An Indispensable Tool for Acute and Chronic Care
By Roger Berton, DC, CKTI and Jill Snell, DC, CKTI
It's honestly hard to say where elastic therapeutic taping makes the most difference in my chiropractic practice. I use taping in many different areas of treatment. I have had especially great success with motor-vehicle-accident patients, who often cannot initially tolerate aggressive manual therapy techniques. When this occurs, I initially use only passive modalities such as laser, ultrasound, breathing techniques and therapeutic taping.
I truly appreciated the use of the tape on these occasions due to its longer physiological therapy time over larger areas or multiple body parts at the same time, in contrast with the other therapeutic modalities I use. Tape can also be used at the same time as traction / decompression or mobilizations / manipulations when the patient starts to heal. It only becomes more useful when we are ready to re-educate damaged tissue and muscles by adding neurological support / stability.
I am glad I do not have to keep track of how many times I use taping applications in ordinary treatment activities. I apply it to my patients on a daily basis as a pain, swelling and functional treatment modality. Taping is used to help support my other treatment modalities, assisting and supporting the patient between office visits, and helping support their out-of-office care. It can be used every visit, although generally as the patient improves, the techniques for applying the tape change, with the goal being to use less tape until none is needed at all.
Acute and Rehab Care
Working in an outpatient orthopaedic clinic, I use elastic therapeutic taping initially on patients for acute care when treating swelling, by applying a lymphatic drainage technique with fan cuts, or for space corrections – using it with a web cut if no specific channeling is needed. In the subacute phase, but before strengthening is needed, I may choose muscle relaxation techniques, using mostly "Y" cuts to cover a greater surface area of the muscle. (The Y cut merely indicates a strip of tape divided into a Y on one end.) At the subacute phase, I will also consider the function of the tissues and consider what may be limiting their full capacity.
With these goals in mind, I may add fascial corrections or scar corrections to try to maximize my gains before I start rehabilitation protocols. When I am ready to rehabilitate the patient with active exercises or for athletic injury prevention, I apply muscle facilitation techniques, primarily with "I" strips to facilitate the tissue over the belly and motor point of the involved muscles. (The basic "I" cut – essentially a single strip of tape of varying length – is generally used to stimulate directly over the target tissue.)
In addition, I also add the appropriate corrective techniques as needed to help accomplish my treatment goals, such as functional corrections to optimize or limit joint-specific range of motion, and ligament corrections to add neurological stability and support. Treatment may also involve mechanical corrections to assist the patient in relearning certain motor patterns.
Therapeutic taping is not always a stand-alone therapy, but acts as a valuable adjunct to other well-accepted treatment options. Among other reasons, this is because the tape acts to extend the effective time period of other manual therapies. A recent study in Serbia combined elastic therapeutic taping with Mulligan therapy and achieved positive results in comparison with supervised exercise without taping. The Serbian researchers listed a number of practical conclusions:
"Mobilization With Movement (MWM) technique and [therapeutic] taping are widely applied to different painful joint conditions. They can be applied in impingement shoulder syndrome at any time. MWM technique intends to realign subtly malpositioned relationships in shoulder joint and to practice active movement within these corrected circumstances. [Elastic therapeutic] taping seems to have a helping role in maintaining these corrected relationships of the joint-creating structures. Initial effects in improving ROM and reducing pain in impingement shoulder syndrome are better [compared] with supervised exercise program."1
The other conditions I am often faced with can be of a more chronic nature, such as osteoarthritis, disc degeneration or overuse-type syndromes. Taping protocols will change as the patient progresses, but again, space corrections using web cuts and "I" cuts can be incredibly useful in helping to reduce pain so the patient can progress to rehabilitation care. A web or fan cut [a strip of tape cut so as to have multiple "tails"] is used to assist in the acute phase to treat swelling and provide drainage. Its use provides greater surface area and a pressure gradient change between the tape and skin.
An Example: Shoulder Instability
For example, shoulder instabilities can develop after acute dislocations, chronic subluxation or long-term overuse activities that stretch the shoulder capsule. In most cases the instability is the result of an acute injury to the anterior region of the shoulder capsule. Elastic therapeutic tape is not designed to mechanically stop a motion or movement of body tissue. It will not stop the humeral head from dislocating. However, taping may help to reduce edema and pain, and provide proprioceptive stimulus through the skin to cause the tissues to adjust to the tension.
During the first 24 to 72 hours after an acute trauma, the primary goal is to limit inflammation. A fan taping application would be used. With the first strip, place the base of the fan near the posterior inferior angle of the posterior deltoid, directing the five tails of the fan over the AC joint and toward the clavicle region. Place the base of the second fan cut strip near the anterior inferior angle of the anterior deltoid, directing the five tails over the AC joint toward the lower trapezius insertion. The two strips should form a crisscross pattern.
For treating the subluxed shoulder, cut an "I" strip of elastic therapeutic tape about 12 to 16 inches long. Start the long anchor tape just proximal to the elbow joint on the lateral aspect of the arm. Apply the end of the tape immediately above the glenohumeral joint. While the arm is supported in a reduced position – somewhat outstretched from the scapula – apply tape with 15-25 percent tension to the acromion process. Put the humerus into horizontal abduction while applying tape across the scapula to the middle of the back using 15-25 percent tension to the vertebra.
This taping application should never be used for an uninjured, normal shoulder or an impinged shoulder. If used inappropriately, this technique may actually cause impingement.
Most patient populations tolerate tape very well when it is applied appropriately. I can use it on my pediatric and geriatric cases, as well as my athletes, although I may choose different application techniques depending on the population I am taping. The other great thing about the tape is that if for any reason, any patient feels itchy or uncomfortable, they can remove it immediately, so there tend to be very few adverse reactions.
I receive constant positive feedback from my patients; it has even been called the "miracle tape" by a motor-vehicle-accident patient who was allergic to medication. All of which reinforces the efficacy of the modality, and continuously reinforces the need and reasons I use elastic therapeutic taping in my office.
Dr. Roger Berton, a graduate of National University of Health Sciences, owns and operates health care clinics in Tecumseh and Windsor, Ontario. He also worked as the program coordinator and instructor for CDI's registered massage therapy program in Windsor. Prior to his association with CDI, Dr. Berton devoted three years to the athletic department of St. Clair College as chiropractor, acupuncturist, and sports nutrition instructor for the continuing education department. He is a certified Kinesio taping instructor and has been asked to present at the Canadian Athletic Therapists Association Annual Conference, the Action Sport Physiotherapy Symposium and the College of Chiropractic Sports Sciences Symposium. Overall, Dr. Berton has taught more than 85 taping workshops and seminars worldwide.
Dr. Jill Snell, who also contributed to this article, is a member of the College of Chiropractors of British Columbia and works within a multidisciplinary clinic in Fernie, British Columbia. A 1997 graduate of New York Chiropractic College, she became a certified Kinesio taping instructor in 2008. Since then, she has instructed on taping protocols throughout the U.K. and Ireland at numerous locations, including the Olympic Medical Institute (OMI), the University of Bath and the Fulham Football Club.