Kinesiotaping Introduction OTAC 2018 Handout [Read …symposium.otaconline.org/application/files/3015/2121/6163/Session...Kinesiotape works by subcutaneously lifting the skin. Depending

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INTRODUCTION TO KINESIOTAPING OTAC Spring Symposium 2018Paul L. Penoliar, OTD, OTR/L, C/NDTAdjunct Professor, Clinical Instructor andInternational Program CoordinatorCalifornia State University Dominguez Hills

OBJECTIVES

Identify what Kinesiotape is and what it is used for.

Properties, indications and contraindications of the tape.

The theory behind muscle tapings and lymphatic tapings.

Applications and removal of the tape.

Corrective Taping Techniques.

Clinical Considerations.

INTRODUCTION

Kinesiotape was developed in the early 1970s by Dr. Kenzo Kase.

Initial concept: reduce build-up of fluids between the layers of soft tissue

This decrease in fluid pressure would allow improvement in muscle function generally associated with pain and edema

Kase et al. (2013)

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Can be used in all phases of an injury acute, subacuteand rehabilitative.

It mimics the qualities of human skin. Being light and as flexible as the skin. This is to avoid the bodies perception of weight which avoids added sensory stimuli.

Kinesiotape works by subcutaneously lifting the skin. Depending on how you apply the kinesiotape it can work

in different ways. Enhances muscular, joint and circulatory function by

facilitating a muscle, inhibiting a muscle, working with the lymph system to help with edema.

Kase et al. (2013)

PROPERTIES

Comprised of a polymer elastic strand wrapped by 100% cotton fibers and treated with a water resistant coating

The tape is designed to stretch between 40 – 60% of its resting length (10” strip will stretch from 14”-16”)

Only stretches along the longitudinal axis and has a 100% acrylic heat activated adhesive applied in a wave pattern (fingerprint)

Tissue stretch and tape stretch create convolutions in the sking

The creation of convolutions aids in normal blood, lymph dynamics and tissue remodeling

Kase et al. (2013)

SKIN The body is made up of 3

layers: the endodoerm, mesoderm and the ectoderm. Because all three layers are interconnected, Kinesiotapecan treat the entire body from the outside in.

Kinesiotape effects the sensors of the skin through its application process. Through the manipulation of these sensors the kinesiotape can change the healing processes of the body.

Kinesiotape can reduce pain by alleviating pressure on the neural and sensory receptors and reduce swelling by increasing fluid movement.

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PHYSIOLOGICAL EFFECTS

Skin

Circulatory/ Lymph system

Fascia

Muscle

Joint

APPLICATION ESSENTIALS

The target tissue skin should be dry and free of perfume, oils and lotions to adhere properly.

The tape can be worn 24 hours a day and left on for 3-5 days.

Can shower and ice over the area.

Towel dry. DO NOT USE A HAIR BLOWER to the tape.

Moist heat is ok but dry heat is not.

Pull the tape off gently, do not yank like a band-aid.

TERMINOLOGY

Anchor – the beginning of the tape application. Applied with no tension.

Ends – the last portion of tape that is laid down.

Tails – the portion of the tape following the split in the Y, X or fan cuts

Tension – the amount of stretch applied

Proximal/Origin – Tissue attachment closest to the body

Distal/Insertion – Tissue attachment furthest from the body

Inhibition – stimulus to relax and elongate the muscle

Facilitation – stimulus to activate and shorten the muscle

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TAPE DIRECTION

INSERTION TO ORIGIN (Distal to Proximal) – geared for acutely over used or shortened muscles; this will offer a calming stimulus for muscle inhibition or rest (Inhibition)

ORIGIN TO INSERTION (Proximal to Distal) – generally used for chronically weak muscles or an elongated muscle; offers increased support (Facilitation)

PRECAUTIONS

Diabetes

Kidney disease

Congestive heart failure

CAD or Bruits in the carotid artery

Fragile or healing skin (milk of magnesia in elderly can be beneficial)

Facility Policies and Procedures: MD clearance to tape if these conditions are present

CONTRAINDICATIONS

Deep vein thrombosis

Cancer

Over active cellulitis or skin infection

Open wounds

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Tearing Kinesiotape for Application

Practice tearing the paper and seeing the elasticity of the tape.

Anchor - the tape will require 0% stretch, tearing will occur at either ends of the strip of tape

Middle Anchor - will require a specified amount of stretch, tearing will occur at the middle of the strip of tape

GENERAL CLINICAL CONSIDERATIONS

Circulatory/ Lymphatic System Kinesiotape can speed

lymphatic drainage and flow by increasing the amount of space beneath the skin, creating a more efficient exchange of lymph and bodily fluids between different tissues.

The tape lifting the skin causes convolutions which creates a channel of low pressure in the congested areas.

Reduces edema Equalizes temperature Decreases pain

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Fascia

Fascia is fibrous and a connective tissue.

Collagen or fat exists between each layer of skin. If the person is not moving sufficiently the collagen may act as glue and adhere the surfaces together.

With all the layers of fascia connected, by taping the skin it can effect the deepest layer of fascia.

Muscle

By understanding the science of muscle movement one can better envision the way that kinesiotape will effect the muscles function.

Must evaluate and decided if pain is coming from a muscle weakness or a tightness and tape accordingly.

Kinesiotape can relieve muscle pain, increase ROM, normalize length/tension ratios to create optimal force, assist with tissue recovery and reduce fatigue.

Joint

Can improve joint alignment and biomechanics

Facilitate ligament and tendon function

Enhance kinesthetic awareness.

Correct muscle imbalance

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BILLING

CPT Codes

CPT – Current Procedural Terminology is meant to describe medical, surgical and diagnostic services and is intended to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, etc. for billing and analytical purposes.

CPT codes for Kinesiotaping

Definition – Neuromuscular Re-ed, Balance, Coordination (97112)

Description - A manner of effecting change through the application of clinical skills and/or services that attempt to improve function. Physician or therapist required to have direct (one on one) patient contact: therapeutic procedure, one or more areas, each 15 minutes neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

Definition – Manual Therapy (97140)

Description - A manner of effecting change through the application of clinical skills and/or services that attempt to improve function. Physician or therapist required to have direct (one on one) patient contact. Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes.

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LET’S TAPE

Getting ready to tape

Different tape cuts for different body parts and applications I strip

Y strip

X cut

Fan cut

Round edges of tape, except ends of fan cut.

Cont..

Want to measure and tape to the length of muscle (where possible).

Decide whether you want to facilitate or inhibit a muscle Facilitation- Improves muscle contraction of a weakened

muscle (Proximal to Distal)

Inhibition- Relaxes an over contracted muscle. (Distal to Proximal)

Keep in mind the length tension curve, too much overlap of the actin and myosin or too little overlap reduces tension

Tape for the pain and the cause of the pain.

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Tape removal

There are two ways to remove the paper backing the roll method and the pressure method.

Remove tape in the direction of the hair growth

Pull the skin back from the tape

Tape can be removed while bathing.

Soap, lotion or oil can also be applied to help remove the tape.

If the tape is itching or increasing pain have athlete remove tape.

If sensitive to tape try a test patch first on hand.

Do not put tape on nape of hair, through axilla or groin.

Avoid trigger points in pregnant females.

Never use the tape to pull body part into position.

Taping possibilities are endless!

CLINICAL APPLICATIONS

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Neck and Shoulder

Potential causes of neck pain may include stress and overuse

Client position: Stretch neck by tilting head forward and tucking chin to chest. Maintain position during application.

Apply 1 inch of anchor strip 0% stretch, tearing off from anchor of I strip at base of neck on one side of the spine, apply full strip down parallel to spine with 25% stretch finishing without stretch at end of tape, repeat process on opposite side of spine

Apply middle anchor strip with 75% stretch, tearing from the middle of I strip over point of pain (beginning at the base of the neck towards each shoulder), applying the end without stretch

Shoulder

Potential causes of shoulder pain may include overuse, stress to the area, ligament or tendon damage, or muscle tears

Client position: Tilt head away from affected shoulder, shoulder is externally rotated and horizontally adducted with elbow and wrist flexed

Apply anchor I strip with 0% stretch at base of deltoid insertion, bring tape with 25% stretch around towards the posterior deltoid apply end with no stretch

Apply another anchor I strip with 0% stretch at base of deltoid insertion, bring tape with 25% stretch around towards the anterior deltoid apply end without stretch

Rotator Cuff Injury

Causes of rotator cuff injury may include overuse, tears, motion beyond normal limits and poor throwing form

Client position: Tilt head away from shoulder, shoulder is externally rotated and horizontally adducted with elbow and wrist flexed

Anchor the 1st I strip with 0% stretch slightly under the point of pain (usually posterior deltoid), bring tape with 25% stretch over the supraspinatus rounding up to the base of the neck finishing without stretch

Cut 2 – 5 inch I strips. Anchor the 2nd I strip tearing the middle of the strip with 75%

stretch and applying across the 1st strip over the distal end of the spine of scapula and towards the coracoid process

Anchor the 3rd I strip tearing the middle of the strip with 75 % stretch and applying across the 1st strip over the proximal end of the spine of the scapula towards the clavicle

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Shoulder Stability

Shoulder pain may be caused by muscle imbalances, notably strong or tight muscles in the chest corresponding with weak muscles in the back

Client position: Retraction of the shoulders, trunk in extension

Identify the AC joint and Inferior angle of the Scapula and draw a line from the AC joint and Inferior angle towards a point in the Spine

Apply 1st anchor I strip with 0% stretch on the point of the Spine, bring tape with 25% stretch towards the AC joint

Apply 2nd anchor I strip with 0% stretch just above the 1st

strip, bring tape with 25% stretch over towards the AC joint.

Shoulder Subluxation (Anterior)

Causes of shoulder subluxation may result from neurological impairment due to CVA or TBI

Client position: Retraction of the shoulders, trunk in extension. Approximate the shoulder joint to ensure the glenohumeral head of the humerus is properly seated in the glenoid cavity of the scapula

Apply 1st anchor I strip with 0% stretch on pectoralis major sternal medial from humeral head, bring tape horizontally over the anterior portion of the humeral head with 75% stretch and wrap towards and finishing on the posterior portion with no stretch.

Apply 2nd anchor I strip with 0% stretch over the origin of the anterior deltoid, bring the tape with 75% stretch at a diagonal over the anterior deltoid finishing on the insertiion without stretch

Apply final anchor I strip with 0% stretch on the proximal end of spine of scapula, bring the tape with 75% stretch over the spine of the scapula towards the posterior deltoid

Thoracic/Lumbar Disc Pain

Disc pain can be caused by herniations, swelling and slippage away from their correct positioning

Client position: Leaning forward to stretch spine Cut 4 – 5 inch strips

Anchor 1st strip applied directly over the area of spine causing pain using a middle anchor with 75% stretch

Apply 2nd strip making a cross directly over the area of spine causing pain using a middle anchor with 75% stretch

Apply 3rd strip making a diagonal cross directly over the area of spine causing pain using a middle anchor with 75% stretch

Apply 4th strip making an opposite diagonal cross directly over the area of spine causing pain using a middle anchor with 75% stretch

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Lumbar/Low Back Pain

Low back pain can be caused by hip misalignments, sitting or standing for long periods of time, overuse, or blunt force trauma caused by a fall

Client position: Leaning forward to stretch the lower back

Apply 1st I strip using a middle anchor with 75% stretch horizontally over the point of pain in the lower back with no stretch at ends of tape

Apply 2nd I strip using a middle anchor with 75% stretch just below the 1st strip with no stretch at ends of tape

Sacroiliac (SI) Joint Pain

SI joint pain may be caused by hip misalignments, pregnancy, poor posture, or sitting for long periods of time

Client position: Leaning forward to stretch the lower back

Anchor 1st strip using a middle anchor with 75% stretch over point of pain

Cut 2 – 5 inch strips Anchor a strip using a middle anchor with 75% stretch at a

diagonal over one of the SI joints

Anchor a 2nd strip using a middle anchor with 75% stretch at a diagonal over the opposite SI joint

Bicep Pain

Causes of Bicep pain may include tears and strains to the muscle or nerve, ligament or tendon damage

Client position: Stretch the bicep out in shoulder abduction to 90 degrees with elbow in full extension

Anchor I strip just above the elbow crease, bring the tape along bicep with 25% stretch laying down the end with no stretch

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Tricep Pain

Causes of tricep pain may include overuse, landing on an outstretched arm, or muscular imbalance

Client position: Reaching behind the shoulders in full shoulder flexion with elbow in flexion

Anchor I strip towards the inferior end of the glenoidcavity of the scapula, bring the tape along the tricepwith 25% stretch laying the end down with no stretch

Tennis Elbow Pain

Inflammation of the outside of the elbow at the lateral epicondyle resulting in soreness and tenderness. Causes may include overuse, racquet sports, or gripping objects too tightly

Client position: Elbow bent at 90 degrees in front of body Cut 2 – 5 inch I strips

Apply middle anchor I strip over the point of pain with 75% stretch laying down ends of tape without stretch

Apply 2nd middle anchor I strip in an X pattern over the the point of pain with 75% stretch laying down the ends of tape without stretch

Apply anchor I strip an inch above X pattern and bring tape down around elbow over point of pain toward the forearm with 25% stretch

Golfer’s Elbow Inflammation of the inside of the elbow at the medial

epicondyle resulting in soreness and tenderness. Causes may include overuse or gripping objects too tightly

Client’s position: Shoulder in abduction and external rotation with elbow bent at 90 degrees

Cut 2 – 5 inch I strips Apply middle anchor I strip over the point of pain with 75%

stretch laying down ends of tape without stretch

Apply 2nd middle anchor I strip in an X pattern over the the point of pain with 75% stretch laying down the ends of tape without stretch

Apply anchor strip 3 inches above elbow bringing the tape around elbow up to the forearm with 25% stretch finishing the application at the end without stretch

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Wrist Pain

Causes of wrist pain may include typing for long periods of time, overuse in sports, landing on an outstretched hand or carrying heavy loads

Client position: Slight shoulder flexion with internal rotation, elbow bent at 90 degrees with wrist in flexion

Cut 2 – 5 inch I strips Apply the 1st 5” middle anchor I strip to volar part of wrist

with forearm in supination with 75% stretch laying ends down without stretch

Apply a 2nd 5” middle anchor I strip to dorsal part of wrist with forearm in pronation 75% stretch laying ends down without stretch

Apply 3rd anchor strip to the dorsal part of the hand and bring up to the forearm with 25% stretch

Edema of the Hand (Lymphatic)

Caused by neurologic insult to the brain from a CVA or TBI reducing the effectiveness of the lymph nodes of the hand and forearm to transport water away from the extremities

Measure from digits of hand to middle of forearm and cut 2 I strips then cut 5 even fan strips approximately ¼ or ½ inch strips leaving a one inch base (make 3 even cuts to the tape)

Position base of 1st fan strip above the area of the edema on the ulnar side, where the lymph drainage is being directed

Apply the tails of the fan with very little tension to the outside of each of the digits

Position base of 2nd fan strip above the area of the edema on the radial side, where the lymph drainage is being directed

Apply the tails of the fan with very little tension to the inside of each of the digits

Knee Support Knee pain can be caused by a loose patella, a meniscus tear, or

arthritis.

Client position: Knee bent at 90 degrees

Cut 2 – 5” anchor I strips

Apply the 1st 5” anchor I strip just below the patella. Use a middle anchor tear with 75% stretch horizontally.

Apply the 2nd 5” anchor I strip just below the 1st strip. Use a middle anchor tear with 75% stretch horizontally.

Anchor the 3rd anchor I strip above the kneecap on the lateral side and tape around the patella with 50% stretch crossing underneath the patella and finishing with 0% stretch.

Anchor the 4th anchor I strip above the kneecap on the medial side and tape around the patella with 50% stretch crossing underneath the patella and finishing with 0% stretch.

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Ankle Support Ankle issues include ankle sprains, stretched ligaments,

inflamed tendons or general weakness

Client position: Ankle in 90 degrees

Anchor 1st strip on the lateral side above the ankle, tape down outer ankle with 50% stretch across bottom of heel and up along inner side of ankle

Anchor 2nd strip along the instep of the foot, lay the tape around the back of the heel with 50% stretch across the arch and lay down on bottom of foot

Anchor 3rd strip along the outside of the foot, lay the tape around the back of the heel with 50% stretch across the instep and lay down on bottom of foot

References

Csapo, R., Alegre, L.M. Effects of Kinesio taping on skeletal muscle strength—a meta-analysis of current evidence. J Sci Med Sport. 2014

Fu, T.C., Wong, A.M., Pei, Y.C. et al, Effect of Kinesio taping on muscle strength in athletes-a pilot study. J Sci Med Sport. 2008;11:198–201.

Gulpinar, D., Ozer, S.T., and Yesilyaprak, S. (2017). Effects of Rigid and Kinesio Taping on Shoulder Rotation Motions. Journal of Sport Rehabilitation

Kase, K., Wallis, J. and Kase, T. (2013). Clinical Therapeutic Applications of the Kinesio Taping Method. 3rd edition. Ken Ikai Co Ltd.

Kase, K. (2008). KT1/KT2 workbook. Kinesio taping Association.

Williams, S., Whatman, C., Hume, P.A. et al, Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness. Sports Med. 2012;42:153–164.