Research Review: The effect of Kinesiology Tape on Subacromial Impingement Syndrome
By Stefanie DiCarrado DPT, PT, NASM CPT & CES
Edited by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
Original Citation: Kaya, E., Zinnuroglu, M., Tugeu, I. (2010) Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clinical Rheumatology. (30) 201-207. ARTICLE
This application serves to inhibit the deltoid muscle
Why is this relevant?: Subacromial impingement syndrome (SIS) is a common shoulder dysfunction related to muscle imbalance and scapular dyskinesis (3). Modalities such as taping can alter sensory input leading to adjustments in motor output and assist in correcting movement impairment.
Study Summary
| Study Design | Controlled clinical trial |
| Level of Evidence | II: Evidence from a controlled study without randomization |
| Subject Demographics |
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| Outcome Measures |
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| Results |
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| Conclusions | Kinesio tape may offer some immediate relief from pain and disability caused by SIS; this modality should be considered as part of any integrated rehabilitation plan. |
| Conclusions of the Researchers | Kinesio taping should be considered as an effective modality for the treatment of SIS, especially in cases that require an immediate effect. |
Similar taping was used in this study to inhibit the deltoid and supraspinatus. This study did not use the functional correction that applied a downward force onto the humeral head.
Review & Commentary:
This study provides strong evidence to suggest a modality like Kinesio tape (KT) can reduce pain and improve function in a person with subacromial impingement syndrome (SIS) within a 1-2 week period. Adding to the strength of the study was the moderate sample size (55 subjects) that allowed the results to have a 90.7% statistical power -- meaning the experiment had a high chance of detecting a significant effect between the modalities. The authors clearly describe the ultrasound settings, the electrical stimulation (e-stim) protocol, and modality application times. The authors adequately describe the KT application to the deltoid, supraspinatus, and teres minor with objective measurements for tape attachment sites, and % of tension applied. Clear descriptions allow readers to replicate the treatment within a clinical setting. The authors referenced a previously written article on the space and lymphatic correction that may be achieved by taping, and clearly describe the intent of that taping. In recognizing that modalities do not create, but merely augment a rehabilitation program, the authors provided a home exercise program to each participant with instructions to perform the exercises twice per day.
The purpose of this study was to compare KT to typical rehabilitation modalities administered daily: intermittent US, TENS, and hot packs. The authors also used the tape to affect muscle activity of the supraspinatus, deltoid, and teres minor, improve lymphatic drainage and increase scapulothoracic stability. The authors listed two possible contributions of KT that could explain the results of this study: the enhanced neuromuscular feedback created by the tape providing pain modulation and/ or increased motor unit recruitment within muscles that provide stabilization and improved motor control.
The authors noted one benefit of using KT over conventional PT modalities was the frequency of application. In this study, the researchers administered traditional modalities daily, whereas they only needed to apply (and re-apply) KT three times during the two week period. Patients rarely attend outpatient physical therapy more than three times per week so KT tape may be more practical for this reason alone. Further, KT may be considered a modality patients take with them providing some benefit, even on days the patient does not attend a physical therapy session.
This study is not without limitations. The authors did not describe the intent of each piece of tape in the shoulder taping protocol, and unfortunately, there is a disparity between how the application is taught by the company KinesioTape and the authors rationale for the taping's effectiveness. According to KinesioTape the application would inhibit all three targeted muscles (application of tape from distal to proximal insertions). In the discussion section; however, the authors described the facilitated supraspinatus as a possible reason for the decreased pain and improved function in the KT group.
The authors note future studies should include a sham taping application group for further comparison as well as randomization of the sample. It would be interesting to see the KT application applied here coupled with taping for activation of serratus anterior and lower trapezius as these muscles are often found underactive in those with SIS (3). The type of exercises used for the HEP were listed, but not the specific exercises used, which makes it difficult to duplicate this study with a larger sample size.
Why is this study important?
This study provides evidence supporting the use of modalities like KinesioTape as an adjunct to movement therapy for subacromial impingement syndrome.
How does it affect practice?
Clinicians should consider the use of taping to enhance the treatment of individuals with movement dysfunction. Although modalities may not alter poor mechanics alone, taping may enhance lymphatics, reduce swelling, increase proprioceptive input, and/or enhance neuromuscular control, providing additional support for an exercise based rehabilitation program.
How does it relate to Brookbush Institute Content?
Taping modalities such as Kinesiology Tape may be considered and applied relative to the inhibition and activation components of the integrated warm-up and rehabilitation templates of the Brookbush Institute. Generally, the Brookbush Institute uses taping at the end of a session, as a means of reinforcing release and activation interventions performed during a session. The intent and goal of these taping applications is to enhance carry over from sessions to session, and in some cases provide a competing stimulus that may help to reduce the perception of pain.
This study focuses on SIS, a common pathology associated with Upper Body Dysfunction (UBD) . As noted in the Brookbush Institute's predictive model of UBD , the impingement of subacromial structures may be due to an excessive anterior and superior glide of the humeral head during arm elevation (2). Such dysfunction may occur due to overactivity of the deltoid and supraspinatus. The methodology section of this article indicated that taping inhibited both the deltoids and supraspinatus which would result in a reduction of anterior and superior translation. However, the taping also intended to inhibit the teres minor which contradicts the UBD model. UBD implies, under-activity or the external rotators (infraspinatus & teres minor) and over-activity of the internal rotators (subscapularis, pectoralis major , & latissimus dorsi ). Unfortunately, the authors of this study did not disclose their means of assessing the activity of the involved muscles (overactive/underactive), or whether changes in muscle activity were the actual cause of the benefits noted in this study.
Since SIS is associated with UBD , one can infer from this article that if taping was a successful part of SIS treatment, it has a place in an integrated approach to correcting UBD . We can further expand upon their taping method and include activation of common underactive muscles: the serratus anterior and lower trapezius which address the scapular dyskinesis portion of SIS (1,2).
Videos on taping are still in production at the Brookbush Institute, but they will be available soon! The following videos focus on rehabilitation exercises to inhibit the supraspinatus and posterior deltoid, mobilize the glenohumeral joint, and activate the serratus anterior and lower trapezius
Posterior Shoulder Stretch Modifications (Sleeper Stretch on Wall)
Supraspinatus SA Static Release
Shoulder Self Mobilization
Serratus Anterior Isolated Activation
Trapezius Isolated Activation
© 2014 Brent Brookbush
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