How physical therapists are using this pain-mitigating modality in athletic populations.
Kinesiology tape has been used in therapeutic communities for over 30 years, though it more recently grew in popularity following the 2008 and 2012 Olympic Games when Kerri Walsh won gold while sporting brightly colored strips of tape on her shoulder. During the most recentOlympic Games, a wider variety of athletes was seen wearing this tape, from soccer players and divers to gymnasts and track runners.
Also known as elastic therapeutic tape, this flexible tape has similar characteristics to skin and is generally considered a very safe therapy technique. Unlike the static, rigid athletic tape used to inhibit motion, elastic therapeutic tape has stretch built into it, allowing patients to maintain a full range of motion.
Michael Czuba, PT, DPT, SCS, ATC, CSCS, physical therapy manager with Athletico Physical Therapy in Riverside, Ill., uses this technique for patients with a wide array of sports-related injuries and conditions.
“I like to say, anything orthopedic with an ‘itis’ or an ‘osis’ we can treat with this type of taping technique,” said Czuba, who has been practicing for 13 years. Conditions might include tendonitis, bursitis, tendinosis, plantar fasciitis, hamstring strain, post-surgical or post-injury swelling and muscle dysfunction, strain or pain.
Therapeutic tape can help reduce pain and swelling, improve posture, aid in neuromuscular facilitation and improve balance and awareness of joint position – all of which can help lead to improved function, facilitate earlier return to activity or sport, and potentially improve sport performance, Czuba said.
When correctly applied, the tape creates a microscopic lifting effect underneath the skin and between the many layers, from the most superficial all the way down to the muscle. The space created between those layers aids in decompression of muscles, allows for fluid drainage and creates a neurosensory effect.
“The skin and the brain are constantly talking to each other, and the tape actually enhances that communication to tell the brain basically what position the body is in space,” explained John K. Koniuto, PT, MSPT, DPT, FMT-C, CEO and founder of Oakdale Physical Therapy & Fitness and Koniuto Physical Therapy in Johnson City, N.Y.
Koniuto, who has been practicing for over 20 years and teaches two kinesiology taping courses, added that “Your joints tell your brain what position your body is in space at the end of the ranges of motion, but in between those end ranges of motion it’s your fascial tissue that tells your brain about your position in space.”
“I like to explain to patients that the tape can act as a cueing mechanism to the patient to move in a certain way – almost like having a brace on, but it’s not quite a brace,” Czuba said. “It can stimulate the neurological system through the skin.”
Before application, it’s important to assess the patient and ensure that the skin will tolerate the tape. “First and foremost is to always make sure the person is safe and that you’re minimizing any adverse reaction to the skin,” Koniuto said.
“We would want to make sure that the individual has good skin integrity,” Czuba said. “For someone that has different conditions that affect the skin, whether it be a recent wound healing or psoriasis, we would want to make sure that the skin is capable of taking some intervention like this – and of course we’re banking on the physical therapist or athletic trainer’s experience and expertise to make sure that it’s safe to proceed.”
Czuba stressed taking precaution with certain conditions. “We would never apply tape to someone that has active cancer, especially in the area, an infection, an open wound or deep vein thrombosis,” he said. However, Czuba might still apply tape for conditions such as decreased sensation, kidney or circulatory disease, congestive heart failure or fragile skin – although with extreme caution. “We’re constantly assessing and reassessing the benefits versus the risks,” he said.
For patient populations with fragile skin, such as pediatrics or geriatrics, it may be best to use a tape that has less adhesive, as it is more gentle and sensitive skin may tolerate it better, Koniuto said. “You always want to monitor – assess, apply and then reassess,” he said. “If I’m ever not sure I tell someone, ‘take it off after a day and check your skin,’ as opposed to ‘leave it on for up to five days right off the bat.’ Being cautious is always more productive than not being cautious.”
Most brands of therapeutic tape do not contain latex, so patients with allergies to adhesives are generally safe using it. “It’s nice to know that that’s the case; however, I always try a small sample on the skin ahead of time so we’re not just applying a mass quantity before really assessing whether it’s going to affect the person in a detrimental fashion,” Czuba said.
Less is More
Therapeutic tape can be applied in various patterns with differing amounts of stretch. “Usually you’ll have an anchor on either end, and then in the middle is the more therapeutic zone,” said Czuba. “There’s usually a low amount of stretch on the two anchors and then varying amounts of stretch in the middle, depending on what your therapeutic goal is.”
Koniuto believes applying the tape with little stretch is the best way to start. “One of our sayings is ‘less is more,’ so you’ll want to apply it with the least amount of tape and the least amount of stretch that will get the job done, and then you go from there,” he said. “You can always be more aggressive afterwards. If you were too aggressive off the bat and put on too much stretch and too much tape, you can get skin irritation or a bad reaction, and then you’re being counterproductive. It’s easier to move up then to move back.”
For pain mitigation, Koniuto typically applies the tape across the muscle fibers with up to 50% stretch. When aiming to support or decompress muscles, he applies the tape in line with the fibers. For edema reduction or fluid dynamics, he starts the anchor proximally, then applies the edema reduction “fingers” distally so the recoil or pulling effect is toward the direction of the heart, in a lattice pattern.
As Czuba noted, patient compliance is crucial for successful outcomes. “It is really important that they follow the instructions that we give them exactly how we tell them,” he said. This applies to the amount of wear time (usually 2-4 days), dabbing the tape dry if it gets wet so that it doesn’t peel off, and not pulling it off prematurely or carelessly, which may have negative effects on the skin.
If a patient has any skin irritation, itchiness or rash, they should take the tape off right away, Koniuto advised. If they tolerate it well, however, he recommends a maximum wear time of five days.
“The intention of the tape is to help someone get through a phase of being in pain, dysfunction or rehabilitation, and then once the tape is taken off, it’s supposed to normalize the tone of the tissue that it’s targeting, and once the tape is taken off the body actually should be in a more corrected state,” he said.
Overall, despite its many benefits, elastic therapeutic tape is not a miracle cure, Czuba said. “It’s not something that I would do in isolation; it’s something to do in conjunction with other interventions,” he said. “We’re never doing anything in isolation, but this is a really nice adjunct to be able to help get the individual back to the places that they want to be.”