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