DCs have long focused their attention on the mechanical effects of treating soft tissue (skin, fascia, muscles, tendons and ligaments).
And now more emphasis is being given to the nervous system and its ability to normalize tissues, mitigate pain and improve motor control. This is changing the way many approach manual therapy.
If you understand the nervous system and how it responds to stimuli like light touch, deep pressure and vibration, then you can treat your clients’ needs with less time, less pressure and less potential to injure them. This is important for all of your clients, but even more critical for the pediatric patient, whose nervous system is still developing and whose skin and other soft tissues are more sensitive and delicate.
Regarding manual therapies for this special population, your hands are certainly some of the best tools you have, but have you considered IASTM treatment and kinesiology tape?
My daughter Polina was born frank breech. We tried inversion techniques, the Webster technique, and other therapies to avoid a cesarean surgery, but still she was delivered by a cesarean performed at North Collier Hospital in Naples, Florida.
She was gorgeous and healthy by most measures, but the breech position caused her to develop bilateral hip dysplasia and severe torticollis. She wore a Pavlik brace for six weeks to proactively treat the hip dysplasia. During this time, I applied manual and IASTM principles to decrease her discomfort, improve length tension relationships and joint centration as well as improve her motor output.
I used kinesiology tape in conjunction with IASTM for similar reasons. Manual therapies and kinesiology tape can mitigate pain through mechanical disruption and stimulation of light touch receptors.
A gentle approach to tooling and taping
A tool is only as scary or dangerous as the person wielding it. Here are some suggestions when treating kids: Reduce the threat and build a therapeutic alliance with the child and caretaker; explain what you are doing. Let them see, hold and even play with the instrument until they are comfortable. Demonstrate on an area they can see, again explaining what you are doing, and start very light to desensitize the region and inhibit pain.
Light touch is an excellent way to mitigate pain by stimulating interoceptors that have an inhibitory response to nociception. Once you have introduced the tool and decreased pain, then you can progress to deeper pressure or alternative therapies. The tool can provide biofeedback that your hands cannot.
Tools with sharper edges pick up textures in a unique way and provide a significant amount of information about the person you are treating. An IASTM tool with an edge allows for not only comfort but an amount of shear as well.
Tools like kinesiology tape require a similar open, non-threatening approach. When taping a baby or child, make their guardians aware of the effects and possible reactions associated with treatment.
Ask about skin sensitivities or apply a small piece of tape as a test patch. It’s recommended to use smaller pieces of tape, which may require some trimming. There are gentle kinesiology tape options with less adhesive for sensitive skin and easier removal. Be sure to inform the parent or guardian on the removal process, or you won’t get a second opportunity to use this effective tool.
Remove by applying liberal amounts of mineral oil, corn oil or other inexpensive oil to the tape to break down the adhesive. Mineral oil, corn oil or other inexpensive oils work well. Milk of magnesia may soothe the skin after removal and can also be applied before taping to create a protective barrier between the skin and the tape.
By adding IASTM and kinesiology tape to your treatment arsenal, certain pediatric conditions can be a lot simpler to treat. Here are three of them.
Torticollis
Torticollis means “twisted neck,” and it’s a common condition in newborns. Torticolis patients are recognizable by their tilted heads or difficulty turning their heads. Incorrect positioning in the womb, a difficult childbirth and poor sleeping positions are some of the causes. Most cases are treated through passive stretching and various forms of myofascial release.
You can use an instrument to help to downregulate or relax hypertonic neck muscles like the sternocleidomastoid (SCM)—much like you would with your hands—for different biofeedback. Slow “deeper” pressure will target more Ruffini receptors which help stimulate the nervous system to relax and lengthen soft tissues in the region, including the fascial system.
At the same time, identify the more inhibited or lengthened tissues and apply a faster, more oscillatory stimulus to target Pacinian receptors to create more control and awareness. The target mechanoreceptors are fast adapting and can be stimulated in as little as ten seconds—which is beneficial when dealing with a potentially squirming and crying infant.
Treatments are shorter, gentler and effective when you know how specific receptors respond to stimuli. Applying a 2-inch piece of gentle kinesiology tape over SCMs, levator scapulae, traps or spinal erectors may help to increase sensory input to further normalize the tissue and gain control of the region.
Toe walking
Walking on the toes or the balls of the feet, also known as toe walking, is fairly common in children who are just beginning to walk and is usually outgrown. But it may persist in children with cerebral palsy, muscular dystrophy, autism or other nerve and muscle problems. Addressing the length-tension relationship of anterior and posterior tissues may assist in treating this movement pattern.
Kinesiology tape can help as both postural support for kinesthetic cueing and as neurosensory input. Place the foot in neutral and apply kinesiology tape to the anterior chain (anterior tibialis), then completely dorsiflex the foot and apply a second strip to the posterior chain (foot, Achilles tendon, gastroc, soleus, and posterior tibialis). This will create a slight tug or kinesthetic cue if the foot moves into plantar flexion (toe walking) and additional sensory input to the opposing musculature to control the movement.
An advantage to kinesiology tape is that it’s a one-time application that continues to provide benefits 24/7.
Osgood-Schlatter
Osgood-Schlatter disease can cause a painful, bony bump on the shin bone just below the knee. It usually occurs in children and adolescents experiencing growth spurts during puberty and children who participate in sports. The quadriceps can be excessively tight and pull on the patellar tendon.
Some parents may not want to use painkillers, injections or other means of pain control that can have adverse effects. This is a population that can benefit greatly by kinesiology tape and IASTM effects.
First, you may want to start with a light brushing over the painful zones to decrease discomfort. Lightly touching and stimulating interoceptors can mitigate pain and reduce associated painful movements. Now you are ready to address tension of the rectus femoris and quadriceps by downregulation (slow deep Ruffini).
Lastly, upregulate balancing tissues like the posterior chain (hamstrings). A final layer may be the application of kinesiology tape directly over the tibial tuberosity, patellar tendon, and rectus femoris—going as far as the ASIS or even following the psoas—depending on your familiarity with the fascial chains that control hip flexion.
Thanks to modern advancements, musculoskeletal conditions are becoming easier to treat than ever. Though real mechanical injuries and limitations exist, most conditions have a neurosensory component. You can improve outcomes when you assess and treat for both mechanical and sensory effects, and when you use a multitude of approaches to layer your care.
Danny Porcelli, DC, has an extensive background in sports medicine, soft tissue injury and rehabilitation. He was a treating physician at the CrossFit Games and for Olympic and Para-Olympic Athletes at the Central American Games. Porcelli is one of RockTape’s master instructors and teaches other healthcare providers, trainers and athletes how to use tape to decrease pain and improve performance. He can be contacted through rocktape.com.
