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J Int Acad Phys Ther Res 2016; 7(1): 979-988 ISSN 2092-8475
www.iaptr.org http://dx.doi.org/10.20540/JIAPTR.2016.7.1.979
Repetitive stress on joints and tissues by sports activity, daily
life, hard working that may cause loss of function and
musculoskeletal disorder resulting in disabled conditions in many
patients(1). Taping is a one of the therapeutic maneuver used by
many physical therapist to treat musculoskeletal
disorders(2).
Generally, the tape is applied around and over the muscles to avoid
over contraction(3) and theo- rized to reduce inflammation and pain
by increas- ing blood and lymphatic circulation without limit the
ROM of the injured area(3-5). This maneuver diminishes irritation
and pressure of the neu- rosensory receptors which can produce
pain.
Moreover, taping is purported to prevent injury, facilitate and
inhibit muscle activity, improve pro- prioception and reposition
joints(1,2). Also, there are various taping treatments has been
used, such as Mulligan, Kinesio Taping, and McConnell
methods.
Recently, this taping is also being increasingly used in medical
and physiotherapeutic practice. Despite the success and popularity
of this taping, there's a lot of suspicion and academic scepticism
on its efficacy. The latest systematic reviews on elastic taping
also demonstrate insufficient evi- dence to support the use
thereof. Many questions still arise and remain unanswered about how
the tape works and its effects. In conclusion, a com- prehensive
look at all body parts and taping methods,
Rationales and Evidence of Elastic Taping: A clinician’s per-
spective
INTRODUCTION
The purpose of this systematic review is to investigate the effects
of tape application on improving body conditions. The search
strategy for this review included a literature search by members of
the International Kinematic Academy in 12 countries between January
2014 and February 2015 using PubMed, CINAHL, Cochrane, Google
Scholar, websites and national journals. The search words
included“Kinesiotape, Kinesio tape, kinesiotaping, elastic taping,
taping, functional taping, myofascial taping, sensomotor taping”.
The review included all articles, even those published in different
languages. These searches resulted in 821 publications. There are
several effects of tape application were revealed such as improving
blood circulation, lymphatic circulation, body range of motion,
activation of mechanoreceptor and joint stability, and decreasing
pain. No one negative about the positive effects of taping, however
the more effort is required to find evidence of effects of tape
application.
Key words: Taping; International Kinematic Academy; Kinesiotape;
Blood Circulation; lymphatic Circulation
John Langendoena, Caren Fleish- manb, Soon Hee Kimc, Ho Jung
And
aPresident International Kinematic Taping Academy, OMT-Instructor,
Member SC IFOMPT, Kempten Germany; bMember International Kinematic
Taping Academy, OMT-Instructor, Johannesburg South-Africa; cYong-in
University, 134, Yongindaehak-ro, Cheoin-gu, Yongin-si,
Gyeonggi-do, Republic of Korea; dDongnam Health University, Jeongja
3-dong, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea
Received : 27 September 2015 Revised : 29 October 2015 Accepted :
12 November 2015
Address for correspondence Ho Jung An, PT.Ph.D Department of
Physical Therapy, Dongnam Health University, Jeongja 3- dong,
Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea Tel.
82-31-249-6448 Fax. 82-31-249-6440 E-mail.
[email protected]
980
Rationales and Evidence of Elastic Taping: A clinician’s
perspective
and the study is inconclusive about the influence of these methods
has not yet been performed(6-8). Thus, this review tried to address
those questions unanswered in systematic reviews to date, based on
a clinician’s perspective.
The search strategy for this review included a lit- erature search
by members of the International Kinematic Academy in 12 countries
between January 2014 and February 2015 using PubMed, CINAHL,
Cochrane, Google Scholar, websites and national journals. The
search words included
“Kinesiotape, Kinesio tape, kinesiotaping, elastic taping, taping,
functional taping, myofascial tap- ing, sensomotor taping”. The
review included all articles, even those published in different
lan- guages. These searches resulted in 821 publications. These
articles were reviewed. Articles included in
the systematic reviews on patient outcome were excluded as they had
been extensively reviewed elsewhere(3-14). Our research was to
focus on evidence for rationales, explanations and clinically
relevant aspects.
Tapes under investigation: None of the systematic reviews
critically
appraised the Kinesiotape applications used in the studies. As
there is no convincing evidence for any Kinesiotaping applications,
it does not mean that there is no evidence for other elastic taping
con- cepts in general. The principles and rationales for
Kinesiotaping are not in complete agreement with common paradigms
in orthopaedic manual thera- py, western neuromuscular analysis
& manage- ment of dysfunctions and pain(15-18).
Incorrect nomenclature of “placebo”, “sham” All interventions,
taping included, have a placebo
effect but one cannot say that tape felt on the skin (which implies
afferent input) is a placebo intervention(19). Use of the words
“non specific” intervention may be more appropriately used
than
“sham”, compared with a taping application using orthopaedic manual
therapy(OMT) principles.
Use of colours Although colour significantly contributes to
the
popularity of elastic taping, no study showed evi- dence for the
use or non-use of a specific colour for a specific condition and
the colour debate was never mentioned in any systematic review. The
inventor of the elastic tape material, Kase, revealed that there
has not been a specific medical reason for developing different
colours(20).
Limitations of the systematic review Some limitations are
recognized by the reviewers
e.g. limited to English language or randomized controlled outcome
studies, or studies without a control group.
Long term follow up Reviews criticize the lack of long term follow
up
but even in the original concept of taping improv- ing lymphatic
and blood circulation, it was meant to be an intervention with an
immediate and short term effect. On the sports field, time from
treat- ment or training session to another session may be a few
hours while in the clinical setting, treat- ment time can vary from
daily treatments to treatment once a week. Treatment strategies
will vary during the course of treatment dependant on the effect
and so will taping applications. Therefore it is not appropriate to
examine the long term effects of taping, electrotherapy manipula-
tion etc., as they will change as the patient pro- gresses.
The original aim of the originator of elastic tape, Kenzo Kase, was
to stimulate self healing mecha- nisms of the body by improving
lymphatic and blood circulation without restricting range of
motion. It has been demonstrated in single case measurements in
normal subjects with Doppler sonography that elastic tape, applied
to the skin over a major artery, increased the arterial blood
supply in the distal course of that artery(21). An improved blood
supply promotes self healing mechanisms and confirmed an initial
research aim of Kase. Despite this initial evidence, rigorous fol-
low up studies to confirm these findings are lack- ing to date.
Miller et al. demonstrated that there was there was no difference
in blood flow with rigid or elastic tape or conditions(22). It
appeared that the application of either tape may change blood flow
to the targeted area, but most likely as
Analysis of the systematic reviews
METHODS
RATIONALES
981
J. Langendoen, C. Fleishman, S.H. Kim, et al.
a result of prior exercise.Shim et al. demonstrated that taping the
hind leg of a rabbit increased the lymphatic flow, however only in
combination with passive movement(23). However, the effect of
passive movement alone has not been investigat- ed. Post-partum
breast engorgement and mam- mary gland pain were not influenced by
breast lymphatic tapes, as there is no option to add pas- sive or
active movement(24). Lymphatic tape applications as being used in
post-traumatic and post-surgical conditions to reduce swelling do
not emphasise that movement needs to be added to the application.
But there is weak evidence that secondary lymph oedema, e.g. after
breast sur- gery, may benefit from lymph applications, in addition
to manual lymphatic therapy (25-33).
Nunes et al. demonstrated that there was no decrease in swelling
after kinesiotaping of a swollen ankle after a lateral ankle
sprain(34). The principles of increasing arterial blood
supply
and lymphatic drainage are not commonly used by manipulative
physical therapists in neuromuscu- lar treatment, thus other
rationales (mechanical, neurophysiological) should be
considered.
In addition to the self healing philosophy, Kase also used a
mechanical approach, which, however, does not comply with all OMT
principles(35). The McConnell approach, in which rigid taping is
one of the management pillars, in contrast, adheres to OMT and
neuromusculoskeletal(NMS) rehabilita- tion principles(36).
Kawabata et al. could demonstrate with spiral tapes around the
lower and upper leg that the rotatory angle between the femur and
tibia sig- nificantly changed under loading, as with one leg
squatting or drop landing(37)(S. Fig. 2a-d). These tests are
considered relevant in many patients with anterior knee pain
(patello-femoral pain syndrome). Kawabata et al. are the only
researchers to date to demonstrate a change in osseous movements
during functional loading with elastic taping(37).
Further research could reveal that elastic tapes applied according
omt principles instead of kine- siotapes could change positional
faults of the lat- eral malleolus or fibular head after an ankle
sprain or the clavicle after an acromioclavicular joint
sprain.
Neurophysiological processes:
It is the skin that is being taped. The skin is the biggest human
organ with countless nerve end- ings at its layers. Tape on the
skin is perceptible. So, there is afferent input in the somatic
nervous system. Most patients report that the tactile per- ception
is hardly felt. Possibly the unmyelinated c tactile(social)
afferents are being stimulat- ed(38,39).The placebo concept is
therefore mis- leading. Tape can be applied in a general or spe-
cific area but whatever the application, there is always an input.
In studies, one could compare(so called) specific with non
specific(and not placebo) tape applications. It is self evident
that, as in any therapy, there is a placebo effect with any tape
application. Any placebo effect can be used con- sciously, as well
as simultaneously be minimized with increasing specificity of the
treatment. The more precise the examination and treatment is, the
more specific a dysfunction is treated and, subsequently taped, the
less the placebo effect could be. Studies providing the evidence
for this are lacking to date. Probably the most important
explanation for the
effect of taping the skin is offered by current fas- cial research.
Taping the skin, with some stretch in a certain direction, aims to
change the shearing of the skin and fascial layers. Dynamic
mechanoreceptors, such as Ruffini and interstitial receptors, are
localized to the border zones of these soft tissue layers(40-49).
Altered mechanoreceptive afference could alter processing in the
dorsal horn and (inter-)segmental interne- urons, explaining
immediate pain inhibitory effects, increased pain-free range of
motion and increased muscle power. Such observable immedi- ate
changes can be explained neurophysiologically rather than
physiologically by increased arterial blood supply or increased
lymphatic drainage. Investigations with somato-evoked potentials
(SEP) could support the proposed mechanisms. Yamamato could
demonstrate a change in spinal cord excitability with SEP after
taping the skin(50). As 50% of interstitial dynamic
mechanoreceptors
have a high threshold, a sufficient amount of stretch is required
to activate them. To avoid rapid adaptation tape has to be applied
over the joints and movement of the joint ensures repeated stretch
and activation of the receptors. Tape stretch can vary between 0%
(traditionally
with lymphatic, but also in facial and anterior neck applications)
to 100%(only additionally in some osseous or articular conditions
with a mechan-
Mechanical correction
Rationales and Evidence of Elastic Taping: A clinician’s
perspective
ical rationale). The most commonly used amount of stretch for
mechanoreceptor activation is up to 33%. A helpful clinical
guideline is: the softer and more flexible the skin is, the less
stretch is to be applied. The beginning and ending of the tape, are
always applied without stretch to avoid skin irri- tation or
damage, as well as to stabilize the appli- cation. Due to the
stretch and the starting posi- tion, convolutions of tape and skin
are avoided. Despite convolutions being advocated in the liter-
ature, they are not desirable if the shearing behaviour of skin and
fascial layers is to be changed and the dynamic
mechanoreceptor
rationale is adopted. Parreira et al demonstrated that tape
applica-
tions with convolutions are not more effective than sham
(unspecific) tapes in the treatment of chronic low back pain(51).
Convolutions may only be desirable in lymphatic applications for
swelling. However, there is no evidence that these convolu- tions
increase the space between the skin & underlying interstitial
space as is assumed. In addition, there is no evidence that this
decreases pain by reducing pressure on the nociceptors as assumed
by Kase(35). Investigating standardised interventions,
including
Kase & Hashimoto 1998 Miller et al. 2011
Increase of Arterial Blood Supply Single case examples in normal
subjects. No further research or objective confirmation to
date
Kawabata et al. 2007Change osseous positions Further investigations
needed, e.g. for the clavicle after acromio-clavicular joint
sprains, for the fibula after ankle sprain
Selkowitz et al. 2007 (non-elastic tape)
Hsu et al. 2009 Berkmiller 2013
Changing muscle function Further evidence for changing action of
overactive or underactive muscles is needed. The kinesiotaping
approach in changing the direction of application to tonify and
detonify is not in agreement with actual paradigms.
Corey et al. 2001 Stecco et al. 2011 Yamamoto 2011
Activation of(Ruffini and high- threshold interstitial)
dynamic
Mechanoreceptors
Yoshida & Kahanov 2007 Berkmiller 2013 Sazegar 2013
Reciprocal Inhibition Finger to Floor distance decreased after
lumbar tape. Decrease of protective muscle action at a neurodynamic
test with movement against tape resistance(EMG). Further studies
needed
Yamamoto 2011Placebo Any treatment has a placebo effect. Taping is
an inter- vention with mechanoreceptive input. The wording place-
bo tape is not correct by definition. It is to be differentiat- ed
between sham, unspecific and specific tape.
Shim et al. 2003 (animal trial: rabbit hind foot)
Tsai et al. 2009 Brown & Langdon 2014
Parreira et al. 2014 Nunes et al. 2015
Increased Lymphatic Drainage Increase of lymphatic vessel
contraction frequency only in combination with passive movement.
Weak evidence for post-traumatic & post-surgical condi- tions.
Convolutions do not seem to be required.
Björnsdotter et al. 2009 Löken et al. 2009
Activation of C-tactile(social) afferents
ReferenceRationales Remark
983
J. Langendoen, C. Fleishman, S.H. Kim, et al.
tape applications, in a heterogenous group of patients is unlikely
to present convincing evidence for that intervention. Identifying a
homogenous subgroup of patients is necessary before investi- gating
the effect of a standardised intervention (e.g. a tape application)
on selected outcome tools such as relevant physical tests or muscle
activity (with EMG). Systematic reviews to date therefore could not
reveal the benefits of taping as seen in daily practice. In
contrast, in homogenous sub- groups, the effect of a standardized
application on selected, relevant variables can be
investigated.
Randomized controlled trials should therefore investigate the short
term effect of treatments without, as well as with specific and
with sham taping on pain, range of dysfunctional movement patterns
and even muscle activity during test movements(EMG) in homogenous
subgroup of patients(52). A subgroup of patients with the same of
pool of relevant positive tests can be considered as homogenous,
and can be used for immediate and short term(24 to 72 hrs) outcome
measure- ment.
Lack of evidence should motivate clinicians to become more precise,
to consider further ratio- nales, to apply current principles and
guidelines of modern neuromusculoskeletal rehabilitation, as
well as to experiment and innovate. Relevant variables to consider
when applying tape may include: the starting position of the
dysfunctional structure, the range of the dysfunctional move- ment,
the length, the course and the direction of the tape(s) as well as
the amount of tape stretch. This example gives one explanation for
the con-
clusion of many randomised clinical trials and systematic reviews
that standardised interven- tions for a diagnosis(e.g. non specific
low back pain) do not lead to significant improvements.
For some elastic tape applications there is evi- dence that
relevant variables, such as positive tests, may change(37)(55-60).
All these studies can easily be criticized from a clinical point of
view or a theoretical neuro-physiological perspec- tive.
Nevertheless, they confirm regular observa- tions of clinicians.
Two EMG studies demonstrated improved scapular motion(59,61) and
are of importance when considering tape applications in shoulder
pain. Single case reports in paediatrics and central nervous
Fig. 1. 2a-d. Tape application to promote internal rotation of the
tibia in relation to the femur(modified from Kawabata et
al.(37)).
EVIDENCE
984
Rationales and Evidence of Elastic Taping: A clinician’s
perspective
Fig. 2. 3a-c. A patient with low back pain and a flexion pattern(no
limitation of lumbar flexion). A basic lumbar application(Yoshida
& Kahanov(53)) did not reduce pain or improve finger to floor
distance at lumbar flexion. With sound clinical reasoning and
differential testing, such a tape application would nei- ther be
considered for a clinical intervention nor for a scientific
investigation.
Fig. 3. 3d-f. After taping for relaxation of the lateral hamstrings
in the above patient: immediate increase in range and decrease of
pain on lumbar flexion(Sazegar(54)).
system disorders with spasticity, have suggested that elastic
taping can support rehabilitation(62- 66). As management in these
patient groups is generally very individualized, any study requires
investigation of a very limited number of parame- ters in a
relatively homogenous subgroup.
Further possible applications include facial and abdominal taping.
For example, it has been shown that taping the lower abdomen with
horizontal and vertical tapes decreased primary dysmenor- rhoea
pain as effectively as the best possible con-
traceptive pill(67-69). Participating in a study comparing a tape
intervention with a non-tape intervention control group may have
included a significant placebo and/or Hawthorne effect. Taping has
no effect on healthy, normal muscles
and joints(70-73). Nevertheless, taping can be applied
preventatively during or after heavy physical loading, e.g. at
sports to prevent injuries such as ankle sprains, to prevent or
limit fatigue and muscle soreness (74-79).
985
J. Langendoen, C. Fleishman, S.H. Kim, et al.
The evidence in controlled clinical trials in patient groups is
generally weak, as concluded by reviews and systematic reviews. The
methodology, as well as the original applications of Kase being
used in the studies can be critically reviewed. As outlined,
applying the actual principles and evi- dence of
neuro-musculoskeletal therapy to devel- op tape applications is
likely to improve the evi- dence for a positive short-term effect
of elastic taping in homogenous subgroups or selected vari- ables.
Elastic taping with coloured tape cannot be con-
sidered evidence-based to date. Therefore it demands a critical
clinician’s mind using sound clinical reasoning, current principles
of orthopedic manual therapy, (including appropriate re-
assessments) and acceptable rationales, for apply- ing tape to
enhance treatment. Further research is needed to justify the
rationales. Evidence for the explanations could lead to the further
develop- ment of elastic taping applications.
Clinical success in reflective practice(practice based
evidence-PBE) and growing scientific back- up(scientific evidence
SE) will both contribute to establishing elastic tape as a
beneficial adjunct in the comprehensive management of patients with
movement disorders, beyond the initial hype among consumers and in
sports physiotherapy.
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