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Taping for patellofemoral pain requires strict attention to technique

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Vol. 24 • Issue 17 • Page 15

Sports Medicine Focus

The broad category of patellofemoral pain syndrome (PFPS), one of the most common diagnoses treated in outpatient physical therapy, encompasses many varieties and names, ranging from runners' knee to jumper's knee. Regardless of the term used, one thing remains the same across the board: Therapeutic taping for PFPS can decrease pain, improve strength and endurance, and increase overall performance.

Therapeutic tape came onto the scene a few years ago when it seemed all high-profile athletes were taped with brightly colored patterns. But what is therapeutic tape, and why is it so popular?

This tape has become one of the go-to items in a trainer's kit on the sidelines, and as a practicing physical therapist, I personally use it on a daily basis. Therapeutic tape is not painful and can be worn in every environment from the shower to the soccer field. The practice of taping helps patients maintain or even improve their existing range of motion, and increase strength.

For the PFPS Patient

With PFPS, patients experience pain at the front of the knee and in and around the patella. Current research indicates that PFPS may result from repetitive or excessive use of the knee. Other contributing causes may include weakness, tightness or stiffness in the muscles around the knee, or an abnormality in the way the lower leg lines up with the hip, knee and foot.

These conditions can interfere with the ability of the patella to glide smoothly on the femur during movement. The friction between the under-surface of the patella and the femur causes the pain and tenderness commonly seen in PFPS.

When a patient presents with PFPS, the therapist may elect to use therapeutic taping for pain and swelling. Taping is beneficial for the swelling that impacts a patient's range of motion, and the best technique is taping with a fan.

Taping for swelling from PFPS does not require many visits. Most often, if the taping is done correctly, it is effective right away and will only require one or two sessions of tape. The patient needs to be instructed to watch for areas of redness and irritation. If the patient does experience some irritation, the tape should be removed immediately. Personally, I have never had a patient return with any type of negative skin reaction, but it's important to remember as a precaution.

I prefer using tape that does not require a protective layer for the skin. With this type, the tape may be applied right across the patella with direct skin contact, and will not inhibit patellar mobility.

Taping for pain, strength, endurance and improved performance comes with mixed schools of thought. Some believe that the therapist tapes the movement, while others believe the therapist tapes the muscle. Depending on the situation, I feel that both techniques are correct.

With PFPS, for example, you may want to perform a taping technique that facilitates the activation of the vastus medialis oblique and inhibits the action of the vastus lateralis. In theory, this will accomplish two things: The taping should reduce the pain and strengthen the appropriate musculature at the same time. If part of your goal is to strengthen, then you should be able to retest the muscle right after the tape is applied and notice an increase in strength.

In taping for movement, a patient presents with the same pain and weakness, but you must consider the movement of the knee where the fascia is restricted. In this case, you'd look at the joint as a whole and then decide on the best taping method.

When the goals are improved athletic endurance and performance, taping specific large muscles is generally the best approach. In a PFPS patient, for example, you may want to tape for the vastus medialis oblique and the vastus lateralis, if indicated in the assessment. When you tape for these muscles, you want to have the patient flex these muscles as the tape is applied in order to achieve the maximum blood flow to the muscles. This should not be performed until later in the treatment session, after the pain has subsided, because you will be facilitating the vastus lateralis, a muscle that could be a culprit in causing PFPS pain.

Taping Pros and Cons

Therapists can teach patients how to apply therapeutic taping at home. As a result, the benefits of the treatment session are carried over beyond the clinic. With the rising cost of co-pays, patients who purchase a roll of tape and learn how to tape at home may reduce the number of clinic visits and reduce overall expenses. On a positive note, if a patient tapes himself incorrectly, it is unlikely that he will hurt himself. The most likely outcome of improper application is that the tape will not be effective.

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Heather Moore sees success with taping for patellofemoral pain in many of her patients. But there's no 'cookbook' recipe - taping for movement helps in some cases, while others require taping for pain or for swelling.

The downside of taping is that the method has very little research to back up its touted benefits. It is almost impossible to find studies in reputable journals on taping, and insurance companies will not reimburse for its use; therefore, many practitioners choose not to use it. Regardless of the drawbacks, I have seen with my own eyes many times the benefits of taping. I have taped thousands of clients, from children to professional athletes.

Taping for PFPS is not straightforward. Different types of taping methods can be employed depending on what you're trying to accomplish. Don't be afraid to change techniques from one visit to the next as the patient's needs change. Swelling may be the biggest issue during a patient's first visit, but then it may be pain during the second visit. Be certain to re-evaluate the patient each time they come in to make sure you are providing the most effective taping technique.

Tips on Technique

It's important to understand that there is no "cookbook" on taping. There is no single specific recipe that works for each diagnosis. Taping for movement helps at times, whereas taping for swelling and taping for pain will work others.

For one individual case of PFPS, the therapist could tape the patient in the posterior region to fix the problem. The posterior chain, which is dysfunctional in most PFPS cases, can be targeted with the tape. This targeting will be different for different muscles and different movements.

The one school of thought that is common among enthusiasts is the importance of the patient assessment. Assessing the patient is key to performing a correct taping technique. There may be two or three additional techniques that will work even after the assessment, and then it's up to your clinical decision making to determine which one will work the best.

Even though there are no right and wrong techniques depending on the chosen target, mistakes can be made in the application of the tape. The one thing I have seen consistently done wrong by clinicians and patients is putting too much stretch on the tape.

The tape's ability to stretch is one of the properties that make the method effective; however, people tend to get carried away with how much stretch they want to put on it. When the tape is pulled too hard when applied on the knee, the joint's range of motion can wind up being limited. This is not the desired goal of taping.

The wisest thing to do is cut a small piece of tape and play with it, stretching it as far as it will go. Then back off to about 50% of the total stretch, then back off to about half of that tension so the tape is being pulled at about 25% tension. Show the patient how the tape is able to stretch. First have the patient pull it all the way, then tell him to back off to about half that, and then have him back off to about half of that. It's important to find a length and tension that will not cause the patient harm by creating strapping of the joint.

Another technique that is incorrect when taping for PFPS is the application of too much tape. Some clinicians become overzealous with the tape and do not really know when to stop taping for every last little dysfunction. Some patients come out looking like mummies because they are wrapped in so much tape.

The bottom line is to pick one correction that is to be made, and tape for that and only that. Don't try to correct everything all at once with the tape, because none of it will work.

Taping has become an effective tool to resolve PFPS. Whether it be taping for pain, strengthening, increased range of motion or endurance, therapeutic tape can aid in a faster recovery. After an accurate plan of care has been established, the results will be apparent inside and outside the clinic. The benefits of taping can last far beyond the treatment day, making it a sound choice for use on the athletic population or anyone experiencing a diagnosis of PFPS. 

Heather Moore is owner of Total Performance Physical Therapy in North Wales, Pa. She has spent her career in outpatient orthopedics, has treated professional, amateur and collegiate athletes, and specializes in runners and triathletes.




     

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