Taping 2

Overview of Taping and Strapping in Physiotherapy
Taping Purposes

  • Pain Reduction: Taping can help alleviate pain in injured areas by providing physical support, offloading stressed tissues, and stimulating mechanoreceptors, which can interfere with pain signals (gate control theory), thus providing symptomatic relief.

  • Increase Passive Stability: Improves the stability of anatomical structures by physically restricting excessive or undesirable movement, thereby supporting ligaments and joints without requiring active muscle engagement.

  • Reduce Strain: Protects and reduces the strain on injured or vulnerable soft tissues (e.g., muscles, tendons, ligaments) to prevent further damage during activity or movement.

  • Prevention of Injury or Re-injury: Acts as a prophylactic measure against potential injuries, particularly in sports, or helps protect healing tissues from premature stress during the rehabilitation phase.

  • Biomechanical Effect: Addresses biomechanical performance and alignment by subtly correcting positional faults or supporting optimal joint congruence. Examples include correcting patellar tracking or supporting an arch of the foot.

  • Muscle Inhibition and Facilitation: Can selectively inhibit overactive muscles or facilitate underactive muscles, depending on the direction and tension of application, influencing muscle firing patterns and motor control.

  • Enhancement of Proprioception: Improves the body's awareness of its position and movement in space through increased sensory input from the skin and underlying tissues, contributing to better motor control and joint stability.

  • Compression: Useful for managing acute conditions like oedema (swelling) and promoting lymphatic drainage by creating a pressure gradient that encourages fluid movement away from the affected area.

Principles of Tape Application

Basic Philosophy

  • Tape Application Under Tension: The tape is applied while the target tissue (muscle, ligament, joint) is positioned in a specific, often shortened or optimally aligned, position. Tension is crucial for creating the desired mechanical pull or lift.

    • Push Method: The clinician uses one hand to push the tape towards the target area while simultaneously using the other hand to pull (or place) the soft tissues towards the tape. This method emphasizes tissue positioning relative to a fixed tape strip.

    • Pull Method: Conversely, the clinician pulls the tape with tension towards the target anatomical region while using the other hand to push or stabilize soft tissues toward the tape. This method focuses on applying tape tension to a pre-positioned tissue.

Taping Indications

  • Mechanical Effects: Taping can directly influence joint mechanics and alignment.

    • Examples of mechanical effects include:

    • Medial glide and tilt of the patella: Achieved via the use of McConnell tape, commonly for patellofemoral pain syndrome, to correct abnormal patellar tracking and reduce compressive forces.

    • Augmented low-dye tape: Can effectively reposition the calcaneus (heel bone) into inversion and lift the navicular bone, providing support for an excessively pronated foot (flat feet), as demonstrated by Vicenzino et al. (2000).

Additional Taping Effects

Neuromuscular Effects

  • Inhibition or Facilitation of Muscle Activity: Taping provides sensory input to the skin, which can reflexively influence the excitability of motor neurons. This can either promote (facilitate) muscle contraction or reduce (inhibit) muscle tone and activity, depending on the application direction and tension.

  • Alter Timing of Muscle Activation: Through enhanced proprioceptive feedback, taping can help synchronize muscle firing patterns, leading to more efficient and coordinated movement, which is critical in dynamic tasks and injury prevention.

  • Increased Joint Position Sense: The constant tactile input from the tape stimulates cutaneous mechanoreceptors, sending afferent signals to the central nervous system, thereby enhancing the brain's understanding of joint positioning and movement (kinesthesia). This is vital in injury prevention and rehabilitation.

Psychological Effects

  • Increased Confidence and Comfort: The perceived support and protection from the tape can significantly bolster a patient's confidence in their ability to carry out rehabilitation exercises, engage in daily activities, or return to play, often contributing to a placebo effect that aids recovery.

Fluid Movement Theory

  • Applying elastic tape (e.g., Kinesio tape) is theorized to induce a lifting effect on the skin, creating convolutions that decompress subcutaneous layers beneath the tape. This decompression increases the interstitial space, potentially facilitating lymphatic drainage and blood flow, thereby aiding in the reduction of oedema and bruising.

Research Evidence on Taping

Research on taping efficacy is varied, with some studies showing positive outcomes and others reporting no significant effect, highlighting the complex nature of its mechanisms.

  • Barton et al. (2014): Reviewed the efficacy of McConnell taping for patellofemoral pain, resulting in immediate pain reduction, promotion of earlier onset of Vastus Medialis Oblique (VMO) activation (though this finding is debated), and enhanced responses to exercise compared with exercise alone.

  • Kaminski et al. (2019): Meta-analyses and systematic reviews have demonstrated that prophylactic rigid ankle taping or bracing can significantly reduce the risk of ankle sprain incidence and recurrence, particularly in athletic populations.

  • Cowan et al. (2006): Found that general knee taping did not significantly alter electromyographic (EMG) activity of quadriceps or hamstring muscles during stepping tasks in individuals with patellofemoral pain, suggesting limited direct impact on muscle activation patterns in this context.

  • Callaghan et al. (2008): Reported no significant improvement in active or passive joint position sense tests among 32 individuals with knee pain after application of knee taping, suggesting that proprioceptive enhancement might not always be consistently achieved or detectable via these specific tests.

Taping Goals

  • Use of Tape: May aid in various contexts including:

    • Managing acute injuries by providing support and compression.

    • Preventive strategies against injuries during high-risk activities.

    • Rehabilitation efforts post-injury to facilitate movement or protect healing structures.

    • Providing pain relief for chronic or acute musculoskeletal conditions.

    • Any combination of the aforementioned, depending on the clinical presentation and specific patient goals.

  • Contraindications for Taping: Certain conditions preclude the safe application of tape.

    • Known allergies or hypersensitivity to materials used in the tape (e.g., adhesive, latex).

    • Presence of active infection, open wounds, skin lesions, severe abrasions, or fragile skin in the area to be taped.

    • Circulatory compromise or deep vein thrombosis (DVT), where compression could be detrimental.

    • Undiagnosed pain or fractures that require medical imaging or intervention.

    • Importance of assessing the patient for general band-aid allergies or sensitive skin to identify potential adverse reactions.

Application of Tape

Preparation Steps

  • Skin Preparation: Thoroughly clean the skin to remove dirt, oils, sweat, and water using alcohol wipes or soap and water, ensuring it is completely dry. Remove excessive hair if possible to optimize adhesion and minimize discomfort during removal. Cover any open wounds, blisters, or abrasions with appropriate dressings to prevent irritation or infection.

  • Optimizing Position: Ensure both the patient and clinician are positioned adequately and comfortably for effective application. The patient's limb or body part should be placed in the desired therapeutic position (e.g., neutral, slight flexion/extension) before tape application. Utilize bony landmarks and anatomical structures for achieving the correct anchoring and direction of tape pulls.

  • Meeting Aesthetic and Sport-Specific Requirements: Consider the patient's comfort and the demands of their activity. Tailor taping to fit specific sports needs (e.g., avoiding bulk that interferes with equipment) and address aesthetic preferences (if relevant) to enhance patient compliance.

  • Tape Selection and Cutting: Choose the appropriate type of tape (e.g., rigid, elastic, cohesive bandage) based on the treatment goal. Pre-cut tape strips to the required lengths and shapes, rounding corners to prevent peeling.

Warnings and Best Practices

  • Allergic Reactions: Always inquire about known allergies to tape, latex, or adhesives before application. If unsure or if the patient has sensitive skin, conduct a small skin patch test with a piece of the tape for a few hours. Monitor for signs of allergic reactions such as severe itching, redness, rash, or blistering.

  • Monitoring for Discomfort: Instruct the patient to immediately remove the tape if they experience excessive itchiness, persistent redness, numbness, tingling, increased pain, or any discomfort underneath it. These could indicate poor circulation, skin irritation, or an allergic reaction.

  • Duration of Tape Application: Generally, rigid tape should not exceed 1-2 days, and elastic therapeutic tape 2-3 days, to prevent skin maceration, irritation, or other skin-related issues. Prolonged application can increase the risk of adverse skin reactions.

  • Removal Techniques: Avoid ripping the tape off quickly to prevent skin trauma, tearing, or bleeding. Instead, cut the tape to break tension and peel it back slowly and carefully, pulling the skin away from the tape or pushing the tape away from the skin. Utilize underwraps (e.g., Hypafix) to ease discomfort during removal, and consider using warm water, vegetable oil, or specialized tape removal sprays or wipes to aid the process and dissolve adhesive. Ensure proper post-removal cleaning and moisturizing of the skin.

Individualization of Taping Techniques

  • No single “correct” or universal method for taping exists for every condition or individual. Effective taping is an art that combines scientific principles with clinical experience.

  • Multiple options are available, so tailor the technique based on a thorough assessment of the patient's specific impairments, desired functional outcomes, the type of tape being used, and the patient’s response to the application. Continuous reassessment of efficacy and patient comfort is crucial.

Example Cases for Taping Application

Case Studies

  • Jannali (Acute Ankle Sprain): Impairments include significant swelling, pain with weight-bearing, limited range of motion (ROM), and instability (ligamentous laxity). Taping could provide compression to reduce swelling, stability to protect injured ligaments, pain reduction by offloading, and proprioceptive feedback to improve balance, making it critical in the RICE (Rest, Ice, Compression, Elevation) protocol and early rehabilitation.

  • Andy (Post-Cast Removal Following Distal Radius Fracture): Impairments include wrist stiffness, muscle atrophy, reduced grip strength, and impaired proprioception. Taping could be appropriate to provide gentle support to the wrist during exercises, improve proprioceptive awareness to enhance motor control, or facilitate specific muscle groups (e.g., extensors) to regain function, aiding the transition from immobilization to active movement.

  • Kalina (Rotator Cuff Tear): Impairments include shoulder pain with movement, limited ROM, muscle weakness, and potential scapular dyskinesis. Taping might be used to reduce pain by supporting the shoulder joint, facilitate rotator cuff muscle activity or inhibit overactive antagonist muscles, or provide postural correction by supporting optimal scapular position to improve shoulder mechanics during rehabilitation exercises.