Journal Article Review November 2016

Does Kinesio Tape Help Tennis Elbow?

Dilek et al: Kinesio taping in patients with lateral epicondylitis. J Back Musculoskelet Rehabil. 2016 May 20. [Epub ahead of print]

Turkish investigators recently studied 31 patients with lateral epicondylitis using Kinesio Tape. Entry criteria included pain with at least of one of the following tests: resisted middle finger extension, resisted wrist extension, and pain with extension or passive stretch of the wrist extensors. Patients with other possible sources of symptoms, including cervical spondylosis, diabetes, neuropathy, and arthritis were excluded. The researchers also excluded patients who had received physical therapy or injections in the previous three months. There was no control group.

Kinesio Tape was applied twice weekly for two weeks. “Using the muscle technique,” the tape was applied in two longitudinal strips from the lateral epicondyle to the bases of the second and fifth metacarpals.

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Evaluations, consisting of several visual analog scale scores, grip strength, and the Patient-Related Forearm Evaluation Questionnaire, were performed prior to treatment and two and six weeks later.

The visual analog scale scores for pain at rest, with activities of daily living, on palpation, and at night all improved to statistically significant degrees at both two and six weeks. The same was true for the patient-rated score and grip strengths. At the end of the study, grip strength averaged 68% of the opposite side.

Sixteen percent of patients said that they were much improved, 65% said they were slightly better, and 10% noted no change. That leaves 9% that the authors do not explain.

The investigators concluded that Kinesio Taping can be an effective treatment for lateral epicondylitis.

COMMENT: Tennis elbow is a life-style issue for individuals 40-60 years old. It is likely that the connective tissues in younger individuals are sufficiently resilient to avoid these overuse changes; and for older individuals, diminished cardiac reserve, bad knees, or other factors limiting the frequency and intensity of physical activity likely proves to be protectant of the lateral epicondyle.

These annoying symptoms are often the first awareness of middle life and are not accepted easily. But as the commander told Tom Cruise in Top Gun, “Your ego is writing checks that your body can’t cash.” Once the inciting cause of tennis elbow is eliminated or markedly reduced, the symptoms subside spontaneously over months, and the individuals can resume physical activity, just not as frequent, furious, far, or fast as before.

I have not seen a single study on the treatment for tennis elbow where the results convincingly proved that intervention was better than mere activity limitation and patience. The current study does not change my opinion. The lack of a control group markedly weakened the study. I suspect that the presence of the Kinesio Tape caused the subjects to limit their activity. And yes, visual analog scale scores and grip strengths improved, but compared to what? These variables could have been easily addressed with a control group that received no treatment.

And although grip strengths improved, they were still markedly less than the opposite side. Two-thirds of subjects said that they were only slightly better. Also, the study was short. What would have the findings been three or six months after treatment.

Nothing in this study changes the way I approach patients with tennis elbow. I inform them that the symptoms will resolve over 6-12 months. I help them acknowledge their entrance into middle age and ask them to lift parcels with their forearm supinated.

If you have a treatment that you think accelerates symptom relief, expose it to a controlled study, blinded if possible. There are a lot of weekend warriors who would be glad to hear about a quick fix.