1) Patellofemoral pain syndrome is a common condition caused by multiple factors affecting the patella, hip, trunk, and foot. 2) Theories for its pathogenesis include maltracking of the patella, weakness or timing issues of the vastus medialis muscle, altered hip and trunk muscle function, and pronated foot mechanics. 3) Treatment approaches aim to address these various local and proximal factors and may include taping, foot orthoses, and physiotherapy exercises. Short-term benefits have been seen from foot orthoses but combined physiotherapy may be most effective.

1. Alfio Albasini
PT, PostGradManipTherap
Adjunct Fellow, Università Svizzera Italiana (USI)
Member of CEC, Otto Bock Healthcare
International Presenter, McConnell & NDS
alfioalbasini@ticino.com
Switzerland

2. Jenny McConnell
 McConnell J,
The management of
chondromalacia patellae: a
long term solution.
Aust J Physiother
1986, 32:215-23.

3. Original Hypothesis
shifting mechanically the patella medially with the
tape (medial glide) would correct the patella position,
stretch the tight lateral structures, increase the activity
of the VMO muscle, decrease pain thus allowing the
patient to start strengthening the 4-ceps with specific
exercises.

4. Assessment of patella malalignment
Herrington LC, Man Ther, 2002;7:163-167

5. Medial Glide of the Patella

6. Effect of taping the patella on
patellofemoral pain sufferers
 reduces pain (Bockrath et al 1991, Conway et al
1992, Cushnagen et al 1994, Cerny 1995, Powers et al
1997, Gilleard et al 1998, Crossley et al 2000, Hinmann
et al 2003 Whittingham et al 2004, ).

7. Efficacy on Knee Tape in the management of
osteoarthritis of the knee: blinded randomised
controlled trial
 Hypothesis: taping decrease P in OA pat also after
treatment ???
 87 patients with symptoms of knee osteoarthritis
 Therapeutic Tape: medial glide, lat. Tilt , AP Tilt and
Hoffa Fat pad
Control Tape and No Tape
 Three weeks duration and follow up after three weeks
of stop of treatment
Rana S Hinman, Kay M Crossley, Jenny McConnell, Kim L Bennell, BJM
2003;327:135

8. Efficacy on Knee Tape in the management of
osteoarthritis of the knee: blinded randomised
controlled trial
Change in P after 3 weeks:
 Therapeutic Tape 73% of improvement
 Control Tape 49 %
 No Tape 10%
 Benefit of therapeutic tape was maintained also after
three weeks follow up
Rana S Hinman, Kay M Crossley, Jenny McConnell, Kim L
Bennell, BJM 2003;327:135

9. Acute effects of patella taping on
patella position
 12 asymptomatic subjects
 6 male, 6 female
 Age 20.4(+/- 1.2) years
 Pre-post ultrasound
measurements
 Intervention: patella
medial tilt tape
Herrington, L. (2009) The effect of patella taping on patella position measured
using ultrasound scanning The Knee (under review)

10. No tape With tape in-situ
Deep lateral retinaculum
Patella Patella
Lateral femoral Lateral femoral
condyle condyle
Note
Distance between patella & lateral femoral condyle (red line) increases with
tape; patella is tilted medially
Orientation of deep lateral retinaculum changes (solid line)
Herrington, L. (2009) The effect of patella taping on patella position measured
using ultrasound scanning The Knee (under review)

11. Results
 Patella taping
 P=0.0032
12
10
8
Patella position (mm)
6
4
2
0
Pre Post
Herrington, L. (2009) The effect of patella taping on patella position measured
using ultrasound scanning The Knee (under review)

12. 1. Patellofemoral pain syndrome:
clinical features
2. Pathomecanical hypotheses:
local-, proximal-, distal factors
3. Predicting success with
multimodal treatment approach
4. Clinical efficacy

13. Patellofemoral pain syndrome:
clinical features
 Etiology of PFPS is
multifactorial in
nature
 One of the most
prevalent conditions
in active people (7-
15%), rates at sports
medicine betw. 2-
30%
 25% have symptoms
16 years later
(Nimon et al 1998)

14. Pathomecanical hypotheses:

15. Pathomecanical hypotheses:
local factors
 Maltracking of the patella

16. Pathomecanical hypotheses:
local factors: VMO
Vastus Medialis Oblique (VMO)
insufficiency, important
stabilizer (Elias et al 2009)
 Timing
 Endurance
 Magnitude
25 ms
VMO
VL

17. Pathomecanical hypotheses
proximal factors 1: hip
 Evidence suggests that patients with PFPS
demonstrate altered hip kinematic in the frontal
and traverse plane during various taks (Souza et al 2009)
 Females with PFPS demonstrate hip abduction &
external rotation weakness (Bolgla et al 2008)
 Some individual with PFPS have delayed gluteus
medius activity during steping tasks (Cowan et al 2009)

18. Pathomecanical hypotheses
proximal factors 1: hip
(Powers et al., J Orthop Sports Phys Ther, 2003;
Doucette & Child; J Orthop Sports Phys Ther, 1996)

19. Altered hip and trunk muscle
function in individuals with PFP

20. Altered hip and trunk muscle
function in individuals with PFP

21. Pathomecanical hypotheses
proximal factors 2 : trunk

22. Pathomecanical hypotheses distal factors:
foot
Pronated Foot on Limb Alignment

23. Interventions: Taping of the Foot

24. Interventions: Foot orthoses
Vicenzino, Collins, Crossley et al (2008), BMC Musculoskelet Disord, 9:27

25. Taping the foot or using orthoses,
effectiveness ?
 Bill Vicenzino’s work
 179 participants (100 women) 18-40 y.o.
with PFPS > 6/52 without Tretament preceeding the
test 12/12
 6/52 PT, flat inserts, foot orthoses, combination of foot
orth. & PT
 Foot orthoses improvement in short term; no
difference if added to PT
Foot orthoses and physiotherapy in the treatment of patellofemoral pain
Syndrome: randomised clinical trial, Colling et al BMJ 2008; 337: a1735

26. Take home message
 PFPS does not have a homogenous presentations
 PFPS is only one part of the problem
 Not every patient with PFPS has the same
“abnormalities”
 Standard treatment for PFPS does not exist
 Clinician should incorporate the information
gained from their clinical assessment of each
patient &
 Use clinical reasoning to ensure that the
treatment is patient specific

27. What about the shoulder ?
 The effect of tape on glenohumeral rotation
range of motion in elite junior tennis players
 11 male (mean age 16.8±1.3 years) and 10 female (mean age 14.9±0.8 years)
elite junior tennis players
 Two measurements of passive external rotation and internal rotation
ROM were made using a universal goniometer with an attached spirit-
level under three randomly ordered conditions
 Control
 Tape
 Sham Tape

28. THANK YOU
alfioalbasini@ticino.com