Introduction to Taping and Bracing

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Introduction to Taping and Bracing
Introduction to Taping and Bracing
2-7-06

• Art and Science Come Together

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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

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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.

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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.

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Athletic Tape, Cloth and Wraps

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

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Athletic Tape, Cloth and Wraps

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

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Athletic Tape, Cloth and Wraps

• Biomechanical
• Luekotape
• Cover Roll
• Proprioceptive
• Kinesiotape
• Water proof
• Size
• Color

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Athletic Braces

• Rigid
• Off the shelf
• Custom

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Athletic Braces

• Soft Goods
• Off The Shelf
• Custom

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TR Moldable Shell Materials

• Orthoplast
• Aquaplast
• Perforated
• Non-perforated
• Silicone
• Impact
• OSI
• Aquagel

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Non-TR Moldable Materials

• Polypropylene
• Carbon Fiber
• Uni-directional
• Bi-directional
• Laminant
• Lexan
• Kevlar
• PVC

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Casting Materials

• Fiberglass
• Fiberglass Soft
• Sizes
• Cast Padding Options
• Drywall tape
• Brace components

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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?

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State Laws

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

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Applications

• Anchors
• Stirrups
• Horseshoes
• Figure 8
• Heel Locks
• Fans
• Spicas

• Cover Strips
• Modified Heel Lock
• Locking Strips
• Check rein
• Underwrap
• Pressure Pad

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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!

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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.

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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.

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Shoulder

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

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Elbow

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

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Wrist Hand

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

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Thumb/Fingers

• UCL
• Volar
• Rigid Orthosis
• Oval 8
• Stax
• Frog
• Sleeves
• Custom Gloves
• Cutter Gloves

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Thorax

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

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Low Back

• LSO
• Boston Braces
• SI Bracing

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Hip Flexor

• Theraband Assisted
• Wrap
• Strap

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Hip Pointer

• Mechanical
• Functional

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Adductor

• Strap
• Wrap
• Pressure pad
• Adductor Hip Flexor

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Hamstring

• Theraband Assisted
• Wrap
• Sleeve
• Tape
• Backplaster

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Quadriceps

• Wrap
• Sleeve
• Tape

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Knee

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

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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.

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Classifications

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

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Review of the Literature
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Lower leg Shin

• Taping
• Padding
• Rigid Padding
• Achillies/Gastroc Theraband Assisted
• Peroneal Theraband Assisted

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Ankle

• Peroneal Tendon Sublaxation
• Prophalactic/Preventative
• Achillies
• Rigid Bracing
• Soft Goods
• Stirrup Braces
• Orthoplast Stirrups
• AFO

• Mulligan Post. Tib
• Muslin Wrap
• Ankle vs Achillies?

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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

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Head, Neck and Face

• Helmet modifications
• Face Protection
• Dental
• Ear
• Nasal
• Neck Collars
• Bullock
• McDavid
• Firestorm

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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

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Genitals

• Cups
• Bra Cups
• Neoprene Shorts

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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

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Budgeting

• Elastic Tape
• Non-elastic Tape
• Wraps
• Underwraps
• Padding
• Adherent
• Heel and Lace Pads

• Skin Lube
• Tape remover

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Out-Sourcing

• Brace Reps
• O P
• National Labs
• Academic Departments

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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

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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

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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

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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

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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