Acute effect of Kinesio Taping on knee pain and stability . Case report

BACKGROUND AND OBJECTIVES: Knee stability is critical for the execution of functional tasks, maintaining the joint within physiologic limits and preventing possible mechanical loads. A type of taping being increasingly used in recent years is Kinesio Taping, which is often used as resource to improve joint stability and decrease pain. This study aimed at evaluating the acute effect of Kinesio Taping on stability and pain in a patient with chronic knee instability. CASE REPORT: Male patient, 46 years old, with chronic knee instability due to late postoperative period of Anterior Cruciate Ligament injury, was evaluated during two functional activities (up/ down a stair and squat), before and immediately after Kinesio Taping. Evaluation tools were visual analog scale and videometry to evaluate knee varus angle peak during functional activities. There has been significant decrease (p<0.001) in mean knee varus angle peak during functional activities up/ down a stair (Pro-Kinesio: 189.4; Post-Kinesio: 186.2) and squat (Pre-Kinesio: 198.2; Post-Kinesio: 189.6). There has also been decrease in the visual analog scale for up/down a stair (Pre-Kinesio: 4; Post-Kinesio: 0) and squat (Pre-Kinesio: 3; Post-Kinesio: 0). CONCLUSION: Our results suggest that Kinesio Taping was effective to improve knee dynamic stability and decrease pain during functional activities of going up/down a stair and squat.


INTRODUCTION
Knee stability is critical for the performance of functional tasks, maintaining the joint within physiological limits and preventing possible mechanical overloads 1,2 .The anterior cruciate ligament (ACL) helps knee stability acting as major stabilizer and especially preventing excessive anterior translation of tibia with regard to femur, in addition to limiting tibial rotational movements and excessive knee varus and valgus [3][4][5][6][7] .ACL injury is very prevalent in the knee, with incidence of approximately 80 thousand injuries per year [8][9][10] .A major complication of this injury is joint instability which, in the long run, may favor knee cartilage wear and generate early CASE REPORT DOI 10.5935/1806-0013.20170018arthritis and possible functional changes, such as difficulties during gait and relatively simple tasks such as going up and down stairs 11,12 .Some authors have suggested that biomechanical changes in lower limbs, especially in the knee, may influence joint cartilage degenerative process 1,13 .Knee alignment plays important role on joint mechanical overload and may influence cartilage degenerative process, especially in medial compartment, cases when there is increased knee varus angle 13 .In search for effective techniques to improve joint stability, proprioception and alignment, some therapeutic intervention proposals have been used, such as the use of therapeutic tapings, especially rigid and elastic [14][15][16][17] .A taping becoming popular in recent years is Kinesio Taping (KT) which is often used as resource to improve segmental stability in different joints, with the advantage of not limiting functional movements, in addition to helping improving pain and resolution of edema 14,15,[18][19][20][21] .KT was developed during the 1970s by Dr. Kenso Kase, aiming at providing patients with constant therapeutic stimulation which would help muscles and other tissues to search for homeostasis in the intervals between chiropractic sessions.Today it is widely used in ambulatory and sports settings by different health professionals 14,22,23 .This study aimed at evaluating the acute effect of KT on stability and pain of a subject with chronic knee instability caused by late postoperative period of ACL injury.

CASE REPORT
Male patient, 46 years old, in outpatient follow up by the physiotherapy department, Clínica Escola Amarina Motta (CLESAM), Centro Universitário Augusto Motta (UNISUAM) -RJ, with chronic right knee instability caused by late postoperative period (7 years) of ACL injury, confirmed during evaluation with anterior drawer and Lachman tests, in addition to presenting level II arthritis in right knee medial compartment, confirmed by X-rays.Patient was evaluated during two specific functional activities, up and down a 15-cm step with evaluated lower limb fixed on step, and free squat.Evaluation tools were visual analog scale (VAS) to measure pain level and videometry for angular cinematic analysis.Images were captured in the frontal plane with a Sony model HDR-SR10 HD, compact digital camera with frequency of 60 frames per second, positioned on a leveled tripod with distance of 3.00m and height of 92cm.Anatomic points used for knee varus angle measurement were anterior-superior iliac spine, anterior tibial tuberosity and center of joint interline of the tibiotarsal joint, characterized with red Styrofoam round passive markers with diameter of 30mm.Patient was oriented to perform a series of five repetitions of each task and then mean knee varus angle peak for both activities was measured, in addition to being oriented to report pain level during each task.
Both measures (VAS and varus angle) were performed before and immediately after the application of therapeutic elastic taping.Technique of choice to apply KT (Kinesio ® Tex Gold 5cmx5m -color beige) was ligament correction with tape tension between 75 and 100%, with three "I" cuts to promote assistance for joint stabilization 14 .Some care was taken before applying KT, such as application site trichotomy and skin cleaning with 70% alcohol.Participant was positioned in supine position, with knee flexed to 90 0 , with the foot resting on the stretcher during KT application.A tape was transversally applied to patellar ligament, with tape ends over knee collateral, medial and lateral ligaments.The other two tapes were applied on the skin with distal ends of each one on anterior knee and proximal ends on medial and lateral thigh, with therapeutic zone on the region corresponding to collateral, lateral and medial ligaments.Knee varus angle cinematic analysis was performed with the software Kinovea 8.15 and program Sigma Stat 3.5 was used for statistical analysis, through a comparison study (test-t) of analysis parameters of tasks before and after treatment.Safety margin was 95% reliability and tests were according to sample and proposed objectives.Comparison of variables before and after KT application has shown changes with applied intervention.Values of each variable are shown in table 1.There has been significant decrease (p<0.05) of mean knee varus angle peak in both functional activities, especially during squat (pre-KT: 198.2±1.30;post-KT:189.6±0.55).

DISCUSSION
Our results give subsidies that the therapeutic intervention proposal with KT has possibly had a positive influence of knee alignment and decreased pain during functional activities of going up/down stair and squat.
It was possible o observe that knee varus angle peak has decreased both during up/down step and squat, thus suggesting improvement in knee stability and alignment during functional tasks with KT.This might have influenced pain improvement but considerations induced by such results should be evaluated with caution.Joint instability and pain are common findings in individuals with ligament injuries 4,24,25 .KT has been frequently used, alone or in combination with other techniques, to provide external support, thus helping joint stability and decreasing pain in individuals with different types of injuries [24][25][26] .
Evidences about the use of KT and its applicability in the clinical practice are still far from being a consensus, still with many studies with contradictory results [25][26][27][28] .
Our results are similar to other authors who have also observed benefits with the use of KT.A study by Campolo et al. 18 has evaluated the effects of two different taping techniques, KT and NcConnell Taping (MT), in patellofemoral pain syndrome during functional activities of going up and down stairs and free squat.Subjects were divided in three groups (KT, MT and placebo) and evaluation tool was VAS.Results have shown that groups (KT and MT) had significant VAS difference (p<0.05) during tasks as compared to the placebo group.These data are in line with our study, considering that significant VAS difference was also observed during functional activities with KT 27 .However, it is important to stress that study samples 18 and those of this report are different.In our study, participant was a patient with joint stability caused by late postoperative period of ACL, and in the mentioned study 18

CONCLUSION
Kt was effective to improve knee joint stability, decreasing varus angle peak during functional activities of going up/ down step and squat, in addition to having decreased pain level during the performance of tasks.

Table 1 .
Variables (varus angle and visual analog scale before and after Kinesio Taping during functional tasks (up/down step and squat)).
26ldridge29.In this study29, KT has influenced body dynamic stability of female participants during BTSE.In our report, by means of angular analyses before and after KT, there has been positive influence on knee joint segmental stability, with significant decrease of varus angle peak during functional tasks.This might be attributed to sensory KT effects, such as improved proprioception due to sensory stimulation by means of the tape30as well as mechanical effects, giving external support and stabilizing the joint14.Conversely, Shields et al.26have evaluated acute and late effects of KT on postural control in healthy individuals and those with ankle instability.Study results have not shown relevant changes after application of KT on the ankle.This suggests that, although KT is a popular clinical intervention resource, results do not justify its use on individuals with postural control deficits due to ankle joint instability.So, it is clear that the use of KT is still far from agreement about is use in the clinical practice.Within this context, our study has shown satisfactory results, both with clinical relevance (decreased pain during functional activities), and statistical significance, thus confirming the good use of therapeutic elastic taping in the clinical practice.
Although being different segments (ankle and knee) and different health conditions (healthy individuals and injured individuals), our results may somewhat be compared to those ofNakajima &