Therapeutic Therapeutic TapingTaping for thefor the

CervicothoraciCervicothoracic, c,

Maxillofacial & Maxillofacial & TMJTMJ

Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTPDr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTPDr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEASDr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS

Scott & Dyanna Rezac - Taping Cervical Spine 2

Taping for C/S & T/STaping for C/S & T/SIdentify your Asterisk (*) SignIdentify your Asterisk (*) SignTape for * sign, re-checkTape for * sign, re-checkSpine tends to be more taping for Spine tends to be more taping for function than pain (pain follows function than pain (pain follows function)function)Great adjunct to manual techniques to Great adjunct to manual techniques to carry over following Rx.carry over following Rx.

Joint mobilizationJoint mobilizationSoft Tissue mobilizationSoft Tissue mobilizationPNF (scapular)PNF (scapular)Capital Flexion Neuro Re-edCapital Flexion Neuro Re-ed

Scott & Dyanna Rezac - Taping Cervical Spine 3

Sternocleidomastiod Sternocleidomastiod (SCM)(SCM)

Kinesio® TechniqueKinesio® TechniqueSplit strip in two, starting Split strip in two, starting at mastoid, one strip to at mastoid, one strip to manubrium other to manubrium other to clavicleclavicleTape with cervical spine Tape with cervical spine in contralateral sidebend in contralateral sidebend and ipsilateral rotationand ipsilateral rotationFacilitation or InhibitionFacilitation or Inhibition

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Sternocleidomastiod Sternocleidomastiod (SCM)(SCM)

Kinesio® TechniqueKinesio® TechniqueIndicationsIndications

Inhibit SCM to facilitate deep capital Inhibit SCM to facilitate deep capital flexors (longis colli / longus capitis)flexors (longis colli / longus capitis)Correct TorticollisCorrect TorticollisDecrease SCM spasm, facilitate ROMDecrease SCM spasm, facilitate ROMDecrease tension on TMJDecrease tension on TMJHeadachesHeadaches

TestingTestingCapital FlexionCapital FlexionPosturePosturePain / HAPain / HAROMROM

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Posterior Posterior Cervicothoracic Cervicothoracic (Erector Spinae) (Erector Spinae)

MusclesMusclesMcConnell & Kinesio® McConnell & Kinesio®

TechniqueTechniqueSingle strip to facilitate or Single strip to facilitate or inhibit over affected inhibit over affected segments segments Tape with spine in flexionTape with spine in flexionUnilateral or bilateralUnilateral or bilateral

Bilateral extension – facilitate Bilateral extension – facilitate both sidesboth sidesRotation – inhibit side with Rotation – inhibit side with muscle spasm and facilitate muscle spasm and facilitate contralateral side contralateral side

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Posterior Posterior Cervicothoracic Cervicothoracic (Erector Spinae) (Erector Spinae)

MusclesMusclesMcConnell & Kinesio® McConnell & Kinesio®

TechniqueTechniqueIndicationsIndications

Generally effective to tape C/S and T/S for Generally effective to tape C/S and T/S for enhanced postural correctionenhanced postural correctionBilaterally to decrease excess cervical lordosisBilaterally to decrease excess cervical lordosisVertebral rotations - Unilaterally to inhibit muscle Vertebral rotations - Unilaterally to inhibit muscle spasm on contracted side and facilitate less active spasm on contracted side and facilitate less active sidesideImprove painfree C/S and T/S extension or inhibit Improve painfree C/S and T/S extension or inhibit excessive extensionexcessive extension

TestingTestingPosturePostureAROM / quality of motionAROM / quality of motionPainPainSegmental spinal motionSegmental spinal motion

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Posterior SpinePosterior SpineMulligan TechniqueMulligan Technique

Following Joint Following Joint MobilizationMobilization2” strip across the 2” strip across the segment mobilized with segment mobilized with moderate to maximum moderate to maximum stretchstretchCan use this in conjunction Can use this in conjunction with the McConnell & with the McConnell & Kinesio® Erector Spinae Kinesio® Erector Spinae TechniqueTechnique

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Posterior SpinePosterior SpineMulligan TechniqueMulligan Technique

IndicationsIndicationsFollowing Joint Mobilization Following Joint Mobilization for Stabilizationfor StabilizationImprove thoracic extensionImprove thoracic extension

TestingTestingPosturePostureAROM / quality of motionAROM / quality of motionPainPainSegmental spinal motionSegmental spinal motion

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Levator ScapulaeLevator ScapulaeKinesio® TapeKinesio® Tape

Kinesio® TechniqueKinesio® TechniqueSplit strip starting at Split strip starting at transverse processes C1-transverse processes C1-C4 one strip to the medial C4 one strip to the medial border of scapula, other border of scapula, other to the superior angle with to the superior angle with inhibition stretchinhibition stretchTape with cervical spine Tape with cervical spine in contralateral rotation in contralateral rotation and flexionand flexion

Modified Tape Practical Modified Tape Practical ApplicationApplication

Single stripSingle strip

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Upper / Middle Upper / Middle TrapeziusTrapezius

Kinesio® TechniqueKinesio® TechniqueKinesio® TechniqueKinesio® Technique

Split strip starting at the TP of Split strip starting at the TP of the 2the 2ndnd Vertebrae (below the Vertebrae (below the hairline) with minimal stretch hairline) with minimal stretch apply one strip to lateral apply one strip to lateral clavicle / acromion, other strip clavicle / acromion, other strip to medial border of the scapulato medial border of the scapulaTape with cervical spine in Tape with cervical spine in contralateral sidebendcontralateral sidebendIndications – generally Indications – generally inhibitioninhibition

Modified Tape Practical Modified Tape Practical ApplicationApplication

Single stripSingle strip

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Kinesio® Taping UTKinesio® Taping UTDecreased Pain, no change Decreased Pain, no change

EMGEMGMurray H. Effect of Kinesio Taping on Murray H. Effect of Kinesio Taping on Upper Trapezius Muscle Tone and Upper Trapezius Muscle Tone and Cervical Discomfort. 15Cervical Discomfort. 15thth Annual Kinesio Annual Kinesio Taping Symposium 2000Taping Symposium 2000

Upper Trapezius inhibitionUpper Trapezius inhibition15 subjects with neck pain15 subjects with neck painNo significant difference with EMGNo significant difference with EMGSubjective complaint of pain Subjective complaint of pain decreased with tapedecreased with tape

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Effects of Tape on ScaptionEffects of Tape on ScaptionDecreased UT / Increased LT Decreased UT / Increased LT

EMGEMGSelkowitz DM et al. The effects of scapular taping on the surface electromyographic signal amplitude of shoulder girdle muscles during upper extremity elevation in individuals with suspected shoulder impingement syndrome. J Orthop Sports Phys Ther. 2007 Nov;37(11):694-702. Scapular taping decreased upper trapezius and increased lower trapezius activity in people with suspected shoulder impingement during a functional overhead-reaching task, and decreased upper trapezius activity during shoulder scaption.

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Effects of Endura Fix on Lower Effects of Endura Fix on Lower TrapeziusTrapezius

Inhibits Muscle ActivityInhibits Muscle ActivityAlexander CM et al. Does tape facilitate or inhibit the lower fibres of trapezius? Man Ther. 2003 Feb;8(1):37-41. The tape was found to inhibit lower trapezius activity. On average, the application of Endura Fix tape inhibited trapezius by 4%. The application of Endura Sports tape overlaying the Endura Fix tape inhibited trapezius on average by 22%. The inhibitory effect was negated once the tape was removed.

Scott & Dyanna Rezac - Taping Cervical Spine 14

Kinesio® Taping Kinesio® Taping PosturePosture

Decreased Pain/Increased Decreased Pain/Increased GH flexionGH flexionMurray H, Husk L, Garcia D. Effects of Murray H, Husk L, Garcia D. Effects of

Kinesio Taping on Posture and Upper Kinesio Taping on Posture and Upper Extremity Pain. Presented at 16Extremity Pain. Presented at 16thth Annual Annual Kinesio Taping Symposium. 2001Kinesio Taping Symposium. 2001

Unilateral rhomboid facilitation and Unilateral rhomboid facilitation and pectoralis inhibitionpectoralis inhibition15 subjects15 subjectsPain complaints significantly decreased and Pain complaints significantly decreased and GHJ AROM flexion increased by an average GHJ AROM flexion increased by an average of 15 degreesof 15 degrees

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Postural CorrectionPostural CorrectionMcConnell TechniqueMcConnell Technique

Enhance Force CoupleEnhance Force CoupleCan tape from scapula Can tape from scapula to contralateral pelvisto contralateral pelvisUnilateral or BilateralUnilateral or BilateralCarry-over PNFCarry-over PNF

Postural CorrectionPostural CorrectionScapular retraction and Scapular retraction and depressiondepressionUnilateral or bilateralUnilateral or bilateral

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Postural CorrectionPostural CorrectionDecreased KyphosisDecreased Kyphosis

Greig AM et al. Postural taping decreases thoracic kyphosis but does not influence trunk muscle electromyographic activity or balance in women with osteoporosis. Man Ther, 2007 AprThere was a significant effect of postural taping on thoracic kyphosis (p=0.026), with a greater reduction in thoracic kyphosis after taping compared with both control tape and no tape. No EMG or balance effects found.

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ScoliosisScoliosis

Tape single strips moderate to maximum stretch on anterior rotated segments

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Rib Pain Rib Pain (Fracture/Subluxat(Fracture/Subluxat

ion)ion)Athletic & Kinesio® Athletic & Kinesio®

TechniqueTechniqueDecrease pain, similar to Decrease pain, similar to immobilizer brace, but immobilizer brace, but allows mobility of other allows mobility of other segmentssegmentsSingle strip over affected rib Single strip over affected rib light to moderate stretchlight to moderate stretchCross strips unload with Cross strips unload with space corrections (max space corrections (max stretch across middle 1/3, stretch across middle 1/3, no stretch on ends) on no stretch on ends) on either side of fractureeither side of fracture

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Maxillofacial Maxillofacial (sinus)(sinus)

Kinesio® TechniqueKinesio® TechniqueEdema strips Edema strips no stretchno stretch

Single strip Single strip across across frontal sinusfrontal sinusSplit across Split across nasal sinusnasal sinus

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TMJ UnloadTMJ UnloadSpace correctionSpace correction½ strip or 1” tape½ strip or 1” tape~1.5 squares~1.5 squaresMaximal pull over Maximal pull over center 1/3, no pull center 1/3, no pull on lateral 2/3on lateral 2/3Apply 2-4 strips in Apply 2-4 strips in crossing crossing directionsdirections

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C7-T1 Unload C7-T1 Unload (Dowager’s (Dowager’s

Hump)Hump)Decrease pressure / Decrease pressure / pain over C7-T1 jointpain over C7-T1 joint2 - 4 space 2 - 4 space correction stripscorrection stripsMaximal stretch over Maximal stretch over middle 1/3, no middle 1/3, no stretch lateral 2/3stretch lateral 2/3Great carry-over Great carry-over following C7-T1 following C7-T1 fascial releasefascial release

Clinical Evidence-BasedClinical Evidence-BasedGonzalez-Iglesias. Short-term effects of cervical kinesiotaping on pain and cervical ROM in patients with acute whiplash injury: a randomized clinical trial. JOSPT 2009.Tension application vs shamIncrease in ROM and decrease in pain in tension group

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Clinical Evidence-Clinical Evidence-BasedBased

What was your Comparable or Asterisk What was your Comparable or Asterisk (*) Sign? – recheck that after taping(*) Sign? – recheck that after tapingObjective AssessmentObjective Assessment

Capital Flexion TestsCapital Flexion Tests – substitution of SCM / – substitution of SCM / scalenes, mmHG (pressure) they can hold, scalenes, mmHG (pressure) they can hold, number of reps, range they can perform and number of reps, range they can perform and hold timehold timePosturePosture – symmetry, improvement in – symmetry, improvement in excessive or decreased kyphosis or excessive or decreased kyphosis or lordosislordosisAROMAROM – Improvement in range, pain and – Improvement in range, pain and quality of motionquality of motion

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Clinical Evidence-Clinical Evidence-BasedBased

Objective AssessmentObjective AssessmentOutcome MeasuresOutcome Measures - NDI (Neck Disability - NDI (Neck Disability Index)Index)Pain / HeadachesPain / Headaches - at rest, with previously - at rest, with previously aggravating motions and / or activitiesaggravating motions and / or activities

FrequencyFrequencyIntensityIntensityDurationDuration

MMTMMT – spine and UEs – spine and UEsNeurological TestingNeurological Testing

Decreased radicular symptomsDecreased radicular symptomsSpecial Testing – Adson’s, Allen’s, ULT, Shoulder Special Testing – Adson’s, Allen’s, ULT, Shoulder abduction testabduction test

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Clinical Evidence-Clinical Evidence-BasedBasedFunctional ImprovementsFunctional Improvements

Positional Tolerance Positional Tolerance Sitting – at computer, to drive, attend child’s Sitting – at computer, to drive, attend child’s sports activitiessports activitiesStanding with UE activity – washing dishes, at Standing with UE activity – washing dishes, at workworkC/S Extension – overhead hanging curtains, C/S Extension – overhead hanging curtains, changing lightbulb, painting, drywallchanging lightbulb, painting, drywall

Activity ToleranceActivity ToleranceTurning head for driving safelyTurning head for driving safelyLifting – groceries, children, houseworkLifting – groceries, children, houseworkPushing/Pulling – lawnmower, vacuum, pushing a Pushing/Pulling – lawnmower, vacuum, pushing a stroller or grocery cartstroller or grocery cart

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Questions/Comments/Questions/Comments/Discussion?Discussion?

dyanna.rezac@rezacpt.comscott.rezac@rezacpt.com

www.rezacpt.com