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Tuesday, June 6, 2023

Kinesiology Tape Application to the Upper Trapezius Reduces Pain, Trigger Point Irritability and Increases Muscle Strength

Brent Brookbush

Brent Brookbush


Research Review: Kinesiology Tape Application to the Upper Trapezius Reduces Pain, Trigger Point Irritability and Increases Muscle Strength

By Nicholas Rolnick SPT, MS, CSCS

Edited by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Original Citation: Ozturk G, Kulcu DG, Mesci N, Silte A, et al. (2016). Efficacy of kinesio tape application on pain and muscle strength in patients with myofascial pain syndrome: a placebo-controlled trial. The Journal of Physical Therapy Science. 28: 1074-1078. - ARTICLE

The two conditions for kinesio taping used in the current study
Caption: The two conditions for kinesio taping used in the current study

The two conditions for kinesio taping used in the current study - Ozturk et al., 2016

Why is this relevant?: Myofascial pain syndrome (MPS) is characterized by the presence of multiple trigger points and taut bands in muscles, and is common complaint of clients/patients in rehab, fitness and performance settings. Kinesiogy Tape (KT) has been used as an adjunct intervention to reduce pain, alter dysfunctional movement patterns, and increase strength in individuals with MPS; however, there are few randomized controlled trials to investigate these applications. The current study investigated the effects of KT (inhibition-style application) on pain levels, trigger point irritability, and muscle strength in the upper trapezius muscle in those exhibiting MPS.

Study Summary

Study Design Single Blinded Placebo Control
Level of Evidence Level 2
Subject DemographicsNote: 53 patients were evaluated, 40 participants started the study and 37 completed the protocol and were included in the study's analysis while 3 dropped out (of the placebo group only). Results include 20 in the experimental group,  and 17 in the placebo group
  • Age (+ Standard deviation):
    • Experimental Group - 29.95 ± 4.90 years old
    • Placebo Group - 33.86 ± 8.47 years old

  • Gender:
    • Experimental Group - 17 F, 3 M
    • Placebo Group - 14 F, 3 M

  • Additional Characteristics of the Participants:
    • Body Mass Index
      • Experimental Group - 22.71 ± 3.02
      • Placebo Group - 22.4 ± 4.60

    • Duration (Days)
      • Experimental Group - 329 ± 221.19
      • Placebo Group - 532 ± 388.38

    • Occupation
      • All participants were involved in 8 hours of computer-based work per day

  • Characteristics:
    • Study Protocol
      • Patients randomly assigned to kinesio tape (KT) group or placebo (PL) group by closed envelope method.
      • Each group performed a home exercise program including neck muscle stretching and strengthening and a training brochure with additional exercises they could perform at home.
      • Kinesio Tape used for both groups
        • Kinesio Tape was applied by a Kinesio Tape Practitioner.
        • Tape had a width of 5 cm and a thickness of 0.5 mm

      • KT Group Tape Application Protocol (Inhibition Technique)
        • Patient was seated and the neck was was laterally flexed to the contralateral side and rotated to the ipsilateral side for the "inhibition type" application, targeting the trapezius muscle.
        • The tape was anchored (1-2 centimeters of tape applied without tension) just inferior the acromion process and stretched maximally before being anchored just under the hairline, tracing the trapezius muscle.

      • PL Group Tape Application Protocol
        • The tape was applied with the participants neck in neutral.
        • The tape was was applied without tension, horizontally, from acromion process to just lateral the spine.

      • Taping was applied to both groups at the beginning of the week and was left on for 3 days.
      • One day of rest in-between applications was given and a second taping was performed.

    • Outcome Measurements Taken (before intervention (T1), immediately after intervention (T2), and 30 days post-intervention (T3))
      • Visual Analog Scale (VAS)
        • The VAS was used to record the patient's current level of neck pain, with 0 signifying no pain and 10 signifying the worst pain the patient has ever experienced.
        • Levels of pain were recorded by asking the patient to mark on paper, a numbered 10-cm line.  The authors then measured the distance from the start of the line (0) to the marking, which was then used as an objective measure of the pain at the time of the assessment.

      • Analogue Algometer
        • Assessment device that measures pain tolerance level.
          • It is a force gauge fitted with a disc-shaped rubber tip with a surface area of exactly 1-cm².
          • The device expresses pressure measurements as kilograms per square centimeter (kg/cm²).

        • Patient was seated and the assessment device was placed at a chosen trigger point with the rod perpendicular to the surface of the skin.
        • Pressure was increased at a rate of 1 kg/second.
        • The patient was told to indicate when pain was first perceived.
        • The procedure was repeated three times, with one minute in-between each recording.
        • The average of the three trials was used for data analysis.

      • Upper Trapezius Muscle Strength Assessment Using Dynamometer:
        • The patients wore sportswear shoes for this assessment.
        • The patient exerts force on the device, and the dynamometer registers the level of force applied via a radial gauge.
        • Force was generated by the patient while he/she performed an exercise similar to shrug with hip extension.
          • The patient was instructed to extend the knees to approximately 0 degrees, maintain 30-degree flexion of the hips, and told to pull up on the dynamometer while using scapular elevators (upper trapezius, levator scapulae, rhomboids)
          • The average of two strength measurements for each testing period was used in data analysis to separate training effects from learning effects.

    • Statistical Analysis
      • Mean, standard deviation, minimum, maximum, median, and ratio values were recorded and analyzed.
        • Continuous variables were compared using student t-test or Mann-Whitney U test.
        • Categorical variables were compared by Fisher Exact test and Yates' Continuity Correction test.
        • Within-group comparisons were performed using the Friedman Test.
        • Wilcoxon signed rank test was used post-hoc for any variables which reached statistical significance (p < 0.05)

  • Inclusion Criteria:
    • Neck and/or upper back pain with an active myofascial trigger point in the upper trapezius and a taut palpable band
    • Between the ages 18-50
    • Symptom duration of > 2 weeks

  • Exclusion Criteria:
    •  Patients were excluded if they had any of the following:
      • Diagnosis of fibromyalgia
      • Psychiatric disorders (anxiety and depression)
      • Symptoms of radiculopathy
      • Brachial plexopathy
      • Nerve entrapment syndromes
      • Underwent treatment for myofascial pain sydrome within the past 6 months
      • Malignant cancer
      • Pregnancy
      • Infectious disease
      • Inflammatory musculoskeletal disease
      • History of shoulder or neck surgery

Outcome Measures
  • Pre-Intervention (T1), Immediately Post-Intervention (T2), and 30-Day Follow-up (T3) Values For:
    •  Visual Analog Scale Pain Rating (VAS) (1-10)
    • Algometry (kg/cm²)
    • Upper Trapezius Muscle Strength (Newtons of Pressure)


The level of significance was set at p < 0.05 for all comparisons. The following superscripts indicate the differences between conditions:

* = Statistically significant comparison between T1 - T2

** = Statistically significant comparison between T1 - T3

*** = Statistically significant comparison between T2 - T3

Post-hoc Between-Groups Comparisons (The number in parentheses in the data below, signifying mean (average) changes within the group data):

§ - Statistically significant difference between T1 - T2 results of mean changes scores

§§ - Statistically significant difference between T2 - T3 results of mean change scores

  •  VAS
    • T1
      • Group 1 - 6.86 ± 1.87 (7.5)**
      • Group 2 - 6.45 ± 1.19 (6.5)**

    • T2
      • Group 1 - 3.86 ± 2.60 (3.5)*
      • Group 2 - 3.05 ± 2.58 (3.0)*

    • T3
      • Group 1 - 2.64 ± 3.25 (0.0)***§§
      • Group 2 - 2.60 ± 2.82 (2.0)

  • Algometry (Pressure on Trigger Point)
    • T1
      • Group 1 - 3.85 ± 2.62 (4.0)**
      • Group 2  - 4.93 ± 2.53 (5.0)**

    • T2
      • Group 1 - 6.00 ± 3.61 (7.0)*
      • Group 2 - 5.93 ± 2.87 (6.5)*

    • T3
      • Group 1  - 6.85 ± 3.68 (7.0)***§§
      • Group 2 - 6.29 ± 3.20 (6.5)

  • Upper Trapezius Elevation Strength
    • T1
      • Group 1  - 62.25 ± 9.24 (90.0)**
      • Group 2 - 130.71 ± 99.73 (120.0)

    • T2
      • Group 1 - 65.25 ± 10.70 (105.0)*§
      • Group 2  - 134.29 ± 105.23 (115.0)

    • T3
      • Group 1  - 134.50 ± 79.70 (105.0)
      • Group 2 - 137.86 ± 100.47 (115.0)

Results of significance:

  • The mean changes in VAS scores were significantly different between groups at T3 compared to T1 in group 1 (p < 0.05).
  • Within-group analysis of VAS scores demonstrated a reduction in both groups 1 (p < 0.05) and 2 (p < 0.05).
  • The mean changes in algometry scores were significantly different between groups at T3 compared to T2 in group 1 (p < 0.05).
  • Within-group analysis of algometry scores demonstrated an improvement in both groups 1 (p < 0.0001) and 2 (p < 0.05).
  • The mean changes in upper trapezius strength were significantly different between groups at T2 compared to T1 in group 1.
  • Within-group analysis of upper trapezius strength demonstrated improvements in group 1 (p ≤ 0.0001).
ConclusionsInhibition type KT application to the upper trapezius in individuals with myofascial pain syndrome, has a significant impact on pain and strength, both immediately and upon 30 day follow-up.
Conclusions of the Researchers The application of inhibition-style KT to the upper trapezius resulted in a significant and immediate decrease in pain level and increase in strength in patients with myofascial pain syndrome. The decrease in pain and increase in strength persisted to follow-up at 30-days.

Dr. Brookbush applies Kinesiology Tape to the Lower Trapezius for reinforcement of activation exercises done during treatment.
Caption: Dr. Brookbush applies Kinesiology Tape to the Lower Trapezius for reinforcement of activation exercises done during treatment.

Lower Trapezius Facilitation Taping

Review & Commentary:

The current study exhibited strengths in its methodology. First, the study was adequately powered to achieve statistical significance (high effect size of 0.92) in the variables investigated (pain, trigger point irritability (algometry), and muscle strength). The authors previously performed a pilot study to determine the degree of change needed and the number of participants required to achieve statistical significance. Second, the study investigated a common patient/client complaint, upper trapezius myofascial pain. As the application of KT is frequently used for the treatment of pain (1-2), investigating a commonly reported pain syndrome increases clinical relevancy.

The study also had weaknesses worth discussing before implementation into practice. First, the description of the experimental protocol lacked clarity regarding the time between intervention and T2 measurements. From the description it was not possible to determine whether T2 was measured after the first 3-day application of taping and re-measured after the second 3-day application, or measured after both rounds. Future studies, and or the researchers, should specify the timing of these measurements as it has an impact on determining best practices, and what results should be expected from the patient/client and the professional. Second, the protocol had both groups performing neck strengthening and neck stretching exercises. While this is clinically relevant, essential to the type of study performed (RCT), it adds a potential confounding variable. Last, both groups were different in their baseline upper trapezius strength. This could influence results of the degree of change in both conditions.

Why is this study important?

The mechanism by which KT reduces pain is currently unknown. It has been hypothesized that KT increases local circulation, increases or inhibits muscle activity (depending on the application), provides positional stimuli to the receptors of the skin, and/or increases afferent input to the central nervous system (1). More research is needed.

The current study suggests that inhibition-style KT application can reduce pain and increase strength in symptomatic individuals with myofascial pain syndrome of the upper trapezius , and may have long-term benefits (30days). This study also employed a placebo condition as a comparison group, which lends credence to the results of the study.

This study differs from other research studies that have suggested KT is ineffective, as it was used as an adjunct to treatment and not a treatment unto itself. Based on the findings of this study, the inhibition-style application of KT to the upper trapezius can be considered as an appropriate adjunct intervention to reduce myofascial pain along with an exercise program.

How does it affect practice?

Evidence regarding the efficacy of KT tape is mixed, but two previous studies comparing KT to a sham treatment have also shown a positive effect (one on acute neck pain and the other to subacromial impingement syndrome (1-2)). The use of KT as an adjunct therapy in the current study seemed to result in the largest effect size of the three studies, which may suggest that KT is best used as an adjunct therapy. It is interesting to note that in the study regarding KT tape and shoulder impingement the sham was ultrasound, another commonly used adjunct therapy, which may suggest KT tape is a better adjunct therapy than some other modalities (2).

How does it relate to Brookbush Institute Content?

From "The Effect of Kinsiology Tape On Subacromial Impingement Syndrome" :

  • "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."

The current study focused on MPS in the upper trapezius muscle , a common pathology associated with Upper Body Dysfunction (UBD) . Taping of the upper trapezius produced an immediate increase in scapular elevation strength with a concomitant decrease in pain and trigger point irritability. In UBD , the upper trapezius has a tendency towards displaying both long/under-active and short/over-active activation patterns depending on the movement dysfunctions observed in the overhead squat and trapezius muscle strength assessments . In either case, the Brookbush Institute approaches postural dysfunction by releasing and stretching overactive synergists (supraspinatus , levator scapulae , and rhomboids ) and activating and integrating under-active musculature through corrective exercise. In the current study, upper trapezius scapular elevation strength increased after application of KT, which may suggest that application may have a positive impact on pain, quality of motion, and performance following activation and integration of the serratus anterior lower trapezius , and infraspinatus/teres minor .

The following videos are commonly used taping techniques by the Brookbush Institute for those exhibiting Upper Body Dysfunction (UBD) :

Brookbush Institute Videos:

Lower Trapezius Activation Taping:

Shoulder External Rotator Activation Taping

Lower Cervical Extensor Activation Taping:


  1. Gonzalez-Iglesias J, Fernandez-de-Las-Penas, Cleland JA, et al. (2009). Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial. JOSPT. 39: 515-521.
  2. 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.

© 2016 Brent Brookbush

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