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REVIEW SCAPULAR TAPING
muscle fibre which reduces its firing rate and therefore decreases the activity of the motor neurone. Clearly these results have only been investigated on 2 separate muscle groups and further study is needed to consolidate these findings. The results of the study by Ackerman et al (9) demonstrated that taping the supporting shoulder of professional violinists during pieces requiring more vigorous playing resulted in a statistically significant increase in the activity of upper trapezius and produced a concurrent reduction in performance quality. No other effects of the taping were noted on EMG or performance measures for less demanding musical pieces. The authors explained that the violinist would have needed to elevate her shoulder to a greater extent to support the violin during the more vigorous piece. The tape was applied in a way to prevent elevation and protraction. Therefore, greater activity in the upper trapezius to overcome this resistance would explain the results. Overall, the proposed effects of taping in relation to facilitation and inhibition of activity needs further controlled trials into the long term effects in impaired subjects. As stated above, inhibition of the upper fibres of trapezius is often the aim of the investigators. However studies have shown increased scapula elevation to occur in subjects with impingement (10,11) but they have not directly related this to increased upper trapezius activity eg. a tight posterior capsule can cause the scapula to elevate excessively as a compensation strategy. Therefore, to attempt to inhibit a muscle with potentially normal activity lacks reason and needs further clinical studies to examine this issue. It would appear that taping techniques to address the reduced activity in serratus anterior may have greater clinical significance, yet this has not been attempted in the literature.
CLINICAL CASE STUDIES All the above papers investigating the rationale of taping produced conflicting results with the majority not supporting its usage and this could influence the clinician to think twice about using these techniques. However, they all used normal subjects with no history of shoulder dysfunction, which does not reflect clinical practice. Some published literature supports the use
of taping in the clinical setting (1,12,13). These studies utilised a single case study design. All three studies used taping to influence the patients’ ability to stabilise their scapula, which was considered to be at fault. Improved scapula setting (1), reduced winging of the scapula (13) and reduced downward rotation of the scapula (12) were reported immediately
SUBJECTS WITH IMPINGEMENT, BUT ALL HAVE VARIATIONS IN THEIR RESULTS
after tape application. However, these were subjective observations by the authors and were not quantified objectively in any of the studies, which obviously limits the reliability of the studies. Host (12) reported a secondary reduction in pain during functional activities as did Morrissey (1). In all three studies the taping was combined with scapula retraining exercises to improve the force couple relationships and optimise scapula control through range.
Activity modification was also advocated
in all the studies (1,12,13) to reduce the inflammatory response. This was combined with stretching of pectoralis minor and latissimus dorsi (12) and thoracic manipulations, trigger point release to pectoralis minor and local cryotherapy to reduce inflammation (1), to produce a comprehensive treatment package that reflects clinical practice. In all three patient scenarios, tape was used as an adjunct to treatment and the direct effects of the taping can not be clearly identified. However, the observations of the clinicians support the use of tape as a method of improving scapula positioning and control allowing rehabilitation to be progressed more rapidly. The use of single case study designs is often controversial (14). However, they are clinically relevant and reflect the individual nature of physiotherapy practice, but longitudinal controlled experimental studies with larger sample numbers are ultimately needed to support practice (14).
SUMMARY Studies have consistently shown altered recruitment patterns in subjects with impingement, but all have variations in their
STUDIES HAVE CONSISTENTLY SHOWN ALTERED RECRUITMENT PATTERNS IN
results. The available evidence on the use of taping in patients with shoulder impingement is inconclusive. It must be remembered however that some of these papers had significant external validity issues confounded by differing methodology, making direct comparisons difficult. Controlled clinical trials are needed to provide supportive evidence into the effects of taping on scapular muscle activity in patients with shoulder impingement to support the anecdotal and clinical claims that taping works (1,4,12,13,15). Studies could also address combining the use of taping techniques with exercise therapy as these treatments are often combined clinically. Clinicians need supportive evidence to justify the use of taping. Evidence of how taping works to promote rehabilitation in this anatomical region must also be addressed. Future studies could also focus on different outcome measures when combined with motor recruitment. The effect of taping on pain levels and functional ability could be addressed, using scales such as the shoulder pain and disability index or the shoulder disability questionnaire. Both of these questionnaires have been shown to be sensitive and reliable (16,17). Currently, the efficacy of taping as a method of treating shoulder impingement is limited due to the lack of supportive evidence. However, lack of evidence does not necessarily mean there is no clinical benefit, merely that an appropriate measure is required to produce the evidence for or against. Meanwhile, until more evidence is provided, clinicians can only continue to base decisions for using this treatment option on the anecdotal evidence available.
Figure 1: Upper trapezius inhibition taping
Figure 2: Facilitation of lower trapezius taping 19