ChiroACCESS Article



Taping for Patellofemoral Pain: How Does it Alter Structural Dynamics?



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May 10, 2010

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Patellofemoral PainTaping is frequently used to stabilize and position the patella in order to treat patellofemoral pain.  There have been several studies since 2000 that provide evidence supporting the clinical effectiveness of taping.  This research, including a 2005 systematic review at the University of Toledo, have pointed out that “Although patellar taping seems to reduce pain and improve function in people with patellofemoral pain syndrome during activities of daily living and rehabilitation exercise, strong evidence to identify the underlying mechanisms is still not available.”

The first research study that assessed the 3 dimensional dynamics of the knee with taping was published last month (March 2009).  The knees of 14 volunteers were assessed twice, without tapping and with the McConnell taping procedure.  The knees were repeatedly put though maximum flexion and extension.  An MRI was taken at 10 degrees flexion for both untaped (baseline) and taped after the repeated flexion and extension.  The analysis revealed that taping “shifted the patella inferiorly with respect to the femur”.  This shifting resulted in an increased contact area of the patella on the femur.  The increased contact area appears to be responsible for reduced pain.  Taping also provides correction of lateralization of the patella.  Medial or lateral shift is unique to each patient but the authors believed that all knees received a benefit from the inferior shift of the patella.  A review of the evidence related to the prevention, diagnosis and management of patellofemoral pain can be found at ChiroACCESS.

McConnell taping shifts the patella inferiorly in patients with patellofemoral pain: a dynamic magnetic resonance imaging study.

Phys Ther. 2010 Mar;90(3):411-9. Epub 2010 Jan 28.

Derasari A, Brindle TJ, Alter KE, Sheehan FT.
Department of Orthopaedics, University of Miami, Miami, Florida, USA.

BACKGROUND: Patellar taping is widely used clinically to treat patients with patellofemoral pain syndrome (PFPS). Although patellar taping has been demonstrated to reduce patellofemoral pain in patients with PFPS, the kinematic source for this pain reduction has not been identified.

OBJECTIVE: The purpose of this study was to quantify the changes in the 6-degrees-of-freedom patellofemoral kinematics due to taping in patients with PFPS.

DESIGN: A within-subject design and a sample of convenience were used.

PARTICIPANTS: Fourteen volunteers (19 knees) who were diagnosed with patellofemoral pain that was present for a year or longer were included. Each knee had to meet at least 1 of the following inclusion criteria: Q-angle of > or =15 degrees, a positive apprehension test, patellar lateral hypermobility (> or =10 mm), or a positive "J sign."

METHODS: Each knee underwent 2 randomly ordered testing conditions (untaped and taped). A full fast-phase contrast (PC) magnetic resonance image set was acquired for each condition while the participants volitionally extended and flexed their knee. Three-dimensional displacements and rotations were calculated through integration of the fast-PC velocity data. Statistical comparisons between baseline patellofemoral kinematics and the change in kinematics due to taping were performed using a 2-tailed paired Student t test. Correlations between baseline patellofemoral kinematics and the change in kinematics due to taping also were quantified.

RESULTS: Patellar taping resulted in a significant patellofemoral inferior shift. The strongest correlation existed between the change in lateral-medial displacement with taping and baseline (r=-.60).

CONCLUSIONS: The inferior shift in patellar displacement with taping partially explains the previously documented decrease in pain due to increases in contact area. The lack of alteration in 5 of the 6 kinematic variables with taping may have been due to the fact that post-taping kinematic alterations are sensitive to the baseline kinematic values.

The reliability and validity of assessing medio-lateral patellar position: a systematic review.

Man Ther. 2009 Aug;14(4):355-62. Epub 2008 Sep 27.

Smith TO, Davies L, Donell ST.
Orthopaedic Physiotherapy Research Unit, Physiotherapy Department, Out-Patients East, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. toby.smith@nnuh.nhs.uk

Medio-lateral patellar position is regarded as a sign of patellofemoral pain syndrome and patellar instability. Its assessment is important in accurately performing patellofemoral therapeutic taping techniques. The purpose of this paper is to systematically review the literature to determine the reliability and validity of evaluating medio-lateral patellar position. An electronic database search was performed accessing AMED, British Nursing Index, CINAHL, the Cochrane database, EMBASE, Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Zetoc to July 2008. Conference proceedings and grey literature were also scrutinised for future publications. All human subject, clinical trials, assessing the inter- or intra-tester reliability, or the criterion validity, were included. A CASP tool was employed to evaluate methodological quality. Nine papers including 237 patients (306 knees) were reviewed. The findings of this review suggest that the intra-tester reliability of assessing medio-lateral patellar position is good, but that inter-tester reliability is variable. The criterion validity of this test is at worse moderate. These are based on a limited evidence-base. Further study is recommended to compare the McConnell (1986) [McConnell J. The management of chondromalacia patellae: a long term solution. Australian Journal of Physiotherapy 1986;32(4):215-23] and Herrington (2002) [Herrington LC. The inter-tester reliability of a clinical measurement used to determine the medial/lateral orientation of the patella. Manual Therapy 2002;7(3):163-7] methods of assessing medio-lateral patellar position in patients with well-defined patellofemoral disorders.

A systematic review of the effects of therapeutic taping on patellofemoral pain syndrome.

J Athl Train. 2005 Oct-Dec;40(4):341-51.

Aminaka N, Gribble PA.
University of Toledo, Toledo 43528, USA.

OBJECTIVE: To investigate the efficacy of patellar taping on pain control, patellar alignment, and neuromuscular control (ie, vastus medialis oblique activation, knee extensor moment, etc) in subjects with patellofemoral pain syndrome.

DATA SOURCES: We searched MEDLINE, SPORT Discus, PEDro, and CINAHL through December 2004, using the key words patellar taping, therapeutic taping, McConnell taping, taping, chronic injury, patellofemoral pain, and knee.

STUDY SELECTION: Criteria for inclusion criteria were studies that exclusively recruited patients diagnosed with patellofemoral pain syndrome or anterior knee pain and outcome measures specific to pain reduction, neuromuscular control, and patellar positioning.

DATA EXTRACTION: We identified and reviewed 16 studies with an average PEDro score of 4.25/10. Articles were divided into 3 categories based on primary outcome measures: 4 randomized controlled trials on treatment methods and pain, 9 studies on neuromuscular control, and 3 on patellar positioning.

DATA SYNTHESIS: Although patellar taping seems to reduce pain and improve function in people with patellofemoral pain syndrome during activities of daily living and rehabilitation exercise, strong evidence to identify the underlying mechanisms is still not available.

Medial patellar taping changes the peak plantar force location and timing of female basketball players.

Gait Posture. 2002 Apr;15(2):146-52.

Nyland JA, Ullery LR, Caborn DN.
School of Physical Therapy, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 77, Tampa, FL 33612-4576, USA.jn3dkin@aol.com

Subtle changes in patellofemoral joint biomechanics may influence lower extremity function. The McConnell method of patellar taping has become an increasingly popular method of managing patients with various patellofemoral joint disorders. The purpose of this order effect controlled study was to assess medial patellar taping (McConnell Method) for changes in peak plantar force location and timing while running and dribbling a basketball prior to the performance of a basketball lay-up. Sixteen non-impaired, right hand dominant members of a female junior varsity basketball team (age=14.6 +/- 2 years) participated in this study. Subject bodyweight and height were 607.8 +/- 99 N and 1.67 +/- 0.10 m, respectively. All data were collected from the preferred stance limb. A series of two way analysis of variance (ANOVA) (condition, trial) were used to determine statistical significance (P < or = 0.05). During medial patellar taping, subjects displayed a more forefoot directed peak plantar force location 89.9 +/- 18 versus 81.3 +/- 21 mm and delayed peak plantar force onset 141 +/ - 23 versus 130 +/- 29 ms following initial ground contact. Medial-lateral peak plantar force location and peak plantar force magnitude did not differ between conditions, however, medial-lateral peak plantar force location displayed significant trial sequence influences with the latter trials displaying more lateral center of plantar force locations (30.4 +/- 2 vs. 32.5 +/- 3 mm). The results of this study suggest that medial patellar taping influences distal lower extremity function by shifting peak plantar force location toward the forefoot, and delaying its onset. These changes with consideration for known synergistic ankle plantar flexor-subtalar joint invertor and knee extensor function during weight bearing suggest the presence of increased muscular stiffness acting through a more rigid foot to improve the impact force attenuating capability of the lower extremity.

Kinematic MRI assessment of McConnell taping before and after exercise.

Am J Sports Med. 2004 Apr-May;32(3):621-8.

Pfeiffer RP, DeBeliso M, Shea KG, Kelley L, Irmischer B, Harris C.
Center for Orthopaedic and Biomechanics Research, Boise State University, Boise, Idaho, 83725, USA.

BACKGROUND: The authors assessed the effectiveness of McConnell medial glide taping after exercise using an MRI extremity scanner.

HYPOTHESIS: McConnell taping would not be effective in maintaining medial glide of the patella after exercise.

METHODS: Eighteen healthy women (mean age 22.28 +/- 2.02 years) participated in the study. The patellofemoral joint was imaged at 4 knee flexion angles (0 degrees, 12 degrees, 24 degrees, and 36 degrees ) in 3 conditions (no tape, with McConnell taping-medial glide, and with tape after exercise). Effectiveness was determined by measuring lateral patellar displacement. ANOVA and post hoc paired t tests were used to test for changes in lateral patellar displacement at each knee angle and condition.

RESULTS: Statistical analysis revealed significant differences in lateral patellar displacement at all test angles, between the tape and no tape and between tape and tape after exercise conditions.

CONCLUSIONS: McConnell medial glide taping resulted in significant medial glide of the patellofemoral joint at all 4 knee angles before but not after exercise. However, McConnell medial glide taping may be effective under controlled rehabilitation conditions in which exercise is less intense. Clinical Relevance: Beneficial effects of McConnell medial glide taping may be related to factors other than altered patellar alignment.

Patellar taping: is clinical success supported by scientific evidence?

Man Ther. 2000 Aug;5(3):142-50.

Crossley K, Cowan SM, Bennell KL, McConnell J.
Centre for Sports Medicine Research and Education, The University of Melbourne, Australia. k.crossley@pgrad.unimelb.edu.au

Patellofemoral pain syndrome (PFPS) is a common condition presenting to physiotherapy and sports medicine practices. Despite its prevalence, the aetiology, pathogenesis, and recommended treatment remain unclear. One component of treatment for PFPS that has been subjected to scrutiny is patellar taping. This taping was designed to realign the patella within the femoral trochlea, thus reducing pain from PFPS and improving both quadriceps and patellofemoral joint function. Clinical and research findings confirm that the pain associated with PFPS is significantly reduced with patellar taping. Therefore, research has aimed at determining the mechanisms of this pain relief. The means by which patellar tape can relieve pain may provide insight into the aetiology and risk factors for PFPS, thus allowing more appropriately designed treatment regimes and preventative strategies. There is evidence to suggest that patellar tape improves patella alignment (measured radiographically) and quadriceps function (torque production and extensor moments). Evidence that patellar tape enhances the activation of individual vastii (magnitude or timing) is limited in quality and quantity, which probably reflects the difficulties inherent in measuring this complex question. There is preliminary evidence for improved knee control during gait in association with patellar tape. This paper critically reviews the studies that have examined the effects of patellar taping and makes informed recommendations for further research and clinical practice. Copyright 2000 Harcourt Publishers Ltd.

Effect of patellar taping on knee kinetics of patients with patellofemoral pain syndrome.

J Orthop Sports Phys Ther. 1999 Nov;29(11):661-7.

Ernst GP, Kawaguchi J, Saliba E.
US Army-Baylor University Program in Physical Therapy, Ft Sam Houston, Tex., USA. gernst1@juno.com

STUDY DESIGN: Single-group repeated measures examining patients with patellofemoral pain syndrome.

OBJECTIVE: To examine the effect of McConnell patellar taping on single-leg vertical jump height and knee extensor moment and power during a vertical jump and lateral step-up.

BACKGROUND: Patellar taping is used by clinicians in an attempt to maximize knee extensor function during sporting activities and rehabilitation of patients with patellofemoral pain syndrome. No studies have examined the effect of patellar taping on vertical jump height and knee extensor moment and power during a maximal vertical jump or lateral step-up.

METHODS AND MEASURES: Fourteen women (24.4 +/- 5.8 years) with unilateral patellofemoral pain performed a single-leg vertical jump and lateral step-up during 4 knee conditions: patellar tape, placebo tape, no tape, and the uninvolved knee. Maximal knee extensor moment, knee power, and vertical jump height were measured for each condition using a force platform and motion analysis system.

RESULTS: Analysis of variance and post hoc analyses revealed a main effect for knee condition. The patellar tape condition resulted in a greater knee extensor moment (1.57 +/- 0.32 N.m/kg) and power (3.47 +/- 0.67 W/kg) than did the no-tape (1.31 +/- 0.39 N.m/kg and 2.79 +/- 1.21 W/kg) and placebo tape (1.33 +/- 0.30 N.m/kg and 2.70 +/- 0.99 W/kg) conditions. Additional analyses showed that the vertical-jump height was significantly greater in the uninvolved lower extremity (25.69 +/- 2.66 cm) compared with the patellar tape (23.33 +/- 4.22 cm), placebo tape (23.08 +/- 4.20 cm), and no-tape (23.45 +/- 4.54 cm) conditions. The patellar tape condition did not show a different vertical jump height than the placebo or no-tape conditions.

CONCLUSIONS: These results suggest that patellar taping compared with no tape may improve the knee extensor moment and power during weight-bearing activities such as the lateral step-up exercise and the vertical jump.
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