Do ‘Kinesio’ results match the hype?
It started showing up in earnest at the 2008 Olympics in Beijing. Tape on the athletes—not white cloth wound around ankles, but flexible swatches in various hues applied seemingly haphazardly to the body surface, looking like patches on an old inner tube.
Among the high-profile users was the U.S. beach volleyball player Kerri Walsh Jennings, who was competing following rotator cuff surgery and who sported black strips of the elastic “kinesiology” tape—most commonly referred to as Kinesio®, the dominant brand—about her shoulder. With Misty May-Treanor, she won the gold medal and credited the tape with helping her recover from her injury.
Precut kinesiology tape for specific body parts is designed to be self-applied; some athletes claim it provides support without limiting range of motion.
By 2012, the tape was ubiquitous, at the Olympic Games in London and in sports leagues and tournaments around the world. With all the exposure, many orthopaedic surgeons and patients have been asking what does it do, and does it work?
The answer depends on whom you ask. Obviously plenty of elite athletes believe in it and claim that the tape, which replicates the thickness and elasticity of skin, provides support to muscles and joints without limiting range of motion. According to William Schobert, MD, the surgeon who treated the Olympic beach volleyball champions, Ms. Walsh Jennings says, “I absolutely believe in Kinesio tape. It has helped me with function, stability, blood flow, and peace of mind.”
Although the literature does not provide compelling evidence that the product lives up to its claims, Dr. Schobert echoed Ms. Walsh Jennings’ sentiments. Based on his observations, at the very least it gives the wearer valuable confidence and has a place in the athletic trainer’s kit.
“It is a very comfortable, directionally flexible tape used for musculoskeletal support in the athletic training setting,” he said. It is used for soft-tissue support as well as joint support. Its application isn’t a panacea but can be a boost to athletes with injuries in a competitive environment.”
Tale of the tape
Kinesio tape was developed in Japan in the 1970s by Kenso Kaze, a chiropractor and acupuncturist. It is made of cotton, is latex-free, and has a heat-activated acrylic adhesive. (Another brand of similar tape is marketed by SpiderTech, with precut “Spiders” for specific body parts and is designed to be self-applied. Most of the research to date on kinesiology tape has focused on Kinesio.) Among the proposed beneficial effects of the tape are the following:
- To provide a positional stimulus through the skin
- To align fascial tissues
- To create more space by lifting fascia and soft tissue above the area of pain/inflammation
- To provide sensory stimulation to assist or limit motion
- To assist in the removal of edema by directing exudates toward a lymph duct.
Anecdotally, athletes and trainers say they have seen these outcomes in at least some individuals. “I’ve had hit-and-miss results,” said Aaron Brock, ATC, director of sports medicine for USA Volleyball, which encompasses both men’s and women’s teams. “Some people absolutely love it. They’re seeing great results.
“But I don’t say, ‘man, every time I use this, it has great results,’” he continued. “Sometimes, from a therapeutic perspective, we’re doing so many different things that we don’t know what is effective and what isn’t.”
The literature does not provide much conclusive support for the efficacy of the tape, and few well-controlled studies with high-quality evidence have been performed. A randomized, double-blinded clinical trial was done in 2008 to evaluate the effect of tape use on shoulder pain. Patients with rotator cuff tendinitis or impingement received either a tape application or a sham. The tape group did show immediate improvement in pain-free shoulder abduction that was statistically significant (P = 0.005), but by day 6 both groups had significantly improved in all outcome variables, exceeding the criteria for success.
The authors noted that the patient group was young, with an average age of 20, and that older patients might have different results. Because of the initial positive finding, this study has sometimes been cited in the popular press as supporting the use of the tape, but the authors concluded, “Utilization of Kinesio taping for decreasing pain intensity or disability for younger patients with suspected shoulder tendonitis/impingement is not supported.”
Other reliable studies find little evidence to support using the tape, although some small investigations reported some positive results. A recent meta-analysis found that, overall, “the efficacy of Kinesio tape in pain relief was trivial given there were no clinically important results.” Small beneficial results on range of motion were found in one study, and “trivial” results in two other studies across numerous joint measurements were found. The analysis cited a likely beneficial effect for proprioception regarding grip force sense error, but no positive outcome for ankle proprioception.
The analysis concluded that little quality evidence supported the use of Kinesio tape over other types of elastic taping in the management of sports injuries and called for further research to confirm findings of possible positive effects.
Some studies may point to the need for further research. For example, one study found that taping on baseball players with shoulder impingement resulted in positive changes in scapular motion and muscle performance.
None of the studies reported negative effects, which may be why trainers like Mr. Brock of USA Volleyball use the tape on players who report benefits with it.
“Primarily, I like it for some postural cuing around the scapularis,” he said. “It provides some proprioceptive cuing for the scapular stabilizers to improve activation in the scapular muscles, thereby putting the athlete in a better postural position. Bottom line, I like to use it for muscle education or proprioception. I’ll also use it if I feel I can get some activation if for whatever reason a muscle isn’t turning on so well.”
A question of direction
Mr. Brock said he would like to see research that tests whether the direction in which the tape is applied determines whether a muscle is activated or inhibited. Under the theory of directional effect, the tape would be applied distal to proximal for inhibition and from proximal to distal for activation. For quadriceps inhibition, for example, the tape would be pulled from the patella toward the hip. The rationale is that the applied tape would continue to pull directionally with elastic tension.
“I have a hard time thinking that changing the direction completely changes the effect,” Mr. Brock said. For me, that’s a little bit of a stretch.”
He also said he would like to see more research into the effect of taping on edema and swelling, noting the tape could be useful in a physical therapy setting where the patient is not constantly seen. The tape can stay adhered for as long as 5 days and can endure water.
He recommends that anyone interested in using the tape receive instruction. He does not recommend self-application by athletes or patients. Ms. Walsh Jennings said, “Proper application is paramount to its effectiveness.”
“You can experiment with it, but I think it’s important to hear how the people who made the tape recommend using it,” Mr. Brock said. “Depending on what you are trying to do, you’ll put the tape on differently. With the basic guidelines that instructors give you, there’s a lot of leeway for experimentation.”
He added that for volleyball players and overhand athletes, he often turns to elasticized shirts such as those made by IntelliSkin, which operate similarly to Kinesio tape.
“The shirts have a little extra pull in the scapular region,” he said. “I’ll wear one sometimes if I’m getting into that forward-head, rounded shoulder, kyphotic type of position. Surgeons might even want to try it, as well as people who sit at a computer all day. I think it helps posturing. I’ve gone in that direction often for the scapularis. All the men volleyball players have them, and some wear them during matches.”
As for the tape, Mr. Brock will continue to use it, if for no other reason than for the “peace of mind” Ms. Walsh Jennings cited. “There is a psychological component,” he said. “If nothing else, you get a little extra proprioceptive feedback, and maybe your central nervous system and peripheral nervous system are communicating a little better.”
Terry Stanton is senior science writer for AAOS Now. He can be reached at email@example.com
- Kinesio tape is a cloth tape with the thickness and elasticity of the epidermis.
- Among its purported benefits are lifting of the skin and fascia, support of muscles and joints, and enhanced proprioception.
- Although one randomized, double-blinded clinical trial found that the tape provided relief from shoulder pain immediately after application, the effect did not last over time.
- Little high-quality evidence indicates the efficacy of the tape, and more scientifically valid studies are needed to make a conclusive determination for its claims.
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- Hsu YH, Chen WY, Lin HC, Wang WT, Shih YF:The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome. 2009 Dec;19(6): 1092-1099.
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November 2012 Issue
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