This week I treated a previous client who had seen improvements regarding pain, although I was now unsure on the initial diagnosis after reviewing the subjective and objective assessment.
Reflective Summary
Previously, after a thorough objective assessment I came to conclusion that the client had femoroacetabular impingement (FAI). However, after a month of performing home based exercises, they no longer has restriction in hip flexion, which we would expect with FAI, as there is mechanical blocking due to abnormal bone morphology (Carton and Filan, 2019). I felt frustrated and confused that I did not know what was causing the clients pain, although it was positive to know that the treatment was working. I need to remind myself that it may not be a particular pathology causing the pain, it could be due to muscle asymmetry. Next time, it is essential for me to compare rotation at the hip; previous studies have shown that asymmetry in hip rotation can be associated with osteoarthritis of the hip, lower back pain, sacroiliac joint dysfunction and patellofemoral pain (Cibulka et al., 2010).
As the exercises were helping the pain, I continued to progress them by adding resistance. More importantly as the client no longer had pain in flexion I began to incorporate activities that went through the full range of movement (ROM), in order to strengthen different muscles throughout the range.
Firstly, it is proposed that the tape decompresses underlying structures, that allow for enhanced circulation by increasing the subcutaneous space (Dilek et al., 2016). This is known as the Biomechanical Lifting Mechanism (BLM). Likewise, Hammer (2006) suggested that by increasing the interstitial space, it alleviates the pressure which decompresses subcutaneous nociceptors, leading to a decrease in pain.
Another mechanism which can help to explain how K tape can be used to alleviate pain is by increasing afferent feedback by the stimulation of sensory pathways, within the nervous system, which causes blocking of pain signals due to the gate control theory (Dilek et al., 2016). Similarly, Paoloni et al (2011) agreed, suggesting that the stretch stimulation provided by the tape interferes with the transmission of a painful stimuli, delivering afferent stimuli, that facilities pain inhibition thus a reduction in pain.
Conversely, K tape may reduce pain via a placebo effect (Montalvo, Cara & Myer, 2014). Ossipov (2012) found that pain is mediated via an endogenous mechanism which contributes to the emotional component of pain. It is thought that this system reduces pain via the release of opioids, implying a placebo has a physiological effect (Montalvo, Cara & Myer, 2014).
Despite this, the evidence for these theories are still limited and requires extensive research.
| Areas of Improvement | Action Plan |
| When accessing hip flexion, ensure it is done with a straight and a bent leg | Next time I perform a hip assessment ensure hip flexion is done in both positions |
| Understand that some hip pathologies may cause groin pain | Research pathologies that may cause referred pain |
| Consider activity modification as a treatment technique | Research different activity modifications for different conditions that may be able to help other than manual therapy or exercise |
Closing the Loop
Since reflecting on this session, I am now aware that certain pathologies can cause referred pain for example, back pain may be felt in the groin, buttock and thighs. With activity modification it is important to consider other factors that may increase pain – it is important to discuss how clients can actually modify activities such as work or exercise. This is what I have began to do.
References
Carton, P. F., & Filan, D. J. (2019). The clinical presentation, diagnosis and pathogenesis of symptomatic sports-related femoroacetabular impingement (SRFAI) in a consecutive series of 1021 athletic hips. Hip International, 29(6), 665-673.
Cibulka, M. T., Strube, M. J., Meier, D., Selsor, M., Wheatley, C., Wilson, N. G., & Irrgang, J. J. (2010). Symmetrical and asymmetrical hip rotation and its relationship to hip rotator muscle strength. Clinical Biomechanics, 25(1), 56-62.
Dilek, B., Batmaz, I., Sarıyıldız, M. A., Sahin, E., Ilter, L., Gulbahar, S., … & Nas, K. (2016). Kinesio taping in patients with lateral epicondylitis. Journal of back and musculoskeletal rehabilitation, 29(4), 853-858.
Hammer, W. I. (Ed.). (2007). Functional soft-tissue examination and treatment by manual methods. Jones & Bartlett Learning.
Montalvo, A. M., Cara, E. L., & Myer, G. D. (2014). Effect of kinesiology taping on pain in individuals with musculoskeletal injuries: systematic review and meta-analysis. The Physician and sports medicine, 42(2), 48-57.
Ossipov, M. H. (2012). The perception and endogenous modulation of pain. Scientifica, 2012(1), 1-25.
Paoloni, M., Bernetti, A., Fratocchi, G., Mangone, M., Parrinello, L., Del Pilar Cooper, M., … & Santilli, V. (2011). Kinesio Taping applied to lumbar muscles influences clinical and electromyographic characteristics in chronic low back pain patients. European Journal Physical Rehabilitation, 47(2), 237-44.