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Introduction to Taping and Bracing

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Title: Introduction to Taping and Bracing


1
Introduction to Taping and Bracing
Introduction to Taping and Bracing
2-7-06
  • Art and Science Come Together

2
History of Bracing
  • 4th century BC, Hippocrates alludes to splinting
    - bracing of lower extremity injuries with
    instability
  • Adams, FR The Genuine Works of Hippo crates.
    Translated from Greek, with preliminary discourse
    and annotations. New York, William Wood, 1891
  • 1st century AD, noted Greek physician Galen
    discusses bracing methods to permit mobility
    following destabilizing injuries of the joints of
    the lower extremity.
  • Galen On The Usefulness of the Parts of the
    Body. 2 vols. Translated, with introduction and
    commentary by MT May. Ithica, Cornell University
    Press, 1968

3
Role of Taping and Bracing
  • Psychomotor Objectives Pertinent to Athletic
    Taping and Bracing
  • PreventionAppropriate selection, fabrication and
    application of preventive tape and wraps,
    splints, braces, and other special protective
    devices consistent with sound anatomical and
    biomechanical principles.
  • Rehabilitation Applying tape, bandages and wraps
    as well as special protective devices such as
    braces, splints, and pads.

4
Purposes of Taping Bracing
  • Support the ligaments and capsule of unstable
    joints by limiting excessive or abnormal
    anatomical movement.
  • Enhance proprioceptive feedback from the limb or
    joint.
  • Support injuries to the muscle-tendon units by
    compressing and limiting movement.
  • Secure protective pads, dressings and splints.

5
Athletic Tape, Cloth and Wraps
  • Non-elastic Tape and Cloth
  • Size
  • Fiber Count/Quality
  • Color
  • Price
  • Other
  • Moleskin
  • Backplaster

6
Athletic Tape, Cloth and Wraps
  • Elastic Tape and Wraps
  • Size
  • Length
  • Fiber Count
  • Density
  • Rodeo Wrap
  • Other
  • Pressure pads
  • Theraband assisted

7
Athletic Tape, Cloth and Wraps
  • Biomechanical
  • Luekotape
  • Cover Roll
  • Proprioceptive
  • Kinesiotape
  • Water proof
  • Size
  • Color

8
Athletic Braces
  • Rigid
  • Off the shelf
  • Custom

9
Athletic Braces
  • Soft Goods
  • Off The Shelf
  • Custom

10
TR Moldable Shell Materials
  • Orthoplast
  • Aquaplast
  • Perforated
  • Non-perforated
  • Silicone
  • Impact
  • OSI
  • Aquagel

11
Non-TR Moldable Materials
  • Polypropylene
  • Carbon Fiber
  • Uni-directional
  • Bi-directional
  • Laminant
  • Lexan
  • Kevlar
  • PVC

12
Casting Materials
  • Fiberglass
  • Fiberglass Soft
  • Sizes
  • Cast Padding Options
  • Drywall tape
  • Brace components

13
Is there a place for taping or bracing?
  • Know the athlete.
  • Know the rules of the sport (NCAA website)
  • Assess the injury
  • Educate on the role of exercise
  • Augment with OMT
  • Set Criteria for return to play.
  • Do you have a qualified person for application?
  • How will you educate your staff on what you know?
  • Is your team bound by any contractual obligations?

14
State Laws
  • Board of Medicine Standards
  • Who, What and When
  • National Federation Casting Rules

15
Applications
  • Anchors
  • Stirrups
  • Horseshoes
  • Figure 8
  • Heel Locks
  • Fans
  • Spicas
  • Cover Strips
  • Modified Heel Lock
  • Locking Strips
  • Check rein
  • Underwrap
  • Pressure Pad

16
Taping Rules
  • The majority of taping is for ligament
    instability.
  • Always use proper positioning.
  • Always use proper skin preparation.
  • Use as little underwrap as possible.
  • Minimal tape for maximum support.
  • Always follow sound taping principles.
  • Starting angles are the most important aspect.
  • Do not waste tape.
  • No Spatting!

17
Skin Preparation
  • Dry and free of oils.
  • Preferably shaven.
  • Protect high stress areas.
  • Beware of allergies.
  • Treat hot spots early.
  • Use skin adherent when possible.

18
Removing Tape
  • Care should be taken not to damage the skin.
  • Do not attempt to cut along bony prominences.
  • Tape should be removed using a slow controlled
    motion directed in the opposite direction of the
    tape.
  • Make sure to support the skin when removing the
    tape.
  • Be careful with chemicals, scissors and other
    devices designed to remove tape.

19
Shoulder
  • AC Tape/Pad
  • Shoulder Spica
  • Impingement
  • Sawa
  • Sully
  • Dj strap
  • Rigid Orthosis
  • Shoulder Pad Modifications
  • Theraband Assisted

20
Elbow
  • UCL
  • Hyperextension
  • Olecranon Pad
  • Custom Brace
  • OTS Soft Brace
  • Rodeo Tape Job
  • Hockey Pad

21
Wrist Hand
  • Hyperextension
  • Rigid Orthosis
  • Dj Wrist wrap
  • Custom Gloves
  • Cutter Gloves
  • Impact
  • Boxing Tape job

22
Thumb/Fingers
  • UCL
  • Volar
  • Rigid Orthosis
  • Oval 8
  • Stax
  • Frog
  • Sleeves
  • Custom Gloves
  • Cutter Gloves

23
Thorax
  • Rib Belt
  • Padding
  • Rigid Padding
  • Protective Bras
  • Protective Clothing
  • Sternum

24
Low Back
  • LSO
  • Boston Braces
  • SI Bracing

25
Hip Flexor
  • Theraband Assisted
  • Wrap
  • Strap

26
Hip Pointer
  • Mechanical
  • Functional

27
Adductor
  • Strap
  • Wrap
  • Pressure pad
  • Adductor Hip Flexor

28
Hamstring
  • Theraband Assisted
  • Wrap
  • Sleeve
  • Tape
  • Backplaster

29
Quadriceps
  • Wrap
  • Sleeve
  • Tape

30
Knee
  • Hyperextension
  • MCL
  • Tendonitis
  • PFS
  • Rigid Orthosis
  • OTS Soft Goods
  • Tracking Soft Goods

31
History of Knee Bracing
  • 1960 - 70s - Nicholas and Castiglia of Lenox
    Hill Hospital developed the Lenox hill Derotation
    knee brace for professional football player Joe
    Namath.

32
Classifications
  • 1984 - American Academy of Orthopaedic Surgeons
    categorized knee braces
  • Prophylactic knee braces
  • Rehabilitative braces
  • Functional knee braces
  • Unloader/offloader braces

33
Review of the Literature
34
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35
Lower leg Shin
  • Taping
  • Padding
  • Rigid Padding
  • Achillies/Gastroc Theraband Assisted
  • Peroneal Theraband Assisted

36
Ankle
  • Peroneal Tendon Sublaxation
  • Prophalactic/Preventative
  • Achillies
  • Rigid Bracing
  • Soft Goods
  • Stirrup Braces
  • Orthoplast Stirrups
  • AFO
  • Mulligan Post. Tib
  • Muslin Wrap
  • Ankle vs Achillies?

37
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38
Foot/Toes
  • Moleskin Turf Toe
  • Moleskin Arch
  • Turf Toe
  • Air Cast
  • Night Splints
  • C Splint
  • Heel Cups
  • Toe Caps
  • Mid Foot
  • Arches
  • Orthotics
  • Shoe Modifications
  • Upper
  • Sole
  • Carbon Fiber Inserts
  • Full
  • Mortons extension

39
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40
Head, Neck and Face
  • Helmet modifications
  • Face Protection
  • Dental
  • Ear
  • Nasal
  • Neck Collars
  • Bullock
  • McDavid
  • Firestorm

41
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42
Eye Shields
  • NCAA Rules
  • Types
  • Medical Necessity
  • 1999 26 requests
  • 2000 63 requests
  • 2001 93 requests
  • 2002 169 requests
  • 2003 288 requests
  • 2004 298 requests
  • 2005 402 requests
  • Tinted Contacts
  • Polycarbonate Goggles

43
Genitals
  • Cups
  • Bra Cups
  • Neoprene Shorts

44
Materials
  • Velcro
  • Assorted Hardware
  • Paint
  • Glue
  • Thinner
  • Pattern Paper
  • Roller
  • Strapping materials
  • Rivet Gun
  • Oven
  • Scissors
  • Grease Pen
  • Sharpie
  • Heat Gun
  • Tongs
  • Clamps
  • Cold Spray
  • Drill/Bits

45
Budgeting
  • Elastic Tape
  • Non-elastic Tape
  • Wraps
  • Underwraps
  • Padding
  • Adherent
  • Heel and Lace Pads
  • Skin Lube
  • Tape remover

46
Out-Sourcing
  • Brace Reps
  • O P
  • National Labs
  • Academic Departments

47
Timeline of Return to Play
  • 10-8-05 DOI, Radiographs, Parental Involvement
    Meeting
  • 10-9-05 DOS, Report to Parents, Examine
    protective options (design and materials)
  • 10-10-05 First Cardiovascular Workout, Cast mold
    for splint taken
  • 10-11-05 Initiate PT (ROM), Report to parents,
    Fit splint, Begin Bone Stimulator, Calcium
    Supplementation
  • 10-12-05 Initiate RROM
  • 10-13-05 Modified Practice (foot work, receiving,
    handoffs), Modify Splint, Start Hydrotrack
    Workouts
  • 10-16-05 25lb Hammer curls in WR
  • 10-17-05 Athlete feels Good about strength
  • 10-18-05 Hand Dynometer testing, Full ROM25lb
    curls in WR, push ups
  • 10-19-05 Remove Staples
  • 10-22-05 Full Practice
  • 10-27-05 Started vs Boston College

48
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49
THANK YOU!
50
Additional References
  • Acierno S, Ambrosia C, Solomonow M, et al
    Electromyography and Biomechanics of a Dynamic
    Knee Brace for Anterior Cruciate Ligament
    Deficiency. Orthopedics Vol. 18, No. 11, November
    1995 Alexander H In Search of the Perfect ACL
    Brace. The American Journal of Orthopedics April
    1995 Anderson K, Wojtys E, Loubert P, et al A
    Biomechanical Evaluation of Taping and Bracing in
    Reducing Knee Joint Translation and rotation. The
    American Journal of Sports Medicine Vol. 20, No.
    4, 1992 Bagger J, Ravn J, et al Effect of
    Funcitonal Bracing, Quadriceps,and Hamstrings on
    Anterior Tibial Translation in Anterior Cruciate
    Ligament Insufficiency A Preliminary Study.
    Journal of Rehabilitation Research and
    Development Vol. 299-12, 1992 Beck C, Drez D,
    Young J, et al Instrumented Testing of
    Functional Knee Braces. The American Journal of
    Sports Medicine Vol. 14, No. 4, 1986 Beynnon
    BD, Johnson RJ, Fleming BC, Peura GD, Renstrom
    PA, Nichols CE, Pope MH The Effect of Functional
    Knee Bracing on the Anterior Cruciate Ligament in
    the Weightbearing and Nonweightbearing Knee The
    American Journal of Sports Medicine, Vol 25, No
    3, 1997 Beynnon B, Pope M, Wertheimer C, et al
    The Effect of Functional Knee-Braces on Strain on
    the Anterior Cruciate Ligament In-Vivo. The
    Journal of Bone and Joint Surgery, Vol 74A, No 9,
    October 1992 Branch T, Hunter R, Donath M
    Dynamic EMG Analysis of Anterior Cruciate
    Deficient Legs With and Without Bracing During
    Cutting. The American Journal of Sports Medicine
    Vol. 17, No. 1, 1989

51
Additional References
  • Branch T, Indelicato P, Riley S, et al Kinematic
    Analysis of Anterior Cruciate Ligament-Deficient
    Subjects During Side -Step Cutting With and
    Without a Functional Knee Brace. Clinical Journal
    of Sports Medicine 386-94, 1993 Cook F, Tibone
    J, Redfern F A Dynamic Analysis of a Functional
    Brace for Anterior Cruciate Ligament
    Insufficiency. The American Journal of Sports
    Medicine, Vol. 17, No. 4, 1989 DeVita P, P,
    Hunter P, Skelly W Effects of Biomechanics of a
    Functional Knee Brace on the Biomechanics of
    Running. Medicine and Science In Sports and
    Exercise 1992 DeVita P, Torry M, Glover K, et al
    A Functional Knee Brace Alters Joint Torque and
    Power Patterns During Walking and Running. J
    Biomechanics Vol. 29, No. 5, 1996 Erickson A,
    Yasuda K, Beynnon B, et al An In Vitro Dynamic
    Evaluation of Prophylactic Knee Braces During
    Lateral Impact Loading. The American Journal of
    Sports Medicine Vol. 21, No. 1, 1993 Hunter L
    Braces and Taping. Clinics in Sports Medicine
    Vol. 4, No. 3, July 1995 Jonsson H, Karrholm J
    Brace Effects on the Unstable Knee in 21 Cases.
    Acta Orthop Scand 61(4), 1990 Knutzen K, Bates
    B, Hamill J Knee Brace Influences on the Tibial
    Rotation and Torque Patterns of the Surgical
    Limb. The Journal of Orthopaedic and Sports
    Physical Therapy Vol. 6, No. 2, 1984 Langevoort
    G,Maehlum S, Jorgensen U, et al Biomechanical
    Funtional and Subjective Evaluation of Braces in
    Handball. Presentation Second Congress of the
    Medical Committee of IHF Vienna 1995

52
Additional References
  • Liggins B, Bowker P A Quantitative Assessment of
    Orthoses for Stabilization of the Anterior
    Cruciate Ligament Deficient Knee. Proc Instn Mech
    Engrs Vol. 25, 1991 Liu S, Mirzayan R Current
    Review Functional Knee Bracing. Clinical
    Orthopaedics and Related Research Vol. 317,
    August 1995 Malone T, Friedhoff G Knee
    Bracing The Prophylactic Knee Bracing Debate.
    Biomechanics/Physical Therapy May 1997 Marans
    HJ, Jackson RW, Piccinin J, et al Functional
    Testing of Braces for Anterior Cruciate
    Ligament-Deficient Knees. Canadian Journal of
    Surgery April 1991 Regalbuto M, Rovick J,
    Walker P The Forces in a Knee Brace as a
    Function of Hinge Design and Placement. The
    American Journal of Sports Medicine Vol. 17, No.
    4, 1989 Styf J, Lundin O, Gershuni D Effects
    of a Functional Knee Brace on Leg Muscle
    Function. The American Journal of Sports Medicine
    Vol. 22, No. 6, 1994 Vailas J, Pink M
    Biomechanical Effects of Functional Knee Bracing.
    Sports Medicine 15 (3) 210-218, 1993 Volpi P,
    Melegati G, Cawley P Biomechanical, Functional
    and Subjective Assessment of a New Functional
    Knee Brace for Team Sports. J Sports Traumatol.
    Rel. Res. Vol. 17, No. 2, 1995

53
Additional References
  • Walker P, Kurosawa H, Rovick J External Knee
    Joint Design Based on Normal Motion. Journal of
    Rehabilitation Research Vol. 22, No. 1, 1985
    Warming T, Jorgensen U The Effect of Braces on
    Knee Extension Force in Patients with Anterior
    Cruciate Ligament Insufficiency. Acta Orthop Scan
    (Suppl 272) 67, 1996 Wichmann S, Martin D
    Bracing for Activity. The Physician and Sports
    Medicine Vol. 24, No. 9, 1996 Wojtys E, Kothari
    S, Huston L Anterior Cruciate Ligament
    Functional Brace Use in Sports. The American
    Journal of Sports Medicine Vol. 24, No. 4, 1996
    Wojtys E, Loubert P, Samson S, et al Use of
    Knee-Brace for Control of Tibial Translation and
    Rotation. The Journal of Bone and Joint Surgery
    Vol. 72-A, No. 9, 1990 Zvijac J, Ricco A,
    Tjin-A-Tsoi E, et al Measurement of Strains in
    Knee Orthosis During High Performance Activities.
    Presentation AOSSM Orlando, Florida 1996 top
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