Kinesio Tape, Athletic Performance and Self Belief – by Paul Westwood

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.

Vendula sprinting to finish in the top 10 of WTS London 2014 with one of the fastest runs of the day


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


Final Note

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

Interesting Reads:

The Chimp Paradox: Dr Steve Peters,Vermilion London 2011

Whiplash and Other Useful Illnesses: Andrew Malleson, McGill-Queen’s University Press 2002

 

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17 Responses to Kinesio Tape, Athletic Performance and Self Belief – by Paul Westwood

  1. Ben September 1, 2014 at 10:14 pm #

    I can certainly agree that there is sometimes a sympathy associated with wearing a brace or support of some kind, and that may play a negative effect on an athlete in allowing them to identify with and live in their diagnosis or pain. If an athlete states he/she “needs” tape to compete, that is definitely a cause for concern. Injuries do occur, and having access to knowledgable practitioners is crucial for an elite athlete. We all know that if an athlete trains for a long time and travels to their race that they will compete whether they are injured or not.

    However, often times when I am at a USAT sanctioned event as a massage therapist, with over 10 years under my belt as a Certified Kinesio Tape Practitioner and 12 years as a clinical massage therapist, and an athlete comes to me for care. These athletes come to the massage area complaining of something like plantar fasciitis and there is no time to rehab them before their race, and they haven’t found a practitioner to help them properly rehab it whe it first occurred because the bdy doesn’t just heal itself, especially if you continue to train. So, here it is two days before a race and this athlete is still going to run and not expect a PR or even get through the pain to finish. If basic muscle testing shows a weakness in the muscles on the plantar surface of the foot (tested by flexing the toes against manual resistance and comparing the Left and Right feet.) on the affected side, there is a kinesiology tape application to assist the muscles to make that contraction easier and stronger. After the tape application, the test is repeated in addition to testing other movements that may have been painful (this evaluation is pefrormed before and after every tape application I do) and if the pain is significantly reduced or eliminated, the session ends. If not, the tape is removed and the assessment continues to other sources.

    The feedback from the athlete comes at the finish line when he or she arrives stating that there was little or no pain during their race, and they didn’t even think about it. The plantar fasciitis application I commonly apply cannot be felt (as with just about every application) or seen and there is no outside observer giving pity in this scenario. The athlete is instructed on proper exercises that will correct the issue and in most cases, the exercises can be done without the tape application. It is not the goal of this taper or anyone I know to keep an athlete taped all the time and using it or anything else as a crutch needed to perform. This is the most common instance in which I tape my patients and athletes. Tape to reduce or eliminate pain for the purpose of being able to do rehab so he/she can live and compete tape free.

    The problem with tape is that most people are buying it over the counter or online and looking at a video online or looking at a pamphlet on how to apply it. Assessment needs to be done by a movement or soft tissue specialist to determine th correct application for kinesiology taping. I feel that the ability to assess is lacking among most tapers and they are simply using protocols. This leads to ineffective taping applications and people saying, “I don’t believe in it.” Fortunately it is not faith-based and works on basic origin-insertion principles among other effects.

    I agree, the reason for having different colors has totally become commercialized. There used to be only blue (turquoise) and red (pink) following the concept of “color therapy” that is common in Japan. Blue being cooling and red for warming. To hide the tape, beige and black were soon produced. Anything other than those colors have been created by knockoff companies looking to simply sell more tape and are meant for preference. Most people aren’t into color therapy, so assumptions of “look at my bright colors” have been made, in addiion to people thinking it is for show.

    Much like a skilled acupunturist will use 1-3 needles, a skilled kinesiology taper will use as few as possible strips of tape. As we are still learning about fascia and even neurology, I think dismissing kinesiology tape as a placebic fad is a bit too soon, especially when the results are so profound. Thank for posting this and for your input. It is definetly a different point of view than I have ever heard before. I like that you are not initially jumping to use tape when your skills are better utilized as a coach and you have the time to properly train your athletes physically and mentally. Keep it up, and maybe we can meet and talk more at a race sometime. My next USAT event will be in Panama City Beach, Florida in October.

    • Westy September 14, 2014 at 6:33 pm #

      Hi Ben,

      Thanks for your reply, you highlight a number of factors we need to think about with regards to athlete care and you are right that we are constantly learning about anatomy / physiology and the nervous system… unfortunately I find many practitioners miss out the critical thinking part.

      Kinesio Tape is an adjunct to treatment, as is acupuncture, massage, electrotherapy, colour therapy etc etc Tom clarifies this well in his Blog post: http://www.running-physio.com/rub-it/
      Adjuncts primarily work on the nervous system; when we accidentally bang our head for example we give it a rub and the pain goes away, nothing has changed structurally / physically, but the nervous system is no longer deems it necessary to experience pain.
      A skilled acupuncturist only needs to use a few needles because they have become skilled in convincing the recipient’s nervous system it no longer needs to experience pain, a lesser experienced practitioner needs to be more convincing (with more needles) by working harder so the nervous system accepts. Kinesio tape works in a similar fashion in that it helps convince the athlete’s nervous system that they don’t need to have pain… as you said ‘they don’t even think about it’
      In my experience if I have assessed an athlete and found there is nothing significantly damaged or not functioning from a structural point of view, I can explain this to them and through the promotion of capability and other coaching strategies enable them to race pain free. The ‘cure’ comes intrinsically which has better long term outcomes and reduces the risk of any nocebic effect on the athlete.
      The conundrum comes with those athletes who do need to ‘feel better’ in order to perform, as you say this has to be clinically reasoned with the advantages out weighing the potential risk of the athlete slipping into the ‘Rehabilitation Pit’. I will use ‘hands on treatment’ for athletes as a means to facilitate the promotion of capability and get into the athletes head, everyone needs a little TLC now and again. I read a recent quote stating that therapy is about the ‘Interaction of 2 nervous systems’… we have to get this right to precipitate an improvement in our athletes.
      In an ideal World we wouldn’t need adjuncts however they have become the norm and some athletes expect them… the over lying concern is that we are zealously promoting this need for extrinsic / passive treatment and as a result we are taking the power away from athletes, creating the disease, injury and inability. In order to live a fulfilled life we need to experience pain and suffering and not always look for a ‘cure’ accepting it as a normal part of life and thus preventing it from consuming us.

      Thanks for the invite, I almost ended up in Florida for the late season races, good time to escape Europe, in the future maybe?

      Paul

  2. Paul Thornton September 2, 2014 at 2:45 pm #

    Excellent blog. Thank you Tom and Paul.
    I work within a Pain Management Service, treating chronic conditions. The most important point I think you made is ‘normalising’ what they feel. I always tell my patients, as well as colleagues, that the body is fantastically adaptable and it is our job to promote this, rather than indicating we are ‘brittle’ in any way.

    • Westy September 14, 2014 at 9:31 am #

      Thanks Paul,
      I agree. I think sports med and health services have got it the wrong way around. Frontline PT often fails to normalise and promotes catastrophe which (amongst other reasons) IMO is leading to the never ending rise in chronic pain and suffering, which then guys like yourself have to deal with, let alone the athletes / people. I have worked a lot with chronic pain and have found applying similar principles to acute physiotherapy essential in promoting a fast return to normality and future problems. I fear that there is too much money to be made from promoting problems within people and reliance on extrinsic control… means you’ll have plenty of work for the future… keep it up.

      Paul

  3. Brad Beer September 3, 2014 at 2:16 pm #

    Well written Paul.

    Thank you for sharing.

    • Westy September 14, 2014 at 9:33 am #

      Thanks Brad,

      Seems as though it was needed as it has provoked a lot of (critical) thinking within the profession.

      Paul

  4. Richard Stuchfield September 5, 2014 at 4:05 pm #

    Nice article Paul. I’ve always been a bit suspicious of what ‘the tape’ can actually achieve. The only thing that has partically conviced me is its claimed effect of ‘lifting’ the skin to stimulate and improve blood flow to the affected area. I guess that even if this claim is true though, there are better methods of achiving the same result.

    • Westy September 14, 2014 at 9:37 am #

      Hey Stuch,
      Thanks for the feedback.
      The ‘lifting of any skin’ isn’t going to alter anything of significance, especially if you really are injured.

      Paul

  5. MacMan September 8, 2014 at 5:02 pm #

    I think that there is some truth to what is being said here. Could kino tape be considered to be a form of physical therapy or something that a physical therapist would consider using, I don’t know. What I do know is that there is a very valid argument to what is being said here.
    Not so much that the tape doesn’t have its uses. I feel it does. When working with athletes to change their kinesiology and movement patterns, I often times implement physical/tactile cues. This is the same reason that the tape works. The problem is this is normally not the way the tape is being used. As the therapist in the article mentions, the runners are using it as a crutch.

    Weight lifters and power lifters use equipment such as power suits to increase strength, yet the train with them in a regular basis. Most runners don’t tend to use the tape only during the run itself. Could it enhance performance? In theory, yes it could. That isn’t the problem, though. The problem is acerbated with trying to correct a movement pattern consisting of 26.2 miles of running. If we factor in that an average marathon is about 33,000 steps, we are completing thousands of repetitions that the body is not ready to complete. No movement happens in isolation. While the runner addresses on issue, there are several more that are showing up. Therefore we have a vicious cycle that continues to plague the athlete.

  6. cristina September 18, 2014 at 8:50 pm #

    One question from an amateur. I have stretched out ligaments in my right ankle, the result of multiple sprains from almost a decade ago that did not heal right. As a result, my right ankle has too much mobility and I also struggle with proprioception on that side (excessive mobility noted by multiple doctors and physios during clinical exam; stretched out ligaments shown on MRI).

    The lack of stability (and tendency to lose posterior glide in the ankle, as bones shift to where they shouldn’t be) has caused many different injuries, both to my foot/ankle, and in my left hip (compensation).

    I have found that taping my ankle as if it were sprained with KT tape helps me greatly, and has enabled me to train and compete again. I feel that if I taped it with normal sports tape for support, I’d have too much stiffness; but the stretchiness of the KT tape seems to give me just enough support. I definitely don’t believe that the KT tape is helping it heal; it’s just serving like a customized ankle brace.

    What are your thoughts on this use?

    • Westy September 22, 2014 at 7:28 pm #

      Hi Cristina,

      My main issue with K-tape or any other adjunct is it’s use on everyday aches, pains and ‘normal’ injuries / adaptations. If you have a significant injury, which it appears you have in the form of permanent ligament damage then tape can fulfil a function. I have nothing against the use of tape as a form of an ankle brace if the activity is particularly arduous (e.g. Coast to Coast run in NZ). It’s arguable that if managed appropriately from the initial injury your ankle ‘may’ of been OK eventually though this is a long topic for discussion and one that we are still learning about. I know athletes who have suffered recurrent sprains for years but for one reason or another got better with no traditional treatment or rehab.

      Keep doing your sport… that’s the main thing.

      Paul

  7. Andrew October 20, 2014 at 8:55 pm #

    Great article! If you’re considering getting kinesio tape for yourself, consider Vantelin Supports first!
    Vantelin Supports provide benefits that are similar to taping without the hassle. While therapeutic taping requires experience, patience and trial and error to apply correctly, Vantelin Supports provide the appropriate amount of resistance in a convenient form in one easy motion.

    For more info, check out their site!
    http://www.vantelinsupports.com

  8. Gavan November 27, 2014 at 6:50 am #

    It’s like most things, helpful for some and not helpful for others. Refusing outright to use an intervention such as kinesio tape is really no smarter than routinely using it and selling it to all your athletes.

    There certainly may be many athletes out there that underperform when they are taped but (particularly in contact sports) some will feel more confident with it on and play better. Different strokes for different folks!

    • Westy December 5, 2014 at 11:36 am #

      Hi Gavan,
      Thanks for your reply.
      Some things are always helpful, such as training and exercise to improve in a particular sport.
      There are some things which some people say help them such as: compression garments; K-tape; magnets; ZMA etc. however I would rarely recommend them to people as they aren’t needed and there are many other areas we need to spend energy on to improve performance.
      It’s fair enough if K-Tape improves your confidence, though from a coaching perspective I would want to know why you lack this confidence compared to others who don’t, as it could be an area to be worked on to improve your game. May be you just have more of a self preservation instinct? Though K-Tape isn’t going to do anything to stop a significant injury.

      Paul

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