In 2008 Kinesio Tape (KT) was donated to 58 countries for use during the Olympic games. Its brightly coloured strips could be seen on a host of high profile athletes and since then its use in sports has blossomed. More recently footballer Mario Balotelli wore it during the Euros, and Serbian tennis star Novak Djokovic strapped his elbow with it at Wimbledon. With countless athletes wearing kinesio tape during the 2012 Olympics and Paralympics the tape is becoming increasingly sought after but a growing number of people are asking does it really work?
In July the Advertising Standards Authority (ASA) upheld a complaint against a company's claims on the benefits of KT, concluding that there wasn't sufficient evidence to support these claims. Limbvolume had stated, via their website, that KT aided lymphatic and muscle systems, reduced recovery times and improved fitness. It suggested that the tape could be used to treat a huge number of conditions from shin splints to sciatica. Limbvolume provided 47 articles, case studies and clinical trials to support the use of KT but the ASA decided the site was misleading and concluded,
“The claims must not appear again in their current form. We told Limbvolume to ensure they hold adequate substantiation for the claims they make in future”
This would appear to be a fairly damning indication of the effectiveness of kinesio tape but really it just reflects on the nature of Limbvolume's claims. They suggested KT was effective in a huge variety of cases based on a very small amount of research.
So what does the research say?…
Williams et al (2011) performed a Meta-Analysis of the evidence of the effectiveness of kinesio tape in treatment and prevention of sports injuries. They found just 96 relevant articles on KT, which indicates how little research has been conducted, especially when you consider something like acupuncture is said to have had thousands of studies. Of the 96 articles only 10 passed the inclusion criteria and were included in the review. Just 4 of these studies were on the lower limbs, all of which were on healthy subjects and none of the 10 were performed on runners.
Examining research from Williams et al (2011) and others we hope to answer a number of questions surrounding the use of KT.
Does kinesio tape improve performance in runners?
Despite claims from a number of tape manufacturers there seems to be no high quality evidence to show that KT improves running performance. What I wanted to see here was studies comparing KT with a placebo and control group to see its affect on 5km running times, running economy or any number of performance variables. I was unable to find a single study that did this. RockTape present a study on their site showing improvement in cycling performance with KT. But this included just 5 cyclists, has clear issues with potential bias and was even described by the article itself as a “low” level of evidence! What is remarkable about this work is that despite the claims on the site on improvement in sports the performance the study actually confirms the total lack of research,
“…to our knowledge there are no published randomized clinical trials that evaluate the effects of Rocktape in a performance-enhancement application”
It is perhaps unfair to pick on RockTape as other companies have made the same claims and at least they do present some research evidence on their site, they deserve some credit for that. But it is incredible that their slogan is Go stronger, longer and their own research admits there's no evidence to support that!
Does kinesio tape improve strength or muscle activity?
Williams et al concluded that KT may have small benefits on muscle strength but there was no substantial evidence for improvements in muscle activity. Two studies did report significant effects of KT on muscle activity but Williams et al questioned their methodological quality. There is also a question as to what is clinically beneficial in terms of change in muscle activity. In some cases you may seek to increase activity (for example in the medial quadriceps to improve patellofemoral pain) in others a decrease might be the aim (such as in TFL for ITBS).
A recent randomised, controlled clinical trial compared KT on the quadriceps muscles, with nonelastic tape and a control group. The study, by Alano de Almeida Lins et al (2012) concluded,
“Application of KT to RF (Rectus Femoris) VL (Vastus Lateralis) and VM (Vastus Medialis) muscles did not significantly change lower limb function, postural balance, knee extensor peak torque or Electromyographic activity of VL muscle in healthy women”
Thanks to @setherapies for recommending the article.
Does kinesio tape reduce pain or improve proprioception?
Williams et al concluded there was no substantial evidence to support the use of KT in decreasing pain or improving proprioception. (Proprioception is the system by which we monitor joint position and control movements)
Does kinesio tape improve range of movement?
Williams et al found there was some evidence to suggest KT may be beneficial in increasing range of movement but further research was required.
Does kinesio tape help to prevent injury?
I have been unable to find any quality evidence to show that KT can be used to prevent injury. Briem et al (2011) found that KT compared poorly to non elastic tape when used to prevent ankle inversion and would therefore be unlikely to reduce occurrence of ankle sprains.
Is there evidence for the use of kinesio tape to treat specific conditions associated with running?
I found a handful of case studies showing positive results, including 1 for Achilles tendon injury however single case studies are a low level of evidence. Patellofemoral Pain Syndrome (runner's knee) appeared to have been studied most extensively but even this yielded just a handful of articles. The results were mixed, with Akbas et al (2011) finding that adding kinesio tape to an exercise programme made no significant difference to outcome, while Chen et al (2008) found positive effects in reducing pain and altering muscle activity. Tsai and Lee (2010) studied 52 patients with plantar fasciitis and concluded that adding the use of kinesio tape (continuously for 1 week on calf and plantar fascia) might alleviate pain better than traditional physiotherapy alone. The sparsity of evidence and a number of methodological issues make it very difficult to make firm conclusions from this research into specific conditions.
So does kinesio tape work?
In my experience clinically I've found it very effective but there is minimal high quality evidence to support its use in runners.
There was some evidence to show that it doesn't decrease performance in a number of tasks and, in this regard, faired better than other types of taping. So, while we may not have evidence that kinesio tape helps there doesn't appear to be evidence to show it will harm. Clearly that's not a great reason to use the colourful tape but doing so shouldn't negatively affect performance.
Research is an important part of our decision making process with treatments. Lack of evidence isn't something we can ignore, but it also is very common among our treatments. This doesn't make it all ok but rather highlights the need for further work. You might be surprised that extremely common treatments like ice, massage and stretching have a relatively poor evidence base. We've discussed the role of research in sport before on RunningPhysio and opened a bit of a can of worms! My hope is that perhaps we have a similar situation to that faced by acupuncture when it was first used in the UK. At that time there was little high quality evidence to support its use but since then research has developed and acupuncture has become a common treatment for pain and has been included in a number of clinical guidelines.
Alongside research we also use our clinical experience in deciding treatments. I've used KT to treat runners and non-runners and seen some excellent results. I've had patients describe it as 'miracle tape' after a host of other treatments proved ineffective and the tape immediately reduced their pain. KT has proved popular with physios and patients alike. It appears to last longer than Zinc Oxide tape, stays on better during sport and is often more comfortable. The day before Brighton Marathon this year I stood at the expo and worried why my knee was aching so much. It had been all week, so I strapped it with KT and ran the race. I had no pain at all during or after it. The tape stayed on for all 26.2 miles and still looked good. I've run with Zinx Oxide in the past and it fell off after 6 miles!
I feel the tape has its main role as a strategy to offload tissues that are healing or have been overloaded. Considering how common overuse injuries are in running it should, in theory, have great potential in treating runners. In this regard I use the tape more as a traditional taping technique than as recommended by the KT companies or to directly improve performance. Other clinicians have questioned whether a flexible taping is capable of offloading structures involved in weight bearing. I share their concerns but the flexible nature of the tape allows it to be applied under some stretch in a position where the target tissue is under minimal load. For example, when using it to offload the Achilles you tape with the ankle slightly plantarflexed (moved down towards the ground), this means the tape resists dorsiflexion, the upward movement which places greater stress on the tendon. Injured tissues are unlikely to benefit from being completely offloaded as we know some stress on tissues stimulates the healing process. Our aim is optimal loading for the target tissue, perhaps by reducing load by even a small amount it helps to achieve this level of loading.
But sadly, my opinion, or anyone's for that matter, doesn't rank highly in terms of research evidence. You could even say my clear liking of the tape introduces an element of bias to the article! That said, I have done my best to present the research as I've found it.
My final thoughts are this; there is minimal high quality research to support the use of kinesio tape and no evidence that I'm aware of that it improves performance. In time this evidence base may develop and provide more guidance.
My recommendation is that kinesio tape can be used in the treatment of injury but should be used as part of a comprehensive treatment programme and not in isolation.
Oh and there is one other use for kinesio tape….