The Effect of Kinesiotaping on Posture and Balance in Patients With Postural Thoracic Hyperkyphosis

In young adults, the thoracic kyphosis angle varies between 20-45◦ and 40◦ and above is defined as thoracic hyperkyphosis. The prevalence of thoracic hyperkyphosis is between 20-40% and is most commonly idiopathic . Thoracic hyperkyphosis is associated with back pain, limitation of movement-function, loss of balance, decreased quality of life and increased risk of falls. In the absence of pain or loss of function, especially young patients may present to improve cosmetic appearance. In the first stage of treatment, exercise, manual therapy, and in advanced stages, bracing and surgery can be applied . In treatment to reduce kyphosis, exercise is recommended at all ages and bracing is recommended in selected patients who do not respond to exercise. Multimodal combination therapies have been shown to be effective in young people . Kinesiobanding (KT) is an application that supports fascia, muscles and joints and reduces pain and inflammation . The combination of taping and exercise has been shown to have a positive effect on balance in hyperkyphotic adolescents. There is no study in the literature evaluating the effects of kinesiobanding on both balance parameters and kyphosis angle in young adults with thoracic hyperkyphosis. We think that favorable results can be obtained in the young age group with this study and our study may provide findings that kinesiobanting can be added to exercise therapy in routine treatment.

Sample Size of the Study: The sample size was determined by G-power analysis using the reference article. The number of participants to be included in the study was calculated as 16 patients for each group with G-power with a power of 95% and a type 1 error of 0.05 .

Patients will be randomly allocated to 3 groups. The sample size was calculated using G*Power based on a previous study, with a power of 95% and a type I error rate of 0.05, indicating that 16 patients per group (48 in total) are required. Allowing for an anticipated 20% loss to follow-up, a total of 60 patients (20 per group) will be enrolled in the study.

TREATMENT GROUPS:

Group 1 (E+KT): exercise + kinesio taping Group 2 (E+SH): exercise + sham taping Group 3 (E): exercise

The study groups will be determined according to the eligibility criteria among patients who present to the Physical Medicine and Rehabilitation outpatient clinic with complaints of posture disorder or nonspecific back pain and who have a thoracic kyphosis angle of 40 degrees or more on lateral radiography.

Cobb Angle Measurement:

Thoracic kyphosis angle will be measured on thoracic lateral radiograph. According to the literature, the gold standard measurement method is Cobb angle measurement; since the T4-T12 vertebra angle is less visible above the T4 vertebra level due to the superposition of other structures, the T4-T12 vertebra angle is used. The angle at the intersection point of the lines drawn parallel to the upper endplate of the T4 vertebra and the lower endplate of the T12 vertebra gives the Cobb angle . Patients with a Cobb angle of 40 and above and who do not have any additional disease to explain pain or hyperkyphosis will be included in the study.

Grouping of Participants, Patient Follow-up Form and Evaluations Our study was planned as a randomized single-blind prospective cohort, single-center study. Between 01/06/2025 - 01/06/2026 patients who meet the inclusion criteria among young adults aged 18-45 years who applied to Sultan Abdulhamid Han Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with complaints of nonspecific back pain or posture disorder will be included in the study. The study is planned to last 12 months.

Cobb angle measurement on thoracic lateral radiograph, kyphosis angle and index measurement with Flexicurve device, Biodex device, VAS scoring, Berg balance scale, SRS-22 questionnaire, International Physical Activity Questionnaire (Short) (IPAQ) will be used in the study.

Informed consent: After the patients are verbally informed, consent forms will be given to the patients in which the purpose of the study is clearly explained and they will be asked to sign the forms.

Kinesio Taping (1st Group= E+KT Group) Kinesiobant will first be tested on a small area of the forearm and treatment will be discontinued if allergy develops. Taping will be applied with the patient in upright posture and shoulders in retraction. From the level of the acromioclavicular joint, the first 5 cm will be applied without stretching, then maximum stretching will be applied, moving to the diagonal and ending at the lower border of the costa, the adhesion point will be adhered without stretching. The same process will be applied on the opposite side and a total of two I-shaped bands will be used to create an X-shape on the back. The crossing point of the bands will be adjusted to the lower 1/3 of the medial edge of the scapula. Taping will be performed after all initial measurements (T0) and will be renewed weekly (on days 0, 7, 14, 21). At the end of the 1st month, i.e. on day 28 (T1), the last measurements will be made with the kinesio tape and then the tape will be removed. Two months after the end of the treatment, the patient will be called again (T2) and final measurements will be made without the tape.

Sham Taping (2nd group= E+SH group) Sham taping treatment will be performed to exclude the biofeedback effect of taping and to distinguish its functional effect. The patch to be used in sham taping will first be tested on a small area of the forearm and if allergy develops, the treatment will be terminated. Taping will be applied with the patient in upright posture and shoulders in retraction. Skin color, elasticity and non-stretchable plaster of the same color as the skin will be used. From the level of the acromioclavicular joint, it will be applied from the level of the acromioclavicular joint to the diagonal without stretching and will be adhered to the adhesion point without stretching, ending at the lower border of the costa. The same procedure will be applied to the opposite side and an X shape will be formed on the back using a total of two I-shaped plasters. The crossing point of the bands will be adjusted to the lower 1/3 of the medial edge of the scapula. Taping will be performed after all initial measurements (T0) and will be renewed weekly (on days 0, 7, 14, 21). At the end of the 1st month, i.e. on day 28 (T1), the last measurements will be made with the patch and then the tape will be removed. Two months after the end of the treatment, the patient will be called again (T2) and final measurements will be made without the tape.

Exercise Program (3rd group=E group) The exercises were designed as a 4-week home program. In all three groups, the exercises will be performed once a day, 3 days a week, one day apart, for 4 weeks.

Each exercise will be performed with 10 repetitions in the first two weeks and 15 repetitions in the third and fourth weeks, with 5 sec contraction and 5 sec relaxation, with a 1 min break between two different exercises.

In the first phase, patients will be shown exercises to do at home. Afterward, all patients will be given an illustrated exercise brochure and an exercise log; two phone calls per week will be used to encourage patients to adhere to their treatment.

In postural thoracic hyperkyphosis, strengthening, stretching exercises and breathing exercises will be given for the most affected muscle groups. Posture exercises were planned for trapezius, lattismus dorsi, levator scapula, rhomboids, serratus posterior-superior-inferior, longissimus thoracis, spinalis thoracis, iliocostalis thoracis, semispinalis thoracis, multifidus, rotatores thoracis, diaphragm, intercostal externi, abdominal muscles:

• Thoracic and shoulder girdle strengthening exercises
• Pelvic and lumbar stabilization exercises
• Anterior and lateral abdominal muscle strengthening exercises
• Hip flexor stretching exercises
• Lumbar extensor stretching exercises
• Breathing exercises

Kyphosis Angle Measurement with Flexicurve:

At the beginning of the study,at the end of treatment (1st month) and 2 months after the end of treatment (3rd month).The Flexicurve ruler (Staedtler Mars Inc, Nurnberg, Germany),which is a plastic-coated bendable metal band approximately 60 cm long,will be used for the measurements.The ruler bends in only one direction and retains its shape when bent.The patient will stand as upright as possible and the spinous process of the seventh cervical vertebra(C7)and the upper part of the sacrum(S1)will be palpated and marked.The Flexicurve ruler will be placed along the C7-S1 vertebrae to form the shape of the spine,then the ruler will be placed flat on the paper and the lines transferred onto the paper.A vertical line will be drawn to connect the C7 and S1 landmarks.The intersection of this line with the spinal curve previously drawn with the flexicurve ruler will mark the transition between the thoracic and lumbar curves.A straight line drawn between C7 and the intersection point will be recorded as the thoracic kyphosis length (TL) in cm.Thoracic width (TW)will be recorded in cm as the length of the perpendicular line drawn from the apex of the kyphosis to TL.Kyphosis index will be calculated with the formula:(TW/TL) x 100. Each measurement will be performed 3 times by a single assessor, and the mean of the 3 trials will be used for analysis.