Rev. Bras. Reumatol. vol.57 número2

w w w . r e u m a t o l o g i a . c o m . b r

REVISTA

BRASILEIRA

DE

REUMATOLOGIA

Original

article

The

effectiveness

of

Kinesio

Taping

on

pain

and

disability

in

cervical

myofascial

pain

syndrome

Saime

Ay

,

Hatice

Ecem

Konak

,

Deniz

Evcik

,

Sibel

Kibar

a_{UfukUniversity,SchoolofMedicine,DepartmentofPhysicalMedicineandRehabilitation,Ankara,Turkey}

b_{AnkaraUniversity,HaymanaVocationalHealthSchool,DepartmentofTherapyandRehabilitation,Ankara,Turkey}

a

r

t

i

c

l

e

i

n

f

o

Articlehistory: Received18June2015 Accepted20December2015 Availableonline10May2016

Keywords:

Myofascialpainsyndrome KinesioTaping

Disability Pain

a

b

s

t

r

a

c

t

Objective:TheaimofthisstudywastoinvestigatetheeffectivenessofKinesioTapingand shamKinesioTapingonpain,pressurepainthreshold,cervicalrangeofmotion,and dis-abilityincervicalmyofascialpainsyndromepatients(MPS).

Methods:Thisstudywasdesignedasarandomized,double-blindplacebocontrolledstudy. Sixty-onepatientswithMPSwererandomlyassignedintotwogroups.Group1(n=31)was treated withKinesioTapingandgroup2(n=30)wastreatedshamtapingfivetimesby intervalsof3daysfor15days.Additionally,allpatientsweregivenneckexerciseprogram. Patientswereevaluatedaccordingtopain,pressurepainthreshold,cervicalrangeofmotion anddisability.PainwasassessedbyusingVisualAnalogScale,pressurepainthresholdwas measuredbyusinganalgometer,andactivecervicalrangeofmotionwasmeasuredby usinggoniometry. Disabilitywasassessedwiththeneckpaindisability indexdisability. Measurementsweretakenbeforeandafterthetreatment.

Results:Attheendofthetherapy,therewerestatisticallysignificantimprovementsonpain, pressurepainthreshold,cervicalrangeofmotion,anddisability(p<0.05)inbothgroups. Alsotherewasastatisticaldifferencebetweenthegroupsregardingpain,pressurepain threshold,cervicalflexion-extension(p<0.05);exceptcervicalrotation,cervicallateral flex-ionanddisability(p>0.05).

Conclusion: ThisstudyshowsthatKinesioTapingleadstoimprovementsonpain,pressure pain thresholdandcervicalrangeofmotion,butnotdisabilityinshorttime.Therefore, KinesioTapingcanbeusedasanalternativetherapymethodinthetreatmentofpatients withMPS.

©2016ElsevierEditoraLtda.ThisisanopenaccessarticleundertheCCBY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

∗ _{Correspondingauthor.}

E-mail:[email protected](S.Ay). http://dx.doi.org/10.1016/j.rbre.2016.03.012

Efetividade

do

kinesio

taping

na

dor

e

incapacidade

na

síndrome

dolorosa

miofascial

cervical

Palavras-chave:

Síndromedolorosamiofascial Kinesiotaping

Incapacidade Dor

r

e

s

u

m

o

Objetivo: Investigaraeficáciadokinesiotapingedotapingplacebosobreador,limiardedor àpressão,amplitudedemovimentocervicaleincapacidadeempacientescomsíndrome dolorosamiofascial(SDM)cervical.

Métodos: Ensaioclínicorandomizadoduplo-cegocontroladoporplacebo.Foramalocados emdoisgrupos,aleatoriamente,61pacientescomSDM.Ogrupo1(n=31)foitratadocom kinesiotapingeogrupo2(n=30)foitratadocomtapingplacebocincovezesemintervalosde trêsdias,durante15dias.Alémdisso,todosospacientesforamsubmetidosaumprograma deexercíciosparaopescoc¸o.Ospacientesforamavaliadosemrelac¸ãoàdor,aolimiarde doràpressão,àamplitudedemovimentocervicaleàincapacidade.Adorfoiavaliadacoma escalavisualanalógica,olimiardedoràpressãofoimedidocomumalgômetroeaamplitude demovimentocervicalativafoimensuradacomagoniometria.Aincapacidadefoiavaliada comoNeckPainDisabilityScale.Asmensurac¸õesforamfeitasantesedepoisdotratamento. Resultados: Nofimdotratamento,houvemelhoriaestatisticamentesignificativanador,no limiardedoràpressão,naamplitudedemovimentocervicalenaincapacidade(p<0,05) emambososgrupos.Tambémhouveumadiferenc¸aestatisticamentesignificativaentreos gruposemrelac¸ãoàdor,aolimiardedoràpressãoeàflexão-extensãocervical(p<0,05); nãohouvediferenc¸anarotac¸ãocervical,flexãolateralcervicaleincapacidade(p>0,05). Conclusão: Okinesiotapinglevaàmelhorianador,nolimiardedoràpressãoenaamplitude demovimentocervical,masnãonaincapacidadeemumcurtoperíodo.Portanto,okinesio tapingpodeserusadocomoummétododeterapiaopcionalparaotratamentodepacientes comSDM.

©2016ElsevierEditoraLtda.Este ´eumartigoOpenAccesssobumalicenc¸aCC BY-NC-ND(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction

Myofascialpainsyndrome(MPS)isoneofthemostcommon musculoskeletalproblemsandisanimportantcauseof mor-bidityinadults.MPSisaconditioncharacterizedbychronic painandassociatedwithtriggerpointsinoneormore mus-cles,tautbands,characteristicreferredpain,andlocaltwitch response.Patientsrefertohospitalswithlocalorreferredpain, muscleweakness,tightness,limitedmobility,weakness, ten-derness,autonomicdysfunctionsandlocaltwitchresponsein theaffectedmuscle.1,2

TheexactetiologyofMPSisnotfullyunderstood;therefore, thetreatmentisfocusedondecreasingpain,improving mus-clestrengthandprovidinggoodposture.Patients’education andtrainingprograms,nonsteroidalanti-inflammatorydrugs (NSAID),localinjections,physicaltherapy,acupunctureand exerciseprogramsarethemostcommontreatmentmethods.1 KinesioTaping(KT)hasbeen increasingly usedin mus-culoskeletal conditions and sports injuries. This technique was developed in Japan by Kase and recently it became very popular in pain treatment.3,4 _{Kinesio Tape is a thin,} light, and elastic material which does not restrict the jointmovement.4,5 _{Itisfoundtobeeffectiveindecreasing} pain and muscular spasm,increasing the range ofmotion (ROM),improvinglocalbloodandlymphcirculations, reduc-ing edema, strengthen weakened muscles, control joint

instability and postural alignment.6–8 _{Although the exact} mechanisms of KT is not understood, sensorimotor, pro-prioceptivefeedbackmechanisms, inhibitoryandexcitatory nociceptivestimuli,mechanicalrestraintwere explainedas underlyingmechanisms.4,6,7_{Inthisdouble-blinded,} random-ized placebo controlled study, we aimed to compare the efficacyofKTandplaceboKTmethodsonpain,pressurepain threshold,ROManddisabilityinpatientswithMPS.

Materials

and

methods

Afterphysicalexamination,fullbloodcount,erythrocyte sedimentationrate,C-reactiveprotein,andbiochemical mark-erswereevaluated.

This study was prospective, randomized, placebo-controlleddouble-blindtrial.Beforetreatment,allparticipants wereinformedaboutthestudyandsignedwritteninformed consent.ThestudywasapprovedbytheUniversityofUfuk HumanResearchEthicsCommittee.

Randomization

Patientswere randomlyassigned into two groupsby num-beredenvelopesmethod.Thegroup1andgroup2noteswere putintototheclosedenvelopesseparately,andeachpatient randomlychoseanenvelopeandgaveittothe physiothera-pist.Bothpatientsandtwoexaminingphysicianswereblinded totreatmentallocation.Onlythephysiotherapistwhoapplied thetherapywasawareoftheprocedureandphysiotherapist recordthepatientnamesandtheirgroups.

Group1patients(n=31)were treatedwith KinesioTape (KinesioTexGold,2in×103.3ft)suggestedbyKaseetal.five timesbyintervalsof3daysfor15days.Tapingwasperformed byaphysiotherapistwhoiscertifiedforthismethod.The mus-cleinhibitiontechnique which wasdescribed byKasewas used.Weappliedthetapingtolevatorscapulamuscle.The shoulderwasdepressedandneckwasinlateralflexionand rotation position tothe opposite side. A 15–20cm long “I” stripwasused.Applicationstartedfromthesuperior scapu-larangle.Initialportionofthetapewasstretchedmaximum 4–5cm andthen it wasstickedon the muscleorigowhich wasatthelevel of1–4 thoracictransverseprocess without stretching5_(Fig.1).

Group2patients(n=30)weretreatedwithshamtapingfive timesbyintervals of3 daysfor15 days. Shamtaping was appliedwithan“I”stripofthesamematerialonineffective partsofthemusclewithoutatensionwiththeneckinneutral position(Fig.2).

Additionally, all patients received a home-based exer-cise program including isometric-isotonic neck exercises and back extensor stretching exercises everyday for two weeks.

Fig.1–KinesioTapingtechnique.

Fig.2–ShamKinesioTapingtechnique.

No analgesic drugsor NSAIDswere allowed during the treatmentprocess.

Clinicaloutcomes

Patients were evaluated according to pain, pressure pain threshold,cervicalROManddisability.

Pain

Painwasassessedbyusingavisualanalogscale(VAS,0–10cm; 0meansnopain,10meansseverepain).

Pressurepainthreshold

Pressurepainthreshold(PPT)onthetriggerpointwas mea-sured with an algometer (Algometer Commander, JTECH Medical,Utah).Themeasurementwastakenthreetimesand themeanaveragevaluewasrecorded.

Cervicaljointrangeofmotion

TheactiveROMofcervicaljoint(flexion,extension,right–left flexionandrotation)wasmeasuredusingagoniometerwhen thepatientwasinsittingposition.

Disability

Disability was measured byusing the Neck Pain Disability Scale(NPDS).Turkishversionofthisscalewasfoundvalidand reliable.Thequestionnaireconsistsof20itemsandmeasures neckmovements,painintensity,effectofneckpainon emo-tion factors,and interferencewithdailylifeactivities.Each sectionisscoredona0–5ratingscaleandtotalscoreranges from0to100.10

Statisticalanalysis

MAS (n=73)

Analisados (n=31) Lost to follow-up (n=5)

Discordance of therapy in 4 patients, allergic reaction in 1 patient

Group 1 (n=36) Kinesio tape

Lost to follow-up (n=7) Discordance of therapy in 6 patients, allergic

reaction in 1 Group 2 (n=37) Sham kinesio tape

Analyzed (n=30)

Allocation

Analysis 2 weeks Follow-Up

Randomized

Fig.3–Flowdiagramshowingofpatientsthroughtheclinicalstudy.

differencesbetween twogroups, the Mann–WhitneyU test wasused.Alevelofsignificanceofp<0.05wasaccepted.All analyseswere performedusing theSPSS forWindows18.0 softwareprogram.

Results

Thirty-sixpatientsingroup1(27femalesand9males)and37 patientsingroup2(30femalesand7males)withMPSwere includedthestudy.Afterrandomization,4patientsinGroup 1and6patientsinGroup2droppedoutbecausetheycould notattendthefollow-upprogramregularlyinthestudy.Then, onepatientfromGroup1andonepatientGroup2dropped out because allergic reaction occurred. Sixty-one patients completedthestudyandnosideeffectshadbeenobserved (Fig.3).

Table1showsthedemographicandclinicalpropertiesof theGroup1andGroup2.Nostatisticallysignificantdifferences weredetectedbetweenthegroupsatbaselinevalues(p>0.05) exceptNPDS(p<0.05).

Theresultsoffullbloodcount,erythrocytesedimentation rate,C-reactiveproteinandbiochemicalmarkerswerewithin normalrangesforbothgroups.

Aftertwoweeksfollowup,therewerestatistically signif-icantimprovementsinbothgroupsregardingVAS,PPT,ROM andNPDS(p<0.05)(Table2).

Table1–Demographicandcliniccharacteristicsofthe patients.

Group1 (n=31)

Group2 (n=30)

p

Age(years) 44.80±17.19 44.10±17.45 0.76 Gender

(female/male)

22/9 23/7 0.61

Durationofpain (month)

14.48±4.99 13.50±2.76 0.97

VAS 5.00±2.00 4.56±2.17 0.38

PPT(N) 61.29±8.92 61.73±5.35 0.61

NPDS 49.77±21.37 39.80±12.51 0.05a

VAS,visualanalogscale;PPT(N),pressurepainthreshold,Newton; NPDS,NeckPainDisabilityScale.

a _p<0.05.

After the treatment, statistical significant differences wereobservedinVAS,PPT,cervicalflexion-extensionvalues (p<0.05)between thegroups. Howeverno differences were foundincervicalrotation,lateralflexionandNPDS(p>0.05) (Table2).

Discussion

Table2–Comparisonoftheassessmentparametersinbothgroupsandbetweenthegroups.

Group1(n=31) (mean±SD)

Group2(n=30) (mean±SD)

p

Variable(independent)VAS

Baseline 5.00±2.00 4.56±2.17

Posttreatment 2.35±1.99 3.93±1.96 0.004b

p 0.000a _0.000a

PPT

Baseline 61.29±8.92 61.73±5.35

Posttreatment 78.09±7.18 71.43±10.25 0.003b

p 0.000a _0.000a

Cervicalflexion

Baseline 64.58±7.66 59.86±7.01

Posttreatment 71.90±7.54 64.86±6.79 0.001a

p 0.000a _0.001a

Cervicalextension

Baseline 51.93±12.83 44.83±12.42

Posttreatment 55.96±13.63 47.20±14.21 0.015

p 0.007b _0.003b

Rightlateralflexion

Baseline 39.64±13.77 33.83±5.52

Posttreatment 42.61±14.78 35.93±5.80 0.357

p 0.001a _0.003b

Leftlateralflexion

Baseline 40.93±14.4 33.83±5.52

Posttreatment 43.90±14.94 42.43±17.97 0.390

p 0.000a _0.001a

Rightrotation

Baseline 60.58±11.58 61.36±12.31

Posttreatment 64.74±11.04 63.60±9.55 0.348

p 0.001a _0.006b

Leftrotation

Baseline 63.09±12.43 67.53±8.24

Posttreatment 66.83±13.01 67.93±7.97 0.907

p 0.001a _0.10

NPDS

Baseline 49.77±21.37 39.80±12.51

Posttreatment 35.67±20.27 36.10±12.16 0.558

p 0.000a _0.000a

VAS,visualanalogscale;PPT,pressurepainthreshold;NPDS,NeckPainDisabilityScale;SD,standarddeviation.

a _p<0.001.

b _p<0.05.

intheMPStreatmentistoprovidepainreliefontriggerpoints, improvingdisabilityandincreasingcervicalmotion.1,2 Kine-sioTapingisanewalternativetechniqueusedinMPS.3,4_This study was planned as a randomized double-blind placebo controlled study in which efficacy of KT and placebo KT methodsonpain,PPT,ROMofcervicaljointanddisabilityin MPStreatment.After2weeksoftreatment,all assessment parametersshowedstatisticallysignificantimprovementsin bothKTandshamgroups.Therewasastatisticaldifference between the groups regarding VAS, PPT, cervical flexion-extension,exceptcervicalrotation,cervicallateralflexionand NPDS.

Althoughtherearealotofstudiesintheliteratureaboutthe effectoftapingonmusculoskeletalsystemandsportinjuries, therearelimitednumberofrandomizedcontrolledstudieson

painseverity,disabilityandincreasesinROM.15_Although Gon-zalezetal.foundanimprovementinpainandROMinpatients withacutewhiplashinjurywithKT,theseweresmallandnot clinicallymeaningful.8_{Inourstudy,KTgroupshowed} statis-ticallysignificantimprovementsregardingVAS,PPT,ROMand NPDS.Althoughsignificantimprovementswereobservedin pain,PPT,cervicalflexion-extension,comparedtotheplacebo group,therewasnochangeincervicalrotation,cervicallateral flexionandNPDS.

Multipletheorieshavebeenproposedtoexplainthe mech-anismsof KT, including enhance proprioception, cutaneus mechanoreceptors, improved blood and lymphatic circula-tion,reducedpainseverity,realignmentofjoints,assistthe posturalalignmentandrelax theoverusedmuscles.4,7,11 _As aresultofKT,weobservedthatpain,PPT,ROMand disabil-itymeasures showedstatisticallysignificant improvements inKTgroup.Stimulatingthegatecontrolmechanismresults adecreaseinpainthroughtheincreaseinafferentfeedback foundintheskin.Anothertheorysuggeststhattheimproved ROMandpainareduetoanincreasedproprioseptivefeedback mechanismandmusclefacilitation.4,7,8,11

InthestudyThelenetal.,foundthatKTimproved pain-free shoulder range of motion but no effect on pain or function. They also observed KT and cervical spine trust manipulationreduceddisability.16_{Alotofpublishedclinical} trialshavesuggestedthat KT maybebeneficial intreating patellofemoralpain syndrome,shoulder impingement syn-drome,lowerextremityspasticityandposturalrehabilitation inParkinson’sDisease.6,7,17,18 _{Afewsystematicreviewshave} evaluated the effect of KT on musculoskeletal and differ-ent clinical conditions. These randomizedtrials compared KTversusshamtapingorotherinterventions.Theresultsof reviewssuggestedthatKT had no significantbenefitor its effectwas too small interms ofclinical practice.However thesetrialswerelow-moderatequality,smallsamplesizesand verysmallfollow-upperiods.4,7,8_{Themostimportant} differ-enceofourstudywastohavehighernumberpatientsand designed asa randomized double-blind placebo controlled study.

CervicalROMrestrictionmostlyoccursbecauseofmuscle spasminMPS.StudiesshowedimprovementinROMvalues afterKT.8,15_{Inourstudy,asignificantincreasewasobtained} in two weeks in cervical ROM in both groups. Although significantimprovementswereobservedoncervical flexion-extension,comparedtotheplacebogroup,buttherewasno changecervicalrotation,cervicallateralflexion.Theincrease in cervical ROM may be due to the reduction in patients’ cervicalmusclespasmsorexerciseprogramsappliedtothe patients.Inourstudy,homeexerciseprogramwasappliedto allpatientsandimprovementofcervicalROMwasobserved inbothgroups.Thelimitationofourstudywasnottohave an only exercise group which could be compared to KT and shamKT. Also, weinvestigatedthe short-term results ofKT.

Inconclusion,KTisanoninvasive,painlessmethodthat haslesssideeffects,iswelltoleratedandhasbeenusedin MPS.ThisstudyshowsthatKTleadstoimprovementsonpain, PPT,andROM,butnotindisabilityinshortperiod.Therefore, KTcanbeusedasanalternativetherapyinthetreatmentof

patientswithMPS.But,moreresearchisnecessaryforboth clinicalandlong-termeffectsoftheKinesioTapingtechnique.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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