Taping for Collateral and Rotary Insufficiencies of the Knee

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1 Taping for Collateral and Rotary Insufficiencies of the Knee Chuck Whedon, MS, ATC, CSCS Coordinator of Athletic Training and Sports Medical Services Rowan University, Glassboro, NJ

2 Introduction For the past fifteen years I have studied the needs and management nt of the unstable knee. Not until I sustained a grade two medial collateral ligament sprain while wrestling competitively did I actively pursue an effective strapping ping technique. Available techniques reviewed and tested and have been found either too restrictive or offering insufficient support. I have talked with a number of professionals, some of which profess that taping of the knee is ineffective. For ACL injuries, this may be the case, but with most others, the e author must disagree. While some injuries may need to be augmented by bracing (another controversial area) knee taping has a viable place in sport medicine. During these years I tested, modified and settled on a knee strapping technique which has proven to provide an effective balance between en restriction and support.

3 Rationale The rotary support technique is based on the fact that virtually all knee injuries have some rotary component to their mechanism. The taping position and strapping technique take into account these mechanisms related to injury and re- injury. Attention must be paid to both positioning and tension at specific points to maximize effectiveness and comfort, as well as the acceptable state of healing for the technique to be successful.

4 Supplies needed Spray adherent Heel and lace pads 2" white tape Heel prop 3" high-tensile elastic tape Skill and practice

5 Application technique Place the knee in a position opposite to the causative mechanism: For medial collateral ligament sprains and suspected medial meniscus pathology, the tibia should be held in a internally rotated position with the ankle slightly inverted. This produces a varus load, slacking the MCL.

6 Skin preparation/anchors Spray adhesive is applied in the traditional fashion, as are two heel and lace pads in the popliteal fossa. Padding may be used to additionally reduce friction. Pre-taping wrap may be used, but is not recommended, especially on the thigh, as this will promote slippage, and compromise the effectiveness of the taping application. Four to six adhesive straps are placed as anchors using standard 1 1/2" or 2" white tape from one inch above the superior patellar pole to mid-thigh. Three to five adhesive straps are placed as anchors using standard 1 1/2" or 2" white tape from one inch inferior to the tibial tuberosity to mid-calf. Elastic tape can serve as anchors if constriction is a concern.

7 Hyperextension straps Optional used when terminal extension is pathogenic. Two to three straps of white tape are crossed over the popliteal fossa, superior to inferior to prevent hyperextension.

8 Elastic strap # 1 Beginning on the unaffected side (lateral) above the patella, apply a 2 to 3" strap of high-tensile strength elastic tape ( one likely not to rip, especially with the heavy flexion demands of wrestlers). This is angled inferiorly along the lateral patellar border and across the lateral joint line (drawn tautly), around the posterior calf (drawn loosely- complete slack).

9 Elastic strap # 1 The strap is then drawn tightly up across the tibial tubercle over the medial joint line and along the medial patellar border of the affected side.

10 Elastic strap #2 The second elastic support strap begins superior to the patella, following the patellar border across the affected joint line (drawn tautly). Again loosely (complete slack) around behind the calf, and then across the tibial tubercle, along the finish of the first elastic strap on the affected side, overlapping it by 1/2 the width, (drawn as tautly as possible).

11 Elastic Strap # 3/closure The third elastic strap serves both as the final collateral support and a spiral closure. Trace the origin as strap # 2 and overlap by 1/2 the tape width. Draw tautly across the joint line, loosely across the posterior calf, and spiraled upward.

12 Closure The tape should be overlapped by 1/2 width to assure complete coverage. The closure should be secured with white tape at mid thigh

13 Application technique-lateral For lateral collateral ligament sprains, or suspected lateral meniscus pathology, this positioning is reversed: tibia externally rotated with the ankle slightly everted. This, along with traditional knee flexion achieved via a heel prop will allow for enhanced compression of the target compartment. The valgus load will slack the LCL.

14 Elastic strap # 1-lateral1 Beginning on the unaffected side (medial) above the patella, apply a 2 to 3" strap of high-tensile strength elastic tape. This is angled inferiorly along the patellar border and across the lateral joint line (drawn tautly), around the posterior calf (drawn loosely-complete slack).

15 Lateral Elastic strap # 1 The strap is then drawn tightly up across the tibial tubercle over the lateral joint line and along the lateral patellar border of the affected side.

16 Lateral Elastic strap #2 The second elastic support strap begins superior to the patella, following the patellar border across the lateral joint line (drawn tautly). Again loosely (complete slack) around behind the calf, and then across the tibial tubercle, along the finish of the first elastic strap on the lateral side, overlapping it by 1/2 the width, (drawn as tautly as possible).

17 Lateral Elastic Strap # 3/closure The third elastic strap serves both as the final collateral support and a spiral closure. Trace the origin as strap # 2 and overlap by 1/2 the tape width. Draw tautly across the joint line, loosely across the posterior calf, and spiraled upward.

18 ACL Deficiencies Ah the white whale. A combination of mostly medial but also lateral straps can be used to provide support to the ACL deficient knee. Bracing may also be used, and this technique has been used effectively to allow selected players to finish their careers.

19 Summary While no taping technique will work for all athletes (some complain of restriction or unresolved symptoms), this technique has proved successful in the vast majority of cases. It has proved superior to bracing alone in most cases, and has been used effectively along with both "de- rotation" and lateral knee braces, especially in the sub-acute phases of injury. I hope that by sharing this technique, others may enjoy a tool in the management of the often challenging unstable knee.