tures in prophylactic or preventative applications (5) or can be used to facilitate joint proprioception (6).


A justified taping technique should always address the aims of the management plan and should fit in comfortably with other treat- ment modalities being delivered. It must never be used as a sub- stitute for treatment and must not be undertaken unless an ade- quate assessment has taken place (1). Taping techniques should not be used if the diagnosis is uncertain, or there may be the possibil- ity of fracture, total ligament rupture or infection (1). Extreme care is required if considering taping an area with poor skin sensation or poor circulation as the application of a taping technique can fur- ther compromise circulation and cause irritation to the skin which may not be perceived by the athlete (Box 1).


Athletes with allergies to tape should not have any bandage materi- al applied in direct contact with the skin. It is possible to use an ‘underwrap’ foam bandage to offer protection from contact, however regular checks must be made to ensure that the athlete remains safe.


THE PROCESS OF SOFT TISSUE HEALING Following any muscle, tendon or ligament injury the soft tissues undergo cellular changes that are part of the healing process. In the first few hours there is continued bleeding from the damaged site and an outpouring of inflammatory exudates (7). At this early stage, taping techniques can be employed to help control oedema and support the injured tissues to reduce pain as well as to provide some protection from further damage (8). Stretchy bandag- ing material that accommodates the swelling and yet provides some support to the injured tissues would be the material of choice.


Fibrous repair commences from approximately three days post- injury and continues until 4-6 weeks depending on the extent and site of injury and athlete specific factors (7). At this point in the healing process there is generally a greater need for the protection of the injured structures from adverse loads as the athlete regains range of motion, confidence and function. Firmer, non-stretchy restrictive tape may be used, or stretchy applications may continue to be used, but with the addition of reinforcing strips, stirrups or check reins to limit undesired movements (9) (Table 1).


Collagen remodelling takes place from 3-12 weeks and the healing tissues strengthen and reinforce in response to controlled loads. Taping techniques should be modified to reflect this and a variety of materials and applications are employed and adapted to achieve the desired results.


SELECTING A TECHNIQUE Many books and manuals are available demonstrating techniques and applications for different parts of the body. While these can be great resources, it is important to remember that these are cata- logues of techniques that could be applied. An individual technique cannot be applied piecemeal to meet all the needs of the manage- ment plan and therefore must be adapted individually. Alternatively a technique may be very valuable for addressing a particular clinical need initially, but may then need discarding in favour of a different one, to more effectively address the new clinical need as recovery progresses. The choice of materials can also vary and techniques should be modified for the most effective and efficient treatment.


18


BOX 1: CONTRA-INDICATIONS TO THE USE OF TAPING TECHNIQUES


Do NOT tape if: ■ The assessment is inadequate or incomplete ■ The diagnosis is uncertain ■ There is joint instability ■ There is a possibility of fracture ■ There is extreme swelling and/or irritation of the skin.


Be very cautious if: ■ There is poor skin sensation/poor circulation ■ There is an allergy to adhesives/tape.


TABLE 1: COMMON TAPING TERMINOLOGY Anchors:


3


The first strips of tape to be applied. Subsequent pieces of tape are anchored to these. Anchors minimise traction on the skin.


Support strips:


Consist of stirrups and horizontal or Gibney


strips. Stirrups restrict unwanted sideways movements while horizontal strips add stability.


Reinforcing Add tensile strength to strategic areas to strips:


restrict movement.


Check reins: Limit range-of-movement during activity. Locking


strips:


Secure the cut ends of EAB or secure check reins in place.


Heel locks: Add additional support to the talo-crural, sub-talar and/or the mid-tarsal joints.


4


Prior to using taping the therapist should be able to answer the following questions:


■ What is the clinical reason for taping? ■ What does the tape application need to achieve? ■ What materials can do this? ■ What techniques can do this? ■ What other management is required, or being implemented?


This can help to narrow the choices available and focus thinking towards which materials and techniques would be the best to use.


APPLYING TAPE Learning to handle the materials and to apply taping techniques competently takes time. Supervision is required in the early stages to help develop good practical handling skills and clear reasoning. This is usually best met by attending a practical workshop(s) and by working alongside experienced practitioners who can provide critique and valuable tips. As each technique is relatively individ- ual, attention to specific application advice is often required. A general guideline for safe application is given in Box 2. Finally, all techniques need regular practice to develop and retain consisten-


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