Transcript Protective Taping and Wrapping Chapter 4 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Protective Taping
and Wrapping
Chapter 4
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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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
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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
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Application of Tape (cont.)
• Tearing of tape
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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
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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
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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
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Great Toe Sprain (cont.)
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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
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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
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Alternative Arch Support (cont.)
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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
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Alternative Arch Support (cont.)
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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
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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
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Heel Contusion (cont.)
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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
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Open Basket Weave Ankle (cont.)
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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
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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
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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
• Angle back toward heel as it crosses bottom of foot
• Pull up on medial aspect of heel so it runs behind
medial malleolus and around heel to lateral malleolus
– Close with horizontal anchor strips
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Closed Basket Weave (cont.)
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Closed Basket Weave (cont.)
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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
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Modified Ankle Taping (cont.)
– Apply figure-of-eight with heel locks
– Close using successive circular strips around foot,
continuing proximal to distal
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Modified Ankle Taping (cont.)
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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
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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
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Achilles Tendon Strain (cont.)
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Achilles Tendon Strain (cont.)
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Achilles Tendon Strain (cont.)
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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
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Shin Splints (cont.)
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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
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Collateral Ligament – Knee (cont.)
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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
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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
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Rotary Knee Instability (cont.)
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Knee Hyperextension
• Purpose: allow knee flexion and extension, but limit
hyperextension
• Steps
– Patient standing with affected limb resting on a 1½2’’ 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
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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
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Knee Hyperextension (cont.)
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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
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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
• Lift the soft tissue over the medial femoral
condyle toward the patella to provide for a more
secure fixation
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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
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Patellofemoral: McConnell Technique
(cont.)
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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
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Quadriceps and Hamstrings Wrap (cont.)
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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
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Quadriceps and Hamstrings Wrap (cont.)
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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
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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
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Groin Strain (cont.)
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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
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Hip Contusion (cont.)
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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
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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
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Acromioclavicular Joint Sprain (cont.)
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Acromioclavicular Joint Sprain (cont.)
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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
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Shoulder Spica (cont.)
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Shoulder Spica (cont.)
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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
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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
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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
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Elbow Sprain (cont.)
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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
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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
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Wrist Sprain Technique 2 (cont.)
–
As tape moves through web space of the thumb and index
finger, it should be crimped to prevent irritation
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Wrist Sprain Technique 2 (cont.)
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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
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Thumb Sprain (cont.)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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”
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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.
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Kinesio Taping®
Erector Spinae Strain
• Pt. in flexion with rotation to the nonpainful 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.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins