Effect of kinesio taping and exercise on functional impairment in patients with different degrees of knee osteoarthritis

Abstract

BACKGROUND:

Kinesio Taping (KT) is used for musculoskeletal problems. KT optimizes and reduces mechanical stresses on soft tissues. However, the benefits of KT and traditional exercises for different severities of knee osteoarthritis (OA) remains controversial.

OBJECTIVES:

This study aimed to investigate the effects of tension KT and traditional physical therapy on different severities of knee OA.

METHODS:

Fifty-six male patients with knee OA, aged 60–75-y years, were allocated to groups A and B based on grades 1 and 2 and grades 3 and 4 on the Kellgren-Lawrence scale, respectively. Tension KT and traditional physical therapy were administrated to both groups for 6-wks. The extensor peak moment of quadriceps and knee flexion range of motion (ROM) were recorded using an isokinetic dynamometer and universal goniometer, respectively. Visual analog scale (VAS) was used to score pain level. Statistical analysis was performed using the ANCOVA test.

RESULTS:

ANCOVA revealed an increase in peak extensor moment of quadriceps (Pre: 51.6 $\pm$ 2.8 Nm; Post: 63.3 $\pm$ 4.3 Nm), knee flexion ROM (Pre: 112.8^∘ 7.2; Post: 122.9^∘ 4.8), and pain improvement (Pre: 5.1 $\pm$ 1.07; Post: 2.8 $\pm$ 1.6) in group A ( $p<$ 0.001). Group B showed insignificant improvements in all outcome measures ( $p>$ 0.05).

CONCLUSION:

KT with traditional physical therapy improved knee pain, quadriceps strength, and knee ROM in older males with knee OA grades 1 and 2. KT and traditional physical therapy were insufficient to produce considerable effects on grades 3 and 4 of knee OA.

Keywords

Isokinetic dynamometer kinesio taping knee osteoarthritis traditional physical therapy

1. Introduction

Osteoarthritis (OA) is a joint disease that leads to degenerative changes in articular cartilage and subchondral bone, resulting in pain and functional impairments [1]. OA affects patients’ socioeconomic status and their families owing to high treatment session costs and loss of work productivity. In knee OA, chronic knee pain, morning stiffness, and impaired knee function are disabling symptoms that lead to persistent disability [2]. knee OA not only imposes considerable pain and functional impairments, but also decreases the quality of life and escalates socioeconomic costs. However, the healthcare system and the development of advanced drugs and community-based treatments can help mitigate these socioeconomic losses, especially in established highmarket economies [3].

Kinesio Taping (KT) is recommended as an extensive conservative intervention for knee OA [4]. Quadriceps weakness is one of the most critical problems associated with knee OA. Thus, improving the power of the quadriceps muscle is usually considered the primary aim of treating knee OA [5]. Even in combination with other treatments, KT escalates the improvement of outcome measures in knee OA. Danazumi et al. reported that the use of KT is a great addition to combined chain exercises (open and closedchain exercises) for treating pain and functional impairments in mild to moderate knee OA [6].

KT is a common and useful tool for handling knee OA by optimizing patellofemoral balance and reducing mechanical stress on soft tissues. Several studies have demonstrated that KT is an efficient tool for improving isokinetic quadriceps moment and knee pain. KT can improve active range of motion (ROM) change proprioception in individuals with OA and improve muscle strength and function [7].

Depending on the technique, the therapist applies tension to on the skin, elevating the epidermis and increasing the pressure on the mechanoreceptors beneath the dermis. Mechanoreceptors stimulation involves pain modulation, blood and lymphatic circulation improvement, joint realignment, and muscle tension reduction [8]. Previous studies have acknowledged that different KT techniques have apparent therapeutic effects on patients with knee OA, especially improvements pain levels and reductions in activity limitations [9, 10].

Despite the widespread use of KT, the results of these studies conflict regarding its effects on muscle activation and force production. KT application may induce a small instant increase in muscle strength by raising the fascia and stimulating increased muscle activation. However, further studies are needed to experimentally evaluate the impact of KT application [11]. In this context, a previous study evaluated KT application on quadriceps strength under three conditions: (a) without taping, (b) immediately after taping, and (c) 12 h after taping. The results indicated that muscle power did not increase under these three conditions [12].

While there has been increasing clinical interest in the efficacy of KT for various pathologies, the current KT efficacy trials for knee OA pain reduction and activity limitations enhancement indicate disagreement with its efficacy [13]. The contradictory findings on the extent of KT benefits for different severities of knee OA remain controversial [14].

Our hypothesis was that patients with different severities of knee OA would respond positively to the combined effect of KT with tension and traditional physical therapy. Answering this hypothesis will allow therapists and researchers to understand the importance and appropriate use of KT and traditional physical therapy based on the degree of knee OA. Therefore, this study aimed to examine the combined effects of KT with tension and traditional physical therapy on different degrees of knee OA in male patient. Peak moment of the quadriceps muscle, pain level, and knee ROM were measured at baseline and after the intervention.

2. Materials and methods

2.1 Study design

This was a pretest-posttest experimental design conducted between February 2022 and October 2022 at the physical therapy outpatient clinic of the Applied Medical Sciences College, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia. This study aimed to explore cause-and-effect relationships between treatment interventions and outcome measures. The male patients were allocated to either group A or group B. According to the Kellgren-Lawrence (K-L) scale [15], patients in group A were classified as having grades 1 and 2, whereas those in group B included patients with grades 3 and 4. KL scale is considered an essential radiological tool in diagnosing OA in which an anteroposterior (AP) knee radiograph view is used and the assigned grade is scored from 0 to 4. Grade 0 indicates no knee OA, and grade 4 indicates severe OA. Outcome measures were assessed the day before the treatment intervention. For 6-wks, both groups received KT with tension and traditional physical therapy. Finally, outcome measures were evaluated immediately after the end of treatment. All the participants signed an informed consent form to declare approval to participate in the study. The Participants reported that they were informed of the purposes, advantages, and possible problems that may occur during the study. Participants voluntarily contributed to the study and could leave at any time. The Research Ethics Committee (No: RHPT/020/018) of the Physical Therapy and Health Rehabilitation Department, at the above institution granted ethical approval for this study. All procedures adhere to the guidelines of the Declaration of Helsinki (1964).

Figure 1.

Participants’ dropout and retention.

2.2 Participants

A total of 72 male, community-dwelling older patients, aged 60–75-y with symptomatic knee OA and ambulatory status, who were diagnosed by an orthopedist, were eligible for this study. The comprehensive selection process is illustrated in Fig. 1. Participants were included if they were confirmed symptomatically and radiographically as patients with knee OA, which had been established for more than one year. The patients had knee joint problems during standing activities (Koos score [16] was 60–70% or less), fluctuating swelling, and no regimen of any modality or medications prescribed as analgesics for 3-d before the experiment. The most affected knee in each patient was chosen according to the highest score on the visual analog scale (VAS). Patients were excluded if they had inflammatory or metabolic bone diseases, a history of surgery in the lower extremity, or score of 0 on the K-L scale. Further, patients were excluded if they had received an intra-articular injection of the knee joint within the previous 6 months, had any other musculoskeletal disorders affecting the knee joint, had a noticeable loss of sensation or strength in the lower extremity due to neurological or genetic diseases, had systemic rheumatic diseases, or had a history of skin allergy, and leg length discrepancy.

2.3 Assignment procedure

After the eligibility and enrollment processes, 56 symptomatic patients with knee OA were equally allocated to either group A or B under the supervision of an independent investigator. Two other assistant therapists were blinded to groups and conducted the assessment and treatment procedures and one therapist was assigned to each group.

2.4 Outcome measures

The extensor peak moment of the quadriceps muscle was recorded using an Isokinetic dynamometer (Nm). VAS was used to score pain. A universal goniometer (UG) was used to measure the active ROM of the knee joint in degrees-of-freedom. These outcome measures were evaluated at baseline and at the end of 6-wks of treatment.

2.5 Assessment procedures

2.5.1 Strength assessment

The extensor peak moment of the quadriceps muscle was assessed using an isokinetic dynamometer (CSMI Humac 2009, Cybex II, II+, version 129, USA), and the Interclass correlation coefficient (ICC) ranged from 0.74 to 0.89 [17]. The hip and knee joints were positioned at 85^∘ and 90^∘ flexion, respectively. The dynamometer axis was adjusted to the lateral condyle of the femur. Resistance was then applied to the tibia approximately 5 cm above the lateral malleolus. The ROM ranged from 90^∘ of flexion to 0^∘ (full extension). To familiarize themselves with the procedures, the patients performed five cycles of submaximal knee flexions and extensions without resistance, followed by a 3-minute rest interval before completing two sets of three maximal knee extensions with an angular velocity of 60^∘/s. There was a 5-minute interval given between the sets. Peak concentric isokinetic knee extensor moment (Nm) was recorded as the outcome measure. The highest peak moment value was selected for analysis [18].

2.5.2 Pain assessment

Knee pain was assessed using a VAS comprising a 10-cm line, with 0 representing no pain and 10 representing the worst pain. The patient was instructed to locate a number representing the severity of pain on the scale. During the activity, pain was evaluated by instructing the patient to express knee pain after a 10-meter walk [19]. Pain was measured pre-treatment and after 6-wks of treatment.

2.5.3 Active ROM assessment

Active knee flexion ROM was assessed by a UG, with good reliability (ICC $=$ 0.92–0.99) [20]. The center of the fulcrum was placed over the lateral condyle of the femur. The proximal fixed arm of the UG was straightened with the femoral axis using the greater trochanter as a reference point. The distal mobile arm was aligned using the lateral malleolus as reference point. The patients were placed in the prone position with a small cushion to prevent his patella from excessive compression. The therapist instructed the patient to move the knee actively from an extended position to the maximum available non-painful range of knee flexion. The distal mobile arm of UG moved to follow the leg axis. Finally, the average of the three readings of the active knee flexion ROM was calculated.

2.6 Treatment procedures

Figure 2.

Kinesio taping techniques. A: The first Y strip was applied in the caudal direction which the tail encircled the patella medially and laterally. B: The second Y strip was applied in cephalic direction between the tibial tuberosity and apex of the patella where the tail encircled the patella medially and laterally and along the vastus medialis and vastus lateralis, respectively. C: The third I strip was applied around the patella mediolaterally.

2.6.1 Kinesio tape application

The KT (MediSpor XL Kinesiology Tape for sport and therapy use, USA) was applied with tension producing a stabilizing effect: two ‘Y-strips’ and one ‘I-strip’ with no cut down the center of the tape. The Patients were asked to extend their knees to the maximum to obtain length measurements and make final KT adjustments before their application. The trained therapist shaved the treated area first and then instructed the patients to lie supine and flex their knees as much as possible within the available non-hurting ROM. Approximately 10 cm below the anterior superior iliac spine, the therapist applied the strip body in the cephalad direction [21]. A Y-strip was applied to the rectus femoris muscle at 25% tension, and the tails of the strip encircled the patella medially and laterally at 25% tension. The second Y-strip was applied between the tibial tuberosity and apex of the patella while the knee joint was flexed at 90^∘. Under 25% tension, the tails of the second strip were wrapped medially and laterally around the patella, directing the vastus medialis and vastus lateralis, respectively. Finally, the therapist positioned the knee at 30^∘ flexion while applying the third strip, an I-strip, around the patella mediolaterally with 75% tension as shown in Fig. 2.

To determine the tension for KT application, the therapist first measured the origin and insertion of the application points. Then, the mathematical rule of three was used to calculate and determine the tape length. Finally, KT was applied based on the pre-established tension, as mentioned above. The tape was renewed at each session (twice per week) and retained throughout the week; this was repeated until the end of the treatment duration (6-wks). In cases of tape detachment (an occasional occurrence), the patient committed to renewing it. A trained, certified therapist conducted all the taping interventions.

2.6.2 Traditional physical therapy treatment

Traditional physical therapy started with a 10-min warm-up (resistance-free biking exercise) and 10-min resistance-free leg exercise training (leg press, leg curl, leg extension, hip abduction, and calf raises; two minutes of training for each exercise). The hamstring and calf muscles were stretched passively three times/session; each stretch was maintained for 30 s with 10 s of rest. Traditional physical therapy was delivered to patients twice a week and only the most affected knee was treated [22]. The resistance was not prescribed in exercises of traditional physical therapy program aiming to enable the researcher to attribute any improvement of quadriceps strength to the KT application combined with traditional physical therapy. The resistive exercises may significantly increase muscle strength and may lead to faulty interpretation of the KT effects. Secondly, Resistance (loads) was not used in traditional physical therapy exercises to prevent unexpected increased pain in patients of group B (grades 3, and 4 on the Kellgren-Lawrence scale). It was stated that to increase muscle strength (quadriceps muscle) the participant should use 80% to 100% of 1-repetition maximum (1RM) [23], which exacerbates joint pain, and knee swelling [24], especially in elderly people with advanced knee OA (grades 3 and 4).

2.7 Sample size calculation

The sample size was determined based on the estimated effect size (d $=$ 0.40) [25] and a probability of 0.05 using G*power 3.0.10 software (University of Dusseldorf, Dusseldorf, Germany). The power was set at a 70% chance of correctly rejecting the null hypothesis of no difference in the 52 male patients. Thus, the sample size was increased to 56 to allow for a loss of up to 6%.

2.8 Statistical analysis

All analyses were performed using the statistical software package SPSS (version 23.0; IBM, Chicago, IL, USA). Data are expressed as mean $\pm$ SD. The normality of the data and equality of variance were checked using Shapiro Wilk’s and Levene’s tests, respectively. Differences in baseline characteristics between the groups were calculated using an independent $t$ -test for continuous data, whereas Pearson’s chi-square test was used to explore differences in categorical data. Post-treatment analysis of covariance (ANCOVA) was used to examine the differences between groups concerning outcome measures. The pre-treatment values of the outcome measures were set as covariates to evaluate differences between the groups. A paired $t$ -test was used to determine the significance of the differences within the groups. For all statistical tests, a $p$ -value $<$ 0.05 was considered statistically significant.

Table 1
Demographic characteristics of patients

Characteristics	Group A ( $n=$ 26) (CI 95%)	Group B ( $n=$ 26) (CI 95%)	p
Age, years	66.1 $\pm$ 4.5 (64.3–68)	68.2 $\pm$ 4.5 (66.4–70.1)	0.1^†
Weight, Kg	85.5 $\pm$ 4.7 (83.6–87.4)	86 $\pm$ 5 (83.9–88)	0.7^†
Height, cm	173.4 $\pm$ 4.9 (171.4–175.4)	175.5 $\pm$ 5.4 (173.2–177.7)	0.1^†
BMI, Kg/m²	28.6 $\pm$ 0.8 (28.2–28.9)	28.1 $\pm$ 1.2 (27.6–28.6)	0.1^†
Duration of illness, years	3.7 $\pm$ 1.1 (3.2–4.1)	4 $\pm$ 1 (3.6–4.4)	0.2^†
Pain at baseline, (VAS)	5.1 $\pm$ 1 (4.6–5.5)	7.6 $\pm$ 1 (7.1–8)	$P<$ 0.001^†
	No.
Affected side (right/left)	18/8	14/12	0.2^*
Severity of knee OA (no. of cases)	Grade 1 (15) Grade 2 (11)	Grade 3 (14) Grade 4 (12)

BMI body mass index; ^†Independent $t$ -test; ^*Pearson’s chi-square test.

3. Results

Of the 72 patients who were initially screened, 56 were eligible and allocated to the two groups Two patients were lost to follow-up in both groups A, and B and a total of 52 patients were finally analyzed. The patients’ average age was 66.1 $\pm$ 4.5 years in group A, and 68.2 $\pm$ 4.5 years in group B. The mean duration of knee OA was 3.7 $\pm$ 1.1 years, while in group B it was 4 $\pm$ 1 years. In group A, 15 and 11 patients had grades 1 and 2, respectively. In group B, 14 patients had grade 3 knee OA and 12 patients had grade 4 OA. The participants in both groups regularly adhered to the scheduled study sessions at an overall attendance rate of 97% during the study period. No possible adverse or additional manifestations were reported by any of the patients throughout the study procedures from either tape application or traditional physical therapy. There were no significant differences in demographic characteristics between the two groups (Table 1).

Table 2
Influence of Kinesio tape with tension on different severity of knee OA

Outcome measures	Pre-treatment Mean $\pm$ SD (CI 95%)		Post-treatment Mean $\pm$ SD (CI 95%)		Post-treatment difference
	Group A	Group B	Group A	Group B	$P$ -value	Partial $\eta^{2}$
Quadriceps peak moment Nm	51.6 $\pm$ 2.8 (50.4–52.7)	40.7 $\pm$ 3.7 (39.2–42.2)	63.3 $\pm$ 4.3 (61.5–65.1)	41.3 $\pm$ 3.9^† (39.7–42.9)	$<$ 0.001^∗	0.6
Flexion knee ROM, degrees ( $\circ$ )	112.8 $\pm$ 7.2 (109.8–115.7)	96.3 $\pm$ 5.7 (93.9–98.6)	122.9 $\pm$ 4.8 (120.9–124.9)	97.4 $\pm$ 4.9^† (95.4–99.4)	$<$ 0.001^∗	0.6
VAS	5.1 $\pm$ 1.0 (4.6–5.5)	7.6 $\pm$ 1.0 (7.1–8.0)	2.8 $\pm$ 1.6 (2.1–3.4)	7.2 $\pm$ 0.9^† (6.8–7.6)	$<$ 0.001^∗	0.5

ROM range of motion; VAS visual analog scale; Partial $\eta^{2}$ the effect size for significant ANCOVA test; ^∗Significant at $P<$ 0.05; ^†Non-significant differences between pre- and post-treatment in group B.

The combined effects of KT and traditional physical therapy on the outcome measures for different severities of knee OA are shown in (Table 2). There was a significant influence of combined treatments (KT with tension and traditional exercise) in patients with grade 2 or grade 1 knee OA in terms of increasing quadriceps peak moment after controlling for pre-treatment scores, F (1, 49) $=$ 74.7, $p<$ 0.001. Regarding knee flexion ROM, patients with grade 2 or grade 1 showed a significant increase in ROM compared with patients with grade 3 or higher, owing to the effects of the combination of KT with tension and traditional physical therapy when adjusted for pre-treatment values, F (1, 49) $=$ 98.8, $p<$ 0.001. As for knee pain, although patients in both groups showed a reduction in knee pain, the combined effect of KT with tension and traditional exercise significantly reduced knee pain in group A patients with grade 2 or grade 1 after controlling for pre-treatment scores, F (1, 49) $=$ 53.9, $p<$ 0.001.

4. Discussion

Although it is commonly agreed that knee OA can be diagnosed on a KL scale at grade 2, it is not known whether KL grade 2 knee OA has more severe symptoms than KL grade 1 [26]. Therefore, in the present study, the patients were clustered into two main groups group A (grades 1 and 2 on KL scale) and group B (grades 3 and 4 on KL scale) to ease the application of KT and interpret the results comprehensively. In both groups, the male patients were treated individually using standardized treatment programs. Patients in group A showed improvement after 6-wks in almost every outcome, whereas patients in group B showed a slight non-significant improvement in outcome measures.

To the best of our knowledge, pain and swelling are key symptoms of knee OA. The decongestive properties of KT may, at least in part, play a role in the effectiveness of KT on pain, reduction of swelling and increase in knee flexion ROM in patients with knee OA [27]. The skin-lifting effect of KT, which increases blood circulation and improves lymph drainage, may explain these observations [28]. A recent systematic review verified that KT use is an effective tool in improving pain and function in patients with knee OA [29]. Using radiological examination Banerjee et al. [30] suggested that KT can cause mechanical deformation of tissues under the tape in humans. Supporters of this technique claim that it can also create convolutions of the skin, which can lift the epidermis away from underlying tissues and reduce swelling by changing the flow of blood and lymph in the microcirculation. Interestingly these convolutions can be observed when the tape is applied, suggesting that mechanical deformation of the skin may have an impact on the flow of interstitial fluid, blood, and lymph in the skin and superficial tissues [30].

It was noted in another study that after taping for just 10 minutes, the skin temperature around the waist increased significantly among healthy adults suggesting that this could be due to the impact of KT on skin temperature and the promotion of local microcirculation in the human body [31]. Regarding treatment of myofascial trigger points, Wu Wt et al. [32] observed that using the KT application can help in raising the subcutaneous space and improve blood circulation and lymph fluid drainage, which can ultimately reduce the chemical factors around the myofascial trigger points (MTrP) region.

In knee osteoarthritis, therapeutic exercises should be prescribed to strengthen quadriceps muscle which can reduce knee pain and enhance the activity limitations of the patients [33]. Hence, the traditional physical therapy exercises in the current study included open and closed kinetic chain exercises that utilized the advantages of weight-bearing and non-weight-bearing exercises in addition to using KT to improve knee OA. This is consistent with the finding of Jan et al. [34] who reported a marked improvement in knee extensor peak moment in patients with OA after conducting an exercise program of 8-wks of weight-bearing and non-weight-bearing exercises.

Based on the design of the current study and the different severities of knee OA in groups A and B, the pretreatment scores differed in terms of pain level, quadriceps strength, and knee range of motion. This was attributed to the increased pain level in group B compared with that in group A. Moderate to severe knee OA results in substantial decrease in knee range of motion, quadricep strength, and increases activity limitations [35].

The pain level in group A in the current study was significantly reduced by approximately 45% from the baseline score. This is consistent with a previous study that compared KT intervention with traditional exercises involving electrostimulation and traditional exercises. The mean age of patients was 32.9 $\pm$ 12.2 years, and the baseline score of pain was 6 $\pm$ 1.6. Pain significantly diminished by approximately 56% in the KT group. However, that study used electrostimulation, and the improvement in pain may be attributed to the use of electrotherapy with KT [36], which was not tested in our study. In addition, KT with tension combined with traditional exercises in the present study which used aerobic, weight-bearing, and non-weight-bearing exercises produced considerable effects on pain levels in group A. Tanaka et al. reported in their meta-analysis that aerobic and strengthening exercises with or without weight-bearing could improve pain in knee OA [37]. A recent study examined a six-week of the combined effect of KT and conventional therapy on moderate pain in patients with knee OA. The study revealed that KT and conventional physical therapy improved pain intensity by 51.1% [38], compared with the results of the present study whereby pain improved by 45.2% as it decreased from 5.11 $\pm$ 1.07 (medium pain) to 2.8 $\pm$ 1.64 in group A Also, Oğuz et al. investigated the combined effects of KT and traditional exercises (warm-up, resistance exercises, balance, stretching exercises, and coolingdown exercises) on patients with OA grades 2 and 3. They reported positive effects on pain level and activity limitations in patients with mild to moderate knee OA after 6-wks of intervention [39].

KT techniques in the current study used two Y-shaped strips and one I-shaped strip, with tension applied to the rectus femoris muscle. The positive results that were obtained in group A were consistent with previous studies, which found that the application of KT with both I- and y-shaped tension applied to the rectus femoris and upper edge of the patella improved pain and quality of life and decreased symptoms in patients suffering from OA of the knee [40, 41]. Additionally, KT with tension has apparent effects on patellofemoral pain syndrome with K-L scale grades 1 and 2 [36], as in group A of the current study. The findings of the current study support the results of another study that reported that KT influences pain levels by stimulating mechanoreceptors. Stimulation of low-threshold cutaneous mechanoreceptors excites largediameter fibers, which consequently attenuates pain signals in small nociceptive fibers that is C and A-delta fibers. These mechanoreceptors are found in joints, muscles, tendons, and skin [42].

In addition, regarding the effect of traditional physical therapy, only patients in group A showed pain improvement. The traditional physical therapy in the present study which included open and closed kinetic chain exercises and stretching exercises significantly reduced knee pain in group A. This is consistent with the findings of Abdel-Aziem et al. [43] who found that for patients with OA aged 45 to 62 years with a Kellgren-Lawrence score of 1 or 2, a program of stretching exercises, strengthening exercises, pulsed electromagnetic field, and ultrasound was beneficial for improving knee pain intensity, knee range of motion, and isometric quadriceps strength. In contrast, in group B of the current study, the average baseline pain level was 7.61 $\pm$ 1.09 and did not change significantly after the treatment (7.26 $\pm$ 0.96). Wageck et al. found the same finding that the three KT techniques did not induce a significant improvement of high pain levels (7.6 $\pm$ 1.7) after four days of intervention [5].

According to the K-L scale and likely changes occurring in the knee joint [44], and based on the findings of our study, it is clear that KT application with tension and traditional physical therapy improves pain in patients with mild knee OA (group A). Pain improvement was due to the stimulation of cutaneous mechanoreceptors found in the superficial layers but not in the deeper layers.

The substantial changes in the deeper tissues found in knee OA and the source of chronic pain might involve subchondral microfractures, bone extension accompanied by periosteum elevation due to osteophytes, bone angina resulting from diminished blood supply and increased intra-osseous pressure [45]. All or some of these changes may be present in grades 3 and 4 on the K-L scale. Therefore, the lack of significant improvement in pain levels in group B indicates the inability of KT and traditional physical therapy to induce notable changes in the deeper tissues of the knee joint and surrounding structures.

A previous study speculated that the results obtained after KT would be completely different in patients with various pain severities [14]. For instance, Banerjee et al. stated in their study that KT does not alter the painful sensation moderated by mechanosensitive afferents in deeper tissues [46]. The findings of group B in the current study are consistent with Banerjee’s suggestion along with another study that showed that KT did not instantly reduce calf pain in delayed onset muscle soreness (DOMS) after intervention or after the completion of the duathlon sport [47]. Similarly, Sarallahi et al reported that 10 sessions of KT combined with conventional physical therapy did not have the ability to significantly improve pain and function in patients OA measured as grades 3 and 4 on the K-L scale and the same was observed in patients of group B in the current study [48].

Concerning the peak extensor moment of the quadriceps, the current study revealed that KT use and traditional physical therapy enhanced the strength of the quadriceps more in group A. A previous study hypothesized that the recoiling force of KT might be conveyed to the fascia helping muscle contraction particularly if the direction of muscle pull and KT application were the same. In this context, alignment of the direction of KT pull with the direction of muscle contraction would cause excitability of the motor unit (MU) and evoke the muscle spindle reflex [49]. Moreover, KT promotes the isokinetic strength of the quadriceps muscle in patients with knee OA [50]. In addition, in a previous study, patients with mild to moderate knee OA received a combination of open and closed kinematic chain exercises aimed to improving the strength of the quadriceps muscle and the results revealed that the combination of open and closed kinematic chain exercises, as did the exercises used in the current study, promoted quadriceps strength [51]. In addition, a previous systematic review reported that aerobic exercises (stationary cycling, elastic rubber band, balance and coordination training, squat and resistance training, and flexibility exercise, etc.) appear to be effective in terms of pain reduction and strength improvement in patients with knee OA [52], and this is similar to what occurred in group A that used traditional physical therapy.

It is worth noting that patients in group B experienced more pain and quadriceps weakness than those in group A, which may be due to the inability of KT and traditional physical therapy to efficiently stimulate and recruit alpha motor neurons for full activation of the quadriceps muscle. KT application promotes small and immediate muscle power through the fascia’s concentric pull [42], and it is well-known that quadriceps weakness is correlated with pain in OA [53]. This might explain the failure to increase the quadriceps strength in group B. This result could also be attributed to insufficient ability of KT and traditional physical therapy to enhance the quadricps strength in patients with moderate and severe knee OA.

Based on the findings of the present study, it is clear that patients in group B with a high level of pain did not benefit from KT and traditional physical therapy in terms of increasing quadriceps strength. This can be attributed to the decrease in the firing rate of MU for the quadriceps muscle resulting from increased knee pain in the arthritic condition. Farina et al. [54] confirmed this speculation and examined the correlation between the amount of nociceptive activity and the firing rate of MUs in the tibialis anterior muscle in 12 healthy participants. They found a positive correlation between increased muscle pain intensity and progressive reduction in MU firing rates. In addition, the greater the pain in the knee joint, the greater the weakness of the quadriceps muscle in patients with knee OA [55].

The non-significant improvement in quadriceps strength in group B could be related to the augmentation of new MUs of the quadriceps muscle following the inhibition of the existing MU due to severe pain, which helped produce the same force. A hypothesis suggested that to achieve the same muscle force output during pain, the neural system operates numerous MUs to obtain similar muscle force production [56].

Based on the results of the present study and the limited literature on the impact of KT with tension and traditional physical therapy on high-severity knee OA, the results of the current study indicate that patients with knee OA grades 3 and 4 do not benefit from the combined effects of both treatments in terms of increased muscle strength, improved knee flexion ROM, and reduced knee pain.

4.1 Limitations

This study has certain limitations that can be addressed to enhance its acceptability in terms of generalizability. First, the sample included only male participants to avoid the confounding influences of sex variation on quadriceps strength. Further research is required to examine the effects of KT on knee OA in females. Second, care should be taken before generalizing the results as they were based on KT with a tension technique using Y- and I-shaped strips. Third, further investigation is essential to explore different techniques of KT on knee OA, particularly at higher levels of pain intensity. Fourth, the findings of the study are limited to grades 1 and 2 and grades 3 and 4. The influence of KT combined with traditional physical therapy on each grade needs to be explored separately for a more precise interpretation of the effects of combined treatments on knee OA.

5. Conclusion

This study validated the efficacy of KT combined with traditional physical therapy in improving knee pain, increasing quadriceps muscle strength and improving knee ROM among older male patients with grades 1 and 2 knee OA as measured using the K-L scale. However, for individuals with grades 3 and 4 knee OA, KT combined with traditional physical therapy did not yield significant effects, indicating that its effectiveness may be limited in cases of high-severity knee OA in elderly males.

Footnotes

Acknowledgments

None.

Conflict of interest

The authors declare they have no conflicts of interest.

Funding

The authors extend their appreciation to the Deputyship for Research & Innovation, Ministry of Education in Saudi Arabia for funding this research work through the project number (IF2/PSAU/2022/03/22477).

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Effect of kinesio taping and exercise on functional impairment in patients with different degrees of knee osteoarthritis

Abstract

BACKGROUND:

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Materials and methods

2.1 Study design

2.3 Assignment procedure

2.4 Outcome measures

2.5 Assessment procedures

2.5.1 Strength assessment

2.5.2 Pain assessment

2.5.3 Active ROM assessment

2.6 Treatment procedures

2.6.2 Traditional physical therapy treatment

2.7 Sample size calculation

2.8 Statistical analysis

Table 1 Demographic characteristics of patients

Table 2 Influence of Kinesio tape with tension on different severity of knee OA

4.1 Limitations

5. Conclusion

Footnotes

Acknowledgments

Conflict of interest

Funding

References

Table 1
Demographic characteristics of patients

Table 2
Influence of Kinesio tape with tension on different severity of knee OA