As a runner, you are probably already familiar with kinesio tape (or better said ‘kinesiology’ tape), the typically bright coloured tape often seen adorning the limbs of both recreational and professional athletes in an attempt to either help rehabilitate an injury or increase performance on race day. Go to a therapist for a running related injury and there is a high chance you will leave with at least one strip stuck to your body somewhere, normally over the area of pain. But does it actually help? And if so, how?
Kinesiology tape has not actually been in common use for that long. Its first documented use was back in 1979 when Japanese chiropractor Dr. Kenzo Kase developed a strong, stretchy, sticky tape he called ‘Kinesio Tex Tape’, with the purpose of reducing pain and enhancing healing between appointments. The tape was introduced to the USA in 1995 and Europe in 1996 but it was not until the 2008 Olympic Games in Beijing that the world really saw it in action, mainly because Kinesio USA donated 50,000 rolls of it to 58 participating countries. High profile athletes in volley ball, water polo, wrestling, basketball and even on the track were suddenly seen with mysterious flashes of black, pink and blue tape whilst competing.
The 2012 Olympics produced an equally impressive display of the tape, and today we see all levels of athletes, especially recreational runners, often covered in new alternative and popular brands that have hit the market, including Rock Tape and KT Tape. The term ‘Kinesio Tape’ should strictly speaking only be used by Dr Kenzo’s original company Kinesio as they have trademarks on use of the word, so we will refer to it as kinesiology tape or for the sake of brevity in this article, simply tape.
Does It Help?
Good question! But hard to answer. Though some runners claim it ‘saves them on race day’, others report no effect at all. As far as research goes, there is a distinct lack of quality investigation. With the current lack of evidence, claims made by smaller brands such as “aids lymphatic and muscle systems”, “reduces recovery times” or “improves fitness” have lead to them being sued. Fortunately, some of the larger companies like Rocktape have been devoting time and money into producing higher quality research, but for now we will have to wait and see.
Lack of quality research should not be used as a reason to dismiss the use of tape completely. Many of you would be surprised to hear that much of the therapy used to treat injury is not backed by any quality research – ice, heat, massage, to name a few. It is the apparent success they have in a clinical environment that means we still continue to use them, and most therapists do report that used as a adjunct, kinesiology tape does seem to help some runners some of the time.
In November 2014, listeners of ‘The Physio Matters Podcast’ were treated to a highly informative debate between Rocktape UK’s medical director Paul Coker and staunch tape skeptic & triathlon coach Paul Westwood (to the left) about the pros and cons of using Kinesiology tape. With both of these speakers being very experienced and respected full-time physiotherapists, I encourage you (especially therapists) to have a listen to Session 12 of The Physio Matters Podcast.
As Rocktape UK’s medical director, it should not come as much of a surprise to hear that Paul Coker (to the right of presenter Jack Chew in photo) is very much pro use of kinesiology tape. However, what sets him apart from the crowd is the distinct absence of pseudoscientific claims often made by other brands of tape. Paul Coker presents kinesiology tape as a simple, drug-free, low risk option to temporarily reduce pain and help people get moving again; he is very aware of the dangers of allowing clients to perceive it as ‘magic tape’, recognises the limited evidence but also reminds us that other than initial pain relief there is very little evidence for many of the treatments we use, e.g. acupuncture, electrotherapy, manual therapy.
Paul Westwood (on Jack’s left) is a physiotherapist who works with many international level triathletes, and his main issue with kinesiology tape is that it can give athletes the impression that their bodies are fragile, and in turn create dependency. He argues that as therapists we spend too much time chasing pain relief and not enough helping athletes get back into their sport. ‘We already have many methods of pain relief (acupuncture, manual therapy) and do not need another.’ Westwood believes that we need to stop focussing so much on trying to stop pain and accept that it is part of life. ‘If the action of running is causing somebody pain, should we as therapists be promoting and providing tools to help mask that pain so that the runner can potentially continue to ignore the source of the pain? Is that not the same as just telling our runner to take some anti-inflammatories?’
In the search for justification to use tape, many mechanisms of success have been suggested and promoted. Different tensions of tape, direction of application, even colour of tape are promoted as ways of treating different injuries. As of yet, none have been substantiated by any evidence. What the elastic qualities of the tape do seem to do (regardless of degree of stretch) is lift the skin away from the structures underneath it, and it is suggested that this improves blood and lymphatic flow. Photos of bruises with criss-cross patterns on them where tape has been applied for a few days are often used to demonstrate the effect of tape on blood flow. Whether this visual effect has any relationship with recovery from injury has yet to be demonstrated.
The wrinkles that appear after applying tape to a stretched muscle are used as a sign that some type of ‘decompression’ has occurred between the skin and the tissue underneath. The problem is, people see benefits of tape both with and without these wrinkles, so how significant is this ‘decompression’ effect? Is it the physical effect of fluid being able to flow better and speed up healing, or is it that thanks to the tape the brain is receiving different feedback, given that the skin is the first point of contact for the nervous system?
The ‘Good Posture’ Myth
One point that is briefly mentioned in the debate and I believe worth reiterating here is the importance of not allowing the use of kinesiology tape to promote the myth of ‘good posture’ vs ‘bad posture’. Both Coker and Westwood agree adamantly that tape does not ‘correct’ posture. As therapists, we need to recognise that there is no evidence that, for example, having one shoulder higher than the other causes pain. Though striving for symmetry may look neat on paper and create a magnificent place to start ‘fixing’ a patient, symmetry is not part of nature’s plan. More people have uneven leg length than not, and there are certainly many ‘asymmetrical’ runners in no pain at all!
Tape Does Not Fix You
The podcast presents some great information and ideas, along with useful references to papers and research. Of all the angles discussed, the one that sticks with me (no pun intended) is how the use of kinesiology tape runs the risk of a runner believing that they need the therapist or tape to ‘fix’ them. It’s like telling somebody their spine is ‘out of alignment’ and that they need a therapist to ‘put it back into place’ – this may be a highly effective way to ensure regular return visits (which sadly happens) but in doing so it creates dependency rather than self management, and rarely gets long term results. Though I am confident that kinesiology tape can alleviate short term pain, I doubt it confronts the source of an issue or provides any long term benefit. There is a danger that reliance on its use (either knowingly or unknowingly) can result in failure to utilise potentially more effective, long term ways of promoting recovery.
Is It All In The Mind?
Hearing that kinesiology tape may have an effect on the brain & nervous system is interpreted by many as suggesting that ‘it’s all in the mind’. Indeed, common objection to the use of kinesiology tape by both therapists and runners is that it is just a ‘placebo effect’ and therefore a waste of time and money. Such criticism is valid but unsubstantiated as there is no quality evidence to date suggesting kinesiology tape is just a placebo. In fact, involvement of the ‘mind’ or better said the ‘brain & nervous system’ is probably one of the soundest proposed mechanisms out there as to how the tape can help reduce pain. After all, it is our brain that decides if we feel pain, when we feel pain and how much we feel. The skin is one of many important sources of sensory feedback that our nervous system uses in regulation of pain so maybe the presence of the tape does play a mechanical role? As we said previously, research is light but this may be one of the developments in understanding that comes with time.
Can Tape Be Overused?
Just as the effect of kinesiology tape on the nervous system may be the best explanation as to why we decide to use it, it is also the reason that if presented improperly tape could also have a detrimental effect on the wearer and potentially delay recovery. Comments like ‘the tape saved me’ or ‘the tape held me together’ can be counterproductive for runners as they can reinforce ingrained beliefs that the body is weak, delicate, dependent on external support.
When we take a look at how modern neuroscience explains pain, belief of vulnerability becomes a very significant factor when looking for ways to reduce pain and overcome injury. Indeed, research has shown that just understanding pain can itself be a great tool in overcoming it, especially when it is what we call persistent or chronic pain (has lasted for over 3 months).
Despite the common view of pain as an ‘enemy’, it is actually one of the most highly sophisticated defence mechanisms we have to keep us alive and out of danger. It protects us by serving as an alarm system to warn us that the brain feels threatened. The important thing to take from this is that the pain alarm sounds when the brain feels threatened and not just when actual damage has occurred. It would be a pretty useless alarm system if it only sounded when damage had already occurred.
The ‘level of threat’ is based on sensory feedback that the brain receives continuously from all over the body, e.g. our proximity to heat, chemicals, pressure, anything that could result in danger. But sensory feedback of potential threat also includes how we are feeling emotionally, what we see and hear, even memories. Think about a time when you felt no pain until you saw blood. There was no threat until you saw the blood. And how about the runner who has dislocated their knee so many times that it really doesn’t hurt anymore when they do it, as they know someone will eventually pop it back in and everything will be fine.
It is important to point out that we are not saying pain is all in your imagination. Pain is very real. However, if your goal is to reduce pain, you need to take into account all of the sensory feedback that may be contributing to it. Our bodies are much stronger and resilient than you probably think. A tear in a muscle may sound horrific but in reality every time you run you are causing painless micro tears. They heal, you get stronger; that’s the way it works. It is our minds that too often delay recovery due to something we have heard or read. If you use tape in the belief that it is ‘fixing you’ or ‘holding you together’, you may well be subconsciously increasing a perception of vulnerability and threat, fuel for the brain to continue outputting pain.
Tape, braces, crutches… they can all potentially send messages to our brain to make us think we may be in danger. This can be a good thing if we have an acute injury that needs rest. However, the path to recovery (and therefore pain reduction) is one that requires a gradual increase in our confidence to perform. This means you taking responsibility and control of the situation and actively proving to yourself (your brain) that you are able to move better and perform more challenging tasks. On the right person, kinesiology tape can be very useful especially in the early stages of recovery, but it has to form part of a comprehensive treatment programme. It is not magic and does not hold you together.There comes a point when you need to show yourself that you do not need the crutch anymore.