Download Dr saleki

‫بسم هللا الرحمن الرحیم‬
Taping
 Mohammad Saleki MD
 Sport medicine specialist
IUMS
Taping
 Taping is an important skill for the sports
medicine team
 Many technique are used
Goals of taping
 Prophylactic (Athletic tape) :
(adding support ,stability and protect against
acute injuries, limit unwanted joint movement )
Treatment(acute,subacute,chronic):
minimize bleeding ,swelling&pain, limit
rang of motion, to hold dressings and healing
injuries
 Rehabilitative (Kinesio taping)
: Provide stabilization , optimal healing
and protect recurrent injuries
‫‪Taping‬‬
‫مفاصل مناسب‪:‬‬
‫مچ دست و پا‪-‬انگشتان دست و پا‪-‬آكرمیو‬
‫كالویكوالر‬
‫مفاصل نامناسب‪ :‬آرنج‪-‬زانو‪ -‬ستون فقرات‬
TAPING MECHANISMS:
 MECHANICAL
 PROPRIOCEPTIVE
(DIRECT REFLEX STIMULATION– LEARING
PROCESS )
Proprioception is joint position sense (determine
position of joint in space)
 Joint Mechanoreceptors
 Found in ligaments, capsules, menisci, labra,
and fat pads





Ruffini’s endings
Pacinian corpuscles
Free nerve endings
Sensitive to changes in shape of structure and
rate/direction of movement
Most active at end of ranges of motion
 Muscle Mechanoreceptors
 Muscle spindles - sensitive to changes in length
of muscle
 Golgi tendon organs - sensitive to changes in
tissue tension
Selection considerations
 Goals of taping
 Diagnosis of injury(Location,Nature,Severity )
 knowledge of anatomy and biomechanics
 movements that should restrict
 tissues that should protect and support
 Sport & position
 Athletes acceptance
 A taping that is effective for an athlete in
one sport may not be suitable for another
athlete
‫هدف از تیپ‬
‫نوع ومحل آسیب‬
‫رشته ورزشي‬
‫پوزیشن ورزشكار‬
‫مورد قبول‬
‫ورزشكار‬
‫مورد قبول ورزشكار‬
 If the athlete feels that taping is
uncomfortable or decreases
performance the attempt to
support will failed
Type of tape
 Elastic ) sizes: (‫ سانتیمتر‬5-20
Non-adhesive elastic
Adhesive elastic
 Non- Elastic
sizes: ‫ سانتیمتر‬3-8
elastic taping
 To compress & support soft
tissue
 To provide anchors around
muscle thus allowing for
expansion
 To hold protective pads in place
 Good for small, angular body
parts
‫ اعمال فشار وحمایت‬
‫ برای دور عضالت‬
‫ برای نگه داری پدها‬
‫در محل‬
non-elastic taping
 To support inert structures
 To limit joint movement
‫ حمایت مفصل تاندون‬
‫لیگامان از حركات اضافي‬
 To protect against re-
injury
 To secure ends of elastic
tape
 To reinforce elastic tape
 To enhance
proprioception
‫ کاهش دامنه حرکتی‬
‫ پیشگیری از آسیب مجدد‬
‫ براي حمایت وتقویت از‬
‫بانداژ‬
‫ فشار بر محل آسیب‬
‫ افزایش پروپریوسپتیو‬
Differences in Taping methods
Athletic tape
Mechanical
• Functional
immobilization
Target:
• Protect joints and
muscles
• By the tape could be
possible a tailback of
the circulation
Kinesio tape
Mechanical
• Full Range of Motion
Target:
• To support over the
muscle activity the
natural healing process
of the body
• No tailback of the
circulation
13
Athletic tape limits joint movement and is not used for
rehabilitative purposes because of its rigid, supportive
characteristics that do not allow the weakened or injured
muscles to heal and function properly.
Kinesio taping is known more for its therapeutic effects
than as a taping technique. Kinesio tape(KT) was
developed in Japan by Dr. Kenzo Kase in 1963 and
was introduced to the United States in the 1990’s.
14
Athletic Tape
Athletic tape is available in a variety of





Manufactures
Widths (Sizes)
Colors
Strength
Styles
Static cloth-linen
 Elasticity or stretch

 Stretch or elastic tape is used for the smaller, more angular body parts
such as the feet, hands, wrist and fingers.
Strapping Tape & Base Tape
(McConnell Tapping)
Coban / Coflex
Kinesio Tape
(Self Adhesive)
Elastic / Stretch Tape
Elastikon (Stretch Tape)
Cloth Athletic Tape
Supplies
b.
Identify the necessary supplies and their purpose for
prophylactic taping.
1.
2.
3.
4.
5.
Athletic tape (various size)
Underwrap
Heel and lace pad
Adhesive spray
Shark / Scissors
Principle of taping
 Tape selection
 Skin care
 Application
‫انتخاب تیپ مناسب‬
‫‪ Size‬‬
‫‪ Type‬‬
‫‪ Quality‬‬
‫غیر محرك‪-‬برش آسان‪ -‬چسبان‪ -‬قوي‪ -‬‬
‫مقاومت‬-‫چسبندگی‬-‫بافت‬:‫سه خصوصیت مهم‬
 Tape Grade: cost =  fibers


Longitudinal and vertical fibers per inch
More costly (heavier) contains 85 horizontal
and 65 vertical fibers
‫برش آسان‬-‫ غیر محرك‬-‫ قوي‬-‫باتعریق باز نشود‬-‫چسبندگی خوب‬
Underwrap (Pre-Wrap)
Underwrap in a variety of manufactures and colors.
helps to protect the skin but decreases the efficiency
of the tape.
 used
over areas that not shaved or are not free of body
hair.
 It may also be used over areas of irritation
due to adhesive tape.
 Only one layer should be applied.
‫آماده سازي پوستي‬
‫تمیز وخشک كردن پوست‬
‫تراشیدن مو‬
‫زخم پانسمان‬
‫پد گذاری نقاط حساس‬
‫نحوه کاربرد‪Taping‬‬
‫نكات مورد توجه‪ :‬‬
‫وضعیت قرار گیري مناسب درمانگر‬
‫مفصل در حالت پایدار‬
‫نباید مانع حركات اساسي ورزشكار شود‬
‫لیگامان سالم در وضعیت خنثي‬
‫لیگامان آسیب دیده در وضعیت كوتاه شده‬
‫‪Overlap the tape by half ‬‬
‫‪Keep tape roll in hand whenever possible ‬‬
Avoid:
-excessive traction on skin-this may lead to
Skin breakdown
-gaps and wrinkles-this may cause blisters
-continuous circumferential taping-single strip
Produce a more uniform pressure
-excessive layers of tape-this may impair
Circulation and neural transmission
Proper Taping Technique
 Always start taping with anchors
 Always finish taping with locking strips
 Do not apply tape if skin is hot or cold from
treatments
Terminology associated with
prophylactic taping procedures
Anchor –
 Provides a firm base to attach other tape ends.
 With an Ankle
Adhere 1-2 anchor strips at about one third of the way up the lower leg &
also at approximately the mid point of the foot.
Stirrup –
 A vertical "U" piece of tape to support
either side of the ankle.
 With an Ankle
Adhere
a strip of tape to the inside (Medial) upper (Proximal) anchor,
flowing down (Distal) the inside ankle, under the foot & up & over the
outer (Lateral) edge of the ankle.
Back
Figure 8-18
Figure 8-19
Figure 8-17
© 2011 McGraw-Hill Higher Education. All rights
reserved.
‫‪Taping‬‬
‫برروی پوستی که با درمان سرد یا گرم است اجتناب کنید‬
‫پس ازمسا بقه تیپ باز شود‬
‫عوارض‪ :‬‬
‫تحریك پوستي‬
‫كاهش گردش خون‬
‫كاهش اثر بمرور زمان(بعد از ‪ 10‬دقیقه تا‪)%40‬‬
After Taping
Check for comfort as well as signs of impaired
circulation.





Numbness
Tingling
Discoloration
Loss of pulse
Loss of function
Foot Taping
Arch
Technique 2
(for longitudinal
arch)
Figure 8-21
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Sprained Toes
Function
: to support metatarsophalangeal joint
Figure 8-25
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Hallux Valgus
Figure 8-26
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Turf Toe
(prevents excessive hyperextension of
metatarsophalangeal joint)
Figure 8-27
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Hammer or Clawed Toes
(reduces pressure of bent toes against shoes)
Figure 8-28
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Fractured
Toes
(splints injured
to non-injured
toe)
Figure 8-29
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Common Ankle Taping
Procedures
Closed Basket Weave
 Function: to minimize ankle motion
 Dorsiflexion and Plantarflexion
 Inversion and Eversion
 Aids
in controlling swelling
 Closed Basket Weave (Gibney) Technique

Used for newly sprained or chronically weak
ankles
Figure 8-30
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Open Basket Weave
 Function: to minimize ankle motion


Allows more dorsiflexion and plantarflexion
Minimizes inversion and eversion
 Used to support newly sprained ankles allowing
room for swelling
 Used with elastic bandage and cold application

Aids in controlling swelling
Open Basket
Weave
Figure 8-31
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Common Leg & Knee
Taping Procedures
Achilles Tendon
(prevent Achilles over-stretching)
Figure 8-33
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Collateral
Ligament
Function: to
provide joint
stability following
injury to the MCL
or LCL ligaments
Figure 8-34
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Rotary Taping for Knee
Instability
(provides stability following ACL & MCL injury)
Figure 8-35
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Knee
Hyperextension
(Prevent knee
hyperextension,
provide support to
injured hamstring or
slackened cruciate
ligament)
Figure 8-36
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Common Upper
Extremity Taping
Procedures
Elbow
Restriction
(Prevents elbow
hyperextension)
Figure 8-42 & 43
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Wrist Technique 1
(Mild wrist sprains and strains)
Figure 8-44
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Wrist Technique 2
(Protects and stabilizes badly injured wrist)
Figure 8-45
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Sprained
Thumb
(Provides
support to
musculature
and joint)
Figure 8-47
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Figure 8-18
Figure 8-19
Figure 8-17
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Kinesio tape
•
Thickness, weight and stretch ability are similar
to the skin
•
By the sinus waves: leaky for air and liquid
•
Heat activated adhesive
•
Main effects till 3 to 5 days - Can be used till
some weeks
59
Kinesio Taping
 Technique developed in Japan and widely
used throughout Europe and Asia
 Can be stretched to 140% of original length
 Used for edema reduction, pain
management, and inhibition/facilitation of
motor activity
© 2011 McGraw-Hill Higher Education. All rights
reserved.
 Mechanism Kinesio Tape




Improving circulation and lymph by eliminating
tissue fluid or bleeding beneath skin
Correcting muscle function by strengthening
weakened muscles
Decreasing pain through neurological
suppression
Repositioning subluxed joints by relieving
abnormal muscle tension
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Activation of the endogen
analgetic system
• Spinal/ Supra spinal by activation of supra
spinal and spinal analgesic
afferent skin impulse
• By a better circulation
system
by
Support of the joint functions
by
• Proprioceptive stimulation
• Functional correction
• Passive support
• Mechanical correction
• Pain depression
63
Without KT there is pain and pressure on the receptors.
Blood and Lymph is trapped under the skin. With KT the
top layer of tape causes convolutions and lifts the skin.
Pain and pressure is reduced. Blood and Lymph fluid is
dispersed.
64
Kinesio Tape’s
assist to Muscle Function
 Assists a weak muscle
or muscle group

tape from origin to
insertion so that the
tape pulls toward the
origin, assisting in
contraction as the
tape recoils
Kinesio Tape’s
assist to Muscle Function
 Inhibits muscle spasm
 Tape from insertion to
origin; as the tape
recoils it stimulates
the GTO and fascia
and prevents
overwork.
Kinesio Tape
Cutting Techniques
 “I” cut for stabilizing
joints or muscle
 “Y” to surround
muscle belly / fibers
 “X” shape to
stabilize a joint or for
muscles
 “Fan” to reduce
edema, drawing
fluid toward the
anchor
 Basic Application Principles



Apply tape from origin to insertion without
minimal tension for muscle support
Should be applied from insertion to origin during
rehabilitation
Can be worn for 3-4 days


Latex free, cotton fabric
Heat activated adhesive
© 2011 McGraw-Hill Higher Education. All rights
reserved.
‫‪Techniques‬‬
‫‪mechanical technique .1 .1‬مفصل را در راستای درمانی مناسبش از لحاظ‬
‫بیومکانیکی قرار داد‬
‫‪ space technique .2‬در این تکنیک درست در باالی ناحیه درد‪ ،‬التهاب و ادم‬
‫فضای اضافی ایجاد می گردد‪ ،‬و به دنبال ‪ Lifting‬پوست ایجاد شده بر روی ناحیه‬
‫درد یا التهاب‪ ،‬فشار روی ناحیه کم می شود‬
‫‪ Functional technique .3‬با استفاده از تحریکات پوستی می خواهیم محدودیت‬
‫حرکتی روی مفصل ایجاد کنیم‬
‫‪Fascia technique .4‬با استفاده از خاصیت االستیک نوار می توان فاشیا را در‬
‫یک راستای مناسب و دلخواه قرار داد‬
‫‪Tendon/Lig. .5‬لیگامان یا تاندون ‪ Unload‬می شود‬
‫‪Lymph technique .6‬کمک به درناژ لنفی‬
‫جهت بستن نوار در روش ‪Basic‬‬
‫‪ ‬درموارد آسیب های حاد یا کشیدگی ها‪ .‬برای استراحت عضله‪:‬‬
‫نواراز‪ Ins.‬به ‪ Orig.‬عضله کشیده می شود‪.‬‬
‫‪Acute …… Ins.‬‬
‫‪Orig.‬‬
‫(کشش کمترحدود ‪ 15‬تا ‪)%25‬‬
‫‪ ‬درموارد آسیب های مزمن‪ ،‬ضعف‪ ،‬یا اسپاسم‪ .‬بهتر شدن کارعضله یا‬
‫کمک به عضله‪:‬‬
‫نواراز‪ Orig.‬به ‪ Ins.‬عضله کشیده می شود‪.‬‬
‫‪Chronic …… Orig.‬‬
‫‪Ins.‬‬
‫(کشش ‪)%50-25‬‬
‫‪Acromioclavicular Joint‬‬
‫‪Sprain‬‬
‫‪3‬‬
‫‪1‬‬
‫‪2‬‬
‫‪ ‬برش ‪I Strip‬‬
‫‪ ‬چون می خواهیم فشار را از روی مفصل برداریم در نوار برش ی به‬
‫نام برش «دونات تکنیک» استفاده می کنیم‪ :‬با قیچی یک برش‬
‫‪4‬‬
‫وسط نوار تاشده ایجاد می کنیم‪.‬‬
‫‪ ‬بریدن کاغذ به صورت ‪Paper off‬‬
‫‪ ‬سوراخ را روی ‪ ACJ‬می گذاریم‬
‫‪ ‬تنشن ‪ %90‬میانه نوار‪ ،‬و تنشن ‪ off‬دو انتهای نوار‬
‫‪ ‬اگر تنشن بیشتری بخواهید از تکنیک استار استفاده کنید‪ :‬چند ‪I‬‬
‫‪ Strip‬را با تکنیک دونات در جهات مختلف روی ‪ ACJ‬ببندید‪.‬‬
‫‪5‬‬
‫‪Deltoid‬‬
‫)‪(Rotator Cuff Lesion‬‬
‫‪4‬‬
‫•‬
‫•‬
‫•‬
‫•‬
‫‪3‬‬
‫‪2‬‬
‫برش از نوع ‪Y‬است‪ .‬به صورت ‪Tension on the tail‬‬
‫پس پایه کوتاهتر است‪.‬‬
‫هدف‪ :‬استراحت دادن به عضله (جهت نوار از ‪ ins.‬به ‪Orig.‬‬
‫است)‬
‫پایه اولیه را بر روی توبروزیته دلتوئید به صورت تنشن ‪off‬‬
‫می بندیم‪.‬‬
‫برای فیبرهای قدامی دلتوئید‪ ،‬شانه را به اکستانسیون و برای‬
‫‪1‬‬
‫‪6‬‬
‫‪5‬‬
‫‪GHJ‬‬
‫)‪(Rotator Cuff Lesion‬‬
‫‪3‬‬
‫•‬
‫•‬
‫•‬
‫•‬
‫•‬
‫•‬
‫‪2‬‬
‫هدف ایجاد یک وضعیت مکانیکال‬
‫درست برای مفصل شانه است‪.‬‬
‫برش ‪Y‬‬
‫‪Tension on the base‬‬
‫برای بستن پایه‪ ،‬شانه به ‪Ext.‬‬
‫‪ Rot.‬برده می شود‪ .‬در ادامه‬
‫فلکس می گردد‪.‬‬
‫کشش مایوفاشیال با‬
‫‪Downward Pressure‬‬
‫ابتدا و انتهای نوار تنشن ‪ off‬است‪.‬‬
‫‪5‬‬
‫‪1‬‬
‫‪4‬‬
‫‪ACJ‬‬
‫)‪(Rotator Cuff Lesion‬‬
‫•‬
‫•‬
‫•‬
‫•‬
‫•‬
‫برش ‪I‬‬
‫تکنیک ‪Paper off‬‬
‫مفصل ‪ AC‬را بیابید‪ .‬مرکز‬
‫نوار را روی مفصل قرار‬
‫دهید‪.‬‬
‫تنشن مرکزی حدودا ‪70-‬‬
‫‪ 80%‬می باشد‪.‬‬
‫ابتدا و انتهای تکنیک تنشن‬
‫‪ off‬است‪.‬‬
‫‪2‬‬
‫‪4‬‬
‫‪1‬‬
‫‪3‬‬
‫پس مالحظه کردید که در صدمه روتاتورکاف از چندین الیه‬
‫‪ Application‬استفاده شد‪:‬‬
‫‪ ‬الیه ای برای هر یک از عضالت دلتوئید و سوپرااسپیناتوس (به صورت‬
‫‪)Basic‬‬
‫‪ ‬برای مفصل شانه )‪(Mechanical Corrective‬‬
‫‪ ‬برای مفصل اکرومیوکالویکوالر ‪(Ligament/Tendon‬‬
‫)‪Corrective‬‬
‫‪MCL Sprain‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫متد ‪ Lig./Tendon App. Corr.‬است‪.‬‬
‫برش ‪I‬‬
‫توبروزیته تیبیا را بیابید و پایه نوار را بر روی آن ببندید‪.‬‬
‫زانو را ‪ 30‬درجه خم کنید‪.‬‬
‫نوار را روی لیگامان به طرف باال بکشید‪.‬‬
‫‪1‬‬
‫‪2‬‬
‫‪Meniscus Injury‬‬
‫‪3‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪2‬‬
‫برش ‪I‬؛ ‪Paper off‬‬
‫متد ‪Space correction Application‬‬
‫‪ %50‬تنشن وسط‬
‫سپس زانو را خم کنید‪ .‬دو انتهای نوار تنشن ‪ off‬است‪.‬‬
‫در صورت نیاز از تکنیک استار استفاده شود‪.‬‬
‫‪1‬‬
‫‪Sup-Patella Bursitis‬‬
‫‪3‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪2‬‬
‫برش ‪Web‬‬
‫پایه روی توبروزیته تیبیا بسته می شود‪.‬‬
‫زانو در میدپوزیسیون است‪.‬‬
‫در شروع تنشن ‪ off‬است‪ .‬در ادامه ‪ %50‬تنشن دارد‪.‬‬
‫در انتهای عملیات نواربندی‪ ،‬نوارها را از همدیگر دور کنید‪.‬‬
‫‪1‬‬
‫‪Patella Tendinitis‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫برش ‪I‬‬
‫پایه را بر روی توبروزیته تیبیا ببندید‪.‬‬
‫زانو اکستند است‪.‬‬
‫با تنشن ‪ %70‬تا لبه تحتانی کشکک‬
‫بکشید‪.‬‬
‫بعد زانو را فلکس کنید و ازمیزان تنشنی‬
‫که می دهید کم کنید تا نهایتا به تنشن ‪3‬‬
‫‪ off‬برسید‪.‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫گاهی دراین مشکل ‪ VMO‬را نیز درنظرمی گیریم‪.‬‬
‫از‪ Orig.‬به ‪ Ins.‬نوار را می بندیم‪.‬‬
‫برش ‪Y‬‬
‫‪Tension on the tail‬‬
‫نواررا درحالی که زانو خم است می بندیم تا کشیده‬
‫شود‪.‬‬
‫‪‬‬
‫‪2‬‬
‫‪5‬‬
‫‪1‬‬
‫‪4‬‬
‫‪L.B.P‬‬
‫‪3‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪1‬‬
‫‪2‬‬
‫هدف افزایش حس پروپریوسپشن عضالت‬
‫پاراورتبرال است تا همیشه در یک تنشن حفاظتی‬
‫باشند‪.‬‬
‫برش ‪I‬؛ پایه نوار روی ‪PSIS‬به صورت تنشن ‪off‬‬
‫سپس از فرد می خواهید به جلو خم شود‪ .‬برای‬
‫سمت دیگر تکرار کنید‪.‬‬
‫نقطه درد را بیابید‪.‬‬
‫‪Istrip‬؛ به صورت ‪ Paper off‬با تنشن ‪%50‬‬
‫در صورت اعمال فشار بیشتر‪ :‬تکنیک استار‬
‫‪5‬‬
‫‪4‬‬
Kinesio
Taping for
Plantar
Fasciitis
Figure 8-50
© 2011 McGraw-Hill Higher Education. All rights
reserved.