6 Hip and Knee Therapeutic Taping2013

8/12/2019 6 Hip and Knee Therapeutic Taping2013

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Therapeutic Taping for

the Hip & Knee

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

Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS
http://upload.wikimedia.org/wikipedia/en/thumb/9/9f/Hip.jpg/250px-Hip.jpghttp://images.google.com/imgres?imgurl=http://kneevitality.com/images/hv1_03.jpg&imgrefurl=http://kneevitality.com/&h=305&w=317&sz=18&hl=en&start=12&tbnid=n856yPbc5Mr0EM:&tbnh=114&tbnw=118&prev=/images%3Fq%3Dknee%2B%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG


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Scott & Dyanna Rezac - Taping Hip & Knee

Medial Knee Proprioception

Adapted from McConnellMedial Glide with ElasticTape

Single strip, 3-4 squares

Apply from superior and

lateral patellar borders,maximal pull medially

May use a second stripfor added reinforcement

Avoid popliteal fossa

Useful in conjunction withmedial proprioceptivestrips
http://images.google.com/imgres?imgurl=http://www.mja.com.au/public/issues/184_04_200206/bru10319_fm-3.jpg&imgrefurl=http://www.mja.com.au/public/issues/184_04_200206/bru10319_fm.html&h=200&w=300&sz=11&hl=en&start=2&tbnid=wsbwJcaQQLK3wM:&tbnh=77&tbnw=116&prev=/images%3Fq%3DMcConnell%2BPatellar%2Btaping%26gbv%3D2%26svnum%3D10%26hl%3Den


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Medial Knee Proprioception

Medial Glide withmedial

proprioception

strips


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McConnell Patellar Taping

McConnell method involves evaluating thestatic alignment of the patella including tilt,glide and rotation

Correction strips are applied to correct thismalalignment Medial / Lateral Glide

Medial / Lateral Tilt

J-Tape

Radiographic and MRI studies show no changein patella with taping

Generally, the medial glide (providingproprioceptive input to the medial knee) hasbeen shown to be the most effective; however,can use this technique in any direction aboutthe patella for proprioceptive input.


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McConnell Taping

Improved Knee Extensor Moment PFPS

Ernst GP, Kawaguchi J, Saliba E. Effect ofpatellar taping on knee kinetics of patientswith patellofemoral pain syndrome. J OrthopSports Phys Ther1999 Nov; Vol. 29 (11), pp.661-7.

14 women (24.4 +/- 5.8 years) with PFPSperformed a single-leg vertical jump and lateralstep-up during 4 knee conditions: patellartape, placebo tape, no tape, and the

uninvolved knee. Patellar taping significantly improved extensor

moment and power vs no tape or placebo, butnot vertical jump.


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McConnell Taping

Improved Pain / Disability with OA Hinnan R, Crossley K, McConnell J, Bennell K.

Efficacy of knee tape in the management ofosteoarthritis of the knee: blinded randomisedcontrolled 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 secondaryoutcomes with therapeutic taping technique

Therapeutic knee taping is an efficacious

treatment for the management of pain anddisability in patients with knee osteoarthritis.


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Quad Facilitation

Kinesio Taping

Technique Apply a single strip on

quadriceps mod to maxstretch

Split around patella with nostretch

Can augment with medialproprioceptive strips
http://images.google.com/imgres?imgurl=http://www.space.gc.ca/asc/img/newquadricep.gif&imgrefurl=http://www.space.gc.ca/asc/eng/astronauts/osm_ems.asp&h=304&w=198&sz=19&hl=en&start=1&tbnid=23a3xIwxrJpPGM:&tbnh=116&tbnw=76&prev=/images%3Fq%3Dquadricep%26gbv%3D2%26svnum%3D10%26hl%3Den


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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.


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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


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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


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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


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PFPS / Medial Knee Proprioception

Which to choose? Evidence supports improved

pain, function and edema, butnot actual change in patellaralignment or muscle

facilitation Use clinical objective

measures to validatetechnique use

Have seen best results inclinic with medial glide withmedial proprioception strips

Utilize * sign tests to validate


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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 joint


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Patellar Fat Pad Unload

Adapted from McConnell Technique

Split strip attached to tibial tubercle withmaximal, but equal pull medial and lateral

Use step up/down, squat tests to validate
http://images.google.com/imgres?imgurl=http://sportscenteraustin.blogs.com/the_view/images/bfatpad.jpg&imgrefurl=http://sportscenteraustin.blogs.com/the_view/knee/index.html&h=105&w=100&sz=5&hl=en&start=17&tbnid=cxCwCK-UciEdrM:&tbnh=84&tbnw=80&prev=/images%3Fq%3Dknee%2Bfat%2Bpad%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG


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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
http://images.google.com/imgres?imgurl=http://www.physioworks.com.au/images/troch.bursa.jpg&imgrefurl=http://www.physioworks.com.au/trochanteric.bursitis.htm&h=265&w=274&sz=18&hl=en&start=42&tbnid=_sztalscx5WMDM:&tbnh=109&tbnw=113&prev=/images%3Fq%3Dhip%2Bbursitis%26start%3D40%26ndsp%3D20%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DNhttp://images.google.com/imgres?imgurl=http://www.legevakten.no/Artikler/bilder/tractus_iliotibialis.jpg&imgrefurl=http://www.legevakten.no/Artikler/abstracts/iliotibialistendinitt.htm&h=201&w=153&sz=7&hl=en&start=97&tbnid=A7Xf77dbgAXoBM:&tbnh=104&tbnw=79&prev=/images%3Fq%3DIT%2BBand%2Bsyndrome%26start%3D80%26ndsp%3D20%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DN


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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 overbursa

Test with * Sign
http://images.google.com/imgres?imgurl=http://www.physioworks.com.au/images/troch.bursa.jpg&imgrefurl=http://www.physioworks.com.au/trochanteric.bursitis.htm&h=265&w=274&sz=18&hl=en&start=42&tbnid=_sztalscx5WMDM:&tbnh=109&tbnw=113&prev=/images%3Fq%3Dhip%2Bbursitis%26start%3D40%26ndsp%3D20%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DNhttp://images.google.com/imgres?imgurl=http://www.legevakten.no/Artikler/bilder/tractus_iliotibialis.jpg&imgrefurl=http://www.legevakten.no/Artikler/abstracts/iliotibialistendinitt.htm&h=201&w=153&sz=7&hl=en&start=97&tbnid=A7Xf77dbgAXoBM:&tbnh=104&tbnw=79&prev=/images%3Fq%3DIT%2BBand%2Bsyndrome%26start%3D80%26ndsp%3D20%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DN


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Pes Anserine Bursitis / Adductor Unload

McConnell & Kinesio Taping Techniques

1) 1-2 single strips minimal stretch over medialknee to distribute forces

2-4 space correction strips (3-4 squares) overpes anserine bursa

* Sign Tests to validate
http://images.google.com/imgres?imgurl=http://www.med.umich.edu/1libr/sma/pesanser.gif&imgrefurl=http://www.med.umich.edu/1libr/sma/sma_pesanser_art.htm&h=771&w=517&sz=26&hl=en&start=1&tbnid=6HYrXUQgc3H3eM:&tbnh=142&tbnw=95&prev=/images%3Fq%3Dpes%2Banserine%2Bbursitis%26svnum%3D10%26hl%3Den%26lr%3D


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Hamstring (Kenso Kase, Japan)

(

Y


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Hamstrings (English Version)

Kinesio Taping Technique

Inhibition - split strip minimalstretch along borders of hamstring

Facilitation - split strip mod to maxstretch
http://images.google.com/imgres?imgurl=http://www.thedisabledlist.com/files/images/hamstring.jpg&imgrefurl=http://www.thedisabledlist.com/hamstring&h=430&w=402&sz=30&hl=en&start=9&tbnid=2RCV8f8GJZGVdM:&tbnh=126&tbnw=118&prev=/images%3Fq%3Dhamstring%26gbv%3D2%26svnum%3D10%26hl%3Den


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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
http://images.google.com/imgres?imgurl=http://www.thedisabledlist.com/files/images/hamstring.jpg&imgrefurl=http://www.thedisabledlist.com/hamstring&h=430&w=402&sz=30&hl=en&start=9&tbnid=2RCV8f8GJZGVdM:&tbnh=126&tbnw=118&prev=/images%3Fq%3Dhamstring%26gbv%3D2%26svnum%3D10%26hl%3Den


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Hip External Rotation Facilitation

Discussed for piriformis or

gluteus medius in Lumbopelvic

section
http://images.google.com/imgres?imgurl=http://www.tpmassageball.com/content/piriformis.jpg&imgrefurl=http://www.tpmassageball.com/upperhamstring.php%3Fsym%3D13&h=354&w=370&sz=13&hl=en&start=4&tbnid=kk4-w-AupWHqwM:&tbnh=117&tbnw=122&prev=/images%3Fq%3Dpiriformis%26svnum%3D10%26hl%3Den%26lr%3D


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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 ofhip anteversion or

retroversion
http://www.theratogs.com/prodimages/intoeing_4.jpg


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LE IR/ER Strapping

Maguire, C et al. Hip abductor control in

walking following stroke-the immediateeffect 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 comparedwith baseline and cane use.


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Contusion / Edema

Kinesio Taping Technique

Multiple splits strips

4-8 strips (with 2)

No stretch

Great for TKAs


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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


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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


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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
http://www1.cs.columbia.edu/~sedwards/photos/france200506/20050622-9562%20Pain.jpg


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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
http://images.google.com/imgres?imgurl=http://i.a.cnn.net/si/2005/football/nfl/specials/preview/2005/08/03/nfl.workout.darius0808/t1_darius3.jpg&imgrefurl=http://sportsillustrated.cnn.com/2005/football/nfl/specials/preview/2005/08/03/nfl.workout.darius0808/&h=483&w=300&sz=62&hl=en&start=8&tbnid=bx2dFFC5T9juaM:&tbnh=129&tbnw=80&prev=/images%3Fq%3Drunning%2Bdrills%26gbv%3D2%26svnum%3D10%26hl%3Denhttp://images.google.com/imgres?imgurl=http://www.orthopedictechreview.com/issues/marapr05/pg36-2.jpg&imgrefurl=http://www.orthopedictechreview.com/issues/marapr05/pg36.htm&h=377&w=250&sz=12&hl=en&start=3&tbnid=xAnk-HZAYAI1sM:&tbnh=122&tbnw=81&prev=/images%3Fq%3Dbalance%2Bdisk%26gbv%3D2%26svnum%3D10%26hl%3Denhttp://images.google.com/imgres?imgurl=http://www.crossfiteastside.com/uploaded_images/NateStepUp-760820.jpg&imgrefurl=http://www.crossfiteastside.com/2005_12_01_archive.html&h=1024&w=974&sz=64&hl=en&start=5&tbnid=JqooEnvhcQQHXM:&tbnh=150&tbnw=143&prev=/images%3Fq%3Dstep%2Bup%2Btest%26gbv%3D2%26svnum%3D10%26hl%3Den


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Questions, Comments, Discussion

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6 Hip and Knee Therapeutic Taping2013