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Evidence? Taping n Despite its popularity n A scoping review of the Techniques for the Upper and widespread clinical use of elastic therapeutic use, there is relatively tape for neck or upper Extremity little evidence to support extremity conditions the effectiveness of n Journal of Hand Therapy elastic therapeutic tape/ Kristin Valdes, OTD,OT, CHT n 2014 Kinesiotape, let alone for Marybeth Laplant, PT, CHT specific neck and upper n Taylor et al. Mary Loughlin, OTR/L,CHT,CKTP extremity conditions

Reviewed Pain n Of the 14 studies that n Looked at the impact on n Six out of eight studies n But…. were included in this taping on that examined changes in n No long term follow-up scoping review, seven pain for carpal tunnel measurements obtained articles were randomized syndrome, biceps n Pain n elastic therapeutic tape controlled trials (RCTs), tendonitis, medial n Motion may be able to provide four were single-group epicondylitis, rotator cuff an immediate short-term repeated measure studies, n Strength pain, neck pain and reduction in pain two were quasi- n Patient Preference shoulder pain found experimental studies, & statistically significant one was a case report differences in favor of elastic therapeutic tape

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Impact on range of motion Impact on strength n Four of these studies n Three studies (one with a healthy athlete population, involved changes in and two with athletes with shoulder range of motion upper limb conditions) and two studies examined changes in strength. Two measured examined cervical range grip strength, and one of motion. Of these, lower trapezius muscle three studies found strength following immediate application of statistical significance for elastic therapeutic tape. All increased range of found no statistically motion. significant difference between groups.

Patient preference Benefits of Taping n Only one study examined patients' n Another benefit that was n The findings of this preference of elastic therapeutic tape found as part of this scoping review suggest compared to an alternative scoping review was that that elastic therapeutic intervention (in this case, bandaging elastic therapeutic tape is tape may play a role in for lymphedema management). They a treatment modality that reducing short-term neck found statistically significant results has few side-effects. No and upper extremity pain to support the argument that elastic adverse events were and that it may be a reported in any of these therapeutic tape was preferred by more convenient and studies as a result of the participants (p < 0.05). Reasons comfortable alternative use of elastic therapeutic included longer wearing times, less to existing conservative tape. difficult usage, increased comfort treatments. and convenience.

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Kaneko, S & Takaski, H Taping Technique JOSPT 2011 [ CASE REPORT ]

SHOUTA KANEKO, OT, MSc1 • HIROSHI TAKASAKI, PT, MSc2

Forearm Pain, Diagnosed as Intersection Syndrome, n The taping direction for Managed by Taping: A Case Series each patient was n Forearm Pain, ntersection syndrome, an overuse injury afecting the forearm, has the APL and EPB, and those of the ECRL been reported in sporting activity involving the upper limb, such and ECRB; the second may be stenosis, as rowing, canoeing, racket sports, weight lifting, and skiing.16 due to entrapment within the second dorsal compartment that houses the People who have intersection syndrome report pain, crepitus, 4,10,20 1 I ECRL and ECRB. Aso et al argued determined by assessing Diagnosed as and/or swelling in the dorsal forearm, 4 to 8 cm proximal to Lister’s in support of the former mechanism, tubercle,4 where the muscle bellies of the abductor pollicis longus due to the presence of pain on palpation (APL) and extensor pollicis brevis (EPB) cross the underlying extensor and crepitus over the intersection of the APL and EPB, and the ECRL and ECRB, carpi radialis longus (ECRL) and exten- syndrome is uncertain, but 2 potential rather than the distal area of the second crepitus during thumb Intersection Syndrome, sor carpi radialis brevis (ECRB).5 The mechanisms are considered. The first dorsal compartment, and due to thumb pathophysiological basis for intersection may be friction between the tendons of movements that accompany crepitus. A key feature of intersection syndrome on magnetic resonance imaging (MRI) is ! STUDY DESIGN: Case series. plete elimination of crepitus with the application of tape. Crepitus induced by wrist movements, ten- peritendinous edema around the first movements, while BACKGROUND: Intersection syndrome is an ! derness over the dorsal forearm, and swelling were and second extensor compartment ten- Managed by Taping: A overuse injury of the forearm. Taping has been de- no longer present at 3-week follow-up. Disability dons, which extends proximally from the scribed for the management of soft tissue injuries, identified by the disability/symptom subscale of yet there has been no report for the management intersection between the APL and EPB, the Disabilities of the Arm, Shoulder and Hand 4,14 of intersection syndrome using this method. The and the ECRL and ECRB. questionnaire decreased at 3-week follow-up, purpose of this case series was, therefore, to Current management of intersection and this reduction was maintained at 4-week and manual force was applied describe the efcacy of taping for the management syndrome comprises a combination of 1-year follow-ups. Case Series of intersection syndrome. rest, nonsteroidal anti-inflammatory DISCUSSION: Taping improved symptoms and CASE DESCRIPTION: Five patients with inter- ! drugs, and splinting.10,16 One report in- ! function in this small case series. One possible section syndrome were managed by taping, in an dicated that 60% of patients responded explanation for this improvement may be the efort to reduce crepitus induced by thumb move- alteration of soft tissue alignment. to this form of management within 2 to ments. Nonstretch sports tape was applied, with 4 across the soft tissue of 3 weeks. However, splinting the wrist Journal of Orthopaedic & Sports ® Downloaded from www.jospt.org at on December 2, 2014. For personal use only. No other uses without permission. Copyright © 2011 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved. an ulnarly directed tension force across the dorsal ! LEVEL OF EVIDENCE: Therapy, level 4. aspect of the forearm. Taping was performed daily J Orthop Sports Phys Ther 2011;41(7):514-519, in 15° to 20° of extension restricts wrist for 3 weeks. Follow-up took place at 1, 2, 3, and 4 Epub 6 April 2011. doi:10.2519/jospt.2011.3569 and thumb movements, possibly leading to difculty with daily living and work weeks, and at 1 year from the initial consultation. KEY WORDS: overuse syndrome , tape, ! activities.10 Steroid injection is recom- ! OUTCOMES: All patients demonstrated com- thumb, wrist mended for those failing to respond to the dorsal aspect of the

1Staf Occupational Therapist, Shinoro Orthopedic, Hokkaido, Japan; PhD candidate, Sapporo Medical University, The Graduate School of Health Sciences, Department of Occupational Therapy, Hokkaido, Japan. 3PhD candidate, The University of Queensland, School of Health and Rehabilitation Science, Division of Physiotherapy, Queensland, Australia. The patients reported in this study were seen and treated at the Shinoro Orthopedic. All patients provided informed consent to be included in this case series and their anonymity was guaranteed. The opinions or assertions contained herein are the private views of the authors. The authors afrm that we have no financial afliation (including forearm. research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript. Address correspondence to Hiroshi Takasaki, Division of Physiotherapy, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland 4072, Australia. E-mail: [email protected]

514 | july 2011 | volume 41 | number 7 | journal of orthopaedic & sports physical therapy

Application and Wearing of the Taping Technique Tape The patients were also advised n Tape was then applied in an attempt to perform their normal daily to replicate and maintain the n The tape was manually applied force across the removed at night, activities. Following the 3- muscle-tendon unit. The distal end week intervention, all patients of the tape was applied first to the and each patient was instructed to were advised to use the muscle bellies of the APL and EPB. symptomatic limb during Tension was exerted with the free maintain the taping end of the tape as it was applied regimen for 3 weeks activities of daily living and to across the dorsal forearm, and allowed to work without tape. They were perpendicular to its long axis continue work. instructed to reapply the tape if n A 2nd layer of tape was used to they had any return of reinforce the 1st layer symptoms

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Outcomes Scapular Taping The Effects of Scapular Taping on Electromyographic Muscle Activity and Feedback in Healthy Shoulders

1,2 1 1 Jiu-jenq Lin, ∗ Cheng-Ju Hung, Pey-Lin Yang 1School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3 F, 17, Xu-Zhou Road, Taipei 100, Taiwan, 2Department of Physical Medicine and Rehabilitation; Physical Therapy Center, National Taiwan University Hospital, Taipei 100, Taiwan Received 2 August 2009; accepted 12 February 2010 Published online 6 July 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/jor.21146 All patients reported a complete elimination of crepitus n Lin et al showed taping ABSTRACT: We investigated the effects of scapular tape on the electromyographic (EMG) activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), anterior deltoid (AD), and shoulder proprioception in 12 healthy shoulders. Participants were blindfolded and required to complete a target end/mid range position with the hand. They performed six trials under two experimental conditions; no tape and therapeutic tape. EMG activity was measured by surface electrodes, and proprioception was measured by the FASTRAK electromagnetic motion tracking system. Two-way repeated measures ANOVA showed that UT and AD activities decreased 2.65% (p 0.001), and SA muscular activities increased 1.9% (p 0.015) in the taping condition. The proprioceptive feedback magnitude = = was significantly lower in the taping condition than in the no taping condition (11.9◦, p < 0.005). Additionally, correlation coefficients were with the application of tape. Crepitus induced by wrist caused increased serratus higher than 0.5 between muscle activity and proprioceptive feedback with the taping condition; UT and magnitude in the mid range task (R 0.516); LT and magnitude in the end range task (R 0.524); and SA and magnitude in the mid range task (R 0.576). The results = = − = − suggest that scapular tape affects the muscle activity of UT, AD, and SA, and that the effects are related to proprioception feedback. These results implicate that the mechanisms by which scapular taping induces effects can be explained by neuromuscular control and proprioceptive feedback factors. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29: 53–57, 2011

Keywords: shoulder proprioception; scapular taping; electromyography; upper trapezius; lower trapezius (LT); serratus anterior (SA); movements, tenderness over the dorsal forearm, and anterior activity and anterior deltoid (AD)

Shoulder pain and related glenohumeral joint move- lar taping decreased upper trapezius (UT) activity and swelling were no longer present at 3-week follow-up. decreased upper ment dysfunction are common conditions.1,2 These increased lower trapezius (LT) activity in people with dysfunctions are aggravated by frequent use of the arm suspected shoulder impingement during a functional at or above the shoulder level. Consequently, shoulder overhead-reaching task. In contrast, using a scapular impingement, rotator cuff disease, glenohumeral joint taping technique on healthy individuals, Alexander et instability, or adhesive capsulitis may develop.2,3 Scapu- al.11 found a decreased amplitude of the LT H-reflex, lar or humeral movement alterations are thought to be indicating an inhibitory influence of taping. On the Disability identified by the disability/symptom subscale trapezius activity while related to these conditions. A number of factors have other hand, Cools et al.7 found no significant differences been proposed to affect scapular or humeral movement, between scapular taping and no taping for the upper, including soft tissue tightness, muscle activity, and bony middle, and LT, and the serratus anterior (SA). Tape alignment.4,5 Treatments for these complaints aim to may adjust muscle activity via proprioceptive feedback, address these aspects to correct scapular or humeral a sensory modality allowing a person to identify the movements.4,6 position of a limb in space and perceive limb motion.12 of the Disabilities of the Arm, Shoulder and Hand there was no effect on Application of tape is widely used in rehabilitation Subjects with stiff shoulder have reduced proprioceptive and prevention of these shoulder complaints.7–10 The feedback during arm elevation,13 but others reported rationale for taping is that it affords protection and sup- that scapular taping did not affect joint repositioning port for a joint during functional movement.7 Although during active shoulder movements.9 Just how elec- it is unclear if tape protects the glenohumeral joint tromyography (EMG) and proprioception are changed position,8,9 immediate symptoms improve with scapular by taping and whether the altered EMG amplitude is questionnaire decreased at 3-week follow-up, and this lower trapezius taping and relief of symptoms is greater during func- associated with proprioception should be determined. tional movement than in static positions.8,10 The purpose of our study was to determine if EMG Evidence to support that control of the scapula can activity in the scapular muscles is influenced by the be altered by taping is limited.8,11 Selkowitz et al.8 application of tape over the muscle belly of the UT mus- found that compared to the no taping condition, scapu- cle by removing the confounding effects of pain and by including an asymptomatic group. Based on clin- reduction was maintained at 4-week and 1-year follow- ical assumptions and previous investigations,7,8,14–17 ∗ Associate Professor (School and Graduate Institute of Phys- we assumed that with taping, UT activity would ical Therapy) and Adjunct Physical Therapist (Department of decrease and the LT/SA would increase. Additionally, Rehabilitation and Physical Medicine and Physical Therapy Center). we hypothesized that taping would improve propriocep- 8,15,16 Correspondence to: Jiu-jenq Lin (T: 886-2-33668126; F: 886-2- tion feedback. Although previous studies partially 33668161; E-mail: [email protected]) supported these hypotheses in symptomatic subjects, ups. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

JOURNAL OF ORTHOPAEDIC RESEARCH JANUARY 2011 53

Tape Application Shoulder taping to improve ROM

RESEARCH REPORT n Used an “I” shaped n The results suggest The Effects of Kinesio Tape and Stretching Kinesiotape on Shoulder ROM Ai Ujino, MS, ATC, LAT; Lindsey E. Eberman, PhD, ATC, LAT; Leamor Kahanov, EdD, LAT, that KT can increase !4##HELSEA2ENNER -3 !4# ,!4AND4IMOTHY$EMCHAK 0H$ ,!4 !4#s)NDIANA State University

n Subjects were asked to Context: Kinesio tape (KT) is theorized to increase joint range of motion (ROM) by a mechanism that dif- shoulder ROM. fers from that of stretching exercises. Objective: To investigate the combined effects of KT and stretching on shoulder ROM. Participants: Healthy volunteers (n = 71) ranging in age from 18–40 years, with no his- tory of shoulder injury (29 males and 42 females). Interventions: Participants were randomly assigned to fully retract and depress three treatment groups (KT only, Stretch, and KT/Stretch). Main Outcome Measures: Posttreatment ROM measurements were obtained with a digital inclinometer on day 1 and day 4. Results: Analysis of variance Stretching was not identified a significant difference among groups for the magnitude of change in shoulder ROM, F(2,68) = 3.268, p = 0.044, which was greatest for the KT group (mean change = 9.20 ± 17.91). Conclusion: The their scapula and results suggest that KT can increase shoulder ROM. Stretching was not found to have an effect on shoulder found to have an ROM, regardless of whether it was used alone or in combination with KT. maintain the posture. Kinesio tape (KT) is a treatment method conjunction with joint mobilization, ROM theorized to improve joint range of motion exercises, and active/passive stretches, but (ROM) in the neck and lumbar spine,1-4 no evidence of a beneficial effect on shoulder effect on shoulder 1-4,13 but the effect of KT on the shoulder has ROM is available. not been investigated. KT is believed to have therapeutic effects n At the same time, we Shoulder injuries that that promote edema reduction, pain control, Key PPointsoints are common in ath- increased ROM, and blood and lymphatic ROM, regardless of Kinesio tape alone increased glenohumeral letics include instabil- flow within underlying tissue.2,14-22 Because total arc of motion in healthy individuals. ity, impingement, and of its elasticity, KT is theorized to increase applied the Kinesiotape rotator cuff tendinopa- interstitial space by lifting the skin over the Stretching and the combination of Kinesio thy.5 The complexity of targeted treatment area, which is the mecha- tape and stretching did not change range of shoulder girdle function nism believed to decrease pain, increase whether it was used motion in healthy populations. contributes to the vari- blood and lymphatic circulation, and increase from the inferior margin ety of injury types, any joint mobility.14,15,23,24 Multiple therapeutic Stretching and the combination of Kinesio of which may be associ- interventions are often administered con- tape and stretching may have a greater ated with restriction of comitantly,13 which provided the rationale impact in unhealthy, motion restricted glenohumeral ROM.5-9 for assessment of KT with stretching for of the medial 1/3 of the alone or in patients. Shoulder ROM is highly improvement of shoulder ROM.25-29 influenced by scapular dyskinesis/instability, muscle tightness, Procedures and Findings tendon thickening, and capsular restrictions clavicle to T12 with full resulting from scar tissue formation.5,9-12 We used a quasi-experimental post-test combination with KT is currently used in clinical practice in design with three groups: (a) KT only (KT), © 2013 Human Kinetics - IJATT 18(2), pp. 24-28 stretching of the tape KT. 24 ❚ MARCH 2013 INTERNATIONAL JOURNAL OF ATHLETIC THERAPY & TRAINING

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Tape needed Technique

One “I” strip of tape cut n One “I”strip of tape ½ lengthwise until 1 ½ covered the skin surface inches from one end from the anterior portion One “I” shaped piece of the glenoid rim to the inferior border of the surface from the medial portion of the spine of scapula to the anterior portion of the glenoid rim with 50% stretch

Y strip Anterior View

n The upper portion of the n Analysis of variance “Y” strip was pulled identified a significant difference among groups diagonally in a superior for the magnitude of and anterior direction. change in shoulder ROM, Prior to application of F(2, 68) = 3.268, p = the lower portion, the 0.044, and the shoulder was positioned n KT group demonstrated in ER the greatest increase in ROM between day 1 and day 4

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To Improve ROM with Adhesive Initially the duration of stretch is

Innovative Journal of Medical and Health Science 3: 2 March – April (2013) 45 - 51. Contents lists available at www.innovativejournal.in Capsulitis applied for 5 min and progressed to INNOVATIVE JOURNAL OF MEDICAL AND HEALTH SCIENCE

Journal homepage:http://www.innovativejournal.in/index.php/ijmhs

EFFICACY OF KINESOTAPING AS AN ADJUNCT TO POSITIONAL STREATCHING OF 15 min by the end of second week CORACOHUMERAL LIGAMENTS IN PATIENTS WITH PRIMARY ADHESIVE CAPSULITIS.

Pradeepshankar1, Renukadevi .M 2, Nirnay Gowda2, 4, Harish Pai5. 1J.S.S. College of Physiotherapy, Department of Physiotherapy, J.S.S. Hospital, mysore. Karnataka , India n Kinesotape with CHL

ARTICLE INFO ABSTRACT Corresponding Author: Adhesive capsulitis is a condition of uncertain aetiology characterized by a Pradeepshankar progressive loss of both active and passive range of motion of shoulder. positional stretching is Associate Professor, Approximately 2-3 % of adults aged between 40-65 years develop adhesive J.S.S. College of Physiotherapy, capsulitis with greater occurrence in women than man. The Etiological factors Department of Physiotherapy, J.S.S. contributing for primary adhesive capsulitis is iopathic in nature. However Hospital, mysore. Karnataka , India the pathological changes in primary adhesive capsulitis has been proposed by [email protected] many researchers, According to Desai the primary area of pathology in effective in overcome adhesive capsulitis is Coracohumeral ligament (CHL) and rotator interval. Keywords: Kineso Tape, Positional Various physiotherapy intervention has being applied to adhesive capsulitis of Stretching , Coracohumeral Ligament shoulder not considering importance of primary pathology of coracohumeral ligament and scapula dyskinesis effect on adhesive capsulitis. So the study is proposed to find the efficacy of kineso tape adjunct to positional streatching of CHL against only CHL positional stretching in adhesive capsulitis. pain and disability in ; Subjects fulfilling the inclusion criteria were randomly divided into two group’s Group A and Group B, twenty subjects in each group. Each subject underwent assessment to predict the base line values of parameters like VAS, and ROM and DASH SCORE. Level of inferior angle of scapula with respect to T7 level noted in neutral standing position. Group A underwent patient suffering from treatment with positional stretching for CHL alone while Group B subjects were treated with kinesio tape in addition to positional stretching of CHL. The subjects received 3 sessions of treatment per week for 4 weeks. Result shown highly significant improvement in all parameter pre and post of each group. Between group CHL positional streatching with Kineso tape shown significant adhesive capsulitis. improvement in all parameter than only CHL positional streatching. Conclusion; kinesotape with CHL positional stretching is effective in overcome pain and disability in patient suffering from adhesive capsulitis.

©2013, IJMHS, All Right Reserved INTRODUCTION Adhesive capsulitis is a condition of uncertain stated that the absence of synovial fluid in the aetiology characterized by a progressive loss of both active glenohumeral joint , tightly contracted and thickened joint and passive range of motion of shoulder1. Approximately 2- capsule, cellular changes of chronic inflammation with 3 % of adults aged between 40-65 years develop adhesive fibrotic and perivascular infiltration in the synovial layer of capsulitis with greater occurrence in women and usually capsule with reparative inflammatory process are the non dominant arm is involved2. The primary adhesive pathological process of adhesive capsulitis. According to capsulitis is Etiologic factors contributing is idiopathic in Desai the primary area of pathology in adhesive capsulitis nature. However the pathological changes in primary is Coracohumeral ligament (CHL) and rotator interval9 adhesive capsulitis has been proposed by many Coracohumeral ligament plays a major role in researchers as follows According to DePalma stated that counteracting the downward pull of gravitational force on pathological changes in adhesive capsulitis occur primarily arm and in maintaining glenohumeral relation. They in normally flexible fibrous capsule, which becomes proposed that (mengiardis, Omari et al) in adhesive progressively non elastic and shrunken. Initially the capsulitis there will be fibroblastic proliferation and capsule becomes contracted, with loss of inferior capsular thickening of coracohumeral ligament and the capsule at fold. Later stages there will be increased capsular fibrosis the rotator cuff interval there will be complete obliteration and resulting in loss of elasticity of tissues. J. S.Neviaser3 of the fat triangle under the coracoid process are the most

45

n For deltoid muscle; a kinesio Y strip is applied with paper-off tension from insertion n Very light to light to origin. The first tail of y strip is applied to tension (15-25%) is the anterior Deltoid with the arm in applied to the tails of the horizontal abduction and external rotation, kinesio Y strip. The along the outer border of the anterior deltoid superior tail is applied to acromioclavicular joint. The second tail is inferior to clavicle and applied to posterior deltoid with the arm in end of the horizontal adduction and internal rotation, sternoclavicular joint and along the outer border of posterior deltoid to the inferior tail is applied the acromioclavicular joint. Last 2 inches following the lower been applied without tension. For assisting fibers of the pectoralis external rotation by releasing tension of major to the internal rotation; kinesio Y strip is applied to costochondral joint the base of posteriolateral border of humerus

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n Lastly, we performed the taping of Kinesiology Taping vs. Athletic the teres minor muscle. The I-type strip was placed on the lower facet Taping of the greater tuberosity of the ATHLETIC TAPING KINESIOLOGY humerus with no tension. Then, the n Stabilization TAPING patient abducted the shoulder in n Restrictive/supportive n Stabilization horizontal flexion with internal n Restricts fluid exchange n Allows mobility rotation. We placed the rest of the n Worn a few hrs n Increased circulation strip along the axillary border of n Withstands fluids the scapula with light (15–25%) n Examples: McConnell tape, Leukotape, Endura n Can be worn about 3 tension Sports Tape days n Examples: Kinesiotape, Rock Tape, Spider Tech

Kinesiology Taping Kinesiology Taping benefits

-Elastic properties n Provides support -Weight, thickness, elasticity of tape similar to skin n Reduces muscle fatigue -One way longitudinal stretch n Stimulates muscles to strengthen when weak -Allows free movement and for normal tissue n Afferent Sensory Stimulation( pain relief) expansion n Increases vascularity/improves lymphatic flow (clearing inflammation) n Promotes movement across kinetic and fascial chains

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With inflammation, tissue restrictions or other limitations, there becomes increased resistance and decreased space between the skin, fascia and muscle.

Contraindications/Precautions

n DVT n Diabetes n Open Wounds n Kidney Disease n Infection n Ulnar side of elbow n Fragile/sensitive skin (caution due to ulnar nerve) n Heart Failure n Currently under n CHF with edema treatment for Cancer n Respiratory Conditions n Pregnancy n Skin irritation

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Things to remember General Principles n Tell pts never blow dry the tape n Anchors/ends are applied with no tension n Tape is made to stretch in the longitudinal direction only n Tell pts do not use hot packs or heat treatments n Tape can be left on 3-5 days with the tape on n Skin needs to rest at least 24 hrs after tape application, before reapplication. n No oils or lotions on skin when applying n Remove tape immediately and gently if irritation/sensitivity. (can n May need to shave hair off the affected area to do 24 hr. test patch with no tension) have good contact n Teach pts how to remove the tape. n Must wait 30 min before going in a pool or doing a sweaty n Check skin before applying workout in order for tape to adhere well.

Stretch and Recoil Principles Anchor Tail End n Stretch the tape away from the anchor and the No tension Portion of tape No tension tail will recoil back to the anchor where tension is applied n To encourage shortening of a muscle (to Typically 1-2 Typically 1-2 facilitate) apply tape ORIGIN to INSERTION inches inches n To encourage elongation of a muscle (to inhibit) tape INSERTION TO ORIGIN. In case of higher In cases of higher tension(>50%), tension(>50%), n In cases of edema applications, lymphatic flow use rule of thirds use rule of thirds will be directed towards the anchor

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More General Principles Basic Tape Cuts n Majority of techniques 15-25 percent tension. n I strip: Tension is focused within the therapeutic (Most skin irritation due to too much tension.) zone directly over the target tissue n Rule of thirds for higher tension taping(>50% n Y strip: tension is dispersed through and tension) between two tails over target tissue n For all basic application techniques, the muscle/ n X cut: Tension is focused directly over target tissue to be treated should be put in a stretched position in combination with the stretch tissue and dispersed through tails capabilities of the tape. This will create n Fan cut: Tension is dispersed to over target convolutions as the skin is lifted. tissue through multiple tails

Shapes of Tape Cuts Buttonhole cuts

n Can be used so that the tape can be anchored over the digits

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Tape Application Removal of Tape n Prior to taping, make sure skin is clean n Remove in direction of hair growth n Round edges of tape n May gently roll it off the skin using 1 hand while n Typically the joint is moved through a full active other hand supports the skin or passive motion to provide a stretch on the n May be removed while showering or in a bath tissue while tape is applied. In some cases, n Can use baby oil, canola oil, moisturizer, hand alternate positioning may be recommended. lotion to assist with tape removal n Lightly rubbing the tape activates the adhesive

Types of applications How much tension?

n Paper off tension=10-15% n General muscle applications n Advanced Corrective techniques MUSCLE APPLICATIONS-to inhibit 15-25%, insertion to origin -to facilitate 15-35%, origin to insertion -mechanical correction ADVANCED TECHNIQUES -fascia correction n Space correction-10-35% n Fascial correction-10-25% for superficial fascia (advanced oscillating -space correction technique) -ligament/tendon correction n Lymphatic correction-0-20% n Tendon correction 50-75% -functional correction n Functional correction (“spring assist” or “limit”)50-75% n Mechanical correction (“postural hold”) 50-75% -lymphatic correction n Ligament correction 75-100%

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Case study-CTS n 50 year old woman complains of paresthesias in the thumb, index, and middle fingers n Her CTS symptoms have been exacerbated with a full day of paddling/boating n What type of taping technique would you recommend?

CTS Case study-lateral epicondylitis n Measure from palm of n 41 year old male complains of localized pain at hand to medial the lateral epicondyle, and trigger points and epicondyle. Apply tape myofascial restrictions in the proximal dorsal distal to proximal, with 15-25% tension, while forearm musculature after recent performing of wrist and fingers are repetitive throwing drills with his son’s extended. baseball team. n Measure 2/3 around n What kind of taping would you recommend? wrist. Apply15-25% tension over carpal tunnel while wrist extended.

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Lateral Epicondylitis Case study-Dequervain’s n Measure distal to 2nd and n 31 year old dental hygienist progressive onset of 3rd metacarpal insertion pain in first dorsal compartment region to lateral epicondyle. Cut “Y” n Positive finklesteins test leaving anchor uncut. n What kind of taping technique would you n Apply distal to proximal recommend? with 15-25% tension while wrist is flexed and elbow extended.

Dequervains

n Measure from IP joint of thumb to mid-shaft portion of ulna. Cut tape in half for a 1” piece. Small slit in end (“Y”)for distal anchor. Use 15-25% tension apply distal to proximal. If possible, apply with thumb in flexed position.

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Case study-wrist sprain Wrist Sprain n 16 year old lacrosse player diagnosed with wrist n Measure volar palm to dorsal mid forearm. Cut sprain sustained when hyper-flexing wrist during buttonholes for RF/MF. play No tension on distal and proximal anchor/ends in tent n Has had a course of rest and rehab position. 25-50% center tape n Has not returned to quite 100% and wants tension. Move pt into nonrestrictive support during return to play flexion to secure middle of tape. n Measure 2/3 around wrist. Apply dorsal piece 50% tension (mechanical correction) in neutral. Apply ends with wrist extended.

Case study-mallet finger Mallet Finger n 60 year old male sustained a soft tissue mallet injury while n Need Two small I strips n Apply a second tendon playing in weekend softball game about ½ in in width (one correction50% tension with n Pt did a course of 8 weeks mallet splinting about 4” long, one about 1” small piece. No tension on n Pt has orders to begin AROM and wean splint long). ends that wrap around finger. n Pt had some compliance issues during splinting phase , but n Apply with finger in ext. demonstrates full extension with effort when mallet splint n Apply no tension anchor removed. volar distal phal, 50% tension “ ” n Healing is considered fragile tendon correction over distal n Pt wants to return to weekend sports activities and is very active and middle phal, paper off during the week tension to no tension rest of n Afraid of lag developing if pt moves too fast/aggressively finger, no tension on end.

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Case study- CMC OA Moulton, et al, 2001 n 55 year old female professional flute player n Results: 30degrees of MP flexion effectively diagnosed with CMC OA. unloaded the most volar surface of the n Has found custom and prefab splinting options trapeziometacarpal joint regardless of the to work well for most activities except for flute presence or severity of arthritic disease present. playing. n Author’s conclusions: In the presence of n What type of taping would you recommend? hyperextension, early intervention to stabilize the MP joint may slow the natural progression of OA at the trapeziometacarpal jt.

York and Park, 2008 CMC OA

st n For CMC OA, the splint or tape should induce n Measure distance from dorsal n Anchor 1 strip at dorsal wrist at scaphoid, the going aspect dist radius. 50% palmar abduction, slight flexion and medial volarly through web and stretch on tape as it is wound rotation which increase natural stability and around to volar portion of around volar aspect of thumb increase fitting of the joint surfaces. wrist at scaphoid. Cut 3-1” through 1st web. End on wide strips at this length. volar dist.radius. No tension n The goals: increase stability, reduce pain, on anchor or end. Repeat n Pt positions thumb CMC in nd rd decrease inflammation, improve function, 35 deg palmar abd, slight with 2 and 3 strips starting flexion, MP in slight flexion. more distally to encompass reduce mechanical stress that may be causing the the MP joint. instability.

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Case study- scar

n 45 year old female secretary s/p right scaphoid cyst removal with bone graft n Pt has tried traditional scar management techniques including scar massage and scar pad use n Pt displeased that scar is pitting and is also restricted with medial/lateral glide n What type of taping would you use?

Scar Case study- edema n Position pt in maximum n 25 year old male construction worker hit in elongation position. dorsal hand by a board Stretch the middle of an I strip 25-50% and apply n X-rays negative for fracture on top of scar, no n Significant dorsal hand swelling noted tension on ends. n What type of taping would you recommend? n For side pieces. Apply anchor with no tension on side you want tissue to move towards, 25-50% tension on tail.

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References Edema n Kaneko S & Takasaki H. Forearm pain diagnosed as intersection synderome, managed by taping: A case series. JOSPT. 2011;41:514-519 n Need 3 fan cut strips (2 n Kase, Kenzo, Rock Stockheimer, Kim. Kinesiotaping for about 6”, 1 about 8”) Lymphoedema and Chronic Swelling, USA:Kinesio USA,LLC, 2006. n Short pieces-Anchors Print. just proximal to volar n Kase, Kenzo, Wallis, Jim, Kase,Tsuyoshi, Clinical Therapeutic distal radius/ulna. Applications of the Kinesiotaping Method 2nd edition. Tokyo: Kenzo Kase, 2003. Print n Long piece anchor lateral n Kase, Kenzo, Wallis, Jim, Kase, Tsuyoshi, Clinical Therapeutic elbow Applications of the Kinesiotaping Method, 3rd edition. USA, Kinesio n No tension anchors, IP,LLC, 2013. Print 0-15% tension tails, no n KT1,2 and 3 Kinesiotaping Courses, Kinesiotaping Association tension on ends. International, 2014 Phila, Pa. and Baltimore, MD. n Kinesiology Taping Course 2013, Medical Minds in Motion, Cherry Hill, NJ.

n Lin JJ, Hung CJ, Yang PL. The effects of scapular taping on electromyographic muscle activity and proprioception feedback in healthy shoulders. J Orthop Res. 2011;29:53-57 n Pradeepshankar, Renukadevi M, Gowda N, Punith B, Pai H. Efficacy of kinesiotaping as an adjucnt to positional stretching of the coracohumeral ligaments in patients with primary adhesive THANK YOU capsulitis. Innov J Med Health Sci. 2013;3:45 - 51. n Taylor RL, O’Brien L, Brown T. A scoping review of elastic tape for neck and upper extremity conditions. J Hand Ther. 2014;27:235-246 n Ujino A, Eberman LE, Kahanov L, Renner C, Demchak T. The effects of kinesiotaping and stretching on shoulder ROM. Inter J Athl Ther Train. 2013;March:24-28

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