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Monthly taping technique: Ankle Taping

Position: The ankle should be in the neutral position (toes straight up to 90). The athlete should be seated comfortably with the knee at full extension and only the distal (farthest from torso) half of the lower leg off the table.

Preparation: Realizing that some steps are optional, prepare for taping as follows: (1) clean and dry the skin, (2) apply tape adherent, (3) apply heel and lace pads one in front where ankle begins and one behind heel, and (4) prewrap

Procedure: There are several variations on a standard tape application for the ankle. The following is one of the more commonly used techniques taught to student athletic trainers.

1. Place anchor strips (2 or 3) approximately one third of the way up the lower leg below the bellies of the distal aspect of the gastrocnemius (calf muscle). This is the proximal tape anchor. Place a distal anchor around the midfoot. These anchors may be partially taped directly to the skin to provide increased adherence.

2. Now apply the first stirrup. Start this strip at the medial side of the upper anchors, go down over the medial malleolus, cross under the foot, come up over the lateral malleolus, and end on the lateral side of the anchors. The theory behind this is to tape the foot more in eversion than inversion so that one does not predispose an athlete to injury.

3. Next apply a horseshoe by taping from the inside of the midfoot anchor, back across the Achilles tendon, and ending on the outside of the anchor.

4. Repeat the stirrup and horseshoe 2 more times each, moving the position of each one by one half the width of the tape; this should produce a basket-weave appearance. The first stirrup covers the posterior half of the malleoli, the second covers the middle of the malleoli, and the third covers the anterior half.

5. Place closure strips. Start at the malleoli and work up. An additional 1 or 2 strips may be needed to enclose the midfoot. After this step, no areas within the body of the tape job should be uncovered except for the posterior portion of the heel, which is not to be taped.

6. Lateral heel lock: Start with the tape anterior to the lateral malleolus. Go medially across the dorsum of the foot aiming for the longitudinal arch. Proceed across the plantar aspect of the foot to just posterior to the base of the 5th metatarsal. Now go up and posterior on the lateral side of the calcaneus, across the Achilles tendon and its insertion on the calcaneus. Go around to the medial side of the ankle, partially overlapping the malleolus. Finish on the anterior aspect of the ankle and tear.

7. Medial heel lock: Start anterior to the medial malleolus. Go down on the lateral side to where the other strip is coming up to go posteriorly around the calcaneus. Proceed straight across the plantar aspect of the foot to the longitudinal arch. Go up and posterior on the medial side of the calcaneus, across the Achilles tendon and its insertion on the calcaneus. Next, go around the lateral side of the ankle, partially covering the malleolus. Finish on the anterior aspect of the ankle and tear. The heel locks are the most difficult part of the tape job to apply and often take practice to master.

8. Repeat both the lateral and medial heel lock one more time for each. Heel lock application techniques are varied. The above is a commonly accepted example.

9. Final closure strips: Apply final circular strips around the foot and lower leg as needed to tidy up the tape job and ensure that no open spaces or weak spots are present

HEAT ILLNESSES

There are three main disorders that can result during exertional activity in the heat. Below are described each illness' cause, symptoms, treatment, and ways to prevent them from occurring.

Following are some factors the NCAA has put together that can put someone at risk for any of the heat illnesses:

1. Nutritional supplements: e.g. ephedrine, caffeine; can increase dehydration 2. Medication/drugs: e.g. Antihistamines; certain asthma medication; diuretics 3. Medical Conditions: e.g. Illnesses with fevers, sickle cell trait 4. Acclimatization/fitness level- lack of proper acclimatization or poor conditioning 5. Clothing: dark clothes absorb heat; equipment also limits the escape of body heat.

Heat Cramps

Cause: work in heat; sweating; not enough salt intake

Symptoms: muscle twitch and cramps; muscles most affected are calves, hamstrings, and abdomen; Athletes are normally alert; wet, warm skin due to sweating; body temp, pulse and respiration should be normal to slightly elevated.

Treatment: stretching muscle; fluids; athlete may return if symptoms dissipate- monitor closely.

Prevention: proper acclimatization; proper hydration

Heat Exhaustion

Cause: prolonged sweating; inadequate fluid replacement; diarrhea; predisposition to heatstroke

Symptoms: pale, cool, clammy skin; excessive sweating; headache; excessive thirst, dry tongue and mouth; weight loss (2 lb weight loss represents approximately 1 quart of fluid loss); fatigue; weakness; dizziness; small urine volume; elevated body temperature; reduced swelling; rapid, weak pulse

Treatment: rest in cool room, IV fluids if unable to drink; sponge with cool water; keep record of body weight; semi-liquid food; no return to activity for remainder of day.

Prevention: supply adequate fluids and rest in cool environment

Heatstroke SEVERE MEDICAL EMERGENCY call 911

Cause: Failure of primary temperature mechanism (sweating)

Symptoms: Quick onset, usually preceded by a headache, vertigo and fatigue; absence of sweat; hot, flushed, dry skin; increased pulse- may reach 160-180 beats per minute; increased respiration; increased body temp- may rise quickly to 105 or 106 degrees Fahrenheit; athlete complains of "burning up"; diarrhea; vomiting; circulatory collapse may cause death- could lead to permanent brain damage

Treatment: measures to reduce temperature- full body immersion in cold water, fan entire body, massage limbs; temperature must be taken every 10 minutes and not be allowed to fall below 101 degrees Fahrenheit; transport to hospital as soon as possible.

Prevention: Proper acclimatization; proper hydration; educate those supervising activities conducted in heat

Adapt activities to environment; screen participants with past history of heat illness; adapt attire to environment (e.g. less heavy, light colored clothing)

DO NOT HESITATE TO CALL 911 IN ALL EMERGENCIES

Hydration

The NATA (National Athletic Trainers' Association) recommends the following guidelines for fluid maintenance:

Before Exercise: Drink 17-20 ounces of water or sports drink 2-3 hours prior. Drink 7-10 ounces of water or sports drink 10-20 minutes prior

During Exercise: Drink 7-10 ounces of water or sports drink every 10-20 minutes Note: Encourage athletes to drink beyond their thirst. If they are thirsty, they are already slightly dehydrated.

After Exercise: Drink about 20 ounces of water or sports drink per pound of weight lost within two hours after exercise. Within six hours drink 25 to 50 percent more than weight loss.

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