ORIGINAL ARTICLE

The Effect of Addition Kinesio Taping to McKenzie Exercise in Patient

with Chronic Mechanical Low Back Pain
MAYA PUSPA RINI1,2, RUDY HANDOYO1,2
1
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
2
Dr. Kariadi General Hospital, Semarang, Indonesia
Correspondence to Maya Puspa Rini, Email: [email protected]

ABSTRACT
Background: Chronic mechanical low back pain is considered a common problem and can reduce daily activities.
Kinesio taping is a tape which has similar elasticity to skin. It designed to support lower back, improve postural
alignment and reduce stress on the spine during activity.
Aim: To investigate the effect of addition kinesio taping to McKenzie Exercise for functional status in chronic
mechanical low back pain patient.
Method: Randomized, controlled trial. Thirty patients with chronic mechanical low back pain was recruited.
Participants were allocated into intervention group (n=15) received kinesio taping 7 times for 4 weeks and
McKenzie Exercise 3 times a week for 4 weeks and control group (n=15) received McKenzie exercise 3 times a
week for 4 weeks. Visual Analog Scale (VAS) and Roland Morris Low Back Pain and Disability Questionnaire
(RMDQ) were used to evaluate functional status before and after intervention.
Results: The improvement of RMDQ score was greater in intervention group receiving Kinesio Taping and
McKenzie (90.44 ± 9.58) than the control group (67.99 ± 7.84). There was a significant different for RMDQ score
in intervention group compared with control group (p=0,000).
Conclusion: In this study, the functional status in patients with chronic mechanical low back pain who received
kinesio taping with McKenzie exercise was better than those received McKenzie only.
Keywords: low back pain, kinesio taping, McKenzie exercise, functional status

INTRODUCTION and less restriction of mobility than conventional tape. Four

beneficial effects have been claimed for KT: normalisation
Low back pain (LBP) is one of the most common of muscular function, increase in lymphatic and vascular
musculoskeletal disorders, up to 80% of individuals flow, reduction in pain and contribution to correcting
reporting LBP at some point in their life1. Mechanical LBP is possible joint misalignments, although the extent to which
the general term that refers to any type of back pain these mechanisms contribute to any clinical effects is
caused by strain on muscles of the vertebral column and unknown6.
abnormal stress2. Mechanical LBP has been a major public The result from Paolini et al. 7 study showed
health burden for many years, responsible for substantial reductions in pain and disability over the 4-week
work disability and increase healthcare costs. Chronic LBP intervention period yet no statistically significant differences
produces mobility restriction, long-term disability, and between groups. This suggests that KT may have similar
quality of life impairment. There are many causes of LBP, it acute effects as exercise for chronic LBP, although more
sometimes occurs after a specific movement such as lifting precise estimates are required. In the other studies from
or bending. Aging causes degenerative changes in the Sanchez et al. 8, KT reduced disability and pain in people
spine. These changes can start in 30 years old or younger with chronic non-specific LBP, but these effects may be too
and can make LBP, especially if overdo our activities3. small to be clinically worthwhile.
The prevalence of chronic LBP in Asia is 36.8 – McKenzie method (MDT) is a treatment system
69.7%, in 2014 from study at RS Dr Hasan Sadikin developed by New Zealander physiotherapist Robin
Bandung is 35.7%4. The incidence of chronic LBP found at McKenzie, which consists of evaluation, treatment and
age 30-55 years and there was no difference of the ratio prophylaxis stages, with the following bases: 1)
between men and women5. classification of disorders related to spine and extremities;
Treatment for LBP depends on the diagnosis. If pain 2) centralization phenomenon and it reverse
persists or worsens, more involved diagnostic and surgical (peripheralization); 3) classification of patients according to
procedures may be recommended. Rest for a few days three mechanical or non-mechanical syndromes of
allows injured tissue and even nerve roots to begin to heal, derangement, dysfunction or postural; 4) emphasis on
which in turn will help relieve mechanical lower back pain. education and active patient involvement. MDT focuses on
Heat and ice packs help relieve most types of LBP by the spine and its peripheral joints and is based on solid
reducing inflammation. Medications a wide variety of over principles aiming at an accurate evaluation to get the
the counter and prescription medications is available to determining mechanical diagnosis to develop a specific
help reduce symptoms of lower back pain3. treatment adequate for each patient9.
Kinesio Taping (KT), developed by Kenzo Kase in the The result of Ibrahimaj10 study in 2015, McKenzie
1970s, is a technique that has been used in the clinical method increases the mobility and reduces the pain in the
management of people with chronic back pain. The tape, lumbar region more on sub-acute stage. Short-term
which is attached to the skin, is thinner and more elastic treatment of patients, (on subacute and chronic stage) with
than conventional tape. It can be stretched to 120–140% of the McKenzie method is more effective in reducing pain.
its original length, producing a lesser mechanical restraint

P J M H S Vol. 14, NO. 3, JUL – SEP 2020 1256

 Effect of Addition Kinesio Taping to McKenzie Exercise

McKenzie method is most effective in patients in sub-acute statistically analyzed using Statistical Package of the Social
stage. Sciences (SPSS) version 25.0. Descriptive data analysis
There are few studies that investigate the effect of KT showed the mean of the assessed parameters, which
on functional status, especially in chronic mechanical LBP expressed as mean ± SD. Data obtained from both groups
so this study aimed to assess the effect of addition KT to pre- and post-intervention (at 4 weeks) regarding functional
McKenzie exercise for functional status in chronic status was evaluated by Roland Morris Low Back Pain and
mechanical LBP patient. Disability Questionnaire (RMDQ) and pain was evaluated
using Visual Analog Scale (VAS) were statistically analyzed
MATERIAL AND METHODS and compared using independent t-test (normal distribution
data) or Mann Whitney (abnormal distribution data). Data
Design and Samples: This study was a randomized was considered significant at p < 0.05.
controlled pre and post experimental conducted in Physical
Medicine and Rehabilitation Department of one referral RESULTS
hospital in Semarang from August to September 2017.
Thirty subjects who met the eligibility criteria were included This study consisted of 30 subjects with mechanical low
after taking written informed consent. back pain, 11 males and 19 females. The average age of
The inclusion criteria were: subject with chronic the subjects in intervention group was 34.9±5.6 (Mean
mechanical LBP, duration > 12 weeks; age between 25 – Standard Deviation). No statistically significant differences
40 years; Schober test < 5 cm; normal BMI according WHO between the groups were found at baseline. The
criteria (18.50 – 24.99 kg/m2); fill out informed consent to descriptive analysis result of age, sex, onset, BMI, VAS
be included in the research and be able to understand the pre-intervention and RMDQ pre-intervention can be seen in
instruction in the McKenzie exercise. Subjects were Table 1.
excluded from the study if: systolic blood pressure > 200 VAS was evaluated in both groups before and after
mmHg and/or diastolic > 110 mmHg before exercise; had intervention. As can be seen from the table 2, the baseline
HNP, tumor in lumbar area; pregnant; had structural of VAS level in intervention group (4.5±0.52) was greater
scoliosis, kyphosis, leg length discrepancy; spine X-ray than control group (4.4±0.51). However, after further
(fracture, spondylolisthesis, osteoporosis, sacroilitis, coxitis, analysis using the Mann Whitney test, there was no
bamboo spine); had allergy or skin infection or wound in KT significant difference for baseline VAS level with p=0.539.
area; got KT within the last month; got manual therapy/ There was a significant difference on VAS level after 4
lumbar corset / analgetic/ physical modalities within the last weeks intervention (p=0.011) between both groups.
week; history of spine surgery, laparotomy in last 2 years; a Decreasing VAS level in intervention group and control
history/clinical signs of heart disease. All participants were group were statistically significant with p=0.000, from 4.5 ±
required to complete the entire intervention program. Drop 0.52 at baseline to 1.1±0.35 in intervention group and from
out criteria were: subjects who missed KT 1 time, missed 2 4.4±0.51 at baseline to 1.7±0.49. Although VAS level in
consecutive times of McKenzie exercise and absence of both groups decreased, the decrease of VAS level in
the evaluation test before and after intervention. intervention group (3.4±0.63) was higher than control group
Ethical clearance: This study obtained the ethical (2.7±0.70). There was a significant difference in the
clearance from the Ethics Committee of Medicine Research decrease of VAS level between both groups (p=0,021).
of Faculty of Medicine Diponegoro University/ Dr. Kariadi Comparison and difference of RMDQ score in
Hospital. All subjects provided an informed consent prior to intervention and control group are shown in table 3. At
their participation. baseline, RMDQ score in control group (9.2 ± 4.84) was
Treatments: The subjects were randomly divided into higher than the intervention group (8.47 ± 4.52) and there
intervention and control groups. Intervention group were was no significant difference for RMDQ score in both group
given a KT seven times for 4 weeks and Mc Kenzie (p=0.616). There was a change of RMDQ mean score
exercise 3 times a week for 4 weeks while the control after four weeks of intervention. Based on the statistical
group was given McKenzie exercise 3 times a week for 4 test, there was a significant difference in RMDQ score after
weeks. Five minutes warm up was given before the intervention (p=0.000). Although there was a decrease of
McKenzie exercise and five minutes cooling down was RMDQ score in both groups, the value of improvement
given after the McKenzie exercise. Functional status was RMDQ in intervention group (90.44 ± 9) was higher than
assessed before intervention and after four weeks of control group (67.99 ± 7). There was a significant difference
intervention. of value of improvement RMDQ between both groups
Data Analysis: Data were collected, tabulated and (p=0000).

Table 1. Characteristic of subjects

Variables Intervention group (n=15) Control group (n=15) p
Age (year) 34.9 ± 5.6 31.5 ± 6.0 0.126y
Gender 1.000z
- Male 6 (40%) 5 (33.3%)
- Female 9 (60%) 10 (66.7%)
Onset (week) 17.2 ± 4.6 15.1 ± 2.7 0.161y
BMI (kg/m2) 22.52 ± 1.05 22.36 ± 1.51 0.735x
VAS Pre-intervention 4.5 ± 0.52 4.4 ± 0.51 0.539y
RMDQ pre –intervention 8.5 ± 4 9.12 ± 4.9 0.616x
Significant (p<0.05); x Independent sample t test; y Mann Whitney test; z Chi Square test; BMI: Body Mass Index; VAS: Visual Analog Scale; RMDQ: Roland
Morris Low Back Pain and Disability Questionnaire

1257 P J M H S Vol. 14, NO. 3, JUL – SEP 2020

 Maya Puspa Rini, Rudy Handoyo

Table 2: Comparison and difference of VAS in intervention and control group

VAS Intervention group (n=15) Control group (n=15) p
Pre-intervention 4.5 ± 0.52 4,4 ± 0,51 0.539y
Post intervention 1.1 ± 0.35 1,7 ± 0,49 0.011*y
P value 0.000*w 0.001*w
∆ VAS 3.4 ± 0.63 2.7 ± 0.70 0.021*y
*Significant (p<0.05); y Mann-Whitney test; w Wilcoxon test; VAS: Visual Analog Scale

Table 3. Comparison and difference of RMDQ in intervention and control group

RMDQ Intervention group Control group p value
Pre-intervention 8.47 ± 4.52 9.2 ± 4.84 0.616y
Post-intervention 2.8 ± 1.15 0.87 ± 0.83 0.000*y
Value of improvement RMDQ 90.44 ± 9 67.99 ± 7 0.000*x
* Significant (p<0,05); x Independent sample t test; y Mann Whitney test; Value of improvement RMDQ = [(pre – post): pre] x 100%

Figure

Subject with chronic

mechanical LBP
Inclusion Exclusion
criteria criteria
Functional status assessment
with RMDQ for baseline

Randomization
(n=30)
Intervention Group Control Group
KT+MK (n=15) MK (n=15)

Drop out
criteria
Results

Functional status
assessment with RMDQ

Data Analysis
DISCUSSION groups with p-value of 0.021.
Kinesio tape exhibits its effects through the activation of
In this study, subjects of the intervention and control groups neurological and circulatory systems with movement. It is
were 15 subjects and there was no drop out. used to support the fascia, muscles, and joints while
Characteristics of the subjects were no significant offering unrestricted range of motion. KT is also suggested
differences between two groups in age, onset, BMI, pre- to reduce injury recovery time by decreasing pain. The
VAS, and pre RMDQ. These variables did not affect the benefits depending on the amount of stretch applied are to
difference of the results of this study. provide a positional stimulus through the skin, align fascial
Castro Sanchez et al11 compared the short-term tissues, to create more space by lifting fascia and soft
effects of KT vs placebo tape application to the lumbar tissues above area of pain/inflammation, to provide sensory
spine in chronic non-specific LBP. The result was KT stimulation to assist or limit motion, and to assist in the
reduced disability and pain in people with chronic non- removal of oedema by directing exudates toward a lymph
specific LBP, but these effects may be too small to be duct. Free-ending unmyelinated nerve fibres are abundant
clinically significant8. Other study examined the effect of KT around joint capsules, ligaments, and the outer parts of the
in improving pain and function in 8 subjects with non- intraarticular meniscus. They mediated pain when the joint
specific LBP, but it was not effective on disability and pain. strained and operated in excitatory reflex to protect the
That study was conducted on a small sample size of 8 capsule. Kinesio Tape can improve joint function by
hence it was not enough to get proper conclusion, whereas stimulating the proprioceptors within the joint by application
exercise therapy improved moderately the disability and over the ligaments and biomechanically supporting the
pain of participants. joint. The proprioceptors in the ligaments and joint capsules
In our study, a significant greater reduction in pain of provide information to the nervous system that allows the
the subjects with chronic mechanical LBP was obtained musculoskeletal system to provide the appropriate
immediately after treatment in intervention group. The perception of support and movement to the injured joint
result was significant when we compared VAS of both and provide feedback into the tissues/joints they heal2,6,7,12.

P J M H S Vol. 14, NO. 3, JUL – SEP 2020 1258

Effect of Addition Kinesio Taping to McKenzie Exercise

The best estimate effect of KT in pain in this study REFERENCES

(improvement of 3,4 cm on a 10-cm VAS) was higher than
the minimum clinically significant effect from Hagg et al.13 1. Walker BF, Muller R, Grant WD. Low back pain in Australian
adults: Prevalence and associated disability. J. Manip Physiol
study in 2003 (2 cm). Although the effect on pain was mild, Ther 2004; 27: 238-44.
it was long-lasting, being sustained for four weeks after the 2. Bae SH, Lee JH, Oh KA, Kim KY. The effects of kinesio taping on
end of the therapy. The mechanism by which four weeks of potential in chronic low back pain patient’s anticipatory postural
taping would cause a long-lasting reduction in pain was not control and cerebral cortex. Journal of physical therapy science
2013; 25(11): 1367.2
clear. Perhaps the week of taping engendered a greater
3. Sathya P, Ramaksrishnan KS, Phadke SD, Jena R. Comparison
confidence in the participants to remain active despite their of Kinesio Taping with McKenzie and Only McKenzie Technique
pain. Perhaps the taping gave the participants a greater in the Treatment of Mechanical Low Back Pain. International
awareness of the back while moving, thus preventing Journal of Therapies and Rehabilitation Research 2016; 5: 28-32.
movements that were detrimental to the healing of the 4. Patrianingrum M, Oktaliansah E, Surahman E. Prevalensi dan
Faktor Risiko Nyeri Punggung Bawah di Lingkungan Kerja
affected lumbar tissues. Pain could prevent people for
Anestesiologi Rumah Sakit Dr. Hasan Sadikin Bandung
doing activity, so this also affects the functional status. [Prevalences and risk factors of low back pain in anesthesiology
Decrease of RMDQ score showed in both groups, but working environment of Hasan Sadikin Hospital]. Jurnal Anestesi
the value of improvement RMDQ in intervention group Perioperatif, 2001; 3(1): 47-56.
(90.44±9) was higher than control group (67.99±7). When 5. Meliala L. Pathophysiology of Pain in Low Back Pain. In: Widjaja,
S.B.S, et al, editor. KONAS V PERDOSRI. Semarang:
the result of RMDQ both groups were compared, it was
PERDOSRI; 2001: 100-110.
significantly improved (p=0.000). The components of the 6. Kase K, Wallis J, Kase T. Clinical therapeutics applications of the
scale: pain; activities like sitting, standing, walking, stair Kinesio Taping method. Tokyo: Ken Ikai; 2003
climbing, sleeping, dressing, transferring; appetite; and 7. Paolini M, Bernetti A, Fratocchi G, Mangone M, Parrinello L,
emotion have effectively improved in KT with McKenzie Cooper MP. Kinesio Taping applied to lumbar muscles influences
clinical and electromyographic characteristics in chronic low back
than only with McKenzie technique.
pain patients. European Journal of Physical and Rehabilitation
There were no serious side effects of KT, it was Medicine. 2011; 47: 237–244.
simple, did not require special equipment and could be 8. Castro-Sánchez AM, Lara-Palomo IC, Matarán-Peñarrocha GA,
received by participants well. This was demonstrated by Fernández-Sánchez M, Sánchez-Labraca N, Arroyo-Morales M.
the enthusiasm and absence of drop out during the study. Kinesio Taping reduces disability and pain slightly in chronic non-
specific low back pain: a randomised trial. Journal of
The limitations of this study were short duration of
Physiotherapy 2012; 58(2): 89-95.
intervention and subjectivity of RMDQ. Further research is 9. Machado LA, de Souza MV, Ferreira PH, Ferreira, ML. The
suggested on outcomes after KT applications for longer McKenzie method for low back pain: a systematic review of the
time periods. literature with a meta-analysis approach. Spine 2006; 31(9): 254-
62.
10. Ibrahimaj A, Deliu S, Miftari S. Effectiveness of The McKenzie
CONCLUSIONS Method in The Treatment of Low Back Pain in Subacute and
Chronic Stage. Research in Physical Education, Sport and Health
Subjects with chronic mechanical LBP had significantly 2015; (4): 79-86
greater in reducing pain and improving functional status 11. Goinzalez Enciso JR. Does kinesio taping improve the
obtained after treatment of addition KT to McKenzie functionality and pain relief of people with non-specific low back
exercise rather than McKenzie exercise only. pain? Evidence Based Practice 2009; 3(2).
Acknowledgements: There is no conflict of interest in the 12. Campolo M, Babu J. A comparison of two taping techniques
(Kinesio and McConnell) and their effect on anterior knee pain
process of study. during functional activities. International journal of sports physical
therapy 2013; 8(2): 106-110.
13. Hagg O, Fritzell P, Nordwall A. The clinical importance of
changes in outcome scores after treatment for chronic low back
pain. European Spine Journal 2003; 12: 12–20

1259 P J M H S Vol. 14, NO. 3, JUL – SEP 2020