Kinesio taping in patients with shoulder impingement

Study Design: Prospective Observational Study Background: Physical therapy is one of the primary treatment options for these patients, however, we were unable to identify previously published research that objectively assesses the impact of taping on joint range of motion or on pain levels in patients with SAIS. This gap in the literature motivated the present study. Objectives: To describe the results of the application of neuromuscular taping in patients with subacromial impingement syndrome (SAIS), with respect to their pain levels, joint range of motion, and acromiohumeral distance, assessed via ultrasound Methods: A prospective series of cases was evaluated at the Hospital Italiano de Buenos Aires between April and September of 2018. Twenty-four patients from age 25 to 65 were invited to participate (9 men and 15 women), all of whom had been diagnosed with rotator cuff tendinopathy, impingement syndrome, or bursitis with positive signs of impingement in the affected shoulder and anterior shoulder pain in fl exion Result: Signifi cant changes in AHD (Figure 2), pain, and anterior fl exion were registered after taping. Superfi cial dermatitis was detected in only two patients, but this did not affect the assessment. Conclusion: In the results obtained by this study, it has been observed that the application of neuromuscular taping using the method described above signifi cantly increases AHD, leading to short-term improvements in pain and joint range of motion. Research Article Kinesio taping in patients with shoulder impingement Sorin P*, Ramirez FJ, Joly A, Patiño O and Terrasa S Department of Physical Therapy, Hospital Italiano of Buenos Aires, Autonomous City of Buenos Aires, Argentina *Address for Correspondence: Pablo Sorin, Department of Physical Therapy, Hospital Italiano of Buenos Aires, Autonomous City of Buenos Aires, Argentina, Email: pablo.sorin@hospitalitaliano.org.ar Submitted: 08 May 2019 Approved: 21 May 2019 Published: 22 May 2019 Copyright: © 2019 Sorin P, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited


Introduction
Shoulder pain is the second most common musculoskeletal disorder following low back pain [1], and a frequent af liction among workers and athletes. It has an incidence of nearly 30 new cases per 1000 individuals per year, and among those aged 18 and 44 its prevalence is almost 22% [2].
Subacromial impingement syndrome (hereinafter SAIS) is one of the most frequent causes of shoulder pain and functional deterioration [3,4]. Impingement of the tendons of the rotator cuff, biceps, and soft tissue between the coracoacromial arch and the humeral head causes edema, in lammation, and shoulder pain [5]. There are structural and functional factors that lead to subacromial crowding, and subsequently SAIS. Weakness of scapular muscles and those of the rotator cuff, a type III acromion, and soft tissue retractions are some of such factors.
Conservative treatment of SAIS includes a wide variety of therapies that aim to diminish pain and improve joint mobility. Treatments include: exercise protocols for muscular strengthening and stretching [6], corticosteroid injections, cryotherapy, acupuncture, thermotherapy, manual therapy [7], prolotherapy, manipulations, ultrasound and transcutaneous electrical nerve stimulation (TENS) [8,9], extracorporeal shock wave therapy, joint mobilization techniques, magnetic ields, and various alternative therapies [10]. Nonetheless, there is still a lack of solid scienti ic evidence to support the use of these treatments, and it should be noted that when so many treatment options exist for a determined pathology, it is reasonable to think that none shows clear evidence of superiority over the rest.
Physical therapy is one of the primary treatment options for these patients, and in recent years new techniques have been developed such as neuromuscular tapingcommonly known simply as "taping" -which basically consists of attaching an adhesive and elastic band on the affected zone with the objective of regulating biological processes such as pain, in lammation, muscle activation, and circulation [11][12][13].
In patients with SAIS, taping seeks to reposition the shoulder complex in order to augment the subacromial space. Some authors [14], have documented improvements in pain and immobility in patients with rotator cuff tendinitis and shoulder impingement.
Nonetheless, the effectiveness of taping and its in luence on results are not conclusive, given that in the majority of cases it was combined with a supervised shoulder exercise program. It is therefore dif icult to determine the fraction of improvement attributable to each of the therapeutic interventions [15,16].
The height of the subacromial space is central for normal shoulder functioning; this can be assessed by measuring the acromiohumeral distance (AHD), which is the distance between the acromion and the apex of the humeral head. When carried out by a trained professional, scapular taping can augment the AHD and facilitate rotator cuff tendon gliding in shoulder movements [17]. However, we were unable to identify previously published research that objectively assesses the impact of taping on joint range of motion or on pain levels in patients with SAIS. This gap in the literature motivated the present study.

Objective
To describe the results of the application of neuromuscular taping in patients with subacromial impingement syndrome (SAIS), with respect to their pain levels, joint range of motion, and acromiohumeral distance, assessed via ultrasound.

Methods
A prospective series of cases was evaluated at the Hospital Italiano de Buenos Aires between April and September of 2018. Twenty-four patients from age 25 to 65 were invited to participate (9 men and 15 women), all of whom had been diagnosed with rotator cuff tendinopathy, impingement syndrome, or bursitis with positive signs of impingement in the affected shoulder and anterior shoulder pain in lexion (these were the inclusion criteria). The exclusion criteria for participation in this study included having underwent previous shoulder surgery, rotator cuff calci ications, cervical radiculopathy, fractures, luxations, adhesive capsulitis, and neurological disorders with effects on the upper limb.
The research protocol was approved by the Ethics and Research Protocol Committee at the Hospital Italiano de Buenos Aires, and all participants provided written informed consent.
Description of procedures and measurements.
Three assessments were carried out on each of the 24 patients -one to establish the base line, one after the application of the therapeutic taping, and another three days after application. All relevant variables were assessed in each instance.
Pain was assessed using a visual analog scale (VAS). Joint range of motion was measured using a Prohab Mod U310 goniometer, using reference values of 0 -150°/170° for anterior lexion, 0 -160°/180° for abduction, 0-70° for inward rotation, and 0-70° for outward rotation (values de ined by the AO Foundation -the Association for the Study of Internal Fixation). A cromiohumeral distance (AHD) measurement was carried out on all patients by the same technician. The ultrasound system used was a Philips HD-15 (Washington, USA) with a 12-5 MHz and 15-7 MHz linear transducer, depending on the patient's physical state. The patient was seated on the examining table with their upper limb in a neutral position and the transducer was placed in the coronal plane with its medial margin over the lateral edge of the acromion, such that the proximal extremity of the humerus and the acromion were visible in the same image. The AHD was measured vertically from the inferior border of the acromion to the superior border of the humeral head before and after taping.
As previously mentioned, therapeutic taping was applied immediately after the irst ultrasound. Two strips of tape were applied, the irst from the inferior scapular angle to the inferior surface of the midclavicular line, and the second from the inferior scapular angle to the inner surface of the bicipital groove. Both strips of tape were applied at 90% to 100% of their tension (joint correction technique) (Figure 1).

Results
Twenty-four patients were examined, with a median age of 50 years (15 were women, or 62.5%) and a median pain evolution of four weeks. Their base line characteristics are described in the following table 1.
As the results in table 2 show, after application of therapeutic taping, a moderate augmentation of 0.65 mm (0.45 to 1; p<0.0001) was observed in the subacromial space, which was accompanied by a marked improvement in pain: -3 (-3 to -2; p<0.0001) and an increase in range of motion for anterior lexion of the shoulder (17.5 (12.5 to 20) with p <0.0001).
Signi icant changes in AHD (Figure 2), pain, and anterior lexion were registered after taping. Super icial dermatitis was detected in only two patients, but this did not affect the assessment.

Discussion
We have presented a series of patients with subacromial impingement syndrome who have been closely monitored, and have observed an increase in AHD after the application of Kinesio Tape, which was accompanied by a clinically relevant improvement in pain and joint range of movement (particularly anterior lexion). These changes were maintained three days after the application of therapeutic tape.
We believe that a possible change in the mechanism of joint repositioning aided by the application of the Kinesio Taping method was responsible for the bene its brought about in patients with shoulder pain.
Regarding the limitations of our study, we should point out the absence of a control group and short monitoring period. Future studies that include a control group (one that is not treated with this method) and random assignment of treatment, as well as longer monitoring times, will allow for further assessment of the effectiveness of Kinesio Taping in patients with subacromial impingement syndrome.

Especial thanks
Physical Therapy Department -Hospital Italiano de Buenos Aires -Argentina Diagnostic Imaging Department -Hospital Italiano de Buenos Aires -Argentina

Conclusion
In the results obtained by this study, it has been observed that the application of neuromuscular taping using the method described above signi icantly increases AHD, leading to short-term improvements in pain and joint range of motion. Three days after the application of therapeutic tape. 2 Immediately after the application of therapeutic tape. IQR: Interquartile range. VAS: visual analog scale.

Figure 2:
Ultrasound pre-and post-taping, which demonstrates change in AHD.