6 Hip And Knee Therapeutic Taping 101 2r5gg

Therapeutic Taping for the Hip & Knee Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTP Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS

Medial Knee Proprioception • Adapted from McConnell Medial Glide with Elastic Tape • Single strip, 3-4 squares • Apply from superior and lateral patellar borders, maximal pull medially • May use a second strip for added reinforcement • Avoid popliteal fossa • Useful in conjunction with medial proprioceptive strips Scott & Dyanna Rezac - Taping Hip & Knee

Medial Knee Proprioception • Medial Glide with medial proprioception strips

Scott & Dyanna Rezac - Taping Hip & Knee

McConnell Patellar Taping • McConnell method involves evaluating the static alignment of the patella including tilt, glide and rotation • Correction strips are applied to “correct” this malalignment – Medial / Lateral Glide – Medial / Lateral Tilt – J-Tape

• Radiographic and MRI studies show no change in patella with taping • Generally, the medial glide (providing proprioceptive input to the medial knee) has been shown to be the most effective; however, can use this technique in any direction about the patella for proprioceptive input. Scott & Dyanna Rezac - Taping Hip & Knee

McConnell Taping Improved Knee Extensor Moment PFPS – Ernst GP, Kawaguchi J, Saliba E. Effect of patellar taping on knee kinetics of patients with patellofemoral pain syndrome. J Orthop Sports Phys Ther 1999 Nov; Vol. 29 (11), pp. 661-7. – 14 women (24.4 +/- 5.8 years) with PFPS performed a single-leg vertical jump and lateral step-up during 4 knee conditions: patellar tape, placebo tape, no tape, and the uninvolved knee. – Patellar taping significantly improved extensor moment and power vs no tape or placebo, but not vertical jump. Scott & Dyanna Rezac - Taping Hip & Knee

McConnell Taping Improved Pain / Disability with OA • Hinnan R, Crossley K, McConnell J, Bennell K. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial. BMJ 19; 327(7407): 135. 2003 – 87 patients with OA as defined by College of Rheumatology – Patients reported significant improvement in primary outcomes and most secondary outcomes with therapeutic taping technique – Therapeutic knee taping is an efficacious treatment for the management of pain and disability in patients with knee osteoarthritis.

Scott & Dyanna Rezac - Taping Hip & Knee

Quad Facilitation • Kinesio® Taping Technique – Apply a single strip on quadriceps mod to max stretch – Split around patella with no stretch

• Can augment with medial proprioceptive strips

Scott & Dyanna Rezac - Taping Hip & Knee

Kinesio® Taping Patellar Dislocation Pain/Edema • Osterhues, D 2004 The use of Kinesio® Taping in the management of traumatic patella dislocation. A case study. Physiotherapy Theory and Practice. Dec 20 (4): 267-270 – Case study 49 year old female s/p traumatic patellar dislocation – After 5 weeks of taping (Y quad facil), with NSAIDs, IFC, R0M and ice she returned to all activities with minimal pain and edema and normal gait. Scott & Dyanna Rezac - Taping Hip & Knee

Kinesio® Taping PFPS Improved Pain / Function • Brandon R, Paradiso L 2005 The use of Kinesio® Tape in patients diagnosed with Patellofemoral pain (PFP) – Kinsesio Taping Association website, not published – 3 Case studies • 91 y/o female s/p L ORIF and secondary PFS x 2 weeks – No pain with gait or at night, immediate relief following taping

• 56 y/o female 3-4 yr hx of PFS – No pain with walking, ascend/descend stairs and less pain at end of day with taping

• 12 y/o female 1 yr hx of PFS – No pain with running or ADL with tapin

– Results demonstrate 3 cases of positive improvements in pain and function immediately following taping Scott & Dyanna Rezac - Taping Hip & Knee

Kinesio® Taping Improved Strength/ROM ACL Repair • Murray, H 2000 Kinesio® Taping, Muscle Strength and ROM after ACL Repair. Journal of Orthopedic and Sports Physical Therapy 30(1) – 2 subjects s/p ACL RepairSignificant improvement in AROM and EMG amplitude between no tape / athletic tape and kinesio tape groups – Authors speculate this is due to increase in mechanoreceptors

Scott & Dyanna Rezac - Taping Hip & Knee

Kinesio® Taping PFPS Improved Function with Both Tapes • Jancaitis G et al 2006 Short Term Effects of Kinesio® Taping on Symptoms of PFPS – University of Virginia study submitting for Platform Presentation with NATA and publication – Randomized controlled trial – 14 subjects between 18-50 years old with + hx of PFS – Baseline measurements, taped with Kinesio Tape or sham tape (cross strip above & below patella) and measured on initial taping and 2 days later – LE Functional & Visual Analogue Scale, 1 & 10 step down – Reduction in pain in 10 step down test for both groups

Scott & Dyanna Rezac - Taping Hip & Knee

PFPS / Medial Knee Proprioception • Which to choose? • Evidence s improved pain, function and edema, but not actual change in patellar alignment or muscle facilitation • Use clinical objective measures to validate technique use • Have seen best results in clinic with medial glide with medial proprioception strips • Utilize * sign tests to validate Scott & Dyanna Rezac - Taping Hip & Knee

Knee Hyper-extension Block Athletic Tape Tecnique • Same as for elbow • Two strips maximal stretch from mid-thigh to mid-calf • Two single strips across t

Scott & Dyanna Rezac - Taping Hip & Knee

Patellar Fat Pad Unload • Adapted from McConnell Technique • Split strip attached to tibial tubercle with maximal, but equal pull medial and lateral • Use step up/down, squat tests to validate

Scott & Dyanna Rezac - Taping Hip & Knee

IT Band / Hip Bursa Unload • IT Band – – – –

Modified Kinesio® Taping Technique Maximal stretch 1-2 strips along IT Band Can also help facilitate lateral hip control Test pain with ambulation, Trendelenburg

Scott & Dyanna Rezac - Taping Hip & Knee

IT Band / Hip Bursa Unload • Trochanteric Bursa – Used by Athletic, McConnell, Mulligan & Kinesio® Taping – Space Correction 3-4 squares x 24 strips in multiple directions over bursa – Test with * Sign

Scott & Dyanna Rezac - Taping Hip & Knee

Pes Anserine Bursitis / Adductor Unload • McConnell & Kinesio® Taping Techniques • 1) 1-2 single strips minimal stretch over medial knee to distribute forces • 2-4 space correction strips (3-4 squares) over pes anserine bursa • * Sign Tests to validate

Scott & Dyanna Rezac - Taping Hip & Knee

Hamstring (Kenso Kase, Japan) うつ伏せになり、両脚はやや開きます。テープの 基部をももの裏上部 ( お尻の下部）に固定する。

そのまま、ももの裏に沿って貼っていく。

字部分は一方をひざの外側側部に、もう一方 をひざ内側側部に向かって貼っていく。 Y

完成。

Scott & Dyanna Rezac - Taping Hip & Knee

Hamstrings (English Version) • Kinesio® Taping Technique – Inhibition - split strip minimal stretch along borders of hamstring – Facilitation - split strip mod to max stretch

Scott & Dyanna Rezac - Taping Hip & Knee

Hamstrings Modified Version • Does not seem to make a clinical difference whether tape borders or along muscle belly • 1-2 strips with moderate stretch over hamstring • Can direct laterally s/p ACL medial hamstring graft

Scott & Dyanna Rezac - Taping Hip & Knee

Hip External Rotation Facilitation • Discussed for piriformis or gluteus medius in Lumbopelvic section

Scott & Dyanna Rezac - Taping Hip & Knee

LE IR/ER Strapping • Used mainly for Pediatric populations, but also useful for neurological (similar to Thera Togs) • IR: start laterally on the calf and come medially spiral up the leg across the anterior pelvis • ER: start medially on the calf and spiral up the leg laterally across the posterior pelvis • Can

apply unilaterally or bilaterally • Also useful for correction of hip anteversion or retroversion Scott & Dyanna Rezac - Taping Hip & Knee

LE IR/ER Strapping • Maguire, C et al. Hip abductor control in walking following stroke-the immediate effect of canes, taping, and TheraTogs on gait. Clinical Rehabilitation. Volume 24(1), p 37-45. Jan 2010. • 13 patients s/p CVA • Hip abductor taping and TheraTogs increased hemiplegic hip abductor activity and gait speed during walking compared with baseline and cane use.

Scott & Dyanna Rezac - Taping Hip & Knee

Contusion / Edema • • • • •

Kinesio® Taping Technique Multiple splits strips 4-8 strips (with 2”) No stretch Great for TKA’s

Scott & Dyanna Rezac - Taping Hip & Knee

Scar Tissue • Only to be used on fully closed incisons, no open wounds • Works similarly to Cica-care in that it lifts the surrounding tissues and helps the collagen fibers realign flat with surrounding tissue • Lie tape along the scar without any stretch • Great for long incisions as with a TKA

Scott & Dyanna Rezac - Taping Hip & Knee

Clinical Evidence-Based • Objective Assessments – Gait • Gait mechanics (at IC, MS, TS, etc) – – – – –

• • • • •

Trendelenberg LE IR, Q angle Genu Valgum Knee hyperextension Calcaneal, midfoot, forefoot position

Stride Length Stance Time Distance Speed Assistive Device

Scott & Dyanna Rezac - Taping Hip & Knee

Clinical Evidence-Based • Objective Assessment (cont). – Pain • • • •

at rest with AROM previously aggravating positions / activities VAS (Visual Analog Scale)

– Outcome Measures • LEFS (Lower Extremity Functional Scale)

– AROM – MMT

Scott & Dyanna Rezac - Taping Hip & Knee

Clinical Evidence-Based • Objective Assessment (cont). • Functional Tests (Asterisk Signs) – Step up, step down, squat, SLS, jumping • Less pain, more reps, improved range / height?

– Cutting, cross-overs, uneven surface – ADLs • Sit <> stand, stair negotiation, kneeling

Scott & Dyanna Rezac - Taping Hip & Knee

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