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Fisioterapia. 2016;xxx(xx):xxx---xxx

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ORIGINAL

Short term effectiveness of Pressure Release and

Kinesiotaping in Cervical Myofascial Pain caused by
sternocleidomastoid muscle: A randomized clinical
trial
M.Á. Capó-Juan a,c,∗ , A. Grávalos-Gasull b , M. Bennasar-Veny c ,
A. Aguiló-Pons c , A. Gamundí-Gamundí d , J.E. De Pedro-Gómez c

a
Department of Social Services and Cooperation, Balearic Islands Government, Spain
b
Rehabilitation Service, Hospital Son Llàtzer, Palma, Balearic Islands, Spain
c
Department of Nursing and Physical Therapy, Balearic Islands University, Palma, Balearic Islands, Spain
d
Department of Biology, Balearic Islands University, Palma, Balearic Islands, Spain

Received 9 March 2016; accepted 25 July 2016

KEYWORDS Abstract
Neck pain; Objective: The aim of this study is to evaluate the effectiveness of 2 different therapies,
Myofascial pain pressure release (PR) and kinesiotaping (KT) for myofascial pain syndrome in the sternoclei-
syndromes; domastoid muscle.
Kinesiotaping; Methods: Experimental, randomized, controlled, single-blind study. KT was applied for group C,
Trigger points; PR to treat group B and placebo to treat group A. The used variables were: Algometry, Numerical
Ischemic compression Pain Scale (NPS), Questionnaire of Quality of Life SF-12, and Goniometry of cervical complex.
Participants were assisted in public hospitals of the Balearic Health Service (Spain), from March
2012 to March 2013. The study includes a sample of 75 patients with cervical myofascial pain
syndrome of the sternocleidomastoid muscle. Each patient received three appointments. Each
appointment lasted 20 minutes approximately.
Results: Questionnaire SF-12 shows that the improvement of the quality of life with KT was
10.32 points (P < 0.001), with PR was 5.0 points (P < 0.05) and the group A with placebo treatment
scored 2.20 points (P < 0.05). NPS for KT shows a reduction of pain of 24.00% (P < 0.001), for PR
a reduction of 11.20% (P < 0.001), and in group A no significant outcome was found. Algometry
shows that the pain is reduced with the KT and the PR significantly. Goniometry of cervical
complex improved significantly with KT for all range of mobility.

∗ Corresponding author.
E-mail address: miguelcapo@dgad.caib.es (M.Á. Capó-Juan).

http://dx.doi.org/10.1016/j.ft.2016.07.003
0211-5638/© 2016 Asociación Española de Fisioterapeutas. Published by Elsevier España, S.L.U. All rights reserved.

Please cite this article in press as: Capó-Juan MÁ, et al. Short term effectiveness of Pressure Release and Kinesiotap-
ing in Cervical Myofascial Pain caused by sternocleidomastoid muscle: A randomized clinical trial. Fisioterapia. 2016.
http://dx.doi.org/10.1016/j.ft.2016.07.003
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FT-421; No. of Pages 7 ARTICLE IN PRESS
2 M.Á. Capó-Juan et al.

Conclusions: KT and PR are two therapeutic techniques which help to reduce pain, show
increased levels in Goniometry (cervical movements) and contribute to improve quality of life.
It seems that KT could be more effective than PR.
© 2016 Asociación Española de Fisioterapeutas. Published by Elsevier España, S.L.U. All rights
reserved.

PALABRAS CLAVE Efectividad a corto plazo de la liberación por presión y del kinesiotaping en el dolor
Dolor de cuello; miofascial cervical causado por el músculo esternocleidomastoideo. Ensayo clínico
Síndromes del dolor aleatorizado
miofascial;
Kinesiotaping; Resumen
Puntos gatillo; Objetivo: Este trabajo evalúa la eficacia de 2 terapias, la liberación por presión (LP) y el
Compresión kinesiotaping (KT) para el síndrome de dolor miofascial en el músculo esternocleidomastoideo.
isquémica Métodos: Estudio experimental, aleatorizado, controlado a simple ciego, en el que se aplicó
KT (grupo C), LP (grupo B) y placebo (grupo A). Las variables utilizadas fueron: algometría,
escala numérica del dolor, cuestionario de calidad de vida SF-12 y goniometría del complejo
cervical. Los participantes fueron atendidos en hospitales públicos del Servicio de Salud de
las Islas Baleares (España), desde marzo de 2012 hasta marzo de 2013. El estudio recoge una
muestra de 75 pacientes a los que se realizaron 3 visitas de 20 min cada una.
Resultados: El SF-12 muestra la mejora de la calidad de vida de 10,32 puntos (p < 0,001) con
el KT, de 5,0 puntos (p < 0,05) con la LP y de 2,20 puntos (p < 0,05) con el Grupo A. La escala
numérica del dolor señala una reducción del dolor del 24% (p < 0,001) con el KT, del 11,20%
(p < 0,001) con la LP, y con el grupo A no se obtienen resultados significativos. La algometría
muestra una reducción significativa del dolor con el KT y la LP. La goniometría mejoró significa-
tivamente con el KT para todos los rangos.
Conclusiones: El KT y la LP son 2 técnicas terapéuticas que ayudan a reducir el dolor, aumentan
los rangos de movilidad cervical y contribuyen a mejorar la calidad de vida. Parece ser que el
KT podría ser más eficaz que la LP.
© 2016 Asociación Española de Fisioterapeutas. Publicado por Elsevier España, S.L.U. Todos los
derechos reservados.

Introduction Neuromuscular therapy is carried out through the appli-

Neck pain is a common symptom suffered by the
population.1 In fact, the cervical region is an area with
potential muscle risk of injury, and this risk involves a loss of
cervical range of motion (CROM). This risk is the main rea-
son to have an appointment in rehabilitation centers. Neck
pain is often presented as myofascial pain syndrome (MPS).
MPS has an important relevance in Primary care units,2 but
a higher prevalence in specialized care centers.3
The most affected muscle of the front cervical region
is the sternocleidomastoid (SCM) muscle. Its location and
functions make it responsible for the pain in the cervical
front region and head. Anatomically it has two divisions,
sternal and clavicular, and it receives the motor innervations
of the spinal accessory nerve.4
The MPS is the set of symptoms caused by myofas-
cial trigger points (MTrPs), where the most severe pain
is located.5 The treatment of cervical MPS could be con-
servative, with good prognosis; it usually improves with a
1---4 week treatment of local heat, electrotherapy, active
exercises, muscle stretching and education about good
posture.6
cation of kinesiotaping (KT). It is a technique developed
in 1979 by Dr. Kenzo Kase that uses an elastic tape,
which allows elongate up to 130---140% with a compara-
ble thickness like the human skin.7,8 The principles on
which this technique is based are that the movement and
muscle activity are essential to maintain and restore the
health. The KT improves local circulation, it stimulates
cutaneous mechanoreceptors, and it also reduces inflam-
mation, apart from increasing the reabsorption of edema
and augmenting the functional capacity of the patient.9 This
bandage only needs one session to be stitched for some
days (4---7 days). The analgesic effect attributed to it and
other therapeutic properties, with or without injury, make
it a valuable therapeutic technique according to recent
studies,10---13 and reviews,14 although some of these authors
express the lack of scientific evidence of the benefits of
KT.
Ischemic compression (IC), and its variant, pressure
release (PR),5 are techniques that claim to act on the MTrPs.
The IC consists on applying pressure which will be increasing,
depending on the response of the muscle, and it may reduce
the symptoms.15 A study carried out by Kim et al.,16 shows

Please cite this article in press as: Capó-Juan MÁ, et al. Short term effectiveness of Pressure Release and Kinesiotap-
ing in Cervical Myofascial Pain caused by sternocleidomastoid muscle: A randomized clinical trial. Fisioterapia. 2016.
http://dx.doi.org/10.1016/j.ft.2016.07.003
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Effectiveness of Pressure Release and Kinesiotaping in Cervical Myofascial Pain
that when the pressure is maintained 30---60 s no signif-
icant improvement is obtained. On the other side, the
PR develops a lighter pressure during 30---90 s to obtain
tissue release and relaxation without reaching pain thresh-
old. Nevertheless, according to several studies,17---20 and
reviews,21,22 on PR and/or IC and studies referred to the
above subject, these methods show therapeutic evidence on
MPS.
Therefore, according the previous information, the aim
of this study is to determine in one session the effectiveness
of KT and PR in SCM muscle by reducing pain, improving qual-
ity of life and mobility of the cervical complex in patients
with MPS.
Methods
Study design
A randomized, controlled, single-blind study was carried out
in Hospital Son Llàtzer (Palma de Mallorca, Balearic Islands)
and Hospital Mateu Orfila (Maó, Balearic Islands) between
March 2012 and March 2013. The study was approved by the
ethics committee of Balearic Islands, and all participants
gave informed consent.
Participants and procedure
From an initial sample of patients with muscular neck pain
diagnosed by Rehabilitation Physicians from both Hospital
Rehabilitation Services, the Principal Physiotherapist found
83 patients with current clinical characteristics for MPS.4,5
Eight patients failed to meet the treatment criteria, end-
ing up with a final sample of 75 patients aged between
23 and 54 years old, affected by MPS. Patients were ran-
domly divided into three groups A (placebo), B (PR) and C
(KT). The patients were assigned to different groups (A, B,
or C) according to an allocation number generated from a
random table. Only the Principal Physiotherapist knew the
assignment group of each patient.
Sociodemographic (age, weight, height) and clinical
measures (pain, quality of life, Goniometry) were included
as covariates in the statistical models described in this arti-
cle. The dependent variables used for assessing outcomes
were objective (Algometry in the MTrPs of SCM and joint
range active in all CROM by Goniometry) and subjective
pain was determined by the Numerical Pain Scale (NPS)
and quality of life by Questionnaire SF-12. These tests
are often used in clinical practice.17,22,23 In this study, we
Table 1 Demographic characteristics of the population participating in the study.
Patient characteristic Total (N = 75) Group A (n = 25)
Age (SD) 38.28 (0.68) 36.92 (1.62)
Weight (SD) 65.82 (0.63) 65.84 (2.37)
Height (SD) 164.61 (0.75) 165.68 (1.61)
BMI (SD) 24.21 (0.14) 23.95 (0.73)
P < 0.05 was considered statically significant (one-way ANOVA). SD: standard deviation; BMI: body mass index.
Please cite this article in press as: Capó-Juan MÁ, et al. Short term effectiveness of Pressure Release and Kinesiotap-
ing in Cervical Myofascial Pain caused by sternocleidomastoid muscle: A randomized clinical trial. Fisioterapia. 2016.
http://dx.doi.org/10.1016/j.ft.2016.07.003
3
used the digital algometer ‘‘Stech® ’’ and a manual plastic
goniometer ‘‘Baseline® ’’.
The sample consisted in patients, both male and female,
between 20 and 55 years old diagnosed with MPS in
SCM muscle. All participants agreed with the conditions
of the treatment and they were committed to follow
them. Patients with back surgery or medical records
of accidents suffered in the past six months, cardio-
respiratory difficulties, neurological injuries, joint diseases,
neurodegenerative, psychiatric and/or motion disorders
were excluded. Patients who failed to follow the agreed
terms and conditions along the study such as not being
treated with immunosuppressive, muscle relaxant drugs or
simple analgesics, as well as not modifying bandages or
performing unadvised physical activities or other therapeu-
tic modalities were also excluded. The terms of exclusion
were checked during the third visit according the patient’s
response.
Measures
The study was carried out by means of three appointments.
The first appointment, with the Rehabilitation Physician and
Principal Physiotherapist, confirmed the diagnosis of MPS in
SCM muscle in possible participants. In the second appoint-
ment, the selected participants were assessed for the level
of pain (NPS), quality of life and cervical movement. More-
over the patients were assigned to one of the three groups
and they were applied the corresponding treatment. In
the third appointment, after one week, the patients were
reassessed. Each appointment lasted 20 minutes approxi-
mately.
The therapeutic treatment, according to the group in
which the participant was included, was the following:
Application of algometric bilateral pressure for the placebo
group (group A), PR treatment for group B, and KT treatment
for group C. The KT was placed at 25% strain on both sides
covering both portions of SCM muscle in a disto-proximal
direction. The patients only received one session of thera-
peutic intervention.
In this study we did not calculate the initial sample size.
Given the variability in the sample size of previous studies
and reviews related to the application of KT and PR,10---22 we
chose to select a sample as big as possible, obtained from
all affected patients attending Hospital Son Llàtzer’s and
Hospital Mateu Orfila’s Rehabilitation Services that met the
inclusion criteria.
Group B (n = 25) Group C (n = 25) P
38.80 (1.91) 39.12 (1.63) 0.625
64.72 (2.11) 66.92 (3.09) 0.832
163.16 (1.49) 165 (1.88) 0.548
24.25 (0.64) 24.45 (0.93) 0.891
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Statistical analysis

Table 2 Test evaluation of quality of life SF-12 of the population participating in the study (N = 75). Goniometry of cervical complex of the population participating in the

Group C (n = 25)

14.68 (2.36)

47.80 (1.98)

63.20 (1.11)
We compared means between groups with t-Student test for

25 (2.18)
independent samples and the data correlations with Spear-

<0.001

<0.001
man. Pre-treatment data from the second appointment were

RL
compared with post-treatment data from the third appoint-

46.00 (1.89)

61.20 (1.20)
ment. Post-treatment data were compared between groups.

Group C (n = 25)
Algometry, NPS, SF-12 and Goniometry were considered. All

<0.001
analyses were performed by using IBM SPSS Statistics Ver-

RR
sion 22.0.0 software (IBM Corporation, Armonk, NY), with a
significance level set at 0.05.

35.80 (1.31)

46.20 (1.05)

<0.001
Results

E
Table 1 describes demographic characteristics of the partici-

34.20 (1.59)

44.00 (1.82)
pants. The distributions of the participants by sex included

<0.001
60 women and 15 men. There were 25 participants in group
A (4 men and 21 women), 25 in group B (6 men and 19

F
Group B (n = 25)
women) and 25 in group C (5 men and 20 women). No sig-

54.20 (1.79)

56.80 (1.95)
24.36 (1.93)
19.32 (1.62)
nificant differences in age, weight, height and BMI were
found among the study groups. The analysis was by original

>0.05
<0.05
assigned groups.

RL
Table 2 shows the results obtained with the Questionnaire

55.00 (1.91)

56.60 (1.84)
of Quality of Life (SF-12) and the cervical biomechanical
results.

Group B (n = 25)

>0.05
The table presents different results for each group

Goniometry scores mean, SD

RR
between the second and the third appointment. 0 was con-
sidered that the highest level of quality of life, while the SF-12 scores mean, SD

43.60 (1.51)

45.80 (1.46)
worst level was 47 (taking into account all the aspects
together). We compared the results of the third appoint-

<0.05
ment between the three groups. However, the results of the

E
Quality of Life Questionnaire are only significant between

40.00 (1.77)

44.00 (1.29)
group A and group C (P < 0.05). Participants of this study

SD: standard deviation; F: flexion; E: extension; RR: right rotation; LR: left rotation.
improved the quality of life in 21.95% with KT, 10.72% with

<0.001
PR and 4.68% after group A.
In the third appointment, significant differences between
F
Group A (n = 25)

groups were found for all mobility parameters comparing

55.20 (1.51)

54.80 (1.71)
22.20 (1.74)

group A with group C (flexion P < 0.05, extension P < 0.05,

24.40 (2)

right rotation P < 0.001, left rotation P < 0.001). Regarding

>0.05
<0.05

the biomechanics (considering all movements), an improve-

RL

ment of 18.81% mobility with KT, and an improvement of

55.00 (1.47)

54.40 (1.64)

3.85% mobility with PR were registered, as well as a decrease

of 0.59% in group A.
Group A (n = 25)

>0.05

Table 3 shows the results obtained in NPS and the results

RR

of the pain measured with Algometry in MTrPs of the SCM

40.60 (1.66)

40.00 (1.63)

muscle.
The NPS was considered to be 10 for the maximum of pain
>0.05

and 0 for the minimum. Before the treatment, all the groups
registered similar results of NPS. In the third appointment,
E

significant differences between group A and C (P < 0.05) and

38.60 (1.81)

38.60 (1.17)

between B and C (P < 0.05) were found. Pain decreased with

NPS 24% with KT, 11.20% with PR and 6.40% group A.
>0.05

The results of the third appointment comparing the right

Second appointment (SD)

SCM between groups show significant differences between

Third appointment (SD)

Second appointment

groups A and B (P < 0.05) as well as groups A and C (P < 0.001),

Third appointment

but no relevant differences for group B and C (P > 0.05). Sim-

study (N = 75).

ilar results were found for the left SCM between groups. Very
Appointments

Appointments

significant differences were found between groups A and B

(P < 0.001) and between A and C (P < 0.001), but not between
P value

P value
(SD)

(SD)

B and C. Algometry patients improved 2.50% with KT, 1.40%

with PR, but patients got worst 0.26% in group A.

Please cite this article in press as: Capó-Juan MÁ, et al. Short term effectiveness of Pressure Release and Kinesiotap-
ing in Cervical Myofascial Pain caused by sternocleidomastoid muscle: A randomized clinical trial. Fisioterapia. 2016.
http://dx.doi.org/10.1016/j.ft.2016.07.003
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Effectiveness of Pressure Release and Kinesiotaping in Cervical Myofascial Pain 5

Table 3 Numerical Pain Scale of the population participating in the study (N = 75). Algometry of the population participating
in the study (N = 75).

Numerical Pain Scale mean, SD

Appointments Group A (n = 25) Group B (n = 25) Group C (n = 25)

Second appointment (SD) 5.04 (0.48) 5.36 (0.37) 5.32(0.42)
Third appointment (SD) 4.40 (0.41) 4.24 (0.38) 2.92 (0.52)
P value >0.05 <0.001 <0.001

Algometry scores mean, SD

Appointments Group A (n = 25) Group B (n = 25) Group C (n = 25)

SCM R SCM L SCM R SCM L SCM R SCM L

Second appointment (SD) 1.80 (0.27) 1.80 (0.28) 1.76 (0.24) 2.08 (0.23) 1.88(0.26) 2.12 (0.27)
Third appointment (SD) 1.68 (0.33) 1.28 (0.28) 3.12 (0.28) 3.52 (0.33) 4.72 (0.32) 4.28 (0.31)
P value >0.05 >0.05 <0.001 <0.001 <0.001 <0.001
SD: standard deviation; SCM R: sternocleidomastoid right; SCM L: sternocleidomastoid left.

Discussion information. The participants of group C show better

This study compares three different cohorts with patients
with MPS in SCM muscle: group A (placebo), group B (PR)
and group C (KT).
There are studies that compare PR24 or IC25 and KT13
separately, with other therapies in neck pain as mentioned
above. There are no studies that compare the effectiveness
of the treatment between the PR and the KT techniques
in the muscle SCM. Most of the studies are focused on
upper trapezius,22,24---26 because this allows a good location
of MTrPs.
Socio-demographic groups are all fairly similar in terms
of age, weight, and height (P > 0.05). The fact that most
patients who are diagnosed with neck pain are women
between 20 and 50 years old is concordant with the
literature,6 in this study women represent a 66.66% of
the sample. There are no initial significant differences
about pain between groups according NPS and Algometry
(P > 0.05).
After analyzing all the results in the perception of the
quality of life through the SF-12 Questionnaire, all groups
have improved the quality of life between the second and
the third appointment. However, although group B and group
C participants improved importantly in the third appoint-
ment in comparison with placebo group A, we did not find
significant improvement in groups B and C. These results
agree with those reported by Garcia Llopis and Campos
Aranda11 in a study in which the Questionnaire Quality of
Life SF-36 was used. We decided to use Questionnaire SF-
12 because it seems to be more adequate for its validity,
reliability and quickness to carry it out.23
Regarding NPS, only the groups B and C improved during
the third appointment compared to the second. In addition,
both groups improved in the third appointment when they
are compared between them. In the Algometry, both groups,
B and C, improved significantly from the second compared
to the third appointment; and both groups improved if they
are compared with group A during the third appointment.
The results of Goniometry provide quite heterogeneous
mobility at the third appointment compared to group A.
Group B does not show differences in all movements.
Kim et al.,16 applied trigger point injection with poste-
rior IC of 30 or 60 s. One week after treatment they found
a reduction of pain with the NPS (4.20---4.30 units), and
with the Algometry (2.41---3.00 units). The lateral bending
of neck improved 6.75---8.30◦ . In a recent study,26 in which
the experimental group received cryotherapy followed by IC
in trapezius muscle, the lateral bending of neck improved
7.20◦ . The pain decreased 6.40 units according to the Algom-
etry, and 2.10 units according to the NPS. In our study, similar
results were obtained. The pain was reduced 1.12 units with
NPS, the Algometry showed a decrease on average of 1.40
units, and the CROM improved a total of 10.40◦ .
Saavedra-Hernández et al.,27 applied KT at cervical
posterior muscles in one experimental group, in which
decreased 2.50 units the pain (NPS), and the extension
was the CROM that improved the most with 3.90◦ . Dawood
et al.,13 in a study about neck dysfunction, showed that the
combined therapy of KT with an exercise program improved
the rotatory angle parameter and the pain. According to Ay
et al.,28 the KT at cervical posterior muscles in MPS leads to
improvements in pain 2.65 units (NPS), in pressure thresh-
old and in CROM (the flexion was the CROM that improved
the most with 7.32◦ ). In our study the pain was reduced
2.40 units (NPS), and the flexion was the parameter that
improved least with 9.8◦ .
Ours results show correlations between Questionnaire
SF-12 and Goniometry in all groups (P < 0.05). NPS and
Algometry correlate perfectly (P < 0.001) in all groups.
The positive results obtained by the application of PR in
this study are coincident with results of other studies and
reviews.24,29 The results obtained by the application of KT
are consistent with findings of other studies,10,11,27 in which
an improvement in cervical biomechanical amplitude is reg-
istered. According to the results of this study and recent
review,14 the KT decreases the pain and it could be used
as the preferred main treatment, although more research is
needed.29

Please cite this article in press as: Capó-Juan MÁ, et al. Short term effectiveness of Pressure Release and Kinesiotap-
ing in Cervical Myofascial Pain caused by sternocleidomastoid muscle: A randomized clinical trial. Fisioterapia. 2016.
http://dx.doi.org/10.1016/j.ft.2016.07.003
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FT-421; No. of Pages 7 ARTICLE IN PRESS
6 M.Á. Capó-Juan et al.
According to some authors,17,29,30 MPS requires more
studies to establish the evidence of different treatments
with a multimodal plan. Future studies should further
explore the effect of these therapies in other muscles. More
research is also needed to determine the long term effects
of KT and PR with more than one therapy session.
Clinical implication
The results of this study claim that the KT and PR as single
treatments imply improvements of cervical biomechanics
and they also decrease pain in cervical MPS.
KT shows better improvements of efficacy, efficiency and
therapeutic effectiveness in one session, until such point
that the KT keeps working beyond the session while it is
stuck. According to the results, KT could be used as a more
effective treatment.
Limitations and future directions
KT and PR show optimal improvements in MPS caused by SCM
muscle in the short term.
These results show that one session of each treatment is
not enough to treat MPS in SCM muscle. The lack of long-term
follow-up and the lack of consideration of other muscles on
the same region limit the strength of conclusions.
Ethical disclosure
Protection of human and animal subjects. The authors
declare that the procedures followed were in accordance
with the regulations of the relevant clinical research ethics
committee and with those of the Code of Ethics of the
World Medical Association (Declaration of Helsinki). The
study was approved by the ethics committee of Balearic
Islands (IB 1731/11 PI) and in accordance with the Decla-
ration of Helsinki.
Confidentiality of data. The authors have followed the pro-
tocols established in hospitals where it has been carried out
the study. All patients were informed and signed informed
consent, which they are stored under our responsibility.
Right to privacy and informed consent. The authors guar-
antee the privacy of patients protecting their identity.
Funding
We certify that no party which has a direct interest in the
results of the research which has supporting this article has
conferred or it will confer a benefit on us or on any organi-
zation which is associated with us.
Conflict of interest
The authors have no conflict of interests to declare.
Please cite this article in press as: Capó-Juan MÁ, et al. Short term effectiveness of Pressure Release and Kinesiotap-
ing in Cervical Myofascial Pain caused by sternocleidomastoid muscle: A randomized clinical trial. Fisioterapia. 2016.
http://dx.doi.org/10.1016/j.ft.2016.07.003
Acknowledgments
The cost of KT has been financed by the Hospital Son Llàtzer.
All study was conducted in Hospital Son Llàtzer (Palma) and
Hospital Mateu Orfila (Maó) without costs to the research
team.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at http://dx.doi.org/10.1016/
j.ft.2016.07.003.
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