R E H A B I L I TAT I O N

Shoulder taping
in the clinical setting
. . . . . . . . . . . . . . . .

David Kneeshaw

Shoulder taping is used frequently in the clinical setting as a helpful adjunct to other
physiotherapy modalities when treating shoulder pathology and dysfunction.
Discussion of proposed mechanisms of action is detailed, as are some of the regularly
utilised techniques in the clinical setting. # 2002 Harcourt Publishers Ltd

Introduction position (Morrissey 2000; Gerrard et

David Kneeshaw
Bachelor of Applied Science (Physiotherapy),
Member Australian Physiotherapy Association,
Principal Physiotherapist Balmain Physiotherapy
Centre, Montague Street, Balmain, Sydney,
Australia
Correspondence to: D. Kneeshaw
E-mail: balmainphysio@bigpond.com.au
Received January 2001
Revised March 2001
Accepted April 2001
...........................................
Journal of Bodywork and Movement Therapies (2002)
6(1), 2^8
# 2002 Harcourt Publishers Ltd
doi: 10.1054/jbmt.2001.0233, available online at
http://www.idealibrary.com on
Taping has been widely used by
therapists as an aid for prophylaxis
and rehabilitation for many years.
Research has been more frequently
conducted in recent history and the
benefits of taping are still under
contention (McNair et al. 1995;
Perlau et al. 1995; Gilleard et al.
l998). However, it is still widely
accepted in clinical practice that
taping applied in the correct manner
and situation is an important and
useful treatment modality (Gilleard
et al. 1998; Powers et al. 1997; Ernst
et al. 1999; Alt et al. 1999; Gerrard
et al. 1998). As yet the mechanisms
of action of taping are inconclusive
though most theories focus on
proprioceptive and mechanical
effects with lesser effects
hypothesized to be psychological
(Hume et al. 1998). Taping is
considered an important modality in
treatment of shoulder dysfunction as
it stimulates greater proprioceptive
feedback and helps to improve
scapulo-humeral rhythm and joint
al. 1998; Allingham 1998; Watson
2000). The aim of this paper is to
provide examples of shoulder taping
and to discuss the possible
mechanisms behind their success.
Clinical anatomy and
relevance to taping theory
The shoulder complex is made up of
three joints—the gleno-humeral or
scapulo-humeral joint, the acromio-
clavicular joint and the scapulo-
thoracic joint (Moore 1985: Kibler
1998). The shoulder is a highly
mobile complex, more so than any
other peripheral joint, with over
16 000 different positions available,
measured on a three-dimensional
topographical analysis on a degree-
by-degree basis (Moseley et al.
1992). This flexibility results in the
region being stabilized by both static
and dynamic components (Ginn
1993; Davies & Dickoff-Hoffman
1993; Warner et al. 1990; Kibler
1998), with dynamic stabilizers

2
J O U R NA L O F B O DY W O R K AN D M OVE ME N T T H E R A PIE S JANUARY 2 0 02

being more important than other
peripheral joints (Davies & Dickoff-
Hoffman l993). As the humeral
head’s radius is on an average three
times that of the glenoid fossa,
increased flexibility is a trade-off for
reduced stability (Davies & Dickoff-
Hoffman l993). The resultant
necessity is for an intricate
coordination of rotator cuff muscle
activation timing and correct passive
tissue length characteristics to
maintain the humeral head centrally
rotating against the glenoid fossa
(Kibler 1998).
The scapulo-thoracic joint is not
a true physiological joint, but is
arguably the most crucial of the
three shoulder joints as it is
considered the major base of
support for shoulder motion (Kibler
1998; Davies & Dickoff-Hoffman,
1993). The position of the scapula
will determine the angulation of the
glenoid fossa and thus the relative
location of the humeral head to the
acromion (Kibler 1998; Moseley et
al. 1992; Glousman et al. 1988; Pink
& Perry 1996). Hence its position is
the prime determinant of the size of
the sub-acromial space and also the
vulnerability of the supraspinatus
tendon to impingement at rest and
through movement (Kibler 1998;
Davies & Dickoff-Hoffman 1993).
As the supraspinatus tendon has
been shown to be hypovascular at
resting position (Warner et al. 1990)
it is imperative that the scapula be
suitably oriented to negate the
effects of compression and possible
further reduction in circulation to
the tendon. Most throwing and
serving sports are performed with
shoulder elevation between 70 and
110 degrees (Kibler 1998; Davies &
Dickoff-Hoffman 1993). This is
where the dynamic stabilizers need
to perform at their greatest
compressive force to locate the
humeral head in the socket and the
scapula needs to have rotated to the
applicable position to gain proper
joint congruence. The orientation of
J O U R NA L O F B O DY W O R K AN D M OVE ME N T T H E R A PIE S JANUARY 2 0 02
Shoulder taping in the clinical setting
the rotator cuff fibres reinforces that Physiotherapists do this in a number
this range is where their involvement of ways — soft-tissue release,
is most necessary. Kibler has electrotherapy, stretching,
published a list of roles the scapula strengthening and proprioceptive
plays in shoulder function (Table 1). re-training. It is considered that
For these functions to be performed taping is a useful adjunct in
well there must be a complementary facilitating these modalities to
relationship between the inert provide the biomechanical and
capsular and connective tissues and proprioceptive changes necessary to
the contractile elements, such as stimulate repair and promote a good
their length, flexibility and outcome. It has been known for
activation timing and strength some time that neuromuscular
(Davies & Dickoff-Hoffman l993). receptors are damaged after injury
The acromio-clavicular joint acts (Davies & Dickoff-Hoffman 1993;
as a strut for the scapula to rest Forwell & Carnahan 1996; Perlau et
against the thorax, providing al. 1995) and obviously to achieve
stability through elevation (Kibler the best results these deficits must be
1998; Shamus & Shamus 1997). The rectified. Useful taping techniques
combination of crankshaft shape and their possible mechanisms of
and the acromio-clavicular action will be discussed in a later
ligaments (Kibler l998; Shamus & section of this article.
Shamus 1997) allows enough
translation and rotation to complete
full abduction (all other things being
Taping overview
equal). The joint is susceptible to Taping is a widely used treatment
injury via frank trauma such as modality. Its use could be
direct falls, or accumulated micro- considered an extension of the
trauma from repetitive stresses such traditional compression and crepe
as throwing, serving or rugby bandages that in themselves have
tackling. It has been reported to be been demonstrated to improve
the most commonly sprained joint proprioception in research
of the shoulder (Shamus & Shamus conducted on injured knees (Perlau
1997). et al. 1995). The effects have been
Rehabilitation of the injured shown to last well after the
shoulder invariably involves re- application of the tape (Perlau et al.
training of the specific function of 1995). In the author’s knowledge,
the contractile elements throughout there are no definitive studies to
motion and altering the resting explain the theories that have
length of these components to surfaced surrounding how and why
improve length-tension taping succeeds. There is, however,
relationships, thereby improving general acceptance that it does
scapulo-humeral rhythm and benefit the patient despite conflicting
posture (Brukner & Khan 1997). evidence of its efficacy. Following
Table 1 Roles of the scapula in shoulder function (Kibler1998)
1st Role To be a stable part of the glenohumeral articulation
2nd Role Retraction and protraction along the thoracic wall
3rd Role The scapula must rotate in the cocking and acceleration phases to clear the
acromion from the rotator cuff to decrease impingement and coracoacromial
arch compression
4th Role Being a link in the proximal-to-distal sequencing of velocity, energy,
and forces that allows the most appropriate
shoulder function
3

the success in taping ankles for
increased stability and taping knees
to improve patello-femoral function
(Gerrard 1998; Refshauge 2000;
Ernst et al. 1999), shoulder taping
has steadily diversified to include
several often-used techniques that
will be outlined in later sections.
The two most frequently
proposed mechanisms of taping are
the proprioceptive and mechanical
(Moseley 2000; Ernst et al. 1999;
Gerrard 1998), with an assumption
that taping has a positive
psychological effect (Hume et al.
1998). Tape is said to stimulate
neuromuscular pathways via
increased afferent feedback from
cutaneous receptors (Parkhurst &
Burnett 1994; Perlau et al. 1995;
McNair et al. 1995) which with
expert re-training can facilitate a
more appropriate neuromuscular
response. The mechanical effects are
to re-locate the joints in such a way
as to stabilize the joint (Gerrard
1998; Kibler 1998), provide a splint
or alter length-tension relationships
(Moseley 2000; Watson 2000;
Allingham 1998; McConnell 2000;
Parkhurst & Burnett 1994) to create
the required musculo-skeletal
posture or motor pattern. As
far as the psychological factor
is concerned, there is the obvious
placebo effect of receiving
attention, but also the heightened
consciousness resulting from
the feeling of applied tape.
There continues to be contention
in the literature as to whether
taping makes a significant
contribution to patient
improvement and if the proposed
mechanisms are valid (Refshauge et
al. 2000; Ernst et al. 1999; Alt et al.
1999; Powers et al. 1997; McNair
et al. 1996).
In the clinical setting the first step
to success with taping is to make the
correct diagnosis and identify the
pertinent causative factors of which
the therapist can attempt to change.
In the author’s opinion, the
J O U R NA L O F B O DY W O R K AN D M OVE ME N T T H E R A PIE S JANUARY 2 0 02
Kneeshaw
difficulty in shoulder taping lies in Allingham’s strap
the paucity of stable structures upon
Allingham’s strap (Fig. 1) is used for
which to anchor tape. This reduces
impingement syndrome of the
the ability of the tape to splint the
rotator cuff insertion underneath the
joint, but should not reduce the
acromion. Allingham (1998) believes
other mechanical or proprioceptive
that the technique is most useful in
actions. If the chosen application
the acute and sub-acute stages of
initially provides the desired result it
impingement. Firstly apply three
should be re-applied in conjunction
hypoallergenic mesh tapes from
with relevant treatment and exercise
mid-shaft of the lateral humerus to
until the symptoms disappear or the
the mid-belly position of middle
desired motor pattern has been
and upper trapezius. Following this
achieved free of tape (Morrissey
lay down three rigid tapes, side-
2000).
by-side from anterior to posterior
deltoid without tension to the
Taping techniques sub-acromial space and then
moderate to firm tension to the
The following section will describe
latter position. Patients often
often-used taping techniques and
comment ‘my arm feels supported
discuss possible reasons for their
as if in a sling’.
success and the neuromuscular
The longitudinal bunching of the
processes behind them. The
trapezius fibres which are oriented
techniques discussed include
from the acromion to the spine in a
Allingham’s strap, Watson’s strap,
virtually horizontal fashion serve to
the various techniques to inhibit or
improve these fibres’ cross-bridging
facilitate shoulder girdle muscles,
capacity which will enhance the
the acromio-clavicular strap and the
muscle’s length-tension relationship
external rotation limitation strap.
(Bak & Magnusson 1997). The
Currently there is still contention as
increased ability of these fibres to
to the effects of taping — the author
contract causes a lateral rotation of
has attended two lectures of Jenny
the scapula upon attempts at
McConnell and Craig Allingham,
scaption, which in turn clears the
who have both created taping
rotator cuff tendon from the
techniques, but could not give
acromion. Therefore the procedure
definite answers as to why the
serves to fulfil the third role of the
technique had their desired effect.
scapula, as defined by Kibler (1998).
The usual priming procedures
As the supraspinatus is
should be employed before applying
hypovascular at the lower reaches of
tape — cleaning excess oils off the
abduction (Warner et al. 1990),
skin and then applying a
hypoallergenic adhesive barrier gel.
The first tape should be a mesh,
hypoallergenic tape, applied without
tension. Finally the rigid, zinc oxide
tape can be applied with the desired
tension. The client should be careful
when removing the tape to pull
slowly back along the extent of the
tape and thus avoiding irritation of
the skin. McConnell (2000) believes
that reckless removal of tape and
the subsequent skin irritation is
the greatest hindrance to early
re-application. Fig. 1 Allingham’s strap.
4

Allingham’s tape is important in
allowing proper repair of damage by
increasing the sub-acromial space.
Improper biomechanics as a result
of muscle inhibition is a significant
problem in the acute phase of injury,
so the reduction in shoulder hitching
with Allingham’s strap is beneficial
in reducing recovery times. The
humeral head is likely to be more
effectively compressed by the
stimulated horizontally aligned
muscle fibres.
As described by Kibler (Kibler
1998), proximal stability is necessary
for upper limb rehabilitation, and
correct scapular orientation is
therefore one of the primary targets,
provided by the Allingham’s straps.
The greatest proprioceptive input
for the upper limb is from the
shoulder (Forwell & Carnahan
1996) and the extra cutaneous
mechanoreceptor and intramuscular
receptor input provided by taping
should also be of benefit.
Watson’s strap
Watson’s strap (Fig. 2) is best
utilized for those with ‘drooping
shoulders’ (Watson 2000) which is
demonstrated by those with anterior
and medial rotation and anterior tilt
of the scapula. This resting position
is an indicator of poor muscle tone
in the rhomboids and lower traps,
and from the author’s clinical
experience, hypomobile scapulae.
Fig. 2 Watson’s strap.
J O U R NA L O F B O DY W O R K AN D M OVE ME N T T H E R A PIE S JANUARY 2 0 02
Shoulder taping in the clinical setting
There may be excessive traction
stresses on the upper trapezius,
which results in chronic spasm and
also the possibility of functional
thoracic outlet syndrome (Watson
2000; Leung et al. 1999). The net
effect is reduced sub-acromial space
and dysfunctional scapulo-humeral
rhythm. The clinician elevates and
laterally rotates the affected scapula
with one hand after attaching tape
to a point anterior of the lower third
of the scapula, in the axilla (which in
the cases of hirsute armpits, should
be shaved around 48 h before
application to avoid skin irritation).
Then the tape is attached to the
spine of the opposing scapula,
effectively re-locating the drooped
shoulder and helping to resolve the
above mentioned postural deficits.
The re-location of the scapula has
both mechanical and proprioceptive
effects. The obvious mechanical
effect is the re-location itself that
improves the length-tension
relationship of rhomboids by
shortening this underactive muscle
(Morrissey 2000). It has been
demonstrated that patellar position
and muscle activation in the VMO
can be positively affected with
taping (Gerrard 1998) and it should
be the case that the scapula is no
different. The action of the tape to
improve rhomboids and upper/
middle trapezius contraction should
encourage greater scapular stability,
early lateral rotation of the scapula
and thus increase sub-acromial
space. The shortening of the
rhomboids and middle trapezius
fibres should aid in the activation of
the force couples of rhomboids and
serratus anterior for scapular
stability (Kibler 1998; Watson
2000).
The proprioceptive effect is the
feedback loop developed by the
gross alteration in scapula position,
hopefully stimulating better muscle
co-ordination. As with any taping,
Watson’s strap will have effects on
providing more afferent feedback to
5
the sensori-motor cortex (Morrisey
2000; Perlau et al. 1995; McNair
et al. 1995). Though cutaneous
mechanoreceptors are considered
more important in the distal part
of the upper limb (McNair et al.
1995), the author suggests that there
must be altered stimulus by virtue
of tape on skin — this is still a
contentious point (Forwell &
Carnahan 1996; Bullock & Sexton
1993). Simple elasticised bandages
have been shown to improve
proprioception (Perlau et al. 1995),
therefore it is expected that taping
should prove to do the same. This,
in conjunction with the
psychological reminder the tape
provides (Hume et al. 1998), should
aid in re-training proper scapulo-
humeral rhythm (Voight et al. 1996).
Scapular-stabilising tapes
There are various tapes that are
meant to re-locate the scapulae and
alter muscle activation levels to
improve scapular stability (Figs
3–5). A study was cited in this
journal that demonstrated
immediate reduction in upper
trapezius activity with a cross-tape
(O’Donovan, 1997, cited in
Morrissey 2000). It is likely that the
derangement of fibres from this
lateral bunching reduces the ability
of the actin and myosin to cross-
bridge (Parkhurst & Burnett 1994).
McConnell uses a gross bunching
Fig. 3 Upper trapezius inhibition utilising
the lateral bunching of muscle fibres to reduce
recruitment.

Fig. 4 Facilitation of serrotus anterior and
rhomboids.
Fig. 5 Facilitation of scapular retraction and
depression.
technique to reduce vastus lateralis
activation in patello-femoral
rehabilitation (2000). As previously
mentioned longitudinal bunching
should promote greater muscle
activation through an increased
number of available cross-bridges,
so these techniques should follow
the rule of lateral bunching of over-
active muscles and longitudinal
bunching for under-active muscles.
The author believes that this
mechanism is of much greater
significance than other effects such
as augmentation of cutaneous inputs
(though every little bit helps!), and is
therefore in some disagreement with
Morrissey (2000) who in this
journal, July 2000 remarked that
changes in motor patterns with these
scapula techniques is effectively
cutaneously mediated
proprioceptive biofeedback. This
author feels that as there is greater
proprioceptive feedback from
J O U R NA L O F B O DY W O R K AN D M OVE ME N T T H E R A PIE S JANUARY 2 0 02
Kneeshaw
neuromuscular elements, it is more
likely that motor patterns are
developed by the disruption or
augmentation of more actin-myosin
cross-bridges and the reduced/
increased activity in muscles with
the relevant training exercises. The
varieties of techniques are most
often used for scapula retraction and
upper trapezius inhibition.
Acromio-clavicular strap
Previous studies demonstrate the
positive effects of the acromio-
clavicular (AC) strap (Fig. 6) in
rehabilitation of ligamentous
injuries around the acromio-
clavicular joint (Shamus & Shamus
1997). This technique primarily
works on the mechanical action of
taping by imitating the stabilizing
properties of the surrounding
ligaments and joint capsule.
Damage to the joint reduces its
capability to act as a strut for the
scapula (Kibler 1998; Shamus &
Shamus 1997) and the likely
resultant distal clavicular elevation
reduces the crankshaft’s ability
to translate and rotate correctly
to allow proper, full elevation.
Though it has an important role in
shoulder function, this commonly
sprained joint (Shamus & Shamus
1997) is a less complex one, which
lends itself to successful taping. The
tape is applied firstly at the coracoid
process and applied in a posterior
Fig. 6 Acromio-clavicular joint strap.
6
direction to around the mid-section
of the thoracic cage.
Rigney’s strap
The author first saw the final
technique for discussion on a
representative rugby union player
who required surgery to the rotator
cuff and anterior joint capsule. He
was however also required to
complete the season’s rugby and as
such was taped by his club’s
physiotherapist, Mr Luke Rigney,
to prevent further damage and allow
him to effectively compete. To
control his multi-directional
instability, which most frequently
manifested itself in the abducted,
externally rotated position, the
following taping technique was used
(Fig. 7). The position for taping is
important — abduction to 908 and
full internal rotation. Elastic anchor
tapes are wrapped around the distal
humerus and mid-thorax. From the
posterior and inferior of the humeral
anchor lay a rigid tape anteriorly
across the superior part of the
glenohumeral joint ending at the
second anchor. Continue taping
with a more anterior accent. The
mechanical effect is to reduce the
shoulder’s available external
rotation in abduction and therefore
reduce likelihood of dislocation and
rotator cuff stresses. There are
obvious limitations to this taping —
it is difficult to tape without
hindering the throwing or serving
action because of the reduced
capacity for wind-up in the
preparatory phase. This technique is
therefore similar to the ankle taping
post-inversion injury where the tape
acts to limit available range of
motion.
There would also seem to be a
proprioceptive effect of significant
proportions. Though progressive
external rotation in elevation the
strong pull on the skin, excites
cutaneous mechanoreceptors which
will send greater afferent feedback to

Fig. 7 Rigney’s strap
the central nervous system to
promote an earlier reflex activation
of the relevant rotator cuff muscles
(McNair et al. 1995; Perlau et al.
1995; Parkhurst & Burnett 1994). It
is assumed that the sensori-motor
cortex is tricked into believing the
capsule and muscles are at a greater
length than in reality, which as in the
stretch-shortening cycle (Hutton &
Atwater 1992) may produce a
stronger antagonistic contraction to
limit the problem movement,
properly orient the humeral head
and reduce anterior ‘opening up’.
Conclusion
Taping is a widely used modality
that has been shown to be of marked
benefit in the clinical setting.
Shoulder taping can be more
difficult compared to other body
regions due to its complex
stabilizing mechanisms and the
necessity for dynamic stability
produced from contractile
structures. Research into its efficacy
and to clearly define the mechanisms
behind shoulder taping seems to be
required. However it should be
considered that taping is a useful
adjunct to physiotherapeutic
treatment due to weight of success in
clinical experience. Taping and then
re-training movement has the added
J O U R NA L O F B O DY W O R K AN D M OVE ME N T T H E R A PIE S JANUARY 2 0 02
Shoulder taping in the clinical setting
benefit of making the patient aware
of the big picture, that is to alter the
causative factors of shoulder injury
and reduce the likelihood of re-
injury. This effect and the relief of
symptoms taping can produce make
it an important part of shoulder
rehabilitation.
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