Technology and Health Care 21 (2013) 607–612 DOI 10.3233/THC-130753 IOS Press

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Case Report

Efficacy of kinesiology taping for recovery of dominant upper back pain in female sedentary worker having a rounded shoulder posture Gak Hwang-Boa , Jung-Hoon Leeb,∗ and Hyun-Dong Kimc a Department

of Physical Therapy, College of Rehabilitation Science, Daegu University, Daegu, Korea of Physical Therapy, Inje University Busan Paik Hospital, Busan, Korea c Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Busan, Korea b Department

Abstract. BACKGROUND: Sedentary workers are most prone to work-related musculoskeletal disorders. OBJECTIVE: We report the case of a female sedentary worker with rounded shoulder posture (RSP) whose dominant upper back pain decreased after correction of her RSP with kinesiology taping. METHODS: We applied kinesiology taping around the patient’s upper back and shoulder for 1 month (six times per week, each session lasting approximately 16 h) without any other interventions. RESULTS: After kinesiology taping, the RSP decreased progressively and the dominant upper back pain gradually disappeared. The patient no longer complained of dominant upper back pain during desk work. CONCLUSION: We believe that kinesiology taping may be used to enable recovery from dominant upper back pain in female sedentary workers with RSP. Keywords: Kinesiology tape, rounded shoulder posture, upper back pain, rhomboid muscle, seated worker

1. Background Most sedentary workers find that maintaining a correct good posture while sitting for a long time is difficult because of increased fatigue of the lumbar extensor muscles [1]. A slouched posture during long hours of desk work could lead to rounded shoulder posture (RSP) [2,3]. RSP has been known to be a possible factor contributing to upper quarter pain [4]. However, research on recovery from upper back pain in sedentary workers with RSP is scarce. We report a decrease in the dominant upper back pain in a female sedentary worker with RSP through the correction of RSP after kinesiology taping. ∗

Corresponding author: Jung-Hoon Lee, Department of Physical Therapy, Inje University Busan Paik Hospital, 633-165, Gaegum-dong, Busanjin-gu, Busan 614-735, Korea. Tel.: +82 51 890 6032, Fax: +82 51 894 3350; E-mail: dreampt@hanmail. net. c 2013 – IOS Press and the authors. All rights reserved 0928-7329/13/$27.50 

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G. Hwang-Bo et al. / Efficacy of kinesiology taping for recovery of dominant upper back pain Table 1 The physical assessment results

Visual analogue scale (VAS) Distance of double square (inch) Supine RSP distance (inch) Total scapular distance (inch) Pectoralis minor length (inch) RSP, Rounded shoulder posture.

First Left Right 6 1 4.95 4.75 2.9 2.7 9 8.5 6.55 7

After 1 week Left Right 4 1 4.5 4.3 2.5 2.3 8.8 8.3 6.7 7.2

After 2 week Left Right 3 0 4.3 4.1 2.3 2.1 8.2 7.75 7.3 7.8

After 3 week Left Right 1 0 4.1 3.9 2.1 1.9 8.1 7.75 7.4 7.85

Final Left Right 0 0 3.7 3.5 1.7 1.5 8.0 7.7 7.5 7.75

Fig. 1. The supine measurement of RSP on the left shoulder. (Colours are visible in the online version of the article; http://dx. doi.org/10.3233/THC-130753)

2. Case description A 23-year-old female sedentary worker was diagnosed with RSP resulting in repeated dominant (left) upper back pain during desk work. She habitually sat in a hunched position without using the back of the chair for support. She complained of severe pain especially when writing, using the mouse, using her dominant upper limb (more with inward movement), and sitting in a slumped position. She tried to maintain a good posture during desk work to attempt recovery without seeking medical treatment, but was unable to do so. Despite continuous pain, she normally worked for > 7 hours in a sitting position. In the initial assessment (Table 1), the visual analogue scale (VAS) score (0, no pain; 10, the worst imaginable pain) was 6/10 and 1/10 in the dominant and non-dominant upper back, respectively. To measure the RSP of both shoulders, the distance from the wall to the tip of the anterior portion of the acromion process was measured with the double square [5] with two 12-inch combination squares (Johnson Level and Tool Manufacturing Co, Inc, Mequon, Wisconsin). The dominant and non-dominant sides measured 4.95 and 4.75 inches, respectively. The supine measurements of RSP [4] as measured with a straight ruler (the distance from the posterior aspect of the lateral acromion to the table), were 2.9 and 2.7 inches on the dominant and non-dominant side, respectively (Fig. 1). In addition, RSP was also observed in the antero-posterior view of the left shoulder (i.e., the greater tuberosity located more

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Fig. 2. The antero-posterior view of the patient’s left shoulder (A, initial radiograph; B, final radiograph; line, acromion; arrow, greater tuberosity).

proximally than the acromion) (Fig. 2A). The total scapular distance (TSD), measured with a tapeline [6] (the distance from the inferior angle of the acromion to the spinous process of the 3rd thoracic vertebrae) were 9 and 8.5 inches on the dominant and non-dominant sides, respectively. The pectoralis minor length (PML), measured by using a tapeline [7,8] (the distance from the inferomedial aspect of the coracoid process to the caudal edge of the 4th rib at the level of the sternum) were 6.75 and 7 inches on the dominant and non-dominant sides, respectively.

3. Methods We applied only kinesiology taping around the patient’s upper back and shoulder for 1 month (six times per week, each session lasting for approximately 16 h) without any other interventions such as medication and physical therapy. To correct the RSP, kinesiology tape (BB TAPE, WETAPE Inc, Seoul, Korea) was applied with approximately 50–60% stretch to accommodate for a more rounded posture in the dominant upper back and shoulder, and approximately 40–50% stretch in the non-dominant upper back and shoulder, without stretch at the ends of the tape, while holding the shoulder retraction posture. To protect against possible skin problems, taping was performed after applying a hypoallergenic undertape measuring 50 × 75 mm (Fixomull stretch; BSN Medical GmbH, Hamburg, Germany) to the anterior aspect of the acromial area. The first kinesiology tape was applied from the anterior aspect of the acromion to the spinous process of the 10th thoracic vertebra (Fig. 3A). The second kinesiology tape was applied to the same area with approximately 50% overlay to enhance mechanical correction (Fig. 3B) (Fig. 3; arrow, direction of tape application). The patient was instructed to remove the tape if she experienced pruritus. After the initial assessment, a total of four assessments were performed when the tape was removed.

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G. Hwang-Bo et al. / Efficacy of kinesiology taping for recovery of dominant upper back pain

Fig. 3. Application of rounded shoulder taping (RST) by using kinesiology tape. (Colours are visible in the online version of the article; http://dx.doi.org/10.3233/THC-130753)

4. Results As shown in Table 1, after repeated rounded shoulder taping (RST) for 1 month, the dominant upper back pain had decreased to 0/10, the distance of the double square measurements had decreased to 3.7 and 3.5 inches on the dominant and non-dominant sides, respectively. The supine RSP measurements RSP had decreased to 1.7 and 1.5 inches on the dominant and non-dominant sides, respectively. In addition, the final antero-posterior view of the left shoulder showed that the RSP had decreased as compared to the initial level (i.e., the greater tuberosity was located distal to the acromion) (Fig. 2B). The TSD had decreased 8 and 7.7 inches on the dominant and non-dominant sides, respectively. The PML had increased to 7.5 and 7.75 inches on the dominant and non-dominant sides, respectively. The patient no longer complained of dominant upper back pain during desk work. 5. Discussion A habitual hunched or slouched posture causes the development of RSP [2]. Although the relationship between posture and muscle imbalance is not yet clear, posture is commonly thought to cause muscle imbalance [9]. The pectoralis minor muscles become short and tight, which is believed to cause RSP [4,

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7]. During desk work, the worker in this case habitually sat in a hunched posture, with the dominant upper limb in a more inward and curved position. Therefore, the initial assessment of the dominant shoulder revealed a more rounded posture. Kinesiology taping is now being increasingly used for injury prevention and care of athletes in sports competitions [10], in clinical medicine to improve lymphatic circulation [11], relieve pain [12–15], enhance muscular functions [16,17], and correct misalignments of the pelvis [18] and the shoulder [19]. The elasticity of the kinesiology tape used in this study made it possible for it to revert to its original length [20] following free movement throughout the range of elasticity [15]. Due to the patient’s RSP during desk work, the tape is stretched and placed under increased tension, which subsequently induces the shoulder to return rapidly into a pre-RSP state. Therefore, we believe that RSP is controlled by the flexibility of the tape. In addition, the decrease of RSP through repeated RST application possibly affects the lengthening of the pectoralis minor muscle and decreases the supine RSP distance, double square distance, and TSD as seen in this case study. A cause-and-effect relationship between pain and alignment is not yet clear; however, alignment is one of many factors leading to mechanical pain [9]. A recent study showed that shoulder pain decreased after mechanical correction of the scapular elevation by using repeated kinesiology taping in a patient with scapular depression syndrome [19]. It was demonstrated that the patient’s dominant upper back pain disappeared because of decrease in RSP after kinesiology taping. 6. Conclusions This case study showed that the dominant upper back pain decreased after the RSP decreased through application of RST by using kinesiology tape in a female sedentary worker. We believe that kinesiology taping could be used for recovery from dominant upper back pain in such patients. Acknowledgement This study was supported by the Daegu University Research, Grant NO 20110284. Conflict of interest The authors declare that they have no conflict of interest. References [1] [2] [3] [4] [5] [6]

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Efficacy of kinesiology taping for recovery of dominant upper back pain in female sedentary worker having a rounded shoulder posture.

Sedentary workers are most prone to work-related musculoskeletal disorders...
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