Artigo - Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle

Case study Application of posterior pelvic tilt taping for the treatment of chr onic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle Jung-hoon Lee a , W on-gyu Y oo b , * a Department of Physical Therapy , Inje University Pusan Paik Hospital and Department of Physical Therapy , The Graduate School, Inje University , Republic of Korea b Department of Physical Therapy , College of Biomedical Science and Engineering, Inje University, 60 7 Obang-dong, Gimhae, Gyeongsangnam-do, 621-749, Republic of Korea article info Article history: Received 1 2 January 201 1 Received in revised form 1 7 May 201 1 Accepted 23 October 20 1 1 Keywords: Kinesio taping P ALM Pelvic inclination Sacroiliac joint abstract Objective: Kinesio T aping (KT) is a therapeutic method used by physical therapists and athletic trainers in combination with other treatment techniques for various musculoskeletal and neuromuscular problems. However , no research has evaluated the effect of KT in patients with low back pain (LBP). The purpose of this case was to describe the application of posterior pelvic tilt taping (PPTT) with Kines io tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle. Design: Case report. Case description: The patien was a 20-year -old female amateur swimmer with a Cobb \u2019 s angle (L1 e S1) of 68 \ue001 , a sacral horizontal ang le of 45 \ue001 , and pain in both medial buttock areas and sacroiliac joints. We performed PPTT with Kinesio tape for 2 weeks (six tim es per week for an average of 9 h each time). Results: The patient \u2019 s radiographs showed that the Cobb \u2019 s angle (L1 e S1) had decreased from 6 8 \ue001 to 4 7 \ue001 and that the sacral horizontal angle had decreased from 45 \ue001 to 3 1 \ue001 . Reductions in hypomobility or motion asymmetry, as assessed by the motion palpation test, and in pain, as measured by the pain-provocation tests, were observed. On palpation for both medial buttock areas in the prone position, the patient felt no pain. The patient experienced no pain or stiffness in the low back area while performing forward \ufb02 e xion in the standing position with knees fully e xtended when washing dishes in the sink. Conclusions: The ca se study demonstrated that PPTT interv ention favoura bly affected the pelvic incli- nation and sacral hor izontal angle, leading to bene \ufb01 cial effects on sacroiliac joint dysfunction (SIJD) and medial buttock pain. Additional research on the clin ical effects of this taping procedure req uires greater numbers of athletes with SIJD or LBP who have inappropriate anterior pelvic tilt angles and hyperlor dosis. Ó 201 1 Elsevier Ltd. All rights reserved. 1 . Introduction Low back pain (LBP) is an important health problem that affects adults in general, and postura l change is one of the risk factors for LBP ( Evcik & Yücel, 2003 ). Clinical observations ha ve suggested that maintenance of normal lumbar lor dosis is important in the treat- ment of spinal disorders; therefore, measurement of the lumbar curve is important for making clinical decisions ( Chen, 1 999; Chernukha, Daffner , & Reigel, 1 998 ). Various studies have e xam- ined the relationship between back pain and chang es in the angle of the lumbar spine ( Lin, Jou, & Y u, 1 992 ). Increased lordosis has been advocated as the ma jor cause of postural pain, radiculopath y, and facet pain ( Cailliet, 1 995 ). The possible negative consequences of this ex cessive lordosis include increased compr ession of the apoph yseal joint and increased anterior shear force at the lumbo- sacral junction, which may progress to spondylolisthesis ( Neumann, 20 09 ). L5 e S1 segmental lordosis reportedly increases in patients with chronic low back pain ( Korovessis, S tamatakis, & Baikousis, 1 999 ). The degree of lumbar lordosis increases when the anterior pelvic tilt increases in the standing position ( Levine & Whittle, 1 996 ), and increases in lumbar lordosis lead to increases in sacral inclination and sacr al horizontal and lumbosacral angles ( Evcik & Yücel, 2003; Sarikaya, Ozdolap, Gümüs ¸ tass ¸ , & K oç, 20 07 ). The sacroiliac joint (SIJ) is a known source of LBP , conferring pain to the low er limbs ( Maigne, Aivaliklis, & Pfefer, 1 996; Schwarzer , Aprill, & Bogduk, 1 995 ) and buttock region ( Hansen & Helm 20 03 ). Previous studies ha ve established the clinical reality that the SIJ may be a source of LBP by demonstr ating symptomatic relief after intra-articular injection of the SIJ ( Ilaslan, Arslan, Koç, Dalkiliç, & Naderi, 201 0; Rupert, Lee, & Manchikanti, 20 09 ). SIJ-mediated * Corresponding author . Tel.: þ 82 55 320 3994; fax: þ 82 55 329 1 678. E-mail address: won7y@inje.ac.kr (W .-g. Y oo). Contents lists available at SciVerse ScienceDirect Physical Therapy in Sport journal homepage: www.elsevier.com/ptsp 1 466-853X/$ e see front matter Ó 20 1 1 Elsevier Ltd. All rights reserved. doi: 1 0. 10 1 6/j.ptsp.201 1 . 1 0.0 03 Physical Therap y in Sport 1 3 (201 2) 279 e 285 pain can result from in \ufb02 ammatory arthritis, ankylosis ( Berthelot, Gouin, Glemarec, Maugars, & Prost , 20 01; Braun, Sieper , & Bollow, 20 0 0 ), osteoarthritis, post-traumatic arthritis ( Bernard & Cassidy , 19 9 1 ), and infection ( Grace, Sim, Shives, & Coventry , 1 989 ). Although controv ersial, sacroiliac joint dysfunction (SIJD) is thought to be the primary source of SIJ pain ( Dreyfuss, Michaelsen, Pauza, McLarty , & Bogduk , 1 996; Elgafy , Semaan, Ebraheim, & Coombs, 20 01 ). Lev angie (1 999) proposed two hypotheses with respect to the pain associated with SIJD. The \ufb01 rst proposed that the pain is caused by nociceptive mechanical stress on the structures attached to the innominat es or within the SIJ due to asymmetry of the pelvic ring. The second suggested painful mechanical stress on the surrounding and interv ening tissues due to SIJ hypomobility , with or without positional abnormalities, within one or both SIJs. On the other hand, DonTign y (20 05) de \ufb01 ned SIJD as a pathological release of the self-bracing position with anterior pelvic ro tation. In addition to bilateral SIJD, this patient showed increased lumbar lordosis, and the pelvis w as tilted anteriorly ( Don Tign y, 2005 ). The use of Kinesio Taping (KT) is gradually incre asing in ortho- pedic, sports medicine, and neuromuscular rehabilitation ( Y asukaw a, Patel, & Sisung, 200 6 ). Both lymph and blood circula- tion may be enhanced ( Kase, W allis, & Kase, 20 03 ) and the muscular and affected myofascial functions may improve at the sites where KT is applied ( Y oshida & Kahanov , 20 07 ). The applica- tion of KT to the skin stimulates cutaneous mechanorec eptors ( Chang, Chou, Lin, Lin, & W ang, 201 0 ), increasing the isokinetic eccentric peak torque ( Vithoulka, Beneka, Malliou, Aggelousis, Karatsolis, & Diamantopoulos, 20 1 0 ) and relieving the pain of shoulder impingement syndrome ( Kay a, Zinnuroglu, & Tugcu, 201 1 ). Accor ding to previous studies, the application of K T in hemiplegia patients promo ted the functional use of the upper extr emities by supporting the weakened muscles, reducing pain ( Jaraczew ska & Long, 2006 ), and increasing the bioelectric activity of the low trapezius ( Hsu, Chen, Lin, W ang, & Shih, 20 09 ), vastus medialis ( Slupik, Dwornik, Bialoszewski, & Z ych, 2007 ), and scap- ular muscles ( Lin, Hung, & Y ang, 201 1 ). No studies to date have evaluat ed the effect of KT in patients with LBP . The purpose of this case report was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to red uce the anterior pelvic tilt angle. 2. Case descrip tion A 20-year -old female amateur swimmer who complained of severe pain in both the medial buttock areas (e.g., appro ximately 5 cm lateral from both posterior superior iliac spines (PSIS)) and SIJs was assessed over a 1-month period. She complained of continuous LBP for 2 years, and an e xamination revealed that her pelvis w as tilted anteriorl y . She had not undergone any speci \ufb01 c treatment for this condition. More recently , the SIJ and medial buttock pain had become severe following repeated lumbar hyper extension whilst swimming the butter \ufb02 y stroke. The patient was unable to sleep in the supine position due to the pain and alw ays slept on her side. When she performed forw ard \ufb02 exion in the standing position with her knees fully e xtended while washing dishes in the sink , she experienced pain and stiffness in her lower back. 2. 1 . Radiographic views All radiographs were taken using the same X -ray machine and the same type of high-quality \ufb01 lm plate. While taking the radio- graphs, the patient w as in the upright position with the right side of her body facing the \ufb01 lm, her arms folded across the chest and hands on the opposite shoulders. The distance between the \ufb01 lm and the radiographic tube w as 1 0 0 cm ( T suji, Matsuyama, Sato, Hasegaw a, Yimin, & Iwata, 20 01 ). In this case, we measured the lumbar curve in the sagittal plane. The angle w as measured between the upper end plates of L1 and S1 ( Berlemann, Jeszenszky , Bühler, & Harms, 1 999 ), and the sacral horizontal angle w as de \ufb01 ned as that between a horizontal line and a line drawn tangent ially to the upper end plate of the sacrum ( Evcik & Yücel, 20 03; Sarikaya et al., 2007 ). According to a radiographic view of the sagittal plane, Cobb \u2019 s angle (L1 e S1 , Fig. 1 A) was 6 8 \ue001 (normal range, 50.4 \ue003 10.93 \ue001 ) ( Sarikay a et al., 20 07 ) and the sacral horizontal angle ( Fig. 1 B) w as 45 \ue001 (normal range, 31 .77 \ue003 6.02 \ue001 )( Kim et al., 2006 ). 2.2. Pel vic inclination The pelvic inclination was measured with a palpation meter (P ALM; Performance Attainment Associates, St. Paul, MN, USA) by one examiner . P ALM consists of an inclinometer and two caliper arms. This instrument is a valid, cost-effecti ve, and reliable clinical tool ( da Costa, Armi jo-Olivo, Gadotti, W arren, R eid, & Magee, 20 1 0 ; Petrone, Guinn, Reddin, Sutlive, Flynn, & Garber , 20 03 ) for calcu- lating the height discrepancy between landmarks ( Gnat, Saulicz, Bia 1 y, & K 1 aptocz, 20 09 ). The intratest reliability of the P ALM was 0.90, and the intertest reliability w as 0.85. The patient removed their shoes and spread their feet (about 1 0 e 1 2 cm) during the measurement and stood upright with the ant erior aspect of the thighs against the stabilizing table ( Gnat et al., 20 09 ). The sagittal plane rotati on of the innominate was measured with the caliper Fig. 1 . Cobb \u2019 s angle (A: 68 \ue001 ) and sacral horizontal angle (B: 45 \ue001 ) of the patient at the initial assessment. J.-h. Lee, W.-g. Y oo / Physical Therapy in Sport 13 (20 1 2) 279 e 285 280 tips of the PALM in contact with the ipsilater al anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) ( Gnat et al., 2009; Preece, Willan, Nester , Graham-Smith, Herrington, & Bowker , 20 08 ). At the initial assessment, the anterior pelvic tilt angles were 1 7 .5 \ue001 and 1 9 \ue001 on the right and left sides (normal range, 11 \ue003 4 \ue001 )( Hagins et al., 1 998; Levine & Whittle, 1 996 ), respectively . 2.3. Motion palpation tests The motion palpation t ests included determination of the PSIS level in a standing or sitting position ( Levangie, 1 999 ) to detect hypomobility or motion asymmetry of the SIJs ( Lindsay , Meeuwisse, Vyse, Moone y, & Summersides, 1 993 ). The motion palpation tests used in this study were as follow s: (1) The Gillet test, wherein the patient stands on 1 leg and mov es the opposite knee tow ards the chest; the response is positi ve if the PSIS remains at the same level or mov es superiorly ( Hansen & Helm, 2003; Magee, 20 07 ). (2) The standing trunk \ufb02 exion t est, wherein the patient slowly bends forw ard from the standing position; the response is positive if 1 PSIS mov es before the other or 1 PSIS is higher at the end of the movement ( Magee, 20 07 ). (3) The supine-sitting test, wherein the patient slow ly sits up from a supine position without shifting the pelvis; the response is positiv e if the positions of the medial malleoli are not at level ( Mag ee, 20 07 ). (4) The sitting forward \ufb02 e xion test, wherein the patient slow ly bends forward from the sitting position; the response is positive if 1 PSIS moves before the other or 1 PSIS is higher than the other at the end of the movement ( Magee, 20 07 ). In our patient, the supine-to-sit t est provided positi ve results for both SIJs. The Gillet, standing trunk \ufb02 exion, and sitting forw ard \ufb02 exion tests gav e positive results for the right SIJ but not for the left SIJ ( T ables 1 and 2 ). Cibulka and Koldehoff (1 999) used a combination of SIJ-motion palpation tests, including standing \ufb02 e xion, sitting \ufb02 exion, and supine-to-sit tests, to determine SIJD. Lueck (2009) found that the k max intrarat er reliability of the Gillet, standing \ufb02 exion, sitting \ufb02 exion, and supine-to-sit tests by an experienced examiner w as 87%, 69%, 83%, 69%, respectively . 2.4. Pain -provocatio n tests The pain-provocation tests repr oduced pain at both SIJs through stressing ( Zelle, Gruen, Brown, & George, 2005 ). All the provocation tests wer e scored as positive or as negati ve, and an increase in familiar pain indicates a positi ve response. The t est result was deemed negative if the patient experienced pain prior to the full range of mo tion or did not display familiar pain ( Laslett, Aprill, McDonald, & Y oung, 20 05; van der Wurff, Bui js, & Groen, 200 6 ). The following pain-provocation t ests were used in this study: (1) The Gaenslen test, wherein the patient lays do wn in the supine position along the side of the table, draws bo th legs up on the chest, and then lowers the affect ed leg to achieve full e xtension of the hip ( Hansen & Helm, 20 03; Zelle et al., 20 05 ); (2) the Patrick test, wherein the patient lay s down in a supine position and places the foot of the affected side on the opposite knee to achiev e \ufb02 exion, abduction, and ext ernal rotation of the hip, and the examiner holds the opposite ASIS in a \ufb01 xed position and applies pressure on the patient \u2019 s affected knee ( Hansen & Helm, 20 03; Kokme yer , van der Wurff, A ufdemkampe, & Fickenscher , 20 02; Zelle et al., 20 05 ); (3) the resistiv e abduction (REAB) test, wherein the patient la ys down in the supine position and performs a 30 \ue001 abduction of the affected leg until the hip is full ext ended, e.g., the patient pushes the affected leg to the side while the e xaminer holds the ankle of the leg in a \ufb01 xed position ( Broadhurst & Bond, 1 998; Zelle et al., 20 05 ); and (4) the posterior shear or thigh thrust (POSH) test, wherein the patient lays down in the supine position and performs a 90 \ue001 \ufb02 exion and slight adduction of the affected knee, applying axial pressure on the femur ( Kokmey er et al., 20 02; Laslett et al., 20 05 ). For both the SIJs, the Gaenslen, Patrick, and REAB tests showed positive results, but the POSH test showed negative results ( T ables 1 and 2 ). As the reliability and validity of the clinical pain-provocation tests are v ariable, various composites of these tests have been used to identify pain arising from the SIJ ( Br oadhurst & Bond, 1 998 ). Broadhurst and Bond (1 998) reported that the sensitivity of the combination of the Patrick, POSH, and REAB tests ranged from 77% to 87%, with a speci \ufb01 city of 1 0 0%. Dreyfuss et al. (1 996) and Laslett and Williams (1 994) reported that the Gaenslen, Patrick, and POSH tests display ed clinical reliability > 80%. 2.5. Pa lpation for tenderness The patient described her responses to a visual analog scale (VAS), with 0 represent ing no pain and 1 0 representing the worst imaginable pain. A VAS score of 8/1 0 was obtained for the palpation state of both medial buttock areas in the prone position ( T ables 1 and 2 ). Slipman et al. (200 0) demonstrated that 94% of patients with SIJ pain described referred butt ock pain. 2.6. Interv ention: posterior pelvic tilt taping W e performed PPTT with Kinesio tape for 2 weeks (six times per week for an a verage of 9 h each time) to provide continuous mechanical correction to the posterior tilt of the innominates. For PPTT , the Kinesio tape was stret ched by appro ximately 30 e 40% over the original length and applied by a physical therapis t fully trained in KT . The methods used to place the tissue into the desire d position were as follow s; \ufb01 rst, the tissue was placed in the correct or desired position using manual techniques including joint posi- tioning. Second, the elastic qualities of the KT were used to main- tain the desired position ( Kase et al., 20 03 ). For the external obliq ue (EO) muscle, KT was applied when the patient was in the side-lying T able 1 The patient physical assessment results (right). 1st e PPTT 2nd e PPTT 8th e PPTT Final Pre Post Pre Post Pre Post assessment VAS (Tenderness at palpation) 8 7 7 6 1 0 0 Gillet test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Standing Trunk Flexion test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Supine-Sitting test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Sitting Forward Flexion test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Gaenslen test þþ \ue004 \ue004 \ue004 \ue004 \ue004 Patrick test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Posterior shear or thigh thrust test \ue004\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 REAB test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 T able 2 The patient physical assessment results (left). 1st e PPTT 2nd e PPTT 8th e PPTT Final Pre Post Pre Post Pre Post assessment VAS (Tenderness at palpation) 8 7 7 5 1 0 0 Gillet test \ue004\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Standing Trunk Flexion test \ue004\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Supine-Sitting test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Sitting Forward Flexion test \ue004\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Gaenslen test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Patrick Test þ\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 Posterior shear or thigh thrust test \ue004\ue004 \ue004 \ue004 \ue004 \ue004 \ue004 REAB test þ\ue004 þ \ue004 \ue004 \ue004 \ue004 J.-h. Lee, W.-g. Y oo / Physical Therapy in Sport 13 (20 12) 279 e 285 281 position, tilting the pelvis posterior ly , from the inguinal region to the T1 2 spinous process ( Fig. 2 ). Mechanical correction of the posterior pelvic tilt w as exerted by applying the I-Type strip from the ASIS to the PSIS when the patient was in the side-lying position, tilting the pelvis posteriorl y ( Fig. 3 ). For the rectus abdominis (RA) muscle, the KT was applied when the patient was in the hook -lying position, from the part near the pubic symph ysis to the xiphoid process and the 5th to 7th costal cartilages ( Fig. 4 ). In addition, to prevent terminati on of the treatment due to adverse reactions to the Kinesio tape, the Kinesio T ape was immediately remo ved if the patient e xperienced itching of the skin underneath it. In this study , other therapy or home ex ercise was not attempted to treat either the chronic LBP or the increased anterior pelvic tilt angles. 3. Results Further assessments we re carried out before and after the PPTT . After the initial application of the PPTT , the anterior pelvic tilt angles were reduced to 1 1 \ue001 and 1 2 \ue001 on the right and left sides ( Figs. 5 and 6 ), respectively . On palpation of both medial buttoc k areas, the VAS scores decre ased to 7/1 0 in the prone position. The positive motion palpation test results of the right SIJ all reversed, becoming negative, as did the supine-sitting test result of the left SIJ. In the pain-prov ocation tests for the right SIJ, the Gaenslen test yielded a positive result, but the Patrick, POSH, and REAB tests yielded negative results. Nega tive results were yielded in the pain- provocation t ests for the left SIJ ( T ables 1 and 2 ). After remov al of the PPTT , the anterior pelvic tilt angles were 1 3 \ue001 and 1 7 \ue001 on the right and left sides ( Figs. 5 and 6 ), respectiv ely , being higher than those measured at the initial PPTT application (1 1 \ue001 and 12 \ue001 , respectiv ely) but lower than those measure d at the initial assessment (1 7 .5 \ue001 and 1 9 \ue001 , respectively). On palpation of both medial buttock areas in the pr one position, the VAS score remained at 7/1 0. The results from the motion palpation tests of bo th SIJs remained negativ e, even after the removal of the PPTT . No pain w as experienced in the Gaenslen, Patrick, POSH, or REAB tests for the right SIJ. Although no pain w as experienced in the Gaenslen, Pat- rick, or POSH tests for the left SIJ, the REAB test yielded a positive result ( T ables 1 and 2 ). After the second PPTT application, the anterior pelvic tilt angles were reduced to 1 0 \ue001 and 1 4 \ue001 on the right and left sides ( Figs. 5 and 6 ), respectiv ely . On palpation of bo th medial buttock areas in the prone position, the VAS score decreased to 6/1 0 on the right side and 5/1 0 on the lef t side. In the motion palpation tests for both SIJs, the negative results persisted. Similar ly , no pain was e xperienced in the Gaenslen, Patrick, POSH, or REAB tests for the right and lef t SIJs ( T ables 1 and 2 ). After remov al of the second PPTT , all of the motion palpation test results had become negati ve, and the pain experienced in the pain-prov ocation tests was resol ved. On palpation of both medial buttock ar eas in the prone position, no pain w as experienced after the 8th PPTT application on either the right or left side ( T ables 1 and 2 ). In the \ufb01 nal assessment performed after the remov al of the PPTT on the day after the 1 1th PPTT application, the anterior pelvic tilt angles had decreased to 1 0 \ue001 on the right side ( Fig. 5 ) and 1 0.5 \ue001 on the left side ( Fig. 6 ). All \ufb01 ndings remained negative for the motion palpation test of bo th SIJs. No pain was experienced in the pain- prov ocation tests of either SIJ ( Tables 1 and 2 ). The radiogr aphic view showed that the Cobb \u2019 s angle (L1 e S1 , Fig. 7 A) had decreased to 47 \ue001 and that the sacral horizontal angle ( Fig. 7 B) had decreased to 31 \ue001 . The patient no longer complained of LBP . The subject was able to sleep in the supine position without pain and e xperienced no pain or stiffness of the low er back while performing forw ard \ufb02 exion Fig. 2. Application of Kinesio tape for the external oblique muscle. Fig. 3. Application of Kinesio tape from the ASIS to the PSIS. Fig. 4. Application of Kinesio tape for both rectus abdominis muscles. J.-h. Lee, W.-g. Y oo / Physical Therapy in Sport 13 (20 1 2) 279 e 285 282 in the standing position with knees full y ext ended when w ashing dishes in the sink. 4. Discussion Application of PPTT was performed for 2 weeks to pr ovide continuous mechanical correction to the posterior tilt of the innominates. After two applications of PPTT , all of the previously positive motion palpation test r esults had become negative, and the pain initially experienced in the pain-provocation tests was resolv ed; this status was maintained in the subseq uent taping treatment period. Although subjective VAS scores we re used as a method of measurement, the pain-relieving effect on both medial buttock areas persisted not only during the period of taping, but also after remov al of the tape (e.g., assessment to look at mainte- nance of this change). The RA muscle, to which KT was applied in this case, reduced lumbar lordosis by causing a posterior pelvic tilt ( Lin et al., 1 992 ) because the RA originates from the crest and symph ysis of the pubis and inserts on the xyphoid process and cartilages of 5th to 7th ribs. Furthermore, acting bilate rally the lateral \ufb01 bers of the EO muscle \ufb02 ex the v ertebral column with a major in \ufb02 uence on the lumbar portion to permit a posterior tilt of the pelvis ( Kendall, McCreary , Prov ance, Rodgers, & Romani, 2005; Neumann, 20 09 ). The certain ph ysiological mechanism of the effect of the KT application is not known, but the proposed h ypotheses from previous studies suggest that, unlike conv entional tapes, Kinesio tape applied around the pelvis has an elasticity of 30 e 40% of original length ( Kase et al., 20 03 ). The elasticity of the K T allows for overall joint movement, creating a deformation of the skin ( Shim, Lee, & Lee, 2003 ) and increasing stimulation of cutaneous mechanorecept ors ( Chang et al., 201 0 ). This stimulation activates a nerve impulse, causing local depolarisation that triggers nerve impulses to travel along the afferent \ufb01 bres to the central nervous system ( Kase et al., 20 03 ). In previous studies, K T application increased the bioelectric activity of the scapular muscles ( Lin et al., 20 1 1 ), vastus medialis muscle ( Slupik et al., 20 07 ), and low trape- zius muscle ( Hsu et al., 2009 ). Thus, KT application might have improved the function of the RA and EO muscles and caused the anteriorl y tilted innominates to be post eriorly tilted. The sacroiliac joint function is subtle, but dynamic and impor - tant during ambulation ( DonTign y, 1 990 ). With initial contact on the right foot during ambulation, the right innominate is slightly rotated posteriorly and the left innominate is slightly rotated anteriorl y ( DonTign y , 2005 ). Therefore, as a person ambulat es, the sacroiliac joints also move rec iprocally . The elasticity of Kinesio tape might provide a gently mobilizing effect to the sacroiliac joint by elongating and contracting repeatedly and by allowing dynamic pelvic mov ement such as ambulation with the PPTT . Thus, PPTT application may produce a reduction in h ypomobility or motion asymmetry and pain as assessed by the motion palpation and pain- prov ocation tests, respectively . The mechanical correction techniq ue with KT may be used to assist the positioning of muscle, fascia tissue, or joints in the desired position ( Kase et al., 20 03 ). The tension created by the application of PPTT with KT acts as a preload in the end-of-motion positions ( Kase et al., 20 03 ), res isting the end position of anterior tilt and assisting the posterior tilt of the innominate. In turn, the perception of increased tension in the anterior tilt position of the innominate Fig. 6. Comparison of the anterior pelvic tilt angle before and after posterior pelvic tilt taping (Left ASIS e PSIS angle). Fig. 7 . Cobb \u2019 s angle (A: 47 \ue001 ) and sacral horizontal angle (B: 31 \ue001 ) of the patient at the \ufb01 nal assessment. Fig. 5. Comparison of the anterior pelvic tilt angle before and after posterior pelvic tilt taping (Right ASIS e PSIS angle). J.-h. Lee, W.-g. Y oo / Physical Therapy in Sport 13 (20 12) 279 e 285 283 causes repositioning of the joint to normalise the perce ived skin tension ( Kase et al., 20 03 ). The application of a continuous I-type strip from the anterior superior iliac spine (ASIS) to the PSIS may apply a mechanical correction effect, tilting the pelvis posteriorly . The results of this study demonstrate that the mechanical correc tion bene \ufb01 ts of patellar taping obtained using Leukotape (a non-elastic tape) may also be obtained when Kinesio tape (an elastic tape) is applied over the muscles surroundi ng the pelvis. This study has some limitations. Firstly , caution is necessary in suggesting that the patient had SIJ-mediated pain, as contro versy exists with respec t to the v alidity and reliability of the motion palpation and pain-prov ocation tests. Additionally , the POSH test did not show a positive response on both SIJs. Secondly, this study was conduct ed as an intervention for 2 weeks, and no longer -term follow-up w as performed. Thirdly , the natural resolution of the problems during the PPTT interv ention were no t compared or assessed because this study was a single case. Fourthly , the change in pelvi c inclination might have v aried because it w as dif \ufb01 cult to maintain the tension for the Kinesio tape application at the same level for each PPTT application. Further inv estigation is required to determine the appropriat e level of tension that should be applied. 5. Conclusion W e applied PPTT with Kinesio tape to an amateur swimmer with increased anterior pelvi c tilt angles, sacral horizontal angles, and pain in both the medial buttock area and SIJs during a 2-week intervention. The present study demonstr ated that PPTT favor ably affected the pelvic inclination and sacral horizontal angles and display ed a positive effect on pain in the SIJ and the medial buttock areas. Additional resea rch on the clinical effects of this taping procedure, inv estigating a greater number of athletes with SIJD or LBP who hav e inappropriate anterior pelvic tilt angles and h yper - lordosis is now required. Con \ufb02 ict of Interest Statements None declared. Ethical approv al The subject signed an informed consent document that w as approved by the Human Ethics Committee of the F aculty of Health Sciences at Inje University . Funding None declared. Ackno wledgements This research w as supported by Basic Science Research Progra m through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and T echnology (No. 20 1 1- 00 05580). Refer ences Berlemann, U., Jeszenszky, D., Bühler , D. W ., & Harms, J. (1 999). 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