kinesio tapping for myofascial pain syndrome

(1)

w w w . r e u m a t o l o g i a . c o m . b r

REVISTA BRASILEIRA DE REUMATOLOGIA

Original article

The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome

Saime Ay

^a,∗

, Hatice Ecem Konak

^a

, Deniz Evcik

^b

, Sibel Kibar

^a

aUfukUniversity,SchoolofMedicine,DepartmentofPhysicalMedicineandRehabilitation,Ankara,Turkey

bAnkaraUniversity,HaymanaVocationalHealthSchool,DepartmentofTherapyandRehabilitation,Ankara,Turkey

a r t i c l e i n f o

Articlehistory:

Received18June2015 Accepted20December2015 Availableonline10May2016

Keywords:

Myofascialpainsyndrome KinesioTaping

Disability Pain

a bs t r a c t

Objective:TheaimofthisstudywastoinvestigatetheeffectivenessofKinesioTapingand shamKinesioTapingonpain,pressurepainthreshold,cervicalrangeofmotion,anddis- abilityincervicalmyofascialpainsyndromepatients(MPS).

Methods:Thisstudywasdesignedasarandomized,double-blindplacebocontrolledstudy.

Sixty-onepatientswithMPSwererandomlyassignedintotwogroups.Group1(n=31)was treated withKinesioTapingandgroup2(n=30)wastreatedshamtapingﬁvetimesby intervalsof3daysfor15days.Additionally,allpatientsweregivenneckexerciseprogram.

Patientswereevaluatedaccordingtopain,pressurepainthreshold,cervicalrangeofmotion anddisability.PainwasassessedbyusingVisualAnalogScale,pressurepainthresholdwas measuredbyusinganalgometer,andactivecervicalrangeofmotionwasmeasuredby usinggoniometry. Disabilitywasassessedwiththeneckpaindisability indexdisability.

Measurementsweretakenbeforeandafterthetreatment.

Results:Attheendofthetherapy,therewerestatisticallysigniﬁcantimprovementsonpain, pressurepainthreshold,cervicalrangeofmotion,anddisability(p<0.05)inbothgroups.

Alsotherewasastatisticaldifferencebetweenthegroupsregardingpain,pressurepain threshold,cervicalﬂexion-extension(p<0.05);exceptcervicalrotation,cervicallateralﬂex- ionanddisability(p>0.05).

Conclusion: ThisstudyshowsthatKinesioTapingleadstoimprovementsonpain,pressure pain thresholdandcervicalrangeofmotion,butnotdisabilityinshorttime.Therefore, KinesioTapingcanbeusedasanalternativetherapymethodinthetreatmentofpatients withMPS.

∗ Correspondingauthor.

E-mail:[email protected](S.Ay).

http://dx.doi.org/10.1016/j.rbre.2016.03.012

licenses/by-nc-nd/4.0/).

(2)

Efetividadedokinesiotapingnadoreincapacidadenasíndromedolorosa miofascialcervical

Palavras-chave:

Síndromedolorosamiofascial Kinesiotaping

Incapacidade Dor

r e s u m o

Objetivo: Investigaraeﬁcáciadokinesiotapingedotapingplacebosobreador,limiardedor àpressão,amplitudedemovimentocervicaleincapacidadeempacientescomsíndrome dolorosamiofascial(SDM)cervical.

Métodos: Ensaioclínicorandomizadoduplo-cegocontroladoporplacebo.Foramalocados emdoisgrupos,aleatoriamente,61pacientescomSDM.Ogrupo1(n=31)foitratadocom kinesiotapingeogrupo2(n=30)foitratadocomtapingplacebocincovezesemintervalosde trêsdias,durante15dias.Alémdisso,todosospacientesforamsubmetidosaumprograma deexercíciosparaopescoço.Ospacientesforamavaliadosemrelaçãoàdor,aolimiarde doràpressão,àamplitudedemovimentocervicaleàincapacidade.Adorfoiavaliadacoma escalavisualanalógica,olimiardedoràpressãofoimedidocomumalgômetroeaamplitude demovimentocervicalativafoimensuradacomagoniometria.Aincapacidadefoiavaliada comoNeckPainDisabilityScale.Asmensuraçõesforamfeitasantesedepoisdotratamento.

Resultados: Nofimdotratamento,houvemelhoriaestatisticamentesignificativanador,no limiardedoràpressão,naamplitudedemovimentocervicalenaincapacidade(p<0,05) emambososgrupos.Tambémhouveumadiferençaestatisticamentesignificativaentreos gruposemrelaçãoàdor,aolimiardedoràpressãoeàflexão-extensãocervical(p<0,05);

nãohouvediferençanarotaçãocervical,flexãolateralcervicaleincapacidade(p>0,05).

Conclusão: Okinesiotapinglevaàmelhorianador,nolimiardedoràpressãoenaamplitude demovimentocervical,masnãonaincapacidadeemumcurtoperíodo.Portanto,okinesio tapingpodeserusadocomoummétododeterapiaopcionalparaotratamentodepacientes comSDM.

Introduction

Myofascialpainsyndrome(MPS)isoneofthemostcommon musculoskeletalproblemsandisanimportantcauseofmor- bidityinadults.MPSisaconditioncharacterizedbychronic painandassociatedwithtriggerpointsinoneormoremus- cles,tautbands,characteristicreferredpain,andlocaltwitch response.Patientsrefertohospitalswithlocalorreferredpain, muscleweakness,tightness,limitedmobility,weakness,ten- derness,autonomicdysfunctionsandlocaltwitchresponsein theaffectedmuscle.^1,2

TheexactetiologyofMPSisnotfullyunderstood;therefore, thetreatmentisfocusedondecreasingpain,improvingmus- clestrengthandprovidinggoodposture.Patients’education andtrainingprograms,nonsteroidalanti-inﬂammatorydrugs (NSAID),localinjections,physicaltherapy,acupunctureand exerciseprogramsarethemostcommontreatmentmethods.¹ KinesioTaping(KT)hasbeen increasingly usedinmus- culoskeletal conditions and sports injuries. This technique was developed in Japan by Kase and recently it became very popular in pain treatment.^3,4 Kinesio Tape is a thin, light, and elastic material which does not restrict the jointmovement.^4,5 Itisfoundtobeeffectiveindecreasing pain and muscular spasm,increasing the range ofmotion (ROM),improvinglocalbloodandlymphcirculations,reduc- ing edema, strengthen weakened muscles, control joint

instability and postural alignment.^6–8 Although the exact mechanisms of KT is not understood, sensorimotor, pro- prioceptivefeedbackmechanisms, inhibitoryandexcitatory nociceptivestimuli,mechanicalrestraintwere explainedas underlyingmechanisms.^4,6,7Inthisdouble-blinded,randomized placebo controlled study, we aimed to compare the efﬁcacyofKTandplaceboKTmethodsonpain,pressurepain threshold,ROManddisabilityinpatientswithMPS.

Materials and methods

Seventy-threepatients(50female,23male)withcervicalMPS involvingtheupperneckandlevatorscapulamusclereferred toouroutpatientclinicwereincludedinthestudy.Thediag- nosisofMPSwasbasedonthecriteriadescribedbyTravell and Simons (5 major and minimum 1 minor criteria are requiredforclinicaldiagnosis).⁹Thepatients’inclusioncrite- riawerepresenceofatleastoneactivetriggerpointlocated in levator scapulamuscle, ages greater than 18 years, and symptomdurationofatleast3months.Theexclusioncriteria werediagnosisofﬁbromyalgiasyndrome,cervicaldisclesion, radiculopathy,myelopathy,recent triggerpoint injectionor participatinginaphysicaltreatmentprogramwithinthelast 6months,neurologicandinﬂammatorydiseases,pregnancy orhistoryofneckandshouldersurgery.

(3)

Afterphysicalexamination,fullbloodcount,erythrocyte sedimentationrate,C-reactiveprotein,andbiochemicalmark- erswereevaluated.

This study was prospective, randomized, placebo- controlleddouble-blindtrial.Beforetreatment,allparticipants wereinformedaboutthestudyandsignedwritteninformed consent.ThestudywasapprovedbytheUniversityofUfuk HumanResearchEthicsCommittee.

Randomization

Patientswere randomlyassigned into two groupsbynum- beredenvelopesmethod.Thegroup1andgroup2noteswere putintototheclosedenvelopesseparately,andeachpatient randomlychoseanenvelopeandgaveittothephysiothera- pist.Bothpatientsandtwoexaminingphysicianswereblinded totreatmentallocation.Onlythephysiotherapistwhoapplied thetherapywasawareoftheprocedureandphysiotherapist recordthepatientnamesandtheirgroups.

Group1patients(n=31)were treatedwith KinesioTape (KinesioTexGold,2in×103.3ft)suggestedbyKaseetal.five timesbyintervalsof3daysfor15days.Tapingwasperformed byaphysiotherapistwhoiscertifiedforthismethod.Themus- cleinhibitiontechnique which wasdescribed byKasewas used.Weappliedthetapingtolevatorscapulamuscle.The shoulderwasdepressedandneckwasinlateralflexionand rotation position tothe opposite side. A 15–20cm long “I”

stripwasused.Applicationstartedfromthesuperiorscapu- larangle.Initialportionofthetapewasstretchedmaximum 4–5cm andthen it wasstickedon the muscleorigowhich wasatthelevel of1–4 thoracictransverseprocess without stretching⁵(Fig.1).

Group2patients(n=30)weretreatedwithshamtapingﬁve timesbyintervals of3 daysfor15 days. Shamtaping was appliedwithan“I”stripofthesamematerialonineffective partsofthemusclewithoutatensionwiththeneckinneutral position(Fig.2).

Additionally, all patients received a home-based exercise program including isometric-isotonic neck exercises and back extensor stretching exercises everyday for two weeks.

Fig.1–KinesioTapingtechnique.

Fig.2–ShamKinesioTapingtechnique.

No analgesic drugsor NSAIDswere allowed during the treatmentprocess.

Clinicaloutcomes

Patients were evaluated according to pain, pressure pain threshold,cervicalROManddisability.

Pain

Painwasassessedbyusingavisualanalogscale(VAS,0–10cm;

0meansnopain,10meansseverepain).

Pressurepainthreshold

Pressurepainthreshold(PPT)onthetriggerpointwasmea- sured with an algometer (Algometer Commander, JTECH Medical,Utah).Themeasurementwastakenthreetimesand themeanaveragevaluewasrecorded.

Cervicaljointrangeofmotion

TheactiveROMofcervicaljoint(ﬂexion,extension,right–left ﬂexionandrotation)wasmeasuredusingagoniometerwhen thepatientwasinsittingposition.

Disability

Disability was measured byusing the Neck Pain Disability Scale(NPDS).Turkishversionofthisscalewasfoundvalidand reliable.Thequestionnaireconsistsof20itemsandmeasures neckmovements,painintensity,effectofneckpainonemo- tion factors,and interferencewithdailylifeactivities.Each sectionisscoredona0–5ratingscaleandtotalscoreranges from0to100.¹⁰

Statisticalanalysis

Themeansandstandarddeviationsweregivenasdescriptive statistics. All data for normality were tested by using the Kolmogorov–Smirnov test. Per-protocol analysis was used for the comparison of treatment groups. For determining the difference before and after treatment for all groups, non-parametric Wilcoxon test was used. To compare the

(4)

MAS (n=73)

Analisados (n=31) Lost to follow-up (n=5) Discordance of therapy in 4 patients, allergic reaction in 1 patient

Group 1 (n=36) Kinesio tape

Lost to follow-up (n=7) Discordance of therapy in 6 patients, allergic

reaction in 1 Group 2 (n=37) Sham kinesio tape

Analyzed (n=30) Allocation

Analysis 2 weeks Follow-Up

Randomized

Fig.3–Flowdiagramshowingofpatientsthroughtheclinicalstudy.

differencesbetween twogroups, the Mann–WhitneyU test wasused.Alevelofsigniﬁcanceofp<0.05wasaccepted.All analyseswere performedusing theSPSS forWindows18.0 softwareprogram.

Results

Thirty-sixpatientsingroup1(27femalesand9males)and37 patientsingroup2(30femalesand7males)withMPSwere includedthestudy.Afterrandomization,4patientsinGroup 1and6patientsinGroup2droppedoutbecausetheycould notattendthefollow-upprogramregularlyinthestudy.Then, onepatientfromGroup1andonepatientGroup2dropped out because allergic reaction occurred. Sixty-one patients completedthestudyandnosideeffectshadbeenobserved (Fig.3).

Table1showsthedemographicandclinicalpropertiesof theGroup1andGroup2.Nostatisticallysigniﬁcantdifferences weredetectedbetweenthegroupsatbaselinevalues(p>0.05) exceptNPDS(p<0.05).

Theresultsoffullbloodcount,erythrocytesedimentation rate,C-reactiveproteinandbiochemicalmarkerswerewithin normalrangesforbothgroups.

Aftertwoweeksfollowup,therewerestatisticallysignif- icantimprovementsinbothgroupsregardingVAS,PPT,ROM andNPDS(p<0.05)(Table2).

Table1–Demographicandcliniccharacteristicsofthe patients.

Group1 (n=31)

Group2 (n=30)

p

Age(years) 44.80±17.19 44.10±17.45 0.76 Gender

(female/male)

22/9 23/7 0.61

Durationofpain (month)

14.48±4.99 13.50±2.76 0.97

VAS 5.00±2.00 4.56±2.17 0.38

PPT(N) 61.29±8.92 61.73±5.35 0.61

NPDS 49.77±21.37 39.80±12.51 0.05^a

VAS,visualanalogscale;PPT(N),pressurepainthreshold,Newton;

NPDS,NeckPainDisabilityScale.

a p<0.05.

After the treatment, statistical significant differences wereobservedinVAS,PPT,cervicalflexion-extensionvalues (p<0.05)between thegroups. Howeverno differences were foundincervicalrotation,lateralflexionandNPDS(p>0.05) (Table2).

Discussion

Myofascialpainsyndromeisthemostcommonlyoccurring musculoskeletaldisorders seenbyphysiatrists. Thereisno acceptedstandardtreatmentprogramforMPS.Themainissue

(5)

Table2–Comparisonoftheassessmentparametersinbothgroupsandbetweenthegroups.

Group1(n=31) (mean±SD)

Group2(n=30) (mean±SD)

p

Variable(independent)VAS

Baseline 5.00±2.00 4.56±2.17

Posttreatment 2.35±1.99 3.93±1.96 0.004^b

p 0.000^a 0.000^a

PPT

Baseline 61.29±8.92 61.73±5.35

Posttreatment 78.09±7.18 71.43±10.25 0.003^b

p 0.000^a 0.000^a

Cervicalﬂexion

Baseline 64.58±7.66 59.86±7.01

Posttreatment 71.90±7.54 64.86±6.79 0.001^a

p 0.000^a 0.001^a

Cervicalextension

Baseline 51.93±12.83 44.83±12.42

Posttreatment 55.96±13.63 47.20±14.21 0.015

p 0.007^b 0.003^b

Rightlateralﬂexion

Baseline 39.64±13.77 33.83±5.52

Posttreatment 42.61±14.78 35.93±5.80 0.357

p 0.001^a 0.003^b

Leftlateralﬂexion

Baseline 40.93±14.4 33.83±5.52

Posttreatment 43.90±14.94 42.43±17.97 0.390

p 0.000^a 0.001^a

Rightrotation

Baseline 60.58±11.58 61.36±12.31

Posttreatment 64.74±11.04 63.60±9.55 0.348

p 0.001^a 0.006^b

Leftrotation

Baseline 63.09±12.43 67.53±8.24

Posttreatment 66.83±13.01 67.93±7.97 0.907

p 0.001^a 0.10

NPDS

Baseline 49.77±21.37 39.80±12.51

Posttreatment 35.67±20.27 36.10±12.16 0.558

p 0.000^a 0.000^a

VAS,visualanalogscale;PPT,pressurepainthreshold;NPDS,NeckPainDisabilityScale;SD,standarddeviation.

a p<0.001.

b p<0.05.

intheMPStreatmentistoprovidepainreliefontriggerpoints, improvingdisabilityandincreasingcervicalmotion.^1,2 Kine- sioTapingisanewalternativetechniqueusedinMPS.^3,4This study was planned as a randomized double-blind placebo controlled study in which efficacy of KT and placebo KT methodsonpain,PPT,ROMofcervicaljointanddisabilityin MPStreatment.After2weeksoftreatment,all assessment parametersshowedstatisticallysignificantimprovementsin bothKTandshamgroups.Therewasastatisticaldifference between the groups regarding VAS, PPT, cervical flexion- extension,exceptcervicalrotation,cervicallateralflexionand NPDS.

Althoughtherearealotofstudiesintheliteratureaboutthe effectoftapingonmusculoskeletalsystemandsportinjuries, therearelimitednumberofrandomizedcontrolledstudieson

MPS.^3,11,12However,thereisnoplannedrandomizeddouble- blindplacebocontrolledstudyinwhichefficacyofKTinpain, PPT,ROMofcervicaljointanddisabilityinMPStreatment.A casereporthassuggestedthatKTmaybebeneficialforthe treatmentofapatientwithshoulderpainofmyofascialori- gin.Theyobservedsignificantimprovementinthefunctional testsactiveshoulderrangeofmotionandtherewasnochange intheVAS.¹³ Inarandomizeddouble-blindstudywithMPS includedfiftypatients,theefficiencyofKTwascomparedwith dryneedlingandsignificantdecreaseinpain,PPTanddisabil- itywasobserved.TheyfoundthatKTwasatleastaseffective asdryneedlinginthetreatmentofMPS.¹⁴Hernandezetal.

comparedtheeffectivenessofKTandcervicaltrustmanipu- lationinmechanicalneckpainwith36patients;theyobserved KTorcervicaltrustmanipulationleadstosimilarreductionin

(6)

painseverity,disabilityandincreasesinROM.¹⁵AlthoughGon- zalezetal.foundanimprovementinpainandROMinpatients withacutewhiplashinjurywithKT,theseweresmallandnot clinicallymeaningful.⁸Inourstudy,KTgroupshowedstatis- ticallysignificantimprovementsregardingVAS,PPT,ROMand NPDS.Althoughsignificantimprovementswereobservedin pain,PPT,cervicalflexion-extension,comparedtotheplacebo group,therewasnochangeincervicalrotation,cervicallateral flexionandNPDS.

Multipletheorieshavebeenproposedtoexplainthemech- anismsof KT, including enhance proprioception, cutaneus mechanoreceptors, improved blood and lymphatic circula- tion,reducedpainseverity,realignmentofjoints,assistthe posturalalignmentandrelax theoverusedmuscles.^4,7,11 As aresultofKT,weobservedthatpain,PPT,ROManddisabil- itymeasures showedstatisticallysigniﬁcant improvements inKTgroup.Stimulatingthegatecontrolmechanismresults adecreaseinpainthroughtheincreaseinafferentfeedback foundintheskin.Anothertheorysuggeststhattheimproved ROMandpainareduetoanincreasedproprioseptivefeedback mechanismandmusclefacilitation.^4,7,8,11

InthestudyThelenetal.,foundthatKTimprovedpain- free shoulder range of motion but no effect on pain or function. They also observed KT and cervical spine trust manipulationreduceddisability.¹⁶Alotofpublishedclinical trialshavesuggestedthat KT maybebeneficial intreating patellofemoralpain syndrome,shoulder impingementsyndrome,lowerextremityspasticityandposturalrehabilitation inParkinson’sDisease.^6,7,17,18 Afewsystematicreviewshave evaluated the effect of KT on musculoskeletal and differ- ent clinical conditions. These randomizedtrials compared KTversusshamtapingorotherinterventions.Theresultsof reviewssuggestedthatKT had no significantbenefitor its effectwas too small interms ofclinical practice.However thesetrialswerelow-moderatequality,smallsamplesizesand verysmallfollow-upperiods.^4,7,8Themostimportantdiffer- enceofourstudywastohavehighernumberpatientsand designed asa randomized double-blind placebo controlled study.

CervicalROMrestrictionmostlyoccursbecauseofmuscle spasminMPS.StudiesshowedimprovementinROMvalues afterKT.^8,15Inourstudy,asignificantincreasewasobtained in two weeks in cervical ROM in both groups. Although significantimprovementswereobservedoncervicalflexion- extension,comparedtotheplacebogroup,buttherewasno changecervicalrotation,cervicallateralflexion.Theincrease in cervical ROM may be due to the reduction in patients’

cervicalmusclespasmsorexerciseprogramsappliedtothe patients.Inourstudy,homeexerciseprogramwasappliedto allpatientsandimprovementofcervicalROMwasobserved inbothgroups.Thelimitationofourstudywasnottohave an only exercise group which could be compared to KT and shamKT. Also, weinvestigatedthe short-term results ofKT.

Inconclusion,KTisanoninvasive,painlessmethodthat haslesssideeffects,iswelltoleratedandhasbeenusedin MPS.ThisstudyshowsthatKTleadstoimprovementsonpain, PPT,andROM,butnotindisabilityinshortperiod.Therefore, KTcanbeusedasanalternativetherapyinthetreatmentof

patientswithMPS.But,moreresearchisnecessaryforboth clinicalandlong-termeffectsoftheKinesioTapingtechnique.

Conﬂicts of interest

Theauthorsdeclarenoconﬂictsofinterest.

references

1.GiamberardinoMA,AffaitatiG,FabrizioA,CostantiniR.

Myofascialpainsyndromesandtheirevaluation.BestPract ResClinRheumatol.2011;25:185–98.

2.Radford-GraffSB.Myofascialpain:diagnosisand management.CurrPainHeadacheRep.2004;8:463–7.

3.ParreiraPCS,CostaLCM,TakahashiR,JuniorLCH,LuzJunior MA,SilvaTM,etal.Kinesiotapingtogenerateskin

convolutionsisnotbetterthanshamtapingforpeoplewith chronicnon-speciﬁclowbackpain:arandomisedtrial.J Physiother.2014;60:90–6.

4.ParreiraPCS,CostaLCM,JuniorLCH,LopesAD,CostaLOP.

Currentevidencedoesnotsupporttheuseofkinesiotaping inclinicalpractice:asystematicreview.JPhysiotherapy.

2014;60:31–9.

5.GüvenZ,C¸elikerR,AtalayA,Ba ˘gıs¸S,Aydo ˘gT,KorkmazN, etal.KinezyolojikBantlama ˙IleriKurs.Istanbul,Turkey:

AcıbademÜniversitesi;2012.

6.SaygıEK,AydoseliKC,KablanN,Oﬂuo ˘gluD.Theroleof kinesiotapingcombinedwithbotulinumtoxintoreduce plantarﬂexorsspasticityafterstroke.TopStrokeRehabil.

2010;17:318–22.

7.KayaE,ZinnurogluM,TugcuI.Kinesiotapingcomparedto physicaltherapymodalitiesforthetreatmentofshoulder impingementsyndrome.ClinRheumatol.2011;30:201–7.

8.IglesiasJG,PenasCF,ClelandJ,HuıjbregtsP,VegaMRG.Short termeffectsofcervicalKinesioTapingonpainandcervical rangeofmotioninpatientswithacutewhiplashinjury:a randomizedclinicaltrial.JOrthopSportsPhysTher.

2009;39:515–21.

9.SimonsDG.Muscularpainsyndrome.In:FrictionJR,Awad EA,editors.Advancesinpainresearchandtherapy.NewYork:

RavenPres;1990.p.1–41.

10.BicerA,YaziciA,CamdevirenH,ErdoganC.Assessmentof painanddisabilityinpatientswithchronicneckpain:

reliabilityandconstructvalidityoftheTurkishversionofthe neckpainanddisabilityscale.DisabilRehabil.2004;26:

959–62.

11.BassettKT,LingmanSA,EllisRF.Theuseandtreatment efﬁcacyofkinaesthetictapingformusculoskeletalconditions:

asystematicreview.NZJPhysiother.2010;38:56–62.

12.MorrisD,JonesD,RyanH,RyanCG.Theclinicaleffectsof KinesioTextaping:asystematicreview.PhysiotherTheory Pract.2013;29:259–70.

13.MuroFG,FernandezALR,LucasAH.Treatmentofmyofascial painintheshoulderwithkinesiotaping.Acasereport.Man Ther.2010;15:292–5.

14.WesthuizenVD,HendrikJ.Therelativeeffectivenessof Kinesiotapeversusdryneedlinginpatientswithmyofascial painsyndromeoftrapeziusmuscle,2012.

http://hdl.handle.net/10321/732.

15.HernandezMS,SanchezAMC,MoralesMA,ClelandJA, PalomoIL,PenasCF.Shorttermeffectsofkinesiotaping versuscervicalthrustmanipulationinpatientswith mechanicalneckpain:arandomizedclinicaltrial.JOrthop SportsPhysTher.2012;42:724–30.

(7)

16.ThelenMD,DauberJA,StonemanPD.Theclinicalefﬁcacyof kinesiotapeforshoulderpain:arandomizeddoubleblinded, clinicaltrial.JOrthopSportsPhysTher.2008;38:

389–95.

17.FreedmanSR,BrodyLT,RosenthalM,WiseJC.Shortterm effectsofpatellarkinesiotapingonpainandhopfunctionin

patientswithpatellofemoralpainsyndrome.SportsHealth.

2014;6:294.

18.CapecciM,SerpicelliC,FiorentiniL,CensiG,FerrettiM,Orni C.Posturalrehabilitationandkinesiotapingforaxialpostural disordersinParkinson’sdisease.ArchPhysMedRehabil.

2014;95:1067–75.