MANUAL THERAPY By Ron Alexander, soft tissue therapist

TRADITIONAL USE OF TAPE IN INJURY MANAGEMENT Acute injury Conventionally taping is used for a number of reasons during the rehabilitation process. In the acute stage the overarching goal is to provide support and protection through the reduction of swelling, limita- tion of unwanted range of movement and the reduction of pain. Further injury can be prevented while the appropriate rehabilita- tion process can be facilitated to allow optimal return to function (1).

Chronic injury Taping is also widely used in the manage- ment of more chronic injuries such as patellofemoral pain syndrome although its proposed and actual mode of action remains questionable (2). What has been consistently demonstrated is the ability of taping to alter the pain response in presenting patients. This change in pain allows immediate functional gains in a previously painful movement. This can both encourage the patient to exercise and, possibly more importantly, allow these movements to be performed in a pain free environment. This difference in the use of tape in a more 'chronic' prob- lem, with the added advantage that the patient can reapply the tape themselves as needed, is a powerful rehabilitation tool.

Neuromuscular application The next development has been for tape to be used to increase or reduce muscle activity, to 'excite' or 'inhibit'. Commonly, the former taping is used around the shoulder to 'facilitate' the action and activity of the lower fibres of trapezius. This theory of action has been based on clinical observation and anecdotal evidence. Despite recent evidence ques- tioning its mode of action, it is still commonly used and extremely useful even though it isn't yet understood how this is achieved (3).

FUNCTIONAL FASCIAL TAPING The subtle alteration in the use of taping to off-load has also proved extremely useful. During my 8 years as the principal soft tissue therapist at the Australian Royal Ballet, I was under the common sports medicine practitioner's pressure to get my athletes back to fitness as quickly as possible. Recent studies have demon-

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FUNCTIONAL FASCIAL TAPING

This article reviews the topic of functional fascial taping. While there is little research evidence to support its effectiveness, anecdotal findings continue to impress. If you want to learn more, sign up for one of the workshops listed at the end of the article.

strated the high incidence of musculoskeletal injuries in this popula- tion, with over 75% of dancers reporting an injury during the 19 week trial period, with the majority of these confined to the foot or ankle (4). Through clinical experimentation in my chosen patient population group, I developed a highly effective way of using tape in acute, and especially, sub acute chronic injuries.

In conjunction with the normal assess- ment

and treatment process, it was

observed that direction-specific digital pressure applied over a painful area could alter the pain response. This alteration facilitated increases in pain free range and improved muscle function. These, often notable gains could be maintained by the application of tape using a specific gathering technique allowing the patient to rehabilitate appropriately and return to function earlier. With time it became apparent that this had application in virtually any musculoskeletal condition and has now been used in most sports internationally.

So how does it work? The idea of off loading is not new. The difference lies in the specificity of tape

BOX 1: TAPING CONTRAINDICATIONS

Allergic reactions to tape/sensitive skin - red hair, fair skin people are susceptible Soft skin Damaged or broken skin Thin skin (elastic tape) Sunburn Undiagnosed pathologies Conditions getting worse or not improving.

sportEX dynamics 2007;12(Apr):10-13

application in terms of technique, direc- tion, the amount and the width of tape used. The underpinning factor in its appli- cation being the sound clinical reasoning premise of test, apply tape and retest.

The theory underlying the action of tape has been questioned within the profes- sional literature (2). Whilst not supported by research evidence it is the belief of the author that local fascia provides the clue. The ultimate connectivity of the fascial system throughout the body has been repeatedly demonstrated, in conjunction with anecdotal evidence of the influence of local structures on the function of distant areas (5).

Fascia has three relevant characteristics: 1) it is a connective tissue 2) it is responsive to load 3) it contains an abundance of mechano- receptors and neural tissue.

In response to injury, the body lays down Type III collagen to return structural integrity to the area. With time this is converted to Type I collagen, however the structural alignment of the repaired tissue is altered from that of the original. Whilst locally applied soft tissue mobilisations