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Journal of Bodywork & Movement Therapies (2016) xx, 1e10

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier .com/jbmt

PREVENTION & REHABILITATION: EDITORIAL

Dynamic tape. Is it all about controlling load?

An athlete making an explosive movement puts extremelyhigh loads through the contractile and non-contractilemusculo-tendinous elements attached to their skeletalstructure. The ensuing movement of their skeleton accel-erate their trunk or limbs, which, during a change in di-rection, need to tolerate a rapid deceleration whilemaintaining appropriate balance, dynamic joint positionand control, placing stress on capsules, ligaments and fas-cia.and this continues through out the duration of theirevent or training session.

Once control becomes compromised due to fatigue,repetition, or a loss of focus, amongst a plethora of otherfactors, the control of movement or load may result in in-juries that can range from minor to major, painless topainful, micro to macro. As long as motivation is still pre-sent, and the stakes are high enough, an athlete can chooseto put their pain aside, and continue. ‘It is not pain thatfinally stops them, elite athletes are often able to movebeyond pain,’ says Musculoskeletal Physiotherapist RyanKendrick, when interviewed in Leiden, Netherlands inNovember 2015,’ what stops them is tissue failure and tis-sues don’t fail because of pain, they fail because of over-load. In the literature there is a poor correlation betweentissue damage and pain.’ (Beecher, 1946; Moseley, 2007).Kendrick says, ‘The inability to adequately dissipate oraccommodate load is strongly implicated in conditions suchas tendinopathy and may also result in compensation stra-tegies and maladaptive behaviour’ (Soslowsky et al., 2002,Cook and Purdham, 2009).

The role of a physical therapist in sport not only en-compasses preparation of the athlete in training, managingcurrent injuries to reduce the risk of exacerbation pre-event and the rehabilitation post injury, but it is alsosignificantly focused at the field of play, providing strate-gies to solve the problems that present during the event.

Kendrick, while working in the United Kingdom identifieda problem. How to manage load. Kendrick says, ‘Certainmeasures such as building in adequate adaptation and re-covery periods into the training schedule, manipulating

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equipment and the environment could yield some benefitbut I felt there was limited capacity to directly remove loadfrom the athlete during the performance of their activ-ities.’ The lack of tools available to him in this area he feltwas restricting his ability to reduce risk to his professionalsports clients, who included Tennis Players and EnglishCounty Cricket Players. ‘It is often possible to assess wherean athlete is experiencing over-load, and, for certain con-ditions there is a strong correlation with various kinematicparameters.’ In other words, Kendrick is suggesting that theevidence of tissue overload may be visible in movementpatterns, or it could present as a common overuse injuryconsistent within their sport. The cumulative load may beinfluenced by the athletes’ size, shape and bio-metrics, butall will relate to the movement tasks within the sport. Hesays, ’What is difficult is to be able to do something as atherapist that adequately manages load. To do somethingthat does ‘just enough’ to offload compromised tissues, yetnot interfere with the movement patterns through range,that have contributed to their sporting success. A therapiststill needs to use load as it is also essential for recovery butthe specificity of loading is critical.’

In a musculoskeletal physical therapists’ kit bag there issports tape, Kendrick describes two choices of types oftaping approaches open to him; a ‘biomechanicalapproach’ such as rigid strapping tape and ‘neurophysio-logical approach’ such as the Kinesio-tape range of manu-facturers and products. Would either of these tapingsolutions help with his quest to reduce load within thebodies of his injured or at risk athletes?

Biomechanical tape, common use and suit-ability for off loading through range

The ubiquitous tape combination ‘Leukotape P,’ and itsunder-tape, ‘Fixomull’ (designed to reduce the risk of skinreactions due to its hypoallergenic adhesive) and manu-factured by BSN medical, was marketed to therapiststreating patello-femoral pain syndrome using the McCon-nell patella taping techniques she first described in theAustralian Journal of Physiotherapy (McConnell, 1986).

ic tape. Is it all about controlling load?, Journal of Bodywork &2.009

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Leukotape P is a rigid, cotton, high tensile strength, zincoxide tape and when applied to the patella may alter thepatella’s position and alignment while still allowing theknee to move (with some restriction towards the end ofknee flexion). The rationale suggested that the tapemedially glides the patella so it is better able to resistlateral glide during loaded knee flexion/extension, such aswhen descending or ascending stairs. With appropriateangling to counter patella tilt and correct anchors tominimise the risk of skin traction injuries this taping tech-nique can reduce pain instantly. Smith et al. (2013), how-ever, refers to a controversy where some research suggestspatella taping is a valuable adjunct in therapy while aCochrane review (Callaghan and Selfe, 2012) concludedthat pain outcomes comparing patella taping and a co-intervention e often exercise, and exercise without pa-tella taping did not significantly favour patella taping. Inthe Clinic the taping method is known to reduce pain e thisis not under debate, but research (Gigante et al., 2001)does not clearly indicate the biomechanical mechanisms atwork. Smith quoting Lan et al. (2010) suggests that sub-groups of patients with a higher body mass index or asmaller Q-angle, might not do well with patella taping,creating a washout effect in the research, therefore use ofrigid tape in treating patella issues still has many questionsto answer. Callaghan and Selfe as late as 2010 still call forconsensus on the diagnosis of PFPS (patellofemoral painsyndrome), out come measurement standardisation andacceptable patella taping technique as this may improvethe research design in this area.

Leukotape P when applied in non-sesamoid situations isdesigned to provide rigid joint immobilisation and is oftenused to stabilise at risk or injured ligaments, it is used veryregularly at the shoulder.

For the ‘off-loading’ applications that Kendrick waslooking for, rigid tape was a poor match. When athleteswere taped their ligaments may have been protected buttheir skin was compromised because of the very nature ofthe rigidity of the tape. The zinc oxide fixative itself cancause allergic reactions, movement can create tractioninjuries on the tape ends e ‘anchors’ and the manufac-turers recommend removal of the tape in 18 h. The tapefatigues after a while and permanently stretches poten-tially losing its desired effect. A key issue is that athletesperformance is likely to decrease wearing a rigid tape dueto restrictions in joint range, altered balance and unnaturalmovement patterns. Kendrick had to look elsewhere.

Neurophysiological tape, intended use andsuitability for off loading through range

American trained Japanese Chiropractor Dr. Kenso Kasedeveloped Kinesio-taping (KT) in the 1970’s. During itsdevelopment phase Kase looked for a material thatmimicked the stretch of skin (Kase et al., 2003). So whenhandling the tape (without it’s backing) it is easy to stretchthe tape longitudinally (2-way stretch), increasing itslength by about 40% at which point the tape does have asudden end point. Kuni et al. (2015), compared threeproducts for use in ankle instability; KT, non-elastic (rigid)tape and bracing. The study showed that KT did not show

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any significant relevant stabilising effects on foot kine-matics. It is clear that Kase was not looking to mechanicallyfixate a joint, KT was a definite and conscious move awayfrom rigid taping. His idea was to use the application oftape to create a change in the pain, proprioceptive, motorcontrol or lymphatic systems as a result of the sensory inputcreated via the tape on skin contact. KT is applied with themuscle on stretch and when the joint moves back into midrange the altered shape of the ribbed material, referred toas ‘convolutions’ in the tape, then ‘lifts’ the skin. It ishypothesised that this action creates space in the tissue toenhance circulation or reduce pressure on pain sensitivestructures.

Kinesio Tape ‘is made of tightly woven elasticized cottonfibers and the glue on the back is acrylic, highly durable andwaterproof so the tape can be worn for up to a week,during which time it will withstand vigorous movement,sweat and total immersion in water’ (Taylor et al., 2014).Taylor et al.’s article is a ‘scoping review’ which is a type ofreview that creates a ‘map’ of a topics evidence base,without quality assessment or extensive data synthesis andhelps formulate the questions for later systematic reviews(Armstrong et al., 2011). This choice of review type, in thiscase looking at Kinesio type tapes (which they refer to as‘elastic therapeutic tape’) for neck or upper extremityconditions appropriately indicates that the research in thisarea is still relatively nascent. Walker comments that only 3papers on ‘elastic therapeutic taping’ in the neck andupper limb area have been suitable for inclusion in the 3high quality systematic reviews since 2010 in this area.They found that this type of taping may help reduce short-term neck and upper extremity pain and be convenient toapply, but they comment that there are not yet enoughadequately powered studies to provide satisfactory evi-dence for the clinical claims being made about elastictherapeutic taping. This is reflected through out the cur-rent literature on KT research, that guarded positive find-ings are being made, but not necessarily validating theoriginal hypothesis of the developers. A look through recentresearch found that: there is evidence KT could have apositive effect on muscle fatigue resistance (Zhang et al.,2015), KT doesn’t reduce postoperative pain followinganterior cruciate ligament (ACL) reconstruction (Laborieet al., 2015), and, published later in this Prevention andRehabilitation section of the JBMT, ‘assumptions suggestingthat peripheral to distal application of KT stimulates muscleand distal to peripheral relaxes the muscle, seem to befalse but application of KT in various directions can affectmuscle strength (Vered et al., 2015).

Again, for the ‘off-loading’ applications Kendrick waslooking for Kinesio-tape was also a poor match. When ath-letes are K-taped as the developers intended there maywell be neurophysiological effects in play perhaps affectingpain or proprioception, but certainly little of the easilymeasurable, firmly elastic biomechanical assistance Ken-drick was looking for, KT’s elastic response is weak,measuring in grams. Kendrick was looking to controlexcessive deceleration loads, perhaps measuring in kilos,and provide assistance in the movements return. He real-ised this type of product wasn’t yet in the market. He re-lates on courses that he tried to approximate what he waslooking for by attaching theraband to his clients, but he

ic tape. Is it all about controlling load?, Journal of Bodywork &2.009

Prevention & rehabilitation: Editorial 3

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realised that this was never going to work outside of theclinic. So accidentally, Kendrick admits, he ended upneeding to develop the product he envisaged.

Posture pals to dynamic tape

After initially experimenting with foam tapes which Ken-drick utilised in his initial development of ‘posture pals’which are pre-cut tape shapes that help the wearer main-tain awareness of a more neutral posture, particularly inthe lumbar, thoracic and scapular areas. Market testing ofan early foam tape product indicated that users of apostural taping device still wanted to have a full range ofmotion available to them while wearing the product, suchas the range required to partake in a yoga class. Thisresulted in some skin reactions in a small percentage of thewearers, some from over stretch mechanically shearing theskin or a contact dermatitis magnified by the lack ofbreathability of the foam tape.

Kendrick realised that the tape he required needed tohave:

1. the ability to stretch in 4 directions e to allow the tapeto conform to the body of the wearer and to be able tomove in complex three dimensional movements,creating an even force on the skin thereby reducing thetension points at which excessive tractioning of the skincould produce blisters.

2. strong elastic resistance and recoil e the tape has to actlike the bungee cord used by bridge jumpers, stronglydecelerate the falling body and bounce it back up.

3. a high degree of stretch with no rigid end point e atleast 200% stretch (Kinesio Tape stretches to about 140%but then stops stretching suddenly).

4. visco-elastic properties e one of these properties is thatthe material being stretched can provide a greaterresistance if the load comes on quickly. This means thata tape product can respond to various speeds of load andprovide greater resistance when it is needed at higher

Table 1 Tape comparison.

Dynamic tape Kine

Material Nylon/Lycra or Recycled PET/Lycra

Cot

% Elongation >200% 140Rigid end point No YesResistance and recoil Strong (double layer measured

at 10e15 kg)Wea

Direction of stretch Longitudinal and transverse LonApplication position Shortened LenPrimary mode of action Mechanical e deceleration,

load absorption and assistanceof movement

Neu

Secondary mode of action Neurophysiological Mecrestrigi

Used with the permission of Ryan Kendrick.

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loads. For example the arch of the foot might requiregreater support doing running loads verses walkingloads.

By 2009 Kendrick, working with materials experts, hadproduced Dynamic Tape (DT), a visco-elastic nylon andlycra blend material with 4-way, greater than 200% stretchhe has manufactured in Asia. The material and adhesive arefast drying and breathable meaning that the tape, ifappropriately applied may stay on for up to 5 days, bearingin mind that if any discomfort, itching, burning, stinging orirritation is felt immediate removal is strongly advised. In2010 DT was brought to the market. Kendrick continues todevelop the product and based on feedback and experiencehe has changed the product 7 times since launch, alteringmaterials, adhesive or process. The changes have improvedthe adhesive by 20e25% and the amount of glue on the tapehas doubled.

A new DT e ‘Dynamic Tape Eco’ e made out of recycledplastic bottles is about to be launched at the time ofwriting. This tape has a much greater resistance that buildsmuch sooner in range. Kendrick says, ‘The Eco Tape willideally be used when more resistive force is required insituations where only small movements like glides, rota-tions, and lateral movements of joints occur, as well asproviding ligament support.’

Three tape types, three taping roles

Kendrick is clear, there are three types of tape: RigidAthletic tapes, Kinesiology Tapes and Dynamic Tape. Thedivisions between them Kendrick suggests are based on thematerials properties and how they are designed to be used(See Table 1). This table supplied by Kendrick reflects hisopinion as to the key differences between the tape types.

Understanding the properties of the three tape typesallows a Therapist to use clinical reasoning to decide on aclinical aim and choose what tape, if any, should be used topromote their therapeutic goal.

siology tapes Rigid athletic tapes

ton � Lycra Rayon/Cotton & may containnatural rubber latex

e180% NilYes

k Nil

gitudinal only Nilgthened (generally) Neutral/corrected/shortenedrophysiological Mechanical e restrictive

hanical e resistive/rictive with weak recoil andd end point

Neurophysiological

ic tape. Is it all about controlling load?, Journal of Bodywork &2.009

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Pink, blue or tattoo?

In what appears to be a marketing stroke of genius Kendrickhas had the rolls of DT printed with a unique tattoo design,one style being black on a tan coloured tape e the otherfaded to be much less visible on the tan coloured tape. Thetattoo was designed by Tihoti Tatau a Norfolk Island andTahitian artist. Kendrick was living on Norfolk Island duringthe development phase of DT and wanted to promoteawareness of the Island by incorporating this design.

The tattoo differentiates the tape from other manu-facturers products and when seen on an elite athlete withglobal recognition and resources to pay for the bestStrength and Conditioning, Medical and Physiotherapeuticadvice may intimate a ‘celebrity’ endorsement to thebrand.

There is no therapeutic effect claimed from the designbut if a product ‘looks good’ it may encourage patientcompliance.

Kinesio-Tape is manufactured in different colours butthere are no physical product differences between thecoloured tapes. According to kinesiotape.co.uk, ‘In Japanthey use them as a form of colour therapy. Beige is the mostpopular colour for oedema taping. Pink, black and blue arethe most popular colours for sports and physiotherapytaping’ (websource 1). Paul Coker a physiotherapist and theUK Medical Director at Rocktape, a company that producesa variant of kinesio tape that has 180% stretch, identifies ina discussion about myths in KT theory that the colour of thetape alters the temperature of the tissue under the tape,with lighter colours reflecting heat and darker coloursabsorbing it. He rightly suggests that if a temperaturechange does occur it must be an infinitesimal change andwould immediately be countered by homeostasis(websource 2). In preparation for this editorial no scientificpaper read discussed the colour of KT other than identifyingthe colour of the tape used in the research.

What does dynamic tape do?

For DT to produce a mechanical effect Kendrick suggeststhe tape must be applied to cross one or more joints, beapplied in a shortened position and have a good purchaseon the levers.

Load absorption: DT is applied to the body in a verydifferent way to KT. To maximise KT’s tissue lifting effectKT is usually applied with the tape stretched with the bodypart lengthened to use the proposed tape convolution ef-fect. After the KT has been applied and the body returns tonormal postures the return of the stretch of the tape istheorised to lift the skin a little. In DT application thetechnique to maximise load absorption is to put the tape onwith the body part shortened and with a degree of stretchin the tape (other than the anchors at either end of thetape which must not be placed on in tension). In functionaluse this means the tape is pre-stretched and is ready toprovide support as soon as the musculo-tendinous unitlengthens. Kendrick says, ‘The tape should begin to tensionas the target muscle begins to work eccentrically.’

DT comes in two widths 5 cm and 7.5 cm, with the extrawidth of tape increasing the amount of load absorption

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possible. A greater potential of load absorption can becreated by laminating two layers of DT prior to application,the so-called PowerBand. Kendrick says, ‘recent testing ofa 7.5 cm width PowerBand has shown that Dynamic Tapecan absorb 13 kg or more of force through range.’ To in-crease load absorption parallel tapes can be applied.

Force contribution: As an eccentric movement comes toits end and a returning concentric movement starts, theelastic potential stored in the tape contributes to a light-ening of muscular load required to make the movement.The elastic potential energy being converted into kineticenergy.

Proving that there is work generated in stretching a lightapplication of DT on the flexor surface of the finger handand forearm with the wrist held in flexion Kendrick reportsan as yet unpublished EMG pilot study by Thomas Nikolausthat showed that wrist extensor EMG activity increasedabout 40% when the subjects wrist was extended againstthe force of the tape. The degree to which EMG activitymay vary will be influenced by the position in which thetape is applied, the degree of stretch, the part of the bodythe tape is applied to and the width of the tape. Anotherpreliminary study by Nikolaus on EMG activity of the uppertrapezius pre and 48 h after the application of a cervicaloffload PowerBand technique in a group of office workerswith neck pain showed a desirable significant decrease inEMG activity with the tape (websource 3).

A larger study conducted in Brazil and currently beingwritten up for publication has yielded further support.Natalia Bittencourt, Marcela Gomide and Alysson Zuinassessed elite female volleyball athletes from the MinasTenis Clube, Brazil and identified that the application of DTto resist hip adduction, flexion and internal rotationdecreased the frontal plane knee angle (FPKA) during asingle leg squat. Of the 17 athletes assessed, 10 had a highFPKA (>8�). The as yet non-peer reviewed T-Test revealedstatistical difference pre and post DT (p < 0.0001). Mean ofFPKA pre DT Z 10.5� and mean post DT Z 5.4� (Bittencourtet al., unpublished).

These early findings suggest there are real mechanicaleffects provided by the application of DT. Any personhaving the tape correctly applied immediately perceivesthe physical effects, and clients with tendon or patello-femoral area symptoms can anecdotally report a decreasein load related discomfort as soon as they stand up. AskingKendrick about future investigations into clinical efficacy ofthe tape, he believes the lowest order of evidence gath-ering which is beginning now is promising, but he is con-cerned, ‘In the clinic each application of the tape can bemodified and re-applied until the desired effect is attained,which makes it an effective clinical tool. We start with theend in mind and modify the technique until we achieve ouraim but in the research lab exactly the same taping pro-cedure will be applied to 100 subjects, and a potentialwashout effect, where the taping has been incorrectlyapplied, the wrong taping has been chosen or the subjectshave a poor homogeneity, will hinder the validation of thistool.’ Kendrick adds, ‘I believe the greatest threat to dy-namic taping evidence will be future poor research design.’

Modifying movement: The effect of an application of DTis that it does not hinder range or the movement patternbut that it reduces the load a muscle (group) has to affect.

ic tape. Is it all about controlling load?, Journal of Bodywork &2.009

Photo 1 Kinesio tape (left) and dynamic tape 7.5 cm and5 cm rolls (right).

Prevention & rehabilitation: Editorial 5

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In scapular stabilisation the trapezius muscle and serratusanterior work together to upwardly rotate the glenoidappropriately. Physical therapists teach clients motor con-trol exercises which help recruit under performing muscu-lature (Worsley et al., 2013). Dynamic scapula placementunder low load e arm by the side exercises, can be grad-uated to increased load exercises by abducting or flexingthe shoulder. A therapist can add or subtract load to adaptan exercise to the capabilities of the client in front of themby bending or straightening the elbow to shorten orlengthen the lever. Elbow flexion reduces the weight of thearm making appropriate recruitment easier to achieve. DTcan be used similarly in motor control work with the tapeapplied in such a way so that the taping takes some of theload of the upper limb, while also positioning the shoulderto improve the ability of under recruited musculature(lower trapezius, serratus anterior) to fire, while typicallyover recruited muscles (levator scapulae, rhomboids) arepositionally inhibited.

Dynamic taping technique: examples of aims

Using clinical reasoning to identify the aims for a tapingtechnique requires thought, but a starter list of examples isprovided by Kendrick in his Advanced Dynamic Tapingcourse notes (Kendrick, 2013). Dynamic Tape can aim to:

� resist knee extension to decelerate the leg and reduceeccentric hamstring workload in terminal knee extension

� resist lateral translation of the patella, facilitate thevastus medialis obliquus (VMO) and assist knee extensionin patellofemoral pain syndrome

� support the weight of the upper limb in the subluxedhemiplegic shoulder to reduce load on painful structuresand improve function

� resist excursion of the ulna nerve by resisting elbowflexion, pronation and wrist and finger extension andassisting the function of muscles which may becomeoveractive and serve as an ongoing source of irritation

� reduce loadonthe lateral ligamentcomplexof theanklebydecelerating plantar flexion/inversion, approximating thejoint to augment force closure and enhance stability andproprioception and providing a facilitation of the peronei

� apply a rotation or Mulligan type intervention to improvepain and range of motion

� decelerate the navicular drop and resist flattening of themedial longitudinal arch to reduce loading on tibialisanterior and posterior to assist ‘shin splints’

� assist function of the gastocnemius/soleus/achillestendon complex by resisting dorsiflexion and assistingthe transition into plantar flexion to reduce loading onthe achilles tendon in tendinopathy or following repairof a rupture

� decelerate or resist hip adduction and internal rotationthat presents as collapse at the knee

� take the weight of the upper limb, approximating thegleno-humeral joint, resisting anterior translation, up-wardly rotating the scapula to bring the scapula musclesinto mid range (better lengthetension relationship) toreduce load and improve rotator cuff function and scapulacontrol in someone with bursitis or subacromial pain.

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Learning to use DT

It is perhaps best to be taught how to use DT on courses,though instructional videos are available online. Under-standing that there are direct techniques that clearlyfollow the function of the muscle in movement, forexample, the quadriceps crossing the knee joint, or ahamstring technique crossing the hip and the knee, and thecalf taping crossing the Achilles tendon on to the sole of thefoot to the toes. Using the muscles eccentric role to iden-tify the area needing to be taped, mimicking the eccentricmovement and adding support by taping concentricallywhere it is required. ‘Taping the movement allows the userto support the muscle and/or resist through a full range ofmovement in all functional tasks,’ says Kendrick.

When assistance is required directly over the jointand/or in a rotational direction the techniques of choiceare grouped under indirect techniques. Kendrick de-scribes these as not copying a particular muscles functionbut correcting a movement pattern as a whole by off-loading or supporting a joint. He gives an example of anarch support technique which creates a force vector toshorten the foot and raise the medial longitudinal arch.‘This technique can be started at the great toe with itpositioned in plantar flexion to create an artificial wind-lass mechanism to further resist lengthening and flat-tening of the foot. Circumferential application of thetape around the foot can increase force closure.By decelerating the navicular drop and lengthening of thefoot, a reduction in overactivity of tibialis anterior andtibialis posterior may be achieved.’ Other applications ofDT can use a rotation or glide placed on, over, oraround the joint as part of the technique, such as patel-lofemoral glides with the dynamic tape sling, or upperlimb glenohumeral control of medial or lateral rotation,subluxation and scapula tilt. These techniques follow arotational direction crossing over one joint and continuingin the same 3D movement direction although in theopposite direction, often using anterior and posteriorparts of the same joint. ‘These indirect techniques

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are more complicated and can require significantpractice,’ say course tutors Martin Berg and Patrik Ped-ersen who teach Dynamic Taping courses inSweden (Pedersen, 2015).

Figure 1 Figure demonstrates the Direct Technique e Quadriceps, applied in long sitting or in supine lying with full kneeextension.

Dynamic tape, the future?

It is likely that DT will become a well known product in thesphere of prevention and rehabilitation in the comingyears, it’s simplicity in general concept is easily grasped butperhaps more importantly ‘felt’ by the therapists and theirclients who have tried it on themselves and applied it toothers. It’s scant research base is entirely appropriate atthis stage of it’s development though it will be in the evi-dence gathering phase that the longevity of such a productwill be determined. In the experience of both research intoMcConnell’s patella taping and Kinesio-tape there are likelyto be controversial findings which may or may not supportclinical efficacy. Research design will need to be carefullythought through so that the right questions are asked.

Dynamic Tape (DT) Practical examples

Application

The tape can be applied with different applications pri-marily described as Direct Techniques (Figs. 1, 3 and 4) andIndirect Techniques (Figs. 5 and 6).

Direct Techniques are applied to mimic the action of themusculo-tendinous unit and are applied in the shortenedposition with long lever arms over the joint and momentarms. The aim of the tape is to absorb energy in thelengthening action of the muscle similar to that of a bungeecord. The elastic characteristic of dynamic tape allows for a

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controlled deceleration followed by an assisted shorteningaction.

Direct Technique e Quadriceps

Application recommendationsPrepare the skin correctly (remove hair, clean offmoisturisers).

Remove the backing paper by tearing the paper andavoid contact of fingers and adhesive glue.

Apply the anchor (three or four fingers widths) withouttension; hold the anchor and press in the opposite directionto the technique so that no tension is transmitted to the skin.

In this technique (Fig. 1) after the anchor is applied andheld (as above) the tape is gently tensioned to the onset ofresistance and the applied over the anterior thigh, then theknee joint and finishing approximately 2/3rds down thelength of the tibia.

The second anchor should be placed on the skinwithout any tension. Both anchors held in place 30 s. Goodtaping technique ensures that these anchors have notension and should be held in place for 30 s to ensurewarming of the glue for better skin adhesion. Commontaping errors can result in Traction Blisters; these occur atthe end points of the taping and are the result of too muchtension in the ends during the application. Instructions forapplication are available on the dynamic tape website andthe developer, Ryan Kendrick, Musculoskeletal Physio-therapist advises that users should take time to read andunderstand carefully before applying on realclients (websource 4).

The quadriceps direct technique is useful in muscletears, patella tendonopathy, PFPS, Osgood Schlatters, andfat pad/bursa symptoms and is often applied as a powerband, see Fig. 2A/B.

ic tape. Is it all about controlling load?, Journal of Bodywork &2.009

Figure 2 A and 2B PowerBand (Lamination 2e3 layers of tape).

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A dynamic tape PowerBand is used in clinical situationswhere greater resistance is required to decelerate moreforce within the kinetic chain. This is created by applyingadditional tape lengths in parallel. Particularly useful withlower limb direct and indirect techniques, even shouldertechniques.

Application e Using 2e3 identical lengths of dynamictape. Place one piece on a firm surface, carefully removethe backing sheet of the second and place section by sec-tion down till both sides are laminated together.

Important to note that there should be no stretch be-tween the layers.

Hold and rub the power band to activate the glue.Applied in the shortened position.

Direct Technique e Hamstrings

Fig. 3A For ease of application the client should be pronelying with the lower leg flexed at the knee at approx. 135�

knee flexion (Tape application as described for Fig. 1).The aim of this technique is to assist eccentric knee

extension by absorbing some of the hamstrings load andthen assisting back during the concentric phase into flexion.

Figure 3 A & B hamstri

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Fig. 3B This technique is beneficial in clients withneural provocation symptoms (sciatica) and very helpfulin runners, sprinters and jumpers where the load inhamstrings can be very high. In this case the applicationof tape can even extend over the hip, buttock and diag-onally onto the spine which increases the elastic supportover the joints involved in the kinetic chain during theactivity.

Direct Technique e Calf/Achilles

Fig. 4A: Apply a 5 cm dynamic tape length in plantar flexionfrom the Metatarsal heads over the Achilles tendon ontothe calf e approximately 2/3rds up the muscle belly.

No stretch is necessary because of the shortened startposition.

Fig. 4B: Spray the 5 cm tapes with dynamic adhesivespray then apply a 7.5 cm strip over the top of the 5 cm.This will enhance the resistance and hence offload themusculotendinous unit during functional load.

The Achilles/calf direct technique is useful for calfstrains, muscle tears, muscle fatigue, Achilles tendonop-athy, plantar fasciitis, lower limb pain syndromes.

ngs direct technique.

ic tape. Is it all about controlling load?, Journal of Bodywork &2.009

Figure 4 A. Achilles/calf direct technique 5 cm tape. B. Achilles/calf direct technique 7.5 cm tape.

8 Prevention & rehabilitation: Editorial

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Indirect technique e Deceleration of pronation

Fig. 5A. This indirect technique as described by Kendrick isfor the deceleration of pronation. It is applied often as apower band in the shortened supinated position (dorsi-flexion, inversion and forefoot adduction).

Fig. 5B. The start position is under the first and secondmetatarsal moving towards the navicular tubercle to invertthe foot. Kendrick explains that there is a longitudinal forcevector acting to shorten the medial longitudinal arch andadduct the foot. The supra-lateral direction across the

Figure 5 Decelerat

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anterior talo-crural joint provides a deceleration forcepreventing navicular drop because of the rotation anddorsiflexion direction of the tapes application.

Clinically this technique is useful in exertional lower legpain and shin splints.

Indirect technique e Control of External Rotation

Essentially designed to decelerate end of range externalrotation and assist the gleno-humeral joint back toneutral.

ion of pronation.

ic tape. Is it all about controlling load?, Journal of Bodywork &2.009

Figure 6 A B Control of external rotation e indirect technique.

Prevention & rehabilitation: Editorial 9

+ MODEL

This technique is often applied as a power band forgreater force.

The starting position is variable depending upon howmuch external rotation braking force is required. Athrower may require more horizontal extension andexternal rotation than perhaps a tennis player who mayrequire more external rotation control in overhead flexion.These considerations affect the anterior placement of thetape.

The gleno-humeral joint is positioned in internal rotationand the tape is applied to the lateral part of the armproximal to the elbow. The direction of the application issuperiorly at a 45� angle to create a spiral effect (and avoid

Figure 7 Posture pals.

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circulatory compromise). This creates a force vector up thelimb taking the weight off the arm. The tape comes from aposterior direction over the gleo-humeral joint and con-tinues across the chest at the correct required angle toresist anterior translation.

Fig. 6 A and B demonstrate the start and finish positionsof the taping technique.

Useful in clients with previous gleno-humeral disloca-tions or problems in throwing athletes, fatigue or inhibitionof internal rotators, pectoral muscle strain.

Thoracic X technique

Fig. 7 shows a posture pals technique for postural control.It is applied in thoracic extension and scapula posterior tiltto provide some resistance to thoracic flexion and scapulahitch to unload a sustained thoracic flexion sittingposture.

The tape is slightly stretched until some resistance is feltand applied in the position of choice. It can remain therefor approx. 4e5 days.

Used primarily to aid postural control, headaches, neckpain and back pain, muscle imbalances, shoulder injuriesand rib injuries.

P&R section comment

Saner et al. (2015) have their randomised control trial (RCT)comparing a tailored exercise program versus general ex-ercise for a subgroup of patients with low back pain andmovement control impairment, published later in this sec-tion, though the results showed no significant differencebetween the two groups, of which both improved, thefindings suggest that specific exercise for motor controlimpairments in low back pain research needs to continue.

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websource 1 . http://www.kinesiotaping.co.uk/faq.jsp.websource 2 . http://breakingmuscle.com/uk/mobility-recovery/

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Zhang, S., Fu, W., Pan, J., Lin, W., Xia, R., Liu, Y., 2015. Acuteeffects of Kinesio taping on muscle strength and fatigue in theforearm of tennis players. J. Sci. Med. Sport. http://dx.doi.org/10.1016/j.jsams.2015.07.012.

Warrick McNeill, Dip. Phyty. (NZ) MCSP *Physioworks, 53 Wimpole Street, London, W1G 8YH, UK

Clare Pedersen, MSc, BSc, MCSP 1

Arena Fysio, Mellersta Stenbocksgatan 10, 25437,Helsingborg, Sweden

E-mail address: clare@arenafysio.com (C. Pedersen)*Corresponding author. Tel.: þ46 44 7973 122996.

E-mail address: warrick@physioworks.co.uk (W. McNeill)

1 Tel.: þ46 708 585172.

ic tape. Is it all about controlling load?, Journal of Bodywork &2.009