Taping and Bracing




General Principles





  • Taping and bracing are used as adjuncts to sports protective equipment, treatment, and rehabilitation of an injury.



  • Should not take the place of appropriate diagnostic, treatment, and rehabilitation of an injury



  • Role in prevention, treatment, rehabilitation, and return-to-play decisions



Functions of Taping and Bracing





  • Prevention: Aid in stabilization, support, and protection of uninjured or fully rehabilitated joints and soft tissues



  • Treatment: Minimize pain and swelling in the acute phase, aid in unloading painful structures, and provide support to unstable joints



  • Rehabilitation: Aid in early mobilization, muscle imbalances, neural control, proprioception, and protect healing injuries



Physician’s Role in Taping and Bracing





  • Determine the appropriateness of taping/bracing.



  • Facilitate the selection process.




    • Identify available options.



    • Communicate with the treatment team: athlete, parent, certified athletic trainer, physical therapist, and coach




  • Evaluate effectiveness of the selected support.



Implementation of Taping and Bracing





  • Athlete’s acceptance: Involve the athlete in the decision-making process; must be comfortable and functional; realize positive psychological effects of taping and bracing, which may improve athlete’s confidence on returning to competition



  • Sporting equipment regulations: Know the sport’s regulations. Equipment modifications may be needed. Use materials that do not endanger other athletes. Exposed metal must be covered during contact sports. The environment will affect options.



Practical Considerations





  • Prescription: Braces may require physician prescription, which needs to include diagnosis code, type of brace, length of need, and, occasionally, statement of medical necessity.



  • Cost: Taping materials and braces can be costly. Athletic departments may or may not cover full expense. Insurance coverage varies, and durable medical equipment may not contribute toward the patient’s deductible.



  • Marketing: Types of tape, taping techniques, and braces are full of unsubstantiated claims and disclaimers of liability. New products should be viewed with an open, but critical, mind.





Principles of Taping


Preparation


Decide on an appropriate technique. Gather required tape supplies. Place the athlete’s body part in position of function and/or protection. Use an appropriate table height to optimize the taper’s body mechanics.


Types of Tape





  • Nonstretch tape: good tensile strength with cloth backing that gives mechanical support to ligaments and joints; can also be used to reinforce stretch tape (e.g., standard trainer’s athletic tape)



  • Stretch tape: may be a one-way stretch (in length or width) or two-way stretch (in length and width); conforms to contours of the body and allows normal tissue expansion; typically requires scissors to tear and are more expensive (e.g., Kinesiotape, Elastikon, Lightplast, or Cover-Roll)



  • Cohesive bandages: sticks to itself, waterproof, and reusable; may be used in place of stretch tape (e.g., Coban or Co-Flex)



  • Hypoallergenic tape: alternative to standard zinc oxide nonstretch tape



  • Size of body part determines the appropriate width.



Skin Care





  • Preventive measures:




    • Shave hair: Increases adhesion of the tape and reduces irritation and build-up of residue



    • Apply taping base (e.g., tincture of benzoin): Increases adhesion of the tape and provides a protective layer between the tape and skin



    • Apply tape underwrap (e.g., thin polyester urethane foam): Decreases skin problems and increases athlete’s comfort; may not be appropriate for all uses



    • Apply lubricant to possible areas of irritation (e.g., lace and heel areas of the ankle)




  • Appropriate tape removal: Use scissors or cutters with a blunt tip. Teach the athlete the appropriate removal technique. Cleanse the skin to remove tape residue. Treat skin irritations and wounds promptly; these problems can prevent further taping.



  • Allergic reactions to tape materials: Recognize and treat problems. Consider alternative tape supplies. Investigate other forms of support and protection.



Application





  • Requires skill; proficiency results from practice



  • Elements of appropriate taping technique:




    • Tearing tape is a basic skill; tape must be torn often.



    • Every piece of tape should have a distinct purpose.



    • Place anchor strips proximal and distal to the injured area directly on the skin.



    • Bridge across injury; duplicate anatomy needing support



    • Weave strips to add strength, overlapping by at least one-half the width of the tape



    • Adapt two-dimensional tape to three-dimensional body part



    • Limit pressure around body prominences, particularly when vascular and neural structures are superficial.



    • Use stretch tape over muscle bellies to allow normal muscle expansion.



    • Inspect for and tape over any gaps in taping to prevent blisters and tape cuts.




  • Avoid common problems that restrict circulation: applying too much tape; applying repeated circumferential strips without tearing between turns; forcing tape to go in desired direction; be careful if using tape with acute injuries because swelling causes tightness





Principles of Bracing





  • Bracing material should be functional during sport and daily activities; comfortable, lightweight, and moldable braces enhance their functionality.



  • Braces should fit appropriately and be adjusted as swelling improves and activity progresses.



  • Braces may migrate during activity. Tape, straps, and undergarments may be used to decrease unwanted migration.



  • Brace evaluation over time is necessary to ensure appropriate function and to assess need for part replacement.



  • Over-the-counter braces are instantly available, less expensive, efficient to use, but may not offer as much support as more specialized braces.



  • Custom applications constructed from thermoplastic and other materials available for specific athlete needs (e.g., clamshell brace or ankle foot orthosis). Consultation with experienced orthotist, prosthetist, or occupational therapist recommended.





Prophylactic Taping/Bracing


Knee





  • Controversial whether knee braces prevent knee injuries



  • Hinged knee braces are commonly used by football linemen with the rationale that they will reduce the valgus force on the joint, preventing medial collateral ligament (MCL) sprains.



  • Biomechanical studies show that braces can provide greater resistance to a valgus force, protecting the MCL and in certain cases, even the anterior cruciate ligament (ACL), but whether this translates to injury prevention is unclear.



  • Braces have also been shown to impair performance and increase the incidence of injury in certain player groups. There are several variables in such studies (position, player size, and type of brace) and even when they are accounted for statistically, it is difficult to make clear conclusions.



Ankle





  • Prophylactic ankle taping and ankle braces are used in several sports. Certain studies show a lower incidence of ankle injury with taping and bracing. Whether taping and bracing decrease the incidence in primary and/or secondary prevention and whether one method is superior to the other remains unclear.



  • Certified athletic trainers frequently utilize prophylactic taping ( Fig. 61.1A , ).




    Figure 61.1


    Ankle taping and bracing.



  • Lace-up ankle braces and hinged stirrup braces are often used ( Fig. 61.1, B and C ).



Wrist





  • Wrist taping, wraps, or braces are commonly used in various sports (gymnastics, weightlifting, football lineman, and snowboarding).



  • Wrist guards in snowboarding have a role in preventing serious injury in children and novice riders.


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Jul 19, 2019 | Posted by in SPORT MEDICINE | Comments Off on Taping and Bracing
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