Kinesio tape (KT) is a treatment method theorized to improve joint range of motion (ROM) in the neck and lumbar spine,1-4 but the effect of KT on the shoulder has
not been investigated. Shoulder injuries that are common in ath-letics include instabil-ity, impingement, and rotator cuff tendinopa-thy.5 The complexity of shoulder girdle function contributes to the vari-ety of injury types, any of which may be associ-ated with restriction of glenohumeral ROM.5-9 Shoulder ROM is highly influenced by scapular
dyskinesis/instability, muscle tightness, tendon thickening, and capsular restrictions resulting from scar tissue formation.5,9-12 KT is currently used in clinical practice in
The Effects of Kinesio Tape and Stretching on Shoulder ROM
RESEARCH REPORT
Ai Ujino, MS, ATC, LAT; Lindsey E. Eberman, PhD, ATC, LAT; Leamor Kahanov, EdD, LAT, ATC; Chelsea Renner, MS, ATC, LAT; and Timothy Demchak, PhD, LAT, ATC • Indiana State University
conjunction with joint mobilization, ROM exercises, and active/passive stretches, but no evidence of a beneficial effect on shoulder ROM is available.1-4,13
KT is believed to have therapeutic effects that promote edema reduction, pain control, increased ROM, and blood and lymphatic flow within underlying tissue.2,14-22 Because of its elasticity, KT is theorized to increase interstitial space by lifting the skin over the targeted treatment area, which is the mecha-nism believed to decrease pain, increase blood and lymphatic circulation, and increase joint mobility.14,15,23,24 Multiple therapeutic interventions are often administered con-comitantly,13 which provided the rationale for assessment of KT with stretching for improvement of shoulder ROM.25-29
Procedures and FindingsWe used a quasi-experimental post-test design with three groups: (a) KT only (KT),
Kinesio tape alone increased glenohumeral total arc of motion in healthy individuals.
Stretching and the combination of Kinesio tape and stretching did not change range of motion in healthy populations.
Stretching and the combination of Kinesio tape and stretching may have a greater impact in unhealthy, motion restricted patients.
Key PointsKey Points
context: Kinesio tape (KT) is theorized to increase joint range of motion (ROM) by a mechanism that dif-fers from that of stretching exercises. objective: To investigate the combined effects of KT and stretching on shoulder ROM. participants: Healthy volunteers (n = 71) ranging in age from 18–40 years, with no his-tory of shoulder injury (29 males and 42 females). interventions: Participants were randomly assigned to three treatment groups (KT only, Stretch, and KT/Stretch). main outcome measures: Posttreatment ROM measurements were obtained with a digital inclinometer on day 1 and day 4. results: Analysis of variance identified a significant difference among groups for the magnitude of change in shoulder ROM, F(2,68) = 3.268, p = 0.044, which was greatest for the KT group (mean change = 9.20 ± 17.91). conclusion: The results suggest that KT can increase shoulder ROM. Stretching was not found to have an effect on shoulder ROM, regardless of whether it was used alone or in combination with KT.
international journal of athletic therapy & training march 2013 25
(b) stretching only (Stretch), and (c) KT combined with stretching (KT/Stretch). We measured posttreatment shoulder internal rotation (IR) and external rotation (ER) ROM on two days (day 1 and day 4). Participants in the Stretch and KT/Stretch group completed a 3-day home stretch program. On the basis of the available evidence,14,15,23,24 we hypothesized that KT and KT/stretch groups would demonstrate increased ROM.
A total of 71 healthy individuals (29 males, 42 females, 18–32 years of age) with no history of shoul-der injury provided informed consent for participation in the study. We used a digital inclinometer (Digital Inclo-Matic Series; CheckPoint Professional, Torrance, CA) to measure shoulder IR and ER ROM (Figure 1). The intra-tester reliability of digital inclinometers has been reported to range from 0.79–0.94.30-32 A random number generator was used to assign participants to the three groups (KT = 23, Stretch = 22, KT/Stretch = 26) and the researchers who obtained ROM mea-surements were blinded to group assignments. ROM measurements were obtained with the participant in a supine position, with the shoulder in 90° of abduction and the elbow in 90° of flexion (Figure 2A). For ER measurement, an examiner stabilized the scapula and applied manual force to the participant’s wrist to pas-sively induce ER until the spine of scapula started to tilt posteriorly (Figure 2B). A second examiner aligned the digital inclinometer and obtained the measurement. A similar procedure was used to induce IR until the coracoid process started to rise (Figure 2C). The digital inclinometer was aligned with the ulnar shaft and the ulnar styloid process for both measurements,33 and the same examiner obtained all of the measurements for every participant. Shoulder ROM was derived from the addition of the ER and IR measurements.
The KT treatment consisted of the application of two tape strips to the dominant shoulder for stabiliza-tion of the scapulothoracic joint (Figure 3). One “I” strip of tape covered the skin surface from the anterior portion of the glenoid rim to the inferior border of the
lower trapezius (Figure 4A and B). With the exception of the first and last 2 inches of adhesion to the skin, the tape strip was applied with a 50% stretch of its elasticity.14 A second “Y” strip of tape covered the skin
Figure 1 Digital inclinometer.
Figure 2 a: starting position; B: external rotation rom measurement; c: internal rotation rom measurement.
Figure 3 the top is the “y” strip and the bottom is the “i” strip of Kinesio tape.
(a)
(b)
(c)
26 march 2013 international journal of athletic therapy & training
surface from the medial portion of the spine of scapula to the anterior portion of the glenoid rim (Figure 4A and C), which was applied to skin with 50% stretch of the tape in the same manner described for the first “I” strip. The upper portion of the “Y” strip was pulled diagonally in a superior and anterior direction. Prior to application of the lower portion, the shoulder was positioned in ER. Participants in the Stretch and KT/Stretch groups performed a self-stretching program once per day for 4 days, which included the sleeper stretch, doorway stretch, and cross-body stretch (Figure 5A-C).9,33-36 Each stretch was performed three times
with a 30-second hold and a 15-second relaxation period between stretches.25-28
Analysis of variance identified a significant differ-ence among groups for the magnitude of change in shoulder ROM, F(2, 68) = 3.268, p = 0.044, and the KT group demonstrated the greatest increase in ROM between day 1 and day 4 (Table 1).
DiscussionThe results suggest that KT application may increase shoulder ROM over a 3-day period; however, the Stretch
Figure 4 Kt application on shoulder. a: anterior shoulder view; B: posterior shoulder view with “i” strip; c: posterior shoulder view with “y” strip.
international journal of athletic therapy & training march 2013 27
and KT/Stretch groups did not demonstrate such an increase in shoulder ROM. The purpose of the KT technique was to alter scapular position in a manner that would increase glenohumeral ROM, which was expected for both the KT and KT/stretch groups. Sta-bilization of the scapula could decrease the ROM,37,38 but such an effect was only observed in the KT/Stretch group. KT application may contribute to muscle acti-vation,19,39,40 which could have generated tension in the lower trapezius, supraspinatus, and infraspinatus muscles that affected ROM. Furthermore, KT may have positioned the scapula more posteriorly, which may increase activation of the shoulder musculature.10-12,41 The reason that such effects would have influenced ROM in the KT/Stretch group without similar effects in the KT group cannot be explained. Increased blood flow, decreased pain, and decreased edema have been reported to be therapeutic benefits that can be realized from KT application.2-4,16,20-22 Because our participants were healthy, none of these theorized therapeutic effects are relevant to the interpretation of our findings.
Stretching clearly has a short-term effect,33,42 but attainment of a long-term effect on tissue extensibil-ity probably cannot be achieved unless stretching exercises are continued for more than 4 weeks.43-46 Thus, the addition of stretching exercises to the KT application was not expected to result in a greater ROM increase than that observed for KT application without stretching. The lack of ROM increase in the KT/Stretch group raises a question about the validity of the finding for the KT group. Performance of the stretching exercises may have had some adverse effect on the mechanism by which the presence of KT on the skin would have otherwise produced an increase in ROM. Thus, further research is needed to assess the possible beneficial effect of KT for healthy athletes and the possible therapeutic benefits for injured athletes.
Conclusion
The results suggest that KT increases shoulder ROM over a 3-day period in healthy individuals, but the combination of KT with the performance of stretch-ing exercises does not appear to have such an effect.
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Ai Ujino is an alum of Indiana State University and currently works as an athletic trainer with the BryanLGH Medical Center at Lincoln Christian and Parkview Christian High Schools in Lincoln, NE.
Lindsey E. Eberman is an assistant professor and the Post-Professional Athletic Training Education Program Director in the Department of Applied Medicine and Rehabilitation at Indiana State University in Terre Haute, IN.
Leamor Kahanov is the Chair of the Department of Applied Medicine and Rehabilitation at Indiana State University in Terre Haute, IN.
Chelsea Renner is an alum of Indiana State University and currently works as an athletic trainer with the Fremont Area Medical Center at Fremont High School in Fremont, NE.
Timothy Demchak is an associate professor in the Department of Applied Medicine and Rehabilitation at Indiana State University in Terre Haute, IN.
Trent Nessler, PT, DPT, MPT, Champion Sports Medicine/ Physio-therapy Associates, is the report editor for this article
