Application

1. Apply an anchor around the midfoot with the 1½-in. white tape. Apply the second anchor with the 1-in. tape around the great toe distally.

2. Apply a fan strip with the 1-in. white tape from the second anchor on the distal great toe. Position the great toe into slight flexion within the painfree range. Secure the first fan strip to the initial anchor. Repeat two to three times with additional fan strips to secure the great toes in painfree position.

3. To secure the fan strips, place the 1½-in. white tape over the initial anchor and the 1-in. white tape over the second anchor.

Final Assessment. Check for circulation and ensure that the application has limited the painful motion and is functional for the athlete.

Additional Notes

4. To limit painful flexion, reverse the fan strips, applying ventrally while placing the great toe in slight extension.

5. To gain additional support for cases of multidirectional instability and/or pain, apply toe spica consisting of two 1-in. white tape strips crossing over the medial MTP joint of the great toe prior to the final anchors. Secure with anchors as described above.

∗Custom/Prefabricated Items. Great toe ∗ extension may also be limited by prefabricated steel inserts or a precut plantar fascia strip.

Application

1. Gently apply a half-anchor of the 1½-in. white tape around the metatarsal heads, pulling from the lateral to the medial direction.

2. Apply the 1-in. white tape in an X pattern with three “Xs” running from the first metatarsal head around the heel and returning to the fifth [Page 1607]metatarsal head and three “Xs” running from the fifth metatarsal head around the heel and returning to the first metatarsal head. Overlap each “X” while filling in the arch space. Use a minimum of six “Xs” to fill in the entire arch space.

3. Apply the 1½-in. white tape half-anchors, pulling lateral to medial to cover the arch. Anchors should start proximal and continue distally. Be sure to cover all the loose ends.

4. Complete by securing with two full 1½-in. white tape anchors around the metatarsal heads.

Final Assessment. Check for circulation, and ensure that the application has limited the painful motion and is functional for the athlete.

∗Custom/Prefabricated Items. Supporting the arch can also be achieved by purchasing off-the-shelf orthotics or custom shoe inserts.

Application

1. Apply at least one heel and lace pad at the front of the ankle and the other at the back where the Achilles tendon inserts into the calcaneus. Secure the pads with the prewrap, and cover the area where the tape will be applied.

2. Apply one anchor of the 1½-in. white tape 6 in. above the malleoli, adhering the prewrap to the skin. The second anchor should be placed around the midfoot while avoiding direct compression of the base of the fifth metatarsal.

3. Apply a stirrup running from the medial to lateral direction, from the medial proximal anchor to the lateral side, extending just above the anchors on both sides; this should cover the posterior one third of the malleoli. Apply the first [Page 1609]horseshoe starting directly on the metatarsal anchor along the first metatarsal, traveling behind the heel, and ending along the fifth metatarsal. Apply horseshoes always from the medial to lateral direction unless your goal is to limit eversion, in which case the pull would be in the opposite direction.

4. Apply each additional stirrup in the same fashion while overlapping by half the width of the tape. The second stirrup should cover the middle one third of the malleoli, with the third stirrup covering the anterior one third. Apply horseshoe strips in the same manner, with each strip slightly shorter than the previous, leaving a staircase appearance. Apply the stirrups and the horseshoes in an alternating fashion.

5. Follow the third horseshoe up the leg until you have completely enclosed the ankle and have ended just past your initial anchor. These strips should continue to be applied by overlapping half the width of the tape. Apply additional arch support until the bottom is enclosed.

6. Start applying the tape on the lateral malleolus, and pull around the arch of the foot to begin a figure-eight pattern.

7. Continue the figure-eight pattern by completing a full turn around the ankle so that the roll of tape ends on the medial side, moving downward toward the medial malleolus.

8. From this position, direct the roll of tape to the outside of the heel, and apply a heel lock, ending with the roll of tape moving in a caudal position.

9. Continue by pulling the tape up and around the ankle with a complete turn.

10. Once around the ankle, continue along the lateral ankle, moving toward the medial side of the heel, and apply another heel lock.

11. Once around the ankle, the tape may finish anywhere. Additional figure-eight and heel locks may be added depending on the severity of the injury or the size of the athlete.

Final Assessment. Check for circulation, and ensure that the application has limited either the painful motion or the inversion and is functional for the athlete.

∗Custom/Prefabricated Items. A number of ankle braces can be purchased with the benefits of self-application and increased cost-effectiveness.

Application

1. Apply the prewrap around the foot, ankle, and lower leg. Apply an anchor of the 1½-in. white tape around the metatarsal heads and the other anchor 6 in. above the malleoli. Starting dorsally on initial anchor, apply the 3-in. heavy-duty stretch tape running to the anchor on the lower leg while the foot maintains a relaxed position. The first strip should run in a straight fashion.

2. Apply two additional 3-in. heavy-duty stretch tape strips with each crossing over the painful site to form an X pattern.

3. Cover the anchors with the 1½-in. white tape, ensuring that there are no loose ends.

Final Assessment. Check for circulation, and ensure that the application has limited the painful motion and is functional for the athlete.

Application

1. Apply a strip of the 1½-in. white tape starting laterally, or opposite to the painful side and 2 in. below. Wrap the tape around lower leg while squeezing the Achilles tendon, and end the strip just past the starting point. Always pull the tape so that the painful area moves toward the tibia.

2. Continue to apply additional strips in the same fashion. Be sure to overlap [Page 1614]half of the previous strip. Each strip is applied tightly. Continue strips application until you are 2 in. above the painful site. Each individual strip should overlap and enclose the previous strip. Complete by applying a full anchor on both proximal and distal ends.

Final Assessment. Check for circulation, and ensure that the application causes limited pain and is functional for the patient.

∗Custom/Prefabricated Items. A number of commercial compression sleeves are available that re-create the same effect.

Application

1. Cut strips of coverall long enough to cover the patella and the medial knee. Then apply these strips as a base covering the patella and medial knee.

2. To limit lateral tracking, apply a strip of leukotape laterally on the patella, then pulling medially and placing the other end over the medial knee. Cut off the excess tape.

3. Apply two or three more strips as described above, covering the patella.

Final Assessment. Check the range of motion (ROM) of the knee and the comfort of the tape. Ensure that the application has limited the painful motion and is functional for the patient.

Additional Notes

4. To ensure that the tape will remain on and not fall off prematurely during activity, you may wrap it with nonadhesive stretch tape.

5. To limit tilting in other directions, pull the leukotape in the opposite direction of the motion that you are trying to limit.

∗Custom/Prefabricated Items. Abnormal patella tracking can also be altered by using a commercial brace with a patella buttress.

Application

1. Apply the prewrap over the entire area that will be taped, starting at the midthigh and continuing distally to the midgastrocnemius. (Note: The longer the level of the tape job, the more effective it will be in preventing painful ROM.) Apply two anchors with the 3-in. adhesive elastic tape over the prewrap, one on the midthigh and the other on the midgastroc.

2. Apply strips of the 2-in. heavy-duty elastic tape in an X pattern behind the knee. The first strip should be applied laterally on the thigh anchor, crossing the posterior knee and ending at the medial anchor on the gastrocnemius. Cut off the excess heavy-duty elastic tape.

3. The second strip is applied medially on the thigh anchor, crossing the posterior knee and ending on the [Page 1617]lateral anchor on the gastroc. Cut off the excess heavy-duty elastic tape.

4. Apply two more strips as described above, creating an X pattern behind the knee.

5. Cover the distal anchors up to the tibial tuberosity with the 3-in. adhesive stretch tape. Cover the proximal anchors distally with the 3-in. adhesive stretch tape, ending 3 in. above the superior patella. Note: To ensure normal tracking of the patella, do not cover the patella with the tape.

Final Assessment. Check the ROM of the knee and the comfort of the tape. Ensure that the application has limited the painful motion of the knee and is functional for the athlete.

∗Custom/Prefabricated Items. Off-the-shelf braces with an ROM lock can limit the painful ROM—such as a knee immobilizer.

Application

1. Apply the prewrap over the entire area that will be taped; starting at the upper thigh and continuing down to the midgastrocnemius. Apply two anchors with the 3-in. adhesive elastic tape on the upper thigh and midgastroc.

2. Apply strips of the 1½-in. white tape in an X pattern over the MCL. [Page 1619]The first strip will be applied on the anterior thigh anchor, crossing the medial joint line and ending at the posterior anchor on the gastrocnemius.

3. The second strip will be applied on the posterior thigh anchor, crossing the medial joint line and ending on the anterior anchor on the gastroc.

4. Apply two or three more strips as described above, creating an X pattern over the medial joint line.

5. Cover the distal anchors up to the tibial tuberosity with the 3-in. adhesive stretch tape. Cover the proximal anchors distally with the 3-in. adhesive stretch tape ending 3 in. above the superior patella. Note: Do not cover the patella with the tape, to ensure normal tracking of the patella.

∗Final Assessment. Check the ROM of the knee and the comfort of the tape. Ensure that the application is functional for the patient and gives support to the MCL.

Additional Notes

To tape for an LCL sprain, follow the previous steps, with the X pattern applied over the LCL.

∗Custom/Prefabricated Items. Off-the-shelf braces with a medial stabilizer can be applied.

Application

1. Apply the prewrap, encircling the knee over the patella six to eight times with equal tension.

2. Apply three strips of the 1½-in. white tape anteriorly in the center of the prewrap.

3. Roll the prewrap and tape from the proximal to distal direction to create a strap. Place the strap over the patellar tendon.

Final Assessment. Check the ROM of the knee and the comfort of the tape. Ensure that the application has adequate pressure on the patellar tendon and is functional for the patient.

∗Custom/Prefabricated Items. Jumper's knee straps can be purchased over the counter to re-create this tape job.

Application

1. Begin distal to the site of pain, and apply the compression wrap around the area to be treated in a herringbone fashion with the “Xs” central over the site of pain.

2. Continue proximally overlapping the compression wrap by half the width of the wrap.

3. Secure the wrap with the 1½-in. white tape by placing an “X” over the painful area, and anchor at the top and bottom.

Final Assessment. Check for circulation, and ensure that the application has limited the painful motion and is functional for the athlete.

∗Custom/Prefabricated Items. Commercial compression sleeves, both with and without additional padding, are available.

Application

1. Secure the wrap to the leg by anchoring the wrap around the thigh while pulling laterally to medially.

2. Continue wrapping up and around the trunk, crossing deep in the groin over the adductor muscle group.

3. Finish the wrap on the thigh, and secure with the 1½-in. white tape by tracing the pattern once around the thigh and trunk. Add more tape strips as needed.

4. To secure the wrap further, you can trace the pattern of the wrap with the 3-in. adhesive elastic tape.

Additional Notes

To provide supportive taping for the hip flexor, begin in a similar fashion to the hip adductor wrap but with the patient in a slightly forward-lunge position with a slight forward bend at the trunk. Pull the wrap from medial to lateral, and place an “X” over the site of pain or the hip flexor group.

Custom/Prefabricated Items. Commercial compression garments can be purchased that offer focal and general compression.

Application

The procedure described below is for a rib fracture. The injured area is marked “+.”

1. Start the wrap superiorly to the injured site, encircling the torso and overlapping about 2 in. each time around.

2. Work your way caudally, covering the injured site and ending over the wrap superiorly to the injured area.

3. Apply two to three strips of the 1½-in. white tape at the end of the wrap to secure it.

4. To secure the wrap, you may encircle the wrap and tape with the 3-in. adhesive elastic tape.

Final Assessment. Check the ROM of the torso and the comfort of the athlete during respiration. Ensure that the application provides support to the injured site and is functional for the athlete.

∗Custom/Prefabricated Items. Rib belts can be purchased off the shelf to obtain similar results.

Application

1. Begin wrapping the midhumerus in a clockwise fashion (lateral to medial), and continue in a spiral fashion while overlapping by half the width of the wrap, moving distal to proximal for at least two times around the humerus.

2. Pull medially across the chest and under the opposite axilla, and continue around the torso. Apply the greatest amount of tension over the shoulder and the least amount of tension as you wrap around the torso. Encircle the humerus again.

3. Repeat the pattern at least twice or as needed depending on the size of the patient and the support needed. End the wrap on the arm. Secure the wrap with the 1½-in. tape by tracing the pattern on the humerus.

Final Assessment. Check for circulation, and ensure that the application has limited the painful motion and is functional for the athlete.

Additional Notes

In association with many AC joint injuries, an “AC pad” is often applied directly over the AC joint to provide padding to the injured joint below. Apply the AC pad if needed prior to securing the AC wrap.

∗Custom/Prefabricated Items. Other commercial items that are commonly used to support the shoulder either after injury or during actual play include the Sully Stabilizing Brace.

Application

1. Apply the prewrap over the entire area that will be taped; starting at the midhumerus and continuing distally to the midforearm. (Note: The longer the level of the tape job, the more effective it will be in preventing painful ROM.) Apply two anchors with the 3-in. adhesive elastic tape, one on the midhumerus and the other at the midforearm.

2. Apply a strip of the 2-in. heavy-duty adhesive elastic tape over the anterior elbow. The first strip will begin on the anterior anchor of the humerus and follow the midline of the humerus distally to the forearm, where it ends at the second anchor at the midforearm. Cut off the excess heavy-duty elastic tape.

3. The next two strips will create an X pattern over the anterior elbow. The second strip will be applied laterally on the distal humeral anchor, crossing the anterior elbow and ending at the medial anchor on the forearm (ulna). The third strip will be applied medially on the [Page 1629]distal humeral anchor, crossing the anterior elbow and ending at the lateral anchor on the forearm (radius). Cut off the excess heavy-duty elastic tape.

4. Cover the tape job with the 3-in. adhesive elastic tape. Note: Do not cover the olecranon process with the tape, to ensure ease of movement.

Final Assessment. Check the ROM of the elbow to make sure that it is within the painfree ROM and functional for the patient. Check the distal capillary refill and the comfort of the tape for the patient.

∗Custom/Prefabricated Items. Off-the-shelf braces with an ROM lock can limit the painful motion of the elbow.

Application

1. Apply the prewrap over the entire area that will be taped, starting at the midhumerus and continuing distally to the midforearm. Apply two anchors with the 3-in. adhesive elastic tape over the prewrap, one on the midhumerus and the other on the midforearm.

2. Apply strips of the 1½-in. white tape in an X pattern over the UCL. The first strip will be applied on the anterior humeral anchor, crossing the medial joint line and ending at the posterior anchor on the forearm.

3. The second strip will be applied on the posterior humeral anchor, crossing the medial joint line and ending on the anterior anchor on the forearm.

[Page 1631]

4. Apply two or three more strips as described above, creating an X pattern over the UCL.

5. Cover the tape job with the 3-in. adhesive elastic tape. Note: Do not cover the olecranon process with the tape, to ensure ease of movement.

Final Assessment. Check the distal capillary refill and the comfort and function of the tape for the patient.

Additional Notes

To tape for an RCL sprain, follow the previous steps but with the X pattern applied over the RCL.

∗Custom/Prefabricated Items. There are various off-the-shelf braces that can be purchased that will re-create the function of the tape procedure for the UCL.

Application

1. Apply the prewrap around the elbow two to three times distal to the lateral epicondyle, approximately ½ in.

2. Apply six strips of the 1½-in. white tape in the center of the prewrap distal to the lateral epicondyle.

3. Cover the prewrap and the 1½-in. white tape strips with the 2-in. adhesive elastic tape.

[Page 1633]

Final Assessment. Check the distal capillary refill and the comfort and function of the tape for the patient.

∗Custom/Prefabricated Items. Prefabricated lateral epicondylitis straps can be purchased over the counter.

Application

1. Begin by applying two anchors on the midforearm and one around the hand just proximal to the metacarpophalangeal (MCP) joints. Be sure to keep the MP joints uncovered while slightly folding the tape before it crosses the thumb crease.

2. Apply parallel strips starting at the anchor on the hand and running to the anchor on the forearm. Complete [Page 1634]by applying at least two “Xs” in a similar fashion, crossing over the carpals. Apply parallel strips and “Xs” to the opposite side. If needed, add additional strips to the side in which you intend to limit the most motion (the dorsal side to prevent flexion and ventral side to prevent extension).

3. Close the entire forearm with the anchors.

4. Apply two figure-eight patterns starting on the dorsal side at the ulnar styloid process. Pull the tape between the thumb and the index finger, making sure that you place a small fold in the tape as it crosses through.

[Page 1635]

5. Continue to pull the tape across the palm to the dorsal side of the hand.

6. Continue to pull around the wrist, and end on dorsal side of the wrist. Repeat as necessary.

Final Assessment. Check for circulation and ensure that the application has limited the painful motion and is functional for the athlete.

∗Custom/Prefabricated Items. Various prefabricated splints are available, such as the wrist splint. The velcro allows effortless application by the patient.

Application

The following taping procedure is for a sprained proximal IP of the fourth digit. For any other digits, simply repeat the steps as indicated.

Additional Notes

This is typically a procedure for a sprain in the second to fifth digits; this procedure is not used for the first digit. For a sprained first digit, see the section Thumb Spica.

1. Place the third digit next to the fourth digit in a comfortable, painfree ROM.

2. Apply a strip of the 1-in. white tape to encircle the proximal phalanges of the third and the fourth digits.

3. Apply a second strip of the 1-in. white tape to encircle the middle [Page 1637]phalanges of the third and the fourth digits.

Final Assessment. Check the distal capillary refill of the third and fourth digits. Ensure that the tape is giving support to the fourth digit and is functional for the patient.

∗Custom/Prefabricated Items. Various prefabricated splints are available, such as the aluminum finger splints and the Stax plastic finger splints.

Application

The following procedure is for a hyperflexion injury to the MCP of the first digit. To prevent hyperextension of the joint, follow the steps below, but place the X pattern on the volar aspect of the thumb.

1. Cover the thumb, the proximal hand, and the distal wrist with the prewrap.

2. Place two anchors with the 1½-in. white tape encircling the wrist.

3. Begin a strip of tape on the dorsal aspect of the anchors on the distal wrist. Continue this strip distally, crossing the lateral joint line of the MCP joint of the first digit.

4. Continue the tape around the joint, crossing over the posterior aspect of the MCP joint of the first digit and ending on the volar aspect of the anchor on the wrist. You should have created an X pattern on the dorsal aspect of the MCP joint of the first digit.

5. Apply one or two more strips as indicated above, moving more distally on the first digit. Note: Do not cross the IP joint of the first digit.

6. Cover the anchors on the wrist with the 1½-in. white tape.

Final Assessment. Check the distal capillary refill of the first digit. Ensure that the tape prevents painful hyperflexion and is functional for the patient.

Additional Notes

Use caution when removing the tape from the first digit, so as to prevent damage to the distal phalanx; removing the tape with scissors is recommended.

∗Custom/Prefabricated Items. Prefabricated thumb braces can be purchased to obtain similar results.