Taping for knee osteoarthritis

Volume 42, No.10, October 2013 Pages 725-726

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Handbook of Non Drug Intervention (HANDI) Project Team
This article is part of a series on non drug treatments summarising indications, considerations,
evidence and where clinicians and patients can get further information.

Taping can be used to reduce pain in knee osteoarthritis. There are different methods of taping, but
the common effect is to exert a medially directed force on the patella to increase the patellofemoral
contact area, thereby decreasing joint stress and reducing pain. Taping can be performed by a
physiotherapist, but self taping can be taught, which enhances self management. Taping for knee
osteoarthritis has National Health and Medical Research Council (NHMRC) Level I evidence of
efficacy for pain relief and is associated with negligible adverse effects that generally include minor
skin irritation.

The condition
Knee osteoarthritis is the most common cause of knee pain in people over 50 years of age.
Malalignment of the patella, with abnormal distribution of force on the lateral facet, is thought to
contribute to pain in knee osteoarthritis.

The intervention
The application of strong adhesive tape or strapping, aiming to realign the patella and unload painful
soft tissue.

Taping is a very effective pain-relieving strategy and can assist participation in other strongly
recommended therapies, such as cardiovascular and resistance land-based and aquatic exercises,
for knee osteoarthritis.

Preparing to tape
Tape is applied before painful activities, such as exercise; however the tape can be left in place for
days to weeks depending on adhesion durability. Before applying tape it may be necessary to shave
the skin and this should be done 12 hours before applying tape. Ensure the skin is thoroughly cleaned
and dried before applying tape.

Ask the patient to perform a symptom-provoking activity such as a step down before applying the tape
so that the level of pain can be re-assessed following tape application. Better results will be obtained
if immediate reductions in pain can be obtained with tape.
Apply the tape with the patient either lying or sitting on the edge of a chair with the leg extended and
the thigh muscles relaxed.
Several different taping methods can be used. The choice depends on which combination is most
effective at reducing the patients pain. Prior to placing each piece of rigid tape, place several strips of
hypoallergenic tape across the knee region to cover the patella and the medial and lateral knee
regions.

A 23-step method
The taping method, described below, consists of steps 1 and 2 with or without step 3.
1. Medial tilt and medial glide
Start the tape in the middle of the patella, at the level of the superior aspect of the patella, lift the skin
on the medial side of the knee towards the patella and pull the tape medially. Fix the tape to the
medial aspect of the knee just short of the hamstring tendons ensuring there is some slight wrinkling
of the skin (Figure 1). This tilts the lateral patellar border away from the femur.

Figure 1. Medial tilt and medial glide

2. Anteroposterior tilt and medial glide

Start the rigid tape on the lateral aspect of the knee at the level of the superior aspect of the patella.
Gently lift the skin on the medial side of the knee towards the patella as you pull the tape medially. Fix
the tape to the medial aspect of the knee just short of the hamstring tendons ensuring there is some
slight wrinkling of the skin (Figure 2).
Figure 2. Anteroposterior tilt and medial glide

3. Unloading the infrapatellar fat pad and reducing stretch of inflamed soft tissues
Commence the tape at the tibial tubercle and lift the soft tissue towards the patella, while firmly pulling
the tape to the medial joint line. Repeat with a second piece of tape but firmly pull the tape toward the
lateral joint line (Figure 3).

Figure 3. Unloading of the infrapatellar fat pad

What should I consider?

A physiotherapist experienced in assessment and taping techniques should show the patient how to
apply the tape as precise placement is needed for maximum benefit.

Taping is not recommended as a sole intervention, and exercise programs and weight loss (for
overweight patients) are strongly recommended in conjunction with any other therapy.

Skin care is important. Use hypoallergenic tape to protect the skin from direct contact with rigid
strapping tape. The majority of skin damage is done during tape removal, so remove and re-apply
tape less frequently in older patients. Ensure that the tape is removed slowly and carefully. Hand
cream can be applied to the skin after tape removal. If skin irritation occurs, a skin preparation (spray,
roll-on, plastic film or even calamine lotion, which must dry first) can be applied prior to tape
application.
Availability
Physiotherapist costs and accessibility vary, but many patients would have out of pocket costs.

Physiotherapists typically use an adhesive, non-stretch (rigid) 38 mm sports tape to restrict undesired
motion and improve patella positioning. This is used in combination with a hypoallergenic underlay
tape. Both tapes are available over the counter from pharmacies.

Pre-cut tape is available in packages that contain 1020 applications of pre-cut strong elastic tape
that can be used in the pool or shower. This tape is not rigid so initially may not be as effective in
reducing pain. Depending on use, a package might last 4060 days.

Adverse effects
Taping is associated with negligible adverse effects which generally include minor skin irritation.

Evidence
National Health and Medical Research Council (NHMRC) Level I evidence (systematic review of
randomised controlled trials) for pain relief.

Anything else?
Patients can be taught to self-tape, enhancing their ability to self manage.

Patients with concurrent hand osteoarthritis may find taping difficult. Pre-cut tape could offer some
advantages.

Even tape that does not exert appreciable force on the patella can provide some pain relief. This may
be due to a sensory or placebo effect.

Taping has been shown to have immediate and short-term pain reducing effects while the tape is
being worn and also provides benefits for some weeks after tape removal.

Key references
Crossley KM, Marino GP, Macilquham MD, Schache AG, Hinman RS. Can patellar tape reduce the
patellar malalignment and pain associated with patellofemoral osteoarthritis? Arthritis Rheum
2009;61:171925.
Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations
for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip and knee.
Arthritis Care Res 2012;64:46574.
Page CJ, Hinman RS, Bennell KL. Physiotherapy management of knee osteoarthritis. Int J Rheum Dis
2011;14:14551.
Warden SJ, Hinman RS, Watson MA Jr, Avin KG, Bialocerkowski AE, Crossley KM. Patellar taping and
bracing for the treatment of chronic knee pain: a systematic review and meta-analysis. Arthritis Rheum
2008;59:7883.

Acknowledgements
Handbook of Non Drug Intervention (HANDI) Project Team members include Professor Paul
Glasziou, Dr John Bennett, Dr Peter Greenberg, Professor Sally Green, Professor Jane Gunn,
Associate Professor Tammy Hoffmann and Associate Professor Marie Pirotta. The HANDI Team is
grateful to Professor Kim Bennell for her contribution to the development of this intervention.

Competing interests: None.

HANDI is supported by a grant from the Jack Brockhoff Foundation.
Provenance and peer review: Commissioned; not peer reviewed.

Correspondence afp@racgp.org.au

Downloads
https://www.racgp.org.au/afp/2013/october/taping-for-knee-osteoarthritis/

McConnell Taping Technique

One of the most common treatment techniques for the treatment of patellofemoral (knee joint) pain is patellar
taping, also referred to as McConnell taping. McConnell taping was first introduced in 1984 by Jenny
McConnell, a physical therapist in Australia. The McConnell taping technique can help keep the kneecap in
alignment. This can help reestablish normal movement, decrease pain and allow the muscles that hold the knee
cap in place to redevelop properly.
A knee cap can track ineffectively for a number of reasons: weakness, muscle imbalance, structural deviation
etc. When the knee cap does not track in the trochlear grove, pain can occur. There are several taping techniques
that address different tracking problems. The original intent of performing patellar taping was to alter the tilt and
position of the patella (knee cap), most commonly by shifting a laterally displaced patella more medially to
correct patellofemoral tracking problems.
McConnell would correct this by first applying a protective tape called cover roll stretch and then applying a
piece of thick medical tape (usually called leukotape) placed adjacent to the knee, then pulling the knee cap into
position. While wearing the tape, most patients feel immediate pain relief and they are encouraged to exercise
with the tape in place to provide the muscles with the appropriate feedback to correct the problem. McConnell
taping can be used in the physical therapy setting or taught to the patients so they may use it at home as needed
for exercise and pain relief.

http://www.vasportsmedicine.com/mcconnell-taping-technique.asp
 Patella Taping
by PhysioAdvisor Staff

Health > Taping Techniques > Patella Taping

The following patella taping technique is designed to support the patella, correct
abnormal patella alignment (lateral tracking) and reduce stress on the knee during
activity. It can be used for both the treatment and prevention of knee injuries,
particularly those associated with abnormal patella tracking such as patellofemoral
pain syndrome (runners knee), patella instability and patella dislocation. It may also
assist with improving the activation of the VMO muscle (inner quadriceps Figure 1),
which can aid rehabilitation of many knee injuries.

You should discuss the suitability of this taping technique with your physiotherapist
prior to using it. Generally, it should only be applied provided it is comfortable and
does not cause an increase in pain, discolouration, pins and needles, numbness,
swelling, itchiness or excessive redness of the knee, foot or ankle.

What sort of tape should be used to tape my

patella?
There are many different tapes and bandages available for use by physiotherapists
and patients. However, when the purpose is to restrict undesired motion and to
support and improve positioning of the patella, only adhesive, non-stretch (rigid)
sports tape is appropriate. (For patella taping 38mm is usually the most appropriate
size). This should always be used in combination with hypoallergenic tape as an
underlay, such as Fixomull.

Benefits of Patella Taping

When used correctly, patella taping techniques can:

Decrease pain during sport or activity

Aid healing of certain knee injuries
Correct patella alignment
 Allow an earlier return to sport or activity following injury
Reduce the likelihood of injury aggravation
Prevent knee injuries (such as a dislocated patella) during high risk sports (such as netball,
basketball, football, soccer etc.)
Improve activation of the VMO muscle (Inner Quadriceps figure 1)

Figure 1 The Quadriceps and VMO

Indications for Patella Taping

It is generally beneficial to tape the patella in the following instances:

With certain knee injuries such as patellofemoral pain syndrome where abnormal
patella tracking is contributing to the injury (this should be discussed with the treating
physiotherapist as certain knee injuries should not be taped such as some fractures).
To prevent injury or injury aggravation Patella taping may be beneficial during sports
or activities that place the knee (patellofemoral joint) at risk of injury or injury aggravation
(such as netball, basketball, football, soccer etc.)

When should I avoid Patella Taping?

Patella taping should be avoided in the following instances:
 If you have certain injuries such as some fractures (this should be discussed with the
treating physiotherapist)
If you have a skin allergy to sports tape
If the taping technique results in an increase in symptoms such as pain, ache, itchiness,
discolouration, pins and needles, numbness, swelling, or excessive redness of the knee,
foot or ankle.
If you have sensory or circulatory problems

Weaning off patella tape in general activity is usually recommended as strength,

range of movement, patella positioning, biomechanics and balance improve and
symptoms reduce. In these instances though, taping during high-risk activity (such
as sport) is usually still recommended.

Patella Taping Technique

The following patella taping technique may be used to provide support for the patella
and knee and to reduce abnormal patella positioning or tracking (lateral patella
tracking). Generally it is recommended that the knee is shaved 12 hours prior to
taping (to prevent painful removal of hairs and skin irritation). The skin should be
cleaned and dried, removing any grease or sweat. Low irritant Fixomull tape should
be applied as an under-wrap to reduce the likelihood of skin irritation with rigid sports
tape over the top of this.

McConnell Medial PatellaTaping

Begin lying on your back, with the knee slightly bent, but completely relaxed and a
foam roller or rolled up towel under the knee. Start the tape in line with the middle of
the knee cap at the outer aspect of the knee. Using your thumb on top of the sports
tape, gently push the knee cap towards the inner aspect of the knee (figure 2) whilst
simultaneously using your fingers to pull the skin at the inner aspect of the knee
towards the knee cap. Finish this taping technique at the inner aspect of the knee
ensuring you have created some wrinkling of the skin at the inner aspect of the knee
(figure 3). Repeat this process 1 3 times depending on the amount of support
required.
 Figure 2 Patella Taping

Figure 3 Patella Taping (Completed)

Removing the tape

Care should be taken when removing the tape to avoid injury aggravation or skin
damage. The tape should be removed slowly, pulling the tape back on itself with
pressure placed on the skin as close as possible to the line of attachment of the
tape.Generally tape should be removed within 48 hours of application or sooner if
there is any increase in pain or symptoms (including skin irritation or itchiness).

https://www.physioadvisor.com.au/health/taping-techniques-lower-body/patella/