Literature Review of the Efficacy of McConnell Taping for Patellofemoral Syndrome Nicole Boyko, PT/s

Sources: Felder & Leeson (1997); American Family Physician; Patellofemoral Syndrome (PFS) Common knee problem affecting 1 out of 4 people in the general population Characterized by diffuse ache over ant kneecap,  pain with prolonged activity or sitting and possible grinding or clicking with knee flexion Conservative management: NSAIDS, ice, taping, stretching and quad strengthening Surgical options: shaving the patella or lateral release

Juhn (1999) Review of Pathophysiology  pressure b/t patella & femur with repetitive WB and knee flexion excessive pronation = IR of tibia or femur, upsetting PF mechanics Weak VMO may allow patella to track too far laterally

Gigante et al. (2001); Powers et al. (1999) Theory Behind McConnell Taping “A rehabilitation technique in which tape is applied in an attempt to medialize the patella ” Malalignment is supposedly corrected by taping patella in neutral position Guidelines: if distance b/t medial femoral epicondyle and midpoint of patella is greater than that of lateral epicondyle and midpoint of patella, a medial glide and taping is needed Followed by functional quad strengthening

Kowall et al. (1996) Rationale for Literature Review McConnell taping has gained recent popularity Accuracy relies heavily on palpation skills of PT –Palpation lacks reliability as eval tool Need for evidence-based practice in physical therapy –Leading theory behind this method is modification of patella alignment; however few studies have addressed this issue –Landmark study by McConnell (1986) showed 92%  in pain but lacked ctrl group

Purpose Investigate current literature to determine efficacy of McConnell taping in treating patellofemoral syndrome Propose change in current physical therapy practice

Gigante et al. (2001) Background/Literature Review Subjects/Methods –16 female subjects age yrs –Repeated measures design –CT scans taken before & after taping with or without quadriceps contraction at 0 and 15° Lateral patellar displacement Lateral patellar angle –Classification of malalignment Type I- Lateralized patella (9 subjects) Type II- Lateralized and tilted (11 subjects) Type II- Tilted (12 subjects)

Gigante et al. (2001) Background/Literature Review Data Analysis: Paired t-tests & descriptive statistics Results –No significant differences between taped and nontaped knees at either 0 or 15° knee flexion –Only 4 knees (Type I) showed slight reduction in lateralization –13 knees showed  space between lateral facet of patella and lateral femoral condyle potential worsening of patellofemoral conflict

Powers et al. (1999) Background/Literature Review Subjects/Methods –Convenience sample of 14 subjects (18 knees) 11 symptomatic knees & 7 asymptomatic knees –Actual position of patella determined by MRI –Patellar orientation clinically assessed using McConnell method by PT with 1 yr experience Supine, knee extended, quads relaxed Center of patella, medial and lateral femoral condyles marked & distances measured with tape measure

Powers et al. (1999) Background/Literature Review Data Analysis –ICC for interrater reliability –ANOVA with repeated measurers (1 factor) Results –ICC.85 for MRI and.91 for McConnell method –ICC for MRI vs. Clinical method= 0.44 –McConnell method overestimates lateral displacement by nearly 2x –Medial taping may thus be overused & inaccurate in “correcting” patella position

Kowall et al. (1996) Background/Literature Review Subjects/Methods –17 female, 8 male subjects yrs old –Both groups: PT 2x/wk x 4 wks Quad strengthening: isometric, isotonic, isokinetic Stretching regimen and home exercise program –Exp group: received McConnell taping, initially by PT and then self-applied for home use –Compliance with HEP monitored by EMG –Measures: pre-post X-rays, VAS for pain, Cybex testing & EMG testing

Kowall et al. (1996) Background/Literature Review Results –Evidence of patellar malalignment (via X-ray) similar between the groups –Both groups showed significant decreases in pain frequency & impact on ADLs and increases in strength and EMG activity –No significant differences b/t tape and no tape –No tape group showed decreased effect of pain on athletic participation –The addition of taping did not positively or negatively alter end result of PT

Proposed Changes Physical therapists should rely less on McConnell taping as a modality Further research is needed to determine an alternative to taping in control of patellofemoral pain

Summary/Conclusions McConnell taping found to significantly decrease pain in all studies Questionable validity of McConnell method of evaluating patella position No evidence to support premise that taping significantly alters patella position Patella taping as an adjunct to PT produced no different outcomes than PT alone Lack of evidence-based practice; thus research into alternatives is needed

Questions?