Therapeutic Taping for the Hip &...

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


Medial Knee Proprioception

• Medial Glide with

medial

proprioception

strips


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.


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.


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.


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


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.


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


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


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


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


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


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


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


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


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


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。


Hamstrings (English Version)


– Inhibition - split strip minimal stretch along borders of hamstring

– Facilitation - split strip mod to max stretch


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


Hip External Rotation Facilitation

• Discussed for piriformis or

gluteus medius in Lumbopelvic

section


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


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.


Contusion / Edema


• Multiple splits strips

• 4-8 strips (with 2”)

• No stretch

• Great for TKA’s


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


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



• 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



• 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


Questions, Comments, Discussion

[email protected]

[email protected]

www.rezacpt.com

Therapeutic Taping for the Hip &...

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