6.6 Therapeutic Taping: Rigid, McConnell & Elastic Techniques

6.6 Therapeutic Taping: Rigid, McConnell & Elastic Techniques

Core Clinical Mandate: "Taping" is the fourth named sub-topic of the Mechanotherapy (10%) content area. The exam-relevant distinction is mechanism: rigid tape restricts motion through mechanical restraint, whereas elastic therapeutic tape does not meaningfully restrict motion and acts through cutaneous, proprioceptive, and fluid-dynamic effects. Confusing the two leads to prescribing the wrong tape for the wrong goal.

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The Three Taping Families

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Rigid Athletic Taping

Purpose and Honest Limits

Rigid tape is the only taping family that genuinely restricts joint range. Its classic use is limiting talocrural plantarflexion and subtalar inversion after a lateral ankle sprain, via stirrups, heel locks, and figure-of-eight patterns.

The Loosening Problem: Rigid tape loses a large fraction of its mechanical restraint within roughly 15 to 20 minutes of vigorous activity, as perspiration and repeated loading stretch the fabric and the adhesive bond. Its measurable protective benefit in the research literature is therefore attributed as much to enhanced proprioceptive awareness as to sustained mechanical blocking. A semi-rigid lace-up brace maintains restraint longer and is reusable. Tape supplements rehabilitation; it never substitutes for restored peroneal strength and balance.

Application Sequence

1. Prepare the skin. Shave, clean, and dry. Apply adhesive spray if used, then pre-wrap (underwrap) over areas of friction to protect skin integrity.
2. Position the joint in the corrected position before any tape is laid — for the ankle, dorsiflexed to neutral and slightly everted. Tape applied in the injured position simply preserves the injured position.
3. Anchors first, proximal and distal, applied without tension.
4. Working strips (stirrups, horseshoes, heel locks, figure-of-eight) laid so each overlaps the previous by roughly half its width, with no gaps or wrinkles.
5. Close with locking strips, then check distal circulation, sensation, and comfort.

Safety Checks

• Never encircle a limb with continuous non-elastic tape under tension — circumferential constriction produces a tourniquet effect.
• Check capillary refill and sensation immediately after application, and instruct the patient to remove the tape at once for numbness, tingling, colour change, or increasing pain.
• Do not tape over an acute, undiagnosed, or possibly fractured joint to allow continued play. Tape applied to let an athlete keep competing on an unexamined injury is a liability event.

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McConnell Patellar Taping

Jenny McConnell's technique applies rigid tape over protective underwrap to hold the patella in a corrected position throughout rehabilitation, unloading the painful lateral facet and enabling pain-free strengthening.

Assessing the Component Faults

The patella is assessed for four positional faults and the tape corrects whichever is present:

1. Glide — lateral displacement of the patella. Corrected by taping from the lateral border medially, pulling the patella medially while the clinician gathers the medial soft tissue toward the joint.
2. Tilt — the lateral border tips posteriorly, compressing the lateral facet. Corrected by taping from the middle of the patella medially to lift the lateral border.
3. Rotation — the inferior pole deviates medially or laterally. Corrected by a strip that de-rotates the pole toward neutral.
4. Anteroposterior tilt — the inferior pole tips posteriorly into the fat pad, a potent pain generator. Corrected by lifting the inferior pole out of the fat pad.

The Immediate-Response Test

McConnell taping is validated in the treatment session: identify a provocative task (a step-down, a small squat, stair descent), record the pain on a numeric scale, apply the tape, and repeat the task. A meaningful immediate reduction — conventionally at least 50% — confirms the positional fault is relevant and the tape is correctly applied. No change means the correction is wrong or the pain is not patellofemoral.

Wear and Skin Care

Always apply over hypoallergenic underwrap; rigid tape directly on the skin of the anterior knee for hours produces blistering and shear injury. Remove if itching or burning develops. The purpose of the tape is to create a pain-free window in which to strengthen the hip abductors, external rotators, and quadriceps — it is a bridge, not a destination.

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Elastic Therapeutic Taping

Proposed Mechanisms

Elastic therapeutic tape is applied with the skin stretched into the treatment position so that on relaxation the tape recoils and forms convolutions in the skin. Proposed effects include:

• Cutaneous and proprioceptive input: continuous large-diameter afferent stimulation, consistent with gate-control modulation of nociception and improved positional awareness.
• Dermal decompression: the recoil lifts the epidermis, which is theorized to increase the interstitial space and assist superficial lymphatic and venous flow — the rationale for fan and web patterns over a bruise or subacute swelling.
• Postural and motor cueing: the pull of the tape when the patient moves into a faulty position provides a tactile reminder, for example across a protracted scapula or a slumped thoracic spine.
• It does not provide meaningful mechanical restraint. Do not prescribe it to protect an unstable joint.

Application Rules

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Contraindications and Complications

Absolute contraindications for any taping:

• Open wounds, active skin infection, or cellulitis in the field.
• Known adhesive or acrylic allergy.
• Fragile, atrophic, or previously irradiated skin; active skin malignancy in the field.
• Acute deep vein thrombosis in the segment.
• Uncontrolled circulatory compromise in the limb.

Relative cautions: diabetic or otherwise insensate skin, long-term corticosteroid use, pregnancy (avoid abdominal patterns), and patients who cannot report distal symptoms reliably.

Common complications and their causes:

• Blistering and skin tearing — almost always tension applied at the anchors or through a joint crease.
• Contact dermatitis — adhesive sensitivity; test a small strip for 24 hours in a first-time patient.
• Constriction and distal numbness — continuous circumferential non-elastic tape.
• Dependence — indefinite taping without progressing the underlying strength and motor-control deficit.

Exam Framing: If a question describes a goal of restricting a specific motion after an acute sprain, the answer is rigid tape or a semi-rigid brace. If the goal is cueing posture, facilitating or inhibiting a muscle, or reducing superficial swelling over several days, the answer is elastic therapeutic tape. If the goal is repositioning the patella to permit pain-free strengthening, the answer is McConnell taping over underwrap.