RockTape Research Review 2018

RockTape Research Review 2018

The popularity of kinesiology tape, or coloured sports tape, increased dramatically following the 2008 Olympics and has remained popular amongst athletes participating in many different sports including, running, cycling and crossfit. More recently the tape has become increasingly popular as a treatment adjunct for more sedentary patients attending musculoskeletal clinics for the treatment of common ‘aches and pains’ Tape is also proving beneficial for patients suffering from neurological conditions, such as cerebral palsy, multiple sclerosis and parkinsons disease as some specific examples.

The debate about the clinical efficacy of kinesiology tape is continuing but has somewhat simmered down since we first started teaching. Having said this there are some practitioners who cling to out-dated theories about the purported benefits of kinesiology tape, despite many of these theories having very little evidence behind them. As an example – Tape (probably) does not cause a direct increase blood flow from simply applying it to the skin. This is one of the early claims of Kinesiology Taping which has not been supported by any evidence.

At Rocktape we are committed to furthering the body of scientific knowledge of the effects of kinesiology tape and demonstrating scientifically the positive benefits that we see clinically every day. We are actively supporting many studies that are currently being completed around the world, and we promote “evidence –informed” education in our courses worldwide. We liaise with a number of researchers around the UK and further afield to keep abreast of the latest research, even before its gets published. If you are involved with or aware of any research please let us know.

Research evidence

The literature remains divided on the efficacy of kinesiology tape. High levels of evidence are lacking, and whilst systematic reviews do exist, they are divided in their conclusions. This is likely due to the fact that there are few high quality reviews that exist, so summarizing the evidence is troublesome, and many studies lack sufficient power to draw robust conclusions from. Kalron & Bar-Sela (2013) found that there was “moderate evidence” for pain reduction whilst Lim & Tay (2015) found that kinesiology taping was “superior to minimal intervention for pain relief” for those with more than 4 weeks of pain, and was effective at reducing pain when used as an adjunct to conventional therapies. Sathya et al (2016) found that the addition of kinesiology tape to McKenzie exercises for back pain led to superior outcomes for pain and activity in comparison to the non-taped McKenzie group. Clinically, this supports the way most practitioners would use kinesiology tape, as an adjunct to their existing treatment modalities.

Muscle function

Some of the original beliefs about this family of tapes are simply not based on any scientific evidence. Most notably the notion that the direction in which the tape is applied results in a facilitatory or inhibitory effect on the targeted muscle. there have been a number of studies that debunk this theory such as those by Vercelli et al (2012), Fratocchi et al (2013) and Lumbruso et al (2014). These studies concur with the common sense view that regardless of the direction of the tape application, an elastic tape will always recoil towards its middle. The resultant effect on the muscle could be excitatory or inhibitory, with many studies showing conflicting results. It is clear that applying tape to the skin, regardless of its direction of application, can have an effect on the muscle’s excitability but predicting the effect is difficult.

It seems that there may even be some variation amongst differentmuscle groups, with the Lumbruso et al study showing an excitatory effect on the gastrocnemius muscle occurring quite quickly, but a delay in the excitatory effect for the hamstrings. Other studies show no change in peak torque produced, but the muscles may be able to reach their peak torque more quickly. This was the case in the study by Wong, Cheung & Li (2012) when they measured the effect of tape on the VMO muscle. Chen et al (2008) also found that their knee pain subjects had earlier onset of VMO activity, suggestive of better functional control of descending stairs when compared with untaped controls. Yet other studies show no change in muscle output at all with taping. While some educators report that taping does not, or can not increase muscle power, the evidence that has emerged over the last few years would appear to challenge this considerably.

The following studies demonstrated a statistically significant increase in strength, strength endurance or power…Wong et al 2012; Fratocchi et al 2012; Chen-Yu Huang et al 2011; Alvarez-Alvarez et al 2013; Lumbrosso et al 2013; Bae, et al 2013; Chen et al 2012; Griebert et al 2014; Anandkumar et al 2014; Zhang Shen et al (2016). We discuss many of these studies during our course. One specific study that we discuss utilises a specific spiral taping application to improve lower limb muscle function, kinematics and reduce pain in female patients with Patellofemoral pain, the results from the small study group of 16 reported a positive outcome for all parameters when compared to no tape or sham taping (Song et al 2015)

Effect of tape on pain

An enormous amount of research has been published recently that demonstrates that when people are in pain, their sensory awareness of the affected body part, and indeed even the contralateral limb, can be distorted. This is where we believe the main benefit of Rocktape is achieved. It is theorized that by stimulating the mechanoreceptors in the skin and subcutaneous tissue, the tape can provide the brain with additional input regarding the body’s position in space, and also to potentially be more aware of this area in general. Bae et al (2013) found that in a population with chronic low back pain, kinesiology tape in addition to usual care, resulted in a better pattern of abdominal muscle recruitment compared with pretreatment measures. Parreira et al (2014) also studied this population and found that regardless of the technique of application, tape was helpful in reducing pain and disability for those with chronic low back pain. This effect was even maintained to some extent 8 weeks after the treatment ceased, perhaps suggesting that the associated movement patterns that these patients displayed over the course of their symptoms prior to their involvement in the study, were somehow altered. A more recent study compared two groups of patients receiving help for acute lower back pain. Both groups received reassurance and information with one group receiving the addition of Kinesiology tape applied by a professional to the lower back. The taped group reached ‘pain control’ twice as fast as the non taped group, consumed less paracetamol and had lower final pain scores (Kelle et al 2015).

Griebert et al (2014) showed that kinesiology tape can have a positive effect on the biomechanics in a group of subjects that either had, or were prone to medial tibial stress syndrome, commonly known as “Shin Spints”. Applying tape to this group improved their foot loading patterns as they walked across a force plate, yet the same application made no difference to a control group with good biomechanics. It is this powerful effect that the tape may have on correcting aberrant movement patterns and postures that is one of the most exciting developments in support of kinesiology tape.

It may also be the case that in healthy, asymptomatic individuals whoare often the cohort used in kinesiology taping studies, are less likely to show an effect from taping. This may be because any additional input to the brain that the tape may provide could be very quickly dismissed as it is not meaningful information in the context of the situation at hand, because the system is not under any stress, in a state of pain, or even fatigue. With no apparent physical of neurological deficit tape may simply be unnecessary.

Thedon, Mandrick, Fossiac, Mottet, & Perrey (2011) found that input from tape on the skin may be utilized when subjects are fatigued. Their crossover study measured sway in standing balance in two conditions, a control condition and one where a 10cm length of non-elastic tape was applied on both Achilles tendons. Both conditions were comparable in respect to sway when initially tested. The authors then had subjects perform calf raises to fatigue and then re-measured standing balance and found the subjects in the taped condition had significantly less sway. They surmised that subjects
may preferentially use their muscle spindle input when this input is reliable.

However, when muscle spindle input was degraded through fatigue, the brain then utilized further information provided by tape on the skin, and subsequently standing balance was improved. Konishi (2013) also found the same pattern in a similarly designed crossover trial. In this study the subjects had greater quadriceps strength after fatigue when their knees were taped, compared with their untaped testing. Baseline measures between the taped and untapped conditions were not significant. Cortesi, Cattaneo, & Jonsdottir’s (2011) findings of improved standing balance in subjects
with multiple sclerosis who had their Achilles tendons taped also supports the theory that tape can provide substantial improvements in balance in those with degradation of their sensory inputs, when supplementary information from the cutaneous mechanoreceptors may be of assistance.

Taping for Neurological Conditions

Research conclusions that support the use of Kinesiology tape are increasing in volume. Here in the UK this has coincided with an increased interest from Physiotherapists who specialize in treating neurological problems. In the UK two specialist neurological Physiotherapy tutors developed a one-day education programme for other neurological specialists to learn to incorporate taping into practice. Some of the research that was highlighted during the course development is summarized below:

Multiple Sclerosis

Constantino and colleagues published a study in 2015 involving 40 MS patients split into two groups. Both groups received 5 treatment sessions at 5 day intervals with one group receiving K-Tape and another group receiving thin non-stretch tape which they referred to as the ‘sham tape’. The tapes were applied in a fan shape over the quadriceps region. The results from a walk test and peak torque test at the knee favoured the K-tape over the sham tape with the authors concluding that the tape was well tolerated by the participating MS patients.

Hemiplegic shoulder pain

A double-blind, randomised, placebo-controlled study involving stroke patients with hemiplegic shoulder pain compared the results from the taped group (10 people) with the sham taped group (11 people). The K-tape group experienced greater reductions in the ‘Shoulder Pain and Disability Index’ after three weeks of K-taping intervention when compared with sham taping (Huang et al 2017). In this study sham taping was performed with the same tape but placed away from the painful joint areas and without stretch. What constitutes sham taping varies widely between studies and is an interesting topic of discussion, especially when you consider that any tape will provide a similar sensory influence. In support of taping for shoulder pain Pillastrini and collagues (2015) also reported reduced post-stoke shoulder pain and increase movement from their randomised clinical trial.

Post-Stroke Balance

A study to evaluate the changes in function and balance after K-taping application in stroke patients randomly assigned a group of thirty subjects into an experimental group or a control group. The experimental group received taping before therapeutic exercise, and the control group received only therapeutic exercise. There were statistically significant differences between the results of the straight line walking and 10 m walking tests and the Berg Balance Scale. The author concluded that the application of taping to the paralyzed parts of a stroke patient has a positive effect on improvement of typical asymmetric gait and walking speed (Kim et al 2014). The influence of taping on balance relating to a more specific pathology ‘talipes equinovarus’ was studied by Rojhani-Shirazi et al (2015) who reported an improved forward reach following K-tape around the ankle joint.

Infants with CMT

29 infants with congenital muscular torticollis (CMT) and 5 healthy infants, were randomly assigned to one of two groups, one group receiving a lateral neck taping application on the affected side. The other group did not receiving any form of taping. The results demonstrated that K-Tape applied on the affected side had an immediate positive effect on the muscle imbalance in the lateral flexors of the neck (Ohman 2015).

Cerebral Palsy

Simsek and colleagues (2011). Reported that sitting posture (head, neck, foot position and arm, hand function) was affected positively in a group of 15 cerebral palsied children receiving taping when compared to their studies non-taped control group.

Even if you do not treat patients with the pathologies referenced above it is interesting to read the results of such studies, to consider the mechanisms of action, and to potentially extrapolate these findings in support of your existing taping practices. As always, in addition to the published research there are some fascinating results being achieved in practice. Most of these results remain within the therapists’ confidential realm.

What about Fascia?

Some recent recent studies have focused on the mechanical tissue changes seen following the application of tape. A recent study utilised MRI analysis to record the tissue deformations in the lower limb following the application of tape over the anterior shin. They authors found that the tape influenced the fascia throughout the lower leg in a non-uniform and unpredictable way, thus challenging our view of perhaps more simplistic uniform changes (Pamuk & Yucesoy 2015).

Another recent study observed the reduction in thoracolumbar fascia movement with lumbar flexion following the application of kinesiology tape in the lumbar region (Tue, Woledge & Morrissey 2016). It is not clear how the findings from both of these studies relate to the clinical outcomes of reduced pain and increased movement but they do show that tape is having an objective measurable influence on fascia, we are just not sure how relevant this is yet.

How does it work?

The exact mechanisms of how the tape may work remain unproven. Whilst many studies look at the effect of the tape on various parameters such as pain, inflammation, muscle function and joint position sense, there is very little research into HOW the tape may alter these parameters. One of two primary theories is physical decompression of the subcutaneous space and fascia caused by the mechanical properties of the tape which my offload sensory nerve endings and promote the removal of exudate and nociceptive substances in addition to promoting normal gliding of fascia layers. The second theory is the neurosensory model, which theorises the benefits of altered sensory input on pain perception and motor output. These mechanisms are discussed throughout our courses and new research is regularly referred to.

Inflammation & Circulation

There have also been some studies into the effect of kinesiology tape on inflammation. A Pilot study by Tsai, et al (2009) showed that application of kinesiology tape in addition to usual therapy was equally effective with regard to control of breast cancer related lymphedema when compared with traditional short stretch bandaging and usual therapy. These findings and suggestions by Tsai et al were heavily criticized by Smykla, et al (2013) who reported that the single layer bandage used and the pressure of 15-20 mmHg would not have been enough to treat any kind of lymphedema and that as a result, tape should not be considered as an alternative choice. While it is natural fortaping enthusiasts to bias positive research, this specific example may remind us that we need to consider the validity of both positive and negative findings when choosing our treatment options.

Improvements in circulation may also be the reason behind the improvements in Delayed Onset Muscle Soreness (DOMS) demonstrated in a small study by Bae et al (2014). Their experimental group had a quicker resolution of DOMS symptoms compared to their sham taped control group. A study by Karwacinska et al (2012) showed a positive effect of using kinesiology taping on a group of children with hypertrophic and keloid scarring over a twelve week period. This tissue remodeling may also be suggestive of changes in circulation in the taped area. A recent small study by Nunes et al
(2015) on the use of kinesiology tape for acute ankle sprains also failed to show significant benefits in terms of reducing swelling in this population. So once again, conflicting findings exist and further research is required in this area.

Future Directions for Kinesiology Taping Research

There is much to do regarding further research into the effects of kinesiology taping. Initially we need small, well designed efficacy trials to further define what needs investigating in the larger randomized controlled studies in the future.

The exact mechanisms of effect for the tape remain unknown. The early findings using MRI or ultrasound to visualize the tissue changes after tape application give us an early indication of the possible effects that tape physically has on the tissues. This needs to be looked at further. We need larger randomized controlled studies to further investigate and consolidate the findings of the recent smaller pilot studies. These include studies that have found a decrease in subject’s pain as well as some of the potential benefits of improving performance through promoting muscle efficiency and reducing the negative performance effects of fatigue. We need to determine the optimal length of time of application of the tape. There have been some interesting findings such as those by Lumbruso et al (2014) that found an immediate increase in excitability of the gastrocnemius in their healthy group after the tape was applied, yet a delay in a similar excitability in hamstrings that was only detected 48 hours later.

Many studies have found no significant benefit from the tape immediately after its application, but have not re-tested 24 hours later- is there some delay in the eff ect that the tape has on the slow adapting mechanoreceptors that has not currently been identified? Kaya, Zinnuroglu & Tugcu (2011) found significant differences in outcome measures (DASH scores) of those with shoulder impingement that were treated with kinesiology tape in the second week of their study, whereas these subject’s pain scores decreased after the first week. Evidently the pain decreased first, then functional scores improved later this may have implications for the methodology of future studies. The effect of kinesiology tape in certain populations needs further study, such as those with neurological deficits.

There have been some interesting case studies published on the effect of kinesiology taping in CVA populations and those with cerebral palsy looking at the effect of various taping techniques on function, however larger, randomized studies could follow.

The effects of kinesiology tape on inflammation could also be studied further, with positive early findings in the management of lymphedema being built upon. This area of study could also look at inflammation in orthopedic injuries and post-surgical applications, as well as further work looking at the use of kinesiology tape in recovery from high intensity exercise. Can this tape have a role in the prevention of injuries through improved neuromuscular control? Many studies have identified risk factors for certain injuries that could be addressed with taping. For example, Cameron, Adams, Maher and Misson (2009) studied the hamstring muscle group in Australian Rules football and postulate that the hamstring injuries could occur through errors in position sense during foot contact with the ground whilst running. Some studies into kinesiology tape have demonstrated improved position sense or force sense in taped subjects (Chen et al 2008 and Chang et al 2013) so this may have positive benefits in athletes prone to hamstring injuries, in addition to studies of these athletes with posterior chain taping applied.

Greg Myer’s group has produced numerous papers looking at the risk factors for ACL injuries and patellofemoral pain in adolescent girls. The main risk factor identified by these studies is the valgus collapse that often occurs in landing and cutting actions (Hewett et al 2005). This is the result of decreased hamstring recruitment and poor trunk control leading to increased hip adduction and internal rotation. The effect of spiral taping of the lower limb would be interesting in this group of female athletes identified as having high risk for ACL rupture or patellofemoral pain.

There is more work to be done before kinesiology tape can be considered to have rigorous evidence base. However, it is often said that the lack of evidence does not constitute evidence of lack and many of the treatment modalities we use also lack a rigorous evidence base, from manual therapies, acupuncture and ultrasound as some examples.

Anecdotally practitioners around the world continue to see great benefits in their patientsafter applying kinesiology tape, and it may be that we need to avoid being blinded by the old theories about its mechanism of effect, and embrace the role of the central nervous system in pain and movement disorders before we can truly understand the role of this family of tapes. To date, we have a paucity of high quality, high-level evidence for the use of kinesiology taping. Indeed, in the last five years there have been many systematic reviews published almost too many for the amount of quality
research available to review. Some of the themes that are emerging from the evidence include:

• Tape & exercise is more effective than exercise alone.

• The specific application pattern of the tape may not be important.

• Certain areas of the body and muscle groups appear to be more receptive (or less) to taping.

• Changes in contractile tissue areconsistently reported.

The words of Hodges (2008) offer us a thoughtful conclusion: “In an ideal world the experimental testing of an idea would be completed and all issues resolved and understood before implementation into practice, but this is not practical as nothing would ever be implemented.”

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