Does kinesiotaping increase the efficacy of lidocaine injection in myofascial pain syndrome treatment? A randomized controlled study

Abstract

BACKGROUND:

Myofascial pain syndrome is a common form of musculoskeletal disorder that originates from a painful site in a muscle or related fascia. There are various non-invasive and invasive treatment methods.

OBJECTIVE:

To investigate the efficacy of myofascial trigger point kinesiotaping with that of local anesthetic injection alone on the degree of pain and quality of life in myofascial pain syndrome.

METHODS:

Seventy-six patients with myofascial pain syndrome were randomly assigned to three study groups. Group 1 ( $n=$ 26) received only local anesthetic (1 ml lidocaine of 0.5% for each trigger point) injection. Group 2 ( $n=$ 25) received local anesthetic injection $+$ sham kinesiotaping. Group 3 ( $n=$ 25) received local anesthetic injection $+$ kinesiotaping. Pain intensity was measured by visual analog scale (VAS) at baseline, immediately after treatment, and in the 1st and 4th week post-treatment. To evaluate the effect of treatment on quality of life, Short Form-12 (SF-12) was used at baseline and at 4th week post-treatment.

RESULTS:

Group 3 showed significantly more improvement than other groups at post-treatment VAS, SF-12 physical component evaluations ( $p<$ 0.05). No significant difference was found between groups 2 and 3 in the mental component of SF-12 ( $p>$ 0.05), but the patients in group 3 performed significantly better than group 1 ( $p<$ 0.05). No significant difference was found between groups 1 and 2 in VAS, SF12 Physical Components Summary and SF-12 Mental Components Summary scores at post-treatment evaluations.

CONCLUSION:

This study indicated that kinesiotaping may be useful to increase the efficacy of myofascial trigger point lidocaine injection in myofascial pain syndrome.

Keywords

Myofascial pain syndromes trigger point injection kinesiotape

1. Introduction

Myofascial pain syndrome (MPS) is a common form of musculoskeletal disorder that originates from a painful site in a muscle or related fascia. It has been described as a common cause of musculoskeletal pain with the prevalence from 21 to 85% [1]. It is characterized by myofascial trigger points (MTrP) in muscles, taut bands, referred pain, sensory changes, and local twitch response. An initial injury to muscle fibers may cause trigger points. This injury is sometimes major trauma or repetitive micro-trauma to the muscles. The injured muscle causes pain and stress after that. As the stress on the fibers continues, additional trigger points occur. There are various noninvasive (Spray [freeze] and stretch, transcutaneous electrical stimulation, ultrasound, massage, ischemic compression therapy) and invasive (local anesthetics, corticosteroids and botulinum toxin injections, dry needling) treatment modalities to decrease the pain by inactivating trigger points and loosening taut bands [2]. The local anesthetic injection is known as one of the most common and effective methods in the treatment of MPS [3]. MTrP injections can be painful but using lidocaine may provide immediate anti-nociceptive effect and better treatment results. A study comparing effects of local anesthetic injection with dry needling reported better results with local anesthetic injection [4].

There are three main taping techniques currently used for musculoskeletal conditions: White Athletic Taping, McConnell Taping Technique and Kinesiotaping (KT) method. KT is an alternative taping technique that was developed by Dr. Kenzo Kase and it has been applied in a number of musculoskeletal conditions. Although the full mechanism of KT has yet to be proved, some effects of this technique have been claimed including: enhancement of muscular function, facilitation of lymphatic and vascular circulation and motion due to elevation of skin and subcutaneous tissues, reduction in inflammation and pain, reinforcement of possible articular malalignments [5, 6]. The main mechanism of reduction in pain has been explained to lift of skin away from the tender tissues beneath and to provide space for lymphatic flow by the means of diminishing pressure on tender tissue [7].

Recent studies suggest that KT may be a new treatment option in patients with musculoskeletal problems such as: acute whiplash-associated disorders of the cervical spine [8], subacromial impingement syndrome [9, 10], mechanical neck pain [11], low back pain [12, 13, 14, 15, 16], hamstring muscle flexibility [17], knee osteoarthritis [18], and meralgia paresthetica [19]. According to our knowledge there is one study that investigated the effect of KT method for the relief of MPS [20] and there is a case report of a patient with shoulder pain of myofascial origin who was treated with KT [21]. Although KT is commonly used by clinicians, we consider that there is lack of literature about KT use in MPS treatment. Hence, the present study aimed to investigate the efficacy of MTrP KT with that of local anesthetic injection alone on the degree of pain and quality of life in myofascial pain syndrome.

2. Method

2.1 Design

The present study was a prospective randomized controlled clinical trial with blinded assessment in which only local anesthetic injection, local anesthetic injection $+$ sham KT and local anesthetic injection $+$ KT applications are compared. The study protocol was compatible with the Declaration of Helsinki and all the patients provided written informed consent prior to the study. The study protocol was approved by the local ethics committee.

2.2 Participants

Seventy-six patients who were admitted to the outpatient clinic with neck and shoulder pain who had at least one painful MTrP located on muscles including trapezius, levator scapula, rhomboids, supraspinatus and infraspinatus due to MPS were recruited in this study (Fig. 1).

Figure 1.

Study flow diagram.

The criteria defined by Simons et al. [22] was used for MPS diagnosis whereby five major and at least one minor criteria are required for clinical diagnosis. Patients 18 to 65 years of age (either sex) were eligible for participation. Pregnant, lactating women and patients with fibromyalgia, mental disorder and a history of lidocaine allergy were excluded.

The patients who met inclusion criteria were assigned to three groups by using randomized numbers obtained from QuickCalcs (©GraphPath software) software. Group 1 received only local anesthetic injection ( $n=$ 26), group 2 received local anesthetic injection $+$ sham KT ( $n=$ 25), and group 3 received local anesthetic injection $+$ KT ( $n=$ 25).

2.3 Treatment

Musculus trapezius, m.levator scapula, m.rhom- boideus, m.infraspinatus and m.supraspinatus were the muscles where MTrP were found. Injections and KT applications were done in these muscles.

Trigger point injections were performed as follows: at first, trigger points were determined with palpation and marked by a skin-marker while patients were kept in sitting position and then skin was cleaned with an appropriate antiseptic solution (Fig. 2a).

Figure 2.

a. Trigger point that was palpated and marked by a skin-marker. b. Sham kinesiotape was applied in star shape without tension on myofascial trigger point immediately after the injection. c. Kinesiotape was applied in star shape with the space correction technique on myofascial trigger point immediately after the injection.

A 40 mm long 27-gauge needle was inserted perpendicularly through the skin and moved forward until the trigger point that was ensured to be immobilized between thumb and index finger. 1 ml of 0.5% lidocaine solution was injected after negative aspiration into each MTrP and then the needle was withdrawn.

In group 2, four 7 cm $\times$ 2.5 cm “I shaped” stripes of Kinesiotape (Kinesio-Tex Classic Blue, 5 cm $\times$ 4 m, Kinesio, USA) were applied on each injected trigger point immediately after the injection in star shape (Fig. 2b). No tension was generated to create sham taping. In group 3, four 7 cm $\times$ 2.5 cm “I shaped” stripes of Kinesiotape (Kinesio-Tex Classic Blue, 5 cm $\times$ 4 m, Kinesio, USA) were applied on each injected trigger point immediately after the injection in star shape with proper tension. Approximately 50% stretching was applied to the central 1/3 part of the strips. The other right and left 1/3 sections were placed without stretching to obtain proper tension. Finally, the strips were rubbed by thumbs to provide adhesion (Fig. 2c). In all KT applications, the space correction technique was used to create more space directly above an area of trigger point. All injections and KT applications were applied by the same physiatrist while patients were kept in sitting position. The patients were informed not to take any analgesic drugs or nonsteroidal anti-inflammatory drugs during the evaluation sessions. Patients wore the KT for a 1-week period (renewed in 3–4 days).

2.4 Assessment

Pain intensity was measured by using a 10-cm visual analog scale (VAS) at baseline, at immediately after the treatment, at 1st week and at 4th week post-treatment [23]. To evaluate the effect of treatment on quality of life, Short Form-12 (SF-12) was used at baseline and at 4th week post treatment. Physical Component Summary (PCS) and the Mental Component Summary (MCS) of SF-12 was calculated. The assessments were conducted by another clinician who was blinded to the patients’ groups.

2.5 Statistical analysis

Statistical analysis was done using SPSS version 19.0. (IBM SPSS Statistics 19, SPSS inc., Somers, NY, USA). Data were expressed as mean $\pm$ standard deviation for continuous variables or percentage (%) for ordinal variables. Kolmogorov-Smirnov test was used to assess normal distribution. The Chi-square test was used to compare the categorical variables between the groups. The repeated measures ANOVA test was used for comparisons of the parametric continuous data. The ANOVA test was used to analyze the changes in VAS and SF-12 variables. Post-hoc analysis was conducted by Bonferroni test to determine significant differences. The confidence interval was set to 95.0% and the statistical significance was set at p less than 0.05.

3. Results

Seventy-six patients (25 males and 51 females, 43.09 $\pm$ 14.67 years old) were included in this study. Baseline characteristics of the patients are summarized in Table 1. All groups were similar in terms of age, sex, number of trigger points, duration of pain, and intensity of twitch response. Injections were done into m.trapezius (44.4%), m.levator sscapula (35.7%), m.infraspinatus (12.5%), m.rhomboideus (5.1%), m. supraspinatus (2.2%). The mean and standard deviation of VAS and SF-12 scores are shown in Table 2. VAS, SF-12 PCS and SF-12 MCS scores at baseline were also similar between the groups (Table 2).

Table 1
Baseline characteristics of the patients

Parameters	Groups
	Injection	Injection $+$	Injection $+$
	( $n=$ 26)	sham taping	kinesiotaping
		( $n=$ 25)	( $n=$ 25)
Age ${}^{*}$ , years ( $\pm$ sd)	43.54 $\pm$ 15.19	42.4 $\pm$ 14.08	43.32 $\pm$ 15.29
Trigger points ${}^{*}$ ,	3.73 $\pm$ 1.34	3.92 $\pm$ 1.04	4.00 $\pm$ 1.00
count ( $\pm$ sd)
Sex ${}^{*}$ ( $n$ , %)
Male	7 (26.9)	9 (36)	9 (36)
Female	19 (73.1)	16 (64)	16 (64)
Duration of pain ${}^{*}$ (frq, %)
1–3 month	9 (34.6)	6 (24)	8 (32)
3–6 month	4 (15.4)	4 (16)	5 (20)
$>$ 6 month	13 (50)	15 (60)	12 (48)
Twitch response ${}^{*}$ ( $n$ , %)
Absent	6 (23.1)	1 (4)	2 (8)
Slight	16 (61.5)	17 (68)	20 (80)
Apparent	4 (15.4)	7 (28)	3 (12)

${}^{*}p>$ 0.05 (Chi-squared test was used for qualitative variables and the one-way Anova test was used for quantitative variables).

Table 2

VAS scores and SF-12 parameters at baseline, immediately after injection, at 1st week and at 4th week follow-up of patients

	Groups
	Injection ( $n=$ 26)	Injection $+$ sham taping ( $n=$ 25)	Injection $+$ kinesiotaping ( $n=$ 25)	$p^{*}$
VAS
Baseline	7.54 $\pm$ 0.86	7.60 $\pm$ 0.65	7.76 $\pm$ 0.72	0.557
Immediately AI	2.85 $\pm$ 1.05	2.76 $\pm$ 1.23	2.56 $\pm$ 1.29	0.683
Follow-up 1 ${}^{\text{st}}$ week	3.73 $\pm$ 2.01	3.52 $\pm$ 1.78	2.24 $\pm$ 1.45	0.007
Follow-up 4 ${}^{\text{th}}$ week	4.50 $\pm$ 2.12	4.12 $\pm$ 1.64	1.44 $\pm$ 1.92	$<$ 0.001
SF12 PCS
Baseline	33.40 $\pm$ 5.61	33.07 $\pm$ 6.31	32.67 $\pm$ 6.47	0.912
Follow-up 4 ${}^{\text{th}}$ week	40.83 $\pm$ 7.03	43.06 $\pm$ 5.51	47.52 $\pm$ 7.13	0.002
SF12 MCS
Baseline	39.62 $\pm$ 6.65	37.79 $\pm$ 6.05	38.36 $\pm$ 7.42	0.612
Follow-up 4 ${}^{\text{th}}$ week	44.54 $\pm$ 7.27	45.61 $\pm$ 6.94	49.37 $\pm$ 6.37	0.037

${}^{*}p$ value obtaining by which comparing statistically scores of the scales among the groups, VAS. Visual Analog Scale; AI. After injection; SF12 PCS. Short Form-12 Physical Component Summary; SF12 MCS. Short Form-12 Mental Component Summary.

There were significant differences in 1 ${}^{\text{st}}$ week and 4 ${}^{\text{th}}$ week follow-up measures of VAS scores in intergroup comparison. There were significant differences in 4th week follow-up measures of SF-12 PCS and MCS scores in intergroup comparison (Table 3).

Table 3

Post-hoc comparisons for all outcome measures

Outcome measures	Post-hoc comparisons	$p$	$p t$	$p\gamma$
VAS	Injection vs. injection $+$ sham taping	1.000	1.000	1.000
	Injection vs. injection $+$ kinesiotaping	0.448	0.003	0.001
	Injection $+$ sham taping vs. injection $+$ kinesiotaping	0.928	0.016	0.001
SF-12 PCS	Injection vs. injection $+$ sham taping			0.433
	Injection vs. injection $+$ kinesiotaping			0.001
	Injection $+$ shamtaping vs. injection $+$ kinesiotaping			0.021
SF-12 MCS	Injection vs. injection $+$ sham taping			0.496
	Injection vs. injection $+$ kinesiotaping			0.013
	Injection $+$ sham taping vs. injection $+$ kinesiotaping			0.395

baseline minus immediately after treatment, ${}^{*}$ baseline minus follow-up 1 ${}^{\text{st}}$ week, $\gamma$ baseline minus follow-up 4 ${}^{\text{th}}$ week, VAS. Visual Analog Scale; SF12 PCS. Short Form-12 Physical Component Summary; SF12 MCS. Short Form-12 Mental Component Summary.

Comparison of VAS and SF-12 changes between the groups showed that VAS and SF-12 PCS scores at post-treatment evaluations in group 3 improved more than groups 1 and 2. No significant difference in SF-12 MCS scores was found between groups 2 and 3, but improvement of group 3 was significantly better than group 1.

4. Discussion

In the current study, we tried to investigate the efficacy of MTrP kinesiotaping with that of local anesthetic injection alone on the degree of pain and quality of life in myofascial pain syndrome. We achieved significant improvement in pain, and physical and mental health status with KT application in combination with MTrP injection and KT increased the efficacy of the treatment of MPS.

The most recent systematic reviews on the KT [24, 25, 26] included one randomized controlled study investigating the effect of KT on pain and ROM in patients with acute whiplash injury [8] and another study investigating the effects of shoulder joint stabilization exercises with taping that was applied before stabilization exercises to the upper trapezius muscle on patients with MPS [27].

In the first study, Gonzales et al. reported statistically significant effects of KT compared to sham taping for pain or range of motion (ROM) in individuals with neck pain due to acute whiplash injury; however, improvements in pain and ROM were small and the investigators reported that this improvement may not be clinically significant [8]. Assessment of KT treatment was done after 24 hours in the study of Gonzales et al. [8]. Similarly, in the current study, assessments in immediately after treatment period showed that there is no significant difference in patient groups. But at 1 ${}^{\text{st}}$ week and 4 ${}^{\text{th}}$ week assessment, group 3 gained more improvements in VAS scores and SF-12 scores. Thus, it may be concluded that KT or sham KT do not provide additional therapeutic effect immediately after treatment but KT contribute to the efficacy of local anesthetic injection into the MTrPs in the later assessments.

In the second study, Lee et al. concluded that applying non-elastic taping (twice a week for four weeks) before stabilization exercises is more effective in relieving pain and improving the ability to perform activities of daily living in patients with MAS in the upper trapezius [27]. In the current study, KT was performed by thin and elastic tapes with proper tension. In addition, these tapes have similar physical properties with human skin to allow normal range of motion and aeration. The main difference of KT from traditional tapes is the ability to activate the muscle tissue [28]. Pain relieving mechanisms of KT on musculoskeletal tissues are not clear [29]. It was claimed that KT application may increase intramuscular blood flow may by stimulating the autonomic nervous system and may decrease algogenic substances within muscle [28]. Furthermore, it was also suggested that activating the endogenous analgesic system and inhibiting pain transmission according to the gate control theory by stimulating mechanoreceptors are other hypotheses for pain reduction with KT [30]. When anti-nociception by lidocaine injection and above mentioned effects by KT are taken into account, this may explain how KT increases the efficacy of local anesthetic injection.

In addition to pain assessment with VAS rating, the current study showed superior effects of KT in MPS treatment by SF-12 scale. In 4 ${}^{\text{th}}$ week assessment, PCS component of SF-12 was better in patients who received KT. Similarly, MCS component of SF-12 was better in patients who received injection $+$ KT when compared to injection alone, but this superiority did not reach significant level when compared to injection $+$ sham taping. These positive changes in SF-12 scores support the role of KT in treatment of patients with MPS.

Major limitation of the study was the lack of long-term follow-up and small sample size. Additionally, in order to achieve better recovery of MPS, more than one KT application could have been performed.

5. Conclusion

In conclusion, significant improvement in pain, and physical and mental health status were achieved with KT application in combination with MTrP injection and KT increased the efficacy of the treatment of MPS. In the light of the present study, it can be claimed that KT may be useful to increase the efficacy of myofascial trigger point lidocaine injection in myofascial pain syndrome. Further studies with longer follow-up and larger number of subjects are necessary to investigate the efficacy of KT and to optimize the KT application.

Footnotes

Conflict of interest

None to report.

References

Skootsky

Jaeger

Oye

. Prevalence of myofascial pain in general internal medicine practice. West J Med. 1989; 151: 157-160.

Lavelle

Smith

. Myofascial trigger points. Med Clin North Am. 2007; 91: 229-239.

Cummings

White

. Needling therapies in the management of myofascial trigger point pain: A systematic review. Arch Phys Med Rehabil. 2001; 82: 986-992.

Venancio Rde

Alencar

Zamperini

. Different substances and dry- needling injections in patients with myofascial pain and headaches. Cranio. 2008; 26(2): 96-103.

Kase

KTH

Tomoko

. Development of kinesio tape. Kinesio taping perfect manual. Kinesio Taping Association. 1996; 6: 117-118.

Kase

KWJ

Kase

. Clinical Therapeutics Applicationsof the Kinesio Taping Method. 2nd ed. Tokyo: Ken Ikai Co Ltd; 2003.

The Kinesio Tex Taping Method – Concepts [Internet]. United Kingdom: Kinesio UK; [cited 2012 Dec 3]. Available from: http://www.kinesiotaping.co.uk/tapingmethod.jsp.

Gonzalez-Iglesias

Fernandez-de-Las-Penas

Cleland

, et al. Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: A randomized clinical trial. J Orthop Sports Phys Ther. 2009; 39: 515-521.

Simsek

Balki

Keklik

, et al. Does Kinesio taping in addition to exercise therapy improve the outcomes in subacromial impingement syndrome? A randomized, double-blind, controlled clinical trial. Acta Orthop Traumatol Turci. 2013; 47: 104-110.

10.

Hsu

Chen

Lin

, et al. The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome. J Electromyogr Kinesiol. 2009; 19: 1092-1099.

11.

Saavedra-Hernandez

Castro-Sanchez

Arroyo-Morales

, et al. Short-term effects of kinesio taping versus cervical thrust manipulation in patients with mechanical neck pain: A randomized clinical trial. J Orthop Sports Phys Ther. 2012; 42: 724-730.

12.

Paoloni

Bernetti

Fratocchi

, et al. Kinesio Taping applied to lumbar muscles influences clinical and electromyographic characteristics in chronic low back pain patients. Eur J Phys Rehabil Med. 2011; 47: 237-244.

13.

Castro-Sanchez

Lara-Palomo

Mataran-Penarrocha

, et al. Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain: A randomised trial. J Physiother. 2012; 58: 89-95.

14.

Silva Parreira Pdo

Menezes Costa Lda

Takahashi

, et al. Do convolutions in Kinesio Taping matter? Comparison of two Kinesio Taping approaches in patients with chronic non-specific low back pain: Protocol of a randomised trial. J Physiother. 2013; 59: 52.

15.

Added

Costa

Fukuda

, et al. Efficacy of adding the Kinesio Taping method to guideline-endorsed conventional physiotherapy in patients with chronic nonspecific low back pain: A randomised controlled trial. BMC Musculoskelet Disord. 2013; 14: 301.

16.

Hagen

Hebert

Dekanich

, et al. The effect of elastic therapeutic taping on back extensor muscle endurance in patients with low back pain: A randomized, controlled, crossover trial. J Orthop Sports Phys Ther. 2015; 45: 215-219.

17.

Akbas

Atay

Yuksel

. The effects of additional kinesio taping over exercise in the treatment of patellofemoral pain syndrome. Acta Orthop Traumatol Turc. 2011; 45: 335-341.

18.

Cho

Kim

, et al. Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: A randomized controlled trial. Am J Phys Med Rehabil. 2015; 94: 192-200.

19.

Kalichman

Vered

Volchek

. Relieving symptoms of meralgia paresthetica using Kinesio taping: A pilot study. Arch Phys Med Rehabil. 2010; 91: 1137-1139.

20.

Wang

Chen

, et al. The effect of taping therapy on patients with Myofascial pain syndrome: A pilot study. Taiwan Journal of Physical Medicine and Rehabilitation. 2008; 36: 145-150.

21.

Garcia-Muro

Rodriguez-Fernandez

Herrero-de-Lucas

. Treatment of myofascial pain in the shoulder with Kinesio taping. A case report. Man Ther. 2010; 15: 292-295.

22.

Simons

Travell

Simons

. Travell and Simons’ myofascial pain and dysfunction: the trigger point manual. 2nd ed. Baltimore: Williams & Wilkins; 1999.

23.

Cline

Herman

Shaw

, et al. Standardization of the visual analogue scale. Nurs Res. 1992; 41: 378-380.

24.

Kalron

Bar-Sela

. A systematic review of the effectiveness of Kinesio Taping-fact or fashion? Eur J Phys Rehabil Med. 2013; 49: 699-709.

25.

Morris

Jones

Ryan

, et al. The clinical effects of Kinesio(R) Tex taping: A systematic review. Physiother Theory Pract. 2013; 29: 259-270.

26.

Vanti

Bertozzi

Gardenghi

, et al. Effect of taping on spinal pain and disability: Systematic review and meta-analysis of randomized trials. Phys Ther. 2015; 95: 493-506.

27.

Lee

Yong

Kong

, et al. The effect of stabilization exercises combined with taping therapy on pain and function of patients with myofascial pain syndrome. J Phys Ther Sci. 2012; 24: 1283-1287.

28.

Alvarez-Alvarez

Jose

Rodriguez-Fernandez

, et al. Effects of Kinesio(R) Tape in low back muscle fatigue: Randomized, controlled, doubled-blinded clinical trial on healthy subjects. J Back Musculoskelet Rehabil. 2014; 27: 203-212.

29.

Kelle

Guzel

Sakalli

. The effect of Kinesio taping application for acute non-specific low back pain: A randomized controlled clinical trial. Clin Rehabil. 2016; 30: 997-1003.

30.

Kachanathu

Alenazi

Seif

, et al. Comparison between kinesio taping and a traditional physical therapy program in treatment of nonspecific low back pain. J Phys Ther Sci. 2014; 26: 1185-1188.

Does kinesiotaping increase the efficacy of lidocaine injection in myofascial pain syndrome treatment? A randomized controlled study

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Method

2.1 Design

2.2 Participants

2.5 Statistical analysis

3. Results

Table 1 Baseline characteristics of the patients

5. Conclusion

Footnotes

Conflict of interest

References

Table 1
Baseline characteristics of the patients