WAFL 16: modalities

general goals of taping

improve posture and alignment

promote muscle imbalance

how does taping improve posture and alignment?

provides joint stability

protect joint and ligament integrity

corrects postural deviations

manages contractures

how does taping promote muscle balance?

supports and assists long and weak muscles

relaxes short and overactive muscles

what are the two types of tape

rigid and elastic

rigid tape provides

support

stability

pain relief

joint alignment

immobilization

elastic tape provides

proprioceptive input

muscle assistance

muscle relaxation

movement correction

improves lymphatic flow

what is one thing that elastic tape IS NOT used for

placing and holding a patient into a position

precautions for general taping

impaired/absent sensation

superficial nerves

sensory avoiders

hypersensitivity

malignancy

pregnancy

precautions for elastic taping

malignancy, we do not want to promote lymphatic flow in the affected area

contraindications for general taping

poor skin integrity

open wounds

CHF

adhesive allergies

infection

DVT

renal insufficiency

contraindications for elastic taping specifically

CHF

Infection

DVT

Renal Insufficiency

general principles of rigid taping

-often follow the principle of bracing (3 points of pressure)

-shave hair

-only cover-roll touches skin

-increasing strips of leukotape or increasing the length of the strips will help to distribute forces

-can bathe and towel/airdry

-can be left on for up to 3 days

how often do you perform a rigid taping procedure

it depends on the therapist's purpose.

If skin irritation exists after rigid taping...

allow the tape to only stay on for 4 to 8 hours the first time, use an extra layer of cover-roll, apply liquid skin prep

how do you prevent blisters on the skin with rigid taping?

using long strips so forces are dispersed over a larger area, avoid taping areas where skin moves alot during motions

application guidelines for rigid taping

1. guesstimate strip lengths and pre-cut strips of Cover-Roll and leukotape

2. lay down cover-roll with segment in resting position

3. achieve active or passive correction of posture

4. lay down leukotape while corrected position is held, apply as many overlapping layers as necessary

5. optional: cover with additional layer of cover-roll

the main theory behind elastic taping

skin is an extension of the brain

what are specific to elastic taping

-inflammation, tissue restriction, other soft tissue limitations caused increased resistance and decreased space between the skin, fascia, and muscle

-kinesiology tape decreases resistance, increases conduction, and increases function

-the skin is an extension of the BRAIN

-the tape interacts with the skin to change the brain

general principles of elastic taping

apply 30 minutes before activity

do not wait until the end of the session to apply

the more superficial the target tissue, the more narrow the strips

round the edges

anchors and ends are applied without tension

limit # areas taped to

what are common shapes of tape cuts

I cut

Y cut

X cut

Fan Cut

Web Cut

I Cut Tape

used for relatively long and narrow muscle or body segment. Used for an acutely injured muscle to limit edema and pain

Y cut tape

surrounds a muscle either to assist or relax muscle activation. should be approximately 2" longer than the muscle

X cut tape

used when a muscle's origin and insertion may change depending on the movement pattern. both ends pull towards the center

Fan cut tape

used for lymphatic drainage, reduces edema and bruising

web cut tape

modified fan cut where both ends are left intact to improve circulation, swelling, and pain.

what are the parts of tape application

anchor

base

tails

ends

anchors of tape

usually the 1st 1-2 inches, no tension

base of tape

the tape that is beyond the anchor, stretched portion of tape between anchor and tail/end "Therapeutic Zone"

tails of tape

present in Y, X, and web cuts, stretched portion of tape between base and ends. "therapeutic zone"

ends of tape

the last part that is laid down, no tension here

when removing the paper backing of tape what is important?

only remove enough paper for the anchor first. touch as little of the adhesive as possible

when applying the anchor what is important?

the segment you are taping is in anatomical position, 1-2" beyond the origin/insertion of muscle, rub the anchor prior to proceeding

tissue stretch

the area to be treated should be put in a stretched position as the tail is applied regardless of the therapeutic goals. Skin convolutions are normal

tape tension

KT tape can stretch 40-60% further than it's original length. Too little tension is better than too much and the more superficial the target tissue, the less tension you apply

super light stretch

0-10%

paper-off tension

10-15%

light tension

15-25%

moderate tension

25-50%

severe tension

50-75%

full tension

75-100%

what is important for tape removal?

remove in direction of hair growth

do not use bandaid method

soaking in water or plant oil may be helpful

if you stretch the KT tape away from the anchor what will happen with the tail?

it will recoil back to the anchor

when there are anchors on both ends, if you stretch both anchors away from the middle what will happen?

tape will recoil back to the middle

for lymph flow, where do you place the tape anchor?

you start the anchor in the direction you want the lymph to flow. Lymph will flow toward the anchor

to shorten/assist a muscle how will you tape?

proximal to distal with moderate tension (25-50%)

to lengthen/relax a muscle how will you tape?

distal to proximal with paper-off tension

what are the two ways to increase muscle assistance?

increase tape tension

shorten the muscle (tape the muscle in a shortened position)

what are some corrective taping techniques that are not to resist/relax a muscle)

mechanical (positional hold)

fascia (oscillating tissue)

ligament/tendon (proprioceptive)

space (lifting)

functional (spring assist/limit)

circulatory/lymphatic (channeling)

when evaluating a pediatric patient and determining if taping is appropriate, what is important to understand?

1. observation of their movement

2. typical and atypical postures and movement patterns that affect function

3. which movements (essential components) are missing

4. emphasis on quality of movement

5. determine taping goal

central P-A's

hands over the spinous process (hand over hand technique)

unilateral P-A's

thumbs over the facet joint (tip to tip technique)

in the thoracic spine how will your body positioning change during thoracic PAIVMs?

you will have to angle your body appropriately to assess and treat the thoracic spine because of the angulation of the region

PAVIM spring test of the thoracic spine

3 oscillations per vertebrae up to R1, slow and gentle

what are you looking for in a spring test?

hypomobility, hypermobility, pain/symptoms produced and where

for unilateral PAVIM spring test what is important?

tip to tip technique, standing on the same side of the body as the facet you are testing

PAVIM detailed exam of the thoracic spine

4-5 oscillations that go past R1 or to pain

what are you looking for in a detailed PAVIM assessment?

symptoms through the range

quality of range

end feel

protective spasm

hypomobility

what does the PAVIM detailed exam help you determine?

how to treat the individual, it will help you select a segment to mobilize and the appropriate grade to perform

positively charged ions

cations

negatively charged ions

anions

like charges ________ and opposite charges _________

repel; attract

electric current

the movement or flow of charged particles (ions) from one pole to another. Measured in ampere (A)

electric current is produced by the potential difference between two poles in a circuit or the ......

voltage

voltage

aka Electromotive Force (EMF) that supplies the force capable of moving charged particles such as ions through a conductor. Described as the potential difference between two points in a circuit. Measured in volts (V)

Ohm's Law

Current (I) = Voltage (V) / Resistance (R)

how are current and voltage related?

they are directly proportional (increase voltage = increase current)

how are current and resistance related?

they are inversely proportional (increase resistance = decrease current)

resistance

describes the opposition to the flow of charged particles such as ions, biologically referred to as impedance

provide examples of biological structures and their impedance

fat and air - lot of impedance

muscle and nerve - not a lot of impedance

water and gels - low impedance

successful/comfortable treatment with electrical stimulation depends on

reduction of impedance within the circuit

how do you decrease impedance of human skin

alcohol wipe the skin

direct current

continuous, unidirectional flow of charged particles where electrodes serve as positive and negative poles to facilitate current flow

direct current can be associated with polar physiological effects such as

edema reduction, wound healing, delivery of charged medication

alternating current

continuous, bi-directional, flow of charged particles where there is equal ion flow in each direction within the circuit. the current moves continuously toward one pole of the circuit then changes direction to the opposite pole

how does alternating current occur?

in cycles and in less than one second where the number of cycles per second is described by the frequency (hertz, Hz)

AC current at higher frequencies will encounter less impedance so...

it's more comfortable and has a greater physiological affect

AC current at lower frequencies will encounter more impedance so...

it requires increased current amplitude to achieve physiological effect leading to potentially decreased comfort

low frequencies of alternating current

1-1000 Hz, deliver at a low frequency meaning not as much effect on impedance. Used in portable muscle stimulators

Medium Frequencies of alternating current

1001 to 10000 Hz, clinical muscle stimulators, deliver at a higher frequency meaning less impedance and increased comfort

pulsatile current

discontinuous delivery of electrical current

frequency of pulsatile current

describes the number of pulses per second (pps)

what is a pro of pulsatile current?

allows for better discrimination among sensory, motor and pain fibers

low pulse rate will

result in a muscle twitch

high pulse rate will (>35 pps)

result in a fused muscle contraction

pulses are

inversely related to the period (more pulses per second = less time between pulses)

longer pulse durations are generally less comfortable but

they are more likely to achieve muscle contraction with less current amplitude

does waveform of estim have an impact?

not really, it isn't a huge factor but a triangular wave form may be more comfortable and a rectangular wave form may have more therapeutic impact but there really is not a big difference.

on time

period during which a train of pulses is delivered

off time

period during which there is no current delivery, used to reduce muscle fatigue

what are the two types of electrodes?

invasive

surface

monopolar electrode configuration

one electrode is active (small electrode) and the other is just there to complete the circuit (large electrode)

bipolar electrode configuration

electrodes that are the same size are placed over the treatment area, both are active therefore having equal physiological effects

quadripolar electrode configuration

electrodes of the same size are placed around the specific target tissue, this allows two alternating currents to intersect

adequate stimulation of a nerve depends on

current amplitude and stimulus duration

rheobase

the minimum intensity of an electrical stimulus delivered over an infinite period that will activate excitable tissue and produce an action potential

chronaxie

the duration required for a stimulus with the intensity of two times the rheobase intensity to activate excitable tissue and produce an action potential

strength duration curve

curve that shows the relationship between the stimulus duration and the stimulus intensity. as stimulus duration inc, less stimulus intensity is need to excite tissue

Anodes

positive

coded red

attracts negative ions

decreased nerve excitability

acid formation

wound healing

Cathodes

negative

coded black

attracts + ions

increased nerve excitability

base formation

bone healing

the direction of flow of a direct current

is determined by the polarity selected