TALE OF THE TAPE By Jayson Goo Jayson Goo, MS, ATC, is an Athletic Trainer at the University of Hawai'i and a Certified Kinesio Taping Instructor. The elastic therapeutic taping method first caught the attention of many athletes and sports medicine professionals worldwide during the 2008 Summer Olympics in Beijing. A number of prominent athletes were shown on TV wearing the sometimes strange-looking tape jobs before, after, and even during competition. Some of the world's top tennis players, long jumpers, sprinters, hurdlers, and basketball players had the tape attached to their arms, legs, and shoulders, and people immediately wanted to know what it was and why so many athletes were wearing it. As I watched the Olympics, I had a different reaction--i was glad to see a modality I'd been using for a long time finally gaining broader acceptance. I have been involved with the Kinesio Taping Association as an instructor of elastic therapeutic taping for more than a decade, and I've seen firsthand the many benefits this type of treatment can provide for athletes in practically any sport. Since it was first developed in the 1970s, elastic therapeutic tape has greatly enhanced sports medicine professionals' ability to treat athletes' injuries, relieve their pain, and improve their performance. And this modality is still growing in popularity and evolving in how it can be applied to meet specific therapeutic needs. Based on my own experience, I'm confident that many athletic trainers can enhance their treatment programs by adding this taping approach to their toolbox. WRAP SESSION At its core, elastic therapeutic taping is based on a simple principle: The body has built-in healing mechanisms, and we can speed up their work by removing barriers that impede them. More specifically, the tape provides extended soft tissue manipulation to prolong the benefits of manual therapy administered in the athletic training room. The results are increased fluid flow through an injured area, better control over muscle contractions, reduced pain, and ultimately faster healing. The tape's elasticity allows it to stretch lengthwise 40 to 60 percent beyond its resting length, and its thickness and weight are very similar to that of human skin. It is usually applied with help from a heat-activated acrylic adhesive, and when applied to the skin it creates a mechanical lifting effect, expanding the narrow space between the skin tissue and adjacent muscle tissue.
This space is rich in blood vessels, lymphatic vessels, and neural receptors. When it is enlarged, intercellular fluids can flow more freely--for example, lymph moves more easily out of lymph channels and into the larger lymph ducts. The increased flow of fluids allows more nutrients from the blood to be absorbed into tissue that's healing, thereby helping the rebuilding process. For everyday athletic contusions that lead to swelling and edema, this increased flow has profound effects. Edema leads to localized areas of high capillary pressure, which can restrict lymph and blood availability to a region that greatly needs it. By holding the skin away from the muscle, the tape can relieve this pressure and produce dramatic improvements in healing time for soft tissue injuries. Opening up this space also relieves pressure on nerve endings that send pain messages to the brain. With the resulting decrease in pain, muscles and joints can begin moving in their normal, pre-injury movement patterns earlier in the rehab process. The pain reduction also increases athlete comfort during healing. In addition, this taping method affects the cobweb-like fascia structures surrounding damaged tissue. Muscle injuries typically lead to fascial tightness and scarring, and one goal of manual therapy in an injured area is to stretch the fascia to promote the return of normal function. The tape takes this manipulation a step further by allowing the fascia to be held in a stretched position for extended periods. In the process, it also helps control muscle spasms. These effects make elastic therapeutic taping different from traditional taping methods, which compress the skin and tissue beneath it. While compression can be helpful to control swelling immediately post-injury and limit range of motion of injured body parts, it also has drawbacks. Compression limits circulation to areas that most need blood flow during healing, and sometimes irritates local pain receptors. Elastic therapeutic tape provides support for an injured area without these negative effects. APPLYING IT Using the tape correctly requires specific education and training. The different applications for this modality include muscular; mechanical; fascial; space, ligament, and tendon correcting; functional; and lymphatic. It would be impossible to explain in one article how elastic therapeutic tape is applied to produce maximum benefit, but the following overview will provide an outline of how these treatments work and why they are effective. The essential first step is to identify an athlete's symptoms and determine their cause. Like any other treatment approach, it's important to not simply address an athlete's pain and limitations, but to fix them at their source.
Once a practitioner has determined what area of the body requires treatment and decided the mechanical lifting and pain relieving effects of elastic tape are warranted, the next step is choosing the shape and length of the tape application. The tape is commonly cut into the shape of an X, I, Y, a web, or a fan. The shape that the tape is cut into depends on the size of the area being taped and the specific effects desired in the target zone. An "I" cut is commonly used when taping a tendon, and "Y" cuts are more suited for muscles. "X" cuts are often best when taping broad areas of the body, and the web and fan shapes are used in the lymphatic techniques and for scar reduction. As tape is applied to the skin, the practitioner adjusts the amount of stretching and lifting depending on specific correction and tissue manipulation goals. This process is a combination of art and science, and it's a learned skill that's refined through experience with different types of athletes and injury sites. Often it's not a matter of choosing one type of application and sticking with it, but rather using progressions and combinations of different modalities. Trial and error and listening to athletes' feedback are sometimes the best ways to achieve the desired outcome. Muscle applications of elastic tape are among the most common in athletic settings. In his book Positional Release Techniques, author and researcher Leon Chaitow teaches that pressure directed away from the belly of a muscle toward golgi tendon organs produces relaxation of the muscle, while pressure toward the belly of a muscle strengthens the muscle. Elastic therapeutic tape's stretching properties can produce this positive or negative pressure, essentially through a pulling effect. The direction of the pull is determined by the method in which the tape is applied. Taping a muscle from its origin to its insertion site, or from a proximal point to a distal one, facilitates or improves muscle contraction. On the other hand, taping the muscle from insertion to origin after a massage or a muscle stretch will help the muscle maintain relaxation and a lengthened, elongated state. Rehabilitating a muscle injury often requires building strength in a specific area while also decreasing contractility. For example, following a hamstring injury, the rehab protocol usually calls for hamstring strengthening work and reducing contractility of the quadriceps group. In this situation, tape would be applied to the quadriceps from insertion to origin (or distal to proximal), while the hamstring itself would be taped from origin to insertion (or proximal to distal). For mechanical corrections, the tape can be used much like a brace to change the forces acting on a muscle or joint. In a typical application, strips of tape are placed laterally across specific muscles and tendons to put them in a
mechanically sound resting position and inhibit harmful movements while still allowing an active range of motion. In this way, the tape's function is quite similar to that of a brace or strap, but with the added customization of tape. Fascial applications work to maintain fascial corrections after a practitioner performs stretches and manipulations to the fascia. The tape can be used first to oscillate the fascia, then applied in a manner that helps keep it in the desired position. It can also be used to create or direct movement of the fascia. Many sports medicine professionals are familiar with the concept of trigger points, or areas of tight muscle fiber that cause pain and limit movement. Applying tape over a trigger point can increase fluid flow through that area due to the elastic lifting properties. In addition, after a chiropractic adjustment, the tape can be applied over joints that have been "gapped" to prolong the effects of the adjustment. The tape offers proprioceptive benefits as well. Placing it over a tendon or ligament can produce or amplify signals to the brain regarding the amount of tension over that particular area. In this way, it stimulates the golgi tendon receptors and helps the brain perceive and react to support of the ligament. For functional corrections, the tape is typically applied to muscles and joints with the joint flexed and muscle in a shortened position, using the stretch in the tape to "preload" or assist the joint through its range of motion. When stretched tape is placed onto a shortened muscle, two things happen: more information is passed through the neural network, and muscle contractions are supported and assisted. These effects help prevent muscles from overstretching while also encouraging proper muscle firing. For example, in athletes suffering from carpal tunnel issues, the tape can be used to hold the wrist in an extended position to facilitate contraction of certain wrist muscles that would otherwise be inhibited. IN MY EXPERIENCE For me, the hardest part of becoming proficient in this modality was "unlearning" how to apply traditional athletic tape, particularly with regard to how much tension and pressure to use. I also had to realize that elastic taping is much more versatile than traditional taping protocols--with various techniques and applications, it can be used in all phases of the healing process, from right after an injury to the time an athlete returns to play. In our athletic training room, we'll typically begin elastic tape treatment immediately after an athlete injures a muscle, joint, or tendon. A lymphedemacontrolling tape application is used to reduce swelling by promoting the free flow of lymphatic fluid. When possible, I like to have an athlete move the affected area as soon as possible to assist in this process, so the less-restrictive
nature of this tape provides a definite advantage over traditional strapping methods. We also often use muscle taping applications immediately post-injury to get the affected muscles to relax and elongate while eliminating dysfunctions in movement patterns created by the injury and resulting pain. Then, throughout the healing process, we use the tape in conjunction with massage and other manual therapy to remove any fascial restrictions that may occur. We employ specialized mechanical and tendon-based taping techniques to mitigate secondary issues that arise in the rehab process. For instance, after spraining an ankle, many athletes experience Achilles tendon tightness, which causes the pelvic muscles to change their reflexive movement patterns. Taping the Achilles tendon to promote relaxation while taping the piriformis and gluteal muscles for facilitation helps prevent hip and lower-back pain and gait changes in these situations. Beyond those uses, we regularly apply elastic therapeutic tape to both healthy and injured athletes to promote optimal static and dynamic posture. Aside from facilitating and supporting the muscles that determine posture to eliminate movement dysfunctions, bilateral muscle taping of the distal third of the front of the neck has just enough effect on muscle tone to correct many postural faults. Since elastic therapeutic taping is fairly new to the mainstream athletic training community, some may wonder if this is an evidence-based form of treatment. While much of the support for these applications is anecdotal and only a few randomized, double-blind studies have been completed to date, the body of relevant research is growing. For instance, a study published in the Journal of Orthopaedic & Sports Physical Therapy in 2008 examined the effectiveness of this taping to relieve shoulder pain in college patients diagnosed with rotator cuff tendonitis or impingement. One group wore an elastic therapeutic tape job for two consecutive three-day intervals, while a placebo group wore a "sham" tape job with no physiological effect. The researchers monitored self-reported pain, disability, and pain-free active range of motion. They found that patients wearing the elastic tape showed clinically significant immediate improvement in pain-free shoulder abduction. In the study, the authors did note that overall this method "has gained significant popularity in recent years, but there is a paucity of evidence on its use." While that fact remains, the existing evidence and my experience lead me to believe the future is bright for elastic therapeutic taping applications. Best uses for this therapy are still being theorized, and I'm confident that the clinical research will eventually catch up to the anecdotal evidence.
As the tape continues growing in popularity, you'll likely see it applied to the joints and muscles of more athletes and active individuals in all settings. And as with any new innovation or modality, trying it with an open mind is the most important step toward drawing your own conclusion. If you do, and your experience is anything like mine, you may find yourself using it more and more to help injured athletes achieve the best possible outcomes. Sidebar: WELCOME RECEPTION When elastic therapeutic tape is applied to an athlete's skin, one effect is an amplification of messages sent to the brain by local neural receptors. For an example of this effect in action, I point to my experience using the tape with University of Hawai'i student-athletes returning from hamstring strains. As part of the normal rehab progression, we have these athletes start with jogging and eventually graduate to full-speed running. We always instruct them to stop if the injured leg begins to feel fatigued or just "not right." But before we started using the tape, athletes would inevitably go too far with their running and often ended up re-straining the hamstring to some degree. The first time we applied the tape to an athlete with a hamstring strain, he returned to the athletic training room after a short period of jogging, reported that his hamstring felt "funny," and asked us if he should stop. After an examination revealed no obvious problems, we told him to take the rest of the day off and continue his running program the next day. The athlete progressed through the rest of his rehab without any re-strains or feelings of tightness, and we've since repeated the success with several other athletes rehabbing from hamstring injuries. We think that in this instance, the stretching effect of the tape increases activation of the muscle's stretch receptors. Rather than the athlete not feeling significant pain or tightness until the muscle is re-strained, this "early warning system" causes the brain to send instructions to the agonist and antagonist muscles in the hamstring to stop elongating and start contracting. The lifting effect of the tape also increases the space between the skin and muscle, boosting oxygen and nutrient availability in the area to promote healing. Sidebar: TAPING PRECAUTIONS While application of elastic therapeutic tape may offer several benefits for soft tissue injuries, there are some conditions for which it is contraindicated. The increased flow of fluids through the body created by the tape is potentially dangerous for individuals suffering from certain diseases. It should not be used on over-active malignancy sites, active cellulites or skin infections, open wounds, or deep vein thromboses. It can also raise complications for patients who have diabetes, kidney disease, congestive
heart failure, coronary artery disease, carotid artery bruits, or fragile or otherwise compromised skin. Taping for patients with these conditions should be performed only with physician approval. Some athletes may develop an allergic reaction to the tape. In these cases, a simple coating of milk of magnesia on the skin before application can provide a buffer that helps prevent the reaction. Some practitioners also use a spray adhesive to help the tape stay in place and increase athlete comfort. There are a few other minor complications that can easily be avoided. To prevent the tape from rolling up on the edges, athletes should pat it dry after showering, and trim the edges of the tape if it starts to curl or roll up off the skin. Our athletes have also told us they find it's best to keep the tape application covered by clothes when sleeping, to prevent the bed sheets from pulling on the tape ends. Directions: Answer each question using information from the article. Make sure you read and answer ALL parts of the question. Use quotes or evidence from the article to back up your answer when asked to do so. All answers must be IN COMPLETE SENTENCES. 1. If you were to summarize this article for someone who had not read it, what would you tell them are the main ideas of the article? 2. Elastic therapeutic taping is based off of what basic principle?
3. Explain how and why elastic therapeutic taping benefits the body and aids in rehabilitation and repair of injuries. Be sure to include examples from the article. 4. Explain when you would apply the X, I, Y, web or fan cuts of therapeutic tape.
5. Explain how and/or why the tape is used in the following treatments. Rehabilitation Mechanical Corrections Fascial Applications Trigger Points Proprioceptive Functional Corrections 6. Summarize sidebar: Welcome Reception.