Protective Taping and Wrapping Chapter 4

Uses of Tape and Wraps Provide immediate first aid Limit excessive joint movement Support an injured body part Provide compression Provide proprioceptive feedback Secure protective pads and dressings Allow early resumption of activity Reduce the chance of reinjury Prevent injury 2

Types of Tape and Wraps Elastic Secure protective pads and dressings Provide compression Give proprioceptive feedback Provide support Nonelastic Provide support to joints by restricting excessive motions 3

Application of Tape Preparation Position of Achilles tendon Position of patient Position of function General Overlap strips Snug, but avoid constriction Check circulation and temperature 4

Application of Tape (cont.) Tearing of tape

Removal of Tape Remove immediately after activity Tape cutters – lift up and away; follow natural contours manual – stabilize skin and pull tape in direction of natural hair growth Cleanse with deadhesive and wash Regular inspection of skin 6

Application of Wraps Position of maximum muscle contraction Move from distal to the injury site to proximal Wrap should be stretched from 1/2 to 1/3 of its total elastic capability prior to application Overlap: 1/2 of the previous strip 7

Great Toe Sprain Purpose: limit motion at the first MP joint Protect the nail with adhesive dressing Steps Anchor on great toe and midfoot Tape strip from distal to proximal anchor Apply additional strips until base of first metatarsal is covered Re-anchor

Great Toe Sprain (cont.)

Simple Arch Support Purpose: support arch and midfoot Steps Apply anchor; secure under the fifth metatarsal and apply slight tension in upward direction through the MLA Apply additional strips moving from distal to proximal aspect of the foot Use arch pad for additional support

Alternative Arch Support Purpose: additional support of the arch and plantar fascia Steps Apply anchor at distal metatarsal heads Begin at base of great toe, apply tape along medial aspect of foot, around heel, and angle across the arch to end at starting point Begin at base of fifth metatarsal, apply tape along lateral aspect of foot, around heel, and angle across the arch to end at starting point Repeat pattern until arches covered Close using simple arch

Alternative Arch Support (cont.)

Alternative Arch Support (cont.) Purpose: provide additional support to MLA Steps Apply distal anchor Apply tape from base of great toe along the medial foot around the heel, and angle across arch to starting point With next strip, follow same pattern, but from underneath the foot, angle tape toward the MLA proximal to previous strip Close using simple arch

Alternative Arch Support (cont.)

Metatarsal Arch Support Purpose: provide support for metatarsal arch Steps Place teardrop-shaped felt pad slightly proximal to head of second to fourth metatarsals Anchor with elastic tape

Heel Contusion Purpose: reinforce the calcaneus fat pad Steps Apply anchors behind and below the heel Use basket weave technique until the heel is covered Reapply anchors to close

Heel Contusion (cont.)

Open Basket Weave Ankle Purpose: control swelling and limit motion associated with ankle sprain Steps Apply proximal and distal anchors Apply a stirrup strip Apply a horseshoe strip Continue to alternate stirrups and horseshoes, leaving approximately ½” opening on anterior aspect of foot and lower leg Close plantar aspect of foot with semicircular strips of tape Re-anchor tape edges

Open Basket Weave Ankle (cont.)

Closed Basket Weave Ankle Purpose: provide external support to ankle ligaments and joint proprioception during activity Steps Area: clean, dry, hair free Place lubricated gauze pad to dorsum of ankle and Achilles tendon Position: subtalar neutral with ankle at 90° flexion Apply proximal and distal anchors Apply a stirrup strip Apply a horseshoe strip Continue to alternate stirrups and horseshoes

Closed Basket Weave (cont.) Apply figure-of-eight Start on lateral malleolus Cross over dorsum of foot to medial arch Follow under foot and up lateral aspect of foot Cross over top of foot to medial malleolus Continue behind lateral malleolus and back to start

Closed Basket Weave (cont.) Apply heel locks Start over dorsum of foot and move down medial arch Angle back toward heel as it crosses bottom of foot Pull up on lateral aspect of heel so it runs behind lateral malleolus and around heel to medial malleolus From medial malleolus, start over dorsum of foot and move down lateral side Pull up on medial aspect of heel so it runs behind medial malleolus and around heel to lateral malleolus Close with horizontal anchor strips

Closed Basket Weave (cont.)

Closed Basket Weave (cont.)

Modified Ankle Taping Purpose: provide only a moderate amount of support to ankle; commonly used as a preventive and postinjury taping Steps Area: clean, dry, hair free Position: subtalar neutral with ankle at 90° flexion Apply proximal and distal anchors Apply 3 stirrup strips

Modified Ankle Taping (cont.) Apply figure-of-eight with heel locks Close using successive circular strips around foot, continuing proximal to distal

Modified Ankle Taping (cont.)

Achilles Tendon Strain Purpose: limit excessive dorsiflexion to reduce tension placed on tendon Steps Patient prone; foot in slight plantarflexion Place lubricated pad over Achilles tendon Apply anchors using nonelastic tape—base of metatarsals and 4-6” above ankle

Achilles Tendon Strain (cont.) Apply 3-5 strips of nonelastic tape in an X pattern from distal to proximal anchor; forms a check rein Re-anchor the “X” distally and proximally with nonelastic tape Patient moves to seated position Apply a figure-of-eight and heel locks using nonelastic tape

Achilles Tendon Strain (cont.)

Achilles Tendon Strain (cont.)

Achilles Tendon Strain (cont.)

Shin Splints Purpose: provide some relief of anterior shin pain Steps Use heel lift to relax muscles Apply anchor distally above malleoli and proximally at tibial tuberosity Apply medial and lateral anchor strips distal to proximal, lifting up against gravity Apply in an alternating oblique direction, forming an X over anterior shin; work distal to proximal Apply medial and lateral anchors Apply distal and proximal anchors

Shin Splints (cont.)

Collateral Ligament – Knee Purpose: provide support and stability to collateral ligaments of knee Steps Patient standing with affected limb resting on a 1½-2’’ heel lift Using elastic tape, apply distal anchor 2-3” below level of tibial tuberosity; apply proximal anchor at midpoint of quadriceps Apply lateral and medial strips in an X fashion Reinforce with nonelastic tape Close with successive circular strips, moving from the distal anchor to proximal anchor

Collateral Ligament – Knee (cont.)

Rotary Knee Instability Purpose: provide support and stability to collateral ligaments of the knee Steps Patient standing with affected limb resting on a 1½-2’’ heel lift Using elastic tape, apply distal anchor 2-3” below level of tibial tuberosity; apply proximal anchor at midpoint of quadriceps Apply lubricated gauze pad in popliteal space Cut a piece of elastic tape in the middle at both ends; tear the strip to form an X; place the divided ends so they interlock around the patella

Rotary Knee Instability (cont.) Beginning at superior anchor, a piece of elastic tape is angled down behind the knee, through the popliteal space, ending on the inferior anchor In an opposite direction, a second piece of tape spirals down behind the knee, through the popliteal space, ending on inferior anchor Apply 3-4 spirals in each direction Close with circular strips of tape Additional support may be provided by using nonelastic tape to reinforce the spiral pattern

Rotary Knee Instability (cont.)

Knee Hyperextension Purpose: allow knee flexion and extension, but limit hyperextension Steps Patient standing with affected limb resting on a 1½- 2’’ heel lift Using elastic tape, apply distal anchor 2-3” below level of tibial tuberosity; apply proximal anchor at midpoint of quadriceps Apply lubricated gauze pad in popliteal space

Knee Hyperextension (cont.) From inferior anchor, apply tape strips in an X pattern in popliteal space Pattern should begin wide and become narrower as space is covered The last strip runs perpendicular to the anchors Apply 2-3 anchors on lower leg and 4-5 anchors on thigh, each overlapping ½ of previous strip

Knee Hyperextension (cont.)

Patellofemoral: McConnell Technique Purpose Treat patellofemoral pain by correcting patella alignment Provide a sustained stretch of tight lateral structures and improve lower limb mechanics Steps Patient positioned with knee in full extension Using Fixomull tape, apply base strips Place strips on lateral condyle and extend across anterior aspect of knee to medial femoral condyle LeukoSport tape is used for the remainder of the taping

Patellofemoral: McConnell Technique (cont.) Lateral glide correction Tape begins on the lateral border of patella and is pulled medially Lift the soft tissue over the medial femoral condyle toward the patella to provide for a more secure fixation Lateral tilt correction Tape begins on the middle of patella and is pulled medially to lift the lateral border

Patellofemoral: McConnell Technique (cont.) External rotation correction Tape begins on the middle of the inferior border of patella Rotating the inferior pole internally and superior pole externally, the tape is pulled upward and medially Anterior-posterior correction Tape begins on the superior half of the patella Tape is attached equally on both sides, lifting the inferior pole

Patellofemoral: McConnell Technique (cont.)

Quadriceps and Hamstrings Wrap Purpose: provide compression and/or support for muscle group Steps (quadriceps muscles) Patient standing with affected limb resting on a 2’’ heel lift; thigh in neutral position Place elastic wrap on anterior midthigh distal to painful site Apply wrap in an upward and lateral direction, encircling the thigh Apply elastic for additional support Steps – distal hamstring strain Same as quadriceps wrap except wrap is directed in an upward and lateral manner, encircling the thigh

Quadriceps and Hamstrings Wrap (cont.)

Quadriceps and Hamstrings Wrap (cont.) Steps – proximal hamstring strain Place wrap on posteromedial thigh Encircle thigh several times, pulling from a medial to lateral direction Pull wrap up across greater trochanter, continue around lower abdomen to opposite iliac crest over waist and gluteals, and then cross greater trochanter, ending back on anterior thigh Encircle thigh in a medial to lateral direction Repeat the pattern Reinforce with elastic tape

Quadriceps and Hamstrings Wrap (cont.)

Quadriceps Contusion Purpose: provide compression or protection Steps – compression: Place ½” felt pad over injured site Begin at a point distal to injury, apply elastic wrap in an upward and lateral direction encircling the thigh Steps – protection: Use a foam pad Following application of the elastic wrap, cover with elastic tape

Groin Strain Purpose: prevent stress on hip adductors Steps Patient standing with affected limb resting on a 2’’ heel lift; hip internally rotated Place wrap on lateral thigh and encircle thigh in medial direction Continue wrap around thigh, over greater trochanter, across lower abdomen, cover iliac crest, around the waist and gluteals, cross greater trochanter, and end back on thigh Reinforce with elastic tape

Groin Strain (cont.)

Hip Contusion Purpose: provide protection and support to contused iliac crest Steps Place protective pad over iliac crest Apply elastic wrap in spica pattern; start at distal anterior thigh, move over top of pad, around waist, diagonally down toward lateral thigh, and behind thigh to starting point Repeat pattern and reinforce with elastic tape

Hip Contusion (cont.)

Acromioclavicular Joint Sprain Purpose: provide support to AC joint Steps Patient positioned with arm relaxed and supported at elbow Protect nipple with lubricated gauze Use elastic tape Place first anchor at midbiceps Place second anchor just below spine of the scapula, that runs over shoulder through the midclavicular line, and end under nipple Place third anchor just under the nipple that runs horizontally around the trunk, connecting the two ends of the second anchor

Acromioclavicular Joint Sprain (cont.) Place tape strip on biceps anchor and pull up and over acromion process, ending on the midclavicular anchor Place a second strip on the biceps anchor and pull up and over the acromion process to anchor on the posterior back; two strips form an X over acromion process Apply a midclavicular strip, followed by another horizontal anchor Anchors should overlap at least ½ of previous strip Repeat pattern until the acromion process is covered Xs over acromion process Midclavicular anchor Horizontal anchor: the horizontal anchors should stop just below the axilla and should not impede arm motion Reinforce with elastic bandage wrapped as a shoulder spica

Acromioclavicular Joint Sprain (cont.)

Acromioclavicular Joint Sprain (cont.)

Shoulder Spica Purpose: provide support and stabilization for glenohumeral joint Steps Patient holds injured arm in internal rotation Encircle arm in a posterior to anterior direction at the midbiceps Cross anterior chest in region of pectoralis major Bring the wrap under the opposite axilla, across the back, and over the acromion process in an anterior direction Continue wrap through the axilla, around the arm, and again across the anterior chest Secure the wrap with nonelastic tape

Shoulder Spica (cont.)

Shoulder Spica (cont.)

Elbow Hyperextension Purpose: restrict painful motion, while permitting functional movement Steps Instruct patient to clench fist and hold elbow in slight flexion with the palm facing up Determine the degree of flexion; extend elbow to point of discomfort and then slightly flex from that point Using either nonelastic or elastic tape, apply anchors to midregion of forearm and upper arm Tear 2 strips of tape the same length as the distance between the anchors Construct a check rein by placing the 2 tape strips back to back, and then add 5-6 additional pieces of tape over the template in an X fan shape

Elbow Hyperextension (cont.) Attach checkrein to anchors by applying 3-4 additional anchors Secure the taping with an elastic wrap in a figure-of-eight design

Elbow Sprain Purpose: provide support for the elbow collateral ligaments Steps Patient’s arm: slight flexion Apply anchors to midregion of forearm and upper arm Place 3-4 strips of nonelastic tape over ligament in X pattern Secure above and below the joint with elastic tape Cubital fossa should remain open

Elbow Sprain (cont.)

Wrist Sprain Technique 1 Purpose: provide support and stability for the wrist Steps Apply 3-4 circular strips of tape to the wrist Strips should be positioned from distal to proximal and overlap the previous strip by ½

Wrist Sprain Technique 2 Purpose: limit painful wrist motion Steps Patient spreads fingers; wrist positioned in slight flexion or extension, depending on injury Place anchor strips around wrist and metacarpal heads Limit hyperextension: place 3-4 tape strips in an X pattern over palmar aspect of hand Limit hyperflexion: place X pattern over dorsum of hand Using either elastic or nonelastic tape, apply a figure-of-eight pattern to the wrist and hand Begin on radial aspect of proximal anchor Across dorsum of hand around metacarpal heads Across the palm of the hand End on the ulnar side of the proximal anchor

Wrist Sprain Technique 2 (cont.) As tape moves through web space of the thumb and index finger, it should be crimped to prevent irritation

Wrist Sprain Technique 2 (cont.)

Thumb Sprain Purpose: provide support and limit extension of first MP joint Steps Position thumb in slight flexion and adduction Place anchor on wrist Apply tape on ulnar aspect of proximal anchor and continue upward over palmar aspect of thenar eminence, cross over MP joint, and encircle thumb Re-anchor strip on the dorsal aspect of the anchor; this line of pull makes an X pattern Apply 3-4 Xs Apply anchor to finish

Thumb Sprain (cont.)

Finger – IP Sprain Technique 1 Purpose: provide support for an unstable IP joint Steps Apply narrow tape strips around proximal and distal phalanx of 2 fingers Leave joints uncovered to permit limited flexion and extension of the fingers

Finger – IP Sprain Technique 2 Purpose: provide support for unstable IP joint Steps Place anchors proximal and distal to injured joint Working from distal to proximal, apply 2 narrow tape strips in X pattern over collateral ligaments Apply a longitudinal strip to connect the 2 anchors Figure-of-eight may also be applied

Kinesio Taping® Uses: support muscles by improving the quality of muscle contractions in weakened muscles reduce muscle fatigue reduce cramping and potential injury to muscle tissue increase range of motion and relieve pain Theory to create convolutions in the skin to increase the interstitial space

Kinesio Taping® Design permits longitudinal stretch of resting length Tape polymer elastic strand wrapped by 100% cotton fibers to permit evaporation of body moisture latex free, nonmedicated, quick drying approximately the same weight and thickness of skin easy to apply, non-invasive, comfortable to wear can provide continued treatment for up to 3-5 days

Kinesio Taping® Application One end of a muscle to the other Strips shape of “Y”, “I”, “X”, “Fan”, “Web”, &“Donut” – dependent on muscle size and desired effect muscle on gentle stretch; tape applied at 10% of its resting static length Use Chronic weak muscle- tape stretched from origin to insertion to facilitate muscle function Acute injury - tape is stretched from the insertion to the origin to inhibit muscle function

Kinesio Taping® Application Use Chronic weak muscle- tape stretched from origin to insertion to facilitate muscle function Acute injury - tape is stretched from the insertion to the origin to inhibit muscle function General preparation

Kinesio Taping® MTSS Apply light tension as strip passes over MLA toward origin of tibialis anterior; one strip on either side of the muscle belly Apply additional Y strip

Kinesio Taping® Medial Tibial Stress Syn. Place base of 3” Kinesio tape on medial tibia shaft -- no tension; inferior to painful site. Secure base with one hand, apply light to moderate tension to tape as you pull the skin away from medial tibial border laying down strip in an inferior direction. When tension reaches the part of the tape where the Y’s begin, ask the patient to dorsiflex the ankle. Apply the tails of the Y with no tension in a splayed pattern

Kinesio Taping® Quadriceps Strain Pt. supine, apply an I strip 2”Kinesio tape superior to ASIS with no tension. Have pt. move into hip ext. Apply light tension until strip reaches involved area. Apply light to moderate tension over painful site. Beyond painful site, reduce tension to light. Secure the final 2-3” no tension Initiate glue activation of tape prior to further patient movement

Kinesio Taping® Patellar Tendinopathy Pt. supine and the knee extended, the Kinesio tape is measured & cut equal to distance between medial & lateral femoral condyles Move pt. to long-sitting position with hip flexed at 45° Tear backing off the tape in the middle 1/3; place this section of tape directly over inferior pole of patella Apply moderate tension with downward pressure over inferior pole Have pt. then flex knee to 90°; Kinesio tape is positioned around patella in direction of vastus lateralis & medialis with light tension

Kinesio Taping® Rotator Cuff Impingement Place base of Kinseo Y strip 2”inferior to greater tuberosity with no tension. Have pt. adduct shoulder with hand behind back and flex neck laterally to opposite side. Apply light tension to Y strip; superior tail moves superior to spine of scapula, between upper & middle trapezius and ends on superior med. border of scapula Inferior tail moves along spine of scapula with final 1-2” with no tension. Initiate glue activation prior to any patient movement.

Kinesio Taping® Rotator Cuff Impingement Apply a 2nd Y strip over deltoid Place base of Kinesio Y strip 2” inferior to deltoid tuberosity with no tension. Apply both anterior and posterior tails with light tension. With the pt’s arm abd. 90o, ext. rotated, & in horiz ext., apply anterior tail around the outer border of the ant. deltoid to approx. AC jt with no tension on final 2”. With the arm remaining in abd., move the arm into horiz. flex. with int. rot.; Apply posterior tail along the outer border of posterior deltoid to approx. AC joint with no tension on final 2”

Kinesio Taping® Rotator Cuff Impingement Place base of 6-8” Y strip on ant. shoulder over cor. proc. with no tension Hold base with one hand, apply moderate to severe tension to tails applying inward pressure over area of pain with approx. ½ of Y strip length. When ½ of Y strip length is reached, slide hand securing the base up to the point of end tension on tape. Have pt. move into shoulder flex. with horiz. flex. and apply remaining tails in splayed pattern to dissipate the created force with no tension. Initiate activation prior to any further movement by the patient.

Kinesio Taping® Erector Spinae Strain Pt. in flexion with rotation to the non- painful side. Apply 2 I strips of Kinesio tape with very light to moderate tension Measure the 3rd strip to extend approximately 2”on either side of the previously applied strips. After removing about 2” of the backing from one end of I strip, apply light to moderate tension to secure the base and extend over the region of pain. Do not add any inward tension.

Kinesio Taping® Erector Spinae Strain Slide hand holding base towards the middle of back and hold no tension over the region of the transverse and spinous process. Have pt. move into rotation to assist with minimizing tension on the ends. While continuing to apply no pressure over the spinal column, use the other hand to apply another zone of light to moderate tension on ipsilateral side. Secure the base with no tension. Initiate glue activation prior to any patient movement.