CL I NI CAL MET HODS
Proprioceptive shoulder taping
. . . . . . . . . . . . . . .
Dylan Morrissey
Abstract Proprioceptive shoulder taping is a useful adjunct to expert manual and
exercise therapy in the management of shoulder girdle pathology and dysfunction.
Although the exact mechanisms of action are as yet unproven, hypotheses based on
the available literature are presented. These are accompanied by clinical guidelines for
application and case scenarios. # 2000 Harcourt Publishers Ltd
Introduction programmes to attempt to minimize
or reverse these proprioceptive
Normal upper limb function is
de�cits (Lephart 1997; Magee 1996).
dependent on the ability to statically
Taping is a useful adjunct to a
and dynamically position the
patient-speci�c integrated treatment
shoulder girdle in an optimal
approach aiming to restore full pain-
coordinated fashion (Glousman
free movement of the shoulder
1988, Kibler 1998). Movement
girdle. Taping is particularly useful
faults, for example of the scapulo-
in addressing movement faults at the
thoracic `joint', have been clinically
scapulo-thoracic, gleno-humeral and
(Host 1995) and scienti�cally
acromio-clavicular joints.
(Warner 1991, Wadsworth 1997)
The exact mechanisms by which
shown to be strongly associated with
shoulder taping is e�ective are not
common pathologies. Physiotherapy
yet clear but the suggestion is that
Dylan Morrissey MSc MMACP MCSP
which aims to improve joint
Chartered Manipulative Sports Physiotherapist, the e�ects are both proprioceptive
stability, optimal inter joint
Senior Physiotherapist, Sports Gymnasium,
and mechanical.
coordination and muscle function
Mile End Hospital, Bancroft Road,
This paper will attempt to
London E1 4DG, UK has been shown to be clinically
describe the aims, proposed
Chief Physiotherapist
e�ective in the management of a
mechanisms, practical application
adidas Greater London Leopards Basketball Club
variety of shoulder presentations
and clinical context of
(Ginn 1997).
Correspondence to: D. Morrissey
proprioceptive shoulder taping.
Proprioception is a critical
Tel: [phone]
E-mail: [e-mail] component of coordinated shoulder
girdle movement with signi�cant
Received June 1999
Aims of proprioceptive
de�cits having been identi�ed in
Revised December 1999
shoulder taping
pathological and fatigued shoulders
Accepted December 1999
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (e.g. Forwell 1996; Voight 1996; This paper will focus on the �rst four
Journal of Bodywork and Movement Therapies (2000)
Warner 1996; Carpenter 1998). It is of these aims (Table 1), but some
4(3),189^194
# 2000 Harcourt Publishers Ltd an integral goal of rehabilitation of the suggested taping procedures
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JOURNAL OF BODYWORK AND MOVEMENT THERAPIES JULY 2000
Morrissey
Table 1 Aims of taping
1. Inhibition of overactive movement synergists and antagonists.
2. Facilitation of underactive movement synergists.
3. Promotion of optimal inter joint coordination.
4. Direct optimization of joint alignment during static postures or movement.
5. O�oading irritable neural tissue.
6. Direct or indirect reduction of pain associated with movement.
can be modi�ed to achieve the structures in contributing to
other goals, the latter two will be shoulder girdle proprioception while
the subject of a future paper. cutaneous input is regarded as
having a lesser role (e.g. Jerosch
1996; Warner 1996; Lephart 1997;
Fig. 2. Length � tension curves. Although
Possible physiological
Carpenter 1998). Recent research
lengthened muscle has the capability to
mechanisms
has, however, identi�ed that
generate more force, postural muscles
frequently need to be able to generate most
Proprioception is a complex facilitation of proprioceptive
force in inner range positions in which case it
sensation that is di�cult to de�ne cutaneous input by means of taping
is often desirable that they are relatively short.
(Jerosch 1996). Essentially, is e�ective in the normal ankle joint
information from mechanoreceptors in improving reaction speed and
in the skin, muscles, fascia, tendons position awareness (Robbins 1995; that there is little or no tension while
and articular structures is integrated Lohrer 1999). There is also some the body part is held or moved in the
with visual and vestibular input at evidence that taping the patella can desired position or plane. It will
all CNS levels in order to allow inŻuence the relative onset of therefore develop more tension
perception of activity of the vastus lateralis and when movement occurs outside of
vastus medialis obliquus during these parameters. This tension will
. Position sense (static)
quadriceps activation (Gilleard be sensed consciously thus giving a
. kinesthesia (dynamic)
1998). This may be cutaneously stimulus to the patient to correct the
. force detection.
mediated.
Proprioception is particularly
important for upper limb inter joint
Taping as a form of
coordination (Sainburg 1993) due to
proprioceptive biofeedback?
the complexity of the kinetic chain,
the relative lack of osseous stability A potential mechanism by which
and the precision of the tasks proprioceptive shoulder taping may
performed. be e�ective is via augmented
The literature focuses on the cutaneous input (e.g. tape Figs. 5, 6
role of articular and myofascial and 8). Tape is applied in such a way
Fig. 3. The cross bridge cycle. The primary
motor proteins of muscle, actin and myosin,
have a natural a�nity and hydrolyse their fuel
ATP (adenosine-triphosphate), �rst releasing
inorganic phosphate (Pi) then adenosine
diphosphate (ADP). Each of the stages of the
cross bridge cycle is in an equilibrium and can
move in either direction dependent on a
number of factors. The force generated is
dependant on a number of factors including
the stage of protein action, the degree of
overlap of actin and myosin chains (hence the
Fig.1. Proprioceptive summary. Input from a number of peripheral sources is integrated with number of binding sites available) and the
expected movement patterns and the commands sent to the periphery with the result being a CNS amount of motor units recruited and
representation of movement parameters. coordinated.
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JOURNAL OF BODYWORK AND MOVEMENT THERAPIES JULY 2000
Proprioceptive shoulder taping
Fig 4. Elevation of the shoulder girdle. (1)
Fig. 6. Retraction/Upward rotation. From
Anchor strip applied at level of deltoid Fig. 8. Serratus anterior facilitation and
anterior shoulder just below the coracoid to
tuberosity, encircling two-thirds of the inferior angle abduction. From 2 cm medial to
low thoracic (T10) area. The initial pull on the
circumference of the arm; (2) elevatory strips the scapula border, following the line of the
tape is up and then back as the tape comes
applied from posterior arm / deltoid to the ribs down to the mid-axillary line. Four one-
over the midline.
antero-lateral aspect of the base of the neck; third overlapping strips are applied with the
(3) Elevatory strips applied from anterior origin and insertion pulled together and
arm/deltoid to the postero-lateral aspect of bunching the skin.
the base of the neck; (4) locking strip over
tape one.
Fig. 7. Upper trapezius inhibition. From
anterior aspect of upper trapezius just above
Fig. 9. AC joint relocation; From coracoid
the clavicle over the muscle belly to
process over the distal end of the clavicle with
approximately the level of rib seven in a
Fig. 5. Retraction of the shoulder. From the
a downward pull applied just before the tail of
vertical line. Once partially attached a �rm
anterior aspect of the shoulder, 2 cm medial to
the tape is attached to level of rib 6 in vertical
downward pull is applied and the tail of the
the joint line, around deltoid muscle just
line. Only ever applied after successful
tape attached.
below acromial level to T6 area without
application of elevatory taping (Fig. 4).
crossing midline. Tape pull is into retraction.
movement pattern. Over time and Taping as a means of altering tension curve to the left and greater
with enough repetition and muscle function force development in the inner range
feedback, these patterns can become through optimised actin-myosin
learned components of the motor Mechanically, if taping can be overlap during the cross-bridge
engrams for given movements. applied in such a fashion that a long cycle.
This is e�ectively cutaneously underactive muscle is held in a Equally, if taping can be applied
mediated proprioceptive shortened position (Fig. 2) then in such a fashion that a relatively
biofeedback. there will be a shift of the length- short overactive muscle is held in a
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Morrissey
lengthened position (Fig. 2) then
Table 2 Taping guidelines
there will be a shift of the length
tension curve to the right and lesser
. Decide aims of taping
. Decide where tape should be placed
force development through
. Prepare skin
decreased actin-myosin overlap
. Position shoulder
during the cross-bridge cycle at the
. Apply hypoallergenic mesh base tape
point in joint range at which the
. Apply zinc oxide tape with a little tension
muscle is required to work.
. Retest comparable movement sign
. Apply further strips as necessary
The taping method used to inhibit
. Warn patient about potential skin reaction (itchiness, redness, swelling)
upper trapezius activity (tape Fig. 7)
. Give instructions regarding removal
has been investigated in a pilot study
. Tape can be left on for up to 48 h.
(O'Donovan 1997) and shown to
have a signi�cant inhibitory e�ect
on the degree of upper trapezius
activity in relation to lower trapezius mesh tape is applied without tension The scapulo-thoracic joint gains
during elevation. This is (e.g. Me�x, Molnlycke, Sweden). A some stability in relation to medially
demonstrated as soon as the tape is robust zinc oxide tape directed forces from the clavicular
applied. (Strappal, Smith and Nephew, strut via the acromioclavicular joint.
Clinical e�ects of taping the UK) is then applied with a little This still allows a large range and
shoulder girdle can be signi�cant tension and the comparable amplitude of translatory and rotary
and immediate, especially in movement sign reassessed for the movement that is primarily
promoting altered movement e�ect of the intervention. Further produced, controlled and limited
patterns and allowing earlier tapes may then be applied as by the axio-scapular myofascial
progression of rehabilitation. necessary. structures (Kibler 1998).
Recent study has shown that the The taping is continued until the Compromised thoraco-scapulo-
pull involved in applying the second patient has learnt to actively control humeral rhythm results in the
of the two tapes is critical to the movement in the desired fashion, or potential for impingement due to
electromyographic and mechanical the e�ects on symptoms are downward rotation of the glenoid
positional changes observed during maintained when it is not worn. associated with tipping or winging.
successful taping application If the client develops a skin An anterior tilt (tipping, Box 1) of
(Brown 1999). reaction this can either be due to an the glenoid is regarded as being a
The mechanisms by which the allergic reaction, a `heat rash', or signi�cant occult instability risk
above study results, and the because the tape is concentrating too (Kibler 1998).
clinical e�ects seen during much tension in one area. Tension The scapulo-humeral joint relies
application merit further concentrations usually occur around heavily on the passive stability
investigation. the front of the shoulder. Heat provided by the capsulo-
rashes tend to be localized to the ligamentous structures and the
area under the tape and settle dynamic stability provided by the
Taping guidelines
quickly. Allergic reactions are more rotator cu� (Glousman 1988;
It is essential to be clear about the irritating and widespread, and must Harryman 1990, 1992; Terry 1991;
aims of taping in order to ensure be treated with great caution as Payne 1997). This stability is
optimal results. The shoulder is reapplication is likely to lead to a crucially dependent on intact
particularly assessed for its habitual more severe reaction due to immune proprioception (Nyland 1998).
resting position and for movement sensitisation. Disruption by trauma or repetitive
faults contributing to the
presentation.
The skin is then prepared by
removal of surface oils and body Box 1
hair. The shoulder is actively
Downward rotation occurs about an axis located one-third of the length of the spine
positioned in the desired position
of the scapula lateral to the proximal end of the spine of the scapula. Tipping is when
by the patient with the guidance of
the inferior angle protrudes from the chest wall and the coracoid is pulled down and
the therapist, or passively if the
medially as compared to winging where the entire medial border of the scapula lifts
patient is unable to maintain the
o� the chest wall.
desired position. A hypoallergenic
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JOURNAL OF BODYWORK AND MOVEMENT THERAPIES JULY 2000
Proprioceptive shoulder taping
disadvantageous movement patterns . a positive empty-can test (Magee
Box 2
can result in impingement or & Reid 1996, a static resisted
instability either in isolation or more contraction of abduction with the
Scapula setting has been de�ned as
commonly in combination (Warner arm medially rotated and held at
`Dynamic orientation of the scapula
1995). 908 of abduction in the scapular
in a position so as to optimise the
An example of how taping can be plane).
position of the glenoid and so allow
used in the management of a patient . general restriction of gleno-
mobility and stability of the gleno-
with excessive tipping of the scapula humeral accessory joint glides.
humeral joint' (Mottram 1998).
is presented in Case scenario one. . restricted medial rotation with
An example of how taping can be scapulo-thoracic relative
used to elevate a depressed scapula Żexibility on the kinetic medial
and stabilize a traumatically rotation test (Comerford 1992; satisfactory control of scapula
unstable AC joint is presented in Morrissey 1998). movement during functional
Case scenario 2. . painful, weak static resisted activities and had begun to resume
The case histories have been abduction and lateral rotation. some of his sporting activities.
deliberately chosen to show a range . tight overactive pectoralis minor
of taping techniques that can be as demonstrated by the shoulder
Case scenario two
used either in conjunction or in girdle not being able to lower to
isolation. the supporting surface when the A 23-year-old rugby player
patient was supine and gentle presented 2 weeks after a shoulder
pressure was applied antero- pointer (fall onto the point of the
Case scenario one
posteriorly through the coracoid shoulder causing an inferior blow to
process.
A 33-year-old cricketer presented the acromium) and resultant AC
complaining of persistent and joint sprain.
progressive shoulder pain of non- An initial treatment plan was Assessment showed a visible joint
speci�c onset but particularly formulated including: thoracic step with upper trapezius spasm
related to bowling and throwing. manipulation (HVLA thrust) to accentuating this via its attachment
He had experienced episodes of pain increase the available thoracic to the lateral third of the clavicle
towards the end of the previous extension during elevation; (Johnson 1994). Range of movement
season that had not interfered with pectoralis lengthening using trigger was markedly reduced and the
participation nor persisted after the points and speci�c soft-tissue patient complained of constant pain
end of the season. mobilization to decrease the active aggravated by any movement. He
He had experienced problems scapula tipping; local soft-tissue was still using a sling.
from the start of the current season deŻammation with ice; and scapula The scapula was noted to be in a
which had progressed to the extent setting intially in neutral but then downward rotated, depressed
that he was no longer able to bowl incorporated into dynamic position thus accentuating the step
or throw overam, had pain movement. It was decided to and resultant AC joint pain.
persisting between games and emphasize upward rotation and The initial treatment therefore
overhead activities of daily living retraction as he demonstrated an aimed to decrease the resting joint
were compromised. excessively protracted, tipped pain using large amplitude joint
Assessment showed clear scapula during elevation. mobilizations and interferential
impingement features including: The scapula setting (Box 2) therapy which was partially
proved di�cult for the patient to successful.
. localized pain to the front of the master so the shoulder was taped In order to further reduce the
shoulder. (Figs. 5 and 6). This resulted in an resting pain and e�ect the pain on
. a painful arc on mid-range immediate improvement in the movement it was necessary to
elevation that was associated with patient's ability to set the scapula improve the symmetry of the joint
marked protraction and tipping and an improved scapulo-humeral by decreasing upper trapezius
(Norkin & Levangie 1992) of the rhythm associated with a marked activity and facilitating upward
scapula and accentuated on slow decrease in the painful arc rotation and elevation of the
eccentric elevation. symptoms. The taping was reapplied scapula. This was done using tape
. generalized loss of thoracic for 3 weeks while his treatment and (Figs 4, 5, 7 and 9) and reinforced
extension and rotation focused at rehabilitation were progressed to the with soft-tissue techniques (trigger
T5ą7. extent that he had achieved point massage and speci�c
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JOURNAL OF BODYWORK AND MOVEMENT THERAPIES JULY 2000
Morrissey
Journal of Orthopaedic and Sports Norkin CC, Levangie PK 1992 Joint
soft-tissue mobilization) to the
Physical Therapy 23: 111ą119 Structure and Function: A
upper trapezius.
Gilleard W et al. 1998 The e�ects of patellar Comprehensive Analysis. Philadelphia:
An immediate improvement in
taping on the onset of VMO and VL FA Dacis Co
symmetry was noted and a marked
muscle activity in persons with patello- Nyland JA 1998 The human glenohumeral
increase in painfree ROM. He was femoral pain. Physical Therapy 78: joint: a proprioceptive and stability
25ą32 alliance. Knee Surgery Sports
able to discard the sling. Taping
Ginn L et al. 1977 A randomized, controlled Traumatology, Arthroscopy 6:
remained an integral part of the
clinical trial of a treatment for shoulder 50ą61
treatment until he was able to
pain. Physical Therapy 77: 802ą811 O'Donovan N 1997 Evaluation of the e�ect
actively set the scapula
Glousman R et al. 1988 Dynamic of inhibitory taping on EMG activity in
independently. electromyographic analysis of the upper and lower trapezius during
throwing shoulder with gleno-humeral concentric isokinetic elevation
instability. The Journal of Bone and Joint of the upper limb. Unpublished
Surgery 70A: 220ą226 MSc Physiotherapy thesis, UCL,
Conclusion
Harryman DT II et al. 1990 Translation of London
Management of complex neuro- the humeral head on the glenoid with Payne L et al. 1997 The combined static and
passive gleno-humeral motion. The dynamic contributions to subacromial
musculo-skeletal dysfunction and
Journal of Bone and Joint Surgery 72A: impingement: a biomechanical analysis.
pathology at the shoulder girdle
1334ą1343 The American Journal of Sports
requires an individual multi-
Harryman DT II et al. 1992 The role of the Medicine 25: 801ą808
factorial approach based on careful
rotator interval capsule in passive motion Robbins S et al. 1995 Ankle taping improves
assessment. Strategies used to and stability of the shoulder. The Journal proprioception before and afetr exercise
of Bone and Joint Surgery 74A: 53ą66 in young men. British Journal of Sports
improve mobility, reduce pain and
Host H 1995 Scapular taping in the treatment Medicine 29: 242ą247
improve strength need to be
of anterior shoulder impingement: case Sainburg RL et al. 1993 Loss of
combined with dynamic stability
report. Physical Therapy 75: 803ą811 proprioception produces de�cits in
retraining. Taping is a useful adjunct
Howell S et al. 1988 Normal and abnormal interjoint co-ordination. Journal of
to these processes and has the mechanics of the gleno-humeral joint in Neurophysiology 70: 2136ą2147
the horizontal plane. Journal of Bone and Terry G et al. 1991 The stabilizing function
particular advantage of lasting well
Joint Surgery 70A: 227ą232 of passive shoulder restraints. The
beyond the patient-therapist contact
Jerosch J et al. 1996 Proprioception and Joint American Journal of Sports Medicine
thus extending the duration of
Stability. Knee Surgery, Sports 19: 26ą34
therapeutic stimulus. Repetition and
Traumatology Orthroscopy 4: 171ą179 Voight ML et al. The e�ects of muscle fatigue
long duration experience of altered Johnson G et al. 1994 Anatomy and actions on and the relationship of arm
of trapezius muscle. Clinical dominance to shoulder proprioception.
movement is essential in altering
Biomechanics 9: 44ą50 JOSPT 23: 348ą352
established motor engrams and
Kibler WB 1998 The role of the scapula in Wadsworth DJS, Bullock-Saxton JE 1997
overcoming the e�ects of established
athletic shoulder funtion. The American Recruitment patterns of the scapular
inhibition.
Journal of Sports Medicine 26: 325ą337 rotator muscles in freestyle swimmers
Lephart SM et al. 1997 The role of with sub-acromial impingement.
proprioception in the management and International Journal of Sports Medicine
rehabilitation of athletic injuries. The 18: 618ą624
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