Sports and Community Physiotherapy: Kinesio Taping in Knee Osteo Arthritis: What does Evidence suggest?

To view this entire lecture, kindly click the link: https://www.youtube.com/watch?v=84OFU_WV2LM

NOTE: Please switch the auto-rotation of your mobile to off mode to view the above link properly.

OA Knee
• Osteoarthritis (OA) is a common progressive joint disease, involving not only the joint lining but also cartilage, ligaments, and bone.
• Knee osteoarthritis is a highly prevalent condition with a significant socioeconomic burden to society.

Functional Deficits in the patient
• It is known to affect sufferers through pain, loss of function and changes in health related quality of life.
• Management typically involves pharmacologic and/or exercise based therapy approaches to reduce pain.

Physiotherapy
• Physiotherapeutic approaches have been extensively researched and have level IV to level I B evidences and are globally accepted as therapeutic procedures for the conservative management in Knee Osteoarthritis.
• Physiotherapy Management of OA Knee:

• a. Education

• b. Knee Exercises for weight loss, function and rehabilitation

• c. Physical Agents and Modalities for Pain Management

[Pulsed EMF, US, TENS, LASER]

• d. Orthotics [Bracing and Taping]for the Knee

• e. Footwear Modifications and insoles

• Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003 Dec;62(12):1145-55.

Taping options

• Taping, as a therapeutic modality, has been recommended by the American College of Rheumatology as non-pharmacological agent.

• Hochberg MC, Altman RD, April KT, Benkhalti M, et al. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 64( 4), April 2012,465–474.

• Rigid taping has been proved to be effective in relieving pain, enhancement of function and corrective restoration to some extent.

• Rana S Hinman, Kay M Crossley, Jenny McConnell, Kim L Bennell. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial. bmj.com 2003;327:135

• But use of kinesio taping, although studied extensively in literature, lacks common consensus in its therapeutic applications for persons with Knee OA.

Kinesiotaping for Knee Osteoarthritis
• Kinesio taping, also referred to as elastic taping/ K taping (KT)/ Kinesiology taping has been propagated extensively for its application and roles in therapy.

• The most common techniques proposed in management of knee OA (including anterior knee pain, patello-femoral pain and associated dysfunctions) are:

– Facilitation or Inhibition taping for Muscle

– Lymphatic taping for Oedema

– Pain Taping

– Corrective taping for biomechanical alignment

Pain

• Pain is one of the major factors limiting mobility and function in persons with Knee OA.

• Almost all the studies literature favoured the application of Kinesio Tape for relief of pain in the studies population.

• Castrogiovanni P, Di Giunta A, Guglielmino C, et al. The Effects of Exercise and Kinesio Tape on Physical Limitations in Patients with Knee Osteoarthritis. J. Funct. Morphol. Kinesiol. 2016, 1, 355–368; doi:10.3390/jfmk1040355

• Montalvo AM, Buckley WE, Sebastianelli W, Vairo GL. An Evidence- Based Practice Approach to the Efficacy of Kinesio Taping for Improving Pain and Quadriceps Performance in Physically-Active Patellofemoral Pain Syndrome Patients. J Nov Physiother 2013;3: 151. doi:10.4172/2165-7025.1000151

• Ji-Won Han, Dong-Kyu Lee, Chi-Bok Park. The immediate effects of taping therapy on knee pain and depression in patients with degenerative arthritis. J. Phys. Ther. Sci. 30: 704–706, 2018

• Taheri P, Vahdatpour B, Mahboobeh MA, Ramezanian H. Effects of Taping on Pain and Functional Outcome of Patients with Knee Osteoarthritis: A Pilot Randomized Single-blind Clinical Trial. Adv Biomed Res. 2017; 6: 139.

• Malgaonkar PP, Sai KN, Vinod BK, Rizvi SR. Short term effect of Mulligan's mobilization versus kinesio taping on knee pain and disability for osteoarthritis of knee. International J Physiother, 2014;1(4): 233-240.

• Anandkumar S, Sudarshan S, Nagpal P. Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study. Physiother Theor Pr, 2014;30(6): 375-83.

• The star technique was the most preferred technique for local pain relief.

For details on using Kinesio taping star technique, click the following URL: https://www.youtube.com/watch?v=hNo8Imil5RI

• Techniques for biomechanical corrections, patellar alignment and off-loading techniques were also found to be effective in management of pain in knee OA.

• Although kinesio taping helps in alleviation of pain, it is not proved to be more effective than rigid tape or conventional treatment in management of pain in people with knee OA.

• When a certain area is taped with its muscles stretched the muscles then shrink causing wrinkles and widen the space between the skin and fascia.

• This results in increased blood flow to the muscles, thus alleviating pain.

• Another reason taping therapy brings about pain alleviation is that it activates the afferent neuron responsible for apperception by sense of touch.

• Son GS, Lee MH, Lee CR, et al.: The effects of kinesio taping on the pain and functional improvement in patients with degenerative arthritis. KJSB, 2008, 18:45–52.

• Ji-Won Han, Dong-Kyu Lee, Chi-Bok Park. The immediate effects of taping therapy on knee pain and depression in patients with degenerative arthritis. J. Phys. Ther. Sci. 30: 704–706, 2018

Muscles – Relaxation / activation/ toning?

• The strength of the quadriceps is important in knee OA because this muscle predicts the level of functional disability and activities of daily functioning.

• Wageck B, Nunes GS, Bohlen NB, Santos GM, de Noronha M. Kinesio taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial. J Physiother, 2016;62(3): 153-8.

• Muscle strengthening effect of kinesio taping is amongst the most controversial aspects.

• Strength assessment in this population has been assessed by various tools like a simple hand-held dynamometer , Micro FET 3 to Biodex equipment.

• Saswadkar AA, Shimpi AP, Shyam A, Sancheti P K. Short term effects of kinesio taping on Vastus Medialis in Patients with Osteoarthritis Knee for gait and joint function enhancement. J Evidence-Based Physio Research March -June 2017; 1(1): 27-30.

• Choi IR, Lee JH. Effect of kinesiology tape application direction on quadriceps strength. Medicine. 2018;97:24(e11038)

• Kinesio tape is hypothesized to facilitate small, immediate increases in muscle strength by producing a concentric pull on the fascia, which may stimulate increased muscle contraction.

• KT application may provide tactile input and stimulate the cutaneous mechanoreceptors but may not be strong enough to enhance muscle strength.

• Kaya ME, Mustafaoglu R, Birinci T, Razak OA. Does Kinesio taping of the knee improve pain and functionality in patients with knee osteoarthritis?: a randomized controlled clinical trial. Am J Phys Med Rehabil, 2017;96: 25-33.

• Studies have assessed angular and peak torque generation by isokinetic muscle assessment using kinesio taping and have found variations in torque generation post Kinesio taping, irrespective of the manner of application, hence claiming its clinical efficacy.

• Choi IR, Lee JH. Effect of kinesiology tape application direction on quadriceps strength. Medicine. 2018;97:24(e11038)

• Studies have demonstrated that the application of therapeutic KT is effective at increasing isokinetic quadriceps torque and hence have claimed to have a beneficial effect on strength

• Although few studies have found kinesio taping to be effective in enhancement of the muscle strength, these were documented as short term effects possibly due to increased muscle fibre activations and increased motor unit output which were equivalent to those of placebo taping.

• Choi IR, Lee JH. Effect of kinesiology tape application direction on quadriceps strength. Medicine. 2018;97:24(e11038)

• However, numerous studies have found kinesio taping to be ineffective in increasing the muscle strength and thus using Kinesio tape for this effect in patients with Knee OA is cautioned.

• León-Ballesteros S , Espinosa-Morales R , Clark-Peralta P , Gómez-Pineda AG , Guadarrama-Becerril JH. Kinesiotape and quadriceps strengthening with elastic band in women with knee osteoarthritis and overweight or obesity. A randomized clinical trial. Reumatol Clin. 2018 Apr 7. pii: S1699-258X(18)30071-8.

• Jung HJ, Lee JY, Hwang JK, Choi BR. Comparison of efficiency of elastic and non-elastic taping on induced quadriceps fatigue by knee extension exercise. J. Phys. Ther. Sci. 29: 2199–2200, 2017

• Xin Li, Xuan Zhou, Howe Liu, et al. Effects of Elastic Therapeutic Taping on Knee Osteoarthritis: A Systematic Review and Meta-analysis. Aging and Disease, April 2018;9(2):296-308

Swelling and inflammation

For details on using Kinesio taping lymphatic technique for swelling, click the following URL: https://www.youtube.com/watch?v=ETiTFYJyFSs

• It is proposed that micro-waves are formed immediately under the skin when applying Kinesio Taping, and the microwaves, along with muscle activation, could facilitate the movement of the swelling in the joint towards the lymphatic vessels and consequently improve drainage.

• Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the Kinesio Taping Method. Tokyo, Japan: Kenı´-kai information; 2003

• Controversies exist in using Kinesio taping in reduction of swelling in Patients with Knee OA as the changes observed are hypothesized to occur at cellular levels only.

Proprioceptive Sensibility/ Joint Stability

• Proprioceptive sensibility was assessed by testing the joint position sense through the Biodex system dynamometer.

• Cho HY, Kim EH, Kim J, Yoon YW (2015). Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial. Am J Phys Med Rehabil, 94(3): 192-200.

• Atya ARI, Azza M (2015). Kinesio taping versus sensorymotor training for patients with knee osteoarthritis. IJTRR, 4 (3): 9-14.

• Sedhom MG (2016). Efficacy of kinesio-taping versus phonophoresis on knee osteoarthritis: an experimental study. Int J Physiother, 3(4): 494-99.

• Kinesio taping has been shown to be effective in causing proprioceptive enhancement due to joint compression and cutaneous stimulation.

• Xin Li, Xuan Zhou, Howe Liu, et al. Effects of Elastic Therapeutic Taping on Knee Osteoarthritis: A Systematic Review and Meta-analysis. Aging and Disease, April 2018;9(2):296-308

For details on using Kinesio taping lymphatic technique for swelling, click the following URL: https://www.youtube.com/watch?v=AbpvglPOYpQ

Knee Mobility/ ROM/ Flexibility

• Decreased ROM, which is typically seen in people with knee OA, is linked to pain and arthrogenic muscle inhibition.

• Asay JL, Mündermann A, Andriacchi TP: Adaptive patterns of movement during stair climbing in patients with knee osteoarthritis. J Orthop Res 2009;27:325–9

• Kinesio tape is hypothesized to activate an increase in blood circulation in the taped area, which may increase ROM within the relevant muscle(s).

• Also, kinesio taping may provide proper sensory feedback to patients and hence reduce the kinesiophobia associated with pain in these patients.

• Hence kinesio taping has been shown to have an additional effect in improving the ROM and flexibility in the studied population.

• Cho HY, Kim EH, Kim J, Yoon YW. Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial. Am J Phys Med Rehabil, 2015;94(3): 192-200.

• Xin Li, Xuan Zhou, Howe Liu, et al. Effects of Elastic Therapeutic Taping on Knee Osteoarthritis: A Systematic Review and Meta-analysis. Aging and Disease, April 2018;9(2):296-308

Gait

• Very few studies have assessed the effect of Kinesio taping on gait parameters.

• Kinesio taping has been found to be effective in improving the spatio - temporal parameters of gait such as step and stride length and cadence.

• Numerous mechanisms may play a role in this including reduction of pain, improved mechanical control over the knee and enhanced efferent activity and excitability of the CNS.

Depression

• Although there is a dearth of literature in this topic and on the physiological mechanism behind this, studies have claimed the effectiveness of kinesio taping on depression as well.

• Kwon SS: [The effects of the taping therapy on range of motion, pain and depression in stroke patient]. Taehan Kanho Hakhoe Chi, 2003, 33: 651–658 (In Korean).

• Kang SJ, Kim IS: Effects of a taping therapy on shoulder range of motion and pain, physical function and depression of stroke patients with hemiplegia. J Korean Acad Nurs, 2012, 24: 294–304.

• Wells-Federman C, Arnstein P, Caudill M: Nurse-led pain management program: effect on self-efficacy, pain intensity, pain-related disability, and depressive symptoms in chronic pain patients. Pain Manag Nurs, 2002, 3: 131–140.

• The possible mechanisms in persons with Knee OA have been associated with alleviation of pain and normalisation of movements and their ease of performance post taping in daily life.

• Ji-Won Han, Dong-Kyu Lee, Chi-Bok Park. The immediate effects of taping therapy on knee pain and depression in patients with degenerative arthritis. J. Phys. Ther. Sci. 30: 704–706, 2018

• This may be more due to enhancement in Quality of life rather than the true psychological variation, but needs further exploration.

• Son GS, Lee MH, Lee CR, et al.: The effects of kinesio taping on the pain and functional improvement in patients with degenerative arthritis. KJSB, 2008, 18:45–52.

Knee Health status: Functional changes and performance optimisation

• Many functional tasks of daily life such as bending to the floor, getting in and out of a car, descending stairs, and standing up from a chair require optimum knee ROM and eccentric quadriceps strength.

• McCarthy CJ, Oldham JA: The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee. Rheumatology (Oxford) 2004;43:514–7

• Outcome measures such as Lysholm’s, TUG, Lequesne and WOMAC have been used extensively in literature to study the functional variations in the OA knee post application of the Kinesio tape.

• Xin Li, Xuan Zhou, Howe Liu, et al. Effects of Elastic Therapeutic Taping on Knee Osteoarthritis: A Systematic Review and Meta-analysis. Aging and Disease, April 2018;9(2):296-308

• Authors claim that the enhancement in ROM and reduction in pain have been amongst the major contributing factors towards functional enhancement in people with knee OA. (to the extent of reduction in the need of analgesics by patients)

• Xin Li, Xuan Zhou, Howe Liu, et al. Effects of Elastic Therapeutic Taping on Knee Osteoarthritis: A Systematic Review and Meta-analysis. Aging and Disease, April 2018;9(2):296-308

• However, studies also claim insufficient evidences to this claim and conclude that short term or even long term applications with Kinesio taping is not effective in enhancement of function in these patients.

Challenges

• Evidences in Kinesio Taping are still unclear and warrant clinical trials with larger populations and for a longer duration of follow-up.

• Also the application of stretch/ tension to the tape is largely based on the experience and understanding of the clinician and cannot be quantified.

• Although few patients may show minor skin irritation due to the glue, this has not been documented as a hindrance or contraindication to the application of elastic taping.

• This mode of application is easy and can be taught to the patients for self applications. But it’s worth understanding how much the patient can quantify the application and efficacy when many clinicians themselves are struggling with the tape.

Conclusion

• Inspite of the controversies in the evidences, we still feel that Kinesio tape is definitely a useful tool for therapeutic application in persons with Knee OA.

• It is definitely of a clinical utility in enhancement of pain, functional mobility, and helpful in optimisation of performance in this population.

Taping Helps!!!

References

For Kinesio taping in Knee OA

Xin Li, Xuan Zhou, Howe Liu, et al. Effects of Elastic Therapeutic Taping on Knee Osteoarthritis: A Systematic Review and Meta-analysis. Aging and Disease, April 2018;9(2):296-308
Yu B, Feng N, Qi Q, He JS, Li YH, Zhai Q, et al. Short-term effects of kinesio taping on knee osteoarthritis relief. Chin J Rehabil Med, 2012;27: 56-8.
Anandkumar S, Sudarshan S, Nagpal P. Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study. Physiother Theor Pr, 2014;30(6): 375-83.
Cho HY, Kim EH, Kim J, Yoon YW. Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial. Am J Phys Med Rehabil, 2015;94(3): 192-200.
Kocyigit F, Turkmen MB, Acar M, Guldane N, Kose T, Kuyucu E, et al. Kinesio taping or sham taping in knee osteoarthritis? A randomized, double-blind, sham-controlled trial. Complement Ther Clin Pract, 2015;21(4): 262.
Lee K, Yi CW, Lee S. The effects of kinesiology taping therapy on degenerative knee arthritis patients‘ pain, function, and joint range of motion. J Phys Ther Sci, 2016;28(1): 63-6.
Dhanakotti S, Samuel RK, Thakar M, Doshi S, Vadsola. K. Effects of additional kinesiotaping over the conventional physiotherapy exercise on pain, quadriceps strength and knee functional disability in knee osteoarthritis participants: a randomized controlled study. IJHSR, 2016;6(1): 221-9.
Kaya ME, Mustafaoglu R, Birinci T, Razak OA. Does Kinesio taping of the knee improve pain and functionality in patients with knee osteoarthritis?: a randomized controlled clinical trial. Am J Phys Med Rehabil, 2017;96: 25-33.
Atya ARI, Azza M. Kinesio taping versus sensorymotor training for patients with knee osteoarthritis. IJTRR, 2015;4 (3): 9-14.
Sedhom MG. Efficacy of kinesio-taping versus phonophoresis on knee osteoarthritis: an experimental study. Int J Physiother, 2016;3(4): 494-99.
Malgaonkar PP, Sai KN, Vinod BK, Rizvi SR. Short term effect of Mulligan's mobilization versus kinesio taping on knee pain and disability for osteoarthritis of knee. International J Physiother, 2014;1(4): 233-240.
Castrogiovanni P, Di Giunta A, Guglielmino C, et al. The Effects of Exercise and Kinesio Tape on Physical Limitations in Patients with Knee Osteoarthritis. J. Funct. Morphol. Kinesiol. 2016, 1, 355–368; doi:10.3390/jfmk1040355
Lu Z , Li X , Chen R , Guo C . Kinesio taping improves pain and function in patients with knee osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg. 2018 Nov;59:27-35. doi: 10.1016/j.ijsu.2018.09.015. Epub 2018 Sep 28.
Saswadkar AA, Shimpi AP, Shyam A, Sancheti P K. Short term effects of kinesio taping on Vastus Medialis in Patients with Osteoarthritis Knee for gait and joint function enhancement. J Evidence-Based Physio Research March -June 2017; 1(1): 27-30.
Taheri P, Vahdatpour B, Mahboobeh MA, Ramezanian H. Effects of Taping on Pain and Functional Outcome of Patients with Knee Osteoarthritis: A Pilot Randomized Single-blind Clinical Trial. Adv Biomed Res. 2017; 6: 139.
Ji-Won Han, Dong-Kyu Lee, Chi-Bok Park. The immediate effects of taping therapy on knee pain and depression in patients with degenerative arthritis. J. Phys. Ther. Sci. 30: 704–706, 2018
Choi IR, Lee JH. Effect of kinesiology tape application direction on quadriceps strength. Medicine. 2018;97:24(e11038)

Against Kinesio taping in Knee OA

Wageck B, Nunes GS, Bohlen NB, Santos GM, de Noronha M. Kinesio taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial. J Physiother, 2016;62(3): 153-8.
Ouyang JH , Chang KH , Hsu WY , Cho YT , Liou TH , Lin YN. Non-elastic taping, but not elastic taping, provides benefits for patients with knee osteoarthritis: systemic review and meta-analysis. Clin Rehabil. 2018 Jan;32(1):3-17. doi: 10.1177/0269215517717307. Epub 2017 Jun 29.
Montalvo AM, Buckley WE, Sebastianelli W, Vairo GL. An Evidence- Based Practice Approach to the Efficacy of Kinesio Taping for Improving Pain and Quadriceps Performance in Physically-Active Patellofemoral Pain Syndrome Patients. J Nov Physiother 2013;3: 151. doi:10.4172/2165-7025.1000151
León-Ballesteros S , Espinosa-Morales R , Clark-Peralta P , Gómez-Pineda AG , Guadarrama-Becerril JH. Kinesiotape and quadriceps strengthening with elastic band in women with knee osteoarthritis and overweight or obesity. A randomized clinical trial. Reumatol Clin. 2018 Apr 7. pii: S1699-258X(18)30071-8.
Jung HJ, Lee JY, Hwang JK, Choi BR. Comparison of efficiency of elastic and non-elastic taping on induced quadriceps fatigue by knee extension exercise. J. Phys. Ther. Sci. 29: 2199–2200, 2017

For General taping in knee OA:

Hochberg MC, Altman RD, April KT, Benkhalti M, et al. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 64( 4), April 2012,465–474. DOI 10.1002/acr.21596
Rana S Hinman, Kay M Crossley, Jenny McConnell, Kim L Bennell. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial. bmj.com 2003;327:135

Thank You

Sports and Community Physiotherapy

Monday, 21 January 2019

Kinesio Taping in Knee Osteo Arthritis: What does Evidence suggest?

1 comment: