Kinesiology Taping for the Lower Extremity...

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10/17/14 1 Kinesiology Taping for the Lower Extremity Athlete Maria Cole OTR, CKTP International Rehabilitation Center for Post-Polio Laura Kelly PT, DPT, CLT Certified Lymphedema Therapist Darren C. Rosenberg, DO Assistant Professor Harvard Medical School Department of PMR Medical Director Spaulding Outpatient Center Framingham Objectives • Understand the basic properties of kinesiology tape • Understand the basic applications of kinesiology tape • Demonstrate 3 application kinesiology tape applications • Identify various diagnoses and conditions that may benefit from the use of kinesiology tape. Types of Kinesiology Tape

Transcript of Kinesiology Taping for the Lower Extremity...

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Kinesiology Taping for the Lower Extremity Athlete

Maria Cole OTR, CKTP International Rehabilitation Center for Post-Polio

Laura Kelly PT, DPT, CLT Certified Lymphedema Therapist

Darren C. Rosenberg, DO Assistant Professor Harvard Medical School Department of PMR Medical Director Spaulding Outpatient Center Framingham

Objectives

• Understand the basic properties of kinesiology tape

• Understand the basic applications of kinesiology tape

• Demonstrate 3 application kinesiology tape applications

•  Identify various diagnoses and conditions that may benefit from the use of kinesiology tape.

Types of Kinesiology Tape

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•  Spider Tech Tape is made from Nitto Denko tape

•  Developed in Japan in 1987 •  100% cotton, hypoallergenic

acrylic adhesive

•  Weave Pattern that mimics the skin

•  Can be worn 24 hours, 3-5 days

•  KT Tape is made up of reinforced 100% cotton sheathes

•  Designed to provide durability and increased strength

•  Each box comes with 20 precut strips of 100% synthetic tape

What is Kinesio® Tape?

• Uniquely designed elastic tape

• Patented adhesive in wavelike pattern- mimics skin movement

• Comfortable to wear

• Long wear time-can be worn 24 hours/day; lasts 3-5 days

Image-yzgoldenwell.en.made-in-china.com

References 4,5,6

Tape Demo

Where Can Kinesio® Tape Help?

1.  Muscle

2.  Joint

3.  Fascia

4.  Skin

5.  Circulatory/Lymphatic

References 4,5,6

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Image-bocaratonflchiropractor.com

Who is using Kinesio®taping?

When is Kinesio® taping used ?

• Sprains/Strains

• Acute Pain/Injury

• Chronic Pain Syndrome • Postural & Biomechanical Imbalances

• Neurological Conditions

• Scar Management

Kinesio® Tape Qualities - Finger Demo

•  Latex-Free

•  Patented Wavelike Adhesive Pattern Similar to skin n thickness and weight

•  Stretches 50% of resting length

•  Stretches on longitudinal axis only- FINGER DEMO •  Adhesive is heat activated

• Can get wet References 4,5,6

Taping Goals

•  Pain reduction

•  Provides kinesthetic feedback

•  Taping to facilitate or inhibit muscle function

•  Another “set” of hands

•  Edema management

References 4,5,6

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Determining Appropriate Taping Intervention

• Assessment

• Target Tissue

• Apply Tape

• Re-Assess

Place Lumbar paraspinals phot here

References 4,5,6

•  Therapeutic Zone- Target tissue to be taped

•  Tension- Amount of stretch

applied to tape -Specified as a percentage of tension

•  Anchor and End- Beginning and End of Tape- NO tension on Ends

•  Base- Area of tape applied with tension to target tissue

References 4,5,6

Taping Terminology

Taping Tension Percentage Forearm Demo

Paper Off 10-15%

Light 15-25%

Moderate 25%-50%

• Low tension- Decompression

Severe 50%-75% • High Tension- Compression • Tape has no recoil > 50% tension

Full 75%-100%

•  O% tension applied on anchor and end.

References 4,5,6

Super Light 0-10%

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Applying Kinesio® Tape

•  Do not tape over broken skin. May need to trim/shave area. •  Apply on oil free & dry skin. Alcohol prep/hand sanitize. •  Can reposition tape once;

Not after activating adhesive

•  Rub tape to activate adhesive. Do not use hair dryer on tape.

•  Apply tape with target tissue in stretch position – Maintains & promotes

normal tissues flexibility. – Exposes sensors to be

stimulated. •  Contraindications/

Precautions in supplement

References 4,5,6

You Can Have Too Much Kinesio® Tape

Taping Techniques

• Jumper’s Knee Patella Tendonitis - 5.5 blocks

• Shin Splints Medial Tibial Stress Syndrome - 4.5 blocks

• Lateral Ankle Sprain Edema Control - 4.5 blocks

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Anatomy Slides

Coding

•  Confirm medical necessity

•  Use proper coding

•  Verify third party coverage

•  Bill properly

•  Note: The laws, rules and regulations regarding reimbursement for strapping and taping by health care professionals vary greatly from state to state. Always check your state’s laws to verify which codes apply and work best for your practice.

© 2010 SpiderTech Inc.

http://www.nucapmedical.com/files/SpiderTech_2011_Billing_Codes.pdf http://www.kinesiotaping.com/kinesio/codes.html

Key Points

• Assessment

• Direction- Longitudinal

•  Tension- Less is More

• Recoil- Lift vs. Compression

• Adhesive- Heat Activated

• Adjunct to Other Treatment Interventions

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Jumper’s Knee- Patella Tendonitis Taping Video

Jumper’s Knee- Patella Tendonitis

References 4,5,6

Mechanical Correction

•  Positional hold to influence desired resting position

•  50-75% Tension •  Aids in Inhibiting

pathological motion

•  Maintains circulation

Patella Tendonitis- Mechanical Correction

•  Measure & Cut Y-strip

•  Position in sitting with knee flexion

•  Anchor at Inferior patellar pole

•  At inferior border of patella, separate tails to surround patella

•  Place 1st tail along patella border

•  Apply 50-75% tension

References 4,5, 6

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Patella Tendonitis- Mechanical Correction

•  Place 2nd tail on opposite patella border

•  Apply 50-75% tension •  Request slight increase in

knee flexion

•  End with No tension at superior border of patella

•  Activate adhesive

Removing Tape – Forearm Tape •  Remove tape in direction of hair

growth •  Roll back from edge of tape – gently

removing entire length of tape

•  Skin from Tape Method-gently pull tape from skin using other hand to hold skin in place; or roll over pencil

•  Tape may be removed while bathing

•  Soap, hand lotion or baby oil can help in removal

References 4,5,6

Shin Splints – Medial Tibial Stress Syndrome Taping Video

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Shin Splints – Medial Tibial Stress Syndrome Space Correction

•  Decreases pressure on

painful or swollen tissue

•  Approximates tissue toward medial border of tibia

•  Recoil of tape creates lift over target tissue

References 4,5,6

Shin Splints - Space Correction

•  Position in sitting Knee in flexion; ankle in dorsiflexion •  Cut 4- 5 block inch Y-strip

•  Anchor with NO tension at medial border of tibia in the pain area

Shin Splints - Space Correction

•  Separate tails to apply in splayed pattern around area of pain

•  Apply 25-50% tension to first tail

•  Use other hand to lift muscle & soft tissue toward the tibia

•  Lay first tail down, NO tension on end

•  Repeat with other tail

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Acute Lateral Ankle Sprain Taping Video Circulatory/Lymphatic Application

Acute Lateral Ankle Sprain- Circulatory/Lymphatic Application

•  Increase interstitial lymphatic fluid flow to less congested area

•  Reduces edema and pain

•  Improved fluid dynamics between tissue layers

•  Lifts skins, causing convolutions

•  Create channeling of low pressure in congested areas

•  Anchor proximally with no tension on less congested area

Acute Lateral Ankle Sprain- Circulatory/Lymphatic Application

•  Measure & cut 2 fan cuts with 4-5 tails or use pre-cut fans

•  Anchor 1st fan cut with no tension on medial side of ankle proximal to area of swelling

•  Apply 10-25% tension to each separate tail with spacing between tails

•  End with no tension

•  Activate Adhesive

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Acute Lateral Ankle Sprain- Circulatory/Lymphatic Application

•  Anchor 2nd fan cut with no tension on lateral side of ankle proximal to area of swelling

•  Apply 10-25% tension to each separate tail, crossing over 1st fan strip

•  End with no tension

•  Activate Adhesive

Supplement

Kinesio® Tape

•  Latex Free- Safe for pediatric to geriatric

•  Rehabilitative

•  Longer wear time; 3-5 days

•  Allows normal ROM

•  No pre-tape

•  Can get wet

Athletic Tape

•  Not latex free; skin irritation

•  Acute Injuries/ Injury Prevention

•  Limited wear time

•  Limits or assists motion

•  Pre-tape or spray adhesive

McConnell Tape

•  Rigid, cotton mesh

•  Primarily orthopedic

•  Limited wear- skin irritation

•  For Bracing/Strapping

•  Requires pre-tape

•  Poor adhesive when wet

References 4,5,6

VS. VS..

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Kinesio® Tape Cuts

I Strip

Y Cut

X Cut

Fan Cut

Web Cut

images-athletictapeinfo.com

References 4,5, 6

Considerations

• Patient education is essential

• Area may need to be shaved before taping

• Apply 30 minutes before activity or swimming

• Maalox or milk of magnesia (external application only) helps reduce irritation to skin

• Remove if itching or increased pain occurs References 4,5, 6

What to Avoid

• Do NOT dry tape with hair dryer

• Avoid taping over hair, through axilla or groin

• Do not “pull” tape to position target tissue

• Position first, then apply tape

• Do not touch adhesive backing too much

• Do not tape over broken skin

References 4,5, 6

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Contraindications

• Malignancy- undiagnosed

• Over Active Cellulitis or Infection

• Open Wounds, Fragile or Healing Skin

• DVT

• Previous skin irritation from product

References 4,5, 6

Precautions

• Diabetes

• Kidney Disease

•  Lymphedema-rule out new or recurrent malignancy

• Respiratory Conditions

• Congestive Heart Failure

• CAD or Bruits in Carotid Artery

• Pregnancy- acupuncture points to induce labor References 4,5, 6

Documentation •  Target Tissue- Anatomy to be affected

•  Cut of Tape; can include # of tape blocks

•  Direction and application tension of tape

•  Desired effect of treatment goals – Decrease pain – Decrease spasms – Limit edema

•  Example: Kinesio Taping® to common wrist extensors, Y-cut, distal to proximal at 15% tension to decrease pain and inhibit muscle spasm References 4,5, 6

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Exam and Treatment Plan

• Recommended level of care plus frequency and duration of taping.

•  Treatment(s) that you will use including the taping.

•  Objective measures to evaluate the effectiveness of the taping.

© 2010 SpiderTech Inc.

Research

1)  Gonzalez IJ et al. 2009. Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial. J Orthop Sports Phys Ther Jul;39 (7):515-21.

2)  Saavedra-Hernández M,et al Short-term effects of kinesi- taping versus cervical thrust manipulation in patients with mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2012; 42(8):724-30.

3)  Murray H et al. 2001. Effect of Kinesio taping on proprioception in the ankle. Journal of Orthopedic Sports Physical Therapy, 31(1): A‐37

Research 4)  Yoshida A et al. 2007. The Effect of Kinesio Taping on Lower

Trunk Range of Motions, Research in Sports Medicine, 15:2, 103-112

5)  Hsu Y-H et al. The effects of taping on scapular kinematics and muscle performance. J Electromyogr Kinesiol, doi:10.1016/j.jelekin.2008.11.003, 2009.

6)  Thelen MD, et al. The clinical efficacy of Kinesio tape for shoulder pain: A randomized double-blinded, clinical trial. Journal of Orthopaedic and Sports Physical Therapy, 38:389-395, 2008.

7)  Fu T-C et al. Effect of Kinesio taping on muscle strengthing in athletes – A pilot study. Journal of Science and Medicine in Sport, 11:198-201, 2008

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CPT Code Changes

•  A few changes were made to the CPT Codes for 2010. Some Highlights are that 29220 – Strapping of Low Back was removed from the coding System. To report Low back strapping, use 29799, Unlisted procedure, casting or strapping

– 1. http://www.kinesiotaping.com/kinesio/codes.html

– 2. http://www.nucapmedical.com/files/SpiderTech_2011_Billing_Codes.pdf

© 2010 SpiderTech Inc.

Diagnostic Codes

• Note: The laws, rules and regulations regarding reimbursement for strapping and taping by health care professionals vary greatly from state to state. Always check your state’s laws to verify which codes apply and work best for your practice.

© 2010 SpiderTech Inc.

Diagnostic Codes

• 307.81 Tension Headache • 339.20 Post-traumatic Headache, unspecified • 724.2 Low Back Pain • 648.70 Pregnancy Backache • 716.9 Chronic Arthritis • 847.2 Lumbar Sprain/ Strain • 719.03 Edema of Wrist • 722.52 Degeneration of Lumbar Disc(s)

© 2010 SpiderTech Inc.

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•  959.6 High Thigh Injury •  719.46 Arthralgia of Knee •  715.96 Degenerative Joint Disease of the Knee •  719.47 Arthralgia of Ankle/Foot •  719.06 Edema of Knee joint/Fibula/Patella/Tibia •  719.48 Arthralgia of Cervical Spine/Thoracic Spine/

Lumbar Spine •  840.6 Supraspinatus (muscle) (tendon)sprain and

strain •  781.2 Abnormality of Gait (Ataxic, Paralytic, Spastic,

Staggering) © 2010 SpiderTech Inc.

Diagnostic Codes

THERAPEUTIC PROCEDURES CPT CODES

•  97110 – Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

•  97112 – Neuro-Muscular Re-Education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and or/standing activities

•  97533 – Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes

•  97140- Manual Therapy Technique © 2010 Kinesio USA-

THERAPEUTIC PROCEDURES CPT CODES

•  97799 – Unlisted physical medicine/rehabilitation service or procedure – specify

•  97139 – Unlisted therapeutic procedure – specify

•  99070 – This is a miscellaneous code to be used for supplies and material during an office visit.

© 2010 Kinesio USA-

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References

1.  1. http://www.kinesiotaping.com/kinesio/codes.html

2.  2. http://www.nucapmedical.com/files/SpiderTech_2011_Billing_Codes.pdf

3.  3. www.kttape.com

4.  4. Kase, K., Wallis, J., Kase, T. Clinical Therapeutic Applications of the Kinesio Taping Method 2nd Edition. 2003

References

5. Kinesiotaping Association International KT1 and KT2 Workbook. 2008 6. Kinesiotaping Association International KT3 Clinical Concepts Workbook. 2013