1) A clinician must always receive verbal consent from the patient prior to the application of the tape.
2) The patient may be asked the following questions in order to minimize the risk of skin irritation due to the tape:
• Are you allergic to tape?
• Does your skin get irritated when you use an
* Do you know if you have extra sensitive skin?
3) If the answer is “yes” to any of the above questions,it may be wise to apply tape to a small test patch first and re-assess the effects of the test patch on the skin at the next treatment session.
4) If indicated, shave the area to be taped, as hair will limit the effectiveness of taping.
5) If there is residual lotion or oil on the skin, the tapes will not stick.The skin area must be washed or wiped off with an alcohol swab before tape application.
6) Usually, a hypo-allergic tape is applied on the skin to minimize the potential risk of skin irritation related to taping.These tapes are generally white in colour.The white tape is applied over the skin with only a small amount of tension. When the white tape is applied, it is necessary to firmly rub it on to the skin.To maximize its effectiveness, ensure adherence of tape edges.
7) The second tape that is applied over the white tape must be a non-stretch /rigid tape for optimum results.These non-stretch tapes are generally brown in colour. These tapes are not generally applied directly to the skin due to their strong cause skin irritations, especially on attempts to remove them.
8) To get the most durability out of the brown tape, firmly rub the surface areas; ensure that the corners don’t loosen with time.
9) For many of the techniques, taping effectiveness may be improved if the skin is’wrinkled up’ while applying the brown tape (NOT when applying the white tape). This is referred to as ‘soft-tissue unloading’.
10) Following the application of the white and the brown tapes, small anchors may be applied using small pieces of tape at the distal and proximal ends of the tape to further secure the edges of the tape.
11) Simply adding anchors with both the white and the brown tapes can dramatically increase the strength and durability of the tape.The end result should look like an “I”.
12) Immediately following the application of the tape, ask the patient to perform the activity that consistently reproduces their symptoms (e.g. walking, stair climbing, lifting arm overhead, gripping, etc.). As a general rule the patient must report at least a 50% improvement in symptoms post taping to confirm effectiveness.
13) Depending on the exact type of tape used, the patient may be instructed to leave the tape on for up to one week. The average time is 2-3 days.
14) As long as the tape has been securely applied, patients can be assured that it will not come off with showering
15) Patients must be informed that if they feel the tape is aggravating their symptoms, it should be immediately removed. The tape is to be left on ONLY if it ‘feels good’.
II) Patients must be informed to remove the tape if they feel itchy, hot, or feel any kind of skin irritation.
17) Clearly explain to the patient that the tape is not a cure or a substitution for exercising.The tape is, however, like training wheels on a bicycle and will be discontinued once muscular control is regained.
18) The tape is likely to loosen if the patient performs vigorous activities.
19) As a general rule it is easier on the skin to keep the tape applied for a few days rather than take it off and re-apply each day over the same skin region.
20) For those who admit to having sensitive skin, the risk of skin irritation can be minimized by applying a thin coating of milk of magnesia over the skin.Allow the milk of magnesia to dry for one minute, and then apply the white tape over the whitened skin.The negative side is that the tape does not stick to the skin as well with this method. Milk of magnesia can be purchased from most pharmacies.
21) During tape removal, always pull in the direction of the hair.As the tape is being pulled away, the other hand is to gently pull the skin away.This helps to minimize discomfort and hair loss.
22) NEVER tape over an open wound or already irritated skin.
Indications For Therapeutic Taping
A) To help correct biomechanical abnormalities related to pain e.g. Abnormal foot pronation, Excessive anterior humeral head translation
B) To help prevent the recurrence of a dysfunction following mobilization and/or manipulation techniques e.g. Thoracic taping post extension mobilization / manipulation
C) To help accelerate tissue repair by temporarily supporting and unloading injured soft-tissues e.g. Supraspinatus tendonitis / partial tear Plantar fasciitis
D) To help temporarily support hypermobile segments or joints e.g. Sacro-iliac joint hypermobility and pain Patellar hypermobility syndrome
E) To help unload stress and reduce pain from hypertonic / over-active muscles
e.g. Upper fibres of trapezius overuse / increased tone Tensor Fascia latae / ITB overuse
F) To help restrict and limit potentially aggravating postures and movements e.g. Lumbar flexion and rotation for low back pain
Elbow extension and pronation for “Lateral Epicondylalgia”
G) To help facilitate muscle activity, in order to increase the effectiveness of therapeutic exercises e.g. Patello-femoral taping to activate vastus medialis obliques
H) To help relieve acute perfuse myofascial pain e.g. Whiplash Associated Disorders.
Possible Therapeutic Effects of Taping
1) Proprioceptive feedback
2) Soft-tissue unloading effect
3) Neural tissue unloading effect
4) Bracing effect
Therapeutic taping may “pull” on the skin towards an undesired direction during movement.This sometimes-annoying “pull” contin¬ually reminds the patient of the movement or the posture that they are to temporarily avoid. The proprioceptive feedback function of the tape should be felt immediately following its application
e.g. Taping the popliteal fossa to control habitual knee hyperextension Taping the thoracic spine for postural correction
Soft-Tissue Unloading Effect
Perhaps the most valuable effect of therapeutic taping is related to the soft-tissue unloading effect. For many taping techniques, the underlying skin is “wrinkled” or convolutions of the skin are formed. It is hypothesized that these convolutions increase the space between the skin and the underlying tissues. This may decrease pressure / compressive forces on the nociceptors directly deep to the skin. The soft-tissue unloading and pain-relieving effect of the tape should be felt immediately following its application.
e.g. Taping the patella to unload tissues for medial patellar pain Taping the sacro-iliac joint to unload the overlying tissues
Neural Tissue Unloading Effect
Individuals presenting with mechanosensitive neural tissues are often instructed to avoid postures and movements that lengthen the sensitized peripheral nerve. For example, individuals with sciatic nerve irritation are commonly instructed to avoid lumbar flexion; individuals with brachial plexus irritation are instructed to avoid cervical side flexion away from the painful side. Unfortunately, simply educating individuals on avoiding these aggravating postures and movements is often of limited value.
Many patients benefit from taping as it provides them with proprio-ceptive feedback and may also help decrease traction forces placed on the sensitized neural tissues. Unloading the overlying soft-tissues may indirectly unload mechanosensitive neural tissues. The neural tissue unloading and pain-relieving effect of the tape should be felt immediately following its application
Taping Gluteal Muscle to help Unload the Sciatic Nerve
Taping the lateral elbow to unload the radial nerve
Therapeutic taping may be temporarily used in order to physically limit peripheral joint or spinal mobility. Sometimes individuals require complete rest from movement for a few days in order to allow soft-tissue healing to occur.
If the patient only temporarily benefits from the bracing effect of the tape, then a long-term solution must be found.This includes the use of orthotics or various supportive braces that can simulate the bracing function of the tape.
e.g. If taping to limit subtalar joint pronation is effective, think orthotics.
If taping to limit lumbar flexion and side flexion is effective, think lumbar corset.
Maximizing the Tape Adhesiveness
One of the most common challenges of taping is the fact that it can loosen with movement and functional activities. This often occurs following taping techniques to the foot, the knee, and the lumbar spine. If the tape is no longer firmly adhering to the skin, its effectiveness is dramatically reduced.
One method of dealing with this problem is to use an adhesive skin spray such as Tuf-Skin® prior to the application of the tape. Tuf-Skin® is commonly used prior to athletic taping; however, it may also be used just as effectively prior to therapeutic taping. Although spraying can considerably increase tape adhesiveness, it can also increase the risk of skin irritation to the patient.
In our personal experience and those of our colleagues, allergy to Tuf-Skin® is not very common, but is possible. Therefore, it is imperative to inform the patient of the potential risk of skin irritation prior to the application of the tape and especially when using a skin spray.
For taping procedures involving the lower extremities or the lumbar spine, the spray may simply be applied directly over the skin region. However, for taping procedures at the cervical spine or the shoulder, the spray should be applied to the actual white tape instead of the skin. This is to prevent the risk of accidentally spraying into the patient’s face or eyes. This will also help minimize inhalation of the spray, especially when taping the neck and shoulder regions.
Lightly spraying the tape instead of the skin also prevents needlessly spraying skin regions that will not be taped. The spray is quite sticky and annoying if applied over regions that will not in fact be covered up with tape. The spray can be washed off with soap and water upon tape removal.
Ref: A CLINICAL MANUAL ON THERAPEUTIC TAPING FOR PERIPHERAL & SPINAL SYNDROME (PART I)
Author: BAHRAM JAM, M. PHTY, B.SC.P.T