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the fitness skeptic is a blog that takes a critical look at the health and fitness industry.

in it I'll examine the claims, products, practises and commonly held beliefs and SCRUTINISE the evidence.

My aim is to separate what is true from what is not and encourage the fitness consumer and fitness professional to be more skeptical. 

I’ll take no prisoners when it comes to criticising the scam artist or highlightling the bogus but I’ll also give credit where credit is due.

Welcome to the fitness skeptic

Kinesio Taping in Sport: Another Victory for Marketing over Science?

A brilliant piece of marketing at the 2008 Olympics saw Elastic Therapeutic Tape come to prominence when Kinesio USA donated 50000 roles of their brightly coloured product (Kinesio Tape) to 58 of the participating nations. Before we knew it, athletes from around the globe were sporting strips of fluorescent tape on various parts of their bodies and Kinesio Tape had leapt into the public consciousness.  It's still in common use today and you cant go to a match, meet, regatta, or tournament without seeing it stuck all over the athletes competing. 

The question that's on everyone's mind however, (well probably just mine), is, what on earth does this stuff do or more to the point, is there any evidence that it does anything at all? Would the athletes, if the tape was removed, break down and be carted out of the arena clutching their now un-taped limb in agony?  or is it all an elaborate rouse set up by physiotherapists, who know very well that psychological interventions while treating and rehabilitating injury can have a significant impact on performance? We shall see...   

Now , if you've read my post "Lies, Dammed Lies and Fitness Products" you know that high level sports people wearing or endorsing a product has no bearing what so ever on it's efficacy. That being said most athletes sporting Kinesio tape or one of its variants do so because their physios apply it. The 2008 Olympics aside, I would hope they don't just wear it because of a sponsorship deal........ ( hold on....I better check that............Oh I was wrong, a short search brought up this!! https://www.kttape.com/kt-tape-athletes) ............Ok let's just ignore that for the time being ;-) and focus on the fact that physiotherapists do seem to apply it to their athletes quite a lot. As physiotherapy is for the most part a science based practise (I say 'for the most part' as a lot of physios still use traditional acupuncture, so they're not immune to a bit of pseudoscience), I would hope this would mean there's plenty of evidence for it's use.  So let's see what the science actually says.

Who, Where and Why.

Let's start by going over a brief history of Kinesio taping and what the claimed benefits are. 

According to the Kinesio Tape web site the technique was developed over 25 years ago in 1973?! (If I was being pedantic I'd point out that that's over 40 years ago? but anyway......) It's inventor was Dr. Kenzo Kase, a Japanese chiropractor (I'll do my best to ignore this fact ;-) who wanted to create a therapeutic tape and taping technique which could support joints and muscles, without restricting range of motion. After some research into types of tape and taping methods (it doesn't say which) he came up with Kinesio Tex tape and the Kinesio taping method. 

What are its claimed benefits?

On the official Kinesio Tape website it asserts that Kinesio Taping: 

  • facilitates the body's natural healing process.
  • provides support and stability without restricting range of motion. (this seems counter intuitive to me?)
  • provides soft tissue manipulation.
  • stimulates receptors that relay pain, touch, vibration and heat sensations to the brain thus alleviating pain.
  • facilitates lymph drainage and reduces inflammation. 
  • has the ability to re-educate the neuromuscular system (I don't really know what this means)
  • optimizes performance
  • prevents injury (suggests it can be used as a prophylactic)
  • and assists in returning the body to homeostasis. 

As is often the case with this sort of thing, many of these claims seem vague to say the least. For example, what on earth does 'returning the body to homeostasis' mean? Homeostatic mechanisms in our bodies are responsible for regulating temperature, acidity, glucose concentration, fluid levels and many other things so what exactly does Kinesio tape do to this end? 'Optimizes performance' is another. What does this mean? Improve your endurance? Make you stronger? Make you faster? More balanced? Improve your co-ordination? Any or all of these can improve your performance, so which if any does Kinesio Tape effect? (Again it doesn't say)

Research

But let's not scoff prematurely, some of the claims seem a little less vague (reduces pain, and provides support and stability for example) and have been subject to a fair bit of research.

So what does the research say?

Let's start with a 2015 meta analysis titled "The Effect of Kinesiology Taping on Pain in Individuals With Musculoskeletal Injuries: A Systematic Review and Meta-Analysis ". It found that kinesiology tape may have limited potential to reduce pain in individuals with musculoskeletal injury, the caveat being the reduction in pain may not be clinically meaningful and that taping did not reduce specific pain measures related to musculoskeletal injury above and beyond other modalities. 

A 2014 paper from the Journal of Physiotherapy titled "Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review" (bit of a giveaway as to the results in the title!) compared Kinesio taping with sham taping/placebo, no treatment or other interventions in people with musculoskeletal conditions. It concluded;

The current evidence does not support the use of this intervention in these clinical populations.

The clinical populations being those with shoulder pain, knee pain, chronic low back pain, neck pain,  plantar fasciitis and, what they called, those with multiple musculoskeletal conditions. 

Not looking good so far is it!.....

Another 2015 paper from The Journal of Science and Medicine in Sport titled "Effects of Kinesio® taping on skeletal muscle strength—A meta-analysis of current evidence" concluded; 

the usage of these tapes does not promote strength gains in healthy adults.

An earlier paper from the journal, Sports Medicine in 2012 (another meta analysis) looked at Kinesio taping in the treatment and prevention of sports injuries. Its conclusions were a little more varied. 

To summarise;

  • It suggested the efficacy of KT in pain relief was trivial.
  • There were inconsistent range-of-motion outcome results.
  • There was no positive outcome for ankle proprioception.
  • Seven outcomes relating to strength were beneficial, although there were numerous trivial findings for quadriceps and hamstrings peak torque, and grip strength measures.
  • KT had some substantial effects on muscle activity, but it was unclear whether these changes were beneficial or harmful.

The researchers did however suggest that because of the amount of case study and anecdotal support for Kinesio Tape more research is warranted.

A systematic review of literature from 2013 published in the journal; Physiotherapy Theory and Practise titled; The clinical effects of Kinesio® Tex taping, investigated the results of randomized controlled trials in the management of clinical conditions where Kinesio Tape was used as an intervention. Of the studies looked at, six included patients with musculoskeletal conditions; one included patients with breast-cancer-related lymphedema and one included stroke patients with muscle spasticity. In it's conclusion it noted; 

There was limited to moderate evidence that KTT (Kinesio Tex Tape) is no more clinically effective than sham or usual care tape/bandage.

and

There currently exists insufficient evidence to support the use of KTT over other modalities in clinical practice.

So as you can see the evidence for the use of Kinesio tape in physiotherapy seems lacking.  Strange then that it's used so much by sports people from many different disciplines and applied by their physiotherapists.

At this juncture it's worth noting that not all musculoskeletal taping uses Kinesio tape and the Kinesio taping method. So what we may assume to be Kinesio tape on sports men and women may not be. Other taping modalities exist that have completely different methodology. For example other techniques target specific biomechanical movements and use a very rigid, highly adhesive tape that is applied for relatively short periods of time. This allows athletes to perform sport movements and provides either prophylactic support or support to an already injured part of the body. The effect of this method is to create a bridge over the areas that are injured, mostly to limit ranges of motion and to constrict muscle movement. This is obviously at odds with Kinesio tape (which has some elasticity) and the Kinesio taping method which aims to provide support without restricting range of motion. 

?!?!

So why, given the equivocal research findings, is Kinesio Tape still used so extensively. My hunch (yes skeptics can have hunches, just take them with a pinch of salt like you would any other ;-) is psychology plays a significant role.

Bear with me here.

I think this passage from the Kinesio Tape web site says a lot;

In order to get the desired results from a Kinesio Tex Tape application as well as any other treatment, a full assessment of your patient is necessary. In some cases, the treatment of a condition may require treatment of other underlying conditions as well. This assessment should include manual muscle testing, range of motion testing, gait assessment, and any other orthopedic special tests that you deem necessary. The information gained from these assessments will allow for the proper treatment protocol to be laid out.

As you can see there's a recommendation for full and detailed patient assessment before the application of Kinesio tape as well as the possible treatment of other underlying conditions. Ignoring the fact that the treatment of underlying conditions alone could possibly lead to a positive outcome without further intervention, the process of patient assessment itself will have an important psychological impact. Research carried out examining the Doctor/patient relationship strongly suggests that an empathetic ear together with time spent assessing patients, inspire significant confidence and belief in the validity of an intervention whether it works or not. It's been postulated that this is one of the reasons that homeopathy, the golden child of pseudoscience, is still seen as a valid form of medicine (thankfully by fewer and fewer). Homeopathic "doctors" tend to spend a lot more time with patients as compared to real medical Doctors whose high work loads reduce their contact time with patients.

Physiotherapists who spend time carefully assessing and directing through injury and rehab will, I suspect, have a positive psychological impact on their athletes by reducing anxiety and improving confidence levels. If when they are competing again a physio tells an athlete they should tape up the vulnerable area, it will have exactly the same consequence (reduced anxiety and increased confidence) which from a sports psychology perspective, helps improve performance considerably. 

Although I'm loathed to use the term 'placebo' my guess is this plays a significant role in why Kinesio tape is still extensively used. I only hope that the physios who apply this stuff on sports people know that this is the case. If this is so however, it does open up a whole can of worms in relation to medical ethics in physiotherapy. But that's another discussion and perhaps not one for this blog. 

Fitness Skeptic Score

So to finish let's give Kinesio Tape a Fitness Skeptic Score.

Based on what the research seems to suggest, I'll give the use of Kinesio Tape in sport an FSS of:

Fitness skeptic score (4).png

Although you could argue that it could be a:

...based on the fact there is some consensus that more research maybe warranted.

Either way I personally wouldn't advocate it's use. At least not at the moment. 

References

Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. Journal Of Physiotherapy Vol 60, Issue 1, March 2014. 

Effects of Kinesio® taping on skeletal muscle strength—A meta-analysis of current evidence. Journal of Science and Medicine in Sport. Vol 18, Issue 4, July 2015. 

Effect of Kinesiology Taping on Pain in Individuals With Musculoskeletal Injuries: Systematic Review and Meta-Analysis. The Physician and Sports Medicine. March 2015.  

Kinesio Taping in Treatment and Prevention of Sports Injuries; A Meta-Analysis of the Evidence for its Effectiveness. Sports Medicine, Feb 2014.

The clinical effects of Kinesio® Tex taping: A systematic review. Physiotherapy Theory and Practise. Vol 29, 2013. 

https://kinesiotaping.com/

http://www.webmd.com/fitness-exercise/features/kinesio-tape-athletes-help-hype#1

What is it about homeopathy that patients value? And what can family medicine learn from this. Quality in Primary Care 2014.

Beyond Medicine: Healing Power in the Doctor-Patient Relationship. Psychological ReportsVol 57 issue 2, 1985.

Factors affecting patients’ trust and confidence in GPs: evidence from the English national GP patient survey.  BMJ Open Vol 3, Issue 5.

Placebo and the new physiology of the doctor-patient relationship. Physiological Reviews, July 2013

Placebos as Medicine: The Ethics of Homeopathy. Science Based Medicine June 2011.

When is walking running and running walking?

Cognitive Bias: Making the Irrational Rational.