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2/2/2018
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Elastic Taping
Nicolle Samuels, MSPT, CLT-LANA, CWS, CKTP
Description & Objectives
This instructional session will review the concept of elastic taping as an adjunctmodality to CDT in the treatment of lymphedema and related conditions. Afterreview of concepts, attendees will have the opportunity to participate in a hands-on laboratory session focused on elastic taping applications for variouslymphedema presentations, focal edema issues, and scar mobilization techniques.
Objectives:Participants will:• Understand anatomic and physiological effect of elastic taping on the lymphatic
system• Understand indications, precautions, and contraindications to elastic taping• Observe and actively participate in laboratory session for practical application of
elastic taping to specific patient presentation simulations– Lymphedema (facial, truncal, limb), focal edema, and scar techniques
• Understand patient education topics related to elastic taping application and safety
Lab Sponsors Elastic Taping Effects
• Encourage uptake of lymphatic loads
• Improve blood and lymphatic circulation
• Reroute fluid congestion
• Reduce fibrosis
• Increase tissue mobility
• Reduce pain
• Facilitate muscle activation
Goal of Taping
• Direct lymphatic fluids toward areas of a less congested lymphatic pathway or lymph node grouping
• Optimal route of clearance :– taping across an anastamosis for activation– along a bundle in the limbs– global stimulation of the initial lymph plexus– an alternative route to decongested lymph nodes– around scars or other barriers
• Enhance and follow the patient’s individualized lymphatic drainage treatment strategy
Effectiveness• Stage 1, Early Stage 2:
– Water component
– Clinically effective
• Late Stage 2, Stage 3:
– Tissue fibrosis and adipose proliferation
– Mixed results published
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Lymphagiomotoricity
• Taking up elasticity results in stimulatory mechanical stresses on the anchoring filaments and a resultant “open junction” of the initial lymphatic vessels
• Smooth muscle response
• Similar effects as MLD
– Mechanical deformation
Springerimages.com
Adjunct to CDT
• Literature does not support utilizing taping as a stand-alone treatment or to replace any component of CDT
• In the case of contraindications/complications to MLD or compression bandaging, elastic taping could be utilized as a viable alternative
Applications may be worn beneath garments and bandages or proximal/distal to compression.
Conjunction to Compression Indications
• Activation of anastamoses• Generalized and focal areas of edema• Truncal and head/neck edema where bandaging
is difficult• Scar management• Traditional and alternative drainage pathways• Ecchymosis• Pain relief• Alternative to bandaging (cost, environmental
temperature tolerance, allergy, and quality of life)
Precautions/Contraindications
• direct use over new scars/incision sites, radiation fibrosis, wound sites, cysts, and fistulas
• skin sensitivities• skin insensitivity• fragile skin• allergy• sunburn• deep vein thrombosis• caution: systemic causes of edema
– cardiac and renal conditions
Safety
• Complications: allergy, skin tears
• Safety:
– Avoid wrinkles, folds, creases
– Max of ‘off the paper’ tension
– Test strip advised
– LyE population: CDT & elastic taping certification
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Tape Properties
• 100% cotton, acrylic adhesive
• Longitudinal 10% stretch applied to tape
• 3” preferred for edema applications
• 5 day wear
• Water
• Heat activated
Strategies
• Directional/Anatomic:
– Base at target, tails in anatomical treatment zone
– Ex: ‘octopus’ fan/strips
• Coverage/Zone:
– Maximize skin surface coverage
– Activation of initial lymph plexus
– Ex: wave, spiral, criss-cross
Channeling Concept
• Subcutaneous lift of skin
– Creates space for fluid flow
– Convolutions (microscopic)
Convolution Controversy
• Convolution Effectiveness: Literature demonstrates no difference in taping with or without convolutions
– Positioning in stretched position to allow full ROM results in safety and reduced injury to the skin
Intensity of ApplicationIncreased Decreased
Increasing # of strips Decreasing # of strips
Overlapping the strips No overlap/criss-cross
Increase application over larger surface area
•wave pattern
Decrease surface area treated
•straight/anatomical strips
Reducing space between strips
•maximal intensity is achieved when the width between the strips is equal to the width of the tape strip
Widen distance between strips
Skin Preparation
• Free of oils, lotions, perspiration, and hair
• Barrier products
• Positioning strategy
• Rub application to maximally adhere
– 30-60 min with body heat
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Application Caution
• Do not blow-dry tape
• Do not attach to nape of hair, through axilla, or groin
• Do not ‘pull’ patient into position using the tape
• Do not touch back of adhesive
• Do not utilize over open skin areas
• Remove if itching, burning or ↑ pain occurs
Patient Education
• Avoid activity x 60 min
• Movement
• Skin tolerance
• Pat dry
• Cut away non-adherent portions
• Self application strategy
• Removal
Patient Instruction
• Tape remains effective 3-5 days
• Maximally adhered in 20-30 minutes– Avoid high level activity during this time
• Movement and perspiration
• If tails peel up, cut off any non-adhered ends and leave remainder
• Can shower, just pat dry
• Could cause skin damage if removed prematurely due to high level of adherence
Removal
• Time – epithelial shedding• Moisten• Direction of the body hair• Products:
– commercial adhesive removers– oils
• Safety Strategy: fixate the proximal integument and separate the tape from the skin by utilizing your finger to push the skin down and away from the tape
Tape Removal
• Easiest if tape is moistened• Premature, may damage skin as adhesive is maximally
adhered• Best to remove from top down (direction of body hair)• Lift tape from skin, applying tension b/w skin and tape• Push skin away from tape rather than pulling the tape
away from the skin• Application of mineral oil or milk of magnesia may
assist in removal if tape remains strongly adhered
• Target tissue/anatomy to be effected
• Strategy utilized
• Direction of application
• Tension of tape
• Desired effect or tx goals
– Resolve edema
– Decrease pain
– Improve tissue mobility
• Education provided
Documentation
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Hands-On Lab
Taping Cuts Demo/Discussion
• Cuts:
–Fan
–I strips
–Punch tape
Taping Intensity Demo/Discussion
• Intensity
– Width
– Distance
– Overlap/criss-cross
– Treatment area
• wave
Strategy Case: L UE Stage 2 Secondary LyE
• Directional/Anatomic:
– Base at target, tails in anatomical treatment zone
– Ex: ‘octopus’ fan/strips
• Demo/Lab
Tape may be cut into a fan shape with a unifying base or individual strips. Application may be applied following the anatomical lymphatic drainage pathways or in a wave form to increase integumentary surface area coverage and intensity effect.
Strategy Case: L UE Stage 2 Secondary LyE
• Coverage/Zone:
– Maximize skin surface coverage
– Activation of initial lymph plexus
– Ex: wave, spiral, criss-cross
• Demo/Lab
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Coverage taping is performed on a patient with secondary left upper extremity lymphedema to facilitate activation of the initial lymphatic plexus on the arm. The strips are applied individually and extend in a wave pattern over the poster axillo-axillary anastamosis.
Case: Secondary Stage 2 & 3 Bil LE LyE
• Demo/Lab
– Intensity strategy
– Re-routing critical thinking
– Punch tape
Anatomic taping techniques following MLD route. Punch tape is applied bilaterally along IAs. The limb is taped with fan cuts covering tx areas in successive series over specific zones. Taping toward ipsilateral (involved) inguinal nodes may be utilized in general edema techniques or primary lymphedema, however rerouting laterally is indicated in secondary LyE.
Scar StrategiesThrough a Scar Rerouting
Improving Mobility
Negative Pressure
Space Correction• Lifting
– ↓ pressure on target tissue
– Creates recoil and lift over target tissue
– Multi-strip star application has cumulative effect
• 25-50% tension in middle of base
• Sample technique
– ‘Star’: Four ‘I’ strip
Case: Compression AlternativeSecondary Stage 2 Head/Neck LyE
• Demo/Lab
– Compression alternative
– Routing critical thinking
• Anterior vs posterior
• Bilateral vs unilateral
• Intensity
• Precautions
– Psychosocial considerations
– Long term management strategy
Taping???
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These pts are taped with anatomical taping following MLD patterns toward the left axilla. The base of the fan application is below the anterior and posterior upper horizontal watershed with tails covering the treatment zone. In general, taping can be applied unilaterally or bilaterally depending on patient presentation and treatment strategy. Careful consideration for scars and radiation fibrosis must be observed.
Case: Axillary Webbing
• Demo/Lab
– Adjunct to compression
– Activation of inter-territorial anastamoses
– Webbing: inhibition strategy from insertion to origin
• Improve mobility
• Increase range of motion/function
• Decrease pain
CDT is enhanced by applying fan cuts to anastamoses including: AAA & PAA toward RUQ, left AI toward LLQ, and above the upper horizontal watershed toward the left supraclavicular nodes. An additional strip of tape is applied over the axillary web syndrome cording presenting in this patient from the mastectomy scar distally toward the elbow. Tape is applied from distal point of cording adhesion toward proximal adhesion with off the paper tension or no stretch.
•Shim J, Lee H, Lee D. The use of elastic adhesive tape to promote lymphatic flow in the rabbit hind leg. Yonsei Medical Journal 2003; 44 (6): 1045-1052.
•Rock Tape. http://www.rocktape.co.uk/downloads/evidenceofefficacy.pdf. Published 2010. Accessed May 24, 2016.
•Rodrick JR, Poage E, Wanchai A. Management of lymphedema with complementary, alternative, and other non-complete decongestive therapies: a summary of
the ALFP. Lymph Link. 2013;26(4).
•Malicka I, Rosseger A, Hanuszkiewicz J, Woźniewski M. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment:
a pilot study. Prz Menopauzalny. 2014;13(4):221-6.
•Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the Kinesio Taping Method - 3rd Edition. Kinesio Taping Association;2013.
•Parreira Pdo C, Costa Lda C, Takahashi R, et al. Kinesio taping to generate skin convolutions is not better than sham taping for people with chronic non-specific
low back pain: a randomised trial. J Physiother. 2014;60(2):90-6.
•Parreira Pdo C, Costa Lda C, Takahashi R, et al. Do convolutions in Kinesio Taping matter? Comparison of two Kinesio Taping approaches in patients with chronic
non-specific low back pain: protocol of a randomised trial. J Physiother. 2013;59(1):52.
•Taradaj J, Halski T, Rosinczuk J, Dymarek R, Laurowski A, Smykla A. The influence of Kinesiology Taping on the volume of lymphoedema and manual dexterity
of the upper limb in women after breast cancer treatment. Eur J Cancer Care (Engl). 2015;
•Pop TB, Karczmarek-borowska B, Tymczak M, Hałas I, Banaś J. The influence of Kinesiology Taping on the reduction of lymphoedema among women after
mastectomy - preliminary study. Contemp Oncol (Pozn). 2014;18(2):124-9.
•Smykla A, Walewicz K, Trybulski R, et al. Effect of Kinesiology Taping on breast cancer-related lymphedema: a randomized single-blind controlled pilot study.
Biomed Res Int. 2013;2013:767106.
•Pekyavaş NÖ, Tunay VB, Akbayrak T, Kaya S, Karataş M. Complex decongestive therapy and taping for patients with postmastectomy lymphedema: a randomized
controlled study. Eur J Oncol Nurs. 2014;18(6):585-90.
•Gerasimenko MY, Knyazeva TA, Apkhanova TV, Kul'chitskaya DB. The application of the method of kinesio-taping technique for the combined non-
pharmacological rehabilitation of the patients presenting with lymphedema of the lower extremities. Vopr Kurortol Fizioter Lech Fiz Kult. 2015;92(5):22-7.
•Tsai HJ, Hung HC, Yang JL, Huang CS, Tsauo JY. Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related
lymphedema? A pilot study. Support Care Cancer. 2009;17(11):1353-60.
•Martins JC, De aguiar SS, Fabro EA, et al. Comment on "Safety and tolerability of Kinesio® Taping in patients with arm lymphedema: medical device clinical
study". Taner Dandinoglu, Murat Karadeniz, Özgür Dandin, Ali Onay. Support Care Cancer. 2016;24:1119-1124.
•Bialoszewski D, Wozniak W, Zarek S. Clinical efficacy of kinesiology taping in reducing edema of the lower limbs in patients treated with the ilizarov method –preliminary report. Ortop Traumatol Rehabil 2009; 11 (1): 46-54.
•Tozzi U, Santagata M, Sellitto A, Tartaro GP. Influence of Kinesiologic Tape on post-operative swelling After orthognathic Surgery. J Maxillofac Oral Surg.
2016;15(1):52-8.
•Bosman J, Piller N. Lymph taping and seroma formation post breast cancer. J Lymphoedema. 2010;5(2):12-21.
•Ristow O, Hohlweg-majert B, Stürzenbaum SR, et al. Therapeutic elastic tape reduces morbidity after wisdom teeth removal--a clinical trial. Clin Oral Investig. 2014;18(4):1205-12.
•Taradaj J, Halski T, Zduńczyk M, et al. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a
case report. Prz Menopauzalny. 2014;13(1):73-7.
•Lipinska A, Sliwinski Z, Kiebzak W, Senderek T, Kirenko J. The influence of kinesiotaping application on lymphoedema of an upper limb in women after
mastectomy. Fizjoterapia Polska: 2007; 7(3): 258-269.
•Kaya S, Akbayrak T, Guney H. Effect of kinesio taping with compression garment on lower extremity volume in primary lymphedema: a case report. Fizyoterapi
Rehabiltasyon: 2008;19(3):213.
•Coopee R. Use of “Elastic Taping” in the treatment of head and neck lymphedema. Lymph Link. 2008;20(4).
•Bosman J. Lymphtaping for lymphoedema: an overview of the treatment and its uses. Br J Community Nurs. 2014;Suppl:S12, S14, S16-8.
•Chou YH, Li SH, Liao SF, Tang HW. Case report: Manual lymphatic drainage and kinesio taping in the secondary malignant breast cancer-related lymphedema in
an arm with arteriovenous (A-V) fistula for hemodialysis. Am J Hosp Palliat Care. 2013;30(5):503-6.
•Sijmonsma, J. Lymph Taping: Theory, Technique, Practice. Tjerk Veen: Fysionair; 2010.
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Nicolle Samuels, MSPT, CLT-LANA, CWS, CKTP
