Rationales and Evidence of Elastic Taping: A clinician's per

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J Int Acad Phys Ther Res 2016; 7(1): 979-988ISSN 2092-8475

www.iaptr.orghttp://dx.doi.org/10.20540/JIAPTR.2016.7.1.979

Repetitive stress on joints and tissues by sportsactivity, daily life, hard working that may causeloss of function and musculoskeletal disorderresulting in disabled conditions in manypatients(1). Taping is a one of the therapeuticmaneuver used by many physical therapist totreat musculoskeletal disorders(2).

Generally, the tape is applied around and overthe muscles to avoid over contraction(3) and theo-rized to reduce inflammation and pain by increas-ing blood and lymphatic circulation without limitthe ROM of the injured area(3-5). This maneuverdiminishes 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, thereare various taping treatments has been used, suchas Mulligan, Kinesio Taping, and McConnellmethods.

Recently, this taping is also being increasinglyused in medical and physiotherapeutic practice.Despite the success and popularity of this taping,there's a lot of suspicion and academic scepticismon its efficacy. The latest systematic reviews onelastic taping also demonstrate insufficient evi-dence to support the use thereof. Many questionsstill arise and remain unanswered about how thetape 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 tapeapplication on improving body conditions. The search strategy for thisreview included a literature search by members of the InternationalKinematic Academy in 12 countries between January 2014 and February2015 using PubMed, CINAHL, Cochrane, Google Scholar, websites andnational 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 publishedin different languages. These searches resulted in 821 publications. Thereare several effects of tape application were revealed such as improvingblood circulation, lymphatic circulation, body range of motion, activation ofmechanoreceptor and joint stability, and decreasing pain. No one negativeabout the positive effects of taping, however the more effort is required tofind evidence of effects of tape application.

Key words: Taping; International Kinematic Academy; Kinesiotape; BloodCirculation; lymphatic Circulation

John Langendoena, Caren Fleish-manb, Soon Hee Kimc, Ho JungAnd

aPresident International Kinematic TapingAcademy, OMT-Instructor, Member SC IFOMPT,Kempten Germany; bMember InternationalKinematic Taping Academy, OMT-Instructor,Johannesburg South-Africa; cYong-inUniversity, 134, Yongindaehak-ro, Cheoin-gu,Yongin-si, Gyeonggi-do, Republic of Korea;dDongnam Health University, Jeongja 3-dong,Jangan-gu, Suwon-si, Gyeonggi-do, Republicof Korea

Received : 27 September 2015Revised : 29 October 2015Accepted : 12 November 2015

Address for correspondenceHo Jung An, PT.Ph.D Department of Physical Therapy,Dongnam Health University, Jeongja 3-dong, Jangan-gu, Suwon-si, Gyeonggi-do,Republic of KoreaTel. 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 influenceof these methods has not yet been performed(6-8).Thus, this review tried to address those questionsunanswered in systematic reviews to date, basedon a clinician’s perspective.

The search strategy for this review included a lit-erature search by members of the InternationalKinematic Academy in 12 countries betweenJanuary 2014 and February 2015 using PubMed,CINAHL, Cochrane, Google Scholar, websites andnational journals. The search words included

“Kinesiotape, Kinesio tape, kinesiotaping, elastictaping, taping, functional taping, myofascial tap-ing, sensomotor taping”. The review included allarticles, 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 wereexcluded as they had been extensively reviewedelsewhere(3-14). Our research was to focus onevidence for rationales, explanations and clinicallyrelevant aspects.

Tapes under investigation:None of the systematic reviews critically

appraised the Kinesiotape applications used in thestudies. As there is no convincing evidence for anyKinesiotaping applications, it does not mean thatthere is no evidence for other elastic taping con-cepts in general. The principles and rationales forKinesiotaping are not in complete agreement withcommon 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 theskin (which implies afferent input) is a placebointervention(19). Use of the words “non specific”intervention may be more appropriately used than

“sham”, compared with a taping application usingorthopaedic manual therapy(OMT) principles.

Use of coloursAlthough colour significantly contributes to the

popularity of elastic taping, no study showed evi-dence for the use or non-use of a specific colourfor a specific condition and the colour debate wasnever mentioned in any systematic review. Theinventor of the elastic tape material, Kase,revealed that there has not been a specific medicalreason for developing different colours(20).

Limitations of the systematic reviewSome limitations are recognized by the reviewers

e.g. limited to English language or randomizedcontrolled outcome studies, or studies without acontrol group.

Long term follow upReviews criticize the lack of long term follow up

but even in the original concept of taping improv-ing lymphatic and blood circulation, it was meantto be an intervention with an immediate and shortterm effect. On the sports field, time from treat-ment or training session to another session maybe a few hours while in the clinical setting, treat-ment time can vary from daily treatments totreatment once a week. Treatment strategies willvary during the course of treatment dependant onthe effect and so will taping applications.Therefore it is not appropriate to examine the longterm 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 andblood circulation without restricting range ofmotion. It has been demonstrated in single casemeasurements in normal subjects with Dopplersonography that elastic tape, applied to the skinover a major artery, increased the arterial bloodsupply in the distal course of that artery(21). Animproved blood supply promotes self healingmechanisms and confirmed an initial research aimof Kase. Despite this initial evidence, rigorous fol-low up studies to confirm these findings are lack-ing to date. Miller et al. demonstrated that therewas there was no difference in blood flow withrigid or elastic tape or conditions(22). It appearedthat the application of either tape may changeblood flow to the targeted area, but most likely as

Analysis of the systematic reviews

METHODS

RATIONALES

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J. Langendoen, C. Fleishman, S.H. Kim, et al.

a result of prior exercise.Shim et al. demonstratedthat taping the hind leg of a rabbit increased thelymphatic flow, however only in combination withpassive movement(23). However, the effect ofpassive movement alone has not been investigat-ed. Post-partum breast engorgement and mam-mary gland pain were not influenced by breastlymphatic tapes, as there is no option to add pas-sive or active movement(24). Lymphatic tapeapplications as being used in post-traumatic andpost-surgical conditions to reduce swelling do notemphasise that movement needs to be added tothe application. But there is weak evidence thatsecondary lymph oedema, e.g. after breast sur-gery, may benefit from lymph applications, inaddition to manual lymphatic therapy (25-33).

Nunes et al. demonstrated that there was nodecrease in swelling after kinesiotaping of aswollen ankle after a lateral ankle sprain(34).The principles of increasing arterial blood supply

and lymphatic drainage are not commonly used bymanipulative physical therapists in neuromuscu-lar treatment, thus other rationales (mechanical,neurophysiological) should be considered.

In addition to the self healing philosophy, Kasealso used a mechanical approach, which, however,does not comply with all OMT principles(35). TheMcConnell approach, in which rigid taping is oneof the management pillars, in contrast, adheres toOMT and neuromusculoskeletal(NMS) rehabilita-tion principles(36).

Kawabata et al. could demonstrate with spiraltapes around the lower and upper leg that therotatory angle between the femur and tibia sig-nificantly changed under loading, as with one legsquatting or drop landing(37)(S. Fig. 2a-d). Thesetests are considered relevant in many patientswith anterior knee pain (patello-femoral painsyndrome). Kawabata et al. are the onlyresearchers to date to demonstrate a change inosseous movements during functional loadingwith elastic taping(37).

Further research could reveal that elastic tapesapplied according omt principles instead of kine-siotapes could change positional faults of the lat-eral malleolus or fibular head after an anklesprain or the clavicle after an acromioclavicularjoint sprain.

Neurophysiological processes:

It is the skin that is being taped. The skin is thebiggest human organ with countless nerve end-ings at its layers. Tape on the skin is perceptible.So, there is afferent input in the somatic nervoussystem. Most patients report that the tactile per-ception is hardly felt. Possibly the unmyelinated ctactile(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 isalways an input. In studies, one could compare(socalled) specific with non specific(and not placebo)tape applications. It is self evident that, as in anytherapy, there is a placebo effect with any tapeapplication. Any placebo effect can be used con-sciously, as well as simultaneously be minimizedwith increasing specificity of the treatment. Themore precise the examination and treatment is,the more specific a dysfunction is treated and,subsequently taped, the less the placebo effectcould be. Studies providing the evidence for thisare 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 stretchin a certain direction, aims to change the shearingof the skin and fascial layers. Dynamicmechanoreceptors, such as Ruffini and interstitialreceptors, are localized to the border zones ofthese soft tissue layers(40-49). Alteredmechanoreceptive afference could alter processingin the dorsal horn and (inter-)segmental interne-urons, explaining immediate pain inhibitoryeffects, increased pain-free range of motion andincreased muscle power. Such observable immedi-ate changes can be explained neurophysiologicallyrather than physiologically by increased arterialblood supply or increased lymphatic drainage.Investigations with somato-evoked potentials(SEP) could support the proposed mechanisms.Yamamato could demonstrate a change in spinalcord excitability with SEP after taping theskin(50).As 50% of interstitial dynamic mechanoreceptors

have a high threshold, a sufficient amount ofstretch is required to activate them. To avoidrapid adaptation tape has to be applied over thejoints and movement of the joint ensures repeatedstretch and activation of the receptors.Tape stretch can vary between 0% (traditionally

with lymphatic, but also in facial and anteriorneck applications) to 100%(only additionally insome osseous or articular conditions with a mechan-

Mechanical correction

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ical rationale). The most commonly used amountof stretch for mechanoreceptor activation is up to33%. A helpful clinical guideline is: the softer andmore flexible the skin is, the less stretch is to beapplied. The beginning and ending of the tape, arealways 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 shearingbehaviour of skin and fascial layers is to bechanged and the dynamic mechanoreceptor

rationale is adopted. Parreira et al demonstrated that tape applica-

tions with convolutions are not more effectivethan sham (unspecific) tapes in the treatment ofchronic low back pain(51). Convolutions may onlybe 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. Inaddition, there is no evidence that this decreasespain by reducing pressure on the nociceptors asassumed by Kase(35).Investigating standardised interventions, including

Kase & Hashimoto 1998Miller et al. 2011

Increase of Arterial Blood Supply Single case examples in normal subjects. No furtherresearch or objective confirmation to date

Kawabata et al. 2007Change osseous positions Further investigations needed, e.g. for the clavicle afteracromio-clavicular joint sprains, for the fibula after anklesprain

Selkowitz et al. 2007 (non-elastic tape)

Hsu et al. 2009 Berkmiller 2013

Changing muscle function Further evidence for changing action of overactive orunderactive muscles is needed. The kinesiotapingapproach in changing the direction of application to tonifyand detonify is not in agreement with actual paradigms.

Corey et al. 2001Stecco et al. 2011Yamamoto 2011

Activation of(Ruffini and high-threshold interstitial) dynamic

Mechanoreceptors

Further evidence on patient groups with Somato-EvokedPotentials(SEP) needed

Yoshida & Kahanov 2007Berkmiller 2013Sazegar 2013

Reciprocal Inhibition Finger to Floor distance decreased after lumbar tape.Decrease of protective muscle action at a neurodynamictest with movement against tape resistance(EMG). Furtherstudies 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. 2009Brown & Langdon 2014

Parreira et al. 2014Nunes et al. 2015

Increased Lymphatic Drainage Increase of lymphatic vessel contraction frequency only incombination with passive movement.Weak evidence for post-traumatic & post-surgical condi-tions.Convolutions do not seem to be required.

Björnsdotter et al. 2009Löken et al. 2009

Activation of C-tactile(social)afferents

Neurophysiological investigation needed to demonstratechanges in afferent activity and to provide evidence for ageneral, unspecific effect of skin taping

ReferenceRationales Remark

Table 1. Rationales and Evidence for Elastic Taping

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tape applications, in a heterogenous group ofpatients is unlikely to present convincing evidencefor that intervention. Identifying a homogenoussubgroup of patients is necessary before investi-gating the effect of a standardised intervention(e.g. a tape application) on selected outcome toolssuch as relevant physical tests or muscle activity(with EMG). Systematic reviews to date thereforecould not reveal the benefits of taping as seen indaily practice. In contrast, in homogenous sub-groups, the effect of a standardized application onselected, relevant variables can be investigated.

Randomized controlled trials should thereforeinvestigate the short term effect of treatmentswithout, as well as with specific and with shamtaping on pain, range of dysfunctional movementpatterns and even muscle activity during testmovements(EMG) in homogenous subgroup ofpatients(52). A subgroup of patients with the sameof pool of relevant positive tests can be consideredas homogenous, and can be used for immediateand short term(24 to 72 hrs) outcome measure-ment.

Lack of evidence should motivate clinicians tobecome more precise, to consider further ratio-nales, to apply current principles and guidelines ofmodern neuromusculoskeletal rehabilitation, as

well as to experiment and innovate. Relevantvariables to consider when applying tape mayinclude: the starting position of the dysfunctionalstructure, the range of the dysfunctional move-ment, the length, the course and the direction ofthe tape(s) as well as the amount of tape stretch.This example gives one explanation for the con-

clusion of many randomised clinical trials andsystematic reviews that standardised interven-tions for a diagnosis(e.g. non specific low backpain) do not lead to significant improvements.

For some elastic tape applications there is evi-dence that relevant variables, such as positivetests, may change(37)(55-60). All these studiescan easily be criticized from a clinical point ofview or a theoretical neuro-physiological perspec-tive. Nevertheless, they confirm regular observa-tions of clinicians. Two EMG studies demonstratedimproved scapular motion(59,61) and are ofimportance when considering tape applications inshoulder 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(modifiedfrom Kawabata et al.(37)).

EVIDENCE

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Fig. 2. 3a-c. A patient with low back pain and a flexion pattern(no limitation of lumbar flexion). A basiclumbar application(Yoshida & Kahanov(53)) did not reduce pain or improve finger to floor distance atlumbar 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: immediateincrease in range and decrease of pain on lumbar flexion(Sazegar(54)).

system disorders with spasticity, have suggestedthat elastic taping can support rehabilitation(62-66). As management in these patient groups isgenerally very individualized, any study requiresinvestigation of a very limited number of parame-ters in a relatively homogenous subgroup.

Further possible applications include facial andabdominal taping. For example, it has been shownthat taping the lower abdomen with horizontaland vertical tapes decreased primary dysmenor-rhoea pain as effectively as the best possible con-

traceptive pill(67-69). Participating in a studycomparing a tape intervention with a non-tapeintervention control group may have included asignificant placebo and/or Hawthorne effect.Taping has no effect on healthy, normal muscles

and joints(70-73). Nevertheless, taping can beapplied preventatively during or after heavyphysical loading, e.g. at sports to prevent injuriessuch as ankle sprains, to prevent or limit fatigueand muscle soreness (74-79).

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The evidence in controlled clinical trials inpatient groups is generally weak, as concluded byreviews and systematic reviews. The methodology,as well as the original applications of Kase beingused in the studies can be critically reviewed. Asoutlined, 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 elastictaping in homogenous subgroups or selected vari-ables.Elastic taping with coloured tape cannot be con-

sidered evidence-based to date. Therefore itdemands a critical clinician’s mind using soundclinical reasoning, current principles of orthopedicmanual therapy, (including appropriate re-assessments) and acceptable rationales, for apply-ing tape to enhance treatment. Further research isneeded to justify the rationales. Evidence for theexplanations could lead to the further develop-ment of elastic taping applications.

Clinical success in reflective practice(practicebased evidence-PBE) and growing scientific back-up(scientific evidence SE) will both contribute toestablishing elastic tape as a beneficial adjunct inthe comprehensive management of patients withmovement disorders, beyond the initial hypeamong consumers and in sports physiotherapy.

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Rationales and Evidence of Elastic Taping: A clinician's per

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