RU2844453C1 - Method of therapeutic taping for pain and swelling of various geneses of knee joint - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to traumatology and rehabilitology, and aims at reducing a rehabilitation period in the patients suffered injuries or minimally invasive procedures of a knee joint. If there is a hair coat, the skin is shaved and then treated with an alcoholised napkin. Further, 1st step includes the application of the transdermal "Voltaren" patch in the form of a rectangle with size of 2×3 cm in amount from 1 to 4 locally on area with greatest painful accent. 2nd stage involves applying tape 8-10 cm long and 5 cm wide with fixing the anchors within a tuberosity of tibia from below and an anterior surface of thigh from above. Longitudinal cuts are made in the middle of the length with creation of central mini-tapes. Mini-tapes are applied in a semicircle from the centre to the periphery; the application duration is 24 hours from the moment of application. Then the tapes are removed for 3-4 hours. Thereafter, the transdermal patch and kinesio tape may be reapplied.

EFFECT: method provides reducing pain syndrome, inflammatory processes and oedema, as well as reducing the length of rehabilitation and improving patient’s quality of life, as well as promotes faster recovery of the function of the joint.

3 cl, 3 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and rehabilitation, and is intended to reduce the rehabilitation period of patients who have suffered injuries (bruises, sprains of the capsular-ligamentous apparatus, damage to intra-articular structures), minimally invasive procedures in the knee joint area, improve the quality of life, and also to reduce the patient's hospital stay after arthroscopic manipulations.

According to the modern strategy of fast track surgery (accelerated rehabilitation surgery), there is currently a constant search for optimized, effective methods of treating patients who have undergone surgical procedures, with the aim of early stabilization of their condition and reducing the period of their stay in hospital [Kehlet H. Fast-track surgery - an update on physiological care principles to enhance recovery. Langenbeck’s archives of surgery. 2011. 396 (5). 585-590].

It should be noted that minimally invasive manipulations on the knee joint include various procedures, the main principle of which is intervention in the joint cavity without the use of large open approaches, for example, puncture or arthroscopic operations. Among the arthroscopic manipulations performed, the most extensive in modern medicine is considered to be reconstructive plastic surgery of the anterior cruciate ligament. Accordingly, the most diverse and long-term rehabilitation of patients in comparison with other minimally invasive interventions on the knee joint is possible after this operation.

Currently, there are many different options for managing patients who have undergone minimally invasive interventions on the knee joint, including elements of an orthopedic regimen, kinesiotherapy, treatment of edema, pain syndrome, and combating the formation of contractures [Balki S. Kinesio taping as a treatment method in the acute phase of ACL reconstruction: A double-blind, placebo-controlled study. 2016; Andrade R. How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II). 2019; Kochetkov A.V. Kinesiotherapy in the rehabilitation of patients after plastic surgery of the anterior cruciate ligament of the knee joint. Methodological manual. 2013]. The recommendations described in these sources include the use of complete immobilization of the limb in the early post-manipulation period, which in turn causes lymphostatic phenomena that form an edematous-irritation syndrome, which increases the manifestation of pain.

According to the works of a number of authors, there is no need for complete immobilization and the effectiveness of early kinesiological activation of the limb in patients who have undergone minimally invasive reconstructive surgeries on the knee joint has been proven [Marshall N.E. Current practice: postoperative and return to play trends after ACL reconstruction by fellowship-trained sports surgeons. 2018; Kruse L.M. Rehabilitation after anterior cruciate ligament reconstruction: a systematic review. 2012; Brandsson S. Is a knee brace advantageous after anterior cruciate ligament surgery? A prospective, randomized study with a two-year follow-up. 2001].

The “Method of rehabilitation for knee joint injuries” is known (Patent RU No. 2657852, IPC A61H 1/02, A61H 15/02, A61N 5/08 - 15.06.2018, Bulletin No. 17), the essence of this patent is the use of massage, pharmacopuncture, magnetic therapy, transcutaneous electrical neurostimulation, acupuncture and therapeutic exercises.

The "Method of rehabilitation for post-traumatic hemarthrosis of the knee joint" is known (Patent RU No. 2580192, IPC A63B 21/00, A61F 5/00 - 10.04.2016, Bulletin No. 10), includes therapeutic and breathing exercises, rehabilitation sessions are carried out in the following sequence: therapeutic exercises, breathing exercises for at least 5 minutes with imitation of the respiratory system in a static position of the body of motor activity with varying degrees of intensity, after which running work is carried out with an adjustable decrease in the load on the musculoskeletal system on an antigravity treadmill, the session ends with thermal procedures and therapeutic massage.

The disadvantage of these methods is the use of special equipment that is not available in traditional patient care. The therapeutic effect of these methods is not constant, requiring periodic visits to rehabilitation facilities. These methods cannot be used in the early post-traumatic and/or early postoperative periods, and therefore they imply long-term rehabilitation management.

There are a number of useful models used for developing the knee joint:

Patent US 20140094721 A1, A61H1/024, 03.04.2014, patent US 9474675 B2, A61H1/008, 25.10.2016, patent US 20110137215 A1, A61H1/024, 09.06.2011, patent US 20090275868 A, A61H1/024, 05.11.2009, patent US 7695416 B2, A61H1/024, 13.04.2010 - these original devices are aimed at developing passive movements in the knee joint and can be used after injuries and minimally invasive interventions. Because the main purpose of these devices is kinesiotherapy, then in this case little attention is paid to the fight against pain and edematous-irritational syndromes. Passive development of movements in the joint in the early post-traumatic and postoperative periods is accompanied by pain syndrome and requires the parallel use of relaxing, analgesic agents and leads to microtraumatization of the capsular-ligamentous apparatus, which can lead to an exacerbation of the pain syndrome or even bleeding. Such techniques of influence on the joint can contribute to a long-term course of pain syndrome and repeated traumatization of intra-articular structures.

There are known analogues that use knee joint bandages: Patent RU #2506061, IPC A61F 5/01, A61F 5/24, A61F 13/06 - 10.02.2014, Bulletin #4; Patent RU #2469683, IPC A61F 5/01, A61F 5/30 - 20.12.2012, Bulletin #35. These devices are not aimed at combating edematous-irritation syndrome. The main purpose of using these fixation methods is the immobilizing effect on the joint. Such devices cause a pressing effect on soft tissues subject to edema in the early post-traumatic period, and therefore they can contribute to an increase in pain, reducing the patient's quality of life.

The closest analogue is the author's method of applying kinesiotapes to the knee joint - KR 200458431 Y1, 20.02.2012. This method involves the use of 6 adhesive tapes. The first tape is applied from the anterior tuberosity of the tibia to the outer upper thigh, the second tape - from the anterior upper thigh to the outer lower part with a cross on the first tape, the third tape - from the upper front part of the knee to the inner lower part, the fourth - from the anterior lower knee to the inner upper part with a cross of the third tape, the fifth tape is applied horizontally around the shin, fixing the lower anchors of the tapes, the sixth - horizontally around the thigh with fixation of the upper anchors.

The disadvantage of this method is that when applying tapes, this method does not take into account the lymph flow in the knee joint, since such a cross-application does not include the popliteal lymph nodes, and a transdermal patch is not used to relieve inflammation and pain. The application of horizontal tapes contributes to the compression of soft tissues and obstruction of lymph flow from the knee joint. It should also be noted that fixation of the patella in the normoposition position in this method is partial. In this regard, this method of taping should not be used in the early post-traumatic and / or postoperative period.

Despite the existence of many different methods used for knee joint rehabilitation, the main problem remains the lack of an individual approach, which can lead to insufficient treatment effectiveness and slow recovery. Many patients are faced with the fact that traditional methods, such as physiotherapy or drug treatment, do not always give the expected results. In such cases, it becomes important to use alternative and additionally effective rehabilitation methods.

One such method is kinesiotaping. This approach is based on the use of special elastic bands that are glued to the skin in a certain configuration. Kinesiotaping helps relieve pain, improve joint functionality and speed up the recovery process. By supporting soft tissues and stimulating blood circulation, this method helps reduce swelling and inflammation, and improves knee mobility.

Kinesio taping is an inexpensive and accessible method that can be used both in clinical settings and at home. It is suitable for patients of all ages and levels of physical activity. It is important to note that before starting to use kinesio tapes, it is recommended to consult with a qualified specialist who will help you choose the right technique and tape configuration to achieve the best results. Thus, kinesio taping becomes an excellent addition to traditional methods of knee joint rehabilitation.

In addition, early rehabilitation is difficult due to severe pain at the initial stage.

The objective of the claimed invention is to develop a reliable immobilization-functional method of patient management that prevents the development of edematous-irritation syndrome and promotes lymphatic drainage, leading to parallel active kinesiotherapy.

The technical result of the proposed method of medicinal taping for pain and swelling of the knee joint is a reduction in pain syndrome, inflammatory processes and swelling, as well as a reduction in rehabilitation time and an improvement in the quality of life of patients suffering from these symptoms. In addition, the method promotes a faster restoration of the lost function of the joint.

The technical result of the claimed invention is achieved due to the fact that the transdermal patch "Voltaren" is used to relieve inflammation and pain in the area of action and the application of a dermal adhesive tape in a certain way over the dermal patch.

The advantage of the method is its variability and combination with other methods of rehabilitation treatment, such as therapeutic physical training, kinesiotherapy, wearing orthoses. Thus, this method is available to patients of different profiles: traumatology and orthopedics, sports medicine, physical and rehabilitation medicine, neurology. Another advantage of this method is a single application and prolonged action for 24 hours.

The details, features, and advantages of the present invention follow from the following description of the implementation of the claimed technical solution using drawings showing:

Fig. 1 - Application of Voltaren patch.

Fig.2, Fig.3 - Application of two diagonal tapes.

The method is carried out as follows: After the patient has been examined and diagnosed, the procedure is carried out in this way:

Before application, in preparation for the presence of pronounced hair, the skin is shaved, followed by mandatory treatment with an alcohol-soaked napkin for the purpose of antisepsis and degreasing of the skin of the entire area to which the kinesiotape will be applied.

The application of the Voltaren patch is performed locally on the area with the greatest pain accent.

The procedure for applying the canvases consists of two stages:

1 - application of the transdermal patch "Voltaren" in the form of a rectangle measuring 2*3 cm (Fig. 1), the number of rectangles depends on the area of pain, from 1 to 4, each rectangle is glued to the painful area;

2 - application of dermal adhesive tape with anchor reinforcement in the area of the tibial tuberosity below and the anterior surface of the thigh above, 8-10 cm long (Fig. 2 and Fig. 3). In this tape, longitudinal incisions are made in the middle of the length in the projection of the application in the popliteal region, creating central mini-tapes. These mini-tapes are applied in a semicircle from the center to the periphery, repeating the direction of lymphatic fluid irritation. The degree of tension is average. This window fixes the position of the patella and its own ligament, stabilizing the structures, and maintains lymphatic drainage of soft tissues along the anterior surface of the knee joint.

The duration of the application is 24 hours from the moment of application. Then the tapes are removed for 3-4 hours, after which it is possible to re-apply the transdermal patch and kinesiotape if necessary.

The duration of the second application is also 24 hours. Longer adhesion can cause maceration of the skin.

Dermal tapes consist of cotton fabric up to 5 cm wide, coated on one side with a special hypoallergenic adhesive agent.

In patients with a history of knee instability or who have undergone reconstruction of the capsular-ligamentous apparatus, a functional orthosis is put on, which allows controlling the flexion angle in the knee joint. In the first week after the procedure, the flexion angle is set at 45°, in the second 60°, in the third 90°. Wearing an orthosis in the outpatient period is indicated until the end of the second month.

In the early period after the manipulation, it is recommended to perform kinesiotherapy in the form of isometric exercises for the muscle groups of the thigh and lower leg, including flexion-extension movements in the ankle joint, 10-12 repetitions 3-4 times a day. Passive and active exercises on the knee joint are recommended to be performed 24 hours after the intervention. Such exercises include alternating tension of the posterior and anterior muscle groups of the thigh, flexion and extension in the knee joint. This kinesiotherapy is performed in the first three days after the manipulation, then the patient is recommended to supplement the set of exercises with adduction of the lower leg, lifting and abduction of the straightened leg, full passive extension. Each exercise is performed 10-12 repetitions 3-4 times a day.

The use of orthopedic devices for walking (crutches, canes, walkers) is individual and is recommended depending on the severity of the patient's condition, the extent of the surgical intervention, and the presence of other concomitant diseases.

The applied adhesive tapes help immobilize and stabilize the knee joint and its structures, create a tightening effect of soft tissues in relation to the musculoskeletal system, also helping to reduce pain, and lead to better lymph drainage from the knee joint area in combination with kinesiological effects and lymphatic drainage massage.

Clinical example

Patient A., 26, professional football player. Gonarthrosis grade 1-2. Tendinitis of the patellar ligament. Complaints at admission: pain and swelling syndromes in the right knee joint, increasing with physical activity, stiffness of movement. At the time of the initial examination, the pain intensity was estimated at 5-6 points on the visual analogue scale, knee flexion was 50°, extension 180°. The circumference of the knee joint was measured at the apex of the patella in front, the middle of the popliteal fossa at the back and was 32 cm. Written consent to participate in the study was obtained.

Medicinal taping of the knee joint was performed, a transdermal patch "Voltaren" was applied and on top of it kinesio tape, dermal adhesive tape in the manner described above.

After the examination and diagnosis, the patient underwent the procedure in the following manner:

Before application, as a preparation, the skin was treated with an alcohol-soaked napkin for the purpose of antisepsis and degreasing of the entire area to which the kinesiotape will be applied.

The Voltaren patch was applied to the painful area on the front side of the knee joint using two rectangular pieces measuring 2 by 3 cm.

The second stage involved the application of two diagonal tapes with anchors secured in the area of the tibial tuberosity below and the anterior surface of the thigh above, 8-10 cm long. Respectively, on the lateral and medial sides of the right lower limb.

In this tape, longitudinal cuts are made in the middle of the length in the projection of the application in the popliteal region, with the creation of central mini-tapes. These mini-tapes are applied in a semicircle from the center to the periphery, repeating the direction of irritation of the lymphatic fluid. The degree of tension is medium.

This window fixes the position of the patella and its own ligament, stabilizing the structures and supporting lymphatic drainage of the soft tissues along the anterior surface of the knee joint.

On the 2nd day, a decrease in swelling was noted on the anterior surface of the knee joint, the circumference was 31 cm.

The pain syndrome significantly decreased, being estimated at 2-3 points on the visual analogue scale, the pain increased only with excessive increase in movement in the knee joint. At rest, the pain syndrome was reduced. The range of motion is within standard values: flexion 50°, extension 180°.

On the 3rd day, the swelling subsided to (30 cm), no complaints of pain in the knee joint were noted at rest. A total of 3 procedures of the medicinal taping method were performed for pain and swelling of various origins of the knee joint.

At the same time, the patient was recommended to use kinesiotherapy in the form of isometric exercises for the muscle groups of the thigh and lower leg, including flexion-extension movements in the ankle joint, 10-12 repetitions 3-4 times a day. Passive and active exercises on the knee joint are recommended to be performed 24 hours after the intervention. It was also recommended to perform isometric exercises: alternating tension of the posterior and anterior muscle groups of the thigh, flexion and extension in the knee joint. This kinesiotherapy is performed in the first three days after the manipulation, then the patient is recommended to supplement the set of exercises with adduction of the lower leg, lifting and abduction of the straightened leg, full passive extension. Each exercise is performed 10-12 repetitions 3-4 times a day.

On the 4th day she was discharged with recommendations for outpatient treatment in a satisfactory condition.

Claims (3)

1. A method of medicinal taping for pain and swelling of the knee joint, including the application of kinesio tapes to the knee joint, characterized in that before the application, as a preparation in the presence of hair, the skin is shaved and then treated with an alcohol napkin, then the 1st stage is the application of a transdermal patch "Voltaren" in the form of a rectangle measuring 2 × 3 cm in an amount of 1 to 4 locally on the area with the greatest pain accent, the amount depends on the area of pain, after the 2nd stage is the application of a dermal adhesive tape-tape consisting of cotton fabric coated on one side with an adhesive hypoallergenic agent, 8-10 cm long and 5 cm wide with anchors strengthened in the area of the tuberosity of the tibia from below and the anterior surface of the thigh from above, in this tape in the middle of the length, longitudinal incisions with the creation of central mini-tapes, these mini-tapes are applied in a semicircle from the center to the periphery, the duration of the application is 24 hours from the moment of application, then the tapes are removed for 3-4 hours, after which it is possible to re-apply a transdermal patch and kinesiotape if necessary, the duration of the second application is 24 hours. 2. A method of medicinal taping for pain and swelling of various origins of the knee joint according to paragraph 1, characterized in that in case of instability of the knee joint or reconstruction of the capsular-ligamentous apparatus, a functional orthosis is put on, allowing control of the flexion angle in the knee joint: the first week after the procedure, the flexion angle is set at 45°, in the second 60°, in the third 90°, wearing the orthosis in the outpatient period is carried out until the end of the second month. 3. The method of medicinal taping for pain and swelling of various origins of the knee joint according to paragraph 1, characterized in that in the early period after the manipulation, kinesiotherapy is performed in the first three days after the manipulation in the form of isometric exercises for the muscle groups of the thigh and lower leg, including flexion-extension movements in the ankle joint 10-12 repetitions 3-4 times a day, passive and active exercises on the knee joint are performed 24 hours after the intervention, then the patient performs a set of exercises with adduction of the lower leg, lifting and abduction of the straightened leg, full passive extension, each exercise is performed 10-12 repetitions 3-4 times a day.