Taping for the Upper Quarter[1]

Taping For The Upper Quarter

Andrew LeipusB.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

ShoulderFacilitation 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


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


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


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

ShoulderAnterior 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

ShoulderAnterior 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


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)


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


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

ShoulderPosterior 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

ShoulderMultidirectional Instability

Application of BOTH anterior taping and posterior taping

Can also use rotator cuff facilitatory taping prior to (underneath) the instability taping

ShoulderRelocation 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



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


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

ShoulderAcromioclavicular Joint

Aims– To support and stabilise the AC joint

following subluxation/dislocation sprain– Facilitation of proprioception of the shoulder



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


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 rotationApplication of Anchor

– Arm anchor around insertion of deltoid (don’t completely surround arm, no tension)


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


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


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


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 LSPreparation/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


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


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


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


Aims…– Net result is a downwardly rotated scapula

with delayed/lacking upward rotation during elevation = ‘winging’


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


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


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


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

Documents

Taping for the Upper Quarter[1]