Dynamic Tape reduces pain and muscle fatigue in those with CLBP – research commentary

Research on ‘Chronic Non-Specific Low Back Pain’ has always been one of my pet hates. Lack of a diagnosis does not a diagnosis make. Subjects within this classification can have wildly different contributing factors. The paper by Martin Rabey, Toby Hall et al from 2017 highlights this. Some may have nociceptive or inflammatory mediated pain while others may have far stronger influence from psychosocial amplifiers. Some may have tissue damage or be on the cusp of it, others may have little evidence of ongoing structural influences and so it goes on. Applying the same intervention to all and expecting an effect is a search for a panacea rather than a clinically reasoned, evidence informed management approach.

It is therefore interesting when a study shows an effect in this sort of group as is the case in the paper by Alhamari et al, published in late 2020. The immediate and short-term effects of dynamic taping on pain, endurance, disability, mobility and kinesiophobia in individuals with chronic non-specific low back pain: A randomized controlled trial.

The results showed that Dynamic Tape and Kinesiotape improved pain over the no tape condition. Again, it is hard to discern the mechanism as there is no specific deficit identified that the tape is trying to address. Dynamic Tape did however improve spinal mobility and spinal extensor muscle endurance over Kinesiotape and no tape groups. This supports the assertion that Dynamic Tape can provide significant force to do some of the work thereby reducing extensor muscle fatigue and possibly aiding in the control of movement through range, exactly what it was designed to do. Whether that has an effect on pain depends entirely on the nature of the pain and tissue damage. If the extensor muscles are a factor in the development of pain e.g. a muscle strain or perhaps due to fatigue then it could be anticipated that the application of Dynamic Tape may have a beneficial effect on pain.

There may be benefits in those without ongoing tissue damage but with maladaptive movement patterns, extension dominant splinting and guarding. This paper did show changes to kinesiophobia favouring Dynamic Tape but again, a large washout effect would be anticipated as many subjects in the cohort may not have fear of movement. Correctly identifying those who display these movement adaptations and combining the taping application with appropriate pain education may provide further benefit by reducing overwork of the splinting muscles that may be acting as peripheral drivers of pain, while also help to restore movement choice and re-educate more optimal movement patterns and control while reducing the perceived threat. Further, more robust and specific studies are required to evaluate the contribution of each.

Once again, we see that Dynamic Tape can effectively introduce force into the system to modify movement or load. Whether that is clinically beneficial depends on correctly identifying a deficit, its relationship to the presenting condition, the mechanisms by which introducing an external force with the tape can address this deficit, correct application and thorough evaluation to determine that a sufficient force was in fact created. Simply taping everyone with pain in a particular region the same way will yield mediocre results. Thorough understanding, assessment, clinical reasoning and application are central to the approach.

The effect over time is interesting in this paper and would support a clinically reasoned hypothesis that by a. doing some of the work of the weak, fatigued, overworked and peripherally sensitised structures that an immediate improvement in pain and endurance would result as observed b. by reducing load, pain and peripheral drive more normal movement can result and this can challenge beliefs around the association between movement, tissue damage and pain, and while a small improvement might occur immediately, this would take more time to manifest (particularly in those with a stronger contribution from psychosocial influencers and amplifiers or central nervous system changes) – as observed in disability, mobility and kinesiophobia. Appropriate preparatory education and instructions consistent with the pain mechanisms identified would potentially enhance this.

While further studies are required with more homogenous subject cohorts and clearly identified deficits/aims/proposed mechanisms, this study provides evidence that Dynamic Tape can introduce a force into the system which reduces work of muscle/improves endurance and reduces pain immediately and over time – presumably initially due to reduced load and firing of peripherally sensitised structures and potentially some contribution due to reduced kinesiophobia with these effects building over time due to a dampening down of the system from the top down and bottom up.

The-Effects-of-Dynamic-Tape-on-Delayed-Onset-Muscle-Soreness

The Effects of Dynamic Tape on Delayed Onset Muscle Soreness within the Hamstring Complex

Welch L
University of Chichester Institute of Sport, 2018.

This study investigated the effect of applying one piece of 5cm wide Dynamic Tape to resist knee extension (in order to reduce eccentric demand on the hamstrings) prior to a DOMS inducing eccentric loading protocol using the Cybex. Pressure Pain Thresholds, Muscle Girth and Range of Motion were measured. The procedure was repeated with taping on the contralateral limb the week later. Dynamic Taping was show to reduce/prevent the changes associated with DOMS that were exhibited in the untaped limbs.

This study only had 10 subjects and did not have a sham tape group who were taped in a lengthened position such that there was no deceleration of knee extension possible via the tape so it is not possible to say that the effect is due to a change in kinetics resulting from the external application of force resulting in a flexion moment at the knee.

A further, larger and more robust study to answer these questions and provide a clearer understanding of the mechanisms is planned however this study provides preliminary evidence that by contributing force with Dynamic Tape, sufficient reduction in work requirements resulted in the taped limb to prevent the onset of DOMS. This was also with only a single layer of 5cm tape. PowerBands or more comprehensive techniques might be indicated for muscle strains and tendinopathies to increase the amount of unloading, particular in transition stages during rehabilitation were an increase in rate of loading and magnitude of loading occur and re-injury risk is higher e.g. starting to kick a ball hard or increasing speed of running.

* Images have be reproduced with permission from the original study author

Dynamic Tape - Research

An investigation into the effects of dynamic tape on time to stabilisation, foot length, foot width and navicular drop in athletes.

Evans L
University of the West of England, Hartpury College,  2018. Thesis provided.

This preliminary study looked at the effect of Dynamic Taping on foot length, foot width and navicular drop. It also looked at time to stabilisation (TTS) following a counter-movement jump as an indication of any potentially beneficial or detrimental effects of taping in this way with regards to functional stability.

The results showed that Dynamic Taping significantly influenced foot length, foot width and navicular drop compared with no tape. Sham tape (Dynamic Tape applied in the lengthened position) did not produce significant changes. TTS remained the same. This is an important finding as clinicians are often concerned that this taping application which effectively supinates the foot may lead to increased risk of ankle inversion injury. This preliminary study would suggest that this is unlikely however alternative applications exist and would be recommended in athletes who have a past history of ankle sprain or instability or are performing high risk activities. The alternative techniques still aim to elevate the medial and lateral longitudinal arches and the transverse arch to decelerate the navicular drop but do not target the rearfoot position like the technique used in this study.

Larger, more robust studies are required to validate these findings however this study does add support to our own in-house research which has shown that when taped correctly, navicular height changes in weight bearing of 5-10mm are common. These do not occur when taped in the lengthened position with no tension, again suggesting a mechanical mechanisms (which can be immediately seen, felt and measured when applied correctly). Please contact us if you would like to obtain the full white papers that we produced.

Furthermore, more comprehensive techniques can be used if required and clinical evidence would suggest that these result in greater and longer lasting effects.

An example of the arch support technique used in this study. Note that the resting position changes if the technique is applied correctly. The 1st MTP joint should be in flexion, the calcaneum inverted and the metatarsals should be convex on the dorsum of the foot. If these changes are not present in non weight bearing, the technique is unlikely to be applying a genuine force into the system so cannot affect kinetics let alone the kinematic changes reported in this study.

Dynamic Tape Combo Black Tattoo 3" and 2"

Plantar Pressures with Arch Support Taping

In further support of the technique above, this case was supplied to us from a clinician in the USA. The subject was suffering with pain in the region of the 2nd MTP joint with a history of Moreton’s Toe and surgery. The arch support technique resulted in a measurable reduction in loading through the symptomatic region.

Mechanical Effect – pressure changes in weight bearing with the arch support technique. In this case it has reduced weight bearing on the medial aspect of the forefoot, particularly the first and second MTP joints as evidenced by the reduction in signal intensity on the medial forefoot of the right foot (taped) of the left pairing when compared to the right pairing. Similarly, an increase in weight bearing is noted laterally on the taped foot (right) in the left pairing when compared to the untaped version (right pairing).

Dynamic Tape Ankle Wrap Application

The effect of different taping techniques to lower extremity jumping performance and dynamic postural control

Gazi University Institute of Health Sciences 2015
Dogan Fe

This Masters Thesis project was provided to us. It investigated the effect of Kinesiotaping, Dynamic Taping and a Placebo Taping (using a rigid athletic tape) compared with no taping on dynamic balance and jump performance in 24 male professional soccer players.

The results showed that Dynamic Taping increased reach distances in the Star Excursion Balance Test when compared to all other groups. There were no significant differences when the other conditions were compared with each other. Furthermore, Dynamic Taping was the only one to show a significant improvement in single leg hop for distance compared with no tape.

Previous studies have reported mixed results in regards to detrimental effects on performance – generally worse or no change. This is the first study that we have seen that increased performance. The technique used was also very light compared with what we generally recommend and has far less of a force closure component to it however it did look to apply a resistance to inversion and a recoil into eversion. Dynamic Tape does allow normal movement to occur during the loading or wind up phase whereas a rigid tape may impact this negatively. However, the mechanism behind the improved performance is not fully elucidated in this study. The kinesiotaping application actually covered more skin and therefore had more input into the system so this sort of neurophysiological effect alone does not account for the difference. Briem et al showed an increase in mean muscle activity with a rigid tape when compared to kinesiotape so perhaps the stronger pulling of Dynamic Tape creates this effect. It may simply be improved confidence and beliefs around self efficacy that aid the performance. In the more comprehensive techniques, far more joint compression is obtained which would result in an increase in coefficient of friction at the articular surfaces and therefore an increase in stability via the force closure mechanism. The stronger recoil and spiralling application in this study would increase this slightly however as there was no sham Dynamic Taping technique (i.e. same orientation of tape but with no tension/compression), it is not possible to attribute the increase in performance to an increase in force closure. Further studies are required.

A far more comprehensive technique than the one used in this study results in firm, triplanar compression to increase force closure and stability (LEFT). When applied correctly, the rear foot should be resting in full eversion such that there is immediate and significant resistance and deceleration of inversion (RIGHT). This resistance increases with increasing velocity of the movement due to the viscoelastic properties of the tape. Normal movement however is preserved to allow the person to maintain normal balance strategies, accommodate to the ground surface and perform movements required for the sport.

Judo

Influence of Dynamic Tape on the functionality of the quadriceps in non-specific pain in the judo athlete.

Sales, CR
Dissertação de Mestrado em Fisioterapia Desportiva apresentado à Universidade Fernando Pessoa, Porto, 2013.

https://bdigital.ufp.pt/bitstream/10284/5488/1/DM_30710.pdf

37 Judo athletes with non-specific knee pain were evaluated for static and dynamic balance, strength, flexibility and pain. Volunteers were submitted to the Standing Stork Test (SST), Y Balance Test (YBT), Four Square Step Test (FSST), Single Leg Hop Test (SLHT), Lower Limb Flexion Test (TFMI) and Extension Members Test (TEMI). After the tests, they answered to the Numerical Pain Scale (END).

No significant differences were found for the SST test (p=0.6794), however the YBT, SLHT, TFMI, TEMI and END (p<0.0001), as well as the FSST test (p = 0.0026) showed significant statistical differences, suggesting that the implementation of DT produced positive effects on the performance of the athletes.

Dynamic Taping improved semi-dynamic and dynamic balance, flexibility and pain.

It must be noted here that applying the same technique to a cohort of subjects with ‘non specific’ knee pain does not follow our general recommendations. Ideally, Dynamic Taping should be applied to address a deficit identified on assessment and demonstrated to be an important contributing factor in this patient (and ideally by the research). For example, if quadriceps weakness is identified and poor ability to accept load onto the leg during a single leg squat or landing task is observed, then Dynamic Taping could be applied to aid in load acceptance and knee control which may reduce loading on sensitised or damaged structures responsible in part for the pain being experienced. Ideally, those structures, their state and the pain processes at play should also be identified.

Nevertheless, this study does show that assisting knee extension control and load reduction in this group has resulted in improved dynamic balance, pain and flexibility. This may then allow appropriate reintroduction of loading exercises to build sufficient capacity such that the taping is not required. Further studies comparing with Dynamic Tape applied in the lengthened position with no tension and with a more specific and homogenous subgroup of subjects would provide further insight into the mechanisms and appropriate indications and use of Dynamic Tape.

gait

The Effects of Applying Dynamic Tape to the Lower Limb of a Patient with Sequelae of Stroke

Farias B B, Lumini J A.
Estudo de Caso, 2015 Fernando Pessoa University

http://bdigital.ufp.pt/handle/10284/4765

This study looked at the effect of Dynamic Taping on gait and a range of other functional tasks in a stroke patient 5 years post stroke.

Dynamic Tape resulted in improved angular values and velocity measured during walking, Timed Up and Go Test improved from 18.4s to 13.9s, Four Square Step Test improved from 15.1s to 12.2 s, Functional Reach Test improved from 15cm to 17.5cm and Step up and down improved from 8.9s to 6.1s.

No research has been conducted to our knowledge on subjects early on in their rehabilitation to determine if there are any improvements in motor relearning. The aim of the application and indications for its use in these situations however are very much determined by the patient. The aim is not to cure the foot drop but to improve function. This may simply be to enable someone to walk outside on uneven ground with less risk of falls due to improved dorsiflexion and a more stable ankle. We were contacted by a gentlemen who wanted to walk his daughter down the aisle without the use of an AFO. The aim of our treatment is not always to cure or to have lasting effects. A patient centred approach is critical.

Immediate effect of Dynamic Tape®on external torsion tibial clinically painful in a football player.

A case report by De la Cruz Torres B, Albornoz Cabello M, Espejo Antúnez L.
Rev Andal Med Deporte. 2016; 9(1):50–53.

This study looked at kinematics and tensio-myography in a footballer with lower extremity pain believed to be influenced by the observed external tibial torsion.

Dynamic Taping was applied to address this resulting in a reduction in Thigh-Foot angle and a 55% reduction in pain, however this could have been a function of time. No reference is made to how long the pain had been present prior to the intervention.

Interestingly, thigh-foot angle reduced from 20º to 2.5º and the muscles involved with external rotation of the shank showed changes consistent with a reduction in stiffness and activity and those associated with external rotation of the femur (relative internal rotation of the tibia) showed an increase in strength/activity/stiffness.

From this study we cannot conclude that the changes in kinematics and muscle activity were directly responsible for the change in pain nor be definitive about the mechanism behind the observed kinematic changes but to say that the application of Dynamic Tape resulted in marked changes in movement and muscle function.

https://doi.org/10.1016/j.ramd.2014.10.072

case study

Dynamic Tape Case Report

Toma Vasilescu
Romania.

This clinical case report investigates the effect of Dynamic Taping on a subject with Radial and Ulnar Nerve transection due to a knife injury. In this case there is no possibility of facilitating muscle activity as the nerves are not in tact. What we do see however is an immediate change in position and motion and consequently function due to the strong resistance, recoil and elongation of Dynamic Tape.

Of course, this will not accelerate the nerve regeneration but in addition to the immediate functional improvement and its benefits on activities of daily living. The results of this application may help to maintain range of motion and reduce swelling. As some return occurs, the patient will be practising a more correct movement pattern rather than compensatory patterns when there is insufficient strength to move correctly, and this could result in better movement outcomes.

The ideal technique would address both wrist and fingers simultaneously to allow for a functional grasp. These two videos, however, show the targeted mechanical effect resulting from the application of the tape.

study

Dynamic Tape Case Report

Keith Cronin & Ryan Kendrick
Denver, CO.

This single case report does however help to shed some light on the mechanism. In this case, a subject with neurological deficit resulting in a partial foot drop (very weak dorsiflexion and eversion) was examined using the BodiTrak system which evaluates centre of pressure. He was asked to do a single leg standing task with eyes closed.

Dynamic Tape BodyTrak Study

In the untaped condition (left) the COP measurement shows that the subject tries to maintain a neutral COP. As soon as his COP moves slightly laterally ( to the left of the centre line and into inversion), he does not have the strength to correct and loses his balance. In the taped condition (right), the subject actually rests in slight inversion (COP is slightly to the left of the centreline) which would normally result in a loss of balance. With the tape in situ he is able to rest on the tape and even correct using the recoil if he goes into inversion improving his single leg standing time significantly.

Unfortunately due to time constraints, he was not tested in the lengthened position but the neurological deficit would suggest that any mechanism is likely to be mechanical. This is illustrated further in the wrist case study below where the nerve has been transected with a knife so the only possible mechanism is a mechanical one.

dynamictape on a female volleyballer

Dynamic tape in elite volleyballers with instability post lateral ankle sprain

Pereira A, Ribeiro V, Silva R, Zuin A.
Revista Movimenta 2017; (4) 895.

This study was presented at the VIII Congress Brasileiro e vi Congress Internacional da Sociedade Nacional de Fisioterapia Esportiva (SONAFE) in 2017. 20 elite male volleyballers between 16 and 22 years of age with a history of lateral ankle sprain were investigated. Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM) and Y Balance Test were evaluated with and without Dynamic Taping.

Dynamic Taping resulted in significant improvement in all measures. Again, it is difficult to draw conclusions regarding the mechanism behind the improvement with this intervention as a sham group was not investigated. Taping in the lengthened position results in the same skin contact, same appearance (and likely expectation) but without the possibility of the same mechanical effect and can therefore help determine whether the mechanism is largely mechanical or more related to skin contact, expectation or some other neurophysiological mechanism however clear improvements in dynamic balance and function were achieved.

www.revista.ueg.br/index.php/movimenta/issue/view/396

Dynamic Tape Hip Closure

Dynamic taping and high frontal plane knee projection angle in female volleyball athletes

Bittencourt N, Leite M, Zuin A, et al
Br J Sports Med 2017; 51:297-298

This study which was presented at the International Olympic Committee Injury Prevention Conference evaluated the effect of a hip extension, abduction and external rotation Dynamic Taping technique on high frontal plane knee projection angle in elite female volleyballers during a single leg squat.

Results showed that 10 of 18 athletes had high FPKPA (>8o) and the T-test revealed statistical difference pre and post DT (p<0,0001). Pre DT Mean of FPKPA was 10.5ºand Post DT mean was 5.4º.

While larger studies including a group who are taped in the lengthened position will reveal more about the mechanisms involved (and have been conducted elsewhere showing the effect only occurs when taped in the shortened position), this study provides preliminary support for use of Dynamic Tape to address high frontal plane knee projection angle when indicated. This may have relevance in some athletes or patients post ACL injury, patella tendinopathy, PFPS, greater trochanteric pain syndrome or pelvic girdle pain subjects with poor force transfer capacity through the SIJ for example.

An example of this technique is shown adjacent.

View Article
http://dx.doi.org/10.1136/bjsports-2016-097372.36

Does Dynamic Tape Alter Gait and Reduce Pain in Women with Greater Trochanteric Pain Syndrome?

A Double-Blind Randomised Controlled Trial

Robinson N, Spratford W, Gaida J, Fearon A.

Nicole Robinson recently won the ‘Best New Investigator Award’ from Sports Medicine Australia ACT, Australian Physiotherapy Association (ACT branch) ‘Best Student Paper’ and ‘Best Overall Paper’ for this well-conducted study that investigated the effect of Dynamic Taping on a Greater Trochanteric Pain Syndrome (GTPS) population.

This study showed reductions in hip adduction angle and momentum as well as hip internal rotation in the active Dynamic Taping group taped in the shortened position compared with no tape and taping in the lengthened position. This provides support that the mechanism has a mechanical component and is not simply somatosensory or due to expectation alone. It is suggested that these changes reduce the loading on the ITB directly via contributing some of the force but also indirectly due to the changes in kinematics and consequent reduction in compressive loading that occurs due to the change in position. Pain was also improved more in the active taping group.

View Article

 

Clinical Reasoning When Taping Biomechanically Demonstrated In This Single Case Study Investigating Hip And Knee Taping For Dynamic Knee Valgus

The Problem

35-year-old male with 17-year history of left sided L3/4 nerve root compression resulting from disc protrusion. Managed conservatively and has intermittent pain but has had consistent weakness in quadriceps.

 

The Investigation:

ViPerform motion analysis by DorsaVi was used to provide information regarding frontal plane and sagittal plane motion, more specifically magnitude and velocity of frontal plane motion (generally looking at control of dynamic valgus at the knee) along with tibial inclination. The functional movement assessed was single leg hop/land and the subject was assessed with no tape, Dynamic Taping into knee extension (to resist the collapse of the knee into flexion under the weight of the body) and Dynamic Taping into hip extension, external rotation and abduction to resist movement in the opposite directions. Multiple repetitions of each condition were performed, and the mean values reported.

 

The Results:

In the untaped condition total frontal plane motion was 25º and speed on landing was 150º/sec. Tibial inclination on landing was 34º.

 

With Dynamic Taping for knee extension total frontal plane motion was reduced to 19º and the speed on landing was reduced to 124º/sec. Tibial inclination on landing was reduced to 31º.

 

With Dynamic Taping to resist hip flexion/adduction/internal rotation total frontal plane motion was unchanged at 25º but speed on landing was reduced dramatically to 102º/sec (the most deceleration ever recorded by the DorsaVi consultant). Tibial inclination on landing was much the same as the untaped condition at 33º.

 

The Conclusion:

Dynamic Taping for knee extension to provide a resistance to the knee collapsing into flexion resulted in reduction in magnitude and velocity of frontal plane motion and reduced tibial inclination suggestive of less need to flex the knee to absorb load on landing nor to compensate in the frontal and transverse planes. The unique properties of Dynamic Tape however still permitted the same amount of flexion to occur in preparation for the jump and thereby does not appear to interfere with correct performance of the task.

 

Dynamic Taping of the hip to resist adduction, internal rotation and flexion resulted in a larger deceleration of movement into those directions however the magnitude of frontal plane motion remained the same. Presumably, this is because the deficit was knee extensor strength. As this sagittal plane motion was not addressed with hip taping, the compensation still occurred in the frontal plane albeit decelerated maximally due to the resistance of the tape (which would alter the kinetics associated with Dynamic Valgus at the knee). Again, the ability to perform the task was not hindered.

 

Studies by Bittencourt et al, 2017 (http://dx.doi.org/10.1136/bjsports-2016-097372.36) and Robinson et al, 2019 (https://doi.org/10.1016/j.gaitpost.2019.02.031) also demonstrate that Dynamic Taping reduces velocity and magnitude of hip adduction and internal rotation in single leg squat and gait.

 

This current investigation highlights however that as clinicians we must determine the underlying cause of the aberrant motion and address that. In this case, additional knee extension moment was required and taping to create this force externally reduced the compensatory hip motion also. Don’t just tape the hip because the movement is occurring there. Ask, why?

 

The Relevance:

Quadriceps weakness is often a sequelae post-surgery for anterior cruciate repair and total knee replacement. Increasing dynamic valgus at the knee is predictive of both initial and recurrent non-contact ACL ruptures and has been suggested as a contributing factor in Greater Trochanteric Pain Syndrome (GTPS), Patellofemoral Pain Syndrome (PFPS) and Patella Tendinopathy.

 

The ability to apply a force externally to reduce demand on the body thereby improving control of inner range of knee extension and frontal plane motion not only serves to improve function and functional loading immediately but may also be beneficial in scaling magnitude and rate of application of load, re-educating the desired technique or managing pain where this pain is load dependent as is generally the case with tendinopathy, all of which may aid intrinsic force generation.

 

If deficits are identified on assessment and are deemed to be a relevant contributing factor, Dynamic Taping may provide a way to immediately alter this both as part of management but also to furnish further information to support or challenge your hypothesis.

 

DorsaVi Reports

 

Untaped Condition

 

 

Knee Extension Taping

 

Hip Ab/Ext/ER Training

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