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FUNCTIONAL OUTCOMES OF KINESIO TAPING VERSUS

STANDARD ORTHOTICS IN THE MANAGEMENT OF SHIN
SPLINT
Shaji J. KACHANATHU, Fahad S. ALGARNI, Shibili NUHMANI,
Aqeel M. ALENAZI, Ashraf R. HAFEZ, Abdulrahman D. ALGARNI
The Journal of Sports Medicine and Physical Fitness 2017 Oct 24

DOI: 10.23736/S0022-4707.17.07520-X
Article type: Original Article
© 2017 EDIZIONI MINERVA MEDICA
Article first published online: October 24, 2017

Manuscript accepted: October 5, 2017
Manuscript revised: September 26, 2017
Manuscript received: February 27, 2017
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Title Page
Manuscript Title:
FUNCTIONAL OUTCOMES OF KINESIO TAPING VERSUS STANDARD
ORTHOTICS IN THE MANAGEMENT OF SHIN SPLINT
Author Names and Affiliations
Shaji John Kachanathu1*, Fahad Saad Algarni1, Shibili Nuhmani2, Aqeel M. Alenazi3
Ashraf R. Hafez4, Abdulrahman D. Algarni 5
1
College of Applied Medical Sciences, King Saud University, Riyadh, KSA; 2Dammam
University, KSA; 3 Salman Bin Abdulaziz University, KSA; 4Department of Orthopaedic
Physiotherapy, Derayya University, Minya, Egypt; 5Department of Orthopaedic, King Saud
University, KSA
*P.O. Box 10219
Office #2083, Building #24
Department of Rehabilitation Health Sciences
College of Applied Medical Sciences
King Saud University
Riyadh 11433, Kingdom of Saudi Arabia
Mobile: +966534781109
Office: +966014696228
Fax: +966014355883
E-mail: johnsphysio@gmail.com
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FUNCTIONAL OUTCOMES OF KINESIO TAPING VERSUS STANDARD
ORTHOTICS IN THE MANAGEMENT OF SHIN SPLINT
Abstract
Background: Exercise-related or lower-limb overuse injury characterized by pain located
between the knee and the ankle that occurs during activity is commonly referred to as shin splint.
Hyperpronation is considered the ultimate culprit in the development of overuse injuries such as
shin splint. This study endeavors to compare the functional outcomes of the most commonly
used anti-pronation techniques, kinesio taping and standard orthotics.
Methods: A total of 40 subjects (mean age, 24.16 ± 2.6 years) with symptoms of shin splint
participated in the current study. These subjects were randomly allocated to two groups (n = 20)
and underwent anti-pronation kinesio taping and standard orthotics, respectively. The functional
outcomes were assessed using the navicular drop test, visual analog scale, and hop distance.
Results: The kinesio taping intervention group showed significant improvements in pain and hop
distance compared to the standard orthotics intervention group, whereas an insignificant
intergroup difference was observed for the navicular drop test. Patients in both groups benefited,
but the response to kinesio taping was better than that to orthotics.
Conclusions: Kinesio taping played a vital role in improving functional outcomes compared to
orthotics by reducing pain and improving functional activity in patients with shin splint;
however, navicular drop correction did not occur using either intervention.
Key Words: Shin Splint, Kinesio Taping, Orthotics
Introduction
Exercise-related leg pain or lower-limb overuse injury is characterized by pain between
the knee and ankle that occurs during activity. The condition encompasses the clinical and
pathological features of several commonly used labels such as shin splint, medial tibial stress
syndrome (MTSS), periostitis, stress fractures, tendinopathies, and compartment syndrome.1
Shin splint is one of the most common causes of exercise-related leg pain. Shin splint injuries
reportedly comprise 13.1% of all running-related injuries.2 The most common complaint of
patients with shin splint is vague, diffuse pain of the lower extremity along the mid-to-distal tibia
associated with exertion.3 The various tibial stress injuries appear to be caused by alterations in
tibial loading since chronic repetitive loads cause abnormal tibial strain and bending.4 In the
early course of shin splint, pain is worse at the beginning of exercise and gradually subsides
during training and within minutes of exercise cessation. As the injury progresses, however, pain
presents after less activity and may occur even at rest.
Various researchers have proposed a wide variety of etiologies for shin splint, including
training on hard surfaces or uneven terrain, improper training techniques, sudden increase in
training intensity and volume, changes in footwear, muscle imbalance or inflexibility, and
biomechanical abnormalities.5,6 An excessively pronated foot and increased navicular drop, a
measure of pronation, appear to be associated with MTSS injury.3 However, the most commonly
believed etiological factor is foot pronation; abnormal alignment may stretch and weaken the
intrinsic foot muscles by elongating them beyond their neutral physiological resting
position.7 Several active exercises are frequently prescribed and performed in the context of
sports and rehabilitation to strengthen the intrinsic foot muscles and enhance the longitudinal and
transverse arches.8
Regarding injury prevention, different intervention strategies have been developed for
controlling foot pronation. Among them, foot orthotics, motion control footwear, and therapeutic
adhesive taping are the most commonly used interventions by clinicians. Studies have
investigated the effect of various taping techniques and found it effective in controlling pronation
and that it plays an important role in controlling symptoms in addition to conservative
management9. This study aimed to compare the functional outcomes of the most popularly used
anti-pronation treatment techniques such as kinesio taping and orthotics in managing shin splint.
Patients and Methods
A total of 40 study subjects (mean age, 24.16 ± 2.6 years) who presented with symptoms
of shin splint participated in the current study. Institutional ethical approval and each subject’s
written informed consent were obtained. Subjects were recruited from different athletic stadiums
and assessed against inclusion/exclusion criteria. The inclusion criteria included both sexes aged
20–30 years; hyperpronated foot (navicular drop  10 mm); atraumatic history of >1 week of
medial tibial pain exacerbated by running; presence of at least 10 cm of diffuse palpatory
tenderness at the distal two-third of the posteromedial aspect of the leg with a positive
provocative test; pain during forced passive ankle dorsiflexion; and pain during active ankle
planter flexion against resistance. Exclusion criteria were stress fractures, bone tumors,
compartment syndrome, congenital anomalies, vascular insufficiencies, known allergy to tape,
and any other injuries to the lower extremities that required reduced activity and treatment from
another health care practitioner.
The subjects were randomly allocated to a kinesio taping group and an orthotics group (n
= 20 each), and they underwent anti-pronation kinesio taping and standard orthotics,
respectively. The study outcomes were assessed using a visual analog scale (VAS), a line scale
of 0 to 10 (0 indicating no pain, 10 indicating the worst pain imaginable). Functional activity
difficulties were assessed using a 6-m single-leg distance hop test. In this test, each subject was
asked to hop on the affected leg and try to cover as much distance as possible without causing
pain or discomfort. The distance covered by the subject without pain was measured.
Hyperpronation of the foot was assessed by the navicular drop test with the subject seated
and the subtalar joint in the neutral position. The examiner placed a ruler at the medial aspect of
the rear foot and placed a corresponding mark at the navicular level. The mark was drawn with
an indelible ink pen onto the skin for accurate relocation among all trials. The subject then
assumed a full weight-bearing position that allowed the foot to relax. The navicular level was
noted. The difference between the two measurements, called navicular drop, indicates the degree
of foot pronation. Any measurement > 10 mm was considered abnormal.
Radiographic measurements are the gold standard validated tool for foot screening.
However, due to financial burden, X-ray exposure, and various clinical practice concerns, other
validated tools such as arch index and normalized navicular height, hence current study also
sought NDT as an alternative validated and reliable tool for measuring foot posture. Moreover,
normalized navicular height displayed the strongest association with radiographic
measurements.10
The NDT is helpful for evaluating the degree of foot mobility, specifically pronation, in
runners and is easy to practice in clinics with minimal cost.11 The intra-rater reliability of the
NDT assessed using the intra-class correlation coefficient (ICC) is reportedly 0.73–0.96.12 The
navicular position test was shown to have a high intra-day and intra- and inter-tester reliability
and can be used in prospective observational studies investigating the role of arch type on the
development of various lower-limb injuries.13 Experienced raters reported high reliability and
association in pain reduction with the normalized navicular drop among a variety of foot and
ankle measurements in individuals with patellofemoral pain syndrome with a more pronated foot
posture.14
The kinesio taping technique used in this study was a modification of the MTSS
technique. All taping was applied by the same certified athletic trainer trained in this specific
tape application. Prior to the application of kinesio tape (KT; Kinesio USA, Charlotte, NC,
USA), hair was removed from the medial tibia, and the area was cleaned with an alcohol swab.
Tape adherent was applied to the area to improve the adhesiveness of the tape. A single Y-strip
of KT was applied beginning with the tail placed on the proximal third of the medial tibia. Each
half of the Y-strip was then applied so that it lay anterior and posterior to the medial malleolus
and terminated under the medial longitudinal arch of the foot. No tension was applied on the
proximal and distal ends of the tape, while the remainder of the tape was applied with 75%
tension15.
Foot orthotics consisting of non-custom semi-rigid shoe insoles with medial arch support
were given to all of the subjects in the orthotics group. Participants in this group were initially
trained with the insoles in their shoes so they became acclimated to wearing them.
Both groups were asked to perform the stretching and strengthening exercise three times
per day along with the respective intervention. The stretching exercises consisted of standing on
a step with the heels over the edge, knees kept straight, and heels below the step and holding for
10–20 sec; standing on a step with the heels over the edge, squatting slightly with both knees
bent and the heels below the step and holding for 10–20 sec; and repeating 10 times.
Strengthening exercises consisted of heel walking (walk on the heels, pulling the toes toward the
shins, and walking 10 steps), heel raise (standing on the floor next to a table for support, rising
on the toes, and holding for 10–15 sec), and a towel gathering exercise. The total study duration
was 1 week. The VAS score, navicular drop height, and distance covered by the one-leg hop test
were recorded pre- and post-intervention.
Results
Descriptive data including age, height, and mass for patients in both groups matched, and
non-statistical differences were found at baseline. An intergroup VAS comparison revealed non-
significant differences between them at pre-intervention (p > 0.05) and significant improvements
for both groups post-intervention (p < 0.05). However, an intergroup comparison of mean pain
values revealed significant improvement in the taping group compared to the orthotics group (p <
0.05).
An intergroup comparison of navicular drop test values revealed an insignificant
difference pre- versus post-intervention (p > 0.05). Some changes were found in mean post-
intervention values, suggesting that both treatments had an effect on navicular height, but the
intergroup difference was insignificant (p > 0.05).
The mean pre-intervention hop distance did not differ significantly between the two
groups (p > 0.05); however, the intergroup post-intervention hop distance difference was
significant (p < 0.05). Moreover, significant changes were observed in the taping group
compared to the orthotics groups at day 7 (p < 0.05) (Table 1).
Discussion
The purpose of this study was to assess the functional outcomes of anti-pronation
interventions such as kinesio taping and standard orthotics in the management of shin splint. The
overall study results indicate that both groups benefited from the interventions. However, the
kinesio taping intervention showed significant improvements in pain and hop distance compared
to the standard orthotics intervention. An insignificant intergroup difference in navicular drop
was noted.
The current study demonstrated statistically significant improvement after both
interventions in terms of VAS and hop distance. These biomechanical findings support the
clinical practice of using anti-pronation taping at the first consultation to control abnormal
pronation, although the effect on navicular drop correction was insignificant. In addition to its
restrictive effects, kinesio taping may also have neuromuscular effects including changes in
muscle activity. KT is elastic and reportedly increases local circulation, reduces edema,
facilitates muscle activity, and improves joint function by enhancing sensory mechanisms.16
Taping creates a pulling effect on the skin during movements, suggesting that it may be caused
by enhanced stimulation of the cutaneous receptors by the close contact between the tape and the
skin.17 Moreover, the tape may increase cutaneous input, which increases the excitability of the
motor neuron pool.18 Although the scientific basis of taping remains unclear, it is generally
agreed that taping has a combination of mechanical and neuromuscular effects.
The current study result is consistent with that of a previous study that observed that both
interventions better controlled vertical navicular height after 20 minutes of exercise than tape and
orthotics.19 Tape is reportedly more effective at controlling vertical navicular height immediately
after application, whereas the orthotic maintained correction more effectively than the tape over
the 20-minute exercise period.19 Although there are several criticisms about navicular drop
height measurements, there is no agreement in the current literature about the amount of
movement that is thought to be excessive. A navicular drop measurement ≥ 10 mm is generally
accepted as an indicator of excessive pronation.20 Brody (1982) suggested that 10 mm is normal
and 15 mm is excessive pronation.11 Moreover, the mean navicular drop of the current study
subjects was 12 at pre-intervention and 10–11 post-intention, i.e., neither intervention created a
significant change.
The results of the current study suggest that greater pain reduction occurred between
subjects who received taping than those who used orthotics. This finding is supported by an
observation that the pain recovery of the taping group was better that of the orthotics group.21 In
addition to taping, custom-made orthotics have been shown to effectively limit excessive
pronation;22 however, molded orthotics are more expensive than taping methods and can be time-
consuming to produce.23
Hadley compared the ability of anti-pronation taping and temporary orthotics to correct
tibial rotation position after exercise and reported that taping was superior to temporary orthotics
and control intervention after 10 minutes of exercises and showed significant improvement in
pain and functional outcomes. They concluded that taping is superior to orthotics for controlling
tibial rotation caused by pronation, both after tape application and during exercise.21
A lateral shift in peak plantar pressure occurred with the kinesio taping in the midfoot
area. That is, less pressure was exerted in the medial midfoot (1.4 N/cm2), and more pressure was
exerted in the lateral midfoot (2.6 N/cm2) with the application of tape.24 These phenomena may
also explain why the taping group displayed a greater decrease in pain. During normal gait prior
to the mid-stance phase, the lateral foot contacts the ground and initiates unlocking of the
subtalar joint, revealing a less stable loose-packed position.25 This enables shock absorption and
adaptation to the walking surface.26 This might be the reason for the greater functional outcomes
with the use of taping.
Orthotics, unlike taping, exert no direct leverage and appear to exert less of an influence
on lower-limb alignment compared with the taping technique used in this study. The main cause
of excessive pronation is joint hypermobility and tightness of the posterior lower-leg muscle
groups.27 In the current study, both groups performed stretching and strengthening exercises
using taping or orthotics. Our result is also consistent with that of a recent review that concluded
that foot orthotics are effective for preventing overall injuries, shin pain, and stress fractures of
the metatarsals, tibia, and femur but do not provide shock absorption.28 Stretching and
strengthening exercises were useful for the conservative management of shin splint. This
program of exercises is valuable because it can correct functional risk factors. The prime focus of
this program was the leg muscles (soleus, gastrocnemius, tibialis posterior, tibialis anterior,
flexor digitorum longus, flexors hallucis longus). This approach of conservative management is
widely used by therapists for reducing symptoms and improving functional activity.4,29 These
conventional exercise regimens improved lower extremity strength without causing pain and
improved the hop test results.
The reduction in symptoms noted after the application of tape or orthotics that correct
hyperpronation indicates that there is an association between altered foot biomechanics and the
condition producing the symptoms. However, a future longer-duration study with a larger sample
size should be performed to corroborate these findings. The degree of biomechanical correction
required to relieve symptoms is unknown. Thus, future studies must address the required degree
of pronation control for the treatment of shin splint.
The use of non-custom orthotics is one of the limitations of this study. However, the
standard orthotics inserts used in this study are inexpensive, universally available, and easily
replaced. The combined use of orthotics and KT should be considered in a future study.
Conclusions
The findings of the current study suggest that kinesio taping plays a vital role in
improving functional outcomes compared to orthotics by reducing pain and improving functional
activity in patients with shin splint; however, navicular drop correction was insufficient after
both interventions. The authors recommend kinesio taping over orthotics for the management of
shin splint.
Acknowledgements
The authors extend their appreciation to the Deanship of Research, Research Center,
College of Applied Medical Sciences at King Saud University for the constructive scientific
support of this study.
Conflict of interest:
The author(s) declare no conflicts of interest regarding the publication of this article.
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Group *VAS-0 VAS-7 **NDT-0 NDT -7 ***HOP-0 HOP-7
K group 6.26 ± 1.43 3.46 ± 1.18 12.13 ± 2.13 10.60 ± 2.87 2.60 ± 0.73 4.66 ± 0.81
P value P < 0.05 P > 0.05 P < 0.05
O group 5.66 ± 1.63 4.53 ± 1.35 12.13 ± 2.13 11.06 ± 1.79 3.26 ± 1.16 3.66 ± 1.29
P value P < 0.05 P > 0.05 P < 0.05
* visual analog scale; ** navicular drop test; *** one-leg hop test
Table 1. Comparison of study variables for the kinesio taping and orthotics groups

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FUNCTIONAL OUTCOMES OF KINESIO TAPING VERSUS

The Journal of Sports Medicine and Physical Fitness 2017 Oct 24

Article type: Original Article

© 2017 EDIZIONI MINERVA MEDICA

Article first published online: October 24, 2017

Subscription: Information about subscribing to Minerva Medica journals is online at:

EDIZIONI MINERVA MEDICA

FUNCTIONAL OUTCOMES OF KINESIO TAPING VERSUS STANDARD

ORTHOTICS IN THE MANAGEMENT OF SHIN SPLINT

Author Names and Affiliations

Ashraf R. Hafez4, Abdulrahman D. Algarni 5

University, KSA; 3 Salman Bin Abdulaziz University, KSA; 4Department of Orthopaedic

Physiotherapy, Derayya University, Minya, Egypt; 5Department of Orthopaedic, King Saud

*P.O. Box 10219

Office #2083, Building #24

Department of Rehabilitation Health Sciences

College of Applied Medical Sciences

King Saud University

Riyadh 11433, Kingdom of Saudi Arabia

FUNCTIONAL OUTCOMES OF KINESIO TAPING VERSUS STANDARD

ORTHOTICS IN THE MANAGEMENT OF SHIN SPLINT

Background: Exercise-related or lower-limb overuse injury characterized by pain located

used anti-pronation techniques, kinesio taping and standard orthotics.

distance compared to the standard orthotics intervention group, whereas an insignificant

Key Words: Shin Splint, Kinesio Taping, Orthotics

Exercise-related leg pain or lower-limb overuse injury is characterized by pain between

syndrome (MTSS), periostitis, stress fractures, tendinopathies, and compartment syndrome.1

presents after less activity and may occur even at rest.

biomechanical abnormalities.5,6 An excessively pronated foot and increased navicular drop, a

and that it plays an important role in controlling symptoms in addition to conservative

Patients and Methods

medial tibial pain exacerbated by running; presence of at least 10 cm of diffuse palpatory

compartment syndrome, congenital anomalies, vascular insufficiencies, known allergy to tape,

another health care practitioner.

of 0 to 10 (0 indicating no pain, 10 indicating the worst pain imaginable). Functional activity

of foot pronation. Any measurement > 10 mm was considered abnormal.

normalized navicular height displayed the strongest association with radiographic

were recorded pre- and post-intervention.

An intergroup comparison of navicular drop test values revealed an insignificant

intergroup difference was insignificant (p > 0.05).

compared to the orthotics groups at day 7 (p < 0.05) (Table 1).

to the standard orthotics intervention. An insignificant intergroup difference in navicular drop

The current study demonstrated statistically significant improvement after both

agreed that taping has a combination of mechanical and neuromuscular effects.

movement that is thought to be excessive. A navicular drop measurement ≥ 10 mm is generally

accepted as an indicator of excessive pronation.20 Brody (1982) suggested that 10 mm is normal

with the use of taping.

improved the hop test results.

of pronation control for the treatment of shin splint.

support of this study.

Phys Ther 2007;2:170-80.

2. Yüksel O, Özgürbüz C, Ergün M, Islegen C, Taskiran E, Denerel N, et al.

Inversion/eversion strength dysbalance in patients with medial tibial stress syndrome. J

Sports Sci Med 2011;10:737-42.

3. Bennett JE, Reinking MF, Pluemer B, Pentel A, Seaton M, Killian C. Factors

Orthop Sports Phys Ther 2001;31:504-10.

management. Sports Med 1998;26:265-79.

6. Moore M. Shin splints: diagnosis, management, prevention. Postgrad Med 1988;83:199-

pronated foot. J Bodywk Move Ther 2017;21:216-22.

Higher Education, New York; 2009.

foot pronation: a meta-analysis. Br J Sports Med 2011;45:743-51.

Ankle Res 2009;2:22.

Group VAS-0 VAS-7 NDT-0 NDT -7 HOP-0 HOP-7