Therapeutic%20Taping%20for%20the%20Hip%20

1
Therapeutic Taping for the Hip Knee

• Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTP
• Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS

2
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

3
Medial Knee Proprioception

• Medial Glide with medial proprioception strips

4
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.

5
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.

6
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.

7
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

8
Kinesio TapingPatellar 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.

9
Kinesio TapingPFPS 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

10
Kinesio TapingImproved 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

11
Kinesio TapingPFPS 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

12
PFPS / Medial Knee Proprioception

• Which to choose?
• Evidence supports 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

13
Knee Hyper-extension BlockAthletic Tape Tecnique

• Same as for elbow
• Two strips maximal stretch from mid-thigh to
  mid-calf
• Two single strips across joint

14
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

15
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

16
IT Band / Hip Bursa Unload

• Trochanteric Bursa
• Used by Athletic, McConnell, Mulligan Kinesio
  Taping
• Space Correction 3-4 squares x 2-4 strips in
  multiple directions over bursa
• Test with Sign

17
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

18
Hamstring (Kenso Kase, Japan)

  ???????????????????????????????(?????)??????
  ???????????????????
  Y??????????????????????????????????????
  ???
19
Hamstrings (English Version)

• Kinesio Taping Technique
• Inhibition - split strip minimal stretch along
  borders of hamstring
• Facilitation - split strip mod to max stretch

20
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

21
Hip External Rotation Facilitation

• Discussed for piriformis or gluteus medius in
  Lumbopelvic section

22
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

23
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.

24
Contusion / Edema

• Kinesio Taping Technique
• Multiple splits strips
• 4-8 strips (with 2)
• No stretch
• Great for TKAs

25
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

26
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

27
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

28
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 ltgt stand, stair negotiation, kneeling

29
Questions, Comments, Discussion
www.rezacpt.com

• dyanna.rezac_at_rezacpt.com
• scott.rezac_at_rezacpt.com