Taping For The Upper Quarter

Andrew Leipus
B.Appl.Sc.(Exercise&Sports Science) B.Appl.Sc.(Physiotherapy) M.Appl.Sc.(Musculoskeletal&SportsPhysio) Physiotherapist Indian Cricket Team 1999-2005

Taping for the Shoulder and Scapula

Facilitation

of rotator cuff Shoulder anterior or posterior instability Relocation of HOH AC joint sprain Inhibition of upper trapezius/Levator Facilitation of lower trapezius Facilitation of serratus anterior

Shoulder Facilitation of Rotator Cuff

Aims

Facilitation of activation of the co-contracting stabilising function of the rotator cuff Light restriction to shoulder rotation Proprioception of the glenohumeral joint

Cuff Anatomy

Shoulder Facilitation of Rotator Cuff

Patient

position

Sitting with arm comfortably supported Approx 45 abduction in scapular plane Neutral shoulder rotation 50cm elastic or rigid sports tape Shaving if necessary ?gauze Vaseline pad over sensitive anterior axillary region

Preparation/Precautions

Shoulder Facilitation of Rotator Cuff

Application

of Anchor tapes

Needed if patient likely to become sweaty Anchor rigid tape lightly around mid upper arm Anchor from chest over trapezius along medical border of scapula Can also apply relocation tape initially if HOH sits anteriorly in glenoid

Shoulder Facilitation of Rotator Cuff

Application

of Tape

First elastic tape applied posteriorly with no tension from the anterior aspect of upper arm, around arm, then pull with tension up along the line of the spine of scapula Second elastic tape applied in opposite direction finishing along line of the clavicle anteriorly

Shoulder Facilitation of Rotator Cuff

Application

of Tape

The two tapes cross at right angles to each other adjacent to HOH and lateral to joint line Lock by repeating arm anchors with rigid tape May need to lock over lateral deltoid to prevent rolling of tape in abduction Can apply rigid tape on top of these to provide increased rigidity if required

Shoulder Anterior or Posterior Instability

Aims

To provide a mechanical block to glenohumeral movement in positions of instability (extremes of rotations +/- horizontal extensions) Used either for anterior, posterior or multidirectional instability To provide excellent proprioceptive feedback prior to the shoulder reaching a position of instability

Shoulder Anterior Instability

Patient

position

Sitting comfortably, arm held in 90 flexion 90 Shoulder internal rotation 75mm elastic tape + 50mm rigid tape Shaving if necessary, including axilla ?gauze or Vaseline pad over sensitive anterior axillary region

Preparation/Precautions

Shoulder Anterior Instability

Application

of Anchor tapes of Tape

None required if tape passes around chest* Start elastic tape from inferior angle of scapula Pass tape superiorly over acromion, anterior to HOH Ask patient to contract bicep
(*but advisable)

Application

Shoulder Anterior Instability

Application

of Tape

Pass tape without tension underneath proximal humerus and back around to the anterior HOH The tapes cross almost at right angles to the each other anterior to HOH with some tension Tape then passes diagonally across the chest and finishes back up at the start position of the medial border of the scapula

Shoulder Anterior Instability

Application

of Tape

Reinforce the bisection of the tapes with two strips of rigid tape, also crossing anterior to the HOH Can repeat this with a second tape slightly more medial to the first Lock the elastic tape with a small strip of rigid tape

Shoulder Posterior Instability

Same

principal as the taping for anterior instability except applied in a reverse manner Start tape application medial to nipple (5th rib level) Tapes cross at the posterior aspect of HOH Start position will be arm in 90 abduction and 90 external rotation

Shoulder Multidirectional Instability

Application

of BOTH anterior taping and posterior taping Can also use rotator cuff facilitatory taping prior to (underneath) the instability taping

Shoulder Relocation of Head of Humerus

Aims

Relocation of the HOH to mid-position when it is sitting anteriorly in the glenoid Light restriction to internal rotation Facilitation of normal proprioception and mechanics of the g/h joint Anterior shoulder pain reduction

Shoulder Relocation of Head of Humerus

Shoulder Relocation of Head of Humerus

Patient

position

Sitting comfortable, elbow supported Arm in neutral flexion/extension Arm in slight external rotation 50mm rigid sports tape May require under-tape to anterior aspect of shoulder due to skin tractioning effects

Preparation

Shoulder Relocation of Head of Humerus

Application

of Anchor tapes

Small strip applied vertically over medial aspect of anterior fibres of deltoid (over corocoid process) Second strip applied vertically along medial border of scapula

Shoulder Relocation of Head of Humerus

Application

of Tape

Apply rigid tape to the anterior anchor and pull firmly around the shoulder to attach to second anchor Keep the tape as close to the acromion as possible to avoid blocking glenohumeral abduction Ensure an AP pressure relocates the HOH in the glenoid

Shoulder Relocation of Head of Humerus

Repeat

this with 3-4 strips in a fanning distribution across the scapula Apply locking tapes accordingly

Shoulder Acromioclavicular Joint

Aims

To support and stabilise the AC joint following subluxation/dislocation sprain Facilitation of proprioception of the shoulder

Shoulder Acromioclavicular Joint

Shoulder Acromioclavicular Joint

Preparation/Precautions

50mm rigid sports tape Shave if patient has a hairy shoulder, back, or chest Gauze or Vaseline pad over sensitive anterior axillary region

Shoulder Acromioclavicular Joint

Patient

Position

Sitting comfortably with the arm resting on a table/pillows Arm held in 30-45abduction in the plane of the scapula with neutral rotation

Application

of Anchor

Arm anchor around insertion of deltoid (dont completely surround arm, no tension)

Shoulder Acromioclavicular Joint

Application

of Anchor

Second anchor from mid-scapular level passing vertically across top of the medial clavicle till approximately 3-4th rib on anterior chest Use protective under-tape if available in the following pattern

Shoulder Acromioclavicular Joint

Application

of Tape

Place small donut-shaped pad over the AC joint and fix with small piece of tape First tape is applied from the posterolateral humerus anchor across the AC joint and onto the chest anchor Second tape is applied from the anterolateral humerus anchor up over the AC joint to the scapula anchor

Shoulder Acromioclavicular Joint

Application

of Tape

Third tape applied vertically from the deltoid insertion anchor up over the AC joint to the trapezius anchor All three are applied with some tension Can repeat and basket-weave for large shoulders

Shoulder Acromioclavicular Joint

Application

of Tape

A fourth tape can be applied with tension in a posterior-anterior direction from the midscapular region across the mid clavicle and onto the pectoral region (to depress the clavicle) Apply rigid locking tape to fixate the tape ends

The Scapula
Note

that tape on the scapula is primarily to facilitate or inhibit muscle action The scapulas natural mobility makes it impossible to restrain movement Taping most commonly useful when there is overactive scapular elevators (+/- hitching) with under-active scapular depressors

The Scapula
Often

scapular problems are found with impingements, cuff dysfunctions, poor deep cervical flexors, forward head posture, and clinical evidence of poor scapular control Main over-active players tend to be the upper trapezius and levator scapulae, whilst lower trapezius and serratus anterior tend to be under-active

The Scapula
Pattern

Over-activity in Levator Scapulae & Rhomboids with relative inactivity of serratus anterior & lower trapezius leading to a downwardly rotated scapula

Pattern

Inefficient upward rotation of scapula typical in throwers or multidirectional instability patients

Upper Trapezius/levator Scapulae

Aim

Encouragement of inhibition of over-active muscle, in this case either UT or LS 50mm rigid tape Use under-tape since bunching and skin traction will occur and can become very uncomfortable

Preparation/Precautions

Upper Trapezius/Levator Scapulae

Application

of Tape

No anchors required Tape is applied at right angles to the intended muscle For upper trapezius the tape is applied vertically over the top of the shoulder girdle For levator scapulae the tape goes on an angle across the muscle adjacent to its insertion into the root of the scapula spine

Upper Trapezius/levator Scapulae

Application

of Tape

Fix one end of the tape with the index finger and hold firmly Place the middle finger over the muscle belly and firmly compress and hold Pull the tape firmly over the middle finger Fix the strip of tape with the fourth finger

Upper Trapezius/Levator Scapulae

Application

of Tape

Remove the middle finger leaving a bunching of skin over the muscle where the middle finger was The second piece of tape is applied in the same way but from the opposite direction A locking tape may be require to cover both of these tapes by a few cms each end to prevent lifting

Facilitatory Taping Lower trapezius

Aim

Facilitation of an under-active muscle Commonly useful if over-active elevators/hitching and under-active depressors Protective under-tape 50mm rigid sports tape

Preparation/Precautions

Facilitatory Taping Lower trapezius

Patient

Position

Sitting comfortably with shoulder girdle relaxed but supported Arm kept in slight lateral rotation

Application

of Tape

First tape applied starting from anterior glenohumeral joint line, drawing HOH posteriorly

Facilitatory Taping Lower trapezius

Application

of Tape

Tape is tensioned parallel to the spine of the scapula finishing just beyond the medial scapula border to pull the scapula into slight retraction Second tape starts as per the first but passes in a more inferior direction behind the scapula to finish in the midline at the level of T7

Facilitatory Taping Lower trapezius

Application

of Tape

Tension in the tape will tend to pull the scapula down and back Tapes are repeated to create two layers Use a locking tape at the ends to prevent lifting of the tape

Facilitatory Taping Serratus Anterior

Aims

Encouragement of facilitation of an underactive serratus anterior Often found with over-active levator scapulae, rhomboids +/- pec minor and latissimus dorsi Often found with under-active trapezius (upper and lower) and lower serratus anterior

Facilitatory Taping Serratus Anterior

Aims

Net result is a downwardly rotated scapula with delayed/lacking upward rotation during elevation = winging

Facilitatory Taping Serratus Anterior

Preparation/Precautions

Protective under-tape Gauze pad and Vaseline 50mm rigid sports tape

Patient

Position

Sitting with the arm supported or actively held in elevation to approximately 120 abduction in the scapular plane

Facilitatory Taping Serratus Anterior

Application

of Tape

No anchors but under-tape should be applied as below but under no tension First tape starts at the root of the scapular spine and is pulled down along the medial border then anteriorly around the inferior angle pulling the scapula outwards and anteriorly

Facilitatory Taping Serratus Anterior

Application

of Tape

Second tape starts at the inferior angle and is tensioned anteriorly and upwards in the direction of the fibres of serratus anterior pulling the scapula laterally and upwards Often used in conjunction with other inhibitory and facilitatory taping

Facilitatory Taping Serratus Anterior

Application

of Tape

The pull of the tape on the skin will tend to draw the scapula forwards and upwards leading to a facilitatory stretch on serratus and lower trapeziusand healthier scapular mechanics