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The value of shoulder tap/strapping in physical therapy
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In this EBP Module, we offer you an overview of the typing techniques that are sometimes used in the clinic to improve movement and stability around the shoulder.
So yes, these techniques are frequently questioned!
Can they be used safely? In what case? For what purpose? And more importantly, what is the evidence of its effectiveness in reducing pain, improving shoulder stability and function?
We will attempt to answer these various questions in this EBP Module. You will also discover on video the installation of 4 shoulder taps to help you in a very concrete way in your clinical practice.
So first, as physiotherapists, we need to use our clinical judgment to determine whether the use of a tape is necessary, and to choose the appropriate type of tape. Next, we will need to assess and monitor the results of this decision.
The use of the tape can be a complement to our rehabilitation of our patient's shoulder, as it allows us to prolong the effects of the treatment after the patient leaves the office. And yet, in the literature, the results on the effectiveness of tape, whether made with elastic or rigid tape, vary (Celik et al. 2020; Cupler et al. 2020; Ghozy et al. 2020; Lim et al. 2015; Lim et al. 2015; Lim et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. 2015; Saracoglu et al. This variability can in part be explained by a standardized research approach.
In clinical practice, the health professional can perform a thorough examination of the patient to determine if the tape is appropriate, and if so, choose the most appropriate tape technique to obtain the desired results.
The main motivation behind using taps in the management of shoulder pain is to alleviate the patient's symptoms or to contribute to their reduction.
When symptoms do not improve by at least 50%, Jeremy Lewis (2021) highlights the practitioner to think about several aspects, such as:
The accuracy of the positioning of the tape
The quality of the application of the tape, avoiding excessive tension that could damage the skin or insufficient tension that would make the tape ineffective.
The position of the shoulder at the time of applying the tape.
Choosing the appropriate typing technique.
The choice of tape chosen for the patient in question.
The relevance of the tape in the case of this patient
Generally, scarves and splints are commonly used clinically to unload tissue and reduce pain in patients. For a similar purpose, tape can also be used, as it has the potential to influence load distribution, which contributes to the reduction of symptoms and the improvement of function.
So be careful, it is essential to note that the tape is not a standalone treatment, but rather a technique to be integrated as part of a global approach to care.
When the patient's symptoms are significantly alleviated through the use of tape, this can strengthen the patient's compliance with the treatment. Additionally, tape can be used to facilitate or inhibit muscle activity, which in turn can speed up the improvement of symptoms.
Remember, joint stability results from a collaboration between passive structures, mainly ligaments, and active structures, muscles.
However, the viscoelastic properties of ligaments and their responses to loads or movements may reduce their effectiveness as joint stabilizers.
When passive structures are altered, muscles can be mobilized optimally to minimize joint instability and pain (Solomonow et al. 2006).
The tape offers a variety of ways to achieve this goal, including improving joint position and stability, strengthening muscle function, and providing proprioceptive input.
Objective of the tape
As mentioned above, the choice of the type of tape in a treatment depends on the initial evaluation of the patient's shoulder. The main objective of the tape is to relieve pain, which is the main concern of patients. A secondary objective is to improve the positioning of the humeral head in the glena and to correct the scapular position to minimize any possible scapular dyskinesia. So, before I get bumped into it, I emphasize that the presence of scapular dyskinesia does not necessarily imply a pathology, but if improving the position of the scapula presents the symptoms, it may suggest an involvement of the scapula in the patient's shoulder symptoms.
In any case, it is essential to reassess the patient's symptoms after each tape application, aiming to achieve at least a 50% reduction in symptoms.
What are the effects of taping on pain?
It is known that inflamed and painful tissue can react weakly to movement and stretching. One of the key approaches to relieving these tissues is then to position them in a shortened posture in order to reduce symptoms. In these cases, we will rather choose a non-stretchy tape, because it offers support to the tissues while allowing joint movement.
Shoulder patting can contribute to increasing acromiohumeral distance (ADH), especially in individuals with symptoms, where this distance is often reduced. Studies, such as the one conducted by Harput et al. (2017), have shown that applying Kinesio-tape to the scapula can increase acromiohumeral distance, as well as build strength and improve mobility in the internal and external rotators of the shoulder. This research suggests that scapular taping may be beneficial in treating subacromial impingement syndrome (SIS).
On the other hand, Bdaiwi and colleagues (2017) reported that applying rigid tape to the scapula in asymptomatic individuals significantly increased the acromiohumeral distance at 60° of passive arm abduction. These results suggest that taping, by promoting posterior scapular inclination and improving scapular upward rotation, could be a useful adjunct to the rehabilitation of patients with SIS, due to its effect on acromiohumeral distance (Bdaiwi et al. 2017).
Athletes suffering from rotator cuff tendinopathy (CR) have shown an increase in acromiohumeral distance (ADH) with the application of a rigid therapeutic tape at 60 degrees of shoulder abduction compared to the absence of a bandage (Leong et al. 2019).
These researchers observed a significantly earlier activation of the middle trapezius, inferior trapezius, and large dentatus anterior muscles under therapeutic tape and placebo tap conditions compared to no tape (Leong et al. 2017).
They also noted a slight increase in scapular upward rotation when comparing therapeutic tape conditions and the absence of tape, suggesting that scapular tape may improve neuromotor control of the scapular muscles (Leong et al. 2017). It is possible that the application of a rigid scapular tape may change the activation pattern of scapular stabilizers, which may reduce the acromiohumeral distance at the beginning of the abduction range, where there is no conflict, but improve the acromiohumeral distance to 60 degrees, where subacromial structures may be compromised, and where space becomes more critical.
Adding taping to a therapeutic exercise program has been shown to be more effective than the exercise program alone in treating subacromial impingement syndrome (Simsek et al. 2013; Teys et al. 2013). For example, Teys et al. (2013) found that adding tape to mobilization with movement (MWM) techniques in the treatment of SIS significantly improved range of motion over a period of one week, compared to using MWM alone.
In 2021, Letafatkar and his team conducted a three-arm randomized controlled trial to investigate whether adding KT to therapeutic exercise is an effective treatment for improving clinical outcomes compared to therapeutic exercise alone and no intervention, in patients suffering from shoulder impingement syndrome.
The authors showed that although therapeutic exercises alone had a positive effect on clinical outcomes, adding KT to therapeutic exercises had more significant effects with larger effect sizes. The authors suggest that adding a KT to therapeutic exercises may help clinicians improve clinical outcomes in patients with subacromial impingement syndrome (Letafatkar et al. 2021).
However, the benefits of taping are not universal, as other studies have reported that Kinesio taping does not improve shoulder symptoms, especially in younger patients (Keenan et al. 2017; Thelen et al. 2017; Thelen et al. 2017; Thelen et al. 2017; Thelen et al. 2008).
In 2021, the team of de Oliveira et al. carried out a randomized controlled trial to assess the medium and long-term effects of KT, added to a 6-week rehabilitation program, on the symptoms and functional limitations of people with rotator cuff shoulder pain (RCRSP).
The authors found that although symptoms, functional limitations, ROM, and ADHD improved in both groups (KT and non-KT), no differences between the groups in the medium and long term were observed. Therefore, the authors suggest that KT did not provide additional effects to a 6-week rehabilitation program for people with RCRSP in order to improve symptoms and functional limitations (by Oliveira et al. 2021).
Although the evidence regarding the benefits of taping for shoulder symptoms is not definitive, it can be considered as an evidence-based care option, subject to consideration of appropriate and appropriate communication to patients, as part of a shared decision-making model.
When the objective of the intervention is to increase muscular activity, the application of the tape should follow the direction of the muscle fibers (Macgregor et al. 2005). In this context, the use of a more elastic tape may be considered, as it has the ability to stimulate the muscle during contraction and to stretch with movement.
However, the research results are mixed. For example, a study conducted by Alexandre et al. 2003 showed that applying the tape along the entire length of the lower trapezius (LT), from insertion to origin, reduced the muscular H-reflex. Note that this study was carried out on young and asymptomatic individuals, whose muscles may have been functioning more optimally than in symptomatic individuals. It is possible that in asymptomatic individuals, applying tape may improve muscle efficiency, thereby reducing the recruitment of fewer motor units, which could improve muscle fatigue resistance.
Effect of tape on proprioception
The concept that taping improves motor performance in the presence of muscular fatigue was suggested by Weerakkody and Allen (2017) in a study involving amateur cricket players without symptoms. They found that errors in the sense of joint position increased immediately after exercise, and that taping had no effect on position errors before exercise, but significantly reduced position errors after exercise, especially in middle ranges of shoulder flexure. They concluded that the additional skin input provided by the tap could contribute to the perception of shoulder position (Weerakkody and Allen. 2017).
In contrast, Aarseth et al. 2015 reported that the perception of shoulder joint position at 90 degrees of elevation was altered by the application of Kinesio taping in athletes without symptoms, who did not participate in sports involving movements above the head.
Thus, the preparation of the motor program when the individual is familiar with the activity above the head seems to be an important element to consider when evaluating the perception of joint position (JPS) in relation to the application of tape and the effects of activity-induced fatigue. More research is needed, especially in people with symptoms, in order to better understand these differences (Lewis et al. 2021).
In their 2023 systematic review, Ager et al., attempted to synthesize evidence on the effects of elastic KT on proprioception in healthy and pathological shoulders. The authors concluded that there was very low to low certainty evidence that elastic KT improves active and passive shoulder proprioception. The body of evidence is currently so weak that any recommendation on the effectiveness of elastic KT on shoulder proprioception remains speculative (Ager et al. 2023).
Effect of taping on pain
According to Yildiz et al. 2020, the application of taping led to an increase in scapular upward rotation, although the results were mixed with respect to scapular external rotation and posterior inclination. Additionally, most studies indicated that taping reduced activity in the upper trapezius (UT) muscle, but the evidence regarding the activity patterns of other periscapular muscles was contradictory (Yildiz et al. 2020).
In contrast, Intelango et al. 2016 found that scapular taping did not induce significant changes in electromyographic (EMG) signals in UT, LT, and anterior dentate (SA) muscles, nor did they induce significant changes in the isometric force of shoulder flexure, abduction, and external rotation in symptomatic individuals.
Dhein et al. 2020 also reported that applying Kinesio taping caused a reduction in EMG activity in the LT muscle in patients diagnosed with SIS, suggesting that caution was needed when using this type of taping in this group of patients, as it may have adverse effects on scapular kinematics and increase symptoms (Dhein et al. 2020).
The application of rigid taping, aimed at repositioning the glenohumeral joint with anchors on the lower edge of the scapula in young and asymptomatic individuals, has been associated with an earlier onset of contractions of the upper trapezius (UT) and lower trapezius (UT) and lower trapezius (LT) muscles compared to the middle deltoid (MD) during shoulder abduction and flexure. However, these changes in the time of onset of contractions are not maintained 24 hours after taping (Snodgrass et al. 2018).
According to Snodgrass et al. 2018, applying the taping technique resulted in an immediate increase in range of motion during active shoulder abduction. They suggested that this may be because the taping technique promoted upward rotation of the scapula through an earlier onset of UT and LT muscle contractions.
However, they noted that further research would be needed to confirm this hypothesis. The authors also pointed out that while taping may initially change the relative activation of scapular muscle contractions, additional intervention would be required for lasting changes or changes in corticomotor excitability.
They suggested that the optimal time to engage in rehabilitation exercises aimed at facilitating the onset of trapezius muscle contractions during shoulder movements would be immediately after applying the tape.
Effects of taping on the inhibition (minimization) of muscle activity
When it is considered that reducing the activity of the antagonist muscle would be beneficial in improving the performance of the agonist muscle affected by pain, the application of a firm tap on the antagonist muscle may be considered (Tobin et al. 2000).
For example, Selkowitz et al. 2007 reported that rigid taping applied to the upper trapezius (UT) reduced UT activity and increased lower trapezius (LT) activity during a functional elevation task, especially above 90 degrees, in individuals diagnosed with subacromial impingement syndrome (SIS).
However, in individuals with asymptomatic scapular dyskinesia, applying Kinesio taping to UT was sufficient to reduce UT activity, but did not appear to change LT activity (Huang et al. 2019).
Reynard et al. 2018 conducted a study to assess the effects of Kinesio taping compared to fictional taping (ST) and no taping six and twelve weeks after rotator cuff surgery. Their results showed that the Kinesio taping reduced upper trapezius (UT) recruitment, but did not impact deltoid or infraspinatus activity.
They also observed that Kinesio taping and ST increased the flexural range of motion at six weeks, although the differences from no taping were not clinically significant. In summary, while shoulder taping has the potential to reduce UT muscle hyperactivity, it has not shown other significant clinical benefits in people who have had rotator cuff surgery (Reynard et al. 2018).
Effectiveness and efficiency of taping for shoulder pain
Using different types of pads can lead to varying clinical outcomes for people with shoulder pain. The use of tape in people with subacromial impingement syndrome (SIS) showed low to moderate standardized mean differences (DMS) compared to the use of placebo tape, indicating a moderate beneficial effect of taping (Celik et al. 2020).
Saracoglu et al. 2018 reported low-quality evidence that suggests a positive effect of taping as an adjunct to improve pain, disability, range of motion, and muscle strength in people with SIS (Saracoglu et al. 2018). However, current evidence on the isolated use of Kinesio tape for the management of shoulder pain is contradictory, with small effects.
Lim et al. 2015 concluded that current evidence did not support the superiority of Kinesio taping over other therapeutic approaches to reduce pain and disability in people with chronic musculoskeletal pain (Lim et al. 2015).
Ghozy et al. 2020 confirmed that Kinesio taping alone was not effective in reducing pain and disability in individuals with shoulder pain compared to placebo, but it was effective when combined with exercise (Ghozy et al. 2020).
Even more recently, in 2022, a double-blind randomized controlled trial consisted of 50 subjects suffering from cuff tendinopathy, with 25 subjects assigned to the KT group (to receive a therapeutic application of KT) and 25 subjects to the placebo group (to receive a dummy application of KT). Taping was applied to all participants every 4 days, which equated to a total of three applications during the study period.
Participant evaluations were conducted at the start of the study, at the end of the registration period (day 12), as well as one month after registration (day 30). In conclusion, the authors found that the standardized therapeutic KT used for shoulder pain was no superior to a simulated application of KT to improve pain and disability in patients undergoing an RCT (Taik et al. 2022).
Adverse effects
When applying the tape, clinicians may encounter a major skin problem. The first problem is friction, which often occurs in the form of a blister. This friction can be caused by several factors, including vigorous tape application, uneven tape tension, or rapid tape removal. To avoid these skin irritations, here are some potential solutions:
Be Careful When Applying the Tape
Use Your Other Hand to Relieve Skin Tension as You Remove the Tape
Start at the back and slowly peel the tape to the front.
You can also apply eucalyptus oil or tea tree oil to the tape before removing it.
Use skin protection, such as Comfeel, Calamine lotion, Cutifilm, Opsite, to protect the skin.
Practical montages
McConnellâą tape is both a clinical system for applying tape and a specific tape product. McConnellâą tape uses a firm, non-elastic tape with a hypoallergenic tape underneath to protect the skin.
McConnellâą tape has a slight stretch in two directions for optimal support. The tape is used, as we saw earlier, to unload tissue, with the aim of reducing pain, so that treatment can be focused on improving function.
Humeral Head Repositioning Tape
This setup has been examined in asymptomatic individuals. A study showed that in elite junior tennis players with no history of shoulder injury, the use of the âglenohumeral repositioningâ tape increased the passive mobility of the internal and external rotation of the shoulder, suggesting an improvement in humeral head mobility (McConnell et al. 2009).
However, another study conducted on elite athletes, one group of whom had already experienced shoulder injuries and the other did not, found that taping improved passive rotation mobility in both groups. However, dynamic external rotation of the shoulder occurs slightly in the previously injured group, while it increased slightly in the uninjured group (McConnell et al. 2012; McConnell et al. 2011). These differences were minimal and not very noticeable in clinical practice, suggesting that the effect of taping on shoulder mobility may vary depending on the athlete's history of shoulder injury.
In the group of athletes who had already suffered shoulder injuries, the shoulder tap may have caused changes for a variety of reasons, including the possible reduction of the anterior translation of the humeral head by altering the activation patterns of the rotator cuff muscles and scapular stabilizers. Small adjustments in the position of the center of the shoulder joint could potentially influence the ability of the shoulder muscles to generate forces.
Although taping caused only a modest 4-degree change in external rotation during the throw, this slight change may have impacted shoulder stability and mobility. One hypothesis is that taping could improve the neuromotor control of rotator cuff muscles and scapular stabilizers, thus providing a more stable platform for aerial movements. The precise application of taping can allow for better control of humeral translation, thereby reducing stress on anterior structures and improving shoulder stability. However, more research is needed to confirm these hypotheses.
Deltoid muscle tape
Upper Trapezius Muscle Tape
Inferior Trapezius Muscle and Major Serrated Muscle Tape
In conclusion, muscle strengthening and taping can be considered as evidence-based treatment options for individuals with musculoskeletal disorders affecting the shoulder. However, it is essential to take a shared decision-making approach, taking into account possible risks such as skin injuries and allergies, as well as anticipated benefits, while drawing on available research evidence.
It should be noted that the evidence currently available regarding the effectiveness of applying tape is limited and somewhat contradictory. Clinically, the use of adhesive tape may be further considered when the patient sees an immediate reduction of at least 50% in symptoms after applying the tape. However, the precise mechanisms by which duct tape contributes to the reduction of symptoms still require extensive research.
It is important to emphasize that tape should not be considered as an independent treatment, but rather as an adjunct to an appropriate rehabilitation program.
Bibliographies
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â Yildiz, Taha Ibrahim, Birgit Castelein, Birgit Castelein, Birgit Castelein, Gulcan Harput, Gulcan Harput, Irem Duzgun, and Ann Cools. âDoes Scapular Corrective Taping Alter Periscapular Muscle Activity and 3-Dimensional Scapular Kinematics? A Systematic Review.â Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists 33, no. 3 (2020): 361-70.
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