Julie Kalke, CMMT, has just finished her first foray into therapeutic taping, and she's pleased with the result. More importantly, so is her patient, a frequent visitor whose lower-back pain (LBP) leaves him incapacitated and out of work for weeks at a time.
"I had him bend over, so he stretched those muscles," said Kalke, of AgeWell Services, Muskegon, MI. "Then I applied the tape. We kept it on him for six days. Now he's totally free of pain. He took three Ibuprofens, mainly on the first and second days, and I only had to do massage therapy on him twice. I just saw him the other day and he's moving freely."
Steven Kleinman, PT, MPT, is another believer. "I had a guy walk in who was hunched over," offered Kleinman, the only PT on staff at Cornerstone Chiropractic and Rehabilitation. "I had him flex forward to elongate the muscle, then put the tape on with a stretch to it so it gives a little pull and relaxes the muscle. It increases blood flow in the area, and improves lymphatic drainage. It took pressure off the nerves in that segment of his spine and allowed him to stand up straight and walk again."
Despite a paucity of clinical trials validating it, therapeutic taping is steadily gaining adherents among PTs and other rehab clinicians, who view it as a valuable adjunct to more time-honored LBP therapies.
One unabashed advocate who has formally researched the topic, Barton Bishop, PT, DPT, CKTP, declared: "The taping we used in our study is indicated in the treatment of lower back pain by both PTs and rehab professionals."
Off-Loading Principles
Japanese chiropractor Kenzo Kase invented kinesiology taping in New Mexico in the 1970s, refined it in Japan, and re-introduced the treatment in the U.S. in the mid-1990s.
Today, his company offers its tape for sale online or through PTs, chiropractors and other clinicians.
However, a number of competitors have entered the market, offering tape products through sporting goods stores to everyone from professional and amateur athletes to wounded weekend warriors.
These brightly-colored, oddly-patterned tapes can rest over-stressed muscles, reduce swelling and ease pain, their manufacturers claim.
In the PT arena, lumbar spine taping works on the same principle as taping other areas of the body, such as the peripheral joints, explained Joseph Donnelly, PT, DHS, OCS, Orthopaedic Section Practice Committee Chair for the American Physical Therapy Association.
"It uses off-loading principles and inhibition principles," Donnelly said. "Anecdotally, people have been using it a long time, such as to support the posture of persons with disc herniation, keeping them in a biased posture that gives them relief."
Kleinman, who has done taping for scapular winging on high school baseball pitchers, now tapes mostly to relieve LBP, relax muscles and correct postures."For LBP, I use taping in conjunction with strengthening, conditioning and soft-tissue mobilization," he said. "I don't use it just by itself."
Methods Vary
Taping methods vary, depending on what's wrong with your patient, Kalke stressed. No one taping method fits every patient.
"Depending on what the patient's condition is, you apply more stretch to the tape, or less, to achieve a desired result," she said. "It's best to see a qualified practitioner for your taping."
Kleinman agreed. "It depends on whether the low-back pain is due to muscle spasm or related to a herniated disc," he said. "That is, it depends on whether you are relaxing a muscle, or facilitating a muscle, or pinpointing a segmented muscle for a herniated disc, for example, in which you do a space correction or star technique to relax that area." Taping initiates a complex chain of events involving Merkel cells, nerve fibers known as A-beta fibers and another set of nerves called C-fibers, resulting in sensory gating, an adaptive mechanism in the brain that prevents over-stimulation, manufacturers maintain.
In other words, taping sends a signal through the nerve endings up your spine to your brain to blunt the sensation of pain-theoretically, at least.
Validating Research
Formal research validating taping's therapeutic value is sparse but does exist. One article published in 2009 in the Journal of Orthopaedic and Sports Physical Therapy found that therapeutic taping had a statistically significant improvement in relieving pain and improving cervical range of motion in patients with whiplash.1
"However," Donnelly said, "the effect was still small enough that the researchers had some reservations about fully supporting the therapy."
In 2010, Bishop led a research team that randomized 37 LBP patients to receive standard treatment, or standard treatment plus taping-with a favorable outcome for taping.
"Both groups had significant reduction in pain levels but only the taping group had significant reductions in the Oswestry Disability Index (ODI), the gold standard for evaluating disability in the lower back," said Dr. Bishop, a certified clinical instructor for the University of Maryland, Shenandoah University, and the University of South Carolina.
"The taping group started with a disability of 33 percent and finished, on average, with a disability of 17 percent, significantly lower at discharge than the standard treatment group. This shows that the only difference was taping, as it was the only dependent variable."
Fear Avoidance
Bishop also tested both his groups with the Fear Avoidance Beliefs Questionnaire and, again, found that taped patients fared better.
"We assessed their fear of performing physical tasks and how much they avoided them," he said. "The taping group showed reductions in both those fears. The control group did not."
True, taping might reduce fear and anxiety in people with LBP. On the other hand, it could have the opposite psychological effect, Donnelly warned.
"Taping could reduce fear or it could reinforce fear avoidance and work against you," he said. "You must use your clinical reasoning. Don't feed into someone's fear avoidance."
Nevertheless, taping can relieve the anxiety of low-back pain patients who clinicians are trying to wean off the total support offered by a back brace, observed Donnelly's colleague, Mandy Blackmon, PT, DPT, OCS, board member of the Performing Arts Special Interest Group for the APTA's Orthopaedic Section.
"Some patients in back braces who are improving and ready to wean off the brace may have a fear of movement after being immobilized," she said. "I'll tape them so they have some support if not 100-percent support."
Self-Taping
Everyone interviewed for this story expressed concern that consumers can buy medical tape in stores and thus self-apply it with no formal training. Clinicians who want to become certified in therapeutic taping must take a six-day course.
"Tape needs to be applied by a trained professional who knows how to prep the skin beforehand and how to take it off correctly, and can train the patient to do likewise," Dr. Blackmon said.
Amateurish application and removal not only guarantees less-than-optimal results, but also poses the risk of skin irritation. "When I took the taping course, they taught us to take a small piece of tape and affix it to the back of the patient's hand for 24 hours and check for any skin irritation," Kleinman said.
"I've seen people who have taken it off improperly, or had a reaction and had skin problems. Some therapeutic tape is 100-percent acrylic, heat-activated, cotton-fiber tape. You have to make sure the skin is nice and wet when removing it, especially in an area with hair," he said.
Different tapes are made differently, Donnelly noted, citing one brand of rayon-backed sports tape that features a zinc oxide adhesive. "Some people have latex allergies or sensitivities to certain adhesives," he said. "Patient education in symptoms and usage is paramount. Skin irritations can be severe."
For those trained in it, though, self-taping apparently works as well as it does on patients. "I use it on myself, and my wife, who is a PT also," Kleinman said. "We both have back pain now and then and we tape each other. I'm all for it."
Reference
1. González-Iglesias, J., del Rosario Gutiérrez-Vega, M., Fernández-de-las-Peñas, C., et al. (2009). Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: A randomized clinical trial. Journal of Orthopedic and Sports Physical Therapy, 10, 3072.
Michael Gibbons is an editor at ADVANCE.