Bandaging and Taping Techniques
Taping
1. In general, taping requires practice, but some simple techniques can be easily mastered.
2. Taping is most often used to treat mild to moderate sprains and strains, where some functional capacity, such as weight bearing and lifting, is maintained.
3. Although taping offers dynamic support, it is in no way comparable with splinting, which can immobilize an extremity.
4. The most common tape applied is white athletic (or adhesive) tape, often used by trainers in organized sports. Another very useful product is self-adherent elastic wrap that functions like a tape, but sticks only to itself, such as Coban.
5. Athletic tape may be applied to skin, although it may lose adhesion if the body part is not shaved and tape adhesive not applied.
6. Circumferential wrapping techniques should be used with considerable caution with acute injuries. Marked swelling may cause severe vascular constriction when tape encircles the extremity. Always monitor distal neurovascular status.
Types of Tape
a. Although the major advantage of athletic tape is versatility, its major disadvantage is the tendency of zinc oxide to lose adhesive properties with heat and moisture, thus resulting in loss of support when the patient sweats.
b. A variety of techniques are used to increase the durability of athletic tape under these conditions, described later in this section.
a. Elastic tape (e.g., Elastikon) is cotton elastic cloth tape with a rubber-based adhesive. The elasticity of the tape allows for greater flexibility and is particularly useful for large joints such as the knees or shoulders.
b. Coban is a self-adherent elastic wrap that functions like tape, but sticks only to itself. It is available in sterile and nonsterile styles, and in a variety of widths and colors.
Skin Preparation
1. Skin preparation involves measures meant to increase longevity of tape adhesion and patient comfort.
2. If tape is to be applied directly to the skin, the area is usually shaved to remove hair that may interfere with direct contact.
3. Care must be taken to avoid small abrasions in the skin when shaving because these can serve as sites of infection.
4. Any abrasion should be covered with a thin layer of gauze or small adhesive strip before taping.
5. A variety of commercially available skin adhesives are available in aerosolized form.
a. These preparations use benzoin as the adhesive. One example is Tuf-Skin.
b. Skin adhesives are applied after the skin has been shaved and abrasions dressed.
c. In the wilderness environment, a small plastic bottle of tincture of benzoin is practical. It can be applied with a sterile applicator or gauze pad.
6. If the area is not shaved, a foam underwrap or prewrap is used to protect body hair. Prewrap is generally supplied in 7.5-cm (3-inch) rolls.
7. After applying a topical skin adherent such as Tuf-Skin, prewrap is applied over the part to be taped in a simple, continuous circular wrap.
8. The prewrap is sufficiently self-adherent that it does not need to be taped down.
9. When tape is applied over bony prominences, it can create tension on the skin surface that leads to blistering. Therefore heel-and-lace pads and foam pads are used to provide greater comfort by relieving potential pressure points. Heel-and-lace pads are prefabricated pieces of white foam that are stuck together with petroleum jelly and then applied to the anterior and posterior aspects of the talus when the ankle is taped.
10. Pads of foam can be cut to size to fit over painful areas that need to be taped, as in medial tibial stress syndrome, or they can be used for support in special cases such as taping for patellar subluxation.
Ankle Taping
1. The most common injury to the lower extremity while hiking is a sprained ankle.
2. Pain and swelling linger for several days, and taping can help offer support if the patient is able to bear weight.
3. Because most injuries occur to the lateral ligaments, taping supports the lateral surface by restricting inversion.
4. Ankle taping uses anchor strips on the lower leg and foot, stirrups that run in a medial to lateral direction underneath the calcaneus, and support from either a figure-8 or heel-lock technique (Fig. 23-1).
-inch) tape at the lower leg and distal foot. B, (3) Apply three stirrups from medial to lateral in a slight fan-like projection. C, (4) Fill in gaps with horizontal strips.D, (5) Begin figure-8. Apply tape across front of ankle in left-to-right direction. E, (6) Continue under the foot to the opposite side, and cross back over the top of the foot. F, (7) Complete by wrapping around the leg, and end at the anterior aspect of the ankle.G, (8) Apply heel locks for both feet (omit if not familiar with this technique). Start in left-to-right direction, and apply tape across front of joint. H, (9) Wrap around the heel (bottom margin of tape should be above the superior edge of the calcaneus) to form the first heel lock. I, (10) Continue under the foot to the opposite side, and cross back over the top of the foot.J, (11) The tape is then brought back around the superior margin of the calcaneus and down and around the heel. K, (12) Finish by wrapping around the ankle. Repeat figure-8 or heel lock as desired.5. The heel lock requires some expertise to perform, so most operators are more comfortable with the figure-8 initially.
Toe Taping
1. Taping toes that are sprained or fractured is simple and effective.
2. This treatment involves buddy-taping to the adjacent toe with one or two pieces of tape to provide support. Figure 23-2 demonstrates buddy-taping of fingers.
FIGURE 23-2 Buddy-taping of fingers.
3. A piece of gauze, cotton, or cloth can be placed between the toes to avoid skin breakdown.
Lower Leg Taping
1. Medial tibial stress syndrome, commonly referred to as “shin splints,” can be taped for support and comfort.
2. Tape is brought from a lateral to medial direction, and a small foam pad can be cut to cover the area of tenderness.
3. Underwrap should be used over a foam pad to secure it in place (Fig. 23-3).
FIGURE 23-3 Lower leg taping.
