Saturday, June 7, 2014

Why Do Olympians Wear Colored Tape?



The colored tape the Olympians and other athletes wear is called “Kinesio® Tex Tape”, which is essentially just an elastic cotton strip with an acrylic, heat activated adhesive.  The tape was designed in the 1970s by a Japanese chiropractic and acupuncture specialist, Kenzo Kase. To date, there hasn’t been a single study to conclusive show that this tape actually does anything the makers and athletes claim it does, though as Kevin Anderson, director of Kinesio UK, states “There’s a lot more needed on the research side to confirm the positive results we’re seeing so far.” (In fact, there have been numerous studies in the over 30 years it’s been around and so far the results of using the tape have been more or less in-line with the placebo effect. It’s interesting that the company itself can make such claims when they apparently have not done research themselves to back them despite being around for over 30 years; otherwise, I’d assume Mr. Anderson would be citing said research, rather than saying research is needed.)
So to answer your question as to why Olympians and other athletes are wearing colored tape – because they think it helps in some medically significant way. The lack of evidence to support this never stopped athletes from wearing Phiten bracelets/necklaces or Power Balance holographic bracelets, which in their heyday both got amazing reviews from athletes as to the performance benefits, only to go out of fashion when it was conclusively shown that they didn’t do anything (and when the sponsorship dollars to said athletes dried up).
So it’s not surprising that Kinesio tape has become popular; it certainly seems more believably beneficial than an over priced plastic bracelet with a holographic sticker on it. Further, the placebo benefit is potentially better than nothing.  Basically, if nothing else, it’s probably good in such athletic competitions to think you have a slight edge… the power of positive thinking and all that.  As Amy Powell, associate professor of sports medicine at the University of Utah School of Medicine said in a recent interview, “Anything that [athletes] perceive as an edge, they’ll try, whether it’s scientific or not. And the athletes are convinced that [Kinesio tape] is really helpful.  It wouldn’t be the worst placebo in the world; it’s not doing any harm.”
As mentioned, this tape has been around for a while, even seen in the Olympics since 1988, but has only recently become widely popular among athletes after Kinesio very wisely donated 50,000 rolls of their tape to be used by various Olympians from 58 countries during the 2008 Olympic Games.  They also switched gears from primarily offering skin colored tape to pushing colored tape.  They say on their website, “The colors were developed to be compatible with color therapy…”  And, more accurate and surprisingly candid, they go on to state the colors were made to “provide field advertising at athletic events, a conversational opener, and instant product recognition.”
According to sports chiropractor and strength and conditioning specialist, Chad Peters, they also “paid [Olympic volleyball player] Kerri Walsh to wear black tape instead of flesh tones in Beijing.  After that, it just exploded. Everybody wanted it.”  Specifically, after the Beijing games, sales skyrocketed to 300% of what they were before and Kinesio tape has become “must use” by athletes the world over.
As to what the tape is supposed to do, this is from the Kinesio website,
In cases of injury or overuse, the muscle loses its elasticity. Dr. Kase needed to develop a tape that would have the same elasticity as healthy human muscle. He knew from his practice that the tape would also need to stay on the skin where it was applied. He spent two years doing a lot of research relating to elasticity, adhesives and breathability.
Finally, he came up with a tape that possessed the proper degree of elasticity, and that lifts the skin microscopically.  From that beginning, Kinesio® Tex Tape was invented. Its unique properties were based on a study of kinesiology.
Kinesio® Tex Tape is used to
  • Re-educate the neuromuscular system
  • Reduce pain
  • Optimize performance
  • Prevent injury
  • Promote improved circulation and healing
…Kinesio® Tex Tape is used to treat anything from headaches to foot problems and everything in between.
As to the inspiration behind the tape, Kenzo Kase states, “Our pain sensors are located between the epidermis and the dermis, the first and second layers of your skin, so I thought that if I applied tape to the pain, it would lift the epidermis slightly up and make a space between the two layers.”
To date, the main study that is often cited seeming to indicate that the Kinesio tape actually does any of these things better than a placebo is The Clinical Efficacy of Kinesio Tape for Shoulder Pain: A randomized, Double-blinded, Clinical Trial.  Unfortunately for Kinesio, there are quite a lot of problems with the way this study was done and even then the results don’t say what many media outlets are saying it does.
The first questionable aspect of the study is the fact that its primary author is a certified Kinesio taping  practitioner and someone who has applied for two patents for Kinesio-type tape.  Granted, in a study like this, you need a Kinesio expert to apply the tape, but it brings up the question of bias when the primary author has great interest in the study providing a positive result.  It would be better to simply hire a Kinesio expert to apply the tape and have independent parties actually perform the study.
Nevertheless, just because a certified Kinesio Taping practitioner was the primary author, if his methods were sound, we can’t throw out the results altogether.  So were there any other problems with the study?  In a word, yes.  64 people were initially eligible for this study, with applicable shoulder problems, but 22 were weeded out as “an attempt to eliminate subjects with pathology that would be less likely to respond to the selected taping intervention.”  While it is good to weed out subjects that aren’t fit for what you’re studying, weeding them out because “they would be less likely to respond to the selected taping intervention” sounds an awful lot like trying to fix the results, not selecting from “randomized” test subjects, as the title implies. Again, not conclusively showing bias, as maybe they really did weed out subjects simply because they weren’t fit for the study, but their wording sounds fishy.  Further, such a small sample-size is also questionable, in terms of actually providing conclusive results, positive or negative, unless there was a clear, strong contrast between the control and the test subjects.
This brings us to the real problem with this study.  There is no control group.  Both the “control” group and the test subjects had Kinesio tape applied.  The only difference was that one group had the tape correctly applied, based on the methods taught to Kinesio taping practitioners, the other group had it incorrectly applied, but it was the same Kinesio tape both times.  This might be proper if studying the benefits of one method of applying the tape vs. another, but not to study whether the elastic tape actually does something or not.  Again, as with the small sample size, whether the results came out positive, negative, or inconclusive, one can hardly take them seriously in this context.
And, in fact, the “control” group showed similar results as the ones given the correct taping method.  Specifically, the final results of this study can be summed up (though in a much more glowing way in the paper, highlighting initial possible differences within the first 48 hours that went away after) as: some people got better, some people got worse with the correctly taped group, and some people got better and some worse with the incorrectly taped group.  Or, as they state in the paper, “The improvement noted in both groups makes it difficult to determine any specificity of effect the intended therapeutic tape application may have had over the sham application for all outcome measures in this study.”
Despite the results explicitly being inconclusive, the small sample size, the potential bias of the author, and the lack of control group, this paper is often cited in the media as conclusively showing the tape was beneficial for helping with shoulder problems.
I was going to write about a few additional studies on the effects (or often lack thereof) of Kinesio tape, but this article’s already about 10 times longer than I anticipated it would be and I’m guessing there are about zero people that made it this far. But just in case I’m wrong, I’ll refer you few brave souls that waded through the last 1500 words or so, and for some odd reason want more,  to several linked studies at the top of the References below if you’d like to read up more on studies pertaining to Kinesio tape, including one such study that simply looked at 97 other studies on Kinesio tape’s “effectiveness”.  For the most part, they all seem to conclude with something to the effect of “Use of the tape doesn’t seem to produce clinically significant results, but more rigorous testing is needed to be sure.”  But a few are very slightly more positive, leaning towards thinking there is at least some benefit, even if not what the company claims, though again tending to state that more rigorous testing is needed to be sure and to test whether any type of tape would have the same benefit.
So in the end, is Kinesio tape actually beneficial with respect to “reducing pain, optimizing performance, preventing injury, promoting improved circulation and healing, and re-educating the neuromuscular system”?  Probably not, at least not for all those claims, but the placebo effect can’t be ignored completely in terms of perhaps providing some benefit to athletes, if they believe the tape works. And, who knows? Maybe someday someone will prove that Kinesio tape really is beneficial beyond what would be expected with the placebo effect, possibly even lining up with some of their claims! Stranger things have happened and the use of an elastic tape to help support inflamed or sore body parts as they move seems like it probably could be helpful, just perhaps not at treating “anything from headaches to foot problems and everything in between”.
As Dr. David Geier, orthopedic surgeon and director of sports medicine at the Medical University of South Carolina stated,  “If there is structural damage like a torn ACL or meniscus, it’s not going to be effective; after all, it’s tape.”

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