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Literature Review of the Efficacy of McConnell Taping for Patellofemoral Syndrome

Literature Review of the Efficacy of McConnell Taping for Patellofemoral Syndrome. Nicole Boyko, PT/s. Patellofemoral Syndrome (PFS). Common knee problem affecting 1 out of 4 people in the general population

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Literature Review of the Efficacy of McConnell Taping for Patellofemoral Syndrome

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

  2. 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 Sources: Felder & Leeson (1997); American Family Physician; www.sechrest.com

  3. 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 Juhn (1999)

  4. 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 Gigante et al. (2001); Powers et al. (1999)

  5. 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 Kowall et al. (1996)

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

  7. Background/Literature Review • Subjects/Methods • 16 female subjects age 16-25 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)

  8. 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 Gigante et al. (2001)

  9. 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)

  10. 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 Powers et al. (1999)

  11. Background/Literature Review • Subjects/Methods • 17 female, 8 male subjects 14-40 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)

  12. 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 Kowall et al. (1996)

  13. 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

  14. 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

  15. Questions?

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