Kinesio Taping for Upper Trapezius Myofascial Trigger Points

Myofascial pain syndrome is characterized by hyperirritable nodules located within tautbands of skeletal muscle, known as myofascial trigger points. The upper trapezius is themost commonly involved muscle in the neck and shoulder girdle, and trigger points in thisregion are an important cause of neck pain, restricted mobility and loss of productivity.Kinesio taping has become increasingly popular in the management of myofascial triggerpoints because it is non‐invasive, painless, inexpensive and has few adverse effects.Systematic reviews and meta‐analyses suggest that kinesio taping reduces pain intensityand improves pressure pain threshold and range of motion in myofascial pain syndrome.However, the taping techniques used across studies differ substantially. Two techniquespredominate: the space correction technique, in which strips are applied over the triggerpoint in a star‐shaped pattern, and the muscle inhibition technique, in which a singleI‐strip is applied along the muscle fibres from insertion to origin with low tension. Atrial directly comparing these two techniques found no significant difference betweenthem, whereas a sham‐controlled trial found that the space correction technique was notsuperior to sham at 72 hours. Studies using the inhibition technique have reportedsignificant improvements in pressure pain threshold. Because the inhibition technique ismechanistically aimed at reducing muscle tone and is supported by stronger evidence, itwas selected for this trial.In addition, outcome measures in previous studies have been largely subjective. Pressurealgometry provides a quantitative measure of the mechanical sensitivity of the triggerpoint, while B‐mode ultrasonography allows measurement of muscle thickness and ultrasoundelastography allows objective assessment of tissue stiffness. Strain elastography withcalculation of the strain ratio has shown good reliability in patients with uppertrapezius myofascial pain syndrome and can differentiate active trigger points, latenttrigger points and control sites.To the best of our knowledge, no sham‐controlled randomized trial has evaluated kinesiotaping of upper trapezius myofascial trigger points using pressure pain threshold as theprimary outcome together with muscle thickness and strain elastography as objectivesecondary outcomes. A sham‐controlled design was chosen because sham taping alone mayproduce a substantial placebo response, and only a sham comparator can isolate the truetherapeutic effect.In the intervention group, a single I‐shaped kinesio tape strip will be applied frominsertion to origin along the upper trapezius with 15‐25% tension while the muscle isheld in a stretched position. In the sham group, an identical tape of the same brand,colour and size will be applied to the same region without therapeutic tension and withthe neck in a neutral position, so that the skin convolutions responsible for thetherapeutic effect are not produced. Both groups will receive four applications over twoweeks (twice weekly); at each session the existing tape is removed and a new tapeapplied, so the tape remains on the skin continuously throughout the treatment period.Patients will be randomly allocated in a 1:1 ratio using a computer‐generated randomnumber list. The study is single‐blind: the practitioner applying the tape cannot beblinded due to the nature of the intervention and therefore takes no part in anyassessment. All pain, pressure pain threshold and ultrasonographic measurements will beperformed by a researcher blinded to group allocation, after tape removal.