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DOI 10.3233/IES-2011-0413
IOS Press
Initial effects of kinesio
taping in patients
with patellofemoral pain syndrome: A
randomized, double-blind study
Aydan Aytar
a,
, Nihan Ozunlu
a
, Ozgur Surenkok
b
, Gul Baltac
c
, Pnar Oztop
d
and Metin Karatas
d
a
Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara,
Turkey
b
Department of Physical Medicine and Rehabilitation, SinoUnited Health Clinic, Shanghai, China
c
Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara,
Turkey
d
Department of Physical Medicine and Rehabilitation, Baskent University Hospital, Ankara, Turkey
Abstract. The purpose of this randomized, double-blind study was to determine the acute effects of kinesio taping on pain,
strength, joint position sense and balance in patients with patellofemoral pain syndrome (PFPS). Twenty-two subjects with PFPS
participated in the study. Subjects were separated into two groups; kinesio taping (KT) and placebo kinesiotaping (PKT).
All subjects were assessed before and 45-min after the applications. Muscle strength, joint position sense, static and dynamic
balance and pain intensity were used as the main outcome measures. Among all outcome parameters signicant differences
were found between strength of quadriceps muscle at 60 and 180
/s, and static and dynamic balance scores before and 45-min
after application of KT. There was also a signicant difference between strength of quadriceps muscle at 60
knee
exed position. Light or paper-off tension (without
stretch) was applied until the Y in the kinesio strip
has reached the superior pole of the patella. Then the
tails of the Y shaped kinesio tape with a 5075%ten-
sion for correction were applied just below the tibial
tuberosity with no initial tension. The tails of the Y
shaped kinesio tape without stretch were inserted into
and around the medial and lateral borders of the patel-
la including the vastus medialis and lateralis, respec-
tively. Finally for two mechanical patellar correction
techniques, two I shaped kinesio tapes were applied
around patella to 5075% tension at 45
knee exed
position (Fig. 1a) [14].
In the PKT group subjects were taped with a sticking
plaster without stretch. The main reasons for preferring
the sticking plaster was similarity with KT, easy acces-
sibility and no strech property. Application places were
similar to the KT group. A sticking plaster and KT
allowed for the same dynamics in application (Fig. 1b).
Although groups application materials and pressures
were different, they were well concealed under cloth-
ing. Therefore, we did not believe that blinding of the
subjects was compromised.
2.2. Outcomes measures
2.2.1. Muscle strength
An isokinetic dynamometer (Cybex 770 Norm,
Lumex Inc, Ronkonkoma, NY, USA) was used to eval-
uate quadriceps strength. At the beginning of each
evaluation, the dynamometer was calibrated. Subjects
were seated with hips and knees exed at 90
. The
axis of the dynamometer was positioned parallel to the
lateral femoral condyle. Tests were done for the knees
A. Aytar et al. / Initial effects of kinesio
/ sec-
ond. Joint position sense evaluated between 0 degree
knee extension to 90 degree knee exion total 90 de-
gree knee movement. Knee movement from exion
to extension was stopped by pressing the abort button
when subjects felt they were in the mid-position of the
range (45
). When sub-
jects felt ready, the testing procedure started. At the
test subjects were asked to press the abort button when
they felt they were at mid point of the range (45
). The
outcome measure consisted of the deviation from 45
p < 0.05.
tween groups at the end of applications. The level of
signicance was set at p = 0.05. The SPSS 15.0 was
used for the statistical analyses.
4. Results
The descriptive characteristics of the subjects are
shown in Table 1. Signicant pre-post differences in
strength at 60
/s (p =0.012),
static (p = 0.012) and dynamic (p = 0.046) balance
scores were indicated for the KTgroup (Table 2). There
were also signicant pre-post differences in strength at
60
/s; static
and dynamic balance scores and joint position senses
(Table 3).
5. Discussion
The present ndings indicate no signicant differ-
ence between KT and PKT groups regarding proprio-
ception, pain, balance and muscle strength in patients
with PFPS. Even though case series and small pilot
studies have previouslyreported improvements in func-
tion, pain, range of motion (ROM) and propriocep-
tion, some results indicate no benet due to KT ap-
plication, representing low level evidence [7,9,12,24,
30]. Our results are partially consistent with previous
reports showing that KT may have a positive effect on
muscle strength and balance but this effect is signif-
icant in the KT application group before and 45-min
after application. Results indicate no signicant dif-
ferences between the PKT and KT groups in propri-
oception, pain, balance and muscle strength. Specif-
ically proprioception results do not concur with Mur-
ray and Hulsk [19] who have suggested that KT ap-
plication enhanced proprioception. However, Halseth
et al. [9] showed that KT application did not enhance
proprioception in healthy subjects, which was similar
to our results. Some researchers thought that adhesive
taping increased proprioceptionby increasing feedback
information from the muscle spindles, soft tissue and
skin. We can only speculate that KT may not be enough
to increase cutaneous sense to affect joint propriocep-
tion as KT covers less area and is less restrictive on
the skin, resulting in lesser afferent stimulation com-
pared to adhesive tape application. Furthermore, cu-
taneous mechanoreceptors may rapidly accommodate
and thus would not provide useful feedback during re-
peated movements [9].
Several mechanisms may help explain the pain-
relieving effect of therapeutic tape. Adhesive tape
can improve patellar alignment in healthy controls and
those with PFPS [18,28]. Therapeutic tape may ease
pain by improving patellar alignment. Hinman et
al. [10] and Cushnaghan et al. [3] demonstrated instant
and daily pain reduction by taping application. Pain
modulation via the gait control theory is another plau-
sible explanation for such a change; as it could stim-
ulate neuromuscular pathways via increased afferent
feedback [17]. Worth mentioning, pain and functional
measures were not different between groups in either
our study or at Thelen et al.s [24], in variance with
other studies which have applied KT [6,29]. This lack
of agreement could be due to a number of factors. Al-
though some previous studies were only case serious
and no control group, it was difcult to ascertain cau-
sation. Also some of our subjects reported lower initial
function and VAS scores. These ndings show that KT
140 A. Aytar et al. / Initial effects of kinesio
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A. Aytar et al. / Initial effects of kinesio
p < 0.05.
Q = Quadriceps Muscle.
application may stimulate cutaneous receptors but not
sufcient to decrease the pain unlike taping. As we
mentioned above, KT application is not widely spread
around the knee like taping.
Afferent stimulation by cutaneous mechanoreceptors
could decrease pain and increase balance and facilitate
motor activity [21]. There have been only a few publi-
cations in peer-reviewed literature on the effects of KT
on motor activity recruitment. Murray [20] found that
the elastic tape applied to the anterior thigh enhanced
active ROM and increased surface electromyograph-
ic (EMG) activity of the quadriceps in two individu-
als with recent anterior cruciate ligament reconstruc-
tion. Application of athletic tape demonstrated little or
no difference in active ROM or EMG measurements.
The author suggested that further research should in-
clude randomized controlled studies to determine short
and long term efcacy and analysis of the success of
the elastic taping. However, our ndings could not
point out signicant differences in balance and motor
activity in the two groups. A strong placebo effect
of taping has been well documented in subjects with
patellofemoral joint pain. Hopkins and Ingersoll
11
sug-
gested that application of elastic tape may affect by
mediation through cutaneous mechanoreceptors which
could enhance proprioception and facilitate motor ac-
tivity. Our subject size and methodology is complete-
ly different from that of the Murrays study. It may
explain the diversity between two studies [2,26].
This study has several limitations. First, all of our
subjects were female and their strength, pain and joint
position sense differently compared to males. Second is
the lack of a control group. To increase evidence level,
this study must have control group. Third, our study
focused on initial effects; there may be some changes
after 60-min or a day in the outcome measurements.
6. Conclusions
Other than a signicant effect on quadriceps strength,
this study failed to indicate improvements in pain, bal-
ance and joint position sense. Consequently, applica-
tion of KT for decreasing pain or increasing joint po-
sition sense for PFPS does not constitute an effective
treatment method when compared with PKT.
References
[1] L.A. Bolgla, T.R. Malone, B.T. Umberger and T.L. Uhl, Hip
strength and hip and knee kinematics during stair descent
in females with and without patellofemoral pain syndrome,
Journal of Orthopaedic and Sports Physical Therapy 38(1)
(2008), 1218.
[2] E.A. Christou, Patellar taping increases vastus medialis
oblique activity in the presence of patellofemoral pain, Journal
of Electromyography and Kinesiology 14(4) (2004), 495504.
[3] C. Cushnaghan, C. McCarthy and P. Dieppe, Taping the patella
medially: a new treatment for osteoarthritis of the knee joint?
British Medical Journal 308 (1994), 735755.
[4] J.J. Eng and M.R. Plerrynowski, Evaluation of soft foot or-
thotics in treatment of patellofemoral pain syndrome, Physical
Therapy 73(2) (1993), 6268.
[5] G.P. Ernst, J. Kawaguchi and E. Saliba, Effect of patellar tap-
ing on knee kinetics of patients with patellofemoral pain syn-
drome, Journal of Orthopaedic and Sports Physical Therapy
29d(11) (1999), 661667.
[6] S. Frazier, J. Whitman and M. Smith, Utilization of kinesio
tex tape in patients with shoulder pain or dysfunction: a case
series, Advanced Healing (2006), 1820.
[7] T.C. Fu, A. Wong, Y. Pei, K. Wu, S. Chou and Y. Lin, Effect
of kinesio taping on muscle strength in athletes: a pilot study,
Journal of Science and Medicine in Sport 11(2) (2008), 198
201.
[8] W. Gilleard, J. McConnel and D. Parsons, The effect of patellar
taping on the vastus medialis obliques and vastus lateralis
muscle activity in persons with patellofemoral pain, Physical
Therapy 78(1) (1998), 2532.
142 A. Aytar et al. / Initial effects of kinesio