The popularity of kinesiology tape, or coloured sports tape, has increased dramatically over the last decade. Despite being invented in the 1970’s by Dr Kenzo Kase, kinesiology tape rose to prominence following the Beijing Olympics in 2008, and is increasingly seen on athletes at all levels of competition.  Despite this rise in popularity, there is still some debate about the clinical efficacy of kinesiology tape.  This is due in part with the historical beliefs of some practitioners who cling to out-dated theories about the purported benefits of kinesiology tape, despite many of these theories having very little evidence behind them.  At RockTape we are committed to furthering the body of scientific knowledge of the effects of kinesiology tape and demonstrating scientifically the positive benefits that we see clinically every day.  To this end, we are actively supporting many studies that are currently being completed around the world, and we promote “evidence – informed” education in our courses worldwide.

How does it work?
The exact physiological mechanisms of how the tape may work remain largely unproven.  Whilst many studies look at the effect of the tape on various parameters such as pain, inflammation, muscle function and joint position sense, there is very little research into HOW the tape may alter these parameters.  In one of the first projects to explore this, a researcher from the USA demonstrated through ultrasound imaging that the tape does in fact have a lifting effect on the subcutaneous tissue layers.  In this unpublished trial by Capobianco (2013), he showed by imaging pre and post tape application, the imaging demonstrates a visible change in the interstitial space.  This early finding is in keeping with the long held belief that part of the tape effect is based on the creating a decompressive effect on the local tissues.  An MRI study by Pamuk and Yucesoy (2015) also demonstrated superficial tissue convolutions after taping the tibialis anterior of healthy subjects.  They also showed heterogenous changes within the tibialis anterior muscle representing mixed areas of excitation and inhibition.  Interestingly they also showed some tissue changes within all muscles of the lower limb compartment, demonstrating that kinesiology tape applied to the skin has a local mechanical effect, but also a more remote effect on adjacent and deep musculature that could seemingly only be explained through neurological means.
The lifting effect that creates convolutions in the skin and superficial tissues is proposed to have three main effects.  Firstly, it may decrease the pressure on the superficial nociceptors and stimulate the mechanoreceptors, leading to less perception of pain in the region.  Secondly, the lifting effect may also allow better glide between the tissue layers, a concept that has been proposed to potentially improve flexibility of the body region being taped, but does not yet have any supporting research evidence.  Thirdly, superficial convolutions have also been proposed to potentially decompress the lymphatic vessels, possibly allowing exudates to be removed from the area more easily.  Some, or all of these factors combined, may be behind the clinical improvements we see with RockTape applications.

Research evidence
The literature remains divided on the efficacy of kinesiology tape.  High levels of evidence are lacking, and whilst systematic reviews do exist, they are divided in their conclusions.  This is likely due to the fact that there are few high quality studies that exist, so summarizing the evidence is troublesome, and many studies lack sufficient power to draw robust conclusions from.  Kalron & Bar-Sela (2013) found that there was “moderate evidence” for pain reduction whilst Lim & Tay (2015) found that kinesiology taping was “superior to minimal intervention for pain relief” for those with more than 4 weeks of pain, and was effective at reducing pain when used as an adjunct to conventional therapies.  Clinically, this supports the way most practitioners would use kinesiology tape, as an adjunct to their existing treatment modalities.

Neurological input – how does tape affect the perception of pain?
An enormous amount of research has been published recently that demonstrates that when people are in pain, their sensory awareness of the affected body part, and indeed even the contralateral limb, can be distorted.  This is where we believe the main benefit of RockTape is achieved.  It is theorized that by stimulating the mechanoreceptors in the skin and subcutaneous tissue, the tape can provide the brain with additional input regarding the body’s position in space, and also to potentially be more cogniscent of this area in general.  Bae et al (2013) found that in a population with chronic low back pain, kinesiology tape in addition to usual care, resulted in a better pattern of abdominal muscle recruitment compared with pre-treatment measures.  Parreira et al (2014) also studied this population and found that regardless of the technique of application, tape was helpful in reducing pain and disability for those with chronic low back pain.  This effect was even maintained to some extent 8 weeks after the treatment ceased, perhaps suggesting that the associated movement patterns or “neurotag” that these patients displayed over the course of their symptoms prior to their involvement in the study, were somehow altered.  Griebert et al (2014) showed that kinesiology tape can have a positive effect on the biomechanics in a group of subjects that either had, or were prone to medial tibial stress syndrome, commonly known as “Shin Spints”.  Applying tape to this group improved their foot loading patterns as they walked across a force plate, yet the same application made no difference to a control group with good biomechanics.  It is this powerful effect that the tape may have on correcting aberrant movement patterns and postures that is one of the most exciting developments with regard to kinesiology tape.

It is often the case that kinesiology taping trials using healthy, asymptomatic individuals show little effect.  This may be because any additional input to the brain that the tape may provide could be very quickly dismissed as it is not meaningful information in the context of the situation at hand, because the system is not under any duress.  In a state of pain or even fatigue, where there is a relative “compromise” in the system, the potential of additional afferent input may be considered more meaningful and therefore affect the efferent outputs more.  For example, Thedon et al (2011) found that input from tape on the skin may be utilized once subjects are fatigued. Their crossover study measured sway in standing balance in two conditions, a control condition and one where a 10cm length of non-elastic tape was applied on both Achilles tendons.  Both conditions were comparable in respect to sway when initially tested.  The authors then had subjects perform calf raises to fatigue and then re-measured standing balance and found the subjects in the taped condition had significantly less sway.  They surmised that subjects may preferentially use their muscle spindle input when this input is reliable.  However, when muscle spindle input was degraded through fatigue, the brain then utilized further information provided by tape on the skin, and subsequently standing balance was improved.  Konishi (2013) also found the same pattern in a similarly designed crossover trial.  In this study the subjects had greater quadriceps strength after fatigue when their knees were taped, compared with their untaped testing.  Baseline measures between the taped and untaped conditions were not significant, consistent with our view that immediate effects of taping healthy muscles are typically insignificant. Cortesi, Cattaneo, & Jonsdottir’s (2011) findings of improved standing balance in subjects with multiple sclerosis who had their Achilles tendons taped also supports the theory that tape can provide substantial improvements in balance in those with degradation of their sensory inputs, when supplementary information from the cutaneous mechanoreceptors may be of assistance.

How does tape affect muscle function?
It is clear that some of the original beliefs about kinesiology tapes are simply not based on any scientific evidence.  To be fair, Kase introduced many of these theories in the 1970’s and there are very few therapeutic concepts in use today that remain true to their 1970’s philosphies.  Tendonopathy management is one such example where the shift in “evidence informed practice” has been significant even in the last decade thanks to the research work of a number of brilliant minds such as Jill Cook, Craig Purdham and their team.

With regard to kinesiology tape, one such 1970’s concept that has been completely debunked by modern research is the notion that the direction in which the tape is applied results in a pre-determined facilitatory or inhibitory effect on the targeted muscle.  There have been a number of studies that have investigated this theory such as those by Vercelli et al (2012), Fratocchi et al (2013) and Lumbruso et al (2014).  These studies concur with the common sense view that regardless of the direction of the tape application, an elastic tape will always recoil towards its middle.  The resultant effect on the muscle could be excitatory or inhibitory, with many studies showing conflicting results.  It is clear that applying tape to the skin, regardless of the direction of its application, can have an effect on the muscle’s excitability but predicting the effect would appear impossible.  It seems that there may even be some variation amongst different muscle groups, with the Lumbruso et al study showing an excitatory effect on the gastrocnemius muscle quite quickly, but a delay in the excitatory effect for the hamstrings.  Other studies show no change in peak torque produced, but the muscles may be able to reach their peak torque more quickly.  This was the case in the study by Wong, Cheung & Li (2012) when they measured the effect of tape on the VMO muscle. Chen et al (2008) also found that their knee pain subjects had earlier onset of VMO activity, suggestive of better functional control of descending stairs when compared with untaped controls.  Yet other studies show no change in muscle output at all with taping.  Many studies have demonstrated no gain in strength when kinesiology tape has been applied to healthy subjects.  At RockTape, we believe that this is certainly the case – applying tape to a “healthy” muscle group will not make it produce more force.  However, recently two studies have demonstrated that there may be a delay in the onset of fatigue when healthy subjects are taped.  Zhang et al (2015) demonstrated that taping the extensor muscles in a group of tennis players reduced the “work fatigue” of the muscles over 50 contractions significantly more than a placebo tape.  Ahn et al (2015) showed
that once fatigued, kinesiology tape applied to the quadriceps resulted in an immediate improvement in force output compared with placebo tape or no tape.  Both of these small studies concur with our beliefs that kinesiology tape can improve muscle function when there is a compromise in its normal function.  That compromise could be due to fatigue, injury, pain, or even a neurological deficit.

There is a paucity of research on the effect of kinesiology tape on neurological populations, however recent studies such as that by Tamburella et al (2014) found that kinesiology tape had some profound effects on a small group of subjects with spinal cord injury when compared with placebo taping.  After 48 hours kinesiology tape had improved all the primary outcome measures – significantly reducing spasticity, improving balance and improving the quality of gait and distance covered in the 6 minute walk test.

Another interesting study was published by Farquharson and Greig (2015).  This study showed that kinesiology tape was superior to static stretching or PNF stretching in improving hamstring flexibility over a 30 minute period.  PNF stretching was immediately more helpful, however the benefit of the kinesiology tape continued to increase until approximately 24 minutes after application.  This may be of benefit to those people whom experience chronic hamstring tightness during their sporting activities and certainly warrants further research.

Can kinesiology tape affect inflammation & circulation?
The proposal that kinesiology tape produces improved outcomes in the areas of inflammation and circulation is not well researched.  There have been some studies looking at the effect of kinesiology tape on inflammation but they show conflicting results.  One by Tsai et al (2009) showed that application of kinesiology tape in addition to usual therapy was equally effective with regard to control of breast cancer related lymphedema when compared with traditional short stretch bandaging and usual therapy.  In this study they found that when compared with the traditional therapy, those that had the kinesiology tape intervention had greater compliance with wearing the tape, decreased difficulty in its use as family members did not have to re-apply after showering etc, and reports of greater comfort by the patients.  Conversely, Smykla et al (2013) found that bandaging was more effective than kinesiology tape in their population of breast cancer related lymphoedema patients.  A recent small study by Nunes et al (2015) on the use of kinesiology tape for acute ankle sprains also failed to show significant benefits in terms of reducing swelling in this population.  To date there is insufficient evidence to draw definitive conclusions regarding the efficacy of using kinesiology tape in the treatment of inflammation.  Anecdotally in the clinic there seems to be reductions of inflammation in some patients, whereas others show little change.

Interestingly, there is a lot of anecdotal evidence that shows the dramatic effect that kinesiology tape can have on bruises.  Many pictures exist of pre/post taping over bruising and the results are profound.  The mechanism of effect of this dramatic reduction in bruising underneath taped areas is unknown but has been proposed to be due to improvements in lymphatic and superficial blood flow.  To my knowledge, there are no research articles that have investigated this effect of taping over haematomas, nor any comparison to traditional methods of acute injury management including the R.I.C.E. paradigm.

The creation of convolutions in the skin with taping may also be the reason behind the improvements in Delayed Onset Muscle Soreness (DOMS) demonstrated in a small study by Bae et al (2014).  Their experimental group had a quicker resolution of DOMS symptoms compared to their sham taped control group.

A trial by Tsai, Chang & Lee (2010) also showed some interesting findings with kinesiology tape applied to subjects with plantar fasciitis.  When compared with controls, the experimental taped group showed a reduction in pain scores but interestingly a reduction in the thickness of the plantar fascia at the insertion site as measured by ultrasound imaging.  The sonographer was blinded for group allocation.  This change was seen with one week of taping and may suggest an increase in circulation to the region in order for tissue remodeling such as this to occur?  Also a study by Karwacinska et al (2012) showed a positive effect of using kinesiology taping on a group of children with hypertrophic and keloid scarring over a twelve week period.  This tissue remodeling may also be suggestive of changes in circulation in the taped area.

Future Directions for Kinesiology Taping Research
There is much to do regarding further research into the effects of kinesiology taping.
–  Initially we need small, well designed efficacy trials to further define what needs investigating in the larger randomized controlled studies in the future.
–  The exact mechanisms of effect for the tape remain largely unknown with only one published MRI study providing any guidance.
–  We need larger randomized controlled studies to further investigate and consolidate the findings of the recent smaller pilot studies.  These include studies that have found a decrease in subject’s perception of pain as well as some of the potential benefits of improving performance through promoting muscle efficiency and reducing the negative performance effects of fatigue.
–  We need to determine the optimal length of time of application of the tape. There have been some interesting findings such as those by Lumbruso et al (2014) that found an immediate increase in excitability of the gastrocnemius in their healthy group after the tape was applied, yet a delay in a similar excitability in hamstrings that was only detected 48 hours later. Many studies have found no significant benefit from the tape immediately after its application, but have not re-tested 24 hours later- is there some delay in the effect that the tape has on the slow adapting mechanoreceptors that has not currently been identified?  Kaya, Zinnuroglu & Tugcu (2011) found significant differences in outcome measures (DASH scores) of those with shoulder impingement that were treated with kinesiology tape in the second week of their study, whereas these subject’s pain scores decreased after the first week. Evidently their pain decreased first, then functional scores improved later- this may have implications for the methodology of future studies.
–  The effect of kinesiology tape in certain populations needs further study, such as those with neurological deficits.
–  The effects of kinesiology tape on inflammation could also be studied further. This area of study could also look at inflammation in orthopedic injuries and post-surgical applications, as well as further work looking at the use of kinesiology tape in recovery from high intensity exercise.
–  Can this tape have a role in the prevention of injuries through improved neuromuscular control and reduction of fatigue?  Many studies have identified risk factors for certain injuries that could be addressed with taping. For example, Cameron, Adams, Maher and Misson (2009) studied the hamstring muscle group in Australian Rules football and postulate that the hamstring injuries could occur through errors in position sense during foot contact with the ground whilst running.  Some studies into kinesiology tape have demonstrated improved position sense or force sense in taped subjects (Chen et al and Chang et al) so this may have positive benefits in athletes prone to hamstring injuries, in addition to studies of these athletes with posterior chain taping applied.  Greg Myer’s group has produced numerous papers looking at the risk factors for ACL injuries and patellofemoral pain in adolescent girls.  The main risk factor identified by these studies is the valgus collapse that often occurs in landing and cutting actions (Hewett et al 2005).  This is the result of decreased hamstring recruitment and poor trunk control leading to increased hip adduction and internal rotation.  The effect of spiral taping of the lower limb was investigated by Song et al (2015) in a small study.  Spiral taping of the femur from VMO to PSIS decreased the knee pain of subjects with patella-femoral pain.  This study did not show immediate changes in kinematics, but it would be interesting to re-test some days after application to see if this had occurred.

There is much work to be done before kinesiology tape can be considered to have a rigorous evidence base.  However, it is often said that the lack of evidence does not constitute evidence of lack of effect.  Anecdotally practitioners around the world continue to see great benefits in their patients after applying kinesiology tape, and it may be that we need to avoid being blinded by the old theories about its mechanism of effect, and embrace the role of the central nervous system in pain perception and movement disorders before we can truly understand the role of kinesiology tape in clinical practice.

REFERENCES
Ahn, I.K., Kim, Y.L., Bae, Y., & Lee, S.M., (2015). Immediate effects of kinesiology taping of quadriceps on motor performance after muscle fatigued induction. Evidence-Based Complementary and Alternative Medicine http://dx.doi.org/10.1155/2015/410526
Bae, S., Lee, Y, Kim, G., & Kim, K., (2014). The effects of kinesio-taping applied to delayed onset muscle soreness on changes in pain. International Journal of Bio-Science and Bio-technology 6, 3, 133-142
Bae, S.H., Lee, J.H., Oh, K.A., & Kim, K.Y., (2013). The effects of kinesio taping on potential in chronic low back pain patients anticipatory postural control and cerebral cortex. Journal of Physical Therapy Science 25, 1367-1371.
Capobianco, S., (2013). The effect of kinesiology tape on superficial tissues – a pilot study using ultrasound imaging. Unpublished trial
Cameron, M.L., Adams, R.D., Maher, C.G., & Misson, D., (2009). Effect of the HamSprint drills training programme on lower limb neuromuscular control in Australian football players. Journal of Science and Medicine in Sport 12 (1) 24-30.
Chen, P.L., Hong, W.H., Lin, C.H., & Chen, W.C., (2008). Biomechanics Effects of Kinesio Taping for Persons with Patellofemoral Pain Syndrome During Stair Climbing. International Federation for Medical and Biological Engineering Proceedings Vol 21. 395-397.
Cortesi, M., Cattaneo, D., & Jonsdottir, J., (2011) Effect of kinesio taping on standing balance in subjects with multiple sclerosis: a pilot study. Neurorehabilitation 28 365-372.
Farquharson, C., & Greig, M., (2015). Temporal efficacy of kinesiology tape vs traditional stretching methods on hamstring extensibility. International Journal of Sports Physical Therapy Vol 10 No. 1 45-51.
Fratocchi, G., Di Mattia, F., Rossi, R., Mangone, M., Santilli, V., & Paoloni, M., (2012). Influence of Kinesio Taping applied over biceps brachii on isokinetic elbow peak torque. A placebo controlled study in a population of young healthy subjects. Journal of Science and Medicine in Sport doi 10.1016/jsams.2012.06.003
Griebert, M.C., Needle, A.R., McConnell, J., & Kaminski, T.W., (in press). Lower leg kinesio tape reduces rate of loading in participants with medial tibial stress syndrome. Physical Therapy in Sport doi.org/10.1016/j.ptsp.2014.01.001
Hewett,T.E., Myer, G.D., Ford, K.R., Heidt, R.S., Colosimo, A.J., McLean, S.G., van den Bogert, A.J., Paterno, M.V., Succop, P., (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. American Journal of Sports Medicine 33 (4) 492-501.
Kalron, A., & Bar-Sela, S., (2013). A systematic review of the effectiveness of Kinesio Taping – Fact or fashion. European Journal of Physical & Rehabilitation Medicine 49, 1-11
Karwacinska, J., Kiebzak, W., Stepanek-Finda, B., Kowalski, I.M., Protasiewicz-Faldowska, H., Trybulski, R., & Starczynska, M., (2012). Effectiveness of kinesio taping on hypertrophic scars, keloids and scar contractures. Polish Annals of Medicine 19, 50-57.
Konishi, Y., (2012). Tactile stimulation with Kinesiology tape alleviates muscle weakness attributable to attenuation of Ia afferents. Journal of Science and Medicine in Sport.
Nunes, G.S., Vargas, V.Z., Wageck, B., Hauphental, D.P.dS., da Luz, C.M., de Noronha, M., (2014). Kinesio taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial. Journal of Physiotherapy http://dx.doi.org/10/1016/j.phys.2014.11.002
Lim, E.W.C., & Tay, M.G.X., (2015) 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 doi: 10.1136/bjsports-2014-094151
Lumbruso, D., Ziv, E., Vered, E., & Kalichman, L., (2014). The effect of kinesio tape application on hamstring and gastrocnemius muscles in healthy young adults. Journal of Bodywork and Movement Therapies 18, 130-138.
Parreira, P.S., Costa, L.M., Takahashi, R., Hespanhol Jr, L.C., da Luz Jr, M.A., da Silva T.M., & Costa, L.O.P., (2014). Kinesio taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial. Journal of Physiotherapy 60, 90-96.
Song, C., Huang, H., Chen, S., Lin, J., & Chang, A.H., (2015). Effects of femoral rotation taping on pain, lower extremity kinematics, and muscle activation in female patients with patello-femoral pain. Journal of Science & Medicine in Sport 18 (4) 388-393
Tamburella, F., Scivoletto, G., & Molinari, M., (2014). Somatosensory inputs by application of Kinesio Taping: effects on spasticity, balance , and gait in chronic spinal cord injury. Frontiers in Human Neuroscience 8, 367, 1-9
Thedon, T., Mandrick, K., Fossiac, M., Mottet, D., & Perrey, S., (2011). Degraded postural performance after muscle fatigue can be compensated by skin stimulation. Gait and Posture 33 686-689.
Tsai, C., Chang, W., & Lee, J., (2010) Effects of short term treatment with kinesiotaping for plantar fasciitis. Journal of Musculoskeletal Pain 18 (1) 71-80.
Tsai, H., Hung, H., Yang, J., Huang, C., Tsauo, J., (2009). Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study. Support Care Cancer 17 1353-1360.
Vercelli, S., Sartorio, F., Foti, C., Colletto, L., Virton, D., Ronconi, G., & Ferriero, G., (2012). Immediate effects of Kinesio Taping on quadriceps muscle strength: a single-blind, placebo controlled crossover trial. Clinical Journal of Sports Medicine 22 (4) 319-326
Wong, O.M.H., Cheung, R.T.H., & Li, R.C.T., (2012). Isokinetic knee function in healthy subjects with and without Kinesio Taping. Physical Therapy in Sport 13 255-258
Zhang, S., Fu, W., Pan, L., Xia, R., & Kiu, Y., (2015). Acute effects of Kinesio taping on muscle strength and fatigue in the forearm of tennis players. Journal of Science and Medicine in Sport doi.org/10.1016/j.jsams.2015.07.012