Athletic Taping, Padding, and Bracing Core Concepts in Athletic Training and Therapy Susan Kay Hillman

Objectives Identify the types of tape commonly used in athletic taping. Explain the “check reign” used in athletic taping and identify different styles or shapes. Describe the five different taping techniques (spiral, figure 8, teardrop, herringbone, and horseshoe) and give an application of each. Identify the points to consider when developing preventive and protective pads. Identify six basic products used in the construction of pads and braces for injury protection or prevention. Explain why a fiberglass cast on a football lineman’s wrist should be padded for practice and games, regardless of rules. Identify the three categories of knee braces and when each might be used.

Introduction Athletic Taping and Bandaging is one of the more psychomotor skills of the A.T. Prevent injury Facilitate injured persons return to physical activity Support ligaments and capsule of unstable joints limit excessive or abnormal motion Enhance proprioceptive feedback from the injured limb or joint Requires a great deal of practice

Anatomy and Injury Mechanism as the Foundation for Taping and Bracing Necessary to have understanding of anatomy and mechanism of injuries Important to understand link between anatomical structure, mechanism of injury, and purpose for which the tape is being applied Human anatomy is the foundation for everything you learn about athletic training

Materials for Taping and Wrapping Elastic tape, non elastic tape, elastic wraps, commercially manufactured braces Non elastic Standard white tape: porous, different sizes Optimal support to joints and strategically restrict abnormal/excessive motion Elastic tapes/wraps Support for body parts that require more ROM Apply compression to acute injury to minimize swelling Braces Prevent injury Support unstable joints Reduce cost of athletic tape

Prerequisites to Taping and Bracing Thorough injury evaluation Nature and mechanism of injury Associated with appropriate rehabilitation program Criteria of full return to activity has been met Optimal ROM, strength, progression of functional activity, psychological readiness Safety of athlete is #1 concern

Preparing for Taping Ergonomic taping area Proper illumination, ventilation and free from excessive heat and humidity Area should be coeducational Patient should be willing participant Area to be taped should be clean and shaven for optimal support Prewrap may be applied Tape adherent and friction pads over bony prominences or muscle tendons

Applying Tape Creativity with taping techniques and supplies is valuable skill for A.T. Various Application Techniques Spiral: Used when padding, compression or general support of joints or soft tissue is the objective Overlapping circles, usually by 1/d tape/wrap width Distal to Proximal Promote venous return and function Commonly used for thigh (hamstring, quad), groin, hip, wrist and lower leg

Spiral Taping/wrapping

Proximal and distal anchors with stack technique to limit dorsiflexion Applying Tape Check Reigns: Using strips of tape that cross a joint to limit normal or excessive movement Anchor strips applied proximally and distally are anchor points for various check reigns Stacks Strips of tape placed directly on top of each other to add strength to application Proximal and distal anchors with stack technique to limit dorsiflexion

Applying tape: Check Reign Techniques Fan Similar to stacking method, but one end is wider than the other Allows for taping over a joint where proximal aspect is larger than distal or vice versa Greater contact area=greater control of motion and support The “X” Crisscross method to provide more control/support in one area and more movement in another

Applying tape: Check Reign Techniques The “Y” Type of stack check reign that is cut at 1 end and split to facilitate attachment to anchor Split end can be cut long enough to be placed in circular fashion The “Double Y” Like “Y” but split at both ends Different from X because center is ore elongated and covers larger area Often used for elbow hyperextension and Achilles pathologies

THE DOUBLE “Y”

Applying Tape Figure 8 Foundational technique applied in numerous situations to benefit multiple joints Limit motion or provide support to joint Circular and angular patterns crossing over itself while forming an “8” proximally and distally Tape tension, joint placement, and type of tape are key factors

Applying Tape Teardrop Strip of tape originates and ends in same spot to form an oval or “teardrop”

Applying Tape Herringbone Overlapping strips that cross over each other in alternating and opposite directions Sequential support from overlapping strips Compression and support due to directional pull applied

Applying Tape Horseshoe (Stirrup) Used during taping of ankle, heel and shoulder Used when circumferential tape application is not possible Direction of pull, amount of tension, % of overlap, and type of tape all affect the benefit of this technique

Padding Valuable in preventing or lessening severity of injuries from sporting competition Many different types of pads and protective equipment have been developed Different material Moldable plastic Foam Felt Commercially manufactured padding

Pad Fabrication Considerations a. Density Weight of product compared to its size Higher density offer greater protection and more resistant to deformation b. Strength Maximal external stress or load material can withstand Compression sleeve vs. ankle brace. c. Rigidity Amount of bending or compression that occurs in response to amount of applied stress Fiberglass splint more stiff and has less elasticity Aluminum splint less stiff and lower elasticity d. Conformability Ease in which material forms to the body

Pad Fabrication Considerations e. Self-Adherence Strength in which material bonds to itself Integrity and durability of the splint f. Durability Ability to withstand repeated stress More durable=last longer g. Ease of Fabrication Time, equipment and skill needed to shape material for support and comfort h. Availability and Cost

Type of density Custom vs. prefabricated High modulus of elasticity vs. low modulus Boil and bite designed for custom fit

Pad Construction Materials Closed Cell Foam Higher density Regains original shape quickly after deformation Provides better protection fro higher levels o impact Stiffer foam, less comfortable Can have adhesive backing for ease of application Open Cell Foam Lower density Slowly regains shape after deformation Better protection for low levels of impact More comfortable Can have adhesive backing for ease of application

Pad Construction Materials Thermomoldable foam Closed or open cell that can be heated and molded to body part Improves conformability Great padding for cast and braces Felt Varying thickness Used in conjunction with foam or other padding Can have adhesive backing

Pad Construction material Gel Made entirely or partially with silicone or sorbothane Effective in dispersing different levels of impact Comfortable and increased ability to conform to body part Can create adherence problems, must secure well

Pad Construction Material Heat and Moldable Plastics Activated by heat or water Hard covering for foam or felt Increased absorption of high level of impact Elevated strength levels Can also be used for immobilization or ROM restriction A.T. may vary how padding is used Doughnut or bubble techniques

Role of Bracing Prevent injury or support unstable joints Ankle Braces Knee Braces Preventative, rehabilitative, and functional braces Shoulder Braces Support unstable glenohumeral joints Elbow Braces Wrist Braces