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بسم هللا الرحمن الرحیم Taping Mohammad Saleki MD Sport medicine specialist IUMS Taping Taping is an important skill for the sports medicine team Many technique are used Goals of taping Prophylactic (Athletic tape) : (adding support ,stability and protect against acute injuries, limit unwanted joint movement ) Treatment(acute,subacute,chronic): minimize bleeding ,swelling&pain, limit rang of motion, to hold dressings and healing injuries Rehabilitative (Kinesio taping) : Provide stabilization , optimal healing and protect recurrent injuries Taping مفاصل مناسب: مچ دست و پا-انگشتان دست و پا-آكرمیو كالویكوالر مفاصل نامناسب :آرنج-زانو -ستون فقرات TAPING MECHANISMS: MECHANICAL PROPRIOCEPTIVE (DIRECT REFLEX STIMULATION– LEARING PROCESS ) Proprioception is joint position sense (determine position of joint in space) Joint Mechanoreceptors Found in ligaments, capsules, menisci, labra, and fat pads Ruffini’s endings Pacinian corpuscles Free nerve endings Sensitive to changes in shape of structure and rate/direction of movement Most active at end of ranges of motion Muscle Mechanoreceptors Muscle spindles - sensitive to changes in length of muscle Golgi tendon organs - sensitive to changes in tissue tension Selection considerations Goals of taping Diagnosis of injury(Location,Nature,Severity ) knowledge of anatomy and biomechanics movements that should restrict tissues that should protect and support Sport & position Athletes acceptance A taping that is effective for an athlete in one sport may not be suitable for another athlete هدف از تیپ نوع ومحل آسیب رشته ورزشي پوزیشن ورزشكار مورد قبول ورزشكار مورد قبول ورزشكار If the athlete feels that taping is uncomfortable or decreases performance the attempt to support will failed Type of tape Elastic ) sizes: ( سانتیمتر5-20 Non-adhesive elastic Adhesive elastic Non- Elastic sizes: سانتیمتر3-8 elastic taping To compress & support soft tissue To provide anchors around muscle thus allowing for expansion To hold protective pads in place Good for small, angular body parts اعمال فشار وحمایت برای دور عضالت برای نگه داری پدها در محل non-elastic taping To support inert structures To limit joint movement حمایت مفصل تاندون لیگامان از حركات اضافي To protect against re- injury To secure ends of elastic tape To reinforce elastic tape To enhance proprioception کاهش دامنه حرکتی پیشگیری از آسیب مجدد براي حمایت وتقویت از بانداژ فشار بر محل آسیب افزایش پروپریوسپتیو Differences in Taping methods Athletic tape Mechanical • Functional immobilization Target: • Protect joints and muscles • By the tape could be possible a tailback of the circulation Kinesio tape Mechanical • Full Range of Motion Target: • To support over the muscle activity the natural healing process of the body • No tailback of the circulation 13 Athletic tape limits joint movement and is not used for rehabilitative purposes because of its rigid, supportive characteristics that do not allow the weakened or injured muscles to heal and function properly. Kinesio taping is known more for its therapeutic effects than as a taping technique. Kinesio tape(KT) was developed in Japan by Dr. Kenzo Kase in 1963 and was introduced to the United States in the 1990’s. 14 Athletic Tape Athletic tape is available in a variety of Manufactures Widths (Sizes) Colors Strength Styles Static cloth-linen Elasticity or stretch Stretch or elastic tape is used for the smaller, more angular body parts such as the feet, hands, wrist and fingers. Strapping Tape & Base Tape (McConnell Tapping) Coban / Coflex Kinesio Tape (Self Adhesive) Elastic / Stretch Tape Elastikon (Stretch Tape) Cloth Athletic Tape Supplies b. Identify the necessary supplies and their purpose for prophylactic taping. 1. 2. 3. 4. 5. Athletic tape (various size) Underwrap Heel and lace pad Adhesive spray Shark / Scissors Principle of taping Tape selection Skin care Application انتخاب تیپ مناسب Size Type Quality غیر محرك-برش آسان -چسبان -قوي - مقاومت-چسبندگی-بافت:سه خصوصیت مهم Tape Grade: cost = fibers Longitudinal and vertical fibers per inch More costly (heavier) contains 85 horizontal and 65 vertical fibers برش آسان- غیر محرك- قوي-باتعریق باز نشود-چسبندگی خوب Underwrap (Pre-Wrap) Underwrap in a variety of manufactures and colors. helps to protect the skin but decreases the efficiency of the tape. used over areas that not shaved or are not free of body hair. It may also be used over areas of irritation due to adhesive tape. Only one layer should be applied. آماده سازي پوستي تمیز وخشک كردن پوست تراشیدن مو زخم پانسمان پد گذاری نقاط حساس نحوه کاربردTaping نكات مورد توجه : وضعیت قرار گیري مناسب درمانگر مفصل در حالت پایدار نباید مانع حركات اساسي ورزشكار شود لیگامان سالم در وضعیت خنثي لیگامان آسیب دیده در وضعیت كوتاه شده Overlap the tape by half Keep tape roll in hand whenever possible Avoid: -excessive traction on skin-this may lead to Skin breakdown -gaps and wrinkles-this may cause blisters -continuous circumferential taping-single strip Produce a more uniform pressure -excessive layers of tape-this may impair Circulation and neural transmission Proper Taping Technique Always start taping with anchors Always finish taping with locking strips Do not apply tape if skin is hot or cold from treatments Terminology associated with prophylactic taping procedures Anchor – Provides a firm base to attach other tape ends. With an Ankle Adhere 1-2 anchor strips at about one third of the way up the lower leg & also at approximately the mid point of the foot. Stirrup – A vertical "U" piece of tape to support either side of the ankle. With an Ankle Adhere a strip of tape to the inside (Medial) upper (Proximal) anchor, flowing down (Distal) the inside ankle, under the foot & up & over the outer (Lateral) edge of the ankle. Back Figure 8-18 Figure 8-19 Figure 8-17 © 2011 McGraw-Hill Higher Education. All rights reserved. Taping برروی پوستی که با درمان سرد یا گرم است اجتناب کنید پس ازمسا بقه تیپ باز شود عوارض : تحریك پوستي كاهش گردش خون كاهش اثر بمرور زمان(بعد از 10دقیقه تا)%40 After Taping Check for comfort as well as signs of impaired circulation. Numbness Tingling Discoloration Loss of pulse Loss of function Foot Taping Arch Technique 2 (for longitudinal arch) Figure 8-21 © 2011 McGraw-Hill Higher Education. All rights reserved. Sprained Toes Function : to support metatarsophalangeal joint Figure 8-25 © 2011 McGraw-Hill Higher Education. All rights reserved. Hallux Valgus Figure 8-26 © 2011 McGraw-Hill Higher Education. All rights reserved. Turf Toe (prevents excessive hyperextension of metatarsophalangeal joint) Figure 8-27 © 2011 McGraw-Hill Higher Education. All rights reserved. Hammer or Clawed Toes (reduces pressure of bent toes against shoes) Figure 8-28 © 2011 McGraw-Hill Higher Education. All rights reserved. Fractured Toes (splints injured to non-injured toe) Figure 8-29 © 2011 McGraw-Hill Higher Education. All rights reserved. Common Ankle Taping Procedures Closed Basket Weave Function: to minimize ankle motion Dorsiflexion and Plantarflexion Inversion and Eversion Aids in controlling swelling Closed Basket Weave (Gibney) Technique Used for newly sprained or chronically weak ankles Figure 8-30 © 2011 McGraw-Hill Higher Education. All rights reserved. Open Basket Weave Function: to minimize ankle motion Allows more dorsiflexion and plantarflexion Minimizes inversion and eversion Used to support newly sprained ankles allowing room for swelling Used with elastic bandage and cold application Aids in controlling swelling Open Basket Weave Figure 8-31 © 2011 McGraw-Hill Higher Education. All rights reserved. Common Leg & Knee Taping Procedures Achilles Tendon (prevent Achilles over-stretching) Figure 8-33 © 2011 McGraw-Hill Higher Education. All rights reserved. Collateral Ligament Function: to provide joint stability following injury to the MCL or LCL ligaments Figure 8-34 © 2011 McGraw-Hill Higher Education. All rights reserved. Rotary Taping for Knee Instability (provides stability following ACL & MCL injury) Figure 8-35 © 2011 McGraw-Hill Higher Education. All rights reserved. Knee Hyperextension (Prevent knee hyperextension, provide support to injured hamstring or slackened cruciate ligament) Figure 8-36 © 2011 McGraw-Hill Higher Education. All rights reserved. Common Upper Extremity Taping Procedures Elbow Restriction (Prevents elbow hyperextension) Figure 8-42 & 43 © 2011 McGraw-Hill Higher Education. All rights reserved. Wrist Technique 1 (Mild wrist sprains and strains) Figure 8-44 © 2011 McGraw-Hill Higher Education. All rights reserved. Wrist Technique 2 (Protects and stabilizes badly injured wrist) Figure 8-45 © 2011 McGraw-Hill Higher Education. All rights reserved. Sprained Thumb (Provides support to musculature and joint) Figure 8-47 © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 8-18 Figure 8-19 Figure 8-17 © 2011 McGraw-Hill Higher Education. All rights reserved. Kinesio tape • Thickness, weight and stretch ability are similar to the skin • By the sinus waves: leaky for air and liquid • Heat activated adhesive • Main effects till 3 to 5 days - Can be used till some weeks 59 Kinesio Taping Technique developed in Japan and widely used throughout Europe and Asia Can be stretched to 140% of original length Used for edema reduction, pain management, and inhibition/facilitation of motor activity © 2011 McGraw-Hill Higher Education. All rights reserved. Mechanism Kinesio Tape Improving circulation and lymph by eliminating tissue fluid or bleeding beneath skin Correcting muscle function by strengthening weakened muscles Decreasing pain through neurological suppression Repositioning subluxed joints by relieving abnormal muscle tension © 2011 McGraw-Hill Higher Education. All rights reserved. Activation of the endogen analgetic system • Spinal/ Supra spinal by activation of supra spinal and spinal analgesic afferent skin impulse • By a better circulation system by Support of the joint functions by • Proprioceptive stimulation • Functional correction • Passive support • Mechanical correction • Pain depression 63 Without KT there is pain and pressure on the receptors. Blood and Lymph is trapped under the skin. With KT the top layer of tape causes convolutions and lifts the skin. Pain and pressure is reduced. Blood and Lymph fluid is dispersed. 64 Kinesio Tape’s assist to Muscle Function Assists a weak muscle or muscle group tape from origin to insertion so that the tape pulls toward the origin, assisting in contraction as the tape recoils Kinesio Tape’s assist to Muscle Function Inhibits muscle spasm Tape from insertion to origin; as the tape recoils it stimulates the GTO and fascia and prevents overwork. Kinesio Tape Cutting Techniques “I” cut for stabilizing joints or muscle “Y” to surround muscle belly / fibers “X” shape to stabilize a joint or for muscles “Fan” to reduce edema, drawing fluid toward the anchor Basic Application Principles Apply tape from origin to insertion without minimal tension for muscle support Should be applied from insertion to origin during rehabilitation Can be worn for 3-4 days Latex free, cotton fabric Heat activated adhesive © 2011 McGraw-Hill Higher Education. All rights reserved. Techniques mechanical technique .1 .1مفصل را در راستای درمانی مناسبش از لحاظ بیومکانیکی قرار داد space technique .2در این تکنیک درست در باالی ناحیه درد ،التهاب و ادم فضای اضافی ایجاد می گردد ،و به دنبال Liftingپوست ایجاد شده بر روی ناحیه درد یا التهاب ،فشار روی ناحیه کم می شود Functional technique .3با استفاده از تحریکات پوستی می خواهیم محدودیت حرکتی روی مفصل ایجاد کنیم Fascia technique .4با استفاده از خاصیت االستیک نوار می توان فاشیا را در یک راستای مناسب و دلخواه قرار داد Tendon/Lig. .5لیگامان یا تاندون Unloadمی شود Lymph technique .6کمک به درناژ لنفی جهت بستن نوار در روش Basic درموارد آسیب های حاد یا کشیدگی ها .برای استراحت عضله: نواراز Ins.به Orig.عضله کشیده می شود. Acute …… Ins. Orig. (کشش کمترحدود 15تا )%25 درموارد آسیب های مزمن ،ضعف ،یا اسپاسم .بهتر شدن کارعضله یا کمک به عضله: نواراز Orig.به Ins.عضله کشیده می شود. Chronic …… Orig. Ins. (کشش )%50-25 Acromioclavicular Joint Sprain 3 1 2 برش I Strip چون می خواهیم فشار را از روی مفصل برداریم در نوار برش ی به نام برش «دونات تکنیک» استفاده می کنیم :با قیچی یک برش 4 وسط نوار تاشده ایجاد می کنیم. بریدن کاغذ به صورت Paper off سوراخ را روی ACJمی گذاریم تنشن %90میانه نوار ،و تنشن offدو انتهای نوار اگر تنشن بیشتری بخواهید از تکنیک استار استفاده کنید :چند I Stripرا با تکنیک دونات در جهات مختلف روی ACJببندید. 5 Deltoid )(Rotator Cuff Lesion 4 • • • • 3 2 برش از نوع Yاست .به صورت Tension on the tail پس پایه کوتاهتر است. هدف :استراحت دادن به عضله (جهت نوار از ins.به Orig. است) پایه اولیه را بر روی توبروزیته دلتوئید به صورت تنشن off می بندیم. برای فیبرهای قدامی دلتوئید ،شانه را به اکستانسیون و برای 1 6 5 GHJ )(Rotator Cuff Lesion 3 • • • • • • 2 هدف ایجاد یک وضعیت مکانیکال درست برای مفصل شانه است. برش Y Tension on the base برای بستن پایه ،شانه به Ext. Rot.برده می شود .در ادامه فلکس می گردد. کشش مایوفاشیال با Downward Pressure ابتدا و انتهای نوار تنشن offاست. 5 1 4 ACJ )(Rotator Cuff Lesion • • • • • برش I تکنیک Paper off مفصل ACرا بیابید .مرکز نوار را روی مفصل قرار دهید. تنشن مرکزی حدودا 70- 80%می باشد. ابتدا و انتهای تکنیک تنشن offاست. 2 4 1 3 پس مالحظه کردید که در صدمه روتاتورکاف از چندین الیه Applicationاستفاده شد: الیه ای برای هر یک از عضالت دلتوئید و سوپرااسپیناتوس (به صورت )Basic برای مفصل شانه )(Mechanical Corrective برای مفصل اکرومیوکالویکوالر (Ligament/Tendon )Corrective MCL Sprain متد Lig./Tendon App. Corr.است. برش I توبروزیته تیبیا را بیابید و پایه نوار را بر روی آن ببندید. زانو را 30درجه خم کنید. نوار را روی لیگامان به طرف باال بکشید. 1 2 Meniscus Injury 3 2 برش I؛ Paper off متد Space correction Application %50تنشن وسط سپس زانو را خم کنید .دو انتهای نوار تنشن offاست. در صورت نیاز از تکنیک استار استفاده شود. 1 Sup-Patella Bursitis 3 2 برش Web پایه روی توبروزیته تیبیا بسته می شود. زانو در میدپوزیسیون است. در شروع تنشن offاست .در ادامه %50تنشن دارد. در انتهای عملیات نواربندی ،نوارها را از همدیگر دور کنید. 1 Patella Tendinitis برش I پایه را بر روی توبروزیته تیبیا ببندید. زانو اکستند است. با تنشن %70تا لبه تحتانی کشکک بکشید. بعد زانو را فلکس کنید و ازمیزان تنشنی که می دهید کم کنید تا نهایتا به تنشن 3 offبرسید. گاهی دراین مشکل VMOرا نیز درنظرمی گیریم. از Orig.به Ins.نوار را می بندیم. برش Y Tension on the tail نواررا درحالی که زانو خم است می بندیم تا کشیده شود. 2 5 1 4 L.B.P 3 1 2 هدف افزایش حس پروپریوسپشن عضالت پاراورتبرال است تا همیشه در یک تنشن حفاظتی باشند. برش I؛ پایه نوار روی PSISبه صورت تنشن off سپس از فرد می خواهید به جلو خم شود .برای سمت دیگر تکرار کنید. نقطه درد را بیابید. Istrip؛ به صورت Paper offبا تنشن %50 در صورت اعمال فشار بیشتر :تکنیک استار 5 4 Kinesio Taping for Plantar Fasciitis Figure 8-50 © 2011 McGraw-Hill Higher Education. All rights reserved.