16.2 Taping, Bracing & Orthoses

Quick Answer: After a first lateral ankle sprain, external support plus rehabilitation beats hope. A lace-up or semirigid brace is often as effective as tape—and frequently more cost-effective—for recurrent-sprain prevention. Closed-basketweave tape still has a mechanical and proprioceptive role, but tape loosens with activity. McConnell tape is a rigid, mechanical patellar technique; kinesiology tape (KT) evidence for strength and performance is modest to negligible—never claim a 20% strength increase. Classify knee braces as prophylactic, functional, or rehabilitative; an ACL brace does not replace neuromuscular (NM) training. Prep skin, screen allergy, and recheck circulation. Exam trap: KT “makes you 20% stronger.”

PA8 Domain IV, task 0404, is selecting, fitting, and educating on preventive and protective devices—tape, wraps, braces, splints, and orthoses—then checking that the device is doing the job without creating a new one (skin breakdown, neurovascular compromise, a false sense of immunity).

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Closed-Basketweave Ankle Tape vs Brace After the First Sprain

The closed-basketweave (Gibney strips, heel locks, figure-8s, closing anchors) is still the classic exam picture for a lateral ankle. Purpose after the first sprain is to limit excessive inversion/plantarflexion, add cutaneous proprioceptive input, and support return to activity while the athlete completes strength, balance, and sport-specific work. Tape is not a ligament graft.

Evidence, not locker-room folklore: systematic reviews (Handoll; Verhagen; Zwiers; later ISAKOS summaries) support external support for reducing ankle sprains, especially recurrences. Bracing and taping both reduce risk; several analyses find a lower number-needed-to-treat and better post-exercise residual restriction for semirigid braces than for tape, and Olmsted-style cost analyses favor braces over a season of daily tape. Classic lab teaching is that tape loses a large share of its restriction within about 15–20 minutes of activity (often summarized around a 40% drop)—so “I taped it this morning” is not the same as “it is still mechanically equivalent to a brace in the fourth quarter.” Re-tape or use a brace that can be retensioned. Combining brace or tape with neuromuscular training beats either in isolation for chronic ankle instability.

Do not tell an athlete that tape is uniquely superior, that a brace is “cheating,” or that once tape is on they can skip rehabilitation. Skin irritation is more common with tape than with many braces; that is a practical, not a moral, difference.

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McConnell Tape vs Kinesiology Tape

McConnell taping uses rigid (usually zinc-oxide) tape over a protective underlayer to mechanically reposition the patella—classically a medial glide/tilt correction for patellofemoral pain—so the athlete can complete quadriceps and functional work with less pain. Immediate pain reduction with tailored medial patellar taping has reasonably consistent support as an adjunct; it is not a stand-alone cure for patellofemoral pain, and the correction is only as good as the exam that chose the direction.

Kinesiology tape is elastic, applied to skin with variable stretch, and marketed for “lifting fascia,” “increasing circulation,” and “facilitating muscle.” High-quality syntheses on strength and sport performance in athletes are largely negative or trivial (Csapo and Alegre; later athlete-only reviews and 2024 meta-analyses finding no clinically relevant lower-limb strength gain versus sham/control). Pain and proprioception findings are inconsistent and often small. KT may still be used as a low-risk adjunct for comfort or cueing if the athlete values it and skin is intact—after you have explained that it is not a strength drug.

Exam trap: claiming KT increases strength 20%. That number is marketing, not a Board of Certification fact. Do not write it in a note. Do not promise it to a combine athlete.

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Knee Braces, Patellar Straps, and Other Field Devices

Name the intent of a knee brace; the words are not interchangeable:

• Prophylactic: worn by uninjured athletes (often linemen) in hope of reducing MCL/valgus injury. Evidence of population-level prevention is mixed and sport-specific; they do not make the knee invincible and can alter mechanics if poorly fitted.
• Rehabilitative: post-injury or post-surgical braces with adjustable ROM stops (locked extension after some reconstructions or meniscus repairs as the surgeon wrote). These are protocol devices, not fashion.
• Functional: worn when returning to activity after a ligament injury (classic: ACL-deficient or post-ACL reconstruction cutting sports). They may add confidence and some mechanical constraint. They do not replace NM training, quadriceps/hamstring capacity, hop testing, or a criteria-based return-to-play plan. An athlete in a functional ACL brace who cannot decelerate on one limb is not “braced ready.”

A patellar tendon strap (Cho-Pat-style) can reduce pain in some jumper’s knee / Osgood-Schlatter presentations by altering tendon load-sharing; it is an adjunct to load management, not a reason to keep jumping on an irritable tendon at full volume.

Other devices that show up in practical exams: thumb spica for ulnar collateral ligament (gamekeeper/skier’s thumb) and some scaphoid-precaution positions; buddy tape for stable finger sprains (never as the only management of a rotated or intra-articular fracture); horse-collar pads for acromioclavicular protection in football—limited injury-prevention data, equipment-rule dependent; cervical rolls in pads—do not treat them as proven catastrophic-injury prevention. Fit and rules matter more than brand mythology.

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Foot Orthoses, Skin Prep, Allergy, Circulation

Foot orthoses (prefab or custom) for pes planus and plantar fascia pain can reduce load on the fascia and tibialis posterior as part of a program that still includes calf capacity, load management, and shoe discussion. Evidence is mixed but clinically useful as an adjunct; they do not “cure a fallen arch” in one visit. Watch for new blistering over the navicular or medial arch when you first issue a device.

Application rules that prevent iatrogenic injury:

• Skin prep: clean, dry skin; shave only if tape will not stick and the athlete consents; use adherent (benzoin-type) only if you have screened for allergy; underwrap reduces skin trauma but can reduce mechanical stick—know why you chose it.
• Allergy: prior tape, latex, benzoin, or neoprene reactions are a stop for that product. Switch materials; do not “push through” a spreading rash.
• Circulation and nerve checks: after any circumferential tape, wrap, spica, or brace, reassess color, capillary refill, temperature, sensation, and motor distal to the device. Numbness, pallor, or increasing pain under the device means loosen or cut it off. Recheck after the athlete is dependent (standing, skating) because edema changes.
• Education: the athlete should know how to loosen a brace, when to stop wearing a device overnight, and that a device is not permission to skip rehab.

Exam trap, restated: KT does not increase strength 20%. An ACL brace does not replace NM training. Tape that was perfect at 7:00 a.m. is not guaranteed at 4:00 p.m.