Understanding and Using:

NSM(Neurosensory / Structural /

Microcirculatory)

Approach to Kinesiology Tape Application to Improve Patient Outcomes

Marcia Hamilton, MSHS, OTR/L, BCP, NSTP-1

Note:Knowledge presented today is based on learning that occurred over both 5 years of experience using kinesiology tape in sub-acute care and through the certification process of the Neurosensory / Structural / Microcirculatory (NSM) methodology, a 16-hour course providing a curriculum forming the basis of understanding the Neurosensory and Structural and Microcirculatory uses and applications of kinesiology tape.

NSM course dates and locations can be found under the Education tab of SpiderTech.com

Today’s tape applications were donated by:

What is Kinesiology TapeKinesiology tape is a cotton, elastic, lightweight therapeutic tape that has many applications for improving function in rehabilitation. Dr. Kenzo Kase, Chiropractor invented the tape in the 1970s. Characteristics of this tape are:Made of cotton with fibers allowing for increased airflow and evaporation. Hypoallergenic.Unidirectional elasticity with 140% longitudinal stretch, similar to skin.Heat activated, water resistant Other names; Spider Tech Taping, Elastic Therapeutic Taping, MyoFascial Taping, Elastic Rehabilitative Taping, KT Kinesiology Tape, Neuro Muscular Taping and Neurostructural Taping.

(Jones, 2013, DeRu, 2014)

2008 Olympics

http://www.spidertech.com

World class Javelin Thrower

http://www.wellness4lifechiro.com/Kinesiotape_javlin.jpg

David Beckamhttp://chirocentre.co.uk/wp-content/uploads/David-Beckham-Pink-Coloured-Kinesio-Tape.jpg

Simple applications-Quick results

Pediatric application for torticollis

More Characteristics:Lightweight, yet supportiveColorful or notAvailable commercially to public, Wal-Mart, CVSCan be worn for 3-5 daysCan be worn during swimming, bathing, showeringReported to be over 60 brands

The end cap at

WA

LMA

RT

What is the science behind it?Kinesiology: Knowledge of muscle movement, force vectors

and the relationship to the rest of the body systems.Biomechanics: Providing support to a joint that through

gentle compression allows the joint to move through full AROM. Enabling movement to heal.

Neurosensory: Neurophysiology of PainNociceptionNeuromuscular Plasticity

What types of theories exist about kinesiology tape?

• I. Original Model: Convolutions, Skin Lifting, Proprioception, Origin-Insertion direction.

• II. Fascia Models• A. Fascia/biotensegrity• B. Anatomy trainsIII. Skin (brain) model A. Dermatomes/segmental taping B. Entrapment cutaneous nerves IV. Energy Model Meridians and acupuncture points

(deRu Ba, 2012)

NSM Model, Application and Clinical Reasoning:• Evidence led approach taking into account structural and

neural influence of the tape on the body.• Application techniques are based on clinical objectives:• Neurosensory:

• Pain modulation, nociception, neuroplasticity

• Structural: Support an unstable joint, Postural Support• Microcirculatory::

• Accessing the lymphatic system

Why use a NSM Taping Approach?

Decrease painDecrease nociceptive influence of the CNS: based on theory of

sensory gating. Restore muscle activation and normalization of muscle tone.Restore and improve range of motion.Promote a faster rate of healing.

(Jardine, 2012)

Important reasons for using the NSM Taping Methodology

In conclusion there are many different theories and ways to apply tape, however the NSM taping method provides:•A frame of reference, that is reflective of research and pertinent scientific discovery.•A curriculum aligned with the frame of reference.•A curriculum that aligns with occupational therapy frames of reference, (Sensory Integrative, NDT, Open system models of occupational performance- MOHO, EHP, PEOM) •Ongoing therapist education and support•Ongoing patient education and support.• Convenient pre-cut patterns increase and optimize patient success for using tape. •http://www.spidertech.com/testimonials

Occupational Therapy Frames of Reference in relation to NSM Application

Frame of Reference• Biomechanical

• Sensory Integrative

• Neurodevelopmental

Use of Kinesiology Tape: • Remediate loss of motion, strength, endurance,

edema, pain

• Adaptive responses will occur through integration of multiple sensory systems. The brain will seek stimulation to organize itself. The CNS has plasticity. Activity is easier to engage in when there is a sense of emotional security.

• Scapular/Pelvic stability, trunk and neck control are prerequisites for limb mobility. Normalization of muscle tone can be achieved by various techniques such as breaking up synergy, inhibition of reflexes, weight shifting and reciprocal movement.

More Frames of Reference:

Frame of Reference• Model of Human Occupation (MOHO):

• Ecology of Human Performance, (EHP):

• Rehabilitative:

Use of NSM Taping Methodology to support client-centered change

• Promote engagement in occupations that restore, reorganize or maintain their motivation, patterning and performance capacity, affecting occupational lives. This will occur through providing opportunities for the person to themselves accomplish their own change.

• Establish/Restore, Alter, Adapt, Prevent , Create intervention strategies to improve performance

• Strategies to enable the greatest amount of independence in meaningful occupations.

(Brown, 2013)

The World Health Organization’s International Classification of Functioning, Disability and Health (ICF)

• Health Condition(disorder or disease)

Body Structure & Activity ParticipationFunction

Environmental Factors Personal Factors

In a nutshell, what is it good for? Acute Pain Chronic Pain Rehabilitation after Surgery Poor posture Swelling, Edema and Bruising Muscle and Joint Injuries Optimizing athletic performance Improving independence with ADL

Understanding Pain and making clinical decisions:

Types of Pain:•Cramping, dull, aching; Muscle•Sharp, shooting: Nerve Root•Burning, pressure-like, stinging; Sympathetic nerve•Deep,sharp,severe; fracture•Throbbing, diffuse; VascularSympathetic Nervous System Response:•Response can be visualized in fascia•Our goal is to calm the nervous system and reduce the stress

Mechanisms of Action of NSM Taping:

Mechano-disruption: Physical distortion of tissue causes firing of neural signals to CNS

Mechano-transduction: Mechanical stimulus is converted into bioelectrical or biochemical signals

Mechano-corrective: Structural restraint of potentially harmful positions.

( Jardine &Tsaggarelis, 2012)

Categories of Therapeutic Effect of NSM Taping:

Psychological: conscious kinesthetic awarenessNeurosensory: Inhibition of nociceptive pain impulsesStructural: provides support to weak or lax joints.Microcirculatory: Tissue repair, tissue flow, tissue adaptation

(Jardine & Tsaggarelis, 2012)

Microcirculatory

http://www.spidertech.com

Skin after removal of tape: http://www.erringtonchiro.com/uploads/2/2/4/8/22483854/1342379.jpg?246

Lymphatic System

http://www.corpshumain.ca/en/images/lymphatiquehomme_2_Full_en.jpg

Lymphatic Circuit:

http://www.worldtherapycenter.com/category/fitness/

Anatomy of the skin and fascia:

http://true.massage-research.com/2013/06/fascia-and-reflexology.html

Understanding the importance of fascia; (fascia can be considered to be all collagenous soft connective tissues)

Fascia is now known to be a 3-D network of fibrous, dynamic, gluey and wet proteins that hold our bodies together and at the same time enables them to move. (Day, Copetti, Rucli, 2012, Lockwood,1991)

Understanding fascia can begin with the embryogenesis of the musculoskeletal system, (Day, Copetti, Rucli, 2012)

Recently termed as a “biomechanical regulatory system”, (http://anatomy trains.com).Consists of:•Superficial fascia- mostly adipose •Deep fascia- (epimysium, perimysium, endomysium)•https://www.youtube.com/watch?v=3YfgMABGf7U•https://www.youtube.com/watch?v=JgNoUrNlgr4•https://www.youtube.com/watch?v=-uzQMn87Hg0

Skeletal System

http://1.bp.blogspot.com/-X7ZExNZt5FU/UoGiNjLk4sI/AAAAAAAAC3g/PqNMpZHKsn4/s1600/Skeletal+System.jpg

Muscular System

http://homepage.smc.edu/wissmann_paul/anatomy1/1muscles.html

Functional Anatomy Review:

https://www.google.com/search?q=famous+athletes+wearing+kinesiology+tape&espv=2&biw=768&bih=603&tbm=isch&imgil=RQLb-tItH0FSlM%253A%253BKwM_vtwCx7UOCM%253Bhttp%25253A%25252F%25252Fchirocentre.co.uk%25252Fkinesio-tape-coloured-taping-athletes-sport-injury%25252F&source=iu&pf=m&fir=RQLb-tItH0FSlM%253A%252CKwM_vtwCx7UOCM%252C_&usg=__oiGSMqGRGEcbmoIJNe__EOgKVIs%3D&ved=0CDUQyjc&ei=g_sGVcbSHYqXNv6mgqgI#tbm=isch&q=trapezious+muscle+and++kinesiology+tape+images&imgdii=_&imgrc=zmQfcK9QYY4eyM%253A%3BHjYLONyjcSy5gM%3Bhttps%253A%252F%252Fs-media-cache-ak0.pinimg.com%252F736x%252Fd8%252F56%252Fd1%252Fd856d174acf787710e206b6dcb315348.jpg%3Bhttps%253A%252F%252Fwww.pinterest.com%252Fshilosessions%252Fkt-tape%252F%3B587%3B587

The Deltoid:

• Attaches, (origin) around spine of scapula and clavicle forming a “V’. (Same as insertion of trapezius).

• Three segments: anterior, middle and posterior• All fibers: AB/duct the GHJ• Anterior: Extend, laterally rotate and horizontal AD/duct• Posterior: Extend GHJ, laterally rotate GHJ, horizontal AB/duct

Involved in most functional movement of the shoulder.

Taping to help support the?

The Rotator Cuff a major GHJ stabilizer:

Relationship of the muscles moving scapula and GHJ:

Stabilizing scapula and SITS group

Scapular Control • Rhomboids: To palpate in prone, place arm behind back

with palm out. Located deep to trapezius and superficial to erector spinae muscles.• Rhomboids : Action AD/duct scapula, Elevate scapula,

Downward rotate the scapula• R. Major: Origin is T2-T5• R. Minor: C7-T1Levator Scapula: Origin is TP of C1-C4, Insertion medial

border of scapula, between sup. Angle and spine of scapula

Rhomboids and Levator Scapula:

Anterior chest muscles and control of scapula:

Muscles of the Shoulder

The Triceps and its Role in Shoulder Stability:

• The triceps brachii is the only muscle located on the posterior surface of the arm and is responsible for extending the elbow and shoulder. It serves as the antagonist to the biceps brachii. As the name indicates there are three heads;• Long head: Origin is infraglenoid tubercle of the scapula• Lateral head: Posterior surface of proximal half of the humerus• Medial head: Posterior half of the distal half of the humerusAll three insert on the olecranon process.

The Triceps;

Biceps and Coracobrachialis

Muscles acting on the Elbow:• Brachialis• Brachioradialis

Muscles moving the wrist and fingers

Pronation and Supination

Thumb and finger muscles

One more time……

Abdominal Muscle Function: http://www.sycoxt.com/images/ab-

muscles.jpg

.

http://www.discovery.com/tv-shows/curiosity/topics/nervous-system-pictures.htm

http://bethycotter.wdfiles.com/local--files/somaticautonomicnervoussystems/Screen%20Shot%202012-09-03%20at%209.45.43%20AM.png

KinesiologyKinesiology is the study of movement incorporating anatomy,

physiology, physics, geometry as it relates to movement.In fact, neuromuscular physiology, musculoskeletal anatomy

and mechanics are used to understand movement, both generally and specifically.

(Lippert, 2011)

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Kinesiology Tape Application

Spider Tech offers comprehensive instructional videos on their web-site. NSM Application videos are good for both practitioners and patients:

SpiderTech Educational Videos:Lower BackKneeShoulderElbowMicrocirculatory

Thinking outside of the pattern:

Using clinical reasoning, palpation, knowledge of neural responses, lymphatic system and kinesiology don’t be afraid to try something different:•Using a hip spider to provide stabilization of GHJ and prevent scapular winging.•Use more than one application, for example low back and hip, shoulder and elbow.

Precautions:Never apply to burned or open skinTake care with the geriatric and pediatric population , due to

fragile skin. There is a “sensitive skin’ variety. Use SpiderTech Gentle

Do not remove when wet. If pain increases remove. Watch for creases in tape. Remove if excessively itchyAvoid applying over large blood vessels, particularly jugular

vein and carotid artery, under axilla.

Why are we using kinesiology tape as Occupational Therapy Practitioners?IMPROVE PATIENT OUTCOMES:Increase rate of healingDecrease painIncrease pain free movement to improve overall functionIncrease carry over of NDT handling/ cueingEnable participation

IT IS AN EXTENSION OF OUR PRACTICE & OUR HANDS

DOCUMENTATION

Include information in standard SOAP note: 97112, 97110Reflect gains in function with respect to all areas normally reported.Report carry over with ADL and IADL in assessment section.Teach patients and caregivers when nearing discharge.

Billing Codes:

Thorax 29200Shoulder: 29240

Elbow/Wrist: 29260Finger: 29280

Enabling Participation

Support where it is needed:

http://www.pinterest.com/pin/469148486156626495/

Why?

http://lookbookers.info/uncategorized/kinesio-tape/

https://www.google.com/search?q=Inspirational+kinesiology+tape+videos&client=safari&rls=en&tbm=isch&tbo=u&source=univ&sa=X&ei=PUxeVOnJHqPIsATg94GwAw&ved=0CF4Q7Ak&biw=524&bih=503

References:

• Brown, R., (2013). Common theories, models of practice and frames of reference used in occupational therapy. http;//www.academia.edu/9129736/Common_Theories_Models_of_Practice_and_Frames_of _reference_Used in _occupational _therapy Ret:2/17/15

• Christiansen, C., Baum, C., Bass-Haugen, J., (2005). Occupational Therapy: performance, Participation and Well-Being, Slack Incorporated, Thorofare, NJ

• Day, A., Copetti,L., Rucli, G., (2012). From clinical experience to a model for the human fascial system. Journal of Bodywork and Movement Therapies,16, 372-380

• de Ru Ba, E., (2014) . New treatment models and hypotheses in Elastic Therapeutic (Kinesio) taping: Presented at “International Disabled Peoples Day, March Scientific Meeting, Zgorzelec 3/20/14

• Jardine, • Jardine, K., Tsaggarellis, B. (2013) Neurostructural Taping Technique, COLLABORANS,

Inc. Toronto, Canada• Jones, K. (2013). Therapeutic Taping, Physical Therapy Products, Feb-March 2013;

(pages 25 -29) Allied Media, Overpark, Kansas• Lockwood, T., (1991), Superficial Fascial System of the trunk and extremities, a new

concept. Plastic & Reconstructive Surgery 87:6• Myers, T., (2014) Anatomy Trains, Churchill Livingstone Publishing Company

References continued:

Photo Images: 1. 2008 Olympics: http://www.spidertech.com/contact-us2. Microcirculatory:http://www.spidertech.com/contact-us/3. Anatomy of Skin and Fascia:http://true.massage-research.com/2013/06/fascia-and-reflexology.html4. Lymphatic System:http://www.corpshumain.ca/en/images/lymphatiquehomme_2_Full_en.jpg5. Skeletal System: http://1.bp.blogspot.com/-X7ZExNZt5FU/UoGiNjLk4sI/AAAAAAAAC3g/PqNMpZHKsn4/s1600/Skeletal+System.jpg 6.Muscular System: http://homepage.smc.edu/wissmann_paul/anatomy1/1muscles.html

7. Nervous System:http://www.discovery.com/tv-shows/curiosity/topics/nervous-system-pictures.htm

8. Tape on Belly: http://www.pinterest.com/pin/469148486156626495

9. Tape on abdomen: http://lookbookers.info/uncategorized/kinesio-tape/

10. Tape on Diver:https://www.google.com/search?q=Inspirational+kinesiology+tape+videos&client=safari&rls=en&tbm=isch&tbo=u&source=univ&sa=X&ei=PUxeVOnJHqPIsATg94GwAw&ved=0CF4Q7Ak&biw=524&bih=503 11. http://www.worldtherapycenter.com/category/fitness/