For 35 years Kinesio has been dedicated to research which can further our understanding of how Kinesio Taping affects the human body and aid in the continuous development of Kinesio Tape. When Can A. Yucesoy and Ulu├ž Pamuk's research into how Kinesio tape can affect targeted tissues was published at the end of 2015 we were intrigued by what they discovered.
About Can and Ulu├ž
Can A YucesoyUluc Pamuk
Can A. Yucesoy is the director of the Biomechanics Lab in the Institute of Biomedical Engineering in Boğazi├ži University, Istanbul. He is a mechanical engineer by training, with a PhD degree in biomechanics. His research focuses on muscle mechanics and the role of fascia-muscle integrity, particularly on muscle function.
Ulu├ž Pamuk is undertaking a PhD in biomechanics and is a research assistant at the Biomechanics Lab. He is a physicist by training and his research focus is on the use of medical imaging modalities in muscle mechanics.
Both researchers are fascinated by human physiology and how it is manipulated by mechanical stimuli. The continuity of tissue within the human musculoskeletal system and how it governs mechanical stimuli is of huge interest to them.
We contacted Can and Ulu├ž to speak with them further about their findings, what they mean for Kinesio taping and their plans for research in the future.
To begin, can you tell us where you conducted this study?
The imaging part of the study was conducted in Ac─▒badem Kozyatağ─▒ Hospital, Istanbul, Turkey, and the data processing and development of the scientific viewpoint was conducted at Boğazi├ži University.
Why did you choose to study Kinesio Taping?
Kinesio Taping is widely used, but a strong scientific basis for understanding its mechanism of action was lacking. It is a promising research field for physiotherapy, sports science and biomechanics. The factors make it attractive for research. In addition, Can has strong connections with the International Fascia Research Society. This kind of research is considered very important to them too. Our research techniques, based on imaging modalities, are very suitable for conducting this work.
What were you attempting to determine when undertaking this research?
We tried to determine the mechanical outcome of externally imposed loading, using Kinesio Taping, internally on targeted and non-targeted tissues. We achieved a high resolution of 1mm cube local tissue elements in order to determine this outcome in terms of tissue length changes.
What did you hypothesise?
We hypothesised that Kinesio Tape induced loading, within the tissue, is not limited to the tape adhering direction, or the tape location. We anticipated widespread effects outside the directly targeted tissues as well.
What was the reason you choose to look at both targeted and adjacent tissues?
Our research group has a focus on the continuity of muscular and connective tissue and also on the implications of such continuity in muscle mechanics (for an extensive review see Yucesoy, 2010). We refer to this as myofascial force transmission. We consider Kinesio Taping as a loading over the skin and we expected that myofascial force transmission mechanism would spread that effect deeper into the underlying tissues. With such continuity in action, it would be inconceivable to see mechanical effects strictly limited to target regions.
What were your outcome measures and what tools did you use to measure them?
The magnitude and direction of local tissue lengthening and shortening, due to Kinesio Taping, were our outcome measures. Advanced magnetic resonance imaging (MRI) techniques were used to assess these changes in tissue from the Kinesio Tape application.
What was your reasoning behind using those tools?
Our magnetic resonance imaging method allows subdividing the entire tissue volume (i.e., the lower leg in this analysis) into small elements and determining, for each of them, the shape changes occurring in vivo. This gives a unique opportunity to assess the primary mechanical impact of Kinesio Tape on human tissue.
Can you describe what taping application you used and explain why you made that decision?
We used a drop foot correction technique. Firstly, it is a commonly used Kinesio Taping application for stroke and spastic cerebral palsy patients suffering from drop foot. This makes it clinically interesting for our research group. Also, we often study lower leg with our MRI methods, so we knew what to make of our results and we had the necessary leg and foot fixation apparatus. However, it should be noted that what we are looking into is not related to specific taping applications. Our aim was to identify the mechanism of taping effects on a level that has never been achieved before. Once sufficient understanding has been gathered, we aim to relate our findings to specific taping applications and their particular aims.
How would you briefly summarise the results of your study?
We found that Kinesio Taping not only affects the directly targeted tissues, but also those that are non-targeted. Although, the magnitude of shape change in the latter was smaller. Remarkably, the direction of Kinesio Tape induced shape change in the tissue was only in concert with expectations for one region of the targeted tissues. In contrast, in the remaining regions, mechanical loading of the Kinesio Taping application manipulated tissue in directions other than the application would have suggested. Firstly, we found skin to be "crimped" - partially lifted and partially compressed - which would be an expected outcome of other Kinesio Taping applications aiming to improve lymphatic flow. We also found shortening and lengthening occur simultaneously within the tibialis anterior muscle. In the non-targeted tissues, the shape changes observed were heterogeneous in direction - with no discernible pattern present. We also found inter-subject variability to be noteworthy. In short, the direct expectations in terms of Kinesio Taping effects were only partly met. However, a more complex outcome is achieved and that should still be capable
cing the benefits of Kinesio Taping. Only, it appears we need to look into Kinesio Taping effects in a more involved way.
How do your results compare, if at all, to other studies in a similar field?
Other studies focus on physiological outcome measures such as muscle activity, strength, joint range of motion, limb volume and proprioception. One main issue is that they often use methods capable of testing the Kinesio Taping effects on the entire individual. That is great and necessary; however for us it is not specific enough. In that respect, ours is the first study to investigate the primary mechanical effects of mechanical loading due to Kinesio Taping locally in the tissue level. Therefore, our results do not directly compare to other studies. Instead, we aim to fill the gap between the expected physiological outcomes from the Kinesio Taping application and the actual tissue manipulation caused by the Kinesio Taping application. That said, we did find shape changes in tissue that could lead to expected physiological effects.
What mechanisms do you think lead to the results of your study?
Transmission of myofascial loads differentially within the tissue explains varying direction length changes, as well as widespread effects within the entire limb. Continuity of muscular and connective tissues is key in this matter.
In your opinion what would you say your results suggest?
The gap between the expected physiological outcomes of Kinesio Taping and the actual mechanical load imposed by Kinesio Taping is full of surprises and there is much more to be discovered when bridging that gap. Without the knowledge of how superficial loads translate into local length/shape changes on deeper tissues, any expectation may remain (scientifically) not well founded.
Can you let us know what you think the limitations are of the study? How would you look to improve upon these limitations?
Although we studied Kinesio Taping induced lengthening and shortening within the muscle tissue, due to the lack of information on muscle fibre orientation, we cannot say what the length change along the muscle fibres would be. Hence, possible changes in the loading/unloading of muscle spindles may be considered. The addition of diffusion tensor imaging based tractography could allow just that. Our group is capable of doing that.
Another limitation is lack of muscle activity, or joint motion, during the experiment. Comparing before and after tissue length changes upon identical activities would give us the opportunity to show how Kinesio Taping induced external loads can change the tissue mechanics during activity.
How do you believe the results of this study will affect clinical practice?
In terms of Kinesio Taping, we have provided a tool that could allow clinicians and researchers to assess acute mechanical outcomes of Kinesio Taping applications. In general, this is a method that could potentially quantify and visualize the outcome of any manipulation to the muscle and connective tissues.
We hope that this approach will shed some light for clinicians and give them a better understanding of the tools they have at their disposal. Then we can provide them with new and better tools, or ways of using those tools, one day. We consider understanding the mechanism of effects of a treatment to be extremely important. Once that is achieved, there will be a much better control over the outcome. This applies for any treatment, but also for Kinesio Taping.
What research do you believe should to be undertaken next and why is that research important?
Any research combining the expertise of physiotherapists on human anatomy and physiology with the tools provided by various engineering disciplines is feasible, as long as the limitations of the techniques and interpretation of the results are done with a scientific method. In our paper, we have also presented how dividing the problem into smaller pieces and trying to solve one piece at a time can yield surprising results. We think other Kinesio Taping applications should be studied using this methodology to gather a sufficient understanding of what does or doesn't happen. We anticipate, for example, that a greater stretch imposed on the tape while applying it on the skin will not necessarily produce a proportionally bigger effect in the tissue.
Finally, do you have any future plans for research in Kinesio, if so what are they?
Kinesio is a widely used technique and its mechanism of action presents us with many open questions. So yes, we intend to keep utilising it as an external force applied to tissue and see where that leads us. It is certainly a very interesting research line. Testing of different Kinesio Taping applications with, for example, varying stretch on the tape is certainly on our future plans.