultimately, allowing for a faster recovery. As a Certified Kinesio Taping Practitioner, I was surprised with the authors’ description of their taping technique as lymphatic and space corrections. I was instructed that 15 to 25% tension on the tape is used for muscle inhibition, 10 to 15% tension for lymphatic correction, and 25 to 50% for space correction. Despite this discrepancy, I agree with their ultimate results of decreased patient symptoms. Theoretically, muscle inhibition leads to decreased muscle spasm and/or inhibition of over-activated muscles, ultimately allowing for restoration of proper posturing of the glenohumeral joint. Unfortunately, theory is the best evidence currently available for many KT techniques. More research is needed to determine how KT techniques influence clinical outcomes and how to optimize the techniques. More clinical trials will also help establish the clinical utility of KT. As a practicing clinician who uses KT, I have seen similar results of decreased patient symptoms. However, Kinesio tape is not a treatment to be used on its own. It is a secondary modality that is used to assist with other therapeutic interventions. More information regarding KT can be found at http://www.kinesiotaping.com/.
 
Written by: Kathleen White
Reviewed by: Jeffrey Driban

8 comments:

Tom Martin said...

Thanks for the post Kathleen

I agree that this is an area that we don't see alot of in the research. It is nice to see a clinician with your experience in KT review this article.

I have used different taping techniques for more of a postural check to avoid rounded shoulders/increased protraction. (Esp with the groups that respond to the Scapular Retraction Test or modified versions of the test). The results are good initially and I try to get them into active correction as soon as possible.( I guess that would fall under space correction?)

My question is, how long do you utilize it?? For either muscle inhibition or space correction.
Based mainly symtpom relief??

Gabe Fife said...

with the amount that ATCs tape and with the popularity that KT is getting worldwide, it is nice to see someone put out an honest effort to investigate the effects of its use.

I do wonder though, how a clinician is to vary the tape tension (e.g., 15 - 20%). I have to say I did not read the article personally, but wonder if there is some device that can be used to measure the amount of tension that a clinician reports they are applying to a strand of Ktape. Maybe a reliability study on the tension claimed by KT appliers.

Also, It seems a bit tough to make claims that KT had this and that effect when there were various other treatments applied to the participants (e.g., steching, etc..). I think with the amount of pressure on clinicians to practice "evidence based medicine" that clinicians should be at the forefront of producing studies that have a component of randomized control studies...

Gabe Fife, MS, ATC
Seoul, Korea

Jeffrey B. Driban, PhD, ATC, CSCS said...

Hi Gabe:

Thanks for the post. I will let Kathleen address your comments but I wanted to address your last paragraph because it is such a key element to all of the new clinical trials being performed.

In this study, both groups received the extra exercises (like the stretching you reference). Both groups improved and so from that point of view we can't say whether it was the KT/modality or the exercise program (or how much they each contributed to the improvements). The only difference in the treatment/intervention between groups was that one group received KT and the other received an array of modalities. In this study, with this study population, the KT group had more improvement than than the modality group suggesting that since both groups performed the exercises the difference between groups is attributable to either the KT or modalities. Some people may suggested that a randomized controlled trial should be performed BUT having a placebo control has some draw backs. For one, designing a placebo control in a rehab setting can be challenging (doable but challenging; likely someone will always find fault with the control). Perhaps more importantly it's not always ethical to have a control. When it's unethical for us to provide a placebo or withhold an intervention the ideal study may be a randomized comparative effectiveness study, like the one we have here. I suspect this study design will be the new norm in clinical trials. The question being asked by the studies won't be "is your treatment better than a placebo control" (which we know can be quite effective for some treatments) but rather "is your new treatment better than the current standard of care?". Here's a short article describing a recent paper that challenges the use of placebo controls in studies for Rheumatology: http://www.sciencedaily.com/releases/2011/05/110527075909.htm

You are also absolutely correct that we need more clinicians involved in the clinical trials being designed. I think that's one of the values of sessions like the Evidence Based Forums at the NATA Annual Meetings. These are opportunities for clinicians and researchers to sit down together and discuss a topic.

Thanks for the post!

Kathleen White said...

Tom,

Thanks for your question. The postural technique that you are describing would be classified as a mechanical taping. The objective of your taping is to inhibit poor movement or hold a specific position.

The goal with a space correction taping is to allow for an increase in space over the target tissue. For example, an area of increased swelling would respond well to a space correcting taping because it would cause a lifting affect of the skin, allowing for a decrease in pressure directly under the tape.

Like any other therapeutic modality that we use, there is no exact timeline for its use (with a mechanical taping or a space correction taping). As you have suggested the postural taping that you use helps initially, but it is not intended for long term use and it is not the primary treatment. There are also no long term time restrictions for using the tape. Each KT taping is only affective for up to 5 days, but it can be used for several weeks at a time if it continues to benefit the patient. Of course it is our job as clinicians to monitor the patient’s skin response to the tape and it may be necessary to hold off for a week or two to allow the patients skin to heal from any possible irritation. I have found that very few patients have difficulty tolerating this tape, as it is latex free.

Kathleen

Kathleen White said...

Gabe,

Great point about the tension on the tape! That was my initial response when I first started learning how to use KT.

Some background information about the tape; each roll of tape is applied to the paper with 10% tension. So we know that if we apply the tape with “paper off” tension it will be at a 10% stretch over the target tissue. Other than using dozens of rolls of tape and lots of body parts to practice taping, there is no tool or exact mechanism to determine how much tension you are putting on the tape. Similar to many manual therapy techniques used by clinicians, it is a skill that is developed with time and experience. I agree that this is an area in need of a reliability study.

Using your clinical expertise to determine which patient will benefit from the taping and which technique to use is essential to KT. I have seen that proper application of the tape to the appropriate patients results in beneficial improvements. I believe strongly in practicing evidence based medicine and I hope that this area of research continues to grow.

Kathleen

Jdubbers said...

Hi all.

I found this article and kinesio taping in general a great example of the placebo effects certain non evidence based modalities have on mechanical diagnosis.

Especially in this age of high copays, the patients often wants to feel like the practitioner has done "something."

I think kinesiotaping is an excellent way to fill that void.

As for evidence, the incorrect percentages of tension In this article clearly demonstrate the poor reliability in techniques of this kind. Much like the mysterious myofascial release techiques.

As for taping, Tom Martin's use as a postural reinforcement seems to be the most beneficial for shoulder impingement. Great job Tom.

jp8dx JT Podell said...

This article has been very benificial to read, up until now I have been a skeptic of the use of KT and how effective it can be in helping the rehabilitation process of shoulder impingement. It will be interesting to see how KT works as an effetive part of a rehabilitation program for other injuries and conditions in the rest of the body.

Anonymous said...

Thanks for the comment.

It is true that most people are skeptical about the use of KT and the limited amount of research about its uses is a large reason why. I am a strong believer in its use, but this is mostly from my own experience with it as a clinician.

I agree it will be interesting to see more research on the use and benefit of KT and I hope that the research continues. To promote this modality and change the minds of disbelievers will take quite a bit more positive evidence.

-Kathleen

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