How might knee injury risk be reduced with Dynamic Taping?

In the previous newsletter, the award winning study by Robinson et al which investigated the impact of Dynamic Taping to the hip on a Greater Trochanteric Pain Syndrome (GTPS) group was reviewed.  This study showed that Dynamic Taping, when applied in a shortened position to resist hip flexion/adduction/internal rotation had the greatest impact on velocity and magnitude of hip frontal and transverse plane motion and pelvic obliquity during walking gait, and resulted in a significant reduction in pain.

This month, we consider the impact that similar techniques have on the knee and briefly consider other factors that may also be contributing to injury risk based on the movement profile.

A recent study by Chih-Kuan Wu and colleagues (2022) (https://doi.org/10.3390/ijerph192013716)  investigated the influence of hip extension, external rotation and abduction taping on landing biomechanics in young volleyballers using a jump-landing task. Landing Error Scoring System (LESS) and Anterior-Posterior Knee Laxity under 20lbs and 30lbs loads were evaluated. 42 high schools students (21 male and 21 female) who were free from knee injury and had no history of ACL injury or reconstruction, all participating in volleyball five days per week were included in the study.

Results showed that in addition to improving knee laxity, Dynamic Taping significantly reduced landing errors in both sexes, females more than males. Similarly, those with higher risk scores pre-tape had a larger benefit. Scores were essentially aligned with the minimally clinically important difference score identified in previous studies.

How could the risk be reduced further across the population based on observations in this study?

1. Examination of the photo of the technique (Figure 1) shows that the tape passes superior to the hip joint posteriorly thereby exerting minimum extension force. This also means that the tape does not tighten as much during hip flexion on landing and thereby does not resist motion in the other planes as much as it could. Slight changes to the technique would increase it’s effect.

Figure 1. The photos from the study show and describe the technique crossing the lower back. Crossing the hip joint posteriorly i.e. bringing the oblique section distally will result in greater hip extension moment and tighten the tape during hip flexion to also generate more resistance to adduction and internal rotation

2. The reason for the increased risk movement has not been identified. The hip has been the target for taping in each subject however it may be poor quads action and sagittal plane knee control that is resulting in the compensatory hip adduction and internal rotation. In such a case, creating a knee extension force to help address the deficit is likely to yield better changes at both the hip and knee. Similarly, changes at the foot may impact Dynamic Valgus at the knee with preliminary research showing that Dynamic Taping for arch support can address this.
3. Identifying those with movement suggestive of greater risk rather than just taping everyone results in bigger changes i.e. tape those who need it, where they need it.

A study by Mehmet Donmez (supplied) showed that Dynamic Taping for arch support in volleyballers with a low medial longitudinal arch reduced dynamic valgus at the knee in a Single Leg Squat Test, Vertical Jump Drop Test and Single Leg Drop Test when compared to sham tape (Dynamic Tape Global applied in a lengthened position) and no tape. Further support highlighting the various contributors is provided by Eva Ilie et al(https://ibn.idsi.md/vizualizare_articol/119875) who showed that Dynamic Taping for knee extension resulted in increased Single Leg Squat Test in a group of 13 subjects with various knee injuries and pain including ACL injury and ACL reconstruction.

Bittencourt et al, 2016 (https://bjsm.bmj.com/content/51/4/297.3) in BJSM provide further support showing that the hip technique resulted in significant changes to high frontal plane knee projection angles (FPKPA) in elite female volleyballers during a single leg squat task. Pre-tape mean FPKPA of 10.5º was reduced to 5.4º bringing it below the risk threshold.

Once again it is worth remembering that it is always n=1 when assessing and managing your patient or athlete. Thorough assessment and sound clinical reasoning is required to identify clear indications and appropriate application of the research. Correct application of the technique (short position, correct line of pull relative to the axis, tension) are required to get maximum mechanical effect and improvement in the parameters measured associated with a reduction in injury risk.

There is increasing evidence demonstrating the benefits of Dynamic Taping in those with ankle instability. This recent study by Lukasz Pawik et al, provides further support. In their study:

Research on ‘Chronic Non-Specific Low Back Pain’ has always been one of my pet hates. Lack of a diagnosis does not a diagnosis make. Subjects within this classification can have wildly different contributing factors. The paper by Martin Rabey, Toby Hall et al from 2017 highlights this. Some may have nociceptive or inflammatory mediated pain while others may have far stronger influence from psychosocial amplifiers. Some may have tissue damage or be on the cusp of it, others may have little evidence of ongoing structural influences and so it goes on. Applying the same intervention to all and expecting an effect is a search for a panacea rather than a clinically reasoned, evidence informed management approach.

It is therefore interesting when a study shows an effect in this sort of group as is the case in the paper by Alhamari et al, published in late 2020. The immediate and short-term effects of dynamic taping on pain, endurance, disability, mobility and kinesiophobia in individuals with chronic non-specific low back pain: A randomized controlled trial.

The results showed that Dynamic Tape Global and Kinesiotape improved pain over the no tape condition. Again, it is hard to discern the mechanism as there is no specific deficit identified that the tape is trying to address. Dynamic Tape Global did however improve spinal mobility and spinal extensor muscle endurance over Kinesiotape and no tape groups. This supports the assertion that Dynamic Tape Global can provide significant force to do some of the work thereby reducing extensor muscle fatigue and possibly aiding in the control of movement through range, exactly what it was designed to do. Whether that has an effect on pain depends entirely on the nature of the pain and tissue damage. If the extensor muscles are a factor in the development of pain e.g. a muscle strain or perhaps due to fatigue then it could be anticipated that the application of Dynamic Tape Global may have a beneficial effect on pain.

There may be benefits in those without ongoing tissue damage but with maladaptive movement patterns, extension dominant splinting and guarding. This paper did show changes to kinesiophobia favouring Dynamic Tape Global but again, a large washout effect would be anticipated as many subjects in the cohort may not have fear of movement. Correctly identifying those who display these movement adaptations and combining the taping application with appropriate pain education may provide further benefit by reducing overwork of the splinting muscles that may be acting as peripheral drivers of pain, while also help to restore movement choice and re-educate more optimal movement patterns and control while reducing the perceived threat. Further, more robust and specific studies are required to evaluate the contribution of each.

Once again, we see that Dynamic Tape Global can effectively introduce force into the system to modify movement or load. Whether that is clinically beneficial depends on correctly identifying a deficit, its relationship to the presenting condition, the mechanisms by which introducing an external force with the tape can address this deficit, correct application and thorough evaluation to determine that a sufficient force was in fact created. Simply taping everyone with pain in a particular region the same way will yield mediocre results. Thorough understanding, assessment, clinical reasoning and application are central to the approach.

The effect over time is interesting in this paper and would support a clinically reasoned hypothesis that by a. doing some of the work of the weak, fatigued, overworked and peripherally sensitised structures that an immediate improvement in pain and endurance would result as observed b. by reducing load, pain and peripheral drive more normal movement can result and this can challenge beliefs around the association between movement, tissue damage and pain, and while a small improvement might occur immediately, this would take more time to manifest (particularly in those with a stronger contribution from psychosocial influencers and amplifiers or central nervous system changes) – as observed in disability, mobility and kinesiophobia. Appropriate preparatory education and instructions consistent with the pain mechanisms identified would potentially enhance this.

While further studies are required with more homogenous subject cohorts and clearly identified deficits/aims/proposed mechanisms, this study provides evidence that Dynamic Tape Global can introduce a force into the system which reduces work of muscle/improves endurance and reduces pain immediately and over time – presumably initially due to reduced load and firing of peripherally sensitised structures and potentially some contribution due to reduced kinesiophobia with these effects building over time due to a dampening down of the system from the top down and bottom up.