Bracing and Taping Techniques

When to Brace

• Bracing may be appropriate for post-injury support
• Bracing may be appropriate where there is a compromised structure
• Bracing may be indicate to prevent injury
• Bracing may be appropriate for chronic injuries
• Bracing may be indicated after surgery
• Bracing may be indicated to stabilize a joint
• Bracing may be indicated to limit range of motion (ROM)
• Bracing can be used before surgery
• Bracing can be used to manage congenital abnormalities
• Bracing may be considered in situations where ROM needs to be increased
• Bracing may be used for protective purposes
• Bracing can be used to provide compression

When to tape

• Taping can provide proprioceptive feedback
• Taping can be used for time restraints when bracing is possible
• Taping can provide support to injured ligaments
• Taping may be necessary when sports do not allow bracing
• Taping is considered preventative or protective
• Taping can address joint instability
• Taping can provide compression
• Taping poses a risk of allergic reactions for some individuals

Support Structures

• Tensors are a type of support structure
• Slings are a type of support structure
• Insoles are a type of support structure
• Crutches are a type of support structure
• C-collars are a type of support structure
• Casts are a type of support structure

Categories of braces

• There are three categories of braces: rehabilitative, prophylactic, and functional

Rehabilitative Brace

• Rehabilitative braces protect the range of motion of an injured limb immediately following an injury or surgery
• Rehabilitative braces are not appropriate for sports participation or excessive activity
• Rehabilitative braces offer protection from further injury
• Rehabilitative braces may be rigid
• These braces can prevent dropfoot, and are also known as ankle foot orthosis (AFO)

Important Requirements of Braces

• Braces should limit ROM in an adjustable manner
• Braces should be comfortable and allow easy access
• Braces should be cost-effective for short-term use
• Braces should fit the contour of the limb properly
• Braces should provide protection as the athlete increases stress or recovery
• Braces should be easy to apply

Considerations for Rehab Braces

• Rehab braces have no functional qualities
• Rehab braces can be large in size for comfort or to accommodate swelling
• Rehab braces often have ROM stops
• Rehab braces have a simple design

Prophylactic Brace

• A prophylactic brace is designed to prevent or reduce the severity of injuries during sports participation
• Knowledge of ROM and return-to-sport percentages are needed to return
• Athletes must be ready to return and should not return to sport solely because of bracing or taping

Important Requirements

• Braces must not increase the amount of stress or torque on the proximal or distal joint
• Braces must not pre-stress the ligaments of the joint
• Braces should be associated with the mechanism of injury (M.O.I)
• The ideal brace should support the joint and ligaments without interfering with normal joint function
• Braces should be adaptable to individual anatomical variations and not increase risk factors

Requirements Cont.

• Braces must not cause harm to others such as no metal hinges are allowed in rugby
• Braces should be durable and made of hypoallergenic materials
• Braces are desired to be cost effective over constant tape
• Braces require easy maintenance, documented history/efficacy, and easy application by the individual

Functional Braces

• Functional braces augment ligament stability by giving protected function both after injury and during rehabilitation
• Functional braces prevent or decrease the severiy of re-injury during sport participation.

Important Requirement

• Activity requirements should be considered
• Comfort equals increased patient compliance
• Patients must be educated on fit, application, and maintenance
• Braces cannot replace adequate rehab
• Custom braces give a better fit for odd shaped body parts

Requirements Cont'd

• Braces can increase joint stability by one grade
• Activity modification is sometimes a better option than bracing
• Careful attention must be given to the fit
• Individuals must watch for positioning and localized pressure areas

Considerations for Bracing

• Sport demands/requirements must be reviewed
• Sport rules must be followed
• Allergies/sensitivity to materials need to be considered
• Climate and material use (cold vs. hot, breathability, and length of wearer)

Off the Shelf (OTS) vs Custom Braces

• Off The Shelf (OTS) braces are premade and packaged by the manufacturer
• OTS braces can be used immediately without modification once taken out
• Custom braces are constructed according to individual characteristics

Issues of OTS

• The main issue is sizing and fitting
• They are made for the average person
• Preference on material usage
• Perfect fit does exist

OTS

• OTS braces are readily available and cost effective
• OTS braces require a variety of sizes and style
• Body type considerations and the fact they can be highly effective
• OTS braces need a large inventory because the material and warranty periods are short

Qualities in OTS Brace

• Materials used will include metal, fabric and or nylon
• Qualities include length of sleeve, hinge, stitching, and seams
• They may or may not have liners
• There is a location of buttress holes

Custom Brace

• Custom braces are made of durable materials
• Measurement is done by casts, other devices and or images
• They provide a custom fit
• Custom braces are expensive, but can be covered by extended health insurance plans.
• Custom braces have a longer warranty
• Some big budget sports teams use them as prophylactic

Materials

• Options of materials include Neoprene and EpX/Bioskin
• Breathable materials are another option

Neoprene

• Neoprene has advantages such as cheap, with heat, and readily available with different thicknesses
• Disadvantages include allergies, heat, moisture retention, weight, and bulk

EpX/Bioskin

• EpX/Bioskin has advantages such as breathable, uniform compression, low profile, lightweight, thin, comfortable and highly compressive and supportive
• EpX/Bioskin has disadvantages such as expensive, break down quicker, delaminates and tapered ends

Product Comparison (Compression)

• Neoprene: provides heat or warmth, good compression, very durable, retains moisture, cheaper, and has a majority of products
• EpX/Bioskin: has less heat retention, better breathability, more compression, uniform compression, delaminates and has a tapered design

Breathable Materials (Drytex, Cooltex, Coolmax)

• Advantages include breathable, comfortable, low cost, moisture wicking, cooler
• Disadvantage includes no compression, stretch over time, break down over time

Patient Profile

• There are two population groups: athletic/tone leg and a sedentary/fleshy

Athletic/Tone Leg

• An athletic tone leg will be a cone shaped knee
• The brace will be very demanding
• Will often require to replace the brace
• Quad and Calf ratio can be different
• Sport demands placed on the brace
• Short periods of use

Sedentary/Fleshy Leg

• Fleshy thighs
• Braces do not fit well
• The Quad and Calf Ratio is usually different (no great ratio)
• The population usually chooses a brace because it "feels good"
• A sedentary person may wear the brace for ++ hours
• Determining whether the brace is used for Daily Life activities or sporting activities

Fitting Braces – Guidelines

• Circumference measurement
• Type of leg needs to have proper material or style
• Wrap around versus sleeve type of brace material
• Patellar and or Olecronon opening of the brace material
• Tightness of the brace
• Type of use (ADL vs Sport)
• How long will they wear this

Hinges

• Braces can use polycentric hinges
• Braces can use simple (single) hinges
• Braces can use gliding hinges

Osteoarthritis

• Osteoarthritis causes trauma and atraumatic wear and tear of a joint
• Osteoarthritis can involve many compartments of the knee

Special Injury Considerations

• Patellar Femoral Pain Syndrome (PFPS): requires understanding signs and symptoms
• Patellar Dislocation
• Osgood-Schlatter Disease

Special Injury Considerations(Knee)

• Braces and taping are used on the knee to protect: MCL, ACL, and patella tendonitis

Special Injury Considerations(Elbow)

• Braces and taping are used to protect the elbow where there is: epicondylitis medially, laterally and with ligament issues

Special Injury Considerations(Wrist/Hand)

• Braces and taping are used around the wrist and hand: the length of the brace, carpal tunnel, and nerves affected

Special Injury Considerations(Shoulder/Ankle)

• Braces and taping are used around the shoulder with GH dislocations based on vulnerable ranges known
• Braces and taping are used around the ankle with sprains based on known type
• Braces and taping are used around the ankle to protect achilles tendonitis, tendonopathy

Dynamic Splinting

• The goal is to achieve steady and permanent gains in ROM
• Dynamic splinting is used by the patient at home in conjunction with therapy
• Dynamic splinting is an alternative to manipulations or surgical release
• Dynamic splinting can be used as soon as passive stretch is allowed

Indications

• Contractures: Stiffness and elasticity with fixed shortening of involved tissue which results in loss of motion around supporting joint

Indications Cont'd:

• Joint stiffness secondary to fractures (elbow, wrist, ankle, or fingers)
• Post immobilization
• Athletic trauma (sprains, ligament, dislocations, or plantar faciitis)
• Severe burns
• Neurological injuries (cerebral palsy or spinal cord injury)
• Trauma (degloving)
• Skin grafting around indicated joint

Indications Cont'd

• Post surgical loss of motion for joint replacement, osteotomy, or tendon and ligament repairs
• Clients having difficulty gaining ROM using standard at home exercise