EFFECTS OF MCCONNELL TAPING TECHNIQUES ON PAIN IN PATELLOFEMORAL PAIN SYNDROME

Conclusion: Mcconnell taping techniquescan  be effective in improvement of pain intensity in PFPS patients.

Recommendation

1-   The use of McConnell knee taping in treatment of patellofemoral pain syndrome patients.

2-   Replicate this study using the same treatment program for a longer period of time.

3-   Include a larger sample size, with an equal number of males and females in each group.

EFFECTS OF MCCONNELL TAPING TECHNIQUES ON PAIN IN PATELLOFEMORAL PAIN SYNDROME

Mahmoud S. Abd El-Azeem* ; Samah S. Zahran **

and Nadia Abdelazeim Fiyaz ***

*Practitioner of Physical Therapy, Department of Physical Therapy, El-Sahel Teaching Hospital.

**Lecturer of Physical Therapy for Musculoskeletal Disorders and their Surgeries, Faculty of Physical Therapy, Cairo University;

***Professor of Physical Therapy for Musculoskeletal Disorders and their Surgeries, Faculty of Physical Therapy, Cairo University;

Key Words:, Mcconnell  taping, patellofemoral pain syndrome.

ABSTRACT

Background: One of the most common knee problems is patellofemoral pain syndrome (pfps) which is higher rating among females especially athletes than males. It is commonly believed that main problems of PFPS are pain and impaired knee function. Objective: to determine effect of Mcconnell (MCT) taping on pain intensity in patients with PFPS.  Methods: theirty patients (male and female) with PFPS participated in the study. Their age ranged from 18 to 35 years. They were assigned randomly into two equal groups. The first group (A) included 15 patients with a mean age of (24.46 ± 2.23 years) and mean BMI (22.72 ± 2.3 kg/m²) were treated with MCT and exercises for six weeks. The second group (B) was the control included 15 patients with a mean age of (23.86 ± 1.84 years) and mean BMI (22.93 ± 3.23 kg/m²) were treated with quadriceps strengthening exercises only for six weeks. Pain intensity was measured by numerical pain rating scale (ANPRS). All the assessment was done before the study, after 3 weeks (post I) and after 6 weeks (post II)in both groups. Results: Findings revealed the group(A) which used McConnell aping with exercises had shown improvement in pain intensity more efficiently than group(B) which treated by quadriceps strengthening exercises alone (P = 0.0001). Conclusion: Mcconnell taping techniquescan improve pain in PFPS patients.

INTRODUCTION

One of the most common knee problems is patellofemoral pain syndrome (PFPS), which is higher among females especially athletes than males (Witvrouw et al., 2000 and Powers, 2010). Patients with PFPS suffer from anterior knee pain which increases with activities such as ascending or descending stairs, sitting for a long time and squats (Willson et al., 2011). The specific cause of PFPS is unknown but it has been related to mechanical dysfunction around the patella (McConnell, 1986 and Powers, 1999).

Patellar maltracking including increased lateral patellar translation (Souza et al., 2010) tilt (Draper et al., 2011) and spin (Willson et al., 2011) as well as increased lateral PFJ stress (Powers, 2003 and Farrokhi et al., 2011)  may associate with PFP. Owing to its ability to control lateral patellar tracking, vastus medialis oblique (VMO) delay or weakness is considered a key biomechanical risk factor for patellar maltracking. In one systematic review, they reported that VMO onset occurred after vastus lateralis (VL) in some individuals with PFP compared to controls during a range of functional tasks (Chester et al., 2008).

In addition to impaired VMO muscle function, a number of other proximal, distal and local biomechanical factors may contribute to the etiology of PFP (Powers et al., 2012). As a result, numerous conservative interventions such as orthoses, taping and exercise are commonly used in rehabilitation. A recent systematic review identified multimodal physiotherapy as the gold standard approach, and foot orthoses and acupuncture should also be considered (Collins et al., 2012). Multimodal physiotherapy combines a number of interventions including stretching, deep friction tissue massage, strengthening exercises, education, and patellar taping. Patellar taping forms a core component of evidence-based multimodal programmes (Crossley et al., 2002 and Collins et al., 2012). Many taping protocols exist, with the most widely used ones being the McConnell taping technique (Cowan et al., 2001).

The McConnell Taping (MCT) method is one of the most studied and frequently used as an option to the treatment of PFPS (Worrell et al., 1998; Pfeiffer et al., 2004; Derasari et al., 2010 and Lee and Cho, 2013). This taping method was developed by Jenny McConnell in 1984 to correct the abnormal position of the patella in patients with PFPS (Clifford and Harrington, 2013).

In this method, highly adhesive and rigid tape is used to correct lateralization, tilting, and patella alta (Ernst et al., 1999 and Campolo et al., 2013). This correction may result in a reposition of the patella in the trochlear groove, increasing the patellofemoral joint contact area, which results in decreasing patellofemoral joint stresses and reduces pain (Herrington, 2001). Also, it was found that MCT resulted in improving VMO activation during stairs negotiation (Cowan et al., 2001) and single leg squat (Mostamand et al., 2011).

In a recent systematic review, Barton et al (2013) found that there is moderate evidence that MCT (which is customized to the patient to control lateral tilt, glide, and spin) provides immediate pain reduction of large effect, promotes earlier onset of VMO contraction (relative to vastus lateralis contraction), and improve knee function capacity. The purpose of the study is to investigate the effect of Mcconnell (MCT) taping on pain intensity in patients with PFPS.

METHODS

Design of the study:

Thirty patients (male and female) were recruited to share in this study. Sample size calculation was performed using G*POWER statistical software (version 3.1.9.2; Franz Faul, Universitȁt Kiel, Germany) (Faul et al, 2009) and revealed that the appropriate sample size for this study was N=30. Fifteen patients will be assigned to group A (experimental) and fifteen patients were assigned to group B (control). All patients read and signed a consent form prior to the beginning of treatment for ethical issues. Patients were recruited based on the following inclusion and exclusion criteria:

  Inclusion criteria:

• Thirty patients with PFPS.
• Their ages ranged from 18-35 years including both genders.
• Insidious onset of peripatellar or retropatellar knee pain of 6 weeks duration at least.
• Pain provoked by two activities at least from running, walking, hopping/ jumping, squatting, stair negotiation, kneeling, or prolonged sitting (Atbasi et al., 2013).
• Their body Mass Index (BMI) was ≤ 29.9 kg/m2.

Exclusion criteria:

• Current use of anti-inflammatory medications.
• Concomitant injury or pain arising from the lumbar spine or hip.
• Knee internal derangement, laxity or sublaxation.
• History of dislocation, tendinopathy, subluxation or osteoarthritis in the patellofemoral joint.
• Allergy to rigid strapping tape.
• History of traumatic injury to the hip or ankle.

Instrumentation and procedures:

2.1 For assessment:

Numeric Pain Rating Scale (NPRS):

The NPRS is a segmented numeric version of the VAS in which a respondent selects a whole number (0–10 integers) that best reflects the intensity of his/her pain. The common format is a horizontal bar or line. Similar to the VAS, the NPRS is anchored by terms describing pain severity extremes (Hawker et al., 2011).

The Arabic version of NPRS, which has been culturally adapted and validated by Alghadir et al (2016), consists of simple and easily understood words, therefore, it may be used to assess knee pain in Arabic-speaking patients especially elderly and less educated ones in different Arabic countries. It was recommended for clinical and research purposes.

2.2 For treatment:

Rigid taping:

Elastoplast rigid tape with a width of  5 cm and a thickness of 0.5 mm was used. Tape was constructed to be as stable as possible with a rubber zinc oxide adhesive mass.

All patients were given a full explanation of the protocol of the study and a consent form was signed with each patient before participating in the study.

 a- Assessment:

Pain intensity was assessed before the study, after 3 weeks (post I)  and  after 6 weeks (post II)in all groups.

Assessment of Pain intensity:

The pain intensity was assessed using NPRS. Patients were asked to put a placemark on the number which corresponds to their pain. The NPRS comprises of 11 points ‘‘horizontal scale’’ of 0–10 in Arabic numerals anchored by the two ends, the left (0 indicating no pain at all) and right (10 indicates the worst pain ever). The middle points are represented by proportionally increasing numbers up to 10 (Al-Shehri et al., 2017).

b- Treatment:

• Group (A): was receiving MCT technique and exercises for 6 weeks.
• Group (B): was receiving quadriceps strengthening exercises only 3 sessions per week for 6 weeks.

1-McConnel tapping(MCT) procedures:

1. The physiotherapist demonstrated the MCT technique to the patients and delivered instructions to wear the tape for the duration of the treatment.

2. Egypt. J. of Appl. Sci., 34 (12) 2019                                                      455

   The skin was cleaned , dried and the hair was shaved.

1. Non rigid, hypoallergenic tape was used to provide skin protection from lateral femoral condyle to just posterior to the medial femoral condyle.
2. Pre-cut tape (high strength rigid tape) strips were provided. The physiotherapist measured the taping length required for each patient on a case-by case basis to ensure that the tape covered the landmarks and provided the individuals with the pre-cut strips.
3. The patient rested in a seated position with the leg extended and relaxed.
4. The base layer was applied from lateral femoral condyle to just posterior to the medial femoral condyle (Callaghan et al., 2008).
5. Slight tension is then place on the tape towards the medial side of the knee (promoting proper patellar alignment in individuals withPFPS), where the medial side of tape fixed to the skin (Callaghan et al., 2000).
6. Another layer was attached one thumb’s breadth from the lateral patellar border, without pushing the patella, gathering the soft tissue over the medial condyle and adhering to the medial condyle ) (Callaghan et al., 2008).

3- Quadriceps strengthening exercises:

1. Quadriceps set:

-       The patient rested on the floor with the affected leg straight.

-       The patient was asked to tighten the quadriceps muscle by pressing the back of the knee flat down to the floor and holding for about 6 seconds then relax.

-       The patient was asked to repeat for 5 to 10 times.

1. Wall squat:

-       The patient stood with back against the wall, placing feet about two feet out.

-       The patient was asked to lean against the wall with knees at a 90 degree angle and feet on the floor for 10- 20 seconds, working up to 10-15 repetitions.

1. Straight leg raise:

-       The patient rested on his back raising his fully extended leg several inches and hold it up for 5 to 10 seconds then lowered the leg to the plinth, Do the exercise 5 to 10 times.

RESULTS:

Statistical analysis

Subject characteristics were summarized and compared between groups using t-test. Sex distributions were compared between groups using Chi- squared test. Normal distribution of data was checked using the Shapiro-Wilk test for all variables. Levene’s test for homogeneity of variances was conducted to test the homogeneity between groups. Unpaired t test was performed to compare ANPRS between groups and repeated measures ANOVA was used for comparison within groups. The level of significance for all statistical tests was set at p < 0.05. All statistical analysis was conducted through the statistical package for social studies (SPSS) version 25 for windows (IBM SPSS, Chicago, IL, USA).

- Participant characteristics:

Table 1 showed the participant characteristics of group A and B. There was no significant difference in the age, weight, height and BMI between groups (p > 0.05). There was no significant difference in sex distribution between groups (p = 0.71).

Table 1. Descriptive statistics and comparison of the mean age, weight, height, BMI and sex distribution of group A and B.

SD, Standard deviation; χ², Chi squared value; p value, Probability value

Effect of treatment on ANPRS

Within-group comparison pre treatment, post I and post II revealed significant changes in ANPRS in the group A and B. There was a significant improvement in ANPRS at post I and post II compared with that at pretreatment in both groups (p < 0.001). There was a significant improvement in ANPRS of group A and B at post II compared with that at post I (p < 0.05), (table 2, figure 1).

In group A, the percent of change between pre treatment and post I was 76.5%, between pre treatment and post II was 87.1% and between post I and post II was 45.11%. In group B, the percent of change between pre treatment and post I was 50.6%, between pre treatment and post II was 77.57% and between post I and post II was 54.61%.

Between group comparison

Between groups comparison revealed a nonsignificant difference in ANPRS pre treatment (p > 0.05). Comparison between groups at post I and post II revealed a significant decrease in ANPRS of group A compared with that of group B (p < 0.01), (table 2, figure 1).

Table 2.Mean ANPRS pre treatment, post I and post II of group A and B:

SD, Standard deviation; MD, Mean difference; p-value, Level of significance

Figure1.Mean ANPRS pre treatment, post I and post II of group A and B.

DISCUSSION:

This study was conducted to investigate the effect of MCT technique on pain intensity in patients with PFPS.

The results of the present study showed that MCT with exercise more efficient in improve pain intensity in PFPS patients than quadriceps strengthening exercises alone. the results of our study explained by  the results of Warden et al., (2007), the improvement may be attributed to several benefits of MCT which correct patellar alignment by directing the patella medially to promote proper tracking and enhancing VMO muscle activity. Hence, the tape is used to assist the patella to track properly which increases the patellofemoral contact area thereby reducing knee joint stress.

 Our results agreed with Hanafy, (2016) who found that McConnell taping is effective for improving functional performance and reducing pain intensity in patients with PFPS. The findings of Hanafy,(2016) showed a significant reduction in the NPRS scores with therapeutic MCT compared with placebo and no tape conditions.

Kakar et al., (2020) conducted a review to compare the effects of Kinesio taping versus MCT for PFPS. Kakar et al.,(2020) stated that Kinesio taping technique used for muscles can relieve pain but cannot change patellar alignment, unlike McConnell taping. Both patellar tapings are used differently for PFPS patients and substantially improve muscle activity, pain, and quality of life.

The present study agreed with a systematic review conducted by Chang et al., (2015) who found that McConnell taping can adjust patellar alignment and tracking but does not improve proprioception and motor function for PFPS. So, McConnell taping significantly improve muscle activity, motor function, and quality of life which are possibly facilitated by pain relief.

Lee and Cho, (2013) stated that four weeks of McConnell taping to 16 patients with patellofemoral pain syndrome was enough to increase muscle activity of vastus medialis and muscle activity ratio of vastus medialis to vastus latralis which was associated with significant improvement in pain intensity and functional level on NPRS and AKPS respectively.

The results of the present study disagreed with the results of Kowall et al., (1996) who conducted a study to evaluate the efficacy of a MCT program in the conservative management on twenty-five patients with patellofemoral pain. The study suggested no beneficial effect of adding a MCT patellar taping program to a standard physical therapy program in the conservative treatment of patellofemoral pain. Moreover, Kowall et al.,(1996) conducted the study through a limited duration (one week only).

Conclusion: Mcconnell taping techniquescan  be effective in improvement of pain intensity in PFPS patients.

Recommendation

1-   The use of McConnell knee taping in treatment of patellofemoral pain syndrome patients.

2-   Replicate this study using the same treatment program for a longer period of time.

3-   Include a larger sample size, with an equal number of males and females in each group.

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تأثیر شریط ماکونیل علىالالم فی مرضى متلازمة ألم الرضفة وأسفل الفخذ

محمود سمیر عبدالعظیم * ، سماح سعد زهران ** ، نادیه عبدالعظیم فیاز ***

*ممارس العلاج الطبیعی, قسم العلاج الطبیعی, مستشفی الساحل التعلیمی

** مدرس العلاج الطبیعی لاضطرابات الجهاز العضلى الحرکى وجراحته، کلیة العلاج الطبیعی، جامعة القاهرة.

*** أستاذ العلاج الطبیعی لاضطرابات الجهاز العضلى الحرکى وجراحته، کلیة العلاج الطبیعی، جامعة القاهرة.

الخلفیة: یتزاید معدل الشکوی من متلازمة ألم الرضفة وأسفل الفخذ بشکل مستمر لدی الکثیر من الشباب وخاصة الریاضیین منهم والتی تظهر عادة فی صورة ألم مع نقص فی القدرة الوظیفیة .الغرض:کان الهدف من هذه الرسالة هو تحدید تأثیر شریط ماکونیل على الالم فی مرضى متلازمة ألم الرضفة وأسفل الفخذ. الطرق: شارک فی هذه الدراسة ثلاثون  مریضا       ) ذکور واناث ( مصابا بمتلازمة ألم الرضفة وأسفل الفخذ من الفئة العمریة (18-35 سنه). تم تقسیم المرضی الی مجموعتین متساویة عشوائیا. مجموعه (أ) بها خمسة عشر مریضا بمتوسط عمر (24.46 ±2.23  سنة) ومتوسط مؤشر کتلة الجسم (22.72 ± 2,3 کجم/متر²) و قد تلقت هذه المجموعة العلاجبشریط ماکونیل و تمارین التقویة للعضلة الرباعیة الأمامیة لمدة ستة اسابیع متتالیه و المجموعه (ب) بها خمسة عشر مریضا بمتوسط عمر (23.86 ±1.84  سنة) ومتوسط مؤشر کتلة الجسم (22.93  ± 3.23  کجم/متر²) و قد تلقت هذه المجموعة تمارین التقویة للعضلة الرباعیة الأمامیة لمدة ستة اسابیع متتالیه .تم قیاس شدة الألم بإستخدام (مقیاس تقییم الألم الرقمی) تم اجراء الاختبارات قبل الدرسة وبعد ثلاثة أسابیع (قراءة 1(وبعد ستة أسابیع )قراءة 2) لکل المجموعات. النتائج: بمرور الوقت کان هناک انخفاضا ذا دلالة إحصائیة علی مقیاس تقییم الألم الرقمی.بین المجموعات: کشفت المقارنة بین المجموعات انخفاض ذا دلالة إحصائیة للمجموعة (ا) علی مقیاس تقییم الألم الرقمی بعد ثلاثة أسابیع (قراءة 1(وبعد ستة أسابیع )قراءة 2) بالمقارنة بالمجموعة (ب) . الخلاصة:استنادا الی النتائج التی توصلت الیها هذه الدراسة،  تم استنتاج أن شریط ماکونیل له تأثیر فعال على شدة الألم لدی مرضى متلازمة ألم الرضفة وأسفل الفخذ.

  الکلماتالدالة: متلازمة ألم الرضفة وأسفل الفخذ ، شریط ماکونیل.