Kinesiology Taping

Kinesiology taping, developed in the 1970s by Japanese chiropractor Kenzo Kase, came to the U.S. in the mid-1990s. Now, a number of companies are competing with the tape created by Dr. Kase, called Kinesio Tex Tape. Unlike standard athletic taping, which often involves wrapping a joint for support and compression, kinesiology tape is placed in a variety of patterns depending on the injury. It is pulled to differing degrees of tension to create the desired effect and is typically worn for two to five days, unlike standard tape, which is used mainly during an activity. Kinesiology tape works in several ways to provide pain relief, reduce swelling, assist range of movement and give structural support: Take pressure off painful areas, this reduces the tension through weak or inflammed muscles and tendons reducing the pain and further damage caused if the patient has to continue to use the joints, for work, day to day activities etc. Relax muscles, depending how it is applied the tape is thought to activate stretch receptors in the skin which feed back to influence the control of the muscle tension under the skin or activate muscle spindles within the muscle which would increase the activity and endurance of the muscle. Promote blood and lymphatic. When applied to the skin with stretch the tape naturally wants to recoil. As a result it lifts the skin and fascia to allow blood and lymph flow to increase which is thought to speed up the heeling process. There are several brands of kinesiology tapes on the market available at specialty running, triathlon and cycling shops. Tapes are typically available in two-inch or four-inch widths and some brands, including Rock Tape, Spidertech and Kinesio, also have handy precut tape specifically made for certain body parts such as knees, feet, shoulders and backs. And unlike traditional sports tape, kinesiology tape comes in fun bright colors and patterns.

Cold therapy and Heat Therapy in Injury Management

Do you know when to use ice and when to use heat on a sports injury? Most athletes know to apply ice to an acute injury, but aren't so sure when to use heat. The following guidelines will help you sort it out.
There are two basic types of athletic injuries: acute and chronic. Acute Pain is of rapid onset and short-lived, or Chronic Pain develops slowly and is persistent and long-lasting.

Acute and Chronic Injuries

Acute injuries are sudden, sharp, traumatic injuries that occur immediately (or within hours) and cause pain (possibly severe pain). Most often acute injuries result from some sort of impact or trauma such as a fall, sprain, or collision and it's pretty obvious what caused the injury. Acute injuries also cause common signs and symptoms of injury such as pain, tenderness, redness, skin that is warm to the touch, swelling and inflammation. If you have swelling, you have an acute injury. Chronic injuries, on the other hand, can be subtle and slow to develop. They sometimes come and go, and may cause dull pain or soreness. They are often the result of overuse, but sometimes develop when an acute injury is not properly treated and doesn't heal.

Cold Therapy with Ice

Cold therapy with ice is the best immediate treatment for acute injuries because it reduces swelling and pain. Ice is a vaso-constrictor (it causes the blood vessels to narrow) and it limits internal bleeding at the injury site. There is controversy as to whether continued application of ice results in a sudden vasodilation of the blood vessels (the hunting response) and if so, at what time this response begins and how often a cycle of constriction and dilation occurs. To ice an injury, wrap ice in a thin towel and place it on the affected area for 10 minutes at a time. Allow the skin temperature to return to normal before icing a second or third time. You can ice an acute injury several times a day for up to three days. Cold therapy is also helpful in treating some overuse injuries or chronic pain in athletes. An athlete who has chronic knee pain that increases after running may want to ice the injured area after each run to reduce or prevent inflammation. The best way to ice an injury is with a high quality ice pack that conforms to the body part being iced. Examples include Cold Therapy Wraps and SnowPack Cold Therapy products. You can also get good results from a bag of frozen peas, an ice massage with water frozen in a paper cup (peel the cup down as the ice melts) or a bag of ice.

Heat Therapy

Heat is generally used for chronic injuries or injuries that have no inflammation or swelling. Sore, stiff, nagging muscle or joint pain is ideal for the use of heat therapy. Athletes with chronic pain or injuries may use heat therapy beforeexercise to increase the elasticity of joint connective tissues and to stimulate blood flow. Heat can also help relax tight muscles or muscle spasms. Don't apply heat after exercise. After a workout, ice is the better choice on a chronic injury. Because heat increases circulation and raises skin temperature, you should not apply heat to acute injuries or injuries that show signs of inflammation. Safely apply heat to an injury 15 to 20 minutes at a time and use enough layers between your skin and the heating source to prevent burns. Moist heat is best, so you could try using a hot wet towel. You can buy special athletic hot packs or heating pads if you use heat often. Never leave heating pads on for more than 20 minutes at a time or while sleeping. Because some injuries can be serious, you should see your doctor if your injury does not improve (or gets worse) within 48 hours.

Understanding the Underpinning Principles of Injury

There are two types of injury: Intrinsic and extrinsic. Intrinsic injuries are internal injuries that result from individual anatomical or pathological factors. Individuals can be more prone to these injuries because of inherent genetic qualities. Examples of these injuries include overuse injuries such as stress fracture, tendonitis and muscle strain, and injuries such as tears to the Achillies tendon that occur in sports such as squash.

Extrinsic injuries are injuries that result from external factors such as training errors, inappropriate equipment and the nature of the competition. Examples of these injuries include fractures to the clavicle resulting from forceful contact with another player in sports such as rugby or falls from bikes during sprint finishes in professional cycling races, factures to the leg resulting in falls from horses or awkward crashes in skiing, whiplash injuries resulting from crashes in motorsports, and ligament damage caused by contact with another player in sports such as martial arts, football or contact sports such as rugby.

There are additional injury risk factors connected with certain categories:

Older Age Groups: Older age groups can have reduced functional abilities, flexibility, strength, endurance, coordination and balance and are more likely to suffer from arthritis and cardio-vascular disorders. Older people can injure more easily and can recover more slowly. Injuries can be prevented by working within their limitations and taking care with form. It is important to slowly get the body used to moving in new ways.

Children: Children can be very prone to sports-related injuries if their sports are not well coached. Musculo-skeletal immaturity dictates that all intense strength-based training and competitive activates should be monitored and graded. Activities should be broad based and varied rather than sport-specific during early development. Children are also more prone to heat stroke.

Gender: Women tend to be more vulnerable to biomechanically related injuries. Being naturally physically weaker and smaller than men, they have biomechanical disadvantages such as wider hips with increasing femoral angle and genu valgus, wider Q angle, narrow shoulders, wider carrying angle of the elbow and breasts. Sports bras provide the necessary comfort and support. Men however are less prone to intrinsic injuries but demonstrate a greater tendency toward macho risk laden behaviour. Wearing the correct sports clothing can decrease risk of injuries for women and men can reduce the risk of injury by training sensibly within limits.

Medical conditions: Any medical disorder can be aggravated by inappropriate exercise. Common problems include: asthma, hyper and hypo tension, heart problems, arthritis, diabetes, and epilepsy. Individuals should be screened for medical conditions and the medications they take. Medical consent prior to new sports and close monitoring can help prevent injury.

Injury history: Ideally exercise coaches know of a participants injury problems and makes concessions from them and provides rehabilitation assistance. Old injuries can be aggravated

by exercise. Compensatory postures, movements and gait can quickly lead to new injuries. Therefore it is important to seek proper advice from other professionals such as physiotherapists and osteopaths.

De-training effects: Injuries can limit normal training pattern. This leaves the individual prone to regional and general weakening, atrophy, loss of power and reduced endurance. Awareness of this and proper rehabilitation can avoid additional injury.

Fitness levels: Whatever the fitness level, it is the responsibility of the coach to instruct while adhering to the correct principles of training. Doing too much too quickly or more than the individual is accustomed to or too often can increase injury risks. Overload, duration and frequency should be applied gradually so as to allow the body to adapt safely to an improved level of fitness.

Postural and biomechanical problems: Any significant structural malalignment has potential to affect performance and efficiency. It is best to combine remedial and general training.

Nutrition: A healthy balanced diet is important for health and performance. Hydration should be adequate before, during and after exertion and dietary specifics are often incorporated into sports training regimes. Individuals should not exercise soon after consuming a heavy meal to avoid injury.

Painful exercises: Pain is a warning sign that there are problems. It is generally accepted that training through any pain greater than normal exercise discomfort is a bad idea. Alternative exercises are usually available to avoid exercise that causes pain. These exercises avoid overly stressing problem muscles or joints. Pain should always be checked.

The exercise environment: If indoors the area should be suitable for the activity and the number of participants involved. It should be free or clutter, spillages and obstructions. Studios benefit from being well lit and having sprung-wood flooring and large mirrors. If outdoors, the weather will always be an influence and planning should take this into consideration. Ground surfaces should be taken into consideration and grassy areas should be checked for debris. Footwear should be appropriate for the surface ie studs should not be worn on astro turf or hard surfaces; running/tennis trainers should not be worn on astro turf; specialised astro trainers have extra grip tread and should be worn on astro turf. Whether indoors or out there must always be first aid provisions and these should be compliant with legislation requirements as well as the requirements of the sport governing body. For instance in football, the FA now requires a separate defibrilator be avaiable pitch side during matches for exclusive use of players during premiership and league matches. Other sports may have similar requirements.

Exercise equipment: All forms of exercise require at least minimal equipment. Specialised clothing including footwear is desirable for many activities and football, hockey and rugby governing bodies require players at all levels of the game to wear shin pads as a minimum requirement. Equipment should be checked daily, kept clean and should be replaced when

necessary, taking into account effectiveness after a period of time even if excessive wear and tear or damage is not visible. Continuing to use excessively worn or damaged equipment can lead to injury as it can compromise biomechanics. Therapists should always encourage the use of correct equipment.

Excessive repetition: Overuse injuries can occur relatively easily. Muscle fatigue can lead to strain. Tendonitis and other RSI type injuries can develop quickly under inappropriate or unaccustomed repeatitive loading and can take a long time to resolve. Wear bearing exercises that are excessively repeated can lead to undue stress on joints and muscle imbalance. In particular runners can experience shin splints, ilio tibial band syndrome, stress fractures, Achilles tendonitis etc from the excessive repetition that comes about from distance running. Rest, cross training and recovery days can all reduce this risk factor.

Exercising heart rate: To achieve safe aerobic benefit it is recommended to work within the aerobic zone of 50-80 per cent of the individual’s heart rate. The usual method employed to calculate this is 200 minus the individuals age (therefore for an individual aged 28, the maximum heart rate is 200-28=172). Heart rate monitoring enables safer and effective training that does not place undue stress on the cardiovascular system.

Over-exertion: In an ideal exercise programme there should be adequate periods or rest and recovery from exertions. Training exercises should not be so frequent or intense as to cause excessive Delayed Onset Muscle Soreness (DOMS) or other unwanted symptoms. Regular over-exertion can lead to suffering undue fatigue and poor recovery. Heart rates may stay elevate after cool downs. Poor sleep can ensue together with a weakening immune function. Women can experience amenorrhoea. Overuse injuries increase in incidence. Exercise addiction is a growing problem.

Exercising when unwell: When the client is unwell the best course of action is to rest and avoid training. Individuals therefore should be advised to not undertake strenuous exercise when unwell. However minor health complaints should not prevent exercise and it should be remembered that individuals with issues such as multiple sclerosis can have good days as well as bad and some complaints can benefit from remedial exercise. Suffers of asthma and hay fever can have periods of difficulty relating to the training environment.

Injuries can be trivial or serious and they can be classified in a variety of ways. They can be intrinsic or extrinsic and can be classified according to the type of tissue affected or the type of insult inflicted upon the tissues. They can also be described according to the stage of their healing. In simple terms they can be seen as mild, moderate or severe. Furthermore they can be described as being regional for example rotator cuff tendonitis or sport related such as knee cartilage injuries in football.

Primary Injuries: These are the initial injury that occurs.

Secondary Injuries: Athletes returning to activity are also at risk of a secondary injury, which is an injury that occurs as a result of a previous injury being poorly treated or not being fully healed. Athletes risk recurrence of injuries if they commence playing before regaining full strength and range of movement.

Macrotrauma (acute injury from an event): This is defined by the early onset and short duration of the signs and symptoms following the trauma. The injury could involve any one or more of the body’s tissues. Typically the athlete is aware of how the injury occurred and with acute sporting injury the common signs and symptoms include pain, tenderness, swelling, contour deformity or bleeding. An injury is normally described as being acute until the initial signs of inflammation have reduced, and the healing process has begun, which is normally after 48-72 hours.

Microtrauma (Including overuse and cumulative): These tend to come on gradually, initially beginning as a slight discomfort and perhaps a little aching after exercise that eases off with warming up the muscles. If symptoms are ignored they will more often than not exacerbate. Minor discomforts then become so uncomfortable that they affect everyday life as well as exercise and sporting activities

Accidental: The term 'accident' is used to describe events that cause injury in an attempt to highlight the predictable and preventable nature of most injuries.

Overuse: Most overuse injuries begin with a minor inflammatory reaction in the affected tissues and the injury require appropriate acute, sub-acute or chronic treatment. The initial treatment nearly always involves rest and clinical therapy.

Chronic: These injuries usually have a gradual onset, resulting most commonly from repetitive minor insults, the cumulative effects often being the cause of a long-standing problem. Chronic problems often develop when minor injuries are poorly managed. With more severe injuries whether from one traumatic incident or from overuse, the athlete is often left with a chronic problem. Chronic problems usually demand management and rehabilitation that may involve adaptations to normal activities alongside physical therapies.

Sprains and strains are additionally classified as 1^st 2^nd and 3^rd degree injuries that describe the severity of the damage to the muscle, tendon or ligament

1^st degree strain: A first degree strain is a minor partial tear. There will be mild to moderate pain on contraction or stretch, but usually very minor functional impairments, which will be more noticeable during more intense exercise. The muscle may appear weaker than normal and there may also be minor muscle spasm (tightening), possibly accompanied by a mild degree of swelling and discoloration. There is usually tenderness on local palpation. Recovery is usually quick and complete if correct principles of management are applied.

2^nd degree strain: A second degree strain is a more severe partial tear, resulting from a more forceful contraction or stretching. There is a more pronounced set of signs and symptoms associated with a second degree strain. Pain is moderate to strong during stretch, contraction

and palpation, weakness is evident, spasm may be present in affected and adjacent muscles, swelling can be moderate to major and function impaired to a great degree. There may be a palpable indent in the muscle tissue. Obviously, the greater severity of muscle damage, the longer the recovery. Second degree muscle injuries will normally heal with good treatment and progressive remedial exercise in three to six weeks. The therapist should emphasize awareness to the possibility of aggravation of the injury by too early return to full training or competition.

3^rd degree strain: A third degree muscle strain is a complete rupture where there is a complete or virtual lack of continuity in the affected muscle. This injury is the result of a very forceful contraction or overstretching. Typical signs and symptoms include severe pain as the injury occurs, which commonly reduces soon afterwards, significant weakness and loss of function, marked swelling, muscle spasm in adjacent muslces, complete loss of strength on specific resistance testing, palpable fibre bunching (with bump and hollow deformity) and local and diffuse pain. This grade of injury usually necessitates either a surgical repair or at least a few weeks of cast immobilisation prior to a comprehensive rehabilitation programme. Return to full fitness often takes two to three months or longer.

1^st degree sprain: This is a minor partial tearing of fibres. There will be minimal fibre damage, local pain and tenderness and minimal loss of function. The joint should still retain its stability and have no obvious deformity, aside from possible minimal swelling and associated muscle spasm. Recovery is normally quick (two to three weeks) given appropriate therapeutic management.

2^nd degree sprain: A second degree sprain is a more severe partial tearing of ligament fibres. There may be pain at rest, pain on weight-bearing, and pain on stress testing. There is likely to be considerable swelling and loss of function. Return to fitness is usual within three to six weeks.

3^rd degree sprain: A third degree sprain is a complete rupture where there is a complete or virtual lack of continuity in the fibres of the affected ligament. There will be severe pain at the time of injury, but later the pain may be less than that of a second degree sprain. There will also be severe loss of joint function, associated muscle spasm and marked instability. A complete rupture will often lead to a rapid swelling around the joint. This grade of sprain demands surgical repair or at least cast immobilisation prior to a comprehensive rehabilitation programme. Return to full fitness commonly takes three to four months or longer.

Direct: These are extrinsic injuries, usually involving a forceful impact with an opponent or implement (such as a hockey stick or ball). These injuries often produce a contusion but haematoma, nerve damage, dislocation, sprain, strain, fracture of open wound are all possible.

Indirect: These are intrinsic injuries, resulting from excessive forces generated within. Commonly it is the major muscles that span two joints such as the hamstrings, quadriceps and gastrocnemius that are strained during explosive activity. Ligament sprains and meniscus tears can also result from unaccustomed, ill prepared or excessive movements.

The most common types of sports injuries to the soft and hard tissues include:

Strains: A strain is a tear in a muscle or tendon and results from excess tensile stress through the tissues and are commonly called pulled or torn muscles. Strains are usually indirect injuries being caused by an overloading or overstretching of the musculo-tendinous unit. Any extreme loading of a unit, such as with a heavy lift or other powerful movement such as sudden sprint, jump or strenuous throw can result in injury. Strains often occur in fatigued muscles and the athlete may experience a snapping sensation as the injury occurs. The overload can occur during the concentric or eccentric phases of isotonic contraction, but it is generally recognised that strong eccentric contraction are more commonly the cause of muscle injury. The musculo-tendinous junction is considered to be the weakest component of the unit and is therefore a common site for acute muscle injuries. Muscle tissue tends to heal more effectively than other soft-tissues (eg tendons and ligaments) because of the rich blood supply.

Sprains: A sprain is a tearing, partial or complete of a ligament. Ligaments, which are composed predominantly of collagen fibres possess a great deal of tensile strength which they require to perform their job as stabilisers of joints. Ligaments also help to encourage a normal range of motion and prevent unwanted movements. They are non-contractile but have a degree of longitudinal pliability which allows a modicum of stretch to safely occur. However when ligaments are stretched beyond their normal pliable length, they will not recoil and will remain slightly stretched, possibly leading to a laxity and reduced stability in the affected joint. Ligaments can tear at or near to their attachments into bone or anywhere along their length. Severe sprains are often associated with dislocation or fracture.

Fractures: Fractures are complete or partial breaks of bones commonly resulting from a direct impact such as an awkward or heavy fall or a badly timed tackle. Fractures require a considerable recovery time, from three to five weeks for a finger or toe, and up to 15 to 20 weeks for a femoral or tibial break. Fractures sustains by children heal quicker than fractures sustained by adults. For competitive sportspeople severe fractures can be career threatening but, in the main fractures can be recovered from very successfully. If a fracture is at all suspected then the individual must be referred for an x-ray. The signs and symptoms of a fracture are:

à History of fall or other forceful impact

à Swelling, bruising and possibly bleeding

à Local tenderness and pain

à Reduced pain on gentle distraction of the bones

à Increasing pain on gentle compression of bones

à Localised pain on gentle percussion of superficial bony landmarks

à Restricted movement

à Deformity

Certain pathologies affecting the density, strength and resilience of bone such as osteoporosis make the sufferer far more prone to fracture. Children have a vulnerability to growth plate

fractures and these injuries can have a strong negative impact upon their physical development leading to biomechanical problems if not properly managed.

Overuse: After the typical injuries occurring regularly during physical activities, the most common sports injuries are those resulting from repetitive physical stress. The people most prone to overuse injuries are those who train very hard, frequently. Overuse injuries sometimes arise purely from one or two over exertive training sessions and often occur early in the season. Endurance athlete, such as those involved in distance running, race walking and cycling are particularly vulnerable because the very nature of their sport demands an arduous training regime of repetitive motion, which are continually performed for lengthy periods of time. Typically aerobics instructors are prone to overuse injury because they have to put in a lot of practice to get their routine prepared, often on top of an already busy physical working schedule. Competitive athlete are prone to overuse injuries because in the effort to improve fitness and performance there are almost unavoidable physical stresses placed upon the main functioning parts of the body. Stress fractures are hairline micro fractures that result from repetitive physical stress rather than an isolated forceful incident and are a form of overuse injury. They can be the result of abnormal stresses placed on normal bone or because of normal stresses placed on abnormal bone. A stress fracture will typically reveal itself insidiously, initially by a mild aching accompanied by localised tenderness. As the injury develops the aching worsens and the tenderness becomes distinct and strong. Stress fractures do not always show up well on X-ray and indeed the signs and symptoms of a stress fracture may be present long before radiographic evidence reveals the nature of the problem. If a stress fracture is suspected but an X-ray is negative, CT, bone scan or MRI should be performed. Once the diagnosis is confirmed and a management protocol instigated stress fractures can take anything from six to eight weeks to six months to heal properly. Occasionally stress fractures of the lower leg are diagnostically confused with shin splints (periostitis). Periostitis is simply an inflammation of the periosteum, most commonly at the medial distal tibia. Overtraining and the presence of biomechanical malalignment (especially overpronation) are the main causes of this syndrome. Typical symptoms are local pain and tenderness and deep aching and stiffness after activity. There may be palpable thickening and nodules in the affected region. Management usually require relative rest, anti-inflammatory treatment, biomechanical correction and massage therapy to tight or thickened muscle fibres.

Skin problems: Skin is the body’s initial external protector and is frequently subjected to injury including cuts abrasions and bruises. Whenever the skin is damaged underlying tissues such as the muscles, ligaments, nerves and blood vessels may also be affected. It is important to be alert to the possibility of infection with open wounds. Skin is particularly vulnerable to fungal, bacterial and viral infections, especially in a sporting environment where close contact occurs and hygiene can be lacking. Skin infections are often contagious and can be spread by direct and indirect contact. Blisters and chafing can occur at sites of repetitive friction during movement. Extreme environment temperatures can have an adverse effect upon the skin. Miliaria (prickly heat) is common in athlete because of excessive perspiration. Most skin problems can be prevented by steadfast hygiene.

There are three basic and generalised phases of response to injury, each affected by the severity of injury, the tissues predominantly involved and the therapeutic interventions applied during each phase.

Acute (vascular): This phase is the body’s initial reaction to the injury. Typically producing redness, swelling, warmth and pain, resulting in impaired function, it last for the first three to five days following the trauma.

Subacute (regeneration and repair): Also known as the cellular proliferation phase, this is where new tissue is laid down at the injury site and typically lasts for around two to five weeks following on from the inflammatory phase.

Remodelling: Also known as the consolidation or maturation stage, this is where the new tissue gains its strength through structural organisation and usually continues for several months.

Following injury, the acute inflammatory response either leads to a complete repair with the injured tissue being replaced, ideally with similar tissue or more likely, with scar tissue. The unfortunate alternative outcome, when the affected tissues are poor to heal and subjected to continued physical stress, is chronic inflammation where tissues remain swollen and painful and degeneration ensues.