Taping materials

Various forms of tape are available, either elastic or inelastic. In general, elastic tape is used with injured contractile tissue to provide a graded resistance or compression. Inelastic tape is more often used with non-contractile tissue injuries, to take the place of a ligament in reinforcing a joint. Zinc oxide tape is the most common inelastic type. It is air permeable, allowing the skin to breathe and some moisture to escape through the tape. The tape is backed with a strong adhesive which may be a hypoallergenic formation. The tape strength is largely dependent on the number of individual threads per inch, a value known as the thread count (Lutz et al., 1993). The higher quality tapes generally have a higher thread count and are therefore stronger and less affected by body heat and moisture. The edge of zinc oxide taping may be serrated to make tearing off strips of tape during application easier.

Definition

The thread count of a tape refers to the number of threads per inch. Higher thread counts give stronger tapes.

The elastic tapes may be either adhesive backed or adherent. Adhesive elastic tapes will normally stretch both longitudinally and transversely. Typically, this type of tape will recoil to 125% of its original length when initially stretched lengthways (Austin, Gwynn-Brett and Marshall, 1994). However, multiple stretching will cause the tape to fatigue. Rather than tensile strength, elastic tape has good compression qualities and will pull on the skin if applied pre-stretched.

Adherent or cohesive tapes are normally impregnated with latex, enabling them to stick to themselves rather than to the wearer’s skin. This feature makes the cohesive tapes reusable to a certain extent, giving cost savings. Most tapes are water-repellent to some degree, but the latex coated cohesive tapes may also be water-resistant, enabling an athlete to bathe with them on and so maintain fitness by exercising in water.

Beneath the tape, padding materials are used to protect the skin or bony prominences and to fill in superficial anatomical cavities. The padding may be either foam or fibre based. Polyester urethane foam underwrap is used to prevent tape adhering to the skin and to provide a more even compression. Fibre padding such as orthopaedic felt, or its synthetic equivalent, is used where thicker packing is required. These have the advantage that they may be cut and shaped. A variety of taping supplies are listed in Table 3.1.

Table 3.1 Taping supplies

From Norris (1994), with permission.

Splinting or bracing materials vary from thermoplastic materials used to support unstable joints to anatomical braces used to immobilize a joint, especially after surgery. In addition, a variety of elasticated stockinets and purpose-designed braces are available for most major joints. Elasticated braces may be shaped to accommodate the contours of the joint. For example, knee sleeves may be open to reduce compression over the patellar area, while ankle braces are shaped to contour the foot and lower shin. These braces offer compression to prevent pooling of oedema and heighten confidence in a body part through proprioceptive enhancement. Braces may be made of neoprene where the additional advantage of heat retention is useful. Metal or plastic stays are often built into braces to make them more robust.

Contraindications

There are several contraindications and cautions to taping (Table 3.2). Taping should not be applied unless the patient can be fully assessed. In the sport situation it is all too easy to be rushed into applying tape at the request of a player or coach, but tape must not be applied without patient assessment. Where either skin sensation or skin blood flow is compromised, taping must not be applied. Sensation can be assessed by simple skin tests of the affected area in comparison with the uninjured side. Skin blood flow can be judged by skin colour and texture, and with the limbs compression of the nail bed can be used. As the bed is compressed the skin beneath will go white, but the normal red colour should return within 10 seconds if the blood flow is normal.

Table 3.2 Contraindications and cautions to sports tape application

Assessment is not possible

Reduced skin sensation

Compromised skin circulation

Known tape allergy

Unsuitable taping materials

Keypoint

Taping should not be applied to areas of skin where sensation or blood flow is compromised.

Known allergy to taping materials is a contraindication and if the therapist is in any doubt, the skin should be patch tested. For this, a small (cm) piece of tape should be placed on the skin and the athlete monitored for redness and/or a raised wheal on the skin. Where an athlete suggests that they may have had a reaction to taping in the past, the tape should be left on for 2−3 hours to confirm any response. Non-adhesive (adherent) taping is less likely to cause a skin reaction than adhesive tape. Successful tape application requires the availability of several materials. Where these are not available, application may be contraindicated. For example if an injury requires the application of elastic tape when only rigid (non-elastic) tape is available, to simply apply the wrong material in an attempt to ‘make do’ is both ineffective and potentially dangerous.

Once taping has been applied, the patient should be monitored. Be prepared to remove the tape and reapply if it is uncomfortable or restricts circulation. In addition question whether the taping achieves your aims—does it support or limit the movement which you intended? Although many taping techniques are described throughout this book, be prepared to adapt any taping design for an athlete’s individual needs. Be mindful of the underlying anatomy and biomechanics of the structure being treated and equate this with the treatment goals.

Application

Skin preparation

The limb is generally positioned with the injured structure, or part to be protected, in a shortened position. For example, the lateral ligament of the ankle is strapped with the joint held everted and dorsiflexed. Where a general limitation of all movements is required at a joint, the functional mid-range position is chosen.

The contact between the skin and strapping should be as firm as possible to prevent excessive movement which may lead to skin abrasion. Anything that reduces this skin contact will result in a loss of adhesiveness. Substances which are secreted or excreted from the skin, such as the hydrolipid film, dead epidermal cells and sweat, will stick to the tape rather than allowing direct skin contact. Clean and dry skin is therefore a requirement for good adhesion.

Some athletes will have hypersensitivity to components within the strapping and may show severe allergic reactions. Chemical skin reactions are more likely with strong zinc oxide adhesive than with hypoallergenic preparations based on polyacrylate. Where this type of adhesive still causes irritation, cohesive strapping is chosen. Mechanical irritation can result if the drag of the strapping exceeds the elastic properties of the skin, or if the strapping starts to slip and ‘burn’ the skin.

Keypoint

Mechanical irritation of the skin may occur if taping is not secured correctly, and begins to slip.

Before tape is applied, the body area and skin condition is inspected. Sensation and circulation of the skin should be assessed before and after tape application. Minor scratches and abrasions can be protected by petroleum jelly or paraffin gauze, while larger areas should be covered by a sterile dressing. It must be remembered, however, that in cases of a large wound, first aid is required and not simply taping. Any bone prominence which may be irritated by tape should be protected by a heel/lace pad.

The skin is lightly shaved or the hair flattened down and an underwrap applied. Skin preparation products such as adhesive spray and skin toughener can be useful where strapping fixation is poor. The use of underwrap does allow the strapping to be applied onto non-shaved skin, but the cutaneous stimulation is likely to be less than with direct skin application. This may make underwrap better where mechanical rather than functional strapping is used. Superficial skin damage occurs more commonly over areas of soft skin, such as within the popliteal and cubital fossae. In addition, taping over unprotected bony prominences can lead to pressure points if the tape is applied too tightly. This is common over the base of the fifth metatarsal with forefoot taping for example.

Tape application

Tape may be either cut or torn prior to application. To cut tape, it should be loosely folded over the lower blade of the scissors with the non-adhesive face inwards (Fig. 3.1A). If the adhesive face is directed outwards, the tape will stick to the scissors and jam between the blades. When tearing tape, speed rather than strength is the deciding factor. The tape should be stretched over the tips of the thumbs with the non-adhesive face inwards. The thumbs should be held together, and one hand twisted against the other with the aim of rapidly breaking the tape edge (Fig. 3.1B). The faster the action, the less strength required.

Figure 3.1 Tape may be either cut or torn prior to application.

In many circumstances, the strapping is applied along the line of the tissue fibres, so knowledge of the underlying anatomy is obviously important. The aim is to reduce the movement which stresses the injured tissues, but allow a near normal range of motion in other directions.

Tape may either be applied in a number of individual strips or as a continuous roll. Application in strips has the advantage of accuracy both in terms of the underlying anatomy and the tension applied to the individual strips. It can, however, be slow. Continuous application, while being considerably quicker, uses more tape and can make tension difficult to control.

Where strapping is applied in layers, the overlap between successive pieces is normally half the width of the tape. This ensures that the tape layers do not part with movement of the body (Adams, 1985). Gapping of the tape can trap skin between the tape layers, causing skin damage. The tape should be applied smoothly and moulded to the anatomical contours of the body part. Creases should be avoided as these will create pressure spots. Tape is secured to the skin via anchoring strips (Fig. 3.2A). These are either elastic or inelastic strips applied directly to the skin without traction. Care must be taken not to compress the skin as the anchor tape is surrounding the limb and can easily impair the circulation. From the anchors, reins or stirrups may be attached, under traction. A rein travels between two anchor strips (Fig. 3.2B), while a stirrup is a U-shaped loop which passes beneath a body part, for example under the heel and up either side of the shin (Fig. 3.2C). The reins or stirrups are applied along the length of anatomical structures or to pull a joint into a particular position. They relieve stress from ligaments or perform the actions which a muscle would perform were it to contract. Care must be taken to avoid tape slippage which can lead to a friction burn of the skin.