In this edition we discuss how painful shoulder poses a significant challenge in the rehabilitation of hemiplegic patients, particularly those recovering from stroke. NeuroMuscular Taping offers a promising and effective adjunct to conventional therapies by addressing the root causes of pain and muscle imbalance through its decompressive action. The application of NMT has demonstrated significant improvements in pain reduction, shoulder stability, range of motion, and overall functional recovery, enabling patients to achieve better rehabilitation outcomes. Existing evidence suggests that NMT is an excellent complementary tool for managing the painful hemiplegic shoulder and supporting patient recovery.
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Introduction to Hemiplegic Shoulder
Hemiplegia, or paralysis on one side of the body, is a common consequence of stroke and other neurological conditions. A particularly debilitating complication of hemiplegia is shoulder pain, which can significantly impact the rehabilitation process and the overall quality of life. The painful hemiplegic shoulder (PHS) results from a combination of muscle hypertonicity or spasticity, muscle not responding due to CNS trauma o ischemic stroke causing improper joint positioning, often leading to subluxation or dislocation. Managing this pain and preventing further complications are crucial for the patient’s recovery.
In recent years, NeuroMuscular Taping (NMT) has emerged as a promising non-invasive therapeutic intervention to address PHS. Created by David Blow, NMT utilises decompressive taping techniques aimed at improving circulation, facilitating lymphatic drainage, and reducing pain through neuromuscular stimulation. This article explores the effectiveness of NeuroMuscular Taping in alleviating pain and improving functional outcomes in individuals with a painful hemiplegic shoulder.
Understanding the Painful Hemiplegic Shoulder
Painful hemiplegic shoulder is a multifactorial condition that develops after hemiplegia, particularly in patients post-stroke. Causes include muscle imbalances, spasticity, and improper joint alignment, often leading to issues such as shoulder subluxation, capsulitis, and complex regional pain syndrome (CRPS). PHS not only causes physical discomfort but also limits the range of motion, thereby delaying rehabilitation and worsening functional outcomes. Conventional treatments involve physiotherapy, acupuncture, electrical stimulation, and pharmacological interventions, but the outcomes can be mixed, leading to an exploration of complementary therapies like NeuroMuscular Taping.
Mechanism of Action of NeuroMuscular Taping
NeuroMuscular Taping is based on the application of adhesive, elastic tape in a manner that influences the body’s musculoskeletal and circulatory systems. Unlike Kinesio taping, which is applied with tension, NMT uses a decompressive approach. The technique works by gently lifting the skin to create space between the skin and the underlying fascia, which enhances blood flow and promotes lymphatic drainage. This process helps reduce inflammation, relieve muscle tension, and decrease pain, which are essential components in the treatment of PHS.
Additionally, NMT can provide proprioceptive input to the muscles and joints, assisting in improving the alignment of the shoulder joint, reducing the risk of subluxation, and promoting better posture. This neuromuscular feedback aids in activating weak muscles while reducing spasticity in overactive muscles, facilitating a more balanced movement pattern.
Evidence-Based Outcomes of NeuroMuscular Taping in Painful Hemiplegic Shoulder
Several clinical studies have examined the effects of NMT on hemiplegic shoulder pain. Most studies highlight its capacity to:
- Reduce Pain: NMT has been shown to significantly alleviate pain in hemiplegic patients by decompressing the affected area, reducing joint pressure, and improving blood circulation. Patients often report a noticeable reduction in shoulder discomfort, allowing them to engage more fully in rehabilitation activities.
- Improve Range of Motion (ROM): Painful hemiplegic shoulder frequently limits the patient’s ability to move the arm. NMT has demonstrated its ability to enhance the ROM by providing neuromuscular feedback that promotes better joint positioning and muscle coordination.
- Decrease Shoulder Subluxation: NMT’s supportive effect helps in reducing subluxation by stabilizing the joint in a functional position. Over time, this may decrease pain and improve the structural integrity of the shoulder joint.
- Enhance Functionality and Mobility: Patients undergoing NeuroMuscular Taping as part of their rehabilitation regimen have reported improved arm and shoulder functionality. This enables them to better perform daily activities, which accelerates the overall rehabilitation process.
Clinical Studies Supporting NMT for PHS
EFFECTIVENESS OF NEUROMUSCULAR TAPING ON PAINFUL HEMIPLEGIC SHOULDER: A RANDOMISED CLINICAL TRIAL.
Authors: Pillastrini P , Rocchi G , et al.
Disabil Rehabil. 2016 Aug; 38(16):1603-9. doi:10.3109/09638288.2015.1107631. Epub 2015 Dec 18.PMID: 26678717 https://pubmed.ncbi.nlm.nih.gov/26678717/
Abstract: The purpose of this trial was to investigate changes in pain, the range of motion (ROM) and spasticity in people with painful hemiplegic shoulder (PHS) after the application of an upper limb neuromuscular taping (NMT). We conducted a randomised clinical trial. The study included 32 people, 31% female (mean±SD age: 66±9 years), with PHS after stroke with pain at rest and during functional movements. The experimental group received the application of NMT and a standard physical therapy programme (SPTP), whereas the control group received SPTP. The groups received four 45-minute long sessions over four weeks.
Methods: The VAS, ROM and spasticity were assessed before and after the intervention with follow-up at four weeks. The experimental group had a greater reduction in pain compared to the control group at the end of the intervention, as well as at one month after the intervention (p<0.001; all the group differences were greater than 4.5cm, which is greater than the minimal clinically important difference of 2.0cm). The experimental group had a significantly higher (i.e. better) ROM, by 30.0°, than the control group in shoulder flexion (95% CI: 37.3-22.7) at 4 weeks and by 24.8° (95% CI: 32.1-17.6) at 8 weeks as well as in abduction by 30.6° (95% CI: 37.5-23.7) at 4 weeks and 25.1° (95% CI: 33.8-16.3) at 8 weeks.
This study demonstrates that NMT decreases pain and increases the ROM in subjects with shoulder pain after a stroke. Implications for Rehabilitation Painful hemiplegic shoulder is a frequent complication after stroke with negative impacts on functional activities and on quality of life of people, moreover restricts rehabilitation intervention. Neuromuscular taping is a technique introduced by David Blow for the treatment of neuromuscoloskeletal problems. This study shows the reduction of pain and the improvement of range of motion after the application of an upper limb neuromuscular taping. Rehabilitation professionals who are involved in the management of painful hemiplegic shoulder may like to consider the benefits that neuromuscular taping can produce on upper limb.
Advantages of NeuroMuscular Taping
- Non-Invasive: NMT is a non-invasive treatment that can be easily integrated into existing rehabilitation protocols without the need for additional medications or surgical interventions.
- Non-pharmacological: Reducing drug use in patients suffering from stroke or other neurological conditions is of primary importance as outlined by WHO guidelines.
- Long-Term Effectiveness: The decompressive taping technique can provide sustained benefits, as the tape can remain in place for several days, delivering ongoing proprioceptive feedback and mechanical support.
- Easy to Apply: NMT can be applied by trained professionals in both clinical and home settings, making it an accessible treatment option for patients and caregivers.
Conclusion
The painful hemiplegic shoulder poses a significant challenge in the rehabilitation of hemiplegic patients, particularly those recovering from stroke. NeuroMuscular Taping offers a promising and effective adjunct to conventional therapies by addressing the root causes of pain and muscle imbalance through its decompressive action. The application of NMT has demonstrated significant improvements in pain reduction, shoulder stability, range of motion, and overall functional recovery, enabling patients to achieve better rehabilitation outcomes.
Further research is encouraged to standardise NMT protocols and explore its long-term benefits in larger, diverse populations. However, existing evidence suggests that NMT is an excellent complementary tool for managing the painful hemiplegic shoulder and supporting patient recovery.
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