SHOULDER TAPING LAB
TAPING PRECAUTIONS
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Ensure that patient does not have a known tape allergy
Discuss potential skin reactions
Discuss removal of tape with patient (use soap and water)
Can wear for up to 48 hours. I recommend a 24 hour wearing period on first taping
application to ensure safety.
UPPER TRAP INHIBITION
1. Start white tape at just above clavicle over the muscle belly over anterior aspect of upper
trapezius
2. Run white tape in a vertical line to around the level of rib 7
3. Take brown “action” tape and anchor over beginning of white tape
4. Apply a firm downward pressure to shoulder and pull the brown tape snugly down
5. Ensure that no brown tape is touching the patien
SHOULDER RETRACTION
1. Start white tape at anterior shoulder 2cm medial to joint line. Run it around deltoid just below
acromion to around level of T6 in the back. Do NOT cross midline
2. Anchor brown tape. Pull shoulder into retraction and follow same tape line with brown tape.
3. Ensure that brown tape is not touching patient
McConnell Taping
The technique is a bracing or strapping technique which is trying to affect the biomechanics of
the joint. Also used as a biofeedback technique.
Common Uses: patellofemoral disorders, shoulder instability, postural limitation, arch support,
spinal unloading.
Precautions: DVTs, fair skin, fragile skin, fractured bones in area
Patella: Glide, Tilt- Tape worst component first. If sx decrease by 50% after application teach
taping to patients
1. Glide: Distance measured from mid patella to medial and lateral epicondyles of the
femur.
Medial glide: distance from medial epicondyle to mid patella is .5cm < then from lateral
epicondyle.
Lateral glide: distance from lateral epicondyle to mid patella is .5cm < then from medial
epicondyle.
2. Tilt: Compare heights of medial and lateral borders of the patella by placing fingers on
medial and lateral aspects of the patella.
Medial tilt: lateral border is higher than medial.
Lateral tilt: medial border is higher than lateral.- Runners that have tight IT bands, VL is
bigger and stronger will actually pull the patella more laterally
Should be able to feel the superior and inferior poles of the patella. Inferior Tilt is
common for post surgical pts.
Kinesiotaping- can be left on up to 2-3 days and can be used in areas of known fracture
Cutting the tape will dissipate the force
Therapeutic effect- lies in the recoil of the tape
a. Normalize muscle function ( inhibit or facilitate )
a. Inhibit: Tape distal to proximal or insertion to origin, 15%-25% tension
i. Overuse / inflammation : Achilles Tendonitis
1. Anchor at heel (i) gently pull up to muscle belly (o) bc recoil
will be going down
b. Facilitate / Support: Tape proximal to distal or origin to insertion, 25-50%
tension.
i. Weak muscle: Quads
1. Anchor at quad belly (o) and gently pull and attach on
patella tendon (i)
b. Improve lymphatic and blood flow
a. Lymphatic:
i. Proximal to distal, 25% tension
c. Reduce pain- pain inhibits contraction
d. Correct joint mal-alignment and improve proprioception
e. Scar management
Knee
Noncontact injury with “pop”: ACL tear
Contact injury with “pop”: MCL or LCL tear, meniscus tear, fracture
Acute swelling: ACL tear, fracture, knee dislocation
Lateral blow to the knee: MCL tear
Medial blow to the knee: LCL tear
Knee “gave out” or “buckled”: ACL tear, patellar dislocation
Fall onto a flexed knee: PCL tear
Medial Knee: MCL, Pes Anserine, Bursa
Valgus Stress Test performed at 0-5 and 20 deg ext  tests MCL
Structures Injured at FULL EXT if positive
Structures Injured at 20 DEG EXT if positive
1. MCL
1. MCL
2. Posterior oblique ligament
2. Posterior oblique ligament
3. Posteromedial capsule
3. PCL
4. ACL
5. PCL
6. Medial quadriceps expansion
7. Semimembranosus muscle
Lateral Knee- LCL, fibular head, hamstring, lateral patellar retinaculum
Varus stress test performed at 0-5 deg ext and 20 deg ext  tests LCL
Structures Injured at FULL EXT if positive
Structures Injured at 20 DEG EXT if positive
1. LCL
1. LCL
2. Posterolateral capsule
2. Posterolateral capsule
3. Arcuate-popliteus complex
3. Arcuate-popliteus complex
4. Biceps femoris tendon
4. ITB
5. ACL
5. Biceps femoris tendon
6. PCL
7. Lateral gastrocnemius
PCL Injury  Posterior drawer test, Positive posterior sag test- Hooklying and 90/90 (Godfrey’s
test), Dash board injury, Direct blow to anterior knee, Fall on a flexed knee
ACL Injury  Incidence: Athletes greater than non-athletes, Women more than men - 2-10x higher ,
greater Q-angle, Hormonal, Strength ratio and activation patterns quad/ham ,Ages 15-25
MOI- deceleration injury- slowing down, changing direction that creates valgus stress or injury
most are non-contact, pivot or twist, landing or cutting, knee hyperextension- more than
hyperflexion, valgus force at the knee during sports
Tests Lachman’s, Pivot-shift test, knee arthrometer
Rehab
Phase I: 0-1 week
• Control edema
• ROM to 90
• Crutches
• Patellar mobs
• SLR, Isometrics
• Heel slides
• Extension hang
• Weight shift
Phase III: 9-16 wks
• Expect to reach full ROM
• Plyometrics
• Jogging: wk 13
• Dynamic balance
• Jumping/hopping
Phase II: 2-9 wks
• Control pain/edema
• Patellar mobs
• Mini-squats
• Step ups
• SLS
Phase IV: 16-22 wks
• Agility exercises
• Shuttle run
• Carioca
• Sport specific exercise
Meniscal injuries  most common in posterior horn, locking or giving way most common in 40s
Tests McMurray’s, Apley’s- compression and distraction, joint line pain, Ege’s, Thessaly’s
Considerations  Flexion angles >60, weight bearing ex, good quad control needed
Patellofemoral Anterior knee pain, chondromalacia- general knee pain, tracking problem (PF)general knee pain, subluxation, dislocation, fracture
Testspatellar apprehension, J-sign, glide and tilt, Clarke’s Test
RehabilitationNon-surgical, sometimes release is performed, add step ups, squats, bike when
appropriate, restore flexibility somewhere else: ITB, address mm weakness, analyze running
pattern,taping and bracing options
Isolated Ligament Injury Rehab Aggressive non-operative rehab, hinged brace worn 3-4 week,
possible crutches for 1 week, push ROM: bike, electrical stimulation for mm activation as needed,
Begin to strengthen with light resistance, limit squats to 30 degrees, aerobic activity, step ups, finally
progression to function pivot and cutting
Open chain exercises are not recommended due to the excessive anterior translation of the tibia
on the femur during extension.
Return to Sport CriteriaHop test: different versions- straight forward, side to side and timed hops,
percentage strength compared to other side, KT-1000
HIP
Hip OA  SX- hip/groin pain that can radiate to the greater trochanter, pain after sitting, pain with
weight bearing, MORNING STIFFNESS, limited in flexion and IR
CPR for Hip Diagnosis:
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Self reported squatting as aggravating factor
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Active hip flexion causes lateral hip pain
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Scour test with adduction causes lateral hip/groin pain
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Pain with active hip extension
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Passive hip IR <25 degrees
Non surgical Tx- Weight control- educate on options, refer to nutritional counselor, shoe wear,
use of assistive device (cane), modalities, maintain full hip ROM, strengthening exercises,
manual therapy- ant glide, mob with belt, keep moving-but in an appropriate way
THR Anterior Approach  PROS: No hip precautions, able to weight bear more quickly within 12 weeks, 4-5 inch incision rather then 10-12- have more incisional pain, no muscular
detachment CONS: requires specific table for surgery-VERY EXPENSIVE, increased surgeon
skill, surgery procedure lasts longer
Snapping Hip Syndrome INTERNAL: Iliopsoas snaps over structures deep to it: femoral head,
lesser trochanter, AIIS, iliopectineal eminence, pectineus fascia OR tenosynovitis of iliopsoas
insertion EXTERNAL: Snapping of ITB or glut max over greater trochanter, affects females >
males INTRAARTICULAR: Loose bodies, labral tears, snapping of iliofemoral ligament over
anterior femoral head
Femoral Acetabular Impingement (FAI)  Ball and socket rub abnormally leading to deficits in
either the articular or labral cartilage
Cam more common in men : femoral head loss of roundness
Pincer more common in females: acetabulum overcoverage
Legg- Calve-Perthes
Symptoms: insidious onset, Limp with outtoe, leg drag and trendelenberg gait, ache in groin
radiating to medial thigh or inner knee, muscle spasm, limited abduction and IR, may have
hip flexion and adduction contracture
Intervention: Observation ,bracing, surgical
SCFE MOST COMMON hip condition in adolescents -anterior displacement of femoral neck
from capital femoral epiphysis while head remains in acetabulum
SYMPTOMS: Groin or medial thigh pain, knee or lower thigh pain, ROM < IR, flex, abduction,
mild weakness
INTERVENTION: surgery
Systemic Causes of HIP and GROIN pain:
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Cancer Hip pain can occur from spinal metastasis to femur or lower pelvis
o Bone tumors causing hip pain:
o Chondroblastoma
o Chondrosarcoma
o Giant Cell tumors
o Ewing’s sarcoma
Osteoid Ostoma Small benign tumor-painful
o Occurs in often teenagers (ages 4-25 affected)
o Affects males 3x more often then females
o Symptoms: dull, chronic hip/knee/thigh pain, antalgic gait, tenderness, hip ROM
limitations
o Worse at night
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o Occurs in proximal Femur and Pelvis
Psoas Abcess  localized collection of pus commonly in right hip
o pain in medial thigh and femoral triangle.
o Muscular spasm with possible hip flexion and contracture
o internal rotation of hip
o Fever and night sweats
o GI symptoms
o Causes: Abdominal/Peritoneal inflammation including diverticulitis, Crohn’s
disease, appendicitis, Spinal tuberculosis (often associated with AIDS)
o TREATMENT: Draining and antibiotics
Hip Hemiarthrosis  CAUSED BY: hemophilia
o Pain in groin/thigh
o Limited motion hip flex, abd, ER
o Feeling of “fullness” in hip joint – feel like they can’t move
o May show melena(black tarry stool) and fever (Goodman 2000)
o Patient will hemorrhage into psoas muscle
Ureteral Pain
o Pain in groin with radiation around into lower abdomen
o May have general abdominal tenderness
o Nausea, vomiting and decreased intestinal mobility
o May see (+) rebound tenderness
Ascites: fluid collection in peritoneal cavity leading to distended abdomen
Abdominal Aortic Aneuryism (AAA): Experience a “pulsating mass” in abdomen that
may/may not occur with back, hip, groin, flank pain due to pressure on structures- Call
911
ANKLE
Subjective Running Exam
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How long have they been running?
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Where do you run (TM, outside, etc.)
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Workouts-# per week/mileage per workout
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Warm-up, cool down, stretching done
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Type of shoes worn
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Type of socks and # of pairs
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Date of last race/date of next race
Plantar Fascitis  Symptoms : Pain, especially on initial WB in AM, radiating pain up calf or to
toes , imited ADLS
Objective Findings: Pain along medial edge fascia or over medial calcaneal tubercle achilles
tendon tightness
Treatment:
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Night splinting-limited evidence- sheets pull into PF and when you stand up will
micro tear as you DF
Orthotics/shoe modification
Heel cups/taping
NSAIDs
Stretching and strengthening- big toe stretch
Deep Friction massage/IASTM
Home management- ice bottle massage, frozen rolling pins
Sever’s Disease(Calcaneal Apophysitis)  Inflammation of calcaneal apophysitis.
Symptoms: Pain in heel, difficulty walking, swelling
Caused by: repetitive trauma to apophysis due to the pulling of the Achilles on the
tendonal insertion
Treatment: meds, ice, shoe inserts, stretching
Neurological Etiology of Heel Pain
• Heel pain can often have isolated neurogenic etiology or can present with other
mechanisms
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Chronic inflammation of proximal plantar fascia can lead to entrapment of lateral
plantar nerve
Possible symptoms include:
▫ Pain at night, even in NWB position
▫ Increased pain with orthotic device
▫ Pain worse with increased standing/walking
Differential diagnosis includes:
▫ Tarsal tunnel syndrome
▫ Diabetic Peripheral Neuropathy
▫ Lateral plantar nerve entrapment
▫ Medial calcaneal nerve entrapment
▫ Entrapment of first branch of lateral plantar nerve (Baxer’s nerve)
Fibular nerve: PF and invert, bend toes, SLR
Sural: DF and inversion, SLR
▫ Runs posterior to lateral malleoli
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First branch of lateral plantar nerve: DF and evert, SLR
TAKE HOME MESSAGE: If heel or ankle pain doesn’t improve, look to possible neural
causes.