Session 406: Active Care ‐Pain Control Techniques & Tools ...
Transcript of Session 406: Active Care ‐Pain Control Techniques & Tools ...
To comply with professional boards/associations standards:• I declare that I (or my family) do have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation.•Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.
Session 406: Active Care ‐ Pain Control Techniques & Tools to Clinically Progress Patient Outcomes
John Hisamoto, PT, ATC & Shawn Burger, PT, DPT
Leading the Way in Continuing Education and Professional Development. www.Vyne.com
John Hisamoto PT, ATC
Owner, Pro‐Active Physical Therapy
Shawn Burger, PT, DPT
Owner, PearFIT Physical Therapy
Before we get started…
• Phones
• Names on workbooks
• Bathrooms
• Waiver
• Pre‐test
• Latex Allergies?
• Anything else…
Today’s Schedule
• Evidence‐based Pain Relief Tools & Techniques
• Kinesiology Tape
• Topical Analgesic‐ Biofreeze
• Cryotherapy
Pain Relief Tools
Buetel & Cardone 2014. IJSPT. 9(5):666‐73
• 31 websites on kinesiology taping reviewed
• 58% had anecdotal testimonials to promote
Websites are “poor quality and present misleading,
imbalanced information”
Moderate effect size for kinesiology tapeon pain reduction vs. minimal interventions
Effectiveness of Kinesiology Tape on musculoskeletal pain & disability > 4 weeks
More tension and longer applications associated with lower effect size
A Mega Review of Kinesiology Taping Research (Page et al. 2015)
+ Trivial benefit; as effective ‐ Harmful
++ Clinically beneficial ? Unclear/ inconclusive
0 No benefit
Kinesiology Tape Research Summary
• Various studies (and reviews) have various outcomes– As effective as other minimal interventions for musculoskeletal pain
– Reduces pain acutely (about 1 week)
– Potential for small improvements in muscle and joint
– Limited research on neurological & circulatory
• Kinesiology Tape should not be used as stand‐alone intervention– May speed recovery when combined with other
Kinesiology Tape Facts• Mechanism of action unclear
• Research supports short‐term pain relief (Lim & Tay
2015)
– Other outcomes remain unproven (Page 2015)
• Specific patterns, directions, and tensions are not
substantiated
• Tape tension is important; less is probably better (Lim & Tay, 2015)
• You don’t need certification or a training course to
tape!
• XactStretchTM
Integrated stretch guides for 25% and 50%
• Performance
Best in class adhesion and durability
• Research
Most comprehensive research library (over 200 studies) including over 140 techniques
• XactStretchTM
Integrated stretch guides for 25% and 50%
• PerformanceBest in class adhesion and durability
• ResearchMost comprehensive research library (over 200 studies) including over 140 techniques
XactStretch™ Integrated Stretch Guides
~0% paper off tension~100% Available tension
Easier to provide EXACT tension
*Different brands have different available tensions
XactStretchTM
25% of Available Tension
50% of Available Tension
0% Paper Off Tension
TheraBand Kinesiology TapeStress‐Strain
• Kinesiology Tape tension exponentially increases after 50% elongation
• Recoil?
Specified Kinesiology Tape Tensions with Positive, Significant Outcomes
(Page et al. 2015)
0
5
10
15
20
25
30
35
0% 0‐25% 25‐50% 50‐75% 100%
Number of Studies with Significant Outcome, by tension
In well‐controlled studies with significant outcomes, 86% of studies utilized tension <50%;The most common tension used was <25%.
Kinesiology Tape TechniquesApplication Recommended Tension*
Muscle Support < 50%
Joint Support < 50% to facilitate motion> 50% to restrict motion
Neurological Support < 25%
Circulatory Support < 25%
• Greater than 50% tension may increase skin irritation• Use XactStretch Indicators!
*We are not making claims that these tensions produce these results
• TheraBand Kinesiology
Tape increases skin
blood flow regardless of
tension, and continued
for 3 days of wear
(Alexander et al. 2015)
A comparison of adhesion qualities of kinesiology tapes
(Topp et al. 2015)
TheraBand Kinesiology Tape provides significantly more adhesion than competitors
*KT Tape
*KinesioTex Tape
TheraBand Kinesiology Tape
*Significantly less adhesion
Handle the Tape• Cut
– Measure length– Cut & Shape
• Remove backing– Tear backing– 2 anchors– “Bandaid” tear
• Apply– Posture– Anchor– Tension– Rub
Tape Cuts and Patterns
Aftercare is critical!
• May be used up to 5 days
• Caution with > 50%
• Remove if symptoms worsen
• Remove if skin irritation (itch, burn)
• Dry with towel
• Press down on bare skin next to tape and pull
The sustainability of the tape depends on the application
8 Colors Ranging from Subtle to Bold
Black/Black Black/Gray Black/White Beige/Beige
Pink/White Blue/Blue Hot Red/Black Electric Green/Yellow
What can Kinesiology Tape help?
Maxillofacial surgery
Chronic Spinal Cord Injury
Lymphedema
Cerebral Palsy Impairments
Limb‐lengthening surgery
Chronic venous insufficiency
Focal Dystonia
TMJNeck pain/Whiplash
Shoulder ImpingementElbow Pain
Low back painAnterior Knee PainACL Reconstruction
Knee OATotal Knee Replacement
Plantar Fasciitis
Additional Pain Relief Tools
Cryotherapy effects of Biofreeze• Cryotherapy effects induced by Biofreeze® products include:
– Decreased skin temperature (Benkaci 2005)
– Increased skin blood flow (Craighead & Alexander 2016)
– Decreased arterial blood flow (Olive et al. 2010, Topp et al. 2011, 2013, 2014)
‐3
‐2.5
‐2
‐1.5
‐1
‐0.5
0
neck back knee hand
Change
in Pain (VAS score)
* *
*
Minimal Clinically Important DifferenceClinically‐important Difference*
Statistically‐Significant AND Clinically‐Meaningful Changes in Pain
(Bishop 2011, Zhang 2009, Topp 2013, and Sundstrup 2014)
A comparison of topical menthol during delayed onset muscle soreness
• n = 16 healthy subjects
• Induced DOMS in biceps; applied ice or Biofreeze® 2 days later
• Biofreeze reduced DOMS significantly more than ice by 63%
The Effects of Biofreeze® on Self‐Discharge Rates
Setting
Outpatient PT clinic in New York
History
Average discharge rate 6.5% over 3 previous years
“One‐and‐done” self‐discharged patients
Study
Provided Biofreeze Spray to all new patients over 6 month period
Results
Self discharge rate reduced to 1.6% (a 75% reduction)
Biofreeze® Professional Pain Reliever
• Optimized Formula• Smoother consistency• Lasts longer• Available in:
• Gel• Roll‐On• Spray 360
• Available only to healthcare professionals!
Optimized Formula!
Biofreeze® Professional Pain Reliever
Biofreeze in PracticeIn the Clinic: At Home:
• Manual Therapy
• Pre/Post Treatment
• Soft Tissue Mobilization
• Ultrasound
• Kinesiology Tape
• Pain (4x/day)
• Pre/Post home exercise
• Kinesiology Tape
Biofreeze and Ultrasound• There is no evidence of the effectiveness
of phonophoresis with Biofreeze or any other menthol‐based topical analgesic.
• DO NOT use Biofreeze as a 100% coupling agent during ultrasound– it may diminish the transmission of
sound waves or damage the sound head crystals.
• MIX Biofreeze with ultrasound coupling gel at ratios between ½ and ¼ Biofreeze to Ultrasound Gel (Rigby et al. 2014, Myrer et al. 2001)
– Use 1.0 w/cm2 at 3 MHz
"Tape & Spray"Use TheraBand Kinesiology Tape and
Biofreeze at the same time for pain reliefHow to apply TheraBand Kinesiology Tape and Biofreeze Spray safely at the same time:
1. First apply TheraBand Kinesiology Tape as indicated
2. Apply Biofreeze spray on and around tape up to 4 times a day
Using Biofreeze Safely
• Avoid contact with mucous membranes
• Apply no more than 4 times a day
• Mild “burning” sensation, subsides over time
• Do not use with a heating pad
• Do not “bandage tightly”
• Wash hands after application
Topical Menthol, Ice, Peripheral Blood Flow, and Perceived Discomfort
Menthol and Ice reduce blood flow through different mechanisms. When combined, they have an additive effect.
TheraPearl®Key Benefits of THERA˚PEARL
Technology™ • Conforms to body when frozen
• No condensation or leakage
• Place directly on skin
• Maintains temperature for 20 min
• Velcro straps
• Reusable
When frozen, pearls create the “frozen peas” effect, and offer ice therapy without sacrificing flexibility
When microwaved, pearls conform and deliver soothing heat therapy to the desired body part.
Clinical Retail OfferingSports Pack
Sports Pack with StrapBack WrapNeck WrapKnee Wrap
Ankle/Wrist WrapFace Mask
“Pals” for Kids
www.TheraBandKTape.com
Janda’s Upper Crossed Syndrome
Neck Pain
Stability Mobility Pain Control
Lateral Epicondylitis
Stability Mobility Pain Control
Shoulder Impingement
Stability Mobility Pain Control
Janda’s Lower Crossed Syndrome
Lower Back Pain
Stability Mobility Pain Control
Anterior Knee Pain
Stability Mobility Pain Control
Performance Health Academyhttp://www.performancehealthacademy.com
• Research• Articles• Exercise Videos and
Techniques• CE Courses
Appendix: Taping Techniques