Compression and Taping

Instructional Use Statement

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.

Intro to Compression and Taping for Tissue Healing

Compression and taping are most often used during the acute and sub-acute phases of tissue healing. Soft tissues must be protected while working through gentle and progressive motion. PTAs should be able to apply knowledge of tissue healing principles when selecting compression and taping interventions.

Lesson Objectives

Describe symptoms of soft tissue pathology for which compression and taping treatment may be included in a physical therapy plan of care
Describe indications, procedures, and benefits for protective taping and wrapping in response to tissue injury: ankle and scapula
Describe methods to check for impaired circulation following compression
Describe advantages for taping versus. bandaging a soft tissue injury
Define and describe terminology used for grading muscle strains
Define and describe terminology used for grading ankle sprains
Describe the therapeutic benefits of rigid and elastic taping
Compare and contrast rigid versus elastic taping for treatment of signs and symptoms of soft tissue injuries

Physiology Review

The first stage of healing is the hemorrhagic stage. Blood immediately fills the area and clots begin to form. Blood loss into the injured tissue area is minimized by reactive vasoconstriction (blood vessel narrowing). Vasoconstriction slows down the rate of blood flow into the area.

The next phase of healing is the Inflammatory phase. Blood vessels in the area open (vasodilation) and facilitate the rapid delivery of cells (cellular infiltration) involved in debris removal and tissue repair. The cardinal signs of inflammation: redness, heat, swelling, pain, functional loss, are the signs and symptoms of the vasoconstriction-vasodilation-cellular infiltration response in these early stages of tissue healing. Cardinal signs are expected physiological responses that indicate a team of healing cells are on the way and going to work.

What about "no pain - no gain"?

Acute injuries are painful. Pain in this stage is an expected response and outcome. Pain at this stage is protective. Tissue that is in the inflammatory stage of healing is not physiologically or mechanically able to accept additional stress or strain without reinjury. Reinjury to healing tissue typically restarts the inflammatory process and cardinal signs of inflammation will remain in the area.

Interventions that optimize healing during this phase are described in the acronym: PRICEMEM: Protect, Rest, Ice, Compress, Elevate, Manual Therapy, Early Motion, Medication

Acute Healing Stage - General Goals and Interventions in the PT POC

protect the area
- Interventions: bracing, compression, taping, assistive devices as needed, modify activities as needed to maintain function

Role of Compression during Acute Healing Stage

Soft tissue compression can be applied using elastic bandages, rigid tape, and/or elastic tape. Elastic bandages facilitate fluid return and supports injured structures. Rigid tape can provide somewhat firm support to protect affected tendons and ligaments. Elastic tape can facilitate fluid return and decrease muscle guarding through gentle kinesthetic (movement) inputs

pain control
- Interventions: cryotherapy; biophysical agents to reduce pain
minimize edema in extracellular space
- Interventions: cryotherapy, biophysical agents for tissue repair, appropriate compression and elevation
minimize reflexive muscle guarding and atrophy
- Interventions: heat and/or ice (area dependent), gentle movements in adjacent areas
prevent long-term motion loss (joint and soft tissue)
- Interventions: PROM, sub-maximal isometric exercises, self-massage, gentle soft-tissue and joint mobilization

Subacute Tissue Healing Stage

This is known as the "migratory" or "proliferation" stage. Specialized cells migrate into the injured soft tissue and grow to help repair the strength and function of the affected tissue. An organized mix (matrix) of cells prevent infection and progressively build new tissue in the surrounding area. Tissue remains relatively weak and is susceptible to reinjury if overstressed.

Subacute Healing Stage - General Goals in the PTA POC

promote functional pain-free ROM

Interventions - PROM, AAROM, AROM, stretching in straight planes with stable pain symptoms, mobilization to restore tissue mobility and joint mechanics

Role of Compression during the SUBACUTE stage

Compression from fitted elastic sleeves provide modest joint protection and limits forces in end-ranges. Rigid tape can support and provide kinesthetic feedback during progressive AAROM. Elastic tape can increase kinesthetic information during movement to help improve the recruitment of muscles and timing of muscle contraction.

recover strength and endurance

Interventions: electrical stimulation for muscle re-education, submaximal isometrics throughout available range. Progressive resistance training, including against gravity, against resistance, and functional strengthening for endurance. Progressive endurance training by steadily increasing the number of times an exercise is repeated before a rest break (repetitions and sets).

Sprains and Strains

Sprains (overstretch or tear of ligaments) and strains (overstretch or partial tear of muscle) can have varied healing times. Progression from inflammatory phase to controlled motion phase will vary depending on the extent of the injury, health status, and contextual factors.

Sprains and strains are commonly described using clinical grades (I, II, or III). Each grade describes a progressively more severe injury. Lower grade sprains and strains will progress through the stages of tissue healing faster than higher grade sprains and strains.

Grading systems for sprains and strains have undergone changes since advances in ultrasound imaging and magnetic resonance imaging. The classic clinical grading scale is linked in the document on the right. A variety of different grading systems are under development (Grassi, A., Quaglia, A., Canata, G. L., & Zaffagnini, S. (2016). An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints, 4(1), 39–46. https://doi.org/10.11138/jts/2016.4.1.039)

Muscle tissue healing time is also dependent on the extent of the involved muscle tissue, although healing times are generally faster in this well-vascularized issue compared to avascular soft tissue. Care must be taken to allow for progressive rebuilding of muscle tissue, while encouraging progressive ROM.

PTA 101 Muscle Grade References

Clinical Grading Reference

Compression Procedures

Figure 8 - ankle

Video demonstrates a Figure 8 Technique

Compression is applied distal to proximal. The joint is positioned as close to neutral as possible and with the affected limb elevated. The bandage overlaps in its layers and moderate tension is maintained on the bandage during the wrap. This helps prevent the bandage from slipping and losing its compression.

The limb should be inspected to make sure that there are no areas of exposed skin

The bandage should be secured with tape to prevent injury.

Bandages should allow some functional movement

Compression Demonstration - 12 minutes of videos

Intervention Safety

How to Tell If an Ace Bandage is Too Tight

How to make a sling

How to Wrap a Wrist with an Ace Wrap

How to Wrap a Calf with an Ace Wrap

How to Wrap an ankle with An Ace Bandage

How to Wrap a Quad

PT Intervention - Taping

Scapula taping is used to provide stability and kinesthetic input to the shoulder complex (clavicle, scapula, glenohumeral joint). The type and direction of taping is dependent on the patient condition.

Rigid scapula taping is beneficial when there is a need for approximation ("drawing together") of the scapula on the thorax or the humeral head in the socket (glenoid) to improve the timing and coordination of shoulder complex muscles

Elastic scapula taping is beneficial in providing feedback during movement due to changes in elastic length and tape length tension relationships

There is supplemental reading regarding scapula taping approaches and procedures in the linked article on the right. Read the "Context" and "Conclusion" in the abstract. Consult the methods to learn about taping interventions. The Discussion includes the author's rationale

Rigid versus elastic taping

Rigid tape is applied when there is an indication to limit motion and provide stability and increased through the materials. The patient is typically maintaining the joint in a neutral position during rigid taping.

Elastic tape (also known as Kinesiotape) provides compression at rest and kinesthetic input during movement. The patient may maintain the joint in a mid or end-range position during taping so the tape can stretch and relax throughout a range of motion.

Article: Embaby & Abdalgwad - Read the literature review in the article (pgs - 1379-1381). It provides a very succinct review of the primary differences between rigid and elastic tape.

Rigid tape is in the left image. Elastic tape is in the center image. Sham (placebo) tape is in the right image

From: Taping to Improve Scapular Dyskinesis, Scapular Upward Rotation, and Pectoralis Minor Length in Overhead Athletes J Athl Train. 2019;53(11):1063-1070. doi:10.4085/1062-6050-342-17.

PTA 101 Scapula Taping.pdf

Reference: Scapula Taping Research Study

PTA 101 Kinesiotaping.pdf

READ: Article about rigid and elastic tape

Taping Demonstrations - 15 minutes of videos

Taping techniques may vary depending on training, clinical experience, and alignment with clinical decision-making frameworks.

Skin should be clean and dry before taping. Body hair should be removed when tape is applied directly to the skin

The videos below demonstrate some basic applications. PTs and PTAs may modify taping approaches depending on the patient response.

Rigid Ankle Taping

Proximal and distal arch anchors
Apply tape medial to lateral
Cover gaps
Apply "locks" to point of injury (lateral to medial then around heel cord and through the arch

Elastic Shoulder Taping Example

Notice how the tape is applied so the patient can experience some compression and allows changes in tension and full range of motion

Rigid Shoulder Tape

This demonstrates using rigid tape to correct the position of the glenohumeral joint. The therapist uses manual force to reposition the joint and the tape maintains the position and provides an approximating force to the scapula on the thorax

Signs and Symptoms of Inappropriate Compression

A PTA should assess the patient for any signs or symptoms of inappropriate compression following a taping or wrapping procedures. Symptoms of excessive compression include:

delayed capillary refill
tingling
numbness
blanching (lightening) or discolored skin
decreased temperature

Bandages and compression sleeves with a high resting-low working pressure (e.g., "ACE-style wraps") may cause fluid to accumulate above and below the bandage or sleeve. A PTA should assess the the amount of compression provided by the bandage or sleeve to ensure their is adequate pressure to facilitate fluid reduction and return.

Adverse Reactions to Taping

Tape has adhesive and some patients are sensitive to adhesives applied to the skin. Some bandages have latex and some patients have latex sensitivities or allergies. Body hair can increase friction pain when tape is removed.

Rigid tape has strong adhesive so that it can limit motion. Rigid tape applied directly to the skin may result in skin or tissue injury due to friction between the skin and the tape. A flexible barrier, such as cover roll (pre-wrap) or flexible cloth tape is often placed between rigid tape and skin to prevent taping injuries.

Protective Layer

The white tape is a protective layer. Rigid tape is applied over the flexible protective layer to provide stability with minimal friction

Tape Allergy

The image above shows a skin inflammatory response triggered by a reaction to an adhesive. PTAs may choose to apply a test strip or include protective paper tape layer to the skin to assess for sensitivities.

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