Taping for Collateral and Taping for Collateral and Rotary - - PowerPoint PPT Presentation

Taping for Collateral and Taping for Collateral and Rotary Insufficiencies of Rotary Insufficiencies of the Knee the Knee

Chuck Whedon, MS, ATC, CSCS Chuck Whedon, MS, ATC, CSCS Coordinator of Athletic Training and Sports Medical Services Coordinator of Athletic Training and Sports Medical Services Rowan University, Glassboro, NJ Rowan University, Glassboro, NJ

Introduction Introduction

• For the past fifteen years I have studied the needs and manageme

For the past fifteen years I have studied the needs and management of the nt of the unstable knee. unstable knee.

• Not until I sustained a grade two medial collateral ligament sp

Not until I sustained a grade two medial collateral ligament sprain while rain while wrestling competitively did I actively pursue an effective strap wrestling competitively did I actively pursue an effective strapping ping technique. technique.

• Available techniques reviewed and tested and have been found eit

Available techniques reviewed and tested and have been found either too her too restrictive or offering insufficient support. restrictive or offering insufficient support.

• I have talked with a number of professionals, some of which prof

I have talked with a number of professionals, some of which profess that ess that taping of the knee is ineffective. taping of the knee is ineffective.

• For ACL injuries, this may be the case, but with most others, th

For ACL injuries, this may be the case, but with most others, the author e author must disagree. must disagree.

• While some injuries may need to be augmented by bracing (another

While some injuries may need to be augmented by bracing (another controversial area) knee taping has a viable place in sport medi controversial area) knee taping has a viable place in sport medicine. cine.

• During these years I tested, modified and settled on a knee stra

During these years I tested, modified and settled on a knee strapping pping technique which has proven to provide an effective balance betwe technique which has proven to provide an effective balance between en restriction and support. restriction and support.

Rationale Rationale

• The rotary support technique is based on the fact that

The rotary support technique is based on the fact that virtually all knee injuries have some rotary virtually all knee injuries have some rotary component to their mechanism. component to their mechanism.

• The taping position and strapping technique take into

The taping position and strapping technique take into account these mechanisms related to injury and re account these mechanisms related to injury and re-

• injury.

injury.

• Attention must be paid to both positioning and

Attention must be paid to both positioning and tension at specific points to maximize effectiveness tension at specific points to maximize effectiveness and comfort, as well as the acceptable state of healing and comfort, as well as the acceptable state of healing for the technique to be successful. for the technique to be successful.

Supplies needed Supplies needed

• Spray adherent

Spray adherent

• Heel and lace pads

Heel and lace pads

• 2" white tape

2" white tape

• Heel prop

Heel prop

• 3" high

3" high-

• tensile elastic

tensile elastic tape tape

• Skill and practice

Skill and practice

Application technique Application technique

Place the knee in a position Place the knee in a position

• pposite to the causative
• pposite to the causative

mechanism: mechanism:

• For medial collateral

For medial collateral ligament sprains and ligament sprains and suspected medial meniscus suspected medial meniscus pathology, the tibia should pathology, the tibia should be held in a internally be held in a internally rotated position with the rotated position with the ankle slightly inverted. ankle slightly inverted.

• This produces a

This produces a varus varus load, load, slacking the MCL. slacking the MCL.

Skin preparation/Anchors Skin preparation/Anchors

• Spray adhesive is applied in the

Spray adhesive is applied in the traditional fashion, as are two heel and traditional fashion, as are two heel and lace pads in the lace pads in the popliteal popliteal fossa fossa. .

• Padding may be used to additionally

Padding may be used to additionally reduce friction. reduce friction.

• Pre

Pre-

• taping wrap may be used, but is not

taping wrap may be used, but is not recommended, especially on the thigh, recommended, especially on the thigh, as this will promote slippage, and as this will promote slippage, and compromise the effectiveness of the compromise the effectiveness of the taping application. taping application.

• Four to six adhesive straps are placed as

Four to six adhesive straps are placed as anchors using standard 1 1/2" or 2" anchors using standard 1 1/2" or 2" white tape from one inch above the white tape from one inch above the superior patellar pole to mid superior patellar pole to mid-

• thigh.

thigh.

• Three to five adhesive straps are placed

Three to five adhesive straps are placed as anchors using standard 1 1/2" or 2" as anchors using standard 1 1/2" or 2" white tape from one inch inferior to the white tape from one inch inferior to the tibial tibial tuberosity tuberosity to mid to mid-

• calf.

calf.

• Elastic tape can serve as anchors if

Elastic tape can serve as anchors if constriction is a concern. constriction is a concern.

Hyperextension straps Hyperextension straps

• Optional

Optional – – used when used when terminal extension is terminal extension is pathogenic. pathogenic.

• Two to three straps of

Two to three straps of white tape are crossed white tape are crossed

• ver the
• ver the popliteal

popliteal fossa fossa, , superior to inferior to superior to inferior to prevent hyperextension. prevent hyperextension.

Elastic strap # 1 Elastic strap # 1

• Beginning on the unaffected side

Beginning on the unaffected side (lateral) above the patella, apply (lateral) above the patella, apply a 2 to 3" strap of high a 2 to 3" strap of high-

• tensile

tensile strength elastic tape ( one likely strength elastic tape ( one likely not to rip, especially with the not to rip, especially with the heavy flexion demands of heavy flexion demands of wrestlers). wrestlers).

• This is angled inferiorly along

This is angled inferiorly along the lateral patellar border and the lateral patellar border and across the lateral joint line across the lateral joint line (drawn tautly), around the (drawn tautly), around the posterior calf (drawn loosely posterior calf (drawn loosely-

• complete slack).

complete slack).

Elastic strap # 1 Elastic strap # 1

• The strap is then drawn

The strap is then drawn tightly up across the tightly up across the tibial tibial tubercle over the tubercle over the medial joint line and medial joint line and along the medial along the medial patellar border of the patellar border of the affected side. affected side.

Elastic strap #2 Elastic strap #2

• The second elastic support

The second elastic support strap begins superior to the strap begins superior to the patella, following the patellar patella, following the patellar border across the affected border across the affected joint line (drawn tautly). joint line (drawn tautly).

• Again loosely (complete

Again loosely (complete slack) around behind the calf, slack) around behind the calf, and then across the and then across the tibial tibial tubercle, along the finish of tubercle, along the finish of the first elastic strap on the the first elastic strap on the affected side, overlapping it affected side, overlapping it by 1/2 the width, (drawn as by 1/2 the width, (drawn as tautly as possible). tautly as possible).

Elastic Strap # 3/closure Elastic Strap # 3/closure

• The third elastic strap

The third elastic strap serves both as the final serves both as the final collateral support and a collateral support and a spiral closure. spiral closure.

• Trace the origin as strap #

Trace the origin as strap # 2 and overlap by 1/2 the 2 and overlap by 1/2 the tape width. tape width.

• Draw tautly across the

Draw tautly across the joint line, loosely across joint line, loosely across the posterior calf, and the posterior calf, and spiraled upward. spiraled upward.

Closure Closure

• The tape should be

The tape should be

• verlapped by 1/2
• verlapped by 1/2

width to assure width to assure complete coverage. complete coverage.

• The closure should

The closure should be secured with be secured with white tape at mid white tape at mid thigh thigh

Application technique Application technique-

• lateral

lateral

• For lateral collateral ligament

For lateral collateral ligament sprains, or suspected lateral sprains, or suspected lateral meniscus pathology, this meniscus pathology, this positioning is reversed: tibia positioning is reversed: tibia externally rotated with the externally rotated with the ankle slightly ankle slightly everted everted. .

• This, along with traditional

This, along with traditional knee flexion achieved via a knee flexion achieved via a heel prop will allow for heel prop will allow for enhanced compression of the enhanced compression of the target compartment. target compartment.

• The

The valgus valgus load will slack the load will slack the LCL. LCL.

Elastic strap # 1 Elastic strap # 1-

• lateral

lateral

• Beginning on the unaffected

Beginning on the unaffected side (medial) above the side (medial) above the patella, apply a 2 to 3" patella, apply a 2 to 3" strap of high strap of high-

• tensile strength

tensile strength elastic tape . elastic tape .

• This is angled inferiorly

This is angled inferiorly along the patellar border and along the patellar border and across the lateral joint line across the lateral joint line (drawn tautly), around the (drawn tautly), around the posterior calf (drawn posterior calf (drawn loosely loosely-

• complete slack).

complete slack).

Lateral Elastic strap # 1 Lateral Elastic strap # 1

• The strap is then drawn

The strap is then drawn tightly up across the tightly up across the tibial tibial tubercle over the tubercle over the lateral joint line and lateral joint line and along the lateral along the lateral patellar border of the patellar border of the affected side. affected side.

Lateral Elastic strap #2 Lateral Elastic strap #2

• The second elastic support

The second elastic support strap begins superior to the strap begins superior to the patella, following the patellar patella, following the patellar border across the lateral joint border across the lateral joint line (drawn tautly). line (drawn tautly).

• Again loosely (complete

Again loosely (complete slack) around behind the calf, slack) around behind the calf, and then across the and then across the tibial tibial tubercle, along the finish of tubercle, along the finish of the first elastic strap on the the first elastic strap on the lateral side, overlapping it by lateral side, overlapping it by 1/2 the width, (drawn as 1/2 the width, (drawn as tautly as possible). tautly as possible).

Lateral Elastic Strap # 3/closure Lateral Elastic Strap # 3/closure

• The third elastic strap

The third elastic strap serves both as the final serves both as the final collateral support and a collateral support and a spiral closure. spiral closure.

• Trace the origin as strap #

Trace the origin as strap # 2 and overlap by 1/2 the 2 and overlap by 1/2 the tape width. tape width.

• Draw tautly across the

Draw tautly across the joint line, loosely across joint line, loosely across the posterior calf, and the posterior calf, and spiraled upward. spiraled upward.

ACL Deficiencies ACL Deficiencies

• Ah

Ah – – the white whale. the white whale.

• A combination of mostly

A combination of mostly medial but also lateral medial but also lateral straps can be used to straps can be used to provide support to the provide support to the ACL deficient knee. ACL deficient knee.

• Bracing may also be

Bracing may also be used, and this technique used, and this technique has been used effectively has been used effectively to allow selected players to allow selected players to finish their careers. to finish their careers.

Summary Summary

• While no taping technique will work for all athletes

While no taping technique will work for all athletes (some complain of restriction or unresolved (some complain of restriction or unresolved symptoms), this technique has proved successful in symptoms), this technique has proved successful in the vast majority of cases. the vast majority of cases.

• It has proved superior to bracing alone in most cases,

It has proved superior to bracing alone in most cases, and has been used effectively along with both "de and has been used effectively along with both "de-

• rotation" and lateral knee braces, especially in the

rotation" and lateral knee braces, especially in the sub sub-

• acute phases of injury.

acute phases of injury.

• I hope that by sharing this technique, others may

I hope that by sharing this technique, others may enjoy a tool in the management of the often enjoy a tool in the management of the often challenging unstable knee. challenging unstable knee.