HUMERUS FRACTURE TREATMENT WITH NMT IN REHABILITATION
NeuroMuscular Taping Institute, Rome
This is a description of a clinical case in which NeuroMuscular Taping was used to treat a humerus fracture during the immobilization period: the patient was a 47-year-old male who, in a road accident, had sustained a multi-fragment fracture of the neck of the humerus with detachment of the greater trochanter, for which he underwent surgery with open reduction and fixation with plate and screws (figure 1). After the operation the patient was advised to use an abduction shoulder brace for 45 days; the patient also underwent NeuroMuscular Taping in which the tape was applied to the whole arm and shoulder in order to facilitate drainage of the edema and blood congestion caused by the surgery and consequent lack of mobility.
The tapes, applied using the decompressive method, were arranged in a fan-shaped configuration both anterior and posterior to the wound (figure 2). The first of these applications was carried out around 15 days after the surgery; thereafter the patient received once-weekly applications for six weeks. Initially, the fan-shaped construction had to be applied with the arm immobile and forward flexed or extended on account of the need to keep the arm abducted at 25° for the first 45 days. In the first applications the tape was applied around the scar, until it was well formed.
Post-operative X-rays: it is possible to note the plate and the thirteen screws.
Tapes applied using the decompressive method in a fan-shaped configuration anterior to and posterior to the surgical wound. The tape thus surrounds the scar.
After two weeks the swelling had gone down considerably and the hematoma had been resorbed. The appearance of the scar, which had initially been very inflamed, normalized after around two weeks (figure 3).
Tapes applied using the decompressive method: a, for easier application, the tape is cut without an anchor end; b, clear signs of decompression.
After 45 days, the brace was removed and the rehabilitation therapy could be started. Through continuous application of the NeuroMuscular Taping technique it was possible to contain any inflammation of the shoulder, due to stress on the joint during the rehabilitation. The tapes were again applied to the shoulder using the decompressive method in a fan-shaped configuration both anterior and posterior to the wound, this time to facilitate the motor rehabilitation of the joint (figure 4). After four weeks of rehabilitation (sessions four times weekly) the patient had reached up to 90° abduction and 90° elevation.
Decompressive technique; tapes applied, in a fan-shaped configuration, anterior (a) and posterior (b) to the wound.
The use of the NeuroMuscular Taping technique during the immobilization period promoted drainage from the surgical site; at the end of that period, the limb was already ready to be submitted to rehabilitation therapy. As well as having the considerable advantage of saving time, this approach also made it possible to counteract the congestion and muscle retraction that usually tend to occur.
Given the simultaneous administration of pharmacological treatment (targeting the edema), one might wonder to what degree the recovery is to be considered spontaneous or induced by other treatments and to what degree it is to be attributed to the taping. That said, the clinical evidence seems to support this approach, even though it has yet to be investigated in primary studies.
NeuroMuscular Taping is a non-invasive, non-pharmacological technique involving the application of elastic tape with special mechano-elastic properties. This tape, once applied, can bring about mechanical stimulation, creating space in the tissues; this promotes cellular metabolism while at the same time activating the body’s natural healing processes and triggering and/or controlling phenomena that facilitate neuromuscular proprioception. The action of NeuroMuscular Taping is, as mentioned, based on the body’s natural healing processes, which are stimulated by activation of the neuromuscular (mechanical principle) and neurosensory (reflexive principle) systems: it is thus a mechanical and/or reflexive treatment technique that facilitates blood circulation and lymphatic drainage in the treated area and interacts with the complex kinesithetic function, exploiting surface mechanoreceptor, connective tissue receptor and proprioceptor afferents.
NeuroMuscular Taping is a new approach to the treatment of the musculoskeletal system in post-traumatic conditions. Muscles are known to function as mechanical effectors not only in dynamic activities of the body but also, thanks to their visco-elastic properties, in the control of venous and lymphatic circulation and body temperature; consequently, malfunctioning muscles will have negative effects on other systems. By treating muscles with an elastic tape that allows recovery of muscle and joint movement, and therefore of normal homeostasis, normal physiological conditions are restored and the body’s ability to heal is increased.
In rehabilitation, NeuroMuscular Taping is applied using protocols designed to diminish the congestion of body fluids, improve circulation of blood and lymph, reduce excess heat, and restore tissue homeostasis, reducing inflammation and hypersensitivity of pain receptors. NeuroMuscular Taping can also affect arthrokinematics, acting in a reflex manner on muscle tone and mechanically conditioning the fascia and its receptors, thereby altering muscle performance, and affecting the posture of the joint segments.