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)

Types of Taping in Physiotherapy

Quick Comparison Overview

1. Rigid Tape (Zinc Oxide / Athletic Strapping Tape)

What it is

Material Properties

• Cotton or rayon weave backing
• Zinc oxide adhesive (strong, durable bond to skin)
• Available widths: 1.25 cm, 2.5 cm, 3.8 cm, 5 cm
• Tears easily by hand against the weave
• Does NOT stretch in any direction

Mechanism of Action

• Mechanically blocks unwanted joint movement
• Restricts end-range ROM to prevent ligament/tendon overload
• Provides strong proprioceptive feedback through skin pressure
• Pain relief via movement restriction and sensory gating

How to Apply - Step by Step

1. Prepare skin - clean, dry, shave excessive hair
2. Apply underwrap/pre-wrap first (foam or cotton) to protect the skin from the strong adhesive (especially for repeat applications)
3. Apply anchors - lay 1-2 strips of tape above and below the joint without tension (these are the foundation)
4. Apply functional strips - the main support strips going in the direction that limits the target motion (e.g. stirrups under heel for ankle, figure-of-8 for wrist)
5. Apply closing strips - horizontal strips to lock everything in place
6. Smooth and press all strips to ensure adhesion
7. Check neurovascular status - ask patient to wiggle fingers/toes; check for numbness, tingling, or color change

Common Taping Patterns

• Ankle stirrup - for lateral ankle sprain prevention
• Basket-weave - for ankle stability
• Figure-of-8 - for wrist/ankle support
• Thumb spica - for skier's/gamekeeper's thumb
• Dorsal-block - for finger hyperextension prevention

Clinical Uses

• Acute ankle sprains (most common)
• Wrist, thumb, finger injuries
• AC joint sprains
• Pre-event injury prevention in athletes
• Patellofemoral taping (McConnell technique uses rigid tape)
• Mulligan taping (to sustain joint glide forces)

Advantages

• Maximum mechanical support and stability
• Proven gold standard for joint immobilization
• Immediate pain relief through movement restriction
• Cost-effective

Disadvantages

• Loses up to 40-50% of supportive strength within 20-30 minutes of exercise (due to sweat and movement loosening adhesive)
• Limits natural movement - can affect athletic performance
• Skin irritation with prolonged or repeated use
• Requires skin protection (underwrap) for sensitive skin
• Cannot be re-used

Key Evidence

2. Kinesio Tape / K-Tape (Kinesiology Tape)

What it is

Material Properties

• Thin elastic cotton backing
• Heat-activated acrylic adhesive (wave-pattern on backing paper)
• Stretches 120-140% of its original length (similar to human skin)
• Latex-free, hypoallergenic
• Water-resistant - dries in 5-10 minutes
• Available widths: 2.5 cm, 5 cm; also pre-cut rolls

Mechanism of Action

• Lifts the skin microscopically (convolutions/ripples form when tape recoils)
• Reduces pressure on pain receptors and lymphatic channels underneath
• Stimulates skin mechanoreceptors → improves proprioception and body awareness
• Direction of application determines muscle effect:
  • Origin → Insertion (muscle stretched before tape) = INHIBITION (relaxes overactive/tight muscle)
  • Insertion → Origin = FACILITATION (activates weak/underactive muscle)
• Lymphatic/Fan technique promotes fluid drainage and reduces swelling

Tape Cuts Used

Tension Levels in Application

How to Apply K-Tape - Step by Step

1. Prepare skin - clean with alcohol wipe, dry completely, remove oils/lotion; trim excessive hair
2. Position the patient - place muscle/joint in the stretched position required by technique
3. Tear the backing paper - for I/Y cuts: tear at center first, then fold back; leave 2 inches of paper at each end for handling
4. Apply anchor (first 2 inches) with ZERO stretch directly to skin - this is what holds the tape on
5. Apply the middle section with the desired tension % as you peel the backing
6. Apply the tail anchor (last 2 inches) with ZERO stretch
7. Rub vigorously over the tape with your palm for 20-30 seconds to activate the heat-sensitive adhesive
8. Apply 1 hour before activity for best adhesion

Removal

• Soak with baby oil or adhesive remover first
• Fold tape back on itself (do not pull upward)
• Remove slowly in direction of hair growth
• Hold skin down while peeling

Clinical Uses

• Muscle strains and weakness (facilitation/inhibition)
• Oedema and post-surgical swelling (lymphatic fan technique)
• Patellofemoral pain syndrome
• Shoulder impingement
• Neck pain and lower back pain
• Post-stroke rehabilitation (upper limb, gait)
• COPD (respiratory muscle taping)
• Ankle sprains (sensory/proprioceptive support)
• Plantar fasciitis

Wear Time

3. Dynamic Tape (Biomechanical Tape)

What it is

Material Properties

• Highly elastic, strong woven fabric
• 4-way multi-directional stretch (unlike K-tape which stretches mainly lengthwise)
• Much stronger recoil force than K-tape
• Water resistant; zero sticky residue on removal
• Available in standard (black) and ECO (tan) versions; different weights for different load requirements

Key Difference from K-Tape

Mechanism of Action

• Applied across a joint at end range with the tape pre-loaded
• As the joint moves into the loaded range, the tape stretches and stores elastic energy
• As the joint returns, the tape recoils and assists the movement, reducing the demand on the muscle/tendon
• This genuinely reduces biomechanical load on tissues - not just sensory modulation
• Useful when a muscle is weak, fatigued, injured, or overloaded and needs help doing its job

How to Apply Dynamic Tape

1. Identify the movement to unload (e.g. eccentric load on Achilles during walking)
2. Position the joint at end range of the problematic movement direction
3. Apply the tape across the joint in that loaded position - the tape should already be under mild stretch at rest
4. Anchor both ends without stretch
5. Check that the tape resists movement into the problem range and assists the return
6. The tape should NOT restrict ROM - if it does, re-apply with less tension

Clinical Uses

• Achilles tendinopathy (unloads tendon during walking/running)
• Patellofemoral pain syndrome
• Rotator cuff tendinopathy
• Plantar fasciitis
• Post-surgical movement retraining
• Athletic performance (reduce muscle fatigue)
• Any overuse/overload condition in sport

Evidence

4. Cohesive Bandage (Coban / Self-Adherent Wrap)

What it is

Material Properties

• Woven elastic fabric (usually contains latex - check for allergy)
• Adheres to itself via cohesion, NOT adhesive
• Moderate elasticity
• Can be torn by hand
• Available widths: 2.5 cm, 5 cm, 7.5 cm, 10 cm
• Available in many colors (important for some sports competitions)
• Can be re-applied (removed and repositioned to adjust compression)

Mechanism of Action

• Provides light to moderate compression to a joint or limb
• Reduces oedema through compression of lymphatic and venous channels
• Provides proprioceptive feedback through circumferential pressure
• Does NOT provide strong mechanical joint restriction (unlike rigid tape)

How to Apply Cohesive Bandage

1. Start distal (furthest from heart) and wrap proximally (toward heart) - this promotes venous and lymphatic return
2. Wrap with approximately 50% overlap on each pass
3. Apply with moderate, even tension throughout - not too tight (will cut off circulation) and not too loose (ineffective)
4. Do NOT leave it wet on the skin for prolonged periods
5. Check circulation regularly - if the area beyond the bandage becomes numb, cold, pale or blue → remove immediately
6. Can be removed and reapplied to adjust compression as needed (unique advantage over adhesive tapes)

Clinical Uses

• Wrist and finger joint support (e.g. arthritic joints)
• Oedema management in hands/feet/limbs
• Over dressings (to hold wound dressings in place without skin adhesive)
• Mild ankle support for daily activities
• Post-injection site compression
• Suitable for sensitive or fragile skin (elderly, patients on corticosteroids) - no skin adhesive
• Suitable for patients with adhesive allergies

Advantages

• No skin adhesive - safe for sensitive or delicate skin
• Can be reapplied and adjusted
• Easy to remove (just unwind)
• No scissors needed (tears by hand)
• Multiple widths for different body parts

Disadvantages

• Provides only mild support - not suitable for significant joint instability
• Can be applied too tightly by patients at home, causing circulation problems
• Loses cohesion if very wet for long periods

5. Elastic Adhesive Bandage (EAB) - Bonus Type

What it is

Properties

• Woven cotton weave with rubber adhesive
• Available in regular EAB (stronger, healthcare grade) and EAB Tearlite (easier to tear by hand)
• Moderate stretch - allows movement while providing support
• Suitable for constantly-moving joints (elbow, knee)

Clinical Uses

• Moderate joint support where rigid tape would be too restrictive
• Elbow and knee strapping
• Shoulder stabilization
• Used in McConnell taping as an underwrap layer over which rigid tape is applied

6. Underwrap / Pre-Wrap (Foam Wrap)

• Made from polyurethane foam or cotton fleece
• No adhesive (clings lightly to skin)
• Applied directly to skin before rigid tape
• Reduces skin irritation, blistering, and abrasion from strong zinc-oxide adhesive
• Essential for patients with sensitive skin, eczema, or repeat applications

Full Summary Table

Choosing the Right Tape

• Need to restrict movement / prevent injury → Rigid tape
• Muscle is weak, overloaded, or fatigued → Dynamic tape (genuine load reduction)
• Want to keep moving but reduce pain/swelling → Kinesio / K-tape
• Sensitive skin, adhesive allergy, or oedema → Cohesive bandage
• Moderate support for elbow or knee → EAB
• Using rigid tape on sensitive skin → always apply underwrap first

• Physio-pedia: Taping overview - comprehensive clinical breakdown
• Sterosport: Types of Sports Tape - material properties of all tape types
• Dynamic Tape official site - biomechanical tape mechanism
• PhysioEdge 2026: Science Behind Taping - evidence comparison of rigid vs elastic vs semi-rigid