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FROM THE TRAINING ROOM

March 13, 2018

INTRODUCTION:

What does the research say about the use of kinesiology tape? How can instrument-assisted soft tissue mobilization (IASTM) be incorporated into a treatment plan? And when should dry needling and cupping be considered as effective modalities? Phil Page, PhD, PT, ATC, CSCS, FACSM, and editor-in-chief of the Journal of Performance Health, and Sue Falsone, PT, MS, ATC, CSCS, COMT, RYT, share their expertise and candid thoughts on these modalities in this Q and A. Click here to read the Journal of Performance Health.

An Interview with Sue Falsone PT, MS, SCS, ATC, CSCS, COMT, RYT®

Below Phil Page, PhD, PT, ATC, CSCS, FACSM and Editor

in Chief of the Journal of Performance Health, discusses the specifics of different treatment plans in more detail with Sue Falsone.

Kinesiology Tape

Phil:

We’ve been athletic trainers for a long time and tape is a big part of what we do as athletic trainers. Kinesiology tape is something I’ve been using for quite a while and I think it works really well for some people. What are some from your experiences with kinesiology tape and how do you use it in your practice?

SF:

Yes, I’ve used it for a very long time and I think over the years you adjust how you use certain tools. When it comes right down to it, the thing that I use kinesiology tape the most for is for pain relief. I’ve really gotten away from using it for other reasons because I feel like pain relief has been the most effective way for me to utilize kinesiology tape in my practice. But you know the research better than I do, what does the research say?

Phil:

You’re exactly right. Kinesiology tape is a short-term pain reliever that, when it’s compared against minimal or no intervention, works. It’s not more effective than other traditional things we would use such as the modalities, manual therapy, or exercise. But it’s really best used for short-term pain relief for musculoskeletal pain. And you brought up a good point, which is there’s not a lot of re-search supporting the use of tape for things like improving performance or even reducing edema after an ankle sprain. Quite honestly, it’s been shown to not have an effect on how fast that edema is reduced in an acute ankle sprain. So, the question then becomes: is that something you want to spend your time and money on? Are there other things that are as effective or more effective for both time and money as well?

SF:

What about different things such as activating a muscle or decreasing the tone of a muscle? What does the research tell us about that?

Phil:

I’m really glad you asked that because one of the things I’ve learned very recently is kinesiology tape gets a bad rap because people don’t think there is a lot of research about how the tape can activate muscles. However, there are over 400 published articles on kinesiology tape. According to the science, this whole argument of applying it in one direction versus another is absolutely false. I have tons of studies that have compared the direction of application on muscle activation and I can tell you, without a doubt, there is no difference on which way you apply it. You cannot facilitate or inhibit a muscle.

IASTM

Phil:

You know, Sue, I have been personally affected by certain treatments. I had tennis elbow for six months and a friend recommended instrument-assisted soft tissue mobilization, or IASTM as it’s called. Within two treatments, my pain was gone and I have not felt any more problems with that tennis elbow. I thought to myself, “There’s something definitely going on here.” It’s an effective pain reliever and very robust in its effect. I actually looked into the research and there’s some basic science behind it. It’s still really murky and there are not any real outcomes to measure, other than case studies out there. I tend to use it. Athletes love it. I know athletic trainers have been doing it for a while. How are you using it in your practice?

SF:

I have used some form of instrument-assisted soft tissue mobilization for probably a decade. I find it to be extremely effective with those really inspectional tendinopathies, those areas of pain that people are having right as the tendon is coming off the bone. That bone tendon interface is really where I tend to have really, really good results with it. And I continue to use it in my practice. I feel that, as a clinician, the clinical practice always precedes the research literature, right?

Our clinical practice drives clinical questions, which then drives the research side. And so, the research is always going to be lagging behind clinical practice. That doesn’t mean I don’t do things, because if I waited for research to tell me what to do, I might not have any therapeutic intervention to perform. And so, there’s so much information, whether it’s histological, or circulatory, or physiological, or even pain management type things that I think, clinically, those of us who use the modality “know” it works. And I’ll say that in quotes. We know it works, we’ve seen it work. We’ve had stories like you had, and so we continue to utilize it. And we just need to continue to search for answers as far as why is it working and how does it work. Just because we don’t know how it works or why it works doesn’t mean it doesn’t work.

Phil:

That’s right. Another great thing about IASTM, as we both know, is that it takes care of your hands. When we’re doing a lot of manual work with our patients, those instruments really do help us to do more during the day than we could without them.

SF:

Absolutely, and the longer I practice, the more I need hand-saving techniques. So, yes, instrument-assisted tools definitely help save our hands. And even if that’s the only reason to use them, I think it is a very valid one.

Dry Needling and Cupping

Phil:

Another new great modality that’s out there that I’m seeing a lot of is dry needling. I’m really excited to hear your story of it. I know you teach it regularly with your courses and it’s something that I’ve had done to myself. My wife is certified in dry needling and I think that there are some benefits, too. Tell me a little bit about how you came about to start with dry needling and what are the benefits. What can you tell me about it?

SF:

I started using dry needling probably around 2008-2009. I studied and took many different classes over the course of several years. I had the opportunity to create an education company last summer. Now I really teach about dry needling and how I utilize it within my clinical practice, both as an athletic trainer and as a physical therapist. As I said, I’ve had some really, really great results with it. It’s been one of those things that definitely has been practice-changing for me. We don’t exactly know how it works or why it works, but we certainly know that it can work. And I think that it is important to make the distinction between dry needling and acupuncture because everybody asks that question.

Acupuncture, when you look at the root words, “Acu” is sharp and “puncture” is to puncture, so are we utilizing to sharp object to puncture the skin? Yes, we are. That is where traditional Chinese acupuncture comes from, rooted in traditional Chinese medicine. There are so many different offshoots and specialties of traditional Chinese medicine and traditional Chinese acupuncture. Then there’s Western medical acupuncture with even more subcategories. Dry needling is one of those. I’m

a huge advocate that the tool does not define the professional. Each profession, whether you are an athletic trainer, or a chiropractor, or physical therapist, or an acupuncturist, has overlapping skills. We all use manual therapy. We utilize exercise and taping. And a fine filiform needle is no different; it’s just a tool that overlaps multiple health care professions. And we use it in very specific ways based on our education. Just because

I use a fine filiform needle does not make me an acupuncturist; just like when I utilize manipulation, I don’t magically become a chiropractor either. I am not defined by the tools that I use.

Phil:

One of the things that I think a lot of younger therapists don’t know is that dry needling was popular for many years in the 70s with Dr. Travell, remember? The myofascial pain, that’s the way Dr. Travell treated a lot of trigger points. They’ve treated trigger points medically for years and years with really great success. So, I know that it’s a great modality that we can really use in our clinics, and I appreciate all you’re doing to make it safe and have other people actually apply it. How does that fit within the realm of the athletic trainer? I know that it’s mostly done by the physical therapist today. Where does this fit within the scope of athletic training?

SF:

Athletic trainers are healthcare professionals and they function under the guidance of a physician. Every state has different laws, and we have to follow the different state licensure laws. I would just encourage the athletic trainer to look at their state laws and see if this is something that they are able to perform or not. Have that discussion with the supervising physician to see if this is something that you can incorporate

into your practice.

Phil:

Right. Another thing you do that again unique but now is popular is cupping, right? You’ve been doing cupping for years, and I was in China many years ago and I saw the traditional way of doing cupping. But after the Olympics last year, I was intrigued by it, then all of the sudden it explodes. Tell me a little bit about the role, what cupping does. What’s its role in your overall treatments?

SF:

Cupping is an interesting soft tissue modality because everything we have, whether you’re sticking your thumb in someone or using a massage stick or a foam roller, everything is compressive to the tissue. And so, for the first time we really have a distraction in the tissue by utilizing negative pressure. And the cup, it lifts the tissue up and it causes a decompression of the tissue. Now there is compression under the rim and I think that compression to decompression interface is very, very interesting. So, for the first time, we have the ability to decompress tissue. And we don’t exactly know how that is good, bad, or indifferent, or if it’s better than compression in and of itself. But I think, in general, the body likes periodization. We don’t like to eat the same thing every single day. We don’t do the same exact workout every single day. The body adapts to those things.

I think if we purely look at cupping as a way to periodize our soft tissue work, that alone is interesting to me. Let alone, what does decompression do the tissue? What are the circulatory changes? I think there are a lot of other interesting things going on there. But we know, in general, the body does adapt to the same stimulus day in and day out. And yet, we’ll have our athletes grab a foam roller and they’ll foam roll when they come in to the athletic training room, when they leave on an off day, before a workout, after a workout. I mean I can way overprescribe foam rolling. I think cupping gives us an alternative. Again, exactly how that works, I’m not sure, but that doesn’t mean it doesn’t work. Just because I can’t explain it doesn’t mean I don’t have good results with it.