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Kinesiotaping for isolated rib fractures in emergency department

Ali Haydar Akça, Muhammed İkbal Şaşmaz, Şeyhmus Kaplan

PII: S0735-6757(19)30791-0
DOI: https://doi.org/10.1016/j.ajem.2019.11.049
Reference: YAJEM 158626

To appear in: American Journal of Emergency Medicine

Received date: 17 October 2019

Revised date: 25 November 2019
Accepted date: 30 November 2019

Please cite this article as: A.H. Akça, M.İ. Şaşmaz and Ş. Kaplan, Kinesiotaping for
isolated rib fractures in emergency department, American Journal of Emergency
Medicine(2019), https://doi.org/10.1016/j.ajem.2019.11.049

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© 2019 Published by Elsevier.

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Title: Kinesiotaping for isolated rib fractures in Emergency Department

Authors:

1. Ali Haydar Akça, Yüzüncü Yıl University Faculty of Medicine, Department of Emergency
Medicine

2. Muhammed İkbal Şaşmaz, Manisa Celal Bayar University Faculty of Medicine, Department
of Emergency Medicine

3. Şeyhmus Kaplan, Yüzüncü Yıl University Faculty of Medicine, Department of Sports

Medicine

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Correspondence:

Muhammed İkbal Şaşmaz

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Manisa Celal Bayar University Faculty of Medicine, Emergency Department
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ikbalsasmaz84@gmail.com +90 5365505031

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Introduction

Rib fractures, which are among the most common injuries in blunt thoracic trauma, are commonly
encountered in emergency departments. The main symptom is intense flank pain, which may last
for at least 1 month and impede the functions of body movements, deep breathing and coughing (1).
Discomfort in breathing may result in atelectasis, decreased lung compliance, hypoxemia and
respiratory distress (2). Pain management of rib fractures his a challenge for physicians. The
commonly used oral analgesics, usually non-steroidal antiinflammatory drugs (NSAID), provide
limited relief to patients (3,4). Invasive modalities like intercostal nerve block or operative repair
have also been practiced to relieve pain but still have some controversies (5,6).

Kinesiotape (KT) is a drug-free elastic therapeutic tape used for treating various musculoskeletal

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problems such as injury, dysfunction and pain. Kinesiotaping applications were created by a
Japanese chiropractor, Dr Kenso Kase, in 1970s. KT has become increasingly popular amongst

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athletes and practitioners. The profile of KT was significantly raised after it was seen on athletes at
2008 Olympic Games (7). KT is a thin, elastic tape that is claimed to stretch to 120–140% of its
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original length, and then subsequently recoil back to its original length following application, thus
exerting a proposed pulling force to the skin (7). Despite the absolute action mechanism of
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kinesiotape is unclear, investigators assert several mechanisms such as (8); supporting injured
muscle and joints, improving fascia function and position, increasing segmental stability, activation
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of the blood and lymph flow by lifting the skin, decreasing pain by reducing nociceptive stimuli.
Kinesiotaping has been evaluated in several studies for low back pain and other musculoskeletal
injuries especially in sports medicine (9). However, literature has no study about kinesiotaping in
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emergency departments.

In our study we aimed to investigate whether kinesotaping could safely and effectively treat pain
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from rib fractures in an emergency department.

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Materials and Methods

Study design

This was a prospective, quasi-randomised trial conducted in an Emergency Department of a

university hospital between July 2017 – January 2018. The study protocol was approved by the
university ethics board and written informed consent was obtained from all participants prior to
their involvement. Flurbiprofen alone was compared to flurbiprofen and kinesiotaping for pain
control in patients with isolated rib fractures.

Selection of participants

Patients presenting to our Emergency Department with blunt thoracic trauma and diagnosed with
isolated rib fractures on thorax CT included to the study. Exclusion criterias were as follows;
patients younger than 18 years old, with 4 or more rib fractures, with 1st or 2nd or 12th rib fractures,
accompanying hemo/pneumothorax, use of any analgesic within 12 hours of ED presentation,
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patients required surgical operation or hospitalization, patients who refuse to participate in the
study.

Consecutive patients were enrolled into the study 24 h a day and 7 days a week by the senior
resident in the shift. We did not randomize patients. The first and odd numbered patients were
included in the kinesio group and the odd numbered patients were included in the control group.
The last (thirtieth) patient was included in the kinesio group.

Interventions and methods of measurements

Pain severity of patients with rib fractures assessed with 0-10 cm visual analog scale(VAS) by an
observer who is blinded to the treatment groups, then patients assigned into 2 treatment groups. One

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of them received treatment with flurbiprofen 200mg/day (Majezik® tablet 100 mg, Sanovel İlaç
Sanayi ve Ticaret A.Ş. equal to 800mg ibuprofen) and the other group received kinesiotaping in

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addition to the same oral therapy. Patients were numbered and odd numbers were assigned to KT
and oral therapy group, and even numbers were assigned to oral therapy group except the last
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patient. Kinesiotaping applied to the patient immediately after the other procedures in emergency
department had finished. Kinesiotaping group’s pain intensity was assessed again after 15 minutes
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of kinesiotaping application. Then on the 4th day of procedure, both groups were assessed with
VAS in the follow-up visit. Since the kinesio bands maintained their elasticity for 3-4 days, we
measured the pain levels of the patients on the 4th day.
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All participants in Kinesiotaping group were taped by the same physician. Two I-shaped Kinesio
bands (Kinesio tape, Libor, Turkey) with a width of 5 cm and thickness of 0.5 mm were used.
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Patient placed in a position which shoulder abducted as much as possible. First tape was applied
from inferior and posterior to the site of fracture and fan strips were laid in a crisscross pattern over
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the fracture area. Second was applied from inferior and anterior in the same pattern as shown in
Figure 1.
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Outcome measures

The primary outcome measure was pain reduction in VAS score in kinesiotaping group at 15th
minute after taped. Secondary outcome measure was pain reduction in VAS score in both group at
4th day.

Statistical Analysis

Descriptive statistics for the studied variables (characteristics) were presented as mean and standard
deviation. Mann-Whitney U test was performed to compare groups. In addition, Wilcoxon test also
used to compare periods (0- 4th day). Analysis of the data collected in the study was performed
using the Statistical Package for the Social Sciences 22 statistical software package (IBM
Corporation, IL, USA). P < 0.05 with 95% confidence intervals was considered significant in all
analyses.
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Results

Total of 82 patients presented with rib fractures, 52 of them (32 had additional injuries, 9 had
pulmonary contusion, 5 had pneumothorax, 4 were hospitalized, and 2 had a history of analgesic
use) were excluded. Remaining 30 constituted the study group and randomly allocated to
kinesiotaping (n=16) or control group (n=14). All of 30 participants completed the study.

There was no significant differences between two groups in terms of age, gender and baseline
intensity of pain (p=0.984, 0.637 and 0.984 consecutively). (Table 1)

In both groups, pain intensity on the 4th day was significantly reduced when compared with
baseline (p for both<0.01). Additionally, considering the reducing the pain intensity on 4th day,
kinesiotaping was significantly superior than the control group (Table 2).

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On the other hand, pain intensity on 15th minute after kinesiotaping procedure was significantly
reduced from the baseline (p<0.01) (Table 2).

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Discussion:
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Blunt thoracic trauma and rib fractures usually encountered in emergency departments. Once
additional injuries are excluded, pain control is one of the mainstays of therapy for rib fractures.
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Guidelines recommend analgesia as first line therapy for the management of rib fracture in order to
decrease pulmonary complication rates (3). Discomfort in breathing due to pain may result in
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atelectasis, decreased lung compliance, hypoxemia and respiratory distress (2).

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The pain associated with rib fractures usually reaches its peak level in first 2 weeks and it starts to
improve after 2-4 weeks (10). While acute pain control during hospitalization has been well studied
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in the literature, there still exists room for improvement and better therapeutic strategies other than
conventional analgesics and nerve blocker injection are need to be explored (1). Various techniques
for the management of rib fracture pain especially for hospitalised patients have been published in
both the thoracic surgical and anesthesiology literature like intercostal nerve blocks, paravertebral
nerve blocks, epidural analgesia and interpleural catheters. Each of these modalities has their
limitations and risks(11-14).

In this study, we investigated whether kinesiotaping technique should be used as an complementary

therapy in patients with rib fractures without any known adverse effect. In this mean, this study is
the first which is taking into consideration a totally new and effective treatment in emergency
departments. An important result of our study was the siginificant decrease of the pain severity of
the patients within 15 minutes after kinesiotaping. The other is, kinesiotaping in addition to oral
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NSAID was significantly effective than NSAID therapy alone in terms of pain reduction on 4th day.
Additionally, kinesiotaping for 4 days was excellently well-tolerated by patients with no adverse
effect. Intercalarily, kinesiotaping is a rapid-acting method, which succeed to reduce pain score of
patients significantly in 15 minutes.

Consequently, kinesiotaping is widely used in sports medicine and musculoskeletal problems in a

safe and effective way for years. Hence pain intensities of patients significantly reduced with this
treatment modality in a painful condition like rib fracture without any adverse effect, we could
deliberate to use this effective technique in emergency departments.

As a result, kinesiotaping can be used as an adjunct to standard analgesic therapy with oral NSAIDs

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in pain management of isolated rib fractures.

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Limitations:

This study was not randomized and the last patients was mis-allocated. The lack of banding with
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plaster in the oral therapy group may have affected the results, considering that kinesiotaping may
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also have a placebo effect. Another limitation was the low number of patients in our study.
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Conclusion:

This study investigated the use of kinesiotaping for the treatment of rib fracture pain in the
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emergency department. When compared to NSAID therapy alone, combined kinesiotaping and
NSAID therapy appears to be more effective in terms of pain reduction in rib fractures. As a
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conclusion, kinesiotaping should be used as a complementary treatment method to provide

analgesia for rib fractures in emergency setting. On the other hand, our study should be investigated
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by additional researches.

Conflict of Interest: Authors declare that they have no conflict of interest.

References:

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complementary therapy to acute pain relief in inpatients with rib fractures. Biomedical Journal,
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2. Karmakar MK, & Ho AMH. (2003). Acute pain management of patients with multiple fractured
ribs. Journal of Trauma and Acute Care Surgery, 54(3), 615-625.

3. Simon BJ, Cushman J, Barraco R, et al. Pain management guidelines for blunt thoracic trauma.
Journal of Trauma and Acute Care Surgery 2005. 59.5: 1256-1267.
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4. D'arcy Y. Easing pain from blunt thoracic trauma. Nursing 2016 35.12 (2005): 17.

5. HO AMH, Karmakar MK, and Lester AHC. "Acute pain management of patients with multiple
fractured ribs: a focus on regional techniques." Current Opinion in Critical Care 17.4 (2011):
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6. Nirula R, Diaz JJ, Trunkey DD, & Mayberry JC. Rib fracture repair: indications, technical
issues, and future directions. World Journal of Surgery, 2009. 33.1: 14-22.

7. Williams S, Whatman C, Hume PA, & Sheerin K. Kinesio taping in treatment and prevention of
sports injuries. Sports Medicine, 2012. 42.2: 153-164.

8. Kaplan Ş, Alpayci M, Karaman E, et al. Short-term effects of Kinesio taping in women with

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myth or a fact?. The American Journal of Emergency Medicine, 2011. 29.2: 229.

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12. Mohta M, Verma P, Saxena AK, Sethi AK, Tyagi A, & Girotra G. Prospective, randomized
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unilateral multiple fractured ribs—a pilot study. Journal of Trauma and Acute Care Surgery,
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13. Short K, Scheeres D, Mlakar J, & Dean R. Evaluation of intrapleural analgesia in the
management of blunt traumatic chest wall pain: a clinical trial. The American Surgeon, 1996.
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14. Rauchwerger JJ, Candido KD, Deer TR, Frogel JK, Iadevaio R, & Kirschen NB. Thoracic
epidural steroid injection for rib fracture pain. Pain Practice, 2013. 13.5: 416-421.
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Author Contribution Statement
Ali Haydar Akça: Conceptualization, Methodology, Investigation, Formal analysis
Muhammed İkbal Şaşmaz: Methodology, Writing- Reviewing and Editing
Şeyhmus Kaplan: Visualization, Investigation

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Table 1: Baseline characteristics of participants
KT Group (SD) (n=16) Control Group (SD) p
(n=14)
Age,y 50,06 (13,11) 49,4 (12,51) 0,984
Gender (M/F) 12/4 9/5 0,637
Pain intensity 7,94 (1,73) 8,21 (1,12) 0,984
(baseline)
KT: Kinesiotaping; SD: Standard Deviation

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Table 2: Comparison of groups at pain intensity
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KT Group (SD) (n=16) Control Group (SD) (n=14) p1
Baseline VAS 7,94 (1,73) 8,21 (1,12) 0,984
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-VAS after procedure 3,31 (1,25) -
4,63 (1,71) -
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- Difference

Fourth Day VAS 2,00 (0,89) 4,71 (1,27) <0,01

Difference 5,94 (1,69) 3,50 (0,76) <0,01
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p2 <0,01 <0,01
KT: Kinesiotaping; SD: Standard Deviation; VAS: Visual Analog Scale
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p1: Comparison of two groups; p2: Difference in each group at baseline and fourth day
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Figure 1