Patellar Taping

Description[edit | edit source]

Patellar taping was originally developed by Jenny McConnell and is a simple, inexpensive self management strategy.  The aim is to create a mechanical realignment of the patella in the intertrochlear groove and reduce pain. Although patellar taping seem to reduce pain and improve  performance of individuals with PFPS, the exact mechanisms of these phenomena cannot be explained[1]

Purpose[edit | edit source]

The McConnell taping technique was developed to correct altered patellofemoral kinematics and permit participation in normal daily activity [2] and to allow the patient to engage in physical therapy exercise pain free. Although there are several variations of the taping procedure recommended, depending on the specific needs of the patient (eg, glide, tilt, and/or rotation), as reported by McConnell, nearly all patients require a medial glide of their patellas. [3]

McConnell taping is accomplished by way of application of specialized adhesive tape applied across the anterior aspect of the patella, pulling from lateral to medial, to in effect “medialize” the patellofemoral joint (PFJ). Once applied the patients should experience a reduction in their symptoms associated with PFPS, thus enabling them to engage in physical therapy exercise. As such, the ability of the strapping procedure to maintain the medialized position of the patella is critical for the duration of the physical activity. [3]

Indications[edit | edit source]

Patellar taping may be used as a treatment for Knee Osteoarthritis, Patellofemoral Pain Syndrome and Chondromalacia Patellae.[4][5][6][7]  In most of the cases these symptoms aggravate during physical activities such as: ascending and descending stairs, kneeling, running and squatting.[8][6][4]

Application[edit | edit source]

Begin with the patient in supine lying with the knee slightly bent.  The knee should be completely relaxed and a foam roller or rolled up towel under the knee.  Start the tape in line with the middle of the knee cap at the outer aspect of the knee. Using your thumb on top of the sports tape, gently push the patella towards the inner aspect of the knee whilst simultaneously using your fingers to pull the skin at the inner aspect of the knee towards the patella. Finish this taping technique at the inner aspect of the knee ensuring you have created some wrinkling of the skin at the inner aspect of the knee. Repeat this process 1 - 3 times depending on the amount of support required. [9]

Main Advantages of Patella Taping[edit | edit source]

Pain Reduction[edit | edit source]

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.[4][5][8][6][7][10]

Improvement in Disability[edit | edit source]

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.[8][7]

Effect on Quadriceps Function[edit | edit source]

Patellar taping demonstrated significantly greater concentric and eccentric quadriceps torque.[5][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.[5][10][4]

Effect on Knee Joint during Gait[edit | edit source]

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.[5][12]

Effect on the Activation/Timing of the Vastii[edit | edit source]

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.[13][14][4]

Re-align the Patella[edit | edit source]

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.[5][5][8][6][7]

References[edit | edit source]

  1. Aminaka N, Gribble PA. Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. Journal of Athletic training. 2008 Jan;43(1):21-8.
  2. Aditya Derasari, Timothy J. Brindle, Katharine E. Alter, Frances T. Sheehan., McConnell Taping Shifts the Patella Inferiorly in Patients With Patellofemoral Pain: A Dynamic Magnetic Resonance Imaging Study, Physical Therapy, 2010; 90 (3): 411 – 420
  3. 3.0 3.1 Ronald P. Pfeiffer, Mark DeBeliso, Kevin G. Shea, Lorrie Kelley, Bobbie Irmischer and Chad Harris., Kinematic MRI Assessment of McConnell Taping Before and After Exercise, The American Journal of Sports Medicine, 2004; 32: 621 – 628
  4. 4.0 4.1 4.2 4.3 4.4 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.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 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.
  6. 6.0 6.1 6.2 6.3 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 and Rheumatism (Arthritis Care and Research) Vol.59, No. 1. 2008 January; 73-83.
  7. 7.0 7.1 7.2 7.3 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.
  8. 8.0 8.1 8.2 8.3 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.
  10. 10.0 10.1 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.
  11. 11.0 11.1 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. 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.
  13. 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. 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.