Immediate effects of Kinesio taping on pain, proprioception, and posture in round shoulder individuals with subacromial impingement syndrome: A randomized, double-blinded controlled trial

Abstract

Background:

Round shoulder posture (RSP), characterized by forward shoulder positioning from weakened and tense muscles, disrupts normal biomechanics and can cause Subacromial impingement syndrome (SIS), resulting in pain during specific movements or positions. This study examines the immediate effects of Kinesio taping (KT) on pain, proprioception, and posture in individuals in round shoulder individuals with SIS.

Methods:

The study involved 114 patients diagnosed with RSP and SIS. Pain intensity was assessed using a Visual Analog Scale (VAS), proprioception was measured with an inclinometer, and posture was evaluated using The New York Posture Rating Chart (NYPRC). Participants were randomly assigned to experimental group (EG) (n = 57), which received KT application, or to sham group (SG) (n = 57), which underwent a sham procedure. KT was applied to the affected shoulder and scapular regions. Assessments were conducted both before and after the application of Kinesio tape.

Results:

According to the study results, the differences in VAS scores (P = .002), proprioception abduction (P = .023) and NYPRC scores (P = .04), were statistically significant in the EG compared to the SG (P < .05). However, there was no significant difference in proprioception flexion between the groups (P > .05).

Conclusion:

KT demonstrates immediate benefits in reducing pain and improving scapular alignment in individuals with RSP and chronic shoulder pain. These findings underscore its potential effectiveness as a therapeutic intervention for managing symptoms associated with RSP and impingement syndrome, particularly in terms of pain relief and posture enhancement.

1. Introduction

Subacromial impingement syndrome (SIS) is a health condition causing shoulder pain and functional impairment, comprising 44% to 65% of all shoulder pain cases and affecting patients across different age groups.^[1] Its occurs when the structures (tendons, bursa) passing beneath the acromion of the scapula become compressed or irritated. This compression can occur due to various reasons such as repetitive overhead activities, poor posture, muscle imbalances, or anatomical variations in the shoulder joint.^[2,3] Especially, round shoulder posture (RSP) is believed to exacerbate symptoms of SIS, potentially increasing their severity.

RSP is characterized by scapular protraction, anterior tilting, and downward rotation, which results in a forward shoulder position, increased stress on the shoulder, significant postural imbalances, and abnormal upper limb movement patterns, ultimately leading to muscle weaknesses in the neck and shoulder girdle.^[4,5] These alterations impact the alignment of the dorsal cervical muscles and the scapula, progressively restricting scapular upward rotation.^[6,7] Consequently, shoulder mobility may be impaired, with forward-fixed shoulders and shortened pectoral muscles due to habitual trunk flexion, potentially leading to impingement syndrome.^[8]

These muscle imbalances significantly contribute to chronic pain by intensifying strain and altering biomechanics in the neck and shoulder region.^[9,10] Reduced scapular upward rotation complicates movement mechanics, potentially exacerbating pain and functional limitations RSP without timely intervention can result in secondary complications such as impingement syndrome, cervicogenic headaches, shoulder instability caused by muscle imbalance, diminished joint proprioception, and reduced maximal ventilatory capacity.^[11]

Kinesio taping (KT), a therapy utilizing elastic bands, has been applied to various neuromuscular, orthopedic, and sports-related conditions, with previous studies indicating its efficacy in alleviating pain, enhancing muscle activity, improving function, and supporting proper positioning.^[8,12] Additionally, the tension created by KT during active movement is hypothesized to stimulate mechanoreceptors, enhancing proprioceptive feedback.^[13] Previous studies indicate that scapular taping can significantly enhance shoulder joint range of motion in subjects with SIS by correcting scapular positioning. This intervention may improve functional outcomes and alleviate pain in chronic shoulder pain cases.^[4,14]

Although previous studies have demonstrated that KT can have immediate effects on pain reduction and range of motion improvement in various shoulder disorders,^[15,16] there remains a need for further investigation into its specific impact on improving posture and proprioception, particularly in the context of combined RSP and SIS.^[17,18] Current literature has explored the effects of KT on SIS and RSP separately; however, research on KT’s effectiveness in addressing the combined presentation of these conditions remains limited. This study specifically addresses this gap by examining the immediate effects of KT on pain, proprioception, and posture in individuals with both SIS and RSP. The objective of this research is to investigate KT’s potential to stimulate mechanoreceptors, thereby enhancing proprioceptive feedback and improving perception and control of end-of-motion positions. These effects are hypothesized to mitigate biomechanical stress associated with RSP, consequently alleviating chronic pain and improving functional outcomes.

2. Methods

2.1. Study design and setting

This study was designed as a double-blind, cross-sectional study. Ethical approval for the study was obtained from the Ethics Committee of Medipol University with protocol number (E-10840098-772.02-2825), dated from June 2023 to May 2024. The study was planned in accordance with the Helsinki Declaration and registered under ClinicalTrials.gov with the registration number (NCT05858073).

2.2. Study participants

Patients aged 30 to 60 years with SIS complaints who applied to the physiotherapy department of a university hospital were included in the study. Patients who showed pain in at least 2 of the following 5 impingement symptoms were included in the study: Neer impingement test; Hawkins–Kennedy impingement test; empty box test; external rotation resistance test; and pain on palpation of the rotator cuff.^[19]

The inclusion criteria were: a diagnosis of SIS, symptoms of RSP with an acromial distance ≥ 2.6 cm measured in the supine position with shoulders in a neutral position,^[19,20] shoulder pain persisting in the dominant arm for 3 months, and a visual analog scale (VAS) score ≥ 4. The exclusion criteria included a history of spinal surgery or fractures, joint diseases other than SIS, osteoporosis, acute rheumatoid arthritis, blood disorders, congestive heart failure, malignancy, severe skin sensitivity, shoulder joint restrictions, and other joint pathologies excluding SIS. The exclusion criteria included a history of spinal surgery or fractures, joint diseases other than SIS, osteoporosis, acute rheumatoid arthritis, blood disorders, congestive heart failure, malignancy, severe skin sensitivity, shoulder joint restrictions, and other joint pathologies excluding SIS.

2.3. Sample size calculation

In the power analysis, the sample size for the study was determined based on an effect size of 0.592, as reported in previous research on proprioception by Keenan et al.^[18] Using the G*Power 3.1.9.7 software, it was calculated that each group should have 53 participants to achieve 85% power at a 0.05 significance level. Considering potential dropouts, the total required sample size was set at 125 participants. Ultimately, 114 participants completed the study, with 57 in each group; 5 participants did not meet the inclusion criteria, and 6 participants were excluded from the study.

2.4. Study protocol

In our study, participants were randomized into 2 groups: experimental group (EG) and sham group (SG) using randomization conducted through random.org. Our study will examine the acute effects following a single application. Evaluations were conducted using double-blind assessment, with separate physiotherapists performing the application and assessments. This study consists of 3 stages: pre-intervention assessment, intervention and post-intervention assessment.

2.4.1. Pre-intervention assessment

Patients participating in the study were instructed to refrain from strenuous physical activity on the assessment day. Only experiencing shoulder pain in their dominant arm were included for evaluation. Pain intensity was measured using a VAS, proprioception was assessed using an inclinometer and posture was evaluated using The New York Posture Rating Chart (NYPRC).

Shoulder pain intensity was evaluated at the end point of the shoulder range of motion using a 100 mm VAS. This measurement is known for its excellent reliability.^[21,22]

In our study, we applied an inclinometer (The Baseline Digital Inclinometer, Norwalk) device to measure angular movements relative to gravity, a tool often used in clinics and research due to its precision and ease of use. Proprioception was assessed by instructing participants to maintain specific shoulder flexion angles (30°) and shoulder abduction angles (120°) while standing and sitting, and each position was repeated 3 times. Data from these trials were averaged for analysis. This method added valuable data to our study by providing insight into proprioceptive accuracy in different body positions. Differences in measurements were calculated and added to the table.^[18,23]

The NYPRC was used to assess body posture from both lateral and posterior perspectives. Scores were assigned based on the observed posture: 5 points for correct posture, 3 points for moderate impairment, and 1 point for severe impairment, with a total possible score ranging from 13 to 65. According to the chart’s criteria, scores were categorized as follows: ≥45 (very good), 40 to 44 (good), 30 to 39 (medium), 20 to 29 (poor), and ≤19 (bad).^[24]

2.4.2. Intervention

In our study, all participants were randomly divided into 2 groups, EG and SG, and were treated using standard 5 cm KT (KT-X050; Kinesio Tex, Tokyo, Japan). The EG received therapeutic KT following the protocol summarized by Kase et al, while SG received a sham-KT application. The taping was administered by a physiotherapist with 7 years of experience and an international KT certification. However, the evaluators and participants, except for the physiotherapist who applied the taping, were blinded.

Participants in the EG first lay on their backs with their necks stretched contralaterally and their upper extremities extended behind them. The Y-strip was applied with paper-off tension, or without tension, from the starting point to the supraspinatus insertion. Next, an I-strip spanning from the coracoid process and applied with 50% to 75% stretching was placed around the posterior deltoid.^[25] The shoulder was first brought into external rotation without elevation, then into modest horizontal adduction and anterior elevation as the band was applied without stretching. This I-strip ended in a Y form. Lastly, a Y-strip was applied with paper-off tension from the T10–T12 region to the medial edge of the scapula to facilitate the lower trapezius muscle. Hands were applied in a cross-chest motion over the middle thorax as the shoulder was pulled into horizontal adduction.^[7]

Participants in the SG received standard sham taping with KT applied in a 5 cm width. The sham-KT involved applying 2 strips, 1 over the acromioclavicular joint and the other over the lower trapezius muscle, without applying any tension.^[7] (Fig. 1).

Figure 1.

Application of Kinesio taping (KT). Tape application. (A) Kinesio (KT-X050; Kinesio Tex, Tokyo, Japan) taping (B) Sham-Kinesio taping.

2.4.3. Post-intervention assessment

After a 30-minute interval, measurements were taken again as in the pre-intervention assessment and recorded. This interval was implemented to ensure more uniform adhesion of the tape and to enhance its therapeutic effect.^[26]

2.5. Statistical analysis

SPSS statistical software version 26 (SPSS Inc., Chicago) was utilized for all data analyses. The normal distribution of baseline values for the dependent variable was assessed using the Shapiro–Wilk normality test. Parametric and nonparametric tests were employed for both intra- and intergroup analyses. Within-group and paired-sample intergroup comparisons were conducted using the independent samples t-test and Independent test, respectively. Nonparametric tests such as Mann–Whitney U, Kruskal–Wallis, and chi-square tests were utilized as appropriate. Significance level was considered as P < .05.

3. Result

A total of 125 participants who met the inclusion criteria were enrolled in the study. However, 2 participants suspected the sham application, 5 participants were unable to perform full joint movement due to shoulder pain during the assessment, and 4 participants exhibited itching or allergic reactions after taping, leading to their exclusion from the study. Consequently, a total of 114 participants were included, with example (n = 57) and SG (n = 57) (Fig. 2).

Figure 2.

Consolidated standards of reporting trials (consort) flow chart for trial recruitment.

3.1. Sample characteristics

The participants’ descriptive characteristics revealed that the mean age was 49.40 ± 15.10 years for the EG and 48.10 ± 14.10 years for the SG. The mean BMI was 26.48 ± 4.78 for the EG and 25.27 ± 7.00 for SG. In terms of gender distribution, the EG had 29 females and 29 males, while the SG had 36 females and 21 males. There were no statistically significant differences in descriptive characteristics between the groups (P > .05) (Table 1).

Table 1.

Study characteristics and patient demographic details.

	EG (n = 57) (Mean ± SD)	SG (n = 57) (Mean ± SD)	P
Age (yr)	49.40 ± 15.10	48.10 ± 14.10	.718
Height (cm)	169.51 ± 11.93	168.25 ± 10.13	.618
Weight (kg)	76.05 ± 15.56	71.44 ± 10.84	.105
BMI (kg/m2)	26.48 ± 4.78	25.27 ± 7.00	.364
Gender (n)	29 Female	36 Female	.162
	29 Male	21 Male

Abbreviations: BMI = body mass index, SD = standard deviation.

*Statistically significant (P <.05).

3.2. Results pre- and post-intervention

For the EG, the VAS scores decreased from 4.73 ± 2.59 to 3.40 ± 2.12 (P = .00, P < .05), and for the SG, from 4.56 ± 2.76 to 3.72 ± 2.31 (P = .865, P > .05). The difference between groups was statistically significant (P = .002, P < .05) (Table 2).

Table 2.

Comparison of patients with subacromial impingement syndrome between the experimental group and the control group before and after the intervention.

	EG (n = 57)				SG (n = 57)			P value	Between groups difference P value
	Pre-intervention (mean ± SD)	Post-intervention (mean ± SD)	In-group change (Δ)	P value	Pre-intervention (Mean ± SD)	Post-intervention (Mean ± SD)	In-group change (Δ)
VAS	4.73 ± 2.59	3.40 ± 2.12	1.29 ± 1.16	.00*	4.56 ± 2.76	3.72 ± 2.31	0.81 ± 1.00	.865
Proprioception
Abduction	15.12 ± 6.46	10.89 ± 6.24	6.58 ± 2.42	.00*	15.48 ± 6.29	14.73 ± 6.42	0.47 ± 3.46	.818	.023*
Flexion	12.77 ± 11.54	10.67 ± 5.86	1.57 ± 0.55	.011*	12.58 ± 8.84	10.82 ± 6.65	1.1 ± 0.56	.026*	.816
NYPRC	51.07 ± 6.19	53.21 ± 6.36	1.97 ± 4.03	.006*	54.20 ± 7.28	54.72 ± 6.54	0.80 ± 2.41	.256	.040*

Abbreviations: EG = experimental group, NYPRC = The New York posture rating chart, SD = standard deviation, SG = sham group, VAS = visual analog scale.

^*Statistically significant (P <.05) difference between sham group and experimental group.

For the EG, there was a statistically significant increase in NYPRC values before and after the intervention (P = .006, P < .05), whereas for the SG, these changes were not statistically significant (P = .256, P > .05). When comparing between the groups, the observed increase in example was statistically significant (P = .040, P < .05) (Table 2).

Proprioception for abduction demonstrated a significant improvement in the EG (P = .000, P < .05) but not in the SG (P = .818, P > .05), with a statistically significant difference between the groups (P = .023, P < .05). Proprioception for flexion improved significantly in both the EG (P = .011, P < .05) and SG (P = .026), with no statistically significant difference between the groups (P = .816, P > .05) (Table 2).

4. Discussion

In this study, the immediate effects of KT on pain, proprioception, and posture in patients in individuals in RSP individuals with impingement syndrome were investigated. According to the study results, the changes in VAS scores, proprioception abduction results and NYPRC scores were statistically significant in EG compared to SG. However, the change in proprioception flexion was not significantly different between the groups.

RSP develops due to prolonged static postures, resulting in muscle imbalances in the upper body characterized by tightness and weakness, often leading to pain.^[27] Shoulder pain primarily results from tonic muscle overactivation (e.g., upper trapezius, levator scapula) and phasic muscle inhibition (e.g., pectoralis minor), disrupting normal shoulder joint function and leading to chronic pain.^[13,14] In our study, we investigated the effects of KT techniques in managing shoulder pain management in SIS individuals by addressing these muscle imbalances.

Research has explored the impact of KT on various pain conditions, revealing diverse application techniques. Studies evaluate KT’s efficacy, including muscle inhibition, ligament support, fascial manipulation, and lymphatic drainage applications, in alleviating pain among.^[28] However, conflicting findings exist regarding its short-term pain-relieving effects in shoulder conditions.^[16,29] While some studies show no immediate or week-long pain reduction post-KT^[16] others indicate decreased pain intensity during movement shortly after KT application.^[30] These variations underscore the complexity of KT’s efficacy and highlight the need for further research to clarify its role in pain management.

Comparative studies have shown that KT can more effectively reduce pain during activity in the short-term compared to sham taping.^[25,29] Similarly, in the presence of pain due to posture disorder, KT application has been observed to alleviate pain.^[13] Our study findings are consistent with these observations, demonstrating significant improvement in pain scores during movement in the KT group compared to the sham taping group. These findings underscore KT as a promising method for short-term pain relief.

Studies have reported altered scapular kinematics in patients with SIS, and that taping can improve posture and provide relief.^[7,31] Ozer et al noted that KT of the shoulder and scapular region improved scapular dyskinesis.^[7] Han et al found that applying taping with similar tension to our study corrected RSP. However, they emphasized that more research is needed to determine the most effective taping method for posture correction due to the lack of sufficient studies on KT for this purpose.^[8] Additionally, Rayjade et al reported that KT improved neck and shoulder posture.^[13] In our study, we observed similar effects as measured by NYPRC scores. The group that received KT showed postural improvements in patients with round shoulders, resulting in increased NYPRC scores. This suggests that KT may be effective in enhancing scapular positioning and overall posture in patients with RSP and SIS.

Based on the available evidence, the effects of KT on proprioception are mixed and inconclusive. Some studies indicate that KT can enhance proprioception by stimulating cutaneous mechanoreceptors, potentially leading to improvements in pain reduction and functional performance.^[23,32] Conversely, other studies, including those involving both healthy subjects and individuals with conditions such as SIS, have reported no significant changes in proprioception, shoulder strength, or scapular kinematics with KT application.^[18,33] In our study, the proprioception evaluated in abduction showed a significant increase compared to the SG, while flexion did not show a significant difference between the groups. This discrepancy might be due to the specific mechanics and muscle involvement in these movements. Abduction heavily relies on the deltoid and supraspinatus muscles, which may have responded more effectively to the KT application, enhancing proprioceptive feedback. In contrast, flexion involves a different set of muscles and joint mechanics that might not have been as influenced by the taping, leading to no significant difference in proprioceptive improvement.

5. Limitations

Limitations of this study include the short-term assessment period, which may not capture long-term effects of KT. Additionally, the study did not explore potential differences in response based on severity or duration of symptoms. Further research with longer follow-up and stratified analysis could provide deeper insights into the sustained benefits of KT for individuals with RSP and impingement syndrome.

6. Conclusion

In conclusion, our study underscores KT as a viable adjunctive therapy for immediate pain relief, enhanced proprioception, and improved posture in individuals with RSP and SIS. These findings contribute to the growing body of evidence supporting KT’s role in musculoskeletal rehabilitation, emphasizing its potential as a therapeutic tool in clinical practice.

Acknowledgments

The authors also thank the subjects for their time and effort.

Author contributions

Conceptualization: Gamze Demircioglu, Hazal Genç.

Data curation: Gamze Demircioglu, Hazal Genç.

Formal analysis: Hazal Genç.

Funding acquisition: Gamze Demircioglu.

Investigation: Gamze Demircioglu, Hazal Genç.

Methodology: Gamze Demircioglu, Hazal Genç.

Project administration: Gamze Demircioglu.

Resources: Gamze Demircioglu.

Software: Gamze Demircioglu, Hazal Genç.

Supervision: Hazal Genç.

Validation: Gamze Demircioglu, Hazal Genç.

Visualization: Hazal Genç.

Writing – original draft: Gamze Demircioglu, Hazal Genç.

Writing – review & editing: Gamze Demircioglu.