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979 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 Langendoen a , Caren Fleish- man b , Soon Hee Kim c , Ho Jung An d a President International Kinematic Taping Academy, OMT-Instructor, Member SC IFOMPT, Kempten Germany; b Member International Kinematic Taping Academy, OMT-Instructor, Johannesburg South-Africa; c Yong-in University, 134, Yongindaehak-ro, Cheoin-gu, Yongin-si, Gyeonggi-do, Republic of Korea; d Dongnam 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]

Rationales and Evidence of Elastic Taping: A clinician’s per- spective · 980 Rationales and Evidence of Elastic Taping: A clinician’s perspective and the study is inconclusive

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979
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]
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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
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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
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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
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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).
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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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