Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer... Introduction: Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT). Aim of the study: The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment. Material and methods: The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer. All the patients were diagnosed with grade I  secondary lymphedema. Kinesiology Taping was applied to a  total of 14 randomly selected women. The remaining 14 patients constituted a  control group. The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software. Results: A significant reduction in the extent of lymphedema (p = 0.0009) was achieved in the KT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.36). Conclusions: Kinesiology Taping applications are an effective method of early-stage edema management. Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods. Key words: breast cancer, lymphedema, Kinesiology Taping. Analyses of therapeutic efficacy of different sec- Introduction ondary lymphedema-reducing methods performed Studies conducted to date show that the most ef- so far fail to include Kinesiology Taping (KT) because fective method of secondary lymphedema treatment in it is a relatively new treatment modality, though it be- women after axillary lymphadenectomy due to breast comes increasingly common for lymphedema control. cancer is complete decongestive therapy (CDT) consist- The mechanism underlying KT has not, as yet, been ful- ing of manual lymphatic drainage (MLD), compression ly understood. Similarly to other methods that deform techniques (bandaging, compression sleeves), physical the skin of the extremity, KT increases lymph flow and exercise and skin care. Complete decongestive therapy can be used in the treatment of peripheral lymphede- makes it possible to achieve an average of 45% of edema ma. According to authors using KT in their practice, reduction. A  slightly less effective therapeutic option is the method relieves tissue fluid congestion, augments complex physical therapy (CPT), a combination of differ - blood and lymph circulation, and improves subcutane- ent methods of lymphedema treatment, typically MLD ous lymphatic drainage [2, 3]. Kinesiology Taping ap- and intermittent pneumatic compression (IPC), though plications pull the skin slightly, creating more space other options are also possible depending on the health- between the dermis and fascia [4]. Lymphatic taping care facility’s experience. With CPT, edema can be re- is thus quite similar to lymphatic drainage, though it lieved by an average of ca. 30%. Self-application of MLD allows patients to receive therapeutic benefits 24 hours or IPC allows for up to 25% edema reduction. The effica- a  day [5]. Based on analysis of physiological effects it cy of other methods used for the treatment of secondary can also be argued that KT is more similar to compres- lymphedema of the upper extremity, such as continuous sion therapy in that it reduces capillary filtration rather compression therapy, laser therapy, self-massage, physi- than enhancing lymphangiomotor function. cal exercise or appropriate extremity positioning, ranges A  few studies (e.g. Tsai et al.) [6] demonstrated between 5% and 11% of edema reduction [1]. no significant differences in edema reduction between Corresponding author: dr Iwona Malicka, Wydział Fizjoterapii, Akademia Wychowania Fizycznego we Wrocławiu, Submitted: 12.02.2014 e-mail: iwona.malicka@awf.wroc.pl Accepted: 17.07.2014 221 Przegląd Menopauzalny/Menopause Review 13(4) 2014 standard CDT combined with pneumatic compres- The first group (study group, n = 14) consisted of sion (bandage) and modified CDT (combined with KT). women who received KT applications. 78.6% of them had A 17% edema reduction was seen in the group treated undergone mastectomy and 21.4% – breast-conserving surgery. In addition, 71.4% had received radiotherapy, with CFT combined with bandage and only 3% reduc- 85.7% – chemotherapy and 64.3% – hormone therapy. tion in the group receiving CFT with KT. It was found, The mean post-treatment period was 6.0 ± 4.8 years. however, that KT might be a more useful option for pa- Patients in the second group (control group, n = 14) tients with poor tolerance of bandaging, as it is more did not receive any anti-edema treatments. 85.7% of comfortable to the skin especially in hot climates and them had undergone mastectomy and 14.3% – breast- during the summer. Moreover, KT is a simpler and less conserving surgery. In addition, 35.7% of study partici- demanding technique than compression bandaging, pants had received adjuvant treatment in the form of which prompts patients to use it more systematically. radiotherapy, 71.4% – chemotherapy and 50% – hor- At the same time, the study demonstrated a higher risk mone therapy. The mean post-treatment period was of wounds caused by K-tape than bandage. 5.8 ± 4.8 years. Kinesiology Taping, on the other hand, may have There were no significant differences between a significant influence on lymph flow during exercise, as groups in variables that could potentially affect study noted in experimental studies in rabbits. Even though results. Detailed characteristics of study patients are the use of tapes resulted in no significant differences given in Table I. in lymph flow, their application during passive exercise markedly increased lymph flow rates [7]. The observa- tion can be explained by thermal and mechanical pro- Methods cesses involved in KT. Lymphedema measurement In view of the above, the aim of the study was to as- sess the effects of KT on the extent of lymphedema of All the women studied had the circumference of their the upper extremity in women post cancer treatment. upper extremities measured at 6 levels, using a centim- eter tape. The first level was at the proximal base of the metacarpal bones and the second across the ulnar and Material and methods radial styloid processes. The remaining four levels were defined by measuring consecutive 10 cm distances from Study group the styloid processes up the extremity. The study was conducted in a group of 28 middle- The results obtained from the above measurement, aged women, with a mean age of 59.75 years (± 5.95), based on the difference of the circumference between after axillary lymphadenectomy due to breast cancer. the swollen limb and the not-swollen limb were used All the study patients were diagnosed with grade I sec- to calculate the edema volume [ml] (Table II). The Limb Volumes Professional 5.0 program was used to perform ondary lymphedema and were not given any anti-ede- the calculations. This is a software for limb edema and ma treatment either before or during KT applications. lymphedema tracking, documentation and reporting. The patients were randomized into 2 groups. Tab. I. Characteristics of study patients and significance of values for differences between the study group (1) and the control group (2) Parameter Group 1, n = 14 Group 2, n = 14 p Age [years] 60.1 ± 6.3 59.5 ± 5.7 0.56 Body mass [kg] 75.4 ± 12.8 76.2 ± 11.8 0.69 Body height [cm] 161.5 ± 3.9 159.9 ± 7.1 0.29 Radical surgery [n] 11 12 0.87 Surgery on the right breast [n] 7 8 0.76 Post-surgery period [years] 6.0 ± 4.8 5.8 ± 4.8 0.76 Adjunctive treatment [n] 14 13 0.76 Radiotherapy [n] 10 5 0.11 Chemotherapy [n] 12 10 0.53 Hormone therapy [n] 9 7 0.53 222 Przegląd Menopauzalny/Menopause Review 13(4) 2014 Tab. II. Example circumference result calculation into volume values Centimetres Circumferences (cm) Segment number Volume (ml) from wrist Right (affected) Left (not affected) Right Left 0 17 17 10 24 21 1 338 288 20 26.5 26 2 508 441 30 28.5 26.5 3 602 549 40 33.5 31.8 4 767 678 Edema 258 It automatically uses the application of circumference- tors of neighboring territories. These are so called anas- based methods to determine the edema volume on the tomoses – fusions. Lymphatic encumbrances for the basis on the appropriate algorithm. given region of lymph confluence can in such a  case The first measurement (1) was performed at base- be transported to adjoining areas with lymph nodes line, i.e. prior to the initiation of therapy. The second without morbid condition. In our research this was the – after 2 weeks of KT applications and the final one (in lymph nodes’ area based opposite armpit: armpit – the study and control groups) after the completion of armpit anastomosis. KT, i.e. 4 weeks. In the second sub-group, the tape was applied only to the upper extremity in a double fan shape within the Kinesiology Taping applications arm and forearm (Fig. 1B). All the study group women received KT therapy. None of the above groups took part in any other A total of 4 applications were made, one in each con- physiotherapeutic sessions during the research. Within secutive week. The patients were randomly divided into the groups there were also no physical improvement two sub-groups of seven. Each sub-group was given exercises. two different types of applications according to the KT methodology. Lymphatic application was performed us- ing tape with a 1 cm wide base and tails divided into Statistical analysis four parts. The maximum tension of the tails was 15%, Statistical analysis was made with STATISTICA soft- after holding down the base of the tape during applica- ware using basic descriptive statistics and, due to the tion. During the tape application procedure the patients fact that the patient groups were small, non-parametric were in the sitting and supine position, depending on analyses of the significance of differences: for inde- the application given. In the first sub-group, the tape was applied to the pendent variables (between groups) – the Mann-Whit- ney U test; for dependent variables (between measure- edematous upper extremity in individual fan shapes on ments within groups) – the Wilcoxon test; and for the the arm and forearm, and along anastomoses (Fig. 1A). It is assumed that in big lymphatic vessels of trunk analysis of reduction in the extent of lymphedema – planes in certain places there occur links with collec- the Friedman test. A B Fig. 1. A) KT applications in subgroup 1. B) KT applications in subgroup 2 223 Przegląd Menopauzalny/Menopause Review 13(4) 2014 Tab. III. Significance of differences between edematous and the opposite extremity Group Edematous extremity Non-edematous extremity Baseline Final V [ml] V [ml] assessment assessment p p Baseline Final Baseline Final assessment assessment assessment assessment Study group (1) 2511.43 ± 532.26 2275.51 ± 482.12 2230.78 ± 353.61 2230.78 ± 353.61 0.0005 0.47 Control group (2) 2344.92 ± 311.67 2356.42 ± 310.96 2218.92 ± 272.10 2218.92 ± 272.10 0.02 0.02 Tab. IV. Significance of differences between preliminary and final assessments within and between groups Group Difference: edematous extremity vs. non-edematous extremity, V [ml] Baseline assessment Final assessment p Study group (1) 280.35 ± 231.89 44.78 ± 226.38 0.0009 Control group (2) 126.00 ± 192.64 137.50 ± 192.74 0.36 p 0.04 0.30 X Results served as a result of KT applications. Figure 2 presents results referring to two sub-groups selected randomly The results were based on the total extremity val- based on the type of KT applications. A statistically sig- ues obtained from the circumference measurements nificant reduction was found in both cases (cf. Table V). with the use of LVP program. During baseline assessment (1), a significant differ - ence in total volume [ml] was found between the up- Discussion per extremity on the operated side and the opposite Lymph flow can be promoted e.g. by walking, arte- side for both groups. Nonetheless, the difference was rial pulsation, lymphangiomotor function, muscle activ- not demonstrated in the study group during final as- ity, physical exercise, massage or breathing, which are sessment (3) (cf. Table III). This means that in the group all recognized as causes of tissue deformation. Lymph of patients undergoing KT applications a  significant formation and transport can be explained as a  result reduction in the extent of lymphedema was obtained of extension and compression of the initial lymphatics, between the baseline assessment – 1 and final assess- determined by the deformation of tissues in which they ment – 3 (0.0009). No such difference was found in are embedded. Passive exercise or cyclic compression the control group (0.36), even though the study group have been shown to produce an increase in lymph flow (subjected to KT applications) had a statistically greater rates in rabbit hind legs [7]. (p = 0.04) extent of lymphedema (cf. Table IV). The observation suggests that all methods which Further statistical analysis was performed only for deform the skin of the extremities may also improve the study group, describing in detail all changes ob- lymph flow and hence can be successfully used for the therapy of peripheral lymphedema. At present, the mechanism is used by physical therapy comprising 3000 compression therapy, MLD and physical exercise. A  relatively new method of tissue deformation is KT, first developed in 1973 [3]. Kinesiology Taping has been increasingly used for lymphedema reduction even though its mechanism of action has not been suffi- ciently elucidated and there is no absolutely convinc- ing evidence that KT is clinically beneficial. Kinesiology Taping is believed to alleviate pain or abnormal sensa- Subgroup 1 Subgroup 2 Control group tion, enhancing muscle function, removing lymph accu- mulating under the skin and improving the position of Edematous extremity, baseline assessment [ml] joints. Kinesiology Taping increases the space between Edematous extremity, final assessment [ml] Non-edematous extremity [ml] the skin and muscle tissue, thus facilitating blood and lymph flow. Kinesiology Taping is better tolerated by Fig. 2. Mean values [ml] obtained in 2 subgroups depending patients and can be worn for 1-3 days – or longer. on the type of KT applications 224 Przegląd Menopauzalny/Menopause Review 13(4) 2014 Tab. V. Significance of differences found in 2 subgroups depending on the type of KT applications A) KT with anastomoses p p p Subgroup 1 assessment 1 [ml] assessment 2 [ml] assessment 3 [ml] X 0.06 0.01 assessment 1 [ml] 0.04 0.58 0.70 NE [ml] B) KT without anastomoses p p p Subgroup 2 assessment 1 [ml] assessment 2 [ml] assessment 3 [ml] X 0.01 0.01 assessment 1 [ml] 0.01 0.01 0.70 NE [ml] 1 – Edematous extremity, assessment 1 [ml], 2 – Edematous extremity, assessment 2 [ml], 3 – Edematous extremity, assessment 3 [ml], NE – non-edema- tous extremity [ml] Being waterproof, the tape does not need to be re- of KT application (with or without anastomoses), a sta- moved before washing. tistically significant reduction in circumferences was Because of the progressive nature of lymphedema, noted in the upper extremities on the operated side in the effects of treatment depend both on whether it is the study group. initiated early enough and whether the right method Lack of significant differences dependent on the is adopted. Even early stages of lymphedema should type of KT application (with or without anastomoses) not be overlooked since lymph circulation disorders may stem from the discussion on the possible waste of adversely affect muscle function, fascia and skin tone, lymph flow after armpit lymphadenectomy. The median thus reducing patients’ mobility [2]. sagittal lymphatic watershed boundary and the trans- Women post breast cancer treatment usually report verse lymphatic watershed boundary, divide the trunk reduced mobility and muscle weakness in the upper ex- into four quadrants. However the density of the anasto- tremity on the operated side as well as pain, discomfort, moses varies from individual to individual [15]. Besides, subjective sensation of “tissue burst” and increased despite existing anatomical possibilities, collateral path- limb circumference, leading to the development of sec- ways will not form if the area is blocked by extensive ondary lymphedema [8-10]. Disturbed lymph flow in scars. In this context, it is said that both the generation mastectomy patients can manifest itself any time. It of new lymph vessels and the formation of lympho-lym- may emerge during the first postoperative days or have phatic anastomoses play an important role [15]. a latency period of up to 30 years [11]. Consequently, The above result may thus suggest a  successful this group of patients should receive special care. The use of KT in the initial symptoms of the lymphedema majority of women after breast cancer treatment scale regardless of the lymphatic application used. The tape down their daily physical activity, primarily due to fa- acts as a pump continually stimulating the lymph cir- tigue, which is the most common symptom associated culation on a 24 hr/day basis. Next, there occurs lift- with cancer treatment [12, 13]. Compromised physical ing and folding of epidermis with the papillary layer activity, in turn, makes it impossible for lymph circula- of dermis. That, in result, leads to the increase in the tion to be improved by muscle pump activation, result- blood flow capacity within the subpapillary vessel net ing in the development or exacerbation of secondary and in deep skin vessels and multiplication of lymph lymphedema. A vicious circle emerges. Reduced mobil- transport from papilla lymph capillaries to blood ves- ity, originally a consequence of disease treatment, de- sels. Thanks to this process, more beneficial circum- creases the activity of the muscle pump. Lymphedema stances for regeneration within the morbid condition occurs, further reducing the physical activity of patients area develop. Finally, normalization of muscle tension and adversely affecting their daily functioning and qual- appears followed by activation of blood and lymph ity of life, often leading to social isolation and mental flow and decrease in pain ailments and motility im- disturbances [8, 14]. provement [16]. Therefore, it is vital to introduce edema prophylaxis Except for a few reports [2, 4, 17-20] in the literature, and early physical therapy in patients. Depending on there are no well-conducted randomized, controlled the site and type of application, KT can produce differ - studies with KT and breast cancer related lymphedema. ent effects. Applied in lymphologic disorders, KT im- More efficient treatment protocol is needed for clinical proves lymph microcirculation. Regardless of the type practice. 225 Przegląd Menopauzalny/Menopause Review 13(4) 2014 In view of the above observations, it appears that 2. Regardless of the type of KT applications, the edema KT applications might be beneficial in standard edema- was found to have decreased significantly. reducing physical therapy. Physical exercise is especially 3. There were no differences in the extent of edema important during complete decongestive therapy, i.e. reduction induced by different types of Kinesiology lymphatic drainage combined with bandaging. Limb Taping. bandaging, however, markedly reduces the possibility of leading an active life and performing a full spectrum Disclosure of movements. In this light, replacing bandaging with KT applications seems a therapeutically reasonable so- Authors report no conflicts of interest. lution. A study by Tsai et al. [6] confirms this possibility. The researchers demonstrated a  significant reduction References in the extent of lymphedema both in the group of pa- tients receiving bandaging and in the group undergoing 1. Moseley AL, Carati CJ, Piller NB. A  systematic review of common con- servative therapies for arm lymphoedema secondary to breast cancer KT applications. treatment. Ann Oncol 2007; 18: 639-646. Benefits of this modification of CDT have also been 2. Białoszewski D. Przydatność kliniczna metody Kinesiology Taping demonstrated experimentally in rabbit studies. Kinesi- w  redukcji obrzęków kończyn dolnych u  pacjentów leczonych metodą ology Taping combined with a 15-minute exercise pro- Ilizarowa – doniesienie wstępne. Ortopedia, Traumatologia, Rehabili- tacja 2009; 1: 46-54. gram resulted in significant differences in lymph flow 3. Kenzo K, Walles J. Clinical Therapeutic Applications of the Kinesio Taping rates [7]. nd Method. 2 ed. Ken Ikai Co. Ltd., 2003. Physical exercise is of crucial importance for the 4. Lipińska A, Śliwiński Z, Kiebzak W, et al. Wpływ aplikacji kinesiotapingu na obrzęk limfatyczny kończyny górnej kobiet po mastektomii. Fizjo- elimination of edema, as the muscle pump promotes terapia Polska 2007; 3: 258-269. lymph flow. Insufficient physical activity may lead to in- 5. Put M. Taping jako metoda postępowania terapeutycznego. Fizjoterapia adequate outflow of lymph [17]. 2007; 15: 27-34. Kinesiology Taping thus opens up the way for a safe 6. Tsai H-J, Hung H-Ch, Yang J-L, et al. Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related new therapeutic modality in the treatment of patients lymphedema? A pilot study. Support Care Cancer 2009; 17: 1353-1360. who have contraindications to other methods. It can be 7. Shim JY, Lee HR, Lee DC. The use of elastic adhesive tape to promote a  good alternative for patients with bandaging prob- lymphatic flow in the rabbit hind leg. Yonsei Med J 2003; 44: 1045- lems (poor tolerance or contraindications resulting 8. Smoot B, Wong J, Cooper B, et al. Upper extremity impairments in wom- from coexisting conditions). en with or without lymphedema following breast cancer treatment. In a study by Tsai et al. [6], KT applications were bet- J Cancer Surviv 2010; 4: 167-178. ter tolerated by patients than bandaging, mainly due 9. Dawes D, Meterissian S, Goldberg M, et al. Impact of lymphoedema to greater comfort and no problems with everyday ac- on arm function and health-related quality of life in women following breast cancer surgery. J Rehabil Med 2008; 40: 651-658. tivities. Kinesio Tex tape, similar in its properties to hu- 10. Rietman JS. Long term treatment related upper limb morbidity and man skin, can be a  simple and well-accepted method quality of life after sentinel lymph node biopsy for stage I or II breast of edema management which, as a rule, is multi-phase, cancer. Eur J Surg Oncol 2006; 32: 148-152. long and costly, and does not always bring entirely sat- 11. Wójcik A. Metody obrazowania w  diagnostyce obrzęku limfatycznego. Acta Balneologica 2007; 4: 223-233. isfactory results. 12. Winters-Stone KM, Bennett J, Nail L, et al. Strength, physical activity and Major limitations of the present study were its rel- age predict fatigue in older breast cancer survivors. Oncol Nurs Forum atively small study group, which increased the risk of 2008; 35: 815-821. 13. Fialka-Moser V, Crevenna R, Korpan M, et al. Cancer Rehabilitation. Par- randomness of results, and a  short follow-up period. ticularly with aspects on physical impairments. J Rehabil Med 2003; 35: Future studies would be useful to investigate the ex- 153-162. tent of lymphedema reduction after KT applications in 14. Chachaj A, Malyszczak K, Pyszel K, et al. Physical and psychological a larger group of patients. A bigger study group would impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 2010; 19: 299-305. increase the reliability of conclusions and lower the risk 15. Földi M, Földi E. Textbook of Lymphology. Elsevier, Munich 2006. of errors. Furthermore, remote effects of the method 16. Zajt-Kwiatkowska J, Rajkowska-Labon E, Skrobol W, et al. Kinesio tap- should be monitored to evaluate long-term mainte- ing metoda wspomagająca proces usprawniania fizjoterapeutycznego nance of efficacy. – wybrane aplikacje kliniczne. Nowiny Lekarskie 2005; 74: 190-194. 17. Senderek T, Breitenbach S, Hałas I. Kinesiotaping – nowe możliwości fizjoterapii kobiet w czasie ciąży. Fizjoterapia Polska 2005; 5: 266-271. 18. Szczegielniak J, Krajczy M, Bogacz K, et al. Kinesiotaping in physiothera- Conclusions py after abdominal surgery. Fizjoterapia Polska 2007; 3: 299-307. 19. Szczegielniak J, Krajczy M, Bogacz K, et al. Kinesiotaping after thotaco- 1. Kinesiology Taping is an effective method of reduc- surgeries. Fizjoterapia Polska 2007; 3: 344-350. tion in early-stage lymphedema of the upper extrem- 20. Szczegielniak J, Łuniewski J, Bogacz K, et al. The possibilities of using ki- ity in women after breast cancer treatment. nesio taping in patients after cardiac surgery. Fizjoterapia Polska 2007; 4: 456-471. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Przegla̜d Menopauzalny = Menopause Review Pubmed Central

Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

Przegla̜d Menopauzalny = Menopause Review , Volume 13 (4) – Sep 9, 2014

Loading next page...
 
/lp/pubmed-central/kinesiology-taping-reduces-lymphedema-of-the-upper-extremity-in-women-FL03zuP4sZ

References (20)

Publisher
Pubmed Central
Copyright
Copyright © 2014 Termedia
ISSN
1643-8876
eISSN
2299-0038
DOI
10.5114/pm.2014.44997
Publisher site
See Article on Publisher Site

Abstract

Introduction: Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT). Aim of the study: The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment. Material and methods: The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer. All the patients were diagnosed with grade I  secondary lymphedema. Kinesiology Taping was applied to a  total of 14 randomly selected women. The remaining 14 patients constituted a  control group. The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software. Results: A significant reduction in the extent of lymphedema (p = 0.0009) was achieved in the KT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.36). Conclusions: Kinesiology Taping applications are an effective method of early-stage edema management. Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods. Key words: breast cancer, lymphedema, Kinesiology Taping. Analyses of therapeutic efficacy of different sec- Introduction ondary lymphedema-reducing methods performed Studies conducted to date show that the most ef- so far fail to include Kinesiology Taping (KT) because fective method of secondary lymphedema treatment in it is a relatively new treatment modality, though it be- women after axillary lymphadenectomy due to breast comes increasingly common for lymphedema control. cancer is complete decongestive therapy (CDT) consist- The mechanism underlying KT has not, as yet, been ful- ing of manual lymphatic drainage (MLD), compression ly understood. Similarly to other methods that deform techniques (bandaging, compression sleeves), physical the skin of the extremity, KT increases lymph flow and exercise and skin care. Complete decongestive therapy can be used in the treatment of peripheral lymphede- makes it possible to achieve an average of 45% of edema ma. According to authors using KT in their practice, reduction. A  slightly less effective therapeutic option is the method relieves tissue fluid congestion, augments complex physical therapy (CPT), a combination of differ - blood and lymph circulation, and improves subcutane- ent methods of lymphedema treatment, typically MLD ous lymphatic drainage [2, 3]. Kinesiology Taping ap- and intermittent pneumatic compression (IPC), though plications pull the skin slightly, creating more space other options are also possible depending on the health- between the dermis and fascia [4]. Lymphatic taping care facility’s experience. With CPT, edema can be re- is thus quite similar to lymphatic drainage, though it lieved by an average of ca. 30%. Self-application of MLD allows patients to receive therapeutic benefits 24 hours or IPC allows for up to 25% edema reduction. The effica- a  day [5]. Based on analysis of physiological effects it cy of other methods used for the treatment of secondary can also be argued that KT is more similar to compres- lymphedema of the upper extremity, such as continuous sion therapy in that it reduces capillary filtration rather compression therapy, laser therapy, self-massage, physi- than enhancing lymphangiomotor function. cal exercise or appropriate extremity positioning, ranges A  few studies (e.g. Tsai et al.) [6] demonstrated between 5% and 11% of edema reduction [1]. no significant differences in edema reduction between Corresponding author: dr Iwona Malicka, Wydział Fizjoterapii, Akademia Wychowania Fizycznego we Wrocławiu, Submitted: 12.02.2014 e-mail: iwona.malicka@awf.wroc.pl Accepted: 17.07.2014 221 Przegląd Menopauzalny/Menopause Review 13(4) 2014 standard CDT combined with pneumatic compres- The first group (study group, n = 14) consisted of sion (bandage) and modified CDT (combined with KT). women who received KT applications. 78.6% of them had A 17% edema reduction was seen in the group treated undergone mastectomy and 21.4% – breast-conserving surgery. In addition, 71.4% had received radiotherapy, with CFT combined with bandage and only 3% reduc- 85.7% – chemotherapy and 64.3% – hormone therapy. tion in the group receiving CFT with KT. It was found, The mean post-treatment period was 6.0 ± 4.8 years. however, that KT might be a more useful option for pa- Patients in the second group (control group, n = 14) tients with poor tolerance of bandaging, as it is more did not receive any anti-edema treatments. 85.7% of comfortable to the skin especially in hot climates and them had undergone mastectomy and 14.3% – breast- during the summer. Moreover, KT is a simpler and less conserving surgery. In addition, 35.7% of study partici- demanding technique than compression bandaging, pants had received adjuvant treatment in the form of which prompts patients to use it more systematically. radiotherapy, 71.4% – chemotherapy and 50% – hor- At the same time, the study demonstrated a higher risk mone therapy. The mean post-treatment period was of wounds caused by K-tape than bandage. 5.8 ± 4.8 years. Kinesiology Taping, on the other hand, may have There were no significant differences between a significant influence on lymph flow during exercise, as groups in variables that could potentially affect study noted in experimental studies in rabbits. Even though results. Detailed characteristics of study patients are the use of tapes resulted in no significant differences given in Table I. in lymph flow, their application during passive exercise markedly increased lymph flow rates [7]. The observa- tion can be explained by thermal and mechanical pro- Methods cesses involved in KT. Lymphedema measurement In view of the above, the aim of the study was to as- sess the effects of KT on the extent of lymphedema of All the women studied had the circumference of their the upper extremity in women post cancer treatment. upper extremities measured at 6 levels, using a centim- eter tape. The first level was at the proximal base of the metacarpal bones and the second across the ulnar and Material and methods radial styloid processes. The remaining four levels were defined by measuring consecutive 10 cm distances from Study group the styloid processes up the extremity. The study was conducted in a group of 28 middle- The results obtained from the above measurement, aged women, with a mean age of 59.75 years (± 5.95), based on the difference of the circumference between after axillary lymphadenectomy due to breast cancer. the swollen limb and the not-swollen limb were used All the study patients were diagnosed with grade I sec- to calculate the edema volume [ml] (Table II). The Limb Volumes Professional 5.0 program was used to perform ondary lymphedema and were not given any anti-ede- the calculations. This is a software for limb edema and ma treatment either before or during KT applications. lymphedema tracking, documentation and reporting. The patients were randomized into 2 groups. Tab. I. Characteristics of study patients and significance of values for differences between the study group (1) and the control group (2) Parameter Group 1, n = 14 Group 2, n = 14 p Age [years] 60.1 ± 6.3 59.5 ± 5.7 0.56 Body mass [kg] 75.4 ± 12.8 76.2 ± 11.8 0.69 Body height [cm] 161.5 ± 3.9 159.9 ± 7.1 0.29 Radical surgery [n] 11 12 0.87 Surgery on the right breast [n] 7 8 0.76 Post-surgery period [years] 6.0 ± 4.8 5.8 ± 4.8 0.76 Adjunctive treatment [n] 14 13 0.76 Radiotherapy [n] 10 5 0.11 Chemotherapy [n] 12 10 0.53 Hormone therapy [n] 9 7 0.53 222 Przegląd Menopauzalny/Menopause Review 13(4) 2014 Tab. II. Example circumference result calculation into volume values Centimetres Circumferences (cm) Segment number Volume (ml) from wrist Right (affected) Left (not affected) Right Left 0 17 17 10 24 21 1 338 288 20 26.5 26 2 508 441 30 28.5 26.5 3 602 549 40 33.5 31.8 4 767 678 Edema 258 It automatically uses the application of circumference- tors of neighboring territories. These are so called anas- based methods to determine the edema volume on the tomoses – fusions. Lymphatic encumbrances for the basis on the appropriate algorithm. given region of lymph confluence can in such a  case The first measurement (1) was performed at base- be transported to adjoining areas with lymph nodes line, i.e. prior to the initiation of therapy. The second without morbid condition. In our research this was the – after 2 weeks of KT applications and the final one (in lymph nodes’ area based opposite armpit: armpit – the study and control groups) after the completion of armpit anastomosis. KT, i.e. 4 weeks. In the second sub-group, the tape was applied only to the upper extremity in a double fan shape within the Kinesiology Taping applications arm and forearm (Fig. 1B). All the study group women received KT therapy. None of the above groups took part in any other A total of 4 applications were made, one in each con- physiotherapeutic sessions during the research. Within secutive week. The patients were randomly divided into the groups there were also no physical improvement two sub-groups of seven. Each sub-group was given exercises. two different types of applications according to the KT methodology. Lymphatic application was performed us- ing tape with a 1 cm wide base and tails divided into Statistical analysis four parts. The maximum tension of the tails was 15%, Statistical analysis was made with STATISTICA soft- after holding down the base of the tape during applica- ware using basic descriptive statistics and, due to the tion. During the tape application procedure the patients fact that the patient groups were small, non-parametric were in the sitting and supine position, depending on analyses of the significance of differences: for inde- the application given. In the first sub-group, the tape was applied to the pendent variables (between groups) – the Mann-Whit- ney U test; for dependent variables (between measure- edematous upper extremity in individual fan shapes on ments within groups) – the Wilcoxon test; and for the the arm and forearm, and along anastomoses (Fig. 1A). It is assumed that in big lymphatic vessels of trunk analysis of reduction in the extent of lymphedema – planes in certain places there occur links with collec- the Friedman test. A B Fig. 1. A) KT applications in subgroup 1. B) KT applications in subgroup 2 223 Przegląd Menopauzalny/Menopause Review 13(4) 2014 Tab. III. Significance of differences between edematous and the opposite extremity Group Edematous extremity Non-edematous extremity Baseline Final V [ml] V [ml] assessment assessment p p Baseline Final Baseline Final assessment assessment assessment assessment Study group (1) 2511.43 ± 532.26 2275.51 ± 482.12 2230.78 ± 353.61 2230.78 ± 353.61 0.0005 0.47 Control group (2) 2344.92 ± 311.67 2356.42 ± 310.96 2218.92 ± 272.10 2218.92 ± 272.10 0.02 0.02 Tab. IV. Significance of differences between preliminary and final assessments within and between groups Group Difference: edematous extremity vs. non-edematous extremity, V [ml] Baseline assessment Final assessment p Study group (1) 280.35 ± 231.89 44.78 ± 226.38 0.0009 Control group (2) 126.00 ± 192.64 137.50 ± 192.74 0.36 p 0.04 0.30 X Results served as a result of KT applications. Figure 2 presents results referring to two sub-groups selected randomly The results were based on the total extremity val- based on the type of KT applications. A statistically sig- ues obtained from the circumference measurements nificant reduction was found in both cases (cf. Table V). with the use of LVP program. During baseline assessment (1), a significant differ - ence in total volume [ml] was found between the up- Discussion per extremity on the operated side and the opposite Lymph flow can be promoted e.g. by walking, arte- side for both groups. Nonetheless, the difference was rial pulsation, lymphangiomotor function, muscle activ- not demonstrated in the study group during final as- ity, physical exercise, massage or breathing, which are sessment (3) (cf. Table III). This means that in the group all recognized as causes of tissue deformation. Lymph of patients undergoing KT applications a  significant formation and transport can be explained as a  result reduction in the extent of lymphedema was obtained of extension and compression of the initial lymphatics, between the baseline assessment – 1 and final assess- determined by the deformation of tissues in which they ment – 3 (0.0009). No such difference was found in are embedded. Passive exercise or cyclic compression the control group (0.36), even though the study group have been shown to produce an increase in lymph flow (subjected to KT applications) had a statistically greater rates in rabbit hind legs [7]. (p = 0.04) extent of lymphedema (cf. Table IV). The observation suggests that all methods which Further statistical analysis was performed only for deform the skin of the extremities may also improve the study group, describing in detail all changes ob- lymph flow and hence can be successfully used for the therapy of peripheral lymphedema. At present, the mechanism is used by physical therapy comprising 3000 compression therapy, MLD and physical exercise. A  relatively new method of tissue deformation is KT, first developed in 1973 [3]. Kinesiology Taping has been increasingly used for lymphedema reduction even though its mechanism of action has not been suffi- ciently elucidated and there is no absolutely convinc- ing evidence that KT is clinically beneficial. Kinesiology Taping is believed to alleviate pain or abnormal sensa- Subgroup 1 Subgroup 2 Control group tion, enhancing muscle function, removing lymph accu- mulating under the skin and improving the position of Edematous extremity, baseline assessment [ml] joints. Kinesiology Taping increases the space between Edematous extremity, final assessment [ml] Non-edematous extremity [ml] the skin and muscle tissue, thus facilitating blood and lymph flow. Kinesiology Taping is better tolerated by Fig. 2. Mean values [ml] obtained in 2 subgroups depending patients and can be worn for 1-3 days – or longer. on the type of KT applications 224 Przegląd Menopauzalny/Menopause Review 13(4) 2014 Tab. V. Significance of differences found in 2 subgroups depending on the type of KT applications A) KT with anastomoses p p p Subgroup 1 assessment 1 [ml] assessment 2 [ml] assessment 3 [ml] X 0.06 0.01 assessment 1 [ml] 0.04 0.58 0.70 NE [ml] B) KT without anastomoses p p p Subgroup 2 assessment 1 [ml] assessment 2 [ml] assessment 3 [ml] X 0.01 0.01 assessment 1 [ml] 0.01 0.01 0.70 NE [ml] 1 – Edematous extremity, assessment 1 [ml], 2 – Edematous extremity, assessment 2 [ml], 3 – Edematous extremity, assessment 3 [ml], NE – non-edema- tous extremity [ml] Being waterproof, the tape does not need to be re- of KT application (with or without anastomoses), a sta- moved before washing. tistically significant reduction in circumferences was Because of the progressive nature of lymphedema, noted in the upper extremities on the operated side in the effects of treatment depend both on whether it is the study group. initiated early enough and whether the right method Lack of significant differences dependent on the is adopted. Even early stages of lymphedema should type of KT application (with or without anastomoses) not be overlooked since lymph circulation disorders may stem from the discussion on the possible waste of adversely affect muscle function, fascia and skin tone, lymph flow after armpit lymphadenectomy. The median thus reducing patients’ mobility [2]. sagittal lymphatic watershed boundary and the trans- Women post breast cancer treatment usually report verse lymphatic watershed boundary, divide the trunk reduced mobility and muscle weakness in the upper ex- into four quadrants. However the density of the anasto- tremity on the operated side as well as pain, discomfort, moses varies from individual to individual [15]. Besides, subjective sensation of “tissue burst” and increased despite existing anatomical possibilities, collateral path- limb circumference, leading to the development of sec- ways will not form if the area is blocked by extensive ondary lymphedema [8-10]. Disturbed lymph flow in scars. In this context, it is said that both the generation mastectomy patients can manifest itself any time. It of new lymph vessels and the formation of lympho-lym- may emerge during the first postoperative days or have phatic anastomoses play an important role [15]. a latency period of up to 30 years [11]. Consequently, The above result may thus suggest a  successful this group of patients should receive special care. The use of KT in the initial symptoms of the lymphedema majority of women after breast cancer treatment scale regardless of the lymphatic application used. The tape down their daily physical activity, primarily due to fa- acts as a pump continually stimulating the lymph cir- tigue, which is the most common symptom associated culation on a 24 hr/day basis. Next, there occurs lift- with cancer treatment [12, 13]. Compromised physical ing and folding of epidermis with the papillary layer activity, in turn, makes it impossible for lymph circula- of dermis. That, in result, leads to the increase in the tion to be improved by muscle pump activation, result- blood flow capacity within the subpapillary vessel net ing in the development or exacerbation of secondary and in deep skin vessels and multiplication of lymph lymphedema. A vicious circle emerges. Reduced mobil- transport from papilla lymph capillaries to blood ves- ity, originally a consequence of disease treatment, de- sels. Thanks to this process, more beneficial circum- creases the activity of the muscle pump. Lymphedema stances for regeneration within the morbid condition occurs, further reducing the physical activity of patients area develop. Finally, normalization of muscle tension and adversely affecting their daily functioning and qual- appears followed by activation of blood and lymph ity of life, often leading to social isolation and mental flow and decrease in pain ailments and motility im- disturbances [8, 14]. provement [16]. Therefore, it is vital to introduce edema prophylaxis Except for a few reports [2, 4, 17-20] in the literature, and early physical therapy in patients. Depending on there are no well-conducted randomized, controlled the site and type of application, KT can produce differ - studies with KT and breast cancer related lymphedema. ent effects. Applied in lymphologic disorders, KT im- More efficient treatment protocol is needed for clinical proves lymph microcirculation. Regardless of the type practice. 225 Przegląd Menopauzalny/Menopause Review 13(4) 2014 In view of the above observations, it appears that 2. Regardless of the type of KT applications, the edema KT applications might be beneficial in standard edema- was found to have decreased significantly. reducing physical therapy. Physical exercise is especially 3. There were no differences in the extent of edema important during complete decongestive therapy, i.e. reduction induced by different types of Kinesiology lymphatic drainage combined with bandaging. Limb Taping. bandaging, however, markedly reduces the possibility of leading an active life and performing a full spectrum Disclosure of movements. In this light, replacing bandaging with KT applications seems a therapeutically reasonable so- Authors report no conflicts of interest. lution. A study by Tsai et al. [6] confirms this possibility. The researchers demonstrated a  significant reduction References in the extent of lymphedema both in the group of pa- tients receiving bandaging and in the group undergoing 1. Moseley AL, Carati CJ, Piller NB. A  systematic review of common con- servative therapies for arm lymphoedema secondary to breast cancer KT applications. treatment. Ann Oncol 2007; 18: 639-646. Benefits of this modification of CDT have also been 2. Białoszewski D. Przydatność kliniczna metody Kinesiology Taping demonstrated experimentally in rabbit studies. Kinesi- w  redukcji obrzęków kończyn dolnych u  pacjentów leczonych metodą ology Taping combined with a 15-minute exercise pro- Ilizarowa – doniesienie wstępne. Ortopedia, Traumatologia, Rehabili- tacja 2009; 1: 46-54. gram resulted in significant differences in lymph flow 3. Kenzo K, Walles J. Clinical Therapeutic Applications of the Kinesio Taping rates [7]. nd Method. 2 ed. Ken Ikai Co. Ltd., 2003. Physical exercise is of crucial importance for the 4. Lipińska A, Śliwiński Z, Kiebzak W, et al. Wpływ aplikacji kinesiotapingu na obrzęk limfatyczny kończyny górnej kobiet po mastektomii. Fizjo- elimination of edema, as the muscle pump promotes terapia Polska 2007; 3: 258-269. lymph flow. Insufficient physical activity may lead to in- 5. Put M. Taping jako metoda postępowania terapeutycznego. Fizjoterapia adequate outflow of lymph [17]. 2007; 15: 27-34. Kinesiology Taping thus opens up the way for a safe 6. Tsai H-J, Hung H-Ch, Yang J-L, et al. Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related new therapeutic modality in the treatment of patients lymphedema? A pilot study. Support Care Cancer 2009; 17: 1353-1360. who have contraindications to other methods. It can be 7. Shim JY, Lee HR, Lee DC. The use of elastic adhesive tape to promote a  good alternative for patients with bandaging prob- lymphatic flow in the rabbit hind leg. Yonsei Med J 2003; 44: 1045- lems (poor tolerance or contraindications resulting 8. Smoot B, Wong J, Cooper B, et al. Upper extremity impairments in wom- from coexisting conditions). en with or without lymphedema following breast cancer treatment. In a study by Tsai et al. [6], KT applications were bet- J Cancer Surviv 2010; 4: 167-178. ter tolerated by patients than bandaging, mainly due 9. Dawes D, Meterissian S, Goldberg M, et al. Impact of lymphoedema to greater comfort and no problems with everyday ac- on arm function and health-related quality of life in women following breast cancer surgery. J Rehabil Med 2008; 40: 651-658. tivities. Kinesio Tex tape, similar in its properties to hu- 10. Rietman JS. Long term treatment related upper limb morbidity and man skin, can be a  simple and well-accepted method quality of life after sentinel lymph node biopsy for stage I or II breast of edema management which, as a rule, is multi-phase, cancer. Eur J Surg Oncol 2006; 32: 148-152. long and costly, and does not always bring entirely sat- 11. Wójcik A. Metody obrazowania w  diagnostyce obrzęku limfatycznego. Acta Balneologica 2007; 4: 223-233. isfactory results. 12. Winters-Stone KM, Bennett J, Nail L, et al. Strength, physical activity and Major limitations of the present study were its rel- age predict fatigue in older breast cancer survivors. Oncol Nurs Forum atively small study group, which increased the risk of 2008; 35: 815-821. 13. Fialka-Moser V, Crevenna R, Korpan M, et al. Cancer Rehabilitation. Par- randomness of results, and a  short follow-up period. ticularly with aspects on physical impairments. J Rehabil Med 2003; 35: Future studies would be useful to investigate the ex- 153-162. tent of lymphedema reduction after KT applications in 14. Chachaj A, Malyszczak K, Pyszel K, et al. Physical and psychological a larger group of patients. A bigger study group would impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 2010; 19: 299-305. increase the reliability of conclusions and lower the risk 15. Földi M, Földi E. Textbook of Lymphology. Elsevier, Munich 2006. of errors. Furthermore, remote effects of the method 16. Zajt-Kwiatkowska J, Rajkowska-Labon E, Skrobol W, et al. Kinesio tap- should be monitored to evaluate long-term mainte- ing metoda wspomagająca proces usprawniania fizjoterapeutycznego nance of efficacy. – wybrane aplikacje kliniczne. Nowiny Lekarskie 2005; 74: 190-194. 17. Senderek T, Breitenbach S, Hałas I. Kinesiotaping – nowe możliwości fizjoterapii kobiet w czasie ciąży. Fizjoterapia Polska 2005; 5: 266-271. 18. Szczegielniak J, Krajczy M, Bogacz K, et al. Kinesiotaping in physiothera- Conclusions py after abdominal surgery. Fizjoterapia Polska 2007; 3: 299-307. 19. Szczegielniak J, Krajczy M, Bogacz K, et al. Kinesiotaping after thotaco- 1. Kinesiology Taping is an effective method of reduc- surgeries. Fizjoterapia Polska 2007; 3: 344-350. tion in early-stage lymphedema of the upper extrem- 20. Szczegielniak J, Łuniewski J, Bogacz K, et al. The possibilities of using ki- ity in women after breast cancer treatment. nesio taping in patients after cardiac surgery. Fizjoterapia Polska 2007; 4: 456-471.

Journal

Przegla̜d Menopauzalny = Menopause ReviewPubmed Central

Published: Sep 9, 2014

There are no references for this article.