EDUCATIONAL OBJECTIVES

The learner should, at the completion of the chapter, be able to perform the following:

• Recognize the importance of proper injury evaluation prior to application of preventive/supportive techniques.
• Understand the purpose and philosophy of taping and wrapping.
• Recognize the proper selection of supplies and equipment in this area.
• Identify the protocol in preparation of taping and/or wrapping.
• Identify the proper steps in the application and removal of taping procedures.
• Understand the guidelines for the application of elastic wraps.
• Recognize the precautions taken in the application of preventive/supportive techniques.

Before one applies a preventive or supportive technique, a proper injury evaluation should be completed by a certified athletic trainer or qualified health care professional. If questions arise, a physician should perform medical diagnosis. Following injury evaluation, a qualified health care professional can then make recommendations concerning application of protective techniques. This helps ensure that proper wrapping techniques are applied for support and compression. Also, it is imperative that the health care professional develop a thorough knowledge of wrapping and taping application fundamentals. While the basic principles of taping and wrapping are presented in this chapter, the learner should consult taping and wrapping textbooks for a comprehensive description of taping and wrapping techniques.

PURPOSE OF TAPING AND WRAPPING

The primary purpose for tape application is to provide additional support, stability, and compression for the affected body part. The purpose of elastic wraps is for support and compression. Through proper application, taping and wrapping techniques can be applied to:

• Shorten the muscles angle of pull
• Decrease joint range of motion
• Secure pads, bandages and protective devices
• Apply compression to aid in swelling reduction.

With tape application, proper angle, direction and tension must be considered. Because elastic tape has the ability to contract and expand, this tape is commonly used in areas that need greater freedom of movement. Elastic tape also has the characteristic of conformability. It can be placed on the body part with fewer wrinkles and at greater angles. When applying elastic tape, proper tension must be applied.

Elastic wraps are primarily utilized in the application of applying either compression or support to injured anatomical structures. It is left to the discretion of the health care professional to select adhesive or elastic tape, and elastic wraps in the application of any preventive technique.

DESCRIPTION OF ATHLETIC TRAINING SUPPLIES

In this text, tape terminology used will be adhesive white tape or elastic tape. The adhesive white tape is traditionally marketed as non-elastic, white tape. Elastic tape provides greater freedom of mobility to the affected body part, and is marketed as elastic tape. Both adhesive white tape and elastic tapes are produced in a variety of widths. The terminology for elastic wrap is defined as a woven fabric that also allows for expansion and contraction, in which either compression or supportive techniques can be utilized. This product is typically produced in 1, 2, 3, 4, and 6 inch widths. In certain situations, an extra long length is more desirable. The ankle cloth wrap is non-elastic cloth that is 1 1/2 inches wide and between 72 - 96 inches in length. Additionally, adhesive and elastic tape is utilized to stabilize the wrap. In the preparation of some body parts, skin protection such as adhesive bandage with a lubricant must be considered.

SELECTION OF PROPER SUPPLIES AND SPECIALTY SUPPLIES

One of the most critical aspects of taping techniques is the selection of proper supplies. Your selection depends on the number and types of sports offered and frequency of injuries. Purchasing supplies depend on budget, philosophy of medical staff regarding taping techniques, and occurrence of injury. Special consideration must be given to these additional supplies: benzoin (spray adherent), adhesive white tape versus elastic tape, width of adhesive white tape and elastic tape, and length and width of elastic wraps.

PREPARATION OF BODY PART TO BE TAPED OR WRAPPED

In preparing the body for taping and wrapping application, consider these six items:

1. Removal of Hair: The athlete should shave the affected body part. This will ensure a good solid foundation for the tape, will allow for easy tape removal, and will reduce skin irritation.

2. Clean the Area: After hair removal, make sure the skin is clean and moisture free.

3. Special Considerations: Skin protection is important. Provide special care if the skin has allergies, infections, or open and closed wounds.

4. Spray Adherent: Spray the affected area with an adherent to aid in the adhesive quality, and to provide stability for the supportive technique.

5. Skin Lubricants: In areas of high friction or sensitivity, a skin lubricant with the dressing/bandage (heel and lace pads) will help reduce the possibility of irritation.

6. Underwrap: This foam wrap is used primarily in cases when the athlete is allergic to tape or it is used to hold heel and lace pads in place at high friction areas. In the application of adhesive and elastic tape, the use of underwrap over the entire taping area can compromise the stability of the taping technique. When applying an elastic wrap, underwrap material should not be utilized.

APPLICATION AND REMOVAL OF TAPING PROCEDURES

To tear tape, the adhesive white tape is held firmly on each side of the proposed tear line. With proper tension applied on the tape, the free end is pulled away at an angle so that the force crosses the lines of the fabric of the backcloth at a sharp angle. The tear then occurs sequentially through the backcloth. The more quickly this maneuver is done, the more evenly tape edges will be torn. Some brands of elastic tape are extremely hard to tear by hand. Cut those brands with scissors to ensure proper tape application and neatness.

Easy removal of adhesive white tape and elastic tape is accomplished by using bandage scissors or a specially constructed tape cutter. A small amount of lubricant on the tip of the cutting device will allow the instrument to slip under the tape more readily, thus allowing removal of the tape with ease. Avoiding bony prominence, move the scissors or cutter along the natural channels or in areas of greatest soft tissue cushion.

Once this has been completed, remove the tape from the skin in a constant and gradual manner. It is preferred that the tape be removed in the opposite direction from which it was applied. When pulling the tape from the skin at an angle of 180 degrees, care should be exercised to minimize removal of skin tissue and skin irritation. It is recommended that pressure be applied to the skin (pull the skin away from the tape), to reduce the possibility of skin irritation. The daily use of a tape remover is recommended to help keep the skin clean and to prevent skin irritations and/or infections. Tape remover and/or alcohol will aid in the removal of tape mass and adherent from the skin.

PURPOSE AND APPLICATION OF ELASTIC WRAPS FOR SUPPORT

During physical activity, supportive wraps are utilized to aid in muscle function and support and to reduce excessive range of motion. These applications are usually used for short periods, typically for competition or practice. Common terminology for these wraps is spica, figure of eight, and pad support. Spica wraps are traditionally employed at the hip and shoulder joints. Figure of eight wraps are placed over ankle, knee, elbow, and wrist and hand joints. Supportive wraps aid in securing pads after the proper placement of felt, foam rubber, and protective devices.

PURPOSE AND APPLICATION OF ELASTIC WRAPS FOR COMPRESSION

Compression wraps are utilized in initial injury treatment protocol: Protection, Rest, Ice, Compression, Elevation, and Support (P.R.I.C.E.S.). In applying a compression wrap, use a spiral pattern, and, beginning distal to the injury, cross the injured joint, and finish proximal to the affected area. This combined with elevation, assists in moving fluids out of the injured area. In certain situations, it is preferred that the wrap starts below the next joint. The removal and re-application of compression wraps should take place every four hours.

SPORT SPECIFIC RULES ON TAPING AND WRAPPING

If you apply supportive techniques to an athlete, you should be aware of specific rules governing tape application in that particular sport. Your application must fall within the guidelines established for each sport by appropriate governing bodies.

BRACES AND SPECIAL DEVICES

The use of protective devices is beneficial if they are properly selected, used in the appropriate setting, correctly fitted, properly applied, and used within the rules and guidelines of the specific sport. The types of braces and special devices commonly utilized in athletics are listed.

Immobilizing: A device used to protect and limit the mobility of a specific joint. Examples of immobilizing devices include casts, straight leg braces, aircasts.

Functional: A device used to add support, stability and protection with minimal loss of mobility to the joint during functional or athletic activity. These are two primary types of functional devices.

1. Compression Supports - Anatomical supports used for compression and heat retention. Examples include neoprene sleeves, patellar tendon strap.
2. Ligament Support - Braces used to provide additional joint support for reinforced stability.

Foam: Whether adhesive or non-adhesive, foam can be used in conjunction with various taping/wrapping procedures to increase the beneficial nature of the technique. When applying foam, consider the proper size, thickness, shape, and foam composition needed prior to the application of the tape or wrap.

Thermoplastic: This rigid material can allow the injured athlete to return to practice and/or competition with an increased awareness that the injury will be protected from further harm. Because of the hard composition of this product, thermoplastic material may be restricted from some sports or allowable only on a certain body part.

Felt: This product should be applied with many of the same considerations as with foam rubber products. Factors that should be considered in the construction and application of a felt pad are size, thickness, and use of either adhesive or non-adhesive felt.

Viscoelastic Material: Made of elastic material, this flexible product is used to secure padding to a body part. Viscoelastic material is commonly used to cover the ankle, knee, elbow and wrist/hand.

In the construction of a special pad using foam, thermoplastic felt or viscoelastic material, the following criteria should be considered.

1. Does the pad meet specific rules and guidelines of the sport? If NO, then do not use the pad.

2. Does the pad perform the function for which it was designed? If NO, then do not use the pad.

3. Will the pad contribute to further injury to the area or to an adjacent area? If YES, then do not use the pad.

4. Will the pad alter the function or void the warranty of a manufactured piece of equipment (i.e., helmet, shoulder pads)? If YES, then do not use the pad.
These questions should routinely be asked and then answered by the certified athletic trainer before the construction of any specialty pad.

PRINCIPLES OF PHYSICAL REHABILITATION

Supportive techniques along with a rehabilitation program enhance an athlete’s return to activity. Please note that taping and wrapping procedures are NOT a substitute for proper injury rehabilitation. You should follow the standard operating procedures regarding injury rehabilitation and supportive taping techniques, as outlined by a physician.

PRECAUTIONS

Before applying any technique, the athlete’s skin temperature should be normal following therapeutic treatment. Allow adequate time for the skin to return to its normal temperature. This reduces the chance of skin irritation. When applying support techniques, the safety of the athlete should be your priority. Improper tape application can cause further injury, so use caution. With all injured athletes, consultation with a physician is recommended. Tape application should not be used to allow participation with any disabling conditions.

TIPS FROM THE FIELD

• Know what body part and injury you are providing support and/or compression.
• Cover sensitive body parts (nail/nipple) with an adhesive bandage.
• When applying a technique, learn to tape from a stationary position.
• Position the body part to be taped at your elbow height.
• When practicing, start with small length and width elastic wraps so you can learn common techniques like figure of eight, joint spica, etc. Once you are proficient with wraps, then utilize adhesive white tape and elastic tape.
• Apply proper tension to the tape/wrap so that circulation will not be restricted.
• Follow the tape/wrap with your hand to smooth out all wrinkles.
• Overlap tape/wrap one-half its width to avoid spaces that could cause cuts and friction burns.
• When applying a compression wrap, always start distally and wrap proximally (toward the heart).
• Start angle of tape high so the tape angles will look better.
• To allow the tape ends to meet at the anchor strips, angle the tape to conform with the body structure. If you do not succeed, retry angle at a sharper degree.
• When applying closure strips, it is recommended to always apply closure strips proximal to distal.
• When applying tape on a foot, start on the superior (top) aspect of the foot and pull the tape laterally (outside). This will reduce excessive tension/compression on the 5th metatarsal area.
• Above All:     PRACTICE    PRACTICE    PRACTICE

While basic taping and wrapping techniques are listed next, the learner should consult this chapter's reference list for texts that address comprehensive descriptions of taping and wrapping techniques.

Wrapping Techniques for Compression

Ankle
Knee
Elbow
Wrist/Hand

Ankle Cloth
Knee Joint
Hamstring
Quadriceps
Hip Flexor
Hip Adductor
Glenohumeral

Rib
Low Back

Wrist
Thumb Spica
Thumb C-Lock
Finger Splint
Collateral Interphalangeal Joint
Hyperextension of Phalanges
Contusion to Hand

Compression: the act of applying pressure to the anatomical structures (skin, bone, muscle, soft tissue).
Diagonally: slanted or oblique direction.
Diamond Shape: an object that is in the shape of two equilateral triangles placed base to base.
Extension Wrap: a wrap used to assist in the extension of specific joint (upward and outward pull).
External Rotation: turning outwardly or away from the midline of the body.
Internal Rotation: turning of a limb toward the midline of the body.
Figure of Eight: the bandaging of a joint where the initial turn circles the one part of the joint and the second turn circles the adjoining part of the joint to form a figure of eight.
Flexion Wrap: a wrap used to assist in the flexion of that joint (upward and inward pull).
Joint Range of Motion: the maximum range of movement of a joint measured in degrees of a circle.
Muscle Contracted: the shortening of the muscle.
Pad Support: a pad placed in a certain area to sustain, hold up, or maintain a desired position.
P.R.I.C.E.S.: Protection, Rest, Ice, Compression, Elevation, and Support.
Shorten the Angle of Pull: decreasing the range of motion of a joint.
Spica Wrap: a figure eight (8) bandage that generally overlaps the previous to form V like designs; used to give support, to apply pressure or to hold a dressing.
Spiral: applying a bandage around a limb that ascends the body part overlapping the previous bandage.
Swelling: increase in size of an area due to an increase in fluid.
Support: to sustain, hold up or maintain a desired position.
X Pattern: the crossing of two pieces of tape in the shape of an X.

SUMMARY

Prophylactic taping, wrapping, and bracing must be done with proper application techniques, under the auspices of the physician, and must provide the proper biomechanical support and or stabilization. When done under those guidelines, the athlete can return to practice and competition quickly and safely. The physical structures of the human body can be assisted by the application of tape, wraps and braces. However, understand that taping and wrapping techniques are no substitution for proper conditioning, rehabilitation and strength.
 

REFERENCES

Anderson, M. & Hall, S. (1995) Sports Injury Management. Baltimore: Williams & Wilkins.

Arnheim, D. & Prentice, W. (1997). Principles of Athletic Training (9^th ed.). St. Louis: McGraw-Hill.

Cerney, J. (1972) Complete Book of Athletic Taping Techniques. Parker Publishing, Inc.

Gallaspy J. and May D. (1995) Signs and Symptoms of Athletic Injuries (1^st ed.) St. Louis: Mosby.

Hafen, B. (1994) First Aid for Health Emergencies. (4^th ed.) St. Paul, MN: West Publishing.

Johnson & Johnson (1986) Athletic Uses of Adhesive TapeSkillman, NJ: Johnson & Johnson Products.

Miller, R. & Dunn, R. (1979) Athletic Training Techniques. Bowling Green, KY: WKU Press.

McDonald, R. (1994) Taping Techniques: Principles and Practice. Oxford: Butterworth-Heinemann

Williams, P. & Warwick, R. (1980) Gray's Anatomy (36^th ed.) Philadelphia: W.B. Saunders.

Wright, K. and Whitehill, W. (1996) The Comprehensive Manual of Taping and Wrapping Techniques (1st Ed) Gardner, KS: Cramer Products, Inc.

Wright, K. and Whitehill, W. (1996) Sports Medicine Taping Series. St. Lousi: Mosby Year Book, Inc.

Completion:

1. Elastic tape has the ability to _______ and __________.
2. __________ is used in the initial treatment of acute injuries.
3. Proper skin temperature reduces the chances of _________.
4. Taping and wrapping procedures are not a substitute for proper __________.

Short Answer:

1. What is the primary purpose of tape or elastic wraps?

2. How is a compression wrap applied?

3. In preparation of some body parts for applying tape, what would be applied for protection of the skin?

4. What is the importance of skin lubricants?

5. List four specialty supplies utilized in special pad techniques.

6. What should the skin temperature be for applying any taping technique?

7.Why should caution be used in the application of any taping and wrapping procedure?

8. What is the advantage of removing hair prior to applying a taping technique?

9. What are the six items to be considered before application of tape and/or wrap?

Back to Homepage