Chapter 4 Basic Pathology

The majority of injuries incurred during participation in sports activities are sprains, strains and contusions involving the musculo-skeletal system. The taping techniques demonstrated in this guide are particularly helpful for these conditions. Although some form of splinting and protection is also necessary for fractures, dislocations, nerve injuries, lacerations, abrasions and blisters, these conditions are beyond the intended scope of this guide.

In order to choose the appropriate tape and technique, you should first have a working knowledge of the repair process as it applies to the soft tissues. There are three recognized phases of healing.

1. The acute phase. This is the phase immediately following an injury which consists of an inflammatory process, to a greater or lesser degree, depending on the extent of the injury. During this phase, which lasts between 3 and 7 days,^1,² taping is aimed at compressing the injury site. This means that a stretch tape such as a cohesive bandage would be the tape of choice, or a Tubigrip. These will compress the site while allowing movement when the tissues swell. Care should be taken not to apply the bandage or Tubigrip too tightly and the patient should be advised to remove any bandaging that is too tight and seek immediate advice.

2. The proliferative phase, so called due to the proliferation of cells during this phase. This is also known as the regeneration or matrix phase, as this is when a loose matrix is laid down to effect a temporary repair to the tissues. This is the phase when tape is applied so that the tissues can be stressed without causing further damage. So we would opt for a stronger taping technique during this phase. The loose matrix is easily damaged but the tissues need to be stressed in order for them to form a strong matrix along the lines of force.

3. The remodelling phase is, as the name suggests, the phase in which the tissues reform to ‘normal’. No one at present knows when this phase is completed, as the cells of tissue repair have been found in and around an injury site up to 12 months after it was deemed that the injury had recovered.³ During this phase we would opt for taping techniques that allow greater movement while still offering support.

Tape is reported to lose 20–40% of its effectiveness by approximately 20 minutes after application.^4,⁵ However, this does depend on the type of tape used.⁶ This is a very negative way of reporting statistics and if we look at these from another perspective, we could say that tape retains 60–80% of its effectiveness after 20 minutes. However, joint control is increased when muscles are warm and therefore, the stabilizing effect of tape is more important during the initial stages of training or competition,⁷ so we really only need tape to be maximally effective during this time.

We know that when athletes are fatigued there is a decrease in neuromotor control.⁸ Tape may offer support that could have a prophylactic role when the athlete is fatigued.

R.I.C.E.S

Rest, Ice, Compression, Elevation, Support: this is a well-established protocol for initial first aid,⁹^–¹³ the evidence for which is largely anecdotal.^14,¹⁵ Regardless of this, it is one of the few aspects of treatment and rehabilitation that is agreed on by many therapists.¹⁶^–¹⁸ There are some questions you should ask of yourself before recommending R.I.C.E.S. to a patient.

• What does rest mean for this patient? Does it mean complete rest? Does it mean rest from those activities that are likely to exacerbate, maintain or create a new injury? If the answer to the second question is yes, then what activities can they do?

• The use of ice at present is controversial.¹⁹^–²¹ What do you expect from icing? Vasoconstriction? Vasodilation? Decreased pain? Does the site of the injury matter? Do superficial injuries need the same amount of icing time as deeper tissues? How long should you ice for and for what period of time?^18,¹⁹ Should you ice on the injury? Proximal to it? Or distal to it?

• The evidence for compressing an injury is at best ambiguous.^15,^22,²³ Many tapes, Tubigrips and braces will offer different levels of compression. Which one do you choose and why? Why do we compress the injury? How long do you need to compress the injury for? And for what period of time? How much compression is necessary?

• Many authors recommend elevating an injury. However, no evidence was found either for or against the use of such a treatment modality. How are you going to recommend that the patient elevate the injury site? Do they need to elevate a shoulder injury? How long should you elevate for and for what period of time?

• Support can take many guises; what type of support is going to be best for your patient?

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