Rev Dor.

São Paulo, 2013 jan-mar;14(1):27-30 ORIGINAL ARTICLE

Effectiveness of Kinesio Taping in pain and scapular dyskinesis in athletes

with shoulder impingement syndrome*
Efeito do Kinesio Taping na dor e discinesia escapular em atletas com síndrome do impacto
do ombro
Valéria Mayaly Alves de Oliveira1, Laísla da Silva Paixa Batista1, Ana Carolina Rodarti Pitangui2,3 , Rodrigo Cappato de
Araújo2,3,4
* Received from the Research Laboratory for Women Musculoskeletal Rehabilitation and Health (LAPRESM), University of Pernambuco (UPE),
Petrolina, PE.

ABSTRACT

BACKGROUND AND OBJECTIVES: Shoulder impingement RESUMO

syndrome (SIS) is characterized by pain and functional limitation
being frequent in people practicing physical activities involving JUSTIFICATIVA E OBJETIVOS: A síndrome do impacto do
repeated movements of upper limbs above the head. This study ombro (SIO) caracteriza-se por dor e limitação funcional sendo
aimed at evaluating the effectiveness of Kinesio Taping (KT) for frequente em praticantes de atividade física que envolva movimen-
pain and scapular dyskinesis and at checking whether there is as- tos repetidos do membro superior acima da cabeça. O objetivo
sociation between pain and scapular dyskinesis in people with SIS deste estudo foi avaliar os efeitos do Kinesio Taping (KT) na dor e
and practicing physical activities. discinesia escapular e verificar se há associação entre dor e discine-
METHOD: Fifteen amateur male athletes with SIS were evaluated. sia escapular em praticantes de atividade física com SIO.
Slide Scapular Lateral Test was used to evaluate scapular dyskinesis MÉTODO: Foram avaliados 15 atletas amadores com SIO, sexo
and visual numerical scale (VNS) was used to evaluate pain at masculino, praticantes de atividade física. Utilizou-se o Slide Scapu-
rest, during activities and at effort. KT was placed after tests. All pa- lar Lateral Test para avaliação da discinesia escapular e a escala visual
tients were evaluated before and two weeks after KT. Chi-square and t numérica (EVN) para avaliação da dor no repouso, durante ativi-
paired tests were used for statistical analysis with significance of p < 0.05. dades e ao esforço. Após os testes foi feita a colocação do KT. Todas
RESULTS: There have been significant differences in VNS scores as avaliações foram realizadas antes e duas semanas após a aplicação
for pain at rest (p = 0.03), at daily activities (p = 0.001) and at do KT. Para análise estatística foram utilizados os testes de Qui-
effort (p = 0.001) before and after KT. There has also been statisti- quadrado e t pareado, com significância estatística de p < 0,05.
cal difference in scapular dyskinesis at re-evaluation (p = 0.001). RESULTADOS: Foram observadas diferenças significantes nos es-
There has been no statistically significant association between pain cores na EVN para dor no repouso (p = 0,03), nas atividades diárias
and dyskinesis. (p = 0,001) e no esforço (p = 0,001) antes e após o uso do KT. Tam-
CONCLUSION: KT has improved scapular dyskinesis and pain bém foi observada diferença estatística na discinesia escapular na
scores of people practicing physical activities with SIS, however reavaliação (p = 0,001). Em relação à associação entre dor e discine-
there has been no association between pain and dyskinesis. sia não foi verificada associação estatisticamente significativa.
Keywords: Athletic tape, Pain, Shoulder impingement syndrome. CONCLUSÃO: O uso do KT proporcionou melhora na discinesia
escapular e nos escores de dor dos praticantes de atividade física com
SIO, no entanto não foi verificada associação entre dor e discinesia.
Descritores: Dor, Fita atlética, Síndrome de colisão do ombro.
1. Student of the Graduation Course in Physical Therapy, University of Pernambuco. Petro-
lina, PE, Brazil. INTRODUCTION
2. Assistant Professor, Department of Physical Therapy, University of Pernambuco. Petro-
lina, PE, Brazil.
3. Professor of the Master Program in Hebiatry, University of Pernambuco. Recife, PE, Brazil. Scapular dyskinesis is defined by changes in scapular position and
4. Professor of the Associated Post-Graduation Program in Physical Education University movement, resulting from the activation imbalance between scap-
of Pernambuco/Federal University of Paraíba. College of Physical Education, University of ula stabilizing muscles, especially serratus anterior and trapezius
Pernambuco. Recife, PE, Brazil.
muscles. These changes impair the scapular humeral rhythm and
Submitted in November 16, 2012. may contribute for the presence of shoulder painful conditions1,2,
Accepted for publication in February 18, 2013. such as shoulder impingement syndrome (SIS).
Correspondence to: SIS is one of the major reasons for shoulder pain, being frequent
Rodrigo Cappato de Araújo, M.D. in practitioners of physical activities involving elevating the arm
Universidade de Pernambuco, Campus Petrolina, above the head3. Major associated symptoms are movement am-
Departamento de Fisioterapia.
BR 203, km 2 S/N, Vila Eduardo plitude restriction (MA) and consequent limitation of daily life
56300-000 Petrolina, PE. activities and sports practice4. So, the adequate management of

c Sociedade Brasileira para o Estudo da Dor 27

Rev Dor. São Paulo, 2013 jan-mar;14(1):27-30 Oliveira, Batista, Pitangui et al.

symptoms and the correction of possible factors related to SIS are during daily activities (eating, dressing and bathing) and during
critical to reestablish shoulder function and return to activities2. effort activities (reaching, raising, pushing, pulling, throwing an
Kinesio Taping (KT) has been used as therapeutic proposal both in object).
prevention and in directly acting on sports injury symptoms and on Then, to evaluate the presence of scapular dyskinesia, Slide Lateral
injuries affecting the shoulder. It is believed that such technique im- Scapular Test was performed, which consists in measuring the dis-
proves circulation and decreases local edema, as well as sensory stim- tance between the lower scapular angle to the corresponding spi-
ulation offering stability and proprioception during movements5,6. nous process. To perform the test, volunteers were positioned in
In addition, it also promotes pain relief since it stimulates central orthostasis and the shoulder was abducted in the frontal plane in
nervous system sensory pathways increasing afferent feedback and 0°, 45° e 90° angles (Figure 1). The test is positive when differences
decreasing direct pressure on subcutaneous nociceptors7. between left and right measures are higher than 15 millimeters3.
KT has been investigated both by research and the clinical prac- After pain and dyskinesia evaluation, KT was fixed on the region
tice, especially with regard to its effects on pain; however, results of the coracoid process and positioned on the scapula with ten-
to date are not yet well established. While some authors have ob- sioning toward the fibers of lower trapezius muscle (Figure 2). All
served pain relief after KT4, others have not observed differences volunteers used KT for two weeks. During this period, the tape
in pain scores, although observing improvement in shoulder MA was replaced as needed. After this period, all volunteers were re-
of athletes with SIS8. valuated.
In addition, it is important to stress that since SIS is related to mus- Programs SPSS version16.0 and GraphPad Prism version 5.0 were
cle imbalance of scapular stabilizers, KT could provide benefits for used for statistical analysis. Data normality was checked with Sha-
the correction of position changes and scapular movement, thus piro-Wilk test. To evaluate the association between pain and dys
contributing to decrease pain. So, pain improvement would be
related to the effects on nociceptors, being result of the adequate
positioning and consequent stability provided by KT7. However,
there are no studies to date investigating the effects of KT on SIS
scapular dyskinesia.
Due to the broad use of KT in clinical practices and to the high
incidence of pain and scapular dyskinesia in SIS patients, added to
the scarcity of studies about the effects of KT in both situations,
the need for further studies on the subject is justified.
This study aimed at evaluating the effects of KT on pain and scapu-
lar dyskinesia and to check whether there is association between
these conditions in physical activity practitioners with SIS.

METHOD
Figure 1 – Slide scapular lateral test.

This is a study with 15 male volunteers, mean age of 22.00 ± 3.87

years, body mass of 73.37 ± 8.57 kg and height of 1.76 ± 0.08 m,
amateur athletes of the city of Petrolina, PE, practitioners of activi-
ties involving repetitive arm movements above the head for at least
six months, with minimum frequency of four times a week and
more than six training hours per week.
Inclusion criteria were: presence of signs, symptoms and confirmed
diagnosis of SIS; shoulder pain for at least six weeks, presence of
pain at palpation and positivity of at least two of the applied tests
(Neer, Hawkins-Keneddy and Jobe)9. Exclusion criteria were volun-
teers with history of surgeries, fractures and degenerative joint
diseases in scapular girdle, shoulder and cervical spine. It is worth
stressing that participated in this study only individuals who for Figure 2 – Application of Kinesio Taping.
at least six months had been not submitted to physical therapy or
drug therapy (use of anti-inflammatory drugs). All volunteers have kinesia, Chi-square test with Yates correction was used and a logis-
signed the Free and Informed Consent Term (FICT). tic regression model was applied with odds ratio (OR) calculation
Initially, history was taken to collect personal and anthropometric and Woolf association when frequencies were equal to zero. To
data, and physical exam. Clinical tests were perform to confirm compare pain scores and the presence of scapular dyskinesia before
SIS and a verbal numeric scale (VNS) was applied to evaluate pain and after KT, paired Student’s t and Chi-square were used, respec-
scores. VNS is a unidimensional scale made up of a ruler with num- tively. All with significance level of 5%. Quantitative variables were
bers from zero to 10 cm, being zero no pain and ten unbearable expressed by mean and standard deviation and qualitative variables
pain10. Pain was evaluated at rest (arm pending along the body), were described in absolute and relative frequencies.

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 Effectiveness of Kinesio Taping in pain and scapular dyskinesis Rev Dor. São Paulo, 2013 jan-mar;14(1):27-30
in athletes with shoulder impingement syndrome

This study was approved by the Research Ethics Committee, Uni- kinesia in physical activity practitioners with SIS in the period of
versity of Pernambuco, protocol 274/2010. two weeks after TK application.
It is believed that KT effects on pain scores are related to supposed
RESULTS benefits such as joint realignment, muscle facilitation or inhibition,
as well as increasing proprioception by stimulating skin mechano-
As shown in table 1, there has been significant VNS pain scores ceptors may contribute to pain improvement and consequent im-
decrease in the three situations evaluated after the use of KT: rest provement of limb functionality11.
(p = 0.03), daily activities (p = 0.001) and effort (p = 0.001). As A study8 has compared the effects of KT and a placebo tape on
to scapular dyskinesia, there has also been statistically significant MA and pain scores of individuals with shoulder pain, by the visual
difference at revaluation (p = 0.001). analog scale (VAS) and the Shoulder Pain and Disability Index
With regard to the association between scapular dyskinesia and (SPADI). For such, measurements were taken before application
pain, no statistically significant results were found, as shown in and in the 1st, 3rd and 6th day after KT application, being observed
table 2. statistically significant difference only in the first 24 hours after
application.
DISCUSSION However, when comparing KT associated to physical therapy for
disability and pain in SIS individuals during two weeks, Kaya,
KT effects have been investigated in pain scores of musculoskeletal Zinnuroglu and Tugcu12 have observed that there has been decrease
shoulder injuries, however, the effects of this therapeutic measure in VAS scores for pain at night, at rest and during activity only after
on scapular dyskinesia of SIS individuals have not been evaluated the first week of intervention. In this sense, our study is in line with
to date. Our study has observed significant difference in lower pain the results of above-mentioned studies with regard to pain relief,
scores at rest, daily activities and effort; presence of scapular dys- fact which may reinforce the hypothesis that the pain gate theory is

Table 1 – Absolute and relative frequency of scapular dyskinesia and mean pain scores in the numeric visual scale at evaluation and
revaluation.

Pain
Evaluation Revaluation p value
Pain at rest 1.53 (2.29) 0.53 (0.99) 0.03*
Pain during DLA 2.66 (2.16) 1.13 (1.24) 0.001*
Pain at effort 5.46 (2.03) 3.06 (1.57) 0.001*

Scapular Dyskinesia

Evaluation Revaluation p value

Present 14 (93.3%) 4 (26.6%) 0.001*
Absent 1 (6.7%) 11 (73.4%)

*Statistically significant difference (p < 0.05)

Pain during DLA = pain during daily life activities.

Table 2 – Distribution and association between presence of scapular dyskinesia and the presence of pain at rest and during daily
life activities and sports practice.
Dyskinesia Odds Ratio p value*
Presence Absence OR CI 95%
Pain at rest
Presence 5 (33%) 0 (0%) 1.74 0.06 - 50.47 0.536
Absence 9 (60%) 1 (7%)

Pain during DLA

Presence 12 (80%) 0 (0%) 15.00 0.46 - 485.73 0.438
Absence 2 (13%) 1 (7%)

Pain at effort
Presence 14 1 1.00 0.06 – 17.634 1.00
Absence 14 1

* Chi-square test.
Pain during DLA = pain during daily life activities.

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Rev Dor. São Paulo, 2013 jan-mar;14(1):27-30 Oliveira, Batista, Pitangui et al.

controlled by afferent stimulation provided by KT8,12. scapular positioning and movement, in addition to studies with
On the other hand, while these authors8,12 have stated that KT has control or placebo groups, as well as follow up studies for the analysis
only short term effects, corresponding to the maximum period of of long term KT effects.
one week, our study has observed positive effects after two weeks
of application. This result is relevant with regard to late KT ef- CONCLUSION
fects on pain. A possible hypothesis for the late effect would be the
constant information about joint correction and proprioception Our study has observed improvement in scapular dyskinesia and
given to the individual, which may improve joint positioning dur- pain scores after KT. However, no association was seen between dys-
ing activities generating further mechanical advantage to joint and kinesia and pain. So, it is suggested that KT may be applied as addi-
decompression of subacromial space structures7. tional therapeutic measure during rehabilitation of SIS individuals.
In addition to the effects on muscle activity, KT may also have pro-
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