23

April

Pulling the Stretchy Tape Over Your Eyes

Working in my own office provides a sheltered, controlled setting. However, my eyes were opened for the past 4 years working for Rev3 triathlon as their Active Release Techniques coordinator. As I estimate it, I treated about 2,000 triathletes over those 4 years and heard stories of frustration and anguish about their musculoskeletal complaints. Being in this setting, I was out of my own sheltered clinic and was able to peek into the current treatments these triathletes were receiving. One thing that I was initially astonished by, but later learned to just shake my head about was the excessive, unabashed use of colorful, stretchy tape that was plastered all over legs and shoulders.

Triathletes are adventurous by nature and are willing to try just about anything to get them through a race. I get that. However, the therapists/chiropractors in their home towns were often sticking this tape on their patients skin without ever getting to the cause of the problem. Even worse was that these triathletes were telling me that their therapists/chiro’s were billing their insurance companies for them to put this stuff on their patients. One could argue this is possibly insurance fraud and if you need the evidence on that, click here and be taken to the bottom of this page for the info.

Equally strange is the idea that you need to be a clinician to slap this stuff on your skin. In the “does it work?” section below, you will find that it doesn’t matter if it’s put on correctly, or even in the reverse! However, if you want to believe it works, there are videos all over the web showing you how to do it. It’s not rocket science. See here, here, here, or here. So why would anyone need to make an appointment and pay outrageous rates? Here is a sample from another provider’s webpage:

I really don’t take issue with some clinicians utilizing conservative treatments that have a lack of scientific evidence because it has yet to be fully studied…as long as it makes rational sense. However, when you are utilizing things that have actually been proven to NOT be effective, that’s problematic. In other words, there is a difference between something not being studied enough, and something that has been studied and shown to be ineffective. Colorful, stretchy tape falls into that category.

OK, so that’s the executive summary. If you want to take my word for it, then stop reading, however, if you want the details, further down this page I have outlined the proposed, theoretical mechanisms of how this stretchy tape (hereby referred to as KT) works and then listed the research studies that have examined each proposed mechanism.

DOES IT WORK?

To start with, Bassett et al (2010) did a review of the literature up to 2010 and concluded, “At present there is no substantial evidence to support the use and treatment efficacy of KT within a clinical musculoskeletal population.” More recently, Williams et al., (2012) did another review of the literature up to 2012. I will be referring to this review frequently. There are 4 main proposed benefits to using KT:

  1. Supporting the muscle – in terms of strength/endurance
  2. Improved blood and lymph flow
  3. Reducing pain
  4. Correcting joint problems – in terms of increasing range of motion

1. Supporting the muscle – in terms of strength/endurance

Going to the Williams review, they concluded that up to 2012, “there is some evidence for KT having at least a small beneficial effect on strength. However, there was also one unclear and eight trivial results for measurements of strength, which preclude a clear conclusion being made. Further studies on similar muscles, and in particular KTs long-term effect on strength gain, warrant investigation.” Funny they recommended more studies, because since the Williams review, there has in fact, been more studies…and they’ve been negative:

  1. Vercelli et al., 2012 – Took 36 subjects and tested the strength of the quadriceps and single leg hopping. The did 4 trials – one with the subjects taped up to “facilitate” strength, one to “inhibit” strength, one “sham” taping job and one “no” taping scenario. In the end, there was no difference between any of the trials. However, in a post-experiment interview, the subjects were asked if they felt stronger, unchanged or weaker after being taped and 45% stated that they felt stronger when taped. This strengthens the idea of the placebo type of influence that KT provides. The funny thing was that they “felt” stronger regardless of whether they were taped to “facilitate” or “inhibit” the strength. In other words, it doesn’t matter how you put the tape on your skin.
  2. Lins et al. 2012 – Took 60 subjects and tested single hop, triple hop, balance and quadriceps strength. There were 3 groups – one with no taping, one with KT and one non-elastic taping. In the end, they found no difference in hopping, strength or balance with any of the groups
  3. Wong et al., 2012 – Took 30 subjects and taped their quadriceps again and tested the quadriceps strength in taped and non-taped trials. They again found that there was no difference between the taped and non-taped situations. They did find that the taped situation had less time to generate the force.

2. Improved Blood and Lymph Flow

From the Bassett review article: “Support for an improvement in blood flow via KT came from an unpublished study [on the KT website] who found that following KT application, peripheral blood flow, measured via Doppler ultrasound, increased by 20-60% in patients with chronic disorders and poor circulation…. Despite these claimed benefits from KT there is no substantial evidence to support them…. At this time without specific scientific analysis, the perceived physiological benefits of KT are hypothetical

3. Reducing Pain

The proposed mechanism that KT can reduce pain is via stimulating sensory input to the brain, thereby diminishing perceived pain. In other words, if you had foot pain and I kicked you in the knee, you would process less pain from the original foot complaint. This is because your brain can only process so much incoming information at once (aka. gate control theory of pain). In the case of KT, the tape is pulling on the skin which essentially distracts the brain from the deeper, painful structure. When Williams et al (2012) did their review of all the current literature, they found 10 studies that were well designed. Of the 10 studies that looked at KT reducing pain, only one reported a statistically significant difference between the sham and the KT group and even then, the results were “unlikely to be clinically important”.

The one study that KT proponents consistently refer to was a 2008 study by Thelen et al., who found that there was indeed lower pain ratings for those with “real” KT taping procedures compared to the sham group, however the difference between groups was gone within 24 hours after application. The pain reduction quickly abating is likely due to adaptation of the neurologic system. If you’re trying to “trick” the brain into feeling less pain, it quickly adapts to the trick and the pain returns. The authors concluded, “KT may assist clinicians to obtain immediate improvement in pain-free shoulder abduction ROM. However, over time, KT appears to be no more efficacious than sham taping at decreasing shoulder pain intensity or disability.”

The results do show promise however, for those who require something to help reduce pain immediately. For example, if you are a volleyball player in the Olympics and this is something you need to get through a match. However, you also need to consider the consequences: If you are stimulating the skin to help mask the deeper pain originating from damaged tissue, you may be risking further damage to the underlying source of pain.

4. Correcting Joint Problems:

Williams et al., reported that of the 10 studies they looked at, 4 of them found that there were increases in range of motion following the application of KT, however, they were inconsistent and conflicting, “The effect of KT on range of motion remains unclear because of the limited number of studies on a variety of joints, and the conflicting results.” Even in the studies that Williams et al., counted as increasing joint motion, the authors of the original studies were skeptical.

For example, a study by Gonzalez-Iglesia et al (2009) was included in Williams review as a positive study, but the original authors concluded that the “improvements in pain and cervical range of motion were small and may not be clinically meaningful.

Conclusion: Applying this colorful stretchy tape to wherever you hurt may help reduce pain in some small, clinically insignificant way. In a recent journal editorial titled “How Much is Kinesiotaping a Psychological Crutch?“, Vercelli (the researcher listed above) states, “In our opinion, these psychological attributes might help to explain the widespread use of KT by athletes observed during sports competitions“. If you need that, fine, but know that you may be making things worse by masking pain. Also, make sure you get to the root cause of your problem and not just cover it up. In addition, when driving down the road and see your OIL light start blinking…it’s telling you something! Covering it up with KT may block the annoying red light, but you’d better get your car checked out.



Clinicians Billing for Applying Stretchy Tape

NJ based Law firm: “kinesio taping or other taping (which is bundled into the payment for other services) is not reimbursable by PIP and shall not be billed using a strapping code. The only appropriate code to report separately for this service is the cost of the tape from the Durable Medical Equipment Fee Schedule. N.J.A.C. 11:3-29.4(g).”

From Target Coding (a company that helps clinicians bill properly), “I have not read any insurance carrier policies recently that state it will cover Kinesio® taping for alleviating pain, reducing inflammation, promoting good circulation and returning the body to homeostasis. Therefore, you should consider Kinesio® taping a non-insurance payable procedure….We do not recommend you billing CPT codes 29200, 29240, 29260, 29280, 29520, 29530, 29540 or 29799 for Kinesio® taping. In my opinion these Casts and Strapping codes are meant to “immobilize” a joint or body part and are therefore should not be used for Kinesio® taping. Also, we do not recommend you bill CPT codes 97110 or 97112 for Kinesio® taping.”

CPT® Assistant, March 2012, states that “Kinesio taping is a supply and therefore is included in the time spent in direct contact with the patient to provide either re-education of a muscle and movement or to stabilize one body area to enable improved strength or range of motion. This includes the application of Kinesio tape or McConnell taping techniques.”

American Chiropractic Association: “As such, when applying Kinesiology Taping to a patient in conjunction with another therapy, the Kinesiology Taping service should not be separately reported. It is not appropriate to code 97110 or 97112, etc. if kinesiology taping is the only work performed. The only appropriate code to report, in addition to the therapy service rendered, would be the supply code for the tape itself, either A4450 Tape, non-waterproof, per 18 sq. inch or A4452 Tape, waterproof, per 18 sq. inch.”

- Kevin Maggs, ,

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