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Taping Performance

Elastic therapeutic tape will once again make an Olympic appearance

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Vol. 23 • Issue 12 • Page 18

Taping

Elastic therapeutic tape is used by physical therapists to change muscle tone, move lymphatic fluids, correct movement patterns and improve posture. Each of these effects occurs to differing degrees depending upon the application of the tape. Regardless, the effect is to assist in the healing of injured or dysfunctional joints, muscles, tendons and other commonly occurring neuromuscular conditions.

Many sources attribute the invention of elastic therapeutic tape, also known as Kinesio Tape or KT, to Japanese chiropractor Kenzo Kase in the 1970s. In truth, the first patent for the acrylic adhesive belongs to a company named Komp, which filed the patent in 1965. The patent was eventually issued in 1970. Kase subsequently became famous for developing effective techniques that reportedly enabled the healing of his patients more rapidly and effectively.

The tape had its brightest moment in the sun during the 2008 Summer Olympics where most of the world saw American beach volleyball player Kerri Walsh regularly sporting a masterfully constructed pattern to support a surgically repaired right shoulder. Walsh and her partner, Misty May, went on to win the gold medal at the games that year. Walsh led the charge with a powerful overhead serve, enhanced by the elastic tape stabilizing her shoulder. Elastic tape has become an essential part of her game-time equipment.

Elastic therapeutic tape, however, is not just designed for use with world-class athletes like Walsh. The tape can be effective for recreational athletes during training and competition. Additionally, therapeutic tape has limitless applications for workplace athletes, seniors or anyone with an acute or chronic injury. PTs specializing in orthopedics, sports, neurological conditions, pediatrics and more use elastic tape for the array of conditions they treat daily.

Function of Elastic Tape

When muscles are overused, either by exerting too much force or because of a constant repetitive force for prolonged periods of time, they become inflamed. Inflamed or stiff muscles compress the space between the muscle and the skin. This restricts the flow of lymphatic fluid and applies pressure to the pain receptors beneath the skin's surface. The result is myalgia.

Myalgia often leads to restricted movement and a patient will enter a negative feedback cycle, further increasing pain and restricting movement. In recent years, it has become evident that muscle pain can interfere with motor control strategies. Different patterns of interaction are seen during rest, static contractions and dynamic conditions.

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One of the first goals for a PT working with a patient who presents with any neuromuscular disorder is to restore normal passive and then active range of motion. By reducing inflammation and decreasing pain, elastic taping can expedite this process. The tape is applied by a PT and it can stay on a patient for up to three to five days depending on wear and tear. During that time, it constantly facilitates edema control, muscle activation or inhibition and restoration of movement.

Why Does Taping Work?

Restoration of normal movement is crucial to reducing inflammation and often relieves pain. Normal movement allows muscles to flush edematous fluids from injured regions and also facilitates the secretion of synovial fluid. Elastic tape helps restore normal movement by facilitating the firing of dormant muscles or by relaxing fatigued or spasmed muscles.

The flexible tape is applied to the skin in specific patterns, depending on the injury. The technique is designed to support and guide injured muscles, lymph and joints without limiting a patient's or athlete's range of motion. There are varying techniques for the use of elastic tape. In general, the most common rules are:

• Muscles should be held in a stretched position by the PT as the tape is applied.

• For muscle support or facilitation of a weakened muscle, the tape is applied from the muscle origin to the muscle insertion-proximal to distal. The tape is then wrapped around the affected muscle.

• To inhibit an overused or spasmed muscle, apply the tape from the insertion to the muscle origin-distal to proximal.

• For the purposes of edema relief, the goal is to lift the skin.

         The muscle group under the inflamed area should be stretched as the tape is applied.

         Leave a small space between thinly cut strips of tape. Strips can be cut in lengths of tape
         from a roll or can be purchased pre-cut. The thinner and more plentiful the strips, the
         more surface area there will be to create a lifting effect on the skin.

         Apply the ends of the tape with no stretch or tension in the tape.

         Stretch the middle 80 percent of the tape to 50 percent beyond its normal length.

Effective Use of Elastic Tape

I have found elastic taping to be effective for the treatment of Achilles tendinitis and calf strains. These types of injuries are common among the recreational athlete population. They are often caused by overtraining combined with inefficient technique, particularly in endurance athletes such as runners, cyclists, basketball players and tennis players. I've seen an increased prevalence of Achilles injuries in athletes switching to more of a forefoot running technique and minimalist shoes without proper education or sufficient time allowed for mileage increases.

Depending upon the severity and the chronicity of the injury, I'll vary the degree with which I use each modality, but I typically use a combination of a warm-up, stretching, strengthening, functional activities, laser therapy and taping.

There are several variations of taping for a gastrocnemius strain or Achilles strain. Because the injury is due to overuse, the PT will want to inhibit the firing of the patient's muscle, so taping should be done from distal to proximal. The procedure I most commonly use is the following:

1. The patient should be in a stretched position throughout the taping procedure. This can be standing or in prone.

2. Use pre-cut tape or cut rounded edges to prevent furling.

3. Use an 8-inch strip of tape, cut in half about ¾ of the way from one end.

4. Anchor distally, starting about two inches below the injury site. Apply the anchor with no tension.

5. At the injury site, apply the two strips of tape around the injury site. Do not apply any tension or stretch on the tape.

6. Rub the tape vigorously for a few seconds to warm it and increase adhesion. Be careful not to furl the ends.

Prior to applying elastic tape, I always clean the patient's skin very well, removing any oils or dirt. I also recommend shaving excessive hair from the area. Make sure the patient knows to be very gentle applying and removing clothing to avoid furling the ends of the tape.

At this point, the evidence behind the efficacy of elastic taping is only anecdotal. The scientific literature remains inconclusive. Several studies have shown little or no effects, but other double-blind studies demonstrate significant decreases in pain and increases in ROM with the application of elastic tape.

Many patients and practitioners swear by the benefits of therapeutic tape. I encourage you to do your own research. There are many wonderful resources available ranging from effectiveness studies published by The National Institutes of Health to taping demonstrations that are available for context on YouTube.

And be sure to tune into coverage of the 2012 Summer Olympics, as we will most certainly see the increased use of elastic therapeutic tape.

Daniel Seidler is executive director of WSPT (www.wspt.org). He is a Columbia University graduate with a master's degree in physical therapy. His areas of expertise are aquatic therapy and orthopedic manual physical therapy based on the Maitland technique of assessment and treatment.


Injury Treatment: Hot or Cold?

Do you know when to use heat or cold therapy for an injury? If not, a recent review article by two University of Washington sports doctors, Matthew Karl, MD, and Stanley Herring, MD, can be your guide. Drs. Karl and Herring point out that the application of superficial heat to your body can improve the flexibility of your tendons and ligaments, reduce muscle spasms, alleviate pain, elevate blood flow and boost metabolism. The mechanism by which heat relieves pain is not exactly known, although researchers believe that heat can induce the release of endorphins, powerful opiate-like chemicals which block pain transmission.

Increased blood flow occurs in heated parts of the body because heat tends to relax the walls of blood vessels. That's one reason why sports doctors recommend that you steer clear of the practice of heating up already inflamed joints. Heat appears to be best for untightening muscles and increasing overall flexibility; the proper tissue temperature for vigorous heating is probably 104 to 113 degrees Fahrenheit (40 to 45 degrees Celsius) and the correct duration of temperature elevation is about five to 30 minutes. Although heating can reduce muscle spasms after a back injury, heat should not be used on sprained ankles.

What About Cold Treatment?

Cold therapy can also reduce muscle spasms, and cold is noted for killing pain, reducing swelling, and lowering metabolic activity. Cold's pain-killing effect is caused by its "deadening" of nerve-cell activity; hospital studies show that patients who use cold therapy on injuries tend to require much less pain medication. This effect, though, can sometimes be counterproductive; an athlete who has "iced down" an injured body part may get so much pain relief that he/she returns to activity too soon.

Combined with compression, cold can produce dramatic drops in tissue swelling, because cold initially constricts the walls of blood vessels and compression restricts the amount of blood which can reach an injured body part (another therapeutic intervention, elevation, helps 'drain' a damaged body region of excess fluid). Studies show that cold produces large decreases in edema (swelling) and better reduction in discomfort, compared to heating.

Cold decreases muscle spasms by making muscles less sensitive to being stretched and can be used to treat low-back pain. Research suggests that cold works better for individuals who have had back pain for more than 14 days, while heat may be more effective for those with more recent pain. Traditionally, doctors have recommended applying cold packs or ice bags to injured areas for 15-30 minutes at a time, but recent research carried out at the University of Brussels indicates that the permeability of Iymphatic vessels decreases after about 10 minutes of cold therapy. Since Iymphatic vessels drain fluid away from injured tissues and thereby relieve swelling, the Brussels researchers recommend that cold be applied to damaged tissues in no longer than 10-minute intervals. Recent research suggests that ice chips in a plastic bag are most effective, followed by frozen gel packs and blue ice packs. 

Resource: Karl, M., & Herring, S. (1994). Superficial Heat and Cold: How to Maximise the Benefits. The Physician and Sportsmedicine, 22(12), 65-74.

Note from the editors: The patent held by the Komp company in 1965 was for an adhesive process. It did not relate to elastic therapeutic tape.


 

How would you bill for Kineso taping when used for swelling? Lymphedema and post tramatic swelling?

Thank you,

Susan

Susan Cohen,  Clinical Director,  Rehab/Bacharach inst for RehabilitationOctober 11, 2013
Linwood, NJ, NJ




     

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