Effect of rigid taping on subacromial impingement syndrome: systematic review (2024)

Objective

This systematic review analyzed the recently available information regarding the efficacy of rigid taping in alleviating pain and improving functional status in subacromial impingement syndrome.

Introduction

Rigid taping is commonly utilized in the rehabilitation of subacromial impingement syndrome (SIS). It is proposed to have positive effects on alleviating pain and shoulder function, but the scientific evidence of its efficacy is still not clear.

Methods

An electronic search was conducted on Scopus, CINAHL, Cochrane Library, Web of Science, MEDLINE, Embase, EBSCO, Google Scholar databases, and a manual search from the bibliography of the included studies. Randomized trials (published between March 2010 and November 2023), which included rigid taping as an experimental or control treatment for the pain function state in subacromial impingement syndrome, assessed pain using the visual analog scale (VAS) or numeric pain rating scale (NPRS), and assessed functional status using Shoulder Pain and Disability Index (SPADI) or the Disabilities of the Arm, Shoulder and Hand (DASH), were included. The quality of the included studies was assessed using PEDro scale.

Conclusion

There is a moderate level of evidence that using rigid tape in treating patients with shoulder impingement syndrome has no positive effect in reducing pain intensity, while there is a moderate level of evidence that using rigid tape in treating patients with shoulder impingement syndrome has a positive effect in reducing disability and improving the function.

Systematic review registration

Submitted to PROSPERO.org.

Shoulder impingement is a medical syndrome by which soft tissues become painfully entrapped around the shoulder joint. Patients present with shoulder impingement syndrome (SIS) usually demonstrate pain while elevating the arm or while lying on the affected side. Shoulder pain is the 3rd most common musculoskeletal complaint in orthopedic practice, and impingement syndrome is one of the more common underlying diagnoses [1]; it accounts for 44–65% of most shoulder complaints [2].

The subacromial impingement may be classified as either primary or secondary. The primary impingement is a direct result of compression of the rotator cuff in the subacromial arch. The secondary impingement occurs due to the degeneration and narrowing of the subacromial space. Various factors such as muscular dysfunction, poor posture, and improper scapulohumeral rhythm precipitate the onset of secondary impingement [3]. Regardless of the classification, patients with SIS usually demonstrate postural abnormalities, a painful arc of movement, and altered muscle biomechanics [4].

Aiming to control pain, and restore mobility, SIS could be treated conservatively or surgically, and the decision is usually taken based on the duration and intensity of pain, the degree of disability, and the extent of structural damage [1].

Physiotherapy is the main conservative line of SIS treatment. Interventions such as education, electrotherapy modalities, postural retraining, muscular control exercise, and taping have already been utilized successfully to improve posture, minimize the biomechanical deviation of the shoulder joint, reduce abnormal muscle activity [2], and relieve discomfort [5]. These measures demonstrated about 80% success rate [5].

Two types of taping have already been utilized in shoulder rehabilitation: flexible and rigid. Although multiple studies have been conducted to investigate the effect of flexible (kinesiology taping) on shoulder problems [6, 7], the therapeutic effects of rigid taping (RT) have not been adequately studied. Moreover, these studies revealed contradicting conclusions [8]; as reported by few studies, rigid taping can improve range of motion and improve mechanical alignment and tactile sensation [2, 7, 9,10,11,12], and other studies noticed increased skin irritation and limitation in upper extremity mobility [13]. Systematic reviews are warranted to give a collective overview of the literature regarding the effectiveness of rigid taping in treating SIS and to provide healthcare practitioners with evidence-based information [4].

The purpose of this systematic review is to examine the existing literature and develop a better comprehension of the efficiency of RT on shoulder pain and function in patients with SIS.

The current systematic review was conducted and reported according to the PRISMA guidelines for reporting systematic review and meta-analysis [9].

Eligibility criteria

The included studies met the following eligibility criteria: (1) randomized controlled trial (RCT), (2) published between March 2010 and November 2023, (3) English language, (4) conducted on SIS (not following stroke) adult population, (5) only RT was used as a single treatment or added to standard intervention, (6) assessed pain (measured by visual analog scale or numeric pain rating scale) and /or function (measured by any related functional scale), (7) contain at least one esxperimental group and one control, and (8) studies designed to assess the immediate, short-term and long-term effects were also included.

Exclusion criteria

The studies that did not meet the inclusion criteria were excluded such as studies reported in languages other than English, study designs other than RCTs, studying other types of taping, or reporting different outcomes. Moreover, if the full article was not accessible, the study was excluded.

Information sources

A systematic search of Scopus, CINAHL, Cochrane Library, Web of Science, MEDLINE, Embase, and EBSCO databases was conducted in the period between 20–30 March 2021 and 30 November 2023. This step was followed by a manual search of the reference list in the related studies.

Search strategy

Two authors conducted the electronic search using “rigid,” “McConnell,” “taping,” “tape,” “shoulder,” “shoulders,” “glenohumeral,” “scapula,” “rotator cuff,” and “subacromial.” Pain, pain intensity, function, functional status, and disability as keywords. They followed the search guidelines described by each search engine and followed the exclusion and exclusion criteria to determine the filters and limits of the search. The same researchers conducted the manual search.

Selection process

The results of the search process were uploaded to Rayyan QCRI.org [10], an Internet-based software program that facilitates collaboration among reviewers during the assessment of studies against the inclusion and exclusion criteria [11]. Before the formal screening process, training was conducted to refine the screening procedures and familiarize the screening team with the Rayyan software. Two authors were responsible for checking the uploaded studies against the inclusion and exclusion criteria by screening the title and the abstract. The eligible studies were further precisely examined after downloading the full article. The final decision on inclusion was taken if there was a consensus. In case of disagreement, a third researcher was involved to make the consensus. The full process was summarized in the flow chart (Fig.1).

Data collection process

Using the Excel program for Windows 10, a table was constructed to collect the important characteristics of the included studies. These characteristics included the year of publication, funding source, the setting, and country of the study, outcome measures, time points for assessing outcomes, interventions, sample size, and different rigid taping techniques, in addition to other data (Table1).

Methodological quality and risk-of-bias assessment

The PEDro scale was used to assess the quality of the included studies. This scale is a widely used form of assessment of RCTs in the field of physical therapy research. It covers five areas: patient selection, blinding, intervention, outcomes, and statistics. Each criterion was graded on a yes/no (1/0) basis, and the scoring was conducted by summing the total yes (1s) items. Only the first item in this scale was omitted from the scoring as advised by the providers. Studies obtained a score of 4 were considered of low quality, while a score higher than 4 and less than 7 indicates medium quality, and the high-quality rank was given to those having a score above 7 (Table2) [12].

The systematic search

The process of electronic search resulted in 85 records; these records were uploaded to the Rayyan website in preparation for finding duplicates and assessment against the inclusion and exclusion criteria. Five studies were repeated and consequently deleted. Eighty records were subjected to initial screening through the revision of the title and the abstract; when there was uncertainty or lack of details, the full article was downloaded and examined. This process revealed a single RCT [2] which met the criteria for inclusion. Additionally, three RCTs [8, 13, 14] were found through a manual search of the references list of the related articles and included after exposure to the appropriate assessment (Fig.1).

The characteristics of the included studies

Unfortunately, three RCTs only met the inclusion criteria and joined the current review. These studies investigated the effect of adding rigid taping to standard treatment programs on pain intensity and functional disability in patients with SIS. The standard treatment was different among the four trials. Apeldoorn et al. [2] used an individualized physical therapy program which was not described in their study. Teys et al. performed mobilization with movement as a standard treatment for both groups [14]. In Kumar’s study, both study and control groups received a standard program consisting of icing, strengthening, stretching, mobilization, and education [13]. Arslan et al. divided patients into four groups: kinesio taping group, McConnell taping group, manual therapy group, and control group. Conventional physiotherapy (5 days a week for 4 weeks) was applied to the patients in all groups.

Regarding the taping material, technique, and duration of application, the four studies were quite different: Apeldoorn [2] and Kumar [13] used the same type (Leukotape), while Teys et al. used a different one (porous hypoallergenic adhesive tape), and Arslan et al. [8] is using McConnell taping. The taping technique differed between the four trials, and Apeldoorn used a single strap with pain-dependent tension on the lateral acromion and upper arm. In Teys’ study, the tape was applied on the interior arm and shoulder and reached back to the scapula in a diagonal fashion. Bilateral straps applied baraspinally from T1 to T12 were used by Kumar et al. [13] and in Arslan [8]. The technique was not clearly illustrated. The purpose of McConnell’s over-humerus head relocation technique is to lift the humerus head upward anteriorly and backward and to increase the area between the acromion and the elevated humerus. Regarding the duration of taping, Apeldoorn et al. [2] used different durations ranging from 2 days up to 7 days according to the level of pain. Kumar applied the tape three times per week for 6 weeks, and they instructed patients to remove the tape 48 h before the next session [13]. Arslan applied the McConnell taping every day after the treatment 5 days a week in 5 sessions for 4 weeks.

Pain intensity measurements were used in three studies only; NPRS was used by Apeldoorn et al. [2]. While VAS was used by Teys et al. [14] and Arslan et al. [8], functional disability measurements were performed in three studies. The first [2] assessed function using a simple shoulder test. The second study [13] used Shoulder Pain and Disability Index (SPADI), and the third study [8] used Disabilities of the Arm, Shoulder and Hand (DASH).

Methodological quality of the studies

The results of the critical appraisal for the selected studies are presented in Table1. According to PEDro scale, a single study [2] was of high quality, while the other three [8, 13, 14] were of medium quality.

There are a few points regarding the quality that need to be clarified: Firstly, eligibility criteria were specified (inclusion/exclusion criteria) mentioned in the four studies [2, 8, 13, 14]. Secondly, subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received) in all four studies [2, 8, 13, 14]; thirdly, allocation was concealed in only one study [2]; fourthly, the groups were similar at baseline regarding the most important prognostic indicators in three studies [2, 8, 13]; fifthly, there was blinding of all subjects in one study [13]; sixthly, there was blinding of all therapists who administered the therapy in only two studies [2, 14]; seventhly, there was blinding of all assessors who measured at least one key outcome in only one study [13]; eighty, measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups in all four studies [2, 8, 13, 14]; ninthly, all subjects for whom outcome measures were available received the treatment or control condition as allocated, or, where this was not the case, data for at least one key outcome was analyzed by “intention to treat” in all four studies [2, 8, 13, 14]; tenthly, the results of between-group statistical comparisons are reported for at least one key outcome in all four studies [2, 8, 13, 14]; and eleventh, the study provides both point measures and measures of variability for at least one key outcome in all four studies [2, 8, 13, 14].

The objective of this systematic review was to examine the existing literature and develop a better comprehension of the efficiency of rigid taping on shoulder pain and patient-reported functional disability in patients with SIS.

From the available literature, there is a moderate level of evidence indicating that using rigid taping in SIS patients does not improve pain but improves functional outcomes, and pain outcomes were assessed in only two studies (by visual analog scale [14] and numerical rating scale [2]); in these two studies, rigid taping was used in (one session [14] and from 2 to 7 days [2]) which is very short period to have a significant effect in improving pain or may be due to the effect of other treatment used in addition to rigid taping (individualized physiotherapy or Mulligan’s mobilization with movement).

This finding is supported by a systematic review [15] of the effect of kinesio taping in shoulder impingement comparing it against nonelastic taping in three RCTs out of seven RCTs showing small improvement in pain scores up to 3 days which were seen for all patients. Up to 7 days of pain improvement was seen for 21 of 36 intervention patients. Neither study reported clinically significant improvement in pain beyond 2 weeks.

While the functional assessment tools were used in two studies [2, 13], in the first study [2], rigid taping was used for 2–7 days and used a simple shoulder test as a functional assessment tool and showed no differences in functional outcomes in favor of either treatment protocol, while in the other study, rigid taping was used 3 days a week for 6 weeks and used SPADI as a functional assessment tool and shows significant improvement in functional outcomes.

This finding is supported by another systematic review by McLaren (2016) [4] as they reviewed five articles that used scapular taping on patients with SIS (four articles on kinesio taping and one article on rigid taping), while this current review included four articles that used rigid taping. McLaren’s study concluded that the existing evidence was limited and had low quality regarding the effectiveness of rigid taping on pain and function in the short term.

In the current review, rigid taping did not show a significant improvement in pain intensity. This finding might be attributed to the short application period of rigid taping or due to the variations in the taping techniques. On the other hand, rigid taping showed significant improvement in functional outcomes that could be attributed to the correction of the scapular mechanics after using rigid taping.

Several factors determine the success of a patient’s treatment with SIS. Firstly, improving the biomechanics of the scapulohumeral and scapulothoracic joints is one that relieves the patient’s symptoms. Scapular taping may be one way to improve scapular alignment. Holding the scapula in better alignment with tape may provide a prolonged stretch to the tight structures around the shoulder. Additionally, this improvement in position helps to increase the subacromial space. Thus, the taping may relieve any excessive tension placed on the involved structures of the impingement. Muscle and collagenous tissue are both very adaptable, and studies have shown that low-load, long-duration stretching is more effective than short-term, vigorous stretching. Taping may be one way to achieve this low-load, prolonged-duration stretching [13].

Limitation

This systematic review was limited by a small number of articles included (n = 3). However, our study is the only systematic review focused on the specific use of rigid taping for pain management and functional outcomes in shoulder impingement. Rigid taping is still a relatively new technique, and only a few high-quality studies based on its application to the shoulder have been conducted at present. While all the studies included in this review focused on shoulder impingement, there was still significant heterogeneity with very few studies investigating precisely the same population or taping technique, making meta-analysis challenging. For example, we cannot definitively conclude that rigid taping in isolation is less effective than taping combined with physical therapy, and all articles conclude rigid tape is different in taping technique, period of application, pain scale, and functional scale.

VAS:

Visual analog scale

NPRS:

Numeric pain rating scale

SPADI:

Shoulder Pain and Disability Index

DASH:

Disabilities of the Arm, Shoulder and Hand

SIS:

Shoulder impingement syndrome

RT:

Rigid taping

RCT:

Randomized controlled trial

Authors and Affiliations

1. Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia

   Ibrahim M. Dewir

2. Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha’il, Saudi Arabia

   Ahmed A. Ibrahim&Hisham M. Hussein

3. Department of Physical Therapy and Rehabilitation, King Khalid Hospital, Ha’il, Saudi Arabia

   Amal M. Albjeedi

4. Department of Basic Sciences for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt

   Hisham M. Hussein

Contributions

IM, idea, writing, search, data analysis, and approval of final version. AM, search, quality assessment, and approval of final version. HH, idea, editing, quality assessment, and approval of final version. AE, search, quality assessment, and approval of final version.

Corresponding author

Correspondence to Hisham M. Hussein.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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