Kinesiology Tape for Pain?

Does Kinesiology Tape work for pain? How?

We are always striving for better pain management for patients. Better pain management improves patients’ quality of life and addresses one of the barriers to exercise. Various modalities can be used to manage pain, for example, heat and cold packs, electrophysical agents like transcutaneous electrical nerve stimulation, massage, exercise, etc.[1] What if there is another modality that is easy to use by patients themselves to manage their own pain? Kinesiology Tape (KT) has gained popularity over the past 50 years with over 150 thousand practitioners using it in their practice globally for various purposes,[2] such as enhancing exercise performance, blood circulation, joint positioning, pain reduction, etc, despite ambiguous research evidence for many of these. My interest in pain science spurred me to look at the literature on KT and pain reduction. This article aims to present a brief overview of the literature on the potential role of KT as a pain management strategy and its implications for physiotherapy practice.

Mechanism of Pain Reduction by KT: The Gate Control Theory

There are different proposed mechanisms by which KT relieves pain. The theory most referenced by studies is the Gate Control Theory. It states that Ab fibers, nerve fibers responsible for conducting touch signals, are bigger in diameter and faster in conduction velocity than those responsible for detecting pain, including Ad and C fibers.[3] Stimulating the Ab fibers with touch will then stimulate the inhibitory neuron, thus modulating pain signals travelling to the brain. This mechanism of pain mitigation can explain the natural reaction to rub the area of pain after a painful event like bumping into something. It is thought that KT applied onto the skin provides a similar stimulation to touch, thus help mitigate pain signals travelling to the brain.

I am aware that the Gate Control Theory doesn't represent the full picture of the physiology behind pain modulation with touch. However, it is not inaccurate to use it to simplify or explain one of the pain modulation mechanisms. Readers interested in pain science can read Sufka, K. J., & Price, D. D. (2002). Gate control theory reconsidered. Brain and Mind, 3, 277-290. Recent discoveries also demonstrated that pain modulation with touch doesn’t only happen in the spinal cord, but also in the primary somatosensory cortex. For more, read Lu, J., Chen, B., Levy, M., Xu, P., Han, B. X., Takatoh, J., & Wang, F. (2022). Somatosensory cortical signature of facial nociception and vibrotactile touch–induced analgesia. Science Advances, 8(46), eabn6530.

It May Relieve Pain!

To speak to the effectiveness of KT for pain reduction, a study has to compare the application of KT alone with a control group (no intervention) and demonstrate a significant difference between groups post-intervention. There are a few studies that show that KT alone was effective in pain reduction. In one study, twenty patients with unilateral anterior knee pain experienced a reduction in pain during stair ascending and descending immediately after the application of KT, compared to having no tape.[4] Paoloni et al. compared the effect of KT alone, exercise and KT, and exercise alone in 39 patients with chronic low back pain (CLBP). All three conditions reduced pain to the same degree after four weeks, showing that KT alone was an effective pain management strategy in the study.[5] Castro et al. compared the effects of KT application (applied on the area) to sham KT (applied above the area) and found that KT was effective in reducing back pain in 60 CLBP patients, but not sham KT.[6] The Gate Control Theory can explain the findings in these studies. When KT was applied to the site of pain, the cutaneous mechanoreceptor sends signals to “distract” the pain signal sent to the brain. A study demonstrated that the effectiveness of pain relief by touch decreases as the touch moves away from the painful site.[16] Therefore, it is not surprising that KT not applied to the area of pain is unable to contribute to pain relief.

A systematic review and meta-analysis concluded that KT is effective in reducing pain compared to minimal intervention.[7] However, the authors highlighted that the heterogeneity between the studies is high, meaning that the studies vary greatly in their methodology, which makes it difficult to compare results. Furthermore, none of the studies report effect sizes, which are measures of how meaningful statistical differences are in practice. So there is no way to know whether the pain reduction effect is substantial and meaningful, even though statistical significance was achieved. For example, in a study that found statistically significant pain reduction in taping the knee, the median effect on a pain scale was only a 0.5 reduction,[4] which is lower than the threshold of minimal clinically important change: improvement of 1 on the scale of 0-10.[8] It is reasonable to say that there is some evidence to suggest KT can have some effect on relieving pain, though whether the amount of pain reduction is meaningful is uncertain.

When interpreting these studies, it is important to consider the psychological effects of the interventions. It is impossible to determine whether the results are actually due to the intervention, or a general placebo effect. For example, experiencing care from the practitioner or believing and hoping that the tape will work could “trick” the mind to perceive pain relief. Yet, improving patient quality of life by decreasing pain experienced is one of the clinician’s goals, whether it is from a psychological effect, physiological effect, or both. Some people wear a basic neoprene sleeve around their joint of complaint and experience pain relief, even though the sleeve may not be doing much for the joint. KT could be a low-risk and low-cost pain management strategy for patients seeking pain reduction.

Application Technique May Not Matter

If the Gate Control Theory explains the pain reduction in patients post-KT application, does the technique of application matter as long as some tape is applied on the area of pain? Wilson et al. compared different techniques of taping on 71 subjects with patellofemoral pain syndrome (PFPS).[9] The three different techniques are: taping that attempts to pull the patella medially, laterally, and no pull (just taping over the patella), all with Leukotape P (a non-stretchable tape commonly used in the McConnell Taping method to facilitate medial patellar glide). They found that all taping techniques reduced pain during a single step-down test compared to no tape. However, the no pull and lateral pull taping was found to provide a significantly larger reduction in pain compared to medial, and the difference was found to be clinically meaningful. The authors were unsure why neutral and lateral taping was superior to medial taping. However, this raises the question of whether we need a particular way of taping to address pain. The traditional way of taping PFPS is the McConnell Taping method. But a study comparing the pain reduction effect between McConnell Taping and KT found that only KT resulted in a significant difference in pain reduction compared to no tape.[4] This, again, questions the necessity of a particular taping method for therapeutic effects.

There are a few other studies that compared KT application to sham KT. Three studies compared KT applied with tension (expected to provide therapeutic effect) and KT applied with tension (sham condition). Thelen et al. studied 42 subjects with shoulder pain[10] while Parreira et al. studied 148 subjects with LBP.[11] Both found that KT applied with and without tension has similar effects on pain relief. Their findings echoed the Gate Control Theory that any sort of light touch stimulus can distract the pain signals travelling to the brain. One study, however, suggested otherwise. Cho et al. studied 46 older adults with PFPS, comparing KT applied with and without tension.[12] There was improvement in pain in the KT group, but no improvement was found in the group that had KT without tension. The authors speculated that older adults may have a reduction in their sense of touch, which may warrant greater skin stimulation to elicit an inhibitory effect on pain signals.

The abovementioned studies cast the question of whether a particular taping technique is crucial to the extent of pain relief. Even though KT certification courses and KT application manual (eg., Kase, 2003[13]) exist to provide education on how to tape, full replication of “textbook techniques” is not necessary to see the results of taping for pain management. Rather, an understanding of pain physiology and human anatomy would suffice. Clinicians who would like to incorporate KT as a pain self-management strategy for patients can provide a brief education on how to tape for their pain concerns, and patients could implement this on their own. In a Korean study, 69 older adults with knee pain were able to implement self-taping and experience pain reduction compared to no tape.[14] Yet, future studies should investigate how self-taping compares with clinician taping.

KT as an Adjunctive Therapy

Whereas having studies isolating KT as its own intervention is important for us to know that the effect of KT on pain reduction is not confounded with other interventions, it is not reflective of typical rehabilitation settings where multiple interventions are used. It is therefore worth seeing whether KT used in conjunction with other forms of therapy provides an additive effect on treatment outcomes.

KT Does Not Address Functional Outcomes

Although KT can be effective in managing pain, it cannot replace exercise and it cannot deliver the benefits of exercise. Devereaux et al. randomly allocated 100 patients with subacromial impingement into three groups: KT with exercise group, NASID with exercise group, and exercise alone group. After a two-week intervention period, all three groups experienced decrease in pain when compared to pre-intervention, and there was no significant difference between the groups on all outcome measures. This suggested that exercise alone is as effective as exercise with KT, which means that KT did not provide any additional effect on pain relief in this study. Pain relief through exercise alone can be explained by the exercise-induced hypoalgesia phenomenon.[17] In the previously mentioned study by Paoloni et al., even though all groups (KT with exercise, KT alone, and exercise alone) experienced similar pain relief, only the exercise alone group demonstrate a reduction in disability.[5] These studies suggest that KT cannot be considered a substitute for therapeutic exercise.

KT May Help with Early Exercise Intervention

Is there any value in using KT as an adjunctive therapy? Therapy has multiple purposes and pain relief is only one of them. While exercise is what ultimately improves function, one can question whether having KT as a pain relief strategy can facilitate therapeutic exercises. Kaya et al. randomly allocated 60 participants with shoulder pain into KT with exercise group or physiotherapy modalities (PT) (ultrasound, TENS, and hot pack) with exercise group.[15] After the first week of intervention, the KT group reported a significantly greater reduction in pain from baseline, compared to the PT group. However, there was no significant difference between the two groups in the second week of intervention, with both groups reporting significant pain reduction. If immediate pain management is desired, for example, to allow exercises to be done with less pain and apprehension, KT may provide short-term pain relief better than traditional physical therapies to allow earlier excise intervention. However, it would be interesting to see future studies looking at KT-related pain relief and long-term exercise adherence.

Conclusion

KT is likely able to provide some pain relief effects, which can be explained using the Gate Control Theory. However, the clinical significance of the results were unclear. KT application technique doesn’t seem to matter as long as the tape is applied on the area of complaint. This could facilitate patients’ pain self-management using KT if desired. Finally, the literature is less certain about the added benefits of KT when used with other treatment modalities. It could serve as a basic pain management strategy, but it should not replace exercise, which is the primary means of improving function and decreasing disability. Clinicians can explore the option of using KT for pain management as a strategy to improve exercise adherence.

Unanswered Questions

Future studies should focus on refining and standardizing their methodology based on existing systematic reviews on this topic, report effect sizes, and whether their results achieve clinical significance. Moreover, future studies can explore longer-term effects of KT use on pain relief and exercise adherence, as well as whether self-taping is as effective as clinician taping. A review on TENS for pain control suggested that targeted use of TENS during movement or exercise may provide the most benefit.[18] It would be interesting to see whether KT functions similarly as TENS in this regard. Lastly, there are a few other factors that were not considered in this article that warrant further research: 1) How would individual variability in processing pain[19] influence the effectiveness of KT? 2) Would long-term application of KT develop tolerance? If so, what are the strategies to prolong the analgesic effect from KT? 3) What are the optimal KT application parameters to work around skin habituation to the tape sensation? Before the research answers these questions, clinicians who wish to use KT as a pain management strategy should exercise clinical reasoning and consider patient response to individualize and optimize KT application for pain management.

Originally published:

Tiu, T. Using Kinesiology Tape in Physiotherapy Practice for Pain Management. Physiotherapy Practice. Canadian Physiotherapy Association. Spring 2023. Available from physiotherapy.ca.

References

[1] Rakel, B., & Barr, J. O. (2003). Physical modalities in chronic pain management. Nursing Clinics, 38(3), 477-494.

[2] Drouin, J. L., McAlpine, C. T., Primak, K. A., & Kissel, J. (2013). The effects of kinesiotape on athletic-based performance outcomes in healthy, active individuals: a literature synthesis. Journal of the Canadian Chiropractic Association, 57 (4), 356-365.

[3] Melzack, R. (1996). Gate control theory. Pain Forum, 5(2), 128-138. https://doi.org/10.1016/s1082-3174(96)80050-x

[4] Campolo, M., Babu, J., Dmochowska, K., Scariah, S., & Varughese, J. (2013). A comparison of two taping techniques (kinesio and Mcconnell) and their effect on anterior knee pain during functional activities. International Journal of Sports Physical Therapy. 8(2).

[5] Paoloni, M., Bernetti, A., Fratocchi, G., Mangone, M., Parrinello, L., Cooper, M. D. P., & Sesto, L. (2011). Kinesio Taping applied to lumbar muscles influences clinical and electromyographic characteristics in chronic low back pain patients. European Journal of Physical and Rehabilitation Medicine, 47(2), 8.

[6] Castro-Sánchez, A. M., Lara-Palomo, I. C., Matarán- Peñarrocha, G. A., Fernández-Sánchez, M., Sánchez-Labraca, N., & Arroyo-Morales, M. (2012). Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain: A randomised trial. Journal of Physiotherapy, 58(2), 89–95. https://doi.org/10.1016/S1836-9553(12)70088-7

[7] Lim, E. C. W., & Tay, M. G. X. (2015). Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. British journal of sports medicine, 49(24), 1558-1566.

[8] Devereaux, M., Velanoski, K. Q., Pennings, A., & Elmaraghy, A. (2016). Short-term effectiveness of precut kinesiology tape versus an NSAID as adjuvant treatment to exercise for subacromial impingement: A randomized controlled trial. Clin J Sport Med, 26(1), 9.

[9] Wilson, T., Carter, N., & Thomas, G. (2003). A multicenter, single-masked study of medial, neutral, and lateral patellar taping in individuals with patellofemoral pain syndrome. Journal of Orthopaedic & Sports Physical Therapy, 33(8), 437–448. https://doi.org/10.2519/jospt.2003.33.8.437

[10] Thelen, M. D., Dauber, J. A., & Stoneman, P. D. (2008). The clinical efficacy of Kinesio Tape for shoulder pain: A randomized, double-blinded, clinical trial. Journal of Orthopaedic & Sports Physical Therapy, 38(7), 389–395. https://doi.org/10.2519/jospt.2008.2791

[11] Parreira, P. do C. S., Costa, L. da C. M., Takahashi, R., Junior, L. C. H., Junior, M. A. da L., Silva, T. M. da, & Costa, L. O. P. (2014). Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: A randomised trial. Journal of Physiotherapy, 60(2), 90–96. https://doi.org/10.1016/j.jphys.2014.05.003

[12] Cho, H., Kim, E.-H., Kim, J., & Yoon, Y. W. (2015). Kinesio Taping improves pain, range of motion, and proprioception in older Patients with knee osteoarthritis: A randomized controlled trial. American Journal of Physical Medicine & Rehabilitation, 94(3), 192–200. https://doi.org/10.1097/PHM.0000000000000148

[13] Kase, K. (2003). Clinical therapeutic applications of the Kinesio taping method. Tokey, Japan.

[14] Lee, J. H. (2018). Effects of self taping therapy on knee pain and physical functions in older adult. The Journal of the Convergence on Culture Technology, 4(1), 33-39.

[15] Kaya, E., Zinnuroglu, M., & Tugcu, I. (2011). Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clinical Rheumatology, 30(2), 201–207. https://doi.org/10.1007/s10067-010-1475-6

[16] Mancini, F., Nash, T., Iannetti, G. D., & Haggard, P. (2014). Pain relief by touch: a quantitative approach. PAIN®, 155(3), 635-642.

[17] Rice, D., Nijs, J., Kosek, E., Wideman, T., Hasenbring, M. I., Koltyn, K., & Polli, A. (2019). Exercise-induced hypoalgesia in pain-free and chronic pain populations: state of the art and future directions. The Journal of Pain, 20(11), 1249-1266.

[18] Vance, C. G., Dailey, D. L., Rakel, B. A., & Sluka, K. A. (2014). Using TENS for pain control: the state of the evidence. Pain management, 4(3), 197-209.

[19] Conditioned Pain Modulation (CPM) and Temporal Summation of Pain (TSP) characterize how individuals process pain. Inefficient CPM and enhanced TSP could lead to a higher risk of acquiring pain. Inefficient CPM could influence the efficacy of KT. Impaired exercise-induced hypoalgesia response could also impact how well individuals respond to exercise therapy (see citation 17). The interaction between pain processing characteristics and KT application efficacy is yet to be researched. Readers interested in CPM and TSP can read Yarnitsky, D. (2015). Role of endogenous pain modulation in chronic pain mechanisms and treatment. Pain, 156, S24-S31.