THE EFFECTS OF ELASTIC TAPING ON PAIN IN PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME: A SYSTEMATIC REVIEW

Olivia Fritchey, SPT, Clancy Allmoslecher, SPT, Tom Sneed, PT, DPT, OCSSouthwest Baptist University, Doctor of Physical Therapy Program

Shoulder impingement syndrome (SIS), is a loosely definedterm for a variety of disorders of the shoulder. SIS is oftenassociated with rotator cuff tendinitis and inflammation of avariety of structures found within the subacromial space.Regardless of etiology, it seems to result in pain, weakness,and/or decreased range of motion due to irritation andinflammation in tissues of the shoulder.General treatment of SIS has evolved to include a variety of

interventions with one of the most common treatments beingstrengthening, specifically the scapular stabilizers. Lack ofstrength, poor muscle firing, and pain can be an obstacle forpatients to overcome in early stages of therapy. Elastic tapingsuch as Kinesiotape or “other tape” has been proposed tobridge this gap.In general, there has been a number of different proposed

benefits of elastic taping. Proposed benefits include facilitatingan increase in patient’s proprioception, increased musclefacilitation, reduced delayed onset muscle soreness, as well asmuscle fatigue, enhanced healing, reduction in edema orswelling, improved drainage of lymph, improved blood flow, andan increase in pain inhibition. One theme that runs prevalentand parallel to these propositions, however, is the lack ofresearch in the literature verifying the effectiveness elastictaping has been theorized to provide. Of these proposedbenefits, pain can be easily tracked with an outcome measurelike the visual analog scale (VAS) or numerical pain rating scale(NPR or NPRS). Elastic tape is theorized to decrease pressurebetween tissues acting to decompress subcutaneous painreceptors or nociceptors thereby decreasing patient pain.Use of elastic taping has gained in popularity as evident on

athletes in professional sporting events and the Olympic gameswhich has led to its incorporation into use in therapeuticpopulations such as the elderly and non-athletic patients. Ifphysical therapists are to appropriately utilize this intervention,then the question for its use at the shoulder on SIS should be:What are the effects of elastic taping on pain reduction as seenin patients with shoulder impingement syndrome?

IntroductionSearch Strategy - Databases searched: CINAHL complete,Cochrane central register of controlled trials, MEDLINE,SPORTDiscus, and Ovid. Search terms used: 1) “shoulder” and“taping” 2) “shoulder” and “taping” and “impingement” 3)“shoulder impingement” and “taping” 4) “shoulder impingement”and “elastic tape” 5) “shoulder impingement” and “elastic taping”.Initial searches yielded 472 studies after which duplicates wereremoved narrowing the studies to 263. The screening process oftitle and abstract review decreased the yield of studies from 263to 23. This level of review identified studies utilizing elastictaping on shoulder impingement with an outcome measure. Fulltext hard copies of the 23 studies were obtained. Eighteen (18)studies were removed following the full text examinationsleaving 5 studies. Studies were incorporated into the review ifthe subjects were diagnosed with SIS and elastic taping was theintervention used. Specific taping techniques and brand ofelastic tape were not taken into consideration for inclusion. Onlystudies using VAS as an outcome measure were included. SeeDiagram 1 for a visual representation of this process.

Methods

Use of the AACPDM quality assessment tool revealed that out ofthe five studies reviewed in the systematic review, two studies(Shakeri 2013 and Thelen 2008) boasted a level II researchdesign while the remaining three studies (Shaheen 2015,Selkowitz 2007, Pogliaghi 1998) were a level IV research design.The two strongest studies (level II’s) each reported immediatepain reduction in the patients who received the taping intervention,highlighting the acute effectiveness of this intervention andreporting that the pain reducing quality of the taping interventionwore off after time (>6 days). Only one study out of five, a level IVwith a quality rating of 4/7 (Selkowitz 2007) reported no painreduction in the patients who underwent the taping intervention.The remaining four studies all reported a reduction in pain. Twostudies (Shakeri 2013, Pogliaghi 1998) also reported a significantdecrease in nocturnal pain as a result of the taping intervention.

Results

Study Level/ (Quality)

1 2 3 4 5 6 7

Shakeri (2013) II (7/7) yes yes yes yes yes yes yes

Shaheen (2015)

IV (4/7) yes no yes no yes yes no

Selkowitz (2007)

IV (4/7) yes no yes no yes yes no

Thelen (2008) II (7/7) yes yes yes yes yes yes yes

Pogliaghi (1998)

IV (4/7) Yes no yes no yes no yes

Elastic taping displays effectiveness of pain reduction in theacute phase of shoulder impingement syndrome. Physicaltherapists can take advantage of this reduction in pain andperform more advanced therapeutic interventions that may nothave been tolerated otherwise. Elastic taping decreases painwhich allows for the opportunity of improvement in ROM. As aresult, patients can perform movement patterns that theypreviously could not due to their pain level. This also leads tomore productive therapeutic sessions due to the patient’sability to perform previous exercises that were too painful. Ifimprovements in shoulder kinematics can be obtained, maybeit is possible postural improvements could be attained. Thisprogression may lead to a reduction in shoulder impingementsyndrome symptoms which leads to decreased risk for futurecomplications at the shoulder complex. Elastic tapingdecreases pain allowing the patient to increase therapeuticintensity and could be considered an appropriate adjunctintervention for treatment of shoulder impingement patients.

Conclusion/Recommendation

Shakeri H, Keshavarz R, Arab A M, Ebrahimi I. Clinical effectiveness of kinesiological taping on pain and pain-free shoulder ROM in patients with shoulder impingement syndrome: A randomized, double blinded, placebo-controlled trial. The International Journal of Sports Physical Therapy. 2013;8(6):800-810.

Shaheen A, Bull A, Alexander C. Rigid and elastic taping changes scapular kinematics and pain in subjects with shoulder impingement syndrome; an experimental study. Journal of Electromyography and Kinesiology. 2015;25:84-92.

Selkowitz D, Chaney C, Stuckey S, Vlad G. The effects of scapular taping on the surface electromyographic signal amplitude of shoulder girdle muscles during upper extremity elevation in individuals with suspected shoulder impingement syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2007;37(11);694-702.

Thelen M, Dauber J, Stoneman P. The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial. Journal of Orthopedic & Sports Physical Therapy.2008;38(7):389-395.

Pogliaghi S, Malgrati D. A new shoulder technique for shoulder impingement: a pilot study. Europa Medicophysica.1998:34(3):137-144

References

Methods  cont’d

Methodology - The five (5) selected studies were furtherevaluated for their level of research and the quality of the studyusing an assessment tool by the American Academy forCerebral Palsy and Developmental Medicine (AACPDM). TheAACPDM assessment tool for group design studies is a seriesof questions (7 questions) answered as to whether the studymet or did not meet the criteria. It is a simple yes or no responseresulting in a score out of 7. Scores of 6-7 yes responses areconsidered strong. Scores of 4-5 yes responses are consideredmoderately strong. Scores of 3 or less yes responses areconsidered weak. See Table 1 for results of the scoring.

Table 1 – Research Level & Quality of Study Score

Diagram 1 – PRISMA Flow Diagram visual representation of search process

DiscussionAs a result of the analysis of the five studies, it is generally

agreed that elastic taping appears to decrease pain in patientswith shoulder impingement syndrome. From the review it appearsthe most significant results were reduction of acute pain and painduring sleep. The pain reduction also appears to be of shortduration, days as opposed to weeks. The Shaheen study showedthat 10 of the 11 subjects preferred wearing elastic tape asopposed to any other taping option. The only study that did notseem to show a significant reduction in pain was a level IV studyof moderate strength. While there was a reduction in pain duringmovement, the already low average of initial pain reports waslikely the reason for not finding a further significant reduction inpain with the tape intervention applied. The studies’ data providessome insight into the benefits of pain reduction in patients withSIS. Although it only seems to provide acute relief of pain, thereduction in pain seems to be immediate and elastic taping mightbe able to provide comfort from nocturnal pain. Therefore, whileelastic taping may not be a “quick fix” to SIS, it may be a valuabletool in pain control.

Limitations of this review include:• Lack of studies available with small patient populations.• No gold standard for SIS diagnosis used across studies.

Results in a heterogeneous population.• No distinction between primary & secondary impingement.• Variety of taping techniques/applications used across studies.