Athletic Taping

Athletic Taping is a type of treatment which utilises woven fabric (rigid or elastic) to provide additional proprioceptive stimulus and additional support to enable participation in sports while limiting the risk of re-injury or further injury. It is often used in rehabilitation of muscle and tendon injuries. Athletes and coaches should be aware of various techniques of taping which could come in handy when the need arises during training or competition. Taping can provide additional stability while allowing flexibility unlike some bracing devices.

Ankle joints are most commonly taped to prevent lateral ankle sprain. Other common parts which may benefit from taping are knee, shoulder, wrist, Interphalangeal joints (fingers and toes), hamstring and quadriceps, foot and Achilles tendon.

You may contact me at draston@gmail.com if you are interested in organising a course for your athletes or coaches.

Here are some of the photos taken from the work of students in a taping workshop:-

Lee Chong Wei - Qualifies for Badminton Olympic Finals

Congratulations to Lee Chong Wei and coach Misbun Sidek for achieving the feat of qualifying for the Men's singles for the Beijing 2008 Olympics. He defeated South Korean Lee Hyun-il 21-18, 13-21, 21-13 in the semi-finals Friday at the Beijing University of Technology Gymnasium. Looking forward to see you play again on Sunday, Chong Wei. Malaysia will cheer on for you!

Beijing Olympics 2008 - One World One Dream

As the world braces itself against economical socio-political turmoils and environmental challenges, the focus of 6 billion people will be on the greatest sporting event of all times, the Beijing Olympic 2008. The games starts on the 6th August 2008 with soccer and closes on the 24th August 2008. The highlights for most would be the Opening Ceremony on the 8th August 2008. Beijing will play host to the 28 summer sports and 10,500 athletes are expected to demonstrate the Olympic Motto, "Citius, Altius, Fortius".

Athletes will compete in 31 venues in Beijing, Qingdao(sailing), HongKong (Equestrian), Tianjin, Shanghai, Shenyang and Qinhuangdao to determine the worthy recipients of the Olympic medal.

Malaysia is proud of the 33 athletes from 10 sports who have fought hard for their place in the Olympics.
The Malaysian Contingent:
1) Archery: Cheng Chu Sian, Muhammad Marbawi Sulaiman, Wan Mohd Khalmizan Wan Ab Aziz
2) Athletics: Roslinda Samsu, Yuan Yu Fang, Lee Hup Wei
3) Badminton: Lee Chong Wei, Wong Choong Hann, Koo Kien Keat , Tan Boon Heong , Lee Wan Wah , Choong Tan Fook , Wong Mew Choo , Wong Pei Tty, Chin Ee Hui
4) Cycling: Azizul Hasni Awang, Josiah Ng, Mohd Edrus Yunus, Rizal Tisin
5) Diving: Bryan Nickson anak Lomas, Leong Mun Yee, Elizabeth anak Jimie, Pandelela Rinong anak Pamg
6) Sailing: Dr. Kevin Lim
7) Shooting: Hasli Izwan Amir Hasan
8) Swimming: Daniel William Henry Bego , Siow Yi Ting, Khoo Cai Lin, Lew Yih Wey, Leung Chii Lin
9) Taekwondo: Elaine Teo Shueh Fhern, Che Chew Chan
10) Weightlifting: Amirul Hamizan Ibrahim

Good luck and all the best to all of you!

Vastus lateralis tendinitis (tendinoses) and Iliotibial Band Syndrome

A forklift driver came this morning with complaints of left knee pain since the past 1 week with prolonged driving. His pain is worse at the end of the day and it was so bad that he could not sit or squat. He apparently felt better after massaging his thigh.

He had tenderness at the insertion of the vastus lateralis tendon, Iliotibial band (ITB)insertion and gluteus medius origin. He also had restriction of knee flexion (0-80 degrees) and had pain extending his knee against resistance.

As part of the treatment, he was given a day off, reassigned to other duties, told to do RICE treatment,given some stretching exercises for gluteal muscles, quadriceps and ITB and some NSAIDS for 5 days. He would also benefit from ultrasound, TENS, myofascial release and he had some taping done to restrict the pull on the vastus lateralis tendon.

Port Dickson International Triathlon 19-20th July 2008

The Port Dickson International Triathlon is one of the major triathlon events held in Admiral Cove, Port Dickson yearly. This year I had the opportunity to be an unofficial observer as some of my patients were enrolled for the event! I wanted to compare it with the Manchester Commonwealth Games in 2002 where I was assigned to accompany the triathletes of the Malaysian team. The swim start has always been a scramble comparable with a stampede where a competitor needs to be fend off the flailing limbs of other triathletes. After surviving the 1.5km swim by the beach, the able bodied triathletes change to their cycling gear while getting onto their bicycles. The 40 km ride would often be interspersed with hills and valleys (and a beautiful scenery of Port-Dickson). By the time they return their bicycles and start running, they would be bathing in the morning sun for another 10km.

They had a full team of ambulances, Civil Defence forces, Police and paramedics to attend to emergencies. There were a few who sustained minor bruising and muscle cramps during the event.

I had these photos to tell about the event.

Shock Wave Treatment for Achillis tendon Calcific Tendinitis

A young male hockey player came with chronic pain in his Achilles tendon several months ago. His earlier Ultrasound scan showed calcification of his Achilles tendon adjacent to the insertion to the calcaneal bone. He was given extracorporeal shock wave therapy(ESWT) (2000 pulses) weekly and felt much better after the second treatment. He went on to play the Kuala Lumpur Hockey League without any symptoms after 8 weeks rehabilitation and has been symptom-free since then.

ESWT has been approved for plantar fasciitis and has been found to be useful in treating calcific tendinitis.

I took a few photos of the treatment session.





Related websites:
International Society for Musculoskeletal Shockwave Therapy
FDA New Device Approval
EMS Website
Principles of Shockwave Treatment

Foot Contusion and bruise from bike fall

A young lady in her 20s came in with a swollen and bruised right forefoot and toes from a fall off her bike. I sent her for an X-ray which did not show any signs of fracture. She was treated with RICE Treatment, topical Anti-Inflammatory gel and some Cox-2 Selective NSAIDS. The swelling and bruising should subside within 1 week but she will be reviewed in a week.

Hip-hop Dance and Fracture in the foot

An 11 yrs old girl came yesterday complaining of a swollen and painful left foot after hearing something snap in her foot while doing hip-hop barefoot. She had been training barefoot for 1 year but it did not cause any pain. Now, she could not walk or put pressure on the side of her foot or even tip-toe.

I examined her left foot and found that she had some bruising and swelling around outer part of her midfoot (lateral aspect adjacent to the base of 5th metatarsal). There was severe tenderness at the base of the the 5th metatarsal.

Her X-rays shown that her left foot had a non-displaced transverse fracture of the base of 5th metatarsal (Jones Fracture). She was treated non-surgically with non-weight bearing posterior slab crutches to allow the swelling to subsides. She would benefit from a daily dose of low frequency ultrasound (Exogen) to promote healing. Once the swelling subsides we may consider placing her foot in a functional walking brace but she would not be allowed to walk until after 6 weeks later.

Interesting links:
Diagram of metatarsal fractures

Finger fracture with long extensor tendon rupture

A gentleman came in this morning clutching his wrist with a profusely bleeding left middle finger. His finger was hit by a falling panel which dislodged his wedding ring and cut his finger while deforming it instantly.

The left middle finger had a swan neck deformity and a gaping laceration across the middle phalanx oozing out with blood. There was crepitus (indicating a fracture) and he could not extend his distal phalanx suggesting a ruptured long extensor tendon.


I quickly cleaned his wound with Povidone iodine, applied a pressure bandage to stop bleeding, did a buddy taping with a finger splint running across the hand on both sides. He was referred to an Orthopaedic surgeon for further evaluation and treatment. If he was an athlete who had to use his upper limb, he should be out of training for at least 4 weeks.

Lateral Ligament Complex Sprain: Anterior Drawer's Test

Toe abrasions from cycling without proper footwear

I took these 2 photos of the right forefoot of a young cyclist who decided to ride to a grocery shop in slippers instead of cycling shoes. It would be prudent for cyclists to wear suitable footwear even if they are making short trips as abrasions like these are quite common otherwise.

Foot contusion from soccer

A recreational soccer player came to me showing off his bruised left foot 2 weeks ago. He told me he was kicked by an opponent and had difficulty sprinting fully although he was a forward.

I examined him and found that he only had slight difficulty toeing-off while running and was able to do resisted ankle dorsiflexion. Besides the RICE treatment, he was given an anti-inflammatory gel e.g. Reparil and 5 days of Cox-2 selective NSAIDS as he has previous history of gastric pain. He was advised him to avoid full sprints and jumps for the next week. If he was to play, he needs to tape his ankle and foot to avoid the full plantarflexion (to allow pain-free range of motion). I expect him to be better within 1 to 2 weeks.

Disabled Sailing using the Single Person Boat (Access 2.3)

Here are some photos I took during the Malaysian Paralympiad 2008. The Disabled sailing was held at Admiral Cove, Port Dickson featuring 10 disabled sailors. The male and female athletes competed against each other in the single person boat called Access 2.3.

Achilles Tendon Paratenonitis

Mr Lim is a businessman who does regular brisk walking. He came 2 weeks ago with complaints of painful swelling in his back of his left ankle (Achillles Tendon). He started using a pair of leather shoes with a high heel tab which comes in contact with the Achilles tendon every time he walks.



He was examined and I found that had pain standing on his toes (ankle plantarflexion) but little pain stretching his calf (ankle dorsiflexion). He had severe tenderness, oedema and mild redness over the middle of his Achilles tendon.


I advised him to use a low-cut shoe, apply RICE treatment and Anti-Inflammatory gel (e.g. Reparil, Volteran Emulgel). His gait was otherwise normal and he did not have any calf muscle spasm. He would do well with a course Ultrasound treatment.

14th Paralympiad Malaysia Kuala Lumpur 2008

The 14th Paralympiad Malaysia Kuala Lumpur 2008 will be held at National Sports Complex and University Putra Malaysia (UPM) from the 3-9 May 2008. More than 1500 athletes from the 15 states will be competing in this games. The official opening ceremony will be held at the National Stadium, Bukit Jalil, Kuala Lumpur at 7.45pm 3rd May 2008 and the closing ceremony will be held at 7.45pm on the 9th May 2008 at Putra Stadium, Bukit Jalil, Kuala Lumpur. Entrance is free!

Doctors and physiotherapists will be involved in medical coverage and Classification of athletes according to the various disabilities. Classification will be held from 1-2 May 2008 at the Engineering College, UPM just adjacent to the Games Village. The athletes who do not have valid classification would need to be classified. However, athletes who are unsure of their status should get their classification status confirmed at the classification station before 3pm of 2nd May 2008.




Athletes are reminded that there would be doping control testing during the competition. Hence, caution should be taken to avoid medication which are on the WADA Prohibited list 2008.

Enjoy the games!

Extensor Retinaculum Injury and Extensor Digitorum Longus tenosynovitis

A male artistic gymnast was seen a few days ago with complaints of pain in the dorsum of the left foot after intensive training involving runs and jumps since 2 weeks earlier. He had difficulty standing on-toes, taking-off from jumps and landing.

After examining his ankle, I found that he had slightly reduced range of plantarflexion in the left ankle due to pain. There was tenderness and mild oedema of the extensor retinaculum and mild tenosynovitis of the Extensor Digitorum Longus tendons. However, resisted extension was pain free.






I did a simple taping to prevent extreme plantarflexion while enabling him to point his toes during his routine(Two figure of 6, and a double medial and lateral ankle locks and closed up the 'holes'). That seemed to do the trick and he should be back doing some training. However, he was told to refrain from sprinting or jumping to his maximal height as it may aggravate the injury. He was advised to undergo physiotherapy to reduce the symptoms and strengthen his lower limb.

Hallux Valgus

A fencing athlete was seen with her big toes (hallux) turned outwards (valgus), hence crowding into her second toe. She was lucky as she did not have any symptoms of pain usually seen in the prominent bunions. Gymnasts and dance athletes often suffered from painful bunions. She could consider using nights splints for the big toe, taping during training and some icing after training to assist her. If she wanted something off-training, she could buy a broad forefoot footwear and use a silicone gel spacing device between the toes.

Just don't wear the toe spreader to run or play badminton or table-tennis. You might get really bad blisters.