KINESIOTAPING and KNEE OSTEOARTHRITIS

 

Knee osteoarthritis (OA) is the most prevalent chronic joint disease. Cartilage is the central tissue affected by OA and causes subsequent symptoms, including joint pain, stiffness and joint swelling, which diminishes the range of motion (1,2).

Currently, no reliable treatment has been confirmed to prevent progression of knee OA. The aim this review was to evaluate the efficacy of Kinesio Taping (KT) in reducing pain and increasing knee function in patients with OA.
 

Knee osteoarthritis

(Information extracted from: Lu, Zhijun, et al. "Kinesio taping improves pain and function in patients with knee osteoarthritis: A meta-analysis of randomized controlled trials." International Journal of Surgery (2018))

 

Kinesio Taping Application

Five studies were included in this review. They compared an intervention group who received KT to a placebo group received sham Taping.

1. Cho et al. (3) an I-shaped KT starting at the origin of the rectus femoris and a Y-shaped KT proximal to the superior patellar boarder. While KT was applied, the quadriceps muscle was being stretched.
 

Cho et al.

 2. Wageck et al. (4) three KT elements applied simultaneously. 

A) Drainage element of the experimental application. B) Muscle strength element of the experimental application. C) Pain-relief element of the experimental application. D) Combined experimental application.
 

Wageck et al.

 3. Mutlu et al. (5) KT on their quadriceps femoris and hamstring muscle. First, patients were taped with a Y-shaped Kinesio type at the quadriceps femoris. The tape was applied a point 5 cm inferior to the anterior superior iliac spine to the knee cap (origin to insertion), with the patient in a supine position with 25% tension. Then, each patient flexed his or her knee, and the Y-shaped tape (the tails of the tape) was circled around the patella, ending at its inferior side with no tension.
 

Next, patients were taped with a Y-shaped Kinesio type at the hamstring muscle. The tape was applied from ischial tuberosity to the back of the knee, with the patients in a standing position with their trunk bent. Then, the Y-shaped tape (the tails of the tape) was applied around the lateral side of the knee and medial side of the knee.
 

Mutlu et al.

 4. Aydogdu et al. (6) KT on quadriceps and hamstring muscles was performed with Y-shaped technique. The subjects lay in the supine position with the hip flexed at 30◦ and the knee flexed at 60◦. In the supine position, taping was first applied to the quadriceps femoris. The tape was applied from a point 10 cm inferior to the anterior superior iliac spine, bisected at the junction between quadriceps femoris tendon and the patella, and circled around the patella, ending at its inferior side. The first 5 cm of the tape were not stretched. The portion between the first part of tape and superior patella was stretched to 50–70%. The remaining tape around the patella remained un-stretched. After that, in the prone position, hamstring was taped secondly with the same method.
  

Aydogdu et al.

5. Rahlf et al. (7) KT on their quadriceps femoris and hamstring muscle. A medial and a lateral “I” strap as well as 1 “I” strap over the patella were applied. “I” strap means the tape is not cut into different parts; The strap across the patella was applied in individual maximum knee flexion. The base of the tape was applied at the tibial tuberosity and pulled in maximum tension over the patella, ending at the lower third of the quadriceps femoris muscle. The medial and lateral straps were applied in 45° knee flexion along the collateral medial and lateral ligaments.
  

Rahlf et al.

Outcomes after place KT

Visual analog scale (VAS)

VAS scale was adopted to measure pain and it was considered a subjective method.

Taping was associated with a significantly reduction in VAS scale at rest, as well as at movement in patients with knee OA. This pain reduction can be attributed to neurological suppression, due to stimulation of cutaneous mechanoreceptors.

Anandkumar et al. (8) showed that there was a decreased pain in Kinesio Taping groups while climbing stairs. The present meta-analysis indicated that Kinesio Taping was associated with a significantly reduction in VAS scale at rest.

Range of motion and McMaster Universities Arthritis Index (WOMAC) scale
Articular cartilage can be damaged by normal wear and abnormal mechanical loading which may cause abnormal cellular activities in cartilage and synovium, resulting in stiffness, loss of range of motion (9).

Our review demonstrated that Kinesio Taping was associated with an improved WOMAC compared with sham Taping. So Kinesio Taping could significantly improve knee flexion range of motion.
 

Muscle strength

Quadriceps femoris muscle weakness is a common symptom in knee OA and this may affect joint function and accelerate progress of degeneration (10,11). There was no significant difference in quadriceps femoris muscle in patients with knee OA.
 

Conclusions

Kinesio Taping is effective in improving for pain and joint function in patients with knee OA.
 

Bibliography

 1. M. Hurley, K. Dickson, R. Hallett, R. Grant, H. Hauari, N. Walsh, C. Stansfield, S. Oliver, Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review, Cochrane Database Syst. Rev. 4 (2018) CD010842. 

2. S. Demehri, D. Shakoor, Structural Changes in Aging-knee versus Early-knee Osteoarthritis: Review of Current Evidence and Future Challenges, Osteoarthritis and cartilage, 2018. 

3. H.Y. Cho, E.H. Kim, J. Kim, Y.W. Yoon, Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial, Am. J. Phys. Med. Rehabil. 94 (3) (2015) 192–200. 

4. B. Wageck, G.S. Nunes, N.B. Bohlen, G.M. Santos, M. de Noronha, Kinesio Taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial, J. Physiother. 62 (3) (2016) 153–158. 

5. E. Kaya Mutlu, R. Mustafaoglu, T. Birinci, A. Razak Ozdincler, Does kinesio taping of the knee improve pain and functionality in patients with knee osteoarthritis?: a randomized controlled clinical trial, Am. J. Phys. Med. Rehabil. 96 (1) (2017) 25–33. 

6. O. Aydogdu, Z. Sari, S.U. Yurdalan, M.G. Polat, Clinical outcomes of kinesio taping applied in patients with knee osteoarthritis: a randomized controlled trial, J. Back Musculoskelet. Rehabil. 30 (5) (2017) 1045–1051. 

7. A.L. Rahlf, K.M. Braumann, A. Zech, Kinesio taping improves perceptions of pain and function of patients with knee osteoarthritis. A randomized, controlled trial, J. Sport Rehabil. (2018) 1–21. 

8. S. Anandkumar, S. Sudarshan, P. Nagpal, Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study, Physiother. Pract. 30 (6) (2014) 375–383. 

9. D. Chen, J. Shen, W. Zhao, T. Wang, L. Han, J.L. Hamilton, H.J. Im, Osteoarthritis: toward a comprehensive understanding of pathological mechanism, Bone Res. 5 (1) (2017) 1–13. 

10. C. Slemenda, D.K. Heilman, K.D. Brandt, B.P. Katz, S.A. Mazzuca, E.M. Braunstein, D. Byrd, Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women? Arthritis Rheum. 41 (11) (1998) 1951–1959. 

11. M.B. Conroy, C.K. Kwoh, E. Krishnan, M.C. Nevitt, R. Boudreau, L.D. Carbone, H. Chen, T.B. Harris, A.B. Newman, B.H. Goodpaster, Muscle strength, mass, and quality in older men and women with knee osteoarthritis, Arthritis Care Res. 64 (1) (2012) 15–21.

WHAT IS PILATES

Image 1: Pilates material

         The increase in the importance of healthy habits in our society has made that people focus their interest in other types of sport and other forms to have an active life style.
Actually, we can see a lot of adverts, products and clinics with the word Pilates but, do we really know what is it? What are the benefits and contraindications? I will answer this and more questions in the next report.

Joseph Hubertus Pilates was the creator of that modality of sport, which is based on the control movements, breathing and core strength. He wanted to design a training plan for military, but the physiotherapist realized that it was also possible to adapt it for people with any pathology.

If you want to begin Pilates you should practice the follow advices:

-          Lie on your back with a bent towel under your head.
-          Flex your knees and ankles supporting your feet on the ground.
-          Flex your head trying to hang on an imaginary egg with your chin and breastbone.
-          Get a neutral posture of your hip (Image 2)
-          Inhale with the noise and exhale with your mouth
-          Breathe increased your rib grille, not the stomach
-          When you exhale, hide your belly button and elevate your pelvic floor. Increasing the strength of your CORE but not the pression in your pelvic floor

 

Image 2: a) Neutral pelvic, b) Retroversion, c) Anteversion

Core is a muscular box with:

- Abdominal muscles in the FRONT

- Erector spinae and glutes on the back

- Diaphragm as ROOF

- Muscles of the pelvic floor and the hip joint as FLOOR

We must take this into account because CORE helps us to stabilize the body in the different Pilates exercises and to be able to control the movements.

Image 3: CORE muscles

        Benefits:

-          High the strength muscular
-          Increase the flexibility
-          Become aware of your body
-          Correct the posture
-          Improves relaxation

Contraindications:

-          Be careful during pregnancy with posture, tension in CORE and specific exercises
-          Be careful in patients with incontinence urinary in doing well the elevation of pelvic floor in ever exhalation

Pilates  Pilates exercises What is pilates

WHAT I SHOULD PUT ON, HEAT OR COLD?

In the event of injury, is it better to apply cold or, on the contrary, what should we use is heat? It is one of the most asked questions in consultation, so we would like to resolve this question in a generalized way.

Image 1: heat or cold

As a general rule:

- If the injury occurs in the back or we are sure it is a muscle contracture, we will apply heat to the area.

- After physical exercise apply cold.

- In case of traumatic injuries such as blows, sprains or breaks, follow the following advice:

• Acute injuries: (less 3 days from the injury)

We will apply cold until 72 hours after traumatic injuries if we notice that we have red, bulging or reddened area. Maintain the application of cold 20 minutes being able to repeat the operation 3 and 5 times a day allowing at least 2 hours between each one.

• Subacute injuries: (between 3rd day and 1 month since the injury)

We will alternate cold and heat by direct application (bags or gels), containers with cold and hot water or in the shower. The application will be 3'calor + 2'frío + 3'calor + 2'frío + 3'calor. Being able to repeat the operation 3 and 5 times a day allowing at least 2 hours between each of them. Remember that if we do physical exercise and we notice swelling or redness we will apply cold immediately afterwards.

• Chronic injuries: (more than 1 month since the injury)

Apply heat for 20 minutes and can repeat the operation 3 and 5 times a day allowing at least 2 hours between each. Also, remember that if we do physical exercise and we notice swelling or redness we will apply cold immediately afterwards.

Image 2: cold contraindications

Cold contraindications:

- Raynaud's syndroms
- Heart problems
- Alterations of circulation
- Hypersensitivity or allergy to cold
- Acute inflammation of unknown origin or fever

Image 3: heat contraindications

Heat contraindications:

- Heart problems
- Alterations of sensitivity
- Wounds, ulcers, burns
- Fever
- Varicose veins
- Lymphedema
- Diabetes

sciatica pain relief hot or cold

BEFORE DOING PHYSICAL EXERCISE ... TO STRETCH OR NOT TO STRETCH? ... THAT IS THE QUESTION

The static stretching is held in a stretch of the muscle at rest until a certain position and maintaining the position for 15 - 30 seconds. It is commonly practiced by athletes as part of a routine prior to exercise and as part of a continuous exercise program.

Every weekend I can see that, before a race, a lot of athletes do this type of stretching, which makes me think if I should imitate them or not. With this article I want to scientifically verify if static stretches before physical exercise fulfill the benefits that most people believe they have:

· Improve flexibility,
· Improve physical performance and / or,
· Prevent injuries in the musculotendinous unit.

FLEXIBILITY

There is consistent evidence that static stretching increases flexibility in the short term, although gains in flexibility decrease relatively quickly, so that they are lost in 30 minutes 1-5. But there is also consistent evidence that stretches performed regularly over several weeks produce significant improvements in the range of motion ^6-11.

The mechanism of how this increase in range of motion occurs is subject to debate, which may be changes in neurophysiological factors (for example, changes in the tolerance to stretching) or mechanical factors (for example, viscoelastic changes).

Several studies have shown that static stretching does not change the mechanical properties of the musculotendinous unit ^10,12-18. This would suggest that the increase in range of motion is due to a greater tolerance to stretching, rather than to any mechanical alteration in the tissues.

In summary:
· Static stretching increases flexibility in both the short and long term.
· The mechanism through which static stretching achieves greater flexibility is still debatable. While a greater tolerance to stretching is likely and mechanical changes are very unlikely.

PHYSICAL PERFORMANCE

Effect on explosive strength, power and muscular performance.

Several recent reviews and meta-analyzes ^19-22 have agreed that, static stretching maintained for more than 45 seconds immediately before exercise:

· Influences negatively on maximum strength, power, explosive muscular performance (for example, jumping and running), balance and agility or,

· It has no effect on performance.

In other words, none of the reviews showed a beneficial effect of static stretching on explosive muscle performance.

Effect on endurance performance

The influence of stretching on activities such as running and cycling is less clear. A recent review 23 described how several studies ^24-27 show a negative influence, while others ^23,28-30 show no change in performance. Very few studies 60 report improvements in endurance performance after stretching.

In summary

· Stretching should be avoided for more than 45 seconds immediately prior to participation in activities where strength or power are important, since performance is likely to be reduced without any clear benefit to justify continued use.
· In endurance activities, stretching is difficult to justify immediately before participation, since performance can be reduced without clear benefits that justify continued use.

INJURY PREVENTION

It seems intuitively to make sense that stretching should help prevent injuries or help speed up the return to activity. However, the relationship between the reference flexibility and the future risk of injury is complex, and many studies ^31,32 show that there is no relationship between the two.

In fact, several systematic reviews have evaluated the effect of stretching on the risk of injury ^33-35, concluding that:

- "There is insufficient evidence to support or interrupt routine stretching before or after exercise to avoid injury among competitive or recreational athletes" ³³ and

- "In light of these findings, routine stretching exercises before the start of sports activities are not a proven and effective method to reduce injury rates" ³⁶.

In summary:

· Static stretching does not seem to reduce the risk of injury.

CLINICAL IMPLICATIONS

It is difficult to justify the use of stretching for any of the objectives examined in this article:

· Flexibility: stretching is very effective both in the short and long term. However, flexibility is not as important a factor in performance and injury prevention as was previously thought.

· Short term performance: stretching can decrease performance, especially when performed immediately before explosive activities.

· Injury prevention: there is very little evidence that stretching is effective.

Therefore, the only area in which static stretching seems to offer a specific advantage is in the one with the greatest flexibility. There may be times when the most important goal is to improve flexibility (for example, ballet) by being only in these isolated circumstances in which static stretching may be justifiable.

BIBLIOGRAPHY

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2.            DePino G, Webright W, Arnold B, Duration of maintained hamstring flexibility after cessation of an acute static stretching protocol. J Athl Train 2 2000; 35:56-59.

3.            Spernoga SG, Uhl TL, Arnold BL, Gansneder BM. Duration of maintained hamstring flexibility after a one-time, modified hold-relax stretching protocol. J Athl Train 2001; 36:44-48.

4.            Ford P, McChesney J. Duration of maintained hamstring ROM following termination of three stretching protocols. J Sport Rehabil 2007; 16:18-27.

5.            O'Sullivan K, Murray E, Sainsbury D. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord 2009; 10:37.

6.            Harvey L, Herbert R, Crosbie J. Does stretching induce lasting increases in joint ROM? A systematic review. Physiother Res Int2002; 7:1-13.

7.            Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C. Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med 2006; 40:870-875.

8.            Bandy WD, Irion JM, Briggler M. The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles. J Orthop Sports Phys Ther 1998; 27:295-300.

9.          Chan SP, Hong Y, Robinson PD. Flexibility and passive resistance of the hamstrings of young adults using two different static stretching protocols. Scand J Med Sci Sports 2001; 11:81-86.

10.          Reid DA, McNair PJ. Passive force, angle, and stiffness changes after stretching of hamstring muscles. Med Sci Sports Exerc 2004; 36:1944-1948.

11.          Decoster LC, Cleland J, Altieri C, Russell P. The effects of hamstring stretching on range of motion: a systematic literature review. J Orthop Sports Phys Ther 2005; 35:377-387.

12.          Halbertsma JP, Goeken LN. Stretching exercises: effect on passive extensibility and stiffness in short hamstrings of healthy subjects. Arch Phys Med Rehabil 1994; 75:976-981.

13.          Klinge K, Magnusson SP, Simonsen EB, Aagaard P, Klausen K, Kjaer M. The effect of strength and flexibility training on skeletal muscle electromyographic activity, stiffness, and viscoelastic stress relaxation response. Am J Sports Med 1997; 25:710-716.

14.          Magnusson SP, Simonsen EB, Aagaard P, Boesen J, Johannsen F, Kjaer M. Determinants of musculoskeletal flexibility: viscoelastic properties, cross‐sectional area, EMG and stretch tolerance. Scand J Med Sci Sports 1997; 7:195-202.

15.          Gajdosik RL, Allred JD, Gabbert HL, Sonsteng BA. A stretching program increases the dynamic passive length and passive resistive properties of the calf muscle-tendon unit of unconditioned younger women. Eur J Appl Physiol 2007; 99:449-454.

16.          Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation? Phys Ther 2010; 90:438-449.

17.          Konrad A, Gad M, Tilp M. Effect of PNF stretching training on the properties of human muscle and tendon structures. Scand J Med Sci Sports 2014.

18.          Ben M, Harvey L. Regular stretch does not increase muscle extensibility: a randomized controlled trial. Scand J Med Sci Sports 2010; 20:136-144.

19.          Behm D, Bambury A, Farrel C, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exerc 2004; 36:1397-1402.

20.          Kay AD, Blazevich AJ. Effect of acute static stretch on maximal muscle performance: a systematic review. Med Sci Sports Exerc 2012; 44:154-164.

21.          Simic L, Sarabon N, Markovic G. Does pre‐exercise static stretching inhibit maximal muscular performance? A meta‐analytical review. Scand J Med Sci Sports 2013; 23:131-148.

22.          Winchester JB, Nelson AG, Landin D, Young MA, Schexnayder IC. Static stretching impairs sprint performance in collegiate track and field athletes. J Strength Cond Res 2008; 22:13-18.

23.          Peck E, Chomko G, Gaz DV, Farrell AM. The effects of stretching on performance. Curr Sports Med Rep 2014; 13:179-185.

24.          Wilson JM, Hornbuckle LM, Kim JS, Ugrinowitsch C, Lee S-R, Zourdos MC, et al. Effects of static stretching on energy cost and running endurance performance. J Strength Cond Res 2010; 24:2274-2279.

25.          Lowery RP, Joy JM, Brown LE, Oliveira de Souza E, Wistocki DR, Davis GS, et al. Effects of static stretching on 1-mile uphill run performance. J Strength Cond Res 2014; 28:161-167.

26.          Wolfe AE, Brown LE, Coburn JW, Kersey RD, Bottaro M. Time course of the effects of static stretching on cycling economy. J Strength Cond Res 2011; 25:2980-2984.

27.          Esposito F, Cè E, Limonta E. Cycling efficiency and time to exhaustion are reduced after acute passive stretching administration. Scand J Med Sci Sports 2012; 22:737-745.

28.          Mojock CD, Kim JS, Eccles DW, Panton LB. The effects of static stretching on running economy and endurance performance in female distance runners during treadmill running. J Strength Cond Res 2011; 25:2170-2176.

29.          Hayes PR, Walker A. Pre-exercise stretching does not impact upon running economy. J Strength Cond Res 2007; 21:1227-1232.

30.          Allison SJ, Bailey DM, Folland JP. Prolonged static stretching does not influence running economy despite changes in neuromuscular function. J Sports Sci 2008; 26:1489-1495.

31.          Bennell K, Tully E, Harvey N. Does the toe-touch test predict hamstring injury in Australian Rules footballers? Aust J Physiother 1999; 45:103-109.

32.          Wang HK, Chen CH, Shiang TY, Jan MH, Lin KH. Risk-factor analysis of high school basketball–player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility. Arch Phys Med Rehabil 2006; 87:821-825.

33.          Thacker SB, Gilchrist J, Stroup DF, Kimsey CJ. The impact of stretching on sports injury risk: a systematic review of the literature. Med Sci Sports Exerc 2004; 36:371-378.

34.          Herbert RD, Gabriel M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. BMJ 2002; 325:468.

35.          Shrier I. Does stretching improve performance? A systematic and critical review of the literature. Clin J Sport Med 2004; 14:267-273.

36.          Schiff MA, Caine DJ, O'Halloran R. Injury prevention in sports. Am J Lifestyle Med 2010; 4:42-64.

stretch

stretch before or after exercise