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Revista Brasileira de Reumatologia

Print version ISSN 0482-5004On-line version ISSN 1809-4570

Rev. Bras. Reumatol. vol.57 no.2 São Paulo Mar./Apr. 2017

http://dx.doi.org/10.1016/j.rbre.2016.03.012 

Original articles

The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome

Saime Aya  * 

Hatice Ecem Konaka 

Deniz Evcikb 

Sibel Kibara 

aUfuk University, School of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey

bAnkara University, Haymana Vocational Health School, Department of Therapy and Rehabilitation, Ankara, Turkey

Abstract

Objective:

The aim of this study was to investigate the effectiveness of Kinesio Taping and sham Kinesio Taping on pain, pressure pain threshold, cervical range of motion, and disability in cervical myofascial pain syndrome patients (MPS).

Methods:

This study was designed as a randomized, double-blind placebo controlled study. Sixty-one patients with MPS were randomly assigned into two groups. Group 1 (n = 31) was treated with Kinesio Taping and group 2 (n = 30) was treated sham taping five times by intervals of 3 days for 15 days. Additionally, all patients were given neck exercise program. Patients were evaluated according to pain, pressure pain threshold, cervical range of motion and disability. Pain was assessed by using Visual Analog Scale, pressure pain threshold was measured by using an algometer, and active cervical range of motion was measured by using goniometry. Disability was assessed with the neck pain disability index disability. Measurements were taken before and after the treatment.

Results:

At the end of the therapy, there were statistically significant improvements on pain, pressure pain threshold, cervical range of motion, and disability (p < 0.05) in both groups. Also there was a statistical difference between the groups regarding pain, pressure pain threshold, cervical flexion-extension (p < 0.05); except cervical rotation, cervical lateral flexion and disability (p > 0.05).

Conclusion:

This study shows that Kinesio Taping leads to improvements on pain, pressure pain threshold and cervical range of motion, but not disability in short time. Therefore, Kinesio Taping can be used as an alternative therapy method in the treatment of patients with MPS.

Keywords: Myofascial pain syndrome; Kinesio Taping; Disability; Pain

Introduction

Myofascial pain syndrome (MPS) is one of the most common musculoskeletal problems and is an important cause of morbidity in adults. MPS is a condition characterized by chronic pain and associated with trigger points in one or more muscles, taut bands, characteristic referred pain, and local twitch response. Patients refer to hospitals with local or referred pain, muscle weakness, tightness, limited mobility, weakness, tenderness, autonomic dysfunctions and local twitch response in the affected muscle.1,2

The exact etiology of MPS is not fully understood; therefore, the treatment is focused on decreasing pain, improving muscle strength and providing good posture. Patients’ education and training programs, nonsteroidal anti-inflammatory drugs (NSAID), local injections, physical therapy, acupuncture and exercise programs are the most common treatment methods.1

Kinesio Taping (KT) has been increasingly used in musculoskeletal conditions and sports injuries. This technique was developed in Japan by Kase and recently it became very popular in pain treatment.3,4 Kinesio Tape is a thin, light, and elastic material which does not restrict the joint movement.4,5 It is found to be effective in decreasing pain and muscular spasm, increasing the range of motion (ROM), improving local blood and lymph circulations, reducing edema, strengthen weakened muscles, control joint instability and postural alignment.6-8 Although the exact mechanisms of KT is not understood, sensorimotor, proprioceptive feedback mechanisms, inhibitory and excitatory nociceptive stimuli, mechanical restraint were explained as underlying mechanisms.4,6,7 In this double-blinded, randomized placebo controlled study, we aimed to compare the efficacy of KT and placebo KT methods on pain, pressure pain threshold, ROM and disability in patients with MPS.

Materials and methods

Seventy-three patients (50 female, 23 male) with cervical MPS involving the upper neck and levator scapula muscle referred to our outpatient clinic were included in the study. The diagnosis of MPS was based on the criteria described by Travell and Simons (5 major and minimum 1 minor criteria are required for clinical diagnosis).9 The patients’ inclusion criteria were presence of at least one active trigger point located in levator scapula muscle, ages greater than 18 years, and symptom duration of at least 3 months. The exclusion criteria were diagnosis of fibromyalgia syndrome, cervical disc lesion, radiculopathy, myelopathy, recent trigger point injection or participating in a physical treatment program within the last 6 months, neurologic and inflammatory diseases, pregnancy or history of neck and shoulder surgery.

After physical examination, full blood count, erythrocyte sedimentation rate, C-reactive protein, and biochemical markers were evaluated.

This study was prospective, randomized, placebo-controlled double-blind trial. Before treatment, all participants were informed about the study and signed written informed consent. The study was approved by the University of Ufuk Human Research Ethics Committee.

Randomization

Patients were randomly assigned into two groups by numbered envelopes method. The group 1 and group 2 notes were put into to the closed envelopes separately, and each patient randomly chose an envelope and gave it to the physiotherapist. Both patients and two examining physicians were blinded to treatment allocation. Only the physiotherapist who applied the therapy was aware of the procedure and physiotherapist record the patient names and their groups.

Group 1 patients (n = 31) were treated with Kinesio Tape (Kinesio Tex Gold, 2 in × 103.3 ft) suggested by Kase et al. five times by intervals of 3 days for 15 days. Taping was performed by a physiotherapist who is certified for this method. The muscle inhibition technique which was described by Kase was used. We applied the taping to levator scapula muscle. The shoulder was depressed and neck was in lateral flexion and rotation position to the opposite side. A 15–20 cm long "I" strip was used. Application started from the superior scapular angle. Initial portion of the tape was stretched maximum 4–5 cm and then it was sticked on the muscle origo which was at the level of 1–4 thoracic transverse process without stretching5 (Fig. 1).

Fig. 1 Kinesio Taping technique. 

Group 2 patients (n = 30) were treated with sham taping five times by intervals of 3 days for 15 days. Sham taping was applied with an "I" strip of the same material on ineffective parts of the muscle without a tension with the neck in neutral position (Fig. 2).

Fig. 2 Sham Kinesio Taping technique. 

Additionally, all patients received a home-based exercise program including isometric-isotonic neck exercises and back extensor stretching exercises everyday for two weeks.

No analgesic drugs or NSAIDs were allowed during the treatment process.

Clinical outcomes

Patients were evaluated according to pain, pressure pain threshold, cervical ROM and disability.

Pain

Pain was assessed by using a visual analog scale (VAS, 0–10 cm; 0 means no pain, 10 means severe pain).

Pressure pain threshold

Pressure pain threshold (PPT) on the trigger point was measured with an algometer (Algometer Commander, JTECH Medical, Utah). The measurement was taken three times and the mean average value was recorded.

Cervical joint range of motion

The active ROM of cervical joint (flexion, extension, right–left flexion and rotation) was measured using a goniometer when the patient was in sitting position.

Disability

Disability was measured by using the Neck Pain Disability Scale (NPDS). Turkish version of this scale was found valid and reliable. The questionnaire consists of 20 items and measures neck movements, pain intensity, effect of neck pain on emotion factors, and interference with daily life activities. Each section is scored on a 0–5 rating scale and total score ranges from 0 to 100.10

Statistical analysis

The means and standard deviations were given as descriptive statistics. All data for normality were tested by using the Kolmogorov–Smirnov test. Per-protocol analysis was used for the comparison of treatment groups. For determining the difference before and after treatment for all groups, non-parametric Wilcoxon test was used. To compare the differences between two groups, the Mann–Whitney U test was used. A level of significance of p < 0.05 was accepted. All analyses were performed using the SPSS for Windows 18.0 software program.

Results

Thirty-six patients in group 1 (27 females and 9 males) and 37 patients in group 2 (30 females and 7 males) with MPS were included the study. After randomization, 4 patients in Group 1 and 6 patients in Group 2 dropped out because they could not attend the follow-up program regularly in the study. Then, one patient from Group 1 and one patient Group 2 dropped out because allergic reaction occurred. Sixty-one patients completed the study and no side effects had been observed (Fig. 3).

Fig. 3 Flow diagram showing of patients through the clinical study. 

Table 1 shows the demographic and clinical properties of the Group1 and Group 2. No statistically significant differences were detected between the groups at baseline values (p > 0.05) except NPDS (p < 0.05).

Table 1 Demographic and clinic characteristics of the patients. 

Group 1
(n = 31)
Group 2
(n = 30)
p
Age (years) 44.80 ± 17.19 44.10 ± 17.45 0.76
Gender (female/male) 22/9 23/7 0.61
Duration of pain (month) 14.48 ± 4.99 13.50 ± 2.76 0.97
VAS 5.00 ± 2.00 4.56 ± 2.17 0.38
PPT (N) 61.29 ± 8.92 61.73 ± 5.35 0.61
NPDS 49.77 ± 21.37 39.80 ± 12.51 0.05a

VAS, visual analog scale; PPT (N), pressure pain threshold, Newton; NPDS, Neck Pain Disability Scale.

ap < 0.05.

The results of full blood count, erythrocyte sedimentation rate, C-reactive protein and biochemical markers were within normal ranges for both groups.

After two weeks follow up, there were statistically significant improvements in both groups regarding VAS, PPT, ROM and NPDS (p < 0.05) (Table 2).

Table 2 Comparison of the assessment parameters in both groups and between the groups. 

Group 1 (n = 31)
(mean ± SD)
Group 2 (n = 30)
(mean ± SD)
p
Variable (independent) VAS
Baseline 5.00 ± 2.00 4.56 ± 2.17
Posttreatment 2.35 ± 1.99 3.93 ± 1.96 0.004b
p 0.000a 0.000a
PPT
Baseline 61.29 ± 8.92 61.73 ± 5.35
Posttreatment 78.09 ± 7.18 71.43 ± 10.25 0.003b
p 0.000a 0.000a
Cervical flexion
Baseline 64.58 ± 7.66 59.86 ± 7.01
Posttreatment 71.90 ± 7.54 64.86 ± 6.79 0.001a
p 0.000a 0.001a
Cervical extension
Baseline 51.93 ± 12.83 44.83 ± 12.42
Posttreatment 55.96 ± 13.63 47.20 ± 14.21 0.015
p 0.007b 0.003b
Right lateral flexion
Baseline 39.64 ± 13.77 33.83 ± 5.52
Posttreatment 42.61 ± 14.78 35.93 ± 5.80 0.357
p 0.001a 0.003b
Left lateral flexion
Baseline 40.93 ± 14.4 33.83 ± 5.52
Posttreatment 43.90 ± 14.94 42.43 ± 17.97 0.390
p 0.000a 0.001a
Right rotation
Baseline 60.58 ± 11.58 61.36 ± 12.31
Posttreatment 64.74 ± 11.04 63.60 ± 9.55 0.348
p 0.001a 0.006b
Left rotation
Baseline 63.09 ± 12.43 67.53 ± 8.24
Posttreatment 66.83 ± 13.01 67.93 ± 7.97 0.907
p 0.001a 0.10
NPDS
Baseline 49.77 ± 21.37 39.80 ± 12.51
Posttreatment 35.67 ± 20.27 36.10 ± 12.16 0.558
p 0.000a 0.000a

VAS, visual analog scale; PPT, pressure pain threshold; NPDS, Neck Pain Disability Scale; SD, standard deviation.

ap < 0.001.

bp < 0.05.

After the treatment, statistical significant differences were observed in VAS, PPT, cervical flexion-extension values (p < 0.05) between the groups. However no differences were found in cervical rotation, lateral flexion and NPDS (p > 0.05) (Table 2).

Discussion

Myofascial pain syndrome is the most commonly occurring musculoskeletal disorders seen by physiatrists. There is no accepted standard treatment program for MPS. The main issue in the MPS treatment is to provide pain relief on trigger points, improving disability and increasing cervical motion.1,2 Kinesio Taping is a new alternative technique used in MPS.3,4 This study was planned as a randomized double-blind placebo controlled study in which efficacy of KT and placebo KT methods on pain, PPT, ROM of cervical joint and disability in MPS treatment. After 2 weeks of treatment, all assessment parameters showed statistically significant improvements in both KT and sham groups. There was a statistical difference between the groups regarding VAS, PPT, cervical flexion-extension, except cervical rotation, cervical lateral flexion and NPDS.

Although there are a lot of studies in the literature about the effect of taping on musculoskeletal system and sport injuries, there are limited number of randomized controlled studies on MPS.3,11,12 However, there is no planned randomized double-blind placebo controlled study in which efficacy of KT in pain, PPT, ROM of cervical joint and disability in MPS treatment. A case report has suggested that KT may be beneficial for the treatment of a patient with shoulder pain of myofascial origin. They observed significant improvement in the functional tests active shoulder range of motion and there was no change in the VAS.13 In a randomized double-blind study with MPS included fifty patients, the efficiency of KT was compared with dry needling and significant decrease in pain, PPT and disability was observed. They found that KT was at least as effective as dry needling in the treatment of MPS.14 Hernandez et al. compared the effectiveness of KT and cervical trust manipulation in mechanical neck pain with 36 patients; they observed KT or cervical trust manipulation leads to similar reduction in pain severity, disability and increases in ROM.15 Although Gonzalez et al. found an improvement in pain and ROM in patients with acute whiplash injury with KT, these were small and not clinically meaningful.8 In our study, KT group showed statistically significant improvements regarding VAS, PPT, ROM and NPDS. Although significant improvements were observed in pain, PPT, cervical flexion-extension, compared to the placebo group, there was no change in cervical rotation, cervical lateral flexion and NPDS.

Multiple theories have been proposed to explain the mechanisms of KT, including enhance proprioception, cutaneus mechanoreceptors, improved blood and lymphatic circulation, reduced pain severity, realignment of joints, assist the postural alignment and relax the overused muscles.4,7,11 As a result of KT, we observed that pain, PPT, ROM and disability measures showed statistically significant improvements in KT group. Stimulating the gate control mechanism results a decrease in pain through the increase in afferent feedback found in the skin. Another theory suggests that the improved ROM and pain are due to an increased proprioseptive feedback mechanism and muscle facilitation.4,7,8,11

In the study Thelen et al., found that KT improved pain-free shoulder range of motion but no effect on pain or function. They also observed KT and cervical spine trust manipulation reduced disability.16 A lot of published clinical trials have suggested that KT may be beneficial in treating patellofemoral pain syndrome, shoulder impingement syndrome, lower extremity spasticity and postural rehabilitation in Parkinson's Disease.6,7,17,18 A few systematic reviews have evaluated the effect of KT on musculoskeletal and different clinical conditions. These randomized trials compared KT versus sham taping or other interventions. The results of reviews suggested that KT had no significant benefit or its effect was too small in terms of clinical practice. However these trials were low-moderate quality, small sample sizes and very small follow-up periods.4,7,8 The most important difference of our study was to have higher number patients and designed as a randomized double-blind placebo controlled study.

Cervical ROM restriction mostly occurs because of muscle spasm in MPS. Studies showed improvement in ROM values after KT.8,15 In our study, a significant increase was obtained in two weeks in cervical ROM in both groups. Although significant improvements were observed on cervical flexion-extension, compared to the placebo group, but there was no change cervical rotation, cervical lateral flexion. The increase in cervical ROM may be due to the reduction in patients’ cervical muscle spasms or exercise programs applied to the patients. In our study, home exercise program was applied to all patients and improvement of cervical ROM was observed in both groups. The limitation of our study was not to have an only exercise group which could be compared to KT and sham KT. Also, we investigated the short-term results of KT.

In conclusion, KT is a noninvasive, painless method that has less side effects, is well tolerated and has been used in MPS. This study shows that KT leads to improvements on pain, PPT, and ROM, but not in disability in short period. Therefore, KT can be used as an alternative therapy in the treatment of patients with MPS. But, more research is necessary for both clinical and long-term effects of the Kinesio Taping technique.

References

1 Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2011;25:185-98. [ Links ]

2 Radford-Graff SB. Myofascial pain: diagnosis and management. Curr Pain Headache Rep. 2004;8:463-7. [ Links ]

3 Parreira PCS, Costa LCM, Takahashi R, Junior LCH, Luz Junior MA, Silva TM, et al. Kinesio taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial. J Physiother. 2014;60:90-6. [ Links ]

4 Parreira PCS, Costa LCM, Junior LCH, Lopes AD, Costa LOP. Current evidence does not support the use of kinesio taping in clinical practice: a systematic review. J Physiotherapy. 2014;60:31-9. [ Links ]

5 Güven Z, Çeliker R, Atalay A, Bağış¸ S, Aydoğ T, Korkmaz N, et al. Kinezyolojik Bantlama İleri Kurs. Istanbul, Turkey: Acıbadem Üniversitesi; 2012. [ Links ]

6 Saygı EK, Aydoseli KC, Kablan N, Ofluoğlu D. The role of kinesio taping combined with botulinum toxin to reduce plantar flexors spasticity after stroke. Top Stroke Rehabil. 2010;17:318-22. [ Links ]

7 Kaya E, Zinnuroglu M, Tugcu I. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clin Rheumatol. 2011;30:201-7. [ Links ]

8 Iglesias JG, Penas CF, Cleland J, Huıjbregts P, Vega MRG. Short term effects of cervical Kinesio Taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial. J Orthop Sports Phys Ther. 2009;39:515-21. [ Links ]

9 Simons DG. Muscular pain syndrome. In: Friction JR, Awad EA, editors. Advances in pain research and therapy. New York: Raven Pres; 1990. p. 1–41. [ Links ]

10 Bicer A, Yazici A, Camdeviren H, Erdogan C. Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. Disabil Rehabil. 2004;26:959-62. [ Links ]

11 Bassett KT, Lingman SA, Ellis RF. The use and treatment efficacy of kinaesthetic taping for musculoskeletal conditions: a systematic review. NZ J Physiother. 2010;38:56-62. [ Links ]

12 Morris D, Jones D, Ryan H, Ryan CG. The clinical effects of Kinesio Tex taping: a systematic review. Physiother Theory Pract. 2013;29:259-70. [ Links ]

13 Muro FG, Fernandez ALR, Lucas AH. Treatment of myofascial pain in the shoulder with kinesio taping. A case report. Man Ther. 2010;15:292-5. [ Links ]

14 Westhuizen VD, Hendrik J. The relative effectiveness of Kinesiotape versus dry needling in patients with myofascial pain syndrome of trapezius muscle, 2012. http://hdl.handle.net/10321/732. [ Links ]

15 Hernandez MS, Sanchez AMC, Morales MA, Cleland JA, Palomo IL, Penas CF. Short term effects of kinesio taping versus cervical thrust manipulation in patients with mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2012;42:724-30. [ Links ]

16 Thelen MD, Dauber JA, Stoneman PD. The clinical efficacy of kinesio tape for shoulder pain: a randomized double blinded, clinical trial. J Orthop Sports Phys Ther. 2008;38:389-95. [ Links ]

17 Freedman SR, Brody LT, Rosenthal M, Wise JC. Short term effects of patellar kinesio taping on pain and hop function in patients with patellofemoral pain syndrome. Sports Health. 2014;6:294. [ Links ]

18 Capecci M, Serpicelli C, Fiorentini L, Censi G, Ferretti M, Orni C. Postural rehabilitation and kinesio taping for axial postural disorders in Parkinson's disease. Arch Phys Med Rehabil. 2014;95:1067-75. [ Links ]

Received: June 18, 2015; Accepted: December 20, 2015

*Corresponding author. E-mail: saimeay@yahoo.com (S. Ay).

Conflicts of interest

The authors declare no conflicts of interest.

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