Journals

NMTCONCEPT JOURNAL, JANUARY 2013, ISSUE 1

Content

  1. Editorial by David Blow
  2. Introduction
  3. Case 1: Application of NeuroMuscular Taping to Cardiology In-Patients
  4. Case 2: NeuroMuscular Taping in the Treatment of Hematoma
  5. Case 3: Treatment of Rotator Cuff Impingement Syndrome Using the NeuroMuscular Taping Technique
  6. Case 4: The Application of NeuroMuscular Taping in Patients with Tibial Plateau Fracture and MCL Tear
  7. ————–

  8. NMT 2013 Course Schedule
  9. ————-

  10. Download PDF version of this journal

NMTConcept: Editorial by David Blow

The history of therapeutic bandaging dates back 2,500 years to Greek and Roman times. The famous episode occurs in the Iliad where Achilles bandages Patroclus’ arm and dresses his wounds. Bandaging or dressing is by definition, the application of bandages or dressings over an injured area to limit the damage, range of movement and encourage healing.

Over the past thirty years, different non-elastic and elastic bandaging techniques have been developed in different parts of the world, yet all of these methods are rooted in the same concept: the application of compression to different parts of the body. It wasn’t until the 1970s that newer techniques appeared, used mainly in sports, which involved application of an elastic adhesive tape at various tension levels. Again, the stimulus imparted is compression. Starting in 2003, I developed the NeuroMuscular decompressive and compressive taping technique – concepts that set this technique apart from other types of taping and bandaging. Indeed, this has become an innovative rehabilitation technique, based on a specific line of clinical reasoning and a new method of application.

NeuroMuscular Taping (NMTConcept) is a biomechanical treatment system that exploits compressive and decompressive stimuli to obtain beneficial effects on human musculoskeletal, vascular, lymphatic and neurological systems: each application has clear clinical and rehabilitation objectives. Correct tape application causes folds in the skin to form during body movement. These folds facilitate lymphatic drainage, encourage blood flow, reduce pain and improve posture by increasing muscle and joint range of motion.

By focusing on specific clinical situations as they progress through the acute and post-acute to functional stages during rehabilitation, the resulting therapeutic system is a simple and highly functional method for optimizing treatment outcomes. This technique works toward the achievement of the following objectives: normalization of range of motion, reduction of pain, increase in patient autonomy and biomechanical treatment for reducing inflammation. NMTConcept offers medical and rehabilitation professionals an added resource for optimizing patient response, reducing rehabilitation times and improving the quality of life of the recovering individuals.

NeuroMuscular Taping is a non-invasive and non-pharmacological method that, through the application of adhesive elastic tape with specific mechanical and elastic properties, provides mechanical stimulation capable of creating space within tissue. This space promotes cell metabolism, activates the body’s natural healing mechanisms and normalizes neuromuscular proprioception. For these reasons, NeuroMuscular Taping has in recent years achieved significant results in post-surgical orthopedic rehabilitation, neurological rehabilitation of stroke patients, the treatment of spinal trauma and neurodegenerative diseases. The high level of positive results achieved places NeuroMuscular Taping at the cutting edge of new therapeutic techniques. In 2012 I established the NeuroMuscular Taping Institute LLC in the US to offer continuing education in medicine for professionals in the USA. The NeuroMuscular Taping Institute was first founded in 2003 in Italy and is headquartered in Rome. It offers 18 different training programs in continuing medicine, together with the Italian Health Ministry, which are now available here in the US. The Institute and programs are all quality certified ISO 9001/2008 for ongoing rehabilitation education worldwide, Certification N° IT.238071. The Institute offers a quarterly journal and continual updaing of course material as well collaborating with hospitals and clinic research projects. Collaboration between European and American hospitals in research projects is a major objective of the Institute’s activity. While volunteer PT and OT International training programs started in 2011 future projects will be enhancing collaboration with African states in pediatrics, neurologic, orthopedic and post surgery rehabilitation projects.

The Institute offers courses in the area of continuing education program for professionals working in the medical and health area. Courses cover the following areas:

  • Activities that enhance knowledge and skill in examination, evaluation, prognosis and planning, intervention, re-examination, prevention and improving outcomes in physical therapy
  • Clinical interventions and evidence based models improving results in rehabilitation and physical therapy

The founding passion of the Institute is to provide medical professionals working in rehabilitation with innovative and effective treatment protocol skills that improve patients’ overall treatment results and their quality of life.

Through the Institute my objective is to help you maintain high quality standards and improve short and log term rehabilitative care.

To do so the main job is based on developing clear teaching guidelines within our educational program. Our goal is to ensure apprehension and learning of this technique, giving health professionals and therapists the best skills possible. Codified therapeutic procedures may be inserted into the health sector whether they are in hospitals, clinics, or private practices to promote functional recovery, rehabilitation and improve quality life care.

As outlined in our NeuroMuscular Taping Mission Statement – “the NeuroMuscular Taping Institute is committed to creating innovative therapeutic programs to help medical rehabilitation treatment services offer the best therapy possible.”

As anyone who works in medicine, your goal is to improve patients’ overall treatment results and quality of life. Therefore our primary objective is to provide medical education to maintain high quality standards and to improve short- and long-term rehabilitative care. The NMT Rehabilitation Treatment Protocols are becoming mainstream therapy in neurological and orthopedic rehabilitation.

Hoping that our goals match your goals!

Introduction

NeuroMuscular Taping

The NeuroMuscular Taping Institute is a result of a continuing passion for providing medical professionals working in rehabilitation with innovative and effective treatment protocols and skills that improve patients’ overall treatment results and quality of life. The institute was founded in 2003 in Italy and its headquarters are in Rome. It currently provides many ongoing courses in continuing education in rehabilitation. In 2011, over 1,400 physiotherapists and MDs were taught in Italian hospitals, universites and private clinics. Because the NeuroMuscular Taping Concept (NMTConcept) is widely accepted and applied by hospitals as well as private practices, it was decided to establish a US branch in 2012 to introduce the NMTConcept to medical professionals in the US to meet the needs of patients undergoing rehabilitation. This journal is the first of a quarterly edition, covering case studies and clinical trials of the NeuroMuscular Taping concept.

Mission Statement

At the NeuroMuscular Taping Institute, we are committed to creating innovative continuing education programs to help medical treatment rehabilitation services offer the best therapy possible. Our goal is to improve patients’ overall treatment results and quality of life by using our treatment protocols to minimize patients’ rehabilitation time, reduce pain, and enable patients to achieve active and healthy lifestyles. Our primary objective is to provide medical education to maintain high quality standards and to improve short- and long-term rehabilitative care. Our varied education program together with our teaching professionals will guide medical staff in gaining new treatment skills. The programs are designed to ensure that professional therapists acquire the best skills possible.

Philosophy

Our philosophy is to use clear and comprehensive educational programs to offer NeuroMuscular Taping as a flexible technique that can be integrated with many other neurological and physical therapies, such as PNF, osteopathy, chiropractic, occupational therapies, and all types of therapeutic exercise and manual therapies. NeuroMuscular Taping is a method of treatment developed in Italy that has successfully been used in hospitals and clinics by doctors and therapists specializing in post-operative, orthopedic, oncological, and neurological care of patients as well as in sports medicine.

Case 1: Application of NeuroMuscular Taping to Cardiology In-Patients

Stefano della Foglia
Physiotherapist, Don Gnocchi Foundation
Milan, Italy
3/07/2010

Objectives

This article presents an initial experience of the efficacy of NeuroMuscular Taping with a cardiology patient with reference to the reabsorption of large-scale hematomas in a short time. The cases referred to concern inpatients at the Cardiology Department at the S. Maria Nascente Center of Don Carlo Gnocchi Foundation in Milan, with the Chief Physician being Doctor M. Ferratini.

As the underlying principles for applying NeuroMuscular Taping are ever more clearly established and its actual efficacy corroborated, proven techniques are being applied to new clinical cases with confidence of attaining positive outcomes. Results were immediate, particularly in view of the fact that heparinoids were not administered to the patients. Exceeding all expectations, even scar formation benefited from the application of Neuro-Muscular taping, augmenting the renewal process of the skin.

Here we are documenting two applications on two male patients, both over sixty years of age. The men had both undergone the same type of surgical procedure. Both were hospitalized in our department, which specialises in cardiological rehabilitation in general and post-operative rehabilitation in particular. Both patients had undergone a double bypass, entailing a prior saphenectomy of the lower right leg. This operation involves an incision along the medial part of the leg starting from the middle third of the thigh and arriving at the distal third of the limb.

Figure 1
1st Application
Figure 2
9 days later, between the second and third applications

Following this operation, the medical indication was for application of NeuroMuscular taping to deal with hematoma affecting the whole leg. This was much more pronounced in the second case, while the first presented a significant concentration of blood in the distal third of the thigh, centred on the anserine bursa, around 20 cm from the start of the incision. Both patients complained that this leg felt very heavy and that they were limited in their walking, “like having a wedge in your knee”. They also complained of pain, although this was bearable.

The first application of NeuroMuscular taping was made with the leg as extended as possible. The skin had a shiny and taught appearance and it was not possible to manually stretch it any further. However, stretching was easily performed during subsequent applications, as both the edema and the hematoma had been clearly reduced.

On the third application, the patients described a clear sensation of wellbeing in the leg, which by now was no longer causing problems during normal walking; the limb felt free and light.

Figure 3
2nd Application 29th May 2009
Figure 4
1st Application 26th May 2009

The fourth application was made on the day preceding discharge from the ward. Its purpose was to ensure that the draining effect of NeuroMuscular Taping would continue, completely resolving the hematoma. In conclusion, we can assert that the use of NeuroMuscular Taping offers a non-invasive therapy that is well tolerated by patients while clearly reducing the time spans for reabsorption of hematomas and edemas.

Figure 5
2 June 2009

Case 2: NeuroMuscular Taping in the Treatment of Hematoma

David Blow
NeuroMuscular Taping Institute, Rome, Italy
31/05/2011

Causes of hematoma

  • In most cases, trauma that ruptures capillary vessels with hematoma as a consequence.
  • A consequence of surgery
  • Hemorrhagic diseases, especially those involving alteration of coagulation factors, can typically cause hematoma among clinical symptoms.
  • When the hematoma cannot be traced back to trauma, other possible causes are: capillary fragility, blood coagulation disorders, leukemia and ongoing therapy using anticoagulant drugs.

The location and the volume of hematoma depend on the kind and magnitude of the trauma, on the size of the injured vessel and on the characteristics of the tissue in which the hematoma has formed. Symptoms can range from a feeling of tautness and pain in the affected area to acute pain, which is exacerbated by movement of the affected part. Hematomas may be more or less noticeable, subcutaneous or intramuscular and large or small in volume. The blood congestion forming the hematoma is absorbed slowly. The hemoglobin from the red corpuscles partially transforms into pigments that give a yellowish-greenish color to the hematoma being absorbed. Hematomas are rich in iron ions and devoid of oxygen, therefore ideal sites for infection and the spread of bacteria. The same hematoma obstructs inflammatory cells, reducing the ability of phagocytes and other antibacterial processes to access the trauma site. When a hematoma is extensive, surgical emptying may be required to avoid infection.

Traumatic Causes – Contusions

Contusions or bruises are the result of traumatic lesions accompanied by the seepage of blood of varying magnitude. Bruising may develop complications through the formation of hematoma, or rather, localized gathering of blood seeping from broken vessels into adjoining tissues. There are various types of bruising that are differentiated by the area affected: cutaneous, muscular, tendinous, articular and osseous.

Cutaneous bruising is often associated with wounds or skin lesions, which may be more or less deep. The trauma is accompanied by the formation of hematoma, which may take on major significance when larger venous or arterial vessels have been injured. Treatment in the acute phase is through application of ice and rest in order to contain hematoma formation.

Muscular contusions are lesions of varying magnitude of the subcutaneous and muscular fascia. The severity of a contusion is greater if it occurs with the muscle in contraction. Muscular lesions usually occur when the muscle structure has limited elasticity and/or with a sudden or rapid movement. There is always development of hematoma, which tends to spread. Acute-phase first-aid treatment comprises: absolute rest, ice and containing bandaging.

Tendinous contusions usually cause distress to tendon sheaths. Less likely than bruising is lesion of the tendon. Tendons are the fibrous or connective ends of muscles, where they are inserted onto a skeletal segment, another muscle or the derma. Tendinous bruises lead to tenosynovitis. Acute-phase first-aid treatment consists in: absolute rest, ice and containing bandages.

Articular contusions affect the joints and may cause an immediate hemarthrosis – the seeping of blood into a joint cavity. Or it may also cause a synovial reaction with hydrarthrosis – the effusion of synovial fluid into a joint cavity, which may not always be immediate but can occur within 12 to 24 hours of the injury. Therapies to be applied are ice and rest, even without absolute immobilization.

Osseous contusions are accompanied by sharp pain located in the periosteum – the fibrous membrane enveloping the external surface of the bone. The most suitable first-aid intervention here is the use of ice.

Decompressive Technique:

  • Decompression of skin, vascular, neurological, lymphatic, muscular, tendinous and articular tissue
  • Improve vascular circulation and lymphatic drainage nurture and drain tissues

Compressive Technique:

  • Compression of muscular, tendinous and lymphatic tissue
  • Improve muscular and tendinous performance as well as articular stability

FIRST AID

  • If bruising is moderate it is enough just to apply ice. The cold causes vasoconstriction, limits the discharge of blood and leads to healing in a few days.
  • When the trauma has affected a risk zone: head, chest or abdomen, medical consultation is essential. In such cases, even though the hematoma may be invisible it might have affected an internal organ.
  • In general, where the hematoma is limited in size, it will be reabsorbed spontaneously within a few days, leaving no trace within a week or two following the trauma. A large-sized hematoma, however, will tend to transform into a concentration of liquid enclosed within a fibrous shell.

RICE(rest, ice, compression, elevation)

is a first-aid approach to treating soft tissue lesions and managing accidents involving trauma.Damage to soft tissue invariably leads to swelling and edema. Swelling is caused by the release of intercellular fluid at the point of injury, as well as by an increase in blood flow to the site. The build up of fluids in edema slows down the healing process being the body’s mechanism for hindering articular movement and serving as a signal to the body not to use the injured joint by reducing blood flow as well as any drainage in the area. The application of ice to the area has the effect of restricting the flow of blood to the affected area. This is useful of trauma treatment during the acute stage as it reduces the amount of swelling. Ice also has a secondary effect on pain receptors in the affected structures. In general, the application of cold is most effective within the first 72 hours following a soft-tissue lesion. Compression is a useful first-aid treatment as the application of pressure reduces the effects of any internal hemorrhaging. Compression has two distinct roles:

  • Limits damage to the soft tissue at the trauma
  • Reduces blood flow towards the injury

The duration of the acute stage of a lesion and its treatment using RICE depends directly on the magnitude of the lesion. As the acute phase of the trauma is overcome, the application of cold and compression lose their usefulness and may indeed reduce the body’s ability to heal itself. Cutaneous and muscular tissue depends on continuous vascularization and lymphatic drainage for reconstruction of damaged cells at the trauma site. Application of NeuroMuscular Taping in decompression, with the purpose of promoting vascularization and drainage has become a fundamental rehabilitative method for the post-acute stage therapy. Applied using the fan-shape-cut technique and in decompression, the tape increases the interstitial spaces that have become congested by the edema and hematoma.Application of NeuroMuscular Taping specifically to hematic congestion has become today’s most innovative and widely used technique for the initial post-traumatic and post-surgical rehabilitative window, as it guarantees rapid, visible outcomes and offers a highly reliable solution

Case Study 1: Contusion Trauma
Before application of the fan-cut
Case Study 1: Contusion Trauma
Application of the decompressive fan
Case Study 1: Contusion Trauma
Three days later
Case Study 2: Post-surgical hematoma following fracture of the femur
7th day after surgery
Case Study 2: Post-surgical hematoma following fracture of the femur
1st Application
Case Study 2: Post-surgical hematoma following fracture of the femur
After 2 days
Case Study 2: Post-surgical hematoma following fracture of the femur
3rd application after 5 days
Case Study 2: Post-surgical hematoma following fracture of the femur
Final result after a total of 7 days

Case 3: Treatment of Rotator Cuff Impingement Syndrome Using the NeuroMuscular Taping Technique

Maurizio Mazzarini
University Polyclinic A. Gemelli di Roma Università Cattolica del Sacro cuore
Rome, Italy
31/05/2011

Objective

  • Observe improvements in shoulder ROM and function in patients affected by Impingement Syndrome after four NeuroMuscular Taping protocol treatment sessions
  • Substantial acceleration of physiological recovery times with drastically reduced costs and treatment times

Patient History

65-year-old female diagnosed with tendinopathy of the supraspinatus, loss of structural homogeneity and tendinopathy of the long head of the biceps muscle on the right shoulder.

Active Functional Movements Prior to Application of NeuroMuscular Taping

On the first visit, the patient with pain accompanying each movement, was able to:

  1. Elevate the arm forward approximately 130°
  2. Abduct the shoulder approximately 45°

The patient also had trouble fastening her bra and in bringing her hand behnd her head.

Application

The sole therapy employed was NeuroMuscular Taping: Two weeks of treatment with NeuroMuscular Taping only, without any type of manually or mechanically aided therapy. Double fan on shoulder.

Results

After four applications over two weeks, the patient was able to:

  1. Elevate the arm forward 180°
  2. Abduct the shoulder through 90° with improvement of scapulothoracic compensation
  3. Bring the arm behind the head more functionally and without compensatory movements
  4. Manage to fasten her bra

All of the above was performed without pain. Therefore, the NeuroMuscular Taping method may be considered an effective support for shoulder conflict syndrome treatment offering significant reductions in costs and treatment times. Progress in improvement of ROM and movement function of the upper limb with four sessions over two weeks.

Case 4: The Application of NeuroMuscular Taping in Patients with Tibial Plateau Fracture and MCL Tear

Angela Ciurleo
Chiropractor, Laboratorio ALBARO
Genoa, Italy
3/07/2011

Tibial Plateau Fracture

This case describes a 49-year-old male with a previous epiphysal fracture of the proximal left tibia with MCL tear. Therapy included motor re-education therapy with active physio-kinesitherapy exercises with gradual adjustment of brace flexion in line with achieved articular flexibility.

The patient continued to complain of pain, poor muscle performance of the left knee with evident local inflammation and parasthesia in the region of the fourth and fifth metatarsal during specialist examination, subsequent to four cycles of ten sessions of the above-mentioned therapy. At this time, the flexion and extension angles of the joint were measured using an appropriate measurement system, generating the following data: angle of flexion – 74° and angle of extension – 163°. In view of these findings, the therapist decided to treat the symptoms with the draining technique by NeuroMuscular Taping of the affected knee.

Applications were carried out as shown in the photographs on the next page. Specifically an anterior 25 cm long double fan, one laid on top of the other, beginning 10 cm above the knee cap, with a 20 cm long posterior fan positioned symmetrically to the longitudinal axis of the limb 10 cm above the popliteal line were placed.

Following twice-a-week applications of NeuroMuscular Taping, as described, for four weeks, measurements were taken again. These were to verify improvements the patient had indicated since treatment began: increased feeling in the left foot, better movement of the involved leg and noticeable reduction of the swelling to the left knee and ankle, due to better vascularization. On checking the new angles of flexion and extension, using the same instruments and procedures as before, the following results were obtained: angle of flexion – 110° and angle of extension – 176°. In conclusion, this clinical case further supports application of NeuroMuscular Taping as a fundamental technique in resolving post-operative issues as it improves lymphatic drainage.

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