Post on 04-Oct-2018
Therapeutic Taping for
the Hip & Knee
Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTPDr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
Medial Knee Proprioception
• Medial Glide with
medial
proprioception
strips
Scott & Dyanna Rezac - Taping Hip & Knee
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.
Scott & Dyanna Rezac - Taping Hip & Knee
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.
Scott & Dyanna Rezac - Taping Hip & Knee
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.
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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.
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
Hamstring (Kenso Kase, Japan)
うつ伏せになり、両脚はやや開きます。テープの基部をももの裏上部(お尻の下部)に固定する。
そのまま、ももの裏に沿って貼っていく。
Y字部分は一方をひざの外側側部に、もう一方をひざ内側側部に向かって貼っていく。
完成。
Scott & Dyanna Rezac - Taping Hip & Knee
Hamstrings (English Version)
• Kinesio® Taping Technique
– Inhibition - split strip minimal stretch along borders of hamstring
– Facilitation - split strip mod to max stretch
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
Hip External Rotation Facilitation
• Discussed for piriformis or
gluteus medius in Lumbopelvic
section
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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.
Scott & Dyanna Rezac - Taping Hip & Knee
Contusion / Edema
• Kinesio® Taping Technique
• Multiple splits strips
• 4-8 strips (with 2”)
• No stretch
• Great for TKA’s
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
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
Scott & Dyanna Rezac - Taping Hip & Knee
Questions, Comments, Discussion
dyanna.rezac@rezacpt.com
scott.rezac@rezacpt.com
www.rezacpt.com