The patellofemoral joint is influenced significantly by the quadriceps muscle (line of pull, strength), shape of the trochlear sulcus, shape of the patella, surrounding soft tissue, biomechanics at the hip and foot, position of the tibiofemoral joint (quad insertion), pelvic obliquities/SI joint dysfunction, leg length differences, lower extremity flexibility and/or muscle imbalances (1).
“Compressive forces begin at 20-30 degrees of flexion between the medial and lateral facets of the patella and the femoral condyles. As flexion continues, the patellar articular surfaces segmentally come in contact with the trochlear groove with the exception of the odd facet. Continuation of flexion allows a smaller portion of the medial aspect of the patella to be contacted, with greater resultant compressive force. With extreme flexion, the odd facet comes into contact with the inner margin of the femoral condyle in the region of the intercondylar groove (1). Below is an image displaying the area where compressive forces are focused at the knee joint when performing knee flexion”.
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).
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.
“Compressive forces begin at 20-30 degrees of flexion between the medial and lateral facets of the patella and the femoral condyles. As flexion continues, the patellar articular surfaces segmentally come in contact with the trochlear groove with the exception of the odd facet. Continuation of flexion allows a smaller portion of the medial aspect of the patella to be contacted, with greater resultant compressive force. With extreme flexion, the odd facet comes into contact with the inner margin of the femoral condyle in the region of the intercondylar groove (1). Below is an image displaying the area where compressive forces are focused at the knee joint when performing knee flexion”.
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.
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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)
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)
 Lateral tilt component is corrected by pulling the tape from the midline of the patella medially. |
 Excessive lateral tracking is corrected by pulling the patella medially. |
 Excessive external rotation of the patella is corrected by taping from the middle inferior patellar pole upward and medially. |
 An anteriorposterior tilt of the patella is corrected by attempting to tilt the inferior pole of the patella anteriorly by placing a strip of tape at the superior pole of the patella and pulling the tape medially. |
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.
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