Taping, Needling, Poking, Prodding, Manual Therapy … the case for the short-term goal
I want to fix stuff. Fast. My patients know it. Athletes at whatever venue know it.
What is a FIX?
Defining “fix”: Complete resolution of symptoms. Correction of correctable underlying faulty biomechanics. Accommodation for uncorrectable anatomical perpetuating factors. Restoration of predisposing length/strength/control/loading problems.
This is a tall order, of course. For athletes suffering from chronic overload who are in-season, “fixes” might be possible, and they might not. Nevertheless, these individuals hurt and they are asking for my help.
Is a purist, single-modality approach justified when the competition is upon us and there’s no time for rehabilitative exercise?Must we declare our allegiance to nothing-but-exercise when we have the opportunity to reduce or eliminate pain using approaches that have not been shown to cure a particular chronic overuse injury?
A Case to Introduce my Case
Example: Plantar fascitis. This weekend we have the Colorado State Track & Field Championships for High Schools. I saw a distance runner who will compete in three events. A simple test running outside my clinic revealed 5/10 pain immediately upon running. Both feet hurt, but one side is quite a bit more severe than the other. This problem has been brewing for several weeks, but I just yesterday saw this athlete for the first time. Examination confirmed plantar fascitis.
I did not launch this athlete into a barrage of passive therapies. I didn’t “adjust” her foot with an Activator, perform miracle manual mobilizations, or jelly up her soles with therapeutic ultrasound. But neither did I ignore the need of the moment. Using a tab-and-pull method adapted from techniques I learned from Tim Brown, DC (called specific proprioceptive response taping) I applied leukotape to lift the plantar fascia medially on both sides. Re-test running outside my clinic showed an immediate reduction of pain to 0/10 bilaterally.
Am I a miracle worker? Do I walk on water? Did I cure the plantar fascitis? No, no, and no. What did I do? I took away the pain. I solved the immediate problem. How long will this effect last? I don’t know. Was it placebo effect? I don’t know, but I suspect not. In 29 years of practice, I’ve seen this effect last for hours, sometimes days. What effect, specifically? Pain reduction or elimination during running with the tape applied a certain way. That’s all. A scientific study would undoubtedly show this technique to be non-curative. It would advise that I not consider this taping technique as a useful tool in the management or treatment of plantar fascitis. The Cochrane Collaboration would look upon my non-evidence-based practice with chagrin.
The Short-Term Goal
My hope is that when I tape this athlete just prior to competition on Thursday the effect will last long enough for the event to be completed pain-free. I make my case for the “short-term goal.”
Am I holding scientific process in contempt. Not at all! After the track meet and the season are over, let’s buckle down, look at load control, flexibility issues, strength, biomechanics issue, and anything relevant and literature-based, and let’s FIX it. But for now, I’m coloring outside the lines. I am shamefully using a “technique” to shamelessly achieve an expedient goal: comfort for competition.
Countless athletes appreciate immediate pain relief when preparing for an upcoming competition. While I will continue to learn as much as I can and adapt my practice to FIXES, I will not jettison the very wide and very helpful set of treatment procedures that I freely acknowledge to NOT be a cure. These procedures include needling, taping, poking, prodding, manual therapy, and even (hold your breath) passive modalities.
Placebo? Probably not, but if so, who cares? If the pain is gone, it is gone. A pain free athlete is a better competitor, period.
Caveats: I will not reinforce dependence upon my therapy. I will always educate toward a FIX for the problem.
I will continuously update procedures and methods to meet patients needs expeditiously and inexpensively.
I will proactively educate against any concept that equates chronic pain with tissue damage or fragility. (Assumption: that I have ruled out all pathologies that might be accompanied by real tissue damage.)
The reader will have to decide if the Short-Term Goal is worth addressing. Some will say that by doing these fun tricks with tape I’m simply prolonging the problem. I respectfully disagree. I am addressing an immediate need (effectively, I might add) with every intention of FIXING the problem once the season is over and load-control, mechanotherapy, and full exercise rehabilitation can be engaged.
In some sectors there is a lot of bashing going on about the uselessness of poking and prodding, taping, needling, etc. There are abuses, to be sure, including many within my own profession and among physical therapists/physios and technique peddlers worldwide, it seems. But the aims of most clinical trials for sports injury are clearly not focused on discovering or or reporting about immediate short-term pain relief to putatively enhance performance. Such trials are expensive enough and need to answer “larger” questions. Still, as a sports medicine specialist I’m faced with giving athletes any edge they can get so that they can be as competitive as possible.
Thanks for reading!