What is Patellofemoral pain?

Patellofemoral pain is pain at, around or behind the patella in the absence of other concomitant pathologies such as intra-articular tibiofemoral pathology, patellar tendinopathy or the adolescent equivalent, Osgood schlatter, isolated fat pad pain or pre-patellar bursitis. Although the true nociceptive source within patellofemoral pain remains open for debate, the theory with the greatest amount of research behind it, is overload of the highly innervated subcondal bone, and there are a number of additional soft tissue theories that are continuing to be explored. As a result, we would expect to see a vague pattern of symptoms.

If you want to learn more about this topic, you can watch Simon Lack & Brad Neal's lecture here:

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How effective is taping and bracing as adjuncts for Patellofemoral pain?

Taping

Taping is probably the most common adjunct in clinical practice at present. If we lean on one of the most recent systematic reviews on the topic, it’s quite clear that taping techniques, regardless of their design, have a very positive effect on symptoms in the short term during a variety of different tasks.

So when should we use taping?

A recent systematic review stated that taping is a useful thing to do for people with pain in the short term. If we use pain scales to help us make this decision, when someone presents with above average symptoms, for example 5 out of 10, this is when we should be looking to lean on taping techniques. If someone presents with low severity and low irritability symptoms, there are probably more effective things that we could be doing. It is like the analogy 'taking paracetamol for a headache’. We make that decision ourselves. If we think we need it, we go to it. If we think we can carry on without, we generally do so.

What types of taping should we use?

We have the more traditional, rigid taping techniques, sometimes referred to as McConnell taping which have moderate evidence of a large effect which has a short duration. These techniques don't stay on for a particularly prolonged period of time. We then have more flexible taping techniques, Kinesio tape, irrespective of the brand that you choose to use, these have limited evidence to back them up. It has generally a smaller effect, but most often a prolonged duration. So our clinical reasoning can help us decide if we need to look for a larger effect on symptoms that may last for a short period of time or a smaller effect that we may be able to adhere to, for a more prolonged period of time

Bracing

If we look at a very simple neoprene sleeve with a patella doughnut, which, when pulled onto the knee and sized well, provides good quality afferent input around the knee, such braces may not necessarily have a large influence on pain, but from this recent short term randomized control trial, what we do see with these types of braces is a significant influence on how people score on kinesophobia scales.So if we have someone who is perhaps not necessarily in significant pain but fearful of movement, this is when we could look to implement bracing interventions.

Thus, whatever taping technique we choose to use, or whether we look to lean on bracing, we should be doing so to help take someone who is in pain or fearful of movement, to being able to exercise, ideally without pain or with less pain or with reduced fear of movement. That’s where these interventions come in, and that’s why their short term effect is absolutely what we would be looking for.

If you want to learn more about this topic, you can watch Simon Lack & Brad Neal's lecture here:

Click here

Sources:

1. 'Patellofemoral pain course' by Brad Neal and Simon Lack