971764

research-article2020
CRE0010.1177/0269215520971764Clinical RehabilitationLetafatkar et al.

CLINICAL
Original Article REHABILITATION

Clinical Rehabilitation

Comparing the effects of no 2021, Vol. 35(4) 558­–567

© The Author(s) 2020
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DOI: 10.1177/0269215520971764
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additional Kinesio tape in patients

with shoulder impingement
syndrome. A three-arm randomized
controlled trial

Amir Letafatkar1 , Pouya Rabiei2 ,

Sarvenaz Kazempour1 and Samaneh Alaei-Parapari1

Abstract
Objective: To investigate if adding Kinesio tape to therapeutic exercise is an effective treatment to
improve clinical outcomes compared to therapeutic exercise alone and no intervention, in patients with
shoulder impingement syndrome.
Design: Three-arm randomized controlled trial
Setting: Outpatient setting
Subjects: One hundred and twenty patients (mean (SD): age 37.8 (5.4)) with shoulder impingement
syndrome.
Intervention: Patients were randomly assigned to eight-weeks therapeutic exercise alone, therapeutic
exercise with Kinesio tape, and control group.
Main measures: Pain was measured with a numerical rating scale and disability and scapular kinematics
were measured with a relative questionnaire and motion analysis software respectively, at baseline and
after eight-weeks intervention.
Results: There was significant differences in therapeutic exercise with Kinesio tape group vs. therapeutic
exercise alone and control group respectively for pain (d = –0.34, P = 0.042; and d = –1.53, P = 0.001),
disability (d = –0.46, P = 0.024; and d = –2.18, P = 0.001), scapular upward rotation at sagittal plane (d = 0.33,
P = 0.033; and d = 0.68, P = 0.001), scapular plane (d = 0.18, P = 0.045; and d = 0.43, P = 0.001), scapular tilt
at sagittal plane (d = 0.55, P = 0.043; and d = 1.39, P = 0.001), and scapular plane (d = 0.29, P = 0.034; and
d = 0.58, P = 0.001). Therapeutic exercise alone was superior over control group in all significant outcomes
(P < 0.05).

1
Sports injury and corrective exercises, Faculty of physical Corresponding author:
education and sports sciences, Kharazmi University, Tehran, Iran Pouya Rabiei, Department of Physical Education and Sports
2
Department of Physical Education and Sports Sciences, Karaj Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran.
Branch, Islamic Azad University, Karaj, Iran Email: [email protected]
Letafatkar et al. 559

Conclusion: Although therapeutic exercises alone showed positive effect on clinical outcomes, adding
Kinesio tape to therapeutic exercises had more significant effects with larger effect sizes. Adding Kinesio
tape to therapeutic exercise may be of some assistance to clinicians in improving clinical outcomes in
patients with shoulder impingement syndrome.

Keywords
Exercise therapy, kinematics, kinesio tape, shoulder impingement syndrome

Received: 24 August 2020; accepted: 15 October 2020

Introduction posture, alter muscle activity, and improve muscle

recruitment patterns.9,12 Saracoglu et al.13 in their
Shoulder impingement syndrome accounted for systematic review about the use of Kinesio tape on
44% to 65% of all complaints of shoulder pain1 shoulder impingement syndrome pointed out that it
that leads to a malalignment in scapular kinemat- can be useful associated with exercises especially at
ics.2,3 Any alteration in scapular kinematics is the beginning of the treatment. The authors empha-
believed to contribute to developing pathologic sized that the use of Kinesio tape as adjuvant therapy
shoulder conditions.3 A meta-analysis identified in the rehabilitation of patients remains a subject that
altered scapular kinematics with more scapular needs further investigation.
internal rotation and less scapular upward rotation Due to inconsistencies and lack of high-quality
and posterior tilt during upper extremity elevation, evidence, and the need for the studies with a larger
in the patients with shoulder impingement syn- sample size, we aimed to investigate if adding Kinesio
drome.3 Thus, optimal scapular motion seems to be tape to therapeutic exercise is an effective treatment
important for proper shoulder function and treat- to improve clinical outcomes in patients with shoul-
ment targets. der impingement syndrome, compared to therapeutic
The aim of therapeutic exercise must be to restore exercise alone and a control group who received a
normal scapular kinematics by improving the muscle treatment-guideline brochure. We hypothesized that
activity, strength, flexibility, and balance in muscle adding Kinesio tape to therapeutic exercise might
force couples that control the scapular position and enhance treatment effects primarily on pain, and sec-
motion.4 The focus of rehabilitation should be on ondarily on disability and scapular kinematics.
motion awareness and strengthening of the scapular
upward rotators and the rotator cuff muscles.5
Although a recent systematic review reported an Material and methods
exercise therapy alone is beneficial in relieving pain This study was a three-arm single accessor blinded
and disability compared to no exercises, it failed to randomized controlled trial with a 1:1:1 ratio allo-
find any study with reliable evidence for the positive cation carried out in the department of Kharazmi
effect of exercise therapy alone on scapular kinemat- University, between November 2018 and April
ics in the shoulder impingement syndrome patients.6 2019, and prospectively registered at www.umin.
Using Kinesio tape may be considered as an ac.jp (UMIN000035348), registered date of
appropriate strategy along with exercise treatment 2018/11/23). The study was performed by the ethi-
of shoulder impingement syndrome in a clinical set- cal standards in the World Medical Association
ting.7–9 The effect of Kinesio tape as a single inter- Declaration of Helsinki. Ethical approval was
vention on scapular kinematics, in previous studies, obtained from the Ethical Committee of Kharazmi
has not been fully confirmed.10,11 Conversely, add- University (IR.KHU.REC.1398.011).
ing Kinesio tape to different interventions acted as Patients were recruited by physical therapists
an extrinsic feedback mechanism to improve via flyers displayed at physical therapy clinics to
560 Clinical Rehabilitation 35(4)

receive physiotherapy treatment. All patients were Pain intensity was measured using numerical
informed of the nature of the study and those who rating scale (0–10), with 0 signifying no pain and
agreed to participate signed an informed consent 10 worst imaginable pain. The patients were asked
agreement. They also were free to leave the study to rate their current level of pain. This scale is a
at any time they prefer. reliable and valid tool for evaluating self-reported
To be eligible to participate, patients should pain.19
meet all the following criteria: (1) pain lasting > The Iranian version of the Disabilities of the
six weeks, (2) having painful arc during exertion of Arm, Shoulder, and Hand questionnaire was used
flexion and abduction, (3) positive Neer or Hawkins- to assess the disability of the upper limbs.20 Scores
Kenney tests,14,15 (4) painful resisted external rota- range from 0 to 100, with higher scores indicating
tion, abduction or painful Jobe’s test.16 Exclusion a worse condition. This version of the question-
criteria were (1) history of surgery, fracture, trau- naire is valid and reliable.20 A decrease of 10-points
matic onset, the existence of massive rotator cuff on the questionnaire can be considered a clinically
tears, long head of biceps tendon tears, degenerative important improvement.20
joint disorders at the shoulder complex,17 (2) being Scapular kinematics were assessed using the
pregnant, and (3) receiving steroid injections during 3-dimensional motion software (Innovative Sports
the last six months before the study.18 Training, Inc, Chicago, IL) with the patients in a
A total of 120 participants including both males relaxed standing position in front of the transmitter.
and females met the study criteria and were ran- Kinematic motion analysis consisted of select-
domly assigned to therapeutic exercise alone ing the scapular data of humero-thoracic elevation
(n = 40), therapeutic exercise with Kinesio tape for both sagittal and scapular plane arm elevation.
(n = 40), and control group (n = 40). Patients were The planes were standardized using a flat surface
randomized by the slot-drawing method to two to guide movement and ensure the proper plane of
experimental groups and a control group. The ran- arm elevation.
domization sequence was not disclosed until par- During elevation, patients were instructed to keep
ticipants had completed their baseline assessments. their thumb pointing toward the ceiling, to slide their
The allocation was by sealed opaque envelopes, hand on the board, and to elevate their arm at a rate
patients were assigned to each group by a sealed such that full elevation was accomplished over
envelope containing the name of one of the three approximately 3 seconds. Three complete cycles of
groups. the movement were completed. Sensors were not
The patients were assessed within a week before removed or replaced between trials but were removed
the intervention (baseline) and after an eight-week between the baseline and post-intervention measure-
intervention (post-intervention) by a blind physical ment sessions. This procedure is reliable during ele-
therapist with over five years of experience. The vation and lowering of the arm in asymptomatic
primary outcome was pain and secondary out- individuals and patients with shoulder impingement
comes were disability and scapular kinematics syndrome based on Camargo et al.21 Please see
(scapular internal rotation, upward rotation, and Supplemental Appendix 1 for detailed information
posterior tilt). Only the involved side of each par- about the scapular kinematics assessment.
ticipant was assessed for kinematics data (with no The therapeutic exercise intervention was based
applied Kinesio tape). At baseline and post-inter- on the study of Camargo et al.21 The intervention
vention, all outcomes were collected at the labora- was over eight  weeks, three  days a week, for
tory of biomechanics at the university. The one hour. This included three stretching and three
interventions were provided at the university health strengthening exercises performed for either
center by two licensed and Persian native speaker involved or uninvolved sides. Both experimental
physical therapists (one for therapeutic exercise groups were similarly instructed and trained by a
and one for Kinesio tape) with three average years physical therapist. Both groups received the exer-
of experience. cises on different days (even days for therapeutic
Letafatkar et al. 561

exercise group and odd days for therapeutic exer- type I error probability level of alpha =  0.05, type II
cise with Kinesio tape group). Please see error probability level of beta  =  0.20, a medium
Supplemental Appendix 2 for detailed information effect size of 0.25, and an anticipated dropout rate
about the therapeutic exercise intervention. of 20%. Sample size calculations using G*Power
Kinesio tape was applied based on the study of software as by the previous studies 14 resulted in
Ozer et al.11 The taping technique was to improve 99 patients (a 33-per arm of the trial), with a 15%–
shoulder and scapular biomechanics during exer- 20% dropout-rate. Thus, a total sample size of 120
cises. In the first session, the physical therapist was required (40 patients per group).
explained the details about Kinesio tape (e.g., his- Shapiro-Wilk and Levene tests were used to
tory, materials, different colors, and different usage assess data distribution. One-way analysis of vari-
based on the techniques) for patients in therapeutic ance (ANOVA) was used to compare the group
exercise with Kinesio tape group. Also, patients demographics and post hoc independent t-tests
were watched for any allergic reaction to the tape were performed in the case of a significant omni-
and no one had taping allergy. It took about bus test. The dependent variables of interest were
five minutes to tape a participant for each session. the kinematics, disability, and pain scores.
Standard 5-cm Kinesio Tex (Kinesio tape-X050; One-way analysis of covariance (ANCOVA),
Kinesio Tex, Tokyo, Japan) was used. Each ses- with a between-factor of the group (control, thera-
sion, Kinesio tape was removed before therapeutic peutic exercise alone, or therapeutic exercise with
exercise and applied again after therapeutic exer- Kinesio tape) and patients’ baseline scores included
cise for 24h. Please see Supplemental Appendix 3 as a covariate, was used to determine between-
for the fully instructed Kinesio tape technique. group differences. In the case of a significant omni-
To maximize the compliance in the treatment bus test, pairwise comparisons were performed to
groups, besides being explained about the impor- examine potential between-group differences. 95%
tance of the exercise intervention at the initial of confidence intervals (CI95%) were calculated
each session, the patients were given a brochure of based on the adjusted group mean differences and
exercises accompanied by explaining how the pro- effect sizes of the mean group differences were cal-
gram would positively affect the patients` symp- culated as Cohen’s D (0.2 = small effect, 0.5 = mod-
toms and daily activities. Patients in both erate effect, and 0.8 = large effect).23 SPSS software
experimental groups received exercise intervention version 22 with an alpha of 0.05 was used for sta-
for eight weeks while those in therapeutic exercise tistical analysis.
with Kinesio tape group were given the tape as
well.
Patients in the control group received no inter-
Results
vention; however, to consider the ethics of non- One hundred and fifty-seven were considered and
active management of the control group, patients 120 met the inclusion criteria of the study entered
were given a brochure about preventing overuse the study. Seven patients discontinued the treat-
shoulder injuries and explaining how being active ment before post-testing due to personal reasons
would relieve their symptoms. They were also (three for the therapeutic exercise group and four
encouraged to contact the team, in case of any for therapeutic exercise with Kinesio tape group)
problem or concern. In the case of pain, the control (Figure 1). There was a high degree of adherence to
group was advised to use ice for about 20 minutes, all three interventions (of the possible 24 sessions,
three times a day,22 or take a pain medication pre- therapeutic exercise alone group, 22 sessions, and
scribed and guided by a physician. therapeutic exercise with Kinesio tape group, 21
The sample size calculation was considered a sessions). No adverse events were reported. Eleven
power calculation to detect between-group differ- patients (four females and seven males) in the con-
ences in the primary outcome measure (pain). trol group reported that they used an ice pack
Statistical power calculations were also based on a between 1 and 2 days. No patients in the control
562 Clinical Rehabilitation 35(4)

Figure 1.  The CONSORT flow diagram.

TE with KT: therapeutic exercises with Kinesio tape; TE: therapeutic exercise alone.

group reported receiving medication during the tape group had better scores vs therapeutic exercise
study. There were no significant differences among alone for disability (P = 0.024). The control group
the groups in demographic data (age, weigth, gen- showed no significant changes for pain and disabil-
der, arm dominance, and duration of sympthom; ity (P > 0.05) (Table 2).
P > 0.05) (Table 1). For kinematic outcomes, the control group
A significant treatment × time interaction effect showed no significant changes (P > 0.05). No sig-
was found for the pain, disability, scapular nificant differences were observed in both experi-
upward rotation, and scapular tilt (P < 0.05). No mental groups for scapular internal rotation
significant main time effects were found for scapu- (P > 0.05) (Table 3). While, for scapular upward
lar internal rotation (P > 0.05). rotation, therapeutic exercise with Kinesio tape
For all measured outcomes, the effects of both showed significant effect vs therapeutic exercise
theraputic exercise alone and therapeutic exercise alone, at a sagittal plane (P = 0.033), and scapular
with Kinesio tape were significantly superior over plane (P = 0.045). The results weren’t significant in
the control group (P < 0.05). The therapeutic exer- therapeutic exercise for scapular upward rotation
cise with Kinesio tape group had better scores vs (P > 0.05) (Table 3). For scapular tilt, the thera-
therapeutic exercise alone for pain (P = 0.042). peutic exercise with Kinesio tape group showed
Like pain, the therapeutic exercise with Kinesio significant effect vs therapeutic exercise alone at
Letafatkar et al. 563

Table 1.  Participants demographics and characteristics.

TE with KT TE Control P value

Age, years; mean (SD) 35.4 (4.4) 40.5 (5.5) 37.5 (6.3) 0.109
Weight, kg; mean (SD) 76.1 (5.3) 73.7 (7.2) 69.4 (8.1) 0.098
Gender – female; n (%) 20 (50) 22 (55) 21 (52.5) 0.522
Arm dominance – right; n (%) 11 (55) 12 (60) 12 (60) 0.528
Duration of symptoms; n (%)
  6–12 weeks 14 (35) 14 (35) 13 (32.5) 0.675
  >12 weeks 26 (65) 26 (65) 27 (67.5) 0.648

SD: standard deviation; TE with KT: therapeutic exercises with Kinesio tape; TE: therapeutic exercise alone.

Table 2.  Mixed within-between groups for the pain and disability outcomes assessed in the study.

Within-group Between-groups

Variable Groups Baseline Post- Effect size and 95% P Main effects P
mean (SD) intervention CI (Lower limit– with respect
mean (SD) Upper limit) to time
Pain TE with KT 6.2 (1.6) 3.1 (1.4) 2.06 (1.5 to 2.98) 0.001Ф F = 4.26; 0.001*
TE 5.9 (1.3) 3.8 (2.5) 1.05 (0.87 to 1.43) 0.035Ф P = 0.023Ω 0.004¥
Control 6.3 (1.9) 6.8 (2.8) 0.08 (–0.08 to 0.58) 0.416 0.042‡
Disability TE with KT 25 (11.4) 11.7 (8.2) 1.33 (0.39 to 1.78) 0.001Ф F = 7.43; 0.001*
TE 23.7 (7.8) 15.9 (9.8) 0.88 (0.34 to 1.15) 0.005Ф P = 0.011Ω 0.011¥
Control 26.1 (3) 26.7 (5.2) –0.14 (–0.7 to 0.07) 0.628 0.024‡

SD: standard deviation; TE with KT: therapeutic exercises with Kinesio taping; TE: therapeutic exercise alone; CI: confidence
interval.
Ф
Significant within-group changes.
*Significant between combined TE with KT and control groups.
¥
Significant between TE alone and control groups.
‡
Significant between combined TE with KT and TE alone groups.
Ω
Significant group × time interaction.

the sagittal plane (P = 0.043), and scapular plane shoulder impingement syndrome. These findings
(P = 0.034). Significant differences in therapeutic may indicate the potential benefits of adding
exercise alone in the sagittal plane (P = 0.001) and Kinesio tape to therapeutic exercise to improve
scapular plane (P = 0.046) were observed (Table 3). pain, disability, and scapular kinematics after
eight-week intervention.
Adding an adjunct therapy to significantly
Discussion enhance the effect of exercise therapy in patients
Our results showed that therapeutic exercise with with shoulder impingement syndrome is debatable.
Kinesio tape could have positive effects on pain Camargo et al.21 showed for pain, function, or
and disability with higher within-group differences scapular kinematics, the exercise-alone group
and larger effect size than therapeutic exercise demonstrated greater improvement than the exer-
alone and control groups. In addition, adding cise-plus–manual therapy group after four weeks of
Kinesio tape to therapeutic exercise showed more an intervention. However, Şimşek et al.9 stated that
significant effects than therapeutic exercise alone Kinesio tape is effective in the rehabilitation of
on scapular upward rotation and tilt in patients with shoulder impingement syndrome when adding to a
564 Clinical Rehabilitation 35(4)

Table 3.  Mixed within-between groups for the kinematic outcomes assessed in the study.

Within-group Between-groups

Variable Groups Baseline Post- Effect size and 95% P Main effects P
mean (SD) intervention CI (Lower limit– with respect
mean (SD) Upper limit) to time
Sagittal plane elevation
Scapular TE with KT 47.9 (5.3) 46.8 (5.1) 0.21 (–0.65 to 0.2) 0.121 F = 0.32; -
internal rotation TE 47.6 (6.3) 46.4 (8.3) 0.16 (–0.27 to 0.6) 0.136 P = 0.432
Control 49.1 (5.8) 48.4 (5.4) 0.12 (–0.31 to 0.56) 0.426
Scapular upward TE with KT 17.1 (10.8) 23.2 (9.9) –0.58 (–1.03 to –0.1) 0.041Ф F = 3.37; 0.001*
rotation TE 16.6 (8.4) 19.6 (11.8) –0.29 (–0.73 to 0.14) 0.076 P = 0.032Ω 0.021¥
Control 16.2 (14.9) 15.3 (13.0) 0.06 (–0.37 to 0.50) 0.126 0.033‡
Scapular tilt TE with KT –0.4 (1.7) –4.5 (3.2) 1.6 (1.09 to 2.1) 0.001Ф F = 2.53; 0.001*
TE –0.5 (2.3) –2.8 (2.9) 0.87 (0.41 to 1.33) 0.001Ф P = 0.043Ω 0.025¥
Control –0.6 (3.4) –0.5 (2.5) –0.03 (–0.47 to 0.4) 0.314 0.043‡
Scapular plane elevation
Scapular TE with KT 35 (8.3) 33.1 (8.5) 0.22 (–0.21 to 0.66) 0.131 F = 0.43; -
internal rotation TE 38.0 (6.6) 36.6 (4.9) 0.24 (–0.19 to 0.68) 0.174 P = 0.215Ω  
Control 35.9 (6.4) 36.5 (9.8) –0.7 (–0.51 to 0.36) 0.366  
Scapular upward TE with KT 19.5 (13.5) 23.7 (8.8) –0.46 (–0.81 to –0.1) 0.038Ф F = 7.54; 0.001*
rotation TE 20.6 (11.7) 22.1 (8.6) –0.14 (–0.58 to 0.29) 0.106 P = 0.036Ω 0.045¥
Control 20.3 (13.2) 19 (12.5) 0.10 (–0.33 to 0.53) 0.111 0.045‡
Scapular tilt TE with KT –0.3 (1.1) –2.2 (3.9) 0.66 (0.21 to 1.11) 0.001Ф F = 2.66; 0.001*
TE –0.5 (1.1) –1.2 (2.7) 0.33 (0.10 to 0.78) 0.046Ф P = 0.041Ω 0.042¥
Control –0.5 (2.1) –0.5 (1.3) 0.05 (–0.38 to 0.1) 0.211 0.034‡

SD: standard deviation; TE with KT: therapeutic exercises with Kinesio taping; TE: therapeutic exercise alone; CI: confidence
interval.
Ф
Significant within-group changes.
*Significant between combined TE with KT and control groups.
¥
Significant between TE alone and control groups.
‡
Significant between combined TE with KT and TE alone groups.
Ω
Significant group × time interaction.

scapular stabilization and rotator cuff strengthen- effect, joint mechanical correction, and enhance-
ing exercises. ment of muscle function.25 Moreover, the three tap-
How the Kinesio tape mechanism affects pain ing techniques that were applied in this study sought
and function of the shoulder is still unclear. to provide facilitation of the lower trapezius mus-
However, studies showed that Kinesio tape could cle, inhibition of the upper trapezius muscles, and
affect symptoms in individuals with musculoskele- mechanical correction affecting the subacromial
tal pain and dysfunction through stimulating neuro- space.25,26
muscular pathways to provide more proprioceptive In the patients with shoulder impingement syn-
feedback to realign the posture, attaching to the skin drome, a deficit in flexibility or strength in an ago-
while providing assistance or limitation to the nistic muscle, which is compensated by the
motion, and lifting soft tissue and fascia above the antagonist's muscle, may lead to a sub-acromial
area of pain/ inflammation resulting in more micro- space reduction, a shoulder griddle dysfunction,
circulatory flow beneath the skin.8,24 Also, applied and ultimately structural damage.27 Kinesio tape
Kinesio tape may promote a greater proprioceptive might help the therapeutic exercise to increase the
Letafatkar et al. 565

subacromial space as well as to enhance the control in the method section the control group was
of the muscles stabilizing the scapula throughout advised to use ice or take a pain medication pre-
an arc of glenohumeral elevation motion resulting scribed by a physician. This issue might affect
in modulating pain.3 the score of pain intensity in the control group;
Besides, the association of reducing pain with however, it did not seem ethical that because of
decreasing disability has been previously studied data accuracy those in the control group tolerate
and moderate correlation has been reported.28,29 pain. Second, we did not evaluate the long-term
Cook et al.28 reported the correlation of pain effect of the eight-week therapeutic exercise with
intensity and disability in patients with shoulder Kinesio tape intervention. Although the eight-
dysfunction as 0.027 while, Anwer et al.29 reported week therapeutic exercise with Kinesio tape
this correlation as 0.66. Although in the current intervention is shown as effective on symptoms
study we did not analyze data correlation, we in the patients with shoulder impingement syn-
hypothesize that the significant reduction of pain drome, the results may not be transferred to a
in therapeutic exercise with Kinesio tape group longer-term. Third, to minimize any placebo
could reduce disability outcomes. effect, we tried to reduce the length of time
The data of the present study could be found Kinesio tape was applied to. Due to the sliding
consistent with the study of Turgut et al.18 on how nature of the scapula beneath the skin surface,
to improve scapular kinematics through an exer- there may be a limitation to interpret the results
cise program. It seems to be effective on scapular and the clinical value of the intervention.
kinematics a stretching and strengthening exercises Although the study design allows for controlling
should be combined with another adjuvant or exer- non-specific effects of the intervention, adding a
cise therapy.18 control group just applying Kinesio tape may be
Kinesio taping could be applied as an effective useful to control non-specific Kinesio tape
adjuvant therapy to reduce the upper trapezius activ- effects. Fourth, although previous similar studies
ity and to increase lower trapezius activity resulting did not observe any considerable effect of pla-
in more scapular posterior tilt during functional cebo Kinesio tape,11,33 we believe that the results
activities.30 Lower trapezius taping showed a signifi- of our study would be more reliable if we had
cant increase in scapular posterior tilt in baseball another group that received a placebo Kinesio
players with shoulder impingement syndrome.31 tape and we could observe how the placebo
Moreover, the relation between the shoulder Kinesio tape can change the measured outcomes.
proprioception and kinematic has been previ- Finally, it was not clear if patients’ precision
ously described.31–33 Shih et al.31 concluded that about pain and disability scores was affected by
taping-associated immediate improvement in the length of time of Kinesio tape application and
scapular reposition sense was accompanied by hands-on interaction in therapeutic exercise with
enhanced scapular kinematics including increased the Kinesio tape group.
scapular posterior tilt and scapular upward rota- In summary, the findings of this study indicate
tion during arm elevation in the scapular plane. adding Kinesio tape to therapeutic exercise pro-
Although we did not assess shoulder propriocep- vides more advantages to reduce pain and disa-
tion in the current study, it can hypothetically be bility and improve shoulder kinematics in patients
indicated that kinematic outcomes improvement with shoulder impingement syndrome. Adding
in therapeutic exercise with Kinesio tape group Kinesio tape to therapeutic exercise could clini-
might be partly due to enhanced joint propriocep- cally reduce pain and disability resulting in
tion in the direction of scapular tilt and upward/ shoulder kinematics improvement. The authors
downward rotation. suggest providing more studies with a long-term
The authors must acknowledge some limita- follow-up analysis and using placebo Kinesio
tions of the current study. First, as it is indicated tape intervention.
566 Clinical Rehabilitation 35(4)

2. Phadke V, Camargo P and Ludewig PM. Scapular and

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and review of the manuscript. A.L, P.R, and S.K, and 8. McLaren C, Colman Z, Rix A, et al. The effectiveness of
S.AP performed the experiments and analyzed the data. scapular taping on pain and function in people with sub-
A.L and P.R authors discussed the results and com- acromial impingement syndrome: a systematic review. Int
mented on the manuscript. Musculoskelet Med 2016; 38(3–4): 81–89.
9. Şimşek H, Balki S, Keklik SS, et al. Does kinesio taping
Declaration of conflicting interests in addition to exercise therapy improve the outcomes in
subacromial impingement syndrome? A randomized, dou-
The author(s) declared no potential conflicts of interest ble-blind, controlled clinical trial. Acta Orthop Traumatol
with respect to the research, authorship, and/or publica- Turc 2013; 47(2): 104–110.
tion of this article. 10. Keenan KA, Akins JS, Varnell M, et al. Kinesiology tap-
ing does not alter shoulder strength, shoulder propriocep-
Funding tion, or scapular kinematics in healthy, physically active
subjects and subjects with subacromial impingement syn-
The author(s) received no financial support for the drome. Phys Ther Sport 2017; 24: 60–66.
research, authorship, and/or publication of this article. 11. Ozer ST, Karabay D and Yesilyaprak SS. Taping to
improve scapular dyskinesis, scapular upward rotation,
ORCID iDs and pectoralis minor length in overhead athletes. J Athl
Train 2018; 53(11): 1063–1070.
Amir Letafatkar https://orcid.org/0000-0002-5612- 12. Selkowitz DM, Chaney C, Stuckey SJ, et al. The effects
8340 of scapular taping on the surface electromyographic sig-
Pouya Rabiei https://orcid.org/0000-0003-4216-9755 nal amplitude of shoulder girdle muscles during upper
extremity elevation in individuals with suspected shoulder
impingement syndrome. J Orthop Sports Phys Ther 2007;
Supplemental material
37(11): 694–702.
Supplemental material for this article is available online. 13. Saracoglu I, Emuk Y and Taspinar F. Does taping in
addition to physiotherapy improve the outcomes in sub-
acromial impingement syndrome? A systematic review.
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