Chapter 10 Epilogue
If you ask a patient what brings them to your clinic, or ask an athlete what stops them training or competing, they will not answer with: I think I have a problem with balance or I have too much inversion of my ankle or too much extension at my elbow. They will tell you that pain is the primary reason for their visit and, in the case of athletes, possibly a reduction in performance as well. Pain is quite possibly the most complex issue presented to any practitioner,1 and among the most confounding presentations to treat.
The effects of tape and its ability to reduce pain are fairly well documented,2-15 especially with regards to, but not limited to, the knee.2,3,7,8,10,11,13-15 Studies have been done on other areas of the body, such as the ankle, hip, shoulder, elbow, foot and even ribs.4-6,9,12 Some researchers are looking at the effects of tape on pain in stroke sufferers.5,16
In order for us to understand the reasons for pain reduction, we need to know the reasons for pain. This may at first sight seem simple, as in many cases the answer will be swelling of the tissues caused by trauma. During inflammation, pain is caused by chemical, mechanical and thermal irritants. Taping for this aspect of pain has already been adequately dealt with in the other sections of this book. However, this does not explain chronic pain or why many suffer discomfort long after the original injury has healed. For this we have to look to other areas for the answers. It would be a reasonable statement to say that other factors are multifactoral and therefore, by their very nature, complex. Two such theories have been hypothesized as possible reasons for maintenance of painful joints, represented by Panjabi and his hypothesis of a ‘neutral zone’17,18 and Dye’s hypothesis on joint homeostasis.19-21 Both are very feasible and have led to further research in these areas.
The need for pain reduction has prompted some tapers to look at other ways of obtaining maximal pain-alleviating effects by using tape. In some cases the more traditional tried and tested methods of taping may be inappropriate or contraindicated. In several cases, as the injury recovers less tape is needed to offer the same effect (limit joint range of motion and pain relief). McConnell describes a method of pain-relieving taping as ‘unloading’ and stated that: ‘tape may be used to unload painful structures to minimize the aggravation of the symptoms so treatment can be directed at improving the patient’s “envelope of function” ’.2
There are at present three primary taping techniques used:
Athletic taping is by far the most widely used technique and is primarily used for acute injuries and prevention of injuries (as well as all the reasons laid out in the introduction). It is generally applied prior to a sporting activity and removed immediately after.
McConnell (unloading) taping was devised and researched by Jenny McConnell. It was primarily designed for patellofemoral joint syndrome. It uses a highly adhesive fixation tape in combination with a non-elastic tape. It is also used on other areas such as shoulder and hip. This type of tape can be left on for several hours.
Kinesio Taping® (KT) was pioneered in Japan and uses specific specialized tapes and methods of taping; it too is reported to reduce pain while maintaining full range of motion. Kinesio Taping® can be left on for several days.
A technique not mentioned above is Functional Fascial Taping™ (FFT) pioneered by Ron Alexander. This is very similar to the McConnell style of taping but is used similarly to KT in that it is applied wherever pain is felt, and can be left on for days.
McConnell taping (MT), Kinesio Taping® (KT) and Functional Fascial Taping™ (FFT) have made progress in the area of pain management, especially with regards to application of the tape, but not necessarily how it works. MT, KT and FFT have common ground with regard to tape application; in comparison to the more traditional approach to taping (athletic taping), relatively small amounts of tape are used and, in order for these types of techniques to be effective, it would seem that a certain amount of skin stretching needs to take place or a shortening between the two ends of the tape over the affected region (causing a corrugation effect on the skin). The direction in which the tape is applied may also play a role in how effective these types of tape jobs will be.
There is a growing body of evidence on all taping techniques, and research in this exciting area of therapy is ongoing. At present MT, KT and FFT, although widely used, still have a relatively smaller number of evidence-based research articles (with the possible exception of McConnell taping). However, the research that exists on all types of taping is very encouraging.
As stated in the introduction to this book, different techniques are used at different stages of repair and recovery. I will reiterate here that any area to be taped must be thoroughly examined and properly diagnosed. Any taping technique should be used as part of a comprehensive treatment and rehabilitation programme. It is up to the taper to decide which technique is used, when it is used and why it is used.
1. Casey K.L. Neural mechanisms of pain. In: Carterette E.C., Friedman M.P., editors. Handbook of perception. New York: Academic Press; 1978:183-219.
2. McConnell J. A novel approach to pain relief pre-therapeutic exercise. J Sci Med Sport. 2000;3:325-334.
3. Hinman R.S., Bennell K.L., Crossley K.M., et al. Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis. Rheumatology. 2003;42:865-869.
4. Vicenzino B., Brooksbank J., Minto J., et al. Initial effects of elbow taping on pain-free grip strength and pressure pain threshold. J Orthop Sports Phys Ther. 2003;33:400-407.
5. Kwon S.S. The effects of the taping therapy on range of motion, pain and depression in stroke patient. Taehan Kanho Hakhoe Chi. 2003;33:651-658.
6. Jeon M.Y., Jeong H.C., Jeong M.S., et al. Effects of taping therapy on the deformed angle of the foot and pain in hallux valgus patients. Taehan Kanho Hakhoe Chi. 2004;34:685-692.
7. Whittington M., Palmer S., MacMillan F. Effects of taping on pain and function in patellofemoral pain syndrome: a randomized controlled trial. J Orthop Sports Phys Ther. 2004;34:504-510.
8. LaBella C. Patellofemoral pain syndrome: evaluation and treatment. Prim Care. 2004;31:977-1003.
9. Lewis J.S., Wright C., Green A. Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther. 2005;35:72-87.
10. Aminaka N., Gribble P.A. A systematic review of the effects of therapeutic taping on patellofemoral pain syndrome. J Athl Train. 2005;40:341-351.
11. Hyland M.R., Webber-Gaffney A., Choen L., et al. Randomized controlled trial of calcaneal taping, sham taping, and plantar fascia stretching for the short-term management of plantar heel pain. J Orthop Sports Phys Ther. 2006;36:364-371.
12. Radford J.A., Landorf K.B., Buchbinder R., et al. Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. 2006;9(7):64.
13. Callaghan M.J., Selfe J., McHenry A., et al. Effects of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome. Man Ther. 2008;13(3):192-199.
14. Hunter D.J., Zhang Y.Q., Niu J.B., et al. Patella malalignment, pain and patellofemoral progression: the Health ABC Study. Osteoarthritis Cartilage. 2007;15(10):1120-1127.
15. Selfe J., Richards J., Thewlis D., et al. The biomechanics of step descent under different treatment modalities used in patellofemoral pain. Gait Posture. 2008;27(2):258-263.
16. Jaraczewska E., Long C. Kinesio taping in stroke: improving functional use of the upper extremity in hemiplegia. Top Stroke Rehabil. 2006;13:31-42.
17. Panjabi M.M. The stabilizing system of the spine: part 1, function, dysfunction, adaptation and enhancement. J Spinal Disord. 1992;5:383-389.
18. Panjabi M.M. The stabilizing system of the spine: part 2, neutral zone and instability hypothesis. J Spinal Disord. 1992;5:390-396.
19. Dye S.F. The knee as a biologic transmission with an envelope of function: a theory. Clin Orthop Relat Res. 1996;325:10-18.
20. Dye S.F., Vaupel G.L., Dye C.C. Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia. Am J Sports Med. 1998;26:773-777.
21. Dye S.F. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005;436:100-110.