Movement: Fascia and Function in Soft Tissue Therapy

The world of Soft Tissue Therapy has moved forward at a startling pace over the last decade with more and more people realising the virtue of its benefits.  With this appreciation of the modality comes a more educated and demanding client who wants more than just relaxation, they want tangible results.  Research and the techniques available are progressing at a rapid pace, meaning that we as therapists need to keep up to date with regard to these areas to ensure we are delivering effective treatments and real results for our clients. Continue reading Movement: Fascia and Function in Soft Tissue Therapy

Case Study: The use of Kinesio Tape as part of an Integrated Soft Tissue Treatment Plan

After much scepticism, and lack of available scientific proof on the effectiveness of Kinesio Tape in injury rehabilitation I decided to study Kinesio Taping with the KT Association UK in 2013.  I wanted to see for myself what was involved and more importantly what results could be gained by integrating Kinesio Tape to my treatment of clients with soft tissue imbalances.  From the simple tapings we began with on day one it was clear there was something to this technique, as we increased our range of motions by simply adding tape to either facilitate or inhibit muscle groups.
Over the course of the Fundamental and Advanced Concepts courses we learnt that in addition to muscular Facilitation and Inhibition, Kinesio Tape can also be used to achieve many other treatment goals.  Take for example ‘Mechanical Corrections’ e.g. aligning the tracking of the patella, ‘Lymphatic Drainage’ to help decrease inflammation, ‘Tendon Correction’ to support the healing process of tendon injuries and the ever useful ‘Space Correction’ tapings for pain relief.

To put this to the test, I selected a client with quite an acute problem to document the use of Kinesio Tape in her treatment and the results achieved.  The results were quite outstanding and I have gone on to use Kinesio Taping on many clients with a variety of issues, but the most instant results I have seen are with clients with osteoarthritis of the knee.
Case Description

The patient is a 57 year old female, presenting with osteoarthritis of the right knee.  The client had a fracture of the right femur 25 years ago resulting in a leg length discrepancy due to shortening of the femur on healing of the fracture.  The client has also had her C4 vertebrae removed and C3 and C5 fused resulting in neurological issues in the right leg meaning that pain is felt as tickling, hot as cold and cold as hot.  These injuries have culminated in early onset osteoarthritis in the right knee joint.    
The client plays 6-8 hours of tennis & squash a week and has been finding it increasingly difficult to move around the court.  The client has been receiving soft tissue treatment from me for 6 months which has helped increase flexibility and decrease pain but the condition of the knee has been deteriorating over the last couple of months.  In the days leading up to the first treatment using Kinesio Tape the client’s leg has been hyper-extending and she has struggled to bend the right knee.  The knee loosened up somewhat over the weekend and the client played a tennis match on the day of the first Kinesio Tape application and again the right knee began to lock out and the client could not bend her knee.  At this point the client requested assessment and treatment using Kinesio Tape.  Client has also been referred by her GP to see an orthopaedic knee surgeon for possible knee replacement.
Clinical Assessment

Subjective Assessment
Right knee significantly inflamed.  Client has been sitting with leg up straight to help alleviate swelling in the knee but leg then locked in hyperextension.  On playing tennis the right leg loosened up and some more movement was possible.  The following tennis game caused the leg to stiffen up once more and the client again lost the ability to flex the knee.
Objective Assessment
·         Knee Flexion – approx. 10⁰.
·         Knee Extension – Hyperextended approx. 15⁰ .
·         Knee Medial & Lateral Rotation – Not possible to test due to lack of knee flexion.
·         Rectus Femoris and Vastus Lateralis hypertonic.
·         Anteriorly tilted pelvis Right and Left.
·         ‘Glute Firing Test’ indicates lack of glute strength.
·         No pain on assessment but client indicated ‘tickling’ feeling on contraction of the quadriceps group. Note due to existing neurological issue ‘tickling’ relates to pain for this client.
Treatment Plan

The short term plan is to reduce the swelling of the knee and increase mobility.  We cannot undo the cartilage damage in the knee joint but the client wishes to prolong pain free movement until a knee replacement is performed to allow her to play tennis and squash.  We agree to aim to do this my ensuring her quadriceps remain strong but flexible, by reducing the swelling of her knee, increasing the proprioception and strength of her glutes and hamstrings to support knee flexion.
Session 1
Post tennis match a web space correction using Kinesio Tape was applied to the right knee.  Client could instantly increase knee flexion to 45⁰ which allowed the client to get about her days activities. Appointment made for a 60 minute treatment the next day.
Session 2 – One Day Later
In this session a number of soft tissue techniques were used to release tension in the hip flexors and quadriceps.  Light flushing and effleurage was used to reduce swelling around the knee joint.  Proprioceptive techniques used to engage the glutes and to kick start the rehabilitation of the hip alignment and its impact on the arthritic knee.
The following taping was applied as a ‘Functional’ Taping to Support the clients tennis match the following day:
  • Web Space Correction over the right knee to increase space and allow for greater drainage away from the joint itself
  •  Lymphatic drainage to reduce knee inflammation
  • Facilitate Quadriceps Group
  • Functional Correction to support knee flexion
  • Facilitate Hamstring Group
Following the three days of racket sports, the following taping would be applied as a ‘Recovery’ taping:
  • Web Space Correction over the right knee to increase space and allow for greater drainage away from the joint itself
  •  Lymphatic drainage to reduce knee inflammation
  • INHIBITION of Quadriceps Group
  • Facilitate Hamstring Group

Homecare for the client included glute strengthening work and hip flexor & quadriceps stretches.

NOTE:  These tapings were tailored for this client’s specific situation and vary for all clients; I have used different tapings for different clients with osteoarthritis of the knee depending on the condition of all soft tissues involved.
Session 3 – One Week Later
Client has reported significant decrease in inflammation of the knee and increased mobility on the court.  In addition the knee has not locked in extension since the Kinesio Taping integrated treatment commenced.  In today’s session I taught the client how to ‘self tape’ so that she could tape her knee between sessions as we switch to a monthly ‘maintenance’ treatments to help maintain her flexibility.
Session 4 – One Month Later
Client has now reduced to taping to simply using the supportive taping for the days when she plays racket sport.  No longer requires the hamstring or functional limitation taping on the back of the leg & knee.
·         Knee Flexion – approx. 100⁰.
·         Knee Extension – Hyperextended approx. 10⁰ .
·         Knee Medial & Lateral Rotation – Very slight rotation available.
Outcome

Week 1 Progress Update
Swelling of right knee significantly reduced.  Increased range of motion but knee still feels unstable.

Week 6 Progress Update
Knee stability and range of motion increased and client is now back to playing 6-8 hours of racket sports a week.

6 Month Progress Update
Client has seen her orthopaedic consultant twice since initial treatment and her knee replacement has been delayed for at least another 6 months due to the increase range of motion in the knee and increased quality of life since treatment began.

Client Feedback
‘Before the start of my treatment, I was in almost constant pain, with my knee keeping me awake at night, permanently swollen and stiff. I was desperate to keep playing tennis and squash, but could hardly walk after a game and the pain was awful. It was affecting many aspects of my everyday life and making me feel quite miserable.
From the very first application of the Kinesio Tape, I felt an enormous improvement, with the pain greatly reduced and the stiffness gone. Over the weeks and months that followed, using the tape for five days every week, I noticed that the muscles around my knee were getting stronger and I can walk longer distances and without a pronounced limp.
I can now play tennis or squash on consecutive days and am moving much better around the court, with no stiffness in the knee afterwards. The swelling has virtually disappeared and I can walk without pain again and am sleeping better. The Orthopaedic Consultant was delighted with the improvement and my planned knee replacement has been postponed for at least six months.

It is hard to believe that such a simple, non-invasive treatment could make such a difference, but I feel like a new woman!’