Sticking it to Pain: How to Use Kinesiology Taping
For the past few years I have had the privilege of teaching "Kinesiology Taping and Movement Assessment Strategies" to healthcare professionals all across the country through Medical Minds in Motion. During that time I have changed my thought processes, and the way I teach the course as my understanding of the techniques, applications and evidence/research deepens. Most of the critique and criticisms of this intervention usually come from therapists/chiropractors/or trainers who say it is nothing more then a placebo and furthermore there is no significant evidence to support kinesiology taping. While that may be true I will simply answer that as I always do: I do not care. There is not a ton of evidence to "support" many of the things we do. Lastly, are we asking the right questions with research and do we have realistic expectations of applying a piece of tape on skin?
Let me explain further - if I apply taping on a patient with a sound thought process and reasoning which allows them to have less pain and move better, it simply does not matter how much evidence exists for or against it. I do not believe it "turns on or turns off muscles", I do not believe it "re-positions" anything, but I do believe it can give great feedback to movement. There are so many healthcare offices that continue to use modalities such as ultrasound and stimulation with little to no evidence or clinical reasoning behind it, but in my experience with MDs and PTs/professionals around the country it is the tape that falls under scrutiny, Let me assure you that I would not travel throughout the country to teach something that I did not believe in if I, myself, did not have good results with it. I do think, however, these applications are getting a bit carried away and it seems that everywhere you go everyone is trying to out-do another application by making it more elaborate or creative. While RockTape offers a brand of "Fascial Movement Taping" that may be helpful to athletes competing in sports or endurance events I find it less practical to use during the rehabilitation of patients. So how do I use the tape, and what do I think it actually does? The answer is simple: pain relief through proprioceptive input.
As pain science research improves and we develop a deeper understanding of pain and its interaction on the brain, emotion, and physical dysfunction we can see that areas in pain (particularly chronic pain) do not seem to be as neurally active in brain scans as "healthy" joints do. For those of us who went to PT school we are familiar with the homunculus - for those that did not it is essentially the brain's visual interpretation of our bodies.
What research is showing is that as we do not use areas in pain, these areas in our brains become "smudged". With decreased feedback to the brain, it may have a harder time controlling the joint or deem it under threat - hence it continues to send pain to the area to protect it. This same protective mechanism may be part of the reason people continue to experience pain, even if their MRIs/X-rays are "normal". So can tape help with providing extra feedback to the joint and subsequently the brain? A recent study in 2012 from the Physical Therapy Journal looked at this very topic when it showed that patella taping resulted in an increased brain response during a knee proprioceptive task.
Functional magnetic resonance imaging (fMRI) has emerged as a promising technique for the detection and assessment of physiology and pathophysiology and the regional mapping of human cognitive functions. The study cited below has shown that there is altered brain response when a simple strip of tape (not an elaborate design) is applied to the patella of individuals during a proprioception task. These findings support the theory that taping may be an efficacious therapy due to subtle mechanisms affecting the brain, not just because it gives mechanical support to the patella or alters lower-limb biomechanics as many studies before have tried to prove - with wide ranges of success/failure.
Another important aspect to consider is that the taping application does NOT substitute for manual therapy, or anything else for that matter. It should be an adjunct, or assist to our current practice, not become THE practice. In January 2015 a study was published in the British Journal of Sports Medicine that spoke on this very point. Despite several recent systematic reviews and analyses suggesting that kinesiology tape doesn’t provide clinical benefits, the analysis by Singapore researchers Lim and Tay suggests that kinesiology tape can be clinically beneficial. Through their research they found that kinesiology tape is as effective as other minimal interventions (modalities) at reducing musculoskeletal pain. They go on to say, "Furthermore, when used in combination with conventional therapy, kinesiology tape may be effective at reducing pain.” If people are in less pain they typically move more, if they move more then we may also improve disability, as well as pain, with tape.
So there are two of my current "teaching points" as I go around the country. I tape patients to empower them, reduce their fear avoidance, decrease their pain and provide slight cues to their musculoskeletal/neurological systems to aide in their recovery process. I understand the tape does not "fix" people - time, effort, consistency and pattern corrections will be necessary, but in the mean time I am glad to have the tape on my side because even if it does nothing there is no denying it at least looks really cool.
Until next time Happy Rehabbing!
What is your feelings on taping? Is this something you utilize in your practice? If so how much? Do you feel that the research is valid in leading to a decision?
Callaghan, MJ. et al. "Effects of Patellar Taping on Brain Activity during Knee Joint Proprioception Tests Using Functional Magnetic Resonance Imaging."Physical Therapy 92.6 (2012): 821-30. Web. 15 Apr. 2015
Lim, EC, et al. "Kinesio Taping in Musculoskeletal Pain and Disability That Lasts for More than 4 weeks: Is It Time to Peel off the Tape and Throw It out with the Sweat? A Systematic Review with Meta-analysis Focused on Pain and Also Methods of Tape Application." British Journal of Sports Medicine (2015): n. pag. Web. 15 Apr. 2015.