A Dynamic Approach to ACL Rehabilitation and Prevention: Part IV - A Guest Blog

Last week, we discussed how dynamic tape could be used to control internal rotation and some specific case examples of.  This week, we will start to discuss use of taping to assist in mid-foot control and postural taping.

DYNAMIC TAPING #3: MID-FOOT PRONATION CONTROL

If you have never seen, used, or heard of Dynamic Tape I bet you have never seen a taping that looks like this?  I always loved using rigid tape to support the plantar fascia or to control over pronation. Worked pretty good but often I would get issues up the kinetic chain if I used it too long. Why? Because if I STOP motion with rigid tape or a hard orthotic, kinetic energy still needs to travel somewhere. With pronation, you utilize the mid foot to disperse forces away from the body. This taping:  

• Slows down the navicular through rotation control 
• Supports the plantar fascia longitudinally by creating an artificial Windlass mechanism off the great toe 
• Squeeze up the fat pad to artificially increase the height of the arch

Watch this video on pronation control taping, click here to learn more: 

Does this mean Dynamic Tape can replace all orthotics?

No, but it may be a good start instead of using a rigid orthotic with an over pronating foot. If through reducing workload foot mechanics are re-established, then within the first couple weeks of use improvements should be noted. If not, it is likely orthotic time.

This taping is good for anyone with plantar fascia issues?

Many but not all. If a patient has a hypermobile first ray, this taping irritated the foot as it drives down the great toe in open chain. Those with a “high” arch have poor mobility so the bungee effects of Dynamic Tape are rendered minimal if the body part can’t move.

So, for an ACL rehabbing patient with over pronation, is this something I should use with everyone?

You should use this type of taping with anyone that mechanically is breaking down at the foot. Being in a brace, minimal WB, and altered gait patterns have likely weakened the foot musculature. If foot kinematics are contributing to excessive front plane motions (varus/valgus) and excessive IR at the hip because the foot cannot manage load, this is something to seriously consider for short term use.

DT TAKE HOME MESSAGE

I attend conferences and I will be honest, sometimes I tape my feet because they get exhausted from standing all day. When it comes to pronation control taping relating to the ACL, the purpose still centers around restoring normal lower quarter movement patterns. This taping, while generally not the “main driver” such as the quad or hip, needs to be considered as a viable option as the entire leg, not just the knee, has taken a beating with this surgery.

DYNAMIC TAPING #4: LOW BACK CONTROL VIA THORACIC POSTURAL TAPING

Lumbopelvic stability is pretty much essential to everything in rehab. Probably why clinicians spend so much time talking about “the core” or “the body’s center” during treatment. With Dynamic Tape, the concept of posterior kinetic chain takes on a whole new meaning with a Biomechanical Tape.

Every good ACL rehab program will have some sort of dynamic jump training involved to restore eccentric control. In the previous blogs we have examined this via the hip, quad, and foot but have you ever thought about it through the thoracic? It is not a surprise that many ACL injuries are in younger athletes, at the high school or collegiate levels. And during these years (and it seems for the rest of our lives) we can pretty much determine that handheld devices are destroying everyone’s posture.

This standing, posteriorly pelvic tilt is not the most “athletic” position. While I am making no claims that this position is constant on the field, reality is the muscles in the back are lengthened and weakened regardless. So, with Dynamic Tape, here is an opportunity to get after that problem without constantly saying “STAND UP STRAIGHT!!”

To go after apparent weakness and poor pelvic position we are going to attack this issue from the thoracic. Using the Dynamic Tape X Posutre Pal (note: this can be created with regular Dynamic Tape as well) the thoracic spine is functionally supported. If an over kyphotic position is present, so will be a deficient lordic position. Functional weakness in the thoracic is a very common issue, particulalry with somone laying around resting a knee playing video games. Thoracic strengthening exercises, using prone dumbell flexion and resistance bands in standing are essential in conjunction with correcting posture with biomehcanical tape.

DT TAKE HOME MESSAGE

Postural dysfunction in athletes, or everyone for that matter, affect everything from the mid back down. Whether it is:

·       Landing on the heels due to a posteriorly tilted pelvis

·       Difficulty maintain pelvic stability with lateral movements

·       Fatigue causing excessive rotation through the spine resulting in IR/ADD at the hips

having a practical treatment solution for the thoracic spine is a must for any clinician. With Dynamic Tape and Posture Pals that solution is only a simple step away.

Want to learn more about Dynamic Tape or the Posture Pals pre-cut system? Please contact Keith J. Cronin, DPT, OCS, CSCS at keithjcroninpt@gmail.com or visit the website at www.dynamictape.com

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

A Dynamic Approach to ACL Rehabilitation and Prevention: Part III - A Guest Blog

Last week, we discussed the use of dynamic taping to assist with quad control during the ACL rehabilitation process.  This week, we will look how Dynamic Tape can assist in controling hip internal rotation.

DYNAMIC TAPING #2: HIP EXTERNAL ROTATION TAPING

There are two major strategies for balance: Ankle and Hip. For those with an ACL injury we spend a

lot of time with single and dynamic balance / jumping exercises, while watching how the foot lands. Reality is much of the control comes from the hip. Weakness at the core and hip external rotators drives an already adducted and internally rotated femur inwards. Through any screening observing the risk factors but what can you do to control it on the field?

A few clinicians in Brazil piloted a study seeing if they could change knee control with a single leg jump in volleyball players. Makes sense with a high-risk population for jumping and landing. They used this dynamic tape hip rotation technique to place the femur in a more externally rotated position. The results were amazing, but not shocking once you see this stuff in action (Bittencourt et al, Brit J Sport Med 2017).

With the hip started in full external rotation and extension, the corrective measure was designed to maximally control rotation when the hip was flexed and internally rotated.  

Watch this Spark Motion video to see all this in action.

*Note with this taping, you do not necessarily need to rotate all the way around for SI control if you don’t feel that is an issue*

“Why” This Dynamic Approach

Through proximal control of the femur, changes distally are affected. Correct the angle and direction of landing and reduction in rotation and adduction is achievable.  But a research study is not good enough for me as I wanted to see this in action. So, I met up with Doug Adams, PT and creator of Trace 3D, a motion sensing system that is essentially a “running lab in a box.” His system is validated against the best of the best so I taped him up.

First, we got a baseline for his running and then followed up with taping. After his second run of it, we looked at the data.

A 50% change in reduced IR at the hip with running, throughout the entire cycle.

Could have been a fluke, right? So that same day I did the same taping at Philadelphia Shriners Pediatric gait lab. How would Dynamic Tape fair with this system? The data was even better. We could see that with the hip external rotation approach, Dynamic Tape was able to take someone pathological with hip ER with walking and restore it to within norms.

Now look at the curve. It changed the rotation evenly throughout the entire motion both closed and open chained! And even more fun at its peak it was about a 46% change in motion, almost the exact same amount that it was just 5 hours earlier with a different person and a different system.

To go even further, we took that same person’s opposite hip and tape it from normal into a pathological hip position and as expected, took someone from normal to abnormal with the taping.

DT TAKE HOME MESSAGE

Changes in lower body mechanics take time so why not provide your athlete with a strategy that works now. For those of you worried about tape then “weakening muscles” or movement patterns rest assured, once someone can perform a battery of tests without the tape and passes, you don’t need it anymore! Therapeutic taping is not an “every day” thing, it is designed with a purpose that stems from a biomechanical need. Once the need is gone, so goes the tape.

Want to learn more about Dynamic Tape or the Trace 3D Running System? Please contact Keith J. Cronin, DPT, OCS, CSCS at keithjcroninpt@gmail.com or visit the website at www.dynamictape.com

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

A Dynamic Approach to ACL Rehabilitation and Prevention: Part II - A Guest Blog

DYNAMIC TAPING: #1 QUAD EXTENSOR MECHANISM

Every, and I mean EVERY, rehabilitating ACL injury has quad weakness. The swelling, soft tissue damage, and duration of inactivity is going to shrink that muscle up. When the quad does not work effectively to eccentrically control movement, combinations of adduction and IR at the hip are accentuated, putting at risk an ACL that restrains anterior translation and rotation. There are other things to consider such as:  

• Landing technique 
• Core activation 
• Glute strength and stamina 
• Force absorption (gradual / spread out vs. sharp / high peak forces) 
• Hip external rotator activation 
• Gastroc power / strength 
• Foot Pronation / supination

But that quad is the big stand out every day in therapy.

First glance your response may be, “Wow, that is a lot of tape.” Yes, it is, but let’s talk about why. By having a 2” powerband (two pieces together) and a 3” on top it creates significant resistance to knee flexion, thus, turning potential energy of tape in kinetic active extension.

To see this in action, watch this video:

“Why” This Approach to Quad Control

For those who are skeptical about taping, I understand as so was I. The first time I came across Dynamic Tape it sat on my shelf for 6 months. Wasn’t till I met the creator that I realized he had truly designed a new product and approach to therapeutic taping.

Recently I started playing around with BodiTrak, a portable light-weight force and pressure mat, that is beginning its journey from golf to rehabilitation. This 11-pound stellar tech break through that operates wirelessly from your iPhone (how awesome is that!) showed some interesting information when used with Dynamic Tape. I started examining simple case examples of old ACL injuries using BodiTrak, measuring force production during a single leg jump. In the past couple months, I have done this 5x with the same success every time. The most interesting case was with a female therapist at a course I was teaching. She had a 5-year-old L ACL repair (torn twice) and a chronic history of knee pain. We had her jump up and down on the BodiTrak mat and found that her R leg produced 2.1x body weight, while the L was at 1.4x with awful motor control and high peak forces landing. 8 seconds to figure out how to jump on one leg!

I applied the power band quad taping and the next jump on the R was 2.1x BW, no changes. On the L, it was 2.1x BW!!! And this time it only took her a couple seconds to figure out how to jump. We then took the tape off and she never got above 1.7x BW but the carryover was still present.

DT TAKE HOME MESSAGE

Did the tape exert 50% more force production to make up the difference? No, but what it did to is improve eccentric control. The therapist felt more control and the appropriate motor pattern kicked in. She would absolutely need to continue to strengthen but this was a solid motivator to get her back to working harder. As a clinician, you have a new means to improve quad control while still functionally working through rehabilitation. As a bonus if your patient must wear a brace, Dynamic Tape goes right under it. 😊

Want to learn more about Dynamic Tape or BodiTrak? Please contact Keith J. Cronin, DPT, OCS, CSCS at keithjcroninpt@gmail.com or visit the website at www.dynamictape.com

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

A Dynamic Approach to ACL Rehabilitation and Prevention - A Guest Blog

Throughout the history of this blog, I have attempted to share with you the latest research and how this might influence our assessment of athletes or training of athletes.  Having focused the last 20 years on ACL rehabilitation and prevention I have been blessed to come across a lot of people who share this passion (or what I call a higher calling) to help athletes stay safe and perform better.  Many of these folks have applied the latest research to their craft or technology.  I am inspired by some of the amazing products that are out there that have been created to help you and I do what we do better, to allow us to do it more efficiently and provide the athlete with a better outcome.  

Considering, I have felt like this should be shared with our viewership.  So, over the course of the next several blogs series, I have reached out to some of these folks who are on the cutting to see if they would mind contributing to our blog.  To provide our viewership a glimpse of their products, what the science is behind these products and how this can be applied to the athlete.  I have personally vetted each of these to make sure this is science based and NOT a sales pitch.  So, please sit back and enjoy as we venture into some of the latest and greatest in movement science and sports medicine. - Sincerely ~ Trent Nessler, PT, MPT, DPT
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A Dynamic Approach to ACL Rehabilitation and Prevention - A Guest Blog

Over the course of decades of clinical practice and with my adventures across the country, I get the opportunity to meet some amazing people that are doing some amazing things.  Folks who share my passion for prevention and who are on the forefront of innovation for injury prevention.  Rarely do I come across someone who shares this passion and is doing something innovative that is truly impactful on non-contact injury rates.

Keith J. Cronin, DPT, OCS, CSCS is one of those guys.  I have personally seen the impact of some tapping techniques that he is doing have a direct impact on an athlete's ability to control frontal plane motion and speed of motion at their knee (two major risk factors).  So I have asked Keith to provide a guest blog on what he is doing in order to share this with your audience.

A “Dynamic” Approach to ACL Rehabilitation and Prevention

If you are interested in ACL rehabilitation and looking for: 

• A treatment that impacts an athlete ON and OFF the field 
• A methodology that addresses all movement impairments the result of poor activation, weakness, or body mechanics 
• A system that gives you, the clinician, absolute control in how much force and which direction to push or pull the body to work at its best

This blog series is for you.

Since I first saw the “ACL Play It Safe” program and kit my initial response was, “wow, this just makes sense.” ACL rehabilitation and return to sport is already confounded with many different factors, including, but not limited to: 

• Extent of injury / movement dysfunction 
• Quality of Rehabilitation Adherence / compliance of patient 
• Sport played 
• Internal healing aptitude (yes, some people are just more Wolverine than the rest of us) 
• Anatomy 
• Previous Injuries

If the goal is to maximally train the body using the right series of exercises to inevitably pass a battery of movement tests, what then are we most concerned about? So many things perhaps, but for this article we are going to examine improving movement using a strong recoiling viscoelastic tape is a toll that should be in everyone’s tool belt. And we aren’t talking about rigid tape or kinesiology tape, we are referring to Dynamic Tape, the “Original” Biomechanical Tape, that is changing the way clinicians think about taping.

Dynamic Tape: If Kinesiology Tape and Rigid Tape Had a Baby…….

Before we get into taping techniques, let us start with what we know.

Pretty much everyone is familiar with rigid tape. Whether its leuko (medical duct tape) or white  

athletic tape the product is simple:

• Place the body in a neutral or corrected position 
• Use a rigid, no elastic product to restrict movement 
• Tape across a joint to have a mechanical effect 
• PURPOSE – reduce stress on damaged tissues through mechanically locking up a joint

These techniques have been around for 40+ years and if you are an athletic trainer, you by trade are a master of the craft. Researchers are at least mostly in agreeance that if you prevent a joint from moving overall the kinematics of human movement will change.

In the late 1970s, a chiropractor named Dr. Kenzo Kase figured out how to push this in an entirely different direction. His approach was to use a stretch cotton product that allowed full ROM while having a neurophysiological effect on the body.

1.       Place a muscle in a lengthened position

2.       Use a stretch cotton that extends to 140 – 170% of length to pull on the skin / soft tissue

3.       Tape in different patterns to have different effects on the body

4.       PURPOSE – to create a neurophysiological interface to afferently affect the nervous system to efferent reduce pain and swelling

Millions of rolls are sold throughout the US each year from pediatrics to post-surgical to geriatrics to sports. But here is where a lot of researches and getting into some arguments. It is true that there has been research to support having a positive effect on chronic pain (more than 3 months) with the low back but when it comes to making mechanical changes, the data just isn’t there.

Ryan Kendrick, physical therapist and creator of Dynamic Tape, felt the same way. He worked with professional tennis players and was always looking for way to extend his treatments onto the court. He liked using rigid tape to make mechanical changes but it locked up motion, meaning his athletes could not move the way they wanted. Kinesiology tape allowed 100% range but did not have the ability to absorb force or alter movement patterns that would improve function. He thought to himself what if a tape could:

• Absorb force to reduce the workload in the muscles and underlying tissue
• Change movement patterns immediately through strong recoil 
• Allow for 100% ROM with no rigid end to the tape  Be soft, breathe easy to prevent skin decay 
• Stretch in 4 directions to contour to the human body exceptional well   
• Stack “tape on top of tape” to increase force if necessary

To learn more, watch this 2-minute whiteboard video on the innovation that is Dynamic Tape

From this he created the first even Biomechanical Taping System that sports and rehab have ever seen. Since 2010, this product has made its way into 35 countries on word of mouth alone. You may have seen it and thought it was another kinesiology tape but today you will learn how this advancement in taping technology is going elevate your ability to manage ACL rehab, and everything else for that matter.  

Next week we will begin to discuss how you can use Dynamic Taping to improve quad control in your ACL patient.

About the author Keith J. Cronin DPT, OCS, CSCS

Keith J. Cronin is a physical therapist and owner of Sports and Healthcare Solutions, LLC., a consulting company that works with domestic and international companies to provide quality clinical education and sales training for rehab and athletic products. Keith graduated with his Doctorate in Physical Therapy (DPT) from Belmont University in 2008 and later earned his Orthopedic Certification Specialist (OCS). Keith currently is a reviewer for the International Journal of Sports Physical Therapy (IJSPT) on a variety of topics including throwing athletes, concussions, and ACL rehabilitation. Keith has produced several online CEU courses for PTWebcuation.com on the topics of running injuries, ACL rehabilitation, Patellofemoral Syndrome, and injuries to the Foot and Ankle. In 2012, Keith participated in a concussion education program in Newcastle, OK that resulted in the documentary “The Smartest Team: Making High School Football Safer” which had several runs on PBS worldwide.

Keith has also been published in a variety of media, publishing almost 100 articles through venues including MomsTEAM.com, Advanced Magazine, the 9s Magazine, the American Coaching Academy, and Suite101. Keith was also featured on Fox2News several times on topics of concussions and ACL injuries. In 2008, Keith was a winner of the Olin Business Cup at Washington University for his product innovation “Medibite” a jaw rehabilitation system designed to improve the outcomes for individuals suffering TMJ dysfunction. Prior to graduate school Keith was a collegiate baseball player and top-level high school cross country runner. Keith also had the opportunity to work as a personal trainer (CSCS) prior to his career in physical therapy, providing a very balanced approached to educating fitness and rehabilitation. Keith has focused his career on the evaluation, treatment, injury prevention, and sports conditioning strategies for athletes, with particular attention to youth sports.

Keith lives in the Denver, CO with his wife and two daughters, Ella and Shelby. 

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu.