LAB # 1 THE ANKLE

OBJECTIVES
To enable students to palpate the surface anatomy of the ankle and foot
To understand the principles underlying prophylactic ankle taping
To learn the closed basketweave tape job
MATERIALS
ankle models
1 trainers tape
heel and lace pads
vaseline
tape scissors
tape remover and towels

PART I PALPATIONS
A. Bony Landmarks
calcaneal tuberosity
sustentaculum tali
medial malleolus
head of talus
navicular tubercle
1st cuneiform bone
metatarsal bones (5)
metatarsal-phalangeal joint (MTP jt.)
sesamoid bones
interphalangeal joints (PIP jts. DIP jts.)
styloid process
lateral malleolus
cuboid bone
sinus tarsi
dorsal pedis pulse

B.
C.
D.
E.
F.
G.
H.
I.
J.

Muscles
Tibialis anterior muscle (Tom)
Extensor hallucis longus muscle (Harry)
Extensor digitorum longus muscle (Dick)
Tibialis posterior muscle (Tom)
Flexor hallucis longus muscle (Harry)
Flexor digitorum longus muscle (Dick)
Peroneus longus muscle
Peroneus brevis muscle

K.
L.
M.
N.
O.
P.
Q.
R.
S.

Ligaments
Anterior Talofibular ligament
Posterior Talofibular ligament
Calcaneal-Fibular ligament
Anterior Tibiofibular ligament
Posterior Tibiofibular ligament
Deltoid ligament

T.

ARCHES
U. longitudinal arch (medial, middle, lateral)
V. transverse forefoot arch
W. Pulse Points
dorsal pedal artery
capillary refill test

PART II TAPING
The Closed Basketweave Ankle Tape Job
X. Prepare the leg for taping: clean, dry and shaven
1. Apply light coat of tape adherent (for practice and play only).
2. Apply two lightly greased heel & lace pads, one o0ver the exposed tendons
on the dorsum of the foot, and the other over the Achilles tendon.

3. Apply 2 or 3 anchor strips to the base of the calf flair,

and 1 or 2 fore-foot anchors centred over the styloid
process. Dont forget to splay the fore-foot!!. The strips of
tape should overlap by width. NO shadows or
windows!!!
4. Apply a vertical stirrup by starting the tape on the
MEDIAL side of the ankle (for INVERSION sprain), passing
the tape under the foot and applying tension up on the
LATERAL side to evert the foot before attaching the tape
on the anchor. Put all stirrups under the heel pad.
5. Apply a horizontal horseshoe, making sure to start and
finish it on the fore - foot anchors.

A second stirrup and horseshoe is followed by a third set to

complete the basket weave
the stirrups should lie just in front, directly over, and just posterior to
the malleoli.
Care must be taken to avoid running the tape close to the styloid
th
process of the 5 metatarsal

the horseshoes should lie just inferior to, directly over,

and just superior to the malleoli

6. close down from the calf to a point just below the

malleoli and from the forefoot anchors back so that no
windows or shadows are present.

7. Apply a MEDIAL heel lock by running the tape down the

LATERAL side of the ankle, looping the heel on the MEDIAL
side, and bringing the tape back up the LATERAL side of the
foot
A. The tape can be torn at this point, or, if a continuous application is
desired, the tape would be taken around the ankle to line the tape
up correctly for the next heel lock

. 8.
A LATERAL heel lock is then applied by running
the tape down the MEDIAL side of the ankle, looping the heel on
the LATERAL side, and bringing the tape up correctly for the
next heel lock
One more heel lock must be applied to each side.
DO NOT tape an ankle when:
the injury is still in the acute or subacute stages
further assessment is required
immediately after the application of cold or where there is
significant swelling

NOTES:

LAB # 2 THE ANKLE

OBJECTIVES
To learn and practice the on-field examination of the acute ankle injury
To learn the MODIFIED GIBNEY prophylactic tape job
MATERIALS
1 trainers tape
heel and lace pads
vaseline
tape scissors
tape remover and towels

PART I EXAMINATION OF THE ANKLE

1.
History
What happened?
Any noises associated with the injury?
Has it happened before?
Pain?
2.
Observation
Swelling?
Obvious fractures?
Dislocation?
Discoloration?
3.
Palpation
Hot spots?
Fracture site?
Dislocation?
Pain?
4.
Evaluation of Function
Passive ROM,
Active ROM,
Resisted ROM
5.

Stress tests

Fibular compression
Malleolar compression
Styloid compression
Thompson test
Anterior Drawer test
Posterior Drawer Test
Talar Tilt Test
Hyperdorsiflexion test
NOTES:
Y. Do the examination immediately! Muscle spasm will create false negative test
with time

Z. Each test is for a specific ligament, so the motion of the stress test must be
carefully controlled to isolate that ligament and minimize the pain to the athlete
AA.
Calm the athlete as much a possible and put in a comfortable position to
assess. Do not be scared away from a thorough assessment by the presence of
pain. Get a baseline for individual joint laxity by testing the non-injured joint first.
BB.
Save for last those tests that will stress the tissue(s) you suspect have
been injured, according to the mechanism of the injury
PART II TAPING
CC.
Modified Gibney
Note: This tape job is very similar to the basketweave except that it keeps a lot of the
tape off the forefoot. It is very useful for athletes who have pes planus or whose forefoot
splays excessively upon weight-bearing
1.
Prepare the leg for taping: clean, dry, tape adherent applied and heel and
lace pads in place over the extensor and achilles tendons.
2.
Apply 2 or 3 anchors around the leg, just below the flare of the calf (try to
get the 6 above the malleoli, but dont wrap them around the muscle bulk
3.
Apply three stirrups in succession, lying just in front, just over and just
behind the malleoli
4.
Close down from the leg anchors making sure you DO NOT start or end a
piece of tape on a heel and lace pad
5.
Apply 2 heel locks to each side of the ankle as in the basketweave.
6.
Apply fan and 3 anchors (2 @ original anchor, 1@ just superior to
malleoli)

NOTES:

LAB # 3 THE ANKLE

OBJECTIVES
To give students a thorough understanding of the RICE theory of treating the
acute injury
To give students the theory and application of both the Achilles and Low Dye
Tape jobs
MATERIALS
3 roll of elastic tape
1 trainers tape
tape scissors, tape remover
Band-Aid or heel and lace pads
vaseline
tape scissors
tape remover and towels
PART I TREATMENT OF THE ACUTE INJURY
First, rule out fracture or dislocation. Do not touch if you suspect a break!
Move the injured athlete from the playing surface so the game may restart. Have
the athlete lie down so that the leg may be elevated above the level of the heart
APPLY ICE
DD.
use crushed ice in a plastic bag wherever possible. Mould the ice to the
contours of the ankle
EE.
apply for 20 min on, 40 min off; min. 4x per day
APPLY COMPRESSION.
Use a tensor bandage (3) to wrap the entire lower leg, i.e. Lower calf, ankle, on
top of the ice bag and the entire foot, right over the ends of the toes
ELEVATE the whole leg for the 20 minute ice application and whenever possible
thereafter
Have the athlete do some active RANGE OF MOTION exercises in a PAIN
FREE arc: dorsiflexion, plantarflexion, and rotation
PART 2 TREATMENT AFTER ICING
FF.Dry the treatment area and apply compression to the area that will reduce the
degree of edema until the next treatment session. This can be done by:
using a dry tensor and felt donuts to compress the area around the malleoli.
using compression wrap.
GG.
The athlete should use some form of support if s/he cannot walk normally.
Typically, this means a cane or crutches until walking without a limp is possible.
HH.
Rest from active participation in their sport while a graduated exercise and
therapy program speeds return to activity
Notes:
Some people have little tolerance for cold, so you must put a layer of wet
cloth between the skin and the ice bag. Be sure the cloth is wet or it will not
conduct the cold through to the injury site.

Care must be taken not to burn the skin from intense cold sources (such as
chemical cold packs)!
Other sources of cold are: a bag of frozen peas, tensor bandages soaked
then frozen (limited value)
REFER THE ATHLETE TO A PHYSICIAN
PART 3 TAPING
A. ACHILLES TAPE JOB
Prepare the leg for taping: clean, dry, tape adherent applied and heel and lace pads in
place over the achilles tendon
Apply elastic anchors around the calf muscle bulk. Apply tape anchors around the arch
of the foot, remember to splay the foot.
Using elasticon tape, secure one end under the heel onto the foot anchor. Secure it
with trainers tape. Cut the other end midway across its width, and split the tape until
the point that remains intact is at the bottom of the calf flair. Pull up on the tape
plantarflexing the foot, then wrap the two ends around the lower leg finishing on the
anterior surface of the lower leg. Do this with three pieces of elasticon.
Close off the calf with elastic tape, starting and finishing on the anterior side of the
lower leg.
Apply trainers tape over the ends of the elastic tape. Close down from below the calf
using tape to a point 1 inches above the lesion

B. LOW DYE TAPE JOB

Prepare leg for taping as usual. Give extra application of tape adherent to sides
of 1st and 5th MTP joints.
Apply Band-Aid over achilles attachment at heel
Measure the length of the strip of tape required to go from the head of the 5th
metatarsal back along the lateral side of the foot, around the heel, and forward along
the medial side of the foot to the head of the 1st metatarsal. Tear the tape off at the
appropriate length. Repeat twice more so that you have three strips ready.
Apply one end of the first strip to the side of the 5th metatarsal head and lay the
tape of the lateral side of the foot and around the heel without tension.

As the strip rounds the heel, start applying tension forward and parallel to the
medial side of the foot. Do not attach the tape yet!
With your free hand, push up from the bottom of the metatarsal heads 2, 3, and 4
with you thumb, and down on the top of the 1st metatarsal head with your second finger

While thus accentuating the transverse fore-foot arch and applying forward
tension to the tape, attach the end of the tape to the side of the 1st metatarsal head
When you release both hands, the great toe should be pulled slightly down and
away from the other toes.
Apply two more such strips being careful to ensure they attach on THE SIDE of
the first MTP jt.
Finish off by applying full width strips under the arc of the foot, starting just above
the strips on the lateral side of the foot, just anterior to the malleolus and running
under the arch and up to finish just above the 1@ strips on the medial side.
II. Apply tension as you pull up through the medial arch area.
JJ. Apply sufficient strips, overlapped, to cover the area from just posterior of
the metatarsal heads, to just anterior of the plantar fascia origins.

NOTES

LAB # 4 THE KNEE

OBJECTIVES
To allow students the opportunity to palpate the surface anatomy of the knee
To give students the understanding and application of the knee hyperextension
tape job
MATERIALS
3 roll of elastic tape
1 trainers tape
tape scissors, tape remover, towel

PART I PALPATIONS
BONEY LANDMARKS and Ligaments

Patella
Medial femoral condyle
Medial meniscus
Medial joint line
Medial epicondyle
Tibial tubercle
Gerdys tubercle
Lateral joint line
Head of fibula
Lateral epicondyle

Deep medial capsular ligament

Tibial collateral ligament
Lateral collateral ligament
Infrapatellar ligament
Iliotibial band
MISCELANEOUS
Common peroneal n.
Popliteal space

MUSCLES

Vastus medialis m.
Vastus Intermedius m.
Vastus lateralis m.
Rectus femoris m.
Bicep Femoris m.
Semitendonosis m.
Semimembranosis m.
Gastrocnemius m.
Pes anserinus

PART 2 TAPING
Knee Hyperextension
In taping to prevent knee hyperextension, one can use different methods, to be
described later, but all must prevent the knee from reaching full extension. If the knee
can full extension, it will hyperextend and the tape job will be ineffective. Another point
to remember is to provide as much elastic tape as possible on which to anchor the fan.
The greater the base of the attachment, the greater will be the bond and the more
effective the tape job. It is also important to attach the fan from the upper edge of the
proximal anchor all the way to the bottom edge of the distal fan, again, to maximize the
anchoring of the fan. Be sure to close the fan off by using sufficient elastic tape to cover
the original anchors under the fan.
The two basic methods used to prevent knee hyperextension differ only in the type of
fan used. One uses an elastic tape fan, the other uses trainers tape. The former is
easier to apply but is more uncomfortable for the athlete as it always pulls the lower limb
into flexion. The latter method takes more time and careful adjustment, but is more
comfortable.
NOTES:

LAB # 5 THE KNEE

OBJECTIVES
KK.
To learn and practice the various stress tests used in the examination of
the acute knee injury
LL. To review the acute treatment of the acute knee injury
MM.
To learn and practice the patellar strapping technique for infrapatellar
tendinitis
PART I EXAMINATION
Valgus Stress Test medial collateral ligament
NN.
Apply pressure in on the lateral joint line while holding the ankle securely
in the armpit
OO.
Do this test at 0 degrees flexion - post caps. And 30 degrees flexion- MCL
Varus Stress Test lateral collateral ligament
Apply pressure out on the medial joint line while holding the ankle securely in the
armpit.
Do this at 30 degrees of flexion
Lachman test anterior cruciate ligament
While securing the ankle in your armpit, drop the knee down to 15 degrees of
flexion, place your inner hand on the posterior aspect of the proximal tibia, and
your outside hand on the anterior surface of the distal femur (just proximal to the
patella)
Draw forward in an attempt to displace the tibia anteriorly
Anterior drawer test ACL and rotary instability
PP.
Place the foot flat on the examination table with the knee bent to 90
degreed of flexion. While stabilizing the foot with your thigh, draw the tibia
forward with the fingers of both hands. At the same time use the thumbs to
palpate the joint lines anteromedially and anterolaterally.
QQ.
Feel for a medial or lateral pivot shift
RR.
Feel and look for anterior displacement of the tibia
Posterior Drawer test posterior cruciate ligament
SS.
In the same examining position as above, push the tibia posteriorly
TT.Feel and look for excessive posterior displacement of the tibia
Patellar apprehension test subluxed patella
UU.
With the knee in 15 degrees of flexion, try to laterally displace the patella
VV.
Look for an apprehension reaction from the athlete
Apley Compression/Distraction test meniscal/ligament
WW.
Athlete lying prone, knee flexed to 90 degrees
XX.
Compress joint while rotating the tibia
YY.
Distract the joint
ZZ.McMurray test Then knee is flexed completely and pushed into the chest area.
One hand externally rotates the tibia, while the other hand is placed over he
anteromedial joint line. The knee and leg is extended while the later hand feel for
a click over the medial joint line. This is a test for the medial meniscus. An
internal rotation and extension from the fully flexed position would test the lateral
meniscus.

PART 2 TREATMENT OF THE KNEE

AAA.
Do the examination of the knee immediately
BBB.
If there is any differential laxity, transport the athlete to a medical facility
immediately.
CCC.
Apply Ice, Compression, Elevation
DDD.
Apply ice to the front and both sides
EEE.
Do not apple the tensor bandage too tightly around the back of the knee,
over the popliteal fossa
FFF.
After the thirty minute icing, place semi-lunar felt pads around the patella
and rewrap with a tensor
GGG.
Crutch if the athlete cannot walk properly
PART 3 PATELLAR STRAP TAPING
PURPOSE: To decrease the pull of the patellar tendon through the patellar ligament in
a attempt to reduce patellar tendonitis symptoms
TAPE: 7.5 cm elastic tape
PREPARATION: shave and tough skin
METHOD:
HHH.
Roughly measure a piece of tape for the circumference of the knee
III. Cut tape in half lengthwise from the other edges toward the centre leaving about
5 cm uncut
JJJ.
Fold the outer edges at the centre in half so that there is a narrow band of
tape over the infrapatellar ligament
KKK.
Position the leg in a slightly flexed, relaxed (use something to raise the eel
approx. 5 cm) position
LLL.
Place narrow folded portion of the tape just distal to the interior angle of
the patella and firmly pull the two superior tape ends up and around the knee
(superior to the popliteal space) (Note: patella should squint) Pull the distal tape
ends straight back around the knee (inferior to the popliteal space)
MMM.
Hold elastic tape ends together with a pieces of white trainers tape
NOTES

LAB # 6 BIOMECHANICS/THIGH/SPINE
OBJECTIVES
NNN.
To give students a basic understanding of lower limb biomechanics and
their contribution to injury
OOO.
To allow students to palpate the superficial anatomy of the thigh, pelvis
and lower back
MATERIALS
A full skeleton
Several bone femurs and tibias
Ankle model
PART 1 BIOMECHANICS
Explanation of Terminology
Coxa valgus
Coxa varus
Genu valgus
Genu varus
Pelvic obliquity
Q angle
patellar crepitus
patella alta
patellar subluxation
femoral anteversion
femoral retroversion
tibial recurvatum
pes planus structural
pes planus - functional
Problems
PPP.
Chondromalacia
QQQ.
Subluxed/dislocated patella
RRR.
IT Band Syndrome
SSS.
Anterior compartment syndrome
TTT.
Tibial stress syndrome
UUU.
Plantar fasciitis
VVV.
Medial longitudinal arch pain
WWW. Deltoid ligament sprain
PART 2 THIGH
Hamstring Strains
XXX.
Flexibility test
YYY.
Reconditioning
ZZZ.
RTA
Quadriceps strains
AAAA.
Flexibility test
BBBB.
Reconditioning
RTA
Groin pulls

Thigh contusions
CCCC. Immediate withdrawal from activity
DDDD. ICE with felt pad
EEEE.
1st degree flex knee while icing
FFFF.
RTA when: equal strength, equal flexibility, no pain
GGGG. Pad the injured area for 3 weeks
PART 3 PELVIS & SPINE
HHHH. Palpations
IIII. ASIS
JJJJ.
Ischial tuberosity
KKKK.
Pubic symphysis
LLLL.
Greater trochanters
MMMM. SI joints
NNNN. Spinous processes
OOOO. Muscle tension and knots
PPPP.
Low Back Problems
Williams flexion Xs
McKenzies extension Xs

NOTES

LAB # 7 THE SHOULDER

OBJECTIVES
To allow students the opportunity to palpate the anatomy of the shoulder girdle
To learn how to test the primary function of the shoulder muscles
To learn and apply the various stress tests used in injury assessment of the
shoulder
PART 1 PALPATIONS
Inferior angle of scapula
Medial margin of scapula
Scapula spine
Acromion
Acromio-clavicular joint
Greater tuberosity
Lesser tuberosity
Bicipital groove
Coracoid process
Clavicle
Angle of clavicle
Sterno-clavicular joint
Sternal notch
Xiphoid process
PART 2 FUNCTIONAL MUSCLE TESTS
QQQQ. Pectoralis major m.
RRRR. Latissimus dorsi m.
SSSS.
Deltoid m. anterior, posterior, middle
TTTT.
Serratus anterior m.
UUUU. Triceps m/ (5)
VVVV.
Brachialis m.
WWWW. Biceps brachii m.
XXXX.
Brachioradialis m.
YYYY.
Infraspinitus/teres minor m. (2,3)
ZZZZ.
Supraspinitus m. (1)
PART 3 TESTS
AAAAA. Apprehension test shoulder subluxation
BBBBB. Yergason test subluxing tendon of biceps
CCCCC. drop arm test - supraspinitis m.
DDDDD. External/internal rotation rotator cuff

NOTES

LAB # 8 -- THE ELBOW AND FOREARM

OBJECTIVES
EEEEE. To palpate the underlying anatomy of the elbow
FFFFF. To learn and apply the various stress tests used in injury assessment of
the elbow
GGGGG. To learn to tape to prevent elbow hyperextension
PART 1 PALPATIONS
Olecranon
Medial epicondyle
Lateral epicondyle
Head of radius
Capitulum
Lateral joint line
Lateral collateral lig.
PART 2 TESTS
Valgus stress test medial collateral lig.
Varus stress test lateral collateral lig.
Tennis elbow test extension of wrist, or extension of middle finger
hyperextension

PART 3 TAPING
Elbow hyperextension
Fig.
NOTES

LAB # 9 -- WRIST AND HAND

OBJECTIVES
To allow students to palpate underlying anatomy of the wrist and hand
To learn and apply the various stress tests used in injury assessment of the wrist
and hand
To learn the various tape jobs used in preventing painful ranges of motion in the
wrist and fingers
MATERIALS
Models of the wrist and hand
trainers tae and taping paraphernalia
PART 1 PALPATIONS
HHHHH. ulnar styloid process
IIIII.
scaphoid bone
JJJJJ.
thenar eminence
KKKKK. 1st metacarpal-phalangeal joint
LLLLL. 1st metacarpal
MMMMM. interphalangeal joint 5th metacarpal
NNNNN. pisiform bone
OOOOO. hook of the hamate
PPPPP. tunnel of Guyon
QQQQQ. radial styloid process
RRRRR. radial pulse
PART 2 TESTS
Phelans test for carpal tunnel syndrome
Tinels sign for metacarpal fracture
Test for ruptured tendons of flexor
digitorum superficialis/profundus muscles
PART 3 TAPE JOBS
SSSSS. Contact wrist
TTTTT. Apply circular anchors starting just distal to the flare of the forearm
muscles and progressing distally with half overlaps. As the tape approaches the
hand, reduce the overlap to 1/3 and continue to encircle the wrist until the tape is
sent up across the palm or dorsum of the hand by the flare of the hand. Lead the
tape through a figure 8 up the palm, around the metacarpal heads, back down
the palm and around the wrist.
UUUUU. NOTE: Apple wrist anchors with fingers spread forcefully

VVVVV. Wrist hyperflexion

Apply wrist anchors and hand anchors (around metacarpal heads). Apply a fan to
the dorsum of the hand. Anchor off.
WWWWW.
Wrist hyperextension
Apply wrist anchors and hand anchors (around metacarpal heads). Apply a fan to
the palmar side of the hand. Anchor off.
XXXXX. Thumb hyperextension
Apply wrist anchors. Apply 3 half strip spicas starting on the dorsum of the wrist
and finishing on the palmar side of the wrist. Anchor off.
YYYYY. Thumb hyperabduction
ZZZZZ. Apply wrist anchors. Apply 3 half strip spicas, starting on the palmar side
of the wrist and finishing on the dorsum.
AAAAAA. Thumb butterfly (peppard)
Apply a half strip figure 8 around the distal phalanx of the thumb and the
metacarpal heads. Roll the tape where the figure 8 crosses
BBBBBB. Finger sprain
CCCCCC.
Tape the injured finger to the one beside it that most closely aligns
the knuckles. Place a strip of half-width tape between these two fingers, sticky
side out. Place a piece of gauze pad between the fingers and hold it in place by
squeezing the fingers on it gently. Bind the fingers together with thin strips of
tape around the middle and proximal phalanges. Tape the top end of the
reversed strip of tape and run it around the end and attach it to the dorsal side of
the proximal strip. Anchor these off with one more proximal strip around the
proximal phalanges.
NOTES