Kinesiology Tape: Update
SPORTS
CHIROPRACTIC
Ted Forcum
DC, DACBSP, DACRB
A lot has changed since the first time I placed a strip of kinesiology tape (KT) on a patient in the early 1990s. As someone who looked closely at biomechanical loading, I was applying kinesiology tape in a similar fashion to other light elastic tapes, using the concepts of compression and motion control. The biomechanist in me could not conceive how the application of tape that didn’t restrict motion or store elastic energy could be effective for reducing injury caused by force loads. For several years, I happily snubbed my nose and called “BS” at those who didn’t strictly follow biomechanical principles in tape applications.
As with many things in life, if someone maintains an open mind, they can see their way to change given the proper evidence. This evidence didn’t come through a pile of randomized controlled studies. As with many principles in sports medicine, the applications that rely on cutting-edge concepts follow well behind the empirical data of quality studies. I was fortunate to be involved in increasing awareness of kinesiology taping. In 2008, I was medical staff for Team USA at the Beijing Olympics. During the games, I had the privilege to tape a large number of athletes. During that time, I learned that the sales of kinesiology tape quadrupled. Those Olympics games seemed like the coming out party for kinesiology taping.
Approaching a quarter-century after kinesiology tape entered the market, no large-scale studies have been performed on tape applications. There have been 652 papers that reference kinesiology tape or Kinesio Tape. Eighty-three percent were published in the past 10 years with 62% in the past five years, and as a result, the knowledge base has increased greatly in recent years. Interestingly, the vast majority of tape applications studied were on asymptomatic painfree patients. As one might expect, most of these studies demonstrated no significant change since it is difficult to demonstrate improving the health of an asymptomatic, healthy individual or for someone to feel less pain when they are already pain-free. However, many studies with asymptomatic populations did demonstrate positive results when the study groups were placed in unusual or extreme circumstances. Overall, it appears that the tape outcomes are more significant when the subject’s dysfunction is greater or more subjects are placed in a dysfunction state (Bravi R, 2018). Other causes of negative research outcomes are the result of comparing a shame taping technique with the false assumption that stretch or tension is required in the tape application for kinesiology tape to have an effect. Interfacing anything with the skin will create a response of the body through an afferent feedback loop, whether it is Scotch tape or kinesiology tape.
In the early days, kinesiology tape applications were based on theories developed by Kenzo Kase, chiropractor and developer of kinesiology tape along with concepts of application. However, unlike a religion whose base concepts do not change with time, the art and science of health care change with knowledge gained through new discoveries and experience. Concepts of kinesiology tape application have evolved as a result of research and a quartercentury of tape application clinical experience. Granted, none of these concept changes is rooted in largescale studies. We will review some of the early misconceptions and the basis for the basic goals of kinesiology tape applications. Many of these basic application goals have stayed surprisingly true to those developed early on by Kase.
Figure 2
Some recent findings have dispelled some common misconceptions:
The color of the tape doesn’t appear to affect the performance or function of the tape, as once thought, whether the tape is applied with or without tension (Cavaleri R, 2018 Nov 1; 10:17). There may be an effect of the color of the tape reflecting or absorbing sunlight similar to the effect of wearing a black uniform versus a white one on a sunny day. Often, I use different colors of tape to help me remember which strips are applied with tension versus those with no tension or mild tension.
The direction that tape is applied, whether from origin to insertion or insertion to origin, does not appear to have an effect in facilitating a weak or fatigued muscle (Choi IR, 2018 Jul 20:1-10) (Vered E, 2016). Early training focused a great deal on this concept, challenging the anatomical recall of the practitioner to apply the tape in one direction to facilitate or increase tone in an underlying muscle, or the opposite direction to inhibit or decrease tone in an underlying muscle. This made taping a somewhat complicated process.
The combination of kinesiology tape and compression was shown to be effective in reducing peripheral edema, which may put into question the long-standing theory that kinesiology tape reduces edema by decompressing and lifting the skin, thereby opening lymphatic channels and allowing edema reduction (Aguilar-Ferrandiz ME, 2014). Furthermore, KT does not appear to show improvement in blood flow (Woodward KA, 2015) (Yang JM, 2018) (Shah Y, 2017) (Stedge HL, 2012). Early on, the tape was thought to improve blood flow.
Figure 3
Current thought on the effects of kinesiology tape: Swelling and edema: Although no studies specifically address bruising, KT is well known clinically for reducing bruising. Bruised regions with tape overlying show a significant reduction of discoloration compared to exposed regions. Studies have shown positive outcomes in the reduction of lymphedema and musculoskeletal-related edema. Kinesiology tape was effective for the reduction of breast cancer related lymphedema (Kasawara KT, 2018), extracapsular edema of the hand (Bell A, 2013), knee ALC postoperative edema (Boguszewski D, 2013), edema from total knee replacement (Donee V, 2014), and pes anserine bursitis (Homayouni K, 2016).
Facilitation and Inhibition: While studies have touted KT has no effect on muscle facilitation and inhibition, the studies used healthy subjects and/or failed to overload the tissues tested (Cai C, 2016) (de Freitas FS, 2018). However, there is evidence of improved muscular performance with KT. Endurance of the lumbar extensors and abdominal musculature are important measures for the risk of low back pain. KT has been shown to improve abdominal endurance in supine isometric chest raise, supine double straight-leg raise, and abdominal drawing in maneuver (Pourahmadi MR, 2018). When the Biering-
Sorensen test for trunk extensor muscle endurance was performed before, immediately after, and one day after taping, as well as immediately after tape removal on patients with lumbar disc degeneration, trunk muscle endurance significantly improved when confirmed by magnetic resonance imaging (Chang NJ, 2018). KT was shown to have a significant positive effect on reducing muscle fatigue during repeated concentric muscle endurance in the forearms of tennis players, showing a 13% decrease in work fatigue of the wrist flexors compared to non-taped subjects (Zhang S, 2016).
Several recent studies have shown strength improvements associated with the application of kinesiology tape in both healthy and unhealthy individuals. Strength and vertical jump have been shown to improve when KT is applied to the quadriceps for delayed-onset muscle soreness (DOMS) (Hazar Kanik Z, 2018). Athletes with patellofemoral pain syndrome had their vastus medialis oblique (VMO) taped. Maximal eccentric and concentric peak torques of quadriceps were then measured at 60 and 180 degrees per second angular velocities by an isokinetic dynamometer, and functional performance was evaluated by step-down and bilateral-squat functional tests. Results showed a statistically significant increase in VMO peak torque and also repetition of step-down test and bilateral-squat after using KT (Aghapour E, 2017). KT on the VMO and vastus lateralis provided improved performance during a six-second maximal sprint cycling in healthy and active subjects (Trecroci A, 2017). Concentric lumbar extension peak torque at 60 degrees per second (time taken to reach peak torque) and peak velocity was measured using an isokinetic dynamometer with and without lumbar KT. The results demonstrated that the application of KT overlaying the lumbar extensors significantly improves the maximal lumbar extension peak torque, even in healthy, asymptomatic adults (Knapman HJ, 2017).
Inhibition: There’s a prevailing theory that the application of KT can inhibit facilitation or tightened tissues. There is some evidence that, in fact, KT can affect tissue extensibility. Two studies by Farquharson demonstrated significant increases in hamstring extensibility, much greater than results by static stretching and PNF stretching. Farquharson was able to increase hamstring ROM 129.18% at three days compared to static stretching (106.99 ± 9.84%) and PNF (107.42± 136.13%). Hamstring extensibility was still greater than baseline at five days (Farquharson C, 2015). This supports the theory of a reasonable wear time of KT at three to five days. Chen found that KT combined with stretching was more effective than PNF or static stretching alone (Chen CHI, 2013). I have found KT application to increase ROM the most predictably clinically and more immediately than the results indicated in the studies.
Proprioception: KT seems to have a significant effect on proprioception and balance. KT restored motor control on subjects experiencing sensorimotor disorders associated with intense repetitive training (Bravi R, 2018). Scapular proprioception is central in managing shoulder impingement syndrome. There seem to be positive effects of kinesiology taping on scapular reposition accuracy, kinematics, and muscle activity in athletes with shoulder impingement syndrome in a randomized controlled study (Shih YF, 2018). Ankle KT can improve joint position sense at the fatigue when joint position sense becomes worse. The authors suggest ankle KT may be useful to prevent ankle sprain during sports, so individuals at risk of ankle sprain may consider applying KT before high-load activity (Jahjah A, 2018).
Pain: Several studies relate the application of KT to a reduction of pain for a variety of conditions, including athletes with patellofemoral pain syndrome (Aghapour E, 2017). Pain was reduced in chronic low back pain subjects in a randomized controlled study (Koroglu F, 2017). KT was found more effective in reducing pain for newly diagnosed lateral epicondylitis than extracorporeal shock wave therapy (ESWT) and physiotherapy. Physiotherapy consisted of a cold pack and transcutaneous electrical nerve stimulation. Fifteen sessions were applied over three weeks. Nine sessions of ESWT were applied over three weeks. KT was applied five days a week for three weeks (Eraslan L, 2018). KT reduced pain in patients with low back pain caused by lumbar disc degeneration that had been confirmed by magnetic resonance imaging (Chang NJ, 2018).
The bottom line: Clinical experience as well as research supports the use of kinesiology tape. Kinesiology tape has demonstrated potential benefit to improve performance by affecting a wide variety of parameters, including edema reduction, increasing range of motion, increasing muscle endurance, improving proprioception, and, when inhibited, muscular strength. In the sports arena where half a second could be the difference between standing on the podium or on the sidelines, such outcomes associated with KT applications could make a difference. Certainly, other modes of treatment can affect the same parameters, but nothing that is as safe and that functions around the clock between visits without a practitioner physically present.
Since the early days of kinesiology tape in the 1990s, I now apply kinesiology tape very differently. No longer is there a concern for the direction of application, whether origin to insertion or insertion to origin. I am no longer concerned about the color of the tape having a significant functionality. My primary concern now is using kinesiology tape to increase mobility of shortened tissues and stability of inactive or lengthened tissues. Improving mobility and stability is the ground framework of rehabilitation programs. In addition to improving function, KT application also reduces pain perception. You can look at kinesiology tape in the same way as applying a Band-Aid by addressing localized pain, but when injuries occur due to overuse, often there is compensation in different regions of the kinetic chain. By looking at regional interdependence and applying KT using the principles from the studies previously mentioned, I have found KT tape to be extraordinarily effective in managing sports-related injuries and performance, both at the site of injury as well as at the site of origin or compensation.
TedForcum, DC, DACBSP, DACRB, FICC(hon), CES, PES, CSCS. Joint Commission on Sports Medicine and Science, Board Member. Portland Winterhawks, Team Chiropractor. 2015 USA Track & Field World Championships Medical Team. '07-08 US Olympic Sports Medicine Team Member. AC A Sports Council, Past President 2008-2010
References:
1. Aghapour E, K. F. (2017, Oct). Effects of Kinesio Taping® on knee function and pain in athletes with patellofemoral pain syndrome. JBodywMov Ther, 21(4):835-839.
2. Aguilar-Ferrandiz ME, M.-L. C.-P.-M.-R.-S. (2014, Jul). Effect of a mixed kinesio taping-compression technique on quality of life and clinical and gait parameters in postmenopausal women with chronic venous insufficiency: double-blinded, randomized controlled trial. Arch Phys Med Rehabil, 95(7): 1229-39.
3. Bell A, M. M. (2013, May-Jun). Effects of kinesio tape to reduce hand edema in acute stroke. Top Stroke Rehabil, 20(3):283-8.
4. Boguszewski D, T. I. (2013, Oct). Evaluation of effectiveness of kinesiology taping as an adjunct to rehabilitation following anterior cruciate ligament reconstruction. Preliminary report. Ortop TraumatolRehabil, 31;15(5):469-78.
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8. Chang NJ, C. W. (2018, Feb). Acute effects of Kinesio taping on pain, disability and back extensor muscle endurance in patients with low back pain caused by magnetic resonance imaging-confirmed lumbar disc degeneration. J Back Mnscnloskelet Rehabil, 6;31 (1):85-93.
9. Chen CHI, H. T. (2013, Feb). Two stretching treatments for the hamstrings: proprioceptive neuromuscular facilitation versus kinesio taping. J Sport Rehabil, 22(l):59-66.
10. Choi IR, L. J. (2018 Jul 20:1-10). The effect of the application direction of the kinesiology tape on the strength of fatigued quadriceps muscles in athletes. Res Sports Med.
11. de Freitas FS, B. L. (2018, Aug). No Effect of Kinesiology Tape on Passive Tension, Streength or Quadriceps Muscle Activation of During Maximal Voluntary Isometric Contractions in Resistance Trained Men. Int J Sports Phys Ther, 13 (4): 661-667.
12. Donee V, K. A. (2014, Aug). The effectiveness of Kinesio Taping® after total knee replacement in early postoperative rehabilitation period. A randomized controlled trial. Enr J Phys Rehabil Med, 50(4):363-71.
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14. Farquharson C, G. M. (2015, Dec). Temporal Pattern of Kinesiology Tape Efficacy on Hamstring Extensibility. Int J Sports Phys Ther, 10(7):984-91.
15. Hazar KanikZ, C. S. (2018, Jul). Effects of Kinesio-Taping on the Relief of Delayed Onset Muscle Soreness: A Randomized, Placebo-Controlled Trial. J Sport Rehabil, 24:1-22.
16. Homayouni K, F. S. (2016, Sep). Effects of kinesiotaping versus non-steroidal anti-inflammatory drugs and physical therapy for treatment of pes anserinus tendino-bursitis: A randomized comparative clinical trial. Phys Sportsmed, 44(3):252-6.
17. Jahjah A, S. D.-Z. (2018, Jan). The effect of ankle tape on joint position sense after local muscle fatigue: a randomized controlled trial. BMC Musculoskelet Disord, 9; 19( 1): 8.
18. KasawaraKT, M. J. (2018, May). Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis in clinical trials. Physiother Theory Pract, 34(5):337-345.
19. Knapman HJ, F. T. (2017, May). The effect of elastic therapeutic taping on lumbar extensor isokinetic performance. Phys Ther Sport, 25:9-14.
20. Koroglu F, Q T. (2017, Sep). The effect of Kinesio® taping on pain, functionality, mobility and endurance in the treatment of chronic low back pain: A randomized controlled study. J Back Musculoskelet Rehabil, 22;30(5): 1087-1093.
21. Pourahmadi MR, B. R. (2018, Sep 41(7):609-620). Effect of Elastic Therapeutic Taping on Abdominal Muscle Endurance in Patients With Chronic Nonspecific Low Back Pain: A Randomized, Controlled, Single-Blind, Crossover Trial. J Manipulative Physiol Ther.
22. Shah Y, A. M. (2017, Apr). The acute effects of integrated myofascial techniques on lumbar paraspinal blood flow compared with kinesio-taping: A pilot study. J Bodyw Mov Ther, 21(2):459-467.
23. Shih YF, L. Y. (2018, Nov). Effects of Kinesiology Taping on Scapular Reposition Accuracy, Kinematics, and Muscle Activity in Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Study. J Sport Rehabil, 1;27(6):560569.
24. Stedge HL, K. R. (2012, Nov-Dec). Kinesio taping and the circulation and endurance ratio of the gastrocnemius muscle. JAthl Train, 47(6):635-42.
25. Trecroci A, F. D. (2017, Jan-Mar). Acute effects of kinesio taping on a 6 s maximal cycling sprint performance. Res Sports Med., 25(l):48-57.
26. VeredE, O. L. (2016, Jan). Influence of kinesio tape application direction on peak force of biceps brachii muscle: A repeated measurement study. J Bodyw Mov Ther, 20(l):203-207.
27. Woodward KA, U. V. (2015, Oct). Forearm Skin Blood Flow After Kinesiology Taping in Healthy Soccer Players: An Exploratory Investigation. JAthl Train, 50(10): 1069-75.
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29. Zhang S, F. W. (2016). Acute effects of Kinesio taping on muscle strength and fatigue in the forearm of tennis players. J Sci Med Sport, 19(6):459-64.
