P4R4W6: Sports Outtings

This week there was a South Island Secondary Schools womens soccer tournament at Saxon soccer fields in Nelson and in my non-clinic hours I was down at the soccer fields (it's been a full on week). There was a range of acute conditions, as you would expect. The highlights from this would be watching new ways of strapping, learning more about K-tape (I'll describe this soon), hearing about physiotherapy business and what to aim for in an employment contract. I had some practice with ACC read codes and having clients add extra details or fill in missing boxes on the ACC45 form. In the clinic we completed an online ACC32 form, request for further treatment, for a client and we had it accepted within the week.

Prior to this placement I understood K-tape to increase proprioceptive input (due to its adhesion to skin and elastic nature), or facilitate the reduction of swelling (jellyfish cut k-taping, with the tentacles/tails draped over the area of swelling towards the body of the jellyfish... best I can describe it). This week I learned that k-tape "in theory" can be used to facilitate or inhibit muscle activity depending on the amount of stretch and direction of elastic recoil. Cool idea, but I don't feel entirely convinced...

• To facilitate muscle activation: Apply the tape proximal to distal, aligned with the muscle fibres with 25-50% stretch - the elastic recoil pulls the skin towards a shortened muscle position.
• To inhibit muscle activation: Apply the tape distal to proximal, aligned with the muscle fibres with 0-25% stretch - the elastic recoil pulls the skin towards a lengthened muscle position with the idea that a muscle is more relaxed under stretch.
• To apply a mechanical correction, such as a medial glide of the patella e.g. applied from a bent knee position with  maximal stretch in a horse-shoe shape  on the lateral boarder of the patella, as the client straightens their knee you taper off the stretch (the ends of K-tape shouldn't be under any stretch... so it won't peel itself off). A mechanical correction could also be an AP glide on the GH joint.
• A decompression technique acts to lift the skin and fascia to minimise irritation from additional tape applied over-top (rigid tape). For example, to decompress the skin over the achillies tendon, apply one strip along the length of the tendon itself, stretching 25%, then a second strip is applied at 25% stretch directly over-top of the first strip (the ends can extend passed the first tape to adhere to the skin). Rigid taping, such as an ankle lock can then be applied over-top of this.

I then stumbled upon an article by Lee K, Yi C & Lee S (2016) The effects of kinesiology taping therapy on degenerative knee arthritis patients' pain, function and joint range of motion. The authors applied K-tape applied to the hamstrings, tibialis anterior on patients with pain on knee flexion OR quadriceps or gastrocnemius on patients with pain on knee extension. The control group of patients got a heat pack and some interference wave therapy. Results? Those older persons who had degenerative, painful knees had significantly less knee pain, increased range of motion and improved WOMAC scores (better function, reduced stiffness). Interesting stuff.
 

Tuesday Michael taught us how he goes about examining a foot. The main points that captivated my interest was how to manipulate (grade V mobilisation) the ankle & foot. One of particular interest was the talonavicular joint and talocrural joint. Dorsiflex the ankle into a closed-packed position (end range), then slightly plantarflex it (so it isn't quite at end range). With one hand on the calcaneous (heel), other hand on the talus with hand rolling the navicular away from the talus (gapping the talonavicular joint). Take these joints into a grade 4+ distraction / mobilisation in a caudal direction, then thrust. Amazing! Tuesday was also the first client that I've assessed and treated that required an interpreter.

This weekend I'll be frantically writing up my community project / mini-review for presentation at an in service training session on Wednesday and submission on Friday. Coincidentally, the group research project about falls (my research placement) is due next Friday too - it'll need to be printed and submitted sometime next week.