Is it OK to K tape…?

Thank you, Adam. In fact, this is very similar to what I am experiencing with personal training and massage therapy. No toolbox, no clutter, no bullshit.

That’s interesting, as you demonstrated a number of taping techniques at a course that you ran last year at OMT. I’m certain that you quoted you used them frequently too !!

Interesting article – having only qualified last year and having not been on external courses to get used to adjuncts, it’s nice to use exercise and advice as the only treatments too!

Awesome article Adam!! This is how I’ve been feeling for the last few years. Simple, straight forward advice and reassurance, relying on our knowledge of tissue healing and promotion of good circulation to allow the human body to do what it does best..heal itself!

Interesting views however how do you manage to rehab an athlete as early as possible without adjunct ? I live in malta and we have alot of italian influences infiltrating in which is based on equipment ++ ranging from tecar therapy to shockwave to laser etc. again lots of this is not supported by ebp however its hard to compete against the idea that ‘big teams’ use this staff, and basically some people actually ask for things as they were FED the idea that certain things are essential to heal quicker. What are your views about this ?

Great to hear your reflective and reasoned views on K-Tape Adam. For me this is one of the key factors:
“K Tape was a constant distraction for patients, drawing their focus and attention away from the key message I was trying to get across in the session”
We have so much more to offer than playing “Doctors and Nurses” with athletes and wrapping them up in ‘bandages’.
Westy

Found this really refreshing to hear, Adam. Thanks. Even as a fairly new graduate I feel the pressure to utilise all aspects in my “tool box” and to be honest, with little confidence. This has given me that confidence to keep it simple and accept that some people you will just never covince!
Convince
Katie

Well said Adam. I love your attitude and philosophy towards Physiotherapy.
All the best, Tom

Damn Adam, what will we eat if you keep goring sacred cows? Kidding of course. KT has to be one of the sillier fads to sweep through the athleticy healing world. Thanks for the straight talk.

Hi Adam,
What are your thoughts on the use of the tape as a method of ‘biofeedback’ (stupid word but can’t think of another to use). Such as applying tape so that it stretches when you get into a ‘bad position’ and feeling the stretch alerts you to crappy posture etc.
e.g. taping down the lumbar region so that if you go into lumbar flexion in a squat/deadlift etc you feel it stretch cueing you to use a better position.
As long as you are clear that this is noting more than a cue and the tape is not doing anything magical, surely not a problem (although you may disagree as to whether you think this application of tape is useful).
Cheers
Will

Hi Adam, I am new to your blog, what do you think about dry needling ?
Love your posts !!
Orla

With my students, we have conducted a series of studies to test the effect of K-tape on balance and neuromuscular responses associated with ankle appliciations. Guess what? We could not find any significant effect on either mesures of postural stability or measures of corticomotor derived from TMS. For those interesred, we have a paper coming in J Athletic taining (in press) where we describe our observations regarding the lack of effect on the lower leg motor representation both at rest and during active movements.

Hi Adam, I agree fully with regard to the concept of lifting skin, creating space etc. etc. As an aside though Hug, Hodges, Vicenzino 2014 did show via elastoultrasonography that doing the “Box Tape” by placing the tissue in the shortened position, manually gathering it together and then holding it with tape does in fact reduce tissue stress under contraction at all ranges except when the muscle is at its shortest. This is not lifting the skin concept as per kinesio but does show a mechanical effect on the tissues with consequent reduction in load on those tissues. Earlier work by Vicenzino did show changes in pain free grip and pressure pain thresholds using the McConnell ‘Diamond Box’ for lateral epicondylalgia and perhaps this explains the mechanism in part.
I would also like to hear your opinion with regard to taping (not kinesiotaping) for changing function. For example, taping someone with foot drop. We will use Dynamic Tape – which has about 4 x the recoil force of kinesio and when a couple of layers are laminated together this increases significantly. This is placed on with the foot in full dorsiflexion, plus or minus an inversion/eversion component depending on their gait pattern. The tape is under tension at this point so that there is resistance to plantar flexion even in full dorsiflexion. In effect, the tape is helping to resist the force of gravity dropping the foot down. Improvements in gait parameters e.g. speed, 4 square step test, joint angles etc. are observed. Provided the tape is crossing a joint, is applied with the joint in a short position with resistance on the tape and good purchase can be obtained on the levers then this is basic vector summation. If something else is creating a resistance to gravity, the muscle needs not work as hard to create the same force required to overcome this resistance.
A lot of research when taping mechanically (not kinesio approach) has been shown to change things like foot postures, EMG, 3D Kinematics etc. albeit with varying duration of effectiveness. If our aim is to manage load (e.g. in tendinopathy where it is the main driver through the various stages but is also critical to recovery), improve function where weakness is present and we can provide additional force externally using the strong elastic recoil of the tape (much like a dynamic splint) or modify movement patterns by providing a deceleration or resistive force (basic physics provided the application meets the criteria above) then isn’t this a worthwhile component of our management that will help us meet the aims of our exercise or manual therapy based interventions e.g. reduction in load in a muscle tear may allow earlier weight bearing and functional stress to be applied (without overload, pain, inhibition) thereby providing all the advantages of early mobilisation e.g. collagen synthesis along the lines of stress, less reflex inhibition or disuse atrophy, no compensatory changes in movement, benefits on the pain system by providing normal afferent input, less anxiety, reduced perception of threat etc. etc. Benefits to someone’s function if they have foot drop and no longer catch their toe or have reduced falls risk is obvious, or someone who can maintain a more functional grasp because they can hold their wrist up more against gravity would also seem to be plain.
I, like you, use little in the way of ‘tools’ and I cringe when I see most tape applications. They have no hope of doing the above. However, I also know that if applied correctly we see immediate changes in EMG (just as you may use theraband to provide a resistance and increase work of muscle), immediate changes in position and 3D kinematics and immediate changes in function.

Hi Adam, I couldn’t agree more with a lot of what you say here and on many of your other blogs and I welcome the opportunity to actually discuss where we are coming from. I was not being narky but I must admit that being told that I am confused, a joker and other comments that you made did tend to ruffle my feathers which I am sure was the intended purpose. Showing your own blog, where in fact your own opinion regarding upper traps (and again I agree with it) was relying on your clinical opinion and extrapolation of other research but was without research to directly support your claims, was tongue in cheek but it was not narky.
Now back to the tape. Many of the limitations that you comment on with rigid tape is exactly why we developed Dynamic Tape in the first place. Firstly, we could get a mechanical change but only via restriction of movement which in many cases did not allow our athletes to move through the range they required, secondly the effect was short lived once significant exercise challenges were introduced and thirdly it did nothing to provide a deceleration force through range to try to mitigate the large forces that were experienced.
With a rigid tape, it is only ever going to loosen once it meets resistance through movement. With a strongly elastic tape crossing the joint, placed on in the short position with tension and providing that the soft tissue slack has been taken up or the tape has good purchase on the lever, the more the movement pushes into the tape, the more the resistance (provided you do not extend beyond the elastic zone into the more plastic region). Furthermore, Dynamic Tape is viscoelastic and not cotton like kinesiology tapes so the stiffness is dependent upon the rate of strain. In other words, the faster it stretches, the more resistance it provides. We have actually changed the properties of the fabric 7 times in the last couple of years. We now often laminate two layers together to give us a much stronger resistance and recoil still.
In simple terms, we are trying to use that elastic recoil to provide resistance to movement or gravity and in doing so reduce the necessary work of the musculotendinous unit or connective tissues to do this. I mentioned the case of foot drop above. We are simply using a strong bungee cord to try to reduce the effect of gravity on the foot. I believe some preliminary work in Portugal is being written up for publication which showed changes in the various parameters mentioned. We used to try to tape theraband to people to try to create some of the deceleration or resistance and then recoil but it is not very practical. Theratogs, Dynamic Splints etc. all work on similar ideas. Some preliminary data out of Germany showed that if the tape is applied to the wrist and fingers in flexion that it does in fact take significantly more EMG to overcome the resistance of the tape to hold the wrist in neutral. I accept that this was a preliminary investigation that someone did to get some ideas about further research but the number was about 40. The increased resistance is immediately apparent when applied correctly.
Please note, we are not trying to increase muscle activity via lifting skin, input into the system and so on. In many cases we are trying to reduce muscle activity. As you point out, there is a poor correlation between tissue damage and pain. We are not pain centric at all. In fact, in many cases there is no pain. This however does not mean that there is no tissue damage or that there is not functional impairment. Just in the way that tissue damage doesn’t account for pain, nor does pain account for tissue damage. Tissues fail because of load, not pain or possibly more correctly because of their inability to accommodate, dissipate or adapt to load. As the work of Soslowsky has demonstrated, tendinopathy is most rapidly induced by a combination of compressive and tensile loading. We also know that specificity of loading seems to be critical for recovery. If we consider a patella tendinopathy, we may apply the tape with the knee in full extension, with the tape under tension (and probably a double layer of 7.5cm tape) so that the recoil of the tape is resisting the collapse of the knee into flexion. If the tape can provide some of this force, it follows that less force is required to be generated by the MTU. Will we necessarily see changes in EMG? No. Hug, Hodges et al just wrote a commentary on the fact the EMG does not equal force/load etc. as many other factors come into it e.g. compliance of tendon, changes in leverage due to change in position etc. etc. but provided that we can introduce a genuine force into the system externally, we are reducing load absorption requirements of the tissues – is it clinically significant? Is one way better than another? Good questions that I hope to see answered. A preliminary study on patella tendinopathy in professional football in Spain was recently presented which showed immediate changes in VISA -P and pain but again larger studies need to be conducted. Another showed immediate resolution of an active lag of extension post ACL reconstruction. Again, I am not suggesting that the tape facilitated the muscle but rather that the combination of the tape resisting gravity along with the existing muscle activity was sufficient to overcome the force of gravity flexing the knee. Maybe other mechanisms are also involved.
We may also attempt to reduce compressive load in some cases by applying a ‘box’ technique. Again, the research was with rigid but we are generally able to create an even greater effect because we have a strong recoil continuing to gather the tissues, rather than trying to hold with rigid tape which again loosens quickly – happy to email images.
As mentioned we are not trying to ‘facilitate’ or ‘inhibit’ via input into the system through the skin. There is a huge amount of conflict in the literature with respect to this regardless the type of tape and it has never been one of our aims or proposed mechanism. Our aim may be to change position to improve the length-tension relationship of a muscle and thereby allow them to generate force more efficiently. But we are achieving this through a change in position not neurophysiologically. If we take your scapula example (and I am not suggesting a causative factor), Jeremy Lewis in 2005 demonstrated that postural and scapula taping changed position and significantly increased the range of elevation prior to the onset of pain. Again, I concede that this was with a rigid tape with all its limitations but nevertheless it showed significant effect. Others have shown similar changes with elastic tapes but as the resistance is many times weaker than Dynamic Tape and the application is different, I associate what we do more closely with the mechanical applications with a rigid tape. Our aim may be to bring the scapula into a more upwardly rotated position and provide resistance to it downwardly rotating. This may have several effects. When the scapula is in a more upwardly rotated position one might argue that the lip formed by the architecture of the glenoid and the labrum provide a little passive support to the humeral head. Once we adopt a downwardly rotated position this is lost so less support, longer lever arm so increase drag on the arm and more muscular force to centre the humeral head etc. etc. This can be seen in hemi subluxed shoulders whereby you manually hold the scapula in position and the subluxation reduces quite a bit. In the downwardly rotated position, the upward rotators like lower trapezius (and upper trapezius) are lengthened – poor length-tension relationship and due to mechanical insufficiency have less ability to generate force all the time having increase load to overcome. Bringing into a more upwardly rotated position improves the length-tension relationship and force generation capacity. One proposed function of scapula motion during elevation is to maintain optimal length-tension of the rotator cuff also so by changing the scapula we may indirectly improve upon this also.
Taping circumferentially will also give us a strong tourniquet effect due to the strong recoil. Vleeming and Cholwicki both demonstrated that compression around the pelvis can augment force closure. The force necessary was equated to tying up your shoe laces. Again, if we are looking at the ability to transfer load, augmenting force closure through a compressive tape (which can create far greater and sustainable pressures than a rigid tape) may be advantageous and again create a window of opportunity that allows us to have the person improve their own strength etc. This may have applications at the foot and ankle, wrist and hand for example.
There are many problems with the literature, not only pertaining to tape but pertaining to physio interventions in general. Take for example the recent study by Parriera on 149 low back pain patients. Just because they have had pain for more than a few months and it doesn’t go past the buttock or whatever the criteria is doesn’t make them an homogenous group. Doing the same intervention on all of them and expecting a result is setting yourself up for failure. This is like saying that everyone with chest pain has the same problem, let’s give them the same medication. Now, I excuse the present study because they were looking at a kinesio approach which does seem to suggest that you can slap it on everyone in the same place and the bunching of the tape will do its thing. However, we see the same issue regularly. We need to be looking at classifying things far better, what structures are at fault (if any), what stage of the pathology are they at, what central or peripheral mechanisms are in play, what if any are the major biomechanical factors that may be contributing? We can then take a more homogenous group and get some meaningful answers whether it is with tape or any other intervention.
This is highlighted by the systematic reviews on kinesio (Parreira, 2014, Williams, 2012, Mostafavifar, 2012, Kalron and Bar-Sela, 2012, Montalvo, 2014, Morris, 2013 , which again I must stress is not what I am suggesting for a minute but these reviews all state as you said, that there is insufficient research looking at same populations, same technique, same outcome measures etc. to draw any meaningful conclusions. Parreira for example included the following – shoulder pain in two trials; knee pain in three trials; chronic low back pain in two trials; neck pain in three trials; plantar fasciitis in one trial; and multiple musculoskeletal conditions in one trial. One to three trials at most and even then looking at different groups, different techniques, symptomatics, asymptomatics. If we are going to give an honest appraisal of the literature we must also do the same with these reviews.
This actually is demonstrating the lack of research but is reported as there being evidence against which is not accurate and although personally I think I can do many better things, I don’t think we can say that the research shows it isn’t effective beyond a shadow of a doubt. In fact, most of these reviews do concede some changes including ROM, short term effect on pain and in cases significantly greater than the sham tape – that is a whole other story because most sham tapes with kinesio taping studies are ineffective. You mention placebo and it happens to be a pet subject of mine having done a rather larger literature review on it when I did my masters to go along with my research on central and peripheral pain mechanisms in chronic insidious onset neck pain and whiplash. With expectation being a huge factor as you mention, any sham tape has to at least look as impressive and most don’t. Also if the proposed mechanism is neurophysiological, the same amount of skin must be covered and again most shams are one or two strips while the ‘active’ technique has five or six with nice patterns. What is a placebo, however? Callaghan et al in 2012 showed that just sticking a piece of tape across the knee resulted in changes in brain activity on functional MRI during knee joint proprioceptive tasks. Is it clinically significant? Good question but just sticking tape on, any tape changes some things.
Other studies e.g. Maguire, 2010 have shown hip taping and theratogs increased hip adductor EMG and gait speed in stroke patients. A double layer of Dynamic Tape approximates theratogs force. Kilbreath, McConnell et al, showed glut taping increased hip extension in late stance and increased step length on the unaffected leg when compared to sham and control, also in stroke patients.
We have done some double-blinded placebo controlled pilots looking at arch height and foot length and see significant difference when tape is applied with the foot in the short position to maximise the bungee/mechanical effect when compared to applying it with the foot in a relaxed position. Same skin coverage, same technique just using position to maximise the potential mechanical component so we accounted for expectation and input via the skin. If researchers really wanted to get to the bottom of the mechanisms they would manipulate expectation more and apply ‘active’ techniques with negative expectations, passive techniques with positive expectations and vice versa.
We also did an experimental design, single case study on a distance runner and found that this effect, although slightly diminished lasted for several days. Again, our aim here is to provide an elastic resistance in parallel to resist lengthening of the foot, to augment force closure to help maintain the transverse arch and to reduce flattening of the MLA. Again, this is just a pilot and larger cohorts and well designed studies need to be done on correctly classified subjects. However, we find that many people want to lump Dynamic Tape in with kinesio because it stretches despite being made from completely different stuff, having many times the resistance and recoil force, being designed for a completely different use and being applied to the body completely differently (if done correctly). Researchers want to look at things that we do not claim nor are we trying to effect like vertical jump height. Many are students who have never had hands on a patient let alone taped and we find that even very experienced clinicians take considerable time to work this out – both with their handling and application, and reasoning. But anyone can get hold of our tape, use and research it however they want despite it being completely contrary to our own aims and uses.
Sorry for the long winded response. I agree that many tape companies make claims that are not justified, I agree that the proposed mechanism of kinesio is questionable and has never figured in my patient management but I also suggest that there is evidence to suggest that taping mechanically to improve function, modify a movement pattern, perhaps impart a Mulligan type glide into a position of ease or to potentially reduce work of muscle or assist in load management, based on sound clinical reasoning and hypothesis taking into account various aspects of the research on pain physiology, pathophysiology, pathomechanics etc. has a sound fundamental background and further research is required to determine when, if, how etc. Professor David Sackett who is credited as being the father of evidence based medicine explains that the evidence available in the literature must be incorporated in light of patient and clinician specific factors. The patient’s wishes and expectations must be considered and skilful assessment and diagnosis is required on the part of the clinician. Only then can relevant interventions be considered and applied if the risks are considered acceptable given the potential benefit. We will never have sufficient research to support every intervention at every stage of every pathology in every client given their specific, individual needs.

Adam, I understand that your product is you and this aggressive posturing that you have on here. You might however want to check the timeline as by your own admission you had not read the paper before dismissing it as just teaching clinicians to apply placebos (which also came after calling me confused) and that was what prompted my suggestion of the presence of a confirmation bias. Nevertheless, you have your product to sell also so bash away.
I do not seek your approval only to say that if you want to criticise us do so on the basis of what we are actually trying to do, not the methodology of others which we also do not agree with. The background science is there, preliminary research as mentioned is emerging to support this for the things that we claim – change movement/position, work of muscle, load, and more research is being done. The product has only been on the market for a couple of years in which time most people have used it in a way that we do not suggest and many proposed studies do not look at the things we are trying to effect.
If we do the research, we are of course biased so we cannot win.
It’s been fun…

Adam, I was tagged in on twitter so did not initiate it. I only commented when it was suggested that we are trying to do things that we are not. I have explained how we suggest that we can change work of muscle in my previous post e.g. via position and effect on length-tension, via providing an external deceleration force etc., the background to our approach and the various research, taping and otherwise that led to its development and preliminary research now supporting it. I was also open in discussing the limitations to the research and how it may be improved upon to provide some meaningful results. I am aware of more independent research (RCTs) that has been conducted and sent to me which provides further support however until this is published, I am not in a position to discuss it. By selectively focussing on a couple of words on a flyer which have been used long before they related to tape of any kind, you once again misinterpret that to mean that we suggest that we create a neurophysiological effect via lifting skin etc. etc. As I have said many times before, we do not teach this. In fact I go through and describe various research which shows different results that have been reported when applying tape along muscle, across muscle, in different populations, with different tapes and the lack of consensus in the research with regard to this and how this challenges some of the conventional thinking with regard to rigid ZO taping also.
I would challenge the notion that a change in navicular height of 4 to 4.3mm is clinically insignificant. Meier et al, 2008 showed that changes of on average 2.6mm resulted in reductions in foot related symptoms. Franettovich et al showed changes of about 5mm resulted in changes in EMG and kinematics both locally and up the kinetic chain in those with exercise related leg pain. Results on low dye taping report changes from 3.1mm to over 10mm however the larger scores have been obtained e.g. by Vicenzino, 2000 when only subjects with navicular drops of greater than 10mm have been examined. Again, it comes to correct classification. If someone is not excessively dropping, is there an indication to tape to reduce that and will it be effective? The study that you critique which showed mean changes of 4mm to 4.3mm did not include those only with a large navicular drop. Velocity of navicular drop has also been associated with medial shin soreness groups, Rathleff, 2012. Elastic taping has also been shown to have a greater effect than rigid after exercise on ankle motion – Albian- Vicen, 2009. The preliminary study of our own where we actually also incorporate a longitudinal force vector to shorten the foot and raise the arch as well as use big toe extension to further tighten the tape to provide a windlass effect to further resist foot lengthening showed changes in navicular height of between 5mm and 11mm. It also showed a reduction in navicular drop NWB to WB by about half. Dropping half the distance over the same time suggests reduced velocity. JOSPT Clinical Practice guidelines for plantar fasciitis in 2014 were revised to include taping, both rigid and elastic as having A grade, strong evidence to supports its use.
I also have to challenge the idea that somehow a short term effect is not advantageous. With reference to the study by Jeremy Lewis, previously quoted that showed taping posture and scapula could increase the point in shoulder elevation range at which the pain came on – if an athlete is in the gold medal match in table tennis and can now function in pain free range to play all his shots due to the increase in available pain free range, I would think that the short term benefit is welcome. If someone is in pain and a short term pain relieving effect can reduce their use of analgesics, could this not be considered beneficial? If taping a golfer’s lumbar spine to resist an increase in sagittal plane motion which results in a loss of rotation, can give them the idea of where they need to be so that they can actively retrain an improved swing, that is also a benefit. It comes down to having clearly defined indications and aim. Absolutely there are limitations. I do not suggest it is indicated on everyone. I do not suggest that merely applying tape has a miraculous effect. There is no active ingredient. It is completely reliant on appropriate use.
As for you as a product, I am sure that your blog helps you to fill your own courses and your own clinic. It is this means of self-promotion and positioning yourself as an expert that increases people’s awareness of you and what you have to offer. It’s not a criticism. It is what it is.
I have to bite on the aggressive bit – but I find it hard to see how being called a joker, confused, told ‘No Fucking Way!’ to a sincere invitation, being asked to provide a discussion and then mocked for it’s length and having the elements that were requested ignored can be interpreted as anything but aggressive and provocative. Absolute statements such as there is no evidence whatsoever for changes in position, kinematics or muscle activity when there is as demonstrated by just a small amount of it above (and as determined by JOSPT) is misleading those who have not had the opportunity to review the literature in depth. As for the jibes about being rich for owning a tape company, if only you knew. We are husband and wife clinicians who found that we were unable to achieve what we wanted with available products and as I stated earlier, we tried everything from theraband to neoprene straps to try to create the effect. We didn’t set out to create a tape company. There is no big conglomerate, there is no backing from anyone else. You suggest you would put your money on your opinion, we actually did put our money on the line by selling our house to build this business based on feedback and preliminary research from leading clinicians and colleagues at universities in Australia and in various disciplines from hand therapy to paediatrics. Clearly, I am sensitive so I will sign off here.

Interesting discussion Adam & Ryan, my experience supports your blog Adam about the use of tape.
Strength and conditioning is a good alternative to tape, and it has lasting benefits for the client / athlete. We need to build clients / athletes who are resilient and do not need to rely of tape ‘to get me through’

Really interesting discussion here. I would at the very least agree that a lot of patients tend to get ‘distracted’ by the K Tape rather than focusing on what you’re trying to tell them. Thanks for sharing your thoughts!

Hi Adam.
First of all, great fan (a portuguese one). I follow you on twitter and regularly come here to see your latest posts.
I agree with many thoughts that you put in this text, and I strongly disagree with a few others. I’m not making a huge f*****g commentary here, so I will only suggest you to read a paper text from football medicine, which I tjink it is called “Kinesio Taping in sports”.
Keep up the great work.
Cheers

liked your personal objective opinion on k tape, but, i think it s ok in a matter of psycho-neural therapy to use k tape… imagine all the skin receptors that signals the brain, that something is placed on your local pain zone, and that’s feels “safe” in kind of way… but also this is bad for the long term, how u said about the pacients become dependent…

Hi Adam,
Nice read, especially since it does support my beliefs on our adjucts or whatever you want to call them. I feel that Adjuncts are extremely useful when it comes to patient “buy in”. However I do apply them with care and try to prevent complete reliance on them long term. Our main goal as PT’s is to get clients painfree and active, if a bit of stretchy tape gets them over that hump, perfect. I’ll burst their bubble the week after and then its all exercise from there on it 🙂 Finding myself more often then not removing braces, orthotics, tape etc… and clients are very suprised at how much 2 simple exercises can do (take less than 2 minutes) vs. applying a tape that takes them about 15 minutes to put on.

I think each to tier their own. There are many treatment tools and techniques I was taught during uni and while working which I can best put ‘I never quite mastered’ but that doesn’t mean I should tell all physios that it doesn’t work. It just isn’t a tool I myself can’t use. I love leukotape k it works like a bomb with the right patient , at the right time, with the right technique as with most physio tools. Don’t hack it coz you can’t get it right.

Thanks Adam,
I have read your blog on palpation previously and took the time to re-read it. I do agree with some of the points made especially with relation to some of the work done on TPs and SIJ. I disagree with some however such that those tests that are able to be reliably conducted are dependent upon pain e.g. Lachman’s. In fact, pain and swelling can make Lachman’s testing less reliable. Lack of a solid end feel is a critical finding and can be reliably detected.
There are also problems with the research or with conclusions drawn from some research as is the example that you used on PPTs to say that manual palpation of the cervical spine is not reliable. The study shows that pressure pain thresholds are reduced bilaterally in the entire region when someone has zygapophyseal joint pain and that this threshold is lower than asymptomatics. In Whiplash you can also throw in that Tibialis Anterior thresholds are also lower suggestive of central hyper-excitability. This is already well known and it does not suggest that manual palpation cannot detect the responsible zygapophyseal joints (as determined by selective blocks). The studies that I mentioned previously did show a remarkably sensitive way of detecting this joint using PPIVMs which are looking at motion of the segments and reactivity as opposed to a pain response. PPTs may be reached before motion is even created using a pressure algometer and PPTs may be elicited from other tissue such as the muscle etc. so are also not specific to the joints and therefore cannot provide any conclusions about those joints. It is looking at something completely different to assessment of PPIVM. It just tells us a bit about the pain mechanisms in play.
Your assumption that experience or time (25000 patients etc.) equates to skill can also be debated. On the first day of my post graduate studies half of the class was asked to lie on the bed while the other half performed a grade IV PA mobilisation on L5. They were then asked to rotate around to the next bed and do the same thing. And once again. As one of the ‘patients’ I can tell you that the location, amplitude, pain (false positive through poor handling) was very different despite this being a group of ‘experienced’ clinicians. This is consistent with the results of some of the research for sure. However by the end of that year of practising from 6am to 11pm every day, there was high consistency in these palpation skills as well as in determining symptomatic levels. There are several studies which show this also, some better than others of course. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419570/ or http://www.ncbi.nlm.nih.gov/pubmed/16837235 or http://www.ncbi.nlm.nih.gov/pubmed/10903585. These all look at palpation in isolation which is not how it is used in practice. I believe future studies are looking at palpation combined with a sound clinical reasoning process.
I think in many cases the research which is held up to be an absolute truth is just as subject to flaws as is the subject matter which they are testing. Most researchers have a preconceived idea and test to support rather than negate (on both sides of any question), they often make assumptions or draw conclusions that are not accurate or others draw these conclusions and promote them as fact, they may administer the technique incorrectly or inadvertently bias it through their own behaviour (and subsequent effect on the subject’s beliefs, expectations etc.), the cohort lacks uniformity so they are trying to do the same technique on a varied group and expect a consistent result, they may be third or fourth year students who just want to please their supervisor and the list goes on. When systematic reviews only come up with two reliable studies then the review is also not reliable or lacks any power.
I agree that the mechanisms by which manual therapy may work are many and varied and not necessarily what people have thought in the past but that is a different discussion.
By the way, I don’t teach any palpation courses or have any books.

I put K tape on someone’s anterior 5th rib once. Not only did I fix their knee pain, they got improved symmetry when using a reformer! I also won the bonus ball that weekend so it must work!

I use it because when it’s on the skin, it acts as a constant reminder of being touched by a therapist. Your treatment can continue as long as the tape stays sticking to the skin.

Hello,
Fantastic article! I would be more than pleased if you could share your opinion about foam rolling ? I can’t find reliable articles which could put some shade on that topic. I am from Poland and almost everyone is foam rolling here, cause again they want to ‘release’ their muscles. Not sure if this method sometimes doesn’t cause more damage to tissues than actually help.
Thanks in advance !

If you are looking at the fashion now and how everything is going to pain mechanisms and psychosocial framework you will realize that for example pain mechanism papers are at the level of experts opinion(the first step in order to build qualitative studies), The whole mechanism is not fully understood. So, what are we doing with our clinical reasoning there?
High quality studies proved that KT is not efficient, dry needling is not recommended by latest guidelines and so on, everything can be debatable