The effect of Kinesio ® taping on pain,functionality,mobility and endurance in the treatment of chronic low back pain: A randomized controlled study

Abstract

BACKGROUND:

Low back pain is one of the most important causes of morbidity.

OBJECTIVE:

This study was designed to evaluate the effect of Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping on pain, functionality, mobility and endurance in chronic low back pain treatment.

METHODS:

Patients with chronic low back pain were randomly divided into three groups. Therapeutic ultrasound, hot packs, and transcutaneous electrical nerve stimulation were applied to each group for ten sessions during two weeks, and therapeutic exercises were applied in the clinic under physiotherapist supervision starting from the sixth session. Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ tape was applied to the patients in the first group after each treatment session, and placebo tape was applied to the patients in the second group. No taping was applied to the third group, which constituted the control group. All the patients were evaluated pre and post-treatment in respect of pain, functional status (Oswestry scale), flexibility and endurance.

RESULTS:

The study included 60 patients (32 females). When the initial demographic and clinical characteristics of the groups were evaluated, all assessment results, except the Oswestry scores, were similar ( $p=$ 0.000). When the average changes in the clinical evaluations were evaluated after the treatment, a statistically significant improvement demonstrating the superiority of the taping group was observed in pain, functionality, flexibility and endurance values ( $p=$ 0.000, 0.000, 0.000, 0.000).

CONCLUSIONS:

Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping in chronic low back pain is an easy and effective method which increases the effectiveness of the treatment significantly in a short period when applied in addition to exercise and electrotherapy methods.

Keywords

Back pain Kinesio® taping physiotherapy

1. Background

Low back pain is one of the most important causes of morbidity in all countries of the world, and 80–85% of people experience low back pain at least once during their lives [1]. The lifetime prevalence of low back pain is between 43–51% [2, 3, 4]. Non-specific lower back pain limits the activity of adults younger than 45 years especially in industrialized countries, and it is one of the leading reasons for consulting a doctor [4].

Many conservative methods are recommended with a multidisciplinary approach for the treatment of low back pain. Cognitive behavioral therapy, supervised exercise programs, brief patient education program, back schools, mobilization/manipulation techniques and physical therapy modalities are the most widely used methods [5].

Physical therapy modalities used in rehabilitation programs are effective in the reduction of pain and improvement of functionality in the treatment of chronic low back pain [6, 7, 8, 9]. The effectiveness of the treatment is increased when exercise therapy is applied together with physical therapy modalities [9]; exercise therapy should, therefore, be included especially in the treatment of chronic low back pain [9, 10].

There has been a limited number of studies investigating the efficacy of specialized treatment techniques commonly used by physiotherapists in the treatment of chronic low back pain. Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping (KT) is one of these applications. KT is utilized for a wide range of issues, such as musculoskeletal system, neurological and vascular problems [11]. It is thought that KT improves muscle function and tissue function by creating a gentle repositioning of the fascia, increases blood circulation since it lifts up the skin, and thus decreases pain, edema, and inflammation, contributes to the reduction of pain by stimulating the mechanoreceptors, proprioceptors, and improves joint function and movement [12, 13].

In this study, it was aimed to determine the effect of Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping on pain, functionality, mobility and endurance in chronic low back pain.

2. Methods

The study included patients who presented at Yalova State Hospital, Department of Physical Therapy and Rehabilitation and were diagnosed with chronic low back pain by a physician.

The study was approved by Marmara University, Institute of Health Sciences Ethics Committee and was conducted in compliance with the Helsinki Declaration. Written informed consent was obtained from all patients.

Patients older than 18 years with pain caused by a herniated disk and mechanical low back pain ongoing for at least three months were included in the study. Patients who met any of the following criteria were excluded from the study: receiving any other treatment for low back pain at the time of the study, allergic reaction to the taping, any contraindications for physical therapy modalities or exercise, primary or metastatic neoplasm on spine or other tissues, previously spinal surgery for any reason, infectious pathologies in the spine or inflammatory diseases with spine involvement, radiculopathy, prolonged immobilization that could lead to muscle atrophy, or steroids and similar drugs usage.

The randomized patient list of three groups was created with the internet-based “Randomizer” program. Patients admitted to the clinic were allocated to the groups in the order in which they arrived. A total of 10 treatment sessions were applied to the patients in all three groups, five days per week for two weeks in the Physical Therapy and Rehabilitation Unit. In each session, therapeutic ultrasound (1 MHz, 1.5 W/cm ${}^{2}$ , BTL 4000, Czech Republic, 2011) was applied for 5 mins and a hot pack (30 $\times$ 45 cm, FYSIOMED, 2014) for 20 mins paravertebrally to the lumbar region. In the painful area, Transcutaneous Electrical Nerve Stimulation (TENS) (100 Hz, 250 ms, BTL 4000, Czech Republic, 2011) with four electrodes was applied for 20 mins. All the patients were informed about the therapeutic exercises (Table 1) starting from the 6th treatment session, and these were implemented after each treatment session in the clinic for a total of five sessions under the supervision of a physiotherapist.

Table 1
Elements of the exercise program for the three groups

Stretching lumbar extensor muscles with bilateral hip-knee flex-

ion in a supine position

Stretching hip flexor muscles in a supine position

Stretching hamstring muscles in a supine position

Isometric contraction of abdominal muscles in a supine position

Abdominal crunch with arms out straight ahead and flexed knees

in a supine position

Isotonic contraction of lumbar extensor muscles in a prone posi-

tion

*All exercises performed for 1 set $\times$ 10 rep, hold for 5 sec.

Figure 1.

Taping method.

The KT relaxation technique (Fig. 1) was applied to the patients in the Group 1 (tape group) at the end of each treatment session. The patients were asked not to remove the tapes which were then removed by the physiotherapist in the next session, and new taping was applied after the treatment. Placebo taping was applied to the patients in Group 2 (placebo tape) at the end of each session. Taping was not applied to the patients in Group 3 (control).

In the taping group, patients were positioned so that it was possible to reach the maximum available stretch of the lumbar spine and the surrounding soft tissues and skin. Thus, with the patient standing, they were requested to flex forward as far as possible. The tape of 5 cm width was applied horizontally over the dimples of the back and the second band of tape of the same width was applied immediately above the first tape. When applying the bands, the tension was zero at the beginning and end, but the tape was stretched to 35%–40% of its length over the back. The same physiotherapist applied all the tapes. In the placebo group, the same form of taping was applied horizontally over the dimples of the back but with no tension in the tape.

For each patient, age, height, weight, body mass index (BMI), and gender were recorded on evaluation forms prepared by the researchers before the treatment. All the evaluations were repeated after the 10 sessions of treatment.

Pain was recorded by the participant using a 10-cm visual analog scale, where 0 represented no pain and 10 represented unbearable pain.

For the assessment of disability, the Oswestry Disability Index was used. This scale contains 10 items related to limitations in daily life activities, with each scored on a 0–5 point scale; the total points are then converted to a percentage [14].

Figure 2.

Sit and reach test.

The sit and reach test was used to evaluate trunk flexibility. This test involves the patient sitting on the floor or treatment table with legs out straight ahead and the feet (shoes off) placed with the soles flat against a box, shoulder-width apart. The patient is then told to reach forward as far as possible with open hands and palms facing downwards (Fig. 2). The distance between the middle finger on the right hand of the patient and the box was measured in centimeters. The test was repeated three times, and the average of the scores was recorded for analysis [15].

Figure 3.

Biering-Sorenson test.

In the evaluation of the isometric endurance of the trunk extensor muscles, the Biering-Sorenson test was applied. This is a reliable test for subjects with and without non-specific low back pain [16]. The patients were asked to lie prone on the examination table in with the upper edge of the iliac crests aligned with the edge of the positioning pillow (Fig. 3). The lower body was fixed by the physiotherapist, and the patient was then requested to isometrically maintain the upper body in a horizontal position with the arms folded across the chest. The time was recorded for which the patient was able to maintain the upper body straight and horizontal.

Table 2

Baseline participant characteristics of the groups

	Taping group ( $n=$ 20)	Placebo group ( $n=$ 20)	Control group ( $n=$ 20)	$p$ value
	Frequency (%)	Frequency (%)	Frequency (%)
Gender	12 female (60%)	12 female (60%)	8 female (40%)	0.343
	8 male (40%)	8 male (40%)	12 male (60%)
	Mean $\pm$ SD	Mean $\pm$ SD	Mean $\pm$ SD
Age (years)	47.2 $\pm$ 14.7	50.3 $\pm$ 11.5	47.9 $\pm$ 15.2	0.874
Height (cm)	167.6 $\pm$ 10.0	169.3 $\pm$ 10.9	169.9 $\pm$ 9.9	0.768
Weight (kg)	75.7 $\pm$ 12.3	79.5 $\pm$ 12.4	83.1 $\pm$ 16.1	0.274
BMI (kg/m ${}^{2}$ )	27.0 $\pm$ 4.2	27.9 $\pm$ 5.6	28.9 $\pm$ 6.4	0.856

BMI: Body Mass Index.

Table 3

The outcomes of the three groups

		Taping group ( $n=$ 20)		Placebo group ( $n=$ 20)		Control group ( $n=$ 20)		$p$ value
		Mean $\pm$ SD		Mean $\pm$ SD		Mean $\pm$ SD
VAS	Baseline	8.0 $\pm$	2.2	6.5 $\pm$	3.0	6.4 $\pm$	2.4	0.053
	Final	3.2 $\pm$	2.0	4.8 $\pm$	3.4	5.5 $\pm$	2.9	0.065
Oswestry score	Baseline	34.2 $\pm$	8.8	30.8 $\pm$	8.1	22.6 $\pm$	6.6	0.000
	Final	14.8 $\pm$	7.2	21.9 $\pm$	12.4	18.6 $\pm$	7.6	0.160
SART (cm)	Baseline	$-$ 8.9 $\pm$	19.1	$-$ 5.3 $\pm$	13.3	$-$ 8.6 $\pm$	14.3	0.490
	Final	0.7 $\pm$	18.0	$-$ 3.9 $\pm$	13.4	$-$ 6.0 $\pm$	14.1	0.113
Sorenson (sec)	Baseline	19.1 $\pm$	20.6	17.3 $\pm$	20.4	17.2 $\pm$	20.1	0.887
	Final	34.2 $\pm$	25.7	20.3 $\pm$	22.3	20.1 $\pm$	20.9	0.050

VAS: visual analog scale; SART: sit and reach test.

Table 4

Mean change of outcomes from baseline to final assessment in the three groups

Mean change	Taping group	Placebo group	Control group	$p$ value	$p$ G1-G2
	Mean $\pm$ SD	Mean $\pm$ SD	Mean $\pm$ SD	G1-G2-G3	G1-G3 G2-G3
VAS	$-$ 4.8 $\pm$ 1.9	$-$ 1.7 $\pm$ 1.9	$-$ 0.8 $\pm$ 1.4	0.000	0.000 0.000 0.149
Oswestry score	$-$ 19.4 $\pm$ 5.6	$-$ 8.9 $\pm$ 6.8	$-$ 4.0 $\pm$ 4.5	0.000	0.000 0.000 0.014
SART (cm)	9.7 $\pm$ 6.2	1.3 $\pm$ 6.4	2.6 $\pm$ 4.5	0.000	0.000 0.000 0.904
Sorenson test (sec)	15.1 $\pm$ 13.0	3.0 $\pm$ 4.6	2.9 $\pm$ 4.0	0.000	0.001 0.000 0.799

VAS: visual analog scale; SART: sit and reach test; G1: Group 1 (Taping), G2: Group 2 (Placebo); G3: Group 3 (Control).

Analysis of the results of the study was performed using “Statistical Package for Social Sciences” (SPSS) Version 13.0 (SPSS inc., Chicago, IL, USA) statistical software. In all analyses, $p\leqslant$ 0.05 (two-tailed) was considered as the statistical significance level. Compliance with the normal distribution of data was determined by the Kolmogorov-Smirnov test. For the comparison of parametric data between the groups, ANOVA was used and the Kruskal-Wallis test for non-parametric data. The Chi-square test was used to analyze gender distribution in the groups. The Kruskal-Wallis and Mann Whitney U tests were used to compare the differences in the changes in values between the three groups.

3. Results

The study included 60 patients with chronic low back pain, all of whom were able to complete the study and assessments. With the randomisation process, the patient distributions were as follows: the taping group ( $n=$ 20), the placebo group ( $n=$ 20) and the control group ( $n=$ 20). No significant differences were determined between the groups in respect of the baseline demographic characteristics (Table 2). The patients comprised 32 (53.3%) females, and 28 (46.6%) males, with no statistically significant difference in respect of gender distribution in the groups ( $p=$ 0.343). A total of 33 patients had lumbar disc hernia, 26 patients had mechanical back pain and one had lumbar disk hernia and stenosis. According to the diagnosis of the patients, the distributions in the groups were similar ( $p=$ 0.240).

When the initial clinical evaluation results of the groups were compared, no statistically significant difference was observed in the values between groups except in the Oswestry scores (Table 3). When pairwise comparison was performed in the groups, no statistically significant difference was found between the taping and placebo groups in the Oswestry scores ( $p=$ 0.368) and a statistically significant difference was determined between the control group, and the taping and placebo groups ( $p=$ 0.000) ( $p=$ 0.005).

When the differences in the values of the evaluation parameters were compared after treatment, there was a statistically significant difference between the groups in all parameters ( $p=$ 0.000, 0.000, 0.000, 0.000). When the groups were compared pairwise for the changes in post-treatment evaluation results, the placebo and control groups had statistically similar results regarding pain, flexibility and endurance scores while the KT group was statistically superior to both groups. The highest average change in disability scores was in the taping group, and the lowest average change was in the control group. Pairwise comparison of the groups indicated a statistically significant difference in the change in scores in all three groups (Table 4).

4. Discussion

The results of this study indicated that a greater improvement was obtained in pain, functionality, lumbar mobility and muscle endurance with the application of Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping in addition to the electrotherapy and exercise methods which are commonly used in the treatment of chronic low back pain. The results from this study suggested that the use of KT is an effective supportive method for chronic low back pain rehabilitation.

All the patients in this study received an exercise program under the supervision of a physiotherapist with the physical therapy modalities beginning from the 6th treatment session. The most commonly used physical therapy modalities in chronic low back pain are therapeutic ultrasound, hot pack, and TENS. In different studies, these methods have been indicated to be effective especially in decreasing pain and improving functionality [6, 7, 8, 9]. Exercise treatments have also been proven to be efficient in chronic low back pain treatment, and they are also widely used [9, 17, 18]. Previous studies have reported that effective improvements were obtained in muscle strength, flexibility, pain, and functionality with the application of physical therapy modalities with exercise treatment [7, 9, 19].

In the current study, in addition to the same physical therapy modalities and exercise treatment applied to the three groups, KT was applied to Group 1 by a qualified physiotherapist at each treatment session, and placebo taping was applied to Group 2 to eliminate the psychological effects of taping. Group 3 was considered as the control group, and no taping was applied to this group. It is thought that KT improves muscle function, increases the circulation and thus decreases pain, edema, and inflammation provides reduced pain by stimulating mechanoreceptors, proprioception, and improves joint function, movement, and stabilization [12, 13]. However, there are few studies which have examined the efficiency of KT. In a study conducted with MRI analysis, it was indicated that KT also mechanically affected tissues far from the target, in addition to the targeted subcutaneous connective and muscle tissues [20]. In a study applied with EMG, it was shown that lumbar muscle function returned to normal in a short time in 28% of the patients with chronic low back pain who had KT, and this effect continued during the 4-week follow-up period [21].

In studies of the treatment of low back pain, few have investigated KT application alone or together with exercise and physical therapy modalities. In those studies, the primarily evaluated measurement was the pain score of patients. In many of the studies, KT alone [22, 23, 24], and KT $+$ exercise [21, 25] have been shown to be superior to placebo taping [23, 26] or exercise treatment alone regarding decreasing pain especially in the short-term.

In studies by Kelle et al. [22] and Castro-Sánchez et al. [23], the application of KT only was seen to significantly decrease pain and disability in low back pain compared to the control [22] and sham taping [23] groups. These studies are important in terms of showing that KT is also effective when applied alone. In the current study, the absence of a KT only group could be considered a limitation, although the placebo tape group and the conventional treatment only group can be considered as superior aspects of this study.

There is not yet a full understanding of the exact mechanisms underlying the effect of Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping on musculoskeletal pain and other symptoms. It has been suggested that a possible mechanism by which Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping is effective in reducing pain levels may be related to neural feedback, which may improve the ability of the individual to decrease mechanical irritation of soft tissues when moving the lumbar spine [12]. Furthermore, Kase et al. [27] developed a theoretical framework to explain the decrease in lumbar pain-associated disability observed immediately after Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping. It was claimed that when a muscle is hypertonic, it stimulates the Golgi receptors to transmit information to the central nervous system, where inhibitory motor neurons are activated, and therefore, through the stimulation of the Golgi receptors by the application of Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping, this process would be initiated.

Other hypotheses of pain relief achieved through Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping have suggested that keratinocytes may be non-neural primary transducers of mechanical stimuli, and thus the signal transduction cascade mechanism will evoke a response on adjacent C-fibres [28]. A further hypothesis has been proposed that the Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping provides cutaneous stretch stimulation, which may then interfere with the transmission of mechanical and painful stimuli, delivering afferent stimuli, through which pain inhibitory mechanisms (gate control theory) and pain reduction are facilitated [21, 29].

It has been stated in literature that Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping has positive effects on disability and daily life activities in cases of low back pain [22, 23, 24, 26]. In a randomized controlled study of non-specific chronic low back pain, it was indicated that the results of KT, especially after the first week, were superior to placebo taping in respect of pain and Oswestry scores [23]. The positive effects of KT on pain and disability have been shown in low back pain related to pregnancy [30] and menstruation [31]. In the current study, the disability scores after the treatment improved in all three groups, with the greatest improvement seen in the KT group. The reason for this result can be attributed to better improvements in pain, mobility and muscle endurance in the taping group. The patients in the taping group stated that they were able to more easily undertake daily living activities and could move comfortably.

In previous studies, it has been reported that KT increases the flexion motion range in healthy individuals [32] and patients with low back pain [23, 24, 25]. In the current study, trunk flexibility was evaluated with the sit and reach test. Although the same exercises were applied to all three groups, a greater degree of trunk flexibility was determined in the KT group ( $>$ 7 cm) compared to the other groups. In previous randomized studies in literature, KT has been shown to improve back extensor muscle endurance [23, 33]. The results of the current study indicate that KT applied to the lumbar region was more efficient in improving muscle endurance compared to the other groups. The effect of KT on trunk flexion motion range and endurance can be explained by the optimization of the muscle or fascia function, thereby regulating the circulation and decreasing pain [12, 13].

In contrasting results in the literature, in a study where 48-hour and 7-day taping, placebo, and control groups were evaluated to determine the effect of taping in chronic non-specific low back pain, it was reported that there was no significant difference except in the disability index after 48 hours, and it was concluded that taping was ineffective [34]. Similarly, in two systematic reviews [35, 36] it was suggested that there was no high-level evidence indicating the superiority of Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping to other applications in pain and other outcome results in problems related to the musculoskeletal system. All comparisons have demonstrated that Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping produced better results compared to an active or sham control group. However, the methodology of these studies was moderate level, and the mean PEDro Scale score was determined as 6.1 from a maximum of 10 points [35, 36].

These conflicting results in studies might be caused by differences in taping techniques or differences in training and experience of the clinicians applying this technique and the clinical features of the patients at the beginning of the treatment. To be able to show the actual efficiency of KT in cases of chronic low back pain, there is a need for studies evaluating different application techniques and studies showing whether there is any application difference between clinicians or treatment sessions. The patients included in the current study had low back pain for three different reasons, and only those with low back pain ongoing for at least three months were included, although no upper limit was placed on the duration of pain. These points can be considered limitations of this study. The treatment response may be different in pain of different etiology and which has been ongoing for different periods of time. In order to reach a high-level of evidence in terms of the efficiency of Kinesio ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ taping on low back pain and problems of the whole musculoskeletal system, further randomized, controlled studies with long-term follow-up should be designed.

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

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The effect of Kinesio ® taping on pain,functionality,mobility and endurance in the treatment of chronic low back pain: A randomized controlled study

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1. Background

2. Methods

Table 1 Elements of the exercise program for the three groups

4. Discussion

Conflict of interest

References

Table 1
Elements of the exercise program for the three groups