The biomechanics of step descent comparing an elasticated tubular bandage with neutral patellar taping in patellofemoral pain patients

Abstract

Purpose: This study investigated the effect of an elasticated tubular bandage and neutral patella taping on the threedimensional mechanics of the knee during slow step descent in a group of subjects suffering from Patellofemoral Pain Syndrome (PFPS). Relevance: A number of studies have demonstrated that subjects with patellofemoral pain syndrome have poor eccentric control at the knee. Most previous studies have focused on the use of taping, braces or neoprene knee sleeves; this is the first study to investigate the effect of the low cost alternative of an elasticated tubular bandage on eccentric control during step descent in a PFPS population. Participants: Ten subjects (4 men:6 women) with a diagnosis of patellofemoral pain syndrome referred to a Primary Care Musculoskeletal physiotherapy service (NHS Central Lancashire) for treatment were recruited (Mean: age = 28; Modified Functional Index Questionnaire score = 26; Visual Analogue Scale for Usual Pain in the past week = 29 mm). Inclusion criteria were; presence of traumatic or idiopathic peripatellar pain and pain provoked by deep squatting, kneeling, ascending or descending stairs; alone or in combination. Exclusion criteria; any history of knee surgery. Methods: Slow step descent was used to assess the control of the knee under three randomised conditions: (a) no intervention, (b) elasticated tubular bandage, and (c) neutral patella taping. Kinematic and kinetic data were collected using a ten camera Oqus (Qualisys) motion analysis system and two AMTI force platforms. The segments of the lower limbs were modelled in six-degrees of freedom and joint kinematics and moments were calculated at the knee. Post testing, subjects were asked to rank the test conditions in order of preference. Analysis: A repeated measures (RM) ANOVA was performed together with post hoc pairwise comparison for the coronal and transverse plane knee angles and moments about the knee, comparing the three randomised conditions. A further RMANOVA was conducted to investigate differences in the sagittal plane knee angular velocity in order to confirm that observed differences were not artefacts of descent velocity. Significance was set to P≤0.05. Results: The coronal plane knee range of motion was significantly reduced with taping (P = 0.032) and the tubular bandage (P = 0.006). No significant differences were seen in any other plane or for knee angular velocity or moments. Subjects ranking preference of the test conditionswas evenly split between the two interventions: neutral patella taping (N=5) and elasticated tubular bandage (N= 4); only one subject stated they would prefer to have nothing on their knee. Conclusions: The use of an elasticated tubular bandage and a neutral patella taping technique actually produced a measurable change in the control mechanism of the knee and resulted in subjects with PFPS demonstrating greater knee control and less pain during a step descent when compared to no intervention. The tubular bandage had the greatest mechanical effect, reducing movement in the coronal plane by 30% when compared to no intervention. Implications: An elasticated tubular bandage and neutral patellar taping may represent low cost, convenient interventions in the management of mild Patellofemoral Pain Syndrome.