Chapter 2 Taping Objectives
The rationale for taping is to provide protection and support for an injured part while permitting optimal functional movement. An essential rehabilitation tool, taping enhances healing by allowing early activity within carefully controlled ranges that can facilitate a faster recovery from injury.1-7 Taping also permits an earlier return to activity, play or competition by protecting the area from further injury or exacerbation of the existing injury and avoiding compensatory injuries elsewhere such as delayed hip muscle activation, as can happen with severe ankle injuries.8 Taping also reduces pain (for a full explanation, see the Epilogue).
TAPE VERSUS BRACE
There is ample evidence to suggest that in many cases the use of a brace is as good as and in some cases more efficient than tape at supporting and promoting the repair of damaged tissues.9-23 However, certain types of braces are inappropriate (usually those with metal, hard plastic or carbon fibre), especially in contact sports. Tape is usually the support of choice, especially when the athlete can return to activity, training and competition with the assistance of the support that tape can offer.
We have to ask the question: if an athlete needs significant support in order to train or compete, should they be doing it? The answer of course is NO! Likewise, if after taping the individual still experiences pain with activity, they should STOP! The tape should be removed and the injury should be reevaluated.
PURPOSES AND BENEFITS
The purposes and benefits of correctly applied tape jobs are delineated as follows.
HOW LONG CAN YOU LEAVE TAPE ON FOR?
Sports tape is designed to stay on for the duration of the sport and then it should be removed. Care must be taken when taping, especially when encircling an area of the body as the blood and nerve supplies can be compromised (see below). Always get feedback from the individual, check for signs of a compromised blood supply and ask appropriate questions for a compromised nerve supply. When support is needed for longer periods, one should select the appropriate materials and techniques and warn the individual of what to be aware of and to remove the tape and seek advice if they are unsure.
Taping can only be truly beneficial if the injury is properly assessed and diagnosed and the appropriate taping technique is utilized. An inappropriate taping technique can place strain on associated regions, cause blisters or irritation and, in some cases, increase the severity of the injury and cause further damage to surrounding structures.
In order to apply the tape safely and effectively, it is essential that the taper appreciate both the aims of taping and situations to avoid. In this chapter, these criteria are outlined.
PRETAPING CONSIDERATIONS
Always explain the reasons for taping to the patient so that they are fully informed of why you are recommending tape and they can give their consent to be taped. Always enquire if they have experienced allergic reactions to tape. A simple question is usually sufficient, such as ‘Is your skin irritated by wearing a Band-Aid?’. If in doubt, you may apply a small test patch of tape to the skin as a method of assessment. If the patient does have known allergic reactions or develops one, try underwrap or hypoallergenic tapes or skin balms. Should the patient feel any irritation from the tape at any time, it should be removed immediately and the skin washed and cleaned.
By using the mnemonic S.U.P.P.O.R.T. to review the goals of effective taping, the taper can quickly run through a critical checklist before choosing the best technique and materials for that particular injury.
NOTE:Taping alone is not a definitive treatment: for your convenience, charts have been included in Chapter Four (Basic Pathology) and Chapters Six to Nine (Techniques) to help put the taping in perspective relative to the entire treatment plan.
S SWELLING must be controlled by adequate padding and/or compression to prevent irritating exudates and other fluids from accumulating (oedema) and to ensure the best environment for tissue regeneration and repair.
U UNDUE STRESS to the injured region must be prevented so as to reduce the possibility of additional injury or of increasing the severity of the injury.
P PROTECTION of the area from further soft tissue damage (i.e. bruises, blisters, tape cuts) by using pads, lubricants and other protective materials.
P PAIN and discomfort must be minimized by supporting the injured part, by controlling unnecessary or excessive movement, and by taking care not to cause further irritation to the injured tissues.
O OPTIMAL healing and tissue repair can be enhanced through correctly applying tape, keeping the range of motion within safe limits and maintaining continuous compression.
R REHABILITATION of the tissues to a fully functional state (joint mobility, soft tissue flexibility, muscle strength, ligament stability, neuromotor control and proprioception) must be considered when choosing the right taping technique adaptation for the appropriate stage of rehabilitation (subacute, functional, return to sport).
T THERAPEUTIC CARE in the early stages of treatment is critical for a rapid recovery. Treatment may include the application of electrical modalities (ultrasound, laser, interferential electrotherapy, muscle stimulation, etc.), manual treatment and exercise therapy to control pain and swelling and to promote rapid healing.
POSTTAPING CONSIDERATIONS
In addition to being aware of the purposes of a particular taping application, there are conditions or situations to observe or to avoid after the taping is completed. The mnemonic
P. R. E. C. A. U. T. I. O. N. will help you recall several important points after taping.
P PREMATURE participation in an activity which involves the injured part must be avoided. A major mistake many patients, especially athletes, make is returning to action too soon. This can delay healing and often results in reinjury to the weakened structures as well as increasing the chance of further complications to the compensatory areas.
R RANGE OF MOTION should be restricted but maintained as close as possible to normal for the body part involved. Severe limitation of motion can result in an overextension of surrounding or compensatory structures, prolong repair and recovery and lead to tissue changes in and around the joint injured.24-27 Permitting too free a range of motion will not adequately protect the tissues involved and can leave them prone to further injury.
E EXPERT opinion must be obtained when any serious injury, particularly a fracture, dislocation or tissue rupture, is suspected. Also, a paying agency or government regulation may require a physician’s assessment prior to treatment.
C CIRCULATION in the injured area must be monitored for any sign of constriction. Pressure bandages must be checked regularly.
A ALLERGIES AND SKIN IRRITATIONS present a very real problem, one that is frustrating for both the patient and the taper. The more serious degree of allergic reaction results in localized blistering, welts, pustules, rashes and pain. Simple irritation is generally a less severe reaction of reddened skin or small blisters.
U UNDUE DEPENDENCY ON TAPING is a psychological danger which may arise when patients, especially athletes, think that they cannot perform without taping. In such cases the injured area may not return to its preinjury performance level. Associated with prolonged immobility, this situation may lead to the patient spending unnecessary time having manual therapy to overcome the results of excessive or prolonged taping.
T TENDONS, MUSCLES AND BODY PROMINENCES must be treated with special care and attention so as to avoid pressure build-up and friction.
I ICE should not be applied to an injured part that is to be immediately subjected to taping. The temporary reduction of tissue volume due to icing will result in a taping that will tighten progressively as the body part warms up. Also, patients may have reduced skin sensation after icing, and tissue injury can result from such sensory loss.
O ONLY top-quality supplies should be used in order to ensure a consistently high standard of tape application.
N NERVE conduction and local sensation may be affected by secondary inflammation or by the taping job itself. It is essential to evaluate the level of sensation prior to taping so that factors altering sensation can be assessed properly.
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