Therapeutic Taping Therapeutic Taping for the Hip & Kneefor the Hip & Knee

Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTPDr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTPDr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEASDr. 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® TapingPatellar 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® TapingPFPS 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® TapingImproved 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® TapingPFPS 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 BlockAthletic 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