PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2013

Clinical Scenario

The patient who led me to pursue this question is a 24-year-old female with a diagnosis of PFPS. Medical treatment to date includes self-referral to physical therapy where she received lower extremity strengthening and stretching exercises as well as patellar taping. Problems identified include patellar malalignment, lower extremity weakness (especially of the quadriceps and hip external rotators), and loss of lower extremity flexibility.

Clinical Question

Does patellar taping and exercise reduce knee pain in adults with patellofemoral knee pain more than exercise alone?

Clinical Bottom Line

Based on the results of the two studies by Clark et al. and Whittingham et al., there is inconclusive evidence to suggest that for individuals with PFPS, patellar taping combined with exercise results in an additional decrease in anterior knee pain compared to exercise alone. According to the study by Whittingham et al., application of individualized patellar taping before daily exercise for four weeks may decrease anterior knee pain in the short-term in young adults with acute PFPS. However, the study by Clark et al. showed that in those with PFPS lasting more than three months, standardized patellar taping and exercise six times over three months may not be beneficial in decreasing anterior knee pain one year later. There are at least four main differences between the studies that could account for the different results. First, Clark et al. used a standardized tape application for patella glide only, whereas Whittingham et al. used an individualized approach in which tape was applied to correct specific patella malalignments (glide, tilt, or rotation) identified by the sole treating therapist. The taping protocol performed by Whittingham et al. is more closely aligned with what would be observed clinically and presents a more valid way to test the efficacy of patellar taping. Second, the studies used different exercise protocols. Clark et al. utilized an active warm-up and closed kinetic chain exercises (CKC) and Whittingham et al. began with open kinetic chain (OKC) isometric exercises and progressed subjects to CKC exercises. Third, the acuteness and chronicity of the subjects’ PFPS likely played a role in treatment response. It is possible that the subjects with acute PFPS in Whittingham et al. responded more favorably to all of the interventions than the subjects with chronic PFPS recruited by Clark et al. Last, differences between studies in terms of frequency and duration of treatment and type and timing of outcome measures also make it difficult to draw definitive conclusions from the results. External validity of the study by Whittingham et al. was limited by their protocol involving 28 consecutive visits over four weeks with 100% compliance that is likely not feasible for the clinical population. The small sample size and the narrow populations from which subjects were recruited further decrease the ability to apply these study results to a larger population. More research on this topic should include larger populations, individuals with similar chronicity of PFPS, individualized patellar taping as opposed to standardized taping, short-term versus long-term benefits, influence of different exercise protocols (OKC vs. CKC, isometric vs. dynamic, variations in initial exercises and exercise progression), and look at the differences in effectiveness between therapist-applied tape and patient-applied tape. In addition, studies could examine patient tolerance to exercise with and without individualized patellar taping due to potential immediate decreases in pain; this may allow for more active treatment sessions and more rapid strength gains.

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