Knee Pain

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Does the Perception of Knee Pain Relief Override the Lack of Solid Evidence in the Use of KT Tape in Runners?

Ask any runner about their knees and a common theme will be pain; specifically, knee pain and what to do about it. The pain could be a mild soreness after a long run, or a full-fledged, training-stopping, icepick being driven into the kneecap kind of pain. Most runners have dealt with some sort of pain in the knees at one point or another. And in the past few years, we have seen an influx of colorful tapes on various appendages in an effort to decrease the pain. Kinesiology tape, or KT tape, is a flexible tape that, proponents say, can be applied to correct mechanical, fascial, spatial, ligament or tendon functional, and/or lymphatic problems that may result in pain.1 Despite the proliferation of taped athletes, many practitioners see it as a sham, with no solid research that stands behind it, or that the research that does exist is flimsy. However, if there is no harm caused from the short-term use of KT tape, does the perception of pain relief in the runner outweigh the lack of solid evidence and support athletes’ use of KT tape? And if so, why aren’t we conducting and publishing more peer-reviewed studies?

What exactly is pain? According to the International Association for the Study of Pain, pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is always subjective. Each individual learns the applications of the word through experiences related to injury in early life.”2 Pain exists as our body’s warning signal that something is not quite right. A gross oversimplification of the pain pathway is that pain is caused by a trigger of some sort that activates the nociceptors, the body’s peripheral pain receptors. A painful stimulus causes the release of neurotransmitters that reduces a nerve’s threshold to stimuli, which in turn amplifies the pain response.3

Pain can be typified into several categories, including but not limited to, acute, chronic, referred or radiating. Acute pain is pain in immediate response to tissue injury; chronic pain is pain lasting more the 6 months, usually in response to an ongoing tissue injury; referred pain is that which is felt in a site other than where the cause/injury is located; and radiating pain is pain that follows the dermatome of a nerve due to irritation or inflammation of its root.3 Most athletes, at some point in their life, become familiar with at least one, if not all, of the pain categories. Anterior knee pain and patellofemoral pain syndrome, aka runner’s knee, are two of the most common types of knee pain in a runner. They are described as a diffuse, anteriorly located pain that is aggravated by any activity that places the load onto the flexed knee joint.4

knee_pain_1 The reduction of pain is a vital part of medical practice. Gaskin and Richards5 published a study which estimated that the cost of pain in the United States to be between $560 and $635 billion, when accounting for lost productivity and health care costs annually. Within this sum, an estimated $16 billion was directly related to pharmaceuticals.5 Per a seminal paper done by Bishop6 in the 1980’s, the basic tenet of pain management is purely the alteration the patient’s notion of pain, it would behoove us, as healthcare practitioners to embrace promising new modalities of pain relief.6

KT tape was developed in the 1970’s by Dr. Kenso Kase with the proposed benefits of: pain relief; improved function by muscle and joint realignment; improvement of lymphatic and venous drainage; reduction of pressure on nociceptors; sensory stimulation that can either promote or limit motion and helping return function of muscle and fascia via strengthening.7 KT tape is a pliable, latex-free, skin-mimic that can be applied for up to a week, has a stretch anywhere from 30-140% depending on use, does not hinder range of motion and can be worn in the water with no loss of function.8

knee_pain_2 There are several proposed theories of how KT tape provides pain relief. One of these theories suggests that the mechanism for action lies within the stimulation of sensory pathways and helps to diminish input of nerve fibers guiding nociception. A second theory is that by lifting the skin and promoting circulation and lymphatic drainage, that is what results in decreased pain, spasm and swelling. It is also speculated to be achieved by reduced pressure on subcutaneous pain receptors.9 However, Chen, Hong, Lin and Chen10 proposed via their research, back in 2008, that the pain reduction may come simply from biomechanical posture corrections or by simply realigning the patella within the patellofemoral joint.10
In a cohort study on patellofemoral pain done in 2010, Lan, Lin, Jiang and Chiang11 found that 66 out of 118 study participants had a significant reduction in their level of pain when KT tape was applied.11 They also found that the reported pain relief was higher in those participants with a lower body mass index and those who started with a higher level of pain.11 Clifford and Harrington’s 2013 study4, that built upon previous research establishing the reduction of pain in the patella when KT tape was used, also concurred that the perception of pain relief was statistically significant when KT tape was used as opposed to either a sham taping method or no taping whatsoever.4

In 2011 Aytar, Ozunlu, Surenkok, Baltacr, Oztop and Karatas12 performed a small double-blind study with 22 females who reported patellofemoral pain. While Aytar’s study did not find what they believed to be a significant improvement in pain relief, they did concede to possible pain relieving mechanisms coming from suspected menial alignment of the patella with KT tape application.12 Their thought was that the KT tape did not cover a wide enough area to fully stimulate cutaneous receptors, therefore the reported pain relief was not statistically validated.12 It is also important to mention, that even within the studies that did not find a statistically significant improvement, there was no harm or injury that occurred either. A literature review done in 2013 by Drouin, McAlpine, Primak and Kissel13 found that while there was not enough strong evidence to support the use of KT tape for athletic performance improvements, there was no report of harm or impairment associated with the use of KT tape.13 This theme continues in the more recent study done in 2015 as Poon, Li, Roper, Wong, Wong and Cheung14 came to the conclusion that further studies need to be done that can control or eliminate the placebo effect as their evidence showed that any previous positive findings were due to placebo effect alone.14

Adams1 suggested in his overview of taping published in the online Rehab Management News page that “a lot of athletes feel it helps them.”1 Furthermore, “a strong placebo effect of taping has been well documented in subjects with patellofemoral joint pain.”12 This thought was supported by two 30-something females wearing KT tape at a local marathon event in 2015. When asked why they were wearing KT tape the first female replied that “It seems to help me. I’m not really sure of the science or if I even care what the science says. I guess I am a big believer in the placebo effect, as it seems to work for me.” And the second female stated that “It’s a non-expensive and effective way to relieve pain and promote recovery so I can do what I love even more.”

Most recently, in a meta-analysis done by Csapo and Alegre15, they found that while many of the available studies done on KT tape did show positive improvement, when the sample size was adjusted to the overall population, the results showed that KT tape improvement was actually negligible.15 So it seems that we will continue to see athletes wearing the tape and reporting positive benefits, but as long as we cannot control for the placebo effect, we may never know if they are legitimate or just the athlete’s perception.

References

  1. Adams, B.J. (2013). Therapeutic taping and bracing in athletics. An Overview of different taping types and their application in sports medicine. Rehab Management. Retrieved from http://www.rehabpub.com/2013/08/therapeutic-taping-and-bracing-in-athletics/
  2. Bonica JJ. (1979). The need of a taxonomy. Pain. 1979;6(3): 247–48. [PMID: 460931] http://dx.doi.org/10.1016/0304-3959(79)90046-0
  3. Prentice, W.E. (2009). Therapeutic Modalities for Sports Medicine and Athletic Training. New York: McGrawHill
  4. Clifford, A.M. & Harrington, E. (2013). The Effect of patellar taping on squat depth and the perception of pain in people with anterior knee pain. Journal of Human Kinetics 37, 109-117. http://dx.doi.org/10.2478/hukin-2013-0031
  5. Gaskin, D.J. & Richard, P. (2011). The Economic Costs of Pain in the United States. In: Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US). Appendix C. Available from: http://www.ncbi.nlm.nih.gov/books/NBK92521/
  6. Bishop, B. (1980). Pain: Its physiology and rationale for management. Part I. Neuroanatomical substrate of pain. Physical Therapy, 60 (1), 13-20.
  7. Kase, K., Hashimoto, T., & Tomoki, O. (1996). Development of Kinesio taping perfect manual. Kinesio Taping Association, 6(10), 117e118Mostafavifar, M., Wertz, J., & Borchers, J. (2012). A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. The Physician and Sportsmedicine, 40(4), 33-40. http://dx.doi.org/10.3810/psm.2012.11.1986
  8. Williams, S., Whatman, C., Hume, P., & Sheerin, K. (2012). Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness. Sports Medicine 42, 153-164. http://dx.doi.org/10.2165/11594960-0000000-00000
  9. Chen, P.L., Hong, W.H., Lin, C.H., & Chen, W.C. (2008). Biomechanics effects of kinesio taping for persons with patellofemoral pain syndrome during stair climbing. 4th Kuala Lumpar International Conference on Biomedical Engineering 2008, 395-397. http://dx.doi.org/10.1007/978-3-540-69139-6_100
  10. Lan, T.Y., Lin, W.P., Jiang, C.C. & Chiang, H. (2010). Immediate effect and predictors of effectiveness of taping for patellofemoral pain syndrome. The American Journal of Sports Medicine, 38(9), 1626-1630. http://dx.doi.org/10.1177/0363546510364840
  11. Aytar, A., Ozunlu, N., Surenkok, O., Baltacr, G., Oztop, P., & Karatas, M. (2011). Initial effects of kinesion taping in patients with patellofemoral pain syndrome: A randomized, double-blind study. Isokinetics and Exercise Science 19, 135-142. http://dx.doi.org/10.3233/IES-2011-0413
  12. Drouin, J.L., McAlpine, C.T., Primak, K.A., & Kissel, J. (2013). The effects of kinesiotape on athletic performance outcomes in healthy, active individuals: a literature synthesis. Journal of the Canadian Chiropractic Association, 57(4), 356-365.
  13. Poon, Ky.Y., Li, S.M., Roper, M.G., Wong, M.K., Wong, O. & Cheung, R.T. (2015). Kinesiology tape does not facilitate muscle performance: A deceptive controlled trial. Manual Therapy,20,130-133. http://dx.doi.org/10.1016/j.math.2014.07.013
  14. Csapo, R. & Alegre, L. (2014). Effects of kinesio taping on skeletal muscle strength- A meta-anaylsis of current evidence. Journal of Science and Medicine in Sport 1053. http://dx.doi.org/10.1016/j.jsams.2014.06.014
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Meredith Maguire, BSN, ARNP

Meredith Maguire, BSN, ARNP is currently a student at the University of North Florida.

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