PT Classroom - A Review of Patellar Taping for Patellofemoral Pain Syndrome ׀ by Chai Rasavong, MPT, MBA

It is generally believed that the alteration of patellofemoral kinematics can contribute to patellofemoral pain syndrome. Individuals with patellofemoral pain generally will have one of four patellar malalignments. Please see article “Understanding Patellofemoral Dysfunction” by Kate Grace, PT, OPA-C & Annie Fonte, MBA” for additional information.

 
Interventions for treating patellofemoral pain syndrome (PFPS) can include patellar taping, patellar bracing, selective strengthening of the vastus medialis muscle, stretching tight lateral structures, correcting structural foot abnormalities, or a combination of these interventions (2, 3, 4, 5). In this article we will review patellar taping for the treatment of patellofemoral pain syndrome.

Patellar taping is sometimes utilized by physical therapists in conjunction with other treatment interventions when treating patients with PFPS. It is theorized that that most patients with PFPS would benefit from medialization of the patella which would off load the compressive forces at the lateral patellofemoral joint (2, 5). In a study by McConnell (5) she had a success rate of over 90% when incorporating taping to correct for a glide, tilt and rotational components of the patella along with emphasizing closed-chain exercises. A study by Derasari et al (2) utilizing dynamic magnetic resonance imaging revealed that taping resulted in a significant patellofemoral inferior shift which may account for some of the reported pain relief with taping, due to an increase in contact area. In another study by Gilleard et al (4), they found that taping the patellofemoral joint changes the onset of VMO and VL activity. The earlier activation of the VMO may promote VMO activity during retraining, improving patellar tracking.

Despite the positive findings in the above studies, other studies concluded that although taping the patella medially can contribute positively to PFPS rehabilitation, there were no significant changes in patella positions (6, 7). A study by Gigante et al (6) utilizing computed tomography found that patellar taping didn’t affect patellofemoral lateralization or tilt, while another study by Bockrath et al (3) utilizing Merchant’s view x-rays found no significant changes occurring with patella rotation, patellofemoral congruency, or sulcus angles. Although these studies didn’t reveal significant changes in patella position with taping, their subjects did demonstrate improvement with reduction of pain levels during physical therapy related activities. These authors hypothesized that the success of pain reduction from taping could be a result of increase sensory input from the tape, enhanced support of the patellofemoral ligaments and/or pain modulation via cutaneous stimulation (3, 6, 7).

Although studies may vary as far as taping the patella to correct for patella deviation, the majority of studies do concur that patients did experience some sympotomatic relief with taping and were able to better participate in physical therapy in order to allow for more aggressive functional rehabilitation and to facilitate compliance (2, 3, 4, 5, 6, 7).

Patella Taping Instructions (1)
1) Shave the area prn
2) Clean the area with alcohol prep
3) Position the patient in sitting with the knee in extension and the quadriceps relaxed
4) Apply white pre-wrap (Hypafix). This extends from the lateral epicondyle over the patella medially and posteriorly to the mid-popliteal fossa.
5) Apply the brown rigid tape as indicated below (8)

6) Symptoms should decrease immediately upon application. If present, always correct for AP (+) tilt first, then the worst component next (1).
7) For tape removal, be sure to protect the skin. Peel of slowly and hold the skin down. Tape remover may be necessary. Be especially careful with patients who are elderly and/or who have frail skin.

Last revised: August 2, 2011
by Chai Rasavong, MPT, MBA

References
1. UW Madison PT 527 & 677. Foundations of Physical Therapy Practice / MSA & T. Fall 1998 & Spring 2000.
2. Derasari A, et al. McConnell Taping Shifts the Patella Inferiorly in Patients With Patellofemoral Pain: A Dynamic Magnetic Resonance Imaging Study. Physical Therapy. 2010; 90(3):411-418.
3. Bockrath K, et al. Effects of Patella Taping on Patella Position and Perceived Pain. Medicine and Science in Sports and Exercise. 1993;989-992.
4. Gilleard W, et al. The Effect of Patellar Taping on the Onset of Vastus Medialis Obliquus and Vastus Lateralis Muscle Activity in Persons with Patellofemoral Pain. Physical Therapy. 1998; 78(1):25-32.
5. McConnel J. The Management of Chondromalacia Patellae: A Long Term Solution. The Australian Journal of Physiotherapy. 1986;32(4):215-223.
6. Gigante A, et al. The Effects of Patellar Taping on Patellofemoral Incongruence: A Computed Tomography Study. Am J Sports Med. 2001; 29(1):88-92.  
7. Christou E. Patellar taping increases vastus medialis oblique activity in the presence of patellofemoral pain. J Electromyogr Kinesiol. 2004; 14(4):495-504.
8. Andrews J, Harrelson G, Wilk K. Physical Rehabilitation of the Injured Athlete. Second Edition. W.B. Saunders Company. 1998;384.388.