|Year : 2017 | Volume
| Issue : 1 | Page : 21-29
Comparison of effectiveness of kinesio taping with nonelastic taping and no taping in players with acute shin splints
Urvashi Sharma1, Akhoury Gourang Kumar Sinha2
1 Department of Physiotherapy, DPSRU, New Delhi, India
2 Department of Physiotherapy, Faculty of Medicine, Punjabi University, Patiala, Punjab, India
|Date of Submission||23-Feb-2017|
|Date of Acceptance||18-May-2017|
|Date of Web Publication||18-Aug-2017|
Akhoury Gourang Kumar Sinha
Department of Physiotherapy, Punjabi University Patiala, Punjab - 147 002
Source of Support: None, Conflict of Interest: None
Background: Kinesio taping (KT) has emerged as a popular treatment for several health conditions. It is suggested that application of K-tape may prove beneficial in relieving symptoms of shin splints.
Objective: The aim of this pilot study was to gather preliminary evidence about the effectiveness of KT in shin splints.
Methodology: This prospective case–control study was conducted for 3 days on thirty active sports persons afflicted with shin splints (M = 22, F = 8; mean age 19 ± 2.59; duration of symptoms 48.16 ± 13.42 days) assigned randomly into three equal groups. The intervention in control group consisted of 10 min of ice massage followed by 10 min of transcutaneous electrical nerve stimulation. In KT group, Y-strip K-tape was applied to the lower leg using the technique described by Griebert et al. that had shown a reduction in medial loading in medial tibial stress syndrome. In rigid tape (RT) group, white nonelastic adhesive tape cut into a Y-shape similar to KT strip was applied. Outcome measures were duration of 50 m sprint, volume of limb, and pain response at rest, during resisted isometric contraction (RIC) of select muscles, and after completion of 50 m sprint. Two ways repeated measure ANOVA with time as the repeated factor was conducted for each outcome measure with level of significance set at 0.05.
Results: Between the group difference for age (F = 0.35, P = 0.70) and duration of symptom (F = 0.40, P = 0.67) were not significant. The day-by-group interaction was not significant for any outcome measure. For the patient-reported parameters, i.e., pain at rest, pain at RIC, and pain at 50 m sprint, the main effects were significant (P ≤ 0.05) for time but not for groups.
Conclusion: Any benefits of KT over and above RT and control group were not observed in active players presenting with symptoms of shin splints.
Keywords: Kinesio taping, rigid taping, shin splints
|How to cite this article:|
Sharma U, Sinha AG. Comparison of effectiveness of kinesio taping with nonelastic taping and no taping in players with acute shin splints. Physiother - J Indian Assoc Physiother 2017;11:21-9
|How to cite this URL:|
Sharma U, Sinha AG. Comparison of effectiveness of kinesio taping with nonelastic taping and no taping in players with acute shin splints. Physiother - J Indian Assoc Physiother [serial online] 2017 [cited 2019 Aug 20];11:21-9. Available from: http://www.pjiap.org/text.asp?2017/11/1/21/213278
| Introduction|| |
Shin splints, a nonspecific term to describe exertional leg pain, is one of the most common problems of athletes, ballet dancers, and military recruits. The condition is characterized by pain along the posteromedial aspect of the distal two-thirds of the tibia that occurs before, during, or after activity. Shin soreness, shin splints syndrome, medial tibial stress syndrome (MTSS), and soleus syndrome are the other terms that have been used to describe this exercise-induced pain syndrome. At present, there is no universally accepted consensus on either the etiology or treatment of this condition. The treatment of shin splints focuses on providing symptomatic relief and modifying the risk factors. In clinical practice, the use of various modalities to treat symptoms is common. The acute pain associated with shin splints is treated with the RICE (Rest, Ice, Compression and Elevation) regimen. The use of manual therapy techniques such as digital ischemic pressure, transverse friction massage, and sustained myofascial tension has also been advocated. Besides, nonsteroidal anti-inflammatory drugs, iontophoresis, phonophoresis,, ice massage, ultrasound,, low-energy laser treatment, periosteal pecking, stretching and strengthening exercises, sports compression stocking, lower leg braces,, extracorporeal shockwave therapy,, and pulsed electromagnetic field have been investigated, but it remains unclear which treatment is most effective.,
Over the last decade, kinesio taping (KT) has emerged as a popular treatment for several health conditions. Designed primarily for the treatment of sports-related injuries by a Japanese chiropractitioner, KT is described as different from the traditional white nonelastic athletic tape through its wave-like grain elastic adhesive material mimicking the thickness of human skin. It is claimed that, when applied with appropriate tension, KT lifts the fascia and soft tissue and produces additional space below the area of application which is said to enhance clearance of extra fluid of edema and bleeding by improving circulation and normalize muscle function by realigning fascial tissue and providing increased proprioceptive input. These effects are postulated to bring about immediate reduction of pain and improved athletic performance.
Griebert et al. in 2016 reported that application of KT decreased the rate of medial plantar loading among patients with a history of MTSS and suggested that application of K-tape may prove beneficial in relieving symptoms of shin splints. The investigators could not locate any study that examined the use of KT in shin splints. Keeping this in consideration, this pilot study was designed to have preliminary evidence about the effectiveness of KT in shin splints. The specific research questions were (a) does the addition of KT to conventional symptomatic physiotherapy modalities benefit the players afflicted with shin splints in terms of reducing discomfort and improving performance and (b) can the similar benefits be achieved by application of rigid tape (RT)?
| Methodology|| |
Thirty university level players (mean age 19 ± 2.59 years) of average duration of symptoms 48.16 ± 13.42 days participated in this prospective case–control study for 3 days. Participants were randomly assigned to three groups: KT group, RT group, and control (C) group. The inclusion criteria were (a) players participating in regular training program presenting with history of pain located on the posteromedial border of the tibia induced by exercise that lasted for hours or days after exercise, (b) diffuse tenderness/discomfort on palpation of the lower 1/3rd of posteromedial border of the tibia, and (c) no history of paresthesia. The same criteria were used by Moen et al. The exclusion criteria were (a) painful passive movement of the ankle, (b) history of fractures or surgery of the lower limb, (c) history of skin allergies to adhesive tape, (d) preexisting skin conditions such as eczema, dermatitis, and psoriasis, and (e) positive tuning fork test for stress fracture and positive sphygmomanometer test for chronic compartment syndrome., The exclusion criteria were chosen in an attempt to increase homogeneity of sample by excluding the conditions mimicking shin splints and the contraindications of taping and transcutaneous electrical nerve stimulation (TENS).
Enrollment and group allocation
Forty-five sports persons of nonspecific leg pain sports persons (age 15–30 years) coming to sports clinic for the treatment of nonspecific leg pain were screened for enrollment in the study using a screening form. Participant satisfying the inclusion and exclusion criteria was allocated to three groups according to their order of registration in the clinic. The first patient was allocated to KT group, second to RT group, and third was included in group C. This sequence was repeated till the target sample size of ten in each group was achieved. All participants signed informed consent form. The procedure for the study was approved by the Institutional Ethics Committee of Punjabi University, Patiala, as per the protocol of Indian Council of Medical Research vide IEC letter no. 29 dated January 21, 2016.
The intervention in control group consisted of cryotherapy and TENS. Ice was applied over entire leg by ice cube massage for 10 minutes. Thereafter, four channel TENSs (pulse rate = 150 Hz, pulse width = 150 μs) applied for another 10 min, using two pairs of self-adhesive electrode placed over anterolateral compartment and posteromedial compartment of the lower leg. The intensity was gradually increased up to the limit of participant's comfort.
Kinesio taping group
The intervention in KT group consisted of cryotherapy, TENS, and KT. For the first 20 min, ice and TENS were applied for 10 min each in the same manner as used in control group. Thereafter, KT was applied to the lower leg by a physiotherapist specializing in sports physiotherapy using the technique described by Griebert et al. (2016) that had shown a reduction in medial loading in MTSS. The tail of a single Y-strip of KT was placed on the proximal third of medial tibia. Each half of the Y-strip was applied in a manner that they lay anterior and posterior to the medial malleolus and terminated under the medial longitudinal arch of the foot [Figure 1]. No tension was applied on the proximal and distal ends of the tape; while the remainder of the tape was applied with 75% tension, player was instructed not to remove the tape.
Rigid tape group
The intervention in RT group consisted of cryotherapy, TENS, and RT. For the first 20 min, ice and TENS were applied for 10 min each in the same manner as used in control group. The placement of RT was similar to KT. A 6 inch strip of white nonelastic adhesive tape was torn and cut into a Y-shape similar to KT strip. The tail of the tape was placed on the base of the proximal third of the medial tibia, and the ends of the tape were placed medial and lateral to the medial malleolus similar to KT [Figure 2].
Outcome measures of this study were duration of 50 m sprint, volume of limb, and pain response measured by Numeric Pain Rating Scale (NPRS) on three different situations.
50 m sprint
For conduct of this test, the starting and end point of 50 m area on athletic tract were marked with white chalk. Participant was asked to take the position at the starting point and instructed to run at full speed to the end point at command “go.” The time taken to touch the end point in seconds was noted.
Volume of leg
Water displacement method was used for measuring the volume of leg. A volume meter (38 cm length, 33 cm width, and 33 cm height) made up of translucent material was placed on a leveled surface near water supply outside the athletics ground. A tube was connected to the faucet of supply line for filling water in the volume meter chamber up to the brim of the gutter of the volume meter. Participant sitting on a chair was asked to immerse one leg into the water-filled volume meter so that his/her foot was firmly placed in the bottom of volume meter with heel touching the wall of the instrument. Participant sat still till the water stopped flowing. The water flow out of volume meter was collected in a tub and measured using a 1000 ml beaker, 100 ml cylinder, and 10 ml cylinder with calibration of 0.2 ml. This parameter is used for quantifying the change in the volume of a segment resulting from swelling, generalized edema or atrophy. Comparison with the contralateral segment provides an idea of changes occurring in the affected segment.
The NPRS is a segmented 11-point numeric version of the visual analog scale (VAS) in which a respondent selects a whole number that best reflects the intensity of pain. The numeric scale ranges from “0” representing one pain extreme (e.g., “no pain”) to “10” representing the other pain extreme. The NPRS has been shown to have high interrater/intrarater reliability, excellent internal consistency, and good sensitivity while producing data that can be statistically analyzed. Raw change of 3 points or 27% is required for the NPRS scores to be clinically important in patients with neck/upper extremity/lower extremity. NRPS was used for measuring pain intensity at rest, during resisted isometric contraction (RIC) of select muscles, and after completion of 50 m sprint.
Resisted isometric contraction
The clinic test of resisted isometric movement is used for evaluating muscle, tendon, and its attachments at bone. Depending on the location of elicited pain, a positive test indicates first- and second-degree strain, tendinitis, paratendinitis, or paratenonitis. A strong and painful RIC indicates a local lesion of muscle or tendon. Resisted isometric testing of 11 muscles was performed as per the protocol of standard manual muscle testing. The participant was asked to rate the pain perception of intensity of pain during the RIC of each muscle on NPRS. The muscles evaluated through RIC included extensor hallucis longus, extensor digitorum longus, flexor hallucis longus, flexor digitorum longus, flexor digitorum brevis, tibialis anterior, tibialis posterior, gastrocnemius, soleus, peroneus tertius, and peroneus longus. For the purpose of analysis, the average of 11 scores was computed.
Upon arrival of the participant to clinic, the volume of both legs was measured and the baseline measurement of outcome measures was obtained in the following order: pain at rest, pain with RIC, duration of 50 m sprint, and pain after 50 m sprint. Thereafter, interventions were provided according to the group of participant. After intervention, the outcome measures were evaluated in the same order of preintervention evaluation. Patients were instructed to not to remove KT or consume any medication. The same procedure was followed for the next two sessions conducted at the interval of 24 h. Before start of the 2nd and 3rd session, investigator examined the adherence of tape and if not found proper reapplied the tape. In general, the RT did not retain its place and thus was to be applied afresh in each session. In case of KT, majority of participants retained the tape for the first 2 days.
Descriptive statistics were calculated for all the three groups at 6 time intervals: preintervention for days 1, 2, and 3 and postintervention days 1, 2, and 3. The volume of leg was recorded only preintervention on all the 3 days. Two ways repeated measure ANOVA with time as the repeated factor was conducted for each outcome measure with level of significance set at 0.05. The hypothesis of interest was the group-by-time interaction. Our intention was to conduct planned pairwise comparisons to examine differences from baseline to each follow-up point between groups if a significant interaction was identified on a variable. In an attempt to identify the variable that best represents the magnitude of shin splints, a correlation analysis of all the dependent variables was done using parametric (Pearson's) moment product correlation test. For analysis of data and preparation of graphs, SPSS version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.) and Microsoft excel 2007 were used.
| Results|| |
The sample consisted of 22 male and 8 female participants participating in different sports (athletics, taekwondo, judo, American football, football, boxing, and kabaddi) with mean age of 19 ± 2.59 years. The average duration of symptom was 48.16 ± 13.42 days. The age, gender, and average duration of symptoms of all the three groups are presented in [Table 1]. Between the group difference for age (F = 0.35, P = 0.70) and duration of symptom (F = 0.40, P = 0.67) were not significant [Table 1].
The day-by-group interaction was not significant for any outcome measure [Table 2]. For the patient-reported parameters, i.e., pain at rest, pain at RIC, and pain at 50 m sprint, the main effects were significant (P = 0.05) for time but not for groups. Significant effects of group or days were not observed for the parameter of duration of sprint and volume of limb. The mean scores of all the 3 days of KT, RT, and control groups are presented in [Table 3],[Table 4],[Table 5] respectively.
|Table 3: Daywise mean and standard deviation of all the outcome measures in kinesio taping group|
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|Table 4: Daywise mean and standard deviation of all the outcome measures in rigid tape group|
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|Table 5: Daywise mean and standard deviation of all the outcome measures in control group|
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Statistically significant positive correlation (P < 0.05) of pain at RIC was observed with the parameter of duration of sprint (r = 0.24), pain at rest (r = 0.39), and pain at sprint (r = 0.42). Pain at rest was not significantly correlated with the duration of sprint [Table 4].
| Discussion|| |
Studies evaluating the effectiveness of KT have compared KT with no treatment, sham taping, and other interventions and also the addition of KT with other interventions. The present study falls under last category where effect of the addition of RT and KT was compared with ice and TENS application on active sports persons presenting with symptoms of shin splints. To best of the knowledge, this study is probably the first study that reports the effect of KT on shin splints.
The main finding of this study is that any benefits of KT over and above RT and control group were not observed in patient with presenting with symptoms of shin splints. Data of the study indicate that although some improvement over the time in patient-reported parameters has taken place in all the three groups, it was not meaningful. The objective parameter of the functional performance, i.e., duration of sprint also did not show any improvement posttreatment in any group.
In a systematic review, Parreira et al. observed that the addition of KT was no better than other interventions alone for participants with rotator cuff lesion or/and shoulder impingement syndrome, chronic neck pain, patellofemoral pain syndrome (PFPS), and plantar fasciitis. The findings of the present study extend their observation to the condition of shin splints as well.
In the literature, no validated outcome measure for MTSS is available. The previous studies used different outcome measures making it difficult to compare the findings. Andrish et al. used no reported tenderness or being able to run 500 consecutive meters as outcome measure. Days to return to active duty and time to run 800 m without pain as outcome measure were used as primary outcome measure in the studies of Nissen et al. and Johnston et al. Moen et al. used time to complete a running program as the primary outcome measure.
The objective and duration of our study is different from the previously published RCTs which examined the efficacy of specific therapy regimen on shin splints.,,, We were interested in determining whether the addition of taping contributes to resolution of symptom of pain or not and whether the addition of KT improves the capacity of player to train with less pain and improved speed. Our primary objective of interest was the pain response during sprint and at rest. Limb volume and duration of sprint were the secondary objective. The parameter of pain at RIC of muscle reflects the extent of dysfunction of muscle and tendon. This parameter has not been used previously in the research of shin splints. It is suggested that MTSS is a consequence of repetitive stress imposed by impact forces that eccentrically fatigue the muscle of leg and reduce their shock absorption ability resulting in transmission of excess forces on the bone leading to periostitis, enthesis, fibrositis, myositis, traction periostitis, tenosynovitis, and tendonitis of the tibialis anterior, tibialis posterior, soleus, or flexor hallucis longus muscles. Increased pronation is known to increase the ground reaction forces and thus is considered as associated with the genesis of MTSS. Griebert et al. have shown that KT application reduced the rate of medial loading in participants with history of MTSS. We speculated that proposed correction of altered biomechanics by application of KT would facilitate the muscle function which would be reflected in lesser pain intensity during RICs and improvement of sprint performance.
However, significant between-group differences were not observed either in pain at RIC or duration of sprint. Previous reports with regard to the effect of KT on muscle function and functional performance yielded inconclusive results. The results of this study are in agreement with the studies that reported no effect of KT application on muscle function,,,,,,,,,,, and performance.,,,,,, However, it is in variance with the studies reporting beneficial effect of KT on muscle function,, and performance.,,,,
With regard to the efficacy of KT in pain reduction in acute and chronic conditions, contradictory findings are reported in literature. Some studies have reported significant reduction of pain with application of KT.,,,,,,,,, On the other hand, an equal number of studies have failed to demonstrate a reduction in pain intensity following KT applications.,,,,,, The finding of the present study provides support to the latter group of studies. The parameter of pain at rest and pain with 50 m sprint did not demonstrate significant within or between-group differences before and after application of tape on all 3 days. Further, these differences also did not surpass minimally clinically important difference for pain.
Thelen et al. did not observe any significant difference in pain score either after KT or sham KT (RT) application in participants with shoulder impingement syndrome. Firth et al. (2010) studied the effectiveness of KT on function, pain, and motoneuronal excitability in achilles tendinopathy and reported no immediate effects on KT on these parameters. In patients with PFPS pain, Aytar et al. observed that no significant difference was found between groups regarding the intensity of pain during ascending and descending stairs and walking. Akbas et al. in a randomized controlled trial studied the effect of additional KT over exercise in treatment of patients with PFPS and concluded that the addition of KT did not improve results. Parreira et al. observed that KT with convolutions was no more effective than simple application of tape. Paoloni et al. observed that KT was not more effective than conventional physical therapy in treating chronic low back pain patients.
On the other hand, in a study on the patient with plantar fasciitis, Tsai reported that the addition of KT to traditional physiotherapy program consisting of therapeutic ultrasound and TENS to the plantar fascia produced a significant reduction in pain intensity and in thickness of plantar fascia at the insertion site. However, the methodology of this study has been questioned in subsequent review. Evermann concluded that KT was superior to conventional multimodality physiotherapy but did not report between-group differences in pain severity as a continuous outcome at equivalent time points but did report significantly more rapid resolution of symptoms with KT. Simsek et al. concluded that adding KT to exercises is more effective than exercises alone in shoulder pain. Castro-Sánchez et al. in a study comparing the effect of 7 days of KT with sham taping on back pain observed that although KT reduced disability and pain, the effects were too small to be clinically worthwhile. Similar observation was reported by González-Iglesias et al. in participants with neck pain.
In a systematic review of studies, Parreira et al. concluded that comparison of KT with sham taping either provided no significant benefit or its effect was too small to be clinically worthwhile. On the other hand, the systematic review of Lim and Tay concluded that KT was superior to minimal intervention but was not more effective than other forms of intervention in reducing pain.
Pain-reducing effect of KT is attributed partially to its decongestive property of KT. It is claimed that lifting of skin creates additional space that facilities the accelerated absorption of excess fluid. The parameter of volume of limb was included in the study to evaluate this aspect. It was anticipated that KT would produce significant reduction of limb volume in participants with shin splints. However, no effect of any intervention was observed in any group.
The studies examining this issue have reported contradictory claims. In a study evaluating the role of KT in patients who developed edema of the thigh after undergoing limb lengthening by ilizarov method, Bialoszewski et al. reported that the addition of KT to standard lymphatic drainage therapy resulted in significant reduction of circumference of lower limb, a reduction in limb volume. However, they had not conducted a between-group analysis, and it is not clear whether the reduction was significantly different from sham taping group or not. Tsai et al. reported that the addition of KT to standard decongestive lymphatic therapy in breast cancer-related lymphedema resulted in no significant difference in limb size, water composition of upper extremity, lymphedema-related syndrome, and health-related quality of life scores. Unlike the present study, none of the previous studies have used the parameter of volumetric measurement of limb. This parameter is more objective than the circumference measurement and is routinely used in hand conditions to monitor the swelling. Two inferences can be drawn from the examining the data: (a) interventions were ineffective in reducing swelling or (b) the component of swelling is not a constant feature of shin splints. Investigator could not locate any study that evaluated the volume changes associated with shin splints making it difficult to draw a conclusion. There is a need to explore this issue in future studies.
Parreira et al. attributed the growing use of KT to massive marketing campaigns rather than high-quality, scientific evidence with clinically relevant outcomes. They suggested that the clinicians should carefully consider the costs and the effectiveness of this intervention when deciding whether to use this intervention. The similar opinion was also put forth by Kalron and Bar-Sela who noted that in contrast with most physical therapy modalities, the marketing of KT tape utilizes far more intense promotion strategies that may have the ability to attract the uninformed amateur sports professionals. They further opined that the role of health professional should be to confirm the effectiveness of a modality through evidence-based knowledge not only due to its popularity.
| Conclusions and Limitations|| |
The present study was conducted to evaluate the effect of KT in real life situation where the sports person continued their normal training schedule and the treatment was carried along with the training and aggravating situations. We have not observed any significant advantage of KT application in participants with shin splints over RT or no tape conditions. Being a prospective case–control study, it has not employed independent assessor to record the outcome measures which can be considered as a major limitation of the study. The inability to control the psychological variables that might have affected the outcomes could be another limitation as taping is known to exert placebo effect. In view of relatively small sample size, it is imperative to cross validate the observations on a larger sample size using double-blind randomized trials. Postpriori analysis using the data of VAS at 50 m sprint indicates that a sample size of 23 in each group is required to detect the meaningful clinical difference of 3. In conclusion, much against the popular perception, the addition of KT has not yielded beneficial effect in the management of shin splints.
Financial support and sponsorship
This study was done as part of academic work in the university and no funding was received from any government or non-government organization.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]