Today we’re joined by top physiotherapist and triathlete Paul Westwood. Paul has a wealth of experience with athletes of all levels and has kindly agreed to share his insights from many years working in sport. You can follow him on Twitter via @triathlonphysio. Our previous articles on kinesio tape have discussed the research and potential benefits but, as Paul explains, there are important negatives to consider too…
“We are not made of papier-mâché; we are tough and resilient, adaptable and quick to heal.” Sarno
This blog follows a discussion Tom and I had during his Running Repairs Course on the subject of kinesio tape within the world of running and endurance sport.
As far as I am aware most of the comments opposing the use of tape seem to be along the lines of, “There isn’t any research to support kinesio tape so I’m not using it”. My stance, which Tom thought interesting, is based on my own critical thinking, reading and experience. My belief is that kinesio tape (along with other approaches to athlete care) does more harm to an athlete’s overall function and performance. It isn’t my intent to annoy those who use kinesio tape (I have friends who make money from selling it) it is more a question of encouraging people to ask themselves why they use it. Critical thinking is important in every field.
This is my own opinion based on being involved in endurance sport and triathlon for almost 20 years as a physiotherapist, coach and athlete. I work with athletes of all levels from novice runners to some of the best triathletes in the world and these views apply to all athletes.
I haven’t quoted any studies but most of the theories with regard to current concepts on pain are best summarised in Tom’s blog here.
My first experience of kinesio tape was 6 years ago when I arrived in Germany from New Zealand to do some racing and work. Apart from the usual super fit and professional looking Germans there were some wearing brightly coloured tape all over their legs. First I thought they looked odd, then I thought that they couldn’t be all that good if they needed tape all over them just to race! In my opinion I have largely been right in my latter observation. In fact it has been my experience that I rarely see an athlete performing well wearing tape / supports / bands or any other form of a ‘crutch’… they are either injured, in the ‘Rehab Pit’ of perpetual rehab exercises, under performing for their ability or avoiding competition altogether. An athlete who has a positive attitude, is self-aware and has faith in their body and its ability, is rarely seen wearing tape. These attributes are those that are needed for an optimum performance and essential for a long career at the top.
Traditionally Kiwis have always had a ‘tough as nails’ and a ‘can do’ attitude to sport. The ‘kinesio tape look’ is generally not tolerated.
I have heard many an athlete say, “The tape is all that’s holding me together” or “I’d never have completed the race without the tape”. This sounds like a good reason to use it at first. However it isn’t true of course because tape can never physically make that much difference. However it is an athlete’s lack of trust in their body which causes them to feel like they need something else to help them.
Athletes need to trust their bodies if they are to have a long term career in sport and reach their full potential. Physiotherapists, doctors and any other professionals in sports medicine can have a considerable effect on an athlete’s trust or lack trust in their physical ability. Almost every athlete I see has their own list of issues: “The physio says I have… tight hamstrings / a weak core / flat feet / no balance / poor biomechanics / an inability to squat / no glutes”… or that “my FMS is very poor and I’m going to get injured.”
I know of athletes sponsored by kinesio tape companies who seem to be perpetually injured. Surely this is akin to an alcoholic being sponsored by Jack Daniels!?
Go to any racing start line, at any level and you will hear the normal talk from runners, “Oh yes I’ve had a calf injury for the last few weeks”… “I haven’t been able to train as I pulled my hammie”… “I haven’t done any intervals as my back is playing up’… ‘I’m not expecting much from this race… I’ve been injured”. A lot of this is performance anxiety and an attempt to deflect the pressure of racing and performing by having an excuse. Some athletes are unable to perform without these strategies, however they are unlikely to lead to a good performance. There can be no excuse for an athlete who wishes to achieve their potential – it means entering a world of suffering the brain doesn’t want to comprehend and it will look for any reason it can to not go there. The brain is primarily concerned with survival.
“If you enter the arena carrying some excuse for underperformance, you’re prepared mentally to lose. Be 100% in your mind & go 100% for the win.” Frank Dick
Running injuries are nearly always due to an increase and/or a change in load. The normal adaptations necessary, are due to the gravitational demands placed on humans as a result of us living and moving around on the planet.
Sometimes we get ‘injured’ but it’s totally normal. Our body for the most part will heal quickly, get stronger and adapt; this is a normal process and athletes need to know this. This positive input is vital. Telling athletes they; are weak; have a rupture; have bio-mechanical issues or asymmetries etc. will only lead to negative and ultimately self destructive beliefs – although their body has healed they will still have problems, pain and injury.
The Sport Medicine culture that exists around athletes determines their frame of reference, which strange as it may seem helps to determine what injuries they get and how they recover. For example whiplash only tends to exist in Western societies with a strong medico-legal culture and injuries like plantar fasciitis can spread through a group of athletes once one of them is ‘diagnosed’ with it and then managed inappropriately.
Optimum physiotherapy requires more than what can be achieved in a treatment room. You need to know the athlete, know how they work, know the world they live in and be a part of it.
Kinesio tape can affect an athlete and the culture they inhabit in the following negative ways:
- It promotes the belief that their body is not good enough and they need an extrinsic factor (tape) to allow it to function. The body heals itself, it doesn’t need help other than the basics of movement, nutrition and sleep.
- The athlete becomes unable to function/perform fully without the use of the external factor/tape.
- Any effect of the tape is likely to be placebic and as this effect wears off with repetitive use, you are eventually left with an athlete with chronic pain or injury who doesn’t trust their body.
- It provides a constant reminder to the athlete that they have an issue/pain, turning up their pain amplifier with constant visual and sensory feedback.
- It provides a visible sign to the athlete, other people and the ‘world’ that they have an issue and therefore don’t have to perform. Therefore they have a ‘get out clause’ or excuse.
- It provides attention and sympathy which can be rewarding. This can be dangerous as the brain learns that it can survive and gain attention from being injured and in pain just as much as it can from winning and performing, the latter being much harder to achieve. The primal brain always takes the path of least resistance… the easiest way to survive.
- An athlete strapped with tape is showing a potential weakness. When I first encountered tape I couldn’t believe an athlete would use it because a high performing athlete would be very reluctant for fellow competitors to know they have an injury. The Maori lads I worked with at the NZ Rugby Academy wouldn’t wear tape as they thought it was showing weakness and they knew they would therefore get their injuries targeted and smashed even more by the opposition.
- A physio, competitor and coach could make a note of those athletes wearing tape – as I have done. For example; calf taping for instance may mean the athlete is struggling with their running and this can be exploited. If you attack this athlete hard in the first section of the run it is likely that they won’t follow you.
- Taping means the athlete is likely to have insecurities about their performance and their ability in the race. When the going gets tough other competitors could gain strength from being aware of this whereas the less confident athlete might fold. Successful athletes know how to use others insecurities to their advantage.
- Kinesio tape is a business model designed to make money and it is subject to strong marketing campaigns and strategies – why else would it appear in various different patterns and colours? Conspiracy theories aside, both physiotherapists and athletes are not immune to the power that marketing has to make us do things. Marketing strategies do not make a product worth using.
What follows are two brief examples of triathletes I work with under coach Joel Filliol in his team of World Class athletes as they prepare for the Rio Olympics 2016. (Thanks to Groffy and Ven for letting me use them as examples!)
Addicted to Tape
Vendula Frintova CZE
Before she came to work with me, Vendula had a long history of lower leg injuries – everything from stress fractures to tendon issues and so forth. From being a world class runner in her youth, she had spent her years battling injuries. She avoided running on the road or track, running predominantly on grass. She would always be ‘treating’ some sort of pain with kinesio tape – with purple or pink being her preferred colours. She was under-performing as an athlete and had little self belief that her body wouldn’t fail.
Typical ‘old’ Vendula: Running on grass with both legs taped.
With considered and proactive intervention which promoted her capability and discouraged her need for tape, we worked closely with her coach Joel and managed to get her consistently running back on the road and track after years of avoidance – her running improved quite dramatically over the course of the following 6 months.
Vendula now has a lot more faith in her body and is one of the best runners on the ITU circuit. She is presently ranked 10th in the world and is the current Czech national champion. She still reaches for the tape now and then but engrained habits are hard to break completely – it’s an ongoing process.
They want to put me in a BOOT!?
Sarah Groff USA
After a great start to the race season and her first podium finish in the World Triathlon Series, Sarah started to get foot pain when running. She had an MRI Scan (which I didn’t advise as I think they are often detrimental – another topic for debate) and was diagnosed with a ruptured tendon in her foot. The initial advice was to put her in a boot and stop her running. Talk about finishing an athlete’s season at the peak of her performance, let alone the mental angst and financial loss this would cause! My first job was to calm down a totally pissed off athlete and bring her around to believing she would get better and be running strong. We then had to build her up again and above all get her to trust her body once more but more importantly, we had to not intervene with boots and other extrinsic supports. It would have been a lot easier to tell her not to run, rest for weeks and come back next year, waiting for healing but also months of physical and mental de-conditioning to occur, however physiotherapists are there to make sure athletes can perform through interaction and not just fluffing around until regression to the mean occurs.
Now I have to admit there was a moment of weakness. We were heading towards the last 3 races of the season and I did ‘think’ of using some tape, just to help her through that first race and give her something that just might make her feel better. Sarah soon made me see sense, questioning me, (“I thought you didn’t believe in tape?”) before declaring that she didn’t think she needed it.
Sarah managed her injury most commendably; during the recovery she performed all the training sessions given to her, progression of load was graduated, any issues she felt with her foot were normalised and positive reinforcement was implemented.
She went into the penultimate race of the WTS in Stockholm with no excuse, confident in her athletic ability and won her first gold only 3 months after being told she should stop running and end her season.
Groffy in control of herself and the whole race at WTS Stockholm
Significant tissue damage which causes an inability to run due to pain, cannot be helped by tape and these athletes shouldn’t be running anyway. If the pain is helped by tape then it’s very unlikely that there was significant damage in the first place; therefore other factors should be addressed. Tape isn’t needed: clearing red flags, normalising the cause of injury, reducing load to a tolerable level and building from there – positive intervention and proactive coaching is what’s needed. If adjuncts that is extrinsic intervention should be limited to treatment.
Sure, an athlete may feel better after they’ve put some tape on but I prefer athletes to get better. Western medicine panders to pain far too much, we have gone too far to the left; running injuries, despite all the intervention, seem to be increasing; pain thresholds are getting lower and chronic pain is out of control. We need to get back to the days when if we sprained an ankle, we’d limp around for a few days but then get moving again and back to our sport – running without fear.
Paul Westwood, Physiotherapist – @triathlonphysio
The Chimp Paradox: Dr Steve Peters,Vermilion London 2011
Whiplash and Other Useful Illnesses: Andrew Malleson, McGill-Queen’s University Press 2002