Chapter 18 Taping and Bandaging

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Taping and bandaging are both useful skills in wilderness medicine. Taping can be used to support injured joints and soft tissues; bandaging is most often used to secure a wound dressing (Figure 18-1, online). In addition, bandaging with an elastic wrap is an alternative to taping, and, over larger joints such as the knee, it is often preferable.

FIGURE 18-1 Athletic tape (front row) and elastic bandages (back row) come in varying sizes.

In general, taping requires practice and experience, but some simple techniques can be easily mastered. Taping is most often used for mild to moderate sprains and strains, with which some functional capacities (e.g., weight bearing, lifting), are maintained. Although taping offers dynamic support, it is in no way comparable with splinting, which is intended to immobilize an extremity. The most common tape that is applied is white athletic or “adhesive” tape, which is often used by athletic trainers in organized sports. Athletic tape may be applied to the skin, although it may lose adhesion if the body part is not shaved and if tape adhesive is not applied.

Some keys to successful taping include the following:

Bandaging is accomplished with the use of either elastic wraps or gauze rolls of varying widths. After a dressing is applied to a wound, appropriate bandaging allows the patient to feel confident that the dressing will remain secure during reasonable amounts of activity.

Regardless of the method used, it is important to remember that taping and bandaging—especially when circumferential—should not be so tight as to limit circulation.

Taping

Types of Tape

Athletic tape is composed of fibers that are woven into strips and that are coated with zinc oxide, which is an adhesive compound. Although athletic tape is most commonly colored white, it is available in many colors. Athletic tape is the most commonly used tape in sports and first aid for support and for the prevention of injuries. It is also available in many widths. Although the major advantage of athletic tape is versatility, its major disadvantage is the tendency of zinc oxide to lose adhesive properties with heat and moisture, thereby resulting in a loss of support when the patient sweats. A variety of techniques, which are described later in this chapter, are used to increase the durability of athletic tape under these conditions.

Elastic tape (e.g., Elastikon) is cotton elastic cloth tape that incorporates a rubber-based adhesive. The elasticity of this tape allows for greater flexibility, so it is particularly useful for large joints such as the knees and shoulders.

Skin Preparation

Skin preparation involves measures that are intended to increase patient comfort as well as the longevity of tape adhesion. If tape is to be applied directly to skin, the area is usually first shaved to remove hair that may interfere with direct contact. Care must be taken to avoid small abrasions in the skin when shaving, because these can serve as entry sites for infection. If the area cannot be shaved in a clean and deliberate manner, it is advisable to avoid shaving. Any obvious abrasion or other wound should be covered with a thin layer of gauze or a small adhesive bandage before taping.

Some commercially available skin adhesives are available in aerosolized form. These preparations (e.g., Tuf-Skin) use benzoin as the adhesive. Skin adhesive is applied after the skin has been shaved and after all abrasions have been dressed.

If the area is not shaved, a foam underwrap or prewrap is used to protect the patient’s body hair. Prewrap is available in 3-inch–wide rolls in many colors. After the application of a topical skin adherent (e.g., Tuf-Skin), prewrap is applied over the part to be taped in a simple and continuous circular wrap. The prewrap is sufficiently self-adherent and does not need to be taped.

When tape is applied over bony prominences, it can create tension on the skin surface that leads to blistering. Heel-and-lace pads and foam pads are used to provide additional comfort by relieving potential pressure points. Heel-and-lace pads are prefabricated pieces of white foam that are adhered together with petroleum jelly and then applied to the anterior and posterior aspects of the talus when the ankle is taped. Pads of foam can be cut to size to fit over painful areas that need to be taped (e.g., for medial tibial stress syndrome) or used for support in special cases (e.g., for patellar subluxation).

Ankle Taping

The most common injury to the lower extremity while hiking is a sprained ankle. It is usually the result of inverting the ankle on an unstable surface. Pain and swelling linger for several days, so taping can offer support if the patient is able to bear weight. Because most injuries occur to the lateral ligaments, taping supports the lateral surface by restricting inversion. In general, taping the ankle consists of anchor strips on the lower leg and foot, stirrups that run in a medial to a lateral direction underneath the calcaneus, and support from either a figure-8 or heel-lock technique (Figure 18-2). The heel lock requires expertise to perform, so most operators are initially more comfortable with the figure-8 technique.

FIGURE 18-2 Ankle taping. A, With the ankle bent 90 degrees, apply anchors of 1.5-inch–wide tape at the lower leg and the distal foot. B, Apply three stirrups from a medial to a lateral direction in a slight fanlike projection. C, Fill in any gaps with horizontal strips. D, Begin the figure-8 technique. Apply tape across the front of the ankle in a left-to-right direction. E, Continue taping under the foot to the opposite side, and cross back over the top of the foot. F, Complete by wrapping tape around the leg, and end at the anterior aspect of the ankle. G, Apply heel locks for both feet (omit if not familiar with this technique). Start in a left-to-right direction, and apply tape across the front of the joint. H, Wrap tape around the heel (the bottom margin of the tape should be above the superior edge of the calcaneus) to form the first heel lock. I, Continue under the foot to the opposite side, and then cross back over the top of the foot. J, The tape is then brought back around the superior margin of the calcaneus and down and around the heel. K, Finish by wrapping the tape around the ankle. Repeat the figure-8 or heel-lock technique as desired.

Toe Taping

Taping toes that are sprained or fractured is simple and effective. This treatment involves “buddy taping” to the adjacent toe with one or two pieces of tape to provide support. A small piece of gauze, cotton, or cloth should be placed between the toes to avoid skin breakdown.

A sprain of the first metatarsophalangeal joint, which is also known as turf toe, can be a painful and chronic condition. Taping for turf toe is done in an attempt to support and stabilize the joint (Figure 18-3).

FIGURE 18-3 Toe taping.

Lower-Leg Taping

Medial tibial stress syndrome, which is commonly referred to as shin splints, can be taped for support and comfort. Tape is brought from a lateral to a medial direction. A small foam pad can be placed to cover the area of tenderness. Underwrap should be used over a foam pad to secure the pad in place (Figure 18-4).

FIGURE 18-4 Lower-leg taping.

Knee Taping

Because the knee is a large joint, taping requires expertise. Underwrap should not be used, because adequate traction to support the joint can only be achieved by taping directly to the skin. The patient’s knee should be shaved 6 inches above and below the joint line. Standard athletic tape should not be used, because it cannot provide sufficient support. Three-inch–wide elastic tape provides the foundation. Taping for injuries of the medial aspect of the knee is shown in Figure 18-5.

FIGURE 18-5 Knee taping.

Patella Taping

Subluxation of the patella is exacerbated by the stress of walking long distances across uneven terrain. Incorporating a piece of foam into the taping of the knee can help to relieve symptoms. As with all taping around the knee, underwrap should not be used (Figure 18-6).

FIGURE 18-6 Patella taping.

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