- ▪
The Kinesio Taping Method is the foundation for many emerging elastic sports taping techniques.
- ▪
Traditional athletic taping encloses or encapsulates a joint to provide stability and restrict movement. The Kinesio Taping Method focuses on applying tape over and around muscles that control movement, thus the name Kinesio. It incorporates evaluation of soft tissue and directs treatment toward the cause of the pathology for symptom relief.
- ▪
The effectiveness of the Kinesio Taping Method is contingent upon proper technique and an understanding of the conceptual framework underlying the mechanisms of action.
- ▪
Current research is needed and under way to investigate the physiologic concepts and clinical applications of Kinesio Taping.
Strapping and wrapping techniques have been used for centuries to reduce pain associated with edema and for the protection of healing tissues. Materials through the years have progressed from rags and pieces of fabric to catalogs full of high- and low-tech materials to achieve these same goals. In the treatment of hand injuries, thermoplastic orthotic positioning has traditionally been used to prevent injury, provide support, decrease edema, and control motion during the healing phase. The advent and clinical evidence regarding the benefits of early controlled motion in tissue healing, combined with the changing needs of patients and sports enthusiasts, has prompted the movement from rigid immobilization toward various levels of controlled motion. Today there is an ever-growing arsenal of materials, techniques, and innovations to allow movement and provide support that has been fueled by the sports industry. An increase of sports-related hand injury referrals prompted an entire 1991 issue of the Journal of Hand Therapy on this specialty area. No reference to taping was noted at that time, although it has long been used by athletic trainers and other professionals in sports medicine to provide protected mobility and allow continued sports participation. Depending on the technique and type of tape used, soft tissue and joint structures can be slightly or significantly restricted. Demands in athletics and sports medicine have yielded product innovations and alternative methods of tape application. In the hand therapy clinic, commercially available adhesive tapes, and elastic and cohesive bandages are therapeutic mainstays for edema control, passive stretch, soft tissue support, and joint protection. Numerous articles have appeared in sports journals advocating the use of athletic strapping or taping for the lower extremity to reduce pain and increase proprioception. Implementation of taping in conjunction with therapeutic exercise was found to assist in muscle reeducation. Multiple articles promoted the use of taping to allow for earlier return to activity and prevent reinjury. Clinical indications for taping include subluxation, dislocation, muscle strain, and joint structure injuries with involved soft tissue edema. Selection of a particular type of tape and/or method of application depends on the severity of the injury and stability of the structure.
The increasing acceptance and use of elastic taping techniques is beginning to produce statistically based research studies instead of individual case examinations. At this time a search of published articles in peer-reviewed journals yielded studies involving the lower extremity, lateral epicondylitis, stroke, and pediatrics.
This chapter will focus on the Kinesio Taping Method, as it is the foundation for many emerging elastic sports taping techniques. In recent years it has gained rapid popularity in professional team sports and with sports celebrities (i.e., cycling, Lance Armstrong), resulting in high visibility in the media. This method of taping had its beginnings not in athletics but in rehabilitation. It uses a woven-cotton, highly elasticized tape that is applied to the skin with a light stretch and is significantly different from traditional taping in the method of application and functional goals. Traditional athletic taping encloses or encapsulates a joint to provide stability and restrict movement. The number of layers, combined with the direction and technique of application, serves to control the degree of joint movement. The Kinesio Taping Method focuses on applying tape over and around muscles that control movement, thus the name Kinesio. It incorporates evaluation of soft tissue and directs treatment toward the cause of the pathology for symptom relief.
This chapter is an introduction to the basic theoretical rationale for the Kinesio Taping Method, and a brief historical perspective is included on the development of the taping technique and the recent changes in the Kinesio Tex Tape product.
Because the physiologic effects of all the elastic taping methods are the result of highly elastic tape properties combined with the technique of application, the tape material is reviewed first, followed by a description of a basic muscle application technique. The functional concepts of Kinesio Taping are then outlined in a systems format, and each area includes a brief description of the neurophysiologic mechanisms as they relate to the effects of tape stretch on skin. A case example is provided to demonstrate clinical rationale and goals of Kinesio Taping with illustrations of the application technique. Other clinical applications, limitations, precautions, and contraindications for Kinesio Taping are discussed before the summary.
Background Information
In the early 1970s, Dr. Kenso Kase, a Japanese-born, American-trained chiropractor, was exploring the use of controlled early motion in his clinical practice. Intrigued with the biomechanical role of muscle in aligning skeletal structure and armed with a strong belief in the ability of the body to heal itself with outside assistance, he began to use sports tape to treat soft tissue injuries. He focused on treatment of the muscles and fascia causing the clinical condition rather than direct spinal adjustment. He found that traditional sports tape reduced edema and pain but immobilized the treatment area. Furthermore, when looking at the tissues of the body, Kase observed the elastic quality of skin and muscle. This began the search for a tape that would replicate these properties.
Kase tried many commercially available tapes but was not totally satisfied with any of them. He went on to develop his own tape with a Japanese company and then established a technique to affect the physiologic functions of the body. He introduced Kinesio Tex Tape and the Kinesio Taping Method in 1973. In the first 10 years after its development, Kinesio Taping was used primarily by orthopedists, chiropractors, acupuncturists, and other medical practitioners in Japan. It gained popularity in Japanese athletics and achieved worldwide exposure with the Japanese volleyball team at the Seoul Olympics in 1988. In the fall of 1994, Kase introduced his technique to the United States at a small gathering of chiropractors in Albuquerque, New Mexico. The clinical success of Kinesio Taping has led to rapid popularity and its integration into the clinical practices of athletic trainers, chiropractors, acupuncturists, and therapists. Current research is under way to investigate the physiologic concepts and clinical applications of Kinesio Taping. The International Kinesio Taping Association was formed to share and promote research and education. The website ( www.kinesiotaping.com ) contains information on the technique, instructional courses for certification in the technique, and tape distributors.
Kinesio Tex Tape
In recent years there have been numerous changes in the Kinesio Tex Tape product, and an emerging competitive market is developing as the popularity of elastic sports taping grows. In general elastic tape products use the same technique to create the stretch in the tape and are based on the success of the original Kinesio Tex Tape product. This tape is produced using the same process as in elastic compressive garments, wherein a central elastic core is wrapped with cotton thread and then woven into a fabric (see Fig. 119-1 online). A medical-grade, heat-sensitive acrylic adhesive is then applied to one side with a specific pattern, producing spaces that will allow the skin to breathe and create an escape for moisture and perspiration through the cotton fibers. The tape is applied with a slight stretch to a paper substrate that has 2-inch demarcations to assist in measuring and cutting (see Fig. 119-2 online). The tape stretches in length only and is lightweight, which makes it hardly perceptible to the wearer. There is no latex or medicinal properties, and it can remain on the skin for 3 to 5 days. The patient can shower or bathe with the tape in place, with caution in drying so as not to lift the edges of the tape. The Kinesio Tex product is water-resistant, with an extra water-resisting chemical, typically paraffin-based, that is sprayed on the top of the fabric to reduce moisture absorption. It will still become wet when exposed to moisture but dries quickly.
The original Kinesio Tex Tape product was manufactured in Japan by the Nitto Denko Company until 2007 and has gone through many changes. At this writing it is manufactured in Korea as Kinesio Tex Tape Gold. There was an interim product that replaced the original called Kinesio Tex Tape Advanced Design or “Platinum”. The following is a description of this material and comparison with the original as it may be reinstated in the future.
The Kinesio Tex Gold has a “Wave” adhesive pattern, which is comparable to the original in composition with some variance in stretch (see Fig. 119-3 online).
Kinesio Tex Platinum has a “Diamond” adhesive pattern and a higher stretch ( Fig. 119-4 online) for increased proprioceptive feedback and lifting of the skin. It works well on athletes and patients with good skin integrity and requires some modification in application from original or the “Gold” to prevent lateral shearing forces on the skin. Both types of tape are currently available in 2-inch width and colors (beige, blue, red, and black; inquire of the distributor upon ordering for the latest information).
Tape Application Technique
The effectiveness of the Kinesio Taping Method is contingent upon proper technique and an understanding of the conceptual framework underlying the mechanisms of action. Control of tape stretch during application is imperative to avoid adverse effects and overstimulation of sensory receptors located in the skin. The scope of this chapter is not to provide comprehensive application instruction but to develop a theoretical framework for understanding the relationship between the technique, the tape, and the neurophysiologic mechanisms that are intrinsic to its effectiveness. Improper application and excessive stretch on the tape can increase pain and create adverse reactions; therefore, proper training in elastic taping techniques is recommended. The Kinesio Taping Method offers certification in the technique, although this is not required to purchase or use elastic tape. Books are also available for special areas including: sports, pediatrics, and lymphedema.
Tissue Preparation
The skin must be clean and free of oil, skin debris, and dirt. Coarse or long hair must be clipped or shaved to improve adhesive contact. It is important to achieve maximum lengthening and pliability of soft tissue and fascia before taping. This may be achieved through full range-of-motion (ROM) exercise or through manual massage if ROM is limited or restricted.
Cutting the Tape
Kinesio Taping uses different shapes or cuts of the tape depending on the target tissue or goal. The most common shapes for basic muscle taping are the I , Y , X , or Fan cuts ( Fig. 119-5 ). The size and contractile properties of the muscle determine the shape of the cut. The I and Y cuts are most common. In muscle taping, the X tape is used for treatment of rhomboidal-shaped muscles. In contrast to a fusiform-shaped muscle that has a distinct belly and thin insertional poles, a rhomboidal-shaped muscle has a broad origin and insertional area and contracts to the center. The Fan cut is used most often in lymphatic taping.
Application
The start of the tape is termed the anchor. The tape is first anchored at either the origin or insertion of the muscle, depending on the goal of treatment (described later in this chapter). The muscle is then elongated as tolerated, and the free end is applied, moving from the anchor to the opposite pole of the muscle with pull-off paper tension (25% stretch). Taping is completed by a gentle friction rub over the tape to activate the adhesive. The subject then returns to neutral position. When Y -cut tape is used, the anchor is the base of the letter. The branches or ends of the letter “ Y ” are applied individually to surround the muscle at its margins. Before the adhesive is activated, the tape’s location can be adjusted; however, once the adhesive has been activated by rubbing the tape, it cannot be removed and reapplied. Graphic illustrations are presented in the clinical section of this chapter.
Basic Functional Concepts of Kinesio Taping
How does a piece of tape applied to skin affect muscle tension mechanisms, lymphatic movement, and pain reduction? Knowledge of the neurophysiologic mechanisms of the skin and its effects on various systemic functions of the body is essential to comprehend proper tape application and the mechanisms of Kinesio Taping. The peripheral somatosensory receptors located in the superficial skin layers and their relationship to pain, proprioception, and motor control continue to be investigated, and recent studies support the reported physical effects of Kinesio Taping on skin, lymphatics, and muscle and joint functions. The following is a brief review of this new research as it relates to the theoretical rationale for Kinesio Taping.
Skin Function
Skin is the largest organ of the body and serves as the great outside communicator. It envelops the body with sensory receptors that signal to the central nervous system (CNS) changes in the environment, which then elicits a response. These responses can range from simple reflexes, such as shivering to control heat loss, to reflexes as complicated as intricate muscle control to walk a tightrope blindfolded. Each of these responses requires a different degree of cortical control but functions on the same neurologic pathways. Cutaneous sensory receptors include mechanoreceptors, thermoreceptors, and nociceptors. CNS responses are determined by the type and extent of stimulation to these receptors. Although reflexes are seen as stereotypical, new research is finding that this sensory information may also be controlled by higher brain centers. This may explain why an individual with diabetes can suppress the withdrawal reflex while injecting insulin. The elastic properties of Kinesio Tex Tape, when applied to skin, provide increased low-threshold excitement to these somatosensory receptors during movement and at rest, thereby increasing somatosensory input to the CNS.
Pain and Motor Control
CNS response to peripheral nervous system stimulation may demand inhibition at the spinal cord level or require activation of descending inhibitory pathways. The endogenous analgesic system is used by centers at the brainstem level to decrease pain. Naturally produced opiates are transmitted via the descending inhibitory pathways to modulate pain. Contemporary theory views the transmission of peripheral somatosensory information to the brain as a more complex form of communication. Sensory information is sent to the brain via two spinal-ascending sensory pathways. They are two parallel systems providing multiple avenues for improving and refining our sensory perception. Studies are revealing that somatosensory information is modulated up or down depending on the context and the task performed. The dorsal column, or medial lemniscal system, sends information regarding touch, pressure, muscle, tendon, and joint sensibility through the medulla, pons, midbrain, and thalamus, ending in the somatosensory cortex. Information is modulated up (excitation) or down (inhibition) selectively as it passes through each center.
The anterolateral system transmits information from the skin on crude touch and pressure, contributing to touch and limb proprioception. This pathway also transmits thermal and nociception information to higher brain centers, much like the medial lemniscal system. The gate theory for pain control views the neurologic system as a simple three-axon chain system. This theory supports the idea that superficial stimulation of first-order afferent receptors in the skin can inhibit the transmission of pain at the spinal cord level. This has been supported in literature and is the basis for the use of physical agent modalities such as electrical stimulation, cryotherapy, and orthokinetic cuff experimentation for the reduction of pain ( Fig. 119-6 ).
Theoretically, Kinesio Taping may stimulate the somatosensory system to reduce pain. When properly applied to stretched skin, the elastic recoil of the tape may accomplish the following:
- •
Increases sensory stimuli to mechanoreceptors, thereby activating the endogenous analgesic system;
- •
Possibly activates the spinal inhibitory system through stimulation of touch receptors;
- •
Possibly activates the descending inhibitory system;
- •
Decreases pain by reducing inflammation, thereby decreasing pressure on nociceptors.
Lymphatic Function
According to Ryan, the movement of skin during normal low-amplitude, full-ROM exercise is necessary for lymphatic function.
Lymphatic Flow
The lymphatic system is a one-way system that originates in the capillary bed 2 mm below the surface of the skin and ends at the heart. Limited in its ability to actively propel fluid against gravity to the heart, it relies on a pressure system for control.
Initial lymphatic vessels in the superficial skin form an interconnected plexus or mesh network. Individual vessels are attached to surrounding connective tissue by filaments that prevent collapse of the network. These filaments also function to open and close intercellular junctions in the endothelial walls of the initial lymphatic vessels. Intercellular junctions act like doorways to the initial lymphatic vessel. When open, the vessel can fill with interstitial fluid; when the vessel is full, positive internal pressure passively closes the doors. The functional mechanisms of initial lymphatics have been difficult to study because of the complexity of the lymphatic system and technologic limitations in viewing these microscopic structures. In recent years, with advances in imaging techniques, new theories are emerging regarding the mechanisms of lymphatic transport. Contrary to previous theories of a positive interstitial tissue pressure being responsible for pushing open the doors to the initial lymph vessels, contemporary theories are considering a negative-pressure mechanism. This was prompted by the discovery of contractile tissue in deeper lymphatic vessels called lymphangions. A deeper negative-pressure pumping mechanism is facilitated by muscle contraction and relaxation. The rhythmic contraction and relaxation of lymphangions produces a proximally directed pumping mechanism. The negative pressure creates a vacuum effect, drawing fluid from the superficial initial lymphatics to deeper vessels. When emptied, the negative pressure inside the initial lymph vessel pulls open the intercellular junctions to allow fluid to enter.
Edema occurs when there is an increase in external interstitial fluid pressure between the superficial skin and the initial collecting vessels. This increased pressure tethers the anchoring filaments, pushing closed the intercellular junction doors. This concept supports the efficacy of massage, external compression, and active motion in the reduction of edema. Gentle rhythmic movements of the superficial skin during massage create a lengthening and shortening of the connective tissue, alternating the pressure on the connecting filaments and resulting in an opening and closing of intercellular junctions, thus improving fluid and lymphatic motility. The external pressure of compressive garments supports the skin and decreases the tethering of the connecting filaments. Compression of superficial soft tissue, combined with active muscle contraction and relaxation, varies internal pressure, thereby preventing backflow and enhancing lymph drainage. This edema concept also supports the anecdotal evidence and efficacy of Kinesio Taping. Hypothetically, the recoil of the elastic tape applied to stretched skin lifts the connective tissue filaments, opening the intercellular junctions to improve lymphatic motility and decrease pressure on the nociceptors diminishing pain (see Fig. 119-7 online). Expansion and contractile properties of the tape during active movement function like a compression garment combined with a superficial massage to further assist in edema reduction and tissue healing ( Fig. 119-8 ).
Vascular Flow
Kase completed a Doppler study in 1988 with a small group of normal subjects. This study demonstrated the efficacy of Kinesio Taping in improving blood flow by decreasing spasm in an overlying muscle.
Theoretically, Kinesio Taping may improve lymphatic and vascular motility by lifting the skin and decreasing muscle spasm. When properly applied to stretched skin, the elastic recoil of the tape may accomplish the following:
- •
Facilitates lymphatic drainage directly under the skin;
- •
Reduces excess heat and chemical substances in tissue by improving lymphatic and blood flow;
- •
Reduces inflammation by enhancing lymphatic function.
Muscle Function
The same neurologic afferent pathways that communicate pain also provide sensory input for motor control. In the past decade, many strides have been made in improving our understanding of muscle spindle mechanisms and reflexive movement. Research continues on the relationship of the CNS, Golgi tendon organ (GTO), and somatosensory information in motor control. Complex voluntary movement incorporates sensory information from muscle, tendon, joint, and the skin overlying muscle to regulate motor output. In addition to pain reduction, skin stimulation has been used to facilitate muscle contraction. Rood introduced fast brushing, light moving touch, and icing to the fascia overlying a muscle to facilitate muscle contraction. Evaluation of muscle status is of major importance before application of Kinesio Taping. Determining the needs of the muscle tissue (i.e., stimulation or inhibition) and the mechanisms behind the pathology will dictate the orientation of tape application.
Kinesio Taping to Support Muscle Function
To assist a weakened muscle and provide facilitation, the tape is anchored at the fixed or functional origin and ends at the insertion or moveable aspect. It is important to note that some anatomic muscle origins (e.g., upper trapezius) serve as insertions for certain movements. The tape is applied to support the contractile direction of the muscle. Typically, a Y cut is used to surround the muscle along the fascial margins, increasing the percentage of fascia and muscle support. The recoil effect provides varied sensory stimulation to fascia and skin receptors during movement. In conjunction with joint compression–facilitation and support of the surrounding fascia, the elastic recoil of Kinesio Tape applied properly to stretched skin may accomplish the following:
- •
Enhances contraction of a weakened muscle by input through the somatosensory system;
- •
Reduces muscle fatigue by enhancing contraction;
- •
Increases active ROM by assisting muscle function ( Fig. 119-9 ).
Figure 119-9
Application technique to support weak muscle.
(Courtesy of Dr. Kase.)
Kinesio Taping to Inhibit Muscle Function
Inhibitory techniques advocated by Rood to decrease tone in a muscle include light joint compression, pressure at the tendinous insertion, and maintained stretch. These effects can be explained by the mechanisms of the GTO. The muscle spindle length is controlled by the GTO and the CNS. The GTO is located at the muscle–tendon junction of the muscle insertion and connected to muscle fibers that communicate the status of the muscle spindle. Sensitive to changes in muscle tension from lengthening or contraction, it serves to inhibit its own muscle and excite its antagonist. GTO receptors constantly monitor muscle tension and are sensitive to minute changes in tension. Transmitting only afferent information, they are not under direct CNS control but serve as a monitoring system. Current research is identifying a transcortical communication relationship between muscle and the sensory input from the skin above it. These communication pathways between the primary motor cortex and somatosensory cortex are also seen as important proprioceptive pathways functioning in postural control.
Kinesio Taping is applied to a muscle with increased resting tension and tone by anchoring the tape at the functional insertion and ending at the origin. The elastic properties of the tape provide increased sensory stimulation to the joint and GTO. When applied properly to stretched skin, the elastic recoil of the Kinesio Tape may accomplish the following:
- •
Reduces overstretching and overcontraction of a muscle;
- •
Reduces cramping and possible injuries in exercise or activities of daily living ( Fig. 119-10 ).
Figure 119-10
Application technique for increased muscle tone, spasm.
(Courtesy of Dr. Kase.)
Joint Function
Kinesio Taping works to improve joint function by balancing the tone in muscles that affect articular alignment. Improved joint alignment at rest or during movement will decrease pain and enhance functional performance. A “correction” technique can be used to provide support to a specific ligament. In this special advanced taping application, all of the stretch is taken out of the center portion of an I -cut strip. The tape is placed directly across the joint, using the elastic recoil to draw the fascia to the center to create an outside support.
Theoretically, Kinesio Taping, when applied properly and in accordance with the previous concepts presented, may accomplish the following:
- •
Provides support to injured ligament structures;
- •
Assists in adjusting structural alignment by balancing muscle tone and normalizing fascia involved in the agonist-antagonist relationship;
- •
Improves ROM by relieving pain caused by joint malalignment ( Fig. 119-11 ).
Figure 119-11
Diagrams of functional concepts with Kinesio Taping.
(Courtesy of Dr. Kase.)
Example of Application
Kase developed Kinesio Taping to address the cause of the pathology. The success of the technique directly correlates to the therapist’s ability to evaluate the pathomechanics behind the diagnosis and apply the concepts of Kinesio Taping as it affects skin, lymph, muscle, and joint. The following is a brief case example to demonstrate the rationale for Kinesio Taping.
Case Study
The subject is a 42-year-old letter carrier with right shoulder tendinitis. The major complaint is pain in the anterior shoulder capsule and medial to the scapula. The patient also reports periodic nocturnal paresthesias and, by the end of the day, weakness in grasping and holding objects in the right hand. Palpation assessment of the upper quadrant reveals increased tone and tenderness in the upper trapezius and rhomboid minor muscles. Brawny induration is noted overlying the lower fibers of the upper trapezius and into the middle trapezius. Evaluation for bicipital tendinitis is negative. Anterior palpation assessment of pectoralis minor and pectoralis major reveals taut bands with tenderness and reflexive guarding. Positive trigger points are located at pectoralis minor, with radiating ulnar paresthesias replicating the nocturnal symptoms. Furthermore, the patient reports frequent headaches and numbness over the right ear, and a positive trigger point is noted for upper trapezius.
The goals of Kinesio Taping are as follows:
- •
Skin: Decrease pain to allow improved mobility and return to work.
- •
Lymphatics: Reduce edema and improve circulation to overstretched and overcontracted muscles.
- •
Muscle:
Posterior musculature: Enhance contractility of rhomboid minor to provide scapular stabilization and retraction. Diminish spasm in upper trapezius from overstretch.
Anterior musculature: Decrease overcontraction and shortening of pectoralis minor and major. Reduce pressure over the brachial plexus (pectoralis minor) to address distal symptoms of weakness, paresthesias, and trigger points.
- •
Joint: Establish an improved structural alignment and balance of shoulder complex musculature, thereby decreasing pain and maximizing the benefit of a therapeutic exercise program.
The Kinesio Taping technique is as follows:
Pectoralis minor: Y -cut tape, 2 inches wide. Tape is applied insertion to origin ( Figs. 119-12 and 119-13 ).
