Elsevier

Physical Therapy in Sport

Volume 14, Issue 4, November 2013, Pages 199-206
Physical Therapy in Sport

Original research
The effects of two therapeutic patellofemoral taping techniques on strength, endurance, and pain responses

https://doi.org/10.1016/j.ptsp.2012.09.006Get rights and content

Abstract

Objective

To compare the effects of taping techniques on clinical measures in patellofemoral pain syndrome (PFPS) patients.

Design

Crossover experimental design.

Setting

Controlled laboratory.

Participants

Twenty physically active PFPS patients.

Main outcome measures

Isokinetic strength and endurance, and perceived pain.

Results

Bilateral baseline differences existed for strength (involved = 1.8 ± 0.5 Nm/kg; uninvolved = 2.1 ± 0.5 Nm/kg; p = 0.001) and endurance (involved = 35.6 ± 14.0 J/kg; uninvolved = 40.2 ± 12.9 J/kg; p = 0.013). Strength (McConnell = 2.1 ± 0.6 Nm/kg, 95% SCI = (1.1, 4.2); Spider® = 2.1 ± 0.5 Nm/kg, 95% SCI = (0.9, 4.0)) and endurance (McConnell = 42.9 ± 13.8 J/kg, 95% SCI = (2.9, 11.6); Spider® = 42.5 ± 11.0 J/kg, 95% SCI = (2.6, −11.3)) increased when taped compared to baseline. Pain decreased during strength (baseline = 3.0 ± 2.2 cm; McConnell = 1.9 ± 1.7 cm, 95% SCI = (−1.8, −0.4); Spider® = 1.6 ± 2.0 cm, 95% SCI = (−2.0, −0.5)) and endurance (baseline = 2.5 ± 2.0 cm; McConnell = 1.5 ± 1.8 cm, 95% SCI = (−1.6, −0.4); Spider® = 1.1 ± 0.8 cm, 95% SCI = (−1.7, −0.5)) measurements when taped. Differences between taping techniques were insignificant.

Conclusions

Taping improved clinical measures in PFPS patients. No differences existed between Spider® and McConnell techniques.

Introduction

Patellofemoral pain syndrome (PFPS) is the most prevalent cause of knee pain diagnosed by sports medicine physicians (McConnell, 1986; Powers 1998). The condition is characterized by pain and discomfort on the anterior aspect of the knee, primarily along the medial border of the patella, and it accounts for 25% of all knee injuries seen in athletes in sports medicine clinics (Earl & Hoch, 2011; Overington, Goddard, & Hing 2006). Pain associated with PFPS is exacerbated by activities, such as squatting, running, or ascending and descending stairs that yield considerable forces on the joint (Levine, 1979; Powers, 1998). The exact cause of PFPS is unknown, but it has been linked to an abnormal lateral tracking of the patella (McConnell, 1986; Powers 1998). Several factors contribute to lateral tracking, including a stiff iliotibial band, weak quadriceps musculature, especially the oblique fibers of the vastus medialis (VMO), a large Q-angle, patellar tilting, and neurological dysfunction (Caylor, Fites, & Worrell, 1993; Herrington, 2001; Puniello, 1993). Traditional treatments for PFPS have included patellar taping, stretching, various strengthening exercises, activity modification, bracing, ultrasound, and foot orthoses (Earl & Hoch, 2011).

One proposed intervention for patients suffering from PFPS is the McConnell taping technique. The goal of the McConnell taping technique is to correct abnormal lateral tracking of the patella and to align the patella medially within the trochlear groove in order to diminish pain for patients while they perform therapeutic exercises (McConnell, 1986). Several studies have reported potential benefits of this intervention for perceived pain reduction (Aminaka & Gribble, 2008; Christou, 2004; Whittingham, Palmer, & Macmillan, 2004), but the exact mechanism for this phenomenon is still undetermined. For instance, Christou (2004), Handfield and Kramer (2000), and Herrington (2001) concluded that the results observed with the McConnell taping technique were due to pain modulation via cutaneous stimulation, rather than the changing of patellar positioning, as proposed by McConnell (1986). Other studies have also found that taping over the skin can stimulate cutaneous mechanoreceptors and boost afferent signals to the central nervous system (CNS) for improved proprioception (Chen, Hong, Huang, & Hsu, 2007; Hang, Chou, Lin, & Wang, 2010; Tunay et al., 2008). This outcome is commonly referred to as the nociceptive effect, which elicits neural inhibition by facilitating large afferent fiber input. According to these studies, changes in neural input through afferent receptors, such as cutaneous mechanoreceptors and Messner corpuscles, from the patellar tape application may be enough to block nociceptive input and cause neural inhibition via the large afferent fibers (Aminaka & Gribble, 2008; Chen et al., 2007; Hang et al., 2010; Tunay et al., 2008).

More recently, a new form of therapeutic tape called kinesiology tape®, developed by Dr. Kenso Kase and colleagues in Japan (Kase, Wallis, & Kase, 2003), has been suggested for the treatment of PFPS (Chen et al., 2007). Research states that the use of kinesiology tape® provides additional benefits of improved circulation and reduced inflammation compared to other types of tape (Cowan, Bennell, & Hodges, 2002; Kase et al., 2003; Kinzey & Armstrong, 1998). Some of the characteristics of kinesiology tape® include its similarity to the thickness of human skin, its ability to be stretched up to 120–140% of its length, and its capacity to be worn continuously for 3–4 days (Chen et al., 2007; Hang et al., 2010; Osterhues, 2004; Tunay et al., 2008). This tape has embedded elastic fibers that allow it to recoil when placed on the skin. It also allows for partial to full joint range of motion (Edin, 2004). The elastic recoil in the tape is proposed to lift the skin and increase space between the skin and muscle, and, thus, provide the central nervous system with a large influx of afferent sensory input via mechanoreceptors (Kase et al., 2003). Kinesiology tape® is proposed to increase proprioception by providing constant cutaneous afferent stimulation. By way of this mechanism, the tape leads to an increase in muscle activation (Kinzey & Armstrong, 1998) and a decrease in pain through neurological suppression (Cowan et al., 2002).

Quadriceps muscle performance is one parameter that has been closely linked to PFPS (Alaca, Yilmaz, Goktepe, Mohur, & Kalyon, 2002; Goharpey, Shaterzadeh, Emrani, & Khalesi, 2007; Handfield & Kramer, 2000; Herrington, 2001). Several studies have shown that patients suffering from PFPS tend to have weaker quadriceps musculature than those who are healthy. However, there have been contradictory results with respect to the efficacy of the McConnell taping technique on strength as studies found neither decrease in pain nor increase in force production with the tape application (Keet, Gray, Harley, & Lambert, 2006; Kowall, Kolk, Nuber, Cassisi, & Stern, 1996). Keet et al.'s (2006) results revealed that PFPS patients exhibited a significantly lower isokinetic peak torque than healthy subjects. However, the taping interventions had no significant effect on force production for both the PFPS group and the healthy cohort. The authors concluded that a taping technique may not be an appropriate treatment choice for a physically active population. Instead, they suggested that a rehabilitation program designed for improving strength deficits could be more effective. This claim is supported by research conducted by Kowall et al. (1996), which concluded that taping provides no benefit to a strength based rehabilitation program.

Herrington (2001) investigated the effects of taping on quadriceps strength and perceived pain of 14 participants with PFPS. The researcher found that all participants showed a significant increase in strength and decrease in pain after the tape was applied. Although Herrington observed a positive correlation between the taping intervention and isokinetic strength, this study did not address the possibility that sensory input from the tape may affect pain and strength measures. Handfield and Kramer (2000) addressed this issue in their study by using a protocol similar to Herrington's (2001), but with the application of Hypafix® tape to the knee during the no-tape testing condition. Hypafix tape was used because it stimulates sensory input without affecting the anatomical position of the patella. The results were comparable to those in Herrington's (2001) study in that pain was significantly decreased and strength was significantly increased after the application of tape.

Other researchers (e.g., Alaca et al., 2002; Goharpey et al., 2007; Handfield & Kramer, 2000; Herrington, 2001; Keet et al., 2006) have chosen to compare therapeutic taping techniques with placebo tape in order to account for the placebo effect that tape provides on perceived pain and muscular performance. The placebo effect refers to beneficial outcomes of treatment caused, neither by the biological action of the treatment nor by changes in neural input, but instead by patients' response to the treatment process itself (Wager, 2005). Recent brain-imaging studies (Petrovic, Kalso, Petersson, & Ingvar, 2002; Wager et al., 2004) suggest that placebo-induced expectations of analgesia increase activity in the prefrontal cortex in anticipation of pain and decrease the brain's response to painful stimulation.

Studies that use placebo tape provide conflicting results. Some studies (e.g., Alaca et al., 2002; Goharpey et al., 2007; Handfield & Kramer, 2000; Herrington, 2001) have shown that placebo tape decreases perceived pain and increases functional performance. Others have found no significant differences between therapeutic taping techniques and placebo tape. For instance, Christou (2004), Ng and Cheng (2002), and Wilson, Carter, and Thomas (2003) found that placebo tape was as effective as therapeutic tape in reducing pain. Additionally, Keet et al. (2006) found that neither McConnell tape nor placebo tape decreased pain nor did they increase quadriceps strength. Still other researchers (e.g., Cowan et al., 2002; Ernst, Kawaguchi, & Saliba, 1999; Riemann, 2002; Whittingham et al., 2004) have indicated that therapeutic tape has a greater effect on pain reduction and functional improvement than placebo tape and that placebo tape may result in a decrement in performance. Based on these conflicting findings and in order to limit the scope of the present study, it was determined that placebo tape would not be utilized. It would, however, be valuable to examine the influence of a possible placebo effect on patellar taping. This issue is left to be examined in future studies.

The purpose of the present study was to investigate the effects of different modes of therapeutic taping on quadriceps muscular performance and perceived pain in PFPS patients. The two therapeutic taping techniques that we compared were the McConnell medial glide and the NUCAP Medical Upper Knee Spider® (Spider Tech Inc., Toronto, Canada). It was hypothesized that knee muscle strength and endurance would be significantly greater on the uninvolved leg compared to the involved leg, prior to the taping interventions. After the two taping techniques are applied, it was hypothesized that there would be a significant increase in muscle strength and endurance, and a decrease in perceived pain, for the involved leg, compared to the baseline condition. This study will, therefore, help examine the efficacy of the McConnell and Spider® taping techniques as well as provide information that can be clinically applicable for practitioners treating symptoms of PFPS.

Section snippets

Participants

Twenty participants (7 men, 13 women) were recruited for the present study. Their mean age, height, body mass, and body mass index were 21.2 ± 2.9 years, 169.2 ± 16.8 cm, 68.1 ± 11.6 kg, and 24.5 ± 7.0 kg/m2, respectively. Participation in the study was voluntary, and patients were recruited by means of informational flyers and verbal scripts. The inclusion criteria were as follows: (1) recreationally active (defined as individuals who engage in physical activity with a minimum frequency of

Activity level

Results of the Tegner Activity Scale displayed a statistically significant difference between activity level before and activity level after PFPS symptoms presented themselves (p = 0.001). The activity level results are displayed in Table 1.

Perceived pain

During strength testing, as measured by the standardized VAS, a statistically significant difference was found among conditions (baseline, McConnell, Spider®) with the involved leg for perceived pain (p = 0.001). Tukey's HSD post-hoc analysis revealed that

Perceived pain

The results of the present study showed that patients exhibited significantly lower levels of perceived pain in the two taping conditions (McConnell and Spider®), when each of these was compared to the baseline condition. The reduction in perceived pain level reported in the present study, as quantified by the VAS after tape application, is consistent with previous findings (Aminaka & Gribble, 2008; Earl & Hoch, 2011; Herrington, 2001). Pain reduction has been attributed to the correction of

Conclusion

Within the scope and limitations of this investigation, it is reasonable to conclude that: (1) McConnell and Spider® taping techniques decrease perceived pain in patients with acute PFPS compared to a baseline condition, (2) McConnell and Spider® taping techniques increase quadriceps isokinetic extensor peak moment and total work in patients with acute PFPS compared to a baseline condition, and (3) there are no significant differences between the effects of the McConnell taping technique and

Conflict of interest

None declared.

Ethical approval

The participating subjects signed a consent form, and the study protocol was approved by the East Stroudsburg University Office of the Provost and The Pennsylvania State University Office for Research Protections and Institutional Review Board.

Funding

None declared.

Acknowledgment

We thank Dr. John Hauth, PhD, and Dr. Keith Vanic, PhD for their review of this manuscript. We also thank Dr. Sayers J. Miller, PhD for donating the kinesiology tape product samples.

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