INTERVIEW WITH DAVID BLOW
NeuroMuscular taping for post-surgical rehabilitation
Taping is rapidly entering clinical and rehabilitative settings especially in the post-traumatic and post-surgical fields. The therapy is biomechanical, immediately effective, non-invasive and has no side effects, but is extremely operator-dependent.
Elastic taping, dynamic taping, kinesiotaping, functional taping, neuromuscular taping – what is the difference? In the last twenty years the treatment of most common musculoskeletal disorders with the now popular adhesive tapes with bright colors has taken hold and gained visibility especially in the professional sports field, with the consequent mystifications and myths and above all with the foreseeable errors of interpretation regarding theoretical foundations, indications and technical aspects of these physiotherapy and rehabilitation tools.
Even from a descriptive point of view, the argument is penalized by a substantial ambiguity: the terms mentioned, often used as synonyms, actually refer to uses of taping that are completely different both conceptually and on a practical and application level. In this case, the registered names Kinesiotaping and NeuroMuscular Taping correspond to two methodologies that not only have origins very far from each other in space and over time the first in Asia in the early 1980s and the second – from in Europe at the beginning of 2000 by the Australian David Leonard Blow – but also based on diametrically opposed physiological arguments.
An attempt to shed light is a must, above all in consideration of the fact that for the last 15 years, due to the influence of NeuroMuscular Taping, the use of taping has been shifting from the area of athletic performance to that of clinical rehabilitation activities. We talked about it with David Leonard Blow, creator of the NeuroMuscular Taping (NMT) concept and founder in 2003 in Rome, where he currently resides, of the NeuroMuscular Taping Institute a center entirely dedicated to training and to clinical research on the various applications of neuromuscular taping, done in collaboration with hospitals, local health companies, universities and private institutions, in Italy and in several other countries of the world.
Dr. Blow, how does kinesiotaping and neuromuscular taping differ conceptually and technically?
Kinesiotaping, sometimes referred to as functional taping or neuromuscular bandaging, is based on a compression mechanism that is obtained by applying tape with varying degrees of tension, from paper off to 10% to 100% of tension, in order to activate the elastic material to create a concentric stimulation on the underlying tissues. It basically has a containment function and therefore lends itself to an action of immobilization and stabilization, useful in particular in the sports context or in general in some post-traumatic conditions.
The neuromuscular taping concept, of my creation, originates from a more far-reaching clinical reasoning since it is based, on the contrary, on a decompression mechanism, which is produced by adhering the tape, with the aim of producing an eccentric stimulation in the treated area. The decompressive action determines a dilatation stimulation of the interstitial spaces in the underlying tissues, and at different depths depending on the width of the tape, with consequent strengthening of the microcirculation and lymphatic drainage encouraging fluid exchange. It therefore has a mainly decongestant and, so to speak, prometabolic, favorable effect in all situations characterized by an inflammatory and/or degenerative process, which is of traumatic or surgical origin or linked to the pathophysiological events of a disabling condition.
Given the difference in the theoretical assumptions of the two methodologies, can we say that the method of tape application and technique is of fundamental importance?
Absolutely yes. Indeed, in determining the effectiveness of NMT taping the key word is certainly “human skill”.
Regarding the instrument (tape), the only important aspect is that the tape is of good quality, I recommend always using a product registered with the Ministry of Health as a non-pharmacological medical device – but the result obtained depends exclusively on the specific competence of the operator, that is to say from its ability to choose the application method suitable for the individual case, the location to be treated, the appropriate size (length and width) of the tape, the duration of the treatment necessary to obtain and/or maintain over time the therapeutic action. All of this chosen and performed correctly will ensure results. After all we are talking about medical rehabilitation competency!
I must stress that precisely because the theoretical assumptions are opposed, improper taping can have an effect that is exactly the opposite of the desired one. Speaking of NMT, a priority element, evident even at first sight, is the absence of tension applied to the tape, which, if correctly applied in elongation, must lift the skin in waves or undulations in order to generate decompression and not, vice versa, compression. It follows that a stretched tape over an area where drainage and oxygenation is needed will instead cause more congestion and hypoxia in the underlying tissues.
It is for this reason that training, through accredited courses at various levels, and hopefully especially in collaboration with public facilities, hospitals and clinics, is one of the main missions of the NMT Institute, which to date only in Italy has certified over 14,500 physiotherapists, physiatrists and speech therapists.
What are the main indications for NeuroMuscular taping currently?
By virtue of its mechanism of action it can be said that NMT has an indication whenever the removal of excess liquids, pro-inflammatory substances and metabolic waste and the increase in the supply of oxygen and nutrients can favor the processes of normalization and tissue repair.
The neuromuscular and scheletric applications range from traumatology to prosthetic surgery in orthopedics, from neuromotor rehabilitation in the outcome of cerebral vasculopathy to symptomatic or maintenance therapy in chronic forms such as cerebral palsy and in neurodegenerative progressive pathologies such as Parkinson’s, multiple sclerosis, SLA or SMA, or in malformative conditions such as congenital clubfoot, arthrogryposis or clinodactyly, from anti-inflammatory and pain-relieving treatment in rheumatologic diseases such as rheumatoid arthritis or systemic sclerosis to de-contracting sclerosis in low back pain or cervical dystonia.
Furthermore, the ability of decompressive taping to exert also a sensory stimulation, at the level of the exteroceptive and proprioceptive receptors, amplifies its therapeutic potential, making it suitable in all situations with sensory deficits of any origin (vascular, surgical, traumatic, etc.) rather than in postural disorders. Recently, the validity of NMT is also being tested in the improvement of skin and subcutaneous tissue conditions, for example in reconstructive surgery and in the treatment of scars, diabetic ulcers and burns. There are practically no limitations to the use of NMT, even in combination with other physiotherapy treatments, as long as it is prescribed and implemented appropriately.
What are the prescriptive criteria in traumatology and prosthetic surgery?
The first fundamental rule in programming NMT is to make a distinction between the acute phase, the post-acute phase and the functional phase, setting different therapeutic objectives.
It is obvious that in the period immediately following a traumatic injury or a surgical procedure the local decompressive and dilatation treatment is contraindicated, both for the presence of discontinuity of the skin, in the case of open trauma or surgery, and for the risk hemorrhage. But we can in any case activate a fast track protocol in order to accelerate the restoration of the most suitable conditions for the rehabilitation: in the acute phase it is therefore appropriate to apply the tape proximally to the site of the trauma or surgical site following the anatomy of the lymphatic system , in order to favor the decongestion and lymphatic drainage indirectly. This means, for example, in the case of the knee, applying the tape at the inguinal level or in the case of the ankle at the level of the popliteal fossa, applying tape up to 5-10 cm from the surgical or traumatic site. In the post-acute phase, when the internal and external reparative processes are just underway, the tape application can also be done in correspondence with the surgical area or the traumatic injury with thin tape, up to 1 cm wide, which will work on the surface reducing the inflammation and favoring regenerative events, to be replaced later in the functional phase, characterized by lesser pain and an already advanced degree of mobilization, with wider tabs, up to 5 cm, working more deeply.
Are there specific contraindications to decompressive taping?
NMT is a biomechanical therapy, non-invasive and free of side effects, except for possible allergic reactions to the adhesive substance of the tape or due to patient idiosyncrasies reaction, but the quality of tape and tape monitoring through registering with health ministries must be used with a view to medical-sanitary responsibility. Therefore the application must be avoided in some circumstances: in locations with ascertained or suspected bleeding or thrombotic phenomena; at the level of a surgical site or of a traumatic lesion in the acute phase; on the abdomen in case of gastric or intestinal bleeding, in the presence of uterine fibroids and immediately postpartum; in close proximity with skin neoplastic or deep localizations and in general, as a precaution, in patients with tumor disease that is not well controlled; in subjects with bacterial or viral infections.
Any adverse effects or therapeutic failures of NMT are almost always due to errors in the prescription of the treatment or in the application of the tape.
Colored tape have become quite popular in sports. What are the current applications instead in the clinical setting?
On the part of the operators/therapists/doctors there is a growing interest in the potential of NMT as the possible applications are under studied systematically. There is a lot of debate in the research area on the quality of publications in general. This i salso the case of NeuroMuscular Taping. Understanding the confusion and seeing that many researchers include all types of taping methodology under the same umbrella, many research papers evan though published add to the confusion. When reading a research, not only regarding taping, it is fundamental that the a quality paper follows a clear, distinct and reproducible methodology enhancing understanding and furthering knowledge rather than confusing. It is generally noted that only 10% of all pubblications follow clear scientific methodology.
The demand for training is high, compatibly with the economic resources of hospitals and clinical structures, and the offer is varied, although not always of a suitable quality level: a course of a few hours is not enough to acquire theoretical knowledge, prescriptive ability and technical ability in NMT . Therfore courses are arranged as clear training programs covering min. 4 days for a basic courses to other more specialized programs for amputee rehabilitation, diabetic ulcer treatment and neuropathology treatment and rehab.
On the patients’ part, there is sometimes a skeptic reaction, which however is easily overcome when the taping, proposed and implemented by an experienced operator, begins to quickly produce the first benefits. In fact, immediate efficacy is a feature of this treatment.
EB TALK WITH DAVID BLOW
NEUROMUSCULAR TAPING: STATE OF THE ARTE AND NEW PROSPECTIVES
Roma. 20 JUNE 2017
- Virginia Colibazzi, FT Equipe Terapeutica, Roma.
- Adriano Coladonato, FT ANIK Associazione nazionale idrokinesiterapisti, Roma.
- Emilio Romanini, MD, Artrogruppo Roma.
ABSTRACT: The term in English tape or taping generically refers to a non-elastic or elastic band, which is applied directly to the skin for therapeutic purposes. Potential benefits range from pain inhibition, increased blood circulation and lymphatic drainage, reduction of muscle fatigue, improved posture and sports performance. However, clinical efficacy can not yet be established unequivocally and extensively by the scientific literature and the popularity gained in recent years has fueled a terminological confusion and sometimes improper use of this therapeutic tool. We asked Dr. David Blow, founder of the Neuromuscular Taping concept, a deepening view and explanation on the area of taping treatment.
Key words: Taping, tape, neuromuscular tape, David Blow
With stretch or without stretch: The NeuroMuscular Taping Concept is the application of a tape with certain characteristics with a specific method for therapeutic purposes. The tape with elastic single directional properties is applied in an eccentric way, that is on the skin stretched with a no tensioning of the tape (zero tension). When the patient repositions the part of the body treated in a neutral position, the tape creates skin folds that cause dilatation of the skin and underlying body tissue creating further dilation of blood and lymphatic vessels and decompression of the muscle fascias, muscle and tendon fibre and joint structures with consequent increase in local blood circulation. The basic concept that I am passing to you was created in 2000, but follows the assumption that manual therapy, through movement, favors vascularization and therefore tissue recovery. NMT Know-How is based on the correct application methodology that makes it totally different to other types of “taping” already present.
The potential benefits listed by the proponents of this technique range from pain inhibition to increased blood circulation.
Before these famous colored tape of variable elasticity raged the sports and rehabilitation field, acquiring great popularity; the application of a bandage indicated forms of anelastic and elastic bandage for containing and protective purposes of a joint, generally after a trauma. The term in English tape / taping generically designates a sticking plaster that is applied for therapeutic purposes directly on the skin.
The potential benefits listed by the proponents of this technique range from pain inhibition, increased blood circulation and lymphatic drainage, reduction of muscle fatigue, improved posture and sports performance.
The question on the clinical efficacy of taping was examined by the two main schools of teaching taping: the Kinesiotape of dr. Kenzo Kase and the Neuromuscular tape of dr. David Blow. In the first case, recent systematic reviews have asserted preliminary evidence of poor quality such as not to be able to recommend an extensive use in the treatment or prevention of musculoskeletal disorders. On the other hand, for neuromuscular tape, RCTs are available that are conducted in different rehabilitation settings with limited population samples that affect the external generalizability of the results. In parallel with the effort to obtain evidence of effectiveness, there has been an exponential increase in the popularity of taping thanks to its visibility in public events and some advertising campaigns with consequent commercialization creating confusion on the terminology and methods of application. We interviewed Dr. David Blow to whom we asked several explanations on NeuroMuscular taping.
David Blow is founder and president of the Neuromuscular Taping Institute based in Rome since 2003, New York since 2012 and Jakarta since 2015. He is the method instructor in Europe, Asia and America; has over thirty years of clinical experience in the field and has published several case studies and articles. He is currently involved in research projects in the pediatric, neurological, orthopedic, rheumatological, oncological and post-surgical fields. He has developed several continuing education programs and specialization courses and has various partnerships with universities and hospitals in Italy and abroad.
Among the articles published in Italy:
- Costantino C et al; Neuromuscular taping versus sham therapy on muscular strength and motor performance in multiple sclerosis patients. Disabil Rehabil. 2016; 38 (3): 277-81.
- Pillastrini P et al; Effectiveness of NeuroMuscular Taping on painful hemiplegic shoulder: a randomized clinical trial. Disabil Rehabil. 2016 Aug; 38 (16): 1603-9.
- Camerota F. et al; The effects of NeuroMuscular Taping on gait strategy in a patient with joint hypermobility syndrome / Ehlers-Danlos syndrome hypermobility type.Ther Adv Musculoskelet Dis. 2015 Feb; 7 (1): 3-10 ..
Hello dott. Blow, first of all thanks for the availability, my first question is about terminology: could you define the concept of your Neuromuscular Taping and explain the differences compared to the other forms of taping mentioned in literature and commercially available?
The neuromuscular concept taping consists in the application of a tape for therapeutic purposes in an eccentric way, that is on the skin placed in elongation without tension applied to the tape (zero tension, cit). When the patient repositions the elongated body area in a neutral position, the tape creates skin folds that cause dilation of blood and lymphatic vessels and decompression of muscle, tendon and joint muscle structures with consequent increase in local vascularization. The basic concept that I am explaining here follows the assumption of manual therapy which through movement promotes vascularization and therefore tissue recovery.
On the contrary, other forms of taping involves the application of tape with a pre-tension of variable percentages for stabilizing and containing purposes (the area in which it was first used is sports). The consequence on soft tissues is a concentric return of the elastic fiber in the tape creating a vascular compression and a local ischemia. Other taping techniques invented in recent years represent variants of this “pulled” tape technique.
Can you tell us about the personal and professional path that led you to develop the concept of Neuromuscular Taping?
My background is in Chinese medicine, phytotherapy and acupuncture, which gave me an anatomical knowledge and pathological basis of the body and its healing processes and therefore led me to question about the usefulness of a “stretched” or concentric tape application. Creating in 2000 the NMT concept which is based on an eccentric tape application creating Dilation and decompression stimuls
I founded the Neuromuscular Taping Institute (NMT) which sets objectives for information and training of operators/therapists/doctors as well as research and volunteer training projects in the hope of standardizing training and substantiating the scientific evidence on the subject. The institute is internally financed and therefore does not have external sponsors but exploits the proceeds deriving from training courses for research purposes. Today there is a lot of confusion on the terminology, objectives and who is competent to apply tape for therapeutic purposes.
A question about the institution you founded, which represents an example of a private research organization: please describe how you structured your training and internal organization?
The institute provides subsequent basic and in-depth courses accredited according to the ISO 9001 quality procedure in compliance with the local country legislation for medical and health professions (physiotherapists, speech therapists, occupational therapists and nurses). In recent years I have trained more than 14,500 students creating an Italian know-how on NMT. The students enrolled receive a theoretical and practical preparation and learn our treatment modality which is articulated in a phase of evaluation, treatment and re-evaluation and the desired treatment be applied following the pathology or pathological phase of the patient. This approach creating a therapeutic choice on the one hand makes it possible to understand the efficacy of the treatment, excluding the confounding variables and any placebo effect, on the other it has allowed us to exploit the clinical experience to hypothesize new applications of taping. Hence creating the NMT KNOW-HOW.
Following instructions given during the courses, some colleagues obtained a rapid and prolonged effectivness on the syndrome ” phantom limb pain of the amputee” with NMT in decompression, published article in 2017 from our Ethiopian Volunteer University training project, creating clinical evidence, taping programs specifically for nurses in dilatation taping as an adjuvant in the treatment of pressure ulcers, or it has been inserted in the speech therapy treatment of voice disorders (vocal cord edema) or swallowing disphagia in patients with a stroke or in the management of post-mastectomy lymphedema and breast reconstruction. Obviously NMT must be considered an instrument, in association with other techniques or rehabilitative methods: it is the union of several therapeutic techniques contributing to a final objective, namely the healing or improvement of the patient’s state of health by improving the quality of life; goal in my opinion to share regardless of the training school. As intrinsic advantages there are the cost/benefit analysis of NMT maintenance of the therapeutic effect over longer treatment time frames that create continuous and prolonged stimulation at contained costs. So, to return to your question, if the empirical data tells us that it works and it can be beneficial in patient care process, then correct and supported across the board training is our final objective.
What scientific data are available today? Can you tell us something about the published studies?
With the group Dr. Filippo Camerota and Dr. Claudia Celletti of the University “La Sapienza”, starting in 2014, we have conducted various studies.
A case report in a girl with left hemiplegia with the first encouraging results showing a variation in kinetic and kinematic parameters of the spastic upper limb and its function after tape application.
A second study designed by professor Giorgio Albertini together with the Politecnico di Milano and Manuela Galli on a group of five boys with Down syndrome involved the application of the tape in eccentric mode on the extensors of the neck and on the muscles of the hand and the execution of a videotaped design test with pre and post treatment Motion Capture software. In the conclusions the authors maintained that the tape could modify the proprioceptive inputs and therefore the neural pathway up to the motor cortex and consequently improve dysgraphia and manual coordination in the examined patients.
As an institution we also have training and volunteering projects in countries at war or in developing countries; in the last ten years I have been in Bosnia and Herzegovina as well in Congo and Ethiopia. In Ethiopia we have started several research projects, in particular on the reduction of phantom limb pain in the upper limb amputee patients; I would like to deepen it further in Italy because it could have revolutionary implications for the treatment of the patient who today instead envisages compression of the stump using bandages and modeling aimed at the subsequent prosthesis and subsequent pain killer medication.
The potential applications of NMT also extend into the rheumatology field where Professor Parisi from Turin applied NMT to 58 patients with scleroderma. The protocol included 8 treatments in a month treating every 3-4 days; strength tests, goniometric measurements of the range of joint motility and video recordings to evaluate hand motility were performed. The results show greater mobility and palmar strength, fewer episodes of Raynaud’s phenomenon and recourse to painkillers but also variation of post-treatment capillaroscopy and a 3-month follow-up.
This last study cited above is above all an example of standardization of treatment with taping; Can the creation of specific pathology taping guidelines be considered a future goal?
To date, our students are already implementating our treatment protocols for the various pathologies and many hospitals are using our NMT protocols in orthopedic surgical and neuro rehabilitation area. Protocol standardization is an essential requirement in research methodology and the validation process of these takes time but is definitely a goal to pursue.
And what other goals are you following at the institution level?
I hope that the Neuromuscular Taping concept will become a widespread tool used by all rehabilitators, which will also be offered in institutional locations and will be included in rehabilitation services subject to public health care cover. At the same time, I would like greater uniformity in the training of the operators, an objective that could be achievable by inserting a thematic module in the core curriculum of students at the university level and thus guaranteeing a continous use of this knowledge and KNOW-HOW.
We have also implemented the professional register of trained operators that is already present on the site so that it becomes a resource for colleagues, patients and doctors.
In the professional training course of dr. Blow we recognize the process that distinguishes scientific research: the empirical observation of a given phenomenon leads to a subsequent formulation of a working hypothesis and to the work of translating the data into scientific proof. The passage from one step to the other is not obvious, on the contrary it presents some criticalities of which we have often spoken; in particular today we want to underline the almost exclusive belonging of research to a university environment and / or non-profit foundations with difficulty for the single operator to participate in the process of scientific knowledge if not as a final reader of articles. With the creation of his institute for neuromuscular taping, Dr. Blow has bypassed this condition and therefore represents an excellent example of an individual who also does research; or rather that it uses the proceeds obtained from its own private training courses to finance its own research and / or volunteering projects.
We appreciated the emphasis placed on the need to standardize the preparation of professionals (a theme that emerged already in previous interviews with Dr. Lambeck and Dr. Padua) and the opening to collaboration with different professional profiles of this professional who does not define a researcher, but a clinician who uses research to find explanations and give substance to his actions.
RESEARCH AND DEVELOPMENT
The R&D aspect of the NMT institute is based upon the creation of clinicial experiences and controlled treatment trials leading to research projects that eventually modify how we treat our patients. A good idea is not enough – it has to be substantiated using correct and precise treatment methodology. The role of the NMT Institute is to create correct and duplicable training which is the basis to all continuing education and the primary objective to all training in medicine. Our role is to ensure that the NMT Know-How created over the last 20 years becomes solid and reproducible medical intellegence.
Evidence based medicine NMT publications: Various research articles were published and many of them requires important particular attention.
Towards the end of each academic year there are many university thesis presented and some are developed into research publications. It is our strong intention to sustain research and development together with the tertiary university system.
NEUROMUSCULAR TAPING INTELLECTUAL PROPERTIES
The NMT Institute has created a treatment concept of decompression taping called “NeuroMuscular Taping” widely known in medicine and rehabilitation.The NMTConcept is used in physical rehabilitation, in sports medicine, in nursing, in speech therapy and language pathologies, in all aspects of health care. It is a therapeutic ally in the prevention of and in the active treatment of many conditions requiring increased self-healing capacity.
The “NMT Know-How” and the “Intellectual Property – NMT“ began in 2000 and consolidated during 2003 together with the creation of both the NMT concept and the NMT Institute. The Institute plays a key role in the management of precise training and in the development of specific protocols for pathologies and conditions requiring treatment. Since its creation, the NMT Institute is a benchmark for specific innovative training programs and for its involvement in numerous volunteer initiatives in various parts of the world. Through correct training the NMT Know-How is passed on to health care professionals while in collaboration with tertiary education institutions the NMT intellectual property can be shared to all.