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Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review
Journal of Hand Therapy xxx (2019) 1e9
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Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review Taha Ibrahim Yildiz MSc, PT a, *, Birgit Castelein PhD, PT b, Gulcan Harput PhD, PT a, Irem Duzgun PhD, PT a, Ann Cools PhD, PT b a b
Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
a r t i c l e i n f o
a b s t r a c t
Article history: Received 15 September 2018 Received in revised form 3 March 2019 Accepted 4 March 2019 Available online xxx
Study Design: This is a systematic review. Introduction: Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear. Purpose of the Study: The purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics. Method: MEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment. Results: Eleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles. Discussion: Scapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial. Conclusion: The results of the studies indicated that scapular corrective taping might alter the 3dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts. Ó 2019 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
Keywords: Scapula Taping Electromyography Shoulder Scapular kinematics
Introduction Scapular stability is defined as the coordinated motion of the scapula during the coupled movements with the humerus, which is
Conflict of interest: No funding has been received from any private or government institution. * Corresponding author. Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey. Tel.: þ90 3123051576 186; fax: þ90 3123052012. E-mail address: [email protected] (TahaI. Yildiz).
essential for proper shoulder activities.1 The scapula moves in a complex 3-dimensional motion pattern during upper extremity movements (internal-external rotation, upward-downward rotation, and anterior-posterior tilt). The periscapular musculature is primarily responsible from the scapular motion and stability as the scapulothoracic joint is a “physiological joint” rather then a “true joint”.2 Scapular stability and scapular dysfunction are one of the most common topics studied in the shoulder rehabilitation, but its role in the shoulder problems is not clearly defined yet.3-5 Previous researchers reported alterations in the scapular orientation on patients with shoulder pathologies, such as rotator
0894-1130/$ e see front matter Ó 2019 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jht.2019.03.001
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cuff (RC) tendinopathy,6 shoulder impingement syndrome,7 adhesive capsulitis,8 shoulder instability,9 and other shoulder pathologies.10 In addition, patients with shoulder pathologies may also display abnormal periscapular muscle activities.11,12 The alterations in the electromyography (EMG) activity of the periscapular muscles (serratus anterior [SA] and upper, middle, and lower parts of trapezius [UT, MT, and LT]) were found to be related to abnormal scapular orientation.5,7,13 The scapular dysfunction might be both the cause and consequence of the shoulder problems. Some studies suggest that abnormal scapular motion may not be referred as scapular dysfunction because the prevalence of scapular dysfunction can be similar on both patients with shoulder problems and healthy population.1,14,15 Despite this debating issue, studies revealed positive outcomes of the scapula-focused rehabilitation programs on patients with shoulder and neck pain.16-19 Therefore, improving the scapular stability is still one of the main goals during the management of the shoulder problems.5,18,20,21 Therapeutic taping has been widely used in the management of shoulder problems to decrease the pain and increase the functional outcomes. Although several mechanisms had been proposed for the effectiveness of the taping techniques, the exact mechanism has not been enlightened yet. It is thought that taping may alter the proprioceptive input from the peripheral tissues22,23 and improves the neuromuscular control.22,24-26 In addition, some researchers reported that taping might increase the muscle force,27 and some reported that the positive outcomes of taping may arise from the placebo effects.28 This poor understanding has led to a number of taping techniques applied in the clinics. Scapular corrective taping is one of the most popular taping techniques performed on patients with shoulder problems to decrease the symptoms and increase the function.29 Corrective taping is thought to improve the biomechanical alignment of the shoulder girdle and scapular stability, which enhances the length-tension relationship of the surrounding musculature.29,30 Improvement of the shoulder symptoms with scapular corrective taping was also explained by the increase in the subacromial space.31,32 Yet, it still not clear how does the corrective taping affect the shoulder girdle and improve patient outcomes on patients with shoulder problems. Therefore, we aimed to systematically review and summarize the effects of scapular corrective taping on the EMG activity of the periscapular muscles and 3-dimensional scapular kinematics on both patients with shoulder problems and healthy subjects. Methods This systematic review was designed according to the guideline of Preferred Reporting Items for Systematic Reviews and MetaAnalyses Statement.33 No review protocol was registered for this systematic review.
Table 1 Keywords used in the search strategy PubMed (MEDLINE) search strategy (((((“Shoulder” [Mesh] OR “shoulder Injuries” [Mesh] OR “Scapula” [Mesh] OR “rotator Cuff” [Mesh] OR shoulder OR scapula OR rotator cuff OR shoulder posture OR posture OR impingement) OR (scapular kinematics OR scapular orientation OR 3-dimensional scapular kinematics)) AND (“Electromyography” [Mesh] OR electromyography OR EMG)) OR (subacromial space OR acromiohumeral distance)) AND (“Athletic Tape” [Mesh] OR kinesiotaping OR taping OR tape OR kinesio tape OR kinesiological tape)) Web of science search strategy (((Shoulder OR scapula OR scapular OR scapulothoracic OR acromiohumeral OR subacromial OR shoulder posture OR postural OR posture) AND (taping OR tape OR kinesiotaping OR kinesiotape)) AND ((electromyography OR EMG) OR ((scapula OR scapular) AND (kinematics OR orientation OR 3-dimensional OR position OR positioning OR rotation OR tilt OR tilting))))
The literature was initially scanned for a systematic review concerning the effectiveness of corrective taping on 3-dimensional scapular kinematics and EMG activity of the periscapular muscles, and no review was found. A comprehensive literature search on the MEDLINE and Web of Science databases was conducted with specific MeSH terms and free-text words (Table 1). The databases were searched until April 2018, and the search was only limited to those involving humans. Two authors developed the search strategy (T.I.Y. and B.C.), and the first author conducted the literature search. In addition, hand searching was performed (T.I.Y.) by searching previous literature reviews. Study selection Two reviewers (T.I.Y. and G.H.) independently assessed the title and abstracts of the potential relevant studies identified during the initial search. The articles that met the following eligibility criteria were included to the study: (1) included healthy subjects or patients with shoulder problems, (2) used rigid or elastic taping materials, (3) applied taping techniques aiming to correct scapular positioning (corrective taping), (4) evaluated the 3-dimensional scapular kinematics or EMG of periscapular musculature, and (5) published in English. Studies were excluded if they conducted their research on patients with neurological disorders or musculoskeletal problems other than shoulder pathologies or if they included the taping techniques only aiming to inhibit or activate the periscapular muscles without any active or passive scapular correction. Two reviewers (T.I.Y. and G.H.) independently applied all criteria to the full text of the articles that passed the first screening. Any disagreement between reviewers was resolved by discussion, and if a consensus could not be reached, a third reviewer (B.C.) was consulted for final decision.
Eligibility criteria, search strategy, and information sources
Quality assessment
The research question and search strategy were derived from the PICOS methodology (Patients, Intervention, Comparison, Outcome, Study design). Studies were included in the present review if they investigated the effects of scapular corrective taping using rigid or elastic tape (intervention) on the EMG activity of periscapular muscles or 3-dimensional scapular kinematics (outcome) on patients with shoulder problems or healthy subjects (population) and compared the results with the baseline measurements or those of the control groups (outcome). Studies had to have a randomized control, nonrandomized control or experimental before-after design (study design).
The methodological quality of eligible studies was assessed using the criteria outlined in the Cochrane Effective Practice and Organization of Care (EPOC) guidelines for assessing risk of bias in randomized controlled trials (RCTs), non-RCTs, and controlled before-after (CBA) studies.34 EPOC uses 9 criteria for the assessment, and studies were scored as “low risk”, “high risk”, or “unclear risk” for each criterion during the assessment. The criteria were as follows: (1) random assignment of participants, (2) allocation concealment, (3) blinding of participants, (4) blinding of outcome assessors, (5) incomplete outcome data, (6) selective outcome reporting, (7) similar baseline measurements between study and
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Methodological quality
Table 2 Risk-of-bias analysis of the included studies Studies
1
2
3
4
5
6
7
8
9
Level of evidence
Ackerman et al Colls et al Herzeelee et al Leong et al Lin et al Selkowitz et al Shaheen et al 2013 Shaheen et al 2015 Shih et al Smith et al Takasaki et al
NA NA NA NA NA NA NA NA þ NA NA
NA NA NA NA NA NA NA NA ? NA NA
þ ?
þ
þ þ þ þ þ þ þ þ þ þ þ
þ þ þ þ þ þ þ þ þ þ þ
NA NA NA NA NA NA NA NA NA NA
NA NA NA NA NA NA NA NA þ NA NA
þ þ þ þ þ þ þ þ þ þ þ
Level Level Level Level Level Level Level Level Level Level Level
IV IV IV III IV IV IV IV III IV III
(1) Random sequence generation, (2) Allocation concealment, (3) Blinding of participants and personnel, (4) Blinding of outcome assessment, (5) Incomplete outcome data, (6) Selective outcome reporting, (7) Similar baseline outcomes measurement, (8) Similar baseline characteristics, (9) Protection from contamination. NA ¼ nonapplicable; þ ¼ low risk; ¼ high risk; ? ¼ unclear risk.
control group, (8) similar baseline characteristics of the participants between groups, and (9) protection of the data from contamination. However, four of the criteria (1, 2, 7, and 8) were nonapplicable in the CBA studies included to this review because of their natural design. Therefore, they were scored as “nonapplicable” during the assessment of the risk of bias. Two of the authors (T.I.Y. and G.H.) independently assessed the methodological quality of the studies. Depending on the design of the study and methodological quality, the level of evidence was determined according to the suggestions given in the study by Wright et al,35 in which the studies are classified from level I to level V evidence. Level I evidence represents the highest quality of studies, which are randomized control trials and systematic reviews of level I studies, and level V evidence represents the lowest quality studies, which accounts for expert opinions.35 Any disagreements in the quality assessment and evidence level of the studies were further discussed in a consensus meeting. If no consensus was reached, a third reviewer (B.C.) was consulted (Table 2). Data extraction The first reviewer extracted the data from the eligible studies, and another reviewer (G.H.) checked the extracted data using a standardized spreadsheet.36 Information regarding the (1) study design, (2) study population (sample size, pathology), (3) demographics of the participants (gender, age), (4) taping material, (5) taping techniques, (6) functional task and outcome measurements, and (7) the results of the intervention was collected from the articles and is presented in the evidence table (Table 3). When there were unclear results of a study or a disagreement between reviewers, the article was further discussed. Results Study selection After the initial search with specific MeSH terms on MEDLINE and Web of Science, a total of 155 articles were identified. Also 2 studies were discovered after hand searching. Of those studies, 11 articles met the inclusion criteria after the removal of the duplication and the first (title and abstracts) and second (full texts) screenings (Fig. 1). Ten of these studies were CBA experimental studies, and one of them was a randomized control study.
The two reviewers (TIY and GH) agreed in 95.4% of EPOC items (103/108) during the quality assessment of the studies. We did not report the total score of the studies in this review because Cochrane Collaborations suggest that each item needs to be considered separately regarding their importance because all items do not have the same importance in a study37 (Table 2). For the level of evidence analysis, there was 100% agreement between the two reviewers. Three studies were classified as level III evidence, and 9 studies were classified as level IV evidence (Table 2). Study characteristics The sample size of the included studies varied from 8 to 42 subjects. Five studies recruited patients with shoulder problems (subacromial impingement syndrome and rotator cuff tendinopathy),25,26,30,38,39 and six recruited healthy subjects.22,40-45 Eight studies used rigid taping materials and three studies used elastic ones for the scapular taping. In eight studies, the EMG activity of the periscapular muscles was the main outcome, whereas the 3dimensional kinematics was the main outcome in five studies. The basic characteristics of the studies are summarized in Table 3, and the taping techniques were illustrated in Figure 2. EMG activity of the periscapular muscles Studies mostly focused on the EMG activity of UT, LT, MT, and SA muscles for the assessment of the effects of scapular taping corrective during the shoulder tasks. In addition, the EMG activities of anterior deltoid (AD), sternocleidomastoideus (SCM), and rhomboids muscles were also evaluated. The corrective taping was observed to have same effects on both patients with shoulder problems and healthy subjects. Of the 8 studies investigating the effects of scapular taping on the EMG activity of periscapular muscles, 6 reported alterations in the activity pattern or onset timing of at least one of the periscapular muscles after applying scapular tape on healthy subjects22,40,45 or patients with shoulder problems.25,26,38 In contrast, two studies did not find a significant effect of taping on the EMG activity of periscapular muscles on patients with shoulder problems39 or healthy subjects.41 Seven studies investigated the alterations in the EMG amplitude of the UT during shoulder tasks. Four studies reported decreased activity in the UT during arm elevation,25,26 a typing task,45 placing an object on a shelf,26 and raising the arm to a specific point while being blindfolded22 after the scapular corrective taping. In contrast, Ackermann et al40 found increased activity in the left UT and no difference in the right UT while playing a violin with corrective taping. In addition, Cools et al41 and Shih et al39 also reported no effects of taping on the activity of the UT during arm elevation. Six studies measured the effects of corrective taping on the activity of the LT. Five studies reported no effects of taping on the activity level of LT during arm elevation,25,39,41 raising the arm to a specific point while being blindfolded,22 and typing task.45 However, Selkowitz et al26 found increased activity in the LT muscle during shelf task, and they also reported no effects of taping during arm elevation. Two studies reported no effects of corrective taping on the activity of the MT during arm elevation41 and playing a violin.40 For the SA activity, 3 studies revealed no effects of corrective taping during arm elevation26,39,41 and the shelf task.26 In contrast, Lin et al22 found increased SA activity with corrective taping during raising the arm to a specific point while being blindfolded. It was also shown that scapular corrective taping decreased the activity of
4
Table 3 Summary of the included studies Authors and study design
Population
Demographics and tested extremity
Taping material and taping technique
Placebo
Functional task
Outcome measurements
Conclusion
Ackermann et al (2002)
8 professional violinists
3 male and 5 female; age: between 28 and 47 years; bilateral upper extremity was tested
Rigid tape; I-band from acromion to T4 vertebra and another I-band from acromion to T8 vertebra with active scapular correction
-
The performance of violinists during 3 different excerpts.
Cools et al (2002)
20 healthy subjects
20 male; age: between 20 and 25 years; the dominant side was tested (15 right, 5 left)
-
Arm elevation in sagittal and frontal planes with and without resistance
Taping increased the activity of left UT. Taping has no effect on the activity of right UT and both scapula retractors and SCM during violin performance Taping has no effect on the EMG activity of the periscapular muscles.
Herzeele et al (2013)
25 elite handball players.
20 female; age: 18 1.5 years; dominant side was tested (18 right, 7 left)
-
Arm elevation in sagittal, scapular, and frontal planes.
Leong et al (2016)
26 male volleyball players with RC tendinopathy.
26 male; age: 23.6 3.3 years; the affected shoulder was tested
Rigid tape; I-band from the coracoid process to the thoracic spine crossing over the trapezius muscle with passive scapular correction Elastic tape; I-band from the coracoid process to the thoracic spine crossing over the trapezius muscle with passive scapular correction. Rigid tape; I-band from clavicula to the T12 vertebra crossing over the trapezius muscle with full tension and active scapular correction (scapular retraction and depression).
EMG activity of both UT, scapular retractors (MT and rhomboids) and SCM with and without taping EMG activity of UT, MT, LT, and lower part of the SA muscle with and without taping Three-dimensional scapular kinematics with and without taping
A placebo control tape with the same material and to the same locations without tensioning the tape
Arm elevation in the frontal plane.
The activity onset of UT, MT, LT, and SA muscles Three-dimensional scapular kinematics with scapular taping, placebo taping, and without taping.
Lin et al (2011)
12 healthy subjects
10 male and 2 female; age: 23.7 4.8 years; no information about which side was tested
-
Positioning the arm in a targeted end/midrange point while being blindfolded.
EMG activity of UT, LT, SA, and AD muscles with and without taping
Selkowitz et al (2007)
21 subjects with suspected SAIS.
11 male and 10 female; age: 42.8 years; the affected side was tested
-
Arm elevation in scapular plane and placing a 0.5-kg bottle on a shelf and lowering it.
EMG activity of UT, LT, SA, and infraspinatus muscles with and without taping
Shaheen et al (2013)
13 healthy subjects
5 male and 8 female; age: 23.6 1.7 years; the dominant side was tested (12 right, 1 left)
-
Arm elevations in the sagittal and scapular planes
3-dimensional scapular kinematics with and without taping
Rigid tape; I-band from T1 to T12 and another I-band from the center of scapular spine to the T12 vertebra with active scapular correction
Corrective taping increased the scapular UR, whereas it has no effect on scapular ER and PT Placebo taping have no effect on all scapular rotations. Both corrective and placebo taping improved the activity onset of the MT, LT, and SA muscles. Taping decreased the activity of UT and AD. Taping increased the activity of lower SA. Taping has no effect on the activity of LT. Taping decreased the activity of UT during arm elevation and shelf tasks. Taping increased LT activity during shelf tasks. Taping has no effect on the infraspinatus and SA muscles during arm elevation in scapular plane and shelf tasks. Taping increased scapular UR, ER, and PT on sagittal plane arm elevation. Taping increased scapular ER in scapular plane arm elevation Taping has no effect on scapular UR and PT on scapular plane arm elevation
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Elastic tape; I-band from the medial clavicula to T12 vertebra crossing over the trapezius muscle with active scapular correction (scapular retraction and depression). Rigid tape; I-band from the clavicula to the paraspinal area at the midsections of the scapula by crossing over the UT muscle with passive scapular correction.
Taping increased the scapular PT and UR. Taping has no effect on scapular ER
11 patients with SAIS
8 male and 3 female; age: 47.5 9.4 years; the affected side was tested
Rigid tape; I-band from T1 to T12 vertebrae and another Iband from the center of scapular spine to the T12 vertebra with active scapular correction.
-
Arm elevation and lowering in the sagittal and scapular planes.
3-dimensional scapular kinematics with and without taping.
Shih et al (2018)
30 athletes with SAIS
14 male and 16 female; age: group 1, 24.3 2.8 years; group 2, 23.3 3.3 years; the affected side was tested
Group 1: elastic tape; Y Band from origin to insertion of LT while arm flexed 90 and with maximum scapular protraction and I-band perpendicular to the UT muscle with full stretch during active scapular correction.
Group 2: Micropore tape; the tape was applied without stretching, during sitting in a relaxed posture.
Arm elevation in scapular plane
EMG activity of UT, LT, and SA muscles 3-dimensional scapular kinematics with and without taping
Smith et al (2009)
16 patients with SAIS
7 male and 9 female; age: 29.8 8.3 years; the affected side was tested
Rigid tape; I-band from 1/3 midpoint of clavicula and goes posteriorly to the T12 vertebra with passive scapular correction.
-
Arm elevation in scapular plane
EMG activity of UT and LT muscles with and without taping.
Takasaki et al (2015)
42 healthy subjects
20 male and 22 female; age: 38 11 years; the affected side was tested
Rigid tape; I-band from the midpoint of clavicula to T7 vertebra crossing over the UT muscle with passive scapular correction.
The same taping material to the same locations without tensioning the tape.
15 min of typing task on the desk while sitting on an adjustable chair.
EMG activities of UT and LT muscles with scapular taping, placebo taping, and without taping.
Taping increased scapular ER and AT during sagittal plane arm elevation and lowering. Taping had no effect on scapular UR Taping increased scapular AT during arm elevation and lowering in scapular plane. Corrective taping increased scapular PT and UR, whereas placebo taping had no effect on scapular rotations Both taping techniques had no effect on scapular ER Both corrective and placebo taping had no effect on the EMG activity of UT, LT, and SA muscles. Taping decreased the activity of UT, whereas it has no effect on LT. Taping has no effect on the UT-LT activity ratio on patients with SAIS. Both corrective and placebo taping decreased the activity of UT. There was no difference between the two taping techniques. Both taping techniques had no effect on the activity of LT.
EMG ¼ electromyography; UT ¼ upper trapezius; MT ¼ middle trapezius; LT ¼ lower trapezius; SCM ¼ sternocleidomastoids; SA ¼ serratus anterior; UR ¼ upward rotation; ER ¼ external rotation; PT ¼ posterior tilt; AT ¼ anterior tilt; SAIS ¼ subacromial impingement syndrome; RC ¼ rotator cuff.
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Shaheen et al (2015)
5
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Studies identified through MEDLİNE and WOS =155
Studies identified through hand search =2
157 studies
After removing duplicates = 109
After first screening (based on title and abstract) = 21
Exclusion Criteria Population Intervention Outcome Low methodological quality No full-text
Exclusion Criteria Population Intervention Outcome Design Language
Full-text screening
Included articles to the systematic review = 11 Fig. 1. PRISMA flow diagram. PRISMA ¼ Preferred Reporting Items for Systematic Reviews and Meta-Analyses; WOS ¼ Web of Science.
AD muscle during raising the arm to a specific point while being blindfolded.22 In contrast, it had no effect on the SCM activity while playing a violin40 and infraspinatus26 muscles during the shelf task and arm elevations.
One study investigated the effects of scapular corrective taping on the activity onset of the periscapular muscles.38 They found that both placebo and corrective taping improve the activity onset of the MT, LT, and SA muscles, but it has no effect on the UT.
Fig. 2. Illustrations of the taping techniques used in the included studies: (A) Ackermann et al; (B) Herzeele et al and Lin et al; (C) Shaheen et al 2013 and 2015; (D) Cools et al, Leong et al, and Smith et al; (E) Shih et al; (F) Selkowitz et al and Takasaki et al.
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Three-dimensional scapular kinematics Five studies investigated the effects of scapular taping on the 3dimensional scapular kinematics during arm elevation in sagittal, scapular, and frontal planes. In general, there was an agreement among studies that scapular corrective taping may alter the 3dimensional scapular kinematics in both healthy subjects42,44 and patients with shoulder problems.30,38,39 Four studies reported an increase in the scapular upward rotation (UR) after corrective taping,38,39,42,44 whereas one study reported no effects of taping on the scapular UR.30 For scapular external rotation (ER), two studies found an increase in ER with corrective taping,30,44 whereas three studies found no effects of taping.38,39,42 Finally, three studies observed an increase in scapular posterior tilt (PT) with corrective taping,39,42,44 whereas one study observed a decrease in scapular PT30 after taping. In addition, one study reported no effects of corrective taping on scapular PT.38 When comparing the effects of corrective taping between patients with shoulder problems and healthy subjects, similar effects were observed for scapular UR and ER. However, the scapular PT was increased on healthy subjects with corrective taping, whereas it had no effects on scapular PT on patients with shoulder problems. Discussion The results of the present systematic review indicate that scapular corrective taping may alter the 3-dimensional scapular kinematics in both patients with shoulder problems and healthy subjects, whereas its effect on the EMG activity of the periscapular muscles is controversial. Studies mostly reported an increase in the scapular UR with corrective taping, whereas there is a debate about its effects on scapular ER and PT. For the EMG activity of the periscapular muscles, corrective taping may decrease the activity of the UT on both patients with shoulder problems and healthy subjects depending on the taping technique. However, most of the studies found no effects of corrective taping on the EMG activity of other periscapular muscles. Three-dimensional scapular kinematics There was a consensus among studies that scapular corrective taping alters the 3-dimensional scapular kinematics. All five studies reported changes in the scapular kinematics with corrective taping on both healthy subjects42,44 and patients with shoulder problems30,38,39 during arm elevations. However, there were some differences between the studies concerning the specific alterations in the 3-dimensional scapular kinematics after the taping. There was strong evidence that scapular corrective taping increases the scapular UR during arm elevation. There were three different taping techniques used for scapular correction, and all were observed to be effective for improving the scapular UR38,39,42,44 on both patients with shoulder problems and healthy subjects. Only Shaheen et al30 failed to demonstrate the effects of the corrective taping on the scapular UR on patients with shoulder pain. They recruited patients with impingement syndrome who also had abnormal kyphotic posture. Abnormal postural alignment of the upper trunk might possibly prevent observation of alterations in the scapular UR with corrective taping.30 Therefore, it can be concluded that stabilizing the scapula from anterior to posterior over the UT or from inferomedial to superolateral over the LT with active or passive scapular correction are both effective methods for enhancing the scapular UR, but the postural alignment may have a role on the effectiveness of the corrective taping.
7
The taping technique introduced by McConnel46 and Morin et al43 provided better improvement in scapular PT. Both techniques were designed to support the scapula posteriorly. Yet, only three studies used these taping methods, and two of them reported an increase in scapular PT,39,42 whereas one of them reported no effects of scapular taping on PT.38 Interestingly, the present study also revealed that corrective taping might increase the scapular PT on healthy subjects, whereas it has no effects on scapular PT on patients with shoulder problems. Alterations in the periscapular muscle activity or abnormal shoulder girdle biomechanics on patients with shoulder pain might affect the positive effects of the taping. However, whether the differences between the patients with shoulder pain and healthy subjects arise from the taping technique is not clear because different taping techniques were used in the studies. Therefore, these results are not sufficient to reach a conclusion whether corrective taping alters the scapular PT on both health subjects and patients with shoulder problems. The taping technique used by Shaheen et al30,44 provided an increase in scapular ER, whereas other taping techniques had no effects on scapular ER.38,39,42 The controversial results might arise from the differences in the taping materials because Shaheen et al30 used a rigid tape, whereas Herzeele et al42 and Shih et al39 used an elastic tape. Although Leong at al38 also used rigid taping material, they reported no effects of corrective taping on the scapular internal rotation. Leong et al38 and Shaheen et al30 adopted different taping techniques to improve scapular stability. Therefore, the taping technique may also be important for altering the scapular internal rotation, yet there is no sufficient information about which taping is more effective. In conclusion, scapular corrective taping may be used to improve scapular stability on both patients with shoulder problems and healthy subjects. Studies reported 0.9 to 5.9 improvement in scapular UR,38,39,42,44 2.8 to 4 improvement in scapular PT,39,42,44 and 1.9 to 2.9 increase in the scapular ER30,44 with corrective taping. These results indicate that corrective taping may help to decrease the symptoms of the patients with shoulder pain who were reported to suffer from abnormal scapular orientation and may help to improve shoulder performance on healthy subjects during sport activities. Yet, individuals’ needs should be well analyzed because different taping techniques may have different effects on the scapular motion.
Activity of periscapular muscles There was reasonable evidence that corrective taping might decrease the activity of the UT muscle on both patients with shoulder problems and healthy subjects depending on the taping technique. Of the 7 studies investigating the effects of corrective taping on the EMG activity of the UT, four of them found a decreased activity, whereas one of them found increased activity and two of them found no effects of corrective taping. Studies that reported decreased activity in the UT used a similar taping technique that was applied from acromion to the thoracic spine, aiming to pull the scapula posteriorly (Table 3).22,25,26,45 This technique may help to alter the biomechanical alignment of the shoulder girdle and enhance the length-tension relationship of the UT. Studies reported of decrease in the activity of the UT between 3.3% and 25% while using this technique.22,25,26,45 In contrast, studies that reported increased activity or no effects of corrective taping in the UT39,40 used different taping techniques. They might not be able to lead adequate biomechanical improvement to enhance the length-tension relationship of the UT. In conclusion, depending on the taping technique, the corrective may decrease the UT activity on both patients with shoulder problems and healthy subjects.
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There was strong evidence that corrective taping had no effect on the activity of the LT. Most of the included studies reported no effects of taping on the EMG activity of the LT during the arm elevation,25,26,39,41 raising the arm while being blindfolded,22 and typing tasks.45 Takasaki et al45 and Morissey et al27 suggested that the inhibitory or excitatory effects of taping may mainly result from the cutaneous input from the peripheral tissues. Our results partly support this hypothesis that studies that reported no effects of corrective taping on the LT applied a similar taping technique that provides no cutaneous input to the LT. Although Shih et al.39 and Smith et al.25 applied a scapular corrective tape and provided cutaneous input to the LT, they also found no change in the EMG activity of the LT. Therefore, there may be another factor that induces alterations in the activity of the muscles rather than the cutaneous input. Interestingly, Selkowitz et al26 found increased activity on the LT during shelf task after taping, whereas they also found no effects of corrective taping on the activity of the LT during arm elevation. This might be due to that muscles may have different activity patterns during different functional tasks.47 Therefore, it can be concluded that biomechanical features play a major role in altering the activity patterns of the muscles, and the corrective taping techniques applied in the included studies might not be able to alter the length-tension relationship of the LT enough to change its EMG activity. There was reasonable evidence that scapular corrective taping had no effect on the EMG activity of the SA during arm elevation26,39,41 and shelf task.26 Only, Lin et al22 reported an increased activity in the SA with corrective taping during raising the arm while being blindfolded. However, they used different shoulder tasks during the recording of the EMG data. The difference between studies may arise from the variability in the shoulder task. There was not enough information to interpret whether scapular corrective taping alters the EMG activity of the MT, AD, sternocleidomastoideus, and infraspinatus muscles. Two studies reported no effects of scapular taping during arm elevation41 and playing a violin.40 Only one study investigated the effects of scapular corrective taping on the EMG activity of SCM, infraspinatus, and AD muscles. It was found that corrective taping may increase the activity of the AD during raising the arm while being blindfolded,22 whereas it may have no effect on the activity of SCM during playing a violin41 and infraspinatus during the shelf task.26 Studies revealed that corrective taping had same effects on both patients with shoulder problems and healthy subjects concerning altering the activity of the periscapular musculature. Altering the biomechanical alignment of the shoulder girdle might have similar effects on periscapular muscles regardless of having shoulder problems or being healthy. In conclusion, it can be argued that whether the scapular corrective taping alters the EMG activity of the periscapular muscles is highly dependent on the taping technique. The taping technique proposed by McConnel46 which aims to pull the scapula posteriorly was shown to be effective for decreasing the EMG activity of the UT; however, it had no effect on the activity of other periscapular muscles. The effects of corrective taping on the EMG activity of the muscles were also task dependent such that a taping technique may alter the EMG activities of the muscles during a functional task, whereas it has no effect during another task. Therefore, altering the biomechanical alignment and the lengthtension relationship of the muscles may be the main factor to change the activity patterns of the periscapular muscles, but this effect is highly depended on the taping technique. Limitations One of the limitations of this review was that only studies that applied scapular corrective taping were included. Other studies
that investigated the effects of taping without scapular correction on the EMG activity of periscapular muscles and on the 3dimensional kinematics were excluded.48-51 Nevertheless, including those studies would adversely affect the homogeneity of this review. Another limitation was that all included studies were of level III or IV evidence. However, due to the research question (investigating the immediate effect of scapular taping on EMG activity and scapular kinematics), studies needed to be experimental; therefore, it was not possible to have a higher level of evidence. Third, only three studies performed placebo taping for the control group. Therefore, there was not enough information to interpret whether the scapular taping is effective in the same population. Although this systematic review only focused on the effects of scapular corrective taping on the activity of the periscapular musculature and the 3-dimensional scapular orientation, there are other taping techniques aiming to facilitate or inhibit the periscapular muscles without correction of the scapula. However, these are out of the topic of the present review as they would affect the homogeneity of this study and interfere with the results of corrective taping techniques. Yet, these taping techniques should also be investigated more thoroughly for their effects on scapular kinematics and periscapular musculature. Future directions There are still controversial results about the effects of corrective taping on the activity patterns of the periscapular muscles. Also, little information exists about the effects of corrective taping on the activity of the MT and LT because studies mostly focused on the UT and LT. In addition, although there are several scapular corrective taping techniques, there is a lack of knowledge about their superiorities to each other. Therefore, RCTs are needed to compare the effects of different taping techniques on periscapular muscles especially on MT and SA and scapular positioning. In addition, a meta-analysis that investigates the effects of scapular taping on the activity of the periscapular muscles and periscapular muscle activity could improve the understanding of the mechanism of the effects of the taping. Conclusion The current systematic review focused on the effects of scapular corrective taping on the EMG activity of the periscapular musculature and 3-dimensional scapular kinematics. In summary, it can be concluded that corrective taping may enhance the 3dimensional scapular orientation and decrease the activity of the UT. However, its effects on the EMG activity of the other periscapular muscles are rather controversial. The discrepancies among the included studies are thought to mainly arise from the methodological differences, especially due to the different taping techniques. References 1. McQuade KJ, Borstad J, De Oliveira AS. Critical and theoretical perspective on scapular stabilization: what does it really mean, and are we on the right track? Phys Ther. 2016;96(8):1162e1169. 2. Mottram S. Dynamic stability of the scapula. Man Ther. 1997;2(3):123e131. 3. Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48(8):692e697. bjsports-2013-092148. 4. Kibler BW, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11(2):142e151. 5. Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med. 2013;47(14):877e885. 6. Mell AG, LaScalza S, Guffey P, et al. Effect of rotator cuff pathology on shoulder rhythm. J Shoulder Elbow Surg. 2005;14(1):S58eS64.
T.I. Yildiz et al. / Journal of Hand Therapy xxx (2019) 1e9 7. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Therapy. 2000;80(3):276e291. 8. Rundquist PJ. Alterations in scapular kinematics in subjects with idiopathic loss of shoulder range of motion. J Orthop Sports Phys Ther. 2007;37(1):19e25. 9. Struyf F, Nijs J, Baeyens JP, Mottram S, Meeusen R. Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. Scand J Med Sci Sports. 2011;21(3):352e358. 10. Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90e104. 11. Struyf F, Cagnie B, Cools A, et al. Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. J Electromyogr Kinesiol. 2014;24(2):277e284. 12. Diederichsen LP, Nørregaard J, Dyhre-Poulsen P, et al. The activity pattern of shoulder muscles in subjects with and without subacromial impingement. J Electromyogr Kinesiol. 2009;19(5):789e799. 13. Huang T-S, Ou H-L, Huang C-Y, Lin J-J. Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. J Shoulder Elbow Surg. 2015;24(8):1227e1234. 14. Lawrence RL, Braman JP, LaPrade RF, Ludewig PM. Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. J Orthop Sports Phys Ther. 2014;44(9):636e645. 15. Plummer HA, Sum JC, Pozzi F, Varghese R, Michener LA. Observational scapular dyskinesis: known-groups validity in patients with and without shoulder pain. J Orthop Sports Phys Ther. 2017;47(8):530e537. 16. Hotta GH, Santos AL, McQuade KJ, de Oliveira AS. Scapular-focused exercise treatment protocol for shoulder impingement symptoms: three-dimensional scapular kinematics analysis. Clin Biomech. 2018;51:76e81. 17. Struyf F, Nijs J, Mollekens S, et al. Scapular-focused treatment in patients with shoulder impingement syndrome: a randomized clinical trial. Clin Rheumatol. 2013;32(1):73e85. 18. Saito H, Harrold ME, Cavalheri V, McKenna L. Scapular focused interventions to improve shoulder pain and function in adults with subacromial pain: a systematic review and meta-analysis. Physiother Theory Pract. 2018;34(9):653e 670. 19. Derakhshani A, Letafatkar A, Khosrokiani Z. Comparing the effects of SUREE programs on people with scapular downward rotation syndrome: randomized clinical trial. J Sport Rehabil. 2018:1e30. 20. Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44(5):300e305. 21. Reijneveld EA, Noten S, Michener LA, Cools A, Struyf F. Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome: a systematic review. Br J Sports Med. 2017;51(5):436e441. 22. Lin J, Hung CJ, Yang PL. The effects of scapular taping on electromyographic muscle activity and proprioception feedback in healthy shoulders. J Orthop Res. 2011;29(1):53e57. 23. Kneeshaw D. Shoulder taping in the clinical setting. J Bodyw Mov Ther. 2002;6(1):2e8. 24. Alexander CM, McMullan M, Harrison PJ. What is the effect of taping along or across a muscle on motoneurone excitability? A study using triceps surae. Man Ther. 2008;13(1):57e62. 25. Smith M, Sparkes V, Busse M, Enright S. Upper and lower trapezius muscle activity in subjects with subacromial impingement symptoms: is there imbalance and can taping change it? Phys Ther Sport. 2009;10(2):45e50. 26. Selkowitz DM, Chaney C, Stuckey SJ, Vlad G. The effects of scapular taping on the surface electromyographic signal amplitude of shoulder girdle muscles during upper extremity elevation in individuals with suspected shoulder impingement syndrome. J Orthop Sports Phys Ther. 2007;37(11):694e702. 27. Morrissey D. Proprioceptive shoulder taping. J Bodyw Mov Ther. 2000;4(3): 189e194. 28. Sawkins K. The Placebo Effect of Ankle Taping on Ankle Instability. Med Sci Sports Exer. 2007;39(5):781e787. 29. Lewis JS, Wright C, Green AJ, Therapy SP. Subacromial impingement syndrome the effect changing posture shoulder range movement. J Orthop Sports Phys Ther. 2005;35(2):72e87.
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30. Shaheen AF, Bull AM, Alexander CM. Rigid and elastic taping changes scapular kinematics and pain in subjects with shoulder impingement syndrome; an experimental study. J Electromyogr Kinesiol. 2015;25(1):84e92. 31. Leong HT, Fu SN. The effects of rigid scapular taping on the subacromial space in athletes with and without rotator cuff tendinopathy: a randomizedcontrolled study. J Sport Rehabil. 2018;28(3):250e255. 32. Harput G, Guney H, Toprak U, Colakoglu F, Baltaci G. Acute effects of scapular Kinesio TapingÒ on shoulder rotator strength, ROM and acromiohumeral distance in asymptomatic overhead athletes. J Sports Med Phys Fitness. 2017;57(11):1479e1485. 33. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. 34. Effective Practice and Organisation of Care (EPOC). EPOC Resources for Review Authors. Oslo: Norwegian Knowledge Centre for the Health Services; 2015. http://epoc.cochrane.org/epoc-specific-resourcesreview-authors. Accessed December 2017. 35. Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg. 2003;85(1):1. 36. Harris JD, Quatman CE, Manring M, Siston RA, Flanigan DC. How to write a systematic review. Am J Sports Med. 2014;42(11):2761e2768. 37. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. http:// handbook.cochrane.org. 38. Leong HT, Ng GY, Fu SN. Effects of scapular taping on the activity onset of scapular muscles and the scapular kinematics in volleyball players with rotator cuff tendinopathy. J Sci Med Sport. 2017;20(6):555e560. 39. Shih Y-F, Lee Y-F, Chen W-Y. Effects of kinesiology taping on scapular reposition accuracy, kinematics, and muscle activity in athletes with shoulder impingement syndrome-A randomized controlled study. J Sport Rehabil. 2018;27(6):560e569. 40. Ackermann B, Adams R, Marshall E. The effect of scapula taping on electromyographic activity and musical performance in professional violinists. Aust J Physiother. 2002;48(3):197e203. 41. Cools A, Witvrouw E, Danneels L, Cambier D. Does taping influence electromyographic muscle activity in the scapular rotators in healthy shoulders? Man Ther. 2002;7(3):154e162. 42. Van Herzeele M, van Cingel R, Maenhout A, De Mey K, Cools A. Does the application of kinesiotape change scapular kinematics in healthy female handball players? Int J Sports Med. 2013;34(11):950e955. 43. Morin GE, Tiberio D, Austin G. The effect of upper trapezius taping on electromyographic activity in the upper and middle trapezius region. J Sport Rehabil. 1997;6(4):309e318. 44. Shaheen AF, Villa C, Lee Y-N, Bull AM, Alexander CM. Scapular taping alters kinematics in asymptomatic subjects. J Electromyogr Kinesiol. 2013;23(2):326e 333. 45. Takasaki H, Delbridge BM, Johnston V. Taping across the upper trapezius muscle reduces activity during a standardized typing taskean assessor-blinded randomized cross-over study. J Electromyogr Kinesiol. 2015;25(1):115e120. 46. McConnell J. The McConnell Approach to the Problem Shoulder. Taping: Inhibition of the upper trapezius muscle. Course Notes; 1999:34. 47. Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152(3):S90eS98. 48. Keenan KA, Akins JS, Varnell M, et al. Kinesiology taping does not alter shoulder strength, shoulder proprioception, or scapular kinematics in healthy, physically active subjects and subjects with subacromial impingement syndrome. Phys Ther Sport. 2017;24:60e66. 49. Zanca GG, Grüninger B, Mattiello SM. Effects of Kinesio taping on scapular kinematics of overhead athletes following muscle fatigue. J Electromyogr Kinesiol. 2016;29:113e120. 50. Huang T-S, Cheng W-C, Lin J-J. Relationship between trapezius muscle activity and typing speed: taping effect. Ergonomics. 2012;55(11):1404e1411. 51. Hsu Y-H, Chen W-Y, Lin H-C, Wang WT, Shih Y-F. The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome. J Electromyogr Kinesiol. 2009;19(6):1092e 1099.
Contents lists available at ScienceDirect
Journal of Hand Therapy journal homepage: www.jhandtherapy.org
Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review Taha Ibrahim Yildiz MSc, PT a, *, Birgit Castelein PhD, PT b, Gulcan Harput PhD, PT a, Irem Duzgun PhD, PT a, Ann Cools PhD, PT b a b
Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
a r t i c l e i n f o
a b s t r a c t
Article history: Received 15 September 2018 Received in revised form 3 March 2019 Accepted 4 March 2019 Available online xxx
Study Design: This is a systematic review. Introduction: Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear. Purpose of the Study: The purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics. Method: MEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment. Results: Eleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles. Discussion: Scapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial. Conclusion: The results of the studies indicated that scapular corrective taping might alter the 3dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts. Ó 2019 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
Keywords: Scapula Taping Electromyography Shoulder Scapular kinematics
Introduction Scapular stability is defined as the coordinated motion of the scapula during the coupled movements with the humerus, which is
Conflict of interest: No funding has been received from any private or government institution. * Corresponding author. Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey. Tel.: þ90 3123051576 186; fax: þ90 3123052012. E-mail address: [email protected] (TahaI. Yildiz).
essential for proper shoulder activities.1 The scapula moves in a complex 3-dimensional motion pattern during upper extremity movements (internal-external rotation, upward-downward rotation, and anterior-posterior tilt). The periscapular musculature is primarily responsible from the scapular motion and stability as the scapulothoracic joint is a “physiological joint” rather then a “true joint”.2 Scapular stability and scapular dysfunction are one of the most common topics studied in the shoulder rehabilitation, but its role in the shoulder problems is not clearly defined yet.3-5 Previous researchers reported alterations in the scapular orientation on patients with shoulder pathologies, such as rotator
0894-1130/$ e see front matter Ó 2019 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jht.2019.03.001
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cuff (RC) tendinopathy,6 shoulder impingement syndrome,7 adhesive capsulitis,8 shoulder instability,9 and other shoulder pathologies.10 In addition, patients with shoulder pathologies may also display abnormal periscapular muscle activities.11,12 The alterations in the electromyography (EMG) activity of the periscapular muscles (serratus anterior [SA] and upper, middle, and lower parts of trapezius [UT, MT, and LT]) were found to be related to abnormal scapular orientation.5,7,13 The scapular dysfunction might be both the cause and consequence of the shoulder problems. Some studies suggest that abnormal scapular motion may not be referred as scapular dysfunction because the prevalence of scapular dysfunction can be similar on both patients with shoulder problems and healthy population.1,14,15 Despite this debating issue, studies revealed positive outcomes of the scapula-focused rehabilitation programs on patients with shoulder and neck pain.16-19 Therefore, improving the scapular stability is still one of the main goals during the management of the shoulder problems.5,18,20,21 Therapeutic taping has been widely used in the management of shoulder problems to decrease the pain and increase the functional outcomes. Although several mechanisms had been proposed for the effectiveness of the taping techniques, the exact mechanism has not been enlightened yet. It is thought that taping may alter the proprioceptive input from the peripheral tissues22,23 and improves the neuromuscular control.22,24-26 In addition, some researchers reported that taping might increase the muscle force,27 and some reported that the positive outcomes of taping may arise from the placebo effects.28 This poor understanding has led to a number of taping techniques applied in the clinics. Scapular corrective taping is one of the most popular taping techniques performed on patients with shoulder problems to decrease the symptoms and increase the function.29 Corrective taping is thought to improve the biomechanical alignment of the shoulder girdle and scapular stability, which enhances the length-tension relationship of the surrounding musculature.29,30 Improvement of the shoulder symptoms with scapular corrective taping was also explained by the increase in the subacromial space.31,32 Yet, it still not clear how does the corrective taping affect the shoulder girdle and improve patient outcomes on patients with shoulder problems. Therefore, we aimed to systematically review and summarize the effects of scapular corrective taping on the EMG activity of the periscapular muscles and 3-dimensional scapular kinematics on both patients with shoulder problems and healthy subjects. Methods This systematic review was designed according to the guideline of Preferred Reporting Items for Systematic Reviews and MetaAnalyses Statement.33 No review protocol was registered for this systematic review.
Table 1 Keywords used in the search strategy PubMed (MEDLINE) search strategy (((((“Shoulder” [Mesh] OR “shoulder Injuries” [Mesh] OR “Scapula” [Mesh] OR “rotator Cuff” [Mesh] OR shoulder OR scapula OR rotator cuff OR shoulder posture OR posture OR impingement) OR (scapular kinematics OR scapular orientation OR 3-dimensional scapular kinematics)) AND (“Electromyography” [Mesh] OR electromyography OR EMG)) OR (subacromial space OR acromiohumeral distance)) AND (“Athletic Tape” [Mesh] OR kinesiotaping OR taping OR tape OR kinesio tape OR kinesiological tape)) Web of science search strategy (((Shoulder OR scapula OR scapular OR scapulothoracic OR acromiohumeral OR subacromial OR shoulder posture OR postural OR posture) AND (taping OR tape OR kinesiotaping OR kinesiotape)) AND ((electromyography OR EMG) OR ((scapula OR scapular) AND (kinematics OR orientation OR 3-dimensional OR position OR positioning OR rotation OR tilt OR tilting))))
The literature was initially scanned for a systematic review concerning the effectiveness of corrective taping on 3-dimensional scapular kinematics and EMG activity of the periscapular muscles, and no review was found. A comprehensive literature search on the MEDLINE and Web of Science databases was conducted with specific MeSH terms and free-text words (Table 1). The databases were searched until April 2018, and the search was only limited to those involving humans. Two authors developed the search strategy (T.I.Y. and B.C.), and the first author conducted the literature search. In addition, hand searching was performed (T.I.Y.) by searching previous literature reviews. Study selection Two reviewers (T.I.Y. and G.H.) independently assessed the title and abstracts of the potential relevant studies identified during the initial search. The articles that met the following eligibility criteria were included to the study: (1) included healthy subjects or patients with shoulder problems, (2) used rigid or elastic taping materials, (3) applied taping techniques aiming to correct scapular positioning (corrective taping), (4) evaluated the 3-dimensional scapular kinematics or EMG of periscapular musculature, and (5) published in English. Studies were excluded if they conducted their research on patients with neurological disorders or musculoskeletal problems other than shoulder pathologies or if they included the taping techniques only aiming to inhibit or activate the periscapular muscles without any active or passive scapular correction. Two reviewers (T.I.Y. and G.H.) independently applied all criteria to the full text of the articles that passed the first screening. Any disagreement between reviewers was resolved by discussion, and if a consensus could not be reached, a third reviewer (B.C.) was consulted for final decision.
Eligibility criteria, search strategy, and information sources
Quality assessment
The research question and search strategy were derived from the PICOS methodology (Patients, Intervention, Comparison, Outcome, Study design). Studies were included in the present review if they investigated the effects of scapular corrective taping using rigid or elastic tape (intervention) on the EMG activity of periscapular muscles or 3-dimensional scapular kinematics (outcome) on patients with shoulder problems or healthy subjects (population) and compared the results with the baseline measurements or those of the control groups (outcome). Studies had to have a randomized control, nonrandomized control or experimental before-after design (study design).
The methodological quality of eligible studies was assessed using the criteria outlined in the Cochrane Effective Practice and Organization of Care (EPOC) guidelines for assessing risk of bias in randomized controlled trials (RCTs), non-RCTs, and controlled before-after (CBA) studies.34 EPOC uses 9 criteria for the assessment, and studies were scored as “low risk”, “high risk”, or “unclear risk” for each criterion during the assessment. The criteria were as follows: (1) random assignment of participants, (2) allocation concealment, (3) blinding of participants, (4) blinding of outcome assessors, (5) incomplete outcome data, (6) selective outcome reporting, (7) similar baseline measurements between study and
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3
Methodological quality
Table 2 Risk-of-bias analysis of the included studies Studies
1
2
3
4
5
6
7
8
9
Level of evidence
Ackerman et al Colls et al Herzeelee et al Leong et al Lin et al Selkowitz et al Shaheen et al 2013 Shaheen et al 2015 Shih et al Smith et al Takasaki et al
NA NA NA NA NA NA NA NA þ NA NA
NA NA NA NA NA NA NA NA ? NA NA
þ ?
þ
þ þ þ þ þ þ þ þ þ þ þ
þ þ þ þ þ þ þ þ þ þ þ
NA NA NA NA NA NA NA NA NA NA
NA NA NA NA NA NA NA NA þ NA NA
þ þ þ þ þ þ þ þ þ þ þ
Level Level Level Level Level Level Level Level Level Level Level
IV IV IV III IV IV IV IV III IV III
(1) Random sequence generation, (2) Allocation concealment, (3) Blinding of participants and personnel, (4) Blinding of outcome assessment, (5) Incomplete outcome data, (6) Selective outcome reporting, (7) Similar baseline outcomes measurement, (8) Similar baseline characteristics, (9) Protection from contamination. NA ¼ nonapplicable; þ ¼ low risk; ¼ high risk; ? ¼ unclear risk.
control group, (8) similar baseline characteristics of the participants between groups, and (9) protection of the data from contamination. However, four of the criteria (1, 2, 7, and 8) were nonapplicable in the CBA studies included to this review because of their natural design. Therefore, they were scored as “nonapplicable” during the assessment of the risk of bias. Two of the authors (T.I.Y. and G.H.) independently assessed the methodological quality of the studies. Depending on the design of the study and methodological quality, the level of evidence was determined according to the suggestions given in the study by Wright et al,35 in which the studies are classified from level I to level V evidence. Level I evidence represents the highest quality of studies, which are randomized control trials and systematic reviews of level I studies, and level V evidence represents the lowest quality studies, which accounts for expert opinions.35 Any disagreements in the quality assessment and evidence level of the studies were further discussed in a consensus meeting. If no consensus was reached, a third reviewer (B.C.) was consulted (Table 2). Data extraction The first reviewer extracted the data from the eligible studies, and another reviewer (G.H.) checked the extracted data using a standardized spreadsheet.36 Information regarding the (1) study design, (2) study population (sample size, pathology), (3) demographics of the participants (gender, age), (4) taping material, (5) taping techniques, (6) functional task and outcome measurements, and (7) the results of the intervention was collected from the articles and is presented in the evidence table (Table 3). When there were unclear results of a study or a disagreement between reviewers, the article was further discussed. Results Study selection After the initial search with specific MeSH terms on MEDLINE and Web of Science, a total of 155 articles were identified. Also 2 studies were discovered after hand searching. Of those studies, 11 articles met the inclusion criteria after the removal of the duplication and the first (title and abstracts) and second (full texts) screenings (Fig. 1). Ten of these studies were CBA experimental studies, and one of them was a randomized control study.
The two reviewers (TIY and GH) agreed in 95.4% of EPOC items (103/108) during the quality assessment of the studies. We did not report the total score of the studies in this review because Cochrane Collaborations suggest that each item needs to be considered separately regarding their importance because all items do not have the same importance in a study37 (Table 2). For the level of evidence analysis, there was 100% agreement between the two reviewers. Three studies were classified as level III evidence, and 9 studies were classified as level IV evidence (Table 2). Study characteristics The sample size of the included studies varied from 8 to 42 subjects. Five studies recruited patients with shoulder problems (subacromial impingement syndrome and rotator cuff tendinopathy),25,26,30,38,39 and six recruited healthy subjects.22,40-45 Eight studies used rigid taping materials and three studies used elastic ones for the scapular taping. In eight studies, the EMG activity of the periscapular muscles was the main outcome, whereas the 3dimensional kinematics was the main outcome in five studies. The basic characteristics of the studies are summarized in Table 3, and the taping techniques were illustrated in Figure 2. EMG activity of the periscapular muscles Studies mostly focused on the EMG activity of UT, LT, MT, and SA muscles for the assessment of the effects of scapular taping corrective during the shoulder tasks. In addition, the EMG activities of anterior deltoid (AD), sternocleidomastoideus (SCM), and rhomboids muscles were also evaluated. The corrective taping was observed to have same effects on both patients with shoulder problems and healthy subjects. Of the 8 studies investigating the effects of scapular taping on the EMG activity of periscapular muscles, 6 reported alterations in the activity pattern or onset timing of at least one of the periscapular muscles after applying scapular tape on healthy subjects22,40,45 or patients with shoulder problems.25,26,38 In contrast, two studies did not find a significant effect of taping on the EMG activity of periscapular muscles on patients with shoulder problems39 or healthy subjects.41 Seven studies investigated the alterations in the EMG amplitude of the UT during shoulder tasks. Four studies reported decreased activity in the UT during arm elevation,25,26 a typing task,45 placing an object on a shelf,26 and raising the arm to a specific point while being blindfolded22 after the scapular corrective taping. In contrast, Ackermann et al40 found increased activity in the left UT and no difference in the right UT while playing a violin with corrective taping. In addition, Cools et al41 and Shih et al39 also reported no effects of taping on the activity of the UT during arm elevation. Six studies measured the effects of corrective taping on the activity of the LT. Five studies reported no effects of taping on the activity level of LT during arm elevation,25,39,41 raising the arm to a specific point while being blindfolded,22 and typing task.45 However, Selkowitz et al26 found increased activity in the LT muscle during shelf task, and they also reported no effects of taping during arm elevation. Two studies reported no effects of corrective taping on the activity of the MT during arm elevation41 and playing a violin.40 For the SA activity, 3 studies revealed no effects of corrective taping during arm elevation26,39,41 and the shelf task.26 In contrast, Lin et al22 found increased SA activity with corrective taping during raising the arm to a specific point while being blindfolded. It was also shown that scapular corrective taping decreased the activity of
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Table 3 Summary of the included studies Authors and study design
Population
Demographics and tested extremity
Taping material and taping technique
Placebo
Functional task
Outcome measurements
Conclusion
Ackermann et al (2002)
8 professional violinists
3 male and 5 female; age: between 28 and 47 years; bilateral upper extremity was tested
Rigid tape; I-band from acromion to T4 vertebra and another I-band from acromion to T8 vertebra with active scapular correction
-
The performance of violinists during 3 different excerpts.
Cools et al (2002)
20 healthy subjects
20 male; age: between 20 and 25 years; the dominant side was tested (15 right, 5 left)
-
Arm elevation in sagittal and frontal planes with and without resistance
Taping increased the activity of left UT. Taping has no effect on the activity of right UT and both scapula retractors and SCM during violin performance Taping has no effect on the EMG activity of the periscapular muscles.
Herzeele et al (2013)
25 elite handball players.
20 female; age: 18 1.5 years; dominant side was tested (18 right, 7 left)
-
Arm elevation in sagittal, scapular, and frontal planes.
Leong et al (2016)
26 male volleyball players with RC tendinopathy.
26 male; age: 23.6 3.3 years; the affected shoulder was tested
Rigid tape; I-band from the coracoid process to the thoracic spine crossing over the trapezius muscle with passive scapular correction Elastic tape; I-band from the coracoid process to the thoracic spine crossing over the trapezius muscle with passive scapular correction. Rigid tape; I-band from clavicula to the T12 vertebra crossing over the trapezius muscle with full tension and active scapular correction (scapular retraction and depression).
EMG activity of both UT, scapular retractors (MT and rhomboids) and SCM with and without taping EMG activity of UT, MT, LT, and lower part of the SA muscle with and without taping Three-dimensional scapular kinematics with and without taping
A placebo control tape with the same material and to the same locations without tensioning the tape
Arm elevation in the frontal plane.
The activity onset of UT, MT, LT, and SA muscles Three-dimensional scapular kinematics with scapular taping, placebo taping, and without taping.
Lin et al (2011)
12 healthy subjects
10 male and 2 female; age: 23.7 4.8 years; no information about which side was tested
-
Positioning the arm in a targeted end/midrange point while being blindfolded.
EMG activity of UT, LT, SA, and AD muscles with and without taping
Selkowitz et al (2007)
21 subjects with suspected SAIS.
11 male and 10 female; age: 42.8 years; the affected side was tested
-
Arm elevation in scapular plane and placing a 0.5-kg bottle on a shelf and lowering it.
EMG activity of UT, LT, SA, and infraspinatus muscles with and without taping
Shaheen et al (2013)
13 healthy subjects
5 male and 8 female; age: 23.6 1.7 years; the dominant side was tested (12 right, 1 left)
-
Arm elevations in the sagittal and scapular planes
3-dimensional scapular kinematics with and without taping
Rigid tape; I-band from T1 to T12 and another I-band from the center of scapular spine to the T12 vertebra with active scapular correction
Corrective taping increased the scapular UR, whereas it has no effect on scapular ER and PT Placebo taping have no effect on all scapular rotations. Both corrective and placebo taping improved the activity onset of the MT, LT, and SA muscles. Taping decreased the activity of UT and AD. Taping increased the activity of lower SA. Taping has no effect on the activity of LT. Taping decreased the activity of UT during arm elevation and shelf tasks. Taping increased LT activity during shelf tasks. Taping has no effect on the infraspinatus and SA muscles during arm elevation in scapular plane and shelf tasks. Taping increased scapular UR, ER, and PT on sagittal plane arm elevation. Taping increased scapular ER in scapular plane arm elevation Taping has no effect on scapular UR and PT on scapular plane arm elevation
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Elastic tape; I-band from the medial clavicula to T12 vertebra crossing over the trapezius muscle with active scapular correction (scapular retraction and depression). Rigid tape; I-band from the clavicula to the paraspinal area at the midsections of the scapula by crossing over the UT muscle with passive scapular correction.
Taping increased the scapular PT and UR. Taping has no effect on scapular ER
11 patients with SAIS
8 male and 3 female; age: 47.5 9.4 years; the affected side was tested
Rigid tape; I-band from T1 to T12 vertebrae and another Iband from the center of scapular spine to the T12 vertebra with active scapular correction.
-
Arm elevation and lowering in the sagittal and scapular planes.
3-dimensional scapular kinematics with and without taping.
Shih et al (2018)
30 athletes with SAIS
14 male and 16 female; age: group 1, 24.3 2.8 years; group 2, 23.3 3.3 years; the affected side was tested
Group 1: elastic tape; Y Band from origin to insertion of LT while arm flexed 90 and with maximum scapular protraction and I-band perpendicular to the UT muscle with full stretch during active scapular correction.
Group 2: Micropore tape; the tape was applied without stretching, during sitting in a relaxed posture.
Arm elevation in scapular plane
EMG activity of UT, LT, and SA muscles 3-dimensional scapular kinematics with and without taping
Smith et al (2009)
16 patients with SAIS
7 male and 9 female; age: 29.8 8.3 years; the affected side was tested
Rigid tape; I-band from 1/3 midpoint of clavicula and goes posteriorly to the T12 vertebra with passive scapular correction.
-
Arm elevation in scapular plane
EMG activity of UT and LT muscles with and without taping.
Takasaki et al (2015)
42 healthy subjects
20 male and 22 female; age: 38 11 years; the affected side was tested
Rigid tape; I-band from the midpoint of clavicula to T7 vertebra crossing over the UT muscle with passive scapular correction.
The same taping material to the same locations without tensioning the tape.
15 min of typing task on the desk while sitting on an adjustable chair.
EMG activities of UT and LT muscles with scapular taping, placebo taping, and without taping.
Taping increased scapular ER and AT during sagittal plane arm elevation and lowering. Taping had no effect on scapular UR Taping increased scapular AT during arm elevation and lowering in scapular plane. Corrective taping increased scapular PT and UR, whereas placebo taping had no effect on scapular rotations Both taping techniques had no effect on scapular ER Both corrective and placebo taping had no effect on the EMG activity of UT, LT, and SA muscles. Taping decreased the activity of UT, whereas it has no effect on LT. Taping has no effect on the UT-LT activity ratio on patients with SAIS. Both corrective and placebo taping decreased the activity of UT. There was no difference between the two taping techniques. Both taping techniques had no effect on the activity of LT.
EMG ¼ electromyography; UT ¼ upper trapezius; MT ¼ middle trapezius; LT ¼ lower trapezius; SCM ¼ sternocleidomastoids; SA ¼ serratus anterior; UR ¼ upward rotation; ER ¼ external rotation; PT ¼ posterior tilt; AT ¼ anterior tilt; SAIS ¼ subacromial impingement syndrome; RC ¼ rotator cuff.
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Shaheen et al (2015)
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Studies identified through MEDLİNE and WOS =155
Studies identified through hand search =2
157 studies
After removing duplicates = 109
After first screening (based on title and abstract) = 21
Exclusion Criteria Population Intervention Outcome Low methodological quality No full-text
Exclusion Criteria Population Intervention Outcome Design Language
Full-text screening
Included articles to the systematic review = 11 Fig. 1. PRISMA flow diagram. PRISMA ¼ Preferred Reporting Items for Systematic Reviews and Meta-Analyses; WOS ¼ Web of Science.
AD muscle during raising the arm to a specific point while being blindfolded.22 In contrast, it had no effect on the SCM activity while playing a violin40 and infraspinatus26 muscles during the shelf task and arm elevations.
One study investigated the effects of scapular corrective taping on the activity onset of the periscapular muscles.38 They found that both placebo and corrective taping improve the activity onset of the MT, LT, and SA muscles, but it has no effect on the UT.
Fig. 2. Illustrations of the taping techniques used in the included studies: (A) Ackermann et al; (B) Herzeele et al and Lin et al; (C) Shaheen et al 2013 and 2015; (D) Cools et al, Leong et al, and Smith et al; (E) Shih et al; (F) Selkowitz et al and Takasaki et al.
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Three-dimensional scapular kinematics Five studies investigated the effects of scapular taping on the 3dimensional scapular kinematics during arm elevation in sagittal, scapular, and frontal planes. In general, there was an agreement among studies that scapular corrective taping may alter the 3dimensional scapular kinematics in both healthy subjects42,44 and patients with shoulder problems.30,38,39 Four studies reported an increase in the scapular upward rotation (UR) after corrective taping,38,39,42,44 whereas one study reported no effects of taping on the scapular UR.30 For scapular external rotation (ER), two studies found an increase in ER with corrective taping,30,44 whereas three studies found no effects of taping.38,39,42 Finally, three studies observed an increase in scapular posterior tilt (PT) with corrective taping,39,42,44 whereas one study observed a decrease in scapular PT30 after taping. In addition, one study reported no effects of corrective taping on scapular PT.38 When comparing the effects of corrective taping between patients with shoulder problems and healthy subjects, similar effects were observed for scapular UR and ER. However, the scapular PT was increased on healthy subjects with corrective taping, whereas it had no effects on scapular PT on patients with shoulder problems. Discussion The results of the present systematic review indicate that scapular corrective taping may alter the 3-dimensional scapular kinematics in both patients with shoulder problems and healthy subjects, whereas its effect on the EMG activity of the periscapular muscles is controversial. Studies mostly reported an increase in the scapular UR with corrective taping, whereas there is a debate about its effects on scapular ER and PT. For the EMG activity of the periscapular muscles, corrective taping may decrease the activity of the UT on both patients with shoulder problems and healthy subjects depending on the taping technique. However, most of the studies found no effects of corrective taping on the EMG activity of other periscapular muscles. Three-dimensional scapular kinematics There was a consensus among studies that scapular corrective taping alters the 3-dimensional scapular kinematics. All five studies reported changes in the scapular kinematics with corrective taping on both healthy subjects42,44 and patients with shoulder problems30,38,39 during arm elevations. However, there were some differences between the studies concerning the specific alterations in the 3-dimensional scapular kinematics after the taping. There was strong evidence that scapular corrective taping increases the scapular UR during arm elevation. There were three different taping techniques used for scapular correction, and all were observed to be effective for improving the scapular UR38,39,42,44 on both patients with shoulder problems and healthy subjects. Only Shaheen et al30 failed to demonstrate the effects of the corrective taping on the scapular UR on patients with shoulder pain. They recruited patients with impingement syndrome who also had abnormal kyphotic posture. Abnormal postural alignment of the upper trunk might possibly prevent observation of alterations in the scapular UR with corrective taping.30 Therefore, it can be concluded that stabilizing the scapula from anterior to posterior over the UT or from inferomedial to superolateral over the LT with active or passive scapular correction are both effective methods for enhancing the scapular UR, but the postural alignment may have a role on the effectiveness of the corrective taping.
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The taping technique introduced by McConnel46 and Morin et al43 provided better improvement in scapular PT. Both techniques were designed to support the scapula posteriorly. Yet, only three studies used these taping methods, and two of them reported an increase in scapular PT,39,42 whereas one of them reported no effects of scapular taping on PT.38 Interestingly, the present study also revealed that corrective taping might increase the scapular PT on healthy subjects, whereas it has no effects on scapular PT on patients with shoulder problems. Alterations in the periscapular muscle activity or abnormal shoulder girdle biomechanics on patients with shoulder pain might affect the positive effects of the taping. However, whether the differences between the patients with shoulder pain and healthy subjects arise from the taping technique is not clear because different taping techniques were used in the studies. Therefore, these results are not sufficient to reach a conclusion whether corrective taping alters the scapular PT on both health subjects and patients with shoulder problems. The taping technique used by Shaheen et al30,44 provided an increase in scapular ER, whereas other taping techniques had no effects on scapular ER.38,39,42 The controversial results might arise from the differences in the taping materials because Shaheen et al30 used a rigid tape, whereas Herzeele et al42 and Shih et al39 used an elastic tape. Although Leong at al38 also used rigid taping material, they reported no effects of corrective taping on the scapular internal rotation. Leong et al38 and Shaheen et al30 adopted different taping techniques to improve scapular stability. Therefore, the taping technique may also be important for altering the scapular internal rotation, yet there is no sufficient information about which taping is more effective. In conclusion, scapular corrective taping may be used to improve scapular stability on both patients with shoulder problems and healthy subjects. Studies reported 0.9 to 5.9 improvement in scapular UR,38,39,42,44 2.8 to 4 improvement in scapular PT,39,42,44 and 1.9 to 2.9 increase in the scapular ER30,44 with corrective taping. These results indicate that corrective taping may help to decrease the symptoms of the patients with shoulder pain who were reported to suffer from abnormal scapular orientation and may help to improve shoulder performance on healthy subjects during sport activities. Yet, individuals’ needs should be well analyzed because different taping techniques may have different effects on the scapular motion.
Activity of periscapular muscles There was reasonable evidence that corrective taping might decrease the activity of the UT muscle on both patients with shoulder problems and healthy subjects depending on the taping technique. Of the 7 studies investigating the effects of corrective taping on the EMG activity of the UT, four of them found a decreased activity, whereas one of them found increased activity and two of them found no effects of corrective taping. Studies that reported decreased activity in the UT used a similar taping technique that was applied from acromion to the thoracic spine, aiming to pull the scapula posteriorly (Table 3).22,25,26,45 This technique may help to alter the biomechanical alignment of the shoulder girdle and enhance the length-tension relationship of the UT. Studies reported of decrease in the activity of the UT between 3.3% and 25% while using this technique.22,25,26,45 In contrast, studies that reported increased activity or no effects of corrective taping in the UT39,40 used different taping techniques. They might not be able to lead adequate biomechanical improvement to enhance the length-tension relationship of the UT. In conclusion, depending on the taping technique, the corrective may decrease the UT activity on both patients with shoulder problems and healthy subjects.
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There was strong evidence that corrective taping had no effect on the activity of the LT. Most of the included studies reported no effects of taping on the EMG activity of the LT during the arm elevation,25,26,39,41 raising the arm while being blindfolded,22 and typing tasks.45 Takasaki et al45 and Morissey et al27 suggested that the inhibitory or excitatory effects of taping may mainly result from the cutaneous input from the peripheral tissues. Our results partly support this hypothesis that studies that reported no effects of corrective taping on the LT applied a similar taping technique that provides no cutaneous input to the LT. Although Shih et al.39 and Smith et al.25 applied a scapular corrective tape and provided cutaneous input to the LT, they also found no change in the EMG activity of the LT. Therefore, there may be another factor that induces alterations in the activity of the muscles rather than the cutaneous input. Interestingly, Selkowitz et al26 found increased activity on the LT during shelf task after taping, whereas they also found no effects of corrective taping on the activity of the LT during arm elevation. This might be due to that muscles may have different activity patterns during different functional tasks.47 Therefore, it can be concluded that biomechanical features play a major role in altering the activity patterns of the muscles, and the corrective taping techniques applied in the included studies might not be able to alter the length-tension relationship of the LT enough to change its EMG activity. There was reasonable evidence that scapular corrective taping had no effect on the EMG activity of the SA during arm elevation26,39,41 and shelf task.26 Only, Lin et al22 reported an increased activity in the SA with corrective taping during raising the arm while being blindfolded. However, they used different shoulder tasks during the recording of the EMG data. The difference between studies may arise from the variability in the shoulder task. There was not enough information to interpret whether scapular corrective taping alters the EMG activity of the MT, AD, sternocleidomastoideus, and infraspinatus muscles. Two studies reported no effects of scapular taping during arm elevation41 and playing a violin.40 Only one study investigated the effects of scapular corrective taping on the EMG activity of SCM, infraspinatus, and AD muscles. It was found that corrective taping may increase the activity of the AD during raising the arm while being blindfolded,22 whereas it may have no effect on the activity of SCM during playing a violin41 and infraspinatus during the shelf task.26 Studies revealed that corrective taping had same effects on both patients with shoulder problems and healthy subjects concerning altering the activity of the periscapular musculature. Altering the biomechanical alignment of the shoulder girdle might have similar effects on periscapular muscles regardless of having shoulder problems or being healthy. In conclusion, it can be argued that whether the scapular corrective taping alters the EMG activity of the periscapular muscles is highly dependent on the taping technique. The taping technique proposed by McConnel46 which aims to pull the scapula posteriorly was shown to be effective for decreasing the EMG activity of the UT; however, it had no effect on the activity of other periscapular muscles. The effects of corrective taping on the EMG activity of the muscles were also task dependent such that a taping technique may alter the EMG activities of the muscles during a functional task, whereas it has no effect during another task. Therefore, altering the biomechanical alignment and the lengthtension relationship of the muscles may be the main factor to change the activity patterns of the periscapular muscles, but this effect is highly depended on the taping technique. Limitations One of the limitations of this review was that only studies that applied scapular corrective taping were included. Other studies
that investigated the effects of taping without scapular correction on the EMG activity of periscapular muscles and on the 3dimensional kinematics were excluded.48-51 Nevertheless, including those studies would adversely affect the homogeneity of this review. Another limitation was that all included studies were of level III or IV evidence. However, due to the research question (investigating the immediate effect of scapular taping on EMG activity and scapular kinematics), studies needed to be experimental; therefore, it was not possible to have a higher level of evidence. Third, only three studies performed placebo taping for the control group. Therefore, there was not enough information to interpret whether the scapular taping is effective in the same population. Although this systematic review only focused on the effects of scapular corrective taping on the activity of the periscapular musculature and the 3-dimensional scapular orientation, there are other taping techniques aiming to facilitate or inhibit the periscapular muscles without correction of the scapula. However, these are out of the topic of the present review as they would affect the homogeneity of this study and interfere with the results of corrective taping techniques. Yet, these taping techniques should also be investigated more thoroughly for their effects on scapular kinematics and periscapular musculature. Future directions There are still controversial results about the effects of corrective taping on the activity patterns of the periscapular muscles. Also, little information exists about the effects of corrective taping on the activity of the MT and LT because studies mostly focused on the UT and LT. In addition, although there are several scapular corrective taping techniques, there is a lack of knowledge about their superiorities to each other. Therefore, RCTs are needed to compare the effects of different taping techniques on periscapular muscles especially on MT and SA and scapular positioning. In addition, a meta-analysis that investigates the effects of scapular taping on the activity of the periscapular muscles and periscapular muscle activity could improve the understanding of the mechanism of the effects of the taping. Conclusion The current systematic review focused on the effects of scapular corrective taping on the EMG activity of the periscapular musculature and 3-dimensional scapular kinematics. In summary, it can be concluded that corrective taping may enhance the 3dimensional scapular orientation and decrease the activity of the UT. However, its effects on the EMG activity of the other periscapular muscles are rather controversial. The discrepancies among the included studies are thought to mainly arise from the methodological differences, especially due to the different taping techniques. References 1. McQuade KJ, Borstad J, De Oliveira AS. Critical and theoretical perspective on scapular stabilization: what does it really mean, and are we on the right track? Phys Ther. 2016;96(8):1162e1169. 2. Mottram S. Dynamic stability of the scapula. Man Ther. 1997;2(3):123e131. 3. Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48(8):692e697. bjsports-2013-092148. 4. Kibler BW, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11(2):142e151. 5. Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med. 2013;47(14):877e885. 6. Mell AG, LaScalza S, Guffey P, et al. Effect of rotator cuff pathology on shoulder rhythm. J Shoulder Elbow Surg. 2005;14(1):S58eS64.
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