The previous blog post recalled all the anatomy of the shoulder as a general summary, if you need to read it again before addressing today’s topic do not hesitate to go to the article “The shoulder and its instability”. Now we leave the general overview of this joint and deal with the muscular plane, specifically the superficial one, the deltoid muscle. This muscle is the cause of pain due to overuse and is involved in most sports.

What does the deltoid muscle look like?

The deltoid muscle is divided into three main groups of fibres: the anterior, middle and posterior fibres. They all insert into the deltoid tuberosity of the humerus (creating the deltoid V) and the difference is in their origin. Anterior fibres are on the anterior border, anterior surface and lateral third of the clavicle. The medial fibres on the lateral border and upper surface of the acromion. Posterior fibres are on the inferior border of the posterior border of the spine of the scapula.

The main action of this muscle is abduction of the shoulder joint, performed mainly by the medial fibres, with stabilisation of the anterior and posterior fibres. In addition, the anterior fibres flex and, in the supine position, internally rotate the shoulder. In contrast, the posterior fibres extend and, in the prone position, externally rotate.

Innervation is provided by the axillary nerve (C5-C6).

What injuries does the deltoid have?

The injury par excellence of the deltoid muscle is due to overuse, mainly caused by sports practice but also by work that involves repeated use of the shoulder in abduction, i.e. opening the arms. Injury to the deltoid can also be caused by sudden strain following a major effort or accident. Other causes are associated with other pathologies, such as bursitis, rheumatoid arthritis, fibrillar ruptures of adjacent muscles…

When this muscle is injured, the patient usually has pain or tenderness in the anterior, middle and/or posterior part of the shoulder, especially when abducting the arm. The muscle can go from overload to fibrillar rupture and bruising will appear, so the symptoms range from mild muscle tension to intense, restrictive and limiting pain. Taking into account the intensity of the injury and the patient’s pain tolerance level, this injury sometimes makes arm mobility difficult, even decreasing the articular range of the shoulder.

How to prevent deltoid injuries?

As with all muscle injuries, it is necessary to analyse whether the movement pattern is correct. If this is the case, the intensity and duration of sports training or activities that cause pain should be reduced. If the pattern is incorrect, muscle activity should be re-educated and rebalanced to achieve optimal work.

Preventive work in sport is to respect all the stages, to carry out a good warm-up, a sporting activity that never leads to pain and a much-needed return to calm. In addition, the rest times between sessions must be controlled. This routine is indicated for sport but it is important not to forget that if a person works lifting objects in a warehouse and moving them from one place to another, their work becomes a sport as it requires a high muscular load, they should also warm up and cool down.

Tips to avoid deltoid injury

• Stretching: bring the arm into adduction until you feel the stretch in the deltoid area, hold the position for one minute. Repeat the exercise by bringing the arm back until you feel stretching in the anterior fibres.
• Self-massage with percussive therapy gun.
• Pressure technique (Jones inhibition technique):
  • Locate the point of pain.
  • Press the point and increase the pressure progressively until localised pain appears and in other areas.
  • Maintaining the pressure, mobilise the joint throughout the range until the pain disappears (neurological silence).
  • In this pain-free position, maintain the pressure for 90 seconds.
  • Slowly remove the pressure and return the joint to its natural position. 
• Apply ice after intense activity for 10 minutes (never in direct contact with the skin).

What is the treatment for deltoid pain?

Many people are in the habit of waiting too long before seeing a healthcare professional because they think that the pain will go away on its own. This is a serious mistake because many complaints can be solved in mild degrees and chronicity can be avoided.

At the deltoid level, medical treatment is protocolised as relative rest, use of ice and anti-inflammatory and muscle relaxant drugs depending on the patient’s symptoms.

Simultaneously, physiotherapy treatment based on techniques to reduce pain, restore normal muscle tone and recover function must be carried out. To achieve this, manual work on the damaged and accessory musculature, the use of electrotherapy, joint techniques to restore shoulder mobility, dry needling to eliminate trigger points, kinesiology tape to aid recovery and therapeutic exercises to restore muscle strength are used.

How to perform kinesiology tape of the deltoid?

To help the muscle to function correctly, either at the beginning of the injury to reduce the symptoms or to improve sports practice, a kinesiology tape is applied to the 3 beams.

One consideration prior to the technique would be to decide on the shape of the bandage. If the patient is large, 3 I-bands will be used, if the patient is a standard size, a Y-bandage and an I-bandage, and, finally, if the patient is very small or a child, 3 I-bands will be used, but of lesser thickness. The second option will be described here, but in the case of another type of patient, only minor adaptations will be necessary.

Shoulder pain is very common, whether it is caused by work, daily life or sporting activities, it is likely to appear at some point in a person’s life. The muscle to which we are going to refer this pain at first is the deltoid muscle because it covers the entire surface of the shoulder. As it is the outermost layer, it is the one that will have the first contact, a reflex action when something bothers to press it, in this case the deltoid will be pressed.

The content of this blog already shows some guidelines so that a poorly performed work or a slight discomfort does not develop into an injury. In addition, physiotherapy provides a very useful tool such as kinesiology tape. It is important to remember that the application must always be adapted to the symptoms and the origin of the patient’s injury.

Carried out by the Technical Department of Calvo Izquierdo S.L.

How to cite this blog:

• Calvo Izquierdo. BLOG: deltoid [Internet]. Calvo Izquierdo SL. 2023. Available at: https://calvoizquierdo.es/blog-deltoid/

Bibliography:

• Kase, J. Wallis, T. Kase (2003) Clinical therapeutic applications of the kinesio taping method, 2nd edition.
• Kase, K. (2003) Illustrated Kinesio Taping, 4th edition.
• Bové, A. (2000) El vendaje funcional . Harcourt. 3rd edition.
• Selva, F. (2015) Neuromuscular Taping Manual of practical applications. Physi-Rehab-Kineterapy-Eivissa. 2nd edition.
• Castillo, J. (2020) Bases y aplicaciones del vendaje neuromuscular. Formación Alcalá. 2nd edition.
• Aguirre, T. Agirre, J. (2018) Vendaje neuromuscular kinesiotape en fisioterapia. Biocorp Europa. 1st edition.
• Sijmonsma, J. (2007) Taping Neuro Muscular. Aneid Press, 1st Spanish edition.
• Kendall’s (2007) Musculos, pruebas funcionales postura y dolor. Marbán. 5th edition.
• Martínez, JL. Martínez, J. Fuster, I. (2006) Lesiones en el hombro y fisioterapia. Aran. 1st edition.
• Oliveira, C. Navarro, R. Navarro, R. Ruiz, JA. Jimenez, JT. Brito, E. (2007) Biomechanics of the shoulder and its injuries. Canarias médica y quirúrgica. January-April 2007.
• Girardin, M. (2004) Manual therapy of neuromuscular and joint dysfunction. Paidotribo.

In today’s post we are going to talk about ankle sprains and their 4 phases, i.e. from the moment the injury occurs until the return to sport. A tape adapted to each stage by combining different types of bandages.

What is the ankle like?

It is a hinge joint, formed by the articulation of the tibia and fibula with the talus.

The main movements are dorsiflexion (bringing the toes towards the head) and plantar flexion (bringing the toes away from the head). It is important to emphasise the inversion and eversion movements as they are the mechanism of injury in sprains, the subject of today’s blog. A forced inversion (supination plus adduction of the foot) will cause an external ankle sprain and a forced eversion (pronation plus abduction of the foot) will cause an internal sprain.

The ligaments of the ankle can be classified as internal and external.

• External: anterior peroneoastotalar (PAA), posterior peroneoastotalar (PAP) and calcaneoperoneus. They fix the tibia, fibula and talus.
• Internal: deltoid. Its bundles attach the tibia to the talus, calcaneus and scaphoid.

According to the article “Ankle sprain. Valoración en atención primaria del equipo de atención primaria de Villanueva de la Cañada, Madrid”, ankle sprains are possibly the most frequent trauma injury in the emergency department. Eighty-five per cent involve the external lateral ligament, mainly the anterior peroneoastragal ligament. And 44% of patients have some type of sequelae after one year, hence the importance of good rehabilitation. Due to its percentage of involvement, the external sprain is the one that will be dealt with in today’s post.

What is an external ankle sprain?

An ankle sprain is defined as a traumatic injury that occurs when you bend, twist or turn your ankle into an unnatural position, causing damage to the ligaments and joint capsule. Depending on the extent of the damage, it is divided into three grades:

• Grade 1: strain of the affected ligament, usually (PAA), without associated joint laxity. Less than 5% of the fibres are torn. The patient walks, there is pain and swelling but symptoms are mild.
• Grade 2: Partial ligament rupture, moderate pain with mild joint instability. Between 40% and 50% of the fibres are torn. The patient walks with difficulty and pain, there is swelling and an antalgic position is adopted.
• Grade 3: complete ligament rupture, joint laxity. The pain is intense, there is deformity and great swelling. The patient is unable to walk.

What stages does it go through? How to bandage it?

The third degree is surgical and the torn ligament must be repaired. Conservative physiotherapy treatment is not carried out before surgery, only anti-inflammatory measures. All the kinesiology tape, combined or not, which are described below, are indicated for both degrees of injury, the difference being the time. Grade I will be shorter because there is less involvement of the ligament and adjacent tissues, and grade 2 will be longer, lasting several weeks. All the bandages to be used are described for an external ankle sprain.

STAGE 1:

Acute phase. Initial rest for 48 hours and anti-inflammatory measures, using the classic RICE (Rest: rest, Ice: ice, Compression: Compression and Elevation: Elevation). Avoid support of the injured limb, therefore the use of crutches is mandatory. An octopus bandage is applied with a kinesiology tape to work on the inflammation and on top of that a bandage to help the inflammation with an elastic bandage. In the following video the complete process is described:

STAGE 2:

Healing phase. Manual physiotherapy treatment begins (manual therapy, dry needling and stretching of spasmed muscles, cyriax on ligaments, joint techniques, etc.) and the session ends with a bandage. This stage consists of helping the tissues to heal correctly and progressively achieving total support of the affected limb, i.e. the first few days there will be help from crutches and they are gradually eliminated. Grade I lasts a short time, between 7 and 10 days; grade II lasts a little longer, between 15-20 days. This is the stage with the most elaborate bandaging, consisting of a kinesiology octopus tape identical to stage 1, a layer of pretape to protect the skin, a functional bandage with tape stabilising the joint for the first supports. This bandage will be maintained between physiotherapy sessions, and these are usually 4-5 days apart. In the video is the detailed description of all the steps in each bandage:

STAGE 3:

Pre-final phase. Return to normal activity, incorporating proprioceptive exercises, strength work and finally plyometrics. The duration of this stage will depend on the work that the patient carries out at home, but it should last approximately 10 days. In the physiotherapy sessions, all the exercises are prescribed and explained and then the patient must repeat them at home to increase strength and achieve stability in the ankle joint. As in the previous stage, the bandage is maintained between sessions. The bandage in this stage will also be combined, but with several modifications: the kinesiology tape drainage is replaced by ankle stability with tibialis anterior reinforcement (provided that the inflammation has completely disappeared, otherwise the octopus is maintained), over it the layer of pretape to protect the skin and on top of it a functional bandage with adhesive bandage instead of tape, to close a cohesive bandage. As in the previous stages, the full description is given in the video:

STAGE 4:

Final phase or return to sport. Once the entire rehabilitation process has been completed in the clinic and it is necessary to introduce the patient to sport, the kinesiology ankle stability tape with reinforcement of the anterior tibial muscle is applied for the first few days of activity. In the event that the patient needs more support or is insecure, a functional bandage (both tape and adhesive bandage) can be used for the first sports practice and then removed, leaving only the kinesiology tape for the following training sessions. There is no established duration for this stage either, but the interesting thing is that the patient only needs a bandage for the first few days of activity, so a time of one week is stipulated. The description of the tape is shown in the following video:

With these 4 videos, two objectives are achieved, the first of them is to carry out a treatment with bandages for the patient with external ankle sprain from the moment of the injury to the return to sporting activity, adapting each stage to the needs of the patient. Always bearing in mind that the number of days that each stage will last will be related to the patient’s improvement and the patient’s involvement in the rehabilitation process. The second objective is to demonstrate that the combination of various materials and various types of bandaging is the optimal treatment for obtaining good results. The important thing when bandaging is the objective that you want to have with each application and from there to mix the bandages in the correct way to achieve the maximum benefit for the patient.

Carried out by the Technical Department of Calvo Izquierdo S.L.

How to cite this blog:

• Calvo Izquierdo. BLOG: evolution of an ankle sprain and how to correctly bandage it [Internet]. Calvo Izquierdo SL. 2023. Available at: https://calvoizquierdo.es/blog-evolution-of-a-sprain-ankle-and-how-to-bandage/

Bibliography:

• Kase, J. Wallis, T. Kase (2003) Clinical therapeutic applications of the kinesio taping method, 2nd edition.
• Kase, K. (2003) Illustrated Kinesio Taping, 4th edition.
• Chao YW, et al. (2016). Kinesio taping and manual pressure release: Short-term effects in subjects with myofasical trigger point.
• Salcedo Joven, Sanchez González, Carretero, Herrero, macas, Panadero Carlavilla (2000) Ankle sprain. Assessment in primary care. Madrid
• Bové, A. (2000) El vendaje funcional. Harcourt. 3rd edition.
• Selva, F. (2015) Neuromuscular Taping Manual of practical applications. Physi-Rehab-Kineterapy-Eivissa. 2nd edition.
• Sijmonsma, J. (2007) Taping Neuro Muscular. Aneid Press, 1st Spanish edition.
• Kendall’s (2007) Musculos, pruebas funcionales postura y dolor. Marbán. 5th edition.

The previous entry explained the bone and muscle anatomy of the elbow, if necessary please refer back to the article. Now we are going to continue with the anatomy of soft tissues, specifically the bursa. Many of you will have experienced or heard that you are not walking well because you have bursitis of the hip, that you have a lump in your shoulder and you have not broken anything… these and many other examples are descriptions of a common pathology, bursitis. The following will explain what it is, what the injury looks like, the symptoms it causes and the techniques that can be used to treat olecranon bursitis, colloquially known as elbow bursitis.

What is a bursa?

A bursa is described as a small sac-like structure filled with synovial fluid. It is located between two joint surfaces, tendons or muscles and its purpose is to allow a better relationship, protect or cushion when movement occurs. In other words, the bursa is a small cushion that helps the tendon or muscle glide over the bone. The fluid inside the bursa is synovial; it is thick and absorbs the forces and impact that occur between joint surfaces when movement is generated.

What is bursitis?

Bursitis is therefore the painful condition of inflammation of the previously defined bursa. It is caused by overuse of the joint or by an injury.

Specifically for today’s post we are going to talk about olecranon bursitis, so the above definition will only need to be located in the area. Olecranon bursitis is defined as a painful thickening of the synovial fluid sac at the back of the elbow (the area where the olecranon is located, where the triceps tendon inserts). The pain is typically located at the tip of the olecranon and is not triggered by active or passive movements, it is usually caused by friction with clothing or by leaning on the elbow. In less technical searches it can be found as Popeye’s elbow or student’s elbow.

What is the aetiology of olecranon bursitis?

Its aetiology can be: traumatic, infectious (fungal or viral), microcrystalline or rheumatoid. So, the most obvious causes are prolonged elbow resting on a table, trauma to the elbow or overuse of the elbow, diseases such as rheumatoid arthritis or gout, and infection in the bursa of the elbow.

What symptoms does olecranon bursitis cause?

The most common symptoms of olecranon bursitis include the following:

• Bulging mass and swelling at the back of the elbow.
• swelling
• joint tenderness in the elbow
• pain on movement and stiffness
• discomfort at rest
• pain on elbow support or friction
• redness or warmth in the area 

How is bursitis treated?

There are strategies that will be common in the treatment of this elbow pain but in order to achieve optimal treatment it is necessary to differentiate between the two types: septic or non-septic bursitis. If the origin is septic, the doctor will be in charge of providing pharmacological treatment to make the infection disappear, either orally or by means of infiltrations. If the bursitis is aseptic, anti-inflammatory treatment may be needed, but this is not necessary in all cases; sometimes conservative treatment is sufficient.

Advice for both types can be generalised as follows:

• Relative rest (reduce sporting activity or daily activity involving the elbow).
• Use ice to reduce inflammation.
• Avoid resting elbows on hard surfaces.
• Carry out mobility exercises so as not to atrophy the muscles but which do not cause pain.

If the physiotherapy treatment is more specific, it has two main functions, firstly to reduce the inflammation of the area and secondly to restore the functionality of the elbow. For this, manual therapy techniques, myofascial induction, drainage, electrotherapy, therapeutic exercise and taping are used.

What is kinesiology tape for Olecranian bursitis?

For this type of pathology, kinesiology tape is used to reduce inflammation and reduce pain in the joint. In the case of very acute symptoms, a functional bandage could be superimposed to limit elbow flexion-extension (see bandage to prevent elbow extension in Bové’s book, The functional bandage); by blocking mobility both in full extension and flexion, the friction of the bursa with the bone and tendon plane would be reduced and the injury would improve.

This is the first time that the net bandage is going to be used, as mentioned in previous posts it is useful in elbow, but not so much in the rest of the joints.

Kinesiology tape for olecranon bursitis

The application is done on the posterior aspect of the elbow and on the anterior aspect of the elbow using an X-technique to increase the space.

The webbing is prepared with the elbow in maximum flexion, from 5cm past the olecranon in both cranial and caudal directions. Leave an anchor base of 3-5 centimetres and the central area is cut into 4 active strips of identical proportions. The bases are glued at 0% stretch and it is very important to calculate that the active strips cannot exceed 10%. Finally, a maximum bend of the elbow is made and the 4 active strips are glued together to form a mesh.

This application is described in most of the literature, but if it is based on clinical practice it is more useful to anchor in the distal area, ask for maximum elbow flexion and glue the active straps. Finally, with the elbow in extension, place the other anchor. The second strap is X-shaped and goes on the anterior side. In the video below you will find this application:

This article aims to raise awareness of an injury that is not as common as muscle, tendon or ligament injuries but is also common in soft tissue. A very important conclusion that can be drawn is that olecranon bursitis, like other bursitis, if not in an acute state, can improve or even disappear with the use of the practical advice given above; but this process will last for more than 90 days. If these tips are accompanied by the appropriate medical and physiotherapy treatment, this figure can be reduced and in about 3-4 weeks the injury will be resolved.

Made by the Technical Department of Calvo Izquierdo S.L.

How to cite this blog:

• Calvo Izquierdo. BLOG: Olecranon bursitis [Internet]. Calvo Izquierdo SL. 2023. Available at: https://calvoizquierdo.es/blog-olecranon-bursitis/

Bibliography:

• Kase, J. Wallis, T. Kase (2003) Clinical therapeutic applications of the kinesio taping method, 2nd edition.
• Kenzo, K. (2003) Illustrated Kinesio Taping, 4th edition.
• Kirby, AK. (2012) Biomechanics of the foot and lower extremity. Axon. 1st edition.
• Bové, A. (2000) El vendaje funcional . Harcourt. 3rd edition.
• Selva, F. (2015) Manual of practical applications. Physi-Rehab-Kineterapy-Eivissa. 2nd edition.
• Castillo, J. (2020) Bases y aplicaciones del vendaje neuromuscular. Formación Alcalá. 2nd edition.
• Sijmonsma, J. (2007) Taping Neuro Muscular. Aneid Press, 1st Spanish edition.
• Kendall’s (2007) Musculos, pruebas funcionales postura y dolor. Marbán. 5th edition.
• Ruiz de Adana. (1996) Manual de diagnóstico y terapéutica en A. Primaria. Chapter 58. A. Lopez Garcia-Franco. Editorial Díaz de Santos. 2.a.Edición.

In many publications we have talked about kinesiology tape, specific applications and the RICE method has been mentioned in injuries such as those explained. In today’s post we want to expand on this protocol that is used initially, the first 48-72 hours, in minor injuries. It’s a basic method of first aid, which is why it should be known, as it is useful to apply it in the first instance until it is possible to find a better solution or to combine it with a more specific treatment.

What is the RICE method?

RICE is the abbreviation for Rest, ice, compression and elevation, coined for the first time in 1978 by the American doctor Gabe Mirkin in his Sportsmedicine book. Over the years, this has improved and, soon after, simple protocols that include more effective and beneficial steps have become standardised. RICE is considered the starting point for working on sports injuries or simple accidents.

The RICE method is a first aid treatment used in case of minor injuries and acute inflammatory processes, whose main objectives are to reduce inflammation, relieve pain and accelerate recovery. It is important to note that the RICE method does not treat the problem, it only prevents the symptoms from worsening.

What does each letter of the RICE look like?

The following is a breakdown of the four sections that make up the method. These are:

Rest:

• First phase of the method. No more than 48 hours (if more is needed, it is because the injury is not minor).
• Although the outer and most affected soft tissues are recovering, the inner parts (ligaments or bones) are not healing as they should.
• It may seem that a lot of improvement has been made, but there is still a lot of work to be done internally.
• Avoid continuing with the activity that caused the injury and rest the area without subjecting it to stress.
• Relative rest, i.e. do not use the part of the body that has been injured. But, the rest can and should be active.
• Help from an orthosis, sling, crutches, walker, etc. may be needed.
• Medically, this phase is accompanied by analgesic medication.

Ice:

• Second phase, the anti-inflammatory, vasocontrictive and pain-reducing properties of ice are sought, because it numbs the area and reduces spasms.
• Apply ice to the affected area (never directly on the skin, but wrapped in a bag or handkerchief to avoid direct contact) for 10-15 minutes every 2-3 hours during the first 2-3 days after the injury.
• 6-8 applications per day is a good indication.

Compression:

• Third phase, aimed at stabilising the soft tissue.
• It compresses the injured area to reduce pain during movement, reduce swelling and increase joint function.
• This compression is done by bandaging, usually with an elastic adhesive bandage; it should be snug but not too tight.

Elevation:

• Last phase, the aim is to reduce blood pressure (avoid uncomfortable palpitations, reduce pain and swelling).
• Elevate the area of the injury above the level of the heart to promote venous return.
• It can be combined with light circulatory exercises if prescribed by the doctor or physiotherapist.

What are the indications for the RICE method?

The RICE method is indicated for the first hours of mild injuries with inflammation or more serious injuries, such as fractures (as there is no better method for the first hours of acute injuries of this type).

Some examples of this type of injuries are: tendinopathy in general, muscle sprain, strain or tear, sprains (ankle, knee and elbow the most frequent), sacroiliitis, bursitis (mainly elbow), fractures (it can be used in the case of ankles or small structures because the characteristics of the area lend themselves to it; for larger areas more specific actions should be sought), bruises and haemophilia.

This method is a very good initial way to start the rehabilitation process. In fact, it is a preliminary step, really. It is the set of actions we do to keep the area in the best condition until the specific treatment is given.

What are the advantages of the RICE method?

The advantages of the method are abundant. If, after so many years of its creation, it is still used, it is because it is really functional in many cases. They can be summarised as follows:

• It speeds up healing
• Simple, very easy to perform.
• Helps before the start of rehabilitation.
• It works effectively on joints and muscles, being useful in a number of circumstances of mild category.
• Mildly anaesthetises the affected area, producing great relief.
• The rest is relative, so that simple activities are not renounced.
• Its action allows mobility of the affected area.
• Very effective in reducing inflammation.
• Results can be seen quickly.

What are the differences between protocols?

As it is obvious to think that many years have passed since it started to be used and this has generated updates and even the creation of new nomenclatures.

The acronym PRICE adds the concept of protection to the previous method. As in many first aid methods the initial part is protection. So the only difference is to protect the joint before starting any other steps. Closely linked to the latter, with the difference of adding the letter N, is the PRINCE method. The N stands for “non-steroidal anti-inflammatory drugs”, the principles are identical to the previous one but the use of this medication is not contemplated.

The RICER also has only one difference, it is based on the fact that the whole process is guided by a health professional. Rehabilitation guidelines may be added. The health professional will only observe, prescribe or assist these recommendations.

Most recent, from 2012, is POLICE. The result is “Protection”, “Optimal Load”, “Ice”, “Compression”, “Elevation”. Instead of rest, optimal load is used, i.e. the body’s own load at the beginning of simple activities. We should not shy away from everyday or even other tasks if we are taking good care of ourselves. In this way, an afferent (blood movement) stimulus is provoked and the proprioception of joint and/or muscle receptors is improved. A faster functional recovery is obtained and the possibility of atrophy is almost non-existent; it is ideal in the case of acute muscular injuries.

MEAT stands for “Movement”, “Exercise”, “Analgesics” and “Treatment”. It aims to move the area when necessary to stimulate it, then some exercises to prevent the collagen from misaligning. In addition, natural painkillers are taken, avoiding anti-inflammatory drugs, which intervene in certain healing processes. Finally, treatment refers to whatever the physiotherapist recommends to help increase your blood flow.

In conclusion, it is important to know the RICE method because despite its age it is still useful today. It is a good tool for the beginning of the treatment of minor injuries and it will probably be necessary at some point in our lives.

Carried out by the Technical Department of Calvo Izquierdo S.L.

Como citar este blog:

• Calvo Izquierdo. BLOG: método RICE [Internet]. Calvo Izquierdo SL. 2023. Disponible en: https://calvoizquierdo.es/blog-rice-method/

Bibliografia:

• Mirkin, G. Hoffman, M. (1978) Sportmedicine book. Little brown & Co.
• Van Den Bekerom, M. P., Struijs, P. A., Blankevoort, L., Welling, L., Van Dijk, C. N., & Kerkhoffs, G. M. (2012). ¿Cuál es la evidencia para la terapia de reposo, hielo, compresión y elevación en el tratamiento de los esguinces de tobillo en adultos? Journal of athletic training, 47(4), 435-443.
• Bleakley, C. M., O’Connor, S., Tully, M. A., Rocke, L. G., MacAuley, D. C., & McDonough, S. M. (2007). The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946]. BMC musculoskeletal disorders, 8(1), 1-8.
• Fischer, D. C., Sckell, A., Garkisch, A., Dresing, K., Eisenhauer, A., Valentini, L., & Mittlmeier, T. (2021). Treatment of perioperative swelling by rest, ice, compression, and elevation (RICE) without and with additional application of negative pressure (RICE+) in patients with a unilateral ankle fracture: study protocol for a monocentric, evaluator-blinded randomized controlled pilot trial. Estudios piloto y de viabilidad, 7(1), 1-9.
• Patra, P. C., Mandal, P. K., Gantait, D., Bhowmik, A., & Chakrabarti, P. (2018). Price of PRICE (Protection, Rest, Ice, Compression, and Elevation) redefined: a case of entrapment neuropathy in an individual with hemophilia. Blood research, 53(4), 333-334.
• Baoge, L., Van Den Steen, E. L. K. E., Rimbaut, S., Philips, N., Witvrouw, E., Almqvist, K. F., … & Vanden Bossche, L. C. (2012). Treatment of skeletal muscle injury: a review. International Scholarly Research Notices, 2012.
• Tran, K., & McCormack, S. (2020). Exercise for the Treatment of Ankle Sprain: A Review of Clinical Effectiveness and Guidelines.
• Sloan, J. (2008). Soft tissue injuries: introduction and basic principles. Emergency Medicine Journal: EMJ, 25(1), 33.

Whiplash or cervical sprain is the injury that will be discussed in today’s blog post. It is an injury with a very high incidence and without good treatment will leave sequelae in the patient that can become chronic. If you need to remember the anatomical part to better understand this pathology, please consult the cervical area blog.

What is whiplash?

Whiplash is described as an injury in which the head is subjected to acceleration forces that cause a sudden movement of hyperextension and hyperflexion on the cervical spine, mainly in a motor vehicle accident but also to a lesser extent in subsequent falls in sports or domestic accidents.

What happens in whiplash?

What happens in cervical mobility is that the physiological or normal extension of our neck (bringing the head backwards) in order, starts in the dorsal, lower cervical and upper cervical vertebrae. But during whiplash, which lasts approximately 250-300 msec, this changes. The dorsal area overtakes the cervical area, overtakes the cervical area. This is the most dangerous moment of the accident. There is a forced extension of the neck, while the shoulders move forward. After extension, the inertia of the head is overcome and forward acceleration occurs. At this point, the neck acts as a lever with increased forward acceleration of the head, and forces the neck to flex excessively. This is why the movement is pathogenic and different from normal. The vertebrae first compress and then move, which is very irritating to the joints.

Therefore, it is the joint and capsule that are most irritated, and most responsible for the pain. The three muscles that suffer most in whiplash are the sternocleidomastoid, the upper trapezius and the splenius of the head. It is necessary to pay close attention to the scalenes, in order to reduce the feeling of dizziness and instability reported by the patient after the accident. The most commonly injured ligaments are the nuchal or posterior cervical ligament. The fourth structure injured is the nerve (the two most frequently injured are the greater occipital and median nerves).

What are the degrees of whiplash?

The symptoms listed in the following section will be linked to the degree of whiplash. In order to unify criteria for the assessment of whiplash and the comparison of results from different scientific studies, the Quebec Association for the Study of Whiplash proposed this classification. It is therefore important to be familiar with this classification by degree of whiplas0: No hay signos ni síntomas evidentes del latigazo cervical. El dolor y la contractura muscular son leves.

1: Pain, contracture and stiffness are more evident and more intense, with or without limitation of mobility. However, there are no physical signs of the origin of the injury.

2: The contracture is more noticeable, as it limits movement. The pain also intensifies.

3: Movement of the neck is totally limited by the intensity of the contracture and the severe pain it causes. Among other things, this degree of sprain can cause sensitivity, lack of strength and loss of reflexes. The use of a neck brace is recommended.

4: The injury is severe. Vertebral dislocations or bone fractures are observed. Surgical intervention necessary.

Other symptoms and alterations, such as back pain, deafness or hearing loss, vertigo, drowsiness, loss of memory and concentration, dysphagia and temporomandibular pain, can be found in any of the degrees.

What are the symptoms of whiplash?

The general symptoms of whiplash are as follows:

• Pain in the neck region
• Decreased or limited mobility
• Headache
• Deafness or hearing loss.
• Visual disturbances
• Vertigo
• Weakness and lack of strength
• Paresthesias
• Alterations in concentration and memory
• Dysphagia and TMJ painPsychological disturbances

What is the treatment for whiplash?

According to a 2001 publication entitled “Whiplash Syndrome” it can be stated that studies would indicate that between 14 and 42% of whiplash patients would develop chronic pain in the neck region, and approximately 10% would have constant and significant pain indefinitely.

The above data suggest the importance of good treatment for whiplash. The aim of this treatment will be to eliminate the symptoms and thus avoid the syndrome becoming chronic.

There is no standard protocol with scientific evidence for this injury. In order to improve the patient’s condition, the degree of injury must be identified. From there, a personalised medical and physiotherapy treatment can be created.

In grades 0, 1 and 2 the treatment will be mainly rehabilitative. Physiotherapy techniques will be used with thermotherapy, electrotherapy, manual therapy, therapeutic exercise, dry needling, myofascial techniques, massage therapy and therapeutic exercise to reduce symptoms. All of the above will be accompanied by kinesiology tape that will be maintained between sessions and the performance of exercises at home. In addition, the doctor will prescribe anti-inflammatories and muscle relaxants if deemed necessary.

Phase 3 should begin with medically prescribed rest and the use of a neck brace in case of vertigo and loss of reflexes. Once the problem has subsided, it will be combined with the physiotherapy treatment mentioned above. Finally, phase 4 is absolute immobilisation and surgery.

It should not be forgotten that the injuries will not only appear in the cervical region. There may be ailments associated with the syndrome, such as involvement of the diaphragm, lumbar region, etc. The patient should always be treated as a whole.

What neuromuscular taping helps the cervical area?

Several kinesiology tapes are proposed to help the recovery of the injury that can help with the symptoms. Depending on the degree of the injury and its condition, it is recommended to choose one or the other.

If the pain is more global, the application of kinesiology tape is recommended for cervical pain due to general overload. This application does not work on a specific muscle but on the region as a whole and will help with more global symptoms.

Once the initial phase of the injury has passed, where the whiplash bandage has been used, the applications should be adapted to the more specific muscle pain. If you recall from the previous section “what happens in whiplash”, some of the most affected muscles are the sternocleidomastoid and scalene muscles. Here is an explanation of how to perform kinesiology taping for ecom:

Bilateral technique for the sternocleidomastoid muscles. Prepare two Y-strips, keeping a base of 3-4 cm and the rest at two equal ends.

1st Patient in a seated position with the neck and head in a neutral position. Place the base at 0% stretch on the mastoid process.

2nd Position of the head and cervical area: extension, rotation and contralateral inclination. Place the bandage over the two muscular bellies of the ecom towards the clavicle at 10% stretch.

3º Return to neutral position and anchor at 0% stretch over the clavicle.

Repeat the same process on the contralateral side and monitor the following days; as it is close to the hair, it tends to come off more easily.

In addition, two videos describing how to use the tape on scalenes and the length of the neck, which is also very affected by cervical problems.

In conclusion, cervical injuries are very common and whiplash is one of the most common consequences of a traffic accident. Hence the importance of knowing what the injury is, what symptoms it can cause and how to deal with these symptoms. The aim of the health professional must be to correct the symptoms in order to achieve total improvement for the patient. There are many tools to achieve this goal. The most important thing is to know how to combine them depending on the patient’s condition in order to achieve it.

Prepared by the Technical Department of Calvo Izquierdo S.L.

How to cite this blog:

• Calvo Izquierdo. BLOG: whiplash [Internet]. Calvo Izquierdo SL. 2023. Available at: https://calvoizquierdo.es/blog-whiplash/

Bibliography:

• Kase, J. Wallis, T. Kase (2003) Clinical therapeutic applications of the kinesio taping method, 2nd edition.
• Kase, K. (2003) Illustrated Kinesio Taping, 4th edition.
• Selva, F. (2015) Neuromuscular Taping Manual of practical applications. Physi-Rehab-Kineterapy-Eivissa. 2nd edition.
• Castillo, J. (2020) Bases y aplicaciones del vendaje neuromuscular. Formación Alcalá. 2nd edition.
• Aguirre, T. Agirre, J. (2018) Vendaje neuromuscular kinesiotape en fisioterapia. Biocorp Europa. 1st edition.
• Sijmonsma, J. (2007) Taping Neuro Muscular. Aneid Press, 1st Spanish edition.
• Kendall’s (2007) Musculos, pruebas funcionales postura y dolor. Marbán. 5th edition.
• Combalia, A. Suso, S. Segur, JM. García, S. Alemany, FX. (2001) Whiplash Syndrome. El Sevier.
• Arregui, C. Combalía, A. Velázquez, J. Sánchez, D. Teijeira, R. (2013) Biomechanics of whiplash: kinematic and dynamic concepts. Revista española de medicina legal.

So far the blog posts have focused on global aspects of kinesiology tape or general applications performed by physiotherapists. In today’s post we want to expand this information to other types of techniques that are not so common for the general physiotherapist. They are specific or much more specific fields, or the use of kinesiology taping by other health professionals, such as doctors, nurses specialised in aesthetics or speech therapists.

Kinesiology tape in aesthetics

The use of kinesiology tape is currently booming, as it is a relatively new technique and many fields want to introduce it as a working tool, and the world of aesthetics is one of them.

The effectiveness of the tape in muscle strength, the improvement of the ligament state, the aid to stability and a long etcetera in certain pathologies has been proven. Despite this, no scientific evidence has been found for its use in the field of aesthetics. However, there are numerous professionals in the sector who explain its use both for patients and in the courses they give. The processes in which it is used are: cellulite, post-aesthetic surgery (breast and liposuction), haematomas, abdomen, oedemas, improving muscle tone in the buttocks, breasts, triceps and tired legs, among others.

If you break down the information obtained, there is no scientific evidence for the world of aesthetics in general. No studies have been carried out in this field. But if you extrapolate results, you can think that in processes such as haematomas or oedemas, lymphatic techniques will be used and there are positive results; to work on the postpartum abdomen or the muscles of the buttocks, triceps… muscular techniques will be used, which also have evidence. It has been used for years to work on scars, but not only on an aesthetic level, but also on a functional and analgesic level.

It can be concluded that this is a new field that is being worked on. Although there is no clear evidence scientifically speaking, good results are being achieved based on the clinical practice that has been used for years at rehabilitation level.

Finally, in this sector, phrases have been found on various websites such as: “Tapes solve skin problems with wrinkles and flaccidity, reduce body volume, improve the firmness of the skin and model a beautiful silhouette quickly”, but there is nothing to support such statements. We want to use the bandage for everything, but we want it to be done correctly, with research and evidence.

Kinesiology tape on scars

In the field of aesthetics, we continue with scars. As previously mentioned, kinesiology tape is used to treat the physical appearance of the injury, but physiotherapy has been working for years on both its appearance and its function. To prevent adhesions from occurring and to improve the patient’s quality of life, to avoid the transformation of the scar into the dreaded keloids or to improve the scars produced by burns.

A 2013 clinical case study published in the journal of the Spanish Association of Kinesiology Tape entitled “Application of kinesiology taping in a burn patient: a case study” by Zaga aims to demonstrate the effectiveness of taping in burn patients. After a year of study applying kinesiology tape, very satisfactory results are achieved: improvement in the visible changes of the skin (colouring, density, arches of mobility and sensitivity). It is only a clinical case and it is obvious that results cannot be extrapolated, but it certifies that with treatment maintained over time, positive results can be achieved in complex cases.

If you look in the literature, you will find in France and Germany different articles of creation and review (Effects of Kinesiotaping in the treatment of postoperative scars in the prevention of complications: protocol for a randomised controlled study or review of the protocol on the effects of kinesiotaping® on postoperative scars for a randomised controlled study) of a protocol for the use of kinesiology tape in the treatment of scars. With the creation of such protocols, scientific studies with large sample sizes and reproducible results can be achieved in the future.

Kinesiology tape for Incontinence

Another use of kinesiology tape that has been increasing in recent years is for the treatment of incontinence, both urinary and faecal. This is done through muscular techniques on the musculature itself, on segmental techniques on the appropriate dermatomes for stimulation or with a combination of both techniques.

One of the fields in which there is research in this area is neurological diseases in children. In 2017, a literature review entitled “Therapeutic effects of kinesiology tape in infantile cerebral palsy: a systematic review” analysed different scientific studies and dealt with incontinence in children with this disease.

In the bibliography consulted for this blog, there are several applications for incontinence focused on both adults and children. These describe a segmental application on the dermatomes from S2 to S5 with the aim of stimulating the musculature and serving in combination with manual techniques to re-educate the pelvic floor musculature and improve tone in hypotonia problems in phases of urogynaecological rehabilitation.

In addition to incontinence, there is some bibliography on constipation, as a similar segmental technique will be used. At the first conference on kinesiology tape of the Spanish Association, a presentation was made in which positive results with taping for this pathology were demonstrated and a line of research in this field was urged to be opened.

Kinesiology tape in menstrual pain

The Royal Spanish Academy defines dysmenorrhoea as painful menstruation. Therefore, primary dysmenorrhoea is understood as strong or spasmodic menstrual pain in the lower abdomen, usually starting 24-48 hours before the period and gradually disappearing by the end of the first day.

There are several applications of kinesiology tape to alleviate these symptoms, using muscular or lymphatic techniques with the aim of increasing the space in the area.

As it is a very common ailment, there is a lot of research on the subject. Comparisons have been made between kinesiology tape and ibuprofen (effectiveness of kinesiology taping versus ibuprofen in reducing abdominal pain in patients with Nicolau’s primary dysmenorrhoea), between kinesiology taping and massage therapy (analgesic effectiveness of kinesiology taping versus local massage therapy in women with dysmenorrhoea by Garzón) or between kinesiology taping and transcutaneous electrical nerve stimulation (effectiveness of high-frequency TENS transcutaneous electrical nerve stimulation versus kinesiology taping in patients with primary dysmenorrhoea by Hontecillas).

All these studies offer positive results, there are improvements in menstrual pain with the use of kinesiology taping and also with other techniques; in some cases the effectiveness of other techniques is greater than that of taping, but the same question arises as in previous cases: wouldn’t a combination of both techniques be more beneficial for the patient?

Kinesiology tape in speech therapy

This type of bandage is usually applied by physiotherapists, but it also has its field of application in speech therapy. They are techniques that help to improve muscle tone, control posture and facilitate certain oral functions such as breathing, lip sealing or swallowing.

Some of the most commonly used applications in speech therapy are for sialorrhoea (to reduce drooling), stimulation of swallowing, tongue retraction in dysphagia, to reduce the tone of the masticatory muscles, to increase the tone of the facial muscles, to help the laryngeal muscles, to increase inspiratory capacity and thoracic diameter, to favour lip sealing… In other words, it can be applied to numerous conditions although it is not yet widely used in this area. Used as a complement, it helps in speech therapy treatments, and its positive effect is increasingly being demonstrated.

It is a fairly recent field of action but at the same time it has been accompanied by a lot of research. If it is focused on searches for a pathology, sialorrhoea, a lot of bilbiography can be evaluated with positive results. From a multitude of clinical cases, such as “Effects of kinesiology tape in patients with sialorrhoea” by Gutiérrez and Martín, most of them with positive results for the patient under study. Even scientific studies such as “Kinesiology tape for the control of sialorrhoea in children with neurological diseases” by Sánchez, Yumilla and Pérez, obtaining very satisfactory results with the technique and recommending the use of the method combined with other techniques.

The use and research in this area is still very active and growing, so it is likely that more and more applications will be observed in patients in this field.

After commenting on these 5 areas, aesthetics, scars, incontinence, menstrual pain and speech therapy, it can be concluded that kinesiology tape is becoming more and more widespread and is used for more applications. With a correct knowledge of the technique, the anatomy of the patient and the physiology of the organism, and accompanied by good scientific research, it will be used in many fields and with satisfactory results.

Made by the Technical Department of Calvo Izquierdo S.L.

How to cite this blog:

Calvo Izquierdo. BLOG: special neuromuscular taping techniques. [Internet]. Calvo Izquierdo SL. 2023. Available at: https://calvoizquierdo.es/blog-special-techniques-in-neuromuscular-bandage/

Bibliography:

• Kase, J. Wallis, T. Kase (2003) Clinical therapeutic applications of the kinesio taping method, 2nd edition.
• Dr. Kenzo Kase, (2003) Ilustrated Kinesio Taping, 4th edition.
• Dueñas, L.; Balasch, M.; Espí, G.V: Técnicas y nuevas aplicaciones del vendaje neuromuscular. Letterabooks. Bilbao, 2010.
• Castillo, J. (2020) Bases and applications of neuromuscular taping. Formación Alcalá. 2nd edition.
• Aguirre, T. Agirre, J. (2018) Vendaje neuromuscular kinesiotape en fisioterapia. Biocorp Europa. 1st edition.
• Sijmonsma, J. (2007) Taping Neuro Muscular. Aneid Press, 1st Spanish edition.
• Kaelin, C. Morel, J. Obrist, S. (2017) Effects of Kinesiotaping in the treatment of postoperative scars in the prevention of complications: protocol for a randomized controlled study.Ecole Supérieure de Santé de Valais.
• Sciboz, E. Zanoni, C.Mittaz, H.(2019) Review of the protocol on effects of Kinesiotaping® on postoperative scars for a randomised controlled study. Valais School of Health.
• Zaga Lewison, M. (2012) Application of neuromuscular taping in a burn patient: a case study. Spanish Association of Neuromuscular Taping. 1647-2012
• Ortega Sánchez-Diezma, P. Torres Fernández, A (2013) “Manual del vendaje neuromuscular aplicado a la logopedia”. LDM Ediciones.
• Royal Spanish Academy
• Nicolau, A. (2013) Effectiveness of neuromuscular taping versus ibuprofen to reduce abdominal pain in patients with primary dysmenorrhoea. Comillas Pontifical University.
• Garzón, C. (2013) Analgesic effectiveness of neuromuscular taping versus local massage therapy in women with dysmenorrhoea. Physiotherapy issues. Vol.42.3;302-311.
• Hontecillas, R. (2011) Effectiveness of high frequency transcutaneous electrical nerve stimulation (TENS) versus neuromuscular taping in patients with primary dysmenorrhoea. Digital library of the University of Alcalá.
• Ortíz, J. Pérez, S. (2017) Therapeutic effects of neuromuscular taping in infantile cerebral palsy: a systematic review. Arch.argent.pediatr.vol115-6, Buenos Aires.
• Merino, J. (2013) Application of neuromuscular taping for the treatment of constipation in neuropaediatrics. I Jornada de vendaje neuromuscular: presente y futuro. Madrid.
• Arrate Meléndrez (2016). Application of neuromuscular taping in speech therapy. RIUMA (Institutional Repository of the University of Málaga).
• Gutiérrez, B. Martín, AM. (2018) Effect of neuromuscular taping in a patient with sialorrhoea. Fisioterapia. Vol 40, July-August 2018; 208-2013
• Sánchez, M. Yumilla, B. Pérez, N. (2021) Neuromuscular bandaging for the control of sialorrhoea in children with neurological diseases. XXXIX scientific conference of the CIMEQ. Cuba.