Osteoarthritis (OA) is the most common disease of the joints affecting 6% of adults worldwide. The knee is the most commonly affected joint and is one of the leading causes of disability and pain particularly in people over 40.
OA can be dived into two types: primary, where there is articular degeration without clear underlying cause, and secondary which is the concequence of trauma or another disease process. OA is typically a progressive disease however the intensity and rate of deterioration varies for each individual.
Treatment for primary knee OA begins with conservative management and progresses to surgery and ultimately a knee replacement when conservative treatments become ineffective. There are numerous conservative options and evidence for some options is better than others.
Exercise has a number of high quality studies demonstrating it’s numerous benefits for both managing pain and reducing disability. Taping on the other hand has limited evidence and is often based on sketchy pathophysiological principles yet it remains a very popular treatment option for clinicians around the world.
A new systematic review published in Medicine last week aims to explore what effect elastic taping has on pain in patients with primary osteoarthritis when compared to sham taping. The aim being to answer the question should be using taping to manage pain and disability for people living with primary knee OA?
Pathophysiology Behind Elastic Taping – In Simple Terms!
By elastic taping what we are talking about is high stretch – non-rigid – tape such as kinesio or k-tape. It’s very popular in sports injury settings for numerous musculoskeletal injuries however it is becoming more popular in non-sporting injuries such as knee OA.
In a nutshell the proposed mechanism of action for k-tape is largely based on myofascial principles and the ability of the elastic tape to modify it’s positioning along with the muscle fibres. This leads to a decreased stimulation of nociceptors along with a compressive force which prevents fluid accumulation surrounding the tissue further reducing nociceptor stimulation.
PubMed, Cochrane, EBSCO and grey literature databases using a simple and undisclosed strategy were searched for relevant evidence however it is unclear which data parameters were used. Studies were included if they were RCTs investigating primary osteoarthritis in people over 40, were published in English in peer reviewed journals and used WOMAC as the primary outcome measure. Studies involving post-operatively participants were excluded.
Six articles, a total of 392 participants, were included within the analysis and risk of bias was assessed using the 2005 Oxford standard. Losses to follow up and reasons for drop-out were also analysed and included within results. The primary outcome measure used was WOMAC.
Clinical Importance and Summary
In essence elastic taping leads to no significant change in WOMAC scores when used to treat primary knee osteoarthritis when used as a single treatment. WOMAC is a 3-dimensional scale where pain, stiffness and physical function as assessed.
The results of the individual studies included within this review show a decrease in WOMAC score of between 3%-16%. Just for clarity the minimum percentage change in the WOMAC for a person to have a perciievable change in symptoms is 17%.
One study (Hinman et al 2003) demonstrated that elastic taping had a negative effect on WOMAC score when compared to sham taping for both pain and function. For all studies involved there was high risk of bias due to poor randomisation, blinding and drop out rates. Additionally most of the studies lacked supplementary data so a meta-analysis could not take place.
This systematic review demonstrates that as it currently stands, based on current evidence, elastic taping is ineffective when being used as a treatment for primary osteoarthritis of the knee. Other conservative treatments with a stronger evidence base should be considered.