Effects of elastic tape in pregnant women with low back pain: A randomized controlled trial

Abstract

BACKGROUND:

Low back pain is a common problem in pregnant woman. Elastic tape is an alternative method that may reduce low back pain.

OBJECTIVES:

To compare the effect of elastic tape to placebo tape in the treatment of low back pain in pregnant women.

METHODS:

Forty pregnant women were allocated into two groups: elastic group ( $n=$ 20) and placebo group ( $n=$ 20). All participants were taped by either stretched (elastic group) or non-stretched (placebo group) Kinesio tape at the lower back area for one week.

RESULTS:

After the application of stretched elastic tape, lower back pain was significantly reduced by 29.4% ( $p=$ 0.003) immediately post-taping and by a further 75.4% after wearing the tape for a week. Compared to the placebo group, lower back pain was significantly reduced in the elastic group after one week of wearing the tape ( $p<$ 0.001). Compared to placebo, the application of elastic tape significantly reduced the disability score (Roland-Morris Disability Questionnaire) after one week of wearing the tape ( $p=$ 0.018). Taping to the back improved walking speed (immediately and after one week) in both the elastic ( $p<$ 0.001, $p<$ 0.001) and placebo groups ( $p<$ 0.001, $p=$ 0.001); however, the application of either tape had little effect on posture change.

CONCLUSION:

Elastic tape reduced back pain and improved physical function in pregnant women compared to the placebo tape.

Keywords

Back pain disability kinesio tape postural change pregnancy walking speed

1. Introduction

Low back pain that begins from about the second trimester and peaks around the third trimester [1] affects approximately 50% of all pregnant women (range 25%–90%) [2]. It is thought that low back pain in pregnant women is caused by their increasing body weight and abdominal size which subsequently enhances lumbar lordosis. In addition, the hormonal changes during pregnancy produce ligament laxity leading to instability of the spine and pelvic girdle and thereby low back pain [2]. Unfortunately, low back pain in pregnant women negatively affects their physical, psychological and social well-being [3] and, surprisingly, effective management of back pain during pregnancy is relatively unresearched [4].

Elastic tape is a therapeutic tape that can be stretched out to 140% of its original length. Kinesio tape is an elastic tape that was developed by a Japanese chiropractor in the 1970s, and is currently used to treat pain, injury and abnormal function of muscles and joints. It is believed that elastic tape may have a number of mechanisms by which it works including supporting injured muscles and joints, stimulating fascial function, and reducing pain by deactivation of nociceptive stimuli [5]. Elastic tape also stimulates the circulation of blood and lymph by reducing pressure on the floor of the connective tissue under the skin [5].

The effects of elastic tape in non-specific low back pain has been extensively studied [6], but there are only a few studies that examine the effects of Kinesio tape on lower back pain during pregnancy. Kaplan et al. conducted a study in 65 pregnant women with a gestational age between 10 and 30 weeks [7], and found that lower back pain decreased and functional ability improved significantly after five days of wearing the Kinesio tape compared wearing control tape (i.e. no stretch tape). Kalinowski and Krawulska conducted a crossover study in second and third trimester pregnant women and found that Kinesio tape significantly reduced pain intensity on the second and seventh post-application days and improved the physical functioning score on the seventh post-application day compared to placebo [8]. However, some researchers question the beneficial effect of elastic taping in relieving lower back pain [6]. More studies are required to provide stronger scientific evidence for the use of Kinesio tape on lower back pain in pregnancy [9]. In addition, the effects of elastic tape in the treatment of back pain solely in the third trimester in pregnant women, compared with placebo tape, has not been studied. During the third trimester when the fetus is largest and stress on the lumbar spine is greatest, we would expect that any positive effect of elastic taping would be most beneficial.

This study aims to compare the effect between elastic tape and placebo tape in the third trimester in pregnant women. The primary outcome of this study is the change in patients’ pain score. Secondary outcomes include the effect of elastic tape on the pregnant women’s disability score, walking speed and posture change.

2. Materials and methods

2.1 Participants

This was a double-blind randomized controlled trial on pregnant women who attended an antenatal clinic at Srinagarind Hospital, Khon Kaen, Thailand from July 2018 to September 2018. The inclusion criteria were: pregnant women with mechanical low back pain and aged between 18 and 40 years old, with a gestational age between 28 and 38 weeks. In addition, the pregnant women also had to have a lower back pain score of at least one on the visual analog scale (VAS), be able to walk at least 20 meters and have no contraindication for taping such as allergies or skin lesions. The exclusion criteria were: pregnant women with severe musculoskeletal disorders such as disc herniation or spinal fracture, a history of chronic back pain before pregnancy and high risk pregnancy cases such as twins or a pregnancy with underlying diseases. The study conformed to the Physiotherapy Evidence Database (PEDro) for methodological quality (Appendix) and attained a score of 10 as rated by the principal investigator of this study which represents a study of excellent quality. The study was approved by the Ethics Committee Human Research, Faculty of Medicine, Khon Kaen University under project no. HE611027.

Forty participants were divided into two groups according to the gestation period (28–32 and 33–38 weeks). The participants were allocated by block of four randomization into two groups: elastic group ( $n=$ 20) and placebo group ( $n=$ 20). All participants were taped by either stretched Kinesio tape (in the elastic group) or non-stretched Kinesio tape (placebo group) at the same lower back area. The allocation sequence was generated by computer software and was concealed by sealed and opaque envelopes. The participants were blinded from method of taping and the assessors were blinded from group of allocation.

Both groups received information about the nature, cause, and management of low back pain in pregnancy. The participants were asked not to exercise 24 hours before starting the intervention and patients did not visit a physiotherapy during the study. A simple analgesic such as paracetamol was allowed for severe pain, however, no study participants took any pain killers throughout the experiment.

Table 1
Characteristics of the participants

	Elastic tape group ( $n=$ 20)	Placebo tape group ( $n=$ 20)
Age (year)	30.7 (4.0)	30.2 (5.7)
Gestational age (week)	32.1 (3.4)	33.3 (3.3)
Number of pregnancies	1.9 (1.0)	1.8 (0.7)
Body weight (kg)	67.8 (9.5)	67.0 (9.1)
BMI (kg $\cdot$ m ${}^{-2}$ )	29.1 (7.6)	28.5 (7.6)
Pain score (VAS)	5.7 (1.9)	5.4 (1.8)
RMDQ score	13.5 (4.4)	11.9 (3.4)
Walking speed (m $\cdot$ sec ${}^{-1}$ )	1.0 (0.2)	0.9 (0.2)
Total posture translation in frontal view (cm)	3.8 (2.1)	3.1 (1.5)
Total posture translation in sagittal view (cm)	16.3 (5.6)	14.7 (3.6)

Data are mean (SD). VAS, Visual analog scale, RMDQ, RolandMorris Disability Questionnaire.

Figure 1.

Taping technique at the lower back area. A. The I-shaped sections of tape were stretched as the participant bent forward and were applied vertically from the sacroiliac joint to the twelfth rib along both erector spinae muscles. B. The two I-shaped sections of tape were stretched and applied horizontally and covered the spinous process to the coronal line on each side of the body around the fourth-fifth lumbar spine and the last rib level.

Figure 2.

Total posture translation in frontal and sagittal view analyzed form the mobile application. The summation of deviation of postural line from the ideal line. A. in frontal view (total posture translation in frontal view) and B. in sagittal view (total posture translation in sagittal view).

2.2 Application of tape

In the elastic group, the participants were taped with 5 cm width and 0.5 mm thickness elastic tape (Kinesio tex ${}^{{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}}$ , classic type, Kinesio Holding Corporation, New Mexico, USA). The I-shaped sections of tape were applied vertically from the sacroiliac joint to the twelfth rib along both erector spinae muscles while participants were in a standing position. The tape was stretched to approximately 50% over of its original length as the participant bent forward (Fig. 1A) and then applied to the skin surface. In addition, two I-shaped sections of tape were applied horizontally by beginning at the spinous process and stretching the tape to approximately 50% over its original length to the coronal line on each side of the body. The first horizontal tape was applied around the fourth-fifth lumbar spine and the second horizontal tape was applied at the last rib level (Fig. 1B). In the placebo group, the participants were taped by the same type of tape (Kinesio tape) and the same method was used, but the tape was not stretched.

2.3 Outcome assessment

2.3.1 Back pain

Ratings of back pain severity at the time of testing

Table 2
Comparison of pain score, walking speed and RMDQ score at baseline, immediately and one week after wearing the tape (within and between groups)

	Baseline				Immediately posttaping						One week taped
	Elastic	Placebo	Mean difference (95% CI)		Elastic		Placebo		Mean difference (95% CI)		Elastic		Placebo		Mean difference (95% CI)
Pain score (VAS)	5.7 (1.9)	5.4 (1.8)	0.3	( $-$ 0.9, 1.4)	4.0	(1.2) ${}^{\text{a}}$	4.6	(1.5)	$-$ 0.6	( $-$ 1.4, 0.3)	1.4	(1.0) ${}^{\text{b,c}}$	3.7	(1.0) ${}^{\text{b,c}}$	$-$ 2.3	( $-$ 3.0, $-$ 1.7) ${}^{\#}$
Walking speed (m $\cdot$ s ${}^{-1}$ )	1.0 (0.2)	0.9 (0.2)	0.01	( $-$ 1.0, 0.1)	1.1	(0.2) ${}^{\text{a}}$	1.0	(0.2) ${}^{\text{a}}$	0.1	( $-$ 5.9, 0.2)	1.1	(0.2) ${}^{\text{b,c}}$	1.0	(0.2) ${}^{\text{b}}$	0.1	( $-$ 1.7, 0.2)
RMDQ score	13.5 (4.8)	11.9 (3.4)	$-$ 1.6	( $-$ 1.0, 4.1)	NA		NA				4.6	(3.9) ${}^{\text{a}}$	8.1	(4.2) ${}^{\text{a}}$	$-$ 3.6	( $-$ 6.2, $-$ 1.0) ${}^{\#}$
Total posture translation in frontal view (cm)	3.8 (2.1)	3.1 (1.5)	0.7	( $-$ 0.5, 1.8)	4.2	(1.9)	3.4	(1.3)	0.9	( $-$ 0.2, 1.9)	3.4	(1.4)	4.0	(1.6)	$-$ 0.6	( $-$ 1.5, 0.4)
Total posture translation in sagittal view (cm)	16.3 (5.6)	14.7 (5.9)	1.6	( $-$ 1.4, 4.6)	16.1	(5.9)	15.1	(4.0)	1.0	( $-$ 2.3, 4.2)	14.5	(5.3)	16.2	(3.7)	$-$ 1.7	( $-$ 4.6, 1.2)

Data are mean (SD) along with raw mean difference and 95% confidence interval for the between group change scores. ${}^{\text{a}}$ , significantly different between baseline and immediately post in same group; ${}^{\text{b}}$ , significantly different between baseline and one week post in same group; ${}^{\text{c}}$ , significantly different between immediately post and one week post in same group; ${}^{\#}$ , significantly different between the two intervention groups. Significant $p$ -value $<$ 005. VAS, Visual analog scale, RMDQ, RolandMorris Disability Questionnaire, NA, Not applicable.

were made using a VAS. The VAS score ranged from 0 to 10 points with a straight line of 10 centimeters from 0 (no pain) to 10 (the worst pain). The VAS procedure was explained to each participant prior to the study.

2.3.2 Physical function

Physical function was evaluated using the Roland-Morris Disability Questionnaire (RMDQ). This is a self-administered questionnaire with 24 questions that produces a score from 0 to 24. This paper and pencil questionnaire had been translated into Thai and has good internal consistency [10]. In addition, we also measured the time to walk 20 meters along a straight flat line. Walking speed that is related to low back pain intensity [11] was calculated by dividing the distance (20 m) by the time taken [12]. The average of two tests of walking speed (5 minute seated rest between tests) was analyzed.

2.3.3 Postural change

Posture change was evaluated using a mobile phone application taking photographs of the participants in the frontal and lateral view. The same researcher took pictures each time within about two meters distance from the participant. The pictures were analyzed by the Android application PostureScreen Mobile. The mobile application has shown strong rater reliability and construct validity for postural analysis [13]. The participants were marked on the acromioclavicular joint, episternal notch, lateral side of the eighth rib, anterior superior iliac spine, greater trochanter, lateral femoral epicondyle, center of the ankle. The total postural translation in frontal and lateral views were analyzed (Fig. 3).

2.3.3.1. Total posture translation in frontal view

The application created an ideal line through the center of the body perpendicular to the ground in frontal view. The application also created a postural line between each pair of landmarks from the head to the ground. The summation of the deviation of the postural line from the ideal line at each landmark was analyzed (Fig. 2A).

2.3.3.2. Total posture translation in sagittal view

Similar to the frontal view the application created an ideal line through the center of the body perpendicular to the ground in the sagittal view. The application then created a postural line from the head through the shoulder, greater trochanter, knee down to the ankle joint. The summation of deviation of the postural line from the ideal line in each landmark was analyzed (Fig. 2B).

The outcomes were evaluated before (baseline), immediately after applying the tape (immediately post-tapping) and after one week of wearing the tape (one week tapped). Participants were told to continue living and moving as normal for the whole week and not to change their behaviors.

3. Statistical analysis

The data were analyzed using SPSS version 26 (SPSS Inc., Armonk, USA). The data are presented as mean and standard deviation (mean $\pm$ SD). The data were evaluated for normal distribution by the Kolmogorov-Smirnov test. An independent $t$ test was performed for comparison of continuous data between groups and the dependent $t$ test was performed for comparison of continuous data within the group. An ANOVA with Bonferroni correction was used to analyze repeated measurements between groups. Significant differences were determined at $p<$ 0.05.

The sample size estimation was calculated based on a type I error ( $\alpha$ ) $=$ 0.05, type II error ( $\beta$ ) $=$ 0.2, mean difference ( $\mu_{1}-\mu_{2})=$ 1.92 and variance $=$ 1.98 from the study by Kaplan et al. [7]. The estimated number of participants from this calculation was 16 per group. After correcting 20% dropouts, the total sample size was 20 per group.

Figure 3.

The effect of elastic tape and placebo tape on pain intensity (visual analog score) at baseline, immediately post-taping and one week taped. ${}^{*}$ significant difference $p<$ 0.05.

Figure 4.

The effect of elastic tape and placebo tape on functional ability (RMDQ, Roland-Morris Disability Questionnaire) at baseline, immediately post-taping and one week taped. ${}^{*}$ significant difference $p<$ 0.05.

Figure 5.

The effect of elastic tape and placebo tape on walking speed at baseline, immediately post-taping and one week taped. ${}^{*}$ significant difference $p<$ 0.05.

4. Results

The characteristics of the participants of the elastic and placebo tape are presented in Table 1. At baseline there were no significant differences between the groups for the measures taken. In addition, no adverse effects of taping such as allergies or skin irritations were observed.

Immediately after applying the stretched Kinesio tape to the participants in the elastic group their subjective back pain score (as measured by the VAS) significantly decreased by approximately 29.4% (dropped from 5.7 to 4.0, $p=$ 0.003) and significantly decreased further one week later (VAS $=$ 1.4, $p<$ 0.001) (Table 2). However, applying the same tape without stretch to the placebo group did not immediately effect subjective back pain score (VAS reduced by 15%, $p=$ 0.06), but seven days later had significantly reduced subjective back pain compared to baseline levels ( $p=$ 0.04). Moreover, the magnitude of subjective back pain reduction was significantly greater in the elastic group compared to the placebo group one week after application with a mean difference of $-$ 2.3 ( $-$ 3.0 to $-$ 1.7, 95% CI, $p<$ 0.001) (Fig. 3).

One week after applying the tape, the elastic group had significantly reduced their disability score from 13.5 to 4.6 ( $p=$ 0.001). The placebo group also showed a decreased disability score over this period (from 11.9 to 8.1, $p=$ 0.001). However, compared to the placebo group, the elastic group showed a significantly larger decrease from baseline to one week after wearing the tape in their disability score ( $-$ 3.6, $p=$ 0.018) (Fig. 4).

Immediately after applying the stretched elastic tape, the elastic group had significantly increased their walking speed, which remained improved through to one week after wearing the tape. Similarly, applying the non-elasticized tape to the placebo group, immediately improved their walking speed which was maintained through to the following week (Fig. 5). There was no significant difference in walking speed change between groups.

Taping the lower back with stretched elastic (elastic group) or non-stretched elastic (placebo group) tape for one week did not significantly alter posture as measured by the PostureScreen Mobile application.

5. Discussion

In this study, both Kinesio and placebo taping improved back pain, walking speed and reduced perception of disability (RMDQ score) compared to baseline. However, Kinesio tape had a significantly greater effect on the reduction of back pain and perceived disability than the placebo tape after one week of wearing the tape. This study did not find any postural changes from the midline in either the horizontal or sagittal view as a result of wearing Kinesio or placebo tape.

Previous research has revealed both beneficial and non-beneficial effects of Kinesio tape on non-specific chronic low back pain. A meta-analysis recently concluded that Kinesio tape had no positive effect compared to placebo taping in pain reduction, but it significantly improved disability scores [6]. However, only a few studies examined the effects of such taping on final trimester pregnant women. Our study showed that elastic Kinesio tape reduced low back pain from distressing pain to mild or annoying pain and improved physical functioning in final trimester pregnant women compared to placebo taping.

While this is not the first study that investigates the effects of elastic taping on the reduction of lower back pain and disability in pregnant women [7, 8], previous studies either lacked control groups [7] or did not control for gestational age and thus size and weight of the growing fetus [7, 8]. Our study indicated that elastic taping has a greater effect than non-elastic taping on reducing lower back pain in pregnant women with a similar gestational age.

Mechanisms behind the positive effects of elastic taping include improved lower back stability [14] and increased proprioception [15] resulting in an improvement of postural control. It is also thought that elastic taping may help to widen the interstitial space between the skin and the fascia resulting in increased blood circulation [16] which may help to remove pain-causing substances [17].

Kinesio tape may also improve back muscle activity and posture change. Kang et al. showed that application of postural taping on the lower back area in chronic low back sufferers decreased the back extensor muscle electromyographic activity and rate of perceived exertion while also improving the kinematics of the lumbo-pelvic-hip complex assessed by a 3D motion capture system [18]. The current study did not find any difference in postural correction after taping in pregnant women as assessed by a mobile phone application (PostureScreen Mobile). The mobile phone application may not be sensitive enough to detect small sectional back postural changes from taping. In addition, the participants wore a loose dress (Fig. 3) during the posture screening which may have reduced the accuracy of finding the postural landmarks for the phone application.

The limitations of this study include the fact that it would have been ideal to measure the extent to which the effects of taping lasted and we recommend future studies to continue to measure the effects of taping into the weeks after the tape has been removed. In addition, previous research suggested that the duration of taping should be two weeks [9], therefore our results may not reflect the full extent of adaptation that may occur if the taping period was extended. Also, we recognize that while we initially blinded patients to the intervention, some patients over time may have correctly guessed which intervention group they were in. Finally, a more sensitive measure of postural change would be required in future research to confirm whether postural change caused any improvement in pain reduction.

6. Conclusion

Elastic tape has a positive effect on reducing lower back pain and improves physical function in pregnant women in their third trimester compared to placebo tape. However, taping had no effect on walking speed or postural changes in heavily pregnant women.

Footnotes

Acknowledgments

The authors would like to acknowledge Dr. Jitjira Chaiyarit, Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University for statistical advice and analysis and furthermore thank the participants who were involved in this study.

Conflict of interest

None to report.

Appendix

References

Meijer

Uegaki

Mens

van Dieën

Wuisman

, et al. Pregnancy related pelvic girdle pain, I: terminology, clinical presentation, and prevalence. Eur Spine J. 2004; 13: 575–89. doi: 10.1007/s00586-003-0615-y.

Katonis

Kampouroglou

Aggelopoulos

Kakavelakis

Lykoudis

Makrigiannakis

, et al. Pregnancy-related low back pain. Hippokratia. 2011; 15(3): 205-10.

Olsson

Lena

. Health-related quality of life and physical ability among pregnant women with and without back pain in late pregnancy. Acta Obstet Gynecol Scand. 2004; 83: 351–57. doi: 10.1111/j.0001-6349.2004.00384.x.

Liddle

Pennick

. Interventions for preventing and treating low back and pelvic pain during pregnancy. Cochrane Database Syst Rev. 2015; CD001139A. doi: 10.1002/14651858.CD001139.pub4.

Kase

Tatsuyuki

Tomoki

. Development of kinesioTM tape. KinesioTM taping perfect manual. Kinesio Taping Association. 1996; 6(10): 117–118.

Yin

Jia

Chen

. Effects of kinesiotape on pain and disability in individuals with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2019; 33(4): 596–606. doi: 10.1177/0269215518817804.

Kaplan

Alpayci

Karaman

Çetin

Özkan

Özter

, et al. Short-term effects of Kinesio taping in women with pregnancy related low back pain: a randomized controlled clinical trial. Med Sci Monit. 2016; 22: 1297–301. doi: 10.12659/msm.898353.

Kalinowski

Krawulska

. Kinesio taping vs. placebo in reducing pregnancy related low back pain: a cross over study. Med Sci Monit. 2017; 23: 6114–20. doi: 10.12659/msm.904766.

Reyhan

AÇ

Dereli

Çolak

. Low back pain during pregnancy and Kinesio tape application. J Back Musculoskelet Rehabil. 2017; 30(3): 609–613. doi: 10.3233/BMR-160584.

10.

Jirarattanaphochai

Jung

Sumananont

Saengnipanthkul

. Reliability of the roland – morris disability questionnaire (thai version) for the evaluation of low back pain patients. J Med Assoc Thai. 2005; 88: 407–11.

11.

Simmonds

Lee

Etnyre

Morris

. The influence of pain distribution on walking velocity and horizontal ground reaction forces in patients with low back pain. Pain Res Treat. 2012: 1–10. doi: 10.1155/2012/214980.

12.

Gutke

Östgaard

Öberg

. Association between muscle function and low back pain in relation to pregnancy. J Rehabil Med. 2008; 40: 304–11. doi: 10.2340/16501977-0170.

13.

Szucs

Brown

EVD

. Rater reliability and construct validity of a mobile application for posture analysis. J Phys Ther Sci. 2018; 30(1): 31–6. doi: 10.1589/jpts.30.31.

14.

Shin

Heo

. The effects of Kinesio taping applied onto erector spinae and sacroiliac joint on lumbar flexibility. J Kor Phys Ther. 2017; 29(6): 307–315. doi: 10.18857/jkpt.2017.29.6.307.

15.

Kurt

Büyükturan

Erdem

Tuncay

Sezgin

. Short-term effects of Kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome. J Phys Ther Sci. 2016; 28(7): 2034–2040. doi: 10.1589/jpts.28.2034.

16.

Craighead

Shank

Volz

Alexander

. Kinesiology tape modestly increases skin blood flow regardless of tape application technique. J Perform Health Res. 2017; 1(1): 72–78. doi: 10.25036/jphr.2017.1.1.craighead.

17.

Hong

Chou

. The Kinesio taping method for myofascial pain control. Evid Based Complement Alternat Med. 2015; 2015: 1–9. doi: 10.1155/2015/950519.

18.

Kang

Choi

. Postural taping applied to the low back influences kinematics and EMG activity during patient transfer in physical therapists with chronic low back pain. J Electromyogr Kinesiol. 2013; 23(4): 787–93. doi: 10.1016/j.jelekin.2013.02.009.