Research Review By Dr. Kent Stuber©

Date Posted:

December 2009

Study Title:

Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial

Authors:

Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland J et al.

Author's Affiliations:

Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain; Regis University, Denver, CO; Franklin Pierce University, Concord, NH

Publication Information:

Journal of Orthopaedic & Sports Physical Therapy 2009; 39(7): 515-521.

Background Information:

Various forms of taping or strapping have been used clinically over the past several decades. Kinesiotape is a stretchable form of tape (it can be stretched to approximately 30% of its resting length) whose popularity has increased over the past two decades, particularly as it has been used by several high profile athletes.

Kinesiotape is latex free with an acrylic adhesive that is heat-activated. The cotton of the tape allows for evaporation and drying, and allows the tape to be worn for up to several days (in the experience of the reviewer patients can typically wear it for 3-5 days and some can even go over a week). There are several proposed benefits to using kinesiotape as described by Kase (the developer of the tape and Kinesiotaping technique), including:
  1. Providing a proprioceptive stimulus through the skin
  2. Aligning fascial tissues
  3. Lifting fascia and soft tissue above area of pain/inflammation to “create space”
  4. Providing sensory stimulation to assist or limit motion
  5. Assisting in the removal of edema by directing exudates toward a lymph duct
These effects can theoretically translate clinically into improvements in pain levels, ROM, and function. Despite the relative ease of use of kinesiotaping for musculoskeletal injuries there is a paucity of evidence to support its use. To date there have been several case series and small scale studies and one RCT on kinesiotaping for shoulder impingement where improvements were noted in ROM but not in pain or disability levels when compared with sham tape jobs.

The study reviewed here was an RCT comparing active and sham kinesiotaping for acute whiplash, an injury for which prolonged periods of pain and resulting disability can unfortunately occur.

Pertinent Results:

  • All 41 patients completed the trial, and baseline characteristics between groups were similar
  • Those in the active group (tape with tension) had greater decrease in pain immediately after being taped and at 24 hour follow-up when compared with the placebo/sham group (this was statistically significant)
  • Those in the active group also saw a significant improvement in all ROM directions than the sham group, again immediately after taping and at 24 hour follow-up
  • Overall the changes were small and the differences in pain scores between groups may not have been to a clinically significant degree as they did not surpass the MCID (Minimal Clinically Important Difference) for an NPRS

Clinical Application & Conclusions:

Kinesiotaping is becoming increasingly popular clinically, however as mentioned above there is a paucity of evidence to support its use. Articles such as this one and that by Thelen et al. (1) begin to put together some harder evidence around this technique. At this point it is difficult to make any conclusions on the use of Kinesiotaping for WAD based on this one small RCT that certainly had some significant drawbacks.

From a pain standpoint the differences between groups did not exceed the MCID on the NPRS, despite the fact that statistical significance was achieved. Certainly Kinesiotaping was not mentioned in the report of the Neck Pain Task Force and thus any research on neck pain and/or whiplash on Kinesiotaping is quite preliminary. Perhaps the most useful conclusion that can be reached for the clinician is that applying kinesiotape to a patient with acute WAD II injuries should not be detrimental to the patient and has the potential to aid with pain and ROM for at least a short period of time (i.e. the 24 hours in this study). Kinesiotaping may be a useful adjunct treatment for WAD II, however as it was not studied in combination with other therapies that cannot be stated with certainty.

Study Methods:

This was a double-blinded randomized clinical trial where 41 patients with whiplash (WAD II) of less than 40 days duration were assigned to a group that received an active standardized Kinesiotaping protocol to the neck with tension applied to the tape (n=21) or a sham Kinesiotape intervention to the neck without tension applied to the tape (n=20). The two treatments would appear visibly similar to the untrained eye.

Randomization occurred after baseline examination and used a computer-generated random numbers table. The tape was applied 1 day after baseline examination by a physical therapist who was a Certified Kinesio Tape Practitioner. Patients were not to take NSAIDS or pain-killers 3 days prior to or during the study. Outcome measures consisted of pain (measured on an 11 point numerical pain rating scale, NPRS), Neck Disability Index (NDI, this was only done at baseline), and cervical ROM (measured with a CROM). These measures were taken at baseline, immediately after taping, and 24 hours later by a blinded assessor. Exclusion criteria consisted of previous treatment for whiplash, neck pain, or headache prior to this accident, major illness, a claim for litigation or compensation for the current accident, concussion, or head or upper quadrant injury from the MVA.

Please refer to the article for a figure illustrating the taping procedures used (Editor’s note: please email Shawn if you would like a copy of this article). An appropriate statistical analysis was conducted including the use of 2-by-3 mixed model analyses of variance (ANOVA).

Study Strengths / Weaknesses:

This article did have some strengths in its design, specifically:
  1. It employed a double blinded RCT design. Both the blinding and randomization methods employed were adequate.
  2. The authors make some useful suggestions about future research directions, specifically to combine kinesiotape with exercise in future studies.
  3. Unstretched kinesiotape has potential as a sham therapy for other RCTs on musculoskeletal injuries.
However, there were numerous drawbacks to this study and the results:
  1. The extremely short follow-up period (only 24 hours) – multiple follow-up points including some long term ones would be preferable, but clearly the authors designed this study to simply be a before-after trial.
  2. The authors obtained an NDI measurement but not at either follow-up period (immediately after application and 24 hours), this may have provided useful data.
  3. The exclusion criteria that were employed were limiting, as is often the case subjects with previous history of treatment for whiplash, neck pain, and headache were excluded, as were those involved in litigation for their injury – these subjects could provide illuminating information and are often excluded out of convenience for the researchers.
  4. A relatively small sample size was used
  5. There was only one application of the tape, thus the effect of multiple applications over time is unknown. In addition, taping was the only intervention allowed in the protocol so the effect of adding other interventions (i.e. in a multi-modality treatment plan) is unknown.
  6. The sample came from a single clinic which may not have been representative.
  7. As has been mentioned previously for the pain results, there was statistical significance but a clinically significant result was likely not observed as the MCID for pain on an NPRS was not exceeded. This underscores the importance for readers to consider both factors when reading articles in the future.

Additional References:

  1. Thelen MD, Dauber JA, Stoneman PD. The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial. JOSPT 2008; 38(7): 389-395.
  2. Neck Pain Task Force – see Related Reviews below