The effects of patellar taping on stride characteristics and joint motion in subjects with patellofemoral pain

Effectiveness of Interventions Aimed at Changing Movement Patterns in People With Patellofemoral Pain: A Systematic Review With Network Meta-analysis

OBJECTIVE: To summarize the effectiveness of interventions for changing movement during weight-bearing functional tasks in people with patellofemoral pain (PFP). DESIGN: Systematic review with network meta-analysis (NMA). LITERATURE SEARCH: Medline, Embase, CINAHL, SPORTDiscus, and Cochrane Library were searched from inception up to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials involving people with PFP and nonsurgical, nonpharmacological interventions on task kinematics were included. DATA SYNTHESIS: NMA was conducted for frontal knee movement data, and pairwise meta-analysis was used to pool data when NMA was not possible. Reduced movements were those changes that indicated movements occurring with less amplitude. The GRADE approach was used to grade the certainty of the evidence. RESULTS: Thirty-seven trials were included (n = 1235 participants). Combining knee/hip exercises with internal feedback had the strongest effect on reducing frontal knee movements (standardized mean difference [SMD] from NMA = -2.66; GRADE: moderate evidence). On pairwise comparisons, the same combination of interventions reduced frontal hip movements (SMD = -0.47; GRADE: moderate evidence) and increased sagittal knee movements (SMD = 1.03; GRADE: moderate evidence), with no effects on sagittal hip movements (GRADE: very low evidence), compared to knee/hip exercises alone. There was no effect for single applications of braces on the frontal knee movement (GRADE: very low evidence) and taping on movements of the knee, hip, and ankle (GRADE: very low to low evidence) compared to no intervention. CONCLUSION: Knee/hip exercises combined with internal feedback techniques may change knee and hip movements in people with PFP. The combination of these interventions can reduce frontal knee and hip movements, and can increase sagittal knee movements. J Orthop Sports Phys Ther 2023;53(12):1-13. Epub 14 September 2023. doi:10.2519/jospt.2023.11956.

Taping, Bracing, and Injection Treatment for Patellofemoral Pain and Patellar Tendinopathy

PURPOSE OF REVIEW

This article will focus on additional treatment options for the two most common causes of anterior knee pain, patellofemoral pain syndrome, and patellar tendinopathy. Conservative management is the first-line treatment for these conditions. For clinicians to maximize the efficacy of conservative treatment options for their patients, they must understand the most up-to-date literature evaluating the potential benefit of taping, bracing, and injections as adjunctive treatments for maximizing treatment success.

RECENT FINDINGS

Recent studies of bracing and taping have found them to be helpful for patients in the short-term management of pain and improving function. However, less is known about their exact mechanism but studies are encouraging that they have a subtle role in changing patellofemoral biomechanics. Injections remain a commonly used treatment for musculoskeletal conditions; however, the evidence for their use in patellofemoral pain and patellar tendinopathy is limited. The use of platelet-rich plasma (PRP), sclerosing, high volume, or stem cell injections is an exciting new area in the treatment of patellar tendinopathy. However, evidence at this time to recommend these treatments is lacking, and more well-designed studies are needed. The treatment of patellofemoral pain and patellar tendinopathy consists of a multi-faceted approach of physiotherapy and physical modalities. There is evidence for short-term use of taping and bracing for these conditions. The evidence for injections at this time is limited and remains under investigation. Future well-designed randomized controlled studies will provide insight into the efficacy of several different types of injections in the treatment of patellar tendinopathy. Physicians should feel comfortable integrating taping and bracing into their anterior knee pain treatment paradigm while making cautious use of invasive injections as adjunctive therapy.

What Is the Effect on Kinesio Taping on Pain and Gait in Patients With Patellofemoral Pain Syndrome?

Introduction

Patellofemoral pain syndrome (PFPS) is one of the leading causes of anterior knee pain treated by orthopedists and physical therapists. This syndrome predominantly affects young, active individuals, and remains a challenging syndrome to manage due to the lack of quantitative diagnostic criteria to monitor during treatment. The etiology of this syndrome is believed to be multifactorial, with the gait and movement patterns of a patient potentially contributing to pain due to increased stress on the knee. In this study, we investigated the gait of participants with PFPS using the GaitRite system (CIR Systems Inc., Clifton, NJ) before and after the application of Kinesio Tape in order to assess the impact of Kinesio Tape on cadence, stance time, and pain.

Methods

A convenience sample of 10 participants were recruited for this study, with five participants without PFPS serving as controls, and five with PFPS in the Kinesio Tape group. Participants in the Kinesio Tape groups served as their own internal control, ambulating both before and after taping. All participants ambulated across the GaitRite carpet three times and completed a visual analogue scale pain score for each trip.

Results

The results of our study found there to be no significant difference in the cadence for gait between the participants without PFPS and participants with PFPS (105.2 seconds vs. 105.1 seconds, p = 0.272), or in the stance time between the control and PFPS group (1.43 seconds vs. 1.44, p = 0.907). Similarly, no significant difference was found in participants with PFPS before and after Kinesio Taping in the cadence and stance times (105.1 seconds vs. 107.4 seconds, p =0.288, and 1.44 vs. 1.40, p = 0.272). There was a significant difference in pain in PFPS participants before and after taping, with a 112.5% reduction in pain reported after taping (3.4 vs. 1.6, p < 0.05).

Discussion and conclusion

This study is one of the first studies to utilize the GaitRite system in order to analyze the impact of Kinesio Tape on gait in participants with PFPS. While our study failed to demonstrate a significant difference in the gait of participants with PFPS in comparison to those without PFPS, we did demonstrate a significant reduction in pain after the application of Kinesio Tape. These results suggest other variables addressed by the Kinesio Tape may be causing the pain associated with PFPS.

McConnell patellar taping on postural control of women with patellofemoral pain syndrome: randomized clinical trial

Abstract Introduction: The effects of McConnell patellar taping on the postural control of women with patellofemoral pain syndrome (PFPS) are controversial. Objective: To evaluate the effects of McConnell patellar taping on the static one-leg stance postural control and during squatting in women with PFPS. Method: A randomized, blinded clinical trial that comprised 40 women with PFPS, aged between 18 and 35 years. The study sample was allocated to two groups: McConnell patellar taping group (MPTG) and Placebo taping group (PTG). The analysis included the one-leg static support and squat on the lower limb with PFPS. The center of pressure (CoP) displacement parameters recorded by a force platform were analyzed using two-way ANOVA and Cohen’s d. Results: For the static postural control, no significant differences were found between the groups in terms of time or interaction (p>0.05); with small effect size. For the postural control during the one-leg squat, significant differences were found regarding the time of intervention for both groups, with reduced CoP parameters after the application of taping. However, the MPTG demonstrated a large effect size in frequency of oscillation and medium effect size in speed of oscillation, both during the squat exercise. Conclusion: McConnell patellar taping and placebo taping improved postural control during the one-leg squat. It should be observed that the changes and effect sizes determined for the MPTG were significantly higher compared to the PTG, emphasizing its clinical importance in the treatment of individuals with PFPS, during dynamic activities.

The effect of patellar taping on lower extremity running kinematics in individuals with patellofemoral pain syndrome

Purpose: To investigate the effects of patellar taping (Leukotape® (LT), Pinetown, South Africa, Kinesio Tape (KT), Dortmund, Germany, or no tape) on lower extremity kinematics in runners with and without patellofemoral pain syndrome (PFPS). Methods: In total, 20 healthy individuals and 12 with PFPS ran on a treadmill under different taping conditions and lower extremity kinematics and stride characteristics were obtained using Peak Motus Software, Colorado, USA. Data were analyzed using descriptive statistics and mixed factorial analysis of variance (p < 0.05). Results: Significant taping effects were found for hip (F(2,60) = 16.79, p = 0.0001) and knee (F(2,60) = 17.27, p = 0.0001) flexion angles at initial contact, and peak hip flexion angles during swing (F(2,60) = 6.55, p = 0.003). Increased flexion was noted with LT more than KT and no tape conditions. Similarly, peak knee flexion angles during stance (F(2,60) = 3.51, p = 0.03) and flight time (F(2,60) = 5.01, p = 0.01) revealed significant taping effects, with LT resulting in more flexion (p = 0.04) and shorter flight times (p = 0.01) than the no tape condition. Furthermore, a significant taping effect was seen for peak knee flexion angle during swing (F(2,60) = 4.96, p = 0.01), with the KT resulting in less flexion than LT (p = 0.04) and no tape conditions (p = 0.04). Conclusion: The application of tape during running may impact on hip and knee flexion angles at initial contact, as well as flight time.

The effect of aroma stimulation during isotonic exercise on the rating of perceived exertion and blood fatigue factors of athletes with patellofemoral pain syndrome

[Purpose] The purpose of this study is to examine the effect of aroma stimulation during isotonic exercise on the rating of perceived exertion (RPE) and the blood fatigue factors of athletes who have patellofemoral pain syndrome (PFPS). [Subjects and Methods] The research subjects were seven athletes in their twenties who suffer from PFPS. They were divided into a control group and an aroma stimulation group and performed isotonic exercises repeatedly. After exercising, the RPE and blood fatigue factors, including creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and ammonia, were measured through blood sampling. [Results] The aroma stimulus group showed significantly lower RPE than the control group immediately after exercising, which included leg presses, leg curls, bicep curls, and leg extensions. Among the blood fatigue factors, the change in LDH indicated the effect of aroma stimulation. [Conclusion] We confirmed that aroma stimulation during isotonic exercise has the positive effect of reducing the RPE and blood fatigue factors, such as blood LDH, of the athletes with PFPS.

Patellofemoral Pain and Instability in Adolescent Athletes

Injuries and disorders of the patellofemoral joint in the adolescent athlete can encompass a wide spectrum of symptomatology and pathology. Anterior knee pain is a common presenting symptom in sports medicine clinics, and can have numerous underlying etiologies. This activity-related pain may be the manifestation of enthesopathy, tendinopathy, fat pad impingement, or numerous other conditions, but is more commonly related to more subtle skeletal and muscular imbalances. Treatment is typically nonoperative in nature, and excellent results are reported with physical therapy. Patellofemoral instability usually has a more dramatic onset in the form of dislocation or subluxation events, commonly experienced during athletics. Concomitant injuries to the patellofemoral articular cartilage are common. Again, treatment is typically nonoperative initially, but recurrent or recalcitrant instability may necessitate reconstructive or realignment procedures. Skeletal maturity often dictates what procedures can be safely attempted.

Effects of Taping on Pain and Functional Outcome of Patients with Knee Osteoarthritis: A Pilot Randomized Single-blind Clinical Trial

Background

To determine the effects of knee taping in combination with exercise and medical treatment on functional outcome and pain of patients with knee osteoarthritis (OA).

Materials and Methods

In a randomized single-blinded clinical trial, 36 patients with knee OA were randomly assigned to two study groups. Both groups received exercise and medical therapy for 6 weeks. In addition, the first group (20 patients) received taping in the first 3 weeks. Pain severity (assessed by visual analog scaling), weekly amount of analgesics consumption, timed get up and go test (TUG), and step tests were recorded at baseline, 3 and 6 weeks after the treatment and were further compared between two study groups.

Results

There was no significant difference between two groups in pain severity score (P = 0.228), step test score (P = 0.771), TUG test score (P = 0.821) and weekly amount of analgesics consumption (P = 0.873) at baseline. After 3 weeks, weekly amount of analgesics consumption (P = 0.006), pain severity (P < 0.001) was significantly lower in taping group whereas step test score (P = 0.006) was significantly higher in the taping group. After 6 weeks, patients in taping group had significantly lower pain severity (P = 0.011) and higher step test score (P = 0.042). However, there was no significant difference in TUG test score (P = 0.443) and weekly amount of analgesics consumption (P = 0.270) between two groups.

Conclusion

Therapeutic knee taping may be an effective method for short-term management of pain and disability in patients with knee OA.

Does taping in addition to physiotherapy improve the outcomes in subacromial impingement syndrome? A systematic review

BACKGROUND

Taping is used with or without other interventions for many purposes, especially to manage pain and improve functional activity in patients with shoulder pain.

OBJECTIVES

The aim of this review was to determine whether any taping technique in addition to physiotherapy care is more effective than physiotherapy care alone in patients with shoulder impingement syndrome.

METHODS

A systematic search of Cochrane Database of Systematic Review, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, AMED, EMBASE (OVID), The Kinesio Kinesio® Taping Method, Kinesio® Tex Tape UK and International websites ( www.kinesiotaping.co.uk ; www.kinesiotaping.com ) was conducted to June 2015. The outcome measures were pain, disability, range of motion and muscle strength. As data were not suitable for meta-analysis, narrative synthesis were applied.

RESULTS

Three randomized controlled trials and one controlled trial (135 patients) were included. The results were conflicting and weak on the effectiveness of taping as an adjunct therapy for improvement of pain, disability, range of motion and muscle strength.

CONCLUSION

Clinical taping in addition to physiotherapy interventions (e.g. exercise, electrotherapy, and manual therapy) might be an optional modality for managing patients with shoulder impingement syndrome, especially for the initial stage of the treatment; however, we need further robust, placebo controlled and consistent studies to prove whether it is more effective than physiotherapy interventions without taping.

Validation of the movement system impairment-based classification in patients with knee pain

BACKGROUND

Categorizing patients with knee pain problems based on pathoanatomical sources has not proved to be the most effective method for directing physical therapy interventions. Movement system impairment (MSI) classification system may be an alternative in the assessment, diagnosis, and management of patients with knee pain. No previous study has been conducted to validate the proposed system in these patients.

OBJECTIVE

To assess construct validity of the MSI classification system in patients with knee pain.

DESIGN

A cross-sectional methodological study.

SETTING

Rasul Akram Hospital.

PARTICIPANTS

One hundred eighty subjects with knee pain aged 18-65 years.

METHODS

The MSI classification recognizes seven categories of knee pain problems based on the findings from the symptoms and signs assessment. Three physical therapists examined subjects with knee pain. A principal component analysis (PCA) was used to derive proposed categories. Eigenvalues and a scree plot were also used to determine the factor retention.

RESULTS

Four factors related to three proposed categories were extracted from the PCA. Two factors were related to tibiofemoral rotation (TFR) category. The other two factors were related to proposed categories patellar lateral glide (PLG) and tibiofemoral hypomobility (TFHypo).

CONCLUSION

The results provided evidence for the construct validity of three (TFR, PLG, and TFHypo) of the seven categories proposed by MSI classification. In addition TFR was subcategorized into two groups which were named as tibial lateral rotation (TLR) and femoral adduction/medial rotation (FAdd/MR) in the present study.

The use of McConnell taping to correct abnormal biomechanics and muscle activation patterns in subjects with anterior knee pain: a systematic review

[Purpose] The aim of this review was to present the available evidence for the effect of McConnell taping on knee biomechanics in individuals with anterior knee pain. [Methods] The PubMed, Medline, Cinahl, SPORTDiscus, PEDro and ScienceDirect electronic databases were searched from inception until September 2014. Experimental research on knee biomechanical or EMG outcomes of McConnell taping compared with no tape or placebo tape were included. Two reviewers completed the searches, selected the full text articles, and assessed the risk of bias of eligible studies. Authors were contacted for missing data. [Results] Eight heterogeneous studies with a total sample of 220 were included in this review. All of the studies had a moderate to low risk of bias. Pooling of data was possible for three outcomes: average knee extensor moment, average VMO/VL ratio and average VMO-VL onset timing. None of these outcomes revealed significant differences. [Conclusion] The evidence is currently insufficient to justify routine use of the McConnell taping technique in the treatment of anterior knee pain. There is a need for more evidence on the aetiological pathways of anterior knee pain, level one evidence, and studies investigating other potential mechanisms of McConnell taping.

Altered gait biomechanics and increased knee-specific impairments in patients with coexisting tibiofemoral and patellofemoral osteoarthritis

Coexisting patellofemoral osteoarthritis (PFOA) is a common finding in patients with tibiofemoral osteoarthritis (TFOA). The purpose of this study was to elucidate whether severity of coexisting PFOA in patients with TFOA is correlated with altered sagittal-plane gait biomechanics and greater knee-specific impairments. One hundred and six patients with radiographic TFOA were stratified into three groups of no PFOA, mild PFOA, and severe PFOA. All patients completed instrumented gait analysis, quantitative quadriceps strength testing and knee range of motion assessment. Compared to patients with no PFOA, those with severe PFOA exhibited reduced loading-response knee flexion excursions (p = 0.002) and increased peak single-leg stance external knee flexion moments (p < 0.05). The severe PFOA group also demonstrated lower quadriceps strength compared to the no PFOA and mild PFOA groups (p < 0.001). Regression analysis further revealed that quadriceps strength and knee extension range of motion were independently associated with altered sagittal-plane knee biomechanics during gait (p < 0.03). Reduced loading response knee flexion excursion during gait may be an attempt to decrease patellofemoral joint loading by patients with severe PFOA but it may increase impact loading of their arthritic tibiofemoral joint. Additionally, the greater external knee flexion moments observed during the single-leg stance phase of gait can lead to an overall increase in patellofemoral joint loading and symptoms in patients with more severe PFOA. Given the association between knee-specific impairments and altered gait biomechanics in our study, addressing quadriceps muscle weakness and limited knee extension range of motion may be indicated in patients with TFOA and severe coexisting PFOA.

Anterior knee pain: an update of physical therapy

Anterior knee pain is one of the most common knee problems in physically active individuals. The reason for anterior knee pain has been suggested to be multifactorial with patella abnormalities or extensor mechanism disorder leading to patellar malalignment during flexion and extension of the knee joint. Some patients complain mostly of non-specific knee pain, while others report patellar instability problems. The patients present with a variety of symptoms and clinical findings, meaning that a thorough clinical examination is the key for optimal treatment. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. However, irrespective of whether pain or instability is the major problem, hypotrophy and reduced activity of the vastus medialis are often found, which result in an imbalance between vastus medialis and vastus lateralis. This imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease loading of the patello-femoral joint. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least 3 months before considering other treatment options.

QUADRICEPS STRENGTH, KNEE PAIN AND FUNCTIONAL PERFORMANCE WITH PATELLAR TAPING IN KNEE OSTEOARTHRITIS

Background: Patellar taping has long been reported to be effective in relieving pain in patients with patello-femoral pain syndrome (PFPS). Yet, there is lack of knowledge that supports its use in knee osteoarthritis (OA) management. Purpose: This study examined the effect of therapeutic patellar taping on concentric and eccentric quadriceps muscle peak torques, VAS pain scores, 6-minute walking distance and stair climbing time in patients with knee OA. Methods: A total of 30 female patients with symptomatic knee OA with mean age 51.8 ± 6.3 years and BMI 32.56 ± 3.26 m2/kg participated in the study. They were tested under three taping conditions that were tested randomly; therapeutic, placebo and no-tape. Results: Repeated measure MANOVA revealed that the quadriceps muscle peak torques and 6-minute walking distance increased significantly (p < 0.05) and the VAS scores and stair climbing time decreased significantly with therapeutic tape use compared with the other two tapes. Moreover, the quadriceps muscle peak torques increased significantly and the VAS scores decreased significantly with placebo tape use compared with no-tape use, with no significant difference (p > 0.05) in between for the 6-minute walking distance and stair climbing time. Conclusion: The findings indicate that therapeutic patellar taping is effective in improving quadriceps strength and functional performance and reducing pain in patients with knee OA.

The effect of patellofemoral bracing on walking in individuals with patellofemoral pain syndrome

BACKGROUND

Although knee braces are used by individuals with patellofemoral pain syndrome, the effect of patellofemoral bracing on knee flexion during walking has not been elucidated.

AIM

The purpose of this study was to evaluate the effect of patellofemoral bracing on sagittal plane knee joint kinematics and temporal spatial parameters during walking in individuals with patellofemoral pain syndrome.

STUDY DESIGN

Quasi-experimental.

METHODS

Ten subjects with a diagnosis of patellofemoral pain syndrome were fitted with a knee brace incorporating an infrapatellar strap. Testing was performed at baseline and after 6 weeks of use. Gait analysis and a visual analog scale were used to assess outcomes in this study.

RESULTS

A 59.6% decrease in pain was reported by using bracing. Bracing significantly improved speed of walking (p ≤ 0.001) and step length (p ≤ 0.001). The mean cadence was also increased following 6 weeks of patellofemoral brace use, but this was not significant (p = 0.077). Knee flexion angles improved during initial contact, loading response, and mid-swing (p ≤ 0.001) after 6 weeks of patellofemoral brace use.

CONCLUSION

Knee orthoses resulted in decreased pain, improved temporal spatial parameters (speed of walking and step length), and increased knee flexion angles during ambulation in patients with patellofemoral pain syndrome.

Patellar taping for patellofemoral pain syndrome in adults

BACKGROUND

Patellofemoral pain syndrome refers to the clinical presentation of knee pain related to changes in the patellofemoral joint. Patellofemoral pain syndrome usually has a gradual onset of pain with none of the features associated with other knee diseases or trauma. It is often treated by physiotherapists, who use a variety of techniques including patellar taping. This involves the application of adhesive sports medical tape applied directly to the skin over the patella on the front of the knee. Patients often report an instantaneous improvement in pain and function after the tape is applied, but its longer term effects are uncertain.

OBJECTIVES

The objective was to assess the effects, primarily on pain and function, of patellar taping for treating patellofemoral pain syndrome in adults.

SEARCH METHODS

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, PEDro, SPORTDiscus, AMED, reference lists of articles, trial registers and conference proceedings. All were searched to August 2011.

SELECTION CRITERIA

Randomised controlled trials and quasi-randomised controlled trials testing the effects of patellar taping on clinically relevant outcomes, pain and function, in adults with patellofemoral pain syndrome. We excluded studies testing only the immediate effects of tape application.

DATA COLLECTION AND ANALYSIS

Both review authors independently performed study selection, data extraction and assessment of risk of bias. Trialists were contacted for more information. Data were pooled where possible.

MAIN RESULTS

Five small heterogeneous randomised controlled trials, all at high risk of performance bias and most at risk of at least one other type of bias, were included. These involved approximately 200 participants with a diagnosis of patellofemoral pain syndrome. All compared taping versus control (no or placebo taping) and all included one or more co-interventions given to both taping and control group participants; this was prescribed exercise in four trials. The intensity and length of treatment was very varied: for example, length of treatment ranged from one week in one trial to three months in another. A meta-analysis of the visual analogue scale (VAS) pain data (scale 0 to 10: worst pain), measured in different ways, from four trials (data from 161 knees), found no statistically or clinically significant difference between taping and non taping in pain at the end of the treatment programmes (mean difference (MD) -0.15; 95% confidence interval (CI) -1.15 to 0.85; random-effects model used given the significant heterogeneity (P < 0.0001)). Data for other outcomes measuring function and activities of daily living were from single trials only and gave contradictory results.

AUTHORS' CONCLUSIONS

The currently available evidence from trials reporting clinically relevant outcomes is low quality and insufficient to draw conclusions on the effects of taping, whether used on its own or as part of a treatment programme. Further research involving large, preferably multi-centre, good quality and well reported randomised controlled trials that measure clinically important outcomes and long-term results is warranted. Before this, consensus is required on the diagnosis of patellofemoral pain syndrome, the standardisation of outcome measurement and an acceptable approach for patellar taping.

Effect of the Kinesio tape to muscle activity and vertical jump performance in healthy inactive people

BACKGROUND

Elastic taping applied on the triceps surae has been commonly used to improve the performance of lower extremities. However, little objective evidence has been documented. The purpose of this study was to investigate the effect of elastic taping on the triceps surae during a maximal vertical jump. It was hypothesized that elastic taping to the triceps surae would increase muscle activity and cause positive effect to jump height.

METHODS

Thirty-one healthy adults (19 males and 12 females with mean age, body weight and height for 25.3 ± 3.8 years old, 64.1 ± 6.2 kg, and 169.4 ± 7.3 cm, respectively) were recruited. All participants performed vertical jump tests prior to (without taping) and during elastic taping. Two elastic tapes, Kinesio tape and Mplacebo tape from two different manufacturers, were applied to the participants, respectively.

RESULTS

The results showed that the vertical ground reaction force increased when Kinesio tape was applied even when the height of jump remained about constant. However, the height of the jump decreased, and there was no difference on the vertical ground reaction force in Mplacebo taping group. Although the EMG activity of medial gastrocnemius tended to increase in Kinesio taping group, we did not see differences in EMG activity for the medial gastrocnemius, tibialis anterior and soleus muscles in either group.

CONCLUSIONS

Based on the varied effects of Kinesio tape and Mplacebo tape, different intervention technique was suggested for specific purpose during vertical jump movement. Mplacebo tape was demanded for the benefits of stabilization, protection, and the restriction of motion at the ankle joint. On the other hand, the findings may implicate benefits for medial gastrocnemius muscle strength and push-off force when using Kinesio tape.

Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control

CONTEXT

Patellar taping has been a part of intervention for treatment of patellofemoral pain syndrome (PFPS). However, research on the efficacy of patellar taping on lower extremity kinematics and dynamic postural control is limited.

OBJECTIVE

To evaluate the effects of patellar taping on sagittal-plane hip and knee kinematics, reach distance, and perceived pain level during the Star Excursion Balance Test (SEBT) in individuals with and without PFPS.

DESIGN

Repeated-measures design with 2 within-subjects factors and 1 between-subjects factor.

SETTING

The University of Toledo Athletic Training Research Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty participants with PFPS and 20 healthy participants between the ages of 18 and 29 years.

INTERVENTION(S)

The participants performed 3 reaches of the SEBT in the anterior direction under tape and no-tape conditions on both legs.

MAIN OUTCOME MEASURE(S)

The participants' hip and knee sagittal-plane kinematics were measured using the electromagnetic tracking system. Reach distance was recorded by hand and was normalized by dividing the distance by the participants' leg length (%MAXD). After each taping condition on each leg, the participants rated the perceived pain level using the 10-cm visual analog scale.

RESULTS

The participants with PFPS had a reduction in pain level with patellar tape application compared with the no-tape condition (P = .005). Additionally, participants with PFPS demonstrated increased %MAXD under the tape condition compared with the no-tape condition, whereas the healthy participants demonstrated decreased %MAXD with tape versus no tape (P = .028). No statistically significant differences were noted in hip flexion and knee flexion angles.

CONCLUSIONS

Although patellar taping seemed to reduce pain and improve SEBT performance of participants with PFPS, the exact mechanisms of these phenomena cannot be explained in this study. Further research is warranted to investigate the effect of patellar taping on neuromuscular control during dynamic postural control.

Diagnosis and management of a patient with knee pain using the movement system impairment classification system

STUDY DESIGN

Case report.

BACKGROUND

Selecting the most effective conservative treatment for knee pain continues to be a challenge. An understanding of the underlying movement system impairment that is thought to contribute to the knee pain may assist in determining the most effective treatment. Our case report describes the treatment and outcomes of a patient with the proposed movement system impairment (MSI) diagnosis of tibiofemoral rotation.

CASE DESCRIPTION

The patient was a 50-year-old female with a 3-month history of left anteromedial knee pain. Her knee pain was aggravated with sitting, standing, and descending stairs. A standardized clinical examination was performed and the MSI diagnosis of tibiofemoral rotation was determined. The patient consistently reported an increase in pain with activities that produced abnormal motions or alignments of the lower extremity in the frontal and transverse planes. The patient was educated to modify symptom-provoking functional activities by restricting the abnormal motions and alignments of the lower extremity. Exercises were prescribed to address impairments of muscle length, muscle strength, and motor control proposed to contribute to the tibiofemoral rotation. Tape also was applied to the knee in an attempt to restrict tibiofemoral rotation.

OUTCOMES

The patient reported a cessation of pain and an improvement in her functional activities that occurred with correction of her knee alignment and movement pattern. Pain intensity was 2/10 at 1 week. At 10 weeks, pain intensity was 0/10 and the patient reported no limitations in sitting, standing, or descending stairs. The patient's score on the activities of daily living scale increased from 73% at the initial visit to 86% at 10 weeks and 96% at 1 year after therapy was discontinued.

DISCUSSION

This case report presented a patient with knee pain and an MSI diagnosis of tibiofemoral rotation. Diagnosis-specific treatment resulted in a cessation of the patient's pain and an improved ability to perform functional activities.

Rehabilitation and Nonoperative Treatment of Patellar Instability

Patellofemoral instability can be a difficult condition for clinicians to manage. Differentiation needs to be made as to whether the problem is an acute injury where a traumatic incident has usually precipitated the dislocation or whether the problem is a recurrent instability where the patellofemoral joint is unstable during everyday activities. This review defines instability, discusses the factors affecting instability, and provides assessment procedures and nonoperative intervention strategies for the clinician.

Effects of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome

The aim of this study was to assess the effect of patellar taping of the proprioceptive status of patients with patellofemoral pain syndrome (PFPS). A total of 32 subjects (18 males, 14 females of age 31.9 +/- 11.2, body mass index 25.8 +/- 5.3) with PFPS were tested for Joint Position Sense (JPS) using a Biodex dynamometer. Outcomes of interest were the absolute error (AE), the variable error (VE) and the relative error (RE) of the JPS values for both active (AAR) and passive (PAR) angle reproduction at an angular velocity of 2 degrees /s with a start angle at 90 degrees and target angles of 60 degrees and 20 degrees . Taping was applied in random order across the patella of each subject with each of the subjects acting as their own internal control. Results indicated initially that application of patellar tape did not enhance and in some cases worsened the JPS of the subjects (P > 0.05). However, when the subjects' proprioceptive status was graded according to their closeness to the target angles into 'good' (5 degrees , N = 10) and 'poor' ( > 5 degrees , N = 22) taping enhanced nearly all values of those with 'poor' proprioception, with AE at 20 degrees to statistical significance (P = 0.021). In conclusion, this study has shown that patellar taping did not improve the AAR and PAR JPS tests of a whole sample of 32 PFPS patients. It also has shown that a subgroup of PFPS patients with poor proprioception may exist and be helped by patellar taping.

Effect of patellar taping on vasti onset timing, knee kinematics, and kinetics in asymptomatic individuals with a delayed onset of vastus medialis oblique

This randomized within-subject study investigated the effects of patellar tape on the onset of electromyographic (EMG) activity of vastus medialis obliquus (VMO) relative to vastus lateralis (VL), knee kinematics, and kinetics in 12 currently asymptomatic individuals with a VMO timing deficit and a history of patellofemoral pain. Participants were required to complete stair stepping and normal-pace and fast-pace walking tasks under three experimental conditions; no tape, control tape and therapeutic tape. EMG onsets of VMO and VL were measured by surface electrodes, stance phase knee flexion by the PEAK movement analysis system and vertical ground reaction force by a force plate. A two-way repeated measures analysis of variance showed that neither therapeutic tape nor control tape had any effect on the EMG VMO-VL onset timing difference. Therapeutic tape, but not control tape, led to significant increases in stance phase knee flexion. The first peak vertical ground reaction force was lowered by both control and therapeutic tape but only during fast walking. The results suggest that tape induced effects on neuromotor control of the vasti seen in other studies are related to reductions in pain rather than the presence of a baseline timing deficit. However, this cannot explain the improvements in stance phase knee flexion observed with tape.

Patellar taping does not change the amplitude of electromyographic activity of the vasti in a stair stepping task

OBJECTIVES

To investigate the effect of patellar taping on the amplitude of electromyographic activity (EMG) of vasti activation in subjects with and without patellofemoral pain (PFP).

METHODS

Ten participants with PFP and 12 asymptomatic controls were recruited to the study. The study was designed as a randomised crossover trial. Participants completed a stair stepping task. Three experimental conditions were assessed: no tape, therapeutic medially directed tape, and placebo vertically directed tape. The main outcome measure was the EMG amplitude of the vastus medialis obliquus and vastus lateralis during the concentric phase of stair stepping.

RESULTS

The application of medially directed therapeutic tape significantly decreased pain in subjects with PFP. However, application of tape over the patella (therapeutic or placebo) did not alter the amplitude of vasti EMG when either the PFP or control participants completed the concentric stair stepping task.

CONCLUSION

The results of this study indicate that the positive clinical effects of medially directed therapeutic tape are not due to changes in EMG amplitude of the vasti muscle. Thus other effects such as changes in timing of contraction of the vasti are more likely candidates for the mechanism of efficacy.

The effect of patella taping on vastus medialis oblique and vastus laterialis EMG activity and knee kinematic variables during stair descent

The purpose of this study was to evaluate the effect of patella taping in normal subjects. Previous work has established positive effects of patella taping on patellofemoral pain syndrome patients, but the mode of action remains unclear. It has been hypothesized that taping brings about subtle changes in the internal physiological environment of the joint. It could be expected that in normal joints taping would bring about a measurable change in function, as the joint is no longer operating in an optimal physiological environment. 10 normal female subject's (21.4+/-1.2 years) vastus medialis oblique (VMO) and vastus laterialis (VL) EMG activity and knee kinematics (peak stance flexion angle and angular velocity) were assessed during a step descent, with and without a taped patella. The effect of taping was to significantly decrease VMO and VL EMG activity. Taping also significantly reduced peak stance phase knee flexion and peak stance phase knee flexion angular velocity. In normal asymptomatic subjects patella taping created a situation in which their performance was changed to one similar to that of the pathological patellofemoral pain syndrome population. It would appear that taping caused the joint to function sub-optimally supporting the hypothesis that taping could change the functioning of the patellofemoral joint.

Anterior knee pain: diagnosis and treatment

Anterior knee pain is a frequent clinical problem. It provides a common challenge to diagnose and manage. Basic science studies have provided insight into the origin of anterior knee pain and refined understanding of the anatomy. Clinical evaluation has progressively focused on the contribution of the entire lower extremity to patellofemoral function. Nonsurgical management has been refined by the concept of the "envelope of function" and by increased understanding of the neuromuscular control of the knee. Indications for lateral release have been clarified and narrowed. Although anteromedial transfer of the tibial tuberosity is helpful in certain circumstances, reports of postoperative fracture have led to less aggressive rehabilitation protocols. Chondral resurfacing of the patellofemoral joint and patellofemoral arthroplasty are evolving. Emphasis should remain on nonsurgical management, which is sufficient in most patients.

Physical Therapy Improves Knee Flexion during Stair Ambulation in Patellofemoral Pain

PURPOSE

This study aimed to examine whether a physical therapy intervention, designed to reduce pain and improve the neuromotor control resulted in greater improvements in stance-phase knee flexion during stair ambulation in individuals with patellofemoral pain. The relationship between changes in stance-phase knee flexion and changes in pain, disability, and onset timing of individual vasti activity was also examined.

METHODS

Forty participants aged 40 yr or younger diagnosed with patellofemoral pain were randomly allocated to a physical therapy (N = 21) or placebo (N = 19) treatment group. Stance-phase knee flexion was measured in two dimensions using a PEAK movement analysis system during stair ambulation. Individuals were divided into those with improvements in onset of vastus medialis obliquus (VMO) activity relative to that of the vastus lateralis (VL) of more or less than 10 ms.

RESULTS

Groups were similar at baseline. After the 6-wk intervention, individuals in the physical therapy group had significantly greater changes in knee flexion at heel strike (mean difference 4 degrees, 95% CI = 2-7 degrees) and peak stance-phase knee flexion (mean difference 9 degrees, 95% CI = 5-12 degrees) than those in the placebo group. No differences were noted during stair ascent. Individuals with greater change in the onset timing of the vasti had greater improvements in stance-phase knee flexion. Changes in usual pain in the week before testing and change in the vasti onset timing were independent predictors of change in stance-phase knee flexion during stair descent, together accounting for 27-40% of the variability in knee motion.

CONCLUSIONS

Physical therapy intervention resulted in significantly greater changes in knee joint motion than a placebo treatment, and these changes in knee motion were partly related to changes in pain and changes in onset timing of the vasti.

Effects of taping on pain and function in patellofemoral pain syndrome: a randomized controlled trial

STUDY DESIGN

A randomized controlled trial.

OBJECTIVES

To investigate the effectiveness of daily patella taping and exercise on pain and function in individuals with patellofemoral pain syndrome.

BACKGROUND

Patella taping and muscle-strengthening programs are commonly used to treat patellofemoral pain syndrome. There is, however, little evidence for the effectiveness of these approaches.

METHODS AND MEASURES

Twenty-four men and 6 women aged 17 to 25 years (mean +/- SD, 18.7 +/- 1.2 years) participated in the study. Subjects were randomly and exclusively assigned to 1 of 3 treatment groups: patella taping combined with a standardized exercise program, placebo patella taping and exercise program, or exercise program alone (n = 10 in each group). Taping was applied and exercises performed on a daily basis for 4 weeks. Outcome measures were visual analog scales for pain and the functional index questionnaire, recorded at weekly intervals by a therapist who was blinded to group allocation.

RESULTS

Separate mixed-model ANOVAs, with repeated measures on time, indicated statistically significant improvements in pain and function over time for all groups (P<.01) and also significant differences between groups for all measures (P<.01). Separate independent samples t tests showed that the group receiving taping and exercises had better pain and function scores following treatment than the placebo taping-and-exercise group and the exercise-alone group. There were no significant differences between the placebo taping-and-exercise group and exercise-alone group at any time point.

CONCLUSIONS

These findings indicate that over a period of 4 weeks a combination of daily patella taping and exercises was successful in improving pain and function in individuals with patellofemoral pain syndrome. The combination of patella taping and exercise was superior to the use of exercise alone.

Kinematic MRI assessment of McConnell taping before and after exercise

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.

Knee flexion during stair ambulation is altered in individuals with patellofemoral pain

Reduced knee flexion is a logical gait adaptation for individuals with patellofemoral pain (PFP) to lessen the patellofemoral joint reaction force and minimise pain during stair ambulation. This gait adaptation may be related to the co-ordination of individual vasti components.

PURPOSE

This study investigated the amount of stance-phase knee flexion in individuals with (n=48) and without (n=18) PFP using a cross-sectional design. The relationship between stance-phase knee flexion and onset timing of individual vasti activity was also examined.

METHOD

Stance-phase knee flexion was measured in 2-dimensions using a PEAK movement analysis system during stair ascent and descent. Individuals with PFP were separated into those with synchronous onset of the EMG activity of vastus medialis obliquus (VMO) and vastus lateralis (VL), and those where the onset of VMO EMG activity was delayed relative to the VL.

RESULTS

The amount of knee flexion at heel-strike and peak was less in the individuals with PFP compared with the healthy controls. In addition, there were trends towards individuals with PFP who had a delayed EMG onset of VL having reduced knee flexion during stair descent compared with PFP individuals with simultaneous vasti onsets and the control participants.

CONCLUSION

These results indicate that the amount of stance-phase knee flexion is lower in individuals with PFP and that this may be related to onset timing of the vasti.

The effect of bracing on patellofemoral joint stress during free and fast walking

BACKGROUND

Although several studies have demonstrated decreases in patellofemoral pain (PFP) with the application of bracing, the mechanism by which bracing reduces symptoms has not been elucidated.

HYPOTHESIS

Individuals who responded favorably to bracing will exhibit decreased patellofemoral stress during level walking.

STUDY DESIGN

Repeated measures, cross-sectional.

METHODS

Fifteen subjects with a diagnosis of PFP completed two phases of data collection: 1) MRI assessment of patellofemoral contact area and 2) gait analysis. Data were obtained under braced and nonbraced conditions. Variables obtained from both data collection sessions were used as input variables into a mathematical model to quantify patellofemoral stress.

RESULTS

Subjects reported a 56% reduction in pain following bracing. Bracing significantly reduced peak stress during free and fast walking (17% and 27%, respectively). The decrease in stress was the result of increased contact area as patellofemoral joint reaction forces were increased following bracing.

CONCLUSION

Bracing resulted in a larger increase in patellofemoral contact area than the increase in joint reaction force, resulting in a decrease in joint stress.

CLINICAL RELEVANCE

The results of this study suggest a possible mechanism by which bracing may be effective in reducing PFP and provides experimental support for the use of this treatment method.

A multicenter, single-masked study of medial, neutral, and lateral patellar taping in individuals with patellofemoral pain syndrome

STUDY DESIGN

A multicenter, single-masked study of patients with patellofemoral pain syndrome (PFPS) using a repeated-measures design.

OBJECTIVE

To compare 3 different methods of patellar taping for individuals with PFPS.

BACKGROUND

Patellar taping is commonly used as a treatment for PFPS. It is commonly thought that taping works by medially realigning the patella. However, comparisons have been rarely made with other methods of taping which attempt to realign the patella in different directions.

METHODS AND MEASURES

Seventy-one patients with PFPS (39 men, 32 women; average age +/- SD, 34 +/- 10 years) from 3 different treatment centers were tested. Each patient performed 4 single step-downs from a standard 8-inch (20.3-cm) platform, initially with the patella untaped and then with the patella taped in a medial, neutral, and lateral direction. Pain was recorded on a standard 11-point numerical pain rating scale. The sequence of taping was randomly allocated and patients were masked to the method used. The methods of taping were compared using repeated-measures generalized linear model analysis.

RESULTS

All methods of taping significantly decreased pain when compared to the untaped condition (P<.0001). Neutral- and lateral-glide techniques produced a significantly greater degree of pain relief (P<.0001) than the medial-glide technique.

CONCLUSION

In this study, patellar taping produced an immediate decrease in pain in patients with PFPS, irrespective of how taping was applied. These data raise questions as to the mechanism of action of patellar taping. Furthermore, these results suggest that it is unlikely that taping works by altering patellar position.

Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome

OBJECTIVE

To examine the effect of the application of tape over the patella on the onset of electromyographic (EMG) activity of vastus medialis obliquus (VMO) relative to vastus lateralis (VL) in participants with and without patellofemoral pain syndrome (PFPS).

DESIGN

Randomised within subject.

SETTINGS

University laboratory.

PARTICIPANTS

Ten participants with PFPS and 12 asymptomatic controls.

INTERVENTIONS

Three experimental taping conditions: no tape, therapeutic tape, and placebo tape.

MAIN OUTCOME MEASURES

Electromyographic onset of VMO and VL assessed during the concentric and eccentric phases of a stair stepping task.

RESULTS

When participants with PFPS completed the stair stepping task, the application of therapeutic patellar tape was found to alter the temporal characteristics of VMO and VL activation, whereas placebo tape had no effect. In contrast, there was no change in the EMG onset of VMO and VL with the application of placebo or therapeutic tape to the knee in the asymptomatic participants.

CONCLUSIONS

These data support the use of patellar taping as an adjunct to rehabilitation in people with PFPS.

Recalcitrant chronic low back and leg pain--a new theory and different approach to management

The management of chronic low back and leg pain has always provided a challenge for therapists. This paper examines the influence of a repetitive movement such as walking as a possible causative factor of chronic low back pain. Diminished shock absorption and limited hip extension and external rotation are hypothesized to affect the mobility of the lumbar spine. These compensatory changes can result in lumbar spine dysfunction. Treatment must therefore be directed not only at increasing the mobility of the hips and thoracic spine, but also the stability of the lumbar spine. Sometimes however, the symptoms can be exacerbated by treatment, so the neural tissue needs to unloaded to optimize the treatment outcome. This can be achieved by taping the buttock and down the leg following the dermatome to shorten the inflamed tissue.

Patellofemoral stress during walking in persons with and without patellofemoral pain

OBJECTIVE

To determine whether individuals with patellofemoral pain (PFP) demonstrate elevated patellofemoral joint (PFJ) stress compared with pain-free controls during free and fast walking.

DESIGN

A cross-sectional study utilizing an experimental and a control group.

BACKGROUND

Although the cause of PFJ pathology is believed to be related to elevated joint stress (force per unit area), this hypothesis has not been adequately tested and causative mechanisms have not been clearly defined.

METHODS

Ten subjects with a diagnosis of PFP and 10 subjects without pain participated. All subjects completed two phases of data collection: 1) magnetic resonance imaging (MRI) assessment to determine PFJ contact area and 2) comprehensive gait analysis during self-selected free and fast walking velocities. Data obtained from both phases were required as input variables into a biomechanical model to quantify PFJ stress.

RESULTS

On the average, PFJ stress was significantly greater in subjects with PFP compared with control subjects during level walking. The observed increase in PFJ stress in the PFP group was attributed to a significant reduction in PFJ contact area, as the PFJ reaction forces were similar between groups.

CONCLUSION

Our results are consistent with the hypothesis that increased patellofemoral joint stress may be a predisposing factor with respect to development of PFP. Clinically, these findings indicate that treatments designed to increase the area of contact between the patella and the femur may be beneficial in reducing the PFJ stress during functional activities.

RELEVANCE

Patellofemoral pain affects about 25% of the population, yet its etiology is unknown. Knowledge of the biomechanical factors contributing to patellofemoral joint pain may improve treatment techniques and guide development of prevention strategies.

The physical therapist's approach to patellofemoral disorders

Management of patellofemoral pain is no longer a conundrum if the therapist can determine the underlying causative factors and address those factors in treatment. It is imperative that the patient's symptoms are significantly reduced. This often is achieved by taping the patella, which not only decreases the pain but also promotes an earlier activation of the VMO and increases quadriceps torque. Management needs to include specific VMO training, gluteal-control work, stretching tight lateral structures, and appropriate advice regarding the foot, whether it is orthotics, training, or taping.

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

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.

The effects of patellar taping on knee kinetics, kinematics, and vastus lateralis muscle activity during stair ambulation in individuals with patellofemoral pain

STUDY DESIGN

Pre- and postintervention repeated measures design.

OBJECTIVE

To determine the effects of patellar taping on knee kinetics, kinematics, and vastus lateralis muscle activity during stair ambulation in individuals with patellofemoral pain (PFP).

BACKGROUND

Patellar taping is a common treatment technique for individuals with PFP. Specific data on whether patellar taping improves gait variables, however, are limited.

METHODS AND MEASURES

Ten subjects with a diagnosis of PFP were studied (five men, five women). The subjects' mean age, height, and mass were 36.5 +/- 11.1 years, 173.1 +/- 10.3 cm, and 70.9 +/- 13.3 kg, respectively. Lower extremity kinematics, ground reaction forces, and vastus lateralis EMG were obtained simultaneously while subjects ascended and descended stairs, under taped and untaped conditions. Knee moments were calculated using inverse dynamics equations. Four 2 x 2 (tape condition x stair condition) ANOVAs for repeated measures were generated for cadence and average stance phase knee extensor moment, knee flexion angle, and EMG.

RESULTS

On the average, a 92.6% reduction in pain was observed following the application of tape. Increases in cadence, knee flexion angles, and knee extensor moments were observed under the taped condition for both stair ascent and descent; however, no difference in average vastus lateralis EMG was found.

CONCLUSIONS

Although patellar taping resulted in decreased pain and increased knee extensor moments, knee flexion angles, and cadence during stair ambulation, the vastus lateralis EMG activity level did not change with taping. Based on data from the vastus lateralis, care must be taken if improved gait parameters indicate change in muscle recruitment.

A systematic review of physical interventions for patellofemoral pain syndrome

OBJECTIVE

Physical interventions (nonpharmacological and nonsurgical) are the mainstay of treatment for patellofemoral pain syndrome (PFPS). Physiotherapy is the most common of all physical interventions and includes specific vastus medialis obliquus or general quadriceps strengthening and/or realignment procedures (tape, brace, stretching). These treatments appear to be based on sound theoretical rationale and have attained widespread acceptance, but evidence for the efficacy of these interventions is not well established. This review will present the available evidence for physical interventions for PFPS.

DATA SOURCES

Computerized bibliographic databases (MEDLINE, Current Contents, CINAHL) were searched, including the keywords "patellofemoral," "patella," and "anterior knee pain," combined with "treatment," "rehabilitation," and limited to clinical trials through October 2000.

STUDY SELECTION

The critical eligibility criteria used for inclusion were that the study be a controlled trial, that outcome assessments were adequately described, and that the treatment was a nonpharmacological, nonsurgical physical intervention.

RESULTS

Of the 89 potentially relevant titles, 16 studies were reviewed and none of these fulfilled all of the requirements for a randomized, controlled trial. Physiotherapy interventions were evaluated in eight trials, and the remaining eight trials examined different physical interventions. Significant reductions in PFPS symptoms were found with a corrective foot orthosis and a progressive resistance brace, but there is no evidence to support the use of patellofemoral orthoses, acupuncture, low-level laser, chiropractic patellar mobilization, or patellar taping. Overall the physiotherapy interventions had significant beneficial effects but these interventions were not compared with a placebo control. There is inconclusive evidence to support the superiority of one physiotherapy intervention compared with others.

CONCLUSIONS

The evidence to support the use of physical interventions in the management of PFPS is limited. There appears to be a consistent improvement in short-term pain and function due to physiotherapy treatment, but comparison with a placebo group is required to determine efficacy, and further trials are warranted for the other interventions.

A novel approach to pain relief pre-therapeutic exercise

Musculoskeletal problems are often multifactorial and consequently can be challenging to treat. This paper examines management of chronic musculoskeletal conditions in the light of Panjabi's stabilisation subsystems and Dye's concept of homeostasis and critical symptom threshold. In many circumstances treatment can aggravate symptoms. Tape may be used to unload painful structures to minimise the aggravation of the symptoms so treatment can be directed at improving the patient's 'envelope of function'. This involves specific muscle training of the dynamically unstable segment/s and increasing the mobility of the less flexible surrounding soft tissues. Three case studies of chronic low back and leg pain, patellofemoral pain and shoulder impingement secondary to multidirectional instability, are presented as examples of multifactorial musculoskeletal problems requiring unloading, stabilisation and control.

Patellar taping: is clinical success supported by scientific evidence?

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.

Patellofemoral pain syndrome in the female athlete

Although PFS will continue to be a therapeutic challenge, the prognosis for most female athletes is good, especially if they are motivated and compliant with their treatment program. Particularly in women, care should be taken to avoid placing too much emphasis on biomechanical variants that may not be clinically significant or correctable because such findings can reinforce a feeling that "nothing can be done." In many cases, muscle dysfunction and repetitive loading of the patellofemoral joint rather than fixed biomechanical factors contribute to the development of PFS. Nonetheless, the importance of a detailed biomechanical assessment on physical examination must not be neglected, particularly in athletes who are not improving with conservative treatment and who may become surgical candidates. A practical initial treatment program for most athletes with nontraumatic PFS begins with relative rest, quadriceps strengthening, and stretching of tight myotendinous units. The introduction of NSAIDs, orthoses, taping, knee sleeves, and more specific rehabilitative exercises should be an individualized decision based on physical findings, past treatment results, and athletic expectations. Surgical referral should be considered in cases of PFS or patellar instability refractory to prolonged maximal nonoperative treatment.