Effectiveness of kinesio taping in addition to conventional rehabilitation treatment on pain,cervical range of motion and quality of life in patients with neck pain: A randomized controlled trial

Abstract

BACKGROUND:

Kinesio taping (KT) is a new taping modality frequently used in the clinical setting. However there is contradictory evidence about its effectiveness in patients with neck pain.

OBJECTIVE:

To determine the effectiveness of KT as a supplementary treatment in addition to conventional rehabilitation in patients with neck pain.

METHODS:

Forty-five subjects with neck pain were included in this controlled trial and were assigned to the following groups: Kinesio Taping, placebo (P), and conventional rehabilitation control (CR). A daily self-assessment record of perceived pain, medication intake, quality of life and range of motion was registered at baseline, posttreatment and follow-up.

RESULTS:

Cohen’s coefficient showed large effects in terms of reducing pain perception in all three groups. ANOVAs showed that the course of treatment differed across groups only for neck flexion ( $p=$ 0.043). We found significant differences in neck flexion when comparing baseline and one-month follow-up values and neck flexion significantly increased in all three groups: KT ( $p=$ 0.05); P ( $p=$ 0.01); and CR ( $p=$ 0.04). Between-group analyses showed no significant differences for any of the measurements.

CONCLUSIONS:

A protocol of manual therapy and physical exercises, significantly improved pain and mobility in patients with neck pain. We obtained no evidence of additional benefits from the use of KT in this population.

Keywords

Neck pain physical therapy modalities bandages randomized controlled trial

1. Introduction

Cervicalgia or neck pain is one of the most common sources of musculoskeletal pain in the general population and it constitutes one of the major health problems in western society. Its estimated prevalence ranges between 16.7% and 71.5%, and it should be emphasized that up to 50% of these cases could become chronic [1, 2, 3, 4].

Recently, Kinesio Tape (KT) has become a widely used tool in the practice of physical therapy. The method provides a greater pain-free range of motion in the musculoskeletal system [5]. The singular characteristics of the bandage itself and its application are probably responsible for the physiological effects attributed to Kinesio Taping: analgesic effect; effect on the muscles, by stimulating muscle tone; positional effects, in providing support to the joints; circulatory effects, by activating lymphatic drainage and microcirculation; and neuroreflexive effects.

At present, the scientific literature on KT shows contradictory results; some authors claim clear benefits while others argue that there is no significant improvement derived from the application of the KT technique [6, 7, 8, 9, 10, 11, 12]. In terms of musculoskeletal pathology, KT seems to render positive results in the management of low back pain [13, 14, 15], subacromial impingement [6, 17], patellofemoral pain syndrome [18], recurrent ankle sprain, and plantar fasciitis [19]. However, few studies show contradictory results in cases of cervical pain. More specifically, a study which included subjects who had suffered acute whiplash injury [20] showed that the use of KT provided beneficial effects when compared against a placebo control, improving cervical range of motion, and reducing the level of pain immediately after the accident and 24 hours later. The authors of the study, however, considered that their results were not clinically significant. A subsequent study demonstrated that patients with mechanical neck pain who received cervical thrust manipulation displayed greater range of rotation motion than those treated with KT. However, this study did not include placebo or control groups [21].

Given the current controversy on the presumed usefulness of KT in treating various pathologies, and the paucity of studies aimed at investigating the effectiveness of this technique in cases of neck pain or cervicalgia, the present study was designed to examine the short, medium, and long-term efficacy of KT used as a supplement to conventional rehabilitation in the treatment of mechanical neck pain.

2. Method

2.1 Participants

Patients from a primary health center of Toledo (Castilla-La Mancha, Spain) were selected from among those patients suffering from mechanical neck pain who had been diagnosed by their primary care physician. They were referred to the physical therapy service between February and July, and between October and November of 2011 and 2012.

First an experienced physical therapist performed a clinical assessment of patients who had been referred, fulfilled inclusion criteria and agreed voluntarily to participate in the study. At that time, the physical therapist obtained socio-demographic data (i.e., sex, age, level of education, occupation, and medication), and obtained information on the duration and localization of symptoms. Inclusion criteria were the following: (1) ages between 18 and 55 years; (2) a diagnosis of mechanical neck pain or cervicalgia by their primary care physician; (3) neck pain in situations of stretching, touching, movement, contraction against resistance, or after holding the same position for a period of time; (4) Visual Analog Scale (VAS) score equal to or greater than 50 mm [22]; and (5) asymmetrical lateral flexion of the neck of more than 5 degrees, as measured by clinimetric evaluation [23].

Exclusion criteria, were as follows: (1) neck pain resulting from cervical whiplash or direct traumatism in the neck area; (2) prior neck or shoulder surgery; (3) a medical diagnosis of fibromyalgia; (4) radiculopathy (i.e., acute sensory and motor symptoms in the innervated regions); (5) medical diagnosis of cervical osteoarthritis; (6) being involved in a legal suit; (7) to have received within the previous year, or to be currently receiving, physical therapy treatment, particularly with KT; (8) ongoing cervical pain for three months or more; and (9) allergies to any type of bandage or adhesive material.

2.2 Design

A single-blind randomized clinical trial with parallel design was conducted. Out of the 75 patients recruited from the accessible population, 45 met the selection criteria and were randomly assigned to one of three groups: Kinesio Taping group (KT) to receive real KT and conventional rehabilitation, with a mean age of 42.07 years (SD $=$ 11.43); placebo group (P) to receive a sham taping application and conventional rehabilitation, with a mean age of 43.8 years (SD $=$ 9.54); and controls, with a mean age of 40.69 years (SD $=$ 10.97) that received conventional rehabilitation treatment (CR) alone. During the randomization process, patients were blinded to treatment allocation. They were allocated (ratio 1:1:1) to the KT, CR or placebo group according to randomized codes. The therapist who examined the patients for eligibility criteria and collected all demographic and baseline data was not involved in the rest of the study and prepared the randomization code by using computer software. Treatment allocation was concealed and study personnel were blinded to treatment assignment until after database locking. A second experienced physical therapist (MEPG) who was blinded to group allocation, collected all outcome measures during the trial. In order to blind the physical therapist as to the group affiliation of each patient, all participants donned a thick scarf covering their necks on all measurement sessions after the baseline measurement. Patients were instructed in not to modify the scarf during the assessments and not to reveal treatment to the evaluator. The scarf was entwined around the neck, without limiting the patient’s breathing or movement, especially during the measurement of the range of cervical movement. All treatments were carried out by a physical therapist who was blinded to the outcome measures and baseline examination findings but not to the treatment allocation due to the manual nature of the treatments (taping and manual therapy). The scarf was also administered by the physical therapist who performed the treatments at each measurement sessions.

This study was approved by the Ethical Committee for Clinical Research of the Medical Center in Toledo (Spain) and it complied with the guidelines of the Declaration of Helsinki and with current Spanish legislation for clinical trials. All participants signed consent forms after being debriefed and before their socio-demographic data were obtained. The final results of the study were reported to the patients in both groups.

2.3 Outcome measures

Dependent measures investigated in this study were pain intensity as primary outcome measure and range of motion of the cervical spine and quality of life as secondary outcomes. Data on pain and cervical range of motion were collected before treatment started (baseline measure), immediately after application of the first bandage, 24 hours later, on the fourth day of the protocol after bandage application, and at one month follow-up. Participants completed the quality of life questionnaire on two separate occasions: before beginning the treatment and at one-month follow-up.

Quality of life was measured using the Short Form 36 (SF-36) Health Survey in its Spanish version [24, 25]. It shows both high reliability and validity [26, 27, 28]. It consists of 36 items and 8 scales: Physical Function, Physical Role, Body Pain, General Health, Vitality, Social Behavior, Emotional Role and Mental Health. The scores range between 0 and 100.

The Visual Analog Scale (VAS) was used to assess pain intensity at each time-point [22]. In addition, pain across the day was also registered using this scale by recording their pain level at three different times each day: morning, afternoon, and night. The average value was calculated for further analyses. In order to test treatment effects, the mean values of the first two days and the last two days of treatment were calculated following the previous protocol. Minimal clinically important difference (MCID) ranges from 9 to 11 mm for this outcome [29]. This tool has demonstrated good psychometric properties in assessing pain intensity (ICC of 0.97 [95% CI $=$ 0.96 to 0.98]) [22].

Cervical Range-of-Motion (CROM) was recorded by using an inclinometer (Cervical Range of Motion Device, Performance Attainment Associates, St. Paul ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ , Minn, USA) in order to measure the range of neck mobility. Patients were seated, with the sacrum in contact with the chair and both feet resting on the floor. Next, we placed the CROM on the patient’s head, aligning it on the bridge of the nose and the ears. Patients were asked to move their heads as much as possible without the movement being painful and go through the following movements: flexion, extension, rightward lateral tilt, leftward lateral tilt, rightward rotation, and leftward rotation. Each movement was performed three times and averages of the resulting values were used to carry out the statistical analyses. Previous studies indicate an intraclass correlation coefficient between 0.66 and 0.94 for this outcome [23].

Table 1
Manual therapy procedures during each session

1	Spinal adjustment of the patient in the supine position by means of a triangular foam pad stretching up to D8 (8th dorsal vertebra).
2	Adjustment of the lumbar area by means of active manipulation of the buttocks muscles (soles of the feet flat on the bench) and manual facilitation of sacral support.
3	Relaxation of the legs on foam rollers.
4	Stretching of the scalene muscles: the patient takes three consecutive breaths, focusing on exhalation, while the therapist closes the intercostal space with both hands from the thorax towards D8. On the fourth inspiration, pressure is let off, starting by the right hand (R).
5	Activation of the intrinsic cervical muscles (rotational movement in the sagittal plane, resting the head, chin towards the sternum) with the neck in neutral position [23]: the neck is stretched during inhalation and relaxed during exhalation.
6	Myofascial induction of the sternocleidomastoid muscle (SCM), first towards the R [24].
7	Stretching of the right SCM, with rightward rotation: proximal hand on occipital insertion; distal hand on sternum insertion. Patient is asked to breathe three times and rotation is increased with each exhalation.
8	Stretching of the left (L) SCM, with leftward rotation.
9	Rightward rotation: three deep transversal sliding pressure movements on the L insertion of the complexus muscle.
10	Post-isometric stretching of the L complexus muscle: hand on the patient’s L cheek and, while maintaining neck rotation towards the R, patient is asked to perform a soft isometric contraction toward the L rotation. Eyes closed, looking towards the L. During three inhalations, patient is asked to contract the muscle, and during three exhalations, patient is asked to relax it.
11	Repetition of steps 9 and 10 towards the L.
12	Upper trapezius: bilateral pressure and pinch grip between the thumb and all other fingers, while maintaining cranial-moving traction for three breaths.
13	Suboccipital [24] induction [25] of the rectus capitis posterior minor and the obliquus capitis superior muscles.
14	Pumping of the cranial fascia, using cupped hands and fingers towards the jugular foramen.
15	Right lateral decubitus: craniosacral rhythm technique [24].
16	Standing behind the seated patient, make dorsal movements in the shape of the symbol for infinity (i.e., lemniscata), aiming at D8, while the patient keeps arms crossed over the chest and hands towards the shoulder blades (i.e., one elbow over the other). Eight repetitions, starting with a left posterior direction.

R: right; SMC: sternocleidomastoid muscle; L: left.

Finally, from the beginning through to completion of the physical therapy protocol, patients kept a simple record of their medication intake schedule, including times and drugs taken each day.

2.4 Conventional rehabilitation treatment

Following the protocol treatment of the Spanish hospital for neck pain, patients in all groups were instructed in postural hygiene recommendations and exercises for the cervical spine. The patients received written material on the postures and movements of daily life that might be harmful for the musculoskeletal system. In accordance with this protocol, the physical therapist teaches the patient, who is sitting on a stool, the key to holding an appropriate sitting position, while the patient is led towards a global neutral position of the spine for the next 5 minutes. The purpose is to align the lumbar, thoracic, scapular, and cervical portions of the spine, thus allowing the head to be positioned with minimum muscle exertion [30]. In the fifth treatment session, participants are taught various simple exercises to be performed four times per week at the rehabilitation service under supervision. They also receive written material detailing those exercises [31]. On the other hand, all patients across the three groups also received six 30-min sessions of manual therapy, which included the hands-on procedures described in Table 1 [32]. Patients were instructed not to perform exercises independently nor to receive other physiotherapy/medical treatments until full completion of the study (including follow up period).

2.5 Kinesio taping procedure

Following the first session of manual physical therapy, Cure Tape ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ KT bandages were applied to participants in the experimental group in accordance with the standardized protocol described by Kase et al. [5]. While the patient was seated, the first application consisted of a blue-colored 5-cm Y-shaped strip, with tails being longer than the base and with a length equal to that of the paravertebral musculature of the neck when the neck is bent. The bandage was placed with a degree of tightness of 25% and from the insertion towards the source (in a cranial direction), from D1-D2 through C1-C2. Each “tail” of the bandage is attached to the skin so as to provide the cervical spine with contralateral flexion and rotation. The second strip was 5-cm wide, black in color, and shaped as a capital ‘I’. It was placed at a 90-degree angle with respect to the first strip by means of the space-freeing technique (50%), running from C6 to D1, with the neck bent. The bases were attached without any tightness and with contralateral rotation of the neck. Bandages were replaced at the end of the fourth session of physical therapy. The second KT application was removed on the last day of the trial (Fig. 1A).

Figure 1.

(A) Kinesio Taping application in the cervical area. (B) Placebo procedure.

2.6 Placebo procedure

This group received two 5-cm Tensoplast ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ strips, similar to the aforementioned KT strips and placed on the same neck areas, with neutral placement and applying no pressure. The protocol included two bandages, as in the experimental case. Despite the difference in the material, the tape applications in experimental and placebo groups were highly similar in appearance. The placebo application was performed twice, as in the experimental group, in the first and fourth session (Fig. 1B).

Figure 2.

Flow chart of the recruitment of study participants, treatment protocol, and drop-out cases.

Table 2

Descriptive statistics for baseline values of socio-demographic and clinical variables in the three study groups

Group	KT group	Placebo group	Conventional rehab	$p$ -value
	( $n=$ 13)	( $n=$ 15)	( $n=$ 12)
Age (y)	42 $\pm$ 11	44 $\pm$ 9	41 $\pm$ 11	0.742
Sex				0.712
Male (%)	30.8	20	16.7
Female (%)	69.2	80	83.3
BMI (kg/m ${}^{2}$ )	24.6 $\pm$ 3.7	27.8 $\pm$ 5.61	23.9 $\pm$ 4.68	0.077
Days with pain ${}^{(1)}$	26 $\pm$ 21	34 $\pm$ 15	33 $\pm$ 18	0.456
Neck pain	79.2 $\pm$ 12.5	72.6 $\pm$ 10.3	85.0 $\pm$ 30.6	0.263
Days from assessment to
start of treatment ${}^{(2)}$	6 $\pm$ 4	8 $\pm$ 4	6 $\pm$ 4	0.367
Education level (%)				0.310
Primary	15.4	13.3	0.0
Secondary	61.5	33.3	58.3
College	23.1	53.3	41.7
Occupation (%)				0.837
Standing	46.2	46.7	33.3
Sedentary	53.8	53.3	66.6
Physical activity (%)				0.994
Yes	15.4	20	25
No	84.6	73.3	75
Occasional	0.0	6.7	0.0
Range of mouth opening ( ${}^{\circ}$ )	4.1 $\pm$ 0.64	4 $\pm$ 0.58	4.5 $\pm$ 0.69	0.210
Neck motility ( ${}^{\circ}$ )
Flexion	47.3 $\pm$ 7.9	41.3 $\pm$ 10.9	39.7 $\pm$ 9.5	0.101
Extension	59.6 $\pm$ 13	53.1 $\pm$ 8.7	59.4 $\pm$ 11.8	0.229
Right lateral flexion	37.1 $\pm$ 9.2	32 $\pm$ 9	32.5 $\pm$ 7.6	0.236
Left lateral flexion	43.6 $\pm$ 8.6	37.6 $\pm$ 8.6	36.1 $\pm$ 8.9	0.070
Rightward rotation	63.9 $\pm$ 9.1	55.6 $\pm$ 8	57.5 $\pm$ 7.4	0.026*
Leftward rotation	66.4 $\pm$ 11.7	61.3 $\pm$ 8.7	67 ${}^{\circ}$ $\pm$ 6.4	0.415
Prescription drugs (%)				0.039*
Yes	84.6	60	41.7
No	15.4	40	58.3

${}^{*}$ Significant ( $p<$ 0.05); Values are expressed as relative frequencies (%) for categorical variables and as means $\pm$ standard deviation for continuous variables. Abbreviations: KT, Kinesio taping. ${}^{(1)}$ Days elapsed from onset of neck pain; ${}^{(2)}$ Delay since assessment until starting physical therapy (in days).

Figure 3.

Effect of intervention on the mean VAS score from baseline to one month follow-up. Error bars represent standard error (SE) of the mean. * Significant group * Time interaction (ANOVA, $p<$ 0.05). No group by time interaction effect was achieved.

2.7 Statistical analysis

G*Power software, version 3.1.7 was used to calculate the sample size. According to this program a study using a sample of 15 patients per group can detect a high effect size (d $=$ 0.8) with a power of 90% at a $=$ 0.05 regarding the parameters of outcome measures. Data were analyzed with SPSS 20.0 (SPSS Inc., Chicago, IL, USA). As a first step, socio-demographic variables and baseline measures were subjected to ANOVA and chi-square analyses. Subsequently, for pain intensity and Cervical range-of-motion (flexion, extension, right and left lateral flexion, and right and left lateral rotation) we carried out a 3 $\times$ 6 repeated-measures ANOVAs, with group (KT, P, and MC) and measurement times (baseline, immediately after first treatment, 24 hours later, 4 ${}^{\rm th}$ day after the second application, post-treatment and at one-month follow-up) as between and repeated measures, respectively. Quality of life (SF-36) was analyzed following a 3 $\times$ 3 ANOVA with repeated measures and also group by time interaction (baseline, post-treatment and one month follow-up). The Greenhouse-Geisser method was used to correct the degrees of freedom in cases of sphericity violations. The target result was a significant group $\times$ time interaction. For those cases in which the interaction was statistically significant, one-way ANOVAs were carried out to determine significant differences between treatment groups. Bonferroni tests were also conducted to examine the significant treatment effects across time for each separate group. All analyses followed the intention-to-treat principle and groups were analyzed as randomized. Changes in variable scores within and between groups were measured by means (95% confidence interval) of t-tests for paired or independent samples as appropriate. The effect size was calculated according to Cohen’s $d$ statistic. An effect size $<$ 0.2 reflects a negligible difference, between $\geqslant$ 0.2 and $\leqslant$ 0.5 a small difference, between $\geqslant$ 0.5 and $\leqslant$ 0.8 a moderate difference, and $\geqslant$ 0.8 a large difference. $P<$ 0.05 was considered significant in all tests (two-tailed).

3. Results

Seventy-five people presenting with mechanical neck pain were assessed as potential participants. Of those, only 45 (36 females and 9 males) met inclusion criteria and were willing to participate in the study. Average age was 42.26 years (SD $=$ 10.46). Five of the volunteers (two from the KT group and three from the MC group) discontinued participation prior to completion of the experimental protocol after reporting significant improvement. Figure 2 shows the flow diagram for patient recruitment, reasons for exclusion, and drop-out cases.

The three groups were comparable in most socio-demographic, clinical, and quality-of-life variables (Table 2). With respect to mobility, the only significant difference ( $p=$ 0.026) was that the KT group was capable of greater neck rotation to the right (63.9 ${}^{\circ}$ ) than either the MC (57.5 ${}^{\circ}$ ) or the P (55.6 ${}^{\circ}$ ) group. There were also differences in medication use ( $p=$ 0.039), with more medicated participants in the KT group (84.6%) than in either the P (60%) or the MC (41.7%) group.

3.1 Effectiveness of treatment on pain perception

In terms of the VAS scale, the Group * Time interaction for the 3 $\times$ 6 ANOVA showed no significant differences between groups ( $F=$ 0.659; $P=$ 0.710). Regarding the slope of the mean scores, patients in the three groups experienced a similar decrease in their pain intensity (Fig. 3). Cohen’s coefficient revealed a moderate-large treatment effect in all three groups in the short term (after 24 h, KT: mean change $=$ 28, d $=$ 1.89; P: mean change $=$ 15, d $=$ 0.50; MC: mean change $=$ 12, d $=$ 1.00) and medium term (post-treatment, KT: mean change $=$ 47; d $=$ 5.00; P: mean change $=$ 38, d $=$ 2.52; MC: mean change $=$ 30, d $=$ 3.00).

Similar results were achieved for pain across the day (no differences between groups), showing a similar reduction on this variable (3 $\times$ 2 ANOVA, $F=$ 0.164; $P=$ 0.849). Effect sizes were large for all groups, but greater for the two groups using taping (KT: d $=$ 1.2; P: d $=$ 1.7) than for the control group, which had only received manual physical therapy (MC: d $=$ 0.86). Perception of pain scores were lower in the last two days of treatment for all groups; more precisely, 20 mm (mean change) lower for the KT group, 19 mm lower for the P group, and 15 mm lower for the CR group.

3.2 Effectiveness of treatment on neck mobility

In order to test treatment effectiveness on neck mobility, we conducted separate Group * Time interaction 3 $\times$ 6 ANOVAs on measures of flexion, extension, lateral flexion to the right and left, and rotation to the right and left. Results showed a single significant interaction between treatment groups and course of treatment for the flexion measure (F $=$ 2.12, P $=$ 0.043), however, between-group analyses detected no significant differences across groups at any of the six measurement times. Figure 4 shows the slope of the mean scores for all ranges of motion.

Figure 4.

Effect of intervention on the mean flexion, extension, lateral flexion and rotation scores from baseline to one month follow-up. Error bars represent standard error (SE) of the mean. * Significant group * Time interaction (ANOVA, $p<$ 0.05). No group by time interaction effect was achieved for extension.

Repeated measures analyses demonstrated significant long-term improvements in neck flexion in all three treatment groups, when comparing range of flexion at baseline and at one-month follow-up, showing a large effect size: the KT group progressed from 47.3 ${}^{\circ}$ to 51.1 ${}^{\circ}$ (mean change $=$ 3.65, d $=$ 1.08, $p=$ 0.05); the P group, from 41.3 ${}^{\circ}$ to 47.3 ${}^{\circ}$ (mean change $=$ 6.00, d $=$ 1.14, $p=$ 0.016); and the CR group, from 39.7 ${}^{\circ}$ to 44.8 ${}^{\circ}$ (mean change $=$ 5.15, d $=$ 0.95, $p=$ 0.044).

Short-term and medium-term differences in neck flexion were also found in the P and CR groups. Specifically, the P group increased range of flexion from 41.3 ${}^{\circ}$ at baseline to 47.1 ${}^{\circ}$ at post-treatment on the 4 ${}^{\rm th}$ day (i.e., immediately after the second bandage was applied, mean change $=$ 5.80, d $=$ 1.15, $p=$ 0.014) and to 46.7 ${}^{\circ}$ following completion of the treatment (mean change $=$ 6.00, d $=$ 1.16, $p=$ 0.030). There were also significant gains in flexion mobility in the CR group, which went from a baseline average of 39.7 ${}^{\circ}$ to 47.1 ${}^{\circ}$ 24 hours after the first treatment session (mean change $=$ 7.38, d $=$ 0.88, $p=$ 0.001), to 45.3 ${}^{\circ}$ (mean change $=$ 5.61, d $=$ 0.92 $p=$ 0.002) after the 4 ${}^{\rm th}$ session of manual therapy and to 46.4 ${}^{\circ}$ at post-treatment (mean change $=$ 6.69, d $=$ 0.91, $p=$ 0.009).

3.3 Efficacy of treatment on quality of life and use of medication

No group x assessment time interaction was found in any of the SF-36 subscales, so it was not evidenced that conventional rehabilitation, either supplemented by KT or placebo bandaging, affected the quality of life of the participants, as measured by the SF-36 ( $p\leqslant$ 0.05).

Prior to the start of treatment, 61.9% of the participants were medicated, while 38.1% were medication-free. Prescriptions by primary care physicians consisted of anti-inflammatory drugs (42%), muscle relaxants (4.8%), or a combination of anti-inflammatory drugs and muscle relaxants (14.3%). One week into the treatment, 14.3% of participants were medicated, while 85.7% were medication-free. There were no significant differences in medication reduction across treatment groups at any of the assessment times.

4. Discussion

In general, our results failed to show an additional effect of KT above and beyond those of conventional rehabilitation, as we obtained no significant differences across groups in most of the variables under study.

The most noticeable differences were obtained in terms of pain management in the Kinesio taping and placebo groups. These represented the largest effect sizes, and both were larger than the effect size found in the controls. This finding implies that a placebo effect could mediate in these interventions. Patients’ positive expectations towards therapy may induce endogenous opiate brain activation and produce an analgesic effect [33]. In addition, it is possible that patients change their behavior simply because they are taking part in the study, not because of the research treatment (Hawthorne effect) [34]. On the other hand, some authors have argued the use of a sham taping application as a real placebo because of the mechanical effect produced over de skin and consequently on the cervical range of motion. Perhaps the mechanical restraint supported by the taping gave the participants a greater awareness of the neck while moving and restricting painful movements, while Kinesio taping failed to provide an additional benefit [35].

In terms of neck mobility, all three groups showed improvements in all ranges of cervical motion. The only movement that varied across groups was cervical flexion. Immediately after the first treatment session, the KT group showed a 1.9 ${}^{\circ}$ reduction in neck flexion, while the P group increased the range of neck flexion by 2.1 ${}^{\circ}$ , and CR controls retained the same movement amplitude (39.7 ${}^{\circ}$ ). The following day (i.e., 24 hours later), the CR group is the one that demonstrates the greatest amplitude of neck flexion (47.1 ${}^{\circ}$ ), comparable to that of the KT group (47.4 ${}^{\circ}$ ). The P group seemed to benefit somewhat less from the first treatment session, as their range of flexion was a few degrees smaller (43.5 ${}^{\circ}$ ). These results show a trend in the same direction as previous studies, which had reported greater range of motion with the use of Kinesio Taping [17, 36, 37, 38]. However, the changes fail to reach the threshold for the criterion set for minimum detectable change in neck flexion, this being established at 6.5 ${}^{\circ}$ [39]. We also failed to find a distinct improvement in the quality of life reported by the KT patients, as all three groups endorsed similar scores on the SF-36.

Our data are in agreement with those obtained in previous studies, which did not find statistically significant changes when using Kinesio Taping to prevent ankle lesions [40], to improve joint proprioception at the ankle [41], for maximum grip strength [42], spinal flexion [43], reflex response of the femoral biceps and external calf muscles [44], hamstring flexibility [45], neuromuscular performance of the femoral quadriceps [46, 47, 48], or the patellofemoral pain syndrome [49]. Other researchers who have obtained statistically significant differences when applying Kinesio Taping following cervical whiplash [20] or treating chronic low-back pain [14], ultimately considered that the degree of change was minimal and hardly significant at the clinical level. Our results indicate similar minimum differences. The relevance of this study, however, derives from the fact that it is the first investigation on the use of Kinesio Taping in neck pain in the context of primary medical care, which included placebo and control groups and followed the course of treatment throughout the one-week protocol period and at the one-month follow-up.

In summary, our results indicate a substantial effect of conventional rehabilitation (manual therapy and exercises) on pain perception, neck mobility, and quality of life, while they cast doubt on an added benefit provided by Kinesio Taping. A recent systematic review which screened 38 studies, has also pointed out that techniques such as mobilization and manual therapy (i.e. manipulation, clinical massage) are effective interventions for the management of neck pain. However, there is no evidence in favor of certain passive physical modalities such as electrotherapy or hydrothrepay [50]. Regarding exercises for mechanical neck disorders, as we included in the conventional protocol, evidence suggests its effectiveness, especially in those exercises aimed at strengthening the neck muscles and scapulothoracic/shoulder kinematics [51]. Analyzing scientific evidence, Miller et al. [52] have also stated that manual therapy and exercises provided long-term improvement in pain (Standardized Mean Difference (SMD) $-$ 0.87, 95% CI $-$ 1.69 to $-$ 0.06; ${\rm I}^{2}=$ 54%; three RCTs) and function/disability, (SMD $-$ 0.57, 95% CI $-$ 0.94 to $-$ 0.21; ${\rm I}^{2}=$ 0%; two RCTs) compared to no-treatment control group in patients with acute neck pain. These authors also added that compared to manipulation, mobilization or exercise alone for neck pain, manual therapy and exercise combined produced greater improvements in pain, function, quality of life and patient satisfaction.

The current study has a number of limitations that should be considered. Firstly, the study was designed as a single-blind trial, as the Kinesio Taping bandage needed to be applied by a physical therapist. Secondly, these results cannot be extrapolated to subjects under 18 or over 55 years of age, as that was the age range of study participants. Finally, a no-treatment control group was not included in the current study, so it cannot be established if the improvements noted in both groups are due to the interventions or simply to the passage of time.

5. Conclusions

Subjects suffering from neck pain who receive manual therapy, are instructed in a series of physical exercises, and given postural hygiene recommendations, experience a significant improvement in their level of pain, neck joint mobility, and quality of life. The addition of supplementary therapies such as Kinesio Taping does not appear to significantly affect clinical parameters.

Footnotes

Acknowledgments

The researchers thank all patients who participated in this study.

Conflict of interest

None to report.

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Effectiveness of kinesio taping in addition to conventional rehabilitation treatment on pain,cervical range of motion and quality of life in patients with neck pain: A randomized controlled trial

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1. Introduction

2. Method

2.1 Participants

2.2 Design

2.3 Outcome measures

Table 1 Manual therapy procedures during each session

2.5 Kinesio taping procedure

3. Results

3.1 Effectiveness of treatment on pain perception

3.2 Effectiveness of treatment on neck mobility

4. Discussion

5. Conclusions

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Manual therapy procedures during each session