Kinematictaping

THERAPEUTIC TAPING,
EXERCISE & POSTURE
TECHNIQUES
Tambra Marik, OTD, OTR/L, CHT
Apple Physical Therapy
Gig Harbor/Tacoma WA
Moving Towards Function/Marik
Course Agenda
Characteristics of Tape
Theoretical Constructs of Rigid Tape
Theoretical Constructs of Elastic Tape
What is our evidence for taping?
The Shoulder: From Basic Anatomy, Biomechanics,
Pathology to Posture and Treatment
Rotator Cuff Tendinopathy/Impingement
Lab: Shoulder Girdle Taping and Exercise
Lab: Evidence for Impingement taping

Course Agenda
The Shoulder (cont)
Instabilities
Lab: Anterior Instability, Multidirectional
Instability, AC Joint taping (type I & II)
Lab: TOS taping, review hemiplegia taping,
cervical taping, myofascial shoulder pain
taping, Upper Quadrant taping
PTAPTM_1275
Course Agenda
The Elbow
Basic Anatomy
Elbow Instabilities related to ligamentous
structures
Medial ulnar collateral ligament injuries
Lateral radial collateral ligament injuries
Taping and Exercise lab
Tendinopathy at medial and lateral elbow
Taping and Exercise Lab
Course Agenda
The Elbow
Basic Anatomy
Elbow Instabilities related to ligamentous
structures
Medial ulnar collateral ligament injuries
Lateral radial collateral ligament injuries
Taping and Exercise lab
Tendinopathy at medial and lateral elbow
Taping and Exercise Lab
CHARACTERISTICS/TYPES OF TAPE
ATHLETIC TAPE
RIGID TAPE
Leuko Tape
ELASTIC
Rock Tape
Kinetic/Kinesiology
PTAPTM_1275
BENEFITS OF RIGID TAPE

Pain Relief
Neuromuscular
Proprioception
Tissue
De-loading
THEORETICAL CONSTRUCTS FOR

RIGID TAPE
PAIN REDUCTION
Mechanical Effects:
Joint support
Joint Re-Alignment
Biomechanical Correction
THEORETICAL CONSTRUCTS FOR RIGID

TAPE
NEUROMUSCULAR EFFECTS
Muscle facilitation and/or inhibition
Theory Based: Across muscle inhibits and
along muscle facilitates
Evidence indicates taping along muscle (LT)
facilitate muscle activity (Alexander et al 2003)
PTAPTM_1275

TAPE
Muscle Facilitation
Theory: Muscle held in a
shortened position will have
optimal actin-myosin overlap
during the cross bridge cycle
Photo from: Morrissey
2000
10

TAPE
Photo from: Morrissey 2000
Muscle Inhibition
Theory: Hold muscle in lengthened

position resulting in decreased
actin-myosin overlap
11

RIGID TAPE
PROPRIOCEPTION ENHANCEMENT
Enhances muscle control over targeted joint
Cutaneous
Mediated
Proprioceptive
Feedback
Image retrieved from:

http://content.answcdn.com/main/c
ontent/img/oxford/Oxford_Sports/0
199210896.reflex-arc.1.jpg
12
PTAPTM_1275

RIGID TAPE
TISSUE DELOADING
Surrounding or gathering the tissue around
the painful area to deload the tissue
13

RIGID TAPE
PSYCHOLOGICAL EFFECTS
Feelings of increased confidence, strength
and decreased anxiety
14
ELASTIC TAPE
15
PTAPTM_1275
ELASTIC TAPE
I CUT
Y CUT
FAN CUT
X CUT
16
TAPE APPLICATION
Apply to clean, dry skin. Remove oils from skin

Can use skin adhesives for improved contact
Typically tape is applied to stretched skin
Tape is stretched (~10%) when applying to nonstretched skin
Additional stretch required when applying for
mechanical correction
Tape likely to adhere better to skin where hair has
been clipped or shaven
17
PRECAUTIONS/CONTRAINDICATIONS
Avoid applying tape to persons with:
Skin allergies or sensitivity to tape

Open wounds
Skin infections/conditions
Fresh scars
Fragile and sensitive skin
Circulatory conditions (bleeding or clotting
disorders)
Sensory loss in taped region or distal to tape
Pregnancy avoid selective acupuncture points
Lymphedema requires knowledge of pathways
18
PTAPTM_1275
Peripheral vascular disease

Peripheral neuropathies
Diabetes
Prolonged use of steroids or anticoagulant
medications
Cognitive loss (patient is unable to report any
negative effects of tape)
19
Peripheral vascular disease

Peripheral neuropathies
Diabetes
Prolonged use of steroids or anticoagulant
medications
Cognitive loss (patient is unable to report any
negative effects of tape)
20
ROCK TAPE
An Elastic Tape
p
97% COTTON
3%NYLON
HYPO-ALLERGENIC
ACRYLIC BASED
ADHESIVE
Stretches in
One Direction
No Latex
Thought to
accelerate
healing
21
PTAPTM_1275
ROCK TAPE
THEORETICAL CONSTRUCT
FASCIAL MOVEMENT
TAPING
Reduce swelling
Accelerate blood flow
Contribute to
optimizing movement
patterns
Picture retrieved from:http://davidlasnier.com/
wp-content/uploads/2012/02/anatomy-trains-fascial-arms-line.jpg
22
OTHER THEORETICAL CONSTRUCTS

FOR ELASTIC TAPE
MECHANICAL CORRECTION
FASCIA CORRECTION
SPACING CORRECTION
MUSCULOSKELETAL CORRECTION
(TENDON/LIGAMENT)
FUNCTIONAL CORRECTION
23
Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the KinesioTaping Method. Tokyo, Japan:Ken Ikai Co. Ltd;2003.
THEORETICAL OBJECTIVES
MECHANICAL CORRECTION/Skin Function

GOAL:
1) Position muscle, fascia, or joint. Tape provides
feedback to mechanoreceptors
resulting in the body adjusting to minimize
tension
2) Elasticity in tape assists the body to adjust to
desired position
OR
3) Block movement
Stretch qualities and pressure of the tape provide
sensory input to mechanoreceptors
Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the KinesioTaping Method. Tokyo, Japan:Ken Ikai Co. Ltd;2003.
24
PTAPTM_1275
Mechanical Correction Theory: Tape

Provides Input to Mechanoreceptors
Method 1 Tail Tension/Lateral Epicondylosis Example
1) Mechanical correction for tennis elbow. Cut Y

tape with 1 inch base and 2 inch tails. Place
forearm in supination and elbow flexed at 90
flexion. Apply strip base on distal humerus.
Hold base with one hand. Apply 50% to 75%
tension with downward pressure on each tail
over wrist extensor group.
Leave one inch to the tail and lay down with no
tension.
25
Theoretical Concept
Mechanical Correction / Lateral
Epicondylosis
26
Mechanical Correction Theory:

Tape Blocks Motion
Method 2: Blocking lateral epicondylosis example
1. Place the elbow at 30 flexion and forearm in
supination.
2. Use the center of an I strip with 50% to 100% tension
in the middle of the strip.
3. Apply directly over supinator extensor mass. The
patient actively moves to pronation/elbow
extension(extension for sensory feedback to not move
to end range extension) and the ends are laid down.
4. No tension to the ends of I strip. One end at distal
posterior distal humerus and one end at volar mid
forearm.
27
PTAPTM_1275
Theoretical Concept
Mechanical Correction / Lateral
Epicondylosis
28
FASCIA CORRECTION
GOAL:
1) Elasticity of tape is used to move fascia
or limit fascia movement
or
2) Hold fascia in position or limit
fascial movement after manual
techniques
Kase K, Wallis J, Kase T. Clinical Therapeutic Moving

Applications
of the
KinesioTaping Method. Tokyo, Japan:Ken Ikai Co. Ltd;2003.
Towards
Function/Marik
29
Theory: Limit Fascia Movement

Medial Epicondylitis Example
1. Cut Y strip with a 2 inch base and 2
inch tail.
2. Manually lift the flexor wad from
the medial epicondyle.
2. Place the base of the Y strip
proximal to the medial epicondyle
without tension at the base.
3. Apply the remainder of the base
with 50% tension in a volar radial
distal direction.
*Hold
the corrective position or limit the

unwanted position with tape.
Moving
Function/Marik
Kase K, Wallis J, Kase T. Clinical Therapeutic Applications
ofTowards
the KinesioTaping
Method. Tokyo, Japan:Ken
Ikai Co. Ltd;2003.
30
10
PTAPTM_1275
Theoretical Concept
Fascia Correction / Medial
Epicondylosis
31
SPACING CORRECTION
GOAL:
1) Lift fascia & soft tissue in painful region.
2) Create more space in the area above pain,

inflammation or edema resulting in
decreased pressure in the injured area.
3) Possible increase circulation to injured area
by creating more space.
4) Stimulation of mechanoreceptors possibly
decreasing pain.
Moving
Function/Marik
Kase K, Wallis J, Kase T. Clinical Therapeutic Applications
ofTowards
the KinesioTaping
Method. Tokyo, Japan:Ken Ikai Co. Ltd;2003. 32
Spacing Correction Theory:

Tape Pulls Connective Tissue To Area
Method 1 long head of biceps (LHB)
1. Cut a 4 inch I piece. Tear in the
middle and apply 25% to 50%
tension to the middle of the tape.
2. Place the tensioned tape
horizontally on LHB with the
shoulder in 90 of flexion and ER. http://upload.wikimedia.org
wikipedia/commons/f/f2/
3. Move the shoulder to extension Gray411.png
and lay down the ends with no
tension.
33
11
PTAPTM_1275
Theoretical Concept
Spacing Correction
p Longg Head Biceps
p
Example:
Start shoulder flexion 90
Apply tape with 2550% stretch as the

patient moves
Into extension
34
Spacing Correction Theory:

Tape Pulls Connective Tissue To Area
Method 2 LHB
1. Cut 4-5 in strip with tails at each end. Cut
a hole 1/3 larger than the region you want
to lift up.
2. Place the shoulder in 90 of scaption/ER.
http://upload.wikimedi
wikipedia/commons/f/f2/Gray
Tear away center of hole.
411.png
3. Apply 25% to 50% tension in center for the
hole and apply to painful region.
4. Place the shoulder in extension and lay
down ends without tension.
5. Splay the ends.
35
Theoretical Concept
Spacing Correction
Example 2: Long Head Biceps
25-50% stretch
Shoulder extended lay ends down
36
12
PTAPTM_1275
MUSCLE FACILITATION/INHIBITION
GOAL:
1) Facilitation a muscle contraction by using
tape to displace the skin in the direction of
contraction/origin to insertion
2) Inhibit muscle contraction by using the tape
to displace the skin in the direction of the insertion
to origin thereby, reducing a muscle contraction
Kumbrink B, K Taping: An illustrated Guide. Berlin Heidelberg: Springer-Verlag;2012.
37
Muscle Facilitation Theory: Tape Restores

Force on the Skin towards Direction of
Muscle Origin
Method 1: Facilitate/Increase Tone (Deltoids)
Apply tape from muscle origin to insertion
Place shoulder to side in neutral rotation
Apply I strip to acromion
Lie strip down with no tension up to 0 to 50% to
deltoid tuberosity
*Authors vary regarding recommendations for
tension
38
Theoretical Concept
Muscle Facilitation
Example: Deltoids
Tape shrinks towards origin.

39
13
PTAPTM_1275
Muscle Inhibition Theory: Tape Restores

Force on the Skin towards Direction of
Muscle Insertion
Method 1: Inhibit/Decrease Tone (Deltoids)
Apply tape from muscle insertion to origin
Place shoulder to side in neutral rotation
Apply I strip to deltoid tuberosity
Lie strip down with no tension up to 50% to
acromion
*Authors vary regarding recommendations for
tension
40
Theoretical Concept
Muscle Inhibition
Example: Deltoids
Tape shrinks towards insertion.

41
LIGAMENT SUPPORTING
GOAL:
1) Tape increases stimulation of joint

mechanoreceptors for the brain to interpret as
normal tissue Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the KinesioTaping
Method. Tokyo, Japan:Ken Ikai Co. Ltd;2003.
2) Tape pulls ligaments to the middle

42
14
PTAPTM_1275
Ligament Support: Tape pulls osseous

segments together
Example 1: PIP joint index finger
1. Cut an I strip 1 x 1
2. Tear I strip in the middle
3. Place digit in extension
4. Lie the tape down at lateral & medial 50% to
100% stretch
5. Lie ends down with no tension
6. Apply 1 x 1 cross tape (volar/dorsal support)
Moving
Towards
Function/Marik
Kumbrink B, K Taping: An illustrated
Guide.
Berlin
Heidelberg: Springer-Verlag;2012.
43
Theoretical Concept
Ligament Support/PIP Joint Sprain
2
1
44
Ligament Support: Tape pulls osseous

segments together (LCL ankle joint)
Method 1 Ankle
1. Cut an I strip ~1 inch long & 1 inch wide
2. Tear I strip in the middle
3. Place foot in plantar flexion
4. Lie the tape down with 50% to 100% stretch on
talofibular ligament
5. Lie ends down with no tension
45
15
PTAPTM_1275
Theoretical Concept
Ligament Support/Talo-Fibular Joint
Sprain
46
Functional Taping
GOAL:
1) Limit joint motion through sensory stimulation
provided from the tape
Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the KinesioTaping Method. Tokyo, Japan:Ken Ikai
Co. Ltd;2003.
.
47
Functional Tape: Tension on during

undesired motion and off during desired
motion.
Method 1 (limiting wrist extension):
Cut a 6 inch I strip with two diamond shape holes at
one end of tape
Place the index & long fingers through the holes to
apply tape on the volar surface
Place the wrist in flexion
Hold the base down with no tension
Apply 50% to 100% tension in the middle making a
bridge. Move the wrist towards extension while
rubbing on the tape.
Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the KinesioTaping Method. Tokyo,
Japan:Ken Ikai Co. Ltd;2003.
48
16
PTAPTM_1275
Theoretical Concept
Functional Taping/Limit Wrist Flexion
49
Functional Tape: Tension on during

undesired motion and off during desired
motion.
Method 1 (limiting plantar flexion):
Cut a 6 inch I strip with two diamond shape holes at
one end of tape
Place the 2nd & 3rd toe through the holes to apply
tape on the volar surface
Place the ankle in dorsiflexion
Hold the base down with no tension
Apply 50% to 100% tension in the middle making a
bridge. Move the ankle towards while rubbing on
the tape.
Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the KinesioTaping Method. Tokyo,
Japan:Ken Ikai Co. Ltd;2003.
50
Theoretical Concept
Functional Taping/Limit Plantar
Flexion
51
17
PTAPTM_1275
Hand Edema ReductionTaping for

Patient with Healthy Lympthatics
GOAL: Enhance vascular transport systems
by creating space between the skin and
subcutaneous tissue
Space is created by lifting the skin
Movement contributes to loosening of
connective tissue
Tape channels the movement of the fluid
Fluid moved to lower pressure area
MovingSpringer-Verlag;2012
Towards Function/Marik
Kumbrink B, K Taping: An illustrated Guide. Berlin Heidelberg:
52
Edema Tape for High Volume

Insufficiency following Trauma
Fan Tape Method
The base is affixed to
promote flow towards
lymph nodes
Place patient is a stretched
position
Apply strips with 15% to
25% tension
Kumbrink B, K Taping: An illustrated Guide. Berlin
Heidelberg: Springer-Verlag;2012
Retrieved from: http://www.lytnyc

.com/wp-content/uploads/2012/03/l
ymphatic-system-benefits-from-rebounding.
53
Edema Tape for High Volume

Insufficiency following Trauma
Fan Tape Hand Edema
Affix base proximal medial
epicondyle
Pts elbow extended and
wrist flexed
Apply each strip with 15%
to 25% tension and affix
strips between digits
Kumbrink B, K Taping: An illustrated Guide. Berlin
Heidelberg: Springer-Verlag;2012
Retrieved from: http://www.lytnyc

.com/wp-content/uploads/2012/03/l
ymphatic-system-benefits-from-rebounding.
54
18
PTAPTM_1275
Direct Fans Towards Lymph Nodes
http://www.anatomyatlases.org/
AnatomicVariants/Cardiovascular/
Retrieved from: http://upload.wikimedia. Images0400/0455.gif
org/wikipedia/commons/a/aa/Gray606.png
55
Theoretical Concept
Edema Reduction/Hand
56
WHAT YOU NEED TO KNOW!

EVIDENCE
EBM
Retrieved and adapted from: medresidents.stanford.edu/EBP.html on 10/13/08.

Adapted from: Sackett DL, Rosenberg MC, Gray JA, Haynes RB, Richardson WS. Evidence
based medicine: what it is and what it isn't. BMJ. 1996;312: 71-72.
57
19
PTAPTM_1275
RIGID TAPE
HIGH EVIDENCE
Improved posture for patients with
shoulder impingement (Lewis et al
2005)
Upper Trapezius Inhibition for
patients with shoulder impingement
(Smith et al 2009)
Hemiplegic patients had increased
days without pain (Griffin et al 2006)
58
RIGID TAPE
MODERATE EVIDENCE
Delay onset of pain in hemiplegia
shoulder (Ancliff 1992)
Increase GH rotation in healthy
subjects (McIntosh 2009)
L.T. facilitation/U.T. inhibition in
shoulder impingement (Selkowitz et
al 2007)
59
RIGID TAPE
MINIMAL EVIDENCE
Pain relief 3 weeks post injury in patient with
grade III AC ligament injury (Shammus &
Shammus, 1997)
60
20
PTAPTM_1275
ELASTIC TAPE
HIGH EVIDENCE
MacDermids Quality Evaluation Rating:
Immediate decreased pain with ROM, no

difference at 3 days in patients with impingement
(Thelan et al 2008)
Increased scapular posterior tilt and L.T. facilitation
baseball players with impingement (Hsu et al
2009)
Decreased pain at one week, no difference at two
weeks in impingement (Kaya et al 2010)
61
ELASTIC TAPE
HIGH EVIDENCE
Gonzalez-Inglesias et al 2009 short

term pain relief with cervical taping
Immediate increase with ROM and
pain reduction up to 24 hours
Changes were small may not be
clinically meaningful
62
ELASTIC TAPE
MODERATE EVIDENCE
Increase force sense, but no increase

with grip strength in healthy
individuals (Chang et al 2010)
Increase grip strength (Lee et al 2010)
No difference b/w groups treated
with standard decongestive
lymphatic therapy and pnuematic
pump with and without taping (Tsa
et al 2009)
63
21
PTAPTM_1275
STUDIES NOT MAKING THE CUT

Miller et al 2009 trend towards
pain relief at 2 wks, no difference
at 6 wks
Shamus & Shamus 1997 AC joint
taping
Grieg et al 2008 postural taping
for kyphosis
64

Low Evidence
Muro et al 2009 case
report on treatment of
myofascial pain
Karatas et al 2011
decreased neck and low
back pain in surgeons
65

Schneider et al
improved wrist extensor
strength in tennis
athletes
66
22
PTAPTM_1275
THE SHOULDER & POSTURE
Basic Anatomy
Shoulder Girdle Posture and Biomechanics
Lab: UE posture assessment, taping, exercise
Dynamic Stabilizers
Rotator Cuff/Impingement
Taping and Exercise
Static Stabilizers
GH Instabilities/Arthropathy
Lab: Taping and Exercise
TOS taping
Review Hemiplegic Shoulder Taping
BONES OF THE SHOULDER GIRDLE

STATIC STABILIZERS
CLAVICLE
Illustration from:
Terry G, Chopp
T. Functional
anatomy of the
shoulder. Jour
Athl Training,
2000;
35(3):248-255
HUMERUS
SCAPULA
68
Joint Anatomy: 4 Articulations

Stabilizers
Sternoclavicular
Acromioclavicular
Glenohumeral
Scapulothoracic
Retrieved on 2/26/12 from:

http://upload.wikimedia.org/
wikipedia/commons/thumb/5/59/
Pectoral_girdles-en.svg/510pxMoving Towards Function/Marik
Pectoral_girdles-en.svg.png
69
23
PTAPTM_1275
Shoulder Girdle Muscles

The Dynamic Stabilizers
Scapulohumeral
Axioscapular
Axiohumeral
Illustrations:
http://upload.wikimedia.org/wikipedia/common
s/8/8f/Gray412.png
70
SCAPULA POSTURE POSTERIOR LANDMARKS
ACROMION
SPINE OF SCAPULA
LATERAL BORDER
MEDIAL BORDER
Dorsal Scapula
INFERIOR ANGLE
SUPERIOR ANGLE
Retrieved and modified on 06/06/09 from:

http://www.courses.vcu.edu/
DANC291-003/scapula_landmarks.jpg
Moving Towards Funnction/Marik
71
Anterior Landmarks
Coracoid process
Acromion process
Superior angle
Medial border
Lateral border
Inferior angle
Retrieved from:
http://upload.wikimedia.org/wikipe
dia/commons/4/41/Gray202.png
72
24
PTAPTM_1275
Alignment of the Scapula

Vertical Medial Border
Medial Border ~2 to 3
inches from the spine
Position between
~T2 and T7
Dorsal Scapula
Spine of Scapula at ~T4
Retrieved and modified

06/06/09 from:
http://www.courses.vcu.edu/
DANC291003/scapula_landmarks.jpg
20 to 30 Degree Anterior Tilt

73
Sahrmann 2002
Glenoid fossa shallow

and slightly concave.
Oriented anteverted
and upwards facing.

http://www.actaortho.gr/v57t3/U1.jpg
Freidman et al 1992
74
75
25
PTAPTM_1275
Glenohumeral Alignment
Glenohumeral head should be < 1/3 anterior
to acromion
Neutral rotation
Proximal and distal humerus are vertical
76
Changing Posture Has Effect on

Shoulder ROM
Lewis J, Wright C, Green A.
Subacromial Impingement
Syndrome: The effect of changing
posture on shoulder range of
motion. J Orthop Sports Phys
Ther,2005;35:72-87.
Kyphosis associated with decreased
subacromial space (Gumina et al
2008)
77
POSTURE SPINAL ALIGNMENT

CERVICAL: SLIGHTLY
CONVEX CURVE ANTERIOR
THORACIC: SLIGHTLY
CONVEX CURVE
POSTERIOR
LUMBAR: SLIGHTLY
CONVEX CURVE ANTERIOR
Retrieved from: http://upload.

wikimedia.org/wikipedia/commons/
f/f8/Illu_vertebral_column.jpg
78
26
PTAPTM_1275
POSTURE PELVIS ALIGNMENT

Is anterior superior illiac
spine (ASIS) postured in:
Neutral
Anterior
Posterior
Retrieved from: http://upload.wikimedia.org/
wikipedia/commons/3/32/Gray435.png
79
Posture Lab/Assess Your Partners

Posture
Assessment form located in the back of

manual
Assess your partner. Where is scapula
positioned?
Where is glenohumeral joint positioned?
80

Anterior Pelvis Tilt
Hip flexors shorten and
hip extensors lengthen
Retrieved from: http://upload.wikimedia.org/wikipedia/

commons/thumb/e/e2/Anterior_Hip_Muscles_2.PNG/400
Anterior_Hip_Muscles_2.PNG
81
27
PTAPTM_1275

Posterior Pelvis Tilt
Hip flexors lengthen and
hip extensors shorten
Retrieved from: http://upload.wikimedia.org/wikipedia/

commons/thumb/e/e2/Anterior_Hip_Muscles_2.PNG/400
Anterior_Hip_Muscles_2.PNG
82
Abdominal/Pelvis & Pect. Minor

Connection

http://www.midlandstech.com/
science/kelleherk/210/Images/
83
http://dic.academic.ru/dic.nsf/
PracticeQuiz/muscles2.jpg
enwiki/1085537
KINEMATIC CONNECTION
BETWEEN SHOULDER
GIRDLE AND ANTERIOR PELVIS
Short external obliques,serratus
anterior, and pectoralis major
could contribute to anterior
pelvis tilt.
Retrieved from: http://upload.wikimedia.

org/wikipedia/commons/thumb/5/55/Serratus_
anterior_muscle_2.jpg/800pxMoving Towards Function/Marik
Serratus_anterior_muscle_2.jpg
84
28
PTAPTM_1275
KINEMATIC CONNECTION BETWEEN

SHOULDER
GIRDLE AND POSTERIOR PELVIS
org/wikipedia/com
mons/thumb/5/55/S
erratus_
anterior_muscle_2.j
pg/800pxSerratus_
anterior_muscle_2.j
pg
Tight rectus could contribute too posterior

pelvis tilt.
Tight pectoralis minor likely contributing to
scapula anterior tilt.
1.
85
Posture Taping
Changing Posture May Effect Shoulder
ROM
Ask patient to extend their
thoracic spine.
2. Place protective tape from T1
to T7 followed by strap tape.
3. Ask patient to retract and
depress their scapula.
4. Apply protective tape followed
by strap tape from middle of
the scapula spine to T12
diagonally towards spine.
Lewis et al 2005
86
org/wikipedia/commons/thumb/5/
5/Serratus_anterior_muscle_
2.jpg/800px-Serratus_anterior_
muscle_2.jpg
Stretch Quadratus
Lumborum in
the laterally flexed hip.
Supine with ankles dorsiflexed.
Pelvis stabile.
Reach from waist to opposite side keeping
the pelvis stabile.
87
29
PTAPTM_1275
MORE
POSTURE TAPING
Posture Taping for Kyphosis
T6
Greig et al 2008
89
Posture Taping for Kyphosis

1. Ask the patient to elongate their crown of the
head towards the ceiling and draw the shoulder
blades down and together.
2. Apply protective tape from each anterior acromion
over the trapezius moving diagonally to T6. Tape
crosses at T6.
3. Firmly apply the rigid tape to the anterior AC joint
and follow tape to T6.
4. Apply bilaterally.
90
30
PTAPTM_1275
Extension Over The Chair
1. Sit tall with the top of back rest ending at the level of
the mid back.
2. Hands behind your neck and gently arch back in the
chair.
3. Keep cervical spine in neutral (avoid extension).
4. Keep pelvis stable. Should not feel movement at
lumbar spine.
91
Posture Exercise
Thoracic Extension
1. Tighten core and activate transversus Photo retrieved from
http://upload.wikimedia.org
abdominis. Pelvis neutral and stabile. /
wikipedia/commons/3/32/Ill
u_trunk_muscles.jpg
2. Inhale prepare
3. Exhale push up from mat with cervical spine
in neutral. Should not feel any tension in LB.
4. Inhale and return to neutral.
92
93
31
PTAPTM_1275
94
FORWARD HEAD POSTURE
POSSIBLE SHORT SCALENES, LEVATOR SCAPULA,

AND/OR UPPER TRAPEZIUS.
STRETCH TIGHT MUSCLE AND TEACH GENTLE
NODS.
Retrieved from: http://upload.wikimedia.org/wikipedia/commons/6/6e/Scalenus.png
95
1. Stand, holding hand behind back.

2. Lower left shoulder, then tilt your head to the
right.
3. Slowly roll head backwards until a stretch is
felt. Hold for 10-15 seconds.
4. Repeat for other side.
5. Repeat cycle three times, at least three times
daily.
Retrieved on 3/29/10http://img.medscape.com/pi/emed/
ckb/rehabilitation/305143-316715-29.jpg
Scalene Stretch
96
32
PTAPTM_1275
Role of Dynamic Stabilizers
SHOULDER GIRDLE
BIOMECHANICS
Motions of the scapula, humerus,

& clavicle
Ludewig et al (2009). Motion of the Shoulder
Complex during Multiplanar Humeral Elevation. Jour
Bone & Joint Surg, 91:378-89
3 Dimensional Motions of Scapula

Upward
Rotation
Posterior
Tilt
From Int.
Rot.
Towards
Ext. Rot.
Retrieved on
06/3/12:http://nicktumminello.com/wpcontent/uploads/2010/07/F1.large_Moving Tows Function/Marik
98
300x220.jpg
3 Dimensional Motions of Scapula

Upward
Rotation
Posterior
Tilt
From Int.
Rot.
Towards
Ext. Rot.
Retrieved on 06/07/09:
http://www.flzine.com/wpcontent/uploads/2009/03/rotator.gif
99
33
PTAPTM_1275
Upper Trapezius and

Serratus Anterior
provide
rotatory force early
needed for
Upward Rotation.
Upper Trapezius
limiting scapular
internal rotation.
Picture adapted from:

Donatelli, R. (1997).
Picture adapted from: Donatelli, R.

(1997).
100
Serratus Anterior
provide
force for upward
rotation & post
tilt.
Lower/Middle
Trapezius pulls
inferior for ER.
UT limits scap IR
Trapezius
contributes to
post tilt
101
Motions of the Glenohumeral Joint
Retrieved on 08/02/09
from:
http://www.bosshin.com/
_userfiles/image/winging
%20and%20instability.jpg
Head of humerus moves superior in the glenoid.

Rolls and spins ~2 mm to stay centered in the
glenoid fossa. Moves towards external rotation.
Donatelli, R. (1997). Physical
of shoulder. Philadelphia, PA:102
MovingTherapy
Churchill Livingston.
34
PTAPTM_1275
Anterior and Posterior Balance Forces Needed

to Keep the Glenohumeral Joint Centered
Phase I: 0.7 to
2.7mm of anterior
translation.
Phase II: 0-1.5mm
of posterior
translation.
Phase III: 4.5mm
posterior
translation.

http://upload.wikimedia.org/wikipedia/commons/9/
90/Shoulderjoint.PNG Moving Towards Function/Marik
Ludewig & Cook, 2002.
103
CLAVICLE MOTION
Sternoclavicular Joint
Relative to Thorax
Retraction
15 Degrees
Elevation
>10 degrees
from:http://images.goo
gle.com/imgres?imgurl
=http://moon.ouhsc.
Posterior
Rotation
30 Degrees
104
SCAPULAR MOTION
Relative to the
Acromio-clavicular Joint
SCAPULAR UPWARD ROTATION = SC elevation

and posterior rotation with AC upward rotation
POSTERIOR TILT = SC elevation & post rot couples
with AC posterior rotation
EXTERNAL ROTATION = SC retraction couples with
AC internal rotation
Illustration from: Ludewig P, Braman
J. Shoulder impingement: Biomechanical105
considerations in rehabilitation. Manual Ther, 2011;16:33-39
35
PTAPTM_1275
Rotator Cuff
Tendinopathy/Impingement
OUCH!

http://upload.wikimedia.org/wikipedia/
commons/d/d3/MRI._Subacromial_impi
ngement..jpg
106
Pain Localization
Rotator cuff tendinopathy referred

pain at anterior lateral arm and night
pain
Acromioclavicular arthritis or AC
injury pain at superior anterior
shoulder
Radiculopathy presents as medial
scapular pain and/or parathesia
below the elbow
107
Changes to the Relationship of the Humerus and

Scapula
Primary Impingement
Secondary Impingement
Posterior Impingement(internal or undersurface)
Anterior Impingement
Coracoid Impingement Syndrome
108
36
PTAPTM_1275
Hawkins & Kennedy Test

Scapular Plane
Position of test for impingement against

the coracoacromial arch forcing rotator
cuff tendons under arch
and against coracoid process.
109
Hawkins & Kennedy Test

Patient Position:
90 degree flexion in scapular plane.
Examiner:
Examiners hand on patients elbow while other hand
applies overpressure towards IR.
Positive Test:
Pain at anterosuperior shoulder.
110
Palpate Supraspinatus Tendon
from:http://www.thefreelibrary.com/
Optimal+methods+for+shoulder+tendon+palpation
:
+a+cadaver+study-a018061609
Image retrieved on
9/17/11 from:
http://t2.gstatic.com/ima
?q=tbn:ANd9GcQOmUSo
V2iYOXqf0YxxoUYT4ikh
v0vrAOg2TVHd9TYloV9fC
111
37
PTAPTM_1275
Palpation of Subscapularis Tendon
Illustration from: Mattingly

Mackeray. Optimal
Moving Towards&
Function/Marik
112
Method for Shoulder Tendon Palpation. Phy Ther, 1996; 76(2):167-
Palpate Infraspinatus Tendon
Illustration from Mattingly &

Mackeray, Phy Ther, 1996; 76(2):167-174.
http://t1.gstatic.com/images?q=tbn:ANd9GcR
96vynm9uTd8IYbJTFwHihOQhxpONZNybXZjhq
0EaTsLSkiVtW
113
Hung C, Jan M, Lin Y, Wang T, Lin J.

Scapular kinematics and impairment
features for classifying patients with
subacromial impingement syndromes.
Manual Ther, 2010;15:547-551.
Prediction Variables for Impingement

114
38
PTAPTM_1275
EVIDENCE
Ludewig, P., Cook, T. (2000). Alterations in
Shoulder Kinematics and Associated Muscle
Activity in People with Symptoms of Shoulder
Impingement. Physical Therapy, V 80, 3, 276291
Retrieved on 03/20/09 from

http://images.google.com/
Moving Towards
Function/Marik
images?hl=en&q=sheet+
metal+workers&btnG
115
EVIDENCE
Ludewig, P., Cook, T. (2002). Translations of
the Humerus in Persons with Shoulder
Impingement Symptoms. Jour Ortho & Sports
Phys Ther, 32 (6), 248-259.
Retrieved on 05/30/09 from

http://www.rehab.research.va.gov/jour/03/4
0/4/mcmahonf04.gif
116
Biomechanic Mechanisms
Mechanism
Inadequate Serratus
Activation
Excessive Upper Trapezius
Recruitment
RTC inadequate
Posterior Capsule Tight
Effect
Ludewig & Reynolds, 2009
Decreased upward
rotation/posterior tilt
Increased clavicle
elevation & decreased
posterior tilt
GH not centering
Increased scapula anterior
tilt, humerus translation
ant or sup
Humeral and/or scapula IR
Pect Major and/or Pect

Minor Tightness
117
39
PTAPTM_1275
THERAPEUTIC GOALS
1. Decrease clavicle elevation & scapula posterior tilt
Inhibit Upper Trapezius activity & SA recruitment
2. Increase upward rotation/posterior tilt

Facilitate Serratus Anterior and Lower Trapezius
3. GH not centering
Improve extensibility of capsule & cuff
Improve strengthMoving
of Towards
rotator
cuff
Function/Marik
118
THERAPEUTIC GOALS
4. Decrease humerus translation anterior or
superior
Increase extensibility posterior capsule/cuff
5. Humeral and/or scapula IR

Increase extensibility of pectoralis minor &
thoracohumeral muscles (pect major/lat dorsi)
119
TAPING
AND
EXERCISE LAB
120
40
PTAPTM_1275
Goal #1: Decrease clavicle elevation & posterior

tilt
-Inhibit Upper Trapezius activity & SA recruitment
Goal #2: Increase upward rotation/posterior tilt
-Facilitate Serratus Anterior and Lower Trapezius
Rigid Tape for Impingement: UT Inhibit

Elastic Tape for UT Inhibition
Lower Trapezius (LT) Exercises
Serratus Anterior (SA) Facilitory Taping
SA Exercises
121
Rigid Tape for Impingement:

UT Inhibit
1. Apply protective tape over the
skin
2. The base is placed at the
ant/medial clavicle and extends
posterior in a caudal direction
towards paraspinal region just
proximal to LT origin.
3. Apply rigid tape on top with
compression over the UT.
SELKOWITZ 2007
122
Elastic Tape:
UT Inhibition for Impingement
1. Cut a Y strip ~8-9 inches

2. Place the base at acromion
with pt positioned in
contralateral side flexion.
3. Envelop UT with tape tails
& light stretch. Tails lie
down without tension.
4. Some authors recommend
up to 50% tension, Hsu
studied described no
tension.
(Hsu et al 2008)
123
41
PTAPTM_1275
Lower Trapezius Facilitation

Cut an I piece from ~T12
to acromion.
Place patients arm in
horizontal abduction.
Apply base with no
tension in region of T12.
With 0% to 50% tension
apply tape towards
acromion.
No tension at tail.
124
Option Elastic Tape:

LT Facilitation for Impingement
1. Cut a Y strip ~8-9 inches
2. Place the base at acromion
(per Hsu study).
3. Envelop the muscle with
light stretch. Bring tails to
~T12. Apply the tails with
minimal tension.
4. Some authors recommend
up to 50% tension, Hsu
studied described no
tension.
Pt in Horz Abd
(Hsu et al 2008)
125
EXERCISE GOAL
FACILITATE LOWER TRAPEZIUS
FACILITATE SERRATUS ANTERIOR

INHIBIT UPPER TRAPEZIUS
Goal #1: Decrease clavicle elevation & increase
posterior tilt
-Inhibit Upper Trapezius activity & SA recruitment
Goal #2: Increase upward rotation/posterior tilt
-Facilitate Serratus Anterior and Lower Trapezius
126
42
PTAPTM_1275
Perform Exercises after Taping

Phase I: Lower Trapezius Exercises
Small lift from the pillow and pull the inferior border
of the scapula towards the spine. Hold contraction
6 seconds.
127
Phase II For Lower Trapezius

Emphasis on adduction combined with
depression
when working on scapula force couple.
128
Phase III: Lower Trapezius
Patient is supine with arms in external rotation.

Patient lifts his arms to approximately 125
horizontal abduction. Instruct the patient to hold
arms at shoulder level while sliding the scapula
down (towards back pocket).
De Mey et al 2009
129
43
PTAPTM_1275
SERRATUS ANTERIOR FACILITATION

TAPING FACILITATE SERRATUS
1. Apply tape I strip anchoring
at the upper 6,7,8,9 ribs.
2. Follow the tape up to medial
border of the scapula with up
to 50% tension.
3. Rub to activate glue.
Photo retrieved from: http://

openphysio.co.za/images/
thumb/5/5d/Levator_
scapulae.jpg/150px-Levator
_scapulae.jpg
130
Serratus Anterior Facilitation
131
Phase I: Serratus Anterior
Inferior Glide: Arm is scaption to 90, wrist neutral,

elbow extended, fist clenched on a supportive
surface. Patient applies pressure towards
adduction and inferiorly depressing the scapula.
Hold 6 seconds. Ekstrom et al 2003.
132
44
PTAPTM_1275
Phase II: Serratus Anterior

Wall Slides:
Ulnar side of forearm
pushes into the wall as
patient slides up the
wall. Relax on the way
down.
One foot forward and
one foot back.
Engage core.
Suenaga et al 2003
133
Phase III: Serratus Anterior
Dynamic Hug: Horizontal flexion of humerus at 60

elevation. The hands follow an imaginary arcc until
maximum protraction is attained.
Decker et al, 2003
134
Phase IV: Serratus Anterior
Push-Up Plus: Patient performs a standard push up

followed by a protraction.
Can start push-ups on the wall, progress to knee pushups.
135
45
PTAPTM_1275
Goal #3: Center GH in Glenoid

-Improve extensibility of capsule & cuff
-Improve strength of rotator cuff
Goal #4: Decrease humerus translation anterior
or superior
-Increase extensibility posterior capsule/cuff
Tape to decrease/feedback to decrease anterior
translation of humeral head
Mobilize and stretch tight muscles and capsule
136
Elastic Tape to Decrease GH Anterior

Translation
Pts GH joint
in neutral
rotation.
1. Cut an I strip to wrap ant/posterior humeral head.
2. Tear the tape in the middle.
3. Apply tape with 50% to 75% tension on the anterior
humeral head.
4. Lie tails down without tension.
137
Stretching Posture Capsule

Stabilize the lateral
border of the scapula
with the heal of one
hand.
Apply overpressure
towards horizontal
adduction while
stabilizing the scapula.
138
46
PTAPTM_1275
Taping and Exercise Lab:

Posterior Capsule Stretching
MOBILIZE GH JOINT
POSTERIOR CAPSULE/CUFF STRETCHING
139
Goal #5 :Humeral and/or scapula IR

-Increase extensibility of pectoralis minor &
thoracohumeral muscles
Stretch Tight Muscles
Stretch Pectoralis Minor
Stretch Pectoralis Major
Stretch Latissimus Dorsi
Consider Kinetic Chain
Photos retrieved from:
from:http://images.google.com/imgres
?imgurl=http://upload.wikimedia.org/wikipedi
140
Taping for Tight Pectoralis Major

Inhibit Pectoralis Major:
1. Measure I strip from
intertubercle groove to
sternum with abd/ER(90/90).
2. Apply the base at the
intertubercle groove.
3. Lie one tail down along the
clavicle and the other tail on
sternocostal head with light
tension while the patient is
in 90/90 position.
Photo retrieved from:

Moving Towards
Function/Marik
: http://openphysio.co.za/images/
141
thumb/5/5d/Levator_scapulae.jpg/150px-
47
PTAPTM_1275
Possible Muscle Imbalances

Anterior
Tilt
Anterior tilted scapula

Tight pectoralis minor?
Does the inferior angle of the scapula protrude
from the thorax?
Is there an asymmetry between the posterior
acromions when patient is supine
142
Taping for Scapular Anterior Tilt

Inhibit Pectoralis Minor:
1. Cut a Y strip measure
from coracoid process to
rib 3, 4, & 5.
2. Patient pulls his scapulae
together and down.
3. Place the base at the
coracoid process.
4. Place each tails down
with light tension.
Photo retrieved from:
: http://openphysio.co.za/images/
thumb/5/5d/Levator_scapulae.jpg
/150px-Levator_scapulae.jpg
143
Evidence for Pectoralis Minor

Stretching
1
2
2
Unilateral Self Stretch
Borstad, J., Ludwig,P. (2006). Comparison

of three
stretches for the pectoralis minor muscle.
Moving Towards
Function/Marik
144
J Shoulder & Elbow Surgery, 15:324-330.
48
PTAPTM_1275
PECT. MINOR STRETCHING & MANUAL

TECHNIQUES FOLLOW WITH TAPING
1. Stabilize pect minor at the coracoid process in a loose

position with arm adducted to the side.
2. Bring the arm to ~140 horizontal abduction. The arm
should be parallel to the table without extending the GH
joint below the table.
Technique retrieved from: http://www.mikereinold.com/wp-content/uploads/blogger/12Moving Towards Function/Marik
image%5B64%5D.png
145
IMPINGEMENT
TAPING
146
Immediate Pain Relief for Pain Free Abd

STEP 1
1. Cut a Y strip the length

of supraspinatus from
origin to insertion.
2. Pt side bends cervical
spine to opposite side
and involved hand
internally rotated
behind the back.
3. Apply base with no
tension.
4. Apply tails to surround
supraspinatus.
Thelan et al 2008
147
49
PTAPTM_1275

Step
1. Cut a Y piece from deltoid
insertion to origin.
2. Place base of Y strip at
deltoid insertion.
3. Place patient external
rotation with the shoulder
abducted to 90
4. Anterior tail is applied to
anterior deltoid with light
tension.
Thelan et al 2008
148

Step 3
1. Place patient in internal
rotation and slight
horizontal abduction.
2. Posterior tail is applied to
posterior deltoid with
light tension. with the
patient in horiz. Abd and
internal rotation.
Thelan et al 2008
149

Step 4
1. Cut an I tail measuring from

coracoid process to scapula.
2. Apply the base of tape at the
coracoid process.
3. Hold base down.
4. Apply tape with ~75% tension with
downward pressure around the
head of the humerus.
5. Patient actively flexes the shoulder
with slight IR while tape is being
applied.
Thelan Moving
et al 2008
150
50
PTAPTM_1275
Rigid Taping for Impingement Pain

Relief
1st strap anchored over

anterior deltoid and extends
posterior along spine of
scapula.
2nd strap anchored at corocoid
process and extends posterior
and inferomedially over
scapula to imitate the line of
pull of LT
Miller et al 2009
151
Taping to Increase GH Rotation

Secondary Impingement and/or
Posterior Impingement?
1. Apply protective piece at
anterior humeral head.
2. Pass tape over and lateral
to the acromion process.
3. Finish tape at the inferior
angle of the scapula.
4. Rigid tape is applied over
the protective piece
tension over the head of
the humerus.
152
Long Head of Biceps Taping

Step 1
1. Cut a Y strip from cubital
fossa to glenoid fossa.
2. Patients elbow is
extended.
3. Apply the base of the strip
at the radial head with no
tension.
4. Apply each tail with paper
off tension surrounding the
bicep muscle.
153
51
PTAPTM_1275
Long Head of Biceps Taping

Step 2
1. Cut a Y strip from the pain
point to lateral shoulder.
2. Patients shoulder is
extended.
3. Apply the base to the pain
point without tension.
4. Apply the tails with 25%
tension in the transverse
direction.
154
CONTRIBUTIONS OF GH
STATIC STABILIZERS
155
GLENOHUMERAL STABILIZERS
STATIC
DYNAMIC
Geometry of GH joint
Muscles
Scapular Stabilizers
Glenoid Labrum
Rotator Cuff Muscles
Negative intra-articular
Long head of the
pressures
biceps
Ligaments/Capsule
Finnoff J, Doucette S, Hicken G. Glenohumeral instability and dislocation. Phys

Moving2004;15:575-605.
156
Med and Rebab Clinics of N Amer,
52
PTAPTM_1275
Static Stabilizers
1. Bone Congruency/Geometry of Glenohumeral
Joint
Retr:
Humeral head to shaft

angle 130 to 150
Retroverted 30
Contributes to posterior
inferior stability.
Illustration: http://upload.wikimedia.org/
wikipedia/commons/thumb/0/04/Leonardo_da
_Vinci_-_Anatomical_studies_of_the_
shoulder_-_WGA12824.jpg/421px-Leonardo
_da_Vinci_-_Anatomical_studies_of_the_shoulder_-_WGA12824.jpg
157
Static Stabilizers
2. Glenoid Labrum
Fibrocartilaninous Structure
^ depth of glenoid
fossa by 50%
Provides attachment of
GH ligaments
Firmly attached in all
regions except loosely
superiorly
Illustration retrieved from
http://www.sportsinjuryclinic.net/
gallery/shoulder/glenoid_labrum2.jpg
158
Static Stabilizers
3. Negative intra-articular pressures
4. Negative Intra-articular Pressure

Creates a vacuum effect across GH joint
Primary stabilizer against inferior instability
Also prevents instability in other directions
Illustration retrieved on 2/26/12 from:
http://www.shoulderdoc.co.uk/images/uploaded/labrum_depth.jpg
159
53
PTAPTM_1275
Static Stabilizer
4.Capsule & Ligaments
Superior
Middle
Inferior
Coracohumeral
Illustrations:
http://upload.wikimedia.org/wikipe
dia/commons/3/3b/Gray326.png
160
Capsule Instabilities
LH BICEPS
SGHL
Posterior
Capsule
MGHL
ANT. BAND
IGHL
IGHL
Post. Band
IGHL
CAPSULE
Retrieved and modified on 7-4-10 from:

http://www.eorif.com/Shoulderarm/Shoulder%20anat/Images
/Shoulder-ligaments.jpg
Download from
website
161
ANTERIOR INSTABILITY
Picture retrieved from: http://upload.wikimedia.org/wikipedia/commons/3/3b/Gray326.png

162
54
PTAPTM_1275
Stabilizers Against Anterior Dislocation

Humerus adducted: Subscapularis
Humerus abducted 45: Subscapularis, Middle
anterior GH Ligament, and Superior portion of
Inferior Anterior GH Ligament
Humerus at 90 abduction: Inferior Anterior GH
Ligament
Retrieved from: http://www.radsource.

us/_images/0909_6.jpg
Turkel et al 1981
Illustration retrieved on 3/5/12 from

http://www.acta-ortho.gr/v57t3/U5.jpg
163
164
Anterior Instability
Instability of the anteriorinferior glenohumeral
joint capsule.
OR
Detachment of the
http://images.conquestchronicles.
com/images/admin/shoulder_bankart_lesion_85905_2.jpg
anterior-inferior glenoid
labrum from the glenoid
rim.
Illustrationfrom:http://www.bosshin.com/_
userfiles/image/normal%20hammock.jpg
165
55
PTAPTM_1275
Apply an antero-medial glide to humeral

head
0 to 30 degrees
Ant/Sup Capsule
45 to 60 degrees
Ant/Middle
Capsule
90 degrees
Ant/Middle Capsule
Acute
166
Frequency
Acute injury resulting in

subluxation or dislocation
TUBS: traumatic, unilateral,
bankart
98% of cases dislocate anteriorly, 2%
posterior
Chronic
Repetitive instability episodes

AMBRI: atraumatic,
multidirectional, bilateral,
rehabilitation, inferior shift
Illustration retrieved from:

http://www.theshouldercenter.com
/images/RecurrentInstabilityGrap
h.JPG
Illustration retrieved from:

http://images.conquestchronicles.com/i
167
mages/admin/shoulder_bankart_lesion
85905 2.jpg
SECONDARY IMPINGEMENT

http://www.baseballmusings
.com/archives/JeterThrow5150361
_Yankees_v_Royals.jpg
Impingement related to an anterior

instability.
Andrews & Alexander, 1995.
168
56
PTAPTM_1275
LAB: TAPING FOR ANTERIOR

INSTABILITY
Tape is applied to anterior
humeral head.
Pull tape diagonally across
the scapula.
End the tape medial to the
inferior border of the
scapula.
Finn off J, Doucette S, Chicken G.
Glenohumeral instability and dislocation. Phys Med
and Reba Clinics of N Amer 2004;15:575-605
169
Instability Superior Labrum AnteriorPosterior

SLAP
Etiology: Fall on an
outstretched abducted arm

or sudden contraction of
biceps tendon or repetitive
stress.
Symptoms:
Painful popping,
clicking, or catching
Pain when moving arm
overhead
Illustration retrieved on 3/5/12 from:

from:http://www.athleticadvisor.com/
images/shoulder/SLAP/SLAP_types2.gif
Illustration from:
http://www.ptclinic.com/medlibrary/
images/v2/slapbankart.gif
Moving Towards
Function/Marik
170
SLAP:Superior Labrum Anterior Posterior

Type I/Fraying
Type II/Biceps & Labrum are
becoming detached
Type III/Biceps & Labrum are
stable on glenoid, but a flap
hangs down
Type IV/Bucket handle tear
extending into the biceps
Retrieved on 7-4-10
from:http://www.athleticadvisor.com/
images/shoulder/SLAP/SLAP_types2.gif
171
57
PTAPTM_1275
Peel Back Mechanism in Throwing

Athletes
Retrieved from: http://2.bp.blogspot.com/_

BsgqbRhgCnQ/SRtejHI0PvI/AAAAAAAAANA/
vMjopqYdgrs/s400/SLAP-peel-back.jpg
Retrieved from: Braun S, Kokmeyer D, Millett P.

Current Concepts Review: Shoulder Injuries in the
Throwing Athlete. Jour Bone & Jt Surg, 2009;91(4):
High eccentric activity of the biceps during

arm deceleration.
Torsional peel back force detaching labral
anchor.
172
Lab: Taping to Improve IR for Individuals with

Humeral Head Anterior Translation (2 strips)
Mc Intosh 2009
1. Apply two protective
pieces of tape from
anterior aspect of
humeral head.
2. Apply tape passing
over and lateral to the
acromion and finish at
inferior angle of the
scapula.
173
Elastic Tape to Decrease GH Anterior

Translation
Pts GH joint
in neutral
rotation.
1. Cut an I strip to wrap ant/posterior humeral head.
2. Tear the tape in the middle.
3. Apply tape with 50% to 75% tension on the anterior
humeral head.
4. Lie tails down without tension.
174
58
PTAPTM_1275
Taping and Exercise Lab:

Posterior Capsule Stretching
MOBILIZE GH JOINT
POSTERIOR CAPSULE/CUFF STRETCHING
175
LATE PHASE
ISOTONIC RTC & SCAPULAR STABILIZATION
EXERCISES
10/10 (ER/ABD) to 45/45 TO 90/90
POSITION
RTC STRENGTHENING
176
177
59
PTAPTM_1275
Proprioception Training
178
179
180
60
PTAPTM_1275

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THERAPEUTIC TAPING,

EXERCISE & POSTURE

Moving Towards Function/Marik

Lab: Shoulder Girdle Taping and Exercise

Lab: Evidence for Impingement taping

BENEFITS OF RIGID TAPE

Moving Towards Function/Marik

THEORETICAL CONSTRUCTS FOR

THEORETICAL CONSTRUCTS FOR RIGID

Moving Towards Function/Marik

THEORETICAL CONSTRUCTS FOR RIGID

THEORETICAL CONSTRUCTS FOR RIGID

Photo from: Morrissey 2000

Theory: Hold muscle in lengthened

THEORETICAL CONSTRUCTS FOR

Image retrieved from:

Moving Towards Function/Marik

THEORETICAL CONSTRUCTS FOR

Moving Towards Function/Marik

THEORETICAL CONSTRUCTS FOR

Moving Towards Function/Marik

Moving Towards Function/Marik

Moving Towards Function/Marik

Apply to clean, dry skin. Remove oils from skin

Skin allergies or sensitivity to tape

Peripheral vascular disease

Peripheral vascular disease

Moving Towards Function/Marik

OTHER THEORETICAL CONSTRUCTS

MECHANICAL CORRECTION/Skin Function

Moving Towards Function/Marik

Mechanical Correction Theory: Tape

1) Mechanical correction for tennis elbow. Cut Y

Moving Towards Function/Marik

Mechanical Correction Theory:

Moving Towards Function/Marik

Kase K, Wallis J, Kase T. Clinical Therapeutic Moving

Theory: Limit Fascia Movement

the corrective position or limit the

Moving Towards Function/Marik

2) Create more space in the area above pain,

Spacing Correction Theory:

Start shoulder flexion 90

Apply tape with 2550% stretch as the

Moving Towards Function/Marik

Spacing Correction Theory:

Moving Towards Function/Marik

Shoulder extended lay ends down

Moving Towards Function/Marik

Muscle Facilitation Theory: Tape Restores

Kumbrink B, K Taping: An illustrated Guide. Berlin Heidelberg: Springer-Verlag;2012.

Tape shrinks towards origin.

Muscle Inhibition Theory: Tape Restores

Kumbrink B, K Taping: An illustrated Guide. Berlin Heidelberg: Springer-Verlag;2012.

Tape shrinks towards insertion.

1) Tape increases stimulation of joint

2) Tape pulls ligaments to the middle

Moving Towards Function/Marik

Ligament Support: Tape pulls osseous

Moving Towards Function/Marik

Ligament Support: Tape pulls osseous

Moving Towards Function/Marik

Moving Towards Function/Marik

Functional Tape: Tension on during