135

Isokinetics and Exercise Science 19 (2011) 135142

DOI 10.3233/IES-2011-0413
IOS Press

Initial effects of kinesior taping in patients

with patellofemoral pain syndrome: A
randomized, double-blind study
Aydan Aytara, , Nihan Ozunlua , Ozgur Surenkokb , Gul Baltacc , Pnar Oztopd and Metin Karatasd
a

Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara,
Turkey
b
Department of Physical Medicine and Rehabilitation, SinoUnited Health Clinic, Shanghai, China
c
Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara,
Turkey
d
Department of Physical Medicine and Rehabilitation, Baskent University Hospital, Ankara, Turkey

Abstract. The purpose of this randomized, double-blind study was to determine the acute effects of kinesio taping on pain,
strength, joint position sense and balance in patients with patellofemoral pain syndrome (PFPS). Twenty-two subjects with PFPS
participated in the study. Subjects were separated into two groups; kinesio taping (KT) and placebo kinesiotaping (PKT).
All subjects were assessed before and 45-min after the applications. Muscle strength, joint position sense, static and dynamic
balance and pain intensity were used as the main outcome measures. Among all outcome parameters significant differences
were found between strength of quadriceps muscle at 60 and 180 /s, and static and dynamic balance scores before and 45-min
after application of KT. There was also a significant difference between strength of quadriceps muscle at 60 /s and static balance
scores before and 45 minutes after application of the PKT. Therefore KT application does not seem to be an effective treatment
method for both decreasing pain and improving joint position sense for patients with PFPS.
Keywords: Balance, isokinetics, joint position sense

1. Introduction
Patellofemoral pain syndrome (PFPS) is a common
problem experienced by active adults and adolescents.
Furthermore, studies have shown PFPS to be the single
most common diagnosis among runner and in sports
medicine [23]. However, its etiology has remained
vague and controversial [1]. Management can be challenging, a well designed and non-operative treatment
program usually allows patients to return to recreational
and competitive activities [27]. Physical therapy is the
first line of treatment for PFPS. The clinical efficiency
Address for correspondence: Aydan Aytar, MSc PT, Baskent University, Faculty of Health Sciences, Department of Physical Therapy
& Rehabilitation, Eskisehir Yolu 20.Km, Baglica, Ankara, Turkey.
Tel.: +90 312 2341010/1635; Fax: +90 312 2341054; E-mail: aytara
@baskent.edu.tr.

of several different treatment regimens have been studied; however, a recent systematic review reveals a lack
of high-quality clinical trials in this area [13,25].
Taping is widely used in the field of rehabilitation
as both a means of treatment and prevention of sportsrelated injuries [5,8]. The essential function of most
taping techniques is to provide support during movement. Some believe that the tape serves to enhance
proprioception, motor function and, therefore, reduces
the incidence of injuries [5,31]. The therapeutic effects of knee taping include minimizing pain, increasing muscle strength, improving gait pattern and enhancing functional outcome of patients with sports injuries,
osteoarthritis and PFPS [5,7].
In recent years, the use of kinesio tape (KT) has
become increasingly popular [7,15]. KT was designed
to mimic the qualities of human skin. It has roughly the
same thickness as the epidermis and can be stretched

ISSN 0959-3020/11/$27.50 2011 IOS Press and the authors. All rights reserved

136

A. Aytar et al. / Initial effects of kinesior taping in patients with patellofemoral pain syndrome

between 30 and 140% of its resting length longitudinally [14,16,24,30]. Kase et al. and Thelen et al. have
proposed several benefits, depending on the amount of
stretch applied to the tape during application: 1) to provide a positional stimulus through the skin, 2) to align
facial tissues, 3) to create more space by lifting fascia
and soft tissue above the area of pain/inflammation, 4)
to provide sensory stimulation to assist or limit motion, 5) to assist in the removal of oedema by directing
exudates toward a lymph duct [14,24].
KT can be applied to virtually any muscle or joint in
the body. However minimal evidence exists to support
the use of tape in the treatment of musculoskeletal disorders such as PFPS [9]. The limited information on
KT application shows decrease in pain intensity and improved function, stability and proprioception in acute
patellar dislocation [21], stroke [12], ankle [19] and
trunk dysfunction [30]. This information comes from
case series and small pilot studies and thus represents
lower level clinical evidence.
There appears to be at least some merit for the use
of KT as a treatment adjunct, but to our knowledge no
studies have investigated the initial effects on strength,
joint position sense and balance of the KT with double
blinded randomized, placebo trial. The purpose of the
study was to determine the initial effects of kinesio
taping on pain, strength, joint position sense and balance in patients with PFPS as compared to placebo
kinesio taping (PKT) application.

2. Methods
2.1. Subjects
Twenty two female subjects aged 24.1 3.2 years diagnosed with PFPS participated in the study. Subjects
were included if they had retro-patellar pain longer than
6 months brought on by two (or more) of the following
without traumatic onset: prolonged sitting, stair climbing, descending; running; kneeling; hopping/jumping;
pain on palpation of patellar facets; a step down. Subjects were also clinically diagnosed with PFPS by a
physician. Exclusion criteria for this study were if
subject; a) had a current or previous record of knee
pain, trauma, surgery and other joint disease, b) was
involved in competitive sports, c) had an allergy to adhesive tape. Subjects were instructed to avoid taking
analgesics or anti-inflammatory medications during the
study. All subjects provided written informed consent
before the study began.

Subjects were randomized into two groups: KT

group (n = 12, age: Mean SD = 22.41 1.62 years)
and PKT group (n = 10, age: Mean SD = 26.20
3.52 years). In PKT group, 2 participants dropped out
of the study after applications. Outcome measurements
were taken before and 45-min after the application.
Only the physical therapist who made the taping knew
the treatment condition, others who assessed the preand post-application measurements did not know the
treatment conditions (KT or PKT).
Subjects were taped by a physical therapist certified to apply KT with a Y-Shaped kinesio tape over
the quadriceps territory according to the Kenzo Kases
kinesio taping manual [14]. Two Y strips were applied to the quadriceps. The first tape was initially applied to approximately mid-thigh over the vastus medialis muscle. The thigh was placed in about 45 knee
flexed position. Light or paper-off tension (without
stretch) was applied until the Y in the kinesio strip
has reached the superior pole of the patella. Then the
tails of the Y shaped kinesio tape with a 5075% tension for correction were applied just below the tibial
tuberosity with no initial tension. The tails of the Y
shaped kinesio tape without stretch were inserted into
and around the medial and lateral borders of the patella including the vastus medialis and lateralis, respectively. Finally for two mechanical patellar correction
techniques, two I shaped kinesio tapes were applied
around patella to 5075% tension at 45 knee flexed
position (Fig. 1a) [14].
In the PKT group subjects were taped with a sticking
plaster without stretch. The main reasons for preferring
the sticking plaster was similarity with KT, easy accessibility and no strech property. Application places were
similar to the KT group. A sticking plaster and KT
allowed for the same dynamics in application (Fig. 1b).
Although groups application materials and pressures
were different, they were well concealed under clothing. Therefore, we did not believe that blinding of the
subjects was compromised.
2.2. Outcomes measures
2.2.1. Muscle strength
An isokinetic dynamometer (Cybex 770 Norm,
Lumex Inc, Ronkonkoma, NY, USA) was used to evaluate quadriceps strength. At the beginning of each
evaluation, the dynamometer was calibrated. Subjects
were seated with hips and knees flexed at 90 . The
axis of the dynamometer was positioned parallel to the
lateral femoral condyle. Tests were done for the knees

A. Aytar et al. / Initial effects of kinesior taping in patients with patellofemoral pain syndrome

Fig. 1. a) Kinesio

137

tape application, b) placebo kinesio tape application.

with PFPS. Before tests, trial repetitions were applied

for orientation. The isokinetic strength of the quadriceps was tested at constant angular velocities of 60 and
180 /s with 5 repetitions at each velocity. A 30-s rest
period was allowed between sets. During tests, subjects
were verbally and visually encouraged.
2.2.2. Joint position sense
The same dynamometer was used to evaluate the
joint position sense. Subjects sat with hips and knees
flexed 90 . The axis of dynamometer was positioned
parallel to the lateral femoral condyle. Pneumatic boot
and a blindfold were used to eliminate visual and cutaneous inputs. The continuous passive motion mode
was used for testing at the constant velocity of 5 / second. Joint position sense evaluated between 0 degree
knee extension to 90 degree knee flexion total 90 degree knee movement. Knee movement from flexion
to extension was stopped by pressing the abort button
when subjects felt they were in the mid-position of the
range (45 ). Initially, 4 repetitions were performed
with subjects being alerted by the therapist to the point
coinciding with the criterion position (45 ). When subjects felt ready, the testing procedure started. At the
test subjects were asked to press the abort button when
they felt they were at mid point of the range (45). The
outcome measure consisted of the deviation from 45
based on 3 repetions [22].
2.3. Balance
Kinesthetic Ability Trainer (KAT) 3000 (KAT 3000,
Berg, Vista, CA, USA) was used to assess static and

dynamic balance. KAT is a computerized system designed for static and dynamic balance assessment and
training. The system involves a centrally pivoted balance platform, and the stability of this platform is adjusted using a patented pressure bladder positioned beneath it. As pressure in the bladder is increased, the
platform becomes more stable. As pressure is decreased, the platform becomes less stable. When the
platform deviates from the reference position, this information is transmitted to the computer system via a
tilt sensor connected to the front of the platform unit.
On the computer screen, a circle represents the balance
platform and the center of the circle represents the reference position. The circle is divided into four quadrants. The two upper quadrants (the top half) indicate
the front of the platform and two lower quadrants (the
bottom half) indicate the back of the platform. The
horizontal and vertical lines that form the quadrants
are considered the x axis and y axis , respectively.
The four quadrants are referred to as left front, left
back, right front, and right back, and an individual
balance score is recorded for each of these sections.
The position of the balance platform relative to the horizontal plane is represented by a cursor (red X) on the
test screen. For each quadrant, the computer system
measures the distance from the cursor to the reference
position at every tenth of a second. The testing system
generates seven different parametric data. The sum of
the scores for each quadrant in a test period is recorded
as the overall balance index (BI) score. This value
reflects the persons ability to keep the platform at or

138

A. Aytar et al. / Initial effects of kinesior taping in patients with patellofemoral pain syndrome

Fig. 2. Assessment of static and dynamic balance with Kinesthetic Ability Trainer (KAT) 3000.

near the reference position. Balance index scores range

from 0 to 6000 with lower values indicating better performance.
During static and dynamic balance testing, subjects
were asked to maintain a bilateral stance to perform
balance test with their eyes open while concentrating
on the target at the eye level on a height-adjustable
computer screen one meter in front of them. Three trials
of testing, each lasting 30 seconds, with 10 seconds rest
between trials, were performed. To ensure accuracy of
the balance measurements, the KAT 3000 device was
calibrated according to the manufacturers instructions
(Fig. 2) [22].
2.3.1. Pain
A visual analog scale (VAS) was used to determine
pain intensity. VAS is a 100 millimeter line with no
marks along them, anchored with the words no pain
on one hand, and the most severe pain on the other.
Subjects were simply instructed to place a mark along

the line at a level representing the intensity of their

present pain when walking, ascending and descending
stairs. Subjects were asked to walk a distance of 50-m
in a straight hall then pain intensity when walking was
evaluated with VAS. Subjects were also asked to ascend
and descend standard 12 stairs while the pain intensity
was rated with the VAS. The VAS has been reported as
a valid measure for detection of clinical chance of pain
in subjects with PFPS [4].

3. Statistical analysis
Normal distribution of the data was checked with
Kolmogorov-Smirnov test. As the outcome measures
were not normally distributed, non-parametric tests
were used. Wilcoxon tests were used for the statistical
analyses of comparing values before and 45-min after
the application of KT and PKT; Mann-Whitney U tests
were used for the statistical analyses of differences be-

A. Aytar et al. / Initial effects of kinesior taping in patients with patellofemoral pain syndrome

139

Table 1
Descriptive characteristics of the study subjects
Characteristics of subjects
Age (Mean SD, year)
BMI (Mean SD, kg/m2 )
Duration of Pain (Mean SD, month)
PFPS Side, (n)
Right
Left
Total (n, %)

KT group (n = 12)
22.41 1.62
20.63 2.26
16.16 9.68

PKT group (n = 10)

26.20 3.52
21.86 2.19
13.70 8.00

Total
24.13 3.22
21.19 2.26
15.04 8.83

6
6
12 (% 54,5)

4
6
10 (% 45,5)

22 (% 100)

P value
0.014
0.069
0.812

BMI: Body Mass Index.

PFPS: Patellofemoral Pain Syndrome.
KT: Kinesio tape.
PKT: Placebo Kinesio tape.
p < 0.05.

tween groups at the end of applications. The level of

significance was set at p = 0.05. The SPSS 15.0 was
used for the statistical analyses.

4. Results
The descriptive characteristics of the subjects are
shown in Table 1. Significant pre-post differences in
strength at 60 /s (p = 0.028) and at 180 /s (p = 0.012),
static (p = 0.012) and dynamic (p = 0.046) balance
scores were indicated for the KT group (Table 2). There
were also significant pre-post differences in strength at
60 /s (p = 0.007) and static balance scores (p = 0.042)
for the PKT group (Table 2). No significant difference was found between groups regarding the intensity of pain during ascending and descending stairs and
walking; quadriceps strength at 60 and 180 /s; static
and dynamic balance scores and joint position senses
(Table 3).

5. Discussion
The present findings indicate no significant difference between KT and PKT groups regarding proprioception, pain, balance and muscle strength in patients
with PFPS. Even though case series and small pilot
studies have previously reported improvements in function, pain, range of motion (ROM) and proprioception, some results indicate no benefit due to KT application, representing low level evidence [7,9,12,24,
30]. Our results are partially consistent with previous
reports showing that KT may have a positive effect on
muscle strength and balance but this effect is significant in the KT application group before and 45-min
after application. Results indicate no significant dif-

ferences between the PKT and KT groups in proprioception, pain, balance and muscle strength. Specifically proprioception results do not concur with Murray and Hulsk [19] who have suggested that KT application enhanced proprioception. However, Halseth
et al. [9] showed that KT application did not enhance
proprioception in healthy subjects, which was similar
to our results. Some researchers thought that adhesive
taping increased proprioception by increasing feedback
information from the muscle spindles, soft tissue and
skin. We can only speculate that KT may not be enough
to increase cutaneous sense to affect joint proprioception as KT covers less area and is less restrictive on
the skin, resulting in lesser afferent stimulation compared to adhesive tape application. Furthermore, cutaneous mechanoreceptors may rapidly accommodate
and thus would not provide useful feedback during repeated movements [9].
Several mechanisms may help explain the painrelieving effect of therapeutic tape. Adhesive tape
can improve patellar alignment in healthy controls and
those with PFPS [18,28]. Therapeutic tape may ease
pain by improving patellar alignment. Hinman et
al. [10] and Cushnaghan et al. [3] demonstrated instant
and daily pain reduction by taping application. Pain
modulation via the gait control theory is another plausible explanation for such a change; as it could stimulate neuromuscular pathways via increased afferent
feedback [17]. Worth mentioning, pain and functional
measures were not different between groups in either
our study or at Thelen et al.s [24], in variance with
other studies which have applied KT [6,29]. This lack
of agreement could be due to a number of factors. Although some previous studies were only case serious
and no control group, it was difficult to ascertain causation. Also some of our subjects reported lower initial
function and VAS scores. These findings show that KT

Pre-KT Mean SD
KT
PKT
Post: Minimum-Maximum
KT
PKT

Post-KT Mean SD
KT
PKT

VAS: Visual Analog Scale.

KT: Kinesio tape.
PKT: Placebo Kinesio tape.
p < 0.05.
Q = Quadriceps Muscle.

Pain (VAS, mm)

Descending Stairs
10.0080.00
10.0080.00
50.41 24.35
35.00 21.21
00.0070.00
10.0080.00
46.25 26.38
33.00 21.62
Ascending Stairs
10.0080.00
20.0080.00
52.91 20.27
50.00 17.63
00.0080.00
20.0080.00
51.25 23.75
48.00 16.86
Walking
00.0070.00
10.0070.00
42.50 24.54
45.00 23.21
00.0070.00
10.0070.00
42.08 23.88
41.00 23.78
Strength (Peak
Torque, Nm)
Q 60 /s
55.58141.00
29.82113.88
100.43 26.20
74.97 24.67
61.01150.49
35.25113.88
106.64 24.39
79.85 25.55
16.26113.88
25.7673.21
70.04 31.21
45.69 15.83
18.98115.24
21.6993.55
77.95 28.78
50.30 22.41
Q 180 /s
Static Balance Score 92.00332.00
59.00219.00
167.58 80.05
148.40 62.92
55.00225.00
59.00219.00
128.08 52.44 139.40 63.62
1325.004459.00 1356.003047.00 2702.16 1101.59 1912.30 701.85 1325.004182.00 1356.003047.00 2428.41 959.76 1834.90 674.40
Dynamic Balance
Score
Joint Position Sense
3.663.67
3.665
0.17 2.23
0.260 2.67
3.662.67
35
0.05 1.61
0.46 2.34

Pre: Minimum-Maximum
KT
PKT

Table 2
Results before and 45 minutes after application of KT and PKT

0.007
0.093
0.042
0.066
0.678 0.063

0.028
0.012
0.012
0.046

0.096 0.157
0.317 0.157
0.655 0.180

P value
KT PKT

140
A. Aytar et al. / Initial effects of kinesior taping in patients with patellofemoral pain syndrome

A. Aytar et al. / Initial effects of kinesior taping in patients with patellofemoral pain syndrome

141

Table 3
Difference between groups for the change in the measurement parameters
Outcome measurements
Pain (VAS, mm)
Descending Stairs
Ascending Stairs
Walking
Strength (Peak Torque, Nm)
Q 60 /s
Q 180 /s
Static Balance Score
Dynamic Balance Score
Joint Position Sense

Changes in KT
Mean SD

Changes in PKT
Mean SD

P value

4.16 7.92
1.66 5.77
0.41 3.34

2.00 4.216
2.00 4.21
4.00 9.66

0.438
0.932
0.260

6.20 9.45
7.90 8.62
39.50 63.20
273.75 493.39
0.211 1.158

4.88 6.06
4.60 7.82
9.00 13.07
77.40 213.68
0.733 1.08

0.640
0.311
0.232
0.746
0.151

KT: Kinesio tape.

PKT: Placebo Kinesio tape.
p < 0.05.
Q = Quadriceps Muscle.

application may stimulate cutaneous receptors but not

sufficient to decrease the pain unlike taping. As we
mentioned above, KT application is not widely spread
around the knee like taping.
Afferent stimulation by cutaneous mechanoreceptors
could decrease pain and increase balance and facilitate
motor activity [21]. There have been only a few publications in peer-reviewed literature on the effects of KT
on motor activity recruitment. Murray [20] found that
the elastic tape applied to the anterior thigh enhanced
active ROM and increased surface electromyographic (EMG) activity of the quadriceps in two individuals with recent anterior cruciate ligament reconstruction. Application of athletic tape demonstrated little or
no difference in active ROM or EMG measurements.
The author suggested that further research should include randomized controlled studies to determine short
and long term efficacy and analysis of the success of
the elastic taping. However, our findings could not
point out significant differences in balance and motor
activity in the two groups. A strong placebo effect
of taping has been well documented in subjects with
patellofemoral joint pain. Hopkins and Ingersoll11 suggested that application of elastic tape may affect by
mediation through cutaneous mechanoreceptors which
could enhance proprioception and facilitate motor activity. Our subject size and methodology is completely different from that of the Murrays study. It may
explain the diversity between two studies [2,26].
This study has several limitations. First, all of our
subjects were female and their strength, pain and joint
position sense differently compared to males. Second is
the lack of a control group. To increase evidence level,
this study must have control group. Third, our study
focused on initial effects; there may be some changes
after 60-min or a day in the outcome measurements.

6. Conclusions
Other than a significant effect on quadriceps strength,
this study failed to indicate improvements in pain, balance and joint position sense. Consequently, application of KT for decreasing pain or increasing joint position sense for PFPS does not constitute an effective
treatment method when compared with PKT.

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