Kinesio Tape and similar tapes with their bright colors that bring me memories of 1980s fashion were quite new to me when I first read and heard about them in early 2014. I even experienced it in early 2015 when a friend of mine, who was a massage therapist in San Diego (now retired), had applied a strip of Kinesio Tape to my right side of the lumbar region after the massage session for my chronic low back pain. Even though it felt good to wear a dark strip, it didn’t seem to have much effect in reducing pain or improve my spine’s mobility. But it did give me an “feeling” that it was doing something.

Despite the positive effects that some athletes and physiotherapy patients feel about using Kinesio Tape based on anecdotes, case reports, and some small-sampled studies, the scientific evidence in the last six years point toward little or no clinically significant benefits that Kinesio Tape is better than placebo effects, regular athletic tape, or other types of non-invasive interventions.

There has been at least seven systematic reviews (some with meta-analyses) since 2012 that examined various effects of Kinesio Tape with different issues. One of these early systematic reviews examined the effects of Kinesio Tape with musculoskeletal pain (MSK) based on six randomized-controlled trials (RCTs) and found “insufficient evidence for or against the use of [Kinesio Tape] to improve pain, function, performance, and time to return to play following musculoskeletal injury. The number of high-quality, consistent studies available is limited, and this topic therefore warrants further research with higher levels of evidence, larger sample sizes, powered outcomes, and longer follow-up times to show the effect—or lack thereof—of [Kinesio Tape]. There is also almost no available evidence regarding the use of [Kinesio Tape] to improve return to play.” (1)

Another study that was published in the same year examined different effects of Kinesio Tape on a broader scope with eight qualified RCTs that include side effects, breast cancer-related lymphedema, shoulder impingement syndrome, neck pain, chronic low back pain, plantar fasciitis, knee pain, and stroke-related muscle spasticity. (2) Nearly all of these studies found that Kinesio Tape is not significantly better than sham taping or exercise-only intervention. The exception is with plantar fasciitis, where “short-term [Kinesio Taping] in conjunction with physiotherapy produced statistically greater improvements in pain and fascia thickness compared to physiotherapy alone 1-week post-treatment. However, it is unclear if the differences were clinically important.”

Both of the reviews’ authors acknowledged that there were limited quality studies at the time, and these studies were based on English language publications only, so they could have missed non-English publications that may indicate otherwise.

In 2013, another systematic review was published based on 12 qualified RCTs. Again, the authors found almost the same thing as the 2012 reviews. “One of the primary roles of the health professional is to confirm, through evidence-based knowledge, the effectiveness of a treatment modality, not only due to its popularity,” the authors concluded. Yet they added, “future studies are still warranted.” (3)

And so the pattern repeats itself with further studies and more reviews — two in 2014 and two in 2015. (4, 5, 6, 7) The 2014 Brazilian study, led by Dr. Leonardo Costa from the Universidade Cidade de São Paulo, dissected 12 RCTs that examined Kinesio Tape’s effects on MSK pain compared to sham/placebo, control, and other interventions. With no surprise, the results were quite similar the previous reviews.

“The quality of evidence (GRADE) for all comparisons ranged from low to very low quality, which means that further robust and low risk of bias evidence is likely to change the estimates of the effects of this intervention,” the authors wrote. “Regardless of the comparison used or the outcomes investigated, the trials typically showed no significant difference in outcomes between the groups, or a trivial effect in favour of [Kinesio Tape] (ie, small enough to not be considered clinically worthwhile). (4)

​Costa et al. speculated that the popularity of Kinesio Tape among physiotherapists and athletes is because of the heavy marketing campaigns, such as the one used in the London 2012 Olympic Games, not because of scientific evidence. “Policymakers and clinicians should carefully consider the costs and the effectiveness of this intervention when deciding whether to use this intervention,” the authors suggested.

Not even the latest systematic review with more studies — and non-English studies — added could change the ball game. A Singaporean study that focused on Kinesio Tape’s effects on MSK and disability, based on 17 RCTs, found similar results as previous reviews. (6) Another review based on eight RCTs also found that Kinesio Tape is no better than non-elastic tape for neck pain and low back pain, even when the quality of the RCTs for low back pain are quite high. (7)

So why do many physiotherapists and athletic trainers use Kinesio Tape despite the lack of rigorous scientific evidence?

“My best guess is that because physiotherapists are still not used to check the evidence before investing their time and money into a course. If they decided to play with the word ‘Kinesio Tape’ on PubMed, they would never invest a single cent on these courses,” Dr. Costa speculated in an online interview with Massage & Fitness Magazine. “This is very problematic as a profession as we should not make this kind of mistake. Kinesio Tape is only [one] of many examples of treatments that come and go and just a few people will benefit from this.”

Excuse Me, But How Exactly Does That Work?

Lim and Tay stated in their review that the underlying mechanism of Kinesio Tape is poorly understood.

“…it is tempting to speculate that the afferent stimuli provided by the applied [Kinesio Tape]may inhibit the transmission of nociceptive signals to the spinal level in chronic musculoskeletal pain conditions, leading to the attenuation of pain experience. The basis of such assertion is the commonality in feature, that is, spinal cord hyperexcitability among chronic musculoskeletal pain conditions. However, the approximate thickness of the [Kinesio Tape] in relation to the epidermis of the skin was intended to avoid sensory stimuli when properly applied. To this end, it remains unclear to what extent the gate control theory is involved in the efficacy of [Kinesio Tape].” (6)

A popular notion of how Kinesio Tape works is that it lifts the skin to alleviate pressure to reduce pain and swelling from an injury. This may sound reasonable, but it doesn’t follow on current physiology and physics. Dr. John Brewer, Director of Sport at the University of Bedfordshire in the U.K., explained why in an online news interview:

“[Kinesio Tape] rests on the surface of the skin. As an exercise physiologist, I find it hard to understand how [Kinesio Tape] can have an effect on muscle fibres that lie beneath the fascia of the muscle. The forces involved in physical activity are significant, and the likelihood of tape on the surface of the muscle having any genuine impact on the stability of the muscles is, therefore, limited. Research evidence on the claims is less than conclusive with no evidence to support the claimed increase in blood flow or lymphatic system. Some claims suggest that [Kinesio Tape] ‘lifts’ the surface of the skin; this cannot be possible unless there is a force in the opposite direction, such as pushing down on the skin, so this is highly unlikely.” (8)

“The whole biological rationale of the use of [Kinesio Tape] does not make a lot of sense, in my opinion,” Dr. Costa added. “Their theory is that lifting the skin will reduce the pressure from pain nociceptors and this could reduce pain. They also claim that circulation under the skin would improve. So my question is: What about conditions where the real problem is far from the skin, like shoulder impingement and back pain? The theory is quite simplistic and fragile, in my view.”

When asked if there are any studies that examine how Kinesio Tape works, Costa replied, “There are some small studies on EMG. No one has ever tested if the tape really increase the space between the dermis and epidermis. With regards to alleviating pain from a psychological point of view: All trials demonstrated quite clearly that Kinesio Tape’s effects are due to non-specific effects, including psychological effects.”

“I think the proposed benefits of [Kinesio Tape] are difficult to measure, particularly the physiologically ones,” Dr. Ahmad M. Mostafavifar added. “I think psychological studies could be done.

“Overall, if athletes perceive a benefit and their performance improves because of this perception then there maybe a benefit despite no scientific evidence. Some athletes in major colleges and professionally can absorb the costs where high schoolers and others may not.”

Should We Just Toss Out the Tape?

Not necessarily, and neither is what some researchers and clinicians indicate. Most of the RCTs examined show that Kinesio Tape is just as effective — not superior — as regular taping, exercise, and other interventions that manual therapists might use. Lim and Tay stated that Kinesio Tape could be used as an adjunct to conventional care for physiotherapists. Even if wearing Kinesio Tape or any other gaudy-colored tape is nothing more than a placebo effect, it could influence the outcome of the athletes’ perception of their performance and pain and their actual performance.

But even if there are some benefits to the placebo effects, there are some precautions that athletes, patients, and healthcare professions must consider. Physiotherapist and triathlete Paul Westwood warned that Kinesio Tape could “promotes the belief that their body is not good enough and they need an extrinsic factor (tape) to allow it to function.” He mentioned that the placebo effect might eventually wear off if the athlete rely too much on it. (9)

Manual therapists who find taping — Kinesio Tape or regular taping — useful in their practice may continue to use it, but they should be honest and open about how and why it works (or not work) for some people based on the current scientific evidence and our understanding of pain. Of course, taping is just one out of many “tools” in the metaphorical toolbox of manual therapists and shouldn’t be the mean to the end.

 

References

1. Mostafavifar M, Wertz J, Borchers J. A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. The Physician and Sports Medicine. 2012 Nov;40(4):33-40. doi: 10.3810/psm.2012.11.1986.

2. Morris D, Jones D, Ryan H, Ryan CG. The clinical effects of Kinesio® Tex taping: A systematic review. Physiotherapy Theory and Practice.  2013 May;29(4):259-70. doi: 10.3109/09593985.2012.731675.

3. Kalron A, Bar-Sela S. A systematic review of the effectiveness of Kinesio Taping–fact or fashion? European Journal of Physical and Rehabilitation Medicine. 2013 Oct;49(5):699-709.

4. Parreira Pdo C, Costa Lda C, Hespanhol LC Jr, Lopes AD, Costa LO. Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. Journal of Physiotherapy. 2014 Mar;60(1):31-9. doi: 10.1016/j.jphys.2013.12.008.

5. Montalvo AM, Cara EL, Myer GD. Effect of kinesiology taping on pain in individuals with musculoskeletal injuries: systematic review and meta-analysis. The Physician and Sports Medicine.  2014 May;42(2):48-57. doi: 10.3810/psm.2014.05.2057.

6. Lim EC, Tay MG. Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. British Journal of Sports Medicine. 2015 Dec;49(24):1558-66. doi: 10.1136/bjsports-2014-094151.

7. Vanti C, Bertozzi L, Gardenghi I, Turoni F, Guccione AA, Pillastrini P. Effect of taping on spinal pain and disability: systematic review and meta-analysis of randomized trials. Physical Therapy. 2015 Apr;95(4):493-506. doi: 10.2522/ptj.20130619.

8. Ng N. Kinesio Tape: Fact or Fad? Guardian Liberty Voice. May 10, 2014.

9. Goom, T. Kinesio Tape, Athletic Performance and Self Belief – by Paul Westwood. Running Physio. August 31, 2014.

Further Reading

1. Jacobs D, Silvernail, J. Therapist as operator or interactor? Moving beyond the technique. The Journal of Manual and Manipulative Therapy.  2011 May; 19(2): 120–121.

2. Novella S. Placebo by Conditioning. Science-Based Medicine. July 23, 2015.