Transcript WS-17 Understanding and applying kinesiology tape using the

Understanding and Using:
NSM
(Neurosensory / Structural / Microcirculatory)
Approach to Kinesiology Tape Application to
Improve Patient Outcomes
Marcia Hamilton, MSHS, OTR/L, BCP, NSTP-1
Note:
Knowledge presented today is based on learning that occurred
over both 5 years of experience using kinesiology tape in subacute care and through the certification process of the
Neurosensory / Structural / Microcirculatory (NSM) methodology,
a 16-hour course providing a curriculum forming the basis of
understanding the Neurosensory and Structural and
Microcirculatory uses and applications of kinesiology tape.
NSM course dates and locations can be found under the
Education tab of SpiderTech.com
Today’s tape applications were donated by:
What is Kinesiology Tape
Kinesiology tape is a cotton, elastic, lightweight therapeutic tape that
has many applications for improving function in rehabilitation. Dr. Kenzo
Kase, Chiropractor invented the tape in the 1970s.
Characteristics of this tape are:
 Made of cotton with fibers allowing for increased airflow and
evaporation. Hypoallergenic.
 Unidirectional elasticity with 140% longitudinal stretch, similar to
skin.
 Heat activated, water resistant
 Other names; Spider Tech Taping, Elastic Therapeutic Taping,
MyoFascial Taping, Elastic Rehabilitative Taping, KT Kinesiology Tape,
Neuro Muscular Taping and Neurostructural Taping.
(Jones, 2013, DeRu, 2014)
2008 Olympics
http://www.spidertech.com
World class Javelin Thrower
http://www.wellness4lifechiro.com/Kinesiotap
e_javlin.jpg
David Beckam
http://chirocentre.co.uk/wpcontent/uploads/David-Beckham-PinkColoured-Kinesio-Tape.jpg
Simple applications-Quick results
Pediatric application for
torticollis
More Characteristics:
Lightweight, yet supportive
Colorful or not
Available commercially to public, Wal-Mart, CVS
Can be worn for 3-5 days
Can be worn during swimming, bathing, showering
Reported to be over 60 brands
The end cap at
WALMART
What is the science behind it?
Kinesiology: Knowledge of muscle movement, force vectors
and the relationship to the rest of the body systems.
Biomechanics: Providing support to a joint that through gentle
compression allows the joint to move through full AROM.
Enabling movement to heal.
Neurosensory:
Neurophysiology of Pain
Nociception
Neuromuscular Plasticity
What types of theories exist about kinesiology
tape?
• I. Original Model: Convolutions, Skin Lifting, Proprioception, OriginInsertion direction.
• II. Fascia Models
• A. Fascia/biotensegrity
• B. Anatomy trains
III. Skin (brain) model
A. Dermatomes/segmental taping
B. Entrapment cutaneous nerves
IV. Energy Model
Meridians and acupuncture points
(deRu Ba, 2012)
NSM Model, Application and Clinical
Reasoning:
• Evidence led approach taking into account structural and
neural influence of the tape on the body.
• Application techniques are based on clinical objectives:
• Neurosensory:
• Pain modulation, nociception, neuroplasticity
• Structural: Support an unstable joint, Postural Support
• Microcirculatory::
• Accessing the lymphatic system
Why use a NSM Taping Approach?
Decrease pain
Decrease nociceptive influence of the CNS: based on theory of
sensory gating.
Restore muscle activation and normalization of muscle tone.
Restore and improve range of motion.
Promote a faster rate of healing.
(Jardine, 2012)
Important reasons for using the NSM
Taping Methodology
In conclusion there are many different theories and ways to apply
tape, however the NSM taping method provides:
• A frame of reference, that is reflective of research and pertinent
scientific discovery.
• A curriculum aligned with the frame of reference.
• A curriculum that aligns with occupational therapy frames of
reference, (Sensory Integrative, NDT, Open system models of
occupational performance- MOHO, EHP, PEOM)
• Ongoing therapist education and support
• Ongoing patient education and support.
• Convenient pre-cut patterns increase and optimize patient success
for using tape.
• http://www.spidertech.com/testimonials
Occupational Therapy Frames of Reference in
relation to NSM Application
Frame of Reference
Use of Kinesiology Tape:
• Biomechanical
• Remediate loss of motion, strength, endurance,
edema, pain
• Sensory Integrative
• Adaptive responses will occur through integration
of multiple sensory systems. The brain will seek
stimulation to organize itself. The CNS has
plasticity. Activity is easier to engage in when
there is a sense of emotional security.
• Neurodevelopmental
• Scapular/Pelvic stability, trunk and neck control
are prerequisites for limb mobility. Normalization
of muscle tone can be achieved by various
techniques such as breaking up synergy, inhibition
of reflexes, weight shifting and reciprocal
movement.
More Frames of Reference:
Frame of Reference
• Model of Human Occupation
(MOHO):
• Ecology of Human
Performance, (EHP):
• Rehabilitative:
Use of NSM Taping Methodology
to support client-centered change
• Promote engagement in occupations
that restore, reorganize or maintain
their motivation, patterning and
performance capacity, affecting
occupational lives. This will occur
through providing opportunities for
the person to themselves accomplish
their own change.
• Establish/Restore, Alter, Adapt,
Prevent , Create intervention
strategies to improve performance
• Strategies to enable the greatest
amount of independence in
meaningful occupations.
(Brown, 2013)
The World Health Organization’s International Classification of
Functioning, Disability and Health (ICF)
• Health Condition
(disorder or disease)
Body Structure &
Activity
Participation
Function
Environmental Factors
Personal Factors
In a nutshell, what is it good
for?
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Acute Pain
Chronic Pain
Rehabilitation after Surgery
Poor posture
Swelling, Edema and Bruising
Muscle and Joint Injuries
Optimizing athletic performance
Improving independence with ADL
Understanding Pain and making clinical
decisions:
Types of Pain:
• Cramping, dull, aching; Muscle
• Sharp, shooting: Nerve Root
• Burning, pressure-like, stinging; Sympathetic nerve
• Deep,sharp,severe; fracture
• Throbbing, diffuse; Vascular
Sympathetic Nervous System Response:
• Response can be visualized in fascia
• Our goal is to calm the nervous system and reduce the stress
Mechanisms of Action of NSM Taping:
Mechano-disruption: Physical distortion of tissue causes firing
of neural signals to CNS
Mechano-transduction: Mechanical stimulus is converted into
bioelectrical or biochemical signals
Mechano-corrective: Structural restraint of potentially
harmful positions.
( Jardine &Tsaggarelis, 2012)
Categories of Therapeutic Effect of NSM Taping:
Psychological: conscious kinesthetic awareness
Neurosensory: Inhibition of nociceptive pain impulses
Structural: provides support to weak or lax joints.
Microcirculatory: Tissue repair, tissue flow, tissue adaptation
(Jardine & Tsaggarelis, 2012)
Microcirculatory
http://www.spidertech.com
Skin after removal of tape:
http://www.erringtonchiro.com/uploads/2/2/4/8/22483854/1342379.jpg?246
Lymphatic System
http://www.corpshumain.ca/en/images/lymph
atiquehomme_2_Full_en.jpg
Lymphatic Circuit:
http://www.worldtherapycenter.com/category
/fitness/
Anatomy of the skin and fascia:
http://true.massageresearch.com/2013/06/fascia-andreflexology.html
Understanding the importance of fascia; (fascia can be
considered to be all collagenous soft connective tissues)
Fascia is now known to be a 3-D network of fibrous, dynamic, gluey
and wet proteins that hold our bodies together and at the same time
enables them to move. (Day, Copetti, Rucli, 2012, Lockwood,1991)
Understanding fascia can begin with the embryogenesis of the
musculoskeletal system, (Day, Copetti, Rucli, 2012)
Recently termed as a “biomechanical regulatory system”,
(http://anatomy trains.com).
Consists of:
•Superficial fascia- mostly adipose
•Deep fascia- (epimysium, perimysium, endomysium)
•https://www.youtube.com/watch?v=3YfgMABGf7U
•https://www.youtube.com/watch?v=JgNoUrNlgr4
•https://www.youtube.com/watch?v=-uzQMn87Hg0
Skeletal System
http://1.bp.blogspot.com/X7ZExNZt5FU/UoGiNjLk4sI/AAAAAAAAC3g/Pq
NMpZHKsn4/s1600/Skeletal+System.jpg
Muscular System
http://homepage.smc.edu/wissmann_paul/an
atomy1/1muscles.html
Functional Anatomy
Review:
https://www.google.com/search?q=famous+athletes+wearing+kinesiology+tape&espv=2&biw=768&bih=603&tbm=isch&imgil=RQLbtItH0FSlM%253A%253BKwM_vtwCx7UOCM%253Bhttp%25253A%25252F%25252Fchirocentre.co.uk%25252Fkinesio-tape-coloured-taping-athletes-sportinjury%25252F&source=iu&pf=m&fir=RQLbtItH0FSlM%253A%252CKwM_vtwCx7UOCM%252C_&usg=__oiGSMqGRGEcbmoIJNe__EOgKVIs%3D&ved=0CDUQyjc&ei=g_sGVcbSHYqXNv6mgqgI#tbm=isch&q=trapezi
ous+muscle+and++kinesiology+tape+images&imgdii=_&imgrc=zmQfcK9QYY4eyM%253A%3BHjYLONyjcSy5gM%3Bhttps%253A%252F%252Fs-media-cacheak0.pinimg.com%252F736x%252Fd8%252F56%252Fd1%252Fd856d174acf787710e206b6dcb315348.jpg%3Bhttps%253A%252F%252Fwww.pinterest.com%252Fs
hilosessions%252Fkt-tape%252F%3B587%3B587
The Deltoid:
• Attaches, (origin) around spine of scapula and clavicle forming
a “V’. (Same as insertion of trapezius).
• Three segments: anterior, middle and posterior
• All fibers: AB/duct the GHJ
• Anterior: Extend, laterally rotate and horizontal AD/duct
• Posterior: Extend GHJ, laterally rotate GHJ, horizontal AB/duct
Involved in most functional movement of the shoulder.
Taping to help support the?
The Rotator Cuff a major GHJ stabilizer:
Relationship of the muscles moving scapula and GHJ:
Stabilizing scapula and SITS
group
Scapular Control
• Rhomboids: To palpate in prone, place arm behind back
with palm out. Located deep to trapezius and superficial
to erector spinae muscles.
• Rhomboids : Action AD/duct scapula, Elevate scapula,
Downward rotate the scapula
• R. Major: Origin is T2-T5
• R. Minor: C7-T1
Levator Scapula: Origin is TP of C1-C4, Insertion medial
border of scapula, between sup. Angle and spine of
scapula
Rhomboids and Levator Scapula:
Anterior chest muscles and control of scapula:
Muscles of the Shoulder
The Triceps and its Role in Shoulder Stability:
• The triceps brachii is the only muscle located on the posterior
surface of the arm and is responsible for extending the elbow
and shoulder. It serves as the antagonist to the biceps brachii.
As the name indicates there are three heads;
• Long head: Origin is infraglenoid tubercle of the scapula
• Lateral head: Posterior surface of proximal half of the humerus
• Medial head: Posterior half of the distal half of the humerus
All three insert on the olecranon process.
The Triceps;
Biceps and Coracobrachialis
Muscles acting on the Elbow:
• Brachialis
• Brachioradialis
Muscles moving the wrist and fingers
Pronation and Supination
Thumb and finger muscles
One more time……
Abdominal Muscle Function:
.
http://www.sycoxt.com/images/ab-muscles.jpg
http://www.discovery.com/tvshows/curiosity/topics/nervous-system-pictures.htm
http://bethycotter.wdfiles.com/local-files/somaticautonomicnervoussystems/Screen%20Shot%202012-0903%20at%209.45.43%20AM.png
Kinesiology
Kinesiology is the study of movement incorporating anatomy,
physiology, physics, geometry as it relates to movement.
In fact, neuromuscular physiology, musculoskeletal anatomy
and mechanics are used to understand movement, both
generally and specifically.
(Lippert, 2011)
Testimonials:
• http://www.spidertech.com/testimonials
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with SpiderTech.
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Kinesiology Tape Application
Spider Tech offers comprehensive instructional videos on
their web-site. NSM Application videos are good for both
practitioners and patients:
SpiderTech Educational Videos:
Lower Back
Knee
Shoulder
Elbow
Microcirculatory
Thinking outside of the pattern:
Using clinical reasoning, palpation, knowledge of neural
responses, lymphatic system and kinesiology don’t be afraid to
try something different:
•Using a hip spider to provide stabilization of GHJ and prevent
scapular winging.
•Use more than one application, for example low back and hip,
shoulder and elbow.
Precautions:
Never apply to burned or open skin
Take care with the geriatric and pediatric population , due to
fragile skin. There is a “sensitive skin’ variety. Use SpiderTech
Gentle
Do not remove when wet.
 If pain increases remove.
 Watch for creases in tape.
 Remove if excessively itchy
Avoid applying over large blood vessels, particularly jugular
vein and carotid artery, under axilla.
Why are we using kinesiology tape as
Occupational Therapy Practitioners?
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IMPROVE PATIENT OUTCOMES:
Increase rate of healing
Decrease pain
Increase pain free movement to improve overall function
Increase carry over of NDT handling/ cueing
Enable participation
IT IS AN EXTENSION OF OUR PRACTICE & OUR HANDS
DOCUMENTATION
Include information in standard SOAP note:
97112, 97110
Reflect gains in function with respect to all areas
normally reported.
Report carry over with ADL and IADL in assessment
section.
Teach patients and caregivers when nearing
discharge.
Billing Codes:
Thorax 29200
Shoulder: 29240
Elbow/Wrist: 29260
Finger: 29280
Enabling Participation
Support where it is needed:
http://www.pinterest.com/pin/469148486156
626495/
Why?
http://lookbookers.info/uncategorized/kinesiotape/
https://www.google.com/search?q=Inspirational+kinesiology+tape+videos
&client=safari&rls=en&tbm=isch&tbo=u&source=univ&sa=X&ei=PUxeVOnJ
HqPIsATg94GwAw&ved=0CF4Q7Ak&biw=524&bih=503
References:
• Brown, R., (2013). Common theories, models of practice and frames of reference
used in occupational therapy.
http;//www.academia.edu/9129736/Common_Theories_Models_of_Practice_and_Fr
ames_of _reference_Used in _occupational _therapy Ret:2/17/15
• Christiansen, C., Baum, C., Bass-Haugen, J., (2005). Occupational Therapy:
performance, Participation and Well-Being, Slack Incorporated, Thorofare, NJ
• Day, A., Copetti,L., Rucli, G., (2012). From clinical experience to a model for the
human fascial system. Journal of Bodywork and Movement Therapies,16, 372-380
• de Ru Ba, E., (2014) . New treatment models and hypotheses in Elastic Therapeutic
(Kinesio) taping: Presented at “International Disabled Peoples Day, March Scientific
Meeting, Zgorzelec 3/20/14
• Jardine,
• Jardine, K., Tsaggarellis, B. (2013) Neurostructural Taping Technique, COLLABORANS,
Inc. Toronto, Canada
• Jones, K. (2013). Therapeutic Taping, Physical Therapy Products, Feb-March 2013;
(pages 25 -29) Allied Media, Overpark, Kansas
• Lockwood, T., (1991), Superficial Fascial System of the trunk and extremities, a new
concept. Plastic & Reconstructive Surgery 87:6
• Myers, T., (2014) Anatomy Trains, Churchill Livingstone Publishing Company
References continued:
Photo Images:
1. 2008 Olympics: http://www.spidertech.com/contact-us
2. Microcirculatory:http://www.spidertech.com/contact-us/
3. Anatomy of Skin and Fascia:http://true.massage-research.com/2013/06/fascia-andreflexology.html
4. Lymphatic
System:http://www.corpshumain.ca/en/images/lymphatiquehomme_2_Full_en.jpg
5. Skeletal System: http://1.bp.blogspot.com/X7ZExNZt5FU/UoGiNjLk4sI/AAAAAAAAC3g/PqNMpZHKsn4/s1600/Skeletal+System.jpg
6.Muscular System:
http://homepage.smc.edu/wissmann_paul/anatomy1/1muscles.html
7. Nervous System:http://www.discovery.com/tv-shows/curiosity/topics/nervoussystem-pictures.htm
8. Tape on Belly: http://www.pinterest.com/pin/469148486156626495
9. Tape on abdomen: http://lookbookers.info/uncategorized/kinesio-tape/
10. Tape on
Diver:https://www.google.com/search?q=Inspirational+kinesiology+tape+videos&client=
safari&rls=en&tbm=isch&tbo=u&source=univ&sa=X&ei=PUxeVOnJHqPIsATg94GwAw&ve
d=0CF4Q7Ak&biw=524&bih=503
11. http://www.worldtherapycenter.com/category/fitness/