Reynard et al. BMC Musculoskeletal Disorders (2018) 19:305 https://doi.org/10.1186/s12891-018-2169-5 RESEARCH ARTICLE Open Access Immediate and short-term effects of kinesiotaping on muscular activity, mobility, strength and pain after rotator cuff surgery: a crossover clinical trial Fabienne Reynard1* , Philippe Vuistiner2, Bertrand Léger2 and Michel Konzelmann3 Abstract Background: Kinesiotape (KT) is widely used in musculoskeletal rehabilitation as an adjuvant to treatment, but minimal evidence supports its use. The aim of this study is to determine the immediate and short-term effects of shoulder KT on muscular activity, mobility, strength and pain after rotator cuff surgery. Methods: Thirty-nine subjects who underwent shoulder rotator cuff surgery were tested 6 and 12 weeks post-surgery, without tape, with KT and with a sham tape (ST). KT and ST were applied in a randomized order. For each condition, the muscular activity of the upper trapezius, three parts of the deltoid and the infraspinatus were measured during shoulder flexion, and range of motion (ROM) and pain intensity were assessed. At 12 weeks, the isometric strength at 90° of shoulder flexion, related muscular activity and pain intensity were also measured. Subjects maintained the last tape that was applied for three days and recorded the pain intensity at waking up and during the day. Results: Modifications in muscle activity were observed with KT and with ST. Major changes in terms of decreased recruitment of the upper trapezius were observed with KT (P < 0.001). KT and ST also increased flexion ROM at 6 weeks (P = 0.004), but the differences with the no tape condition were insufficient to be clinically important. No other differences between conditions were found. Conclusions: Shoulder taping has the potential to decrease over-activity of the upper trapezius, but no clinical benefits of KT on ROM, strength or pain were noted in a population of subjects who underwent rotator cuff surgery. Trial registration: The study was retrospectively registered on ClinicalTrials.gov PRS (NCT03379636)on21stDecember 2017. Keywords: Athletic tape, Electromyography, Rehabilitation, Musculoskeletal disorder, Shoulder Background exercises. During this phase, resistance work is avoided. Rotator cuff injury is a common source of complaint From week 13, progressive strengthening is possible, that leads to pain and decreased function. Symptomatic with proprioception and coordination tasks [1]. tears are often repaired surgically. After surgery, physical Rehabilitation protocols often recommend the applica- therapy is necessary to restore shoulder function. Begin- tion of kinesiotape (KT) to decrease pain and enhance ning with passive shoulder joint mobility exercises, the motion control. KT is an elastic acrylic adhesive tape, treatment becomes more active after 6 weeks, with that supports and stabilizes muscles and joints without emphasis on active-assisted to active motion, shoulder restricting the range of motion (ROM). The application proprioception training and sub-maximal isometric of KT over manually stretched structures causes the skin to form convolutions that lift the skin. The theory * Correspondence: [email protected] behind this method is that the convolutions facilitate the 1Department of Physiotherapy, Clinique romande de réadaptation Suva, Sion, regeneration of injured tissues by increasing the intersti- Switzerland tial space, which allows for increased lymphatic and Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reynard et al. BMC Musculoskeletal Disorders (2018) 19:305 Page 2 of 11 venous fluid flow. The decrease in pressure between the regional medical ethics committee (Commission Canto- skin and the underlying connective tissues decompresses nale Valaisanne d’Ethique Médicale, CCVEM no 026/12 subcutaneous nociceptors, leading to decreased pain [2]. Sion, Switzerland). Other proposed benefits are 1) on muscular function, by modifying the recruitment activity patterns of the Subjects treated muscles and by increasing the strength of weak- Four local orthopaedic surgeons specializing in shoulder ened muscles; 2) on joint function, by facilitating surgery conducted the subject recruitment. The inclu- realignment; and 3) on sensory function, by improving sion criteria were as follows: adult subjects who had joint position sense and kinaesthetic awareness [2, 3]. surgery less than 6 weeks prior after a shoulder rotator Indications for the use of KT are numerous, but scien- cuff tear. The exclusion criteria were as follows: re-tear tific evidence remains scarce, with less evidence in of the rotator cuff, associated neurological lesion, or favour of KT found with increasing methodological qual- concomitant cervical or elbow lesion. ity of the studies [4–12]. The sample size was calculated a priori using STATA For shoulder pathologies, KT has been used in ten Version 13.1 software (StataCorp, College Station, TX, studies between 2007 and 2017 [13–22]. All the studies USA). Based on the data of muscular activity from the concerned shoulder impingement syndrome. KT was ei- study by Hsu et al. [13] and considering a statistical ther compared with sham tape (ST) [13, 16–18, 20, 22], power of 80% and a Type I error of 0.05, a need for at exercises [14, 15], or nonsteroidal anti-inflammatory drugs least 36 subjects was necessary to highlight group differ- and sub-acromial corticosteroid injections [19, 21]. Differ- ences. We enrolled 39 subjects. ent outcomes were used: questionnaires on upper extrem- ity function and quality of life, pain, ROM and strength. Taping procedure Only one study used electromyography (EMG) to assess A trained physiotherapist applied the two different tapes, muscle activity [13]. The efficacy of KT in shoulder path- a therapeutic KT and an ST, on each subject, as shown ologies concern essentially pain [14, 15, 17–19], pain-free in Fig. 1. For KT, elastic beige 5-cm width Leukotape®K ROM [16, 19] and scapular ROM [13]. Improvements (BSN Medical, Hamburg, Germany) was used. It was were modest in all of these studies and were limited to applied according to the Kase model [2]. The first strip, some spatial and temporal components. To the best of a Y-strip, was applied with 10 to 15% tension over the our knowledge, the effects of KT have never been studied deltoid muscle from its origin to insertion, with the first after shoulder surgery. tail along the anterior deltoid while the arm was exter- nally rotated and horizontally abducted. The second tail Methods was applied along the posterior deltoid with the arm Aim horizontally adducted and internally rotated. A second The aim of this study was to investigate the immediate strip, an I-strip, was applied for mechanical correction and short-term effects of KT on shoulder muscle activity, transversely in the sagittal plane over the acromioclavi- mobility, strength and pain in a population of subjects cular joint with downward pressure applied to the KT, who underwent rotator cuff surgery. Our hypotheses were with the arm held along the side. that KT would not improve muscle function, mobility, For the sham condition, rigid Leukotape®Classic (BSN strength or pain in a clinically meaningful way. medical, Hamburg, Germany) was used. A 5-cm strip was applied transversely under the deltoid tuberosity with no Study design tension and with no direct influence on shoulder area. A controlled crossover study with three treatment arms The subjects were informed that two different taping - no tape (NT) vs KT vs ST - was conducted between techniques were applied, but they were not given any January 2013 and October 2016 at the Clinique romande further details about the taping procedure and effects. de réadaptation Suva in Sion (Switzerland). A computer block (n = 8) randomization process with sealed opaque Testing procedure envelopes was performed to determine the order of Subjects were assessed on two occasions: 6 and 12 weeks passage of the two taping procedures. The physiotherap- after repair (Fig. 2). Each time, they first answered the ist who applied the tape was not blinded, but he did not French version of the quick Disabilities of the Arm, participate in outcome assessment. The main investiga- Shoulder and Hand (DASH) questionnaire in order to tor (first author) who collected the data was blinded, as assess their physical function and symptoms. This the subjects wore long-sleeved shirts that hid the tape, 11-item questionnaire is valid, reliable and responsive in and the tape was applied behind a folding screen. All shoulder disorders [23, 24]. They also estimated their subjects provided written informed consent, and all their pain intensity at rest using a 100-mm visual analogue rights were protected. The study was approved by the scale (VAS). Reynard et al. BMC Musculoskeletal Disorders (2018) 19:305 Page 3 of 11 a b Fig. 1 Tape application. a Therapeutic kinesiotape application with a Y-strip surrounding the deltoid muscle and an I-strip over the acromioclavicular joint. b Sham tape applied under the deltoid tuberosity A baseline measurement was then performed without Outcome measures any tape, corresponding to the NT condition. The Our primary outcome concerned the activities of im- subjects were seated in a chair without resting on the portant shoulder muscles, i.e., the upper trapezius, the backrest, with their arms beside their body. Shoulder ro- anterior, middle and posterior parts of the deltoid and tation was neutral, with the elbow extended and the the infraspinatus.