Osteoarthritis (OA) is the most prevalent disorder and chief cause of disability in elderly people and constitutes a major public health problem in modern society.1 In particular, the knee is the most commonly affected joint owing to weight bearing and repeated movement. Among the symptoms after development of OA, pain is the greatest concern, and motor disabilities such as immobility and decreased proprioception are the second most common causes for concern.2 Therefore, pain attenuation and improved motor function are pivotal for increasing quality-of-life in patients with OA.
OA is often accompanied by several types of pain, such as pain at rest, with movement, and during walking, and secondary hyperalgesia.3 These kinds of pain generally increase to a greater extent when pressure is placed on the joints during physical activity in patients with OA.4,5 However, these kinds of pain have not been studied well, and most OA pain studies have been conducted at rest. In addition, the effect of intervention on various types of pain remains unclear.
Surgical and conservative interventions such as pharmacologic and nonpharmacologic management are used to reduce symptoms and to improve knee function in patients with OA.6 However, pharmacologic management is often accompanied by gastrointestinal and renal side effects, and surgical intervention is usually used in severe cases as the final option.6 Thus, the demand for safe, noninvasive, and nonpharmacologic treatments for the management of OA symptoms is increasing.
Among the conservative interventions available, the use of various kinds of taping approaches in clinics for management of degenerative disorders of the knee joint is increasing. Among them, Kinesio taping (KT) was originally developed by Kase et al.7 and has been used in clinics for pain control and motor function enhancement in patients with sport injuries or musculoskeletal disorders.8 KT increases muscle flexibility and muscle strength and improves proprioception in patients with various musculoskeletal disorders9–11; however, some studies reported that KT is ineffective in dealing with the management of muscle performance, motor function, and proprioception.12,13 Thus, KT effects on various symptoms are not clear until now, and establishing standard methods, such as the degree of tension or site, for KT in the clinic is required.
The effects of KT on pain caused by OA are unclear, and studies on the effect of KT on movement-evoked pain such as that during walking and secondary pain are rare. In addition, the effect of KT on proprioception or on limitations in the decreased range of motion by OA is unclear. Thus, a study to characterize these effects of KT is necessary, and a randomized controlled trial is needed for a clear characterization of the effect of this intervention.
Thus, the aim of this study was to demonstrate the short-term effects of KT on various types of pain, range of motion, and proprioception in patients with knee OA compared with those treated with a sham KT application. In addition, the authors investigated the correlation between various types of pain and active range of motion (AROM) as well as proprioception after KT in OA patients.
Design and Subjects
This study was designed as a single-blind, randomized controlled trial. From October 2011 to June 2012, a total of 60 volunteer subjects with knee OA who were outpatients at local clinics (Seoul, South Korea) provided written consent for participation in this study. Subjects were included in the study if (1) they had radiographic OA in a symptomatic knee joint that had been documented for more than 1 yr, (2) they had a 100-mm visual analog scale (VAS) score of greater than 50 in the symptomatic knee during walking, (3) they had no ligament or soft tissue damage, and (4) they were older than 50 yrs. Participants with orthopedic disorders (e.g., fracture, sprain, or strain), neurologic disorders, a history of knee joint surgery, or a balance disorder originating from vestibular problems and those who refused participation were excluded (total of 14 patients).
Before conducting the test, the subjects were checked to determine whether they met the inclusion or exclusion criteria. In addition, the participants were prohibited from taking analgesics or nonsteroidal anti-inflammatory drugs for 3 days before the experiment to minimize the analgesic effects of these drugs and elucidate the specific analgesic effects of KT on arthritic pain.8
After the pretests, 46 participants with OA were randomly allocated to either the KT group (n = 23) or the placebo-KT group (n = 23) using a random allocation software program.14 Random allocation was performed by two research assistants under blinded condition. The participants and the researchers were unaware of group assignments.
The involved side was measured, and the experiment was carried out using the more severe side if OA symptoms existed on both sides. The participants listened to an explanation of the study process and experimental intervention before starting the experiments, and the entire process was conducted with the participant’s permission. All experimental procedures were approved by Korea University Institution Review Board. The study procedure is shown in Figure 1.
To measure several types of pain induced by OA, VAS scores at rest and during walking were assessed. In addition, the intensity of pain in the quadriceps and tibialis anterior muscles was measured using an algometer. Furthermore, the ROM of the knee joint was measured by assessing the pain-free AROM of the knee. The proprioception test was also carried out after measuring the active positioning ability of the knee at three different angles. Measurements were performed before experiment and 1 hr after KT. Proprioceptive test results were classified as “good proprioception” or “poor proprioception” on the basis of the accuracy of the scores recorded with regard to the target angle. Good proprioception indicates that the deviation value was less than 5 degrees for the target angle, and poor proprioception indicates that the deviation value was greater than 5 degrees.15
The KT group underwent a standard KT procedure performed by one physical therapist, who is a certified KT practitioner, according to the manual by Kase et al.7 The participants were positioned lying on their side with the hip extended and the knee on the dominant side at 60 degrees of flexion. The more affected limb of each patient with knee OA was taped with an I-shaped KT starting at the origin of the rectus femoris and a Y-shaped KT proximal to the superior patellar boarder. The taping had no tension at its two bases, whereas the portion between the anchor and the superior patella was stretched 15%–25%. In the placebo-KT group, the participants were asked to lie in a supine position with no knee flexion and were applied KT with no tension or stretch to the rectus femoris in the same manner as in the KT group. If the participants felt discomfort, the KT was removed immediately (Figs. 2 A, B).
VAS scores at rest and during walking have been used to measure pain intensity in patients with OA. The VAS is a continuous scale composed of a 100-mm horizontal line in length. The scale is most commonly anchored by “no pain, 0,” and “worst imaginable pain, 100.” Uncomfortable sensations and pain intensity that the participants felt at rest were considered as the “VAS at rest,” and the pain the subjects felt during walking 10 m was considered the “VAS during walking.” The participants marked the amount of subjective pain by themselves, and an investigator marked the distance measured in millimeters. The range of the minimal clinically important difference values in OA is from −11.1 to −19.9.16
An algometer (JTECH Medical, Salt Lake City, UT) was used to measure the pressure pain threshold (PPT) of OA at the midpoint of the quadriceps and the midpoint of the anteromedial aspect of the tibia. The PPT was the point at which pressure elicited pain and is presented as pounds per square centimeter. The pressure head of the algometer contacted the muscle belly, and the pressure intensity was increased progressively in increments of 0.5 lbs/sec until pain was triggered. The PPT has a valid test-retest reliability (r = 0.83) for deep-tissue hyperalgesia in patients with OA.17
A digital inclinometer (Lafayette Inc, Lafayette City, IN) was used to measure pain-free AROM in the knee joint. After attaching the digital inclinometer to the anterior midline of the thigh and the shin, the participant flexed and extended the knee within a range without pain, and AROM was measured. The measurement was carried out three times, and then the values were averaged. The reliability of range of motion measurement using a digital inclinometer in the knee joint is 0.973.18
Proprioceptive acuity was confirmed after measuring the active positioning ability of the knee. The active angle reproduction method was used to check the active positioning ability.19 To test the proprioceptive acuity, the participants were seated in a chair with 90 degrees of knee joint flexion. The lower limb of the participant was moved passively and randomly to each of the target angles of 15, 30, and 45 degrees at 90 degrees of knee joint flexion. Three angles were measured to allow comparison of proprioception occurring in the knee joint according to joint angle. The participants were seated in a comfortable position on the chair with the knee joint bent 90 degrees and their feet floating above ground. The lower limb was held for 10 secs at each target angle and then returned to the starting position. After holding the starting position for 10 secs, the participants extended their knee by themselves.19 The participants extended their knee to the target angle and then stopped. Accordingly, an investigator measured the absolute value of the deviation angle, which is how far off the patient was from the target angle, three times per angle and calculated the mean value.
Sample Size Determination Analysis
Sample size was calculated using G-Power 3.1.3 software. The power and α levels were set to 0.80 and 0.05, respectively, and effect size (ES) was set to 0.8. A priori analysis for the required sample size indicated that at least 21 subjects would be needed in each group. Thus, 23 subjects were used in each group to account for dropout cases.
All statistical analyses were conducted using the Statistical Package for the Social Sciences 12.0 (Statistical Package for the Social Sciences Inc, Chicago, IL). The Shapiro-Wilk test was used to check normality of the outcome variables. The Mann-Whitney U test and the independent t test were conducted to compare dependent variables between the groups. The Wilcoxon’s signed-rank test was used for VAS scores, and paired t tests were used for algometer, AROM, and proprioception outcomes to compare dependent variables within the groups. The Pearson correlation test was used to analyze the correlation between pain and AROM as well as pain and proprioception. α Value was set at 0.05. The ES of KT related to the placebo-KT was calculated.
The general characteristics of the subjects are shown in Table 1. No significant differences were observed between the KT group and the placebo-KT group for sex, age, height, weight, or affected side. In addition, all dependent variables have a normal distribution.
Changes in VAS scores at rest and during walking are summarized in Table 2. Under resting conditions, VAS scores decreased significantly after KT application, whereas sham KT application did not result in any significant changes in VAS score. However, no significant difference was observed between the two groups after applying KT. Similarly, the KT group showed significant changes in VAS score of approximately 26% during walking, but no difference was observed for the subjects in the placebo-KT group (Table 2).
PPT in the quadriceps increased significantly by approximately 33% after KT application, whereas sham KT application did not result in any significant changes in PPT. At the points after application, there was a significant difference between the two groups. Similarly, the KT application effectively increased PPT by approximately 32% in the tibialis anterior, whereas sham KT application did not. In addition, a significant difference was observed between the two groups after application (Table 2).
Pain-free AROM in the knee joint increased significantly (21%) after applying KT but did not in the placebo-KT group. Significant differences between the two groups were evident after application (Table 2).
Before applying the tape, deviations in the three angles in both groups indicated poor proprioception. However, KT application increased proprioception significantly and improved poor proprioception to good proprioception for all three angles. In particular, proprioception at 45 degrees showed the greatest improvement. In contrast, sham KT improved participant proprioception slightly. A significant difference between both groups was observed after analyzing all three angles together (Table 3).
VAS during walking showed a significant negative correlation with AROM, whereas PPT in the quadriceps showed a significant positive correlation with AROM, establishing a correlation between pain and AROM. However, no correlation was observed between VAS at rest and AROM (Table 4). Among the pain measurement methods used, VAS during walking showed the most correlation with AROM.
As shown in Table 5, VAS during walking showed significant positive correlations with proprioception at each angle (15 degrees, 0.516; 30 degrees, 0.475; and 45 degrees, 0.529). No significant correlation was observed between VAS at rest and proprioception (data not shown).
The large ESs were observed in VAS during walking (ES, 1.97), PPT in the quadriceps (ES, 2.58), PPT in the tibialis anterior (ES, 2.45), AROM (ES, 2.01), and proprioception (ES of 15 degrees, 1.76; ES of 30 degrees, 1.73; and ES of 45 degrees, 1.89) after KT application (Tables 2, 3).
This study demonstrated that the patients with OA who received KT showed significant improvements in pain during walking, localized PPT in muscles around the knee joint, pain-free AROM, and proprioception, whereas sham KT application resulted in no significant changes in any of these factors.
In this study, the mean (SD) VAS score at rest was 39.1 (11.6), which was similar to the values reported previously.20 This type of pain did not seem to limit action but produced constant discomfort for patients. Applying KT decreased this discomfort but seemed not to produce the minimal clinically important improvement in OA patients, and its effect was not much different from that of sham KT application.16 Similar to the results of this study, the findings of previous studies have shown that KT decreased the discomfort of acute whiplash-associated disorders21 and rotator cuff tendinitis/impingement8 by 10 and 2.2, respectively; however, these changes did not constitute a clinically important difference. The effects of KT on pain at rest could not be clearly characterized because the discomfort at rest in this study and previous studies was not of a high intensity. Thus, a future study should characterize the effect of KT on OA-induced discomfort.
Generally, OA pain becomes worse with physical activity such as walking and movement.22 According to the results of this study and those of a previous study, VAS scores during walking were higher than those at rest.4,5 This type of pain is known as movement-evoked pain and is related to motor function. In this study, movement-evoked pain decreased by 25.7% after applying KT. A response of 23% or greater is regarded as the minimum clinically important improvement.23 In addition, the large ESs were observed by KT intervention. Thus, KT application to the quadriceps in patients with chronic OA may be effective to decrease movement-evoked pain of OA. The results of this study were different from those of a former study showing that KT application to patients with patellofemoral pain syndrome did not decrease movement-evoked pain effectively.24 These results cannot be compared with those of the present study directly because of differences in the diseases studied and patient age. However, the authors assumed that differences in the severity of functional limitation or pain intensity between the studies occurred as a result of these reasons because pain during walking was approximately 42.5 on the VAS in the previous study, which is low compared with the scores of the present study and other reports. This hypothesis should be characterized clearly in a further study.
The quadriceps and the tibialis anterior are located outside injury sites; thus, PPT at these muscles reflects secondary hyperalgesia after OA. Secondary hyperalgesia generally occurs as a result of sensitization of the central nervous system in OA patients,25 and physical modality such as transcutaneous electrical nerve stimulation, which influences the central nervous system, alleviates secondary hyperalgesia.26 Although the analgesic mechanism of KT on secondary pain is unclear, the authors assumed that KT would have analgesic influences on the pain processing of the central nervous system. The reason for this is that PPT increased not only at the quadriceps where KT was applied but also at the tibialis anterior, which did not receive KT. KT causes changes in the fast afferent fibers according to the previous study.27 Thus, KT applied to a painful area increases the action of fast afferent fibers, and, in turn, this inhibits the transmission of pain perception to the brain, increasing PPT.
KT application decreased pain with movement and secondary hyperalgesia significantly but did not decrease pain at rest. A previous study reported a similar result26; thus, it is difficult to identify correlations between these two different kinds of pain and other characteristics. However, these two different types of pain are the evoked pain induced by external or internal stimuli, and it can be assumed that there is an indirect correlation because PPT was measured in muscle, and muscle recruitment is necessary for walking. A future study should test the correlation between these two types of pain using muscle intervention methods. If these studies show a correlation between movement-evoked pain and pain at rest, it can be assumed that both these types of pain after OA stem from muscle.
AROM increased significantly by approximately 21% after KT application but did not in the placebo-KT group. Previous reports also showed that KT improves range of motion of the joint to which it is applied by 6.5%–17.5%.8,21 In addition, KT increased recruitment of the muscle motor units and maximal voluntary contraction.27,28 Range of motion at various axes increased after treatment, and with the greatest improvement observed for range of motion related to KT-treated muscles.21 In addition, the patients reported that knee extension was easier than knee flexion after KT application, but this was not measured in this study. Thus, range of motion increased as a result of increased muscle activation by KT, based on the abovementioned facts. However, another group reported that KT is unable to recruit more motor units.29 Whereas muscle activation was measured during single joint motion in a static posture after KT application in the current and previous studies, Huang et al.29 measured muscle activation in the dynamic posture of a vertical jump. Thus, this difference in results was caused by the different methods used for characterizing the KT effects on selective muscle activation because using a dynamic posture involves the action of various accompanying muscles and the selected muscle.
Interestingly, sham KT application did not seem to have any effect on AROM. The difference between sham KT and KT application was the presence of tension, and this tension is helpful in creating tension in the soft tissue to which it is applied. Weakness of the quadriceps is a major symptom of OA, and decreased muscle tension is the main symptom of muscle weakness.30 Thus, KT-induced tension in the quadriceps might enhance muscle performance, and it would have aided joint movement by adding neural feedback in OA patients.7 Unlike the sham taping area (Fig. 2 B), the KT area experienced the convolution effects (Fig. 2 A), and this may have increased the blood volume and blood and lymph flow of this area because of the lifting effects, which broaden the space between the muscle and the skin.7,31 These circulatory changes may result in enhanced muscle function and increased AROM.31 In the present study, applying KT decreased movement-evoked pain and secondary hyperalgesia effectively, and AROM was correlated with these two types of pain (Table 4). Thus, pain attenuation is considered an important factor for improving AROM, and pain-free AROM could be used as an indicator of OA-induced pain.
Application of KT not only decreased pain effectively but also improved proprioception at three angles, and these two phenomena were significantly correlated (Table 5). Similar to the results of this study, Shakoor et al.32 applied home exercise in OA patients for 8 wks and found a correlation between the resulting decrease in pain and improved proprioception. On the other hand, several studies have injected anesthetic agents such as bupivacaine intra-articularly in patients with OA33 or those who had undergone total knee arthroplasty34 and suggested that pain was decreased but proprioception was deteriorated, with no correlation observed between the two variables. However, characterizing the correlation between proprioception and mere pain is limited because anesthetics affect not only pain receptors but also various mechanoreceptors. Severe problems occur when suggesting a correlation between proprioception and pain because of loss of joint receptors after total knee surgery. The current study and the study of Shakoor et al.32 were carried out without a direct influence of receptors in the knee structures associated with pain and damage to proprioception, and pain and proprioception improved together. Thus, it was assumed that there was a correlation between pain and proprioception in patients with OA and that pain attenuation is an effective method to improve proprioception.
Even though the authors did not characterize the mechanism of decreased proprioception through OA pain, tonic activation of nociceptive neural signal from damaged joint structures may disturb central modulation of proprioceptive information coming from joint structures and cause presynaptic inhibition to proprioceptive information. Thus, it is likely that KT improved proprioception by facilitating the transfer of proprioceptive information from the joint structures to the nervous system, which was accomplished by switching presynaptic inhibition of OA-induced nociceptive signals to disinhibition.
In this research, KT application showed the large ESs in terms of attenuating the pain during walking and PPT and improving AROM and proprioception in OA patients. This result is comparable with that seen in the following exercise program35 and total joint arthroplasty,36 which have the large therapeutic ESs and have been used to manage pain or other symptoms after OA in clinics. Thus, KT could be thought of being able to be used to manage movement-related pain and secondary pain, AROM, and proprioception in OA, based on the large ESs and the minimum clinically important improvement.
This study performed a single KT trial application to manage OA-related pain and symptoms; thus, the long-term effects of KT application are unclear. In addition, it is unclear whether KT influences other OA symptoms such as muscle weakness or balance deficits. Furthermore, the mechanism for the decrease in pain and increase in proprioception observed is also unclear. The authors suggest that further study should attempt to investigate these effects of KT on several symptoms, such as muscle weakness, decreased motor function, and balance and gait abilities, after OA and identify the mechanisms of KT-related pain attenuation. In addition, the authors will investigate the relationship between the changes in pain intensity and functional activities after KT application in OA patients in their further study.
The authors thank Tae-Sung In, Seok Chan Hahm, and Youngkyung Kim for assistance with collection of data and Drs Young Ju Ahn and Jin Ho Je for recruiting subjects.
1. White PH, Waterman M: Making osteoarthritis a public health priority: Several initiatives are placing this chronic illness on the national agenda. Orthop Nurs
2012; 31: 92–7
2. Burks K: Health concerns of men with osteoarthritis of the knee. Orthop Nurs
2002; 21: 28–34
3. Tonelli SM, Rakel BA, Cooper NA, et al.: Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement. Biol Sex Differ
2011; 2: 12
4. Song IH, Althoff CE, Hermann KG, et al.: Contrast-enhanced ultrasound in monitoring the efficacy of a bradykinin receptor 2 antagonist in painful knee osteoarthritis compared with MRI. Ann Rheum Dis
2009; 68: 75–83
5. Trnavsky K, Fischer M, Vogtle-Junkert U, et al.: Efficacy and safety of 5% ibuprofen cream treatment in knee osteoarthritis. Results of a randomized, double-blind, placebo-controlled study. J Rheumatol
2004; 31: 565–72
6. Kon E, Filardo G, Drobnic M, et al.: Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc
2012; 20: 436–49
7. Kase K, Wallis J, Kase T: Clinical Therapeutics Applications of the Kinesio Taping Method
, 2nd ed. Tokyo, Japan, Ken Ikai Co Ltd, 2003
8. Thelen MD, Dauber JA, Stoneman PD: The clinical efficacy of kinesio tape for shoulder pain: A randomized, double-blinded, clinical trial. J Orthop Sports Phys Ther
2008; 38: 389–95
9. Akbas E, Atay AO, Yuksel I: The effects of additional Kinesio taping
over exercise in the treatment of patellofemoral pain syndrome. Acta Orthop Traumatol Turc
2011; 45: 335–41
10. Chen PL, Hong WH, Chen WC: Biomechanics effects of Kinesio taping
for persons with patellofemoral pain syndrome during stair climbing. IFMBE Proc
2008; 21: 395–7
11. Williams S, Whatman C, Hume PA, et al.: Kinesio taping
in treatment and prevention of sports injuries: A meta-analysis of the evidence for its effectiveness. Sports Med
2012; 42: 153–64
12. Halseth T, McChesney JW, DeBeliso M, et al.: The effects of kinesio™ taping on proprioception
at the ankle. J Sport Sci Med
2004; 3: 1–7
13. Lins CA, Neto FL, Amorim AB, et al.: Kinesio Taping
® does not alter neuromuscular performance of femoral quadriceps or lower limb function in healthy subjects: Randomized, blind, controlled, clinical trial. Man Ther
2013; 18: 41–5
14. Saghaei M: Random allocation software for parallel group randomized trials. BMC Med Res Methodol
2004; 4: 26
15. Callaghan MJ, Selfe J, Bagley PJ, et al.: The effects of patellar taping on knee joint proprioception
. J Athl Train
2002; 37: 19–24
16. Stauffer ME, Taylor SD, Watson DJ, et al.: Definition of nonresponse to analgesic treatment of arthritic pain: An analytical literature review of the smallest detectable difference, the minimal detectable change, and the minimal clinically important difference on the pain visual analog scale. Int J Inflamm
2011; 2011: 231926
17. Wylde V, Palmer S, Learmonth ID, et al.: Test-retest reliability of Quantitative Sensory Testing in knee osteoarthritis and healthy participants. Osteoarthritis Cartilage
2011; 19: 655–8
18. Yaikwawongs N, Limpaphayom N, Wilairatana V: Reliability of digital compass goniometer in knee joint range of motion measurement. J Med Assoc Thai
2009; 92: 517–22
19. Friden T, Roberts D, Zatterstrom R, et al.: Proprioception
in the nearly extended knee. Measurements of position and movement in healthy individuals and in symptomatic anterior cruciate ligament injured patients. Knee Surg Sports Traumatol Arthrosc
1996; 4: 217–24
20. Diracoglu D, Alptekin K, Teksoz B, et al.: Knee vs hip single-joint intra-articular hyaluronic acid injection in patients with both hip and knee osteoarthritis: A pilot study. Clin Rheumatol
2009; 28: 1021–4
21. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland J, et al.: Short-term effects of cervical Kinesio taping
on pain and cervical range of motion in patients with acute whiplash injury: A randomized clinical trial. J Orthop Sports Phys Ther
2009; 39: 515–21
22. Hurwitz DE, Ryals AR, Block JA, et al.: Knee pain and joint loading in subjects with osteoarthritis of the knee. J Orthop Res
2000; 18: 572–9
23. Todd KH, Funk JP: The minimum clinically important difference in physician-assigned visual analog pain scores. Acad Emerg Med
1996; 3: 142–6
24. Aytar A, Ozunlu N, Surenkok O, et al.: Initial effects of Kinesio taping
in patients with patellofemoral pain syndrome: A randomized, double-blind study. Isokinet Exerc Sci
2011; 19: 135–42
25. Woolf CJ: Central sensitization: Implications for the diagnosis and treatment of pain. Pain
2011; 152: S2–15
26. Vance CGT, Rakel BA, Blodgett NP, et al.: Effects of transcutaneous electrical nerve stimulation on pain, pain sensitivity, and function in people with knee osteoarthritis: A randomized controlled trial. Phys Ther
2012; 92: 898–910
27. Konishi Y: Tactile stimulation with Kinesiology tape alleviates muscle weakness attributable to attenuation of Ia afferents. J Sci Med Sport
2012; 16: 45–8
28. Slupik A, Dwornik M, Bialoszewski D, et al.: Effect of Kinesio taping
on bioelectrical activity of vastus medialis muscle. Preliminary report. Ortop Traumatol Rehabil
2007; 9: 644–51
29. Huang CY, Hsieh TH, Lu SC, et al.: Effect of the Kinesio tape to muscle activity and vertical jump performance in healthy inactive people. Biomed Eng Online
2011; 10: 70
30. Slemenda C, Brandt KD, Heilman DK, et al.: Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med
1997; 127: 97–104
31. Yoshida A, Kahanov L: The effect of Kinesio taping
on lower trunk range of motions. Res Sports Med
2007; 15: 103–12
32. Shakoor N, Furmanov S, Nelson DE, et al.: Pain and its relationship with muscle strength and proprioception
in knee OA: Results of an 8-week home exercise pilot study. J Musculoskelet Neuronal Interact
2008; 8: 35–42
33. Hassan BS, Doherty SA, Mockett S, et al.: Effect of pain reduction on postural sway, proprioception
, and quadriceps strength in subjects with knee osteoarthritis. Ann Rheum Dis
2002; 61: 422–8
34. Barrack RL, Skinner HB, Cook SD, et al.: Effect of articular disease and total knee arthroplasty on knee-joint position sense. J Neurophysiol
1983; 50: 684–7
35. Fransen M, Margiotta E, Crosbie J, et al.: A revised group exercise program for osteoarthritis of the knee. Physiother Res Int
1997; 2: 30–41
36. Jones CA, Pohar S: Health-related quality of life after total joint arthroplasty: A scoping review. Clin Geriatr Med
2012; 28: 395–429