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Patellar Taping

From Physiopedia

Original Editor - Joyce De Vos

Top Contributors -

William Jones, Joyce De Vos, Venus Pagare, Rachael Lowe and Eric Robertson

Contents

Description

Patellar taping was originally developed by Jenny McConnell and is a simple, inexpensive self management strategy.

The aim of patellar taping is to create a mechanical realignment in order to correct malalignments of the patella and to reduce pain.

Indications

Patellar taping is used as a treatment of the following disorders.[1][2][3][4]

Knee Osteoarthritis

Patellofemoral Pain Syndrome

Anterior knee pain

Chondromalacia Patellae

Clinical Presentation

The main characteristics for the above mentioned knee-diseases are:

  • pain,
  • (morning) stiffness,
  • instability of the joint,
  • swelling,
  • decrease of muscle power and
  • difficulties in activities of daily living.

In most of the cases these symptoms aggravate during physical activities such as: ascending and descending stairs, kneeling, running and squatting.[5][3][6]

Physical Therapy Management

Patellar taping is a useful treatment to reduce the main symptoms, mentioned in the clinical presentation.[1][2][5][3][4][7][8][9][10][11][6][12][13][14][15] A well-known taping technique is the McConnell patellar taping technique. To demonstrate this technique I added the first movie. The second movie shows another taping technique especially for knee instability .

Main advantages of patella taping

Pain reduction

Almost all studies have demonstrated an immediate decrease in pain during provocative exercise. Studies also found that medial patellar tape induced a significantly greater pain reduction than the lateral patellar tape. Especially patients who suffer from knee osteoarthritis, patellofemoral pain syndrome and chronic knee pain experience a significant pain reduction.[1][2][5][3][4][8]

Improvement in disability

On patients with knee osteoarthritis research demonstrated that therapeutic patellar tape improves the disability of the knee. This advantage of therapeutic tape was maintained until three weeks after stopping treatment. Up until now, the long-term effects are not scientifically proven. Differences have been found between the experimental and the control group, however, the results are insignificant.[5][4]

Effect on quadriceps function

Patellar taping demonstrated significantly greater concentric and eccentric quadriceps torque.[2][11] Another article found significantly greater knee extensor moments and power during weight-bearing activities such as vertical jump and lateral step up in taped conditions in PFPS subjects.[11] There are several possible explanations but they need to be explored in further studies. This benefit is important for patients with PFPS, because decreased quadriceps contractions may lead to a diminution of the shock absorption during weight bearing thus further increasing the load on the patellofemoral joint. An increase in quadriceps muscle force can directly heighten the patellofemoral joint reaction force during gait, so patellar taping is very important for the treatment of PFPS.[2][8][6]

Effect on knee joint during gait

Patients with PFPS have significantly less knee flexion during gait and walk significantly slower. These factors will reduce the load on the patellofemoral joint and will decrease the demand on the quadriceps function. Patellar taping demonstrated a small but significant increase of knee flexion while the patients walk at two different speeds, up and down ramps and stairs.[2][7]

Effect on the activation/timing of the vastii

Patients with PFPS demonstrate decreased activation levels of the vastus medialis and the vastus lateralis. Coordinated contraction of these muscles is important for the patellar alignment during activity ( walk up and down the stairs). The benefit of the patella tape is the raise of the activation or timing of the vastus medialis relative to the vastus lateralis or conversely, the decrease activation of the vastus lateralis relative to the vastus medialis. During step down tasks the contraction of the vastus medialis occurred earlier in taped conditions. This earlier activation may alter the movement of the patella. This benefit should be further explored in order to be more confident of the results.[9][10][6]

Re-align the patella

The three most common radiographic measurements alignments of the patella are: the patellofemoral congruence angle (PFCA), the lateral patellofemoral angle (LPFA) and the lateral patellar displacement (LPD). The PFCA represents lateral patellar glide and lateral tilt, the LPFA represents lateral patellar tilt, while the LPD quantifies the position of the patella in the frontal plane relative to the medial femoral condyle in millimeters. A few studies have provided the evidence that medial patellar taping can confer a radiographic positional change of the patella in PFPS subjects. Researchers found a significant change in LPFA and LPD with patellar tape in PFPS subjects They suggest that this may be sufficient to create a subtle alternation in intra-articular or inter-osseous pressure. So patellar tape can influence patellar position in LPFA and LPD. The benefit of taping on the PFCA is not proven.[2][12][13][14][15]

Recent Related Research (from Pubmed)

References

  1. 1.0 1.1 1.2 Lori A. Bolga, Michelle C. Boling. An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010, Int J Sports Phys Ther. 2011 June; 6(2): 112-125.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 K. Crossley, S.M. Cowan, K.L. Bennell, J. McConnell. Patellar taping: is clinical success supported by scientific evidence?, Centre for Sports Medicine Research and Education, School of Physiotherapy, The University of Melbourne, Australia; McConnell an Clements Physiotherapy, Sydney, Austalia, Manual Therapy. 2000; 5(3): 142-150.
  3. 3.0 3.1 3.2 3.3 Stuart J. Warden, Rana S. Hinman, Mark A. Watson,JR., Keith G. Avin, Andrea E. Bialocerkowski, Kay M. Crossley. Patellar taping and bracing for the treatment of chronic knee pain: a systematic review and meta-analysis, Arthritis & Rheumatism (Arthritis Care & Resaerch) Vol.59, No. 1. 2008 January; 73-83.
  4. 4.0 4.1 4.2 4.3 Rana S. Hinman, Kay M. crossley, Jenny McConnell, Kim L. Bennell. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomized controlled trial, Centre for Sports medicine research an Education, School of Physiotherapy, University of Melbourne, Victoria, 3010, Australia. 2003 July 19; 327(7407): 135.
  5. 5.0 5.1 5.2 5.3 Brian Quilty, Marian Tucker, Rona Campbell, Paul Dieppe. Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patella-femoral joint involvement: randomized controlled trial, The Journal of Rheumatology. 2003; 30:6.
  6. 6.0 6.1 6.2 6.3 Gilleard W., McConnell J., Parsons D.. The effect of patellar taping on the onset of vastus medialis obliquus and vastus lateralis muscle activity in persons with patellofemoral pain, School of Exercise and Sport Science, University of Sydney, New South Wales, Australia., Physical Therapy. 1998; 78(1): 25-32.
  7. 7.0 7.1 H. Mokhtarinia, I. Ebrahimi-takamjani, M. Salavati, S. Goharpay, A. Khosravi. The effect of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome, Tehhran University of Medical Sciences, Acta Medica Iranica. 2008; 46(3): 183-190.
  8. 8.0 8.1 8.2 Sallie M. Cowan, Kim L. Bennell, Paul W. Hodges. Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome, Center for Sports Medicine Research and Education, School of Physiotherapy, University of Melbourne, Australia, University of Queensland, Brisbane, Australia., Clinical Journal of Sport Medicine. 2002; 12: 339-347.
  9. 9.0 9.1 Michael J. Callaghan, James Selfe, Alec McHenry, Jacqueline A. Oldham. Effects of patellar taping on knee joint porprioception in patients with patellofemoral pain syndrome, Manual Therapy. 2006.
  10. 10.0 10.1 C.G. Ryan, P.J. Rowe. An electromyographical study to investigate the effects of patellar taping on the vastus medialis/ lateralis ratio in asymptomatic participants, School of health and social care, Physiotherapy Theory and Practice. 2006; 22(6): 309-315.
  11. 11.0 11.1 11.2 Ernst GP., Kawaguchi J., Saliba E.. Effect of patellar taping on knee kinetics of patients with patellofemoral pain syndrome, US Army-baylor University Program in Physical Therapy, Ft Sam Housten, Tex., USA., J Orthop Sports Phys Ther. 1999; 29(11): 661-667.
  12. 12.0 12.1 Worrel T., Ingersoll CD., Bockrath-pugliese K., Minis P.. Effect of patellar taping and bracing on patellar position as determined by MRI in patients with patellofemoral pain, Krannert School of Physicel Therapy, University of Indianapolis., J Athl Train. 1998; 33(1): 16-20.
  13. 13.0 13.1 Hunter DJ., Zhang YQ., Niu JB., Felson DT., Kxoh K., Newman A., Kritchevsky S., Harris T., Carbone L., Nevitt M.. Patella malalignment, pain and patellofemoral progression: the health ABC study, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, USA.,Osteoarthritis Cartilage. 2007 Oct; 15(10): 1120-1127.
  14. 14.0 14.1 Crossley KM., Marino GP., Macilquham MD., Schache AG., Hinman RS.. Can patellar tape reduce the patellar malalignment and pain associated with patellofemoral osteoarthritis, National ICT Australia, The University of Melbourne, Parkville, Australia, Arthritis Rheum. 2009 Dec; 15;61(12): 1719-1725.
  15. 15.0 15.1 Pfeiffer RP., DeBeliso M., Shea KG., Kelley L. Irmischer B., Harris C.. Kinematic MRI assessment of McConnell taping before and after exercise, Center for Orthopaedic and Biomechanics Research, Boise State University, Am J Sports Med. 2004 Apr-May; 32(3): 621-628.

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