Is there a place for kinesiotape in
modern osteopathic practice?
Author: Richard Moore, 07004959
Abstract
Background
Kinesiotaping (KT) was developed by Kenso Kase in the 1970s as a method of assisting
physical treatment of damaged tissue whilst maintaining full range of motion. It works by lifting
the epidermis to reduce compression of underlying tissues and aid venous and lymphatic
movement. The aim of this paper was to identify evidence for the use of KT in the treatment of
musculoskeletal conditions and suggest how this could inform osteopathic treatment.
Method
A critical literature review was conducted to investigate the effect of KT on musculoskeletal
conditions. Five electronic databases (PUBMED, AMED, PEDRO, CINAHL, SPORTDiscus)
and five key websites were searched up to 19th November 2011. 9 randomised controlled trials
met specified inclusion criteria. The CASP RCT appraisal tool was used to assess validity and
quality of each trial.
Results
Three papers discussed use of KT in patello-femoral pain, three for shoulder impingement, one
for whiplash-affected disorder, one for plantar fasciitis and one for chronic low back pain.
Methodology was varied with taping protocols, comparison and measured outcomes
inconsistent across the studies. Positive effects were seen in muscle flexibility, pain, disability
and fascia thickness when compared to manual therapy and sham taping.
Conclusion
Despite considerable heterogeneity of study design, positive effects of KT have been identified
and could be utilised by osteopaths in the treatment of acute or chronic conditions. Further
research with larger study groups and homogeneous methodology should be undertaken to
provide definitive results in treatment of named conditions.
Keywords: kinesiotaping, osteopathy, patellofemoral pain, shoulder impingement (250 words)
Contents
INTRODUCTION ........................................................................................................... 3
Aims ......................................................................................................................................................... 8
METHODS ...................................................................................................................... 9
RESULTS ...................................................................................................................... 13
Emergent Themes .................................................................................................................................. 20
DISCUSSION ................................................................................................................ 21
Kinesiotaping as a viable alternative ..................................................................................................... 26
Limitations of studies assessing efficacy of kinesiotape ........................................................................ 27
Limitations of this review....................................................................................................................... 28
CONCLUSION.............................................................................................................. 29
Opportunities for future research ......................................................................................................... 29
ACKNOWLEDGMENTS ............................ ERROR! BOOKMARK NOT DEFINED.
REFERENCES .............................................................................................................. 30
Introduction
Kinesiotaping was developed by Japanese chiropractor Kenso Kase in the 1970s as a method of
assisting physical treatment of damaged tissue whilst maintaining full range of motion, unlike
traditional taping methods, which restrict movement (Kinesio UK, 2011). Popular applications
include patellar or achilles tendinopathy, acute shoulder impingement and lower back strain
(Konin, 2010). The Kinesio Taping Association (KTA) has over 10,000 members worldwide
and is training professionals at a rate of over 800 per year in the UK alone (Slater, 2012).
Kinesiotape (KT) first gained widespread attention at the 1988 Seoul Olympics, where 50,000
rolls were donated to 58 countries, giving the product exposure on the world stage (Lowes,
2008). Since then, high profile athletes such as Lance Armstrong, Rory McIlroy and David
Beckham have popularised use of the tape (Wintle, 2012).
KT’s ability to longitudinally stretch and the direction that it is applied, offers the therapeutic
value (Kase et al, 2003). The tape works by lifting the epidermis, as the tape recoils after being
applied with tension (Figure 1). This lifting increases interstitial space between the skin and the
underlying connective tissues, vessels and muscles to reduce compression and aid lymphatic
and venous movement (Yoshida & Kahanov, 2007).
Taped/“Lifted” area
= reduced compression on interstitial space
Non-Taped Area
= blood and lymph vessels
compressed beneath epidermis
Figure 1: The effect of kinesiotape on the skin and underlying tissue (Hitech Therapy, 2012).
The ‘lifting’ also has an effect on underlying fascia, reducing pain, decreasing susceptibility to
microtrauma and improving muscle performance (O'Sullivan & Bird, 2011).
The therapeutic effect is the same for all available colours and is dependant on how the tape is
applied. Figure 2 demonstrates a typical application to inhibit a strained muscle, tension being
applied distally to proximally along the muscle, with 15-25% tension. Figure 3 shows
application in the opposite direction to facilitate a weakened muscle, with 15-35% tension.
Figure 2: Muscle Inhibition.
(Biceps brachii)
Figure 3: Muscle Facilitation
(Biceps brachii)
Application to aid oedema is shown in Figure 4. A single strip is cut into multiple tails placed
over the oedema with 0-20% tension. The ‘head’ of the tape is placed towards the target lymph
nodes.
KT can also be used to stabilise by placing it over the unstable joint, with all the stretch
removed, applying over 75% tension (Figure 5).
Figure 4: Lymphatic correction.
Figure 5: Mechanical support
(Acromioclavicular joint)
The effect on healthy individuals has been the subject of observational studies, focussed on a
range of outcomes, including muscle strength and motor nerve conduction. Of the fifteen trials
identified (Table 1) seven returned positive results in all or some of the outcomes measured,
whilst the remaining studies found nil or inconclusive results.
Where numerous trials have looked at the same outcome, results are contradictory. In the case
of grip strength, Chang et al (2010) found no positive effect from KT applied to the forearm,
compared to sham and no taping, whilst Lee et al (2010) found a clear improvement in grip
strength, albeit without a control group.
Similar contradiction is found in studies looking at effect on the quadriceps. Aktas & Baltaci
(2011) found a positive effect on jump height, Słupik et al (2007) noticed an increase in motor
unit recruitment after taping, whilst Vithoulkaa et al (2010) found that the overall effects of KT
mixed, with eccentric force improved but concentric force the same as control and Fu et al
(2008) found no positive effect.
Table 1: Studies investigating physiological effects of kinesiotaping in healthy individuals
Study
Effect tested /
Application
Sample size
Outcome
Aktas & Baltaci, 2011
Muscle strength
Jump height
(quadriceps)
20 (9 male, 11
female)
Positive
(jump &
peak torque)
Chang et al, 2010
Grip strength
(forearm flexors)
21 (all male).
Nil
Firth et al, 2010
Single leg hop test,
pain.
(Achilles tendon)
Muscle strength
(quadriceps and
hamstrings)
Proprioception
(lateral & medial
lower leg)
Sporting performance
(diaphragm)
48 (24
asymptomatic, 24
achilles tendonitis)
14 (7 male, 7
female).
Nil
30 (15 male. 15
female)
Nil
17 (10 male, 7
female)
Nil
Huang et al, 2011
Vertical jump
(triceps surae)
31 (19 male, 12
female)
Nil
Lee et al, 2010
Grip strength
(forearm flexors)
40 (20 male, 20
female)
Positive
Lee et al, 2011
Motor nerve
conduction velocity
Pelvic tilt
(lumbar erector
spinae)
Motor perception
(knee)
Muscle activity
(Vastus medialis)
17 (9 male, 8
female)
40 (23 male, 17
female).
Nil
19 (9 male, 8
female)
27 (15 male, 12
female)
Positive
Muscle strength
(masseter)
Muscle strength
(quadriceps)
11 (7 male, 4
female)
20 (all female)
Nil
Fu et al, 2008
Halseth et al, 2004
HombradosHernándeza et al, 2011
Lee, Yoo & HwangBo, 2011
Lou, 2008
Słupik et al, 2007
Soylu et al, 2011
Vithoulkaa et al, 2010
Yoshida & Kahanov,
2007
Trunk range of motion 30 (15 male, 15
(lumbar erector
female)
spinae)
Nil
Positive
Positive
Positive
(eccentric
torque)
Positive
(flexion
only)
Overall, studies involving healthy individuals found some positive effect on muscle strength
(Soylu et al 2011, Lee et al 2010, Vithoulkaa et al 2010), flexibility (Yoshida & Kahanov 2007,
Lee et al 2011) and motor nerve conduction (Lee et al 2011), suggesting that KT could be used
in the treatment of musculoskeletal conditions. Further examination of studies investigating the
use of KT is indicated along with how this information could successfully be used by osteopaths
in the treatment of common musculoskeletal conditions, adhering to established osteopathic
principles.
Aims
It is the aim of this paper to identify evidence for the use of kinesiotaping in the treatment of
musculoskeletal conditions and how this information could be used in an osteopathic setting.
Studies will be included if investigating the use of the KT in a pathological state through a
controlled trial, with observational studies or those conducted solely on healthy individuals
excluded. Based on these findings, the implications on osteopathic care will be discussed and
opportunities for further research suggested.
This is framed in the question: “Is there a place for kinesiotaping in modern osteopathic
practice?”
Methods
As an initial search of the Cochrane Library found no existing systematic or literature reviews,
PUBMED, AMED, CINAHL, PEDRO and SPORTDiscus databases were searched up to 19th
November 2011, with the following string:
(kinesio tap*) OR (kinesiotap*) OR (k-tap*)
Additional to the database searching, the websites of the Osteopathic Research Web
(www.osteopathic-research.com), OSTMED (www.ostmed-dr.com), Journal Of American
Osteopathic
Association
(www.jaoa.org/),
Chiropractic
&
Manual
Therapies
(www.chiromt.com) and Open Grey (www.opengrey.eu) were also searched.
Once all duplicates had been removed, inclusion and exclusion criteria (Table 3) were applied to
these results. To focus results, all studies where kinesiotape was not the primary focus were
removed, as were treatments for non-musculoskeletal conditions such as cerebral palsy and
breast cancer. Observational studies on healthy individuals were also discarded. Only controlled
trials were selected for review.
Hand searching of the selected papers returned ten additional papers, one of which met all the
relevant inclusion and exclusion criteria. This gave a total of nine papers to be assessed (Figure
8).
The nine studies selected were then subjected to the CASP assessment tool (Table 4). All papers
submitted for CASP assessment were found to be of a high enough quality to be included in the
review.
Table 3: Selection criteria for papers investigating efficacy of kinesiotape in treatment of
musculoskeletal conditions.
Population
Inclusion criteria
Exclusion criteria
Reasoning
Human
Non-human
Primary MSK condition
being treated
Healthy individuals
To focus on conditions that
may typically present to an
osteopath to maximise
relevance
Non-MSK presentation
e.g. cerebral palsy
Intervention Kinesiotape only
Application by trained
professionals using
recognised techniques
Non-elastic tape
Multi-modal
interventions/comparisons
Applications not specified,
described or focussed on
condition being treated
Control
Control group receiving
sham or no taping
Lack of control group
Outcome
Studies using objective
methods to identify
change is muscle
activity, range of motion
in specific
muscles/joints alongside
subjective measures
Randomised controlled
clinical trials, controlled
clinical trials, controlled
pilot studies
Studies solely using
subjective measures such
as pain scales
Published in English
language
Non-English language
Study
design
Independent from tape
manufacturer, trainer or
distributor
Published in past 10
years
Studies not relating
findings to identified
pathology
Case reports
Observational studies on
asymptomatic participants
Literature reviews, metaanalyses
Studies funded by tape
manufacturers / trainers
To identify effect on
pathological state rather than
effect on healthy tissues
To identify studies looking at
kinesiotape rather than
traditional athletic tape /
‘McConnell’ tape
To focus on effect of
kinesiotape
To ensure tape is used
effectively
To measure effect of tape
against sham / no tape or
alternative intervention
rather than alternative taping
applications
To reduce possibility of bias
(Kane, 2004)
To identify effect of
intervention on identified
pathology
Focus on highest form of
evidence (Sackett,
Rosenberg, Gray, Haynes, &
Richardson, 1996)
Primary studies only
(Aveyard, 2008, p. 23)
English language studies can
only be used due to resource
limitations
To reduce possibility of bias
Most recent material only
Searching electronic databases (n=117)
PubMed
PEDro
CINAHL
AMED
SPORTDiscus
27
17
43
24
6
Osteopathic Research Web
OSTMED
JAOA
Chiropractic & Manual Therapy
Open Grey
0
0
0
0
0
Duplicates removed (n=49)
Abstracts retrieved
(n=68)
Papers reviewed
(n=33)
Papers selected
(n=8)
Reference list searches (n=10)
Additional papers (n=1)
Excluded (n=35)
 Case reports
 Articles
 Non-English
9
10
16
Excluded (n=25)
 Non-MSK
 Healthy individuals
 Non-controlled
 Multimodal
3
8
11
3
Excluded (n=9)
 Non-English
 Case reports
 Healthy individuals
 Non-controlled
 Multimodal
3
2
3
1
3
Papers selected for review (n=9)
Figure 8: Flowchart showing literature selection process for papers investigating efficacy of
kinesiotape in treatment of musculoskeletal conditions.
Table 4: Critical appraisal results using CASP tool for selected papers investigating efficacy of
kinesiotape in treatment of musculoskeletal conditions.
1
Akbas et al
(2011)
Aytar et al
(2011)
Chen et al
(2008)
GonzalezIglesias et
al (2009)
Hsu et al
(2008)
Kaya et al
(2010)
Paoloni et
al (2011)
Thelen et
al (2008)
Tsai et al
(2010)
CASP Questions ( = Yes; ? = Unclear;  = No)
2
3
4
5
6
7
8
9
10







?



?
?





?
?
?















?

































?

?

?















Results
Nine studies were identified with a total of 326 participants, investigating the effect of
kinesiotape (KT) on patellofemoral pain (n=3), shoulder impingement (SI) (n=3), whiplash
affected disorder (n=1), chronic lower back pain (n=1) and plantar fasciitis (n=1).
Table 5 summarises the results for the use of KT in patello-femoral pain (PFPS). Akbas et al
(2011) found that KT in conjunction with strengthening exercises and soft tissue massage
achieved faster improvements (significant at three weeks) in both pain and muscle flexibility
when compared to exercise and massage alone, although final outcome levels at six weeks were
similar in both groups.
The two remaining studies (Aytar et al, 2011 and Chen et al, 2008) looked at the effects of KT
immediately after application. Aytar et al (2011) examined the effect on pain alongside balance,
proprioception and muscle strength when compared to sham tape. Although there were no
statistically significant differences in pain and proprioception after application, positive effects
were seen on muscle strength and dynamic balance in the KT group.
Finally, Chen et al (2008) investigated the effects on stair climbing and found ground force
reaction reduced when descending and muscle firing improved in the symptomatic KT group.
No positive results were seen in the asymptomatic group despite identical application of KT.
Table 6 summarises the results for the use of KT in shoulder impingement. Hsu et al (2009)
adopted a pre-test and post-test model, comparing KT to sham tape applied across the lower
trapezius of symptomatic baseball players. Scapular movement improved in both groups, as did
activation of the upper trapezius and serratus anterior but the KT group also showed
improvements in activity and strength of the lower fibres of trapezius.
Thelan et al (2008) and Kaya et al (2010) both investigated the effects on pain and disability,
with a similar taping protocol across supraspinatus, deltoid and teres minor.
Table 5: Summary of results from selected papers investigating efficacy of kinesiotape in treatment of patello-femoral pain syndrome (PFPS).
Study
Akbas et al, 2011
Aytar et al, 2011
Chen et al, 2008
Presenting
condition
PFPS
(n = 31)
Outcomes measured
Experimental group
Control group
Summary of results
1. Pain
2. Soft tissue flexibility
3. Patellar positioning
1. Strengthening
exercises
2. Soft tissue massage
(n = 15)
 Pain, flexibility improved in
PFPS
(n = 22)
1. Pain
2. Muscle strength
3. Proprioception
4. Balance
1. KT to facilitate
quadriceps, ilio-tibial
band (ITB) and
hamstrings
2. Strengthening
exercises
3. Soft tissue massage
(n = 16)
KT to quadriceps and
around patella
(n = 12)
Identical taping but with
non-flexible sticking
plaster
(n = 10)
 Strength improved in both
PFPS
(n = 25)
1. Ground force
reaction (GRF)
2. Muscle firing
KT to facilitate vastus
medialis and inhibit
vastus lateralis – PFPS
sufferers
(n = 15)
Identical taping in
healthy individuals
(n = 10)
 No positive effect seen in
both groups by end of trial
 Flexibility of soft tissues
(hamstrings and ITB) occurred
faster and greater in KT group
 Neither group saw positive
change in patellar position
groups (60 = both, 180 = KT
only)
 Balance improved in both
groups (static = both, dynamic
= KT only)
 No significant changes in pain
or proprioception in either
group
healthy individuals
 GRF reduced in descending
stairs in KT group
 Timing of activation of vastus
medialis improved in KT
group
Key: KT = Kinesiotaping ; PFPS = Patello-femoral Pain Syndrome
Kaya et al (2010) compared KT applied every three days, along with guided home exercises, to a daily
programme of ultrasound, TENS, heat pack and home exercise. Pain levels at the end of the two-week
trial were similar in both groups but the KT group improved faster with significant differences at the
end of week one. Disability scores were more improved (a drop from 57.5 to 18 compared with a drop
from 56 to 31 on the DASH 100-point score) in the KT group at the end of the trial.
Thelan et al (2008) compared KT to sham tape over a six-day period. By the end of the trial, both
groups achieved similar results for improvement of pain-free range of movement but the KT group
achieved results after just three days compared to six days for the control group. There was no
significant difference in pain or disability in either group by the end of the trial.
Table 7 summarises the results for the use of KT in chronic low back pain (CLBP), whiplash affected
disorder (WAD) and plantar fasciitis (PF).
Gonzalez-Iglesias et al (2009) investigated the effect of KT on pain and cervical range of motion
following WAD over a 24 hour period when compared to sham KT (applied with no tension).
Although there were statistically-significant improvements to both pain and range of motion in the KT
group at the end of the trial, both were at levels deemed not clinically relevant.
Paolini et al (2011) studied the effects on chronic low back pain across three groups; KT only, KT plus
home exercises and home exercises only. An immediate effect was seen on pain in all KT groups but it
was the home exercise group that showed most improvement in disability at the end of the 4-week
trial.
The last paper, Tsai et al (2010) focussed on plantar fasciitis, comparing KT with daily physical
therapy. Both pain and foot function improved more in the KT group and there was a significant
reduction in plantar fascia thickness, as measured by ultrasound, at the insertion site on the calcaneus
in the KT group. However, plantar fascia thickness at the site of most significant inflammation was
unchanged in both groups.
Table 6: Summary of results from selected papers investigating efficacy of kinesiotape in treatment of shoulder impingement (SI).
Study
Hsu, et al, 2009
Kaya et al, 2010
Thelen et al,
2008
Presenting
condition
Shoulder
impingement
(n = 17)
Outcomes measured
Experimental group
Control group
Summary of results
1. Shoulder kinematics
2. Muscle activity
3. Muscle strength
KT to lower trapezius
(n = 17)
Identical taping but with
non-flexible 3M tape
(n = 17)
 Improved scapular posterior
Shoulder
1. Pain
impingement 2. Disability
(n = 55)
KT over supraspinatus,
deltoid and teres minor
+ home exercise program
(n = 30)
Ultrasound, TENS, heat
pack and exercise daily
+ home exercise program
(n = 25)
 Pain improved equally by end
Shoulder
1. Pain
impingement 2. Disability
(n = 42)
3. Range of movement
(ROM)
KT over supraspinatus
and deltoid and across
coracoid process
(n = 21)
KT applied with no
tension in nontherapeutic areas
(n = 21)
 Immediate improvement in
tilt at 30-60 in both groups
 Increased lower trapezius
activity at 60-30 in KT group
 Decreased activity in same
range in control group
 Increase in serratus anterior
and upper trapezius activity in
both
 Increase in strength of lower
trapezius in KT group
of trial but improvement was
initially faster in KT group
 Disability scores lower in KT
group than control group at
end of trial
ROM in KT group but similar
improvement in both groups at
end of trial
 No significant improvements
to pain or disability in either
group
Key: KT = Kinesiotaping ; SI = Shoulder Impingement
Table 7: Summary of results from selected papers investigating efficacy of kinesiotape in treatment of whiplash-affected disorder (WAD), chronic low back
pain (CLBP) and plantar fasciitis (PF).
Study
Presenting
condition
Gonzalez-Iglesias WAD
et al, 2009
(n = 41)
Outcomes measured
Experimental group
Control group
Summary of results
1. Pain
2. Cervical spine ROM
KT along posterior neck
and across lower cervical
spine
(n = 21)
KT applied with no
tension in similar
position
(n = 20)
 Improvements to cervical
ROM and pain in KT group
were statistically but not
clinically relevant
Paoloni, et al,
2011
1. Pain
2. Disability
3. Muscle function (FR
ability)
KT along lumber erector
spinae and midline (3
strips total)
(n = 13)
KT applied in same way
+ home exercises
(n = 13)
 Immediate reduction in pain in
CLBP
(n = 39)
Home exercises only
(n = 13)
Tsai et al, 2010
PF
(n = 52)
1. Pain
2. Foot function
3. Thickness of plantar
fascia in 2 positions
Note: All participants
taped initially for
immediate results on pain
and FR
(n = 39)
KT over gastrocnemius
Daily physical therapy
and plantar fascia
only
+ daily physical therapy
(n = 26)
(ultrasound, TENS)
(n = 26)




all KT groups
Improved FR in 17/39 initially
Pain improved in all groups at
end of trial
Disability improved most in
non-KT group
FR most improved at end of
trial in KT + Exercise group
 Immediate improvement in
pain and foot function in KT
group
 Reduction in plantar fascia
thickness in KT group in 1 of 2
designated sites only
Key: KT = Kinesiotaping ; PF = Plantar Fasciitis ; CLBP = Chronic Low Back Pain ; WAD = Whiplash Associated Disorder ; FR = Flexion-Relaxation
Emergent Themes
As described in the Methodology, a number of themes can be taken from the above results (Table 8).
The papers identified a number of conditions that KT could potentially be used to treat and there were
a number of recurring minor themes, namely the use of KT as a cost-effective alternative to traditional
interventions such as ultrasound, TENS and home exercise and the efficacy of KT on muscle tissue
and fascia in the immediate and short term.
Table 8: Themes drawn from selected papers investigating efficacy of kinesiotape in treatment of
musculoskeletal conditions.
Major Themes
Minor Themes
Kinesiotaping as a treatment for
musculoskeletal pain, namely:
Kinesiotaping as a cost-effective alternative
to ultrasound, exercise therapy or TENS



Patello-femoral pain
Shoulder impingement
Other conditions
o Chronic low back pain
o Whiplash affected disorder
o Plantar fasciitis
Kinesiotaping as a fast-acting/short-term
treatment
Effect of kinesiotaping on muscle tissue and
fascia
Discussion
The purpose of this literature review was to identify evidence for the use of kinesiotape (KT) in the
treatment of musculoskeletal conditions and its role in osteopathic practice. Nine papers satisfied
inclusion and exclusion criteria, with significant variability in study design, methodology and quality
(Table 9).
All three papers addressing the use of KT in treating patello-femoral pain (Akbas et al, 2011; Aytar et
al, 2011; Chen et al, 2008) hypothesised that pain is caused by maltracking of the patella, following
imbalance between vastus medialis and vastus lateralis due to the Q angle (Levangie & Norkin, 2001)
and taped accordingly (Figure 9).
Figure 9: Taping protocols for Patello-Femoral Pain Syndrome
a) Akbas et al 2011, b) Aytar et al 2011, c) Chen et al 2008 (not illustrated in paper)
Despite similar hypotheses, heterogeneity of methodology across the three studies makes direct
comparison difficult (Table 5). Both Akbas et al (2011) and Aytar et al (2011) were well-documented
trials, with clearly presented results focussed on PFPS as the presenting condition. Unfortunately,
differing control groups (sham taping and exercise/massage respectively) makes overall comparison
inconclusive. Chen et al (2008) focussed on biomechanical effects of KT on PFPS sufferers,
comparing its effects against sham taping, no taping and asymptomatic healthy participants. Although
the results are presented in great detail, a poorly documented methodology, makes this study less
meaningful to this review.
None of these studies included a power calculation and featured small (n=31, 25, 22) study groups,
though small groups can be expected from qualitative research (Aveyard, 2008, p. 100).
Table 9: Methodological quality of selected papers investigating efficacy of kinesiotape in treatment
of musculoskeletal conditions.
Study
Akbas et al
(2011)
Aytar et al
(2011)
Chen et al
(2008)
GonzalezIglesias et
al (2009)
Hsu et al
(2008)
Key Strengths/Weaknesses
Strengths:
 Inclusion/exclusion criteria clear and relevant
 Clear protocol of group allocation &
randomisation
 Blinding of participants and examiners
 Outcomes measured are relevant & consistent
Weaknesses:
 KT mixed with exercise rather than alone
 Study groups small with no power calculation
Strengths:
 Inclusion/exclusion criteria clear and relevant
 Blinding of participants and examiners
 Sham KT identical in design/application
 Outcomes measured are relevant & consistent
Weaknesses:
 Randomisation/allocation method unrecorded
 Study groups small with no power calculation
Strengths:
 Sham KT identical in design/application
Weaknesses:
 Inclusion/exclusion criteria undefined
 Blinding of participants only
 Mix of symptomatic and asymptomatic
participants
 Results predominantly biomechanical
 Study groups small with no power calculation
Strengths:
 Sham KT identical in design/application
 Blinding of participants and examiners
 Inclusion/exclusion criteria clear and relevant
 Results consistent, relevant and clearly presented
Weaknesses:
 KT used in both groups
 Randomisation/allocation method unrecorded
 Results measured in first 24 hours only
 Study groups small with no power calculation
Strengths:
 Sham KT identical in design/application
 Blinding of participants and examiners
 Inclusion/exclusion criteria clear and relevant
Rating
High
High
Low
High
Moderate
Weaknesses:
 Extremely specific population studied
 Randomisation method unclear
 No assessment of pain or disability
 Study groups small with no power calculation
Key: KT = Kinesiotaping
Table 9 (cont): Methodological quality of selected papers investigating efficacy of kinesiotape in
treatment of musculoskeletal conditions.
Study
Kaya et al
(2010)
Key Strengths/Weaknesses
Strengths:
 Inclusion/exclusion criteria clearly defined
 Power calculation recorded and adequate group
size recorded
 Results clearly presented
Weaknesses:
 KT mixed with exercise rather than alone
 Allocation based on date of admission rather than
randomised model
 Examiner not blinded
Paoloni et
Strengths:
al (2011)
 Inclusion/exclusion criteria clearly defined
 Enrolment of subjects and progression of trial
very well presented
Weaknesses:
 Central hypothesis (FR) not commonly accepted
as cause of CLBP
 Mixed intervention and assessment protocol
 Study groups small with no power calculation
 No assessment of speed of improvement, just
overall figures at end of trial
Thelen et al Strengths:
(2008)
 Sham KT designed to blind participants
effectively
 Blinding of participants and examiners
 Inclusion/exclusion criteria clearly defined
 Enrolment of subjects very well presented
 Randomisation method clear
 Power calculation included
Weaknesses:
 Subjects recruited from military academy and all
aged 18-24
 Groups smaller than required
Tsai et al
Strengths:
(2010)
 Randomisation method clear
 Blinding of participants and examiners
Rating
Moderate
Moderate
High
High
 Inclusion/exclusion criteria clearly defined
 Testing method relevant and accurate
 Results clearly presented
Weaknesses:
 Study groups small with no power calculation
Key: KT = Kinesiotaping ; FR = Flexion/Relaxation ; CLBP = Chronic Low Back Pain
Positive results in pain, soft tissue flexibility (Akbas et al 2001), muscle activation (Chen et al 2008)
and strength (Aytar et al 2011) echo findings from trials featuring healthy individuals (Aktas &
Baltaci, 2011; Słupik et al 2007; Vithoulkaa et al, 2010), suggesting that KT may be effective in the
treatment of PFPS.
In treating shoulder impingement (SI) Thelen et al (2008) and Kaya et al (2010) taped in a similar
manner (Figure 10a, b) but comparison groups and study duration differed; Thelen at al (2008)
compared with sham KT and measured outcomes after weeks one and two, whilst Kaya et al (2010)
compared against ultrasound, TENS and heat packs and measured outcomes after day one, three and
six. Thelen et al (2008) was the only SI study to include a power calculation but failed to provide
enough participants (26 required in each group, 21 provided) to satisfy.
Hsu et al (2009) featured a taping protocol quite different to the previous two trials (Figure 10c) and
was peculiar in that it focussed on a small number (n=17) of baseball players only, a narrow
population with specific loads on the shoulder complex.
Figure 10: Kinesiotaping approaches to shoulder impingement.
a) Thelen et al (2008), b) Kaya et al (2010), c) Hsu et al (2009)
Figure 10 shows how the taping protocols differed and although Thelen at al (2008) and Kaya et al
(2010) have similarities, there are still fundamental differences in KT approach, including lack of KT
over the mid fibres of trapezius (10a) and KT over the lower fibres of trapezius only in Hsu et al
(2009) (10c). As a result, the efficacy of KT in the treatment of shoulder impingement is not clearly
identified by these three studies.
Paolini et al (2011) addressed chronic lower back pain (CLBP), focusing on “Flexion-Relaxation”
(FR) of the lumbar erector spinae. In healthy individuals, muscle activity is reduced after forward
flexion whilst in CLBP sufferers it is hypothesised that these same muscles are held in a state of
contraction. Featuring a complex model of three intervention groups with testing in two phases, the
results are inconclusive for either KT or home exercise, with an immediate positive improvement in
FR in 33% of participants being the most significant result.
A study of healthy individuals (Yoshida & Kahanov, 2007) found positive results in increased
forward flexion immediately after using KT to facilitate lumbar erector spinae. Although no
assessment was made of pain and a direct connection between increased range of movement and
reduced pain not possible from these results alone, when combined with the results from Paolini et al
(2011) there is indication of how KT could be used in CLBP. Guidelines for the treatment of low back
pain (Koes et al, 2006; UK BEAM Trial, 2004; NICE, 2009) advise remaining active and maintaining
mobility, so KT could be used to increase range of movement and relieve muscle tension.
As each of the remaining papers (Gonzalez-Iglesias et al 2009, Tsai et al 2010) looked at different
conditions, with no additional studies to compare findings to, firm conclusions are difficult.
A unique finding from Tsai et al (2010) was the effect of KT on fascia thickness, as measured by
diagnostic ultrasound. Featuring one of the larger overall study groups (n=52), a mean reduction in the
thickness of plantar fascia of over 16% at the site of calcaneal attachment was one of the clearest
positive outcomes from any the studies.
Kinesiotaping as a viable alternative
Four of the identified studies (Akbas et al 2011, Kaya et al 2010, Paolini et al 2011, Tsai et al 2010)
compared the action of therapeutic KT against manual therapy. Akbas et al (2011) found
improvements in soft tissue flexibility appeared faster in the KT group, whilst a faster reduction in
pain was noted by Kaya et al (2010), Paolini et al (2011) and Tsai et al (2010. In all studies KT was
applied less frequently (typically every 3 days) than alternative treatment (daily in all but Paolini et al
2011, where exercise was three times a week).
This suggests that KT achieves results faster than US, TENS or exercise and can be supplied less
often with less specialist equipment.
Limitations of studies assessing efficacy of kinesiotape
One of the most important issues affecting the reliability of results from these trials is the manner in
which the tape is applied. KT can be applied in a number of ways, at the discretion of the therapist.
Although advantageous in the clinical setting, it makes direct comparison of trials difficult as the
taping protocol may differ greatly.
It is therefore difficult to categorically argue that KT does or does not work for a particular condition,
as success or failure is due to the manner in which the tape is applied, as much as the tape itself.
Clinical Implications and Relevance to Osteopathy
The proposed mechanism of action of KT, the lifting of the epidermis to reduce compression of
tissues and fluid beneath, directly follows one of the key osteopathic principles, the importance of
fluid movement in the maintenance of health (Figure 11, #6).
1. The body is a unit
2. Structure and function are reciprocally interrelated
3. The body possesses self-regulatory mechanisms
4. The body has the inherent capacity to defend itself and repair itself
5. When normal adaptability is disrupted, or when environmental changes overcome the
body's capacity for self-maintenance, disease may ensue
6. Movement of body fluids is essential to the maintenance of health
7. The nerves play a crucial part in controlling the fluids of the body
8. There are somatic components to disease that are not only manifestations of disease but
also are factors that contribute to maintenance of the diseased state
Figure 11: Osteopathic Principles (Sammut & Searle-Barnes, 1998)
Further to this, the ability of KT to improve muscle firing (Chen et al, 2008, Hsu et al 2009) improve
soft tissue flexibility and increase range of movement (Akbas et al 2011, Thelen et al 2008, GonzalezIglesias et al, 2009) suggests that it could be used to help improve the structure and function of the
body, better equipping it to promote repair.
Future treatment of chronic postural
conditions could be influenced by the
findings of Tsai et al (2010), which found
measurable effects of KT on fascia
thickness. Figure 12 shows a chronic,
slouched posture commonly observed, the
muscles held in a state of constant strain.
Myers (2007, p18) describes how collagen
fibres are laid down to support these
muscles, creating an inelastic, fibrous
network. This can be treated with manual
therapy, home exercise and postural
education but the addition of KT to reduce
Figure 12: The effect of chronic postural
adaptations on muscle and fascia (Myers, 2007)
thickness of this tissue alongside these interventions has great potential for success.
The very nature of KT means that application can be adapted for each individual, targeting specific
tissues. This is particularly relevant to the osteopathic approach of treating each patient as an
individual (DiGiovanna et al, 2005), suggesting it could work effectively alongside soft tissue
massage, mobilisation or manipulation.
Limitations of this review
There were numerous limitations to the design of this review, influenced by resources available and
the author’s experience. Due to the nature of this undergraduate study, only one researcher, relatively
inexperienced in research methodology, performed all searches, inclusion/exclusion of papers and
analysis of selected studies, allowing for individual bias (Kane, 2004).
Although a systematic approach was adopted (Aveyard, 2008, p. 13) and care taken to search all
appropriate databases with relevant search terms, the potential still exists for papers to be missed. No
meta-analysis was performed due to heterogeneity of methodology but themes were identified and
discussed.
To strengthen the quality of this review, a second researcher could be used to ensure that searches are
performed and recorded accurately and offer additional opinions relating to study selection and
assessment. This additional resource could also aid thorough searching of online databases, grey
literature, foreign language studies and relevant journals by hand.
Conclusion
This study identified nine randomised controlled trials assessing the efficacy of kinesiotape (KT) in
the treatment of musculoskeletal pathology.
One study (Tsai et al, 2010) found compelling evidence for the positive effect of KT on fascia
thickness whilst four studies (Akbas et al 2011, Kaya et al 2010, Paolini et al 2011, Tsai et al 2010)
found KT to be as effective as ultrasound, TENS and home exercise in improving pain and disability,
when applied three times less frequently. Five papers (Akbas et al 2011, Kaya et al 2010, Thelan et al
2008, Paolini et al 2011, Tsai et al 2010) identified that KT provided faster improvements in pain and
flexibility than control groups, although final outcomes were similar in all but one (Akbas et al 2011).
Studies investigating effect on shoulder impingement and patello-femoral pain, found some positive
results but heterogeneity of methodology makes it difficult to categorically confirm efficacy. Further
research with consistent methodology is required.
The identified positive effects of KT on soft tissue flexibility, fascia thickness, pain and disability
indicate that KT can and should be used by osteopaths to treat both acute and chronic musculoskeletal
presentations.
Opportunities for future research
The application of the tape is as important as the tape itself, so future studies should follow standard
taping protocols and measure homogeneous outcomes to ensure that results can be combined and
conclusions drawn. At present no such protocols exist, so this would need to be established before
additional studies undertaken.
Future studies should aim to improve methodological quality and provide larger sample sizes, at
least large enough to satisfy power-calculated amounts.
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