The potentional contribution of the role of the scapula and mechanics of the scapulothoracic joint have been well defined in the development of subsacromial impingemnt. Any alteration in the position or kinematics of the scapula will alter:
- The size of the subacromial shape
- The quality and quantity of scapulohumeral rhythm
- The contribution and timing of force couple muscles around the joints
Interestingly, it is hard for me to say that scapular position causes each of the three items listed above. Rather, these realistically all work together to cause dysfunction.
Enhancing Scapular Movement Quality
In our professions, we often address the movement dysfunction by assessing scapular kinematics and muscle activity. A common goal is to maximize the ability of the scapula to upwardly rotate and posteriorly tilt during elevation and overhead activities. This often leads us to emphasize the lower trapezius and serratus muscles in an attempt to alter the ratio to upper trapezius to lower trapezius. I’ve talked about the upper trapezius dominant motor pattern, how upper and lower trapezius imbalance can cause impingement, and how I minimize upper trapezius during shoulder exercises.
While studies have shown strengthening programs focusing on these areas can be effective, the use of kinesiotape has also become popular. Despite the popularity, I can’t tell you how many theories I have heard as to why patients and clients like using kinesiotape.
Could it be the constant proprioceptive feedback? Could it be alignment corrections? Could it be improved blood flow or lympatic drainage? Could there be an impact on fascia? Could it simple be another way to alter efferent outputs through afferent inputs? Could it be neuroscience by combing cutaneous input, sensory gating, and decreasing the perceived threat towards movement? Could it inhibit the H reflex? Could it simply be placebo after seeing everyone in the Olympics wearing kinesiotape?
I don’t think there is a definitive answer to these questions, however there are boatloads of anecdotal experience and some research studies trying to demonstrate the effectiveness of kinesiotape.
The Effect of Kinesiotape on Scapular Mechanics
One such study was recently release from Taiwan in the Journal of Electromyography and Kinesiology. In the study, the authors examined the effect of Kinesiotape of the lower trapezius on baseball players with impingement signs and shoulder weakness. The authors used a form of placebo tape (nonelastic) in a control group for comparison.
I have always had one primary concern with studies examining Kinesiotape. There is a lot of variability with kinesiotape – what type of tape? How much tension? Should muscle be short or long? In this article, the authors applied Kinesiotape to “envelope” the lower trapezius with minimal tension on the tape. Although it isn’t decsribed exactly, it looks like to me that they applied the tape without stretch in a shortened position for the lower trapezius in the photo. The scapula should be posteriorly tilted and upwardly rotated in this position, though I guess there is also some protraction. This is more along the lines of traditional Kinesiotaping.
During the study, the authors found:
- Kinesiotape significantly increased upward rotation of the scapula above 60 degrees of elevation
- Kinesiotape showed a trend towards increased posterior tilt with significant increase below 90 degrees of elevation
- Placebo tape increased upper trapezius activity from 90-120 degrees of elevation.
- Both tape decreases lower trap EMG until the eccentric lowering phase when the kinesiotape increased and the placebo tape decreased lower trapezius EMG
- Kinesiotape increased lower trapezius muscle strength testing by 6% while the placebo tape actually showed a touch of a loss of strength of a little more than 1%
At first glance, I though the results were a little contradictory when the authors reported that lower trapezius EMG activity was lower during the concentric phase of elevation. However, if you combine their other results of altered scapular kinematics, one could argue that the altered kinematics resulted in better movement quality with the need for less lower trapezius contribution. The tape somehow imprioved the functional performance of elevating the arm.
I also wanted to point out that I thought it was interesting to see that the placebo tape increased upper trapezius activity. perhaps the use of noneleastic tape somehow restricted the movement.
Comparing scapula studies like this is often hard. There is such a wide variability in scapular position and kinematics in any group of he healthy or sympotamic subjects, which in turn creates variable EMG activity. I like that the authors used the subjects as their own controls with placebo tape instead of just simply using a separate control group.
Clinical Implications
What is the take away from all this? Kinesiotape isn’t magic. But perhaps there is a role? There is always going to be debate and doubters, I don’t think we know why there may be a benefit to kinesiotaping. Some thought to start discussion:
- There may be a role for kinesiotape during the phases of injuries when motion is painful. If the kinesiotape helps increase motion with less pain, I am all for it.
- There may be a role for kinesiotape when working on strength and motor control to enhance movement dysfunction. If kinesiotape helps enhance movement quality, I am all for it.
- Kinesiotape is not a substitute for what we are already doing, but perhaps it may enhance our results or at least make it a little easier to achieve some of our goals.
I am sure there are a lot of opinions on the use of Kinesiotape. We had a nice chat on this on Facebook yesterday. I would love to here more from people. What has been your experience? What pathologies do you think kinesiotaping helps most with? Why do you think kinesiotape works or doesn’t work?
