CH I RO E CO . COM J A NUARY 1 9 , 2 0 1 5 • R E P R I N T ED F ROM CH I RO P RACT I C E CONOM I C S

CLINICALCONCERNS

IT IS COMMON AS A CHIROPRACTOR

TO HAVE PATIENTS EXPERIENCE

amazing results while in your care.Improved range of motion, decreasedpain, and an overall improved sense ofwell-being are typical outcomes.Unfortunately, many times thoseresults are short-lived and the pain andrestrictions soon return.In this scenario, patients can

become frustrated and may seektreatment elsewhere because they areonly seeing temporary relief ofsymptoms. This is an indication thatthe patient needs activities beyondmanipulation to maintain the positiveresults the treatment provides.Certain areas of the body, namely

the cervical and lumbar spine,scapulae, mid-foot, elbow, and knee,

require stabilization after times ofmobilization or manipulation becausethey need to be inherently stable, notexcessively mobile. The brain willcreate the stability around those jointsby making the muscles around the areahypertonic, thus giving the patient asense that the area is “tight.”A common prescription is to give

stretching exercises to these areas tominimize the tightness, but this canmake the muscles irritated as they tryto provide stability. As a clinician, youcan render stabilization withKinesiology tape (K-tape).Taping for support and posture can

provide the stability the brain wantsand allow the muscles to relax. Thepatient will no longer feel the constanttightness and his or her range of

motion will be restored.If you understand how to use K-tape

and exercise post-manipulation, you’lloptimize your ability to get betteroutcomes. In addition to stimulatingthe central nervous system withmanipulation, taping and exercisingthe area after manipulation can providesustainable stabilization benefits.Increased volume and intensity ofexercises can be added over time andvoila: The patient no longer hassymptoms, and you are the hero.

Mechanism of actionThere is a body of work that examineshow an initial episode of back or neckpain can lead to ongoing changes ininput from the spine. Over time, thesechanges lead to altered sensorimotor

Stick to itImplementing kinesiology taping in your practice.BY EDWARD LE CARA, DC, PHD

THINKS

TOCK

integration of input from the spine andlimbs.Research findings have indicated

that areas of spinal dysfunctionrepresent a state of altered afferentinput that may be responsible forongoing central plastic changes.1-4Furthermore, this may be a potentialmechanism that could explain howhigh-velocity, low-amplitude spinalmanipulation improves function andreduces symptoms. They haveproposed that:

Altered afferent feedback from anarea of spinal dysfunction alters theafferent ‘milieu’ into which subsequentafferent feedback from the spine andlimbs is received and processed, thusleading to altered sensorimotorintegration (SMI) of the afferent input,which is then normalized by highvelocity, low-amplitude manipulation.1

This is an academic way of sayingthat misalignment of the spineinterferes with the central nervoussystem and manipulation helps torestore normalcy. Post-manipulationchanges can be seen with improvedrange of motion and decreased painnot only to the segments manipulatedbut to the extremities as well.Unfortunately, even after the pain is

gone and the tissue has healed, themuscles have already learned what it’slike to be hurt. Therefore, the benefittends to be only temporary.Previously injured muscles need

proper stimulus to reset so they cancontract properly. K-taping can be onepiece of the puzzle that contributes toteaching the muscles how to be normalagain.

Theory into practiceFurther research demonstrates that K-taping may be an “efficacious therapy

due to subtle mechanisms affecting thebrain, not just because it gives mechan-ical support.”5 The tape providesafferent mechanoreceptor stimulus tothe brain, and the brain will perceivestability.

In the case of the cervical spine, ifthe area is stable, the brain does nothave to tighten up the muscles aroundthe neck to provide stability. Inaddition, the patient will be cued tokeep the head in the proper posture,which leads to other benefits.When you manipulate or apply

myofascial release to areas that requireinherent stability, follow manipulationwith something to stimulate the centralnervous system. In the cervical spinearea, you can use a simple “H” K-taping technique (see Figure 1).When the patient gains a sense of

stability from the tape, have him or herperform exercises that maintain thestability through muscular contraction.For the cervical spine, activate the deepcervical flexors for seven-second holds.Start with five repetitions and work upto two sets of 10 repetitions.Remind the patient to breathe

through the diaphragm whileperforming these exercises, in throughthe nose for four seconds and outthrough the nose for six seconds. If it istoo difficult to breathe properly, theexercise is too difficult.How long will the muscular return

to normalcy last? You’ll likely find thatthose who are more active tend tosee greater benefits from this type of

care. Have patients who are not activeincrease their cardiovascular activityif possible.Whenever you manipulate or

mobilize an area that requires stability,consider using K-tape post-manipulation to increase afferentstimulation to the brain. The brain inturn will provide pain mitigation andimprove motor control, thus eliminatingthe need for the muscles to behyperactive in providing stability.If motor control exercises are used

in conjunction with manipulation andK-taping, you’ll likely discover evenbetter effects.

EDWARD LE CARA, DC, PhD,ATC, CSCS, recently sold hispractice of 14 years in Californiaand relocated to Dallas. He is thedirector of athletic training at The

KinetikChain and the Director of Trans Globaleducation at RockTape. He can be contactedat ed@rocktape.com, on Twitter andInstagram at @drlecara, or throughrocktape.com.

References1Haavik-Taylor H, Murphy B. Altered centralintegration of dual somatosensory input aftercervical spine manipulation. J ManipulativePhysiol Ther. 2010;33(3):178-88.

2Haavik-Taylor H, Murphy B. The effects ofspinal manipulation on central integration ofdual somatosensory input observed after motortraining: a crossover study. J ManipulativePhysiol Ther. 2010;33(4):261-72.

3Haavik H, Murphy B. Subclinical neck pain andthe effects of cervical manipulation on elbowjoint position sense. J Manipulative Physiol Ther.2011;34(2):88-97.

4Haavik-Taylor H, Murphy B. The effects ofspinal manipulation on central integration ofdual somatosensory input observed followingmotor training: a crossover study. JManipulative Physiol Ther. 2010;33(3):261-72.

5Callaghan MJ, McKie S, Richardson P, OldhamJA. Effects of patellar taping on brain activityduring knee joint proprioception tests usingfunctional magnetic resonance imaging. PhysTher. 2012;92(6):821-830.

R E P R I N T E D F ROM CH I RO P RACT I C E CONOM I C S • J A NUARY 1 9 , 2 0 1 5 CH I RO E CO . COM

CLINICALCONCERNS

Figure 1

Previously injuredmuscles need proper stimulusto reset so they can contract properly.