Comparison of Effectiveness of Mechanical Hold Versus Kinesio Taping in Managing Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a common problem of runners leading to pain and functional limitation in athletes. Patellar taping is an increasingly popular method of treatment for PFPS but comparative effectiveness especially McConnell's taping (MT) and Kinesio taping (KT) techniques is unknown. Objective: To compare the effects of McConnell's taping (MT) and Kinesio taping (KT) in the management of PFPS. Methods: A quasi-experimental study was conducted by recruiting 60 patients of PFPS using the convenience sampling technique. Participants were randomly divided into two groups MT and KT group and received patellar taping on daily basis for MT and on alternate days for KT group. The assessment was done using numeric rating pains scale and range of motion before treatment, immediately after 1st session, after 1 week and after 2 weeks of rehabilitation. After 2 weeks data was entered on SPSS v.21 and Analysis was done. Results: Mean Age in Kinesio taping (KT) was 28.40±4.74 and in McConnell's taping (MT) group was 28.17.70± 4.684. Within the group analysis showed that both techniques were effective in reducing pain intensity, improving range of motion and improving anterior knee pain scale scores ( p- value < 0.05). However, independent sample t-test analysis determined that there was not any particular difference between the results of both aping techniques and p-value > 0.05 that proves our null that there is no difference between the effects of KT and MT in treating PFPS. Conclusions: KT and MT both are equally effective techniques for the management of PFPS and are important in decreasing pain and disability. However further studies are required with control groups to measure additional effects of exercise therapy.


I N T R O D U C T I O N
Syed S et al.

Comparison of Effectiveness of Mechanical Hold Versus Kinesio Taping in Managing Patellofemoral Pain Syndrome
Patellofemoral pain syndrome (PFPS) is a common problem of runners leading to pain and functional limitation in athletes. Patellar taping is an increasingly popular method of treatment for PFPS but comparative effectiveness especially McConnell's taping (MT) and Kinesio taping (KT) techniques is unknown. Objective: To compare the effects of McConnell's taping (MT) and Kinesio taping (KT) in the management of PFPS. Methods: A quasi-experimental study was conducted by recruiting 60 patients of PFPS using the convenience sampling technique. Participants were randomly divided into two groups MT and KT group and received patellar taping on daily basis for MT and on alternate days for KT group. The assessment was done using numeric rating pains scale and range of motion before treatment, immediately after 1st session, after 1 week and after 2 weeks of rehabilitation. After 2 weeks data was entered on SPSS v.21 and Analysis was done. Results: Mean Age in Kinesio taping (KT) was 28.40±4.74 and in McConnell's taping (MT) group was 28.17.70± 4.684. Within the group analysis showed that both techniques were effective in reducing pain intensity, improving range of motion and improving anterior knee pain scale scores (p-value < 0.05). However, independent sample t-test analysis determined that there was not any particular difference between the results of both aping techniques and pvalue > 0.05 that proves our null that there is no difference between the effects of KT and MT in treating PFPS. Conclusions: KT and MT both are equally effective techniques for the management of PFPS and are important in decreasing pain and disability. However further studies are required with control groups to measure additional effects of exercise therapy.

A B S T R A C T
joint (patellofemoral joint) and also because of poor biomechanics of player especially [4]. Retro-patellar pain and diffuse peri-patellar pain are the highly reported issues when sitting for long period with knee exed, running and climbing stairs up and down. Crepitation is also a frequent symptom [5]. In case of weakness of Vastus medialis oblique (VMO) or tightness of illiotibial band along with VMO when correlating anatomical position of patella it induces the stress on patellofemoral joint and is also cause of lateral force vector [6]. Patella can be tracked laterally when there is a gap between the activity of VMO and Vastus Lateralis (VL) in straightening or extending knee [7]. Active females and athletes suffer more with this condition. In a given population, with several authors reporting its occurrence in one-fourth of the general or sporting [8].
There can be a restriction in performing some functions due to the PFPS [9]. Many treatments have failed to treat this [10]. In patients with PFPS, Body Mass Index has the high values and this shows the higher prevalence of Obesity [11]. Many orthodox techniques are known to treat the PFPS like stretching, strengthening, electrotherapy, therapeutic exercises Tapping etc [4]. Main goal of treatment is to align the patella in trochlear groove to reduce the severity of pain. The treatment comprises the stretching of tighten muscles (IT band, tensor fascia latae) and strengthening exercises for weakened muscles to enhance the stability of patella to medial side while patella wearing [12]. Earlier researches explain the facilitating results of orthodox treatments but more deep inspection of orthodox treatment is needed [13,14]. Arthroscopy that is useful for treating the mal-alignment of patella. Postoperative healing time can affect the sportsman choice to rejoin the sport and team. However, there is no particular effect of surgery and conservative treatment about recovery to sports [4]. In MT taping technique a rigid, highly acceptable in preventing the injury during race. It is noticed to have a slight effect on hip and knee kinematics in asymptomatic female and has lowest effect on the adjacent lead mechanisms of PFPS [15]. MT has the noticeable results on proprioception of knee joint. There is increase in the stimulation of sensory signals that are going to brain for processing through mechanoreceptors when we apply taping [16].The basic purpose of current study was to evaluate the comparative effectiveness of mechanical hold through McConnell taping and kinesiotaping among PFPS.

M E T H O D S
A single blinded quasi experimental study was conducted. Total 60 patients were selected according to inclusion and exclusion criteria. The sample size was calculated using mean post treatment pain scores 4±1.0 for MT group and 5±2.0 for KT group keeping α=0.95 using G.power v3.1.9.2. This gave us the sample size of 55 participants. Each group consisted of 30 patients of PFPS selected randomly using coin toss method. Participants were included who were female, had Retro-patellar pain for more than 6 months, had patellar tenderness on physical examination and presented with unbearable pain above 30 mm on a 100 mm Numeric Rating Pain Scale (NRPS) in last week. The exclusion criteria was patients with past knee surgical history, uctuation in patellofemoral joint and patients who were mentally and physically challenged. Common treatment given to both groups, twice daily which included 10 minutes icing plus on alternate days 3X 30 seconds stretching of knee exors and extensors along with 3X 15 repetitions of straight leg raising, pelvic bridging, inner and out hip raises. Treatment was given for two weeks.

R E S U L T S
Patients were assessed before treatment, after 1st session, after one week and at the end of 2 weeks. The nal assessment which was done at the end of 2nd week was done after removing tape. Medial glide to patella was given with 75-100% stretched Kinesio tape. Patients in Group II received Mechanical hold by using taping technique described by McConnell. Patient was positioned in supine position and knee exed about 20 degree. Pain was assessed using Numeric Pain Rating Scale and Range assessment was done using Goniometer. After collection data was entered in SPSS version 21. For continuous variables means were drawn. For categorical variables frequency tables and bar charts were drawn.
A total number of 60 patients were selected in the study i.e. 30 patients in each group. Mean Age in Kinesio taping group was 28.40±4.74 and in MT group was 28.17.70± 4.684 (Table  1).For within the group analysis, repeated measure ANOVA and for between the groups analysis independent sample ttest was used. Within the group analysis showed that both techniques were effective in reducing pain intensity, improving range of motion and improving anterior knee pain scale scores (p-value < 0.05). However, independent sample t-test analysis determined that there was not any particular difference between the results of both taping techniques and p-value > 0.05 that proves our null hypothesis which tells that there is no difference between the effects of KT and MT in treating PFPS.      McConnell taping leads to immediate and clinically better results in PFPS as found in our study it may be due to the reason that mechanical hold immediately stabilizes the patella and corrects its tracking with medial glide. A study concluded that patellar taping results in improved velocity and functional status same was seen in our study as the anterior knee pain scale score signi cantly improved [20]. However, in this, we used exercise as a common treatment in both groups but we did not speci cally observe the effects of exercise and used MT and KT as additional treatment [21]. The reason for this high adherence was maybe that cost of treatment was low and treatment session time was convenient for patients [23]. The same was the result in this study as more than 50% of participants presented to us with PFPS were regularly doing jogging. Research stated that KT is not helpful to enhance the functioning and neuromuscular activities of the lower extremity of a healthy patient [22]. A study stated that in a population who has no pain, KT is helpful and had no relation with ground reaction force (GRF) while doing the activity of climbing stairs [24]. This study also exposed that taping has a statistically considerable in uence on peak knee exion angles this effect was more signi cant in the mechanical hold as compared to Kinesio taping. These results were also supported by the results of a study [4].

D I S C U S S I O N
effective in treating PFPS. Both taping techniques improved range of motion, decreased pain and increased anterior knee pain scale scores. When comparing the effects both techniques were equally effective and between groups no considerable con ict was found except about exion in which mechanical hold was more effective and increased exion more as compared to KT tape.