Luca Giraldi
Villa delle Terme, Falciani, Florence

Clinic case

Under our observation was a 64-year-old patient who had undergone amputation of the left thigh because of gangrene from arteriopathy obliterans. On physical examination, the stump of the left thigh appeared flaccid, set in hip flexion and with pain during extension movements. The lower right limb showed reduced muscular trophicity and tonicity, with venous ulcers and a functional deficit in knee extension with reduced ankle mobility. Other muscle regions also presented conditions of hypotonotrophy. There was a marked dyscrasia of the right leg, with cyanosis of the foot. On palpation the patient complained of a “cold sensation.” Postural transitions and movements were performed with a minimum of help. Standing still on the one leg was difficult due to the hyposthenia and pain in the foot. The patient was admitted to our facility on a Friday. On Saturday, the first application of NeuroMuscular Taping was performed with a fan shape on the front of the leg down to and including the foot and on the triceps muscle of the calf, to promote lymphatic drainage. This was followed by a cycle of physiotherapy, consisting in:

  • Passive-assisted-active and active mobilization of the stump and of the lower right limb;
  • Muscular strengthening exercises of the upper and lower extremities.
  • Rehabilitation of stationary upright stance on one leg
  • Training of postural transitions and movements
  • Walking training at the parallel bar and using two crutches.
Figure 1

On the next application of NeuroMuscular Taping – again using a fan shape – but this time going under the sole of the foot as well, the patient indicated a “return of warmth to his foot” and of a generalized sensation of well-being to the whole leg.

Figure 2

In order to improve the extension of the knee, NeuroMuscular taping was also applied to the flexor muscles of the thigh. On discharge, the patient had regained a considerable degree of autonomy in his movements: both in postural transitions and in walking capablity with the aid of two crutches. Three weeks after discharge, with no further application, the benefits obtained from NeuroMuscular Taping seemed to have been maintained, to the great satisfaction of the patient.

Gonarthrosis is an evolving chronic arthropathy whose effects are severely disabling and limiting on the patient’s life during normal daily, social and work activities. Over the years many therapeutic techniques have been developed to limit damage from this pathology. Not least among these has been the option of surgically implanting a prosthesis to substitute the affected joint (TKR).

Carrying out the surgical procedure for implantation of a knee prosthesis means replacing the joint-covering surfaces comprised of the femoral condyles, the tibial condyles and the posterior surface of the kneecap. This makes the surgery extremely invasive. Along with the possible risks and complications that may arise from any surgical procedure, issues emerge following a TKR implant and subsequent enforced immobility, which may influence the effectiveness and duration of rehabilitation procedures. Pain, bruising and limited ROM may delay or even limit recovery of proper knee function.

Often, in a hospital environment, these aspects are overlooked during the post-acute phase of knee arthoprosthesis with concentration being placed on the recovery of the ability to walk. Once this objective has been achieved, the patient may be discharged. The principle aim of this study is to show how proper application of an elastic bandage during post-acute rehabilitation following TKR can contribute to improved joint articulation, diminished bruising and reduced knee pain. For this study, no special category of patients was chosen on which to apply the rehabilitation technique in question. In spite of this, there was an attempt to create experimental and control groups that were evenly matched for certain specific parameters. This was done to optimize each individual evaluation and physical examination and in order to make the rehabilitative program fully applicable to each patient involved. Of thirty patients selected, fifteen were treated according to traditional rehabilitation procedures, (specifically the protocols laid down by Cameron, Brotzman and Wilk), making up the control group. The other fifteen patients received the same treatment with the addition of NeuroMuscular Taping. The patients involved in this research received rehabilitation treatment lasting approximately three weeks, a period coinciding with their post-acute hospitalization.

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