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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 24-28

Immediate effect of kinesio taping on pain and grip strength in individuals with lateral epicondylitis


1 Department of Orthopaedics, Goa Medical College, Bambolim, Goa, India
2 Department of Physiotherapy, MS Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Submission21-Nov-2018
Date of Acceptance06-Apr-2019
Date of Web Publication3-Jul-2019

Correspondence Address:
Ms. Alisha Gracias
Department of Orthopaedics, Goa Medical College, Bambolim - 403 202, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_19_19

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  Abstract 


Background: Lateral epicondylitis (LE) of elbow, involves tendinitis of the extensor carpi radialis brevis(ECRB). LE is characterised by superficial or deep macroscopic and microscopic tears at the tendinous origin of ECRB. Rigid taping has been proved effective in alleviating pain, improving muscle function and restoring functional movement patterns. Kinesiology taping (KT) has roughly the same thickness as the epidermis and can be stretched between 30% and 40% of its resting length longitudinally. Since KT is more user friendly and it support functions by maintaining active range of motion and without the circulation being repressed as compared to rigid taping, there is a need to study the effect of KT on grip strength and pain in subjects with LE.
Aims and Objectives: 1. To report the pain pressure threshold of subjects in experimental and control groups before and after application of KT. 2. To determine the grip strength of subjects in experimental and control groups before and after treatment using KT. 3. To compare the values of pain pressure threshold and grip strength between experimental and control groups.
Materials and Methods: Subjects satisfying the inclusion criteria were taken for the study by convenience sampling. The subjects of both groups were then assessed for pain and grip strength prior to the application of tape using a pain-pressure algometer and hand-held dynamometer respectively. Subjects in the experimental group were then applied with KT using muscle and space correction technique and the control group received sham taping. The outcomes were then re-assessed immediately after taping.
Results: From the results obtained it was seen that there was a statistically significant difference (P < 0.001) in the pain pressure threshold and grip strength between the both groups indicating that KT was effective in reducing the pain and increasing the grip strength in individuals with lateral epicondylitis.
Conclusion: The findings of the study indicates that, there is a significant improvement in pain pressure threshold and grip strength after the immediate application of KT in the experimental group as compared to the control group.

Keywords: Grip strength, Kinesiology taping, Lateral epicondylitis, Pain pressure threshold, Randomized control trial


How to cite this article:
Gracias A, Shobhalakshmi S. Immediate effect of kinesio taping on pain and grip strength in individuals with lateral epicondylitis. Indian J Phys Ther Res 2019;1:24-8

How to cite this URL:
Gracias A, Shobhalakshmi S. Immediate effect of kinesio taping on pain and grip strength in individuals with lateral epicondylitis. Indian J Phys Ther Res [serial online] 2019 [cited 2019 Jul 20];1:24-8. Available from: http://www.ijptr.org/text.asp?2019/1/1/24/261994




  Introduction Top


Lateral epicondylitis (LE) of the elbow is a type of “repetitive strain injury.”[1] LE is characterized by superficial or deep macroscopic and microscopic tears at the tendinous origin of the extensor carpi radialis brevis. Involvement of the dominant arm is most common as there is a repetitive usage of the dominant hand and hence repetitive strain. LE is a reasonably common musculoskeletal condition, which, as an epidemiological study has shown, accounts for 7 in every 1000 visits to the general medical practitioner.[2] On physical examination, there is a reproduction of pain on direct palpation over the lateral epicondyle. In most cases, there is also a deficit in strength in these muscles.

The strong correlation between level of disability and deficits in pain-free grip strength testing, along with its responsiveness to change and high reliability, has facilitated the use of pain pressure threshold and pain-free grip strength as an indicator of physical impairment and dysfunction not only in the laboratory but also in the clinical setting.

Various types of tapes and methods of kinesiology taping have been extensively used in physiotherapy practice. The application of kinesiology tape has an immediate effect seen which improves the force sense in the forearm of healthy athletes. The possible mechanism of kinesiology taping (KT) is the alteration of the motor response from increased tactile input.[3] It also helps in increasing proprioceptive function by stimulating the cutaneous afferent through the skin.[4] Hence, KT may assist clinicians, when used as an adjunct, to provide the immediate pain-free range of motion (ROM) actively.

There have been varied traditional methods to treat LE, including corticosteroid injection, friction massage, ultrasound, acupuncture, laser, progressive strengthening, stretching exercise, and taping. The traditional interventions of physiotherapy did not improvise on the quality of collagen in tendons, and new vascularity to support tissue recovery and recuperation was not brought about.[5] Forearm bracing is popularly used for treating sportspersons with LE. Many researchers feel that the use of a forearm brace may restrict the muscles surrounding the arm, thus obstructing the circulation and motion.[6]

KT is more user-friendly, which has additional benefits of providing pain-free ROM. It also preserves functional reinforcement without losing active ROM or inhibiting circulation. There is minimal evidence of the effect of KT on pain pressure threshold and grip strength in individuals with LE. Hence, the objective of this study was to evaluate the immediate effect of KT on pain pressure threshold and grip strength in individuals with LE.


  Materials and Methods Top


An ethical clearance was obtained from the Ethical Committee of MS Ramaiah Medical College (ref no. MPT/575/2011 dated December 12, 2011). This double-blinded randomized control trial included 30 individuals [Figure 1]. Both males and females were included within the age group of 20-50 years presenting with pain on the lateral side of the elbow over the forearm extensor origin; pain on active extension of the wrist, pain on resisted wrist extension with elbow in full extension; positive Cozen's test or positive resisted middle finger extension test or positive Mill's test.[7]
Figure 1: Flow chart depicting participants

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The exclusion criteria were patients with dysfunction in the cervical spine, shoulder, and wrist joint, posttraumatic LE, previous surgery of the elbow, arthritis of the elbow and wrist joint, and neurological dysfunctions of the upper extremity. The individuals were explained about the intervention, and after taking informed consent, the individuals were then randomly allocated to either the sham taping group or therapeutic taping group using Stat Trek random number generator which created a list of random numbers. The numbers generated appeared in the random number table.

The individuals of both the groups were assessed for pain and grip strength prior to the application of tape and immediately after application using a pain pressure algometer and handheld dynamometer, respectively, which were measured by a secondary investigator [Figure 2], [Figure 3]. Both the entities were measured with patients in high sitting with the forearm in midprone position.
Figure 2: Measurement of pain pressure threshold post-KT application with pain pressure algometer

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Figure 3: Measurement of grip strength post-KT application with handheld dynamometer

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Individuals in the experimental group were then applied with KT using muscle and space-correction technique using a “Y-” shaped tape with donut space-correction technique. Here, a hole was cut in the center of an approximately 4–6 inch Kinesio 'I' strip [Figure 4]. Glue was activated prior to any patient movement.[7] The control group received sham taping by the principal investigator. In sham taping, the tape was applied without any stretch. The outcomes were then reassessed immediately after taping by the secondary investigator.
Figure 4: Muscle with space correction of KT

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Statistical analysis

The data was analyzed using the software, Statistical Package for the Social Sciences 21.0 (SPSS). Descriptive statistics were used for age and gender. The Student's t-test was used to compare the grip strength and pain levels within and between the groups with statistical significance at P < 0.05.


  Results Top


Thirty individuals were included in this study. The mean age of the experimental group was 40 ± 6 years and the control group was 35 ± 7 years [Table 1]. There is a significant difference in the pre- and postvalues of pain pressure threshold and grip strength in the experimental group (P ≤ 0.05) when compared to the pre- and postvalues of pain pressure threshold and grip strength in the control group [Table 2]. Between-group significance was also noted (P < 0.05) [Table 3].
Table 1: Demographic variables

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Table 2: Within-group comparison of pain pressure threshold and grip strength using t-test

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Table 3: Between-group comparison of pain pressure threshold and grip strength using t-test

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  Discussion Top


The objective of the study was to compare the pain pressure threshold and grip strength between the experimental and control groups. From the results obtained, it was observed that there was a statistically significant difference in the pain pressure threshold and grip strength between the experimental group and the control group, indicating that KT was effective in reducing the pain and increasing the grip strength in individuals with LE.[8]

This improvement in pain pressure threshold could probably be due to the benefits of KT which include (1) a positional stimulus through the skin; (2) normalization of muscle tension resulting in fascia realignment; (3) expansion of the space by raising the fascia over the inflammatory and pain core by the removal of the excess fluid, edema, or bleed present beneath the skin; (4) reduction in the pain through neurological suppression; and (5) and elimination of edema by directing the toxins toward the lymph nodes.[6]

Liu et al. in their study also stated that the tape applied helps in diminishing edema, managing pain, and blocking motor activity. This consequence is seen through the initiation of neurological and circulatory systems with motion. Hence, this helps in reducing the pain and thereby increasing the pain pressure threshold.[7]

In addition, it was also hypothesized that the muscle technique used helped in relieving the muscle tension, thus alleviating the pain. It resulted in a regulation of resting muscle tension, pain relief, and improved loading capacity, leading to quicker healing.[9]

Furthermore, the space-correction technique used elevated the epidermis rightly above the site of pain, inflammation, swelling, or edema. The greater space is believed to diminish the pressure by elevating the skin, thus helping in tapering away from the extent of irritation on the chemical receptors, thereby decreasing pain.[10] An elevated level of blood flow was hypothesized to occur in the area, allowing excessive removal of exudates. Stimulation of the mechanoreceptors must have also aided in reducing pain. Further, by the intensification of sensory stimulation, the gate control theory of pain must have been initiated.[11] Akram et al. stated in their study of LE that there is a repetitive strain at the area and overuse of the muscle. Application of KT reduced the tension over the muscle, thereby assisting in the reduction of the pain and increasing the grip strength.[1],[12]

This is further suggested by Liu et al. who showed an improvement in grip strength post-KT in their study. They hypothesized that therapeutic taping has a prime principle for feeble muscle contractions, wherein the tape is applied to the surrounding muscle that is affected in the direction from the insertion to the origin and causes inhibition.[7] This may help reduce the pain and thereby increase the grip strength of the affected muscle.

As inferred by the findings, there was an improvement of pain pressure threshold and grip strength after the immediate application of KT in the experimental group as compared to the control group. The findings revealed that there was a minimal increase in pain pressure threshold in the experimental group, whereas there was a huge increase in grip strength immediately after the application of KT in the experimental group.[13]

Hence, it may be concluded that KT has a positive and statistically significant effect in the treatment of LE and hence can be implemented in our clinical practice. Limitations of the study suggest that the sample population limits the external validity as the sample was drawn from one center alone. Results of the study have shown an immediate effect, but the same effects may be tested for a longer duration, to check the durability of the effect of the tape application as a future scope of the study. External validity of the study can be strengthened, by including a larger population from across varied centers.


  Conclusion Top


The findings of the present study indicate that there is a significant improvement in the pain pressure threshold and grip strength in the experimental group, immediately after the application of KT.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Amro A, Diener I, Bdair WO, Isra MH, Shalabi AI, Dua II. The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis. Hong Kong Physiother J 2010;28:19-23.  Back to cited text no. 1
    
2.
Gruchow HW, Pelletier D. An epidemiologic study of tennis elbow. Incidence, recurrence, and effectiveness of prevention strategies. Am J Sports Med 1979;7:234-8.  Back to cited text no. 2
    
3.
Chang HY, Chou KY, Lin JJ, Lin CF, Wang CH. Immediate effect of forearm kinesio taping on maximal grip strength and force sense in healthy collegiate athletes. Phys Ther Sport 2010;11:122-7.  Back to cited text no. 3
    
4.
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;38:389-95.  Back to cited text no. 4
    
5.
Melissa Schneider AT. The Effect of Kinesio Tex Tape on Muscular Strength of the Forearm Extensors on Collegiate Tennis Athletes; 2008.  Back to cited text no. 5
    
6.
Kenzo K, Jim W, Tsuyoshi K. Clinical Therapeutic Applications of the Kinesio Taping Method. Tokyo, Japan: Ken Ikai Co Ltd.; 2003.  Back to cited text no. 6
    
7.
Liu YH, Chen SM, Lin CY, Huang CI, Sun YN. Motion tracking on elbow tissue from ultrasonic image sequence for patients with lateral epicondylitis. Annu Int Conf IEEE Eng Med Biol Soc 2007l:95-8.  Back to cited text no. 7
    
8.
Shamsoddini A, Hollisaz MT, Hafezi R. Initial effect of taping technique on wrist extension and grip strength and pain of Individuals with lateral epicondylitis. Iran Rehabil J 2010;8:24-8.  Back to cited text no. 8
    
9.
Vicenzino B, Brooksbank J, Minto J, Offord S, Paungmali A. Initial effects of elbow taping on pain-free grip strength and pressure pain threshold. J Orthop Sports Phys Ther 2003;33:400-7.  Back to cited text no. 9
    
10.
Jafarian FS, Demneh ES, Tyson SF. The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sports Phys Ther 2009;39:484-9.  Back to cited text no. 10
    
11.
Jennifer LW. The Effects of Bracing on Grip Strength and Pain Level in Individuals with Lateral Epicondylitis. Western Ontario London; Faculty of Graduate Studies the University; 1997. p. 1-67.  Back to cited text no. 11
    
12.
González-Iglesias J, Fernández-de-Las-Peñas C, Cleland JA, Huijbregts P, Del Rosario Gutiérrez-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;39:515-21.  Back to cited text no. 12
    
13.
Motyer N. Managing Tennin elbow (lateral). J Aust Assoc Massage Ther 2008:10-5.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
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