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

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w w w . r e u m a t o l o g i a . c o m . b r

REVISTA

BRASILEIRA

DE

REUMATOLOGIA

Original

article

The

effectiveness

of

Kinesio

Taping

on

pain

and

disability

in

cervical

myofascial

pain

syndrome

Saime

Ay

a,∗

_,

_Hatice

_Ecem

_Konak

a

_,

_Deniz

_Evcik

b

_,

_Sibel

_Kibar

a

a_Ufuk_University,_School_of_Medicine,_Department_of_Physical_Medicine_and_{Rehabilitation,}_Ankara,_Turkey

b_Ankara_University,_Haymana_Vocational_Health_School,_Department_of_Therapy_and_{Rehabilitation,}_Ankara,_Turkey

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t

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c

l

e

i

n

f

o

Articlehistory:

Received18June2015 Accepted20December2015 Availableonline10May2016

Keywords:

Myofascialpainsyndrome KinesioTaping

Disability Pain

a

b

s

t

r

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t

Objective:TheaimofthisstudywastoinvestigatetheeffectivenessofKinesioTapingand shamKinesioTapingonpain,pressurepainthreshold,cervicalrangeofmotion,and dis-abilityincervicalmyofascialpainsyndromepatients(MPS).

Methods:Thisstudywasdesignedasarandomized,double-blindplacebocontrolledstudy. Sixty-onepatientswithMPSwererandomlyassignedintotwogroups.Group1(n=31)was treated withKinesioTapingandgroup2(n=30)wastreatedshamtapingﬁvetimesby intervalsof3daysfor15days.Additionally,allpatientsweregivenneckexerciseprogram. Patientswereevaluatedaccordingtopain,pressurepainthreshold,cervicalrangeofmotion anddisability.PainwasassessedbyusingVisualAnalogScale,pressurepainthresholdwas measuredbyusinganalgometer,andactivecervicalrangeofmotionwasmeasuredby usinggoniometry. Disabilitywasassessedwiththeneckpaindisability indexdisability. Measurementsweretakenbeforeandafterthetreatment.

Results:Attheendofthetherapy,therewerestatisticallysignificantimprovementsonpain, pressurepainthreshold,cervicalrangeofmotion,anddisability(p<0.05)inbothgroups. Alsotherewasastatisticaldifferencebetweenthegroupsregardingpain,pressurepain threshold,cervicalflexion-extension(p<0.05);exceptcervicalrotation,cervicallateral flex-ionanddisability(p>0.05).

Conclusion: ThisstudyshowsthatKinesioTapingleadstoimprovementsonpain,pressure pain thresholdandcervicalrangeofmotion,butnotdisabilityinshorttime.Therefore, KinesioTapingcanbeusedasanalternativetherapymethodinthetreatmentofpatients withMPS.

∗ _{Corresponding}_author.

E-mail:saimeay@yahoo.com(S.Ay). http://dx.doi.org/10.1016/j.rbre.2016.03.012

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Efetividade

do

kinesio

taping

na

dor

e

incapacidade

na

síndrome

dolorosa

miofascial

cervical

Palavras-chave:

Síndromedolorosamiofascial Kinesiotaping

Incapacidade Dor

r

e

s

u

m

o

Objetivo: Investigaraeﬁcáciadokinesiotapingedotapingplacebosobreador,limiardedor àpressão,amplitudedemovimentocervicaleincapacidadeempacientescomsíndrome dolorosamiofascial(SDM)cervical.

Métodos: Ensaioclínicorandomizadoduplo-cegocontroladoporplacebo.Foramalocados emdoisgrupos,aleatoriamente,61pacientescomSDM.Ogrupo1(n=31)foitratadocom kinesiotapingeogrupo2(n=30)foitratadocomtapingplacebocincovezesemintervalosde trêsdias,durante15dias.Alémdisso,todosospacientesforamsubmetidosaumprograma deexercíciosparaopescoço.Ospacientesforamavaliadosemrelaçãoàdor,aolimiarde doràpressão,àamplitudedemovimentocervicaleàincapacidade.Adorfoiavaliadacoma escalavisualanalógica,olimiardedoràpressãofoimedidocomumalgômetroeaamplitude demovimentocervicalativafoimensuradacomagoniometria.Aincapacidadefoiavaliada comoNeckPainDisabilityScale.Asmensuraçõesforamfeitasantesedepoisdotratamento. Resultados: Nofimdotratamento,houvemelhoriaestatisticamentesignificativanador,no limiardedoràpressão,naamplitudedemovimentocervicalenaincapacidade(p<0,05) emambososgrupos.Tambémhouveumadiferençaestatisticamentesignificativaentreos gruposemrelaçãoàdor,aolimiardedoràpressãoeàflexão-extensãocervical(p<0,05); nãohouvediferençanarotaçãocervical,flexãolateralcervicaleincapacidade(p>0,05). Conclusão: Okinesiotapinglevaàmelhorianador,nolimiardedoràpressãoenaamplitude demovimentocervical,masnãonaincapacidadeemumcurtoperíodo.Portanto,okinesio tapingpodeserusadocomoummétododeterapiaopcionalparaotratamentodepacientes comSDM.

Introduction

Myofascialpainsyndrome(MPS)isoneofthemostcommon musculoskeletalproblemsandisanimportantcauseof mor-bidityinadults.MPSisaconditioncharacterizedbychronic painandassociatedwithtriggerpointsinoneormore mus-cles,tautbands,characteristicreferredpain,andlocaltwitch response.Patientsrefertohospitalswithlocalorreferredpain, muscleweakness,tightness,limitedmobility,weakness, ten-derness,autonomicdysfunctionsandlocaltwitchresponsein theaffectedmuscle.1,2

TheexactetiologyofMPSisnotfullyunderstood;therefore, thetreatmentisfocusedondecreasingpain,improving mus-clestrengthandprovidinggoodposture.Patients’education andtrainingprograms,nonsteroidalanti-inﬂammatorydrugs (NSAID),localinjections,physicaltherapy,acupunctureand exerciseprogramsarethemostcommontreatmentmethods.1

KinesioTaping(KT)hasbeen increasingly usedin mus-culoskeletal 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 jointmovement.4,5 _It_is_found_to_be_effective_in_decreasing

pain and muscular spasm,increasing the range ofmotion (ROM),improvinglocalbloodandlymphcirculations, reduc-ing edema, strengthen weakened muscles, control joint

instability and postural alignment.6–8 _Although _the _exact

mechanisms of KT is not understood, sensorimotor, pro-prioceptivefeedbackmechanisms, inhibitoryandexcitatory nociceptivestimuli,mechanicalrestraintwere explainedas underlyingmechanisms.4,6,7_In_this_{double-blinded,}

random-ized placebo controlled study, we aimed to compare the efﬁcacyofKTandplaceboKTmethodsonpain,pressurepain threshold,ROManddisabilityinpatientswithMPS.

Materials

and

methods

Seventy-threepatients(50female,23male)withcervicalMPS involvingtheupperneckandlevatorscapulamusclereferred toouroutpatientclinicwereincludedinthestudy.The diag-nosisofMPSwasbasedonthecriteriadescribedbyTravell and Simons (5 major and minimum 1 minor criteria are requiredforclinicaldiagnosis).9_The_patients’_inclusion

crite-riawerepresenceofatleastoneactivetriggerpointlocated in levator scapulamuscle, ages greater than 18 years, and symptomdurationofatleast3months.Theexclusioncriteria werediagnosisofﬁbromyalgiasyndrome,cervicaldisclesion, radiculopathy,myelopathy,recent triggerpoint injectionor participatinginaphysicaltreatmentprogramwithinthelast 6months,neurologicandinﬂammatorydiseases,pregnancy orhistoryofneckandshouldersurgery.

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Afterphysicalexamination,fullbloodcount,erythrocyte sedimentationrate,C-reactiveprotein,andbiochemical mark-erswereevaluated.

This study was prospective, randomized, placebo-controlleddouble-blindtrial.Beforetreatment,allparticipants wereinformedaboutthestudyandsignedwritteninformed consent.ThestudywasapprovedbytheUniversityofUfuk HumanResearchEthicsCommittee.

Randomization

Patientswere randomlyassigned into two groupsby num-beredenvelopesmethod.Thegroup1andgroup2noteswere putintototheclosedenvelopesseparately,andeachpatient randomlychoseanenvelopeandgaveittothe physiothera-pist.Bothpatientsandtwoexaminingphysicianswereblinded totreatmentallocation.Onlythephysiotherapistwhoapplied thetherapywasawareoftheprocedureandphysiotherapist recordthepatientnamesandtheirgroups.

Group1patients(n=31)were treatedwith KinesioTape (KinesioTexGold,2in×103.3ft)suggestedbyKaseetal.five timesbyintervalsof3daysfor15days.Tapingwasperformed byaphysiotherapistwhoiscertifiedforthismethod.The mus-cleinhibitiontechnique which wasdescribed byKasewas used.Weappliedthetapingtolevatorscapulamuscle.The shoulderwasdepressedandneckwasinlateralflexionand rotation position tothe opposite side. A 15–20cm long “I” stripwasused.Applicationstartedfromthesuperior scapu-larangle.Initialportionofthetapewasstretchedmaximum 4–5cm andthen it wasstickedon the muscleorigowhich wasatthelevel of1–4 thoracictransverseprocess without stretching5_(Fig._1).

Group2patients(n=30)weretreatedwithshamtapingﬁve timesbyintervals of3 daysfor15 days. Shamtaping was appliedwithan“I”stripofthesamematerialonineffective partsofthemusclewithoutatensionwiththeneckinneutral position(Fig.2).

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

Fig.1–KinesioTapingtechnique.

Fig.2–ShamKinesioTapingtechnique.

No analgesic drugsor NSAIDswere allowed during the treatmentprocess.

Clinicaloutcomes

Patients were evaluated according to pain, pressure pain threshold,cervicalROManddisability.

Pain

Painwasassessedbyusingavisualanalogscale(VAS,0–10cm; 0meansnopain,10meansseverepain).

Pressurepainthreshold

Pressurepainthreshold(PPT)onthetriggerpointwas mea-sured with an algometer (Algometer Commander, JTECH Medical,Utah).Themeasurementwastakenthreetimesand themeanaveragevaluewasrecorded.

Cervicaljointrangeofmotion

TheactiveROMofcervicaljoint(ﬂexion,extension,right–left ﬂexionandrotation)wasmeasuredusingagoniometerwhen thepatientwasinsittingposition.

Disability

Disability was measured byusing the Neck Pain Disability Scale(NPDS).Turkishversionofthisscalewasfoundvalidand reliable.Thequestionnaireconsistsof20itemsandmeasures neckmovements,painintensity,effectofneckpainon emo-tion factors,and interferencewithdailylifeactivities.Each sectionisscoredona0–5ratingscaleandtotalscoreranges from0to100.10

Statisticalanalysis

Themeansandstandarddeviationsweregivenasdescriptive 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

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MAS (n=73)

Analisados (n=31) Lost to follow-up (n=5)

Discordance of therapy in 4 patients, allergic reaction in 1 patient Group 1 (n=36) Kinesio tape Lost to follow-up (n=7) Discordance of therapy in 6 patients, allergic reaction in 1 Group 2 (n=37)

Sham kinesio tape

Analyzed (n=30)

Allocation

Analysis 2 weeks Follow-Up

Randomized

Fig.3–Flowdiagramshowingofpatientsthroughtheclinicalstudy.

differencesbetween twogroups, the Mann–WhitneyU test wasused.Alevelofsigniﬁcanceofp<0.05wasaccepted.All analyseswere performedusing theSPSS forWindows18.0 softwareprogram.

Results

Thirty-sixpatientsingroup1(27femalesand9males)and37 patientsingroup2(30femalesand7males)withMPSwere includedthestudy.Afterrandomization,4patientsinGroup 1and6patientsinGroup2droppedoutbecausetheycould notattendthefollow-upprogramregularlyinthestudy.Then, onepatientfromGroup1andonepatientGroup2dropped out because allergic reaction occurred. Sixty-one patients completedthestudyandnosideeffectshadbeenobserved (Fig.3).

Table1showsthedemographicandclinicalpropertiesof theGroup1andGroup2.Nostatisticallysigniﬁcantdifferences weredetectedbetweenthegroupsatbaselinevalues(p>0.05) exceptNPDS(p<0.05).

Theresultsoffullbloodcount,erythrocytesedimentation rate,C-reactiveproteinandbiochemicalmarkerswerewithin normalrangesforbothgroups.

Aftertwoweeksfollowup,therewerestatistically signif-icantimprovementsinbothgroupsregardingVAS,PPT,ROM andNPDS(p<0.05)(Table2).

Table1–Demographicandcliniccharacteristicsofthe patients. Group1 (n=31) Group2 (n=30) p Age(years) 44.80±17.19 44.10±17.45 0.76 Gender (female/male) 22/9 23/7 0.61 Durationofpain (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,visualanalogscale;PPT(N),pressurepainthreshold,Newton; NPDS,NeckPainDisabilityScale.

a _p_<_0.05.

After the treatment, statistical significant differences wereobservedinVAS,PPT,cervicalflexion-extensionvalues (p<0.05)between thegroups. Howeverno differences were foundincervicalrotation,lateralflexionandNPDS(p>0.05) (Table2).

Discussion

Myofascialpainsyndromeisthemostcommonlyoccurring musculoskeletaldisorders seenbyphysiatrists. Thereisno acceptedstandardtreatmentprogramforMPS.Themainissue

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Table2–Comparisonoftheassessmentparametersinbothgroupsandbetweenthegroups. Group1(n=31) (mean±SD) Group2(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 Cervicalﬂexion 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 Cervicalextension 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

Rightlateralﬂexion

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

Leftlateralﬂexion

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 Rightrotation 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 Leftrotation 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,visualanalogscale;PPT,pressurepainthreshold;NPDS,NeckPainDisabilityScale;SD,standarddeviation. a _p_<_0.001.

b _p_<_0.05.

intheMPStreatmentistoprovidepainreliefontriggerpoints, improvingdisabilityandincreasingcervicalmotion.1,2

Kine-sioTapingisanewalternativetechniqueusedinMPS.3,4_This

study was planned as a randomized double-blind placebo controlled study in which efficacy of KT and placebo KT methodsonpain,PPT,ROMofcervicaljointanddisabilityin MPStreatment.After2weeksoftreatment,all assessment parametersshowedstatisticallysignificantimprovementsin bothKTandshamgroups.Therewasastatisticaldifference between the groups regarding VAS, PPT, cervical flexion-extension,exceptcervicalrotation,cervicallateralflexionand NPDS.

Althoughtherearealotofstudiesintheliteratureaboutthe effectoftapingonmusculoskeletalsystemandsportinjuries, therearelimitednumberofrandomizedcontrolledstudieson

MPS.3,11,12_However,_there_is_no_planned_randomized

double-blindplacebocontrolledstudyinwhichefficacyofKTinpain, PPT,ROMofcervicaljointanddisabilityinMPStreatment.A casereporthassuggestedthatKTmaybebeneficialforthe treatmentofapatientwithshoulderpainofmyofascial ori-gin.Theyobservedsignificantimprovementinthefunctional testsactiveshoulderrangeofmotionandtherewasnochange intheVAS.13 _In_a_randomized_double-blind_study_with_MPS

includedfiftypatients,theefficiencyofKTwascomparedwith dryneedlingandsignificantdecreaseinpain,PPTand disabil-itywasobserved.TheyfoundthatKTwasatleastaseffective asdryneedlinginthetreatmentofMPS.14_Hernandez_et_al.

comparedtheeffectivenessofKTandcervicaltrust manipu-lationinmechanicalneckpainwith36patients;theyobserved KTorcervicaltrustmanipulationleadstosimilarreductionin

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painseverity,disabilityandincreasesinROM.15_Although

Gon-zalezetal.foundanimprovementinpainandROMinpatients withacutewhiplashinjurywithKT,theseweresmallandnot clinicallymeaningful.8_In_our_study,_KT_group_showed

statis-ticallysignificantimprovementsregardingVAS,PPT,ROMand NPDS.Althoughsignificantimprovementswereobservedin pain,PPT,cervicalflexion-extension,comparedtotheplacebo group,therewasnochangeincervicalrotation,cervicallateral flexionandNPDS.

Multipletheorieshavebeenproposedtoexplainthe mech-anismsof KT, including enhance proprioception, cutaneus mechanoreceptors, improved blood and lymphatic circula-tion,reducedpainseverity,realignmentofjoints,assistthe posturalalignmentandrelax theoverusedmuscles.4,7,11 _As

aresultofKT,weobservedthatpain,PPT,ROMand disabil-itymeasures showedstatisticallysigniﬁcant improvements inKTgroup.Stimulatingthegatecontrolmechanismresults adecreaseinpainthroughtheincreaseinafferentfeedback foundintheskin.Anothertheorysuggeststhattheimproved ROMandpainareduetoanincreasedproprioseptivefeedback mechanismandmusclefacilitation.4,7,8,11

InthestudyThelenetal.,foundthatKTimproved pain-free shoulder range of motion but no effect on pain or function. They also observed KT and cervical spine trust manipulationreduceddisability.16_A_lot_of_published_clinical

trialshavesuggestedthat KT maybebeneﬁcial intreating patellofemoralpain syndrome,shoulder impingement syn-drome,lowerextremityspasticityandposturalrehabilitation inParkinson’sDisease.6,7,17,18 _A_few_systematic_reviews_have

evaluated the effect of KT on musculoskeletal and differ-ent clinical conditions. These randomizedtrials compared KTversusshamtapingorotherinterventions.Theresultsof reviewssuggestedthatKT had no signiﬁcantbeneﬁtor its effectwas too small interms ofclinical practice.However thesetrialswerelow-moderatequality,smallsamplesizesand verysmallfollow-upperiods.4,7,8_The_most_important

differ-enceofourstudywastohavehighernumberpatientsand designed asa randomized double-blind placebo controlled study.

CervicalROMrestrictionmostlyoccursbecauseofmuscle spasminMPS.StudiesshowedimprovementinROMvalues afterKT.8,15_In_our_study,_a_signiﬁcant_increase_was_obtained

in two weeks in cervical ROM in both groups. Although significantimprovementswereobservedoncervical flexion-extension,comparedtotheplacebogroup,buttherewasno changecervicalrotation,cervicallateralflexion.Theincrease in cervical ROM may be due to the reduction in patients’ cervicalmusclespasmsorexerciseprogramsappliedtothe patients.Inourstudy,homeexerciseprogramwasappliedto allpatientsandimprovementofcervicalROMwasobserved inbothgroups.Thelimitationofourstudywasnottohave an only exercise group which could be compared to KT and shamKT. Also, weinvestigatedthe short-term results ofKT.

Inconclusion,KTisanoninvasive,painlessmethodthat haslesssideeffects,iswelltoleratedandhasbeenusedin MPS.ThisstudyshowsthatKTleadstoimprovementsonpain, PPT,andROM,butnotindisabilityinshortperiod.Therefore, KTcanbeusedasanalternativetherapyinthetreatmentof

patientswithMPS.But,moreresearchisnecessaryforboth clinicalandlong-termeffectsoftheKinesioTapingtechnique.

Conﬂicts

of

interest

Theauthorsdeclarenoconﬂictsofinterest.

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