Tapping Book

I

Gontents

Intnoduction to Taping and Bnacing 1lnatomy As the Foundation to Taping and Bracing 1

BoleofTapingand Bracing 4

Xnowing the Sport, Athlete, and lnjury 8

heparing forTaping 9

Applying and Removing Tape 10

'**2 The Foot, Anlrle, and lcgAnkle Sprains 20

Achilles Tendon Strains and Tendinitis 31

Arch Strains and Plantar Fasciitis 33

Morton's Neuroma 36

Great-Toe Sprains 38

Heel Contusions 40

Shin Splints 40

Foot Orthotics 43

t5

,nor*, $ The l(neeCollateral and Cruciate Ligament Sprains

Knee Braces 55

Knee Hyperextension 56

PatellofemoralJointPain 57

4550

vl CONTENTS

Wrist Sprains 110

Thumb Sprains I 13

Finger Sprains 116

Tendon Ruptures and Avulsions 119

Glossary 121

Suggested Readings 123

About the Author 125

cilmftn4 The Thigh, Hip, and PeluisHip Strains 65

Thigh Strains 69

HipandThighContusions 72

"0"'* $ The $houlden and AnmAcromioclavicular Joint Sprains 80GfenohumeralSprains 87Arm Contusions 90

,n**,,* $ The El[ow and FonGaFmElbowSprains 95EfbowHyperextension 97Epicondylitis of the Humerus 100

,nur',r l The wnist and fland 108

Prelace

astering the art and science of athletictaping and bracing requires students ofathletic training to develop the psycho-

motor skills associated with the craft and learnthe scientiflc pdnciples that guide its application.Educators seeking to convey this dual emphasistace the daunting task of teaching students theanatomical architecture of the maior ioints andmuscle groups as wel l as speci l ic tap ing andbracing techniques associated with particulariniuries.

I wrcte Athletic Taping and Bracing, Second. Edi-fiori, as both a guide for instructors and an aid tostudents. The book includes concise descdptionsof anatomy and detailed anatomical illustrations(of the quality usually found in advanced anat-omy texts) integrated with discussions of injurymechanisms and nearly 400 photographs depict-ing the taping and bracing techniques for eachmaior joint and body region. I believe that thisapproach will not only encourage skill develop-ment but also help ensure familiarity with theunderlying anatomical landscapes.

Because exercise plays an equally importantrole in an athlete's safe return to comDetition. Ia lso inc lude a presentat ion of the basic s t retch-ing and strengthening exercises associated withspeciflc injuries. Although these exercises shouldnot replace other therapeutic methods, they canhelp the rehabilitated athlete maintain strengthand flexibility. The methods I present apply tothe athlete who has completed a rehabilitationprogram and met the criteria for returning tocompetition. My approach to this materialemphasizes that athletic taping and bracingand the associated exercises serve as an adiunct.rather than a panacea, to the athlete's total reha-bilitation. By using this multifaceted treatmentapproach we can minimize an athlete's chance ofreinjury. Be advised, however, that rehabilitationand therapeutic exercise are disciplines distinctfrom the treatments that I discuss in this book.

In chapter 1 I establish athletic taping andbracing (hereafter referred to generally as athletictaping) within the context of the multifaceted

practice of athletic training. The chapter stressesthe importance of learning anatomy as the foun-dation to athletic taping and understanding theeffect of taping on athletic performance. Stu-dents will also learn the necessity of followingthe rules of the governing sport organizationsfor the application of tape and braces.

In chapters 2 through 7 I address and illus-trate anatomy, injury mechanisms, taping andbracing techniques, and associated stretchingand strengthening exercises for each region ofthe body. Chapter 2 focuses on the foot-ankle-leg complex and, besides presenting severaltechniques for taping, describes how orthoticscan accelerate an iniured athlete's return tocompetition. Chapter 3 overviews the knee anddescribes the instabilities associated with lisa-ment in jury, as wel l as the ro le o[ prevent ive,rehabi l i ta t ive, and funcl iondl brac ing in in iurymanagement. Chapter 4 concerns the treatmentof hip and thigh inturies, and chapter 5 moveson to the anatomy and injury mechanisms forthe shoulder and arm. Chapter 6 presents thetechniques available to the clinician when treat-ing the elbow and forearm. Chapter 7 serves asimilar purpose for wrist and hand inturies whilealso presenting the method for splinting tendonruptures in the fingers.

In this four-color second edition you willflnd state-of-the-art il lustrations of anatomyand injury mechanisms, produced by PrimalPictures, Ltd. The quality of the photography isunsurpassed, and the edges ofthe tape have beendarkened for easier visualization of the tapingpatterns. Additions in this edition include thetechnique for making a protective pad fromorthoplast, McConnel taping for acromiocla-vicular joint iniurt and several variations tothe taping procedures illustrated in the book.Key palpation landmarks have also been identi-fled and illustrated.

Good luck as you embark on your journeyinto this exciting area of athletic training. Theclinician skilled in the alt and science of athletictaping quickly earns an athlete's confidence. But

v t l

PREFICE

becoming proficient at these skills is a challenge,and you should realize that achieving a highIevel of proficiency comes oniy after manyhours-even years-of practice. I urge you alwaysto visualize the underlying anatomy that you

need to support and the mechanism of iniurythat you seek to prevent. You may feel frustrationas you attempt to master these skills. But withconcentration and practice, you can becomehighly adept at athletic taping and bracing.

'$lJlI {J

lintn o;dturef iio;lili to:Taip;iimrg oinidi Bn€'cln,g

AilATl|MY AS THE FI|UNI|AIIIINTO TAPill|A ANI BRACITI|O

A sound understanding of human anatomy isnecessary for mastering the art and science oftaping and bracing. You must understand theanatomical structures that you are attempting tosupport with the application of tape or a brace.Anyone can learn the psychomotor skills requiredto tape (the art), but you must also understandthe link between the anatomical structure, themechanlsm of iniury, and the purpose for whichtape is applied, such as immobilization, Testrictionof motion, or support of a ligament or muscle (thescience). This book illustrates the most pertinentanatomical structures and mechanisms of iniuryfor each of the body parts that you will learn tosupport with tape or a brace. You should also beable to identify and palpate these anatomicalstructures through your understanding of surfaceanatomy, You will f,nd a list of the key palpationlandmarks in each chapter of the book.

You will also need to leam and adopt the useof anatomical terminology in describing theposition, planes, direction, and movement of thebody. The anatomical position is the reference

human anatomy-Study of structures and therelationships among structures of the body.

surface anatomy-study ofthe form andsurface of the body.

anatomical position-Erect position with thearms at the sides and palms of the handsfacing forward.

he National Athletic Trainers' AssociationEducation Council has identified 12 athletictraining educational competencies for the

health care of the physically active. To becomea competent athletic trainer, the student shouldperfect the cognitive, psychomotor, and affectivecompetencies integral to each domain. Thesethree abilities-which concern the developmentof knowledge, physical skill, and attitudes towardthe athlete and the sport or physical activity inwhich he or she is engaged-are also necessaryfor the application of tape and braces. For thatreason, I have structured the information ln thistext usins the 12 domains.

Athletic Training EducationalCompetencies for the HealthCare of the Physically Active

1. Risk management and injury prevention

2. Assessment and evaluation

3. Acute care4. General medical conditions and disabilities

5. Pathology of injury and illness

6. Pharmacological aspects of injury and illness

7. Nutritional aspects of injury and illness

8. Therapeutic exercise9.Therapeutic modalities

10. Health care administration1 1. Professional development and responsibilities

12. Psychosocial intervention and referral

Adapted,by permission,from National Ath €ti.nainets'A$ociatio,zoas,fhe 1 2Edu.ational Cahpetencies \anline). Available at wwwnataec.orglhtml/content

ATHLETIC TAPING AND BRACING

point for use of this terminology. The medianplane bisects the body into right and left halves,and any plane parallel to the median plane is thesagittal plane. The coronal plane bisects the bodyinto anterior (toward the front) and posterior(toward the back) portions. The transverse (axial)plane divides the body into superior (upper) andinferior (lower) parts.

ln describing the limbs, proximal (closer to)and distal (farther from) identify structures nearerto or farther from the attachment of the limb tothe torso. The position of the paired bones oftheextremities is often used to describe anatomlcallocation. For example, the thumb is on the radialside of the forearm, and the great toe is on thetibial side of the lower extremity. Palmer andplantar are used to describe the anterior surfacesof the hand and foot, respectively, and dorsal

Anatomical Posit ion

describes the other side in both the hand andfoot.

Specific terms also describe movements of thebody. Flexion means bending in a direction thatusually reduces the angle of a joint, and extensionis the opposite movement. Abduction means move-ment away from the midline, and adduction is theopposite motion. Rotation is movement of a bonearound its long axis, and it occurs in the medial(inward) or lateral (outward) direction. Joint-speciflc terms describe movements at the forearmand foot. Supination and pronation describe move-ment of the forearm to position the palm up anddown, respectively (with the elbow at 90'flexion).Inversion and eversion move the sole of the footinward or outward, respectivell Circumduction isa combination of movements at toints that permitsflexion, abduction, extension, and adduction.

lmaqecourtesy of Prlmal Pictures.

Tbe taping, n'rapping, and bracing techniquesfh 1'ou nill leam in this book are designed toTport and protect iniurie5 to rhe bonis, liga-Erts- tendons, muscles, nerves, and ioints of

Knee Joint

INTRODTJCTION TO TAPING AND BRACING

Shoulder Complex

the body. Some of the more common injuries forwhich you will apply tape and wraps are illus-trated throushout the text.

Coracoacromial ligament

Subacromial bursa

Transverse humeral

brach i i , lonq head

brachii, short head

HUmerus

lmage co!rtesy of Prlhal Pi.t!res

lmaqe courresy or Primal Pictures.

aATHLETIC TAPING AND BRACING

Clavicle

Sternum

Human Skeleton

Skul l

Cervicalvertebrae

Scapula

HUmerus

..; )

haqe courteiy or Primal P ctures.

RI|LE l|T IAPINS ANB BRACINEAlthough the National Athletic Trainers' Associa-tion's structure for the domalns of athletic train-ing lists taping as only one of several abilities nec-essary for athletic trainers to function effectively,it is one of the most important, and most visible,skills. You can quickly earn an athlete's confidencethrough proficient application of athletic tape.Learning to master this task, however, will be bothrewarding and frustrating. As with any psychomo-tor skill, taping requires a great deal of practicebefore one achieves excellence.

Ath let ic tap ing and brac ing can preventinjury or facilitate an injured athletes' return tocompetition. In general, the tape should limitabnormal or excessive movement of a sprainedjoint while also providing support to the musclethat the sprain has compromised. Many clinicians

attribute the value oftaping to the enhanced pro-pdoceptive feedback that the tape provides theathlete during performance. For example, athleteswho have injured the anterior cruciate ligamentand suffer from rotary instability in the knee mayreceive sensory cues from the brace before it limitsrotary movement. This early proprioceptive feed-back may enable the athlete subconsciously tocontract the muscles that control rotary instabil-ity. Similarly, athletes involved in volleyball andbasketball may receive sensory cues from a tapedankle that experiences inversion while airborne.

sprain-An overstretching (fi rst degree),partial tearing (second degree), or completerupture (third degree) of a ligament.

proprioception-Awareness of the position of abody part in space.

Rad iusLumbar vertebrae

Sacru m

INTRODUCTION TO TAPING AND BRACING

Athletic Training Educational Competencies Pertinent toAthletic Taping and Bracing

Risk Management and lnjury Prevention, Cognitive Domain; Describes the principles and

concepts relating to prophylactic taping, wrap-ping, and bracing and protective pad fabrica-tion.

> Psychomotot Domdlni Selects, fabricates, andapplies appropriate preventive taping and wrap-pings, splints, braces, and other special protectivedevices that are consistent with sound anatomi-cal and biomechanical principles.

r€pe, in this instance, can be more effective intro\.iding propdoceptive feedback than in actu-allv limiting excessive inversion.

Regardless of how tape and braces work, theyshould not substitute for exercise. Routine tapingof the ankle in the absence of preactivity exerciseprovides the athlete with substandard health care.For this reason, taping should work in coniunc-tion with stretching and strengthening tech-niques. As a matter of policy, you should tape orbrace only those athletes willing to comply withVour requests to attain and maintain optimal jointrange of motion and muscle strength.

Apparatus ofTaping and BracingA variety of tools are needed to cover the differ-ent taping and bracing needs of injured athletes.These include elastic (figure 1.1) or nonelastic(figure 1.2) athletic tape, cloth, wraps, and braces.Manufacturers produce and market athletic tapein many sizes and textures.

Purposes of Taping and Bracing> Support the ligaments and capsule of unsta-

ble joints by limiting excessive or abnormalanatomical movement.

> Enhance proprioceptive feedback from thel imb or jo in t .

> Support injuries to the muscle-tendon unitsby compressing and limiting movement.

> Secure protect ive pads, dress ings, andsplints.

> Affective Domaini Understands the values andbenefits of correctly selecting and using pro-phylactic taping and wrapping or prophylacticpadding.

Theropeutic Exercise> Cognitive Domain; Compares the effectiveness of

taping, wrapping, bracing,and other supportiveand protective methods for facilitation of safeprogression to advanced therapeutic exercisesand functional activities.

Nonelastic Tope and ClothUse nonelastic tape to provide optimal ioint sup-port and to restdct abnormal or excessive jointmotion. Fol example, nonelastic white tapeapplied directly to the ankle can prevent exces-sive inversion.

Figure 1.1 Application of elastic tape to support theknee.

t{


Nonelastic white tape is normally porous and isavailable in 15-yard (13.7-meter) rolls with widthsof 1, 1.5, or 2 inches (2.5, 3.8, or 5.1 centimeters).The size of the athlete, the anatomical site, and

Figure 1.2 Application of nonelastic tape to support thearch,

Figure l 3 A cloth wrap provides inexpensive anklesupport.The cloth wrap is also an excellent way to practicethe figure-eight and heel locktechniques presented inchapter 2.

the preference of the athletic trainer will dictatewhich width to use.

Although nonelastic tape provides the best sup-port, it has the disadvantage of being the mostdifflcult to use. When applying nonelastic whitetape you will find that the contours of the bodycan easily cause the tape to wdnkle. You will needa great deal of practice to master the smooth andeff,cient application of nonelastic tape.

Nonelastic cloth wraps can provide supportindependently or in combination with whitetape (figure 1.3). Cloth wraps, although not asconvenient as tape/ provide acceptable support atconsiderable cost savings; consider them if yourbudgetary resources are limited.

ElasticTope ond WrapsApply elastic tape or wraps to support body partsthat, unlike most joints, require great fteedom ofmovement. For example, when it is necessary tosupport the hamstdng muscle group by encirclingthe thigh, use elastic tape to permit normal musclecontraction without restdcting blood flow. Elastictape and wraps will also secure protective pads tothe body (figure 1.4). An athlete with thigh, hip,

Figure 1.4 An elastic wrap to secure a protective pad tothe anterior thigh.The metal clips used to fasten an elasticwrap should be covered with tape or removed for participation.

INTRODUCTION TO TAPING AND ERACING

'a 1i:,:{-;.r contusions often requlres this extra

Ir':-{i-: r:: I \rill discuss the technique further in&,r+::: { and 5.

::ni::i \\-raps prove especially useful whenryrF,--.--:: i compression to an area that has suf-Er:: .r:r acute injury. Compression, frequently:c::-.-rd r\-ith ice, helps control the swelling thatr: ::-ranies soft-tissue injuries (figure 1.5).

contusion-A bruise.

acute injury-A recent, traumatic injury.

Figure 1.5 (o) Elasti< wrap to secure an ice bag to the ankle. Apply theice directly to the skin for no longer than 20 minutes per hour (b) Theelastjc wrap can also be used in combination with a horseshoe pad toapply compression to an acutely sprained ankle.

When treating athletes with this technique,you should always advise them about the poten-tial dsks of applying elastic wraps to acute iniu-des that will, inevitably, swell. In particular, youshould warn the athletes to watch for signs ofrestTicted circulation by monitoring the color offingernail or toenail beds. A dark blue appearancein a nail bed indicates impaired circulation. If theelastic wrap is necessart be certain to remind theathlete to elevate the iniured joint and apply thewrap loosely if used at night.

Elastic tape, like nonelastic tape, comes intextures and widths for every body part. Elastict a p e c a n b e 1 , , 2 , 3 , o r 4 l n c h e s ( 2 . 5 , 5 . 7 , 7 . 6 , o t

10.2 centimeters) wide. Elastic wrapsmay have widths of 2, 3, 4, or 6 inches(5.L,7 .6,70.2. or 75.2 centimeters); theyare also available in double lengths toaccommodate large body areas, such asthe hip and trunk. Elastic wrap qualityvaries. Because you reuse elastic wraps,unlike tape, you could save money bybuying the bette! often more expen-sive, product. The cheaper, low-qualitywraps do not work well for continuedreapplication.

Protective Devices inCombinqtion With Tope andWrapsProtective splints and pads are fre-quently used to limit motion, protect abody part, or dissipate forces away fromthe injured area. Athletic tape and wrapscan often be used to hold the protectivesplints and pads in place. The protectivematedals include foam, felt, thermoplas-tics, thermofoams, and other materialssuch as flberglass, silicone rubber, andneoprene. The book will provide selectedexamples of these protective materialsand the use of tape and wraps to holdthem in place.

Athletic BrocesBraces prevent injury to healthy iointsand support unstable ioints. A vadety ofbraces is available in the athletic mar-ketplace. In fact, you can find a bracefor every ioint of the bodt although,for athletic purposes, you will mostcommonly need to apply braces forthe ankle, knee, shoulder, elbow, and

IATHLETIC TAPING AND BRACING

wdst. I will not supply a comprehensive reviewof braces; I will focus, instead, on those used totreat common ligament injufies in the ankle andknee, and overuse injuries in the elbow and wdst.ln addition, I provide illustrations for ankle, knee,wdst, elbow and shoulder braces in their respec-tive chapters.

Braces can supplement or replace athletic tape.Some braces, such as those for the ankle, cansave money because, unlike athletic tape, theyare reusable. Braces, however, can be expensive.Functional knee braces, for example, cost ftom$500 to $700.

IOOWIIIIG THE $PI|RT, ATHI.ETE,AND INJURY

To become an effective athletic trainer you mustlearn both anatomy and the mechanisms ofiniury and mastel the psychomotor tasks forappropriate athletic taping. In addition, youshould understand the rules of the sport regard-ing taping and bracing and the needs of yourindividual athletes.

Regulation of Taping and Bracingin SportMost governing athletic associations regulate thedegree of restriction you can provide throughtaping and bracing as well as the matedals thatyou use to protect an injured part. They enforcethese mandates because the application of tapecan give the wearer an unfair advantage duringcompetition, especially in sports such as wrestling.Protective devices and braces can also iniure otherparticipants. Most associations prohibit hard andinflexible materials unless you cover them with asoft, pliable padding.

Sport associations also regulate the manage-ment of athletic injuries during organized com-petition. Wrestling, for example, permits only ashort time to treat an injured athlete. Many othersports require you to remove the athlete ftomcompetition, regardless of the severity of theinjury. You must also follow universal precautionsif the athlete is bleeding, so you should becomevery familiar with these procedures. These andother rules affect how you evaluate an injuredathlete and apply a blace 01 tape. I advise you toconsult the guidelines ofyour appropdate goven-ing organization, such as the National Collegiate

Athletic Association or a state or regional highschool athletic association.

Knowing the AthleteSome athletes cannot pedorm with even a smalldegree of restricted movement, whereas othersdo quite well with a great deal of limitation. Asignificant amount of restriction on the handsand fingers of a football offensive or defensivelineman may not inhibit the athlete's perfor-mance. ln contrast, the same, or lesser, degree ofrestriction would dramatically compromise thedexterity of a quarterback or receiver. Taping ashot-putter's ankle requires you to use a tech-nique different from the one you apply whensuppofting the ankle of a sprinter. These exam-ples show that to master the art and science oftaping, you must understand the different needsof your athletes.

Examining and Treating the InjuryYou must have a thorough mastery of injuryassessment and rehabilitation to taoe and braceef lecLive ly , inc luding knowing when i t is safe toreturn an athlete to practice and competition.

lnjury ExaminationUnder no circumstance should you tape or bracean athlete's injury without first knowing theinjury mechanism and its underlying anatomi-cal structure. By undentanding the mechanism ofinjury you will be able to apply tape in a mannerthat will help prevent further damage. To deter-mine the iniury mechanism and know whetherthe injury is acute or chronic, you must obtain anathlete's history. Be systematic in your evaluationby using the injury assessment protocol on page9. For more information on injury assessmentconsult the reading list at the end of the book,which includes an excellent text that addresseshow to evaluate musculoskeletal iniulv.

Role of ExerciseAs an athletic trainer, you must do more than tapeor brace an iniured athlete; you have a responsibil-ity to provide the athlete with appropriate stretch-ing and strengthening exercises. Preventing injuryor eliminating its recurrence will be possible onlywhen the athlete has achieved normal strength,flexibility, and range of motion! I discuss in thisbook exercises that require minimal equipment.Have the rehabilitated athlete who has met the

INTRODUCTION TO TAPING AND BRACING

#3?tJ€#i{iilf fi J€\nfiF€€g'$?,3vff'{&?"ct^Grr:-j:r strength and flexibility. Criteria for Returning an

Crl)sio for Returning to Competition Injured Athlete to ComPetition

r"r:':-'-ish taping procedures facilitate an athlete's:e-:= to physical activiry these adiunctive mea-i::.-. ao not substitute for the athlete's preinjuryr.-::.-:onal ability. When athletes suffer an upper--E ,.irer-extremity injury, they should possess;-=:rqth, flexibility, and range of motion com-li=:rle to the uninjured side before continuingr--::: the sport. If the injury involves the lower.-r- -:emit\', test the athlete on functional activities'::: include running and cuttins. For example,ij: sthlete displaying an antalgic gait, with or11 :rout tape, should not return to competition.

mechanism of injury-Describes the specificcause ofthe injury.

chronic injury-A nontraumatic injury of anongoing nature.

antalgic gait-A painful or abnormal walking orrunninq pattern.

Injury Assessment Proto(ol

> Obtain the athlete's history relating to themechanism of injury.

> Inspect the area for swelling and deformity.

> Palpate the part for abnormalities.

> Assess the act ive range of mot ion- theathlete's willingness to move the part.

> Determinethe passive range of motion-yourability to move the part while the athleteretaxeS.

> Evaluate the resistive range of motion-theath lete's abilityto contract the muscles aboutthe part.

> Apply special tests to assess the integrity ofthe ligaments of the joint.

> Always compare your findings with the unin-jured extremity!

PREPARING FIIR TAPINOTaping should occur in an environment thatmaximizes your effectiveness. Because you will

> The in jured area has regained normalst rength, f lex ib i l i ty , and range of mot ionwhen compared with the uninjured side.

> The athlete performs functional tests, such asrunning,cutting,and other agility exercises,atfull speed without limPing.

> The athlete's psychological condition dem-onstrates wi l l ingness and enthusiasm toreturn.

devote many houn to this psychomotor task, youwill optimize your clinical taping skills by pre-paring yourself, your facility, and your athletes.Your preparation and the athlete's cooperationare essential.

Taping EnvironmentMaintain the cleanliness and professional appear-ance ofyour taping area. It should have adequateillumination and ventilation. Because heat andhumidity make it difficult to apply tape, storeyour supplies in a cool environment.

Your work wi l l requi re you to spend manyhours performing psychomotor skills. There-fore, construct the taping envi ronment and usea taping table to ensure your comfort. Tapingtables d i f fer f rom t reatment tab les. In genera l ,treatment tables are 72 inches (183 centimeters)long and 30 inches (76 centimeters) high; tapingtables should be approximately 48 inches (122

centimeters) long and 35 inches (89 centimeters)high, depending on the clinician's height'

When t ravel ing wi th a team, arrange an ade-quate facility for pregame taping. Taping from abus seat or hotel bed can turn this pleasurableroutine into an arduous and painful process.

Gender ConsiderationsAthlet ic t ra in ing has at ta ined the staLus o[ anallied health profession, and athletes should betreated in a coeducational environment. In mostpractice settings you will care for both male andiemale athletes. Taping an opposite-gender ath-Iete rarely presents any difficulry but you shouldalways protect your athletes' pdvary. For example,the female athlete should wear a halter top or iog

10 ATHLETIC TAPING AND BRACING

Figure 1.6 Attentive athlete during ankle tapjng. Note how the athletesits with the ankle held at 90o.

to be properly clothed before enteringthe locker room to fulflll your tapingresponsibilities. Should time becomea consideration, have the taping tableremoved from the locker room to anadjacent area. You can then tape yourathletes while the remainder of the teamdresses for competition.

Preparation andCooperation of the AthleteAthletes should sit or stand and payattention when you tape the iniuredarea (figures 1.6 and 1.7). An inattentivea lh le le who is s louch ing or rec l in ing onthe taping table will fail to maintain theiniured body part in an appropdate ana-tomical position. A sagging ankle or limp

wrist will quickly cause you frustration and com-promise the effectiveness of your procedure.

Before applying tape, make certain that the areais clean and, ideally, free of hair. Keep a barber'sclipper handy in your taping area.

You may use an additional adherent whenapplying tape-many are available commer-cially-but it is not necessary if the body part isclean, shaved, and dry. When tape contacts boneprominences and muscle tendons, the resultingftiction often produces blisters. To maximize theathlete's comfort, apply friction pads with lubri-cant to these areas before using tape (figure 1.8).Pretaping underwrap may also prevent blistering,but it often causes the tape to slip (figure 1.9).For this reason, I recommend a minimal amountof underwrap, applied in coniunction with tapeadherent.

APPTYIIIIE ANI| REMl|UINff TAPTHere are several basic skills you must learn whenapplying and removing tape:

. Tearing tape: Although a seemingly simpletask, tearing tape will present your first chal-lenge. Developing this skill is often frustrating,particularly when your instructor prohibits youfrom using your teeth! To tear tape successfully,place your fingers close together at the site of theintended tear, pull the tape apart, and quicklysnap your fingers in opposite directions (figure1.10). If the tape becomes crimped or folded, itstensile strength increases exponentiallt and itwill be impossible to tear. If this occurs, move to

Figure 1.7 Attentive athlete during wrist taping. Notehow the athlete stabil izes the forearm while the athletictrainer applies tape to the wrist.

bra during shoulder taping, and you can applyelastic wraps over tights to the hip and groin inboth male and female athletes.

Team travel away from home occasionally cre-ates an inconvenience rnhen prepar ing an areafor pregame taping, and the difficulty sometlmesincreases when caring for opposite-gender ath-letes. You have the option of waiting for athletes

INTRODUCTION TO TAPING AND BRACING 1 1

Figure 1.8 Friction pads placed over bony prominenceso. areas prone to irritation from tape. Place these pads.ryer the tendons in the front and back of the ankle before:ping to prevent cuts and abrasions.

a different point along the edge of the tape andrn'again.

. Applying tape: Begin taping by first supply-ing anchors that will secure the subsequent strips(figure 1.11). As you apply the tapei overlap theprevious strip by one-half the width of the tape(figure 1.12). Whenever possible, tape from thedistal to the proximal points of an extremiryusing single stdps. Avoid continuously unwind-

Figure 1.9 Underwrap before tape application. For optimaladherence, apply the tape directly to the skin. For some ath-letes, however. underwrap can prevent irritation or rashes thatmay result from the prolonged contact of tape with skin.

ing the tape around an extremity because thistechnique mayproduce wrinkles and compromisecirculation.

distal-A point on an extremity located awayfrom the trunk.

proximal-A point on an extremity located nearthe trunk.

Figure 1.10 Tech-nique for tearing non-elastic tape. (q) Place thefingers close togetherand follow with a quicksnapping motion inopposite directions. (b)The tape should teatbut if it becomes foldedor crimped, move yourfingers away from thefolded area and tryagain.You can tearsome ela5tic tape withthe fingers, but you wil lneed to cut other typeswith scissors.

12 ATHLETIG TAPING AND BRACING

Figure 1.11 Application of anchor strips to start mosttaping procedures, i l lustrating anchor strips on theankle before taping. Note the potential for irritation overthe ankle tendons because of the absence of frictionpads.

. Removing Tape: Athletic trainers shouldbe sure to remove all tape at the conclusionof practices or games. Use surgical scissors orcommercially available tape cutters to cut thetape in an area with the least bone prominenceand greatest tissue compliance (figure 1.13). Pullback the tape with a slow gentle motion whilethe skin is compressed (figure 1.14). Tape-remov-ing agents are available to ease the process. Youshould monitor the skin for cuts, blisters, or signsof allergic reaction. Properly clean and dress cutsand blisters. If the athlete develops a rash, youwill need to find an altemative to treatins theiniury with tape.

I've included this general competency checklistto help instructors and students alike evaluate theknowledge, skills, and techniques necessary foreffective injury assessment and taping.

Figure 1.12 Overlapping strips oftape applied to the leg.Note how each strip overlaps the preceding strip by one-half the width of the tape.Tear each strip after applicationrather than apply the tape jn a continuous fashion. Contin-uously applying nonelastic tape usually produces wrinklesand can constrict blood flow and normal muscle function.Normallt you may apply elastic tape and elastic wraps in acontinuous manner.

The principles I have presented in this chapterwill prepare you for the speciflc treatments thatI discuss in the remaining chapters. Good luckas you begin your training in these gratifyingpsychomotor skillsl

Taping Competency Checklist

1 . Determines mechanism of injury: L ..l2. Ensures a clean,shaved body part: !3. Selects appropriate tape or wrap: !4. Properly positions athlete and body pan: E5. Correctly applies appropriate taping procedure: !6. Correctly instructs athlete on tape removal: n7. Ensu res the ath lete's com pliance with a ppropriate exercise reg imen: !

tgure 1.13 fdj Use surgical scissors with a blunt t ip or a:: p€ cutter to remove tape. (b) Cut the tape where it tends to!e loose because ofthe anatomical confiquration ofthe bodv

Figure 1.14 Appropriate removal oftape from skin. (a) Note how one hand supports the skin while the other fb) slowlyremoves the tape by pull ing in a direction exactly opposite the stabil ized skin.

13

'#

Cl|APTTR''-

the talus with the navicular creates the midtarsaljoint. The base of the five metatarsal bones andthe tarsal bones form the tarsometatarsal (TMT)

ioints, while the heads of the metatarsals andthe phalanges form the metatarsophalangeal

Navicular

5econd cuneiform

Third cuneiform

First cuneiform

r + "' \.- larsometatarsa I Jolnt

\ '+:: .\ \ i i i,

' ',, First metatarsal

l \ "',,\ \ f ' - ' . - . . r

i - * l '

n \ P h a r a n g e s

lf u-..=...-ri -r-f,,}

1 ' t

Th,G Foo,t,An,ltle, aril,d tgg

fqf,r contains a complex collection ofbts . Iigaments, and muscles. The 26 bonesddli ioot create several impotant joints. The

rnJ .alcaneus form the subtalar ioint, andt r:ir^mg of the calcaneus with the cuboid and

Bonesof the Foot

Fibula

lmage courtesy ofPrima Pi.tures.

1 5

1 6 ATHLETIC TAPING AND BRACING

(MP) joints. Each of the toes contains inteflrha-langeal io in ts-one in terphalangeal jo inL i ; lhegreat toe and a proximal (PIp) and distal (DIp)interphalangeal ioint in the remaining four toes.A multitude of small ligaments supports the jointsin the foot.

The bones of the foot also create two arches.The first, a longitudinal arch, appears along themedial border of the foot. Athletes with a Dro-nounced (h igh) iongi tudinal arch are pes cavus,whereas those with flat feet have a pes planusfoot. The second arch, formed by the heads of theflve metatarsal bones, is the transverse arch.

The foot contains four muscle layers, knowncollectively as intrinsic muscles. The most super-ficial layer, the plantar fascia, maintains the lon-gitudinal arch ofthe foot. The medial and lateralplantar nerves inn€rvate the intdnsic muscles.These nerves continue into the toes between themetatarsal heads as interdigital nerves and are acommon point of iritation in athletes.

medial-Toward the inside.pes cavus-A foot with a high longitudinal arch.pes planus-A foot with a flat longitudinal arch.intrinsic muscle-A muscle that originates and

inserts within the foot or hand.superficial-Toward the surface ofthe bodv.lateral-Toward the outside.innervation-The process ofsending a nerve

impulse from the central nervous system tothe periphery to induce a muscle to contract.

interdigital-Located between the digits (i.e.,the fingers and toes).

The articulation of the dlstal tibia and fibulawith the talus, known as the talocrural ioint,lorms the ankle. The ankle and foot move bvusing a combinat ion of the ta locrura l . subta lar ,and midtarsal joints. Ankle dorsiflexion andplantar flexion occur primarily at the talocru-ral joint; inyersion and eversion take place atlhe \ubla lar io in l ( f igure 2.1) . Foot abduct ionand adduction occur at the midtarsal joint.A combination (while non-weight bearing) ofankle dorsiflexion, eversion, and foot abductioncauses pronation; plantar flexion, inversion, andadduction result in supination.

articulation-The point where two or more adiacentbones create ajoint.

dorsiflexion-Movement ofthe foot toward theupper,or dorsal,surface.

plantar flexion-Movement of the foot toward thebottom,or pla ntar, su rface.

invelsion-lnward movemen! or turning, of the foot.eversion-Outward movemen! or turning, of the foot.abduction-Movement away from the midline of the

oooy.

addurtion-Movement toward the midline of thebody.

pronation-Movement ofthe forearm to place thepalm facedown; or, while non-weight bearing,acombination of dorsifl exion, eversion, and footabduction.

supination-Movement ofthe forearm to placethe palm faceup; or, while non-weight bearing, acomblnation of plantar flexion, inversion, and footadduction.

Figure 2,1(a/ Ankle plantarflexion and dorsi-f lexion ranges ofmotion; (b) ankleinversion andeve15ion range5of motion.

IHE FOOT, AI{KTE, ANO LEE 1 7

ligaments reinforce the ankle. On thethe anterior talofi bular, calcaneofibu-

d posterior talofibular ligaments prevenlinversion. The broad and expansive

ligament-a combination of four liga-des stability to the medial asDect

ankle and checks excessive eversion.klrinsic nuscles actins on the toes and

have their origin in the leg. The anteriortibialis anterior, extensor hallucis

extensor digitorum longus, and peroneusce dorsiflexion and toe extension.

L lateral muscles, consisting of the peroneusbgus and peroneus brevis, cause eversion. The-rp posterior-medial muscles, which include thelialis posterior, flexor hallucis longus, and flexor-dtomm longus, produce ilversion and toe flex-in- Plantar flexion occurs from the gastrocne-nius, soleus, and plantaris muscles, also known5 true posterior muscles. The gastrocnemius androleus ioil with the calcaneus to form the Achillestendon. The gastrocnemius and plantaris begin

lnterosseous membrane

HDUta

Anterior tibiofibular

Talocrural

Anterior talofibular I

Lateral malleolus

Fourth metatarsal

Fifth metatarsal

above the knee, but the soleus odginates in theleg. This distinction will be signiflcant dudng thediscussion of stretching exercises for the ankle.

The ankle contains several retinacula thathold the tendons of the extrinsic muscles to theleg as they cross the ankle and pass into the foot.The extensor retinacula will be relevant whenyou use tape to alleviate the discomfort of shinsplints.

anterior-The front or toD surface of a limb.

extrinsic muscle-A muscle that originates inthe leg or forearm and inserts into the footor hand.

origin-The point where muscle attachesto bone; usually refers to the proximalattachment of the muscle.

posterior-The rear or bottom surface of a limb.

retinaculum-A soft-tissue fi brous structuredesiqned to stabilize tendons or bones.

AnkleLigaments

Medial malleolus

Talus

Deltoid

Talonavicular

First metatarsal

Second metatarsal

Third metatarsal

Anterior-LateralAnkle

Peroneus lonqus

Peroneus brevis

Fibula

Anterior talofibular I

Calcaneofibular

Extensor m brevis

Peroneus brevis

Fifth metatarsal

Deltoid

Tibialis anterior

Extensor hallucis

Tibialis anterior

Extensor digitorum longus

Superior extensor retinaculum

Inferior extensor retinaculum

hage courteryotPrima Pictures.

Medial Ankle

Extensor hallucis

First dorsal interosseous

5oleus

Tibia

Plantaris

Tibialis

Ach i l les tendon

Flexor hallucis

Flexor retinaculum

Bursae of Achilles tendon

Abductor hallucis

Flexor diqitorum brevis

Flexor

Longitudinal arch

lmage co!rf€sy offt malP crures.

1 8

THE FOOT. ANKLE. AND LEG 1 9

ligament

Postefior Aspect> Achilles tendon> Gastrocnemius muscle> Soleus muscle

Plantar Surface> Plantar fascia> Transverse arch> Calcaneus

> First metatarso-phalangeal jo in t

Key Palpation Landmarks

Laterol Aspect> Anterior talofibular ligament> Calcaneofibular ligament> Posterior talofibular ligament

Mediol Aspect> Deltoid ligament> Longi tudinalarch

Anterior Aspect> Anterior tibiofibular Dorsal Surface

Surface Anatomy

Tibialis anterior

Medial malleolus

Sustentaculum tali

Abductor hallucis

of navicular

Head offirst metatarsal

lmagecourr€iyof Primal P ctures. (continued)

20

(continued)

Soleus

Achilles tendonExtensor

Short

SurfaceAnatomy

Abductor i t i min imi

ANKTE SPRAINSPhysical activity places excessive stress on the footand ankle and renders this region of the bodyhighly susceptible to injury. Ankle sprains will bethe most common injury that you encounter.

Anlde sprains result from excessive inversjonor eversion. Inversion sprains are more commonbecause of the bone and ligament conflSuratlonof the joint. The four ligaments of the deltoidcomplex are stronger than the three separate, lat-erally placed ligaments, and the mortise createdby the fibula extends more distally than the tibia.These factors limit eversion and account for thehigher incidence of inversion ankle sprains. Youcan support the sprained ankle by applying tape,braces, or a combination of the two treatments.

Closed Basketweave TapingBegin the closed basketvveave procedure by apply-ing anchor stfips and follow with a succession ofinterlocking vertical and horizontal strips. Com-plete the taping with one or more heel-lock stdpson the medial and lateral aspects of the ankle(flgwe 2.2). With an inversion sprain, start thevertical stdps on the medial side of the leg and

ATHLETIC TAPING AND BBACING

mage courresy of Primal Pictures.

Peroneus

Peroneus brevis

Lateral malleolus

Extensor hallucis brevis

Extensor itorum brevis

Peroneus tertius

Head of fifth metatarsal

base offifth metatarsal

Ligament

lmaqecourresy offt malP ctues,

THE FOOT, ANKLE. AND LEG 21

- :o the lateral aspect. For an eversion injury,::.r the veftical strips on the lateral leg and, :o the medial side. Note that horizontal and: ::.al strips pertain to the anatomical position- - ' < body { i .e . , s tanding ere( l .

a. aware that applying an anchor too tight.: -rnd the foot is the most frequent error with

this taping procedure. Because the foot spreadswhen supporting the weight of the body, a con-stdcting distal anchor can be extremely uncom-fortable for an athlete. Apply this anchor as closeto the ankle as possible. You can even omit it forathletes requidng greater dextedty.

Figure 2.2 Closed basketweave taping procedure for the ankle.The athlete holds the ankle in 90. of dorsif lexion. For edseof i l lustration, these photos do not show the use of friction pads. Place two anchor strips on (d) the distal leg and, possibly, (lr)around the foot. Because the foot anchors frequently cause constrictjon and discomfort, consider them optjonal.To prevenr orprotect jnversion sprains, (c) apply a stirrup strip from the medial aspect of the leg and pull under rhe heel to the lateral aspectofthe leg. For eversion sprains,the direction ofthe stirrup would be the opposite, from lateral leg to medial leg. place a hori-zontal horseshoe strip from the medial to lateral aspect of the foot and (d) follow by another stirrup in a weaving fashion. (e,f,)Continue this process unti lyou have applied three stirrups. (conttnued)

{

l

Figure 2,2 (continued) (9) completely enclose the leg with horizontal strips. (h, Apply heel locks to the medial and tateral aspects ofthe ankle in a single manner (application to the lateral side ofthe ankle is shown here). Note how to apply thelateral heel lock by pull ing in an upward direction. (k-n, A more advanced variation would incorporate heel locks in a figure-eight pattern. Note how to apply the lateral heel lock by pull ing in an upward direction and the medial heel lock by pu ing ina downward direction. kontinued)

22

THE FOOT, ANKLE, AND LEG

Figure2.2 (continued) (o)The final prod uct supports the ankle without constricting the dista I aspect of the foot. fp) You::n provide additional support with the application of a 2- or 3-inch (5.1- or 7.6-centjmeter) moleskin stirrup before applying:-e cLosed basketweave.

23

Taping Variations andAlternativesPurchase large rolls of cloth wrap that can be cutinto lengths of 72 inches (about 180 centimete$).

Combining the cloth wrap with a small amount ofwhite tape will provide adequate support (figure2.3). Cloth wraps do not work as well as nonelas-tic tape, but they are a reasonable, cost-effectivealternative.

Figure 2.3 Apply a cloth ankle wrap as a less expensive (although less effective) alternative to closed basketweave taping.Apply this procedure over a sock with the ankle positioned in 90o of dofsif lexion. First, (d-b) use a figure-eight pattern withheel locks incorporated in an upward direction for the lateral aspect and a downward direction for the medial aspect.

(continued)


You can also use the closed basketweave Droce-dure wi th a combinal ion of molesk in t f igu ie 2.2ror nonelastic and elastic tape (figure 2.4). This

Figure 2.3 (continued)(c-e)Trace with nonelastic tape.

altemative may be acceptable for athletes who wantsome protection but do not require the additionalsupport of an all-white taping procedure.

Figure 2.4 Nonelastic and elastic tape combination. For less support. (a-bJ use stirrups of nonelastic tape and apply both afi9ure-eight pattern and heel locks with elastic tape.

(continued)

Figure 2,4 (continued (c) Use elastic ta pe to encircle the leg com pletely to the a nchor strips;you then have the option ofrepeating the figure eight and heel locks with nonelastic tape. (d-f) A variation that would provide additional support usesnonelastic tape for all stirrup and horseshoe strips and then includes elastic tape to apply the figure eight and heel locks. fg-h)Elastic tape could complete the procedure, or you could repeat the figure eight and heel locks wjth nonelastic tape.

25


Open Basketweave TapingThis taping technique supports and compressesthe acute ly in jured an k le. A l lhough s imi la i to thec losed baskeLweave, the open technique Leavesthe dors[m of the foot uncovered (figure 2.5). Insome cases, you can cover the taping procedurewith an elastic l\,Tap to supply more compres-

sion. Instruct the athlete to remove the elasticwrap at night but to leave the taping procedurein place.

dorsum-The top ofthe foot or the back ofthenano.

Figufe2.5 Ankle open basketweave tapinq to compress and support an acutely injured ankle. (a) The procedure begrnswith proximal and distal anchors, but leave them open on the anterjor leg and the dorsum of the foot. (b, For an inversronsprain, pull the stirrup strips from the medial to lateral aspects of the le9. (c/ Apply the horseshoe strips in a manner similar tothe closed basketweave, giving special attention to leaving the anterioileg and dorsum of the foot open. (d-e) Apply stjrrupsand horseshoe strips to enclose completely the plantar surface of the foot and the posterior aspect oithe leg. uie singte neetlocks for (f) the medial and (9) lateral anrre.

Figure 2.5 (continued)(h-, Apply anchor strips to the anteriorleg and dorsum of the foot.0) Threehorizontal strips secure the procedure,although you should instruct the ath-lete to remove these strips if the anklebegins to ache from significant swell-ing. (k-m) Finally, apply an elastic wrapto secure the open basketweave andto offer additional compression to theacutely injured ankle. Remove the wrapwhen applying ice and when the athlete sleeps.

27


Because you apply the open basketweave tapingprocedure to support an acutely sprained ankle,you also may have to f,t and provide the athletewith crutches. The crutches should be fit so thatthey are 6 inches (15.2 centimeters) lateral andanterior to the feet and pelmit two to three fingerwidths of space between the axillae and the axil-lary pads of the crutches. The elbows should beflexed to about 20 to 30", and you should instructthe athlete to bear most of the weight with thehands, not in the axillae (figure 2.6).

Ankle BracesLace braces have become a popular substitute forankle tape, especially when a clinician is unavail-able (figure 2.7). These commercial supports canalso supplement the taping procedure. The brace,normally applied over the sock, often uses lateralstays for reinforcement.

Ankle ExercisesAnkle exercises should restore or maintain normalflexibility, strength, and balance. A loss of normalankle dorsiflexion often results from anklesprains. Athletes recovering ftom these injuriesshould stretch the ankle muscles and pay specialattention to the gastrocnemius and soleus.

Figure 2,5 An athlete with an antalgic gait should befitted with crutches.The hands, not the axil lae, shouldbear most of the weight.

Figwez.7 (o-b)Commercially avail-able ankle bracesthat are alternativesto taping.The bracepermits normal plantar f lexion and dorsif lexion while l imitingexcessive inversionand eversion.

THE FOOT. ANKLE, ANO LEG 29

..:ure 2.8 illustrates techniques for stretchlng- : -trstrocnemius and soleus muscles. Because the::'::ocnemius begins on the femut the athlete:. ): !tretches with the knee completely extended.

--: trthlete continues by repeating the exercise.:: the knee flexed. The flexed knee shortens

-,-.: {astrocnemius and isolates the soleus muscle,:.-cir odginates from the tibia and flbula. Using

. r.;edge board will also effectively stretch these:-,cles. The athlete can manually stretch the:.:raining ankle muscles. lnstruct your athletes: rerform static str€tching-a stretch without:- r\ ement for 10 to 15 seconds-for these andr-, e\ercises that I present in this book.

static stretching-Stretching a muscle in astationarY Position.

Strengthening exercises for the maior musclegroups acting on the ankle implement elasticbands. The athlete simply performs inversion,eversion, plantar flexion, and dorsiflexion againstthe resistance of the band (igure 2.9). The meth-ods for strengthening the ankle are similar tostretchine exercises. The athlete should executenlantar flixion with the knee both extended andflexed to isolate the Sastrocnemius and soleus,respectively. I suggest that the athlete completethree sets of at least 10 repetitions, with resis-tance adjusted to his or her tolerance, for all thestrengthening exercises in this book. The readinglist provides references to more sophisticated pro-tocols [or progressive re\istance exerci\e.

Figure 2,8 (a) Stretch-ing the gastrocnemiusleg muscle using a towel.The athlete should dorsif lex the ankle with hisor her own muscles anduse the towelto providean additional stretch.This stretch should alsocombine (b) ankle inversion and (c) eversionirepeat all three stretcheswith the knee flexedto 90o and with the leghanging over the endof the table to isolatethe soleus muscle. (d)Stretch the anteriorankle muscles by havingihe athlete manuallymove the ankle intoplantar f lexion.


Figure 2.9 Ankle strength-ening exercises with elasticmaterial. lvlove the ankle into(d] inversion, fb, eversion, fc)plantar f lexion, and (d) dorsl-f lexion against the resistanceofthe material. fe, Repeatplantar f lexion with the kneeflexed to 90.to isolate thesoleu5 muscle.

An ankle iniury will often corrrpromlse ana l h l e t e s b a l a n c e a n d p r o p r i o c e p L i o n . B a l a n c edevices are available to address these problems.You can a l :o t reat balance dnd propr iocept iondeficits by having the athlete stand on one legw i lh the eyes open a nd then c losed r f igu re 2. 1 0, .Increase the difficulty of this exercise by applyinglight pressure to the shoulders from four randomdirections when the athlete's eyes are shut.

THE FOOT. ANKLE. ANO LEG

qgure 2.10 Proprioceptive exercises for the ankle.The athlete begins by balancing on one leg with (aJ the eyes open and then fb)- : jed. (c-d) Increase the diff iculty by applying a l ight force from an unknown direction.The athlete must contract the leg muscles': -aintain balance.

ACHIttES IENIII|N STRAINS clinician should alleviate the athlete's discomfortby applying tape to limit excessive dorsiflexion.

ANIl TENl|INITISAchilles Tendon Taping

31

Running and jumping stress the Achilles tendon,the attachment of the gastrocnemius and soleusmuscles to the heel. Achilles tendon strainsand tendinitis are common athletic iniuries.Older athletes and those who are infrequentlyphysically active occasionally rupture this tendoncompletely.

Acute overstretching or a forceful contractionof the gastrocnemius and soleus muscles causesan Achilles tendon strain. Tendinitis tends to bean overuse iniurythat often occurs when athletesrun or jump extensively. With either iniury, the

strain-An overstretching (fi rst degree), partialtearlng (second degree),or complete rupture(third degree) of any component of the muscle-tendon unit,

tendinitis-lnflammation of a tendon or its sheath.

overuse injury-Chronic injury resulting fromrepetitive stress.

Determine the amount of dorsiflexion that pro-duces tendon discomfort. The athlete should

Achil lesTendinit is

ma9e courtesy of Prlmal Pict!re5.

32 ATHLETIC TAPING AND BBACING

slightly plantar flex and maintain this positionduring the procedure. The taping consists ofapplying anchors around the leg and foot and aseries of stdps to limit dorsiflexion. Elastic tapeis the best matedal because it will suarantee thltdors i f lex ion wi l l not come to an abrupt end. youmay also supplement the taping procedure byinserting a 1/4-inch (0.6-centimeter) heel lift inboth shoes (flgure 2.11). When the athlete usesheel lifts, be certain that he or she regularly per-

forms stretching exercises to prevent adaptiveshortening of the Achilles tendons.

Achilles Tendon ExercisesThe exercises for the ankle are also appropdatefor the Achilles tendon when the athlete sives)pecia l a t ten l ion to s t re tch ing and st rengthen ingthe gastrocnemius and soleus muscles (see figures2.8 and 2.9\.

Figure 2.1t Taping procedure applied to l imitextremes ofdorsif lexion and,thus,to protect astrained or inflamed Achil les tendon.ldentify thedesired amount ofdorsif lexion l imitation andposltion the ankle accordingly. (a) Apply anchorstrjps proximally and distally with a friction padto protect rhe Achil les tendon, (b-d, Supply threestrips in an X fashion across the ankle to l imit dor-sif lexion. (e) Apply proximal and distal anchors.

THE FOOT, ANKLE. AND LEG

Figure2.lt (continued) (f g, Vary this proced ure by using elastic ta pe to l imit dorsjf lexion. This wou ld create a softer endpoint for l imiting dorsif lexion. fh-l) Secure the entire procedure by applying both a figure eight and heel locks with elastictape (k) Supplement the procedure with a heel l i ft that can be placed in the athlete's shoe. Place the l ift in both shoes to avordcreating a Ie9 length discrepancy.

ARGH STRAINS precipitates plantar fasciitis. Poorly constructedand improperly fltted athletic footwear can alsocause these iniuries. Some athletes will experi-ence relief from a commercially available plantarlasciitis brace (figure 2.12).

plantar fasciitis-lnflammation of the plantarfascia at its attachment to the catcaneus.

ANII PTANTAR FASCIITI$

33

Physically active people with a pes cavus footexpedence strains to the arch or plantar fascia.Excessive running or jumping causes an archstrain. In addition, running, and particularlythe continual stress that it places on the foot,


Figure 2.12 (d-b) A commercially produced brace that can help alleviate pain associated withplantar fasciit is.

Arch TapingSupportthe longitudinal arch with a simple tapingprocedure (figure 2.13) or a more complex X-archtaping procedure (figure 2.14). The simple proce_dure employs three or four strips placed circularlyaround the foot. To complete an X-arch taping,place an anchor strip around the metatarsal headsand successively overlap strips from the anchor,around the heel, and back to the anchor.

A longitudinal arch pad may make this tapingmore efficacious (figure 2.15).

Figufe 2.13 simple taping to support the longitudjnal arch. fa-b) Apply the tape by starting on the dorsum ofthe foot andthen move in a lateral djrection to l ift, ult imatel, the longitudinal arch. (c/ Three or four strips wil l normally be adequare tosupport the longitudinal arch.

Figure 2.14 X-arch taping to support the longitudinal arch. fa) Following an anchor strip, (b c) apply tape from the baseof the great toe, around the heel, and back to the starting point. (d) Place subsequent strips from the medial to lateralaspect of the plantar su rface of the foot. fe-f) Overlap strips from the lateral to medial aspect of the foot. (9) Apply a horse-shoe strip from the lateral anchor to the medial anchor (h-, Complete the procedure with strips that mimic the simplearch taping procedure described in fi9ure 2.13.

35

ATHLETIC TAPING AND BBACING

Figure 2.15 (d, Fashiona longitudinalarch padfrom soft padding mate-rial and use it to supportthe athlete with a high(pes cavus) longitudinalarch. (b-d) Secure the archpad to the foot usingthe simple arch tapingdescribed in figure 2.13,

Longitudinal Arch ExercisesFlexibility exercises should include stretchinglhe gastrocnemius and soleus muscles t f igure2.8). Athletes can also stretch the arch by hyper-extending the toes (figure 2.16)

Athletes can strengthen the arch by focusing onthe intdnsic muscles of the foot. Activities suchas picking up marbles with the toes and using toecurls to draw a towel across the floor will isolatethese muscles (flgue 2.1,7).

Mt|RTl|N'S NEURI|MAThis iniury, also known as plantar neuroma,occurs when an interdigital nelve becomesinflamed where it passes between the heads oftlvo metatarsal bones. Most often it affects thenerve between the third and fourth metatarsals,but it can involve other interdisital nerves. A

plantar neuroma-lnflammation or irritation ofa plantar nerve.

THE FOOT. ANKLE" AND LEG 37

t a,te2.16 Stretch the planta r fascia by (d) g rasping the ba l l of th e foot a nd (bl extending the toes.

; igure 2 ,17 St rengthen the musc les tha t ma in ta in the: :r of the foot by cuding a towel with the toes. As the-- Jsc es become stronger, add weight to the towe to pro

:e mu5cle reststance,

fallcn transverse arch or poor athletic footwcarprovides the mechanism tbr inluLV.

Transverse Arch TapingAlthough ath let ic tape a lone might pror . ideadequate support for this injur,v, combining tapeand a paci designed to support thc ttansvetse aLchwill be helpful. Use a commcrciallv produced tear-drop pad or a pad constructed from commercialpadding and secure it in place r,r'itl.t tape (frgurc2.18). Completely' resolving plantar neurorna lnayrequirc more deflniti\.e medical treatment.

Transverse Arch ExercisesThe longitudinal alch exercises may also be bcn-ctlcial for this in jury (see ligures 2. 16 and 2.77).

Figure 2.I8fc) Apply a commercrar y produced pad or cut ateardrop pad outoffoanr paddingand fb-c) secure tothe foot with tape.The tape shou ldnot be so tightthat it restrictsnorma footexpansion duringweight bearingactrvrty.

38 ATHLETIC TAPING AND BRACTNG

Great-Toe Sprain

lma9e.ourtesy of Prima Picture5.

First metatarsaphalangealsprain ("turf toe")

GREAT-TOT $PRAINSA sprain of the great toe, also known as turf toe,can be disabling. The injury usually results fromhyperflexion or hyperextension of the first meta-tarsophalangeal joint. Athletes competing onartificial tuf have a higher incidence of injurybecause of the enhanced shoe-ground interface.

Great-Toe TapingDetermine if hyperflexion or hyperextensionproduces the athlete's discomfort (figure 2.19).Begin the procedure by applying anchor stdpsaround the midfoot and the great toe. Then,depending on the mechanism of injury, placelongitudinal strips along the dorsal surface to

Figure 2.19(a) Hyperflexion and(b) hyperextension of

THE FOOT" ANKLE. AND LEG

ll--- :-: hvperflexion or along-:' ': -jrtar surface to preventT : . : : : \ tens ion ( f igure 2.20) .- : . rre cases, strips of tape,- , :1 the dorsal and plantar

;-- . - =r mav be necessary. some!-..-.--:.s may prefer elastic tape- - : : - :s procedure.

I r j may also purchase Steel-" ::: :nserts to use with the tape

2.2r).

Figure 2,20 Taping for great-toe sprains, also known as tu rf toe. fo b) Begin the procedure by applying anchor strjps a rou ndthe toe and foot. fc-d) Apply strips to the plantar surface of the foot to prevent hyperextension or (e) to both the plantar anddorsal surfaces ofthe foot to prevent hyperextension and hyperflexion. (f/ Apply additional strips to provide extra support.& h) Complete the procedure by securing anchor strips around the toe and foot.

39


Figure 2.21 Use a steelplate shoe insert to give addj-tional support for turf toe by l imiting flexion and extensionof the great toe.

Great-Toe ExercisesThe stretching and strengthening exercises forthe longitudinal arch (see f,gues 2.16 and 2.17 ),when directed speciflcally to the great toe, willhe lp the ath lete recover l rom th i \ in jury.

HEEt Cl|NTUSIl|NSA thick fat pad protects the calcaneus, or heelbone, on the plantar surface of the foot. Never-theless, contusions of the calcaneus often causepain and disable a physically active person. Eitheracute trauma or chronic stress can precipitatethis injury. Improper footwear can also bruisethe heel.

Heel Contusion TapingFigwe 2.22 illustrates taping that supports thecalcaneus. You can also secure a pad to the heelwith basketweave taping.

SHIN SPTINT$The colloquial term shin splints refers to legpdin Lhat ar ises f rom a \ ar ie ty of sources, ru.h a i

arch strains, tendinitis, compartment syndrome,or stress fractures of the tibia or fibula. Seek theassistance of an experienced clinician to identifythe source and mechanism of injury.

Arch StrainsA strain, or falling of the longitudinal arch,causes the tarsal bones of the foot to spread. Theflattened foot can place undo stress where theextensor retinaculum ties the anterior tendons tothe leg and cause the athlete to experience painin the distal leg.

TendinitisTendinitis may occur in any of the tendons thatcross the ankle, but the postedor tibial tendonreceives the greatest number of iniudes. Runningon uneven orbanked surfaces that place one anklein continuous eversion will precipitate injury. Ahlperpronated foot could also contribute to theiniury mechanism.

Compartment SyndromeThe tibia, fibula, and superficial fascia of the legcreate a compartment through which the anteriormuscles, the deep peroneal nerve, a vein, and anartery traverse. When the anterior muscles swell,they create chronic anterior compartment syn-drome, producing leg pain and numbness thatradiate into the foot.

Stress FracturesStress fractures to the tibia or fibula are a disrup-tion to the periosteum and commonly occurin athletes who undergo prolonged periods ofrunning. No taping procedure will help thesymptoms associated with a stress fracture. Theathlete usually requires 6 weeks of rest before thesymptoms resolve.

shin splints-A colloquial rerm for pain in theleg that can originate from any number ofpossible sources.

periosteum-Outer layer of bone.

Shin Splint TapingA haphazard taping approach often prevails in thetreatment of shin splints. Several techniques exist

THE FOOT, ANKLE, AND LEG

Figure 2.22 Support a bruisedheel by applying tape designed tolimit movement ofthe fat Pad ofthe heel or to hold a Protective Padin place. (d) Begin the procedure byapplying anchor striPs behind andbelow the heel. (b-c) Overlap stripsin a weave pattern (d) unti lyoucompletely cover the heel.

to remedy leg pain. If the pain occurs because of

a fallen longitudinal arch, the athlete may ind

relicf from simple arch taping combined with

two or three strips placed around the distal leg

to support the extensor retinaculum (flgute 2.23).

A closed basketweave designed to limit eversion

aids posterior tibial tendinitis. Athletes have also

t"poit"d relief from compression taping ratherthan from a procedure that supports the involvedmusculature (figure 2.2'l). No type of taping is

likely to alleviate thc effects of compartmcntsyndrome or stress tractures.

Figure 2.23 Taping procedure for shin spl ints caused by

a weakened or fal len longitudinal arch The procedure com

bines simple arch taping with reinforcement ofthe ankle

ret inacula.The ret inacula secures the anterior tendons of

tne reg.

42 ATHLETIC TAPING AND BRAgING

Figure2.24 Apply tape to the anterior leg to support shin splints, Begin the pro_cedure with (a) proximal and distal and (b) medial and lateral anchor st-rips. Applytape in an obllque direction pull ing fd medialto lateral and (d) lateralto mejialfel in an overlapping fashion. Completely cover the anterior aspect of the le9. (f)Apply medial and lateral anchor strips (9, to complete the procedure.

Shin Splint ExercisesThe stretching and strengthening exercises for theankle (see figures 2.8 and 2.9) and longitudinalarch tsee f igures 2.16 and Z.17 ) can a lso-be et tec-tive in decreasing leg pain. Have the athlete give\pecia la ent ion to achiev ing a balance betwienthe strength of the anterior and posterior legmuscles. The athlete should also use high-qual_ity footwear.

THE FOOT, ANKLE. AND LEG 43

r00I 0RTH0Ilcs-- r -\ can treat many of the iniuries descibed

i- , -1apter. Fjgure 2.25 shows an orthotic that, - r:-. .asily mold and send to the manufacturer- ::-::i:;rtion; other orthotics requile a plaster

, :.!cribe orthotics wisely because they areI r': .:\ e. Have an expedenced clinician carefully

evaluate the foot and lower-extremity biomechan-ics before recommending foot orthotics.

orthotic-A commercially available insertdesigned to realign and alter thebiomechanics of the foot.

Figure2.25 A foam imprint that wil l be used to produce anorthotic. (o) The athlete first pushes the heel to the bottom ofthe foam, and fb) then the athletic trainer pushes the forefootand toes to the bottom of the foam (./ to make an imprint ofthe entire foot. fd) send the impression to the manufacturer forfabrication of fe) the orthotic.

il

.!

I

Gl|APIER

Anterior Knee

Lateraltibial

Fibular head

The- KnBe-

fhe anlcuiaton or rne o israr remur ano lne

I proximal tibia forms the kree. The proximalI tibia and fibula also create a joint that you

will find more relevant to normal ankle inversion

and eversion than knee movement. The glidingaction of the patella in the intercondylar fossa ofthe femur creates the patellofemoral articulation,a resion essential to normal knee function.

Media l t ib ia l

lmage courtesy of Primal Pictures,


Knee movements include flexion and exten-sion (flgure 3.1). The knee is a modified hingejoint because the tibia internally rotates duringflexion and externally rotates during extension.

Posterior cruciate

Media l meniscus

Medial collateral ligament

Several ligaments stabilize the relatively shal-low articulation between the femur and the tibia.The medial collateral ligament, also known as thetibial collateral ligament, suppofts the medial

Ar t icu lar car t i lage

Anterior cruciate ligament

Lateral collateral

Lateral meniscus

Figure 3.1 Knee flexion and extension ranges of motion.

mage courtesy ot Prima Pi.tures.

THE XIIEE 47

aspect of the knee by checking excess valgusdisplacement. The lateral collateral ligament, alsocalled the flbular collateral ligament, stabilizes thelateral aspect of the knee by preventing excessvarls displacement.

The antedor and postedor cruciate ligamentscloss within the knee joint. The anterior cruciateligament prevents the antedor displacement ofthe tibia ftom the femur; the posterior cruciateligament checks postedor displacement. Becausethe cruciate ligaments prevent rotary instabili-ties, their injury frequently causes either anterior-lateral or anterior-medial rotary instability.

valgus*Alignment of a joint or stress to thejoint that places the distal bone in a lateraldirection; the"knock-kneed" position of theknee joint.

varus-Allgnment of a joint or stress to thejoint that places the distal bone in a medialdirection; the "bow-legged" position of theknee joint.

anterior cruciate ligament-A ligament crossingthrough the knee joint that attaches fromthe anterior tibia to the Dosterior femur.Theanterior cruciate ligament limits anteriormovement of the tibia from the femur aswell as rotation ofthe tibia.

Knee Menisci

Lateral meniscus

Transverse meniscal

Anterior-lateral instability occurs when the lat-eral tibial condyle slips forward. Anterior-medialinstability results when the medial tibial condyleslips forward. All these rotational instabilities dis-able physically active people.

The intra-articular cartilage, the menisci, deep-ens the aticulation and protects the joint surfacesof the tibia and femur. The medial meniscus hasan oval shape and firmly attaches to the tibiaand the medial collateral ligament. In contrast,the lateral meniscus is more round and movesmore freely; it does not attach to the lateral col-lateral ligament. Meniscal iniudes are especiallyproblematic because, as avascular cartilage, theyrarely heal.

The knee extends through the contractionof the powerful quadriceps femoris muscles.These muscles include the rectus femods, vastusmedialis (see page 48), vastus intermedius, andvastus lateralis muscles. The fibers of the vastus

menisci-The intra-articular cartilage of theKnee.

avascular-The absence of blood supply.quadriceps femoris-The muscle group in

the anteriorthigh consisting ofthe rectusfemoris,vastus medialit vastus intermedius,and vastus lateralis.

Posterior menisco-meniscal

Articular

Medial meniscus

lmage courtery of Primal Pictures.


Semitendinosus

Sartorius

create. These bursae include the suprapatellar,prepatellar, and the deep and superficial infrapa-tellar bursae. The suprapatellar directly commu-nicates with the capsule ofthe knee ioint. Excessfluid in this bursa lepresents signiflcant swellingin the knee. The prepatellar bursa has a highcontusion rate because of its anterior positionto the joint.

hamstrings-A muscle group in the posteriorthigh consisting of the semitendinosus,semimembranosus, and biceps femoris.

bursa-A fluid sac that reduces frictionbetween two structures.

Posterior Thigh Mus<les

Gluteus maximus

G ra cil is

Adductor magnus

Vastus lateralis

5emimem branosus

Biceps femoris

medialis muscle attach to the medial border ofthe patella, and they are often called the vastusmedialis oblique muscle. The quadriceps attach tothe patella through the tendon of the quadriceps;it passes over and around the patella and attacliesto the tibia as the patellar tendon. These musclessuffer contusions during the athlete,s participa-tion in contact sports.

The hamstring muscle group produces kneeflexion. These muscles include the medial semi-tendinosus and semimembranosus and the lateralbiceps femoris; all these muscles expedence strainduring sprinting activities.

Several bursae exist around the knee to reducethe friction that the overlying muscle tendons

Anterior Thigh Muscles

Vastus media l is

l m a q e . o u , r e s y o f f t m a p d u ' e r

THE KI{EE 49

Medial Aspect> Medial collateral

ligament> Medialjoint line> Medial meniscus

Semitendinosus

Semimembranosus

Gracilis

Sartorius

Medialfemoral

Medial head of gastrocnemius

Laterol Aspect> Lateralcollateral

ligament> Lateraljoint line> Lateral meniscus


Antefior Aspect> Quadriceps tendon> Patella> Patellar tendon

Postefior Aspect> Poplitealfossa> Biceps femoris tendon> Semitendinosus tendon> Semimembranosus tendon

Biceps femoris

Tibial nerve

Common peroneal nerve

Lateral head of

Surface Anatomy

Vastus medialis

Medial parapatella fossa

Patellar tendon

lmage.ourt€sy of Primal Pictures,

lmage courtesy of Primal Pictures.

Medial tibial


Ct|TTATERAT ANII CRUCIATEtIEAMENT SPRAINS

The relative instability of the knee renders ithighly vulnerable to sprains of the collateraland cruciate ligaments. Excessive valgus or varusforces sprain the medial and lateral collateral liga-ments, respectively. You can expect to see feweriniuries to the lateral collateral ligament becausethe contralateral extremity protects the kneefrom varus forces. External forces directed at theoutside of the knee produce valgus stress; theyoften implicate the anterior cruciate ligament andmedial meniscus as well as the medial collateralligament. Clinicians refer to this classic iniury asthe tenible triad.

contralatetal-Refers to the opposite extremity.

Noncontact mechanisms often cause isolatedin judes to the cruciate ligaments, particularly theantelior cruciate. Sudden deceleration, whichoccurs when the athlete changes direction or

Medial CollateralLigament Rupture ,

dismounts ftom a gymnastic apparatus, can pro-duce an isolated rupture of the anterior cruciateligament. An external force anteriorly directed tothe back of the tibia will also injure the anteriorcruciate ligament, iust as a posteriorly directedforce from the front of the knee can iniure theposterior cruciate ligament.

Anterior CruciateLigament Rupture

Knee Sprain TapingIigure 3.2 illustrates how to tape the collateralligaments. Execute a slight flexion by placing alift under the heel. Avoid using a tape roll for thislift because heel pressure will ruin the tape! Aswith the ankle, optimize the procedure by tapingdirectly on shaved skin and using minimal under-wrap. I recommend elastic tape. Begin by placingproximal and distal anchors and then apply, inan X pattern, successive interlocking stdps overthe medial and lateral collateral ligaments. Forthe ath le le wi th a cruc iate I igament in ju ry . tape aseries of medial and lateral spiral stdps to enhanceanterior, postedor, and rotary support.

ma9e.oul1esyot Primal Pi.r!res.

ma9e.ourtesy of Primal Piciures.

Ir51

Figure 3.2 Collateral and cruciateknee sprain taping. (d, First, positionthe knee wjth slight f lexjon by placinga lift under the heel. fb) Apply proximaland distal anchor strips at an equaldistance above and below the knee.Support the collateral l igaments byplacing an X with elastic tape over fc-e)the medial and (f-hJ lateralcollaterall igaments, f, leaving the patella open.

Gontinued)

Figure 3.2 (continued)

52

THE KNEE 53

Figure 3'2 (continued) t '-k, Reinforce the collateral strips by folding the edge of wh ite ta pe a nd placing an add it iona I xover the previously applied elastic tape ftml Apply proximal and distal anchors to complete the coilateraiknee sprain taping.(n-5, For rotary instabil ity that often results from injury to the anterior cruciate l igameni, apply additional strips that begrn onthe anterior proximal thigh, pass behind the knee, and end on the posterior leg. f0 compleie the procedure by enclosrng rnethigh and leg with elastic tape.

Knee ExercisesInjury- f ree, ef fect ive ath let ic par-ticipation requires the quadriceps andhamstring muscles to have adequatestrength and flexibility. Figure 3.3illustrates static stretching exercisesfor these groups.

Figure 3.3 (dl Stretch the quadricepsmuscle group by pull ing the knee intoflexion while the athlete is lying prone.(b, Stretch the hamstring by flexing theh ip wh i le ma in ta in ing knee ex tens ion .Note how the athlete holds the back ina flattened position to ensure optimalisolation of the hamstring muscles.

54

Strengthen the athlete,s quadriceps and ham_string muscles by prescribing open-chain cxer_cises with elastic bands (figure 3.4).

Figure 3.5 illustrates a strengthening device thatprovides progressive resistance for the knee.

Weight-bearing exercises from closed-chainpositions will build the athlete's strength andtunctional ability. The step-up (figure 3.6) andsquat exercises (figure 3.7) are simple, yet effcc_tive, closed-chain exercises.

Figure 3.5 Strengthen the quadriceps and hamstringmuscles with a commercially availabie resistance device.

Figure 3.4 (a, Strengthen the quadriceps by resisting knee extension while the athlete is seated. (b) Strengthen the ham_stflng muscle group by providing resistance to knee flexion while the athlete js lying prone.

ATHLETIC TAPING AND SRACING

open-chain exercise-Exercise in which thedistal segment of the extremity does notbear weight.

closed-(hain exercise-Exercise in which thedistal segment ofthe extremity is fixed tothe ground.

Figure 3.6 The step-up is an excellent example ofaclosed-chain exercise that incorporates the quadricepsas a knee exten50r d"d the ha.nstrings as d nip exten5or.

THE KNEE cc

Figure 3,7 Closed-chain squat exercise for the kneeextensor and hip extensor muscles.

KNTT BRASE$Knee braces fall into thTee categories: preventive,rehabilitative, and functional.

Preventive BracesPreventive braces guard the knee from injuryduring athletic paticipation by protecting themedial collateral ligament ftom excessive valgusforce. Speculation abounds concerning the poten-tial of this brace to reduce injury to the medialcollateral ligament, and they are used far lessftequently than they were in the past. Althoughathletes, coaches, and athletic trainers offeranecdotal reports that the brace has saved theligament, scientific research is less conclusive onthe value of the preventive knee brace. I am waryof prescribing a preventive device because of itsquestionable clinical value and excessive cost.

Rehabilitative BracesRehabilitative bTaces protect the knee immedi-ately after injury or surgery (figure 3.8). Clinicianscan control the range of motion of the knee byadjusting dials on the medial and lateral aspectsof the brace.

Figure 3.8 A rehabil itative brace wjth flexion and extensionstops that can be used to control the degree of knee motion.

Functional BracesFunctional knee braces may be used on athleteswho experience rotary instability because ofiniury to the anterior cruciate ligament (figures3.9 and 3.10). Some physicians recommend orrequire a functional brace following surgicalreconstruction of a knee with a deficient anteriorcruciate ligament. Athletes have found functionalknee braces effective for some anterior cruciateligament injuries; others require surgical recon-struction before returning to competition. Thefunctional knee brace has the disadvantage ofcostins at least several hundred dollars.

Figure 3,9 Afunctional kneebrace to controlrotary instabil-ity ofthe knee.


Knee h).perextension occurs when an antedorlydirected or self-inllicted lorce causes the joinl t;extend beyond its normal anatomical limits. Thecruciate ligaments, as well as the muscles and cap-sule located on the posterior aspect of the knee,may suffer damage.

Hyperextension TapingDetermine the degree of extension requiredto elicit knee discomfort. Place a lift under theheel to flex the athlete's ioint slightly. Be certainthat the athlete maintains this position for theentire procedure. Begin by placing anchor stdpsaround the thigh and calf and then supply suc-cessive strips in an X-pattern from the proximalto distal anchors over the posterior aspect of thejoint. You may wish to complete the taping pro-cedure by using an elastic wrap to enclose theknee (figure 3.11).

Figure 3.10 A functional knee brace with flex-ion and extension stops that can also control theamount of knee motion.

Figqre 3.11 Begin knee hyperextension taping by placing a l ift under the heelto flex the knee. (o, protect the back of theknee with a pad and apply proximal and distal anchor strips. fb, Use elastic tape to appty a vertical strip and fc_e) then overrapwith two strips, creating an X over the back of the knee. (f) Apply proximal and distal anchors to secure the procedure. (9-h)Complete the procedure by enclosing the knee in an elastjc wrap.


Patellofemoral TapingProvide patellofemoral support to displace thepatella medially or realign it. Knee sleeves withlateral buttresses will supply medial displacementr figure 3. | 2 r, a nd the McCon nel taping tech n iquewill realign the patella (figure 3.13). The tapingprocedure requires you to evaluate both the posi-t ion of the pale l la and the par ient 's responie toyour treatment. Carefully analyze whether thetaping relieves the athlete's pain while he or sheperforms functional activities. McConnel taping,which requires a special tape more rigid than thenonelastic variety, is only one component of acomplete patellofemoral treatment and rehabili-tation program.€ond romalacia

Patel la

maqe coudeiy ot Primal Picr!r€s.

Figure3.l2(d-b) Use a kneesleeve with alateral buttress tofacil i tate normaltracking ofthepatella withinthe intercondylarfossa of the femur

Figure 3.13 Mcconnel taping for an athlete with patel-lofemoral pain. (. i 'bl Assess the patella for t i l t and rotationpositioning. (continued)

Figure 3.13 (continued) (c) Use CoverRoll stretch andLeukotaDe (available from Beiersdorf Inc., PO. Box 5529, Nor-walk, CT 06856 5529) for the taping procedure. (d-f) Aftershaving the knee, cover the patella with CoverRoll tape and(9) then reassess for position. fh) Correct t i l t ofthe patella byapplying a piece of Leukotape from the middle of the patellato the medial femoral condyle. (i) Correct glide of the patellaby applying the Leukotape from the lateral border of thepatella and pull ing medially to the medial femoral condyle.

kontinued)

59

60 ATHIETIC TAPING AND BRACING

Extensor Mechanism ExercisesThe stretching exercises for knee sprains, whichrestore the normal Uexibility of boih the quadri-ceps and hamstdng muscles, will also help ath-le les who exper ience pate l lo femoral pa in. Theath lete should a lso s t renglhen lhe quadr icepsmuscles, although providing resistance to kneeextension through the full range of motion of thejoint may increase patellofemoral compressionand aggravate lhe in jury. Modify the quadricepsstrengthening exercises for knee sprains to isolatethe extension of the knee in its final 30. or findthe range of motion through which the athletecan exercise pain-free. Although not as effectiveas resisted knee extension, straight-leg raises willalso exercise the quadriceps without signiflcanttyincreasing patellofemoral compression (fi gure3.14). If necessary, use electrical muscle stimu-lation or biofeedback to strengthen the vastusmedialis oblique muscle-techniques that youwill learn in your therapeutic exeriise class.

electrical muscle stimulation-Use of electricalcurrent to induce a muscle to contract.

biofeedback-Feedback provided throughvisual observation or an audio tone.

Figure3,l3 (continued)

0) Correct external rotation byapplying Leukotape from the infe-rior pole (border) ofthe patella,pull ing toward the opposite shoul-der. fkJ lfthe ti l t ofthe patella isnot correct,apply an additionaltilt strip. ffm) Reassess the athletefor pain while he or she performsthe functional activit ies that causediscomfort.

Figure 3.14Use straight-leg raises tostrengthenthe musclesof the quadriceps withoutconcomrlantincreases inpatellofemoralcompression.

Ihe Thigh,Hip, and Peluis

he ball of the hip, the head of the femur, thesocket, and the acetabulum of the pelvis createan ex I fe mel) \ tab le a r t i ( u la t ion.

The pelvic girdle contains two innominat€bones, each possessing an ilium, a pubis, and anischium. The pelvis protects the abdomen andjoins many of the muscles acting on the hip andtrunk.

Anterior Hip and Pelvis

Anter io r in fe r io r i l i ac sp ine

Femoral head

Greater trochanter

Lesser trochanter

innominate bones-Two flat bones that formthe pelvic girdle;each consists of an ilium,pubis , and ischium.

Hip joint

Pubis

4Cl|APTER,::.

ir- ^

mage courtesy ot Prima Pictures.

61


Posterior Hipand Pelvis

Posterior

Posterior inferior il iac

Pubis

Pubic

lschium

lschia l tuber

Hip ioint movements include flexion andextension/ abduction and adduction, medialand lateral rotation (figure 4.1), and circumduc-tion.

ll iac crest

Greater trochanter

LeSser trochanter

circumduction-A combination of abduction,adduction, flexion, and extensioh.

Figure 4.1 Hip flexion and extension ranges of motion with (aJknee extended and (b, tlexed; (continued)

]mage courtesy of Pimal Picrures.

THE THIGH. HIP. AND PELVIS OJ

Figwe 4.1 (continued.) (c) hip abduction and addudionranges of motion; (dJ hip medial and lateral rotation rangesof motion.

A thick capsule and three maior ligamentsreinforce the hip joint. The anterior ligament,called the Y-ligament, is the iliofemoral; itchecks excessive hip extension. The medial liga-ment, also known as the pubofemoral ligament,limits excess hip abduction. The ischiofemoralligament, located on the postedor, becomes tautr l , , r i n o h i n f l p y i n n

Hip Ligaments

lschiofemoral ligament

lliofemoral

The depth of the hip joint, combined withits substantial capsular and ligament structures,contributes to the considerable stability of thisjoint.

Several muscle groups govern movement atthis multidiTectional ioint. The iliopsoas and therectus femoris muscles of the quadriceps produceflexion. Extension results from the contraction

uinal l igament

Pubofemoral ligament

Obturator membrane

Hip RotatorMuscles

Gluteus medius

Piriformis

Obturator internus

Gemellus inferior

Obturator externus

Trochanteric bursa

Quadratus femoris

lmage courtesy of Primal Pictures.

lmage counesy of Prima Pidures.

64

of the gluteus maximus and the three hamstringmuscles.

The gluteus medius and tensor fasciae lataemuscles produce primary abduction, and theadductor magnus, longus, and brevis musclescause adduction. The muscle group that includesthe piriformis, gemellus superior and inferior,obturator internus and externus, and the qua-dratus femoris produces outward rotation. Thetensor fasciae latae produces inward rotation.

THE THIGH, HIB AND PETVIS 65

HIP SIRAINSHip muscle strains, or groln pulls, involve eitherthe hip flexor muscles or the adductor musclegroup. The athlete usually overstretches or vio-lently contracts the muscles. Lack of flexibility orstrength, as well as inadequa le preeyercise wa rm-up, will precipitate strains.

Anterior> Rectus femoris muscle> Vastus medialis muscle> Vastus lateralis muscle> Anterior superior il iac spine

Surface Anatomy

lliac crest

Anterior superiori l iac sp ine

Tensor fascia latae

Greater trochanter

lliotibial tract

Vastus lateralis

Rectus femoris


Medial> Adductor longus muscle> Gracilis muscle> Adductor magnus muscle

Laterol> ll iac crest

Posterior> Posterior superior il iac spine> lschialtuberosity> Gluteus maximus muscle> Biceps femoris muscle> Semitendinosus muscle> Semimembranosus muscle

External oblique

Rectus abdominis

Femoral nerve,, and vein

Inguinal l igament

Pectineus

Sartorius

Vastus medialis

mage courtesy ot Primal Pi.tur€s.

66 ATHLETIC TAPING AND BRACIT.IG

Hip Strain TapingSupport the hip muscles with an elastic bandagesupplemented with elastic tape. Wrap the ban-dage around the thigh and hip in a spica pattern.Before treatment you should determine if theathlete has damaged the hip flexor or adductormuscles. Examine for pain or weakness in thesegroups by using resistance to test hip flexion andadduction, in that order (figure 4.2). The affectedmuscle group will determlne the direction inwhich you apply the hip spica.

spica-A figure-eight wrap that incorporatesthe thigh and hip or the arm and shoulder.

When wrapping adductor muscles, havethe athlete internally rotate the hip. Place thewrap from a lateral to medial direction. Begin atmidthigh and proceed to encircle the thigh andwind around the waist (figure 4.3). Use double-length elastic wrap, if available, and reinforce thewrap by tracing the pattern with elastic tape.

Figure4.2 (o,)Test the hip flexor muscles for strength by resisting the athlete's efforts to flex the hip while seated. (bJ

Test the adductor muscles by having the athlete on his or her side.The athlete then resists your efforts to abduct the rjghtextremtry.

Figure 4.3 A hip spica with elastic wrap to support a strain ofthe adductor muscles. (a) Have the athlete place the hip in aninternally rotated position. (b-c) Apply an elastic wrap by pull ing the thigh into internal rotation. Note how the elastic wrapfolds over itselfto lock it in place. (continued)

Figure 4.3 (cantinued) (d e)Ihewrap continues around the waist (f)to complete the spica. (9-h) Use elastictape to trace the elastic wrap in theappropriate direction based on thepresence of a hip adductor or f lexorstrain.A hip spica with elastic wrap tosupport a strain ofthe flexor muscles.(, Have the athlete place the hip in anexternally rotated position. r-, Appiyan elastic wrap by pull ing the thighInto external rotation and flexion.

(continued)

67


Figure4,3 tLontinued) tm)The wrapcontinues around the waist to com-plete the spica. f,"l-ol Use elastic tape totrace the elastic wrap in the same direc-tion as the elastic wrap.

Use a similar procedure to suppoft the hipflexor muscles, except begin with the hip in anextemally rotated position and reverse the direc-tion of the pull of the rarap. Before applying thewrap, place a lift under the heel of the extremityto shorten the hip flexors.

Hip ExercisesThe athlete must maintain normal strength andflexibility in the hip muscles to prevent or treatstrains. Figure 4.4 illustrates a static stretch-ing exercise for the hip. Elastic bands can alsosupply resistance to strengthen the joint (figure4.5). Because the rectus femoris of the quadricepsand all three hamstdng muscles act on the hip,the exerclses for these groups are also appropdate(see chapter 3). Figure 4.4 Stretching exercise for the hip.

THE THIGH, HIP, AND PELVIS

Figure 4.5 Strengthening exercises for (d) the hip flexor and (b) extensor musctes.

THIGH STRAINSStrains occasionally occur to the quadricepsfemoris muscles and more frequently to the ham-stdngs. The strain may result from overstretching,a violent contraction, or general muscle fatigue.For hamstring strains, determine whether theinjury involves the medial (semitendinosus and

69

semimembranosus) or the lateral (biceps femoris)muscles. Isolate the medial and lateral hamstrinssdur ing muscle Lest ing by rotat ing the leg in te i -nally and extemally, respectively, durlng resistedknee flexion (figure 4.6).

Figure4.6 Test for hamstring musclestrain.To isolate the medial hamstring, resistknee flexion while internally rotating theleg. For isolation ofthe lateral hamstring,resist knee flexion while externally rotatingthe leg.

70 ATHLETIC TAPING AND BNACING

HamstringMuscle Strain

Thigh Strain TapingSupport the quadriceps and hamstring muscleswith an elastic wrap (figure 4.7) and, if necessary,supplement the wrap with elastic tape (figure 4.8).Use a 4- or 6-inch-wide (10.2- or 15.z-centimeter-wide) elastic wrap to encircle the thigh. Coverthe muscle both distal and proximal to the pointof strain to provide optimal support. For a highstrain, you may need to incorporate a hip spicato support the proximal muscle attachment.You can also use a taping procedure alone or incombination with an elastic wrap to support athigh strain.

Thigh ExercisesThe hamstdng muscles cross the hip and the knee,acting on both ioints. Therefore, supplement thestretching and strengthening exercises for hipextensors with those described for knee flexorsin chapter 3. Similarly, because the rectus femorisofthe quadrlceps group crosses both the knee andhip, include the exercises for knee extensors andhip flexors in the athlete's regimen.

lma9e counesy of Primal Pictures.

Figwe4.7 Elastic wrap to support a strain of the quadriceps muscles. (o) To prevent slipping ofthe wrap, apply tape adher-ent, or roll tape into a small strip and apply the roll to the thigh before applying the wrap. (b-c) Apply the wrap in a circularpattern around the thigh. Adhesive tape may al50 be used to provide support to a strained thigh, which is then encircled withan elastic wrap. (continued)

Figure 4.7 (continued) (d) Applyrnedial and lateral anchor strlps. (e f.)Apply oblique strips oftape pull ingmedial to lateral, and lateral to medial.f9 h) Secure the taping procedure withan elastic wrap.

F igure4.8 E las t icwraptosuppor tas t ra ino f thehamst r ingmusc les .F i rs t ,de termine i f thes t ra in is to themedia i o Ia te ra lhamstrings. lf the medial hamstrings are invoived, (d, begin by pull ing the rnuscle toward the midline of the posterior thigh,and (bl then continue in a circular pattern from the distalto proximal thigh. (continued)

71

72 ATHLETIC TAPING AND BBACING

Figure 4'8 (continued) (c d) Because the ha mstring muscles attach deep beneath the buttock, the wrap wil l probablybemore effective jf applied in combination with a hip spica. (e f) Trace the wrap with elastic tape.

IIIP ANl| THIOH Ct|NTUSItlNS iliac (rest-The superior border of the iliacbone;the colloquial term for a contusion tothis area is hip pointer.

myositis ossificans-The formation of bonewithin a muscle that has suffered aconruSton.

hematoma-A collection of pooling blood.

Hip and thigh contusions involve the iliac crest(hip pointer) or quadriceps muscles ofthe antedorthlgh. Iliac crest injudes, although painful, are notser ious. Quadr i !eps contu\ ions requi re your spe-cial attention because they can create a conditionknown as myositis ossificans, the calciflcation ofthe hematoma caused by a quadriceps bruise.

l l iac Crest Contusion(Hip Pointer)

lmage cou rtsy ot Prima P ctures. lmage courtesyot Prima Pictur€s.

THE THIGH, HIR ANO PELVIS

Hip and ThighPaddingUse elastic wraps and tape tosccure protective pads over thei l iac crest or anter ior th igh.Figure 4.9 illustrates two waysto position a protcctive pad overthe iliac crest-irst with an elas-tic wrap ancl then with an elasticwrap and tape hip spica. Figure4.10 demonstrates how elasticwrap and tape hold a protectivepad over the quadriceps.

Figure 4.9 An elastic wrap to securea protective pad ovef the i l iac crest.(.r-bl Position a pad over the contusedil iac crest (hip pointer) and hold it inpiace with an e astic wrap. fc-el Use ahip spica to provide additional supportto the area and to hold the pad in position. (/ 9J Trace the wrap with elasticrape.

74 ATHLETIC TAPING AND BBAGING

Figure4.10 (a-c) An elastic wrap to secure a protective pad over the quadriceps muscles.

Hip and Thigh ContusionExercisesThe athlete should exercise to maintain normalstrength and range of motion while hip and

thigh contusions heal. Prescribe the stretchingand strengthenlng exercises for both the quadd-ceps (chapter 3) and hip. Experienced cliniciansshould monitor serious thigh contusions for theonset of myositis ossificans.

74 ATHLETIC TAPII{G AIIO BRACII'IG

Figure 4.10 {o-c) An elastic wrap to secure a protective pad over the quadriceps muscles.

Hip and Thigh ContusionExercisesThe athlete should exercise to maintain normalstrength and range of motion while hip and

thigh contusions heal. Prescribe the stretchingand strengthening exercises for both the quadd-ceps (chapter 3) and hip. Experienced cliniciansshould monitor serious thigh contusions for theonset of myositis ossificans.

amdi f,Fm

fn" oon", or rne snouloer glrole Incruoe tne

I clavicle, scapula, and humerus. The proximalI clavicle and stemum form the sternoclavicu-

lar joint, which is the only articulation of theupper extremity with the trunk. The anterior andposterior sternodavicular, the costoclavicular, andthe interclavicular ligaments stabillze the ioint.The distal clavicle and the acromion orocess ofthe scapula create the acTomioclavicular loint, an

Acromioclavicular

Anterior ShoulderGirdle

articulation reinforced by the coracoclavicularand acromioclavicular ligaments.

The glenoid cavity ofthe scapula and the headof the humerus form the shoulder, also known asthe glenohumeral ,oint. The glenoid labrum, theglenohumeral ligaments, and the joint capsulereinforce this shallow, unstable ball-and-socketarticulation.

Acromion process

Articular hyaline cartilage

Coracoid

Glenoid fossa

Humerus

lmage courte5y of Pimal Pictures,

75

Posterior ShoulderGirdle

Articular

Spine ofscapula

Coracoid process

brachii,lonq head

Superior

Middlement

Sca

lnferiorumeral ligament

Shoulder Complex Ligaments

hage court€sy or Pimal Picrures.

]maqe courte5y ot Primal Picrures.

76

THE SHOULDER ANO ARM 77

The pectoralis major (clavicular poftion) andthc anterior deltoid produce flexion. Extensiollresults from the Iatissimus dorsi, teres major,and pectoralis maior (sternal portion). Abduc-tion occuls with the deltoid and tlte rotatorcuff, whose muscles include the subscapularis,

supraspinatus, infraspinatus, and teres rninor(f,gure 5.1).

rotator cuff The muscle group in theshoulder consisting of the subscapularis,supraspinatus, infraspinatus, and teres minor

Figure 5' l ao) Shoulder {gienohumeral) f lexion and extensjon ranqes ofmor i on : , b r snou lde r abdu ( Lon ano addL ( r i on ranges o f . no t . on 1c7 ,hou lde .internal and external rotat ion ranges of motion; fdl shoulder horizontal adduc_tion and abduction ranges of mot;on. (continued)

Figure5.1 (continued) Scapularrangesof motion include (e/ scapular elevation anddepression (f) outward and inward rotat ion;(9) abduction and adduction.

Coracoacromial I

LateralShoulder

Subscapularis

Transversehumeral

Humerus

Teres minor

mage courtesyof Primal Pl.lures

78

THE SHOULDER AI{D ARi/I 79

The contraction of the pectoralis mal'or (stemalportion), latissimus dorsi, and teres major musclescauses adduction. The action ofthe subscapuladsand pectoralis maior muscles precipitates inter-nal rotation, and the SIT muscles of the rotatorcuff-the supraspinatus, inftaspinatus, and teresminor-induce external rotation.

Horizontal flexion occurs with the combina-tion ofthe coracobrachialis, pectoralis major, anddeltoid (anterior portion), and hodzontal exten-sion depends on the infraspinatus/ teres mino!and deltoid (posterior portion).

The movement of the glenohumeral jointoccurs in conjunction with the movement ofthe scapula. The range of the scapula includesabduction (pectoralis minor and seffatus anteriormuscles) and adductlon (rhomboid muscles),outward rotation (seffatus antedor and trapeziusmuscles) and inward rotation (pectoralis minor

Surface Anatomy

Clavicle

Lesser tuberosityof humerus

Pectoralis

Sefratus anterior

Extensor ca radialis

Extensor radialis brevis

and rhomboid muscles), as well as elevation(levator scapulae) and depression (pectoralisminor muscle).

Deltoid

lmage couft esy of Primal Pictures.


Anterior> Deltoid muscle

> Pectoralis major muscle

> Clavicle

Posterior> scapula

Superior> Acromioclavicular joint

Acromioclavicular

of humerus

Triceps brachii,lateral head

Brachialis

Brachioradialis

Lateral

Common extensortendon

80 ATI{LETIG TAPING AND BRACIIIG

Scapular

Deltoid

Teres minor

Teres ma

Triceps brachii, head

Triceps brachii, medial head

Triceos brachii, lateral head

Ulnar nerve

Olecranon

Athletes suffer an acromioclal'lcularjoint sprain (known colloquially as aseparated shoulder) when they fall on thehand, elbow, or the shoulder itself. Clini-cians categorize th€ sprains as first- to third-degree injudes. The fust degree describesa minor tear of the acromioclavlcularligament, and the thlrd degree refers to acomplete rupture of both the acromiocla-vicular and coracoclavicular ligaments. Inthe latter case, the shoulder drops and theclavicle protrudes against the skin of thesuperior shoulder.

Trapezius

Rhomboid ma

Latissimus dorsi

SurfaceAnatomy

hage .ourtesy of Prima Pictures.

AcromioclavicularJoint Sprain(Third Degree)

THE SHO U LOEF AND ARM 81

Acromioclavicular Joint TapingBcgin taping an acromioclavicular joint sprain byplacing anchor strips around the arm, over the topofthc shouldcr, and on the chest and back (hgurc5.2). Make certain that when taping the shouldcror chest you protect the nipple \,\'ith gauze or abandage. Continue taping with succcssive stripsfrom the arm anchor to the shoulder anchor andfrom the chest anchor to the back anchor.

acromioclavicular joint sprain-A sprain tothe acromioclavicu lar or coracoclavicularl igaments of the joint formed by the distalclavicle and the acromion process ofthe scapu la ; a lso known co l loqu ia l l y as a< e n : r a t p d < h o r r l d p r

Figure 5.2 Acromioclavicular joint sprain (separated shoulder) taping. (d/ Any taping of the shoulder or chest that has thepotential to cover the nipple should begin with the application of protective dressing. fbl App y anchor strips to the superiotanteriot and posterior aspects of the shoulder as welL as (c) to the proximal arm. (d f) Apply strips from the arm anchor to thesuperior shoulder anchor and from the anterior to posterior anchors in an overlapping fashion so that the crossing point ofthe tape is over the acromioclavicular joint.

82 ATH LETIC TAPING AND BBACING

You may supplement or replace this procedureby using a protective pad over the injured acro-mioclavicular joint. figure 5.3 illustrates the tech-nique tbr making a protective pad from orthoplastand how to sccure the pad with a shoulder spica

Figure 5.3 (d e, Produce a protective pad from orthoplast andwrap.

with an elastic wrap. You can use this techniquefor making a custom-fitted protective pad toprotect other injuries, such as contusions of thequadriceps, il iac crest, and a blocker's exostosis.

(f-r) secure the pad in place with a shoulder spica elastic

(cantinued)

Figure 5.3(continued) (il)Iheprotecflve paq canalso be applied overthe acromioclavicularjoint taping procedureshown in figure 5.2. (mr) A modified shoulderspica technique thatdoes not Incorporatethe proximal arm canbe used to secure theprotective pad.

(continued)

83

84 ATHLETIC TAPING AND BFACING

Figure 5,3 (continued)

McConnelTaping forAcromioclavicular Joint SprainsYou can use the same kind of tape used for McCo-nnel taping of the patella for acromioclavicular

joint sprains. This taping procedure can be leftin place for an extended period and will help"reapproximate" the acromioclavicular joint(figure 5.4).

Figure 5'4 Mcconnel taping for an acromioclavicularjoint sprain. Use Cover-Roll stretch and Leukotape as with the Mcco-nnel taping for patellofemoral joint pain. fal Apply the first CoverRoll strip vertically from the deltoid tuberosity past theacromioclavicular joint by 3/4 to I I /4 inches (2 to 3 centimeters). fb, Apply the second strip from the coracoid process to thespine ofthe scapula fd Applythe first Leukotape strip vertically overthe cover-Roll srrip wh ile approximating ih"..ro.,oclavicularjoint. (continued)

THE SHOUTDER AI'ID ARM 85

Figure 5.4 (continued)fdJ Applythe second strip ofLeukotape anterior to posterior.fe) The point ofthe crossing stripsshould center over the acromiocla-vicular joint.An additional layer ofLeukotape strip5 may be necessaryto provide ample support.

Shoulder ExercisesMost sports, especially those that require over-head arm motion, rely on adequate strength andflexibility of the shoulder. ConstTuct a simpleT:bar for exercises to stretch the shoulder (figure5.5). Be cetain that the exercise regimen addressesthe fulI ranse of motion of the shoulder.

Figure 5.5 A simple T-bar to stretch the shoulder muscles through (a) flexion, (b) abduction, and (c) external rotation.


Strengthenlng exercises employ dumbbells,elastic bands, or a combination of both devices.Figure 5.6 illustrates how a hand-held weightprovides resistance through each of the motionsof the shoulder. Elastic bands can supply similarresistance while also allowing for exercise thattraces functional movement patterns (figures.7).

Figure 5.6 A hand-held weight to strengthen theshoulder (a) abductor,lbJ flexor, and (cl extensor muscles.Normally,these motions should not exceed the horizontalpositions seen in (a) and (b).

Figure 5.7 Elasticbands are effectivefor strengtheningthe shoulder fa)externaland (b)internal rotatormuscteS.

THE SHOULDER AND ARM 87

OTENI|HUMERAL SPRAINSSprains, subluxations, and dislocations, allcommon injuries of the glenohumeral ioint, causethe shoulder to be chronically unstable. The ath-lete often requires surgery to repat the damage.Although congenital factors may conffibute tothe iniuries, sprains or dislocations usually occurwhen the athlete applies an external force to thearm. Shoulder abduction and external rotation arethe common mechanisms of iniulv for anteriordislocation.

subluxation-A partial dlslocation of a joint.

dislocation-A complete separation of twoarticulatinq bones.

Shoulder Sprain or Instabil i tyTapingYour taping procedure should prevent excessiveabduction and extemal rotation. An elastic-wrapshoulder spica, traced with elastic tape, limits

Common Mechanism ofShoulder Dislocation

these motions (figure 5.8). Have the athleteinternally rotate the shoulder and begin tapingbyencircling the arm and crossing over the anteriorchesti this action pulls the shoulder into internalrotation and limits external rotation. The amountof mobility that the athlete requires will dictatethe degree of limitation that you provide.

Shoulder braces restdct abduction and externalrotation (figure 5.9). You can adjust their restdc-tion from a light to a substantial degree.

Shoulder Sprain or Instabil i tyExercisesCombine the exercises illustrated in flgures 5.5through 5.7 with the shoulder wrapping andbracing procedures. Do not, however, prescribethe stretching exercises that enhance shoulderabduction and external rotation, because, in thiscase, the exercises would stress an unstable shoul-der that is aheady hypermobile. Have the athletefocus on internal-rotation strengthening exercisesbecause they will limit the external rotation ofthe shoulder.

lmage .ourt€sy ot Prima Pictures.

Figure5.8 A shoulder spica withelastic wrap and tape to support theunstable shoulder. (o) The procedurebegins by having the athlete placethe shoulder in an internally rotatedposition with the hand on the hip. (b,Start the wrap on the arm and pullmedjally across the anterior chest.(c-eJ The wrap continues around thearm and again proceeds around thechest. (f-h) Use elastic tape to tracethe elastic wrap.

88

Figure 5.9 (d-e) An elastic wrap canimmobilize an acutely injured shoul-der. ff-g) A commercially producedbrace can limit shoulder abduction andexternal rotation. Control the degreeof abduction through the adjustablestraps ofthe brace.

89


ARM CONTU$IONSAthletes often suffer arm contusions, especiallywhen playing football or other contact sports.Arm contusions, like those of the thigh, maydevelop myositis ossificans, an iniury termedblocker's exostosis.

exostosis-Abnormal bone growth.

Arm Contusion TapingProtect the arm ftom repeated trauma by securinga protective pad to the area. Figure 5.10 illustrateshow to use elastic tape when applying a protectivepad to the lateral aspect of the arm.

Arm Contusion ExercisesThe exercises illustrated in figures 5.5 through5.7 and those for the elbow in chaDter 6 will helothe in jured ath lete mainta in normal : t rengt i rand flexibility, An experienced clinician shouldmonitor the iniury for exostosis in the soft tissueof the arm and prescribe rest if this condltiondevelops.

Figure 5.lO (d-bl Elastjc tape to secure a protective pad to the arm.

Exostosis ofthe Humerus

magecourt€syof tu mal Pi.tur6.


ARM OI|NTUSIONSAthletes often suffer arm contusions, especiallywhen playing football or other contact sports.Arm contusions, like those of the thiSh, maydevelop myositis ossif,cans, an iniury termedblocker's exostosis.

exostosis-Abnormal bone growth.

Arm Contusion TapingProtect the arm ftom repeated trauma by securinga protective pad to the area. Figure 5.10 illustrateshow to use elastic tape when applying a protectivepad to the lateral aspect of the arm.

Arm Contusion ExercisesThe exercises illustrated in f,gures 5.5 through5.7 and those for the elbow in chapter 6 will helpthe injured athlete maintain normal strengthand flexibility. An experienced clinician shouldmonitor the injury for exostosis in the soft tissueof the arm and prescribe rest if this conditiondevelops.

Figure 5.10 (d-b) Elastic tape to secure a protective pad to the arm.

Exostosis ofthe Humerus

Lmagecoudesy of tu malPictures

PosteriorElbow

lmage co!rtesy of Prima Pictures.

Elbow JointLigaments

Ulnar collateralmenr

mage coun-aty of Primal Pict!res.

92

THE ELBOW AND FOREARM 93

The hinge of the elbow permits flexion andextension (figure 6.1). Flexion occurs through theaction of the anterior muscles of the arm, which

Lateral Shoulderand Arm

Subacromial bursa

Humerus

Pectoralis minor

Biceps brachii,head

Brachialis

The radius and ulna of the forearm createthree joints: the proximal radioulnar, the distalradioulnar, and the articulation along the shaftsofboth bones. The fibers ofthe annular ligamentstabilize the proximal radioulnar joint. The inter-osseous membrane ioins the shafts of the radius

include the biceps brachii and brachialis. Thethree heads of the triceps brachii comprise theDosterior muscles and produce elbow extension.

Teres minor

Triceps brachii,lateral head

and ulna, and an artlcular capsule supports thedistal radioulnar joint. Pronation and supinationdescdbe the potential movements of the forearm(figure 6.1). The pronator teres and pronator qua-dratus muscles cause pronation, and the supinatormuscle Droduces suplnation.

lmage courtesy of Primal Picrures,

PosteriorElbow

Figure 6.1 (d, Elbow f lexion and extension ranges of motion;(b/ forearm pronation and supination ranges of motion.

Biceps brachii,head

Olecranon bursa

Pronator teres

Flexor caroi radialis

Flexor digitorum

Flexor digitorumus

Extensor carpiradialis

maqecourtesy of Pr halPicrures.

94

TTIE ELBOW AND FOREARM 95


Anterior> Cubitalfossa> Biceps tendon

Medial> Ulnar nerve> Wrist flexor-pronator group> Medial epicondyle> Medial collateral ligament

Lateral> Wrist extensor-supinator muscle group> Lateral epicondyle> Lateral collateral ligament

Posterior> Olecranon process> Olecranon bursa> Triceps muscle

Ets,$w $,pfid.Ht|$Similar to knee injuries, elbow sprains occurwhen valgus or varus forces damage the medialor lateral collateral ligaments, respectively. Sportsthat depend on the athlete's overarm throwingability will impart chronic stress to the medialcompartment of the elbow and injure the medialcollateral lisament.

Elbow Sprain TapingMedial and lateral instabilities can be difficultinjuries to support, and taping the elbow isunlikely to help the athlete who suffers fromchronic stress to the medial collateral ligament.Figure 6.2, howeveq illustrates a collateral liga-ment taping procedure that you may find valu-able for some cases. The procedure is remarkablysimilar to taping the collateral ligaments of theknee (chapter 3).

Figure6.2 Elbow collateral l igament taping for instabil ityofthe lateral collateral l igament. (d) The procedure beginswith proximal and distal anchor strips. (b-d) Place strips overthe lateral collateral ligament in an X fashion. (continued)


Figure 6.2 (continued) (eJ Secure the tape wlth proxjmal andelbow joint itself.

Elbow ExercisesStretch the elbow flexor and extensor muscleswith the assistance of the contralateral extrem-ity (figure 6.3).

Strengthening exercises should work the mus-cles that produce elbow flexion and extension,

forearm pronation and supination, and wrist flex-ion and extenslon. I recommend a combinationof hand-held weights and elastic bands, as figure6.4 illustrates. Chapter 7 will discuss exercises forthe wdst.

96

distal anchors using elastic tape that encloses all but the

Figure6.3 Stretching ofthe elbow (d) extensor and(bJ flexor muscles with the contralateral exrremtry.

97THE ELBOW AND FOREARM

Figure 6.4 Strengthening exercisesfor the elbow (q, flexor and (b) exten-sor muscles with a hand-held weight.Elastic bands wil l strengthen theforearm fc, pronator and (d) supinatormus<les.

ElbowHyperextensionInjury

ETBI|W HYPEREXTEITISIO NSelf-inflicted or external forces can extend theelbow beyond its normal anatomical limit; themotion produces a hyperextension iniury thatdamages the ulna or humerus where it articu-lates during extension. The soft-tissue structureson the antedor aspect of the elbow could alsosuffer trauma. In severe cases, hyperextensionwill fracture or dislocate the elbow.


Elbow Hyperextension TapingElbow and knee hlperextension share a similartaping procedure (chapter 3). Determine thedegree of extension that produces discomfortand slightly flex the ioint for the duration ofthe taping. Place anchor strips around the armand forearm (figure 6.5). To prevent slippage, Irecommend that you apply the anchors directlyto the skin. You may also find it advantageous tosecure the proximal anchor above the belly ofthebiceps. Thpe successive, interlocking stdps overthe antedor aspect ofthe elbow. Elastic tape works

well when supporting hyperextension injudes.If necessary, complete the taping procedure byenclosing the elbow with elastic tape or wrap.

Hyperextension ExercisesFigure 6.3 details extension and flexion exercisesthat will restore the normal range of motion of theinjured elbow. The strengthening regimen needsto isolate the elbow flexor and extensor muscles(see figure 6.4).

Figure6.5 Elbowhyperextensiontaping procedure. (a) Begin the proce-dure on a shaved arm and apply proximaland distal anchor strips. (b-d) Form an Xwith three strips oftape over the anterioraspect of the elbow. (e, Apply proximaland distal anchor strips to secure thelape. (continued)

Figure 6.5 (continued) (f.) Crimp the strips on the anterioraspect. (g) The bridge created over the anterior elbow can beproblematic for some sports, such as wrestl ing. (h-k) Elimi-nate this problem by enclosing the taping procedure withan elasflc wrap.

99

100 ATHTETIG TAPING AND BRACING

tftfi0illBvltHt$ CIF Tt*E ltsilttBtl$The medial and lateral epicondyles of the humerusattach several muscles. Muscles originate from thelateral epicondyle for forearm supination andwrist extension. The medial epicondyle joinsmuscles for forearm pronation and wrist flexion.Repetitive forearm and wrist motion-such as thatrequired for tennis or throwing-inflames thesemuscles at their points of origin from the medialor lateral epicondyles. Tennis players commonlysuffer from lateral epicondylitis, known collo-quially as tennis elbow. Athletes who repeatedlyuse a throwing motion, especially adoiescenti,frequently experience medial epicondylitis, oft encalled Little Leazuer's elbow

Epicondylitis TapingI have found that taping for epicondylitis is notalways effective. Some patients experience reliefftom strips of tape applied to compress the proxi-mal forearm (figure 6.6). Commercially producedstraps will also selve this purpose (f,gure 6.2).

Exercise caution when treating the adolescentpatient with medial epicondylitis. For many ado-lescents, the strength of the muscles exceeds thetolerance of the immature bone. The throwingmechanism may cause avulsion fractures of thimedial epicondyle. For this reason, do not tape

Figure6,6 The application oftape around theproximalforearm can sometimes alleviate pain asso-ciated with lateral epicondylitis (tennis elbow).

LateralEpicondylitis

an adolescent athlete so that he or she throwsthrough the discomfort associated with medialepicondylitis.

epicondylitis-lnflammation of an epicondyle.avulsion-The tearing away ofa tendon or

ligament atta€hment from bone.

Figure6.7 A commercially produced Drace canalso alleviate pain associated with lateral epicon-dvlit is.

hage counesy of Primal Picturcs.

THE ELBO,lff ATID FOFEARM 101

Epicondylitis ExercisesAfter the inflammation associated with lateralepicondylitis has resolved, prescribe exercisesto enhance the athlete's range of motion andstrength. The stretching exercises for the elbowand forearm will increase flexibi[ry For lateralepicondylitis, hyperflex the wrist during com-plete pronation (flgure 6.8). The strengtheningtechniques should exercise the forearm supinatorsand wrist extensors (chapter 7). Rest is the besttreatment for medial eDicondvlitis.

Figure 6.8 Stretching of the extensor-supinatormuscles commonly implicated in lateral epicon-dvlitis.

rts.Ijl7

Ihe Wnlst

I

1 \

pal bones, and the fingers have 14 phalanges: aproximal and distal phalanx in the thumb and aproximal, middle, and distal phalanx in each ofthe four finsers.

Metacarpophalangealjoints

Second, third, fourth

fn. *r'r, has rwo rows of carpal trones. I ne

I lff 'Jti:l :"# ;il:iH J::J:'|,H,X,"^ S:trapezoid, capitate, and hamate bones completethe distal row. The hand includes five metacar-

Proximal lanx of thumb

First metacarDal

and fifth

T

Ulnar styloid process

Carpalbones

ScaphoidCarpalDOnes

Lunate

Radia l

Wrist andHand Bones

lanx of thumb

Metacarpo pha la ngea I joints

Radius

lmage .oufiesy oi Prima Pictures.

U lna

103

104

The d is ta l rad ius and thescaphoid and lunate proximalc a r p a l b o n e s c r e a t e t h e w r i s tjoint, allowing movements thatinclude flexion, extension, radialdeviation (abduction), and ulnardeviation (adduction) (figure7.1). The distal carpal bones andthe metacarpals form lhe cal -pometacarpal joints. The distalends of the metacarpals and theproximal phalanges ofthe flngerscreate the metacarpophalangealio in ts . These jo ints f lex, extena,abduct, and adduct. Each of thefour f ingers conta jn two io in ls .the proximal interphalangeal(PTl) and the d is ta l in terpha-langeal (DiPr . The in terphalan-geal joints permit flexion andextension. A complex nelworkof ligaments and ioint capsulessupports all the toints in thehand and fingers.

The thumb is crucial becauseit provides specialized dexterity.The carpometacarpal joint oft h e l h u m b p e r m i t s e x L e n ) i o n .flexion, abduction, adduction,opposition (frgure 7.1 r, and Tepo-s i l ion. lhe metacarpophalangea Iand interphalangeal joints ofthethumb permit flexion and exten-sion.

Figure 7.1(d) Wrist flexionand extensionranges of motion;(b) wrist radial andulnar deviationranges of motion;(c) finger flexion,(d, extension,(continued)


Figure 7,1 (continued, fe) a bduction, a nd f, add uction; (g) th u m b extension, fh) flexion, f, adduction, and 0J opposition.

1 0 5

Ligaments ofthe Wrist and Hand

Dorsal carpometacarpalments

Dorsal radiocarpal

Extensor brevrs

Abductor l ic is

Extensorcarpi radialis brevis

Lateral ligament ofthe

Jl ) Anterior Forearm

Palmar intercarpal

Pronator quadratus

Flexor pollicis longus

Pronator teres

Radial collateral I

ma9€.ourtesy of Primal Picturei.

lmag€ court€sy of ft malPl.iures.

106

THE WRIST AND HAND 107

Several ligaments reinforce the joints. The ulnarcollateral ligament of the metacarpophalangealjoint, which prevents valgus displacement, needsconsideration with respect to athletic injury

Several muscles odglnate in the forearm andhand that produce wdst, hand, and flnger move-ment. The flexor carpi ulnaris and the flexor carpiradialis cause wdst flexion, and the contraction ofthe extensor carpi ulnaris and the extensor carpiradialis longus and brevis produce wrist exten-sion. The simultaneous contraction in the wdstof the flexor carpi ulnaris and the extensor carpiulnaris results in ulnar deviation. Conversely, ifthe flexor carpi radialis and the extensor carpiradialis longus contract together, radial deviationoccurs. Several muscles that act on the wdst beginftom the humerus and cross the elbow joint. Theyare, therefore, significant for normal function ofboth the elbow and the forearm.

Three muscles produce movement in the lourfingers (figure 7.1). The flexor digitorum profun-dus and superficialis cause flexion; the extensor

Posterior Forearm

Flexor d superficialis

Flexor u lnans

Flexor carpi radialis

digitorum precipitates extension. The flexor digitorum profundus attaches to the distal phalanx ofthe fingers, and the flexor digitorum supelficialisinserts into the middle phalanx. The first muscleflexes both the PIP and DIP joints, but the lattermuscle flexes only the PIP Both muscles, however,flex all the joints of the wrist and hand as theypass to the fingers. The insertion of the extensoldigitorum gives three tendinous slips to each ofthe four fingers. A central tendon attaches to themiddle phalanx, and two lateral bands pass to thedistal phalanx. Along with some of the intrinsicmuscles of the hand, this mechanism creates theextensor hood,

insertion-The Doint where muscle attaches tobone; usually refers to the distal attachmentofthe muscle.

extensor hood-The anatomical tendonconfiguration on the dorsal aspect ofthefi nger.

Extensor u lnar is

Anconeus

ma9€ cou'tesy of P,rmal Pr.tures.


Extensor Mechanismofthe Finger

Lateralcon extensor tendon

Lateral tendon

Eight muscles act on the thumb to Droduceits remarkable dexlerity. The exlensor polliclsIongus, extensor pollicis brevls, abductor pol-licis longus, and flexor pollicis longus originatein the forearm. The extensor pollicis brevis andlongus create a space at the base of the thumb,the "anatomical snuffbox," The box has clini-cal significance because the scaphoid bone lieswithin its borders; point tenderness at this siteoften indicates a scaphoid fracture. The flexor pol-licis brevis, opponens pollicis, abductor poliicisbrevis, and adductor pollicis muscles orlginatein the hand and creale the thenar eminence, asoft -tissue prominence.

Common extensor tendon

pollicis-Pertaining to the thumb.anatomicalsnuffbox-The space at the base of

the thumb created by the extensor pollicislongus and brevis tendons.

thenar emlnence-lntrinsic muscles of thethumb that include the abductor poilicisbrevis, fl exor pollicis brevis, opponenspollicis, and the adductor pollicis.

AnatomicalSnuffbox

lmaqe co!rtesy of Primat Piclurcs,

ha9e couriesy of PrimalPiciures,

THE WBIST AND HAND 109

Anterior> Pisiform bone> Hook of hamate bone> Thenar eminence> Hypothenar eminence


Posterior> Carpal bones> Ca rpometacarpal joints> Metacarpopha langea I joints> Interpha langea I joints> Ulnar collateral ligament of

thumb

Medial> Anatomical snuffbox> Scaphoid bone> Radial styloid process

Laterol> Ulnar styloid process

Surface Anatomy

Flexor retinaculum

Abductor d

lmage courtesy ol Primal Pictures.


Figure7.3 (continued)

Wrist ExercisesStretch the wrist flexor and extensor muscles withassistance from the contralateral hand (figure 7.4).Hand-held weights will strengthen the flexor andextensor muscles (f,gure 7.5).

FiguraT,4 Stretchjng ofthe wrist (d, extensor and fbJ flexor muscles.

Figure7.5 Strengtheningofthe wrist (d) flexor and (b)extensor muscles with a hand-held weight.

THE WRIST AND HAND 1 1 3

Carpal Tunnel SyndromePeople engaged in activities requiring repetitivemotion of the wrist are susceptible to carpaltunnel syndrome (CTS). CTS is compression ofthe median neNe as it passes through the carpaltunnel of the wrist, and it causes tingling, numb-ness, and paresthesia in the palm, medial thumb,and first and middle fingers. Musicians, industrialand clerical workers, and even athletic trainersengaged in taping for long hours are susceptibleto CTS. A brace designed to plotect and rest thewdst ftom the repetitive stress that produces CTSis commercially available (figure 7.6).

Figure 7,6 A commercially produced brace to relieve thesigns and symptoms of carpal tunnel syndrome.

THUMB $PRAINSThumb sprains result ftom h)?erextension andinvolve injury to the ulnar collateral ligament.The colloquial term for this iniury is gamekeeper'sthumb because the mechanism ofulnar collateralligament injury was common in gamekeeperswho attempted to break the neck of their fowlmanually. Iniuries that completely rupture theulnar collateral ligament usually require surgicalrepair. Partial ligament tears will benefit from ataping procedure.

Thumb Sprain TapingThe athlete's pain and disability, along withthe dexterity that he or she requires, will deter-mine how you proceed. For minor in jur ies, asimple flgure-eight taping around the thumband wrist will suffice (figure 7.7). If the athleteneeds the wrist to move freely, begin the indivi-dual strips on the anterior surface, encircle the

CarpalTunnel ofthe Wrist

Lmage courte5y of Primal Pictures.

Rupture of theUlnar CollateralLigament of theThumb

lmagecouftesy of Pr ma Pictures.


metacarpophalangeal joint of the thumb, andfinish on the postedor aspect of the wrist.

The procedure for more significant injuries,or for athletes who do not need dexterity ofthe thumb, should incorporate the hand foradditional support (figure 7.8). This techniquerequires anchors at the wrist and hand. Applyflgure-eight strips around the thumb and wdst,and overlap horizontal strips from the dorsalto the palmar aspect of the hand. These stripswi l l lur ther 5tabi l i . /e the thumb against hypar-

Figurc7.7 Figure eig ht taping to su pport the metacarpopha la ngeal joint of the th umb. (d) Following application of anchorstrips around the wrist, begin a strip of tape from the palmar surface ofthe wrist and proceed around the thumb. Adduct thethumb as the strip passes toward the dorsal surface ofthe wrist. (b, To prevent the bulk that wil l result from continuous stripsaround the wrist, individually apply the fi9ure-eight strips. fc-e) Successive figure eight strips overlap the preceding strips in astaircase fashion. (F? Anchor strips around the wrist complete the procedure

THE WRIST ANO HAND 1 1 5

extension. Complete the procedure with two orthree additional figure-eight strips around thethumb and wdst. I do not recommend taping

the thumb to the index finger because additionaltrauma has the potential of injuring the other-wise healthy digit.

Figure 7.8 Supplement the thumb figure-eight taping pro-cedure with tape that incorporates the hand. fa, Followingplacement of an anchor strip around the hand, (b-cJ applystriDs from the palmar to dorsal hand anchors over the meta-carpophalangeal joint of the thumb. fd Secure these stripswith additiona | f ig u re-eight strips and (e, complete the pro-cedure by securing anchor strips around the hand and wrist.

' | 18 ATHLETIC TAPING AND BBACING

Figure 7,12 (continued) fb-d, Create an X over the col-lateral l igament with three strips of tape. fe) Secure the tapewith proximal and distalanchors.

Finger ExercisesStretching and strengthening exercises employthe contralateral hand and elastic tubing, respec-tively (figures 7.13 and 7.14). Squeezing a tennisball or racquetball will also strengthen the fingerflexor muscles.

Figure 7.13 Stretching of the finger fd) extensor and (b/ f lexor muscles.

THE WRIST AND HAND

FigureT.l4 Strengthening of the finger (o) extensor and (b) f lexor muscles with elastic tubing.

TElll[0|ll ilUPIUIES 4il0

1 1 9

Alrrlsion of the extensor digitorum tendon fromthe distal phalanx will force the DIP toint to flex.This injury colloquially termed baseball finger,often occurs when a ball stdkes the fingertip.

Rupture of the ExtensorDigitorum Tendon

baseball finger-The colloquial term for anavulsion ofthe extensor digitorum tendonfrom the distal phalanx of the finger; alsoknown as mallet finger.


Tendon Rupture and Avulsion Finger Rupture and AvulsionSplintingManaging the rupture of the extensor digitorumtendon fTom the distal phalanx involves splint-ing the DIP in an extended position for 8 to 10weeks (figure 7.15). Altemate the splint betweenthe palmar and dorsal surfaces of the finger toprevent maceration of the skin. Manually extendthe DIP toint while changing the splint, becauseany joint flexion will require you to restart theimmobilization clock.

ExercisesHave the athlete exercise the flnser to restore itsnormal range of motion and stiength after thetendon rupture or ar,rrlsion heals. Prescribe theexercises illustrated in figures 7 .1,3 and 7 .1,4. Anexperienced clinician with appropriate medi-cal clearance should both approve the athleteto begin the exercises and provide supervision. r r in o tha rao i men

Figure 7.15 (a) A mallet f inger splint designed to preventflexion of the distal interpha la ngeal joint. (b) The joint mustnot f lex while you are changing the splint. (c) A commerciallyproduced spllnt can also be used to prevent flexion.

I

Glossany

abduction-Movement away from the midline ofthe body.

acronioclavicular ioint sprain-A sprain to the acro-mioclavicular or coracoclavicular ligaments of thejoint formed by the distal clavicle and the acromionprocess of the scapula; also known colloquially asa separated shoulder.

acute ioiury-A recent, traumalic iniury.

adduction-Movement toward the midline of thebody.

anatomical positiotr-Erect position with the arms atthe sides and palms of the hands facing forward.

anatomical snuffbox-The space at the base of thethumb created by the extensor pollicis longus andbrevis tendons.

antalgic gait-A painful or abnormal walking orrunning pattern.

anterior-The front or top suface of a limb.

anterlor cruciate liSament-A liSament crossingthrough the knee joint that attaches ftom the ante-rior tibia to the postedor femur, The antedor cruci-ate ligament limits anterior movement of the tibiafrom the femur as well as rotation of the tibia.

articulatlon---The point where two or more adjacentbones create a joint.

avascular-The absence of blood supply.

ayulsion-The tearing away of a tendon or ligamentattachment from bone.

baseball finger-The colloquial term for an avul-sion of the extensor digitorum tendon ftom thedistal phalanx of the finger; also known as malletfinger.

blofeedback-Feedback provided through visualobservation or an audio tone.

bursa-A fluid sac that reduces fuiction between twostructures.

chronic inlury-A nontraumatic iniury of an onSo-lng nalure.

circumduction-A combination of abduction, adduc-tion. flexion, and extension.

closed-chain exercise-Exercise in which the distalsegment of the extremity is fixed to the ground.

contralateral-Refers to the opposite extremity.

contusion-A bruise.

dislocation-A complete separation of two a iculat-ing bones.

distal-A point on an extremity located away fromthe trunk.

dorsiflexion-Movement of the foot toward the uppetor dorsal, surface.

dorsum-The top of the foot or the back of thehand.

el€ctrical muscl€ slimulation-Use of electrical cur-rent to induce a muscle to contract.

€picondylitis-lnfl ammation of an epicondyle.

eversion-Outward movement, or turning, of thefoot.

exostosis-Abnormal bone growth

extensor hood-The anatomical tendon confiSurationon the do$al aspect of the finger.

extrinsic muscle-A muscle that originates in the legor forearm and inserts into the foot or hand.

hamstrings-A muscle group in the postedor thighconsisting of the semitendinosus, semimembrano-sus, and biceps femods.

hematoma-A collection of pooling blood.

human anatomy-Study of structures and the rela-tionships among structures of the body.

iliac crest-The supedor border of the iliac bone; thecolloquial term for a contusion to this area is "hippointer."

innervation-The process of sending a nerve impulsefrom the central nervous system to the pedpheryto induce a muscle to contract.

innominate bones-Two flat bones that form thepelvic girdle; each consists of an ilium, pubis, andischium.

ins€rtion-The point where muscle attaches tobone; usually refers to the distal attachment ofthe muscle.

inierdigital-Located between the digits (i.e., thefingers and toes).

intrinsic muscle-A muscle that oriSinates and insertswithin the foot or hand.

inv€rsion-lnward movement, or turninS, of thefoot.

lateral-Toward the outside.

rnechanism of iniury-Describes the specific causeof the injury

medial-Toward the inside.

menisci-The intra-articular cartilage of the knee.

myositis ossificans-The formation of bone within amuscle that has suffered a contusion.

open-chain €x€rcise-Exercise in which the distal seg-ment of lhe extremity does not bear weiSht.

121

122 GLOSSARY

origin-The point where muscle attaches to bone;usually refers to the proximal attachment of themuscle.

orthotic-A commercially available insert designed torealign and alter the biomechanics of the foot.

overuse iniury-Chronic in;ury resulting from rcpeti-ve stress.

periosteum-Outer layer of bone.pes cavus-A foot with a high longitudinal arch.p€s planus-A foot with a flat longitudinal arch.plantar fasciitis-Inflammation of the plantar fascia

at its attachment to the calcaneus.plantar flexion-Movement of the foot toward the

bottom, or plantat surface.plantar neuroma-Inflammation or irritation of a

plantar nerve.pollicis*Pertaining to the thumb.posterior-The rear or bottom suface of a limb.pronation-Movement of the forearm to place the

palm facedown; or, while non-weight beadng, acombination of dorsiflexion, eversion, and footabduction.

proprioception-Awarcness of the position of a bodypart in space.

proximal-A point on an extremity located near thetrunk.

quadriceps (q)-angle-The degree of obliquity of thequadriceps.

quadriceps femoris---llhe muscle group in the antedorthigh consisting ofthe rectus femods, vastus media-lis, vastus intermedius, and vastus lateralis.

retinaculum-A soft-tissue fi brous structure designedto stabilize tendons or bones.

rotator cuff-The muscle group in the shoulderconsisting of the subscapularis, supraspinatus,infraspinatus, and teres minor.

shin splints-A colloquial term for pain in the legthat can originate from any number of possiblesources.

spica-A figure-eight wrap that incorporates the thighand hip or the arm and shoulder.

sprain-An ove$tretching (fi$t degree), partial teadng(second degree), or complete rupture (third degree)of a ligament.

static stretching-Stretching a muscle in a stationarvpos i t ion .

strain An overstretching (first degree), partial tearing(second degree), or complete rupture (third degreelof any component of the muscle-tendon unit.

subluxation-A partial dislocation of a joint.superficial Toward the sudace of the body.supination-Movement of the forearm to place

the palm faceup; or, while non-weight bearing.a combination of plantar flexion, inversion, andfoot adduction.

surfac€ anatomy-Study of the form and surface ofthe body

tendinitis-Inflammation of a tendon or its sheath_thenar eminence-Intrinsic muscles of the thumb

that include the abductor pollicis brevis, flexorpollicis brevis, opponens pollicis, and the adduc-tor poll icis.

valgus-Alignment of a joint or stress to the iointthat places the distal bone in a lateral direction;the "knock-kneed" position of the knee joint-

varus-Alignment of a ioint or stress to the joint thatplaces the distal bone in a medial direction; the"bowlegged" position of the knee joint.

Tapping Book

Text of Tapping Book

Tapping Book Fico de Castro

Click here for the e-book - "Tapping Your Way To Health Happiness

Tapping Growth

Tapping Chucks

Tapping Solution e Book

Tapping solutionebook

Tapping into Freedom · tapping is an energy therapy technique involving meridian tapping. As a relatively new healing approach, the extent of tapping ... curiosity, compassion and

Moai Tapping

Tapping Method

Exercices Tapping

Big Book of Tapping

Tapping screws

Guitar Book - Dave Celentano - Over the Top - Advanced Two Hand Tapping

PRODUCT & SERVICES CATALOGUE · Cast Iron Pipe Fittings Tapping Saddles – PE Pipe 41 Tapping Saddles – PVC Pipe 42 Tapping Saddles – AC Pipe 43 Tapping Saddles – Spare Parts

Tapping hiddenjobmarket

Tapping Birch

Tapping Fittings

Multiplier Effect book review · ©2013!SAIS! !!! the$conversation$ continues$inside$of$ SAISconnect$ $! BOOK$REVIEW$ The$Multiplier$Effect:$Tapping$the$Genius

Tapping v14

Audio Book Supplemental Material...THE TAPPING SOLUTION FOR MANIFESTING YOUR GREATEST SELF Start with three deep breaths, and then begin tapping on the Karate Chop point. KC (repeat

REMOTE-CONTROLLED HOT TAPPING SUBSEA · Hot tapping challenges subsea The greatest concern associated with subsea hot tapping is that divers - not experienced tapping professionals

tapping valve

Tapping Machines, Drilling Machines, Combination Drilling/Tapping … · 2019-02-25 · 1 TAPPING MACHINES Reed's Direct Tapping Machine is used to drill and tap water mains while

Tapping Book DRAFT for PUAs

Bass Tapping

Tapping with Children - Evidence Based EFT · Tapping with Children A General Overview of Tapping Emotional Freedom Techniques (EFT) is often called ‘tapping’ or ‘psychological

Pleural Tapping

Guitar book dave celentano - over the top - advanced two hand tapping

Tapping creativity

Kinesio Tapping

Documents

Tapping Book

Text of Tapping Book