The

Eect of Kinesio Taping on

Muscle Activation or Pain in Adults
with and without Patellofemoral Pain:
An Evidence-Based Review
Kellie Golik, MS, DPTc
UCSF/SFSU Graduate Program in Physical Therapy
Spring Symposium

Introduction
Kinesio taping (KT) is becoming increasingly
popular







(Thelen et al., 2008)
Taping techniques aimed at improving
circulation, pain, muscle activation,
proprioception, and function
However, there is a lack of conclusive
evidence on its eectiveness




(Thelen et al., 2008)
Understanding of the mechanism of action
is limited

(Stupik et al., 2007)

www.tennisperspective.com/2011/03/
kinesio-tape-in-tennis.html

Clinical Problem: Patellofemoral

Pain Syndrome (PFPS)
PFPS leads to:
Activity limitations (Fredericson et al., 2002)
Participation restrictions
Potential for decreased quality of life

PFPS can be a very challenging pathology

to treat
Multiple contributing factors
Dicult to alter structural abnormalities
and activation patterns





(Bolgla et al., 2011)
www.aafp.org/afp/2007

Signicance
PFPS is the single most
common diagnosis among
runners and in sports
medicine


(Taunton et al., 2002)

Incidence of PFPS in the

general population is 25%



(Witvrouw et al., 2000)

www.aafp.org/afp/2007

Relevance
Physical Therapy is the rst line of treatment for PFPS





(Aytar et al., 2011)
Patients will look to PTs for knowledge about its use and
eectiveness
PTs trained in kinesio taping can easily implement it into
practice
Kinesio taping may be a useful adjunct to standard
treatment

Primary Question
What is the eect of kinesio taping compared to no kinesio
taping on quadriceps muscle activation or knee pain in
adults with or without PFPS?

Healthy adults and adults with PFPS

Kinesio taping on the quadriceps

No kinesio taping

Muscle activation (peak torque) and pain (VAS)

Kinesio Tape
KT is elastic and can be stretched
up to 55-60% of its length
Allows unrestricted movement
(Kase et al., 2003) (Chang et al., 2010)

Wave-like grain provides a pulling

force to the skin and creates more
space by lifting the fascia and soft
tissue under the areas where it is
applied (Kase et al., 2003)

www.rn.fr/acatalog/Kinesio_taping

Eects of Kinesio Taping

To lift fascia and
soft tissue above
area of pain/
inammation
To align fascial
tissues

To provide a
positional
stimulus through
the skin

Proposed
Benets of
Kinesio
Taping

Provides sensory
stimulation to
assist/limit
motion

Removal of edema
by directing
exudates towards
lymph ducts
(Kase et al., 2003)

Kinesio Tape and Muscle Activation

Research is conicting about whether or not kinesio taping
can increase muscle activation






(Stupik et al., 2007)(Chang et al., 2010)
Taping could stimulate cutaneous mechanoreceptors and
deliver more signals to the CNS (Chang et al., 2010)
Increased cutaneous aerent stimulation may increase motor
unit ring


(MacGregor et al., 2005)

Increased space and improved circulation could lead to

improved muscle performance
(Kase et al., 2003)

Kinesio Tape and Pain

Kinesio tape can lift the skin to increase space between skin
and muscle, reducing the localized pressure, promoting
circulation and lymphatic drainage
This theoretically reduces
pain, swelling, and muscle
spasm

(Chen et al., 2008)

www.tigerlilystudios.com/kinesio-tape.php

What factors contribute to PFPS?

PFPS likely results from abnormal tracking of the patella,
and factors that may contribute include:

Quadriceps weakness

Quadriceps muscle imbalances
Abnormal muscle activation patterns
Excessive knee soft tissue tightness
Increased quadriceps angle

Hip weakness
Altered foot kinematics


(Bolgla et al., 2011)

www.btsbioengineering.com

What factors contribute to PFPS?

PFPS likely results from abnormal tracking of the patella,
and factors that may contribute include:

Quadriceps weakness

Quadriceps muscle imbalances
Abnormal muscle activation patterns
Excessive knee soft tissue tightness
Increased quadriceps angle

Hip weakness
Altered foot kinematics


(Bolgla et al., 2011)

www.btsbioengineering.com

Treatment for PFPS

The aim of interventions for PFPS is to improve patella
tracking and reduce abnormal stress on patellofemoral
joint structures

(Bolgla & Boling, 2011)
Rehabilitation regimes often include:
VMO and general quadriceps strengthening
Patellar taping and bracing to improve patellar tracking
Addressing dysfunction at the hip and foot






(Bolgla & Boling, 2011)

Theoretical Construct
Quad imbalance can
lead to abnormal
tracking

Abnormal tracking can

cause excessive stress
to the patellar facets
and surrounding tissues,
causing pain

Kinesio taping may

facilitate muscle
activation/quad balance

Correcting the
imbalance with taping
may decrease
symptoms of PFPS
(Fredericson et al., 2002) (Bolgla & Boling, 2011)

Gap
Increasing amount of literature in the past two years
However, literature covers a wide variety of populations
Outcome measures include muscle activation/strength,
pain, ROM, proprioception, balance, and functional
outcomes
No conclusive evidence on the eect of kinesio taping for
improving muscle activation or decreasing pain
Purpose: To combine results in order to establish more
conclusive evidence

Hypotheses
1

Null: Application of
kinesio tape will have
no eect on muscle
activation

Null: Application of
kinesio tape will have
no eect on pain

Alternate:
Application of kinesio
tape will increase
muscle activation

Alternate:
Application of kinesio
tape will decrease
pain

Expected Findings
Expected to nd 4-5 studies, possible one high-
quality RCT and lower quality RCTs and cohort
studies
Expected kinesio tape would:
Muscle activation
Pain

 Studies with kinesio

taping on the
quadriceps as the
primary intervention
Studies on adults 18
years of age
Studies whose primary
outcomes included
muscle activation and/
or pain

Exclusion criteria:

Inclusion criteria:

Methods

Studies in languages
other than English
Studies on people with
neurologic
impairments
Level of evidence 4 or
below according to
Jewell (2008)

Methods
Databases searched:

Search Terms:
kinesio taping, kinesiotaping, kinesio tape, kinesiotape,
elastic tape, quadriceps, knee, strength, muscle activation,
electromyography, and pain

Statistics
Extracted means and standard deviations (SDs)
Calculated single group eect sizes, 95% condence intervals (CIs)
Used Z-tests to compare eect sizes between groups
Calculated Q heterogeneity statistic
Pooled eect sizes across studies for subgroups with weighting by
inverse variance, calculated grand eect sizes and new 95% CIs
Grand eect sizes converted back to clinical units, and calculated %
change

Results of Search
Records recovered from
electronic and recursive search
(n = 34)

Studies screened and reviewed

(n = 34)

Studies included
(n = 6)
*A secondary reviewer conrmed
that studies met inclusion criteria

Articles excluded based on

inclusion/exclusion criteria:
(n = 28)
Languages other than English
Participants had neurological
impairments
Kinesio taping not primary
intervention
Primary outcomes did not include
muscle activation or pain
Level of evidence below level 4
(Jewell, 2008)
Lacking data or adequate
description of methods

Results
Author

Design

Level of Evidence/
Study Quality *

Aytar et al., 2011

RCT, blinding of participants and

assessors

1b
7/10

Akbas et al., 2011

RCT, no blinding

2b
4/10

Aktas et al., 2011

RCT, crossover study design, no

blinding

2b
3/10

Fu et al., 2008

RCT, crossover study design, no

blinding

2b
5/10

Vithoulka et al., 2010 RCT, crossover study design, no

blinding

2b
5/10

Stupik et al., 2007

2b
3/10

Non-randomized clinical trial, no

blinding

* Level of evidence according to Jewell, study quality rated by author using PEDro scale

Results
Author

Participants

Outcome Measures

Aytar
2011

n = 22 F with PFPS
KT: n = 12 MA = 22.4(1.6)
Control: n = 10 MA = 26.2(3.5)

Peak torque (isokinetic

dynamometry), Pain (VAS)

Akbas
2011

n = 31 F with PFPS
KT: n = 15 MA = 41(11.3)
Control: n = 16 MA= 44.9(7.8)

Pain (VAS)

Aktas
2011

n = 20 healthy
MA = 23.8 range 21-24

Peak torque (isokinetic

dynamometry)

Fu
2008

n = 14 healthy athletes
MA = 19.7(1.0)

Peak torque (isokinetic

dynamometry)

Vithoulka n = 20 inactive healthy F

2010
MA = 27(3.8)

Peak torque (isokinetic

dynamometry)

Stupik
2007

Peak torque/bioelectrical
activity (EMG)

n = 27 healthy
MA = 23(3.5)

Abbreviations: PFPS= patellofemoral pain syndrome, F=female, KT=kinesio taping, VAS= visual
analog scale, MA= mean age, EMG=electromyography

Results
Author

Methods

Follow Up

Aytar
2011

- Peak concentric torque at 60/s and 180/s

- Pain with ascending, descending stairs and walking

Immediate

Akbas
2011

- Strengthening and stretching for both groups for 6

weeks, and KT group received KT every four days
- Pain with 9 functional activities

3 & 6 weeks

Aktas
2011

- Peak concentric torque at 60/s and 180/s

Immediate

Fu
2008

- Peak concentric and eccentric torque at 60/s and 180/s Immediate &
12 hrs after

Vithoulka - Peak concentric and eccentric torque at 60/s and 240/s Immediate
2010
Stupik
2007

- Bioelectrical activity using transdermal EMG, peak

torque extrapolated for isometric contraction

KT=kinesio taping, EMG= electromyography

Immediate,
24, 72, and
96 hrs after

Kinesio Taping Techniques

Aytar et al., 2011

Aktas et al., 2011

Fu et al., 2008

Vithoulka et al., 2010

Kinesio Taping Technique

Stupik et al., 2007

Akbas et al., 2011

Results
Author

Findings

Aytar
2011

Signicant at 60/s (p=0.028) and 180/s (p=0.012)

Pain not signicantly dierent

Akbas
2011

Pain not signicantly dierent between groups (p>.05)

Aktas
2011

Signicant at 180/s (p=0.031), not signicant at 60/s (p>0.05)

Fu
2008

Not signicant for concentric torque at 60/s or eccentric at 60/s and

180/s, signicant for concentric contraction at 180/s (p=0.027)

Vithoulka Not signicant for concentric torque at 60/s and 240/s (p>0.05), but
2010
signicant for eccentric torque at 60/s (p<0.05)
Stupik
2007

Not signicant immediately after taping (p=0.55), signicant increase

in muscle activation at 24 hours (p=0.0005), 72 hrs (p=0.0015)

Forest plot of individual and combined eect

sizes for peak concentric torque at 180/s

Small grand eect

size = .17 (-.14, .47)

Weighted by inverse variance

Fixed eect model used Q = 2.50 p > 0.05

Forest plot of individual and combined

eect sizes for peak eccentric torque 60/s

Small grand
eect size = .07
(-.41, .54)

Weighted by inverse variance

Fixed eect model used Q = 0.43 p > 0.05

Forest plot of individual and combined eect

sizes for peak torque 12-24 hours after taping

Moderate grand
eect size = .56
(-.60, 1.72)

Weighted for inverse variance

Random eects model used Q = 6.14 p < 0.05

Clinical Units
Muscle activation: MCID 10% change (Williams et al., 2012)
Eect Size Equivalent
(peak torque)

% Change

+4.89 Nm

+7.0%

Eccentric torque at 60/s +2.97 Nm

+2.1%

Peak torque 12-24 hours +215.74 V

after taping

+37.5%

Concentric torque at
180/s

Pain
Aytar et al.

Akbas et al.
-0.17

-0.08

-0.02

Descending stairs
Z = -1.13 < (-0.83 - (-0.74)) < .95
Ascending stairs
Z = -1.30 < (-1.23 - (-1.01)) < .86
Walking
Z= -1.11 < (-1.14 - (-1.10)) < 1.03

Discussion
1

Null: Application of
kinesio tape will have
Fail
to orn eject
no
eect
muscle
activation

Null: Application of
kinesio
will have
Fail ttape
o reject
no eect on pain

KT may have a small,

but not statistically
signicant eect on
muscle activation

KT has little to no
eect on pain in
people with PFPS

Discussion
Proposed mechanism for increased strength is that taping
can stimulate cutaneous mechanoreceptors, which can
increase motor unit ring
(MacGregor et al., 2005)
Aerent stimulation from the taping may not have meet
threshold to activate muscle

The eect of KT on pain in PFPS is dependent on changing

muscle activation patterns
PFPS may be due to factors like abnormal hip and foot
mechanics that are not addressed by kinesio taping

Discussion
Dierent taping techniques

(Stupik et al., 2007,

Aktas et al., 2011)

(Fu et al., 2008)

Discussion
Dierence in methods
Study using EMG had more signicant ndings

Subjects

(Stupik et al., 2007)

Ceiling eect for healthy subjects

Follow up
24-72 hours after taping had most signicant ndings, but
only investigated by one study

(Stupik et al., 2007)

Limitations
Limitations in
search
Excluded studies in
languages other than
English
Small number of studies
Only two studies
examined pain in people
with PFPS, and the
results could not be
combined quantitatively

Limitations within
articles
Lack of blinding
Heterogeneity of taping
techniques
Subjects were primarily
healthy young adults

Harm and Adverse Events

Not addressed by any of the primary studies
No studies reported adverse events
Potential for adverse skin reaction including redness or
itching due to the pulling action of the tape
More likely in people with sensitive skin, and older adults





(Thelen et al., 2008)

Cost
Cost not addressed in any of the primary studies
Relatively inexpensive, ~ $11 for 5.5 yards
Applied every 3-5 days

Quick application by trained

practitioner
Easy for patients to purchase and
apply themselves once they have
been trained
www.clinicalhealthservices.com

Implications for Practice

At this time, KT cannot be recommended for increasing
muscle activation or decreasing pain in people with PFPS
However, KT is a safe, low cost intervention that can easily be
trialed with patients and discontinued if ineective
Clinicians should use their own clinical judgment, and continue
to use conventional treatments for PFPS

Important to consider patient preference

KT may oer other clinical benets

Directions for Future Research

More research is needed to further examine the eects KT
on muscle activation and pain in people with PFPS
Longer follow ups, 24-72 hours after application
Examine dierent taping techniques further (VMO)
Compare the eects of kinesio taping and McConnell taping
in people with PFPS
Muscle activation patterns/muscle balance with functional
activities

Conclusions
Kinesio taping on the quadriceps does not produce
statistically signicant improvements in muscle activation
in adults with and without PFPS
However, there is a trend towards increased muscle
activation that is greatest one day after taping

Does not produce statistically signicant decreases in pain

in people with PFPS, however research is limited
Further research is needed to provide clear guidance, due
to a lack of evidence on people with PFPS

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Acknowledgements
Diane Allen, PT, PhD
Betty Smoot, PT, DPTSc
JP Viel, PT, DPT, OCS
Taryn Bean, MS, DPTc
Erin Cardiasmenos, MS, DPTc
DPT Class of 2012
Family & Friends

Questions?