Technical Report
McConnell Taping Shifts the Patella
Inferiorly in Patients With
Patellofemoral Pain: A Dynamic
Magnetic Resonance Imaging Study
Aditya Derasari, Timothy J. Brindle, Katharine E. Alter, Frances T. Sheehan
Background. Patellar taping is widely used clinically to treat patients with patellofemoral pain syndrome (PFPS). Although patellar taping has been demonstrated to
reduce patellofemoral pain in patients with PFPS, the kinematic source for this pain
reduction has not been identified.
Objective. The purpose of this study was to quantify the changes in the 6-degreesof-freedom patellofemoral kinematics due to taping in patients with PFPS.
Design. A within-subject design and a sample of convenience were used.
Participants. Fourteen volunteers (19 knees) who were diagnosed with patellofemoral pain that was present for a year or longer were included. Each knee had to
meet at least 1 of the following inclusion criteria: Q-angle of ⱖ15 degrees, a positive
apprehension test, patellar lateral hypermobility (ⱖ10 mm), or a positive
“J sign.”
Methods. Each knee underwent 2 randomly ordered testing conditions (untaped
and taped). A full fast-phase contrast (PC) magnetic resonance image set was acquired
for each condition while the participants volitionally extended and flexed their knee.
Three-dimensional displacements and rotations were calculated through integration
of the fast-PC velocity data. Statistical comparisons between baseline patellofemoral
kinematics and the change in kinematics due to taping were performed using a
2-tailed paired Student t test. Correlations between baseline patellofemoral kinematics and the change in kinematics due to taping also were quantified.
Results. Patellar taping resulted in a significant patellofemoral inferior shift. The
strongest correlation existed between the change in lateral-medial displacement with
taping and baseline (r⫽⫺.60).
Conclusions. The inferior shift in patellar displacement with taping partially
explains the previously documented decrease in pain due to increases in contact area.
The lack of alteration in 5 of the 6 kinematic variables with taping may have been due
to the fact that post-taping kinematic alterations are sensitive to the baseline kinematic values.
A. Derasari, is Howard Hughes
Medical Fellow, Department of
Orthopaedics, University of Miami, Miami, Florida.
T.J. Brindle, PT, PhD, ATC, is Postdoctoral Candidate, Functional
and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of
Health, Bethesda, Maryland, a collaboration between the National
Institute of Child Health and Human Development and the Clinical Center, National Institutes of
Health.
K.E. Alter, MD, is Senior Clinician,
Functional and Applied Biomechanics Section, Rehabilitation
Medicine Department, National
Institute of Child Health and Human Development, National Institutes of Health, and Medical Director, Rehabilitation Programs,
Mt Washington Pediatric Hospital,
Baltimore, Maryland, an affiliate of
Johns Hopkins Health System
Corp and Maryland Medical System Corp.
F.T. Sheehan, PhD, is Staff Scientist, Functional and Applied Biomechanics Section, Rehabilitation
Medicine Department, National
Institutes of Health, Building 10,
CRC Room 1-1469, 10 Center Dr,
MSC 1604, Bethesda, MD 208921604 (USA). Address all correspondence to Dr Sheehan at:
fsheehan@cc.nih.gov.
[Derasari A, Brindle TJ, Alter KE,
Sheehan FT. McConnell taping
shifts the patella inferiorly in patients with patellofemoral pain: a
dynamic magnetic resonance imaging
study.
Phys
Ther.
2010;90:xxx–xxx.]
© 2010 American Physical Therapy
Association
Post a Rapid Response or
find The Bottom Line:
www.ptjournal.org
March 2010
Volume 90
Number 3
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1
Patellar Taping in Patients With Patellofemoral Pain
P
atellofemoral pain syndrome
(PFPS) is one of the most common causes of orthopedicrelated physician visits each year,
especially among women.1,2 Patellofemoral pain syndrome can be
caused by direct trauma to the
knee, or the cause can be insidious
in nature. Altered lower-extremity
biomechanics, such as poor hip rotation control,3 excessive foot pronation,4 femoral anteversion, tibial
torsion, bone configuration, or
tight muscles are thought to contribute to PFPS by initiating alterations in patellofemoral kinematics.5,6 Vastus medialis oblique
muscle dysfunction also has been
proposed as a contributor to altered
patellofemoral
kinematics.7–10 Interventions for PFPS include patellar taping, patellar
bracing, selective strengthening of
the vastus medalis muscle, iliotibial
band stretching, ankle-foot orthotics, or a combination of these
interventions.11–15
Patellar taping is widely practiced
among clinicians to treat patients
with PFPS. This intervention involves pushing the patella medially
and securing it in this position with
tape on the skin. Originally, the
McConnell taping technique was developed to correct altered patellofemoral kinematics and permit participation in normal daily activity.16
Today, there exist several variations
of McConnell taping techniques,
where attempts are made to alter
patellar tilt, glide, or rotation.17 Clinical application of these techniques
is based on a physical examination of
patellar position, orientation, and
mobility.18,19 The underlying concept is that most patients with PFPS
would benefit from medialization
of the patella, which theoretically
would off-load the compressive
forces at the lateral patellofemoral
joint.16,20
2
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Volume 90
Although patellar taping has been
demonstrated to reduce patellofemoral pain in patients with PFPS,21–26
the kinematic source of this pain reduction has not been identified.
Likely, this failure to identify the kinematic source of the pain reduction
is due to the fact that the complete 6
degrees of freedom patellofemoral
kinematics (post-taping) during active extension has not been quantified in a group of patients with PFPS.
Instead, patellofemoral axial alignment changes (patellar translation
and tilt) due to taping in patients
with PFPS have been quantified in a
small number of studies.21,27–30 The
majority of studies focused on static
evaluation of knee posture without
muscle activity. Isometric quadriceps muscle activity has been incorporated into a few of these studies.21,28 In these studies, no
differences in lateral patellar translation or tilt were found with taping,
with or without muscle contraction.
Thus, the purpose of this study was
to quantify the changes in the
6-degrees-of-freedom patellofemoral
kinematics due to McConnell taping
in people with PFPS during dynamic
knee flexion and extension using
fast-phase contrast (PC) magnetic
resonance imaging (MRI). In doing
so, 2 null hypotheses were tested:
(1) McConnell taping does not alter
the patellofemoral kinematics in all 6
degrees of freedom, and (2) no correlations exist between the baseline
patellofemoral kinematics (untaped
condition) and the change in kinematics due to taping.
Method
Participants
Fourteen volunteers diagnosed with
PFPS gave informed consent prior to
participating in this study. Participants were recruited from local orthopedic clinics and ongoing National Institutes of Health studies.
This recruitment was primarily Webbased (http://clinicalresearch.nih.
Number 3
gov), conducted through the Clinical
Center Patient Recruitment and Public Liaison Office. Participants were
excluded if they had any contraindications to having an MRI scan. Both
knees were evaluated in the initial
screening examination. To be included in the study, each knee had to
be clinically diagnosed with PFPS,
with symptoms present for a year or
longer. An in-house physiatrist, using
both a physical examination and the
patient’s history, excluded any knee
that had: (1) previous surgery (including arthroscopy); (2) ligament,
meniscus, iliotibial band, or cartilage
damage; (3) other lower-leg pathology or injury; or (4) traumatic onset
of PFPS.
In addition, a physical therapist
(T.J.B.) examined each knee for
evidence of altered patellofemoral
kinematics: (1) Q-angle of ⱖ15 degrees,18,31,32 (2) a positive apprehension test, (3) patellar lateral hypermobility of ⱖ10 mm,18 or (4) a
positive J-sign.18,32,33 Any knee that
did not exhibit 1 or more of these 4
signs was excluded. These measures
were used solely as inclusion and
exclusion criteria and were not included in the kinematic data analysis
arm of the study. Both the Q-angle
and lateral hypermobility were measured with the participants in a supine position with the knee in full
extension and muscles relaxed. In
this position, patellar lateral hypermobility was defined as the ability of
the examiner to move the patella laterally by 10 mm or more. To confirm
or deny the presence of a J-sign, participants were seated at the end of
the table and the examiner evaluated
patellar motion as the participants
raised their leg into full extension.
The pain in each knee was evaluated
using a visual analog scale (VAS) pain
score and a Kujula score.30 In total,
19 knees from 14 participants were
included in this study (Tab. 1).
March 2010
Patellar Taping in Patients With Patellofemoral Pain
Procedure
Each knee underwent 2 testing conditions in the MRI (untaped and
taped), which were randomly ordered. For each condition, participants were placed supine in a 1.5Tesla magnetic resonance imager
(CV-9.1M4 or LX-9.1M4).*,32 After acquiring a set of static alignment
scans, the participants were allowed
to practice the extension-flexion exercise until they could repeatedly extend and flex their knee to and from
maximum attainable flexion and full
extension at 35 cycles per minute to
the beat of an auditory metronome.
Participants were instructed to generate knee extension without hip
movement, and a loose strap was
placed over the thighs as a reminder,
but minor femoral motion was allowed to enable a natural movement.
Next, a full fast-PC MRI image set
(x,y,z velocity and anatomic images
over 24 time frames) was acquired
while the participants volitionally extended and flexed their knee to the
beat of the auditory metronome, as
practiced. In addition, fastcard images (anatomic only) were acquired
in 3 axial planes during the cyclic
movement. An in-house musculoskeletal radiologist reviewed all magnetic resonance images to rule out
ligament, meniscus, iliotibial band,
or cartilage damage.
During tape application, participants
were positioned supine with their
quadriceps muscle relaxed. They
were taped by a physical therapist
(T.J.B.) with more than 15 years of
experience in orthopedics and
sports medicine. Initially, Hypafix†
was applied to the skin covering the
knee. Next, a medial glide of the patella was obtained by manually pushing the patella medially to its end
range of motion. Rigid strapping
* GE Medical Systems, 4855 W Electric Ave,
Milwaukee, WI 53219-1628.
†
Smith & Nephew DonJoy, 2777 Loker Ave,
Carlsbad, CA 92010.
March 2010
Table 1.
Demographics and Clinical Intake Parametersa
Measure
Values
No. of knees by sex
16 female, 3 male
Age (y)
28.7⫾8.3
Height (cm)
168.5⫾8.2
Weight (kg)
65.4⫾13.5
Visual analog score
36.4⫾27.9
Kujula score
78.8⫾9.2
Q-angle (°)
16.0⫾3.5
Lateral hypermobility (mm)
8.3⫾4.0
J-sign
9 yes, 10 no
a
In total, 19 knees from 14 participants were included in the study. Where appropriate, values are
provided as mean⫾standard deviation. The visual analog score and the Kujula score were based on a
scale of 100.
tape then was used to maintain the
medial glide of the patella by pulling
the skin and patella medially. Participants were required to walk for 5
minutes at a self-selected, comfortable pace after taping and prior to
the MRI experiment.27,29
Three-dimensional rigid-body rotations and displacements of the femur, tibia, and patella were quantified through integration of the
fast-PC velocity data. It is important
to note that although the fast-PC acquisition was based on a single imaging plane, the 3-dimensional velocity
data allowed the orientation and displacement of all bones to be accurately
tracked
3-dimensionally
throughout the movement.34 Kinematics were defined based on an anatomical coordinate system. Unlike
earlier cine MRI experiments,35,36
this identification was completed for
a single time frame only, and the
fast-PC data were used to track the
bones’ kinematics through all time
frames. Thus, the need to visually
identify anatomical landmarks at
multiple time points35,36 was eliminated, which minimized errors due
to inconsistency in image plane location and orientation37,38 and provided excellent accuracy (⬍0.5
mm39) and precision (⬍1.16°40). The
kinematics of the patella relative to
the femur were defined using 6 variables: 3 displacements—lateralmedial (LM), inferior-superior (IS),
and posterior-anterior (PA)—and 3
rotations—lateral-medial tilt (LM
tilt), extension-flexion (EF), valgusvarus rotation (VV). A significant increase in the superior position of the
patellar origin relative to the femoral
origin was defined as patella alta.
From the patellar-tibial kinematic
data, patellar tendon length was calculated as in a previous study.41 All
data were presented for the extension portion of the movement only.
Due to individual variations in range
of motion within the magnetic resonance scanner, not all participants
were represented at the extreme
ranges of knee flexion and extension. Thus, the average data presented were limited to the central
range of motion, where 3 or more
participants were represented by the
average.
The kinematic data were reduced to
the magnitudes of each of the 6 kinematic variables when the knee
was at 10 degrees of knee extension
(defined as the “value” of that variable). The untaped condition was
considered baseline. A 10-degree
knee flexion angle was used because
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Patellar Taping in Patients With Patellofemoral Pain
Figure 1.
Patellofemoral kinematics in the untaped and taped conditions: Each variable is plotted relative to knee extension, with full extension
being equal to zero (participant movement is read from left to right). Data were interpolated to 1-degree knee angle increments, but
symbols are provided at every 5 degrees for clarity. One standard deviation bars are provided. The dotted line represents a knee
extension angle of 8 degrees. The top row contains displacements (medial, superior, and anterior are the positive directions,
respectively), and the bottom row contains the rotations (flexion, medial tilt, and varus rotation are the positive directions,
respectively). ⌬disp⫽changed in displacement.
not all participants were able to
achieve full knee extension (0° flexion angle). In addition, patellar taping should have the greatest effect
when the patella is in terminal extension and is most free from the constraints of the femoral groove.5,35,42
Data Analysis
Statistical differences between the
taped and untaped conditions were
investigated using a paired 2-tailed
Student t test. Correlations between
the baseline patellofemoral kinematics and the change in kinematics due
to taping were quantified. Minimal
correlations between pain scores
(VAS and Kujula) and patellofemoral
4
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kinematics have been documented
(only the slope of patellofemoral varus relative to knee extension correlated with VAS pain score) in patients with PFPS.5 Because the
current population was a subset of
this earlier study, these correlations
were not performed in the current
study. Statistical significance was set
at Pⱕ.05, (SPSS, version 14.0).‡ An a
priori sample size calculation determined that adequate power (␣⫽.05,
␤ⱖ.80) could be achieved with the
inclusion of 15 knees, assuming that
taping would result in a 2-mm medial
‡
SPSS Inc, 233 S Wacker Dr, Chicago, IL
60606.
Number 3
patellar shift30 and that the standard
deviation associated with this
change would be 2.5 mm.34
Results
The null hypothesis that McConnell
taping does not alter the patellofemoral kinematics was rejected
for a single variable only: IS displacement (Fig. 1, ⫺1.6 mm, P⫽.04). The
only significant effect of patellar taping was an inferior (downward) shift
in the patella. This inferior shift resulted in an insignificant decrease in
the patellar tendon length at 10
degrees of knee extension (⌬length
⫽⫺0.46, P⫽.79). However, there
were significant differences in kineMarch 2010
Patellar Taping in Patients With Patellofemoral Pain
Table 2.
Patellofemoral Kinematic Parametersa
Displacement (mm)
Lateral-Medial
Inferior-Superior
Anterior-Posterior
Participants who were asymptomatic
⫺0.2⫾2.5
20.7⫾6.0
9.7⫾3.9
Participants with PFPS
⫺2.6⫾4.6
25.4⫾6.5
7.3⫾3.0
⫺0.7⫾2.7 P⫽.27
⫺1.6⫾3.1 P⫽.04
⫺0.3⫾2.3 P⫽.56
Rotation (°)
ExtensionFlexion
Lateral-Medial
Tilt
Valgus-Varus
Participants who were asymptomatic
7.0⫾4.0
14.9⫾7.3
12.6⫾4.6
12.1⫾10.6
⫺2.1⫾2.5
0.0⫾3.4 P⫽.74
⫺0.2⫾6.0 P⫽.24
0.3⫾3.0 P⫽.53
Change with taping for participants
with PFPS
Participants with PFPS
Change with taping for participants
with PFPS
0.5⫾2.3
a
Values for patellofemoral displacements (mm) and rotations (°) are reported as mean⫾standard deviation for participants who were asymptomatic from a
previous study,34 for the participants with patellofemoral pain syndrome (PFPS), and for the change in patellofemoral kinematics with taping in participants
with PFPS. For the change in patellofemoral kinematics with taping, the P value is reported for the 2-tailed paired Student t test comparing the taped and
untaped values of patellofemoral kinematics.
matics between the participants
with PFPS included in the current
study and a previous sample of individuals who were asymptomatic.34
On average, the participants with
patellofemoral pain were 2.1 mm
(P⫽.04), 4.2 mm (P⫽.03), and 2.3
mm (P⫽.05) more laterally, superiorly, and anteriorly displaced than
the control population. In addition,
these
participants
were
5.3
(P⬍.001) and 2.5 (P⬍.001) degrees
more flexed and rotated into valgus
than the control population (Tab. 2).
The second null hypothesis that no
correlations exist between the baseline patellofemoral kinematics and
the change in kinematics due to taping was rejected for 3 variables
(Tab. 3 and Fig. 2). The strongest
inverse correlation existed for LM
displacement (r⫽⫺.67), and moderate inverse correlations existed for
LM tilt and VV (r⫽⫺.52 for both).
The correlations indicate that participants with larger absolute baseline
kinematic values (further from the
asymptomatic average34) would see
the greatest absolute change with
taping. Interestingly, not all of the
participants with patellofemoral
pain had baseline values of LM displacement, LM tilt, and VV that were
lateral and valgus, relative to a previMarch 2010
ously defined asymptomatic average.34 Thus, participants who began
with medial displacement, medial
tilt, or varus rotation, relative to the
asymptomatic population, demonstrated a lateral shift in displacement,
lateral tilt, or valgus rotation, respectively, after taping was applied. The
participant with the largest values of
lateral tilt and displacement proved
to be an outlier in that taping caused
a much smaller change in these variables than the correlation would suggest. Data for this participant were
not removed from the analyses, but
when these data are removed, the
correlation between baseline and
change with taping increases
(r⫽⫺.54, P⫽.02) for LM tilt and the
correlations for LM displacement
and VV rotation increase minimally.
Discussion
This study was the first to quantify
changes caused by McConnell taping
in the complete 6-degrees-offreedom patellofemoral kinematics
during volitional knee extension in a
sample of patients with PFPS. On average, the only consistent influence
McConnell taping provided on patellar kinematics was to shift the patella
inferiorly. The benefit of inferiorly
shifting the patella within the femo-
Table 3.
Correlations Between the Baseline Patellofemoral Kinematics (Untaped Condition)
and the Change in Kinematics Due to Taping
Parameter
ra
P
⫺.60
.006b
Regression Equation
Displacement
Lateral-medial
⌬⫽⫺0.31 ⫻ value ⫺ 1.81
Inferior-superior
⫺.19
.431
⌬⫽⫺0.06 ⫻ value ⫹ 0.15
Posterior-anterior
⫺.21
.385
⌬⫽⫺0.27 ⫻ value ⫹ 1.48
Extension-flexion
.02
.734
Lateral-medial tilt
Valgus-varus
Rotation
a
b
c
⌬⫽0.08 ⫻ value ⫺ 0.26
⫺.51
.033
c
⌬⫽⫺0.26 ⫻ value ⫹ 2.88
⫺.52
.004b
⌬⫽⫺0.74 ⫻ value ⫺ 1.24
Pearson correlation coefficient.
Significant at P⬍.01.
Significant at P⬍.05.
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Patellar Taping in Patients With Patellofemoral Pain
Figure 2.
Change in kinematics with taping (taped and untaped conditions) versus baseline. The 3 variables with significant correlations
between the change with taping and the baseline value are shown (top row: lateral to medial displacement and lateral to medial tilt;
bottom row: valgus to varus rotation and legend to symbols). The x-axis indicates the untaped value of each variable (positive values
indicate medial displacement, medial tilt, and varus rotation). The y-axis indicates the change in each variable with taping (positive
values indicate medial displacement, medial tilt, and varus rotation with taping, shown by gray shading). The regression lines are
shown for each variable set using a thick black line. Based on previous work,34 the average value for an asymptomatic cohort
(untaped, n⫽34) for each of the 3 variables is shown using a vertical dashed line (medial displacement⫽⫺0.11 mm, medial tilt⫽14.7,
varus rotation⫽0.52°). All graphs represent kinematics at 10 degrees of knee extension. Participants who were laterally translated,
laterally tilted, and in valgus rotation (relative to the asymptomatic population) are shown in blue. This distinction is independent
for each graph. Thus, a single participant who demonstrated medial displacement and lateral tilt at baseline would be designated
by 2 different colors in each of the respective graphs.
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Patellar Taping in Patients With Patellofemoral Pain
ral groove was an increase in the
patellofemoral contact area. In a previous study, Ward and colleagues43
defined a 19.3% decrease in cartilage
contact area in a group of participants with a 24% increase in the Insall ratio (superior displaced relative
to a control population). In the current study, the patellae in the participants with PFPS were 24% (5.2 mm)
more superiorly placed (dynamically) compared with those of the
asymptomatic population.34 The inferior shift in displacement with taping (1.6 mm) represents 34.8% of the
difference in IS displacement between the participants with PFPS
and the asymptomatic controls
(Tab. 2, 4.6 mm). Increased contact
area decreases contact stress at the
patellofemoral joint by spreading out
the load over a wider area. Ultimately, this decrease in contact
stress may account for some of the
previously reported decrease in
patellofemoral pain after taping.21–26
The correlation between the baseline patellofemoral kinematics and
the change in kinematics due to taping supports earlier work that identified the existence of subgroups
within the patellofemoral pain population.33 The expected medial
change in patellar displacement or
tilt occurred in participants with lateral baseline values of these variables. Conversely, participants with
medial displacement or tilt at baseline demonstrated a lateral change in
displacement or tilt with taping. The
same relationship held true for VV
rotation. Therefore, taping shifts the
patella medially in patients with lateral baseline values of patellofemoral
displacement (relative to an asymptomatic average), and it shifts the patella in the opposite direction in patients with medial baseline values of
patellofemoral displacement. Similarly, taping is effective in medially
tilting the patella in patients with
PFPS and lateral baseline tilt, but it
has the opposite effect for patients
March 2010
with medial baseline tilt. However,
average differences in patellar kinematics after taping across all participants produced no significant
change due to the contrary effect of
patellar taping across participants.
Thus, considering the participants in
this study as a single population
masked the true changes with taping
seen on a person-by-person basis. Regardless, pain relief may have been
further enhanced by the centralization of the patella in regard to patellar LM displacement, LM tilt, and VV
rotation.
One interesting exception in this
study was a single participant who
had the largest lateral displacement
at baseline (⫺14.5 mm), yet demonstrated minimal medialization with
taping. This participant had the highest baseline values of superior displacement (39.0 mm, asymptomatic
average [⫾SD]⫽21.7⫾6.3 mm). If
the inferior shift in patellar placement is considered the primary effect of taping, then the lack of kinematic change for this specific
participant may have been due to
patella alta. In general, for most patients with PFPS with lateral baseline
values of patellofemoral LM displacement, the inferior shift and taping
may lead to further patellar engagement with the femoral sulcus. Thus,
both the force of the taping and the
bone constraint may have medialized
the patella placement. This concept
is supported by a previous study that
demonstrated a strong correlation
between patellofemoral superior and
lateral displacement.5 Yet, for this
participant, the small inferior shift
may not have resulted in patellar engagement with the sulcus, and taping alone was insufficient to cause a
large medialization force.
It is counterintuitive that a medial
taping technique could cause lateralization of the patella in patients with
PFPS. Yet, patients who begin with
medial baseline values for LM dis-
placement do not demonstrate patella alta.33 In the absence of patella
alta, it is likely that the patella remained partially engaged with the
femoral sulcus throughout extension, enabling the patella to remain
medially placed. When the patella
was inferiorly displaced with taping,
the patella was further engaged with
the sulcus. The bony constraints of
the sulcus, due to either the shape of
the groove or limb alignment, resulted in the patella shifting laterally
relative to the femur, and taping
could not overcome this bone force.
The fact that any patient with PFPS
had medial patellar placement relative to the femur may appear contrary to the fact that the clinical
markers used as inclusion criteria
should have confirmed the presence
of excessive lateral tracking. This potential incongruity is explained by a
recently published finding that the
value of Q-angle is correlated with
medial and not lateral patellofemoral
displacement.33
The current results support and expand the findings of previous studies
on the effectiveness of McConnell
taping. Typically, previous taping
studies focused on a static,
2-dimensional evaluation of patellar
alignment with or without muscle
contraction.21,27–30 On average, taping was shown to be ineffective in
shifting and tilting the patella medially. Taping has been shown to be
effective if it was evaluated prior to
any exercise, but a short bout of exercise eliminated this effect.24,29 The
current study design included a short
bout of exercise prior to evaluating
the taping condition, but our study
differed from past studies in its
3-dimensional dynamic evaluation of
a volitional task. Based on this experimental design, McConnell taping
was shown to be effective in shifting
the patella inferiorly after a short
bout of exercise. We also demonstrated that taping tended to shift
patellar LM displacement, LM tilt,
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Patellar Taping in Patients With Patellofemoral Pain
and VV rotation back toward the
asymptomatic average. Thus, it is
likely that the ineffectiveness of taping found in previous studies was
due to the fact that some patients
were not laterally tilted or displaced
prior to taping.
Although the current study used dynamic movement, which is representative of how muscle action can influence patellar kinematics, there
were limitations. The movements
were isolated to the knee, neglecting
the influence of proximal or distal
joints on patellofemoral kinematics.
The range of motion was limited, but
did cover from just prior to and
through terminal extension, where
altered patellofemoral kinematic patterns are most evident. The experimental design did not include an axial compressive load applied to the
leg; thus, it is not known how such
loading could affect patellar kinematics and taping. Another potential limitation of this study was the fact that
the exact force applied with taping
was not quantified. Yet, in previous
studies, participants often applied
their own tape,21,44 and no previous
study measured the force applied
with taping.17,21,24,29,30,44,45 Lastly,
pain was not measured after tape application. This measure was not included in the study design, as previous studies21–26 have clearly shown
the effectiveness of taping for pain
reduction. Thus, the current study
was focused specifically on accurately quantifying how taping alters
3-dimensional patellofemoral kinematics by measuring them noninvasively and in vivo during volitional
activity. The noninvasive nature of
this experiment and its high accuracy, excellent precision, and ability
to demonstrate 3-dimensional kinematic differences during volitional
activities justify these limitations.
Conclusions and Clinical
Relevance
This is the first study to evaluate
3-dimensional changes in patellar kinematics with McConnell taping during voluntary active motion. For the
participants in this study, patellar
taping shifted the patella inferiorly
with respect to the femur, which
may account for some of the previously reported pain relief with taping, due to an increase in contact
area. McConnell taping medialized
the patella in participants who demonstrated lateral displacement at
baseline and lateralized the patella in
participants who demonstrated medial patellar displacement at baseline. Thus, medialization of the patella with taping was dependent
upon the patellofemoral kinematic
alterations present in each participant. This finding reinforces the
need to clinically identify the specific alterations in patellofemoral kinematics present in each patient so
that specific interventions can be
used and optimized to correct these
altered kinematics and reduce pain.
All patients with PFPS and altered
patellofemoral kinematics are likely
to benefit from an inferior shift of the
patella, which should reduce patellofemoral contact stress.
Ms Derasari, Dr Alter, and Dr Sheehan provided concept/idea/project design, data
analysis, and project management. Dr Brindle, Dr Alter, and Dr Sheehan provided writing. All authors provided data collection. Dr
Sheehan provided fund procurement. Ms
Derasari provided participants. Dr Brindle
provided consultation (including review of
manuscript before submission).
The authors thank Elizabeth K. Rasch, PT,
PhD, for support on the statistical analysis
and Steven Stanhope, PhD, for guidance
throughout the project. They also thank
Bonnie Damaska, Jamie Fraunhaffer, Jere
McLucas, Dr Ken Fine, and the Diagnostic
Radiology Department at the National Institutes of Health for their support and research
time.
This study was approved by the National
Institute of Child Health and Development.
8
f
Physical Therapy
Volume 90
Number 3
This research was supported, in part, by the
Howard Hughes Foundation and the Intramural Research Program of the National Institutes of Health (Clinical Center and National Institute of Child Health and Human
Development). Any opinions, findings, and
conclusions or recommendations expressed
in this material are those of the authors and
do not necessarily reflect the views of the
National Institutes of Health or the US Public
Health Service.
This article was received November 18, 2008,
and was accepted October 31, 2009.
DOI: 10.2522/ptj.20080365
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