Integrating Kinesiology Taping Into Upper Extremity Practice:

Advance Taping Techniques ForThe Hand Therapy Practitioner

Tracey Edblom, OTR/CHT

California Education Connection

History Began experimenting with already

existing tapes. Was not getting desired results, so

began to develop a new type of tape. Method originally used only in clinical

rehabilitation settings in Japan. In the late 1980’s, first used on

Volleyball players.

History, continued

Officially Introduced to USA in 1995 Used by every professional sport in

Japan, and is being used by professional teams in the United States and Europe.

Seen in magazines on Lance Armstrong, Brittany Bowes, professional Bull Riders…and more!

Basic Principles of Tex TapingSkin FunctionsMuscular FunctionsLymphatic Functions Joint Functions

Four Physiological Effects of Tex Taping

Relieves Pain and altered sensation in the Skin & Muscles.

Supports the Muscle in Movement (Expanding Effects)

Removes Congestion of Lymphatic Fluid or Hemorrhages under the Skin

Makes room for fresh circulation Corrects Misalignment of the Joint

Tracey’s “Tape Functions”: Reduce edema Increase room for circulation Speed wound healing Reduce pain Muscle spasm Improve muscle function Reduce scar density Improve scar mobility Improve proprioception/sensory remapping

Endogenous Analgesic System:Pain Mgmt & Tex Tapes…

Decrease edema, decrease sensory stimuli to mechanical receptors

Decrease inflammation, decrease irritation of chemical receptors

Possibly activates spinal inhibitory system -through stimulation of the touch receptors in the skin

Gate Control Theory

Muscle Function Improves contraction of a weakened

muscle Reduces muscle fatigue Reduces over-extension and over-

contraction (depends on application used)

Increases Range of Motion Relieves pain

Muscle Function: Facilitation/Muscle Assist

Origin to Insertion Deltoid Facilitation

Direction of tapeshrinkage back toorigin/anchor

Insertion

Origin, tape anchor

Muscle Function: Rest/InhibitionInsertion to Origin Deltoid Inhibition

Direction of tape shrinkageis back to insertion, or in anelongation direction

Insertion, tape anchor

Origin

Lymphatic Function Improves blood and lymphatic circulation Opens lymphatic drainage directly under

skin Reduces excess heat and chemical

substances in tissue Reduces inflammation Reduces abnormal feeling and pain in

skin and muscle

Tex Taping Effects on Lymphatic Drainage Convolutions in the tissue under the tape cause

micro-climates of pressure change Gentle lifting of the skin reduces pressure, and

tensions filament connections to blind-end lymph tubules allowing large molecule movement

Closed fluid system responds to decreased pressure channels under tape allowing high pressure (edema) to flow to low pressure (under tape, back to nodes)

Decreased pain b/c decreased stimulation to pain receptors (chemical and mechanical) and ascending Gate input

By Tracey Edblom, OTR/CHT Deep Collecting Vessels(have smooth muscle walls)

Joint Function Adjusts misalignment caused by

spasm and shortened muscle Normalizes muscle tone and

abnormality of fascia involved Improves range of motion Relieves pain

*Benefits of Tex Taping Assists in re-education of a weakened

muscle Helps reduce muscle fatigue Increases ‘quick’ end-feel to assist in

limiting over-extension (proprioception) Enhances muscle relaxation to decrease

over-contraction of muscle tissue Reduces occurrence of cramping Reduces Pain

Benefits of Tex, continued Reduces inflammation Reduces edema Assists in improvement of range

of motion Aids in removal of hemorrhages Assists in overall joint function

Qualities of Tex Tape which Make it Unique

Elasticity of up to 130-140% of resting length 100% Acrylic heat sensitive adhesive Stretches along longitudinal axis only Thickness and weight approx. same as skin, so

skin is not over-stimulated No medicinal properties in tape, and NO LATEX Able to be worn for several days, able to

shower with tape applied Tape is applied to substrate with a 10% stretch

Application of Tex Taping Joint is moved through a full range

of motion prior to completing tape application

X, Y, I & Fan tape cuts are used, with the “Y” & “I” cut being the most common

1”, 2” & 3” tape are available, with 2” being the most commonly used

Cutting of Tex Tape

Fan Cut

X Cut

Y Cut

I Cut

Application of Tex Taping Tape is applied to stretched tissue,

minimal stretch is added to the tape ( O to I, approx. 15% of the full 40% capability, I to

O basically laying the tape down 5-10% stretch) Tape is slightly stretched if applied to

non-stretched skin Tape is applied with all elastic stretch

taken out only when used as a corrective technique

Application of Tex Taping Skin should be free of oils and dry,

spray or wipe adhesive can be used After application, lightly rub the tape

to activate the heat sensitive adhesive Tape application in moist areas, may

want to use water resistant tape Tape both the pain, and cause of the

pain

There are a variety of skin adhesives on the marketthat will help tape stick tooily, sweaty, or frequently

washed palms

Limitations of Tex Taping Body hair may need to be clipped or

shaved Apply approx. 30 minutes before

activity Application during activity, may require

the use of a tape adherent Patient understanding & willingness to

wear tape for multiple days, or in public

Initial Difficulties in Application Training for use of athletic tapes teach the

need to “pull tape” for support Need to treat both the pain and the cause

of pain, providing for correction of symptoms

Proper muscle evaluation critical in obtaining positive results, also knowledge of the Lymphatic system helpful

Unlearning what “tape” can be used for

General Benefits of Using the Tex Taping Method More Economical Easy to Apply Less Types of Tape Applied For a Longer Period of Time

(application generally lasts 3-4 days)

Removal of Tex Tape Remove in direction of hair growth Use fingers to pull skin away from

tape while depressing skin inward Remove tape while wet such as in

shower If particularly sensitive to removal,

apply mineral oil (or other) to help weaken adhesive

Precautions - Contraindications Allergy or immune system compromise - test

strip Open Wounds - tape around Fresh scars < 6 weeks Lymphedema - must know pathways Newly Irradiated skin Sensitive skin areas Skin itching Pregnancy - selective acupuncture points

Reimbursement OptionsInsurance: Bill your time/intention of Rx

Medicare vs. WComp

Patient Sales vs. self-ordering

Untimed Taping/Strapping Codes: Taping Shoulder 29240Elbow/Wrist 29260Hand/Finger 29280

Thoracic Outlet Syndrome

Compression of the Brachial Plexus &/or subclavian artery and vein, may be due to muscle involvement via nerve entrapment

Pectoralis Minor SubclaviusScalenes

A thorough evaluation is required to identify the cause

Prepare a Y tape

Anchor tape with apex of Y at the coracoid process

Lay tails at an angle directed towards the sternum

Have pt retract & elevate the scapula. Lay superior tail at a more oblique angle toward R-3

Inferior tail is directed more vertical toward R-5

Finished

Cut an I strip

Anchor tape at distal 1/3 of inferior edge of clavicle

Abduct & externally rotate shoulder

Lay tape along the contour of the clavicle

Finished

Scalenes (anterior, posterior, medius, and minimus) Can be taped exactly as in SCM Remember to pre-stretch the specific

muscle according to it’s anatomy Always tape both sides of the neck in

a mirror fashion – it is tolerated better by pts and is less likely to cause other muscle tension or headache

Stretch the skin, not the tape, for increased tolerance of tape on necks

Finished

Lateral Epicondylitis Wrist Extensors & Supinator Group

1 Anchor Y tape at extensor surface of wrist.

2 Flex wrist, extend elbow and place lateral tape leg along lateral edge of extensor muscle compartment.

3 Place medial tape leg along medial edge of muscle compartment.

4 Fully pronate forearm & place I strip anchor lateral to the insertion point of extensor muscle mass. 5 Extend tape over muscle belly continuing to the medial side of forearm.

Measure a length of tape from the styloid process

to just above the supinator tendon origin

Identify the musculo-tendinous junction. Cut tape into a Y configuration with apex of Y at the musculo-tendinous junction

Place anchor above the styloid process with apex of Y at the musculo-tendinous junction

Lay tails over the extensor musculature

Flex wrist, pronate forearm, extend elbow. Lay medial tape along the edge of the muscle.

Finish tape tail over the common tendon

origin above the elbow.

Measure a length of tape from above the tendon origin to medial to the insertion

Have pt pronate forearm. Anchor tape above tendon origin.

? Is this pt in acute pain phase orstrengthening?

Lay tail across muscle belly. Wrist remains

flexed.

Finished

What nerve is commonly involved here?

What would you do if they were acute?

What if it were misdiagnosed?

Medial Epicondylitis

Forearm flexor muscle mass

1 Anchor Y tape at volar aspect of wrist. Extend & supinate wrist. Position lateral tail of tape along lateral aspect of medial forearm muscle compartment.

2 Position medial tail of tape along medial aspect of muscle compartment.

3 Tails may overlap above tendon origin.

4 Anchor I tape above tendon origin and direct tape across muscle belly with forearm in maximum supination.

No tension on ends

Position wrist in extension to place tissue on stretch – increases convolutions and muscle decongestion

Split tape at musculotendinous junction to surround muscle belly to decongest and relax muscle tissue

No tension at ends again for dispersal of forces

Medial EpicondylitisWith Pronator relaxed

DeQuervains Syndrome 1st dorsal compartment syndrome APL and EPB Most common in women Frequently have additional slips of

tendon in the same compartment Complicated by superficial radial

nerve involvement (often)

DeQuervains Radial Splint

Optional long thumb spica ifsymptoms are very severe

Muscle Inhib. & Space Correction

Measure a length of I tape from tip of thumb to upper

1/3 of forearm.

Split tape to 1 in. width.Create a Y tail at distal end of tape approximately 1

in. long.

NOTE: You may want to keep the tape at its 2” width

– this has been very successful as it seems to stay in place longer and give the relaxation message to more

tissue.

Wrap tails of Y around the distal phalanges

Apply remainder of tape to the extensor pollicis

brevis & abductor pollicis longus

Prepare a ‘space correction’ tape by measuring an I tape sufficient to encircle ½ the wrist.

Prepare a Space correction tape. Use 25-50% stretch to the area

over the snuff box. Allow tape to recoil so

‘space’ is created. Remember not to apply

tightly or you risk compressing superficial branch of radial nerve

1st CMC Osteoarthritis Primary site of OA in the hand Can be VERY painful/dysfunctional Frequently leads to surgical solution Conservative methods relieve pain,

but often contribute to further shortening and wasting of thenar musculature

Joint Tapings generally…Are applied with more stretch

Are applied with more downward pressure

Are intended to affect deeper structures

Structures Necessary for Stability of CMCJ

SAOL – sup.ant.oblique ligDAOL – Deep.ant. Oblique lig (‘beak’

lig) **DRL – dorso-radial ligPOL – Post.oblique ligUCL – ulnar collateral ligIML – interMC ligDIML – doral interMC lig

Structures Necessary for Stability of CMCJ

INTRINSIC MUSCLES Originate on trapezium Abductor Pollicis Brevis Opponens Pollicis Flexor Pollicis Brevis Adductor 1st dorsal interosseus muscle

Muscular Balance: CMC PRIME MOVERS:

Flex: FPL, FPB Ext: EPL Add: AP Abd: APL, APB Rot’n: OP

Note: 2 muscles that act ONLY on the CMC

SECONDARY MOVERS:

Flex: AP, OP Ext: EPB Add: EPL, FPL Abd: EPB, OP Rot’n: EPL, FPB, APB

Differential Diagnosis CTS Ganglia deQuervains Other tendonitis Intersection syndrome Scaphoid injury or Scapho-lunate lig injury

Subluxation Patterns: Most common – dorsal subluxation

(thumb pulled more strongly into flexion)

Second most common pattern – radial subluxation (thumb pulled more strongly into adduction)

CMC OA Evaluation, cont’d

PROVOCATIVE TESTSPalpationDistractionGrind TestTorque Test (axial rotation)Stress Test (loading)

CMC OA Traditional Rx Patient education Pain and edema management Anti- inflammatory CMCJ mobilization, AROM,

AAROM Isometric strengthening Joint protection strategies Splinting Taping

CMC Stabilization, Splint Option – MP Free

Palmar Style Thumb Opposition

With permission from D. Slonaker, OTR/CHT

MCP Included

CMC OA Tex Taping (rationale)

Decrease swelling Relax & decongest thenar spasms Provide support for dorsal

intermetacarpal and trapezio MC ligaments

Support CMC joint function Proprioceptive stimulation to muscles

opposing CMC joint collapse

CMC OA Taping –Ligament and Joint Support

Trapezio-MCand

Intermetacarpal LIgaments

With permission from D. Slonaker, OTR/CHT

CMC Supination Assist Taping

Full stretch across

volar CMCJ

With permission from D. Slonaker, OTR/CHT

CMC Supination Assist – cont.

Light stretch to dorsal forearm.

With permission from D. Slonaker, OTR/CHT

CMCJ Supination Assist - cont.

Extra support around wrist

With permission from D. Slonaker, OTR/CHT

With permission from Jan Albrecht, OTR/CHT

See Appendix A & B – Back of Manual

PIP Dislocation/Trauma

PIP Dorsal Dislocation

Initial treatment, rested in PIP extension

Coban as early edema control

DIP mobilization, blocking exercises for intrinsic restoration

Splint for PIP extension if not recovered after edema controlled

Merit screw to assist in IP flexion recovery

Blocking exercises with splint

PIP blocking exercises – no splint

Buddy taping for flexion and function recovery

Mechanical correction for PIP collateral ligament sprain

Dorsal tape for increased edema drainage, decreased pain, increased ROM. If successful, pt will have increased function, too

Note that you could preload PIP &/or DIP in ext. to protect pt from ROM that activates pain signal and progress taping as pt improves

Persistently tender collateral ligaments may require extrasupport/reinforcement with additional ½ inch diagonals

Mallet Finger

Custom bobsled or a Stack splint uninterrupted for 6-8 weeks

Lateral conjoined extensor tendon

Common extensor tendon Lateral fibers

Lateral tendons interossei

Common extensor tendonCentral fibers

Common extensor tendon

Additional volar tape for relaxation/elongation offlexor structures, removalof additional edema

Dorsal tape for edema removal, pain reduction…..

….With mechanical correction to assist DIP extension. Can alsobe done in one long strip volar to dorsal – watch tip pressure.

DIP remains extended on tenodesis, though pt can flex, alsohas assist back into extension – needs daily retaping.

End a.m. Program

Current Cases

Group brain-storm for tape solutions

Intro to Advanced Taping Concepts

Mechanical Correction ”Positional” in nature, to assist in

the positioning of muscle, fascia or joint position to stimulate a perception that results in the body’s adaptation to the stimulus.

Fascia Correction Tape application incorporates

gathering of tissue during application or pre-gathering of tissue and taping to maintain gathered dimension of tissue for improved circulation and tissue extensibility

Space Correction Tape application lifts tissue and

reduces pressure by creating space above injured tissue thereby reducing fluid pressure, improving circulation and clearing inflammatory components (reducing stimulation to chemical and mechanical pain receptors)

Ligament/Tendon Correction Joint is positioned in stretch before

pain occurs. With tape applied at increased stretch, mechanoreceptors (golgi tendon organs) are primed for muscle contraction earlier to prevent entering ROM where pain occurs and tissue is additionally strained (75-100% for ligaments, 25-50% for tendons)

Functional Correction Tape is applied to increase sensory

stimulus in an area as well as to assist or limit a motion

Perceived stimuli are interpreted as proprioceptive stimuli, which acts as a pre-load during end of motion positions

TFCC Components Dorsal and volar radioulnar ligaments Ulnar collateral ligament Meniscus homologue Extensor carpi ulnaris sheath Ulnolunate and ulnotriquetral

ligaments TFC disc proper “TFCC maintains stable but moving

relationship of radius and ulna during pronation and supination”

TFCCUlnotriquetral Lig

Ulnolunate Lig

Volar Radioulnar Lig TFC Articular Disc

Meniscus Homologue

Problem-Solve TFCC Corrective/Functional Tapings

Tape for acute symptoms, edema/pain

Tape for support, light activity, gentle strengthening activities

Ulnar collateral support with mechanical correction.Remember it is “positional” not just space correction

Support ulnotriquetral as well as dorsal and volar stability

Additional dorso-volar support

Space correction above painfularea for edema/pain reduction

Complete circumferential taping with <25% stretch for improvedproprioception and stability

Additional ECU inhibition for improved resting, decreased edema in sheath. May be under or over thecircumferential taping.

Scapho-Lunate LigamentStrain/Sprain

Scapho-lunate dissociation

SL volarcomponent

SL proximalcomponent

SL dorsalcomponent

Often not completely ruptured, needs rad/uln dev. XR and AP clenched-fist XRto confirm diagnosis

Problem-Solve SL Lig Sprain Is pain/instability more volar? Is pain/instability more dorsal?Consider other treatments…

tape & splint combination?How could a k-tape regimen

progress?

S-L sprains frequently from falls with contusion of volar aspectwith localized pain and edema

“Scapholunate dissociation is the most common form of carpal instability” – Hunter.

Star pattern tape will increase proprioceptive message to limitwrist extension or weight-bearing as well as assist in removal ofedema and inflammatory by-products.

Complete with CMC taping to support light thumb function

Optional repeat to CMC taping

Soft Tissue Tapings generally… Are more variable depending on the

degree of sensory/proprioceptive input desired, and the tolerance of the tissue being taped

Involve more combined tapings such as a scar taping (more tension) with a fascial release taping (less tension) to improve ROM, or an edema taping combined with a mechanical correction taping to limit or assist a specific soft tissue motion

NERVES:

Carpal TunnelCubital TunnelRadial Tunnel

A thorough evaluation is necessary to determine the cause and location of the entrapment.

Muscle spasm, fascial restriction or poor patient posture can individually or in combination cause a nerve entrapment.

Two methods of dealing with this problem utilizing Tex Tape are:

Space correction - The tape is applied to create a space in an area of inflammation/pain, OR, To improve circulation, stretch tape lightly and apply it over elongated tissue. This will result in the creation of convolutions in the tissue as the tape recoils. This creates a lifting effect on the skin, decreasing pressure in the underlying tissues improving lymph and vascular flow length of nerve.

Nerve Entrapment

Nerve Entrapment cont’dFascial correction - achieved by either of the

following techniques:

1 The tape anchor is applied with a vibration created by a rapid pulling of the opposite end of the tape while maintaining a constant tension on the tape. This

will relax the tissue and allow a release of the fascia. When this is achieved, apply the remainder of the tape to the skin.

2 Anchor the tape and achieve a myofascial release of the tissue by moving the fascia in the opposite direction. Then apply the tape across the structure to use the elasticity of the tape to facilitate the desired movement

Carpal Tunnel Volar Splint

Carpal Tunnel Volar Splint

Carpal Tunnel: X Strip Taping

Carpal Tunnel X Strip

Carpal Tunnel X Strip & Space Correction

Edema Management: “Tab and Tails”

Carpal Tunnel “Glove” Taping

“Glove” Tape Application

“Glove” Taping continued

“Glove” Taping Completed

Measure a length of I tape sufficient to encircle ¾ of the circumference of the wrist

Apply anchor with 100% stretch applied to tape

“Glove” with Dorsal WristSpace Correction for drainage

CARPAL TUNNEL RELEASE Post-op; Open approach in an elderly woman with long-standing symptoms 3 weeks post-op

Split tape in center

Place tissue on stretch, tape at 90% stretch, and apply, no tension on tails

Finished. This taping helps with scar modeling, decreases local tissue edema, and helps with mild post-op dysesthesia and hypersensitivity. Pt’s can manage this one easily ontheir own

Radial Nerve Pain and/or numbness with stretch and/or

manual compression of radial nerve. May need decompression from above elbow, spiral groove, under ECRL, to arcade of Frohse, supinator, and possibly EDC. Check distally as nerve becomes more superficial

Treat conservatively with nerve mobilization home exercise program, iontophoresis & ergonomic education

Tex taping will enhance circulation and reinforce ergonomic training

Apply 1” width tape distal to proximal following radial nerve path.Make sure wrist is flexed, elbow is straight, and forearm is pronatedas tolerated to mobilize tissue over nerve. Consider fascial gathering especially over areas of greatest irritation.

Quiet supinator with inhibition tape, or use space correction,or use fascial correction directly over most irritated area asidentified by pt.

Horizontally adduct arm as you apply proximalportion of tape over spiral groove, extending to posterior shoulder CAN be helpful

Ulnar NerveAs with radial nerve, frequently there

is more than one irritated area. Identify most irritated area and check

length of nerve with upper limb tension test

Tape length of nerve if necessary making positional adjustments that coincide with ulnar nerve tension test

Begin over guyons canal, with wristin extension

With wrist extended, continue to elbowwith elbow in approx. 90 degrees flexion

Continue along nerve pathway witha triceps stretch position till tape reaches posterior axilla

Then horizontally adduct arm and continuetape application toward spineFinished ulnar nerve taping

Post Traumatic / Surgical Hand Edema1 Requires I strip with buttonhole cut. Tear paper backing at tape’s crease.

2 Peal back paper & place digits 3 & 4 into cut openings. 3 With wrist flexed, apply tape proximally on extensor surface of forearm to extensor tendon origin.

4 Repeat with flexor surface tape with wrist extended apply tape proximally to flexor compartment tendon.

You may use a wrist pain tape for decompression of the carpal tunnel.

Measure an I tape to the elbow joint as above

Crease the tape in half

Cut a diamond from the creased end large enough for pts finger to fit thru.

Cut a second diamond

Break paper at crease

Fold back the ends of the backing paper

Insert pts 3rd & 4th digits thru the diamond

cuts

Have pt flex wrist & apply the tape to the dorsum of the hand.

Apply tape to the forearm extensors to the tendon

origin.

Extend pt’s wrist & elbow. Apply tape to the palm of the hand.

Apply tape to the forearm pronator

muscle group.

Extend tape over the pronator tendon & lymph nodes

Apply a space correction tape to the dorsum of the

wrist. This lifts the tissue, creates

low pressure channel for lymph

to drain

Direction of lymphatic flow, palmar

Direction of lymphatic flow, dorsal

Surgical Hand Edema

Add a dorsal tape to crisscross tails of tape. This creates even greater variations in pressure. RememberTo combine with pt’s regular home exercise program.

Begin at cubital nodes, withskin stretched

Lay tails down over stretched skin with approximately5-10% stretch, or paper-off tension.

Lay tails of second layer directing edema to dorsalupper arm, with skin stretched (in this case,with wrist flexed, elbow extended)

Change position of joints asneeded to maintain stretch onskin, to pt’s tolerance.

High pressure Low pressure

SCAR Management

DupuytrensBurn scars

Dupuytren’s Disease Genetic predisposition to fascial

shortening/thickening in palms with gradual loss of extension of MCP &/or PIP joints

Usually affects 1-2 digits in both hands, worse in one hand

More common in ulnar half of hand, radial disease usually indicates more severe disease

Associated with epilepsy, alcoholism, and diabetes but also idiopathic with no other disease presentation

Resolved surgically or Xiaflex collagenase inject

SCAR MANAGEMENT: Dupuytrens Release 4 weeks Post-op

Carefully assess your pt’s phase of healing and decide how best to cover and maintain coverage of scar tissue

Apply individual scar tapes can be applied with fascial gathering. Increase tension and durability (stimulatelymphatic drainage) with buttonholed cover tape.

Finished palmar view

Have pt make a fist for completion of tape over stretched skin. Finished dorsal view

Remember this hand, 4 weeks post dupuytrens release…

2 Weeks later…and it looks even better now!

Dupuytrens AlternativesExtension assist Lymphatic drainageNerve pain, hypersensitivity

Burn ScarsThere is no data/studies re: use of

kinesiology tape on burn scarsMDs and pt were skeptical until

visual results after just 2 tapingsPt was able to DC use of Jobst glove

and utilize Tex Tape independently

Burn Scars from a scaldafter 14 months. UtilizedTex Tape in order to discontinue use of Jobst glove. Scar changed dramatically in color and in texture. Continually improved with weekly applications for almost 1 year. Pt did make generous use of lotion applications between tapings.

1” dorsal strips applied with 25% stretch to fully flexed digits

Web space tapes have 25-50% stretch over stretched skin

Continue to apply ends withminimal stretch to maximallystretched skin on palm….

….and dorsum of hand

Stabilizing straps to palm and digits

Apply dorsal portions with skin stretched so as notto limit pt’s motion

Small ¼” anchor tapes added to fingers helps with durability of tape between sessions

Surgical Scar Management Scars respond to Tex taping with decreased

turgidity, increased smoothness/softness Photograph scars when possible as color changes

may be harder to document and can be very dramatic!

Try fascial gathering or utilizing tape rebound over a tight ganglion cyst excision scar. This works very well to increase mobility at the same time!

Consider changing direction of application with repeated applications to decrease restriction in another area as first area improves

CMC Interposition Arthroplasty And Carpal Tunnel Release 6 Weeks Post-op

Scar most adherent here

Dorsal scar will not glide distally to allow full thumb flexion

Volar wrist scar will not glide proximally

Carpal Tunnel scar also tight and ‘full’

Post-op scar management taping as previous

Scar management with fascial release, distally

Apply tape distal to proximal so recoil of tape is distal

Remember to encourage pt to utilize tissue actively while wearing tape, will further encourage adaptation

Wrist scar tapedproximal todistal to increasewrist extensionand decrease‘tight’ sensationon flexion

Current Cases

Group problem-solving for tape solutions

HAPPY TAPING!!!! Q & A More cases? Adjourn Thank you for having me