Friday, July 27, 2012

Fascia Therapy --- Sports Injury and Rehabilitation: Acute or Chronic Swelling

This post is intended to complement my earlier post on Multiple Sclerosis (MS) and the multi-modal approach of the Fascia Therapy (formerly the Activ8 System) to address the common symptomatic challenge of lymphedema and chronic inflammation in the lower leg as well as swelling and edema as a result of sports injury.  The multi-modal approach is designed to integrate complimentary interventions in an effort to maximize the potential impact as well as allow for customized modification and adjustment to ever-changing systemic and mechanical environments.  

Lymphedema is a chronic condition that is characterized by the inability for the lymphatic system to remove fluid from the lower extremities in conditions such as MS and can also be the result of acute injury which results in a level of edema accumulating that the lymph system is unable to remove efficiently.  In chronic conditions such as MS, this symptom can be uncomfortable and even incapacitating...therefore focused intervention is not only a productive long-term objective, but it may also be a very real and critical short-term goal as well.  With respect to sports / acute injury (ankle sprain, calf muscle strain, etc...) swelling is a normal part of the healing process, however it is essentially a "supercompensatory" mechanism where there is often times and inordinate amount of fluid that is drawn to the area (capillary flow, osmosis, etc..). This can sometimes create additional levels of pain and, more importantly, affect the ability to implement more aggressive rehabilitative protocols.  Further, the large amount of local fluid draw can also leave the surrounding tissue in some level of nutritional and oxygen deficit which lead to secondary challenges.

The specific multi-modal approach used to address inflammation in the 
Silicone Stress Transfer Mediums
Fascia Therapy concept is the combination of therapeutic taping (Kinesiotaping) and Trans-Fascial Viscoelastic Stimulation (TFVES). Using various stress-transfer mediums, the practitioner is able to access the connective tissue / fascia at all levels including the very deepest visceral / core level.  TFVES is a very comprehensive set of skills, applications, guidelines, and targets that require an extensive process of learning and development...however the overwhelming scientific and clinical evidence shows that is produces extraordinary benefit and contribution to the improvement of connective tissue strength, health, integrity, and homeostasis...therefore reducing fascial dysfunction and the reduction of abnormal pain signalling.  In addition to the enormous systemic benefit, there is also a very significant improvement in the overall health, strength, and integrity of the connective tissue system which contributes to structural integrity and therefore improves functional performance and the reduction in rate of re-injury.  More importantly, and most relevant to this specific application, TFVES is a very effective tool for the manual movement of fluid.  In other words, the very specific loading properties (guidelines) and the specific viscoelastic characteristics of the stress stransfer medium enable the practitioner to access fluids at the deepest level...which are typically unaccessible using the hands alone.  This powerful tool facilitates very rapid and effective movement of the interstitial fluid through the lymphatic system and therefore replenishes the entire system by flushing stagnant fluid and stimulating return of new nutrient rich fluid. 

Kinesiotaping is a specifc technique that has been widely used since the early 1970's in the rehabilitation setting in Japan but since the 80's has risen to become relatively mainstream.  Its function / implementation serves 2 essential purposes:  1) facilitate movement performance, 2) facilitate fluid flow and systemic homeostasis.  For this particular post, it is being implemented as a facilitator of lymphatic drainage and interstitial flow.  It is applied using the lymphatic correction technique (Kase) and is channelled to another part of the system that is functioning properly...therefore application location is highly variable depending on the individual case.  In combination with the TFVES technique, fluid flow is effectively channelled away and therefore facilitating the return of nutrients back into the system as well as the proper elimination of waste and toxic by-product.  I recommend that you refer to my two previous posts that outline the diverse potential of the systemic implications of the use of Kinesiotape.  

Inflammation of the Lower Leg:

 Patient is positioned with the knee in extension and the foot in dorsiflexion.  

Working from proximal to distal, the first fan tape is placed on the posterior medial aspect of the knee.  

Lay down the strips over the area of edema with approximately 25% tension.  The last 2 inches of the strip should be laid down without any tension. 

The second fan tape is placed just superior to the first (or depending on the specific case, can be placed on the lateral aspect of the knee).  

Angle the strips inferiorly and form a criss-cross pattern over the area of edema.  

Initiate glue activation by rubbing the entire application vigorously (but carefully).  Glue activation should be done before any movement is initiated. 

Completed Application

 TFVES application with Kinesiotape:

As previously mentioned, the TFVES technique has very specific guidelines and movement / loading properties that require some expanded and enhanced demonstration and training in order for it to be effective (SEE FASCIA THERAPY Sports Injury Protocols and Courses).  However, I will provide a demonstration that is to serve for illustration purposes only.  

Starting distally, the stress transfer medium is slowly loaded (pressed) into the posterior leg. 


The cylinder is then rolled until it reaches the mid-palm. The pressure is released slightly, and the action begins again from the starting position.

The same guidelines should be applied along the entire length of the lower leg in separate sections (mid-calf, proximal calf) until the proximal end of the application is reached.

In summary, this particular multi-modal intervention has shown significant results in our MS patients as well as the treatment in the healthy individual / athlete. Not only is there a visible and tangible improvement, the patients report overall relaxation and a slight increase in function and performance. These initial reports conclude that further implementation of the multi-modal approach is indicated. Future posts will demonstrate the diversity of this intervention over a wide spectrum of acute and chronic conditions. In addition, the Fascia Therapy Sports Injury and Rehabilitation protocols will further consilidate and formalize specific taping applications and the respective Fascia Therapy techniques.