Neck type cervical spondylopathy (NTCS), a type of cervical spondylosis, is characterized by pain in the neck and shoulder, limited range of movement, and abnormal physiological curvature. In recent years, due to the growing prevalence of poor posture caused by the overuse of Internet, the incidence of NTCS is increasing, especially in students. Therefore, it had a significant impact on daily life (including work and study) of patients with NTCS.
The most common treatment for the pain syndrome in the course of NTCS is physiotherapy, which include manual therapy and Kinesio taping(KT) [1]. Previous studies have confirmed the efficacy of manual therapy and Kinesio taping (KT) in alleviating symptoms of NTCS by altering parafunctional behaviors [2, 3]. Further studies found that the key to perform efficient manual therapy or KT was to localize and release those trigger points.
Trigger points can be localized by palpation examination with the manifestation of nodules at a size of granule. It was formed by muscle fibers with increased tension, which could interfere with muscle movement patterns and weaken muscle strength. The discomfort could be alleviated by releasing trigger points [4, 5].
(KT) has been widely used for treating various injuries [6,7,8,9] and attracted much attention in recent years. It can normalize muscle function, increase microcirculation, relieve pain, and support the work of joint [10,11,12,13] by applying specific tape on patients’ skin. Researchers have proposed it may reduce lymphatic and venous edema, but its effect in muscle disease and vascular condition was poorly reported. The exact mechanism of KT remains unclear. However, it was reported that KT may have short-term effects on muscle activation and support proprioceptive information [14, 15]. In this study, we investigated the effectiveness of Kinesio taping (KT) combined with multi-angle isometric resistance training on the pain and movement function in patients with NTCS.
Methods and participants
Participants
Seventy patients with NTCS in the Department of Neurology and Rehabilitation in our hospital were recruited between March 2016 and December 2019. The assessors and statisticians were unaware of the group allocation throughout the study period. All the researchers received training to ensure strict adherence to the study protocol.
The inclusion criteria were adults aged between 18 to 65 years with changes in cervical curvature showed by X-ray film inspection (such as straightening or anti-bow), and symptoms on the Clinical, Etiological, Anatomical, and Pathophysiological scale. Exclusion criteria were as follows:1) serious heart disease; 2) abnormal functions of the liver, brain, kidney, and other vital organ; 3) blood system diseases and serious mental illness; 5) cervical vertebrae fracture, dislocation, tuberculosis, serious infection; 6) contraindications for KT technique, including thrombosis, wounds, presence of cancer, intolerability of or allergy to surgical tape; 7) pregnancy. Out of 70 participants, 62 patients were recruited in this study (Fig. 1).
This study was registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn) and the registration number was ChiCTR1900024907with the first registration on 03/08/2019(ChiCTR1900024907) . This study was approved by the local Ethics Committee of Wuhan Hospital of Traditional Chinese and Western Medicine (China)( [2016]3). All participants provided informed consent before participation.
Study design
We performed a controlled clinical trial between March 2016 and December 2019. Patients were randomly assigned to KT group (n = 31) and control group (n = 30) by a random number table. Both groups were treated with physical modality therapy and multi-angle isometric resistance training for cervical muscles. The patients in the KT group were supplemented with Kinesio taping. All treatment interventions were carried out by a KT instructor with extensive experience, and he was blinded to the grouping information and measurements for outcomes, and the physical therapists were asked not to reveal the outcome message to the team members.
Kinesio taping application
The tape (Kinesio Tex; Kinesio Nan Jing) used in this study was waterproof, porous, and adhesive. The tape with a width of 5 cm and a thickness of 0.5 mm was applied in the KT group. Patients received the following Kinesio Taping when seated. The first layer of the tape consisted of an X-strip placed over the trigger spot, over the mid-cervical region (C3-C6), with the patient’s cervical spine in flexion to apply tension to the posterior structures (Fig. 2A). The overlying strip was a blue Y-strip placed perpendicular to the X-strip placed over the posterior cervical extension muscles, from the insertion to the origin, with paper-off tension, which the manufacturer applies to the tape against its paper backing at approximately 15% to 25% stretch. Each tail of the second strip (blue Y-strip, 2-tailed) was applied with the patient’s neck in a position of cervical contralateral side bending and rotation (Fig. 2B). The tape was placed from the dorsal region (T2-T5) to the upper-cervical region (C1-C2). The other strip was a Y-typed placed from acromion to the upper cervical region (C1-C2) (Fig. 2C). Patients wore the Kinesio Tape 2 times a week during a 3-week period, and it was removed just before outcome assessment.
Manipulation interventions
The two groups received multi-angle isometric training for cervical muscles. The patients were trained by a physiotherapist. The specific trainings were as follows: 1) Cervical flexion training, the patient put his hands on the forehead to prevent head flexion action, and try to maintain balance so that the head does not move. 2) Cervical extension training. The patient's hands were overlapped and placed at the back of the head to prevent the head extended, while maintain the balance so that the head does not move. 3)Cervical rotation training. The patient's hands were placed on the one side of the head, with one hand exerting resistance to prevent the head to see the shoulder on the other side and maintained the balance. 4) Cervical lateral flexion training. The patient's hands were placed on the one side of the head, with one hand exerting resistance and mintained balance. 5) Cervical neutral position training. The palm of the hand applied external force from different directions (the forehead, the back pillow, and the bilateral cheeks), while the head and neck performed corresponding confrontation exercise to maintain the head in a neutral position. The above exercises were performed 30 min once time, 3 times per day, and 10 days for one course dur period.
Evaluation methods
Four parameters were measured before the treatment and 3 weeks later. 1) Degree of pain was assessed by means of a 10-cm visual analog scale (VAS) from 0 (no pain) to 10 (unbearable pain). 2) Cervical vertebra function was evaluated by the neck disability index (NDI) [16], which measures symptoms and disability related to the neck. NDI could evaluate the following 10 items: the level of pain, daily life, extraction, reading, headache, concentration, work, driving and sleep. Each item was evaluated by 6 questions scoring 0–5 or 6. The total score of NDI was 50. And the score positively correlated with the neck dysfunction of the neck. 3) The range of motion for cervical vertebra was assessed (including flexion, extension, rotation, and lateral flexion). 4) The trapezius muscle state was evaluated with stiffness by Myoton hand-held dynamometer.
Statistical analysis
Descriptive data are expressed as the mean ± SD. The VAS, NDI, CROM and muscle stiffness were assessed for the two groups at baseline and after treatment. Within—and between – group comparisons were performed using Student’s paired t-tests. The data were analyzed with SPSS Version 20.0 (SPSS Inc, USA), and statistical significance was set at p < 0.05.
