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Taping For The Upper

Quarter

Andrew Leipus
B.Appl.Sc.(Exercise&Sports Science)
B.Appl.Sc.(Physiotherapy)
M.Appl.Sc.(Musculoskeletal&SportsPhysio)
Physiotherapist Indian Cricket Team 1999-2005
Taping for the Shoulder and
Scapula

 Facilitation of rotator cuff


 Shoulder anterior or posterior instability
 Relocation of HOH
 AC joint sprain
 Inhibition of upper trapezius/Levator
 Facilitation of lower trapezius
 Facilitation of serratus anterior
Shoulder
Facilitation of Rotator Cuff

 Aims
– Facilitation of activation of the co-contracting
stabilising function of the rotator cuff
– Light restriction to shoulder rotation
– Proprioception of the glenohumeral joint
Cuff Anatomy
Shoulder
Facilitation of Rotator Cuff
 Patient position
– Sitting with arm comfortably supported
– Approx 45° abduction in scapular plane
– Neutral shoulder rotation
 Preparation/Precautions
– 50cm elastic or rigid sports tape
– Shaving if necessary
– ?gauze Vaseline pad over sensitive anterior axillary
region
Shoulder
Facilitation of Rotator Cuff

 Application of Anchor tapes


– Needed if patient likely to become sweaty
– Anchor rigid tape lightly around mid upper
arm
– Anchor from chest over trapezius along
medical border of scapula
– Can also apply relocation tape initially if
HOH sits anteriorly in glenoid
Shoulder
Facilitation of Rotator Cuff

 Application of Tape…
– First elastic tape applied posteriorly with no
tension from the anterior aspect of upper arm,
around arm, then pull with tension up along
the line of the spine of scapula
– Second elastic tape applied in opposite
direction finishing along line of the clavicle
anteriorly
Shoulder
Facilitation of Rotator Cuff

 Application of Tape…
– The two tapes cross at right angles to each
other adjacent to HOH and lateral to joint line
Lock by repeating arm anchors with rigid tape
– May need to lock over lateral deltoid to prevent
rolling of tape in abduction
– Can apply rigid tape on top of these to provide
increased rigidity if required
Shoulder
Anterior or Posterior Instability
 Aims
– To provide a mechanical block to glenohumeral
movement in positions of instability (extremes of
rotations +/- horizontal extensions)
– Used either for anterior, posterior or ‘multidirectional
instability’
– To provide excellent proprioceptive feedback prior
to the shoulder reaching a position of instability
Shoulder
Anterior Instability

 Patient position
– Sitting comfortably, arm held in 90° flexion
– 90° Shoulder internal rotation
 Preparation/Precautions
– 75mm elastic tape + 50mm rigid tape
– Shaving if necessary, including axilla
– ?gauze or Vaseline pad over sensitive anterior
axillary region
Shoulder
Anterior Instability

 Application of Anchor tapes


– None required if tape passes around chest*
 Application of Tape
– Start elastic tape from inferior angle of scapula
– Pass tape superiorly over acromion, anterior to
HOH
– Ask patient to contract bicep
– (*but advisable)
Shoulder
Anterior Instability
 Application of Tape…
– Pass tape without tension underneath proximal
humerus and back around to the anterior HOH
– The tapes cross almost at right angles to the each
other anterior to HOH with some tension
– Tape then passes diagonally across the chest and
finishes back up at the start position of the medial
border of the scapula
Shoulder
Anterior Instability

 Application of Tape…
– Reinforce the bisection of the tapes with two
strips of rigid tape, also crossing anterior to
the HOH
– Can repeat this with a second tape slightly
more medial to the first
– Lock the elastic tape with a small strip of
rigid tape
Shoulder
Posterior Instability

 Same principal as the taping for anterior


instability except applied in a reverse manner
 Start tape application medial to nipple (5th rib
level)
 Tapes cross at the posterior aspect of HOH
 Start position will be arm in 90° abduction and
90° external rotation
Shoulder
Multidirectional Instability

 Application of BOTH anterior taping and


posterior taping
 Can also use rotator cuff facilitatory taping prior
to (underneath) the instability taping
Shoulder
Relocation of Head of Humerus

 Aims
– Relocation of the HOH to mid-position when
it is sitting anteriorly in the glenoid
– Light restriction to internal rotation
– Facilitation of normal proprioception and
mechanics of the g/h joint
– Anterior shoulder pain reduction
Shoulder
Relocation of Head of Humerus
Shoulder
Relocation of Head of Humerus

 Patient position
– Sitting comfortable, elbow supported
– Arm in neutral flexion/extension
– Arm in slight external rotation
 Preparation
– 50mm rigid sports tape
– May require under-tape to anterior aspect of
shoulder due to skin tractioning effects
Shoulder
Relocation of Head of Humerus

 Application of Anchor tapes


– Small strip applied vertically over medial
aspect of anterior fibres of deltoid (over
corocoid process)
– Second strip applied vertically along medial
border of scapula
Shoulder
Relocation of Head of Humerus
 Application of Tape
– Apply rigid tape to the anterior anchor and pull firmly
around the shoulder to attach to second anchor
– Keep the tape as close to the acromion as possible to
avoid blocking glenohumeral abduction
– Ensure an AP pressure relocates the HOH in the
glenoid
Shoulder
Relocation of Head of Humerus

 Repeat this with 3-4 strips in a ‘fanning’


distribution across the scapula
 Apply locking tapes accordingly
Shoulder
Acromioclavicular Joint

 Aims
– To support and stabilise the AC joint
following subluxation/dislocation sprain
– Facilitation of proprioception of the shoulder
Shoulder
Acromioclavicular Joint
Shoulder
Acromioclavicular Joint

 Preparation/Precautions
– 50mm rigid sports tape
– Shave if patient has a hairy shoulder, back,
or chest
– Gauze or Vaseline pad over sensitive
anterior axillary region
Shoulder
Acromioclavicular Joint

 Patient Position
– Sitting comfortably with the arm resting on a
table/pillows
– Arm held in 30-45°abduction in the plane of
the scapula with neutral rotation
 Application of Anchor
– Arm anchor around insertion of deltoid (don’t
completely surround arm, no tension)
Shoulder
Acromioclavicular Joint

 Application of Anchor…
– Second anchor from mid-scapular level
passing vertically across top of the medial
clavicle till approximately 3-4th rib on
anterior chest
– Use protective under-tape if available in the
following pattern
Shoulder
Acromioclavicular Joint
 Application of Tape
– Place small ‘donut-shaped’ pad over the AC joint and
fix with small piece of tape
– First tape is applied from the posterolateral humerus
anchor across the AC joint and onto the chest anchor
– Second tape is applied from the anterolateral
humerus anchor up over the AC joint to the scapula
anchor
Shoulder
Acromioclavicular Joint

 Application of Tape…
– Third tape applied vertically from the deltoid
insertion anchor up over the AC joint to the
trapezius anchor
– All three are applied with some tension
– Can repeat and basket-weave for large
shoulders
Shoulder
Acromioclavicular Joint

 Application of Tape…
– A fourth tape can be applied with tension in
a posterior-anterior direction from the mid-
scapular region across the mid clavicle and
onto the pectoral region (to depress the
clavicle)
– Apply rigid locking tape to fixate the tape
ends
The Scapula

 Note that tape on the scapula is primarily to


facilitate or inhibit muscle action
 The scapula’s natural mobility makes it
impossible to restrain movement
 Taping most commonly useful when there is
overactive scapular elevators (+/- hitching) with
under-active scapular depressors
The Scapula

 Often scapular problems are found with


impingements, cuff dysfunctions, poor deep
cervical flexors, forward head posture, and
clinical evidence of poor scapular control
 Main over-active ‘players’ tend to be the upper
trapezius and levator scapulae, whilst lower
trapezius and serratus anterior tend to be
under-active
The Scapula

 Pattern 1
– Over-activity in Levator Scapulae & Rhomboids
with relative inactivity of serratus anterior &
lower trapezius leading to a downwardly rotated
scapula
 Pattern 2
– Inefficient upward rotation of scapula typical in
throwers or multidirectional instability patients
Upper Trapezius/levator Scapulae

 Aim
– Encouragement of inhibition of over-active
muscle, in this case either UT or LS
 Preparation/Precautions
– 50mm rigid tape
– Use under-tape since bunching and skin
traction will occur and can become very
uncomfortable
Upper Trapezius/Levator Scapulae

 Application of Tape
– No anchors required
– Tape is applied at right angles to the intended
muscle
– For upper trapezius the tape is applied vertically
over the top of the shoulder girdle
– For levator scapulae the tape goes on an angle
across the muscle adjacent to its insertion into
the root of the scapula spine
Upper Trapezius/levator Scapulae

 Application of Tape…
– Fix one end of the tape with the index finger
and hold firmly
– Place the middle finger over the muscle belly
and firmly compress and hold
– Pull the tape firmly over the middle finger
– Fix the strip of tape with the fourth finger
Upper Trapezius/Levator Scapulae
 Application of Tape…
– Remove the middle finger leaving a bunching of skin
over the muscle where the middle finger was
– The second piece of tape is applied in the same way
but from the opposite direction
– A locking tape may be require to cover both of these
tapes by a few cm’s each end to prevent lifting
Facilitatory Taping – Lower
trapezius
 Aim
– Facilitation of an under-active muscle
– Commonly useful if over-active elevators/hitching
and under-active depressors
 Preparation/Precautions
– Protective under-tape
– 50mm rigid sports tape
Facilitatory Taping – Lower
trapezius

 Patient Position
– Sitting comfortably with shoulder girdle
relaxed but supported
– Arm kept in slight lateral rotation
 Application of Tape
– First tape applied starting from anterior
glenohumeral joint line, drawing HOH
posteriorly
Facilitatory Taping – Lower
trapezius
 Application of Tape…
– Tape is tensioned parallel to the spine of the
scapula finishing just beyond the medial scapula
border to pull the scapula into slight retraction
– Second tape starts as per the first but passes in a
more inferior direction behind the scapula to finish in
the midline at the level of T7
Facilitatory Taping – Lower
trapezius

 Application of Tape…
– Tension in the tape will tend to pull the
scapula ‘down and back’
– Tapes are repeated to create two layers
– Use a locking tape at the ends to prevent
lifting of the tape
Facilitatory Taping – Serratus
Anterior

 Aims
– Encouragement of facilitation of an under-
active serratus anterior
– Often found with over-active levator scapulae,
rhomboids +/- pec minor and latissimus dorsi
– Often found with under-active trapezius (upper
and lower) and lower serratus anterior
Facilitatory Taping – Serratus
Anterior

 Aims…
– Net result is a downwardly rotated scapula
with delayed/lacking upward rotation during
elevation = ‘winging’
Facilitatory Taping – Serratus
Anterior

 Preparation/Precautions
– Protective under-tape
– Gauze pad and Vaseline
– 50mm rigid sports tape
 Patient Position
– Sitting with the arm supported or actively
held in elevation to approximately 120°
abduction in the scapular plane
Facilitatory Taping – Serratus
Anterior

 Application of Tape
– No anchors but under-tape should be applied
as below but under no tension
– First tape starts at the root of the scapular
spine and is pulled down along the medial
border then anteriorly around the inferior angle
pulling the scapula outwards and anteriorly
Facilitatory Taping – Serratus
Anterior

 Application of Tape
– Second tape starts at the inferior angle and
is tensioned anteriorly and upwards in the
direction of the fibres of serratus anterior
pulling the scapula laterally and upwards
– Often used in conjunction with other
inhibitory and facilitatory taping
Facilitatory Taping – Serratus
Anterior

 Application of Tape…
– The pull of the tape on the skin will tend to
draw the scapula forwards and upwards
leading to a facilitatory stretch on serratus
and lower trapezius…and healthier scapular
mechanics