PCV/ICU/ ADTir^l C Sports Med 2012. J2 (!) IM164KtVltVV MKIICLC on2-1IM2/12/000201M/S4996/0

© 2012 Adis Data lr^Ta^m•tlon BV All rights ressrved

Kinesio Taping in Treatment andPrevention of Sports InjuriesA Meta-Analysis of the Evidence for its Effectiveness

Sean Williams, Chris Whatman, Patria A. Hume and Kelly Sheerin

jports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University ofTechnology, Auckland, New Zealand

ContentsAbstract 1631. Introduction 1542. Methods 154

2.1 Literature Search 1542.2 Assessment of Study Quality for the Meta-Analysis 1552.3 Data Extraction 1552.4 Meta-Anaiyses 155

3. Findings 1573.1 Properties and Purported Benefits of Kinesio Taping 1573.2 Pain 1573.3 Range of Movement 1603.4 Strength 1613.5 Proprioception 1623.6 Muscie Activity 163

4. Conclusion 163

Abstract Kinesio tape (KT) is an elastic therapeutic tape used for treating sportsinjuries and a variety of other disorders. Chiropractor. Dr Kenso Kase, de-veloped KT taping techniques in the 1970s. It is claimed that KT supportsinjured muscles and joints and helps relieve pain by lifting the skin and allowingimproved blood and lymph flow. The profile of KT rose after the tape wasdonated to 58 countries for use during the 2008 Olympic Games, and was seenon high-profile athletes. Practitioners are asking whether they should use KTover other elastic adhesive tapes. The aim of this review was to evaluate, usingmeta-analysis, the effectiveness of KT in the treatment and prevention of sportsinjuries. Electronic databases including SPORTDiscus™, Scopus, MEDLINE,ScienceDirect and sports medicine websites were searched using keywords"kinesio taping/tape'. From 97 articles, ten met the inclusion criteria (articlereported data for effect of KT on a musculoskeletal outcome and had a controlgroup) and were retained for meta-analyses. Magnitude-based inferences wereused to assess clinical worth of positive outcomes reported in studies. Only twostudies investigated sports-related injuries (shoulder impingement), and just

154 Williams et al.

one of these involved injured athletes. Studies attending to musculoskeletaloutcomes in healthy participants were included on the basis that these out-comes may have implications for the prevention of sporting injuries. The effi-cacy of KT in pain relief was trivial given there were no clinically importantresults. There were inconsistent range-of-motion outcome results, with at leastsmall beneficial results seen in two studies, but trivial results in two otherstudies across numerous joint measurements. There was a likely beneficial ef-fect for proprioception regarding grip force sense error, but no positive out-come for ankle proprioception. Seven outcomes relating to strength werebeneficial although there were numerous trivial findings for quadriceps andhamstrings peak torque, and grip strength measures. KT had some substantialeffects on muscle activity, but it was unclear whether these changes were ben-eficial or harmful. In conclusion, there was little quality evidence to support theuse of KT over other types of elastic taping in the management or prevention ofsports injuries. KT may have a small beneficial role in improving strength,range of motion in certain injured cohorts and force sense error comparedwith other tapes, but further studies are needed to confirm these findings. Theamount of case study and anecdotal support for KT warrants well designedexperimental research, particularly pertaining to sporting injuries, so thatpractitioners can be confident that KT is beneficial for their athletes.

1. Introduction

Taping has long been used for the preventionand treatment of sports injuries to provide protec-tion and support to the joint or muscle duringmovement.''' Taping can improve proprioception,which is believed to play a role in preventing acuteinjury and in the evolution of chronic injury.'" 'Kinesio taping (KT) is an elastic therapeutic tapeused for the treatment of sports injuries and a vari-ety of other conditions.''' Developed by Japanesechiropractor, Dr Kenso Kase, in the 197O's, KThas become increasingly popular amongst athletesand practitioners alike. The profile of KT wasraised after it was seen on athletes at the 2008Olympic Games. Despite the increasing use of KTin clinical practice, uncertainty remains regardingits true merit. While promising anecdotal reportsand case studies exist, a comprehensive review ofthe literature was warranted to guide the futureuse of KT amongst athletes and practitioners. In2010, Bassett et al.'"*' provided a systematic reviewof three studies''•''•''' that reported the use andtreatment efficacy of KT for musculoskeletal con-ditions. Two of the three studies exhibited highmethodological quality, but none of the articles

showed any significant clinical effects for KT. Ouireview expands on Bassett et al.'s'- ' information bvexamining the effects of KT in healthy popula-tions, along with injured populations, and usinumagnitude-based inferences to examine the clinicaworth of reported positive (beneficial) outcome^via a meta-analysis. Using a meta-analysis, the aimof the review is to evaluate the effectiveness of K lin the treatment and prevention of sports injuries.

2. Mettiods

Cochrane Collaboration'^' review methodology(literature search, assessment of study quality, datacollection of study characteristics, analysis and in-terpretation of results, recommendations for clinicapractice and further research) was used to evaluattthe effectiveness of KT in the treatment and pre-vention of sports injuries.

2.1 Literature Searcin

Electronic data bases including SPORTDiscus"Scopus, MEDLINE, ScienceDirect, and sportsmedicine websites were searched using keyword;'kinesio taping/tape'. Of the 96 articles sourced

© 2012 Adis Data information BV. Aii rights reserved. Sports Med 2012: 42 (2

Kinesio Taping Meta-Analysis Review 155

ten studies were used for meta-analysis using thefollowing inclusion/exclusion criteria: (i) the ar-ticle reported data for effect of KT on a muscu-loskeletal outcome (e.g. pain, range-of-motion,proprioception); (ii) the article had a KT groupand a comparison group (e.g. KT applied withouttension, placebo taping, no taping); and (iii) thefull version was available in English. Only twostudies investigated participants with sports-related injuries (shoulder impingement), and justone of those involved athletes. Six studies at-tending to musculoskeletal outcomes in healthyparticipants were included on the basis that theseoutcomes may have implications for the preven-tion of sporting injuries.

2.2 Assessment of Study Quaiity for theiVleta-Anaiysis

The quality of the ten papers that met our in-clusion/exclusion criteria was assessed based on thefollowing key components of the methodologicalquality: (i) randomization of subject allocation;(ii) blinding of subjects; and (iii) blinding of all as-sessors. These criteria have been identified as beingfundamental in reducing bias in clinical trials.'^'

Study quality was ranked 1 to 4, where the largernumber indicates better quality: 4 = controlled ex-perimental study, with randomization of subjectallocation, plus blinding of subjects and assessors;3 = controlled experimental study, with randomi-zation of subject allocation and blinding of subjectsor assessors, but not both; 2 = controlled experi-mental study, with randomization of subject allo-cation, but no blinding of subjects or assessors; and1 = controlled experimental study that lacked ran-domization of subject allocation and blinding ofubjects and assessors. Note, in randomized cross-

over designs, subjects were randomly allocated theorder in which treatments were received.

Methodological limitations were associatedwith many of the studies reviewed in this article,including failure to adequately blind both thesubjects and therapists, failure to use injuredathletic populations and a lack of a placebotaping group to address for the placebo effect oftaping. Studies assessed KT effects on a varietyof joints and muscles, but the small number of

studies of each body area meant there was ofteninsufficient evidence to make a clear conclusion.No studies addressed the long-term effects ofKT in the management of sports injuries. Manystudies made inferences about the efficacy ofKT based only on the p-value derived from a nullhypothesis test. This approach fails to provideinformation on the size of the observed effect,and its clinical importance.'**'

2.3 Data Extraction

For the ten studies included, data were extractedincluding participants" characteristics, study design,methodological quality, interventions, outcomemeasures and results (see table I).

2.4 Meta-Anaiyses

A number of outcome measures were used toevaluate the effectiveness of KT, including strength,pain, range of movement, proprioception andmuscle activity. We analysed all statistically signif-icant results reported within the ten studies, andmade clinical inferences regarding the true value oftheir effects in a manner outlined by Batterham andHopkins.'**! Results that were not reported as beingstatistically significant were also assessed (wheresufficient data were provided), and any resultsfound to be of benefit in our analysis are discussedwithin the thematic sections. The p-value relating tothe outcome measure was used to detennine thelikelihood that the true magnitude of the effect wassubstantial in a clinically beneficial or hamiful way.Thresholds for clinical benefit were taken from ex-tant literature. Where no previously validatedthresholds existed, a Cohen unit of 0.2 of the base-line between-subject standard deviation for theoutcome measure was used as the default. If nobaseline data were provided, a threshold for clinicalbenefit was agreed upon by the authors. An effectwas clinically unclear if there was >25% likelihoodthat the true value was beneficial, with odds ofbenefit relative to odds of harm (odds ratio) <66%.The effect was otherwise clinically clear; beneficialif the likelihood of benefit was >25%, and trivialor harmful for other outcomes, depending on theobserved value. Where a study reported a p-value as'p<0.05', 'p=0.05' was used in the analysis. Where

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156 Williams et al.

Table I. Characteristics ot studies that evaluated the effectiveness of kinesio taping (KT) on strength, pain, range of motion (ROM),proprioception or muscie activity

Study Study Study aimquaiity"

Study design Subject characteristics''

Theien et ai.'' '

Gonzaiez-lgiesias 4et ai.i"!

Hsu

Chang et ai.l^' 3

Vithouika et ai.l"" 2

Yoshida andKahanovi'"

Fuetai.1'21

Haiseth et ai.i'^' 2

Lee et ai.i"i 2

Stupiketai.i'^i 1

Effect of KT vs stiam treatment Randomized, bundedon pain and ROM ciinicai triai

Effect of KT vs sham treatmenton neck pain and cervical ROMin individuals with acutewhipiash-associated disordersEffect of KT vs piacebo tapingon kinematics, muscie activityand strength of the scapuiarregion in basebali players withshoulder impingement

Effect of KT vs placebo and no-taping on maximai grip strengthand force sense of healthycoiiegiate athletesEffect of KT vs placebo and no-taping on quadriceps strengthat maximum concentric andeccentric isokinetic exerciseEffect of KT vs no-taping ontrunk flexion, extension andiaterai fiexion

Effect of KT vs no-taping onmuscle strength in quadricepsand hamstring

Effect of KT vs no-taping onankle proprioception(reproduction of joint positionsense)

Effect of KT vs no-taping ongrip strength

Effect of KT vs no-taping onbioeiectricai activity of vastusmediaiis muscle

Randomized, bundedciinicai triai

Randomized crossover,pre- and post-test repeatedmeasures design. Examinerswere bunded

Randomized, bundedrepeated measures designwith single group

Randomized repeatedmeasures design

Randomized crossover,pre- and post-test repeatedmeasures design

Muscie strength assessed inthree conditions (without KT,immediateiy after applicationof KT and 12 h after tapingwith tape stiii in situ).Randomized order of threeconditions

Randomized repeatedmeasures design

Controi group: 20±2y, 17 M, 4 F.Expérimentai group: 21 ±2y: 19 M. 2 F.Ail patients ciinicaily diagnosed withrotator cuff tendonitis/impingement

Controi group: 32 ± 7 y; 10 M, 10 F.Expérimentai group: 33±6y; 10 M, 11 F.Aii patients reported neck pain as a resuitof a motor accident

17 amateur basebail piayers withshouider impingement: 23±3y

21 heaithy coiiegiate athietes: 21 ±3y

20 heaithy nonathlete F: 27 ± 4 y

30 healthy subjects: 27±6y; 15 M, 15 F

14 healthy coiiege athietes: 20± 1 y;7M, 7F

30 healthy subjects: 18-30y; 15 M. 15 F

40 heaithy subjects: 23±2y; 20 M. 20 FRandomized repeatedmeasures design

Non-randomized controi triai 27 heaithy subjects: 23±4y; 15 M, 12 F

Study quality was ranked 1-4 where the iarger number indicates better quality: 4 = controlled expérimentai study, with randomization ofsubject aiiocation, pius bunding of subjects and assessors; 3 = controlled expérimentai study, with randomization of subject allocation, andblinding of subjects but not assessors: 2 = controlled expérimentai study, with randomization of subject aiiocation, but no blinding ofsubjects or assessors; and 1 =controiied expérimentai study that iacked randomization of subject aiiocation and bunding of subjects andassessors. Note, in crossover designs, subjects were randomiy ailocated the order in which treatments were received.

Age data in years are presented as mean ± standard deviation or ranges where stated.

= femaie; M = maie.

an outcome measure was reported with confidencelimits, inferences were calculated using a spread-sheet for combining independent groups, with a

weighting factor of one for the effect.t' 1 The like-lihood that an effect was substantially harmful,trivial or beneficial was given in plain-language

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Kinesio Taping Meta-Analysis Review 157

terms using the following scale: 0-0.5%, most un-likely; 0.6-5.0%, very unlikely; 5.1-25.0%, un-likely; 25.1-75.0%, possible; 75.1-95.0%, likely;95.1-99.5%, very likely; 99.6-100%, most likely."^'Values are reported with 90% confidence limits toexpress the uncertainty in the true effect.

3. Findings

An overview of details of the ten studies meta-analysed are summarized in table I. Table IIshows the number of statistically significant andnonsignificant results for each outcome variablereported within the ten studies (note, some stud-ies took several measurements for one variable).Tables III and IV summarize the reported posi-tive statistical results of KT, and our interpreta-tion of the magnitudes of the effects and theirclinical importance. Eight studies reported a sta-tistically significant positive outcome for at leastone outcome measure. The results of these studiesare discussed in the following thematic sections.Our introductory comments for each section alsoinclude some reported generic statements fromother studies reviewed that did not meet the meta-analysis criteria. These comments help put thethematic section into context, given the variouspurported benefits of KT.

3.1 Properties and Purported Benefits ofKinesio Taping

KT is a thin, elastic tape that is claimed tostretch to 120-140% of its original length, and

Table II. Number of reported statistically significant and non-significant results, and percentage of positive results from all results,for pain, range of motion (ROM), strength, proprioception andmuscle activity outcome measures

Outcomemeasure

Pain

ROM

Strength

Proprioception

Muscle activity

No. of reportedstatisticallysignificantpositive results

2

16

6

2

4

No. of reportednonsignificantresults

6

56

10

2

18

Positiveresults fromaii results (%)

25

22

38

50

18

then subsequently recoil back to its originallength following application, thus exerting aproposed pulling force to the skin.''"*' Comparedwith conventional tape, it is suggested that KTallows a greater range of motion and can be wornfor longer periods of time without the need forreapplication.''^' The proposed benefits of KTinclude facilitating joint and muscle realignmentby strengthening weakened muscles,''''' improv-ing circulation of blood and lymph by increasingthe interstitial space between the skin and un-derlying connective tissues (allowing for in-creased circulation of both venous and lymphaticfiuid),'"' decreasing pain through the reductionin pressure on nociceptors,'''^' repositioning sub-luxed joints by relieving abnormal muscle ten-sion, helping to return the function of fascia andmuscle'''^' and increasing proprioception throughthe stimulation of cutaneous mechanorectors.'^"'

3.2 Pain

The proposed mechanism for the pain reliev-ing effect of KT is through the stimulation ofsensory pathways in the nervous system, thusincreasing afferent feedback.'^'' This is hypothe-sized to diminish the input from nerve fibresconducting nociception due to the gate controltheory.''' An additional theory is that KT appli-cation lifts the skin and directly reduces pressureon subcutaneous nociceptors.'^^'

Of the ten studies assessed, only one study byGonzalez-Iglesias et al.'**' reported statisticallysignificant results for a measurement of pain (seetable IV). This study had a methodologicalquality of 4 (best available evidence). There was agreater decrease on a numerical pain rating scale(NPRS) in the KT group versus the sham treat-ment group for patients with acute whiplash-associated disorders. A 2-point reduction on theNPRS has been identified as the minimal clini-cally important difference,'"-^' and therefore,while there were statistically significant between-group differences in change scores for immediatepost-treatment (0.9 ±0.2) and 24-hours post-treatment (1.110.3), these changes were bothinferred to be most likely trivial in our analysis.Decreases in pain elicited by KT in this study are

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158 Williams et al.

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160 Williams et at.

therefore unlikely to be clinically important. Thisfinding is in agreement with the results of Thelenet al.''! (methodological quahty = 4) who reportedno statistically significant differences in theshoulder pain and disability index (SPADI) orthe visual analogue scale (VAS) between KT andsham treatment groups in patients diagnosedwith rotator cuff impingement. Our analysis alsoconcluded these results were trivial when com-pared with established thresholds for meaningfulchange.

3.3 Range of Movement

One proposed mechanism for the effect of KTon active range of motion is an increase in bloodcirculation in the taped area; a physiologicalchange that may facilitate an increased range ofmotion within the muscle.'' '! An additional theoryis that fear of movement is associated with painintensity in patients, and so the application of KTprovides sensory feedback that reduces fear ofmovement and thus increases range of motion.''''

Four of the ten studies reported positive out-comes in measures assessing range of motion (seetable III). Two studies''-''! rated methodologicalquality level 4 (highest), while the Hsu et al.'^! studyrated methodological quality 3 and Yoshida andKahanov'"' rated methodological quality 2.

Thelen et al.''! assessed the range of pain-freeshoulder abduction in patients diagnosed with ro-tator cuff impingement, defining a clinically mean-ingful change as a 15° increase. Only one statisticallysignificant positive result was reported from a totalof nine range-of-motion measurements; the mean±standard deviation difference of 19.1° ±10.8° forpain-free shoulder abduction range of motion be-tween KT treatment and sham treatment groupsafter 1 day, represented a 74% likelihood of being atleast a small clinically beneficial effect and, as such,would be a worthwhile intervention. Although notreported as being statistically significant by theauthors, the day 3 difference of 16.6°± 13.3° in pain-free shoulder abduction represented a 58% like-lihood of being clinically beneficial, while the day6 result (10.3°± 15.1°) represented a 30% likelihoodof being beneficial. The remaining six results forrange of pain-free motion were all assessed to be

trivial. Our clinical inference from these results isthat KT has at least a small, immediate effect onpain-free shoulder abduction range of motion but isunlikely to have a beneficial longer-term effect.

Gonzalez-Iglesias et al.''*' assessed cervicalmotion in six directions both immediately post-treatment and 24-hours post-treatment. Group-by-time interactions were statistically significantfor all directions of cervical motion, with pairwise comparisons showing patients in the KTgroup obtained a greater improvement in cervicalrange of motion than those in the control group.The minimal detectable change for each direction ofcervical motion has been previously investigated,'-"''and so these values (9.6° for fiexion, 7.0° for exten-sion, 5.9° for right lateral fiexion, 9.1° for left lateralflexion, 7.6° for right rotation and 6.7° for left ro-tation) were used as thresholds for a meaningfulchange after KT application. Eight of the twelvecervical range-of-motion measurements were in-ferred to be trivial, with all eight of these being overthe 95% likelihood value. Likely beneficial effectswere calculated for cervical extension immediatelypost-treatment, and 24-hours post-treatment, whilepossibly beneficial effects were calculated for rightlateral flexion at both timepoints. Overall, KT had atrivial effect on cervical range of motion for thevast majority of cervical motions, both acutely and24-hours post-treatment.

Hsu et al."! investigated the effect of KT onshoulder kinematics in baseball players withshoulder impingement syndrome. The KT grouphad statistically significant improvements in scap-ular orientations compared with the placebo groupfor posterior tilt at 30° and 60° of humeral eleva-tion, but no other measures of scapular orienta-tions or displacements were statistically significant.No extant literature pertaining to clinically im-portant changes in scapular kinematics was avail-able, so a change of 0.2 of the average baselinebetween-subject standard deviation was used as thesmallest worthwhile effect. Using this threshold,both reported positive results were possibly bene-ficial (see table III). Measurements at 30°, 60° and90° of posterior tilt of the scapular were also pos-sibly beneficial in our analysis, despite being re-ported as statistically nonsignificant by the authors.Our analysis found trivial or unclear differences for

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Kinesio Taping Meta-Analysis Review 161

the 19 other measurements of scapular orienta-tions. No beneficial effects were inferred for any ofthe 24 scapular displacement measurements, withpossibly harmful effects found for eight measure-ments. KT may have beneficial effects on improv-ing scapular kinematics in subjects with shoulderimpingement syndrome, but only for specificdegrees of humeral elevation. Overall, the effect ofKT is likely to be trivial, or even possibly harmfulfor certain measurements, and therefore would notbe recommended for use in treatment of shoulderimpingement syndrome.

Yoshida et al. '" ' assessed the effects of KT ontrunk flexion, extension and lateral flexion in 30healthy patients, using a randomized crossoverdesign. There were positive changes for trunkflexion with a mean increase of 17.8 cm in the KTcondition. However, the taping effect was notaddressed given the comparison was a no-tapingcondition. No smallest meaningful change valuefor trunk flexion was found in previous literature,and no baseline between-subject standard devia-tions were reported, so a change to the 'no taping'condition of 10% (6.4 cm) was set as the thresholdfor benefit. We felt this figure represented aworthwhile increase in trunk flexion. Using thisthreshold, we calculated a 90% likelihood thatthere was at least a small beneficial increase intrunk flexion in the KT condition. The changes inlower trunk extension and lateral flexion wereboth nonsignificant, but the authors did not re-port specific p-values or confidence limits for usto make inferences about the magnitude of theseresults.

The effect of KT on range of motion remainsunclear because of the limited number of studies ona variety of joints, and the confiicting results. Thebeneficial effects of KT in the higher quality studyconducted by Theien et al.''' suggested KT mayhave at least a small, useful short-term effect on therange of motion for certain joints in injured co-horts. Beneficial effects were reported for cervicalextension and right lateral fiexion in patients withacute whiplash-associated disorders,'''' and for cer-tain aspects of scapular kinematics.'^' However, thetrivial and harmful effects inferred from the resultsof Gonzalez-Iglesias et al.''*' and Hsu et al.'^' suggestfurther clarification is needed. At present, we would

not recommend the use of KT for improving rangeof motion in injured cohorts. In healthy partici-pants, there was at least a small beneficial effectfor trunk flexion, calculated from the results ofYoshida and Kahanov's'"' study. However, as noplacebo taping was used, it is unclear whether thisrepresents a benefit of KT over traditional taping.More studies are needed to clarify the effect of KTon range-of-motion measures.

3.4 Strength

KT is hypothesized to facilitate small immediateincreases in muscle strength by producing a concen-tric pull on the fascia, which may stimulate increasedmuscle contraction.'^^' Additional hypotheses sug-gest facilitated muscle activity and improvedmuscle alignment may contribute to marginal in-creases in muscle strength.'^'

Four of the ten studies reported positive out-comes in measures assessing strength (see table IV).Hsu et al.'s study' 1 had a methodological qualityof 3, while the remaining studies had a methodo-logical quality of l.'"''^^"*' Hsu et al'^' assessedchanges in lower trapezius muscle strength using ahand-held dynamometer, before and after tapingapplication. A positive effect of KT was reported,with a significantly larger increase m strength(1.2± 1.0 kg) in comparison to the placebo tapinggroup. A smallest meaningful difference was setusing a Cohen threshold of 0.2 of the baselinebetween-subject standard deviation, which wasexpressed in raw units of ±0.70 kg. Using thisthreshold, this result represented an 81% likelihoodof at least a small clinically beneficial effect.

Lee et al.''''' also assessed the effect of KT onhandgrip strength in 40 healthy subjects. Hand-grip strength was significantly higher for bothmales and females when KT was applied to theflexor muscles of the dominant hand comparedwith the no-taping condition. Both results werecalculated to be likely beneficial in our analysis(using Cohen thresholds to determine the smal-lest beneficial difference). However, as there wasno placebo taping condition, these results shouldbe treated with caution.

Vithouika et al.''°' investigated the effects ofKT on quadriceps peak torque and reported a

© 2012 Adis Data infornnatlon BV. All rights reserved. Sports Med 2012. 42 (2)

162 Williams et al.

Statistically significant increase for the KT con-dition during eccentric assessment. However, thesignificant differences were with regard to a one-way ANO VA result comparing KT, placebo tapeand no-taping conditions. As there appeared tobe a large placebo effect, we used the raw dataprovided to obtain a p-value for the differences inKT and placebo taping conditions, and used thisin our analysis. The smallest meaningful differ-ence was set using a Cohen threshold expressed inraw units from the between-subject standard de-viation of the "no-taping" condition. Using thesethresholds (7.5 Nm for eccentric exercise and8.3 Nm for 'eccentric isokinetic" exercise), wecalculated the reported positive effect of KT onpeak torque during eccentric exercise to have a97% likelihood of being trivial. In contrast, the9.87±7.1Nm difference in peak torque betweenconditions during the 'eccentric isokinetic' exerciserepresented a 64% likelihood of having at least asmall clinical benefit. The result for concentricexercise was not reported as being statistically sig-nificant, but our analysis calculated a possiblybeneficial effect for this result (41% likelihood).The remaining result for concentric isokinetic ex-ercise (reported as nonsignificant) was calculatedto be very likely trivial in our analysis.

Fu et al.''-! examined the effect of KT on musclestrength in healthy collegiate athletes. One statis-tically significant result was reported for the con-centric contraction of the quadriceps at 180°/sec at12 hours after taping, with tape still in situ. Thesmallest beneficial difference was 2.12 kg/m (Cohenthreshold, expressed in raw units), for which wecalculated a likely beneficial effect (79% like-lihood) of KT. No statistically significant resultswere reported for the seven other measures ofpeak torque, although our analysis found one ofthese results (eccentric contraction at 180°/sec) tobe possibly beneficial (31.5% likelihood). Incontrast to these reported positive outcomes,Chang et al.''^' (methodological quality = 3) re-ported no statistically significant difference inmaximal grip strength measured under threeconditions (without taping, with placebo tapingand with KT) in 21 healthy collegiate athletes.

Given that five of the six statistically signif-icant results were inferred to be beneficial in our

analysis, along with the two additional beneficialfindings for results not reported as being sta-tistically significant, there is some evidence forKT having at least a small beneficial effect onstrength. However, there was also one unclearand eight trivial results for measurements ofstrength, which preclude a clear conclusion beingmade. Further studies on similar muscles, and inparticular KTs long-term effect on strength gain,warrant investigation.

3.5 Proprioception

Proprioception is believed to play a role in theprevention of acute injuries,'^! and thus the pur-ported efficacy of KT in improving proprioceptionis of interest. The pressure and stretching effect ofKT on the skin is believed to stimulate cutaneousmechanoreceptors, which in turn conveys in-formation about joint position and movement, andtherefore may enhance proprioception.'-''!

Chang et al."s study''' (methodological qual-ity =3) of force sense error in grip strength mea-surements amongst 21 healthy collegiate athletesreported two positive results with respect to pro-prioception (see table IV). Using a Cohen thres-hold expressed in raw units as the smallestworthwhile effect, the decrease in absolute forcesense error seen in the KT condition was inferredto represent a 95% likelihood of at least a smallchnically beneficial effect, while the decrease inrelated force sense errors was calculated to have a93% likelihood of being at least a small clinicallybeneficial effect. Halseth et al.''''! (methodologicalquality = 2) also examined the effects of KT onankle proprioception. The KT group showed nostatistically significant change in absolute error forankle reproduction of joint position sense mea-surements for both plantar fiexion and inversion,when compared to the untaped condition. Therewere not enough data available for us to makeclinical inferences regarding these results.

Given that a beneficial effect of KT was seenfor force sense errors in grip strength, but nonsig-nificant results were reported for ankle proprio-ception, more studies are required to determinethe effect of KT on proprioception, particularlyamongst injured athletes.

©2012 Adis Data Information BV. All rights reserved. Sports Med 2012. 42 C2)

Kinesio Taping Meta-Analysis Review 163

3.6 Muscle Activity

It is unclear what direction of change in muscleactivity represents a beneficial effect; a decreasemay imply KT is having a supporting effect andthe muscle is working more efficiently, while anincrease could represent a facilitatory effect andenhanced muscle function.''' This is likely to bedependent on the specific muscle being assessed,the selected subjects (healthy or injured subjects)and the taping technique.

Two studies have reported significant effects ofKT on muscle activity measurements using electro-myography (EMG) [see table IV]. The study by Hsuet al.'^' was of methodological quality level 3, whilethe study conducted by Shipik et al.''-'' was ofthe lowest methodological quality (level 1). A 10%change in muscle activity has previously been usedas a smallest meaningful difference, based on theknown typical error associated with measure-ment.'-^ Hsu et al.'^' reported increased lower tra-pezius muscle acti vity in the 60-30° arm loweringphase during the KT condition, when comparedwith the placebo taping condition. The 14 ±12%increase in lower trapezius activity represented a92% likelihood of being substantial. The authorssuggested that increased muscle activity during thisphase implied that the subjects with shoulder im-pingement were responding to the KT treatment.Upper trapezius muscle activity was lower duringthe KT condition between 90-120° humeral eleva-tion (80% likelihood of being substantial). The au-thors suggested that the heightened activation underthe placebo taping condition may have been a resttltof the effort needed to counteract the restrainedscapular movement produced by the nonelasticplacebo tape. No other statistically significant posi-tive results were reported for any of the 16 otherEMG measurements, although two of these werepossibly substantial and one likely substantial in ouranalysis. The remaining results were inferred to betrivial (9) or unclear (4) in our analysis.

Shipik et al.''^' reported a 54% increase in muscleactivity of the vastus mediaiis muscle 24 hours afterapplication of KT. This effect was inferred to bemost likely substantial. After 72 hours there was a22% mean increase, compared with baseline valuesresulting in an effect we calculated to be very likely

substantial. Changes in muscle activity 10 minutesand 96 hours after KT application were both triv-ial. However, the order in which subjects weremeasured under the two conditions (with andwithout KT) was not performed in a crossovermanner, and therefore the order effects were notcontrolled for. There was no placebo group, and sowe were unable to ascertain whether changes werespecifically due to KT, or simply the effect of tapingalone. As a consequence, the results of this studymust be questioned.

In the one study of high methodologicalquality to investigate the impact of KT on muscleactivity, KT was associated with a substantialchange in muscle activity over specific ranges ofhumeral elevation. However, the majority of dif-ferences were trivial or unclear. Further researchis required to determine whether the changes in-duced by KT were beneficial in the treatment ofthe injury.

4. Conclusion

• KT may have a small beneficial effect onstrength, force sense error and active range ofmotion of an injured area, but further clar-ification is needed.

• There was no substantial evidence to supportthe use of KT for improvements in othermusculoskeletal outcomes (pain, ankle pro-prioception or muscle activity).

• Future research should focus on the efficacy ofKT in the treatment of injuries in sportingcohorts.

• Appropriate blinding of subjects and asses-sors, as well as the presence of a placebo tapinggroup, is required to ensure methodologicalquality.

Acknowledgements

The Auckland University of Technology funded this re-view. The authors have no conflicts ofinterest that are directlyrelevant to the content of this review.

There are no competing interests by the iiuthors. Thecorresponding author has the right to grant on behalf of allauthors and does grant on behalf of all authors, an exclusivelicense (or nonexclusive for government employees) on a

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164 Williams et al.

Worldwide basis to the journal editor to permit this article tobe published in the journal.

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