Tapping (Tapotement) in Physiotherapy

What is Tapotement?

Types of Tapping / Tapotement

1. Hacking

• Hand position: Hands held outstretched with palms facing each other; wrists loose
• Contact area: Only the ulnar border (little finger side) of the hand, and slightly the tips of the three medial fingers
• How it's done: Both hands alternately strike the body in rapid succession, with a slight wrist rotation as hands rise and fall
• Depth: Medium - stimulating without being painful
• Best used on: Back, shoulders, thighs, large muscle groups
• Purpose: Stimulates nerves, increases local blood flow, warms up muscles - commonly seen in sports pre-event warm-up scenes
• Note: Fingers and hands must remain relaxed throughout

2. Cupping (Clapping)

• Hand position: Palm formed into a cup-like shape by slightly flexing the fingers
• Contact area: Only the outer rim/edges of the cupped hand - the palm itself never touches the body
• How it's done: Cupped hands are struck rhythmically against the body, producing a distinctive hollow "clop, clop" sound; continued until the skin develops a pinkish coloration
• Depth: Light to moderate
• Best used on: Chest/back (especially in respiratory physiotherapy), fleshy areas
• Purpose: Stimulating and invigorating; relaxes stressed muscles; loosens mucus in the lungs (used in chest physiotherapy for conditions like bronchitis, cystic fibrosis, postural drainage)
• Clinical use: A key technique in bronchial hygiene - Fishman's Pulmonary Diseases textbook notes chest physiotherapy techniques including percussion as important for patients with excess secretions

3. Beating / Pounding / Pummeling

• Hand position: Hands held in a loose, soft closed fist
• Contact area: The little finger (ulnar) side of the closed fist falls on the body
• How it's done: Loosely clenched fists fall alternately onto large muscle areas; wrists stay loose
• Depth: Heavy - produces the deepest effect of all tapotement techniques
• Best used on: Larger muscle groups - thighs, buttocks, back (NOT over bony areas)
• Purpose: Stimulates deep blood circulation, reduces adipose tissue, increases muscle tone, loosens mucus in lungs (excellent post-cold/infection), pre-exercise preparation
• Note: According to physio.co.uk, this technique increases skin surface blood flow, raises muscle temperature, and maximizes performance while preventing injury

4. Tapping (Fingertip Tapping)

• Hand position: Hands loose and relaxed
• Contact area: Only the very tips of the fingers
• How it's done: Fingertips lightly and rhythmically tap the target area; often performed at a slower rate than other forms
• Depth: Lightest of all tapotement movements
• Best used on: Face, head, scalp, over delicate areas
• Purpose: Gentle nerve stimulation, improving circulation in sensitive areas, relaxation
• Note: This is the most gentle form; suitable for areas where heavier techniques cannot be used

5. Slapping

• Hand position: Flat, open hand; fingers relaxed
• Contact area: The flat palm/fingers
• How it's done: Gentle, open-palmed slapping motion applied rhythmically
• Depth: Light to moderate
• Best used on: Larger, fleshy areas
• Purpose: Skin stimulation, increasing local circulation, light nerve activation

6. Plucking

• Hand position: Thumb and fingers in a light pinch
• Contact area: Skin between thumb and fingers
• How it's done: The skin is gently picked up and released in a rapid, alternating movement using both hands - similar to a light pinching or pecking motion
• Depth: Very superficial
• Best used on: Arms, legs
• Purpose: Relaxes stressed and sore muscles, stimulates superficial tissues

Summary Table

How to Apply Tapotement - General Methods

Rate and Rhythm

• Apply at 4-10 strikes per second
• Keep movements rhythmic and consistent - do not lose the rhythm
• Movement originates from the wrist, not the elbow or shoulder
• Always use alternating hands (one after the other), not both simultaneously (except in hacking where simultaneous use is optional)

Pressure

• Start light, then increase gradually
• Never apply over: bony prominences (spine, joints, knees), kidney area, inflamed or paralyzed muscles, directly over varicose veins
• The patient should feel stimulation, not pain

Application Sequence (in a typical session)

1. Begin the massage session with effleurage (warming strokes)
2. Progress through petrissage as needed
3. Apply tapotement near the end of a session to re-stimulate and "wake up" the client
4. In sports massage, tapotement may be done at the start as a pre-event warm-up
5. Always finish with effleurage after tapotement

Draping

• Tapotement may be applied directly to skin OR through a drape/clothing
• Begin with light pressure; increase based on client tolerance

Contraindications

• Osteoporosis or fragile bones
• Directly over the spine, joints, or kidneys
• Inflamed, infected, or acutely injured tissue
• Paralyzed muscles
• Open wounds or recent surgery sites
• Over varicose veins or phlebitis

Clinical Uses in Physiotherapy

Useful References

• Wikipedia - Tapotement - concise overview with all five classic types
• Integrative Healthcare - Massage Stroke Review Part 3: Tapotement - detailed method breakdown with hand positions
• Tapotement.com - practical application guide with FAQs and contraindications
• Physio.co.uk - Beating and Pounding - clinical use of percussion in sports and rehabilitation
• Fishman's Pulmonary Diseases and Disorders - chest physiotherapy using percussion and vibration for bronchial hygiene (postural drainage programs)

Therapeutic Taping in Physiotherapy - Complete Guide

Types of Tape Used

Major Types of Taping in Physiotherapy

1. Kinesio Taping (KT) / Kinesiology Taping

• The tape lifts the skin microscopically, reducing pressure on pain receptors and lymphatic channels underneath
• Stimulates mechanoreceptors in the skin, improving proprioception
• The direction of application (origin-to-insertion vs. insertion-to-origin) determines whether the muscle is facilitated (activated) or inhibited (relaxed)
• Acts through neurophysiological pathways - mechanotransduction at the fascial level

• Muscle technique - to facilitate underactive or inhibit overactive muscles
• Fascia correction - to shift fascial tension
• Space correction - to lift tissue and reduce compression/pain
• Lymphatic correction - Fan cut applied with minimal tension to stimulate lymph flow
• Ligament/Tendon correction - applied with higher tension (50-75%) for structural support
• Mechanical correction - to guide joint alignment
• EDF (Epidermis-Dermis-Fascia) technique - for scar management and fascial work

• 0% (paper-off tension) - lymphatics
• 10-25% - muscle facilitation/inhibition
• 25-50% - space/fascia correction
• 50-75% - mechanical/ligament correction
• 75-100% - maximum structural support

• Origin to insertion (muscle is stretched before tape laid) = INHIBITION (relaxes overactive muscle)
• Insertion to origin = FACILITATION (activates underactive/weak muscle)

• A 2024 systematic review (PMID 37530391) found KT improves balance and gait in chronic stroke patients
• A 2025 systematic review (PMID 40094902) found KT beneficial for acute ankle sprain (pain, swelling, ROM)
• A 2024 meta-analysis (PMID 39039345) found KT reduces neck pain in the short term

2. McConnell Taping

• Rigid tape provides a mechanical force that changes how the joint loads and tracks in real time
• Unlike KT, it does NOT stretch - it physically holds the structure in place
• Unloads painful tissues and corrects joint mechanics while allowing movement

1. Prepare skin - clean and dry; shave if needed
2. Apply under-tape first - hypoallergenic soft tape (e.g. Hypafix or McConnell Under Tape) directly on skin to protect against rigid tape irritation
3. Assess patellar position - determine if correction needed is: medial glide, medial tilt, lateral tilt correction, or rotation
4. Apply rigid tape - placed over the under-tape in the direction needed to correct the patellar position (e.g. anchored on the lateral patella, pulled and anchored medially)
5. Reassess pain during movement - the taping should reduce pain during the aggravating activity; if pain is not reduced by at least 50%, re-assess and reapply
6. Wear time - typically 24-48 hours; up to 1 week with good skin tolerance

• Medial glide - corrects lateral displacement of patella
• Medial tilt - corrects lateral tilt
• Rotation correction - for anteroposterior patellar rotation issues
• These can be combined based on assessment findings

• Patellofemoral Pain Syndrome (PFPS) / Runner's knee
• Chondromalacia patellae
• Knee osteoarthritis
• Post-surgical knee instability
• Shoulder instability and acromioclavicular pain
• Chronic lower back pain
• Rib pain
• Ankle problems

3. Mulligan Taping

• During MWM, the therapist applies an accessory joint glide while the patient performs active pain-free movement
• If the patient's symptoms improve with MWM, tape is applied to replicate and sustain that accessory force
• The tape is applied in the direction that mirrors the passive glide used during MWM
• It essentially extends the duration of the manual therapy effect

4. Rigid Athletic Taping (Strapping)

• Mechanically restricts joint motion beyond a safe ROM
• Provides proprioceptive feedback through pressure on the skin
• Reduces excessive/injurious movements

1. Pre-wrap - apply foam/cotton pre-wrap or underwrap directly to skin first
2. Anchor strips - lay anchor strips above and below the joint
3. Stirrups/support strips - apply functional strips that limit the target motion (e.g. for ankle, apply stirrups under the heel up each side)
4. Closing strips - cover and secure all tape ends
5. Check circulation - ensure no neurovascular compromise (tingling, numbness, pallor = remove tape)

• Acute ankle sprains (prophylactic and post-injury)
• Finger/thumb injuries
• AC joint sprains
• Pre-event sports injury prevention
• Joint instability management

5. Dynamic Taping

• The tape acts like an elastic bungee cord - it resists movement at end range and then recoils to assist the return movement
• This reduces the load on muscles and tendons during fatiguing or painful movements
• Works via genuine mechanical unloading, not just sensory modulation

6. Functional Taping / Prophylactic Taping

• Ankle taping in basketball players with history of sprains
• Thumb/wrist taping in rugby or gymnastics
• Shoulder taping in overhead athletes

Summary Comparison Table

General Principles for Applying Any Tape

1. Skin prep - clean, dry, hair-free skin; use skin prep spray if needed
2. Apply under-tape/pre-wrap if using rigid tape to protect skin
3. Patient position - position the joint/muscle as required by technique (stretched or shortened)
4. Tension control - adjust tension based on the goal (0% for lymphatics up to 100% for max support)
5. Direction - follow technique-specific direction rules (e.g. origin-to-insertion for inhibition in KT)
6. Avoid wrinkles/bubbles - smooth tape well for skin comfort
7. Check neurovascular status after application - tingling, numbness, or colour change = remove immediately
8. Educate the patient on skin checks, duration of wear, removal technique (pull back on itself, not upward)

Contraindications to Taping

• Open wounds, skin infections, or dermatitis over the application area
• Deep vein thrombosis (DVT) - taping can increase risk of clot dislodgement
• Fragile or atrophic skin (elderly, corticosteroid users)
• Known tape allergy or hypersensitivity
• Peripheral vascular disease (impaired sensation means compression risk)
• Malignancy over the taped area
• Active inflammation with skin redness/heat (rigid taping)

Key Reference Articles

• Physio-pedia: Kinesio Taping - comprehensive overview of all KT techniques, cuts, and applications
• MDPI 2025 - Evidence-Based Taping in Sports Rehab - recent review covering all taping types, mechanisms, and evidence levels
• McConnell Therapeutics: McConnell vs Kinesio - written by Jenny McConnell herself; clear clinical comparison
• PhysioEdge: The Science Behind Taping - 2026 evidence-based breakdown of all three tape categories
• PMC systematic review comparing KT vs McConnell for PFPS (PMC4491411)