Knee pain, particularly pain underneath the kneecap (patellofemoral pain), is a common issue that we see at APT. Abnormal walking or running mechanics, overuse, and/or muscle imbalance patterns can cause this type of knee pain. Taping or bracing the kneecap is often an effective treatment for this problem, so a recent study on the topic interested me. Our therapists often tape patellofemoral joints of patients with this type of pain, and therapists frequently have to decide if taping or bracing is a better treatment option.
In a journal article about the study, the authors described a “neutral patellar taping” technique that uses tape to help secure the kneecap in a “neutral” position. In our clinic we use a technique called McConnell taping. An Australian physical therapist, Jenny McConnell also uses tape to properly align the patella, however, in her technique, she describes an unloading of the soft tissue with the tape to decrease the stress on that soft tissue. I’ve used this technique throughout my whole career with great results; the support allows patients to continue their exercise and workouts until (hopefully) the supporting knee muscles are rehabbed or strengthened to correct the abnormal kneecap tracking that was causing the pain.
In the study, doctors from the University of Central Lancashire, United Kingdom, explored the effect of knee bracing and neutral patella taping during a step-down exercise performed by 13 patients (7 men, 6 women; mean age, 32.5 years) diagnosed with patellofemoral pain syndrome (PFPS).
Patients in the study performed a slow step-stair descent using a 20-cm step under three randomized conditions:
- No treatment
- Patellar bracing
- Neutral patellar taping
To analyze results, the authors collected kinematic (motion) data using a 10-camera infrared Oqus motion analysis system.
The authors found that in the frontal plane (see above illustration), the side-to-side knee range of motion was significantly reduced with both taping and bracing. In the transverse plane, the brace decreased leg rotation significantly while the tape did not.
Because these types of leg motions increase stress through the patellofemoral joint, they can contribute to knee pain. Therefore, one of the goals in physical therapy is to reduce this abnormal range of motion. So it is very significant that the motion was reduced with taping and bracing.
Though taping is often a good option to try, it’s not really practical for long-term use. It’s not as convenient, and it can be hard on the skin. Also, as the study’s authors noted, bracing covered a much larger surface area of skin compared with tape; it may have added additional cutaneous stimulation and enhanced neuromotor control. Mechanically, braces can increase the contact area of the patellofemoral joint, resulting in reduced joint pressure. A brace also applies a circumferential pressure to the posterior aspect of the knee, so it can stimulate the hamstrings, gastrocnemius and popliteus muscles, which could in turn contribute to increased stability. In the study, patients ranked the brace as their first preference for home use, followed by taping and then no intervention.
The results validate a good remedy and take it a step further. Patients who are successful in controlling pain under the kneecap with taping in the physical therapy clinic may benefit from using a patellar brace for home use.
Selfe J, Thewlis D, Hill S, et al. A clinical study of the biomechanics of step descent using different treatment modalities for patellofemoral pain. Gait Posture 2011;34:92-96.