chapter 12: Nonoperative Treatment
Jennie McConnell (12) revolutionized rehabilitation of patellofemoral patients with the introduction of taping concepts. Use of special tape to counteract patellar tilt, subluxation, and rotation may be enormously helpful in the rehabilitation process (Fig. 12.11, A to C). Studies and opinions have differed with regard to how these taping techniques work. There seems little doubt that patients benefit from tape around the front of the knee. Cushnaghan et al (13) have shown that patellofemoral taping is helpful in relieving pain in patients with patellofemoral osteoarthritis. Bockrath et al (14) have shown similar benefits of taping in patients with anterior knee pain. Some patients express immediate relief of pain that has gone unrelieved for a year or more. What is happening?
There is undoubtedly great psychological benefit to the patient who becomes involved in his/her own treatment. Tape application brings a sense of "doing something" that is tangible and logical. Taping often brings a new sense of hope and a positive approach to the problem.
Application of tape to the skin around the patellofemoral joint undoubtedly moves skin more than patella (Fig. 12.12). Application of tape, however, may provide additional position sense and improve proprioceptive function around the anterior knee. Increased sense in this area may actually provide improved reflex inhibition of deforming muscle forces while improving reflex and functional support for the patella.
Is it possible that tape anterior to the knee may actually improve alignment? Some studies have indicated that minor changes of patellar alignment may result from patellar taping. In one study, Tom Murray at the University of Connecticut School of Medicine (unpublished data, 1996) demonstrated actual improvement of patellar malalignment immediately following the tape application, doing computerized tomography before and after taping. The changes were noted, however, only with the knee in full extension. Upon flexion of the knee to 15 or 30 degrees, changes effected by the tape were promptly eliminated and pre‑existing subluxation or tilt returned. Nonetheless, this study raised the possibility that taping may, to a minor degree, alter patellar entry into the trochlea.
In any case, major changes of patellar alignment are unlikely using tape. What is clear, however, is that taping is beneficial. The minor changes in alignment, together with patient involvement in the process and improved sensation‑proprioception around the front of the knee, can explain the efficacy of patellar taping for control of patellofemoral pain and the resulting improved rehabilitation after taping in many patients.
Inside Chapter 12: