IPP3M

Taping &
Bandaging
Report
Abderrahman Alshehri

341578
Chief Complaint:  Left knee pain  

HPI: A 25‐year‐old male soccer armature player presents with left knee pain following two
accidents while playing events. The first occurred six weeks ago when he kicked the ball
awkwardly and fell to the ground during a game. He experienced immediate pain and was
able to continue the game through the pain. He did not seek evaluation at that time and
continued with his life style normally as the pain wasn’t severe. Two weeks after the initial
event, he was kicked in the left knee from behind and felt his patella move. This time, his
friends helped him off the field. He noted significant swelling of his knee for approximately 4
weeks. Since then, he reports continued anterior knee pain and feelings of instability. Range
of motion is now limited, such that he is unable to fully flex or extend his knee secondary to
pain. Symptoms are worse with activity and weight‐bearing and better with rest and
paracetamol. Sensation was initially affected, which resolved over 4 weeks as swelling
improved.  

Physical Exam: In general, alert and in no acute distress.  

Musculoskeletal: Left knee:  

‐‐Inspection – some swelling present with no fluid feel. No redness or erythema. Antalgic
gait.

‐‐Palpation ‐ significant tenderness over the medial joint line and just distal to the anterior
medial joint line.

‐‐Range of motion – End range of motion for both flexion and extension is limited due to
pain, with a flexion/extension arc of approximately 15‐120 degrees.   

‐‐Strength ‐ 5/5 in flexion and extension without significant pain.  

‐‐Special tests ‐ 
 Negative results of the Lachman and anterior drawer tests.
 Significant laxity with valgus stress, but with appreciable endpoint.
 Negative valrus stress test and negative posterior drawer test.
 Negative McMurray's; however, limited evaluation since he was unable to fully flex
his knee during this part of the exam.
 Unable to fully squat secondary to pain.  
 Apley's test, negative

Right knee was examined for comparison and was normal.  

Neurovascular: Distal sensation intact. Feet were warm and well perfused.  
Skin: No rashes.

Brief description of findings:

Causes of knee pain in this 25-year‐old soccer player with 2 events of possible knee injury:  
(1) Contusion (bone and soft tissue)
(2) Medial Collateral Ligament (MCL) injury  

Considering the location and type of pain plus the mechanism of the occurring of the injury
adding to that the specific tests outcomes, all point at an MCL injury. Since grade 3 tear
characteristics aren’t present, it was excluded from the diagnosis. And a grade 2 sprain
is the most proper following the below schedule
Symptoms Signs Tests

- mild medial pain - medial edema positive abduction stress test

- possibility of swelling and limping - tenderness
-medial edema
- tenderness

- moderate medial pain - medial edema - positive McMurray's test (if meniscus is involved)
- swelling and limping - tenderness - abduction stress test
- instability

- severe medial pain - marked medial Lachmann test for ACL stability should be accomplished
- swelling edema grade III MCL instability is present.
- knee gives way into valgus - tenderness

Treatment plan:
Acute treatment for the medial collateral ligament is RICE, being rest, ice, compression and
elevation [2]. However, in our patients’ case he is beyond the first 72 hours and so should be
pursuing more functional recovery.

Week 1 to 2:
Duration 1 week. Aims - Eliminate any swelling completely, regain full range of movement,
continue with strengthening exercises and return to slow jogging.
Rest from painful activities, however the athlete may be able to jog slowly as long as it is not
painful. Apply cold therapy following exercise or rehabilitation exercises. Continue with
stretching and strengthening exercises
Introduce dynamic strengthening exercises such as knee extension, knee flexion, half
squats, step ups, single leg calf raise, bridging and leg press are suitable exercises if pain
allows.
Cross friction massage to the ligament can be performed on alternate days. Maintain aerobic
fitness with cycling, stepping machine and gentle jogging but no sudden changes of
direction.
Week 2 to 4:
Duration 2 weeks. Aims to maintain full range of motion, equal strength of both legs, return
to running and some sports specific training.
Continue to apply cold therapy after training sessions. Continue with sports massage
techniques every 3 days. Continue with stretching exercises.
Build on dynamic strengthening exercises such as leg extension and leg curls exercises as
well as squats to horizontal and lunges. Increase the intensity, weight lifted and number of
repetitions. Aim for between 10 and 20 reps. Increase until the strength is equal in both legs.
In addition to straight running, start to include sideways and backwards running, agility drills
and plyometric exercises. Increase speed to sprinting and changing direction drills.
Week 4 to 8:
Duration 3 to 6 weeks. Aims to return to full sports specific training and competition.
Sports massage for surrounding muscles on as weekly basis. Continue with strength training
as above but start to include hopping and bounding exercises. The athlete should now be
ready to gradually return to full sports specific training and then competition.
A knee support or a strapping / taping technique may provide extra support on return to full
training, however do not become reliant on this. It will weaken the joint. Use initially for
confidence building.

Taping & Bandaging method:

- McConnell taping: used to shift the patella medially as one study showed that it helps to
faster recovery of MCL tears and return to sport. Figure 1

-Kinesics taping: Applied to inner knee on MCL to promote healing and support the
sprained MCL.
Figure 1, Medial patellar glide taping
Figure 2, MCL Kinesics taping
Sources:
 Frommer C, Masaracchio M. The Use of Patellar Taping in the Treatment of a Patient with a Medial
Collateral Ligament Sprain. North American Journal of Sports Physical Therapy: NAJSPT. 2009;4(2):60-
69.

 Roald Bahr – Sverre Maehlum- Tommy Bolic (2002), Clinical guide to sports injuries : an illustrated
guide to the management of injuries in physical activity