MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 09/01/09 SECTION: MEDICINE LAST REVIEW DATE: 09/16/14 LAST CRITERIA REVISION DATE: ARCHIVE DATE:

ELASTIC THERAPEUTIC TAPING

Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline must be read in its entirety to determine coverage eligibility, if any.

The section identified as “Description” defines or describes a service, procedure, medical device or drug and is in no way intended as a statement of medical necessity and/or coverage.

The section identified as “Criteria” defines criteria to determine whether a service, procedure, medical device or drug is considered medically necessary or experimental or investigational.

State or federal mandates, e.g., FEP program, may dictate that any drug, device or biological product approved by the U.S. Food and Drug Administration (FDA) may not be considered experimental or investigational and thus the drug, device or biological product may be assessed only on the basis of medical necessity.

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Description:

Traditional tape applications are commonly used as an adjunct for the treatment of fractures, dislocations or musculoskeletal injuries to provide structural support and stability.

In contrast, elastic therapeutic tape, also referred to as kinesio tape, has been investigated to provide support without restricting range of motion. Kinesio® Tape looks like conventional athletic tape but can be stretched before applying on top of the skin to provide a constant pulling force which is thought to play a role in its effectiveness. It is strategically applied, often in “waves”, and needs to be replaced every 3 to 5 days.

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MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 09/01/09 SECTION: MEDICINE LAST REVIEW DATE: 09/16/14 LAST CRITERIA REVISION DATE: ARCHIVE DATE:

ELASTIC THERAPEUTIC TAPING (cont.)

Description: (cont.)

The Kinesio taping method is derived from the theory that muscles not only produce movement but also activate the other body systems such as the neurological and circulatory systems. Therefore, the failure of the muscles to properly function leads to various kinds of symptoms. According to the creator of Kinesio tape, the proposed mechanisms by which Kinesio tape works may include correcting muscle function by strengthening weakened muscles, improving circulation of blood and lymph by eliminating tissue fluid or bleeding beneath the skin by moving the muscle, decreasing pain through neurological suppression, and repositioning subluxation of joints by relieving abnormal muscle tension.

Elastic therapeutic taping has become popular in the athletic community for muscle pain and common injuries such as runners knee, tennis elbow, shin splints and back pain. Kinesio taping of joints and muscles has been investigated for virtually all clinical conditions including pain, inflammation, edema, relaxation of tired muscles and for preventative maintenance.

Kinesio tape is available over the counter and an individual can learn to apply it themselves. Products include, but are not limited to Kinesio Tex Tape, SpiderTech pre-cut tape and Temtex kinesiology tape.

Criteria:

 Elastic therapeutic taping (kinesio taping) is considered experimental or investigational based upon:

1. Insufficient scientific evidence to permit conclusions concerning the effect on health outcomes, and 2. Insufficient evidence to support improvement of the net health outcome as much as, or more than, established alternatives.

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ELASTIC THERAPEUTIC TAPING (cont.)

Resources:

1. Aguilar-Ferrandiz ME, Castro-Sanchez AM, Mataran-Penarrocha GA, Guisado-Barrilao R, Garcia-Rios MC, Moreno-Lorenzo C. A randomized controlled trial of a mixed Kinesio taping- compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency. Clin Rehabil. Jan 2014;28(1):69-81.

2. Castro-Sanchez AM, Lara-Palomo IC, Mataran-Penarrocha GA, Fernandez-Sanchez M, Sanchez-Labraca N, Arroyo-Morales M. Kinesio Taping reduces disability and pain slightly in chronic non-specific : a randomised trial. J Physiother. 2012;58(2):89-95.

3. Choi YK, Nam CW, Lee JH, Park YH. The Effects of Taping Prior to PNF Treatment on Lower Extremity of Hemiplegic Patients. J Phys Ther Sci. Sep 2013;25(9):1119-1122.

4. Djordjevic OC, Vukicevic D, Katunac L, Jovic S. Mobilization with movement and kinesiotaping compared with a supervised exercise program for painful shoulder: results of a clinical trial. J Manipulative Physiol Ther. Jul 2012;35(6):454-463.

5. Donec V, Krisciunas A. The effectiveness of Kinesio Taping(R) after total knee replacement in early postoperative rehabilitation period. A randomized controlled trial. Eur J Phys Rehabil Med. Aug 2014;50(4):363-371.

6. Fu TC, Wong AM, Pei YC, Wu KP, Chou SW, Lin YC. Effect of Kinesio taping on muscle strength in athletes-a pilot study. J Sci Med Sport. 2008 Apr 2008;11(2):198-201.

7. Gonzalez-Iglesias J, Fernandez-de-Las-Penas C, Cleland JA, Huijbregts P, Del Rosario Gutierrez-Vega M. Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial. J Orthop Sports Phys Ther. 2009 Jul 2009;39(7):515-521.

8. Halseth T, McChesney JW, DeBeliso M, Vaughn R, Lien. The Effects of Kinesio™ Taping on Proprioception at the Ankle. Journal of Sports Science and Medicine. 2004 2004;3:1-7.

9. Hsu YH, Chen WY, Lin HC, Wang WT, Shih YF. The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome. J Electromyogr Kinesiol. 2009 Jan 13 2009.

10. Jaraczewska E, Long C. Kinesio taping in stroke: improving functional use of the upper extremity in hemiplegia. Top Stroke Rehabil. 2006 Summer 2006;13(3):31-42.

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ELASTIC THERAPEUTIC TAPING (cont.)

Resources: (cont.)

11. Karadag-Saygi E, Cubukcu-Aydoseli K, Kablan N, Ofluoglu D. The role of kinesiotaping combined with botulinum toxin to reduce plantar flexors spasticity after stroke. Top Stroke Rehabil. Jul-Aug 2010;17(4):318-322.

12. Liu YH, Chen SM, Lin CY, Huang CI, Sun YN. Motion tracking on elbow tissue from ultrasonic image sequence for patients with lateral epicondylitis. Conf Proc IEEE Eng Med Biol Soc. 2007 2007;2007:95-98.

13. Mostafavifar M, Wertz J, Borchers J. A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. Phys Sportsmed. Nov 2012;40(4):33-40.

14. Paoloni M, Bernetti A, Fratocchi G, et al. Kinesio Taping applied to lumbar muscles influences clinical and electromyographic characteristics in chronic low back pain patients. Eur J Phys Rehabil Med. Jun 2011;47(2):237-244.

15. Parreira Pdo C, Costa Lda C, Hespanhol Junior LC, Lopes AD, Costa LO. Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. J Physiother. Mar 2014;60(1):31-39.

16. Parreira Pdo C, Costa Lda C, Takahashi R, et al. Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-speci fi c low back pain: a randomised trial. J Physiother. Jun 2014;60(2):90-96.

17. Simsek TT, Turkucuoglu B, Cokal N, Ustunbas G, Simsek IE. The effects of Kinesio(R) taping on sitting posture, functional independence and gross motor function in children with cerebral palsy. Disabil Rehabil. Mar 14 2011.

18. Slupik A, Dwornik M, Bialoszewski D, Zych E. Effect of Kinesio Taping on bioelectrical activity of vastus medialis muscle. Preliminary report. Ortop Traumatol Rehabil. 2007 Nov-Dec 2007;9(6):644-651.

19. Stedge HL, Kroskie RM, Docherty CL. Kinesio taping and the circulation and endurance ratio of the gastrocnemius muscle. J Athl Train. Nov-Dec 2012;47(6):635-642.

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ELASTIC THERAPEUTIC TAPING (cont.)

Resources: (cont.)

20. Thelen MD, Dauber JA, Stoneman PD. The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial. J Orthop Sports Phys Ther. 2008 Jul 2008;38(7):389- 395.

21. Williams S, Whatman C, Hume PA, Sheerin K. Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness. Sports Med. Feb 1 2012;42(2):153-164.

22. Yoshida A, Kahanov L. The effect of kinesio taping on lower trunk range of motions. Res Sports Med. 2007 Apr-Jun 2007;15(2):103-112.

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