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Supporting Young Muscles

Elastic therapeutic tape is trickling into pediatric physical therapy.

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Elastic therapeutic tape was prominent during the 2014 Winter Olympic Games in Sochi, Russia, and it's being embraced - albeit slowly - by a new population beyond athletes: children with developmental disabilities.

Although it's been around since the mid-1990s, the tape came into prominence during the 2010 London Olympics and was designed to separate layers of skin to avoid pain. Its application has other purposes for the pediatric population, and a growing number of therapists are attesting to benefits for their youngest patients.

The thickness and weight of the tape is designed to be similar to that of skin so it is comfortable and non-invasive. "Kinesiotape helps with situations of muscle imbalance," confirmed Janice Laux, PT, Kennedy Krieger Institute in Baltimore. "The muscle and soft tissue are tight or over-lengthened. The tape helps establish a balanced support of muscles and soft tissue."

Laux can attribute anecdotally to the benefits of the tape for the developmentally delayed population, but concedes little research or evidence supports this observation. Still, she said, many major medical and rehabilitation centers are applying tape for this patient population.

Developing Core Support

The tape is most effective for babies and children with mild-to-moderate impairments. "The tape works at the level of facilitating supporting muscles that are working but could function more optimally," Laux summarized.

As part of therapy, the elastic, cotton, water-resistant tape is applied directly to the skin over the muscle being strengthened. The tape is applied differently depending on the outcome desired, and is typically worn for three to five days, and then left off for one to two days to allow the skin to rest.

Although she stressed that it's not actually a developmental disability, Laux attested to fantastic results in using elastic therapeutic tape when infants have torticollis - trouble tilting and turning their heads due to muscle tightness.

Other infants benefit from having the tape provide 24/7 support."When babies are learning something, they're practicing all the time," Laux explained. "How do we help the baby practice a new skill as much as possible without physically touching them all the time?"

For instance, Laux has seen success is using the tape for developing come-to-sit transition skills for babies. However, therapists must assess whether base muscle strength is there, or the taping can be a waste of time.

"Our abdominal muscles connect the rib cage to the pelvis," she said. "The muscles have to be there, working and engaged. I wouldn't tape if the muscle tone isn't there. I'd have to see an indication of inherent stability. If I need to have my hands supporting the baby's trunk, it's too soon."

In the case of an 8-month old, Laux said, lifting the pelvis in supine independently is a sign of being a candidate for taping. Bringing hands to knees and engaging in anti-gravity play are signs of abdominal use, and taping could provide further encouragement. If the same child is sitting independently but using the "tripod" position, and thus would lose balance by lifting a hand to play, the tape might further engage the abdominal muscles.

In older toddlers and children, those with signs of a developmental coordination disorder or neurogenic diagnosis, such as low tone, hypertonia, delayed development, or low core strength, can utilize elastic therapeutic tape to provide a stronger base for strengthening the trunk muscle.

Pain Relief

One proven area of effectiveness for this modality is in pain relief. The tape is a popular modality for chronic regional pain syndromes, myofascial pain syndrome, musculoskeletal overuse injuries, whiplash, and sports injuries.

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"Patients who have altered neuromuscular coordination, with growth and ovruse will typically develop muscle imbalance across joints," Laux explained. "This causes secondary changes to joint mechanics, thus development of pain. For example, if your patella doesn't track correctly, you'll have knee pain. The Kinesiotape can be very effective in positioning the patella into the right groove. If you need to move, the tape flexes with you."

Shoulders, she said, have very complex movement patterns and must glide a certain way. "Children with spina bifida don't have good use of their legs, but have a good use of their arms," Laux said. "The tape can be effective to support the whole dynamic of how the shoulder complex needs to move."

For others whose pain response has gone into overdrive following a traumatic incident, or adolescents with neuropathic pain or inflammation, the tape can provide welcome relief.

"Connected tissue wraps around every tissue in the body, including the nerves," Laux said. "If the fascia is restricted about the nerve, it can be pain generating. The tape serves to lift and mobilize the tissue about the nerve.

Issues of Effectiveness

Children with cerebral palsy have been documented as having improved posture after using the tape, although their functional skills didn't change, said Laux. "There is not a tool out there that has been validated to reliably document sitting posture," she noted. "Still, it's a nice outcome because posture affects breath support for communication and success in a classroom."

The cerebral palsy outcome illustrates the debate within academic physical therapy circles surrounding elastic therapeutic tape.

"Although the principles behind it make sense, we don't really know how the tape works," conceded Laux. "Children are heterogeneous in how they present and it's hard to find tools to measure change finely enough. I have assessment tools to look at the acquisition of motor milestones, but nothing fine-tuned enough to delineate components of a functional skill to be able to say babies rolled sooner or better after taping their abs than they would have otherwise."

The other equally pressing issue is that the tape works best while in place. One of the tape's greatest success stories is with children who have trouble picking up their feet while walking, yet aren't weak enough for a brace. The tape helps with efficiency so the child doesn't get as fatigued while walking, but foot drop usually returns after the tape is removed.

With repeated use, Laux said motor re-learning is possible but always cautions parents that old habits may return once the tape is removed. While the long-term results can be frustrating, parents and therapists are encouraged at seeing almost instant results in some children's first walking paths with the tape applied, so they see the benefit in continued use.

For results of the taping to last, it must be applied for weeks to months, in patients with mild-to-moderate motor issues, Laux said.

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Sticking Points

Taping for patellofemoral pain requires strict attention to technique.

Parent-Therapist Application

Laux took her first certification course on the Kinesiotaping method 15 years ago and routinely teaches parents some of the more basic techniques (out of hundreds of taping configurations). As a first step, she establishes a trusting relationship with the parents before introducing taping as an adjunct to therapy.

"We have a whole handout on how to remove the tape. It's a careful process," Laux explained. "You don't want to rip it off like a Band-Aid, and must respect the skin. We don't bring it up as an option when we first meet parents because we need to know they'll follow our instructions carefully. If we say not to rip, we need to know they won't."

Laux has never encountered a parent who has voiced objection to the tape, as it's a non-medicated, latex-free, conservative treatment option. After a strip is tested on the child's skin for a reaction, which is extremely rare, the process begins. Parents watch the therapist apply the tape, practice handling the tape, and apply it on the therapist under supervision before being charged with applying it on a child.

The two main aspects of taping are position on the body part and how much stretch should be applied. As Laux explained, the tape is elastic, so users must always consider how much stretch is needed for a particular application.

Simple as it sounds, many children oppose even the gentlest application by parents. If the parent sees benefit and wants to continue the taping practice, therapists usually aren't opposed to applying it in-office.

"The child-therapist relationship is different than the parent-child one," Laux said. "We sometimes make arrangements with parents if the child is coming weekly or more. We have the tape pre-cut in our office and can put it on in a matter of minutes. Often, parents are fine with it if we're the ones applying." 

Robin Hocevar is on staff at ADVANCE. Contact rhocevar@advanceweb.com.




     

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