High-level athletes are expected to ski and ride on closed courses and push the limits. Therefore, injuries happen. The goal of the recreational skier is to have a challenging, fun day and not get injured.
During the London 2012 Olympics, some athletes wore brightly colored tape on their legs, trunks and arms. For the Winter Olympics, tape will be used by many athletes and will be hidden under layers of clothing unobserved. Usually, the elastic therapeutic taping technique is taught to the athlete by a physical therapist or athletic trainer.
I tell my patients that once I show them how to cut and shape the tape and they practice the application of the tape, they will tape themselves even better than I do. This is because the person applying tape to his own body, if properly taught, often has a better sense of the correct tension and location for the tape once he understands the concept of taping. I've used therapeutic taping as a treatment along with manual therapy, therapeutic exercise and modalities for downhill and cross-country skiers, snowboarders and patients going snowshoeing. It's both economical and easy. Patients enjoy having a technique they can apply themselves. The tape can be left on for up to three days, and it's waterproof, so patients can ice right over it.
The effectiveness of the therapeutic tape depends on its correct application on the body tissues for the desired purpose. Each therapist can determine if it's a tool that works for her and her patients.
To my knowledge, there's no strong scientific evidence that elastic therapeutic taping is effective. I'm hopeful that current DPT students will design studies to provide evidence of effectiveness or no effect. Elastic therapeutic taping has been termed a placebo effect by some sources. Personally what I can demonstrate is if the tape is applied correctly, I get desired results. Likewise, if it's applied incorrectly or unnecessarily, it can be a painful irritant. Taping is best performed by keeping the anatomy and intent in mind. The science of taping is based on anatomy and fluid dynamics. The art of taping occurs with practice and being inventive to achieve the desired result.
If the desired effect is a neurosensory pain-inhibition response, then the tissue needs to be stretched and not the tape. An example of this would be taping the low back in a forward-bent position and applying the tape without a stretch.
For proprioception input or posturing, the tape needs to be stretched to facilitate the area. The concept is to provide a tactile cue with the stretch of the tape to support improved muscle function. An example of this would be taping to remind a hip to externally rotate for a longer period of time, reducing early or excessive lower-limb pronation. Another example would be taping the shoulder/scapula as a reminder cue for scapular retraction.
For structural support, a therapist can bring the patient into the painful range of motion and then reduce the range slightly while laying tape across the body part in such a way that the patient will be cued by the tape to avoid the painful arc of motion. The tape will pull on the skin if the person starts to overextend a movement.
How Taping Can Be Effective
For enhanced microcirculation resulting in edema control or lymphatic drainage, the tape needs to have a wave-like or accordion appearance on the skin. With movement of the body, this allows the tape to lift the skin to take pressure and irritation off the neuroreceptors. Mechanically, the idea is to create waves to push the fluids through the tissues. The original concept of the flexible tape was to make a tape that wouldn't be too restrictive or inhibit the flow of inflammatory fluids beneath the skin. This is accomplished by having similar extensibility as the skin and designing a wave form in the flexible tape.
Different manufacturers have different products and colors of tape. As an example for one company, pink tape is used for muscle inhibition or facilitation, black tape is used to stabilize over joints and blue tape is used for inflamed areas. Brown tape is the original tape and is used universally.
There are four cuts used with rehabilitative taping. With all cuts, the ends are rounded to keep clothing from pulling the skin away. The first and most used is the I cut. The second is the Y cut, which is used over larger muscles. The third cut is the X cut used for stabilization. The final cut is the wave form, with multiple fingers for swelling.
In all cases, the tape is applied with a base area that has no pull and is the anchor for the taping application. From that point, the tape is applied with no stretch over a stretched body part, no stretch over a neutral body part, or with the part appropriately positioned and the tape stretched 20 to 50 percent. Stretching 20 percent is thought to inhibit high-tone muscles. Stretching 50 percent is thought to activate a muscle. Generally the ends of the tape, as anchors, should have no stretch and the mid section of the tape has the stretch. The mid-section stretch can be finessed. For example, when taping the knee in one particular technique: above-knee the tape is stretched 20 percent and below the knee, the tape is stretched 50 percent, with no stretch at each anchor.
In skiing, the knees are the most commonly injured area due to the twisting occurring with falls. It would be an overstatement to say that a knee sprain can be prevented by elastic therapeutic taping. The tape stretches 130 to 140 percent and does not provide a rigid protection to the ligaments of the knee. However, the tape is helpful after the injury to provide pain relief and perhaps enhance the healing cycle. Most of the tape used by athletes is to support, protect or relieve pain in an injured area. The idea is to prevent further injury while allowing continued healing.
In winter sports, taping may be used on the neck and low back to inhibit pain and reduce muscle irritation. Taping is used in the shoulder/scapular area to structurally support the weight of the arm in the glenoid and reposition it in a pain-free manner or to restrict movement. Rehabilitative taping may be used for elbow tendonitis, elbow sprains after falls, or to cue to avoid elbow hyperextension. At the wrist, taping can be used with button holes for the fingers to facilitate wrist extension. Tape may also be used to support a sprained wrist or thumb after a snowboarding fall.
At the hip, taping can be used to facilitate the external rotators or any other desired muscle groups. It may also be used to inhibit a high-tone muscle. Taping can be used at the knee for generalized knee pain, tendonitis, to improve patellar tracking or stabilization, or to remind the patient not to hyperextend the knee. Ankle sprains may be taped to reduce edema and pain. Any form of ankle tendonitis can be taped. Plantar fasciitis and foot neuritis seem particularly helped by taping.
Training and Flexibility Key
Since winter sports are seasonal and everyone wants to enjoy the first snow days completely, it's important to have the desired flexibility, balance, coordination, endurance and strength for the sport. At least two months prior, people should become involved in a three-times-per-week program to get ready for a specific sport. Set up a regimen that begins and ends with stretching, while including core and limb strengthening, cardiovascular training and balance exercises. If a person is going to be skiing or snowboarding, he should include eccentric lower-leg exercises.
Choose cardiovascular training that would be a good match for the sport. For example, an elliptical would be preferable to a bike for someone who will be cross-country skiing. Do sport-specific exercises such as wall squats for skiing, balance exercises for snowboarding, repetitive hip flexion for snow shoeing, and trunk and gluteal strengthening for cross country. Since winter sports are done on slippery surfaces, work on balance exercises. Preseason conditioning will possibly result in injury prevention, improved endurance, muscles that can work for hours, better balance and more fun.
If an injury occurs, protect the injury, rest, ice, compress the swelling and elevate (PRICE). Stay out of the hot tub if injured. If you suspect a fracture, get an X-ray. Urgent care offices can be used for immediate medical care; they will refer to an orthopedic physician if necessary.
In physical therapy, patients can expect to receive evaluation and a plan of care. Winter sports rehabilitation may involve reduction of edema with ice and a compression machine, electric stimulation, manual therapy, range of motion, core strengthening and gradual strengthening of the injured area with consideration of tissue healing. In the return-to-sport phase, the injured body part is challenged in a sport-specific manner. Whole-body strength, endurance, coordination and balance are tested in a manner specific for the sport. A test of these skills must be passed to be given the go-ahead to return to winter sports.
The best way to reduce injury is to ski or ride within one's abilities. Improve skiing or riding by taking lessons. Bad technique will increase injury risk. Equipment needs to be properly fitted and maintained. Wear a helmet. Bindings should be checked and adjusted by trained ski mechanics. Boots should be properly fit for high arches, pronation, wide feet, bunions, varus and valgus knee deformity and ability. Overpronation and high arches can change lower-limb rotation and adversely affect turning. Ski orthoses can be custom made or purchased off the shelf.
As with any sport, warming up and cooling down is important. Stretch the whole body, particularly the legs and trunk gently, slowly and effectively. Eat a good breakfast and carry snacks, and stop for rest and water breaks. Stay hydrated and avoid hypothermia. With good preparation, winter sport enthusiasts can have fun and enjoy the outdoors.
Debra Layne is owner/senior physical therapist at North Boulder Physical Therapy Sports Rehabilitation, with two locations in Boulder, CO.