Kinesio Taping in Sports: Does the existing evidence match your clinical practice?

Introduction

Sport is an environment where competition is always present, inside and outside the field, leading its professionals to be proactive, and to seek new strategies in order to accomplish their job more efficiently. Sports medicine staffs are no exception. Clubs and players’ demands regarding medical teams’ performance significantly increased in the last decades, leading to a rise in the techniques, methods and approaches available to treat and manage player health issues more quickly and with better results.

A method that is considerably increasing its popularity among sports professionals and players is the Kinesio Taping^® Method. This technique consists in the application of a specific elastic adhesive tape to the skin – Kinesio^® Tex Tape – stimulating it, in order to, hypothetically, create conditions to return injured tissue to homeostasis through the stimulation of various systems in the body (Mostafavifar, Wertz, & Borchers, 2012; Morris, Jones, Ryan, & Ryan, 2013; Parreira, Costa, Junior, Lopes, & Costa, 2014).

Figure 1 – Rectus Femoris facilitation application

Although the Kinesio Taping Method has surged in popularity recently, it was developed by a Japanese chiropractor Dr. Kenzo Kase in 1979 to improve and maintain his rehabilitation outcomes in a wide variety of clinical conditions. It began to be noticed internationally following its first major exposure in the Seoul Olympic Games in 1988, and the subsequent exposure of its use among prominent athletes (Mostafavifar, Wertz, & Borchers, 2012; Morris, Jones, Ryan, & Ryan, 2013; Parreira, Costa, Junior, Lopes, & Costa, 2014). The sports world was the “engine” responsible for spreading the beneficial effects of Kinesio Taping in musculoskeletal dysfunctions. This led to a significant increase in its usage, after some well-known elite athlete appeared in competition with the Kinesio Tape. Nowadays it is absolutely normal to see a player competing with a Kinesio Taping application.

Figure 2 – David Beckham appearance after match using Kinesio Taping application for a rib dysfunction

In the last decade, researchers have been focused in testing Kinesio Taping effects on several neuro-musculoskeletal dysfunctions and also trying to know more about the mechanisms underneath its effects. However, a very low number of reasonable quality studies are available; when tested in a large scale – systematic reviews and meta-analysis – evidence seems not to support the use of Kinesio Taping (Mostafavifar, Wertz, & Borchers, 2012; Morris, Jones, Ryan, & Ryan, 2013; Parreira, Costa, Junior, Lopes, & Costa, 2014). On the other hand, several experimental studies and case reports have been showing Kinesio Taping beneficial effects, especially on pain management and functional capabilities, similar to what clinicians report as well (Yoshida & Kahanov, 2007; Thelen, Dauber, & Stoneman, 2008; Tsai, Chang, & Lee, 2010; Lee & Yoo, 2011; Campolo, Babu, Dmochowska, Scariah, & Varughese, 2013; Merino-Marban, Mayorga-Vega, & Fernandez-Rodriguez, 2013; Bae, Lee, Kim, & Kim, 2014; Donec & Krisciunas, 2014; Nadali et al., 2014).

At this time, conflicting outcomes exist between published evidence and clinical practice. In consideration of this issue, the present article attempts to explain the fundamentals of Kinesio Taping, discussing evidence and clinical practice findings regarding the use of this method, to provide insight into why this conflict may exist and how to take advantage of it, considering Football Medicine’s clinical expertise.

What is Kinesio Taping?

Properties of the Kinesio Tape

This specific elastic and adhesive tape – Kinesio® Tex – was created mimicking skin’s properties in terms of flexibility, weight and thickness. Its wave pattern and adhesion properties allow a recoil effect that is part of this method’s core (Kase, 2003; Kase, Wallis, & Kase, 2003).

Kinesio® Tex Tape’s texture also allows skin breathing through the tape, minimizing the possibility to develop allergies on the skin and allowing it to be used for three to five days (Kase, 2003; Kase, Wallis, & Kase, 2003; Thelen, Dauber, & Stoneman, 2008).

This tape can be stretched around 130-140% its original size, allowing the therapist to manage the effects according to the tension applied on it (Kase, 2003; Kase, Wallis, & Kase, 2003; Lee & Yoo, 2011).

At the time it is produced, when attached to the paper that holds the Kinesio Tex® strip, it already has a pre-tension level, a small amount of stretch around 10-15%, which means that even if the tape is applied with a paper-off tension, it is applied with a specific small amount of tension. This can be demonstrated with the experiment in Figure 4 (Kase, 2003; Kase, Wallis, & Kase, 2003; Parreira, Costa, Junior, Lopes, & Costa, 2014).

Figure 3 – Kinesio Tex Tape stretch capability: 2 strips of the same size were cut and then appliied on the table with 0% tension (under) and 100% tension (upper)

Figure 4: Demonstration of the paper-off tension: 2 strips with the same size were cut, when the under strip was removed from the paper that holds it and then applied again, a shortening in its length is seen, confirming that it had a pre-tension level

Parts of the Kinesio Tape

In brief, the tape is constituted by the anchor, the base and the end, being each of it applied with a specific limb/body/skin position and tape tension, changing the effects obtained with the tape application (Kase, 2003; Kase, Wallis, & Kase, 2003).

Figure 5 – Parts of the Kinesio Taping application: Left – Anchor; Middle – Base; Right – End

Behaviour of the tape

The recoil effect and its direction

One of the most important effects of Kinesio Taping on skin is the recoil effect of the tape. It is hypothesized that, when tape is applied on the skin, the Kinesio Taping application is going to stretch/drag the tissue that stays under the end and base of the tape towards the anchor, as it is shown in Figure 6 (Kase, 2003; Kase, Wallis, & Kase, 2003; Parreira, Costa, Junior, Lopes, & Costa, 2014).

Figure 6 – Tape application direction and recoil effect direction exemplification

Importance of the tension and type of cuts applied

As mentioned above, managing the tension applied to the tape, different stimulus and reactions will be given by the Kinesio Tape (Thelen, Dauber, & Stoneman, 2008). Studying the mechanical effect of the Kinesio Tape on the skin in vivo is extremely difficult once it is thought to work in the most superficial layers of the skin as we will discuss further in this text, however, some “homemade” experiments may give us an insight on how it may work in our skin, or at least, the forces the Kinesio Tape will transmit to our skin after its application.

In Video 1, it is present an experiment performed by a Certified Kinesio Taping Instructor Frank Tore Jacobsen where he uses a piece of Kinesio® Tex Tape fully stretched to simulate the skin’s behaviour during the tape application (that is also fully stretched, remember the tape has similar properties), and then applies a second piece of Kinesio® Tex Tape on the first one with different tensions and cuts.

When he removes the first tape from the table – simulating the return to normal position during in vivo taping – we can see the hypothetical effect of the Kinesio Tape on the skin, generating more recoil, lifting and decompression, or generating more compression with less recoil, depending on the cutting technique and tension given.

In this experiment is also possible to understand the different effect of the Kinesio Taping compared with usual rigid tape, once the last one will only be able to generate compression on the underneath tissues.

What makes Kinesio Taping different from other taping modalities?

Considering that Kinesio Taping Method was developed to allow and restore full range of motion (ROM), it is completely distinct from other taping modalities since, instead of creating a ROM restriction to improve functionality to the individual – similar to what happens when athletic tape is applied – Kinesio Tape permits full ROM in order to promote individual’s functionality (Kase, 2003; Kase, Wallis, & Kase, 2003; Campolo, Babu, Dmochowska, Scariah, & Varughese, 2013).

Another Kinesio Taping characteristic that distinguishes it from other taping techniques is its target organ. Kinesio Taping concept’s aim is taping the skin to create an afferent stimulus on it in order to influence several systems in the body (e.g. muscular, articular, lymphatic…) through the stimulation of the central nervous system (CNS), changing the paradigm of taping from a mechanical perspective to a neurophysiologic one (Kase, 2003; Kase, Wallis, & Kase, 2003). Most of other modalities use tape to mechanically correct and/or limit movements – taping a joint – or modifying muscular activity with rigid tape like what is intended with some McConnell taping techniques – taping a muscle (Campolo, Babu, Dmochowska, Scariah, & Varughese, 2013). This means that the physiological structures other methods want to influence are the ones where they are going to target their tape, in contrast with the Kinesio Taping concept that focuses on skin to influence other structures.

Kinesio Taping Fundamentals and Principles

Importance of the skin

The skin is the biggest organ of the human body, constituting 16% of the body weight, covering an area of approximately 2m2. This organ has several well-known functions like immune protection, temperature regulation and body barrier (Shimizu, 2007).

Besides that, skin has a great potential to modulate human’s body perceptions and motor scheme, once it has a significant amount of exteroceptive receptors, responsible for transmitting afferent information to the CNS (Kase, 2003; Patestas & Gartner, 2006; Thelen, Dauber, & Stoneman, 2008; Lumpkin, Marshall, & Nelson, 2010; Campolo, Babu, Dmochowska, Scariah, & Varughese, 2013). Researchers have been highlighting the importance of skin receptors in pain modulation through the activation of descendent inhibitory pathways. Skin receptors receive and transmute several types of stimulus (mechanical, chemical and temperature), however mechanical stimulus seem to be predominant in the pain modulation phenomena, specially the afferent information given to the CNS through Ruffini Corpuscles. Those receptors are activated when a stretching stimulus is applied on the skin and, according to recent research, this kind of stimulus has the potential to interact with the CNS and modulate pain (Patestas & Gartner, 2006; Lumpkin, Marshall, & Nelson, 2010).

Figure 7 – Skin layers representation with the possible mechanical effect of the Kinesio Tex Tape on the underneath tissues, creating a lifting

Another interesting fact regarding CNS and epidermis relationship is its origin during the embryologic stage. Body tissues’ origin can be prevenient from three types of cells that constitute three embryologic layers – ectoderm, mesoderm and endoderm – that will differentiate in the various body tissues. Central and Peripheral Nervous System, together with the epidermis differentiate from the same embryologic layer, the ectoderm (Schoenwolf, Bleyl, Brauer, & Francis-West, 2014). This is a key fact that supports the hypothesis of a tight relationship between skin/epidermis and CNS, the influence that both can have in each other, highlighting skin’s potential to influence other tissues, through CNS’ modulation (Kase, 2003; Kase, Wallis, & Kase, 2003).

Figure 8 – Embryologic Layers representation: notice that ectoderm and the neural systems differentiate from the same layer, the ectoderm.

Skin’s potential in rehabilitation may have been underestimated through all over these years considering that all techniques applied targeting any tissue of the body (e.g. muscle, ligament) first contact the skin. Taking in consideration skin’s specific receptors in the stimuli transfer to the CNS, skin cannot be considered a passive element regarding body’s response to any treatment that implies contact on it.

What is believed to be the effect of the Kinesio Taping?

Besides Kinesio Taping’s significant popularity and wide usage, the mechanisms underlying its effects are not yet fully understood. As it has already been highlighted in this article, studying Kinesio Taping effects in vivo is extremely difficult, however, considering the existing parallel research, it is believed that Kinesio Taping may have its effect through the same mechanisms. An example of that are the studies where the researchers found that, when skin was stretched, it stimulated the Ruffini Corpuscles, generating afferent information to the CNS (Roudaut, Lonigro, Coste, Hao, Delmas, & Crest, 2012). Ruffini Corpuscles are known to be responsible for activation of descendent inhibitory pathways and gate control pathway so, if Kinesio Tex® Tape is capable of producing a stretch on the skin with its recoil properties; it may also be able to stimulate Ruffini Corpuscles (Kase, 2003; Kase, Wallis, & Kase, 2003; Patestas & Gartner, 2006; Lumpkin, Marshall, & Nelson, 2010).

One of the key qualities of the Kinesio Tex® Tape is the possibility to manage the tension given in the tape, creating different mechanical stimulus to the skin (Kase, 2003; Kase, Wallis, & Kase, 2003; Lee & Yoo, 2011).

According to the tension applied on the tape (review Video 1), it is believed that Kinesio Tape is able to produce decompression or compression on the skin. As can be observed, with lighter tensions, Kinesio Tape creates a bigger recoil effect on the skin, leading to an eventual lifting of it, thus decompression of the tissue below, showing a significant amount of convolutions, improving fluid circulation and stimulating skin’s receptors that possible can generate efferent stimulus on other systems through CNS stimulation. On the other hand, higher tensions may lead to a smaller recoil effect, originating some sort of compression on the tissues below, stimulating skin’s receptors, creating stronger mechanical input on it, that possibly may increase proprioceptive awareness. As can be perceived, both mechanisms can be beneficial to restore tissues to homeostasis. (Kase, 2003; Kase, Wallis, & Kase, 2003)

Figure 9 – Evidence of convolutions in the lateral aspect of the pectoralis major muscle: pectoralis major inhibition application combined with a lymphatic correction

Clinical reasoning regarding that two ambiguous effects will be discussed further in this text, focusing on its versatility to manage the injury/rehabilitation stage, making the therapist/patient benefits with the use of Kinesio Taping from the acute stage until the return-to-field stage.

Recent research has shown that skin/target tissue responds very specifically to the Kinesio Tex® Tape, regarding not only the direction of the tape application, but also taping’s direction sense. Kuo & Huang (2013), reported that, depending on the direction sense of the Kinesio Taping application – distal to proximal or proximal to distal – different muscular responses could be observed in the wrist and fingers extensors muscles, increasing grip strength in the later one (Kuo & Huang, 2013).

Figure 10 – Hamstring facilitation (left) and inhibition (right) applications: the arrows show the direction in which the tape was applied

Kinesio Taping and Clinical Reasoning

Assessment before the Kinesio Taping application

As any other rehabilitation technique, a satisfying outcome can only be achieved if the diagnosis is accurate. This way, before proceeding to the taping application, it is fundamental that the therapist goes through a detailed clinical evaluation including a detailed clinical history and a proper and meticulous physical examination, in order to detect possible structure(s) – local or at distance – that may be leading to the clinical presentation of the patient.

Considering that Kinesio Taping relies on skin’s influence through the tape application, skin’s assessment should also be taken in count. Regarding our experience, dermoneuromodulation knowledge/understanding may also be a strong tool to associate with the usual orthopaedic evaluation, together with the Kinesio Taping® Method assessment (Kase, 2003; Kase, Wallis, & Kase, 2003).

In the end, before applying the tape, the therapist should be able to identify the following:

• Contraindications/Precautions
• Target tissue(s) – localized or at distance
• Which effect do I wish to create with the tape on the target tissue(s)?
• Type of tape cut
• Tension of the tape application
• Direction of the tape application
• Expected outcomes

Kinesio Taping application should only be kept when, right after finishing the procedure, a new assessment shows subjective or/and objective beneficial effects of the tape to the patient.

Figure 11: Skin irritation due to a Kinesio Taping application: be aware of the precautions

Clinical Reasoning

As it has already been highlighted above, lighter tensions will create decompression in the tissues, recoil and lifting of the skin, that may hypothetically increase the space in the underneath tissues, improving fluid circulation. This way, lighter tension techniques will be prone to be used during the acute stage of injury, in which the inflammatory process is of greater importance, reducing tissues suffering due to the inflammatory signs (e.g. oedema) (Kase, 2003; Kase, Wallis, & Kase, 2003). Besides that, the stronger recoil effect produced may have the ability to transmit a higher level of skin stretch and consequently having a stronger effect on afferent receptors related with pain modulation mechanisms, decreasing pain perception.

On the other hand, during sub-acute and return to field stages, the athlete will probably get more benefit with higher tension applications, once he might need some grade of proprioceptive awareness in order to improve muscle/tendon/joints function during this time in which more challenging tasks are required (Kase, 2003; Kase, Wallis, & Kase, 2003). As it was already mentioned and showed in Video 1, Kinesio Taping applications with higher tensions will provide compression to the underneath tissues, increasing the pressure in the mechanical receptors, possibly increasing proprioceptive awareness to the tissues/systems related with the taping application site.

Clinical reasoning development is possibly one of the most important steps during the rehabilitation process. Together with a proper assessment, it turns the therapist able to make the best decision for the treatment progression (McCarthy, 2010).

The use of Kinesio Taping must rely on the clinical reasoning, this way, during the different stages of rehabilitation, the taping application must change, progressing usually from lighter tension to higher tension applications, depending on the target system and effect the therapist wants to achieve. The following topic will give an insight on how can the therapist change the taping application during the rehabilitation stages.

Concluding, taking advantage of the ambiguous effect of Kinesio taping regarding tension management, athletes may benefit with it since the acute until the return to field stage.

Use of Kinesio Taping in Sports

Kinesio Taping is widely used in a considerable variety of sports. Athletes recognise its beneficial effects contributing to its popularity (Mostafavifar, Wertz, & Borchers, 2012; Morris, Jones, Ryan, & Ryan, 2013; Parreira, Costa, Junior, Lopes, & Costa, 2014).

Below, in Figures 11-15 are shown some Kinesio Taping applications that can be used in football players’ injuries management, showing some progressions during the different stages of rehabilitation.

Besides its amazing popularity, some professionals, based on the evidence available, presume that Kinesio Taping has no beneficial effects on patients’ clinical conditions (Mostafavifar, Wertz, & Borchers, 2012; Morris, Jones, Ryan, & Ryan, 2013; Parreira, Costa, Junior, Lopes, & Costa, 2014). However, something that doesn’t work wouldn’t probably last 30 years and continue to increase its usage, just like what is happening with the Kinesio Taping® Method and Kinesio Tex® Tape. Do you still remember the Power Balance? How long did that trend last? Does it keep increasing its popularity and usage nowadays?

Figure 12 – Lateral ankle sprain applications progression: Left – Lymphatic correction with Epidermis correction applications; Middle – Fibularis brevis facilitation with fibula mechanical correction applications; Right – Fibularis brevis facilitation with a functional correction and a ligament correction applications

Figure 13 – Acromioclavicular (AC) joint injury progression: Left – Lymphatic correction + deltoid and upper trapezius inhibitions applications; Middle – EDF technique + deltoid and upper trapezius inhibitions + humeral head posterior and caudal mechanical correction applications; Right – Humeral head mechanical correction + AC ligament correction applications

Figure 14 – Early stage after knee surgery: Lymphatic correction application

Figure 15 – RF’s central tendon tear progression: Left – Lymphatic correction + RF inhibition applications; Middle – RF facilitation combined with tendon correction application in the central tendon; RF facilitation + Hip functional correction applications

Figure 16 – Kinesio Taping application used for PFS management: patellar mechanical correction application combined with a tibial mechanical correction

Figure 17 – Adductor related long standing groin pain’s in-field management: Adductor group inhibition application combined with tendon correction in adductor longus tendon + inguinal ligament correction applications

Figure 18 – Majed Hassan playing with a Kinesio Taping application after returning from injury together with his testimonial about Kinesio Taping benefits

“Kinesio helped me a lot during the rehabilitation process and also when I returned from injury to competition. When I was using Kinesio pain simply disappeared during changing direction and long pass. Before I thought Kinesio was a trend because I never found benefit on it, but now I know it really helps. I also understood that the most important is not the tape itself, but the way it is applied.”

Majed Hassan (UAE national team player), on Kinesio Taping benefits

What does evidence tell us?

Besides the amazing anecdotally reports of the beneficial effects of this method, the available literature was not able to show good quality evidence in favour of the Kinesio Taping until now (Mostafavifar, Wertz, & Borchers, 2012; Morris, Jones, Ryan, & Ryan, 2013; Parreira, Costa, Junior, Lopes, & Costa, 2014).

In the past two decades, several research projects studied the effect of Kinesio Taping in a vast number of musculoskeletal dysfunctions, however, literature failed to convince the scientific community of its benefits, considering the low quality of the studies, and its prone to bias (Mostafavifar, Wertz, & Borchers, 2012; Morris, Jones, Ryan, & Ryan, 2013; Parreira, Costa, Junior, Lopes, & Costa, 2014).

Most of the studies that found no effect of Kinesio Taping used healthy subjects as a sample, creating a selection bias once, Kinesio Taping® Method was developed to restore tissues’ homeostasis and not to empower body’s capabilities (Viegas, 2014).

On the other hand, when a sample with symptomatic subject was used, researchers reported better outcomes. Most often, the beneficial effects of the use of Kinesio Taping were an improvement on pain threshold, functional capabilities, inflammatory signs, lymphatic circulation, tissue healing rate and faster recovery after muscle damage induced exercise (Yoshida & Kahanov, 2007; Thelen, Dauber, & Stoneman, 2008; Tsai, Chang, & Lee, 2010; Lee & Yoo, 2011; Campolo, Babu, Dmochowska, Scariah, & Varughese, 2013; Merino-Marban, Mayorga-Vega, & Fernandez-Rodriguez, 2013; Bae, Lee, Kim, & Kim, 2014; Donec & Krisciunas, 2014; Nadali, Khabazan, Aryamanesh, Hoseleh, Khabaz, & Bakhshizadeh, 2014).

Thelen, Dauber & Stoneman (2008), studied the effect of a standardized Kinesio Taping application in subjects with shoulder pain. The authors used a combination of deltoid and supraspinatous inhibitions together with a posterior mechanical correction of the humeral head, leading to an immediate significant improvement on the active abduction ROM – mean 16,9º – compared with the sham group, after the tape application. Researchers hypothesised that the positive outcomes were due to pain modulation via gate control theory, changes in supraspinatous through an increase in the motor units recruitment and/or due to the correction and guiding of the humeral head during the motion (Thelen, Dauber, & Stoneman, 2008).

Another study that found a beneficial effect of Kinesio Taping in baseball athletes with shoulder dysfunction was developed by Hsu, Chen, Lin, Wang & Shih (2009), in which they reported that, it is possible to increase inferior trapezius electromyographic activity applying Kinesio Taping to the inferior trapezius, superior trapezius and serratus anterior, resulting also in a cinematic improvement of the scapula with an increased posterior tilt (Hsu, Chen, Lin, Wang, & Shih, 2009).

Three studies investigated the effect of Kinesio Taping on vertical jump performance, not surprisingly only one of them showed beneficial effects of the tape application, once the other two studies used a sample with healthy subjects (Nakajima & Baldridge, 2013; Nunes, Noronha, Cunha, Ruschel, & Borges Jr, 2013; (Nadali et al., 2014). Nadali et al. (2014) studied the effect of RF’s facilitation application on the vertical jump performance in subjects after anterior cruciate ligament (ACL) reconstruction, registering a significant improvement on the vertical jump scores on the Kinesio Taping group compared with the sham tape and control groups. Investigators suggested that the effects achieved with the Kinesio Taping application were due to an increase in RF activity through the RF facilitation application (Nadali et al., 2014).

RF’s facilitation application effect has also been studied in several other studies. Aytar et al. (2011) studied the effect of that application on pain, strength, proprioception and balance in patients with patellofemoral pain syndrome (PFS), concluding that besides significantly increasing strength and balance scores, no significant differences were found compared with the sham tape group. The inexistence of a control group made impossible to understand if Kinesio Taping had a beneficial effect on that outcomes (Aytar et al., 2011).

Another research that investigated the effect of RF’s facilitation application in patients with PFS was the one carried out by Campolo, Babu, Dmochowska, Scariah & Varughese (2013), comparing Kinesio Taping and McConnell taping techniques during functional activities. The authors reported that both taping techniques were able to significantly decrease pain associated with stair climbing, compared with the control group, besides that, no significant differences between the two taping techniques were found. However, the Kinesio Taping application seems to be more confortable and guarantee longer durability during functional tasks than the McConnell taping technique. Researchers hypothesised that the mechanism underlying the beneficial effect of the tape application was the stimulation of cutaneous mechanoreceptors and increased afferent feedback to the CNS resulting in decreased pain (Campolo, Babu, Dmochowska, Scariah, & Varughese, 2013).

Besides the statistical significant differences found in these two studies, the effect might have been too small to be clinically worthwhile. The standardization of the tape applications is one of the biggest limitations of the studies, compromising the strength of the outcomes.

Considering the effect of the Kinesio Taping on the lymphatic circulation, two papers can be found reporting benefits on the oedema management. A high-quality randomized control trial (RCT) compared a lymphatic correction application with short-stretch-bandage (SSB) in the unilateral breast-cancer-related lymphedema. Besides the improvement in both interventions, no significant differences between the two groups were found, however, the Kinesio Taping application is far more comfortable to use than the SSB and allows better functionality to the patient (Tsai, Hung, Yang, & Tsauo, 2009).

A lymphatic correction application was also used in another RCT, in order to study the effect of Kinesio Taping in the early knee postoperative rehabilitation period. Donec & Krisciunas (2014), reported that the Kinesio Taping application significantly decreased pain and swelling associated with the invasive intervention, leading to a faster restore of the knee extension ROM, compared with the control group. Investigators suppose that swelling reduction was due to an improvement in the lymphatic and venous microcirculation speed, through the Kinesio Taping application (Donec & Krisciunas, 2014).

Two studies investigated the effect of Kinesio Taping on ankle’s proprioception, concluding that this method has no beneficial effect on it. However, strong limitations can be perceived in these studies. One of them uses exclusion criteria that turn possible the existence of healthy subjects – that never had any ankle injury/complaint before – leading to the selection bias mentioned before (Halseth, McChesney, DeBeliso, Vaughn, & Lien, 2004).

The other study that investigated ankle’s proprioception compared Kinesio Taping application with non-elastic sports taping, founding no benefits on the Kinesio Taping. However, once again, healthy subjects constituted the study sample (Briem et al., 2011).

Regarding plantar fasciitis rehabilitation, Tsai, Chang & Lee (2010) tried to study the effect of a standardized Kinesio Taping application in 52 patients with plantar fasciitis. After one week the group of patients allocated in the Kinesio Taping group showed significant reduced pain scores and reduced thickness of the plantar fascia at the insertion site compared with the control group. However, analysing baseline data carefully, it was possible to realise that both group had significant different pain scores, making it impossible to establish comparisons in that outcome. Researchers supported the outcomes achieved hypothesising that the Kinesio Taping application might have increased local circulation and decreased the loading effect on plantaris fascia through the pull effect of the tape on the underneath tissues (Tsai, Chang, & Lee, 2010).

In a case study, Lee & Yoo (2011) showed that, applying a tendon correction to the Achilles tendon together with a gastrocnemius muscle inhibition, over 5 weeks, they were able to decrease tendon thickness, improve VISA-A questionnaire score, increase pain threshold, and increase the pain-free dorsiflexion and plantar flexion ROM in a badminton player suffering from an Achilles tendinopathy for six months. The proposed mechanisms to those finding were an improve in the lymphatic circulation, pain modulation through the gate control mechanism and improvement in calf muscle recruitment due to the Kinesio Taping application (Lee & Yoo, 2011).

Bae, Lee, Kim & Kim (2014), showed that Kinesio Taping application prior to a muscle-damage induce exercise is able to decrease the pain associated with the delayed onset muscular soreness (DOMS) compared with a sham tape (Bae, Lee, Kim, & Kim, 2014).

Taking in count only the existent research, Football Medicine professionals conclude that Kinesio Taping beneficial effects cannot be considered an evidence, once the available studies show low quality methodologies, as well as strong limitations and bias possibilities.

To get better knowledge about the available research on Kinesio Taping® Method we suggest the reader to visit the Kinesio Taping Association International, KinesioUK and KinesioItalia websites.

Why do conflicting outcomes between evidence and clinical practice exist?

Kinesio Taping research has deep methodological, internal and external validity limitations.

Considering the ambiguous outcomes regarding evidence and clinical practice in the use of Kinesio Taping, it is emergent to discuss why this may be happening as well as suggesting what could be improved in the studies methodologies.

Kinesio Taping Method® was created to return tissue’s/body’s homeostasis, not to empower tissue’s/body’s performance/skills. This means that, according to the method, Kinesio Taping will interact positively with an injured or dysfunctional body structure, but will not improve the capability of a healthy structure (Kase, 2003; Kase, Wallis, & Kase, 2003).

Surprisingly, healthy subjects constitute a significant amount of the studies’ sample, leading to a significant bias, showing that researchers who conduct this kind of investigation have a lack of understanding of the concept they are trying to test, once it is not supposed that Kinesio Tape improve anything in a healthy subject (Viegas, 2014).

In addition, most of the studies in which Kinesio Taping is tested show lack of a certified practitioner to apply the tape. It is the same as trying to study the effect of a lumbar manipulation on low back pain relief choosing someone that has never been certified to apply that manipulative technique; most probably the technique will not be accurate.

Another limitation of the studies regarding taping’s application is the lack of individualization of the taping application in the studies. As it was mentioned previously in this article, this method always requires a proper assessment in order to achieve the best result with the taping application, considering the individual needs of each patient. However, researchers simply choose a standardized taping application, and try to understand its effect on subjects’ outcomes (Campolo, Babu, Dmochowska, Scariah, & Varughese, 2013).

A significant amount of researches studied the effect of Kinesio Taping on the management of patellofemural pain syndrome (PFS), choosing only one standardized Kinesio Taping application – most of them a RF’s facilitation application. As it is well documented in literature, several reasons can lead to PFS: Lack of hip abductors stability and strength; muscle imbalance between vastus medialis and vastus lateralis; dysfunctional patellar biomechanics (Sanchis-Alfonso, 2014); Considering those reasons, taping applications in the studies should be addressed to the etiologic entity rather than the clinical condition. In a group of subjects with PFS, some of them may benefit with thigh and hip muscle facilitation or inhibition applications rather than patellar mechanical correction applications, while other subjects of the same group may benefit with the opposite. This highlights the importance of a meticulous assessment prior the choosing and applying the Kinesio Tape.

Apart from this, the brand/kind of tape used in the studies can also considered be one of its biggest limitations, once most of the studies don’t specify which kind of tape was used.

Kinesio Tex® Tape has specific properties and has been improving its quality for more than 30 years, being the official tape of the Kinesio Taping® Method. If the kind of tape is not specified in the studies’ methodologies or a different kind of tape is used, researchers cannot assume that they are testing the Kinesio Taping® Method effect, because a different kind of tape, even if visually it looks the same, for sure has different manufacturing, leading to different properties of the tape, that may create different effects or lack of them.

Figure 19 – Kinesio Tex Tape (black) and other brand (pink): notice the different effect and adhesion properties, Kinesio Tex Tape created convolutions on the skin while the other tape was not able to stick properly to the skin, decreasing its capability to stimulate skin’s receptors

These may also be one of the reasons why other techniques that add value and benefits to clinical practice fail to show its potential when tested in a large and standardized scale. This is not an exclusive issue of Kinesio Taping research; it is an issue of several other rehabilitation techniques (e.g. manual therapy techniques), in which researchers gather participants with a general clinical condition (e.g. non-specific low back pain) and select a specific manual therapy technique (e.g. lumbar roll in L3-4 segments), creating a significant bias in the outcomes of that investigations because patients with dysfunction at that level may have benefit with the technique applied but patients with dysfunction in other lumbar segment most probably won’t have benefit with that specific technique. However, both groups can be included in the general clinical condition (e.g. patients with non-specific low back pain) (Orrock & Myers, 2013).

There is no doubt that standardized methodologies used in studies have the potential to make researchers able to better control variables and bias, however, with techniques that act very specifically, this may also be creating a bias on the achieved outcomes.

Football Medicine & Kinesio Taping

Taking in consideration Football Medicine professionals’ experience and expertise using Kinesio Taping in Sports, we believe that with a proper assessment, technique handling and correct tape application selection, Kinesio Taping is a successful treatment method to use in sports injuries.

Combined with other treatment modalities – manual therapy, other taping techniques, exercise – Kinesio Taping is an efficient and safe method to decrease pain and improve functionality in our athletes.

Kinesio Taping has been an incredible weapon in the management of Football Medicine’s athletes’ injuries and daily complains, significantly increasing our athletes’ availability for training and competition, mainly in situations where pain is present. It has also been a powerful technique used in the management of the inflammatory stage in acute injuries of Football Medicine’s athletes.

One example of the beneficial effect of Kinesio Taping on Football Medicine’s players is exemplified in the management of the injury shown in Video 2:

This player suffered a severe ankle sprain during a match in a critical point of the season. As can be seen in Figure 20, on the day after the injury, a considerable inflammatory reaction was already present together with a significant functional limitation not allowing the player to stand on the foot.

Considering this player’s importance to the team, it was important to help him to recover in time for the next match in 7 days. A multi-modality approach was used to rehabilitate this athlete, in which, together with other treatment techniques, Kinesio Taping added value to the outcomes achieved, firstly on the inflammatory stage of the rehabilitation in order to reduce pain and swelling (Figure 21). His clinical condition was being solved without problems. However, when a return to field was tried on the day before the match, the player complained of significant pain (6/10) in the postero-internal compartment of the ankle in tibialis posterior tendon. At this time, the chances to put this player competing in the match seemed strongly reduced considering the limitation caused by the pain. Fortunately, after returning to the changing room and trying another Kinesio Taping application addressed to the new symptoms, pain suddenly decreased to a slight discomfort (2/10) in all field activities, making him able to play the match and contribute to a good result for the team. To resolve this situation, Football Medicine professionals used a tibialis posterior muscle facilitation, as it is shown in Figure 23.

Figure 20 – Hugo Viana’s foot after the injury

Figure 21 – Space correction application to decrease pain and swelling. The effect of the tape can be perceived in the picture when it was removed

Figure 22 – Tibialis posterior facilitation application: an example of the application

Figure 23 – Hugo Viana with his testimonial about Kinesio Taping

“In the morning we tested my possibility to play against Al Jazira I felt a strong and disabling pain in the inner side of my ankle and I thought I wouldn’t be able to join he team. However, after changing the tape and try another Kinesio, the disabling pain changed to a slight discomfort that allowed me to play without limitations. After the injury I never thought I would be able to play Al Jazira match, but, against all my beliefs, Kinesio was fundamental to my rehabilitation and return-to-fied/play process.”

Hugo Viana (former Portuguese national team player), on Kinesio Taping

Conclusion

In conclusion, the present article doesn’t intend to advocate a fundamentalist use of Kinesio Taping as an irreplaceable treatment resource in the management of the sports injuries. However, Football Medicine professionals have been finding a significant amount of clinical conditions that Kinesio Taping when wisely used along with other treatment modalities, guarantees the best results for our players outcomes. As it can be perceived in this article, Football Medicine professionals have an undoubtable positive experience with Kinesio Taping use, which make us strongly advise therapists to use this method in their clinical practice.

“If you have no critics you’ll likely have no success.”

Malcolm X

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