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Kinesio Tapes: Trend or fact?

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Kinesio Tapes: Trend or fact?

Kinesiology, K-taping, kinesio taping, athletic tapes, and elastic tapes are all examples and names of that colorful elastic cotton strips. Almost all of us have noticed some athletes wrapping them around different areas of their bodies. The kinesio taping technique was developed by the Japanese doctor Kenzo Kaze back in the 1970 (1). Kinesio tape is believed to mimic the thickness and flexibility of the skin. It is a thin, cotton, porous fabric with acrylic adhesive and a latex free tape; it can be worn for 3-4 consecutive days and does not require removal for bathing due to its water resistant properties (2). In addition, its unique properties allow moisture and air to flow through its porous fabric, protecting individuals from experiencing skin irritation (2). K-tape is also characterized by its unique elastic properties where it can be stretched up to 120-140% of its original length and can contract back to its normal length after application (2). According to its manufacturers, this elastic property causes convolutions and lifts the skin thereby providing more space for venous and lymphatic fluid movements, which in turn, reduces pain and pressure (3). These special tapes have caught the attention of many athletes and health care professionals after its first use during the 1988 Seoul Olympics to become a quite popular and widely used therapeutic tool following the 2008 summer Olympics in Beijing where a gold medalist, volley ball athlete, appeared wearing the tapes following a previous rotator cuff injury on her shoulder (4). To ensure the continuous development of kinesio tapes, Dr. Kaze developed the International Kinesio Taping Association International (KTAI) which is claimed to provide the highest quality of training to health professionals based on the latest research in the field (1).

In this review article, we will investigate the alleged benefits of K-tapes on different musculoskeletal conditions, in addition to discussing their possible efficacy on athletic performance.

Musculoskeletal conditions

Musculoskeletal conditions are injuries and disorders affecting the musculoskeletal system (muscles, bone and joints). Early systematic reviews and meta-analysis on the topic found insufficient or limited evidence supporting the use of kinesio tapes in the treatment of various musculoskeletal and sports injuries (5–8). Accordingly, Montalvo et al., 2014 published a meta-analysis  and found no overall difference in pain after the application of KT (9). However, Lim et. al provided some evidence regarding the efficacy of KT for reducing pain in individuals with musculoskeletal conditions (10).  It is important to note that although some reviews noted no differences between KT and other interventions, results varied widely between the studies included. In addition, these reviews discussed the effects of KT on musculoskeletal conditions in general rather than in a specific pathology; and since this is a vast area, we will discuss the possible efficacy of KT application on specific musculoskeletal conditions.

Shoulder and Scapular Impingement Syndrome

Shoulder impingement syndrome; also known as subacromial impingement syndrome is the most common disorder of the shoulder and is defined as the compression of the rotator cuff and the subacromial bursa (11). The symptoms of such condition can range from inflammation to degeneration of the bursa and rotator cuff tendons of the subacromial space (12). As we mentioned before, the proposed theory of the efficacy of kinesio tape in decreasing pain lies behind its ability to lift the skin to provide more space for venous and lymphatic fluid movements. Another hypothesized theory is that the tape stimulates neuromuscular pathways by increasing afferent feedbacks (13). Recently, two published meta-analysis on the topic found that the evidence supporting the use of KT for the treatment of shoulder disorders is lacking (14,15). Compared to placebo tapes or sham tapes, both reviews found that KT has no additional benefits on pain, range of motion and function in individuals diagnosed with shoulder problems.

Musculoskeletal Condition  – Shoulder and Scapular Impingement
Author Type of Study Results Quality of Evidence Comments
Ghozy et al. 2019 Meta-analysis Non-significant decrease in pain and disability favoring the KT group All the included studies were randomized controlled trials. However, some studies were of low quality Among the 12 studies included, only five discussed the efficacy of KT compared to placebo.
Celik et al. 2020 Meta-analysis No differences in pain, range of motion and function between KT and sham tapes. According to The Physiotherapy Evidence
Database Scores, the mean score of the included studies was good.
Among the 12 studies included, only five discussed the efficacy of KT compared to sham tapes. In addition, moderate to high statistical heterogeneity was seen between studies.

Chronic low back pain

The main reason to why the majority of people often refer to medical practitioners is low back pain (16). Along with arthritis, low back pain is considered the second greatest cause of disability (17). Although there is no specific reason for low back pain, and as such, the treatment methods remain somehow illusive, kinesio tapes became widely used as an effective treatment in reducing pain and disability in people experiencing chronic low back pain. Controversy exists to whether KT are superior to sham Tapes for individuals with low back pain. Evidence from systematic reviews on the topic provided limited and insufficient evidence regarding the superiority of KT tapes over sham tapes and even no tapes in decreasing pain and disability (16,18,19). Recently, Ramirez-velez et al., 2019 found that the overall results did not show superiority of KT over sham tapes in reducing pain and disability in the immediate post treatment period (17). However, the author mentioned that these findings were supported by a low quality of evidence. Finally, Li et al.,2018 conducted a meta-analysis on the topic and found that KT was not superior to placebo taping for pain reduction (20). However, the author showed a significant effect favoring KT on disability but this assumption was based on two studies only.

Musculoskeletal Condition  – Chronic Low Back Pain
Author Type of Study Results Quality of Evidence Comments
Nelson, 2016 Systematic review Compared to sham tapes, insufficient evidence was present for the effect of KT on pain and disability The overall quality of the included studies was good Only two studies were included for the analysis of the effects of KT versus sham tapes alone
Vanti et al. 2014 Meta-analysis KT did not significantly reduce pain and disability immediately post treatment The overall quality of the included studies was good Only four studies were included for the analysis of KT versus sham or placebo tapes. But it’s important to note that all the four studies displayed a high quality of evidence.
Ramírez-Vélez et al. 2019 Meta-analysis KT was not more effective than sham tapes in reducing pain and disability in the immediate post treatment period Although the included studies were randomized control trials, the results were supported by a low quality of evidence Only four studies were included for the analysis of KT versus sham tapes.
Li et al. 2018 Meta-analysis KT was not superior to placebo tapes for pain reduction. However, KT improved disability compared to placebo All the included studies were randomized controlled trials. However, some studies were of low quality High statistical heterogeneity was obtained between studies assessing pain outcomes. In addition, there were only two studies discussing the disability outcomes so results must be interpreted with caution.

Patellofemoral Syndrome, Anterior Knee Pain and Knee Arthritis.

Patellar taping or knee taping is a common technique often used in physical therapy regimes for treating different knee problems. Along with KT, McConnell tape is a type of tape often used by different practitioners. However, the effects of this kind of taping method (McConnell tape) on knee problems is not within the scope of this review. Thus, the following section will discuss the effects of KT compared to other interventions on knee problems.

Several systematic reviews and meta-analysis were devoted for discussing the effects of knee taping on individuals diagnosed with patellofemoral pain syndrome (21,22). However, these reviews included a variety of taping methods making it hard to draw definitive conclusions regarding the efficacy of KT alone on knee pain and function. Among these different reviews, only one meta-analysis was devoted to discussing the effects of KT and McConnell taping methods on knee pain and function in individuals diagnosed with patellofemoral pain syndrome (23). This meta-analysis showed a small benefit favoring the use of KT for decreasing pain and improving function. However, looking at the differences in methodology, the quality, and the results between the studies raises a lot of skepticism regarding the efficacy of KT. To date, evidence remains inconclusive since recent studies came up with contradictory findings (24,25).

Chang et al. 2015 (23)
Study Design Level of Evidence Intervention Results Comments
Campollo et al. 2013 Prospective cohort study level 2b KT/ McConnel tape/ no tape Pain decreased in both taping groups compared to no taping These kind of study designs provide weaker evidence when compared with randomized controlled trials
Kuro et al. 2012 Non- randomized controlled trial N/A KT + exercise/
Electrostimulation + exercise
Both groups showed decreased pain and improved function in patients with patellofemoral pain syndrome Lack of adequate control group. The inclusion of electrostimulation can be a confounding factor when comparing the results between both groups to tease out the main effect of KT
Akbass et al. 2011 Randomized controlled trial 1b KT + exercise compared to no taping + the same exercise program Both groups showed decreased pain and improved function with no significant difference between them N/A
Aytae et al. 2011 Randomized controlled trial 1b KT versus sham tapes Both groups showed decreased pain and improved function with no significant difference between them N/A

Concerning knee osteoarthritis, two recent meta-analysis showed that the application of KT improved pain and function in patients with knee osteoarthritis compared to sham/no tapes(26,27). In, addition, Lin et al. 2020 conducted a meta-analysis of 15 randomized control trails and found a beneficial effect of physiotherapy combined with KT versus the same physical therapy alone (28).

Musculoskeletal Condition – PFS, anterior knee pain and knee arthritis
Author Type of Study Results Quality of Evidence Comments
Chang et al. 2015 Meta-analysis KT improved pain and function among patients diagnosed with patellofemoral pain syndrome Low to moderate quality of evidence The low number of studies included and the addition of non-randomized trials could have affected the results
Kellish et al. 2020 Randomized controlled trial A significant reduction in pain after the application of kinesio tape compared to no tape Moderate quality Low sample size (10 participants) and all participants were females. In addition, only 5 subjects were diagnosed with patellofemoral pain syndrome.
Melo et al. 2018 Randomized controlled trial No changes in pain intensity following the application of KT Moderate quality All participants were females
Ye at al. 2020 Meta-analysis KT showed a significant effect on pain, physical functions, and range of motion in patients with knee osteoarthritis. The overall quality of the studies was good N/A
Melese et al. 2020 systematic review KT was effective in improving pain and joint function in patients with knee osteoarthritis The overall quality of evidence rated from moderate to high 18 RCTs were included in this review. It’s important to note that some studies compared KT to interventions other than sham tapes. However, these co-interventions were included in both groups to minimize any potential confounder on the results. For example: KT+ physiotherapy compared to physiotherapy alone.
Lin et al. 2020 Meta-analysis Physical therapy combined with KT provided better therapeutic effects in reducing pain and improving function among patients diagnosed with knee osteoarthritis The overall quality of the included study was good. High heterogeneity was obtained between studies. Several combinations of physical therapies were able to gauge whether KT with the therapy provided better effects than the specific physical therapy type alone.

Limitations of Kinesio Taping research

Many studies discussing the efficacy of KT used designs that included a variety of treatment methods combined with the KT technique which in turn made it hard to focus on the main treatment effect of Kinesio tape. However, in this article we tried to minimize the effect of this confounder by discussing the effects of KT compared to sham tapes.

Sham tape is the kind of tape often used in KT literature. It’s important to note that using sham tape as “control” is possibly an inadequate option. Most of the theorized benefits from taping is neurobiological, so sham tape will stimulate the same proprioceptive receptors that taping intervention methods are proposed to influence (29). In addition, the placebo effect or the hawthorn effect where patients are aware of their intervention and observation could be a major limitation in the KT literatures (15).

In support to this, randomized double blind placebo trials comparing the effects of KT versus Sham tapes found that both groups improved in pain scores while there was no difference between them. Thus, raising questions to whether the results are due to the act of taping itself or the type of taping (13,30).

Recent Evidence Regarding the Efficacy of Kinesio Taping on Musculoskeletal Conditions

Recently, Cupler et al., 2020 provided an evidence map review on the topic(29). An evidence map review is a systematic search of a broad field to identify gaps in knowledge while presenting the results in a user friendly format (graph, table…) (31).

In this review of the entire taping literature, the author included 90 studies discussing the efficacy of KT on different musculoskeletal conditions and found a moderate, equivocal evidence regarding the efficacy of KT on anterior knee pain, patella femoral syndrome and shoulder impingement syndrome while favorable evidence was seen in knee osteoarthritis patients. However, concerning chronic low back pain, the author found strong evidence supporting the efficacy of KT (29).

Strength and Performance

 

The hypothesis behind the ability of KT to increase strength lies in its recoiling force which may increase strength in two ways; either by the transmission of this recoiling force to the fascia (which may assist in muscle contraction), or by stimulating cutaneous mechanoreceptors which would increase motor unit excitability and elicit a muscle spindle reflex(32). According to the manufacturer, KT should be applied from origin to insertion in order to facilitate muscle contraction while applying it from insertion to origin inhibits muscle contraction(32). Csapro et al. conducted a meta-analysis on the topic and found that KT did not significantly affect strength in healthy individuals(4). It is important to note that the majority of studies included were non-randomized trials which provide weaker evidence than randomized control trails.

Recently, Yam et al., 2019 conducted a meta-analysis of randomized controlled trials discussing the efficacy of facilitatory KT on lower limb muscle strength and performance in individuals without disability, and those with musculoskeletal diseases and post-operative orthopaedic conditions and the results were as follow:

  Yam et al. 2019
Population Results Comments
Strength Individuals without disabilities Evidence did not support the efficacy of KT in improving lower limb strength and performance N/A
Individuals with muscle fatigue Acute effects of KT compared with minimal intervention (Placebo/sham taping/ no tape) were positive but not significant however the long-term effects were significant Results concerning the long-term efficacy of KT must be interpreted with caution since only two studies were included
Individuals with chronic musculoskeletal conditions Applying KT to the agonist muscle showed significant favorable effects N/A
individuals with post-operative orthopaedic conditions Results were significant for the short term but not for the long term Results concerning the short-term efficacy of KT must be interpreted with caution since only two studies were included
Performance Individuals with musculoskeletal conditions Evidence was insufficient concerning the efficacy of KT among this population N/A

In addition, Reneker et al., 2017 conducted a systematic review on the efficacy of KT on sports performance abilities in healthy athletes and found no convincing evidence for the effectiveness of KT on the majority of sport performance abilities included in their review (33).

Reneker et al. 2017
Measured Sports Ability Outcome Measures Results Comments
Ball Skills Soccer ball kick and handball goal throw Statistically significant difference favoring KT over no Tape in terms of soccer ball kick whereas no tape was superior to KT for the handball goal throw The results were based on 1 high quality study
Squat Performance Power output during a concentric return to stance from a half-squat with 30 kg and 50 kg. Results were positive in favor of KT but were not significantly greater than no tape The results were based on 1 study of low quality
Cycling  Two comparisons for the outcome of Windgate anaerobic power (absolute and relative) and two comparisons for anaerobic
 capacity (absolute and relative)
Out of the four comparisons only the relative anaerobic capacity showed a statistically significant effect favoring KT over no tape The results were based on 1 study of low quality
Cycling  Cycling performance completed 5 comparisons of KT to no tape for efficiency and rate of perceived exertion (RPE) No significant effects between KT and no tapes conditions in terms of overall RPE The results were based on 1 study with moderate quality
Dynamic balance Specific balance and stability tests None of the comparisons produced
 a statistically significant effect in any of the measures between KT and sham tape or no tape
The results were based on two studies, one of high quality and the second of moderate quality
Jumping (vertical and horizontal) vertical jump height, horizontal jump distance, jump power, flight time. No difference between KT and sham tapes in any of the outcome measures These results were based on 6 studies. 4 of high quality, 1 of moderate quality and 1 of low quality
Jumping (vertical and horizontal) Vertical jump height, horizontal jump distance, jump power, flight time. No significant effects between KT and no tape in any of the outcome measures The results were based on 10 studies. 3 were of good quality, 1 of moderate quality and 5 were of poor quality
Agility Speed of the Shuttle Run Test No significant effects between KT and no tape The results were based on one study with poor quality
Sprint Speed 20m sprint No significant effects between KT and sham tapes The results were based on one study with poor quality
Sprint Speed 10m, 20m, 30-yard sprint No significant effects between KT and no tape The results were based on 4 studies, 1 of high quality and 3 of low quality
Distance Running Peak knee flexion angular velocity, peak hip internal and external rotation angular velocity, peak hip anterior and posterior forces, peek knee flexion and extension moment There were no significant effects
for any of the comparisons between KT and no tape conditions.
The results were based on a single study of moderate quality

Takeaway message

The rationale for using Kinesio tapes lies mostly behind its ability to decrease pain and improve function among patients suffering from specific musculoskeletal conditions. When compared with sham tapes, K-tapes failed to show any additional benefits in individuals suffering from shoulder problems, patellofemoral pain syndrome and low back pain. However, it does show some efficacy in individuals suffering from knee arthritis. In addition, K tapes failed to show any benefits for improving performance in healthy athletes, whereas in individuals with musculoskeletal conditions, the evidence was insufficient. Concerning strength improvements, KT did not provide any benefits among individuals without disability. However, it may provide favorable effects in individuals with chronic musculoskeletal conditions and muscle fatigue.

This is a collaboration between Inspire Fitness Academy (IFA) and EBT.

Written by Hamza K. Safa (Researcher/Contributor at IFA)

Edited by Dr. Johnny Nakhleh (Director of EBP&SA at IFA)

IFA is only concerened when it comes to the source material of the article.

References
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The clinical effects of Kinesio® Tex taping: A systematic review. Physiother Theory Pract. 2013;29(4):259–70. 8. Bassett KT, Lingman SA, Ellis RF. The use and treatment efficacy of kinaesthetic taping for musculoskeletal conditions: a systematic review. NZ J Physiother. 2010;38(2). 9. Montalvo AM, Cara E Le, Myer GD. Effect of Kinesiology Taping on Pain in Individuals With Musculoskeletal Injuries : Systematic Review and Meta-Analysis. Phys Sportsmed. 2014;42(2). 10. Choon E, Lim W, Guo M, Tay X. Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks : is it time to peel off the tape and throw it out with the sweat ? A systematic review with meta-analysis focused on pain and also methods of tape application. 2015;1–10. 11. Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, et al. Treatments for shoulder impingement syndrome a prisma systematic review and network meta-analysis. Med (United States). 2015;94(10):1–17. 12. Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech. 2003;18(5):369–79. 13. Thelen MD, Dauber JA, Stoneman PD. The clinical efficacy of kinesio tape for shoulder pain: A randomized, double-blinded, clinical trial. J Orthop Sports Phys Ther. 2008;38(7):389–95. 14. Celik D, Karaborklu Argut S, Coban O, Eren I. The clinical efficacy of kinesio taping in shoulder disorders: a systematic review and meta analysis. Clin Rehabil. 2020;34(6):723–40. 15. Ghozy S, Dung NM, Morra ME, Morsy S, Elsayed GG, Tran L, et al. Efficacy of kinesio taping in treatment of shoulder pain and disability: a systematic review and meta-analysis of randomised controlled trials. Physiotherapy [Internet]. 2019; Available from: https://doi.org/10.1016/j.scitotenv.2019.135907 16. Nelson NL. Kinesio Taping for Chronic Low Back Pain: A Systematic Review. 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Effects of kinesiotape on pain and disability in individuals with chronic low back pain : a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2018; 21. Barton C, Balachandar V, Lack S, Morrissey D. Patellar taping for patellofemoral pain : a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms. Br J Sports Med. 2014;417–24. 22. Haber DB, Provencher MT. Systematic Review of the Effect Patellofemoral Pain Syndrome. Sports Health. 2017;XX(X):1–6. 23. Chang W, Chen F, Lee C, Lin H, Lai P. Effects of Kinesio Taping versus McConnell Taping for Patellofemoral Pain Syndrome : A Systematic Review and Meta-Analysis. Evidence-Based Complement Altern Med. 2015;2015. 24. Kellish AS, Kellish P, Hakim A, Miskiel S, Shahi A, Kellish A. What Is the Effect on Kinesio Taping on Pain and Gait in Patients With Patellofemoral Pain Syndrome ? Cureus. 2020;12(7):1–10. 25. Melo SA, Macedo LDB, Borges DT. 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Effectiveness of kinesiology tape on sports performance abilities in athletes: A systematic review. Phys Ther Sport. 2018;31:83–98.

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