Kinesio taping versus postural correction exercises on mechanically triggered neck dysfunction

Abstract

Background/Aims:
Mechanically triggered cervicalgia is a common complain worldwide. Postural exercises are commonly used for its treatment. Kinesio taping has been proved to help many musculoskeletal disorders. We aimed to determine and compare the efficacy of kinesio taping and postural exercises in mechanical neck dysfunction.

Methods:
Forty-five patients, aged 18–40 years with mechanical neck dysfunction were randomly assigned into two different groups, and received 4 weeks of treatment. Group A received kinesio taping, and group B received postural exercises. Neck pain, disability, cervical curvature and upper trapezius activities were measured pre and post treatment by visual analogue scale, neck disability index, flexible ruler and electromyography. Between group comparisons were performed using multivariate analysis of variance and intra-group comparisons were performed using paired t test.

Findings:
Group-by-time interaction was significant in the multivariable test. Post hoc tests revealed that kinesio taping produced more pain reduction than the postural exercises. However, there was no significant interaction for disability, cervical curvature and upper trapezius activities.

Conclusion:
Kinesio taping has been found to be more effective than postural exercises to reduce pain. However, both have the same effect regarding disability, muscle activities and cervical curvature.

Full text

International Journal of Therapy and Rehabilitation, April 2017, Vol 24, No 4 155
© 2017 MA Healthcare Ltd
RESEARCH
M
echanical neck dysfunction is a
common disorder associated with
disability, reduced health-related
quality of life, and substantial
costs (Fejer et al, 2006). Numerous
treatments, including manual therapies, passive
physical modalities, and acupuncture, are commonly
used to treat neck pain. However, few interventions
have been demonstrated to be effective and most
are associated with short-term benets (Hurwitz et
al,2008).
The natural contours of the spine are very important
because the curves serve specic biomechanical
functions. Forward head posture may be associated
with mechanical neck dysfunction. In this position, the
neck is thrust forward and upward, thus reducing the
length of the posterior neck muscles and increasing
that of the anterior neck muscles (Chukuka et al,
1986), which lead to heightened gravitational load
to some cervical motion segments and increased
extensor muscle activities (Peolsson et al, 2014).
Assessing muscular activities through
electromyography (EMG) provides insight into
patterns of activation or tension developed in the
muscles, which may be of interest because sustained
muscle activity is known to cause ischemic muscular
pain. Even at joint loads as low as 5% of maximum
capacity, localised muscle fatigue has been shown to
develop during sustained contractions (Sommerich
et al, 2000).
Higher amplitudes, less varied muscle activity
and fewer periods of no muscle activity have been
suggested to be important biomechanical risk factors.
(Szeto et al, 2009). The upper trapezius muscle is
suitable for surface EMG detection due to its size and
supercial location (Westgaard et al, 2001).
Postural correction exercises involving repeated
cervical and scapular retractions are commonly used
Kinesio taping versus postural correction
exercises on mechanically triggered
neck dysfunction
Abstract
Background/Aims: Mechanically triggered cervicalgia is a common complain worldwide. Postural
exercises are commonly used for its treatment. Kinesio taping has been proved to help many
musculoskeletal disorders. We aimed to determine and compare the efcacy of kinesio taping and
postural exercises in mechanical neck dysfunction.
Methods: Forty-ve patients, aged 18–40 years with mechanical neck dysfunction were randomly
assigned into two different groups, and received 4 weeks of treatment. Group A received kinesio taping,
and group B received postural exercises. Neck pain, disability, cervical curvature and upper trapezius
activities were measured pre and post treatment by visual analogue scale, neck disability index, exible
ruler and electromyography. Between group comparisons were performed using multivariate analysis of
variance and intra-group comparisons were performed using paired t test.
Findings: Group-by-time interaction was signicant in the multivariable test. Post hoc tests revealed
that kinesio taping produced more pain reduction than the postural exercises. However, there was no
signicant interaction for disability, cervical curvature and upper trapezius activities.
Conclusion: Kinesio taping has been found to be more effective than postural exercises to reduce pain.
However, both have the same effect regarding disability, muscle activities and cervical curvature.
Key words: ■ Cervical pain ■ Electromyography ■ Kinesio taping ■ Postural correction exercises
Submitted 18 January 2016; accepted following double blind peer review: 3 January 2017
Aliaa Elabd
Assistant lecturer, Basic
Science department,
Faculty of Physical
Therapy, Pharos
University, Alexandria,
Egypt
Abeer Ibrahim
Lecturer, Basic Science
department, Faculty of
Physical therapy, Cairo
University, Egypt
Haytham Elhafez
Professor, Basic Science
Department, Faculty of
Physical Therapy, Cairo
University, Egypt
Correspondence to:
Aliaa Elabd
Email:
aliaelabd88@gmail.com
Aliaa Elabd, Abeer Ibrahim, Haytham Elhafez
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.238.007.040 on May 23, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.

156 International Journal of Therapy and Rehabilitation, April 2017, Vol 24, No 4
© 2017 MA Healthcare Ltd
RESEARCH
for managing mechanical neck dysfunction to correct
the underlying pathomechanics and to reduce upper
trapezius muscle spasm (Mclean, 2005).
Another modality increasingly used for the
management of patients with mechanical neck
dysfunction is kinesio taping (Saavedra-Hernández
et al, 2012). It is a thin elastic tape that can be stretched
up to 130–140% of its original length. It may be applied
over or around muscles to provide functional support.
Elastic therapeutic tape is made of tightly woven
elasticised cotton bres and the glue on the back is
acrylic, highly durable and waterproof (Kase, 1997).
The reported functional effects of kinesio taping
may be explained by two main mechanisms: a lifting
effect provides increased blood and lymphatic uid
circulation in the taped area, which creates a wider
space between the skin, the muscle and interstitial
space. An additional theory is that kinesio taping
may apply continual stretching of the skin within the
taped area, and this external activation of cutaneous
mechanoreceptors could inhibit pain through gate
control theory (Yoshida and Kahanov, 2007).
Pain relief by kinesio taping has been reported
in a number of previous studies involving different
conditions: shoulder impingement syndrome (Kaya
et al, 2011); acute whiplash (González-Iglesias et al,
2009), and chronic low back pain (Paoloni et al, 2011).
The interaction of kinesio taping on muscle function
has also been reported (Hsu et al, 2009).
Determining the most appropriate intervention
for individuals with neck pain remains a priority for
researchers. So, the purpose of this randomised trial
was to examine the effects of kinesio taping versus
postural correction exercises on neck pain intensity,
self-reported disability, cervical curvature and upper
trapezius muscle activities in patients with mechanical
neck pain.
METHODS
The study was conducted in accordance with the
1964 Helsinki declaration and its later amendments.
It was approved by the research ethics committee of
the Faculty of Physical Therapy, Cairo University
and reported with respect to CONSORT guidelines
provided by EQUATOR Network. Participation was
voluntary and informed consent was obtained from each
patient before participation in the study. Anonymity
and condentiality were assured, and any procedures
were performed in compliance with relevant laws and
institutional guidelines. Consent has been obtained
giving permission for the material to be published.
Design of the study
A pre and post treatment test randomised blinded
clinical trial was carried out with two parallel groups.
Participants
Participants were ranged in age from 18–40 years, with
a primary complaint of mechanical idiopathic neck
pain, who were referred to physical therapy treatment
at the outpatient clinic of the Physical Therapy
Faculty, Cairo University. Mechanical neck pain was
dened as generalised neck or shoulder pain, which
may be provoked by the following: sustained neck
postures, neck movement, or palpation of the cervical
musculature without any denite pathology. Physical
examination involving vertebral artery, compression
and distraction tests were negative, while patients’
Neck Disability Index (NDI) scores were above 15 (a
minimum score to reect the presence of at least mild
disability) (Vernon, 2008); and their cervical lordotic
angle was less than 340 degrees (normal cervical
curvature) (Harrison et al, 1997).
Exclusion criteria were as follows:
■ History of whiplash or cervical surgery
■
Diagnosis of cervical radiculopathy or myelopathy
or bromyalgia syndrome
■
Previous postural correction therapy or kinesio
tape applications
■ Undergoing current medical or physical treatment
■
Presence with vertebrobasilar insufciency or any
inammatory disorders.
Sample size determination
Calculations to determine sample size were performed
for neck disability as a primary outcome measure using
the G power 3.1 software programme. The calculations
were based on 1.06 effect size. This was determined
by measurements of our pilot study that involved 16
patients assigned randomly and equally into groups.
Group A received kinesio taping and group B received
postural correction exercises. Values of neck disability
in the two studied groups (mean ± standard deviations)
were 25.4 ± 6 and 31.9 ± 6.27, an alpha level of 0.05,
a desired power of 90%, two-tailed t test and 1:1
allocation ratio. The estimated desired sample size
was 20 patients for each group. To accommodate the
expected dropouts before the study’s completion, a
total of 45 participants were included in the study.
Study protocol
Patients received standardised physical examination
involving palpation, neck range of movement testing
and various tests by an assessor blinded to their
allocation to assess eligibility and exclude patients with
any dened disorders. Patients provided demographic
and clinical information and completed a number of
self-reported measures at baseline, which included
a visual analogue scale (VAS) to assess neck pain
intensity (Emshoff et al, 2011), the NDI to measure
self-perceived disability (Vernon and Mior, 1991) and
a body diagram to assess the location and distribution
of pain (Werneke et al, 1999).
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.238.007.040 on May 23, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.

International Journal of Therapy and Rehabilitation, April 2017, Vol 24, No 4 157
© 2017 MA Healthcare Ltd
RESEARCH
Outcome measures
The primary outcome measures were:
■ Neck disability, with neck pain
■ Angle of cervical curve
■ Upper trapezius muscle activity.
The secondary outcome was pain intensity. Pain
intensity was measured by a visual analogue scale
(VAS). The VAS is a 100 mm horizontal line that can
quantify symptoms in a continuous fashion. It has been
shown to have ratio scale properties, demonstrate high
repeatability and test–retest reliability (Rosier et al,
2002). Patients are instructed to indicate the intensity
of their pain by marking on a line anchored by ‘no
pain’ on the left and ‘worst imaginable pain’ on the
right. Then, the score was determined by measuring
from the left end of the line to the point that the patient
marked (Marqui et al, 2008).
Neck disability
Neck disability was measured with the neck disability
index (NDI). The NDI is a 10-item questionnaire
addressing functional activities. It has established
validity and reliability (Vernon and Mior, 1991).
Patients were asked to circle one of the six options
that describes the severity of each item (0–5). Then
the marks were counted and divided by 50 or 45 if
one section was missing, with a total score ranging
from 0 (no pain or disability) to 50 (severe pain and
disability). Finally, the score was multiplied by 100 for
the percentage (score/50) x 100 = % points (Vernon
and Mior, 1991; Ci En et al, 2009).
Cervical curvature
Cervical curvature was measured by exible ruler (ati,
FC-700R, Taiwan), which is portable, inexpensive and
easily used (Dunleavy et al, 2010). The subject sat in a
chair, feet at on the ground, with both elbows on the
arm rest directly below the acromion. The tester rmly
placed the ruler against the subject's erect cervical spine
and took a measurement between the occiput and the
seventh cervical spinous process. The shape of the
Spinocurve was traced on a paper with the endpoints
marked. A mathematical equation was used to calculate
the angle (Rheault et al, 1998) (Figure 1).
This method’s validity and reliability has been
established with acceptable intra- and interrater
reliability coefcients of 0.88 and higher (Rheault
et al, 1989; Dunleavy et al, 2010). Specically, one
previous study demonstrated the concurrent validity
of the exicurve-derived kyphosis measurements with
the radiograph-derived kyphosis measurements with a
Pearson’s coefcient of r=0.69 (Greendale et al, 2011).
Muscle activity
The MyoSystem 1400A (Delesy Inc, Scottsdale, USA)
was used to measure upper trapezius muscle activity
in the form of normalised root mean square (RMS).
The sites of the electrodes placement had been shaved
where needed and cleaned. Electrodes were placed
on each subject’s dominant side as recommended by
Mclean (2005); an active electrode was placed 2 cm
lateral to the midpoint of a line drawn between the
C7 spinous process and the posterolateral acromion,
and the reference electrode was placed over the C7
spinous process.
Raw EMG was amplied (bandwidth=20–450
Hz, common mode rejection ratio >80 db at 60 Hz,
input impedance = 10 GΩ) and collected with a ±
2.5 V range bias removal, and full wave rectication
were performed for data prior to being ltered. The
resulting linear envelope signals were then normalised
to maximal voluntary isometric contractions (MVIC).
Assessment of the MVIC of the upper trapezius was
performed as described by Mclean (2005); the subject
performed isometric shoulder abductions, with the arm
at 900 abduction and neutral rotation. Each contraction
was maintained for 7 seconds and repeated three
times against manual resistance with 30 seconds rest
betweenrepetitions.
After the MVIC assessment, participants wrote
for 15 minutes in a seated position; this task was
chosen because it is the most common daily task for
participants and it involved a semi-static load, which
aggravated their symptoms. Head, neck, shoulder
and the spine positions were standardised during the
assessment to avoid their effect on the activities of
the upper trapezius. Normalised RMS percentage
was calculated (EMG amplitude during writing task
1
2
3
a
b
4
5
6
7
Figure 1. Measurement of cervical curve with
flexible ruler. a: Length between the two
endpoints of the cervical curve; b: Length of
the perpendicular from the midpoint of line
a to the curve. The following equation as
discussed was used to formulate the angle:
Q=4 arc tan (2 b/a)
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.238.007.040 on May 23, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.

158 International Journal of Therapy and Rehabilitation, April 2017, Vol 24, No 4
© 2017 MA Healthcare Ltd
RESEARCH
/average of the 3 trials of MVIC)*100) (Nicoletti et
al, 2013).
All outcomes were collected at baseline and 4 weeks
after the intervention. By an assessor blinded to the
treatment allocation of the patients. Patients were
blinded to their treatment allocation and uninformed
of what intervention the other group would receive.
Allocation
Following the baseline examination, patients were
randomly assigned to receive kinesio taping (group
A) or perform postural correction exercises (group B).
Concealed allocation was performed using a computer-
generated randomised table of numbers created prior
to the start of data collection by a researcher who
was not involved in either recruitment or treatment
of the patients.
Individually, sequentially numbered index cards
containing the randomly assigned intervention group
were folded and placed in sealed, opaque envelopes.
A second therapist, blinded to baseline examination
ndings, opened the envelope and proceeded with
the treatment according to the group assignment. All
patients received the intervention on the day of the
initial examination.
Kinesio taping application
We used a waterproof, porous, and adhesive tape
(Kinesio Tex; Kinesio USA, Albuquerque, NM).
It had a width of 5 cm and a thickness of 0.5 mm.
Patients in group A received the following application
by a therapist experienced in tape application: while
seated in a comfortable neutral position, the rst
layer of the tape consisted of a blue Y-strip placed
over the posterior cervical extensor muscles, from the
insertion to the origin to inhibit paraspinal cervical
muscles activities (Kase et al, 2003).
Each tail of the Y-strip was applied with a paper-
off tension, which the manufacturer applies to the
tape against its paper backing (approximately 15–25%
stretch) while the patient’s neck is in a position of
maximum available cervical contralateral sidebending
and rotation. The tape was placed from the dorsal
region (T1–T2) to the upper cervical region (C1–C2).
The overlying strip (pink) was a space-tape (opening)
placed perpendicular with moderate tension (50%) to
the Y-strip, over the mid cervical region (C3–C6) on
the patient’s exed cervical spine to apply tension to
the posterior structures (Figure 2). Then, the applied
tapes were rubbed for several seconds by the therapist
to generate heat in order to help x the tapes onto
the skin. This application has been used in previous
studies (González-Iglesias et al, 2009; Saavedra-
Hernández et al, 2012; Dawood et al, 2013). The
kinesio tape was replaced every 4 days during the
duration of the study (4 weeks), and it was removed
just before outcome assessment.
Postural correction exercises
This standardised programme for all patients in group
B was conducted according to the protocols of Pearson
and Walmsley (1995). Each exercise was performed
as three sets of 10 repetitions each twice a week for
4weeks. Group B patients were instructed to continue
the exercises as a daily home programme to inuence
the self-correction kinesthetic awareness.
Cervical retraction exercises
While sitting in a comfortable neutral position, the
patient was asked to pull the head and neck into a
position in which the head is aligned more directly over
the thorax (chin in) while the head and eyes remain
level for 10 seconds (Figure 3).
Scapular retraction exercise
While sitting in a comfortable neutral position, the
patient was asked to take a deep breath and expand
the chest. Then the patient was asked to move his or
her shoulders backward bringing the scapulae together
for 10 seconds (Figure 4).
Instructions for daily activities
Patients were given home instructions regarding
proper sitting, computer and telephone using, lifting
andreading.
Statistical analysis
Data were analysed with SPSS Version 22 (SPSS
Inc, Chicago, IL). Potential differences in baseline
demographic and clinical variables between groups
were examined using one-way analysis of variance.
Two-way mutlivariate analysis of variance was used
to examine the effects of treatment on pain, neck
disability, cervical curvature and muscle activities. The
variable of interest was the group-by-time interaction at
Figure 2. Application of kinesio tape; overlying
strip was placed perpendicular to the Y-strip
(placed from from T1–T2 spinous process to
occiput) over the midcervical region (C3 –C6)
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.238.007.040 on May 23, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.

International Journal of Therapy and Rehabilitation, April 2017, Vol 24, No 4 159
© 2017 MA Healthcare Ltd
RESEARCH
a prior alpha level of 0.05. Individual paired ttests (two-
tailed) for each group were performed to determine
the magnitude of changes.
RE S ULT S
Fifty-two patients were screened for eligibility criteria.
Forty-ve patients (mean ± SD age, 27.8 ± 4.10 years;
28 females) satised the eligibility criteria, agreed to
participate, and were randomised to group A (kinesio
tape); n=23; age: 27.07 ± 4.0 years; BMI: 27.92 ±
3.44; 18 females) and group B (posture correction);
n=22; age: 27.4 ± 3.50 years; BMI: 28.53 ± 3.32;
11 females). The reasons for ineligibility are found
in Figure 5 (a ow diagram of patient recruitment
and retention). There was no signicant difference
between groups for demographic data (age, BMI) and
the baseline measurements. The measurements were
based on a 95% condence interval. Table 1 shows
baseline, post intervention, within-group differences
and their associated 95% condence intervals for neck
pain, disability, cervical curvature and EMG activities
of the upper trapezius.
Multivariable tests for outcome measures indicate
a signicant group-by-time interaction (F=2.67,
P=0.038). The interaction was statistically signicant
for pain (F=10.26, P=0.002) and neck disability. The
patients who received kinesio taping experienced
Table 1. Baseline, post intervention and within-group differences and
their associated 95% condence intervals for neck pain, neck disability,
cervical curvature and upper trapezius muscle activities
Group Pre-treatment
Mean ± SD
Post-treatment
Mean ± SD
Within-group
change scores
Mean (95% CI)
Neck pain
A (kinesio tape) 6.08 ± 1.31 2.09 ± .85 4.0 (3.32:4.68)
B
(postural exercises)
6.05 ± 1.25 3.54 ± .96 2.5 (2.11:2.88)
Neck Disability Index
A (kinesio tape) 27.76 ± 6.46 11.98 ± 2.12 15.77
(12.77:18.76)*
B
(postural exercises)
33.03 ± 8.33 22.76 ± 8.47 10.27 (8.80:11.74)*
Cervical curvature
A (kinesio tape) 23.77 ± 5.77 34. 23 ± 3.82 -10. 4 6
(-1 2.18 :- 8 . 74 )*
B
(postural exercises)
24.59 ± 6.77 32.34 ± 6.57 -7. 75
(-8.81:-6.69)*
Upper trapezius muscle activities
A (kinesio tape) 11.34 ± 9.26 3.99 ± 2.63 7.43 (3.87:10.81)*
B
(postural exercises)
12.99 ± 7.55 7.62 ± 4.58 5.37 (3.63:7.11)*
SD: standard deviation; CI: condence interval; *Signicant within-group difference (two-tailed
paired t test, P<0.05)
Figure 3. Cervical retraction exercise; the
patient was asked to perform chin in
Figure 4. Scapular retraction exercise; the
patient moved his shoulders backward
bringing the scapulae together
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.238.007.040 on May 23, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.

160 International Journal of Therapy and Rehabilitation, April 2017, Vol 24, No 4
© 2017 MA Healthcare Ltd
RESEARCH
Figure 5. A ow diagram of patient recruitment and retention
ENROLMENT
ALLOCATION
FOLLOW-UP
ANALYSIS
Allocated to group A (kinesio taping):
n=23
Excluded: n=7
Not meeting inclusion criteria: n=4
Current physical therapy treatment: n=2
Declined to participate: n=1
Lost to follow-up: n=3
Kinesio taping allergy n=1
Declined to continue n=1
Refusal to complete carers’ measure n=1
Lost to follow-up n=1
Other health problems n=1
Analysed: n=21
Randomised: n=45
Allocated to group B (postural exercises):
n=22
Patients with mechanical
neck dysfunction screened
for eligibility
n=52
Baseline measurements n=45
Neck pain intensitiy
Neck disability
Normalised root mean square
Cervical curvature
4 weeks post-treatment assessment:
n=20
4 weeks post-treatment assessment:
n=21
Analysed: n=20
more pain reduction than those who performed
postural correction exercises (P<0.05). There was
no signicant interaction for disability (F=3.68,
P=0.058) or cervical curvature (F=1.217, P=0.273)
also, there was no signicant interaction for upper
trapezius muscle activities (F=0.512, P=0.48). Paired
t tests within group A revealed signicant reduction in
pain, disability and upper trapezius muscle activities
(t=12.24, 10.93 and 4.39 respectively, P<0.01) and
an increase of cervical curvature (t=-12.63, P<0.01).
Within group B, there was a signicant reduction in
pain, disability and muscle activities (t=13.65, 14.49
and 6.43 respectively, P< 0.01) and signicant increase
in cervical curvature (t=-15.178, P<0.01).
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.238.007.040 on May 23, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.

International Journal of Therapy and Rehabilitation, April 2017, Vol 24, No 4 161
© 2017 MA Healthcare Ltd
RESEARCH
DISCUSSION
This study investigated the effects of kinesio taping or
postural exercises on pain, disability, cervical curvature
and upper trapezius electromyographic characteristics
in people with mechanical neck dysfunction. The results
showed that patients in both groups displayed signicant
reduction in neck pain, disability, upper trapezius
RMS and an increase in cervical curvature. Although
alterations of disability scores, electromyographic
activities and curvature angel were not signicantly
different between groups, patients received kinesio
taping displayed greater reduction in their neck pain.
Neck pain is commonly associated with a protective
spasm in the surrounding muscles, producing pressure
within the muscles, thus developing ischemia, more
pain, and an abnormal neck posture. This vicious cycle
that can occur in reverse may be broken by relieving the
pain by reducing the muscle spasm, or by correcting
the abnormal neck posture (Chukuka et al, 1986).
The effects of kinesio taping
Kinesio taping is applied when the muscle is
stretched; when the joint moves back into mid range,
the altered shape of the ribbed material, referred
to as ‘convolutions’ in the tape, lifts the skin. It is
hypothesised that this action creates space in the tissue
to enhance circulation or reduce pressure on pain
sensitive structures. Possible mechanisms by which
kinesio taping induced its effects may be related to the
neural feedback provided to the patients, which can
facilitate their ability to move the cervical spine with
a reduced mechanical irritation on the soft tissues.
In addition, the tape might have created tension in
soft tissue structures that provide afferent stimuli,
facilitating a pain-inhibitory mechanism and thereby
reducing the pain levels of the patients (Kase et
al,2003).
Our results agree with the results of Takasaki et
al (2015), who reported that both tensioned and non-
tensioned taping across the upper trapezius muscle
reduced its activity during a standardised typing
task in healthy participants without interfering with
typing performance. The results are also in accordance
with Shaheen et al (2015), who found an effect of
taping on scapular kinematics and pain in movements
occurring in the sagittal plane in subjects with shoulder
impingement syndrome. Additionally, Paoloni et al
(2011) showed efcacy of kinesio taping on lumbar
muscles’ activities and low back pain. Also, many
previous studies suggested the inuence of kinesio
taping on neck or shoulder pain (González-Iglesias et
al, 2009; Boccthy et al, 2014; Mariana and Carmen-
Oana, 2014). Dawood et al (2013) reported signicant
effects of kinesio taping on cervical curvature in
patients with mechanical neck dysfunction.
Efcacy of postural correction
exercises
Repeated postural exercises may have two main
benets. First, it may regularly reduce the adverse loads
on the cervical joints induced by poor cervical and
scapular postures. Second, it trains the deep postural
stabilising muscles of the spine in their supporting
role. Performing these exercises repeatedly throughout
the day may develop a change in postural habits
(Morningstar, 2002).
We suggest the effect is due to neutral postural
awareness that relieves the tension causing pain.Our
results agree with the results of Mclean (2005) who
found effects of correction exercises on cervical posture.
Abd El-wahab and Sabbahi (2000) showed alterations
of H reex amplitude due to neck retractions and
recommended them to be used for C7 radiculopathy.
In the current study, kinesio taping reduced pain
and improved function more efciently than postural
exercises. We suggest this nding was as a result
of the analgesic effect produced by the tape due to
suppression of pain impulses by the gate control theory,
which encourages patients to perform activities more
easily, thus reducing pain. However, it fails to develop
further normalisation of muscular activities or greater
changes of cervical curvature. Further studies to explain
this nding are highly recommended.
Limitations of the study
The duration of the interventions was 4 weeks to
discover the short-term effects. No follow-up was done
to determine the long-lasting effects and recurrence
of symptoms. Another important limitation is that the
absence of a control group precludes attributing the
measured changes to either intervention, as the changes
could have been due to placebo, repeated testing, or
the natural history of the condition.
CONCLUSIONS
Both kinesio taping and postural correction exercises
are effective in improving cervical curvature,
normalising cervical muscle activity and reducing
both pain intensity and functional neck disability in
patients with mechanical neck dysfunction. However,
kinesio taping appeared to be more effective in
reducing pain intensity. We hypothesise that combining
both modalities may develop better results. So, we
recommend future studies to investigate the efcacy
of a combined kinesio taping and postural correction
exercises programme to enhance health care provided
to mechanical neck dysfunction patients. IJTR
Acknowledgements: The authors thank all staff members of basic
science department, faculty of physical therapy for their support
in the conduction of this study, and all patients participated in
thisstudy.
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.238.007.040 on May 23, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.

162 International Journal of Therapy and Rehabilitation, April 2017, Vol 24, No 4
© 2017 MA Healthcare Ltd
RESEARCH
Conict of interest: none declared.
Abdulwahab S, Sabbahi M (2000) Neck retractions, cervical root
decompression, and radicular pain. J Orthop Sports Phys Ther
30(1): 4-9. doi: 10.2519 /jospt.2000.30.1.4
Boccthy R, O’Brien L, Brown T, Cert G, Sci M (2014) A scoping
review of the use of elastic therapeutic tape for neck or
upper extremity conditions. J Hand Ther 27(3): 235–45. doi:
org/10.1016/j.jht.2014.03.004
Chukuka S, Enwemeka M, Jayanti A (1986) Postural correction in
persons with neck pain: a survey of neck positions recommended
by physical therapists. J Orthop Sports Phys Ther 8(5): 235–9.
doi: 10.2519/jospt.1986.8.5.235
Ci En MA, Clair DJ, Edmondston S (2009) Validity of the Neck
Disability Index and Neck Pain and Disability Scale for
measuring disability associated with chronic, non-traumatic neck
pain. Man Thera 14(4): 433–8. doi:10.1016/j.math.2008.07.005.
Dawood R, Kattabei O, Nasef S, Battarjee K, Abdelraouf O (2013)
Effectiveness of kinesio taping versus cervical traction on
mechanical neck dysfunction. Int J Ther Rehabil Res 2(2):
2–5. doi: 10.5455/ijtrr.00000019
Dunleavy K, Mariano H, Wiatera T, Goldberg A (2010) Reliability
and minimal detectable change of spinal length and width
measurements using the exicurve for usual standing posture
in healthy young adults. J Back Musculoskelet Rehabil 23(4):
209–14. doi: 10.3233/BMR20100269
Emshoff R, Bertram S, Emshoff I (2011) Clinically important
difference thresholds of the visual analog scale: a conceptual
model for identifying meaningful intraindividual changes for pain
intensity. Pain 152(10): 2277–82. doi:10.1016/j.pain.2011.06.003.
Fejer R, Kyvik KO, Hartvigsen J (2006) The prevalence of neck
pain in the world population: a systematic critical review of
the literature. Eur Spine J 15(6): 834–48.doi: 10.1007/s00586-
004-0864-4
González-Iglesias J, Fernández-de-las-Peñas C, Cleland JA,
Huijbregts P, del Rosario Gutiérrez-Vega M (2009) Short-term
effects of cervical kinesio taping on pain and, cervical range
of motion in patients with acute whiplash injury: a randomized
clinical trial. J Orthop Sports Phys Ther 39(7): 515–20. doi:
10.2519/jospt.2009.3072.
Greendale GA, Nili NS, Huang MH, Seeger L, Karlamangla AS
(2011) The reliability and validity of three non-radiological
measures of thoracic kyphosis and their relations to the standing
radiological Cobb angle. Osteoporos Int 22(6): 1897–905. doi:
10.1007/s00198-010-1422-z.
Harrison DD, Janik TJ, Troyanovich SJ, Harrison DE, Colloca CJ
(1997) Evaluation of the assumptions and to derive an ideal normal
cervical spine model. J Manipul Physiol Ther 20(4): 246–54
Hsu YH, Chen WY, Lin HC, Wang WT, Shih YF (2009) The effects of
taping on scapular kinematics and muscle performance in baseball
players with shoulder impingement syndrome. J Electromyogr
Kinesiol 19(6): 1092–99. doi:10.1016/j.jelekin.2008.11.003
Hurwitz EL, Carragee EJ, van der Velde G, et al (2008) Treatment
of neck pain: noninvasive interventions: results of the Bone
and Joint Decade 2000-2010 Task Force on Neck Pain and Its
Associated Disorders. Spine 33(4): S123–52. doi: 10.1097/
BRS.0b013e3181644b1d
Kase K (1997) Illustrated Kinesio Taping. 3rd edn. Ken’i-Kai, Tokyo
Kase K, Wallis J, Kase T (2003) Clinical Therapeutic Applications
of the Kinesio Taping Method. Ken Ikai Co Ltd, Tokyo
Kaya E, Zinnuroglu M, Tugeu I (2011) Kinesio taping comparing
to physical therapy modalities for the treatment of the shoulder
impingement syndrome. Clin Rheumatol 30(2): 201–7. doi:
10.1007/s10067-010-1475-6
Mariana C, Carmen-Oana T (2014) Massage versus kinesio taping.
possibilities to enhance the kinetic program in mechanically
triggered neck pain. Procedia Soc Behav Sci 117(2): 639–45.
doi: 10.1016/j.jbmt.2013.11.007
Marqui M, Marin C, Lauquec D, Lauque, Sorum P (2008) How
patients and physicians rate patients’ pain in a French emergency
department using a verbally administered numerical rating scale
and a visual analog scale. Acute Pain 10(1): 31–7. doi: 10.1016/j.
acpain.2008.01.003
Mclean L (2005) The effect of postural correction on muscle
activation amplitudes recorded from the cervicobrachial
region. J Electromyogr Kinesiol 15(6): 527–35. doi:10.1016/j.
jelekin.2005.06.003
Morningstar M (2002) Cervical curve restoration and forward head
posture reduction for the treatment of mechanical thoracic pain
using the pettibon corrective and rehabilitative procedures.
JChiropr Med 1(3): 113–15. doi: 10.1016/S0899-3467(07)60013-5
Nicoletti C, Spengler C, Läubli T (2013) Physical workload, trapezius
muscle activity, and neck pain in nurses’ night and day shifts: A
physiological evaluation. Appl Ergon 45(3): 1-6. doi: 10.1016/j.
apergo.2013.09.016
Paoloni M, Bernetti A, Fratocchi G (2011) Kinesio taping applied
to lumber muscles inuences clinical and electromyographic
characteristics in chronic low back pain patients. Eur J Phys
Rehabil Med 47(2): 237–44
Pearson N, Walmsley R (1995) Trial into the effects of repeated neck
retractions in normal subjects. Spine 20(11): 1245–51
Peolsson A, Marstein E, McNamara T, et al (2014) Does posture of
the cervical spine inuence dorsal neck muscle activity when
lifting? Man Ther 19(1): 32–6. doi: 10.1016/j.math.2013.06.003
Rheault W, Ferris S, Annfoley J, Schaffhauser D, Smith R (1989)
Intertester reliability of the exible ruler for the cervical
spine. J Orthop Sports Phys Ther 10(7): 245–54. doi:10.2519/
jospt.1989.10.7.254.
Rosier EM, Iadarola MJ, Coghill RC (2002) Reproducibility of pain
measurement and pain perception. Pain 98(1–2): 205–16.
Saavedra-Hernández M, Castro-Sánchez A, Arroyo-Morales
MA, Cleland JC, Lara-Palomo I, Fernández-De-Las-Peñas
C (2012) Short-term effects of kinesio taping versus cervical
thrust manipulation in patients with mechanical neck pain: a
randomized clinical trial. J Orthop Sports Phys Ther 42(8):
724–30. doi:10.2519/jospt.2012.4086
Shaheen A, Bull A, Alexander C (2015) Rigid and elastic taping
changes scapular kinematics and pain in subjects with shoulder
impingement syndrome; an experimental study. J Electromyogr
Kinesiol 25(1): 84–92. doi: 10.1016/j.jelekin.2014.07.011
Sommerich C, Joines S, Hermans V, Moon S (2000) Use of surface
electromyography to estimate neck muscle activity. J Electromyogr
Kinesiol 10(6): 377–98
Szeto G, Straker L, O’Sullivan P (2009) Neck-shoulder muscle activity
in general and task-specic resting postures of symptomatic
computer users with chronic neck pain. Man Thera 14(3): 338–45.
doi:10.1016/j.math.2008.05.001
Takasaki H, Delbridge B, Johnston V (2015) Taping across the
upper trapezius muscle reduces activity during a standardized
typing task – An assessor-blinded randomized cross-over
study. J Electromyogr Kinesiol 25(1): 115-120. doi: 10.1016/j.
jelekin.2014.10.004
Vernon H (2008) The Neck Disability Index: state-of-the-art, 1991–
2008. J Manipulative Physiol Ther 31(7): 491–502. doi:10.1016/j.
jmpt.2008.08.006
Vernon H, Mior S (1991) The Neck Disability Index: a study of
reliability and validity. J Manipulative Physiol Ther 14(7): 409–15
Werneke M, Hart DL, Cook D (1999) A descriptive study of the
centralization phenomenon. A prospective analysis. Spine 24(7):
676–83
Westgaard RH, Vasseljen O, Holte KA (2001) Trapezius muscle
activity as a risk indicator for shoulder and neck pain in female
service workers with low biomechanical exposure. Ergonomics
44(3): 339–353. doi: 10.1080/00140130119649
Yoshida A, Kahanov L (2007) The effect of kinesio taping on
lower trunk range of motions. Res Sports Med 15(2): 103–12.
doi:10.1080/15438620701405206
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 130.238.007.040 on May 23, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.