Medical Chronicle recently presented a free, one-hour, product webinar on the facts about specialised sports strapping and when to use brace support. This webinar was sponsored by Essity and was presented by physiotherapist Riali Roos. The following is based on her presentation.
To watch a replay of this webinar, go to: https://event.webinarjam.com/go/replay/494/kr4vrb8xixguv7u1. Please note this webinar is not for CPD points
Sports taping is defined as the process of applying tape directly or over an under-wrap to the skin to maintain optimal joint positioning.
The indications include:
- Acute injury
- Protection (immobilisation), ice and compression
- Pain relief
- Allow optimal healing
- Subacute phase
- Additional support to the injured area and protection to further injury
- Limit unwanted movement allowing stability
- Injury prevention
- Prevent re-injury
- Player confidence.
Benefits of sports taping
Sports taping reduces pain and aids in recovery. It reduces strain on the affected muscle and muscle groups, and prevents harmful range of motion. Dynamic support allows optimal joint positioning and postural positioning (correct joint alignment), as well as supporting hypermobile joints
It enhances biomechanical postures and restores mobility through proprioceptive feedback. Corrected mobility = less pain.
It normalises muscle function, allowing for recovery form overuse injuries and other injuries, offering tension variety over an affected area, with an immediate result.
It is patient- and injury specific (adjustable), improves the clinical outcome and facilitates rehabilitation. It gives treatment between treatments, resulting in a faster return to sport/ normal activities.
The therapeutic effect is psychological structural and neurosensory. Conscious awareness and the perception of stability creates activity without fear.
The mechanical support provided by tape gives continued and uninterrupted stimulation. It creates enhanced postural and protected range of motion, protecting the healing tissue. It stimulates structural adaption and improves posture and abnormal biomechanics.
Selection of tape
- Understand the aim and reason why you are taping the specific patient
- Chose the appropriate size for the injured limb and size of the athlete
- Choose the appropriate tape size for the specific patient.
- Understand the sporting code.
- Rigid taping (Leuko P) and Fixomull provide high adhesive power and tensile strength, strong backing, and secure fixation even under stress
- Sports tape: High adhesive power, rigid cloth, secure fixation under stress, adheres firmly to the skin and under-wrap
- Elastic adhesive bandage (EAB): Made from high-quality extensive cloth, maintains the stability of injured joints and ligaments, remains firmly in place, central line for accurate overlapping
- K-tape: Allows skin to breath and sweat to evaporate, good adhesion, well tolerated by skin, supports lymphatic drainage, enhances proprioception, helps to reduce pain, improves active range of motion.
Pre-taping and bracing assessment
Answer the following questions:
- Has the injury been assessed thoroughly?
- What is the comparable sign?
- Do you understand the mechanism of injury?
- Which structures are damaged – understand the anatomy?
- What tissue/area needs protection and support?
- Which movements needs to be restricted (normal biomechanics)?
- Is it an acute or chronic injury?
- Is immobilisation required at this stage?
- What is the main purpose of the taping and or bracing?
- Are you familiar with the taping technique or brace is used (principles)?
- Will the patient be comfortable with the taping and or brace?
- Do you understand the sporting code?
- Do you have the suitable material or brace at hand?
Check if the patient is allergic to tape (ask). Apply an under-wrap if the patient is allergic (Fixomull). Remove excessive hair – avoid shaving immediately before taping, rather use a clipper to remove excessive hair. Check if there are any open skin wounds or broken skin – cover open wounds or broken skin. Wash/dry the skin adequately – remove all oils or creams to allow adhesion of the tape (ensure that the area is clean). Also ensure that the skin in dry before taping.
Ensure that the patient and therapist is in a comfortable position – avoid fatigue. Place an injured ligaments in a shortened position before applying the tape and uninjured ligaments in a neutral position before applying the tape.
Use the correct tape, width and amount when applying the tape. Apply the strips of tape in a sequential order. Unroll the tape first to ensure equal tension. Apply even pressure – position the limb instead of pulling on the tape. Apply the tape smoothly and remove creases to prevent skin irritation and blistering. Flow with the shape of the limb. Educate the patient explaining the function of the tape and how it should feel. Ensure that the tape and or brace is functional and comfortable following application. Assess your comparable sign – you should have immediate relief (assess before a match).
Immediately remove the tape if the skin around the tape becomes painful, itchy, red or if there is any blisters (allergic reaction), clean the skin, dry it and asses the skin if the allergic reaction continues, refer to a medical practitioner, do not reapply the tape until the skin reaction has resolved. Remove the tape if it aggravates the patient’s symptoms. Remove the tape and or brace if it is too tight – loss in normal skin colour and pins and needles experience by the patient. Never ever rip tape off, remove the tape carefully by peeling the tape pack on itself and pushing the skin away from the tape. Pull the tape carefully along the axis of the limb. The tape may be softened in cold water beforehand to aid in removal, Leuko tape remover, oil or any oil based cream can be used to aid in tape removal. Check the skin for any broken skin or blisters. Apply lotion to restore skin moisture.
Sports tape should be removed immediately after participating in sport, avoid leaving tape on. Rigid taping can stay on for 24 hours, and K-tape 3-5 days. Prolonged use of tape can cause skin irritation (red and painful skin). Patient education is key.
Contact dermatitis is the most common local skin reaction in response to the tape’s adhesive or caused by a high tensile strength is applied while taping. The tape can also slacken over a relative short period of time, therefore you will need to re-tape to maintain effect, irrespective if the injury site is painful or not
Braces are useful for acute injuries, chronic conditions and prevention of injury, pain reduction, management of swelling, immobilisation, stabilisation, post-surgical usage and protection against injuries or re-injury. They can be used in mild sprains or strains, contusion, overuse syndromes, joint degeneration (mild arthritis).
There is good evidence to support the use of braces, they are relatively low cost and have few adverse effects.
The effectiveness of brace support depends on the type of material used, the patient’s joint stability and previous injuries. Studies have concluded that off-the-shelf braces have the ability to provide up to 20%-30% more resistance to lateral blows to the knee, with custom-fitted braces providing even better protection. However, another study also indicated that braces may affect some performance parameters adversely, depending on the type of brace and the experience and strength of the patient. Bracing seems to be used more as a means of protecting current injuries and less as a means of preventing injuries.
Advantages: It is a cost- and time-effective method of providing support to ligaments and joints. It may provide a degree of protection to lateral blows to the knees. They are quick and easy to put on and comfortable to wear.
Disadvantage: They may adversely affect some performance paraments, especially in more inexperienced and less well-conditioned patients.
Different types of braces:
- Wrist braces
- Kids wrist stabiliser with removable metal stay
- Wrist carpal stabiliser with pre-shaped metal stay
- Adjustable wrist support
- Arthritic wrist support
- Knee braces
- Kids knee support with open patella
- Adult knee support with open patella
- Ankle braces
- Ankle support
- Ankle stabiliser with criss-cross straps (figure of 8).
- Instructions on the fitting (sizing) and care of the braces appear on the products
- Ensure that the brace has been well fitted and that it is comfortable
- Patients with a history of joint instability should undergo proprioception and appropriate strength training in addition to wearing a brace
- Brace according to the specific sports code’s rules
- The brace should be worn during both practice sessions and match play.
Riali Roos is a registered physiotherapist who graduated from the University of the Witwatersrand in 2012. Following her undergrad graduation, Riali completed her master’s degree in Sports Physiotherapy in 2017.
She has a special interest in musculoskeletal injuries and have travelled and worked extensively in the sport field since 2015. This includes:
- South African Wheelchair Basketball Physiotherapist – traveling to World Championships in 2016 (Toronto, Canada)
- University of Johannesburg Rugby (Assupol League)
- University of Johannesburg Rowing (USSA’s)
- University of Johannesburg Athletics (Varsity Cup and USSA’s)
- University of the Witwatersrand Rugby (Varsity Cup semi-finalists and USSA’s)
- University of the Witwatersrand Hockey (Varsity Cup semi-finalists)
- University of the Witwatersrand Soccer (Varsity Cup finalists)
Riali is also a member of:
- The Health Professional Council of South Africa (HPCSA)
- South African Society of Physiotherapy (SASP)
- The South African Sports Medicine Association (SASMA).
Riali’s main aim is to drive quick recovery of her patients, so they can resume their normal way of life without major pain and injury. This applies both to those suffering a sports injury, or something as simple as sitting at a desk all day.