Running total of hours: 128.5

Patient 1 – For my first patient of the session I performed a soft tissue massage treatment for a frequent visitor to the clinic, with this being her sixth session. The assessment was very similar to previous sessions in that small ROM differences were observed and treatment options were discussed; I wanted to ensure that the patient was aware of the transient nature of the massage and that there are other options to be considered, such as mobilisations and exercises. However, the patient was happy to receive a STM only, as this was all she was comfortable with. From previous sessions, I have become aware of the psychosocial element to this patient’s clinic visits and as such feel more than happy to accommodate her in this; by coming in on a weekly basis, this elderly woman has a means to talk about her week and to offload her difficult current situation in a confidential environment in which I am able to provide her with my under divided attention and genuine regard for her wellbeing and happiness. I feel like I have developed a positive and friendly relationship with my patient and I hope I am enhancing her week by being able to listen to her with care. The patient has tried to complete her rehabilitation exercises at home and small improvements to her ROM have been noticed, however not as much as I would like. I would hope to facilitate changes in her physical, as well as her mental wellbeing but I also know that this may take time and perhaps a change in one may lead to a change in the other.
I will continue to encourage her participation in her prescribed home based exercises and advocate their benefits in the hope that she will have a better quality of life through better ROM of her shoulders and neck.

Patient 2 – During my clinical experience in my previous session, I applied kinesiology tape, now known as elastic Therapeutic Taping (ETT) to the patient’s shoulder as requested and as advised by the patient’s previous therapist. The patient reported the tape as beneficial by way of reminding him to correct his posture (mechanoreceptors) and he felt his pain was subsequently reduced.
I applied the tape with full stretch from anterior to posterior without much regard for the location; the patient was in full stretch of his pectoralis muscle group with shoulders as far back as possible, so the tape, regardless of location, would serve to act as postural taping.
I am not confident in my opinion or understanding as to the effectiveness of ETT and therefore efficacy of its and therefore I took the time to conduct some research on this topic, in order to be able to advocate its use in clinic, but also so that I can educate the patient more confidently about the rationale behind this treatment.

Although there are some supported claims of the benefits of kinesiology tape, such as increase in strength, range of motion and proprioception, there is not enough high quality evidence to support its widespread popularity and use in the sports injury context (Williams et al., 2012).
In the treatment of musculoskeletal injuries, a systematic review concluded that ETT did not have enough evidence in support of its use on sports injuries, but that potential perceived effects were noted (Mostafavifar et al., 2013).
Konishi (2013) found that ETT acted to compensate muscle weakness, proposedly by affecting afferent neurophysiology by way of sensory input. This study consisted of two groups, a taping group and a non-taping group with the results showing greater muscle contraction in the taped muscle compared with the non-taped muscles of the knee, particularly the quadriceps femoris. Although these findings seem to support the use of ETT in injuries presenting with muscle weakness, in this particular case of the knee, the design of the study, whereby the control group were not taped, allowed for the potential of the tape having a placebo affect on the intervention group, i.e. the presence of tape alone was enough to benefit the subject.
The suggestion of ETT having a placebo effect is long debated and the subject of controversy and conflicting research. A study by Poon et al. (2015) claimed that any positive effects of ETT should be assumed the result of a placebo effect, with this study finding that this tape did not enhance or assist in muscle strength and performance of the quadriceps.
However, a single-blinded randomized control pilot study in the same year by Han et al. (2015) was conducted on 14 male office workers with rounded shoulder posture using a control group, providing some evidence of its effects by ruling out possible placebo and crediting any positive benefits on forward shoulder posture and increased pectoralis minor length to its mechanical support; the control group subjects had tape applied but with no stretch whereas the intervention group had 35-40% stretch.
More recent research by Shih et al. (2017) also found that both exercises and ETT provided positive improvements to forward head posture, with no significant differences between the two treatments, as conducted on a study on 60 subjects.

Although the purpose or benefits of ETT are unclear and although there is not enough supporting evidence on this treatment in the management of sports injuries or enhancing sports performance, there are studies providing high quality evidence supporting its use on specific sports injuries, such as lateral epicondylitis. In particular, a study by Shamsoddini & Hollisaz (2013) reported a significant difference in grip strength and extension force as well as the reduction in pain in 30 subjects with lateral epicondylitis, compared to the same treatment on the unaffected arms, which provided control data). Another study on the effects of both ETT and therapeutic ultrasound on lateral epicondylitis, finding that this taping modality did have significant effects on pain and more so than the ultrasound (Shaheen et al., 2019).

More specifically, in the treatment of shoulder injuries, the only research I found supporting its effectiveness in postural correction were case studies and provided very poor evidence for its use. However, from the research I have found, as ETT is not likely to cause any harm to the patient, I would consider using this as a treatment method for any control of pain or posture, where neurology becomes a factor and continue to use it on a case by case basis; if the patient reports improvements in their symptoms or performance, then I would continue to use it in their treatment program.

References –

Han, J. T., Lee, J. H., & Yoon, C. H. (2015). The mechanical effect of kinesiology tape on rounded shoulder posture in seated male workers: A single-blinded randomized controlled pilot study. Physiotherapy Theory and Practice. https://doi.org/10.3109/09593985.2014.960054

Konishi, Y. (2013). Tactile stimulation with Kinesiology tape alleviates muscle weakness attributable to attenuation of Ia afferents. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2012.04.007

Mostafavifar, M., Wertz, J., & Borchers, J. (2013). A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. Physician and Sportsmedicine. https://doi.org/10.3810/psm.2012.11.1986

Poon, K. Y., Li, S. M., Roper, M. G., Wong, M. K. M., Wong, O., & Cheung, R. T. H. (2015). Kinesiology tape does not facilitate muscle performance: A deceptive controlled trial. Manual Therapy. https://doi.org/10.1016/j.math.2014.07.013

Shaheen, H., Alarab, A., & S Ahmad, M. (2019). Effectiveness of therapeutic ultrasound and kinesio tape in treatment of tennis elbow. Journal of Novel Physiotherapy and Rehabilitation, 3(1), 025–033. https://doi.org/10.29328/journal.jnpr.1001025

Shamsoddini, A., & Hollisaz, M. T. (2013). Effects of taping on pain, grip strength and wrist extension force in patients with tennis elbow. Trauma Monthly. https://doi.org/10.5812/traumamon.12450

Shih, H. S., Chen, S. S., Cheng, S. C., Chang, H. W., Wu, P. R., Yang, J. S., … Tsou, J. Y. (2017). Effects of Kinesio taping and exercise on forward head posture. Journal of Back and Musculoskeletal Rehabilitation. https://doi.org/10.3233/BMR-150346

Williams, S., Whatman, C., Hume, P. A., & Sheerin, K. (2012). Kinesio Taping in Treatment and Prevention of Sports Injuries. Sports Medicine. https://doi.org/10.2165/11594960-000000000-00000