● Kinesio tapes are thin, stretchable adhesive cotton tapes that can be applied to give certain amount of pressure to selective areas. Guidelines for taping: ● A tape should provide support, but not restrict essential movement. ● The injured ligament should be held in a shortened position while non-affected ligaments remain in neutral position. ● Shave body hair before applying the tape (preferably more than 8 hours before application). ● Clean the skin before taping. ● Care should be taken to avoid sweat. ● Use underwrap (a hypoallergenic tape that protects the skin from irritation) if there is a possibility of skin allergy. ● When applying the tape, anchor proximally and distally to the injury. ● Apply even pressure throughout. ● Overlap previous tape by one half to one third of the length used to ensure strength. ● When removing the tape, use a tape cutter or scissors. Complications: ● If the tape is too tight, it will reduce the blood circulation. ● It requires practice to apply the tape with perfect technique. ● The effect of the tape is reduced with time and daily activities. Using a brace There are many braces used for various purposes. Any joint of the body can be stabilized using a brace. Knee braces are especially used in the rehabilitation phase following ligament and meniscus injuries of the knee as well as knee surgeries. Cervical collars, thoracolumbar, and lumbosacral braces are some of the types of braces used for the pathologies of spine. Advantages: ● Easier to apply than a tape. ● Good quality products will provide long-term support. Disadvantages: ● The patient may experience slipping of the brace during use. ● May require custom-made braces that will be more expensive. ● Patient may rely too much on bracing for support. Ice Ice therapy (i.e., cryotherapy, ice treatment, cold treatment, and cold therapy) is a well known strategy of managing acute soft tissue injuries. Cold therapy can be performed using ice packs, gel packs, ice massage, ice towels, inflatable splints, and vapocoolants (e.g., butane, propane, pentane, ethyl chloride, and fluorohydrocarbon). Application of cryotherapy will reduce the swelling, pain, and redness by minimizing blood flow to the area. Cold therapy normally decreases the muscle performance, but increases the pain threshold, plastic deformation, and viscosity of the tissue [9] . ● Skin irritation. Disadvantages: Ice application, used intermittently for 10 minutes, is the touted as the most effective method of cryotherapy. In his review, Kellett (1986) found that cold therapy for 10 to 20 minutes (depending on the site of injury), 2 to 4 times per day for the initial 2 to 3 days, is effective for full recovery [10] . The therapeutic effect of cold therapy seems to be maximized when the optimal tissue temperature is reduced by 100C to 150C. When the tissue temperature is 13.60C, the analgesic effect is achieved. Though cold therapy is the most effective, widely used, least expensive therapeutic modality after an acute soft tissue injury, it also has some unpleasant side effects. According to many case studies, skin burns (i.e., ice burns), frostbite, and nerve damage are reported with 20 to 30 minutes of cooling. Therefore, care should be taken not to apply ice directly on the skin. Temperature changes of the joint, intramuscular tissues, subcutaneous tissues, and skin usually depend on initial
temperature, application method of cryotherapy, and time of application. These are a few guidelines for ice application [8] , including: ● Ice should be applied immediately after an injury. ● Do not directly apply ice on the skin. Direct application of ice may cause ice burns or frostbite. ● If there is no cooling modality available, a bag of crushed ice covered in a damp towel can be used. ● Usually, the most effective method of application is repeated application of ice for 10 minutes; however, this depends on the location of the injury and the thickness of the subcutaneous fat layer. ● Contraindications for cryotherapy are people with diabetes, the elderly, and people with Raynaud’s syndrome, peripheral vascular disease, and sickle cell anemia. Studies have shown that ice application combined with compression and elevation is most effective for acute soft tissue injury management rather than applying ice alone [11] . Compression It is effective to give external pressure to the injured area through an elastic bandage. This will reduce bleeding; enhance the muscle pump, and the venous return. Nevertheless, compression increases the hydrostatic pressure of the interstitial fluid. So, the fluid is pushed back into the capillaries and lymphatic system. There are several ways to apply compression, including adhesive or non-adhesive elastic bandages/tapes, tubigrips, inflatable splints, and adjustable supports. Guidelines for applying compression: ● The compression should be applied evenly. ● The direction of application should be from distal to proximal. ● It should be applied as early as possible and should continue for 3 days (72 hours). ● Do not fully stretch the bandage. ● Always apply in spiral fashion (never apply circumferential method) and overlap half of the previous tape to enhance the strength of the bandage. ● If necessary, apply protective padding, such as gauze, to cover the injury. ● Distal areas should be checked after applying the compression for any signs of increased pain, numbness, swelling, pallor, and coldness. These signs denote diminished circulation to the area. Elevation Elevating the affected body part above the heart level will reduce swelling. Due to gravity, the blood tends to pool in the lower areas of the body. The action of the muscles pushes the blood up to the heart level. During a soft tissue injury, this muscle pump may get impaired; thereby the blood may accumulate in the affected body parts, especially in the lower extremities. Therefore elevating the affected body part is very important. Guidelines for elevation: ● The injured area should be placed above the heart level. ● It should begin as soon after the injury as possible and continue for 3 days (72 hours). ● The elevated area should be adequately supported (with pillows or slings). Modalities Electrotherapy modalities can be used to promote recovery. In the acute stage, ultrasound therapy can be used for soft tissue injuries. As the blood flow increases to the area, the amount of oxygen and healing nutrients are rapidly transported to the damaged tissues. However, this will also promote evacuation of the exudates. Increasing blood flow to the area leads to absorption of tissue debris and waste products of the inflammatory process effectively into the blood stream. Electrotherapy modalities will be discussed in later chapters of this course.
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