Scars, swelling, fibrosis — and the case for a gentler mechanical dose

I love tape.

There. I’ve said it.

Over the years I have used therapeutic tape in all sorts of ways — around scars, to support movement, with swelling, alongside rehabilitation and sometimes simply to give the body a slightly different piece of information.

For a while, it was something I reached for regularly.

Then I started reaching for it less.

Not because I’d suddenly decided tape didn’t work.

I was simply seeing more people whose skin didn’t seem to like it — sometimes even when I was using one of the supposedly sensitive tapes.

And that made me start asking a much more useful question.

First, let’s clear something up: tape doesn’t “break up” fibrosis

Neither do my hands.

Neither does a cup.

Neither does somebody attacking an area of fibrosis with increasingly aggressive treatment.

Fibrosis involves changes within the extracellular matrix, including altered collagen deposition and organisation, cellular activity and tissue mechanics.

So when we work with fibrotic or scarred tissue, I think it’s much more useful to think about mechanical input than “breaking things down”.

And tape provides a rather unusual mechanical input.

Manual therapy might provide a more substantial stimulus for a relatively short period.

Movement repeatedly loads and unloads tissue.

Compression provides another mechanical environment.

Negative pressure or gentle cupping provides another.

Tape provides relatively low-level mechanical input for a potentially very long period.

Hours rather than minutes.

And then we add something incredibly important:

movement.

LOW FORCE + LONGER DURATION + MOVEMENT

That is what interests me most about tape.

Put elastic tape onto skin and then ask that person to breathe, reach, rotate, walk, bend or use their arm and the relationship between the tape, skin and superficial tissues continually changes.

The mechanical stimulus isn’t static.

Movement beneath an elastic tape repeatedly alters the forces experienced by the skin and superficial tissues.

From a mechanobiological perspective, that’s fascinating.

Cells respond to their mechanical environment. Mechanical forces can influence cellular signalling and extracellular-matrix behaviour.

But here’s where we need to be careful.

A plausible biological mechanism is not the same thing as proving that a particular piece of tape applied in a particular direction remodels fibrosis in a human being.

We don’t yet have evidence strong enough to make that leap.

So rather than saying:

“Tape breaks down fibrosis.”

I’d rather say:

Tape may provide prolonged, relatively gentle mechanical input to the skin and superficial tissues while the person moves.

That is both more accurate and, I think, more interesting.

What about scars?

Here the evidence becomes particularly interesting.

A randomized controlled trial by Atkinson and colleagues studied 70 women following caesarean section. Paper tape was applied to the healing scar for 12 weeks.

At 12 weeks, 41% of the untreated control group had developed hypertrophic scars compared with none of the taped treatment group.

The authors proposed that reducing mechanical tension across the healing scar was an important part of the effect.

Interestingly, four people in the taped group developed a localised red rash — something I’ll come back to shortly.

The study wasn’t showing that tape removed scar tissue.

It was suggesting something much more useful:

Changing the mechanical forces acting upon a healing scar may influence how that scar develops.

A later comprehensive review of taping for hypertrophic scars found evidence supporting non-stretch tapes in reducing characteristics including scar height, colour and itch in linear surgical scars. The authors also found preliminary evidence for elastic tapes, although they were clear that more research is needed.

More recently, a randomized pilot trial examining Kinesio tape in hypertrophic burn scars found improvement over time but no additional improvement from maximum-tension elastic taping compared with lower mechanical tension.

And I find that particularly interesting.

Because more force isn’t necessarily better.

Sometimes the question isn’t:

How much can I make this tissue move?

It is:

What is the smallest useful mechanical dose?

A 2024 systematic review and meta-analysis included 14 randomized controlled trials. It reported favourable effects for outcomes including upper-limb function, quality of life and perceived comfort.

That sounds encouraging.

But look specifically at limb-volume reduction, and the picture isn’t nearly as convincing.

A systematic review of randomized trials found that the evidence for kinesiology tape reducing upper-limb volume in breast-cancer-related lymphoedema was low quality and did not establish a clear volume-reduction benefit.

Another randomized pilot study found that multilayer compression bandaging produced substantially better oedema reduction than Kinesio taping.

And a more recent systematic review and meta-analysis comparing bandaging approaches found no clear advantage of Kinesio taping over other bandaging approaches for arm-volume reduction.

So my interpretation isn’t:

Tape doesn’t work.

It’s:

We need to decide what outcome we’re expecting it to change.

Comfort?

Movement?

Skin mobility?

A feeling of heaviness?

Function?

Swelling?

Scar behaviour?

These aren’t interchangeable outcomes.

And tape certainly shouldn’t automatically replace compression simply because it looks less cumbersome.

Could tape help encourage an alternative lymphatic pathway?

Now THIS is the bit that has made me want to revisit tape in my own clinical practice.

When we’re working with lymphoedema, we aren’t simply thinking:

“There’s fluid here. Push it upwards.”

We’re thinking about the person’s lymphatic history and available pathways.

Where has surgery taken place?

Which lymph nodes were treated?

Was there radiotherapy?

Where is swelling accumulating?

What does the trunk look and feel like?

Where might fluid potentially be redirected?

And what happens when that person actually moves?

There are areas sometimes described clinically in relation to lymphatic territories and watersheds, and treatment approaches may attempt to encourage drainage toward alternative functioning territories.

Interestingly, researchers have experimented with exactly this idea using tape.

In one randomized crossover trial in women with breast-cancer-related lymphoedema, narrow strips of Kinesio tape were applied beginning at the contralateral axilla, travelling across the back and then onto the affected upper limb.

Other studies included taping across the chest toward the unaffected axilla and between axillary and inguinal territories.

So the concept of using tape to influence the superficial tissue environment along alternative drainage territories isn’t something we’ve simply invented in clinic.

It has been investigated.

But — and this is a very important BUT — that doesn’t prove the tape physically transports lymph along the pathway we’ve drawn on the skin.

A randomized controlled pilot study specifically investigated adding Kinesio tape over lymphatic anastomotic regions to complex decongestive physiotherapy.

Both groups improved.

But adding the tape did not produce a significantly greater reduction in limb volume.

That’s exactly the sort of result we need to talk about.

The anatomical and mechanical rationale is interesting.

The clinical technique exists.

But the evidence doesn’t currently justify saying:

“Put tape across this watershed and it will drain the arm into the opposite axilla.”

Biology is rarely that obedient.

So could I use this with somebody already wearing compression?

This is where clinical reasoning becomes more interesting than following a recipe.

I’ve been thinking about some of my regular lymphoedema clients who already manage their condition well and wear their prescribed garment.

Could carefully selected taping of the trunk — perhaps towards an appropriate alternative territory — provide a small additional mechanical input between treatments?

Not instead of their garment.

Not instead of movement.

Not instead of skin care.

Not instead of appropriate lymphoedema management.

But alongside those things.

An extra piece of the puzzle.

Possibly.

And that is something I am interested in exploring — cautiously.

Rather than assuming that it works because the theory sounds good, I’d want to assess.

Apply.

Let the person live and move in it.

Then reassess.

Does the trunk feel different?

Does the person report a change in heaviness or comfort?

Is there any measurable change?

Does movement change?

Most importantly:

Does their skin tolerate it?

If nothing meaningful changes, why keep sticking tape on somebody?

Fi Clinical Pearl

Don’t treat the tape pattern. Treat the person underneath it.

A beautifully applied fan of tape on Instagram tells me very little.

I want to know:

Why is it there?

What did you assess?

What are you trying to influence?

Which tissue?

Which pathway?

What outcome are you measuring?

And what are you going to do differently if your reassessment tells you it hasn’t worked?

ASSESS → APPLY → MOVE → REASSESS

The tape is simply the tool in the middle.

In that surgical-scar paper-tape trial, four participants developed localised red rashes beneath the tape.

Reports from lymphoedema research have also described itching and other minor skin reactions associated with kinesiology taping.

And that matters enormously in lymphoedema.

Skin integrity isn’t an optional extra in lymphoedema management.

Damaging the skin in an attempt to manage swelling rather defeats the object.

We also need to distinguish between different reasons somebody’s skin may react.

There can be irritation from the adhesive.

There may be contact dermatitis.

There can be mechanical irritation from excessive stretch.

And trauma can occur during removal.

The skin may also already be more vulnerable because of ageing, surgery, radiotherapy or other treatment.

And this is why the words “sensitive tape” shouldn’t give us false reassurance.

Sensitive skin can still react to sensitive tape.

My rule?

The skin gets the final say.

If the theoretical benefit of my treatment comes at the cost of compromising the person’s skin, it isn’t the right treatment.

Tape is not one treatment

This is another distinction worth making.

Paper tape used to reduce tension across a healing surgical scar isn’t the same intervention as elastic kinesiology tape applied in a fan pattern for lymphoedema.

And neither is necessarily the same as elastic tape used to provide a movement cue around an established scar.

They may have different:

• mechanical properties
• amounts of stretch
• application techniques
• treatment durations
• intended effects.

So saying simply “research shows taping works” isn’t particularly useful.

We need to ask:

Which tape? Applied how? To whom? For what purpose? And measuring what outcome?

That is where evidence-informed practice becomes much more interesting.

Perhaps tape’s greatest advantage is time

If I work manually with somebody for an hour, eventually they have to leave my treatment room.

Tape potentially stays with them.

They walk in it.

They breathe in it.

They reach in it.

They sleep in it.

Their skin and superficial tissues experience changing mechanical conditions as their body moves beneath it.

Does that mean we have proved it remodels fibrosis?

No.

Does it mean it will control lymphoedema?

No.

But it does make tape a fascinating way of delivering a different mechanical dose.

And perhaps that is where its real value lies.

Not:

MORE FORCE.

But:

LESS FORCE × MORE TIME + MOVEMENT.

Another piece of the puzzle

The more I work with scars, fibrosis and lymphatic dysfunction, the less interested I become in finding the treatment.

Because there probably isn’t one.

Sometimes the missing piece is compression.

Sometimes it’s manual lymphatic drainage.

Sometimes it’s movement.

Sometimes it’s addressing a scar.

Sometimes it’s strength.

Sometimes it’s breathing.

Sometimes it’s helping somebody understand their own body well enough to manage it confidently.

And sometimes, perhaps, it’s a few carefully considered pieces of tape.

Not because tape is magic.

Not because we’re “breaking up” fibrosis.

And not because coloured strips stuck to the skin somehow know where lymph needs to go.

But because the right mechanical input, in the right person, at the right time, may help change the environment in which that person moves and their tissues adapt.

And that’s why I think tape deserves another look.

Just perhaps with a little less enthusiasm for elaborate taping patterns —

and a little more curiosity about why we’re putting them there in the first place.

The evidence behind this article

Yang et al. (2024) — Effect of Kinesiology Taping on Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Fourteen RCTs were included; favourable findings were reported for upper-limb function, quality of life and perceived comfort, while the authors called for larger, better-designed trials.

Kasawara et al. (2023) — Efficacy of kinesio taping on upper limb volume reduction in patients with breast cancer-related lymphedema: a systematic review of randomized controlled trials. The evidence for reducing upper-limb volume remained limited/low quality.

Smykla et al. (2013) — randomized controlled pilot study comparing Kinesio taping with multilayer compression in breast-cancer-related lymphoedema. Multilayer compression produced better oedema reduction, supporting the important point that tape should not simply be considered a substitute for compression.

Ergin et al. (2019) — Effectiveness of Kinesio Taping on Anastomotic Regions in Patients with Breast Cancer-Related Lymphedema. Adding taping over lymphatic anastomotic regions to complex decongestive physiotherapy did not produce significantly greater limb-volume reduction than complex decongestive physiotherapy alone.

Pajero Otero et al. — randomized crossover research included a taping application beginning at the contralateral axilla and travelling across the back and affected upper limb — particularly interesting when considering taping in relation to alternative lymphatic territories.

Atkinson et al. (2005) — randomized controlled trial of paper tape following caesarean section. At 12 weeks, 41% of controls had developed hypertrophic scars compared with none of the taped treatment group, supporting the role of mechanical tension in scar formation.

O’Reilly et al. (2021) — comprehensive review of tape for hypertrophic scar development. Evidence supported non-stretch tape for some characteristics of linear surgical scars, with preliminary evidence for elastic tapes but a need for further research.

Albuquerque et al. (2025) — randomized pilot trial of Kinesio tape in hypertrophic burn scars. Maximum mechanical tension did not provide additional improvement in scar vascularity, pliability or height compared with lesser tension — another reminder that more force isn’t necessarily better.

This article is for education and general information and is not individual medical advice. Lymphoedema management and taping should be selected according to the person’s clinical history, skin integrity, lymphatic status and appropriate professional assessment.

pilatestherapyandbodywork.com – Please get in touch if you have questions or would like to book a treatment with me – 07767 384983