Soft Tissue Injury Management: Compression and Taping
PTA 101 Introduction to Clinical Practice 1

Instructional Use Statement

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.

Intro to Compression and Taping for Tissue Healing

Compression and taping are most often used during the acute and subacute phases of tissue healing. Soft tissues must be protected while working through gentle and progressive motion, so that potential for full healing is maximized. PTAs should be able to apply knowledge of tissue healing principles when selecting compression and taping interventions.

Lesson Objectives

1. Describe symptoms of soft tissue pathology for which compression and taping treatment may be included in a physical therapy plan of care

2. Describe indications, procedures, and benefits for protective taping and wrapping in response to tissue injury.
1. triangular
2. ankle (circular and figure-8)
3. calf
4. scapula
5. elastic taping
   
3. Describe methods to check for impaired circulation following compression
4. Describe advantages for taping vs. bandaging a soft tissue injury
5. Define and describe terminology used for grading muscle strains
6. Define and describe terminology used for grading ankle sprains
7. Identify common sites for muscle contusion injuries
8. Define and describe common types and causes of muscle contusions
9. Describe two primary taping methods use in rehabilitation
10. Compare and contrast rigid vs. elastic taping for treatment of signs and symptoms of soft tissue injuries

A Review of Tissue Healing

Acute Stages of Tissue Healing

"coagulation and inflammation" stage

Vasoconstriction, followed by vasodilation and cellular infiltration trigger the outward, cardinal signs of inflammation:

• redness, heat, swelling, pain, functional loss - in the acute stage, these are all good signs that a team of healing cells are on the way and going to work.

General Goals in the PT POC - Acute Healing Stage

• protect the area - bracing, taping, assistive devices as needed, activity modification to maintain function
• pain control - cryotherapy; modalities for pain decrease sensory feedback and muscle inhibition due to pain
• minimize edema - cryotherapy, modalities, appropriate compression and elevation all help "shrink" the fluid and other elements in the extracellular spaces that stress and stretch related areas
• minimize reflexive muscle guarding and atrophy - heat/ice, gentle movements to related, adjacent areas
• prevent long-term motion loss (joint and soft tissue) - this includes PROM, sub-maximal isometric exercises, self-massage, gentle soft-tissue and joint mobilization to optimize tissue length during healing
• medications - over-the-counter or prescribed as recommended by primary care provider or pharmacist

  Role of Compression

• high resting pressure from elastic bandages faciliate fluid return and support injured structures
• rigid tape provides somewhat firm support to affected tendons and ligaments
• elastic tape can facilitate fluid return and decrease muscle guarding through gentle kinesthetic inputs

Subacute Stage of Tissue Healing

"migratory and proliferative" stage

• specialized cells migrate into the injured soft tissue and grow to help repair the strength and function of the affected tissue
• this results in an organized mix (matrix) of cells that prevent infection and progressively connects new tissue to the surrounding area
• as the cells work to "fill in" the soft tissue area, they remain relatively weak and are susceptible to reinjury if overstressed

General Goals in the PT POC - Subacute Healing Stage

• promote functional ROM - interventions are chosen to help restore optimal length-tension relationships in soft tissue (e.g., PROM, AAROM, AROM, stretching with stable pain symptoms, manual soft tissue mobilization) and normal joint mechanics (e.g., joint mobilization)
• recover strength and endurance: submaximal isometrics throughout available range, gravity as resistance before adding weight, sets and reps to challenge endurance and allow recovery,

Role of Compression

• compression from fitted elastic sleeves provide modest joint protection and limits forces in end-ranges
• rigid tape can support and provide kinesthetic feedback during progressive AAROM
• elastic tape can augment kinesthetic input to optimize muscle recruitment patterns

Self-Assessment: Applying information from Course Readings

Sprains and Strains

Soft tissue healing time is a continuum of overlapping systems that are working toward homeostasis (e.g., back to "normal"). Healing time within each tissue healing stage will vary, and is largely influenced by the extent of the injury. Lower grade sprains and strains will progress through the stages of tissue healing fasters than higher grade sprains and strains.

Ankle sprain

Ankle sprain is one of the most common and recurrent ligamentous injuries.

Review the general information from the American Academy of Orthopedic Surgeons on Ankle sprain to deepen your understanding of the sprain grading system

Here is an example of how the tissue healing stages can vary with a common ankle (anterior talofibular ligament) sprain

Muscle Contusions

Bruises are muscle contusions, usually due to some blunt force to the contractile tissue.

Muscle Strains

 Grading systems for sprains and strains are the same. The higher the grade, the more severe the injury.

Muscle tissue healing time is also dependent on the extent of the involved muscle tissue, although healing times are generally faster in this well-vascularized issue compared to avascular soft tissue. Care must be taken to allow for progressive rebuilding of muscle tissue, while encouraging progressive ROM.

PT Intervention - Compression

Approximately 12 minutes of linked videos serves as content

How to Tell If an Ace Bandage is Too Tight

How to Wrap a Calf with an Ace Wrap

How to Wrap a Wrist with an Ace Wrap

How to Wrap an ankle with An Ace Bandage

How to Wrap a Quad

Applying a Triangular Sling

PT Intervention - Taping

• Scapular Taping - Article downloads - Approximately 25-30 minutes of reading

1. Read the introduction and then skim the content until you reach the 'Assessment' section (p. 806). Focus on treatment and techniques. The Discussion includes the author's rationale

• Rigid vs. elastic taping overview
• Article: Embaby & Abdalgwad - (Article downloads) Read this literature review - it provides a very succinct review of the primary differences between rigid and elastic tape. Based on the literature review, see how you do with transferring this understanding to the flashcard activity below.

Videos of Taping Techniques

Approximately 22 minutes videos of taping techniques

Impingement

Kinesiotaping for Shoulder Strain/Pain

How to Tape a Sprained Ankle

Low-Dye Taping Technique for the Foot

End of Lecture