TapingTechniquesforthePatellofemoralJoint

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JillMonson,PT,OCSMonsonOrthopaedicConsul=ng,LLC

PFJBracing

•  PowersCM,WardSR,ChanLD,etal.Theeffectofbracingonpatellaalignmentandpatellofemoraljointcontactarea.MedSciSportsExerc.2004;36:1226-1232.

–  Painreliefthoughttobetheresultofincreasedpatellofemoralcontactarea

–  Perhapsd/tcompressionofthepatellaintothetrochleainducedbythebrace

2©MonsonOrthopaedicConsulOng,LLC2016

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PatellofemoralTaping

Study Interven=on Task Outcome

CrossleyJOrthopRes

2004

PTinterven=onw/orw/oPFtaping(PFpain)

Gait ImprovedKFwithgaitintapinggroup

BockrathMedSciSportExerc

1993PFTaping 8”Step-down 50%reduc=oninpainin

tapinggroup

WhiZnghamJOSPT2004

PTinterven=onw/orw/oPFtaping(PFpain)

8”Step-downSquaZngAggrava=ngAc=vi=es

Decreasedpainw/aggrava=ngtasksand

throughoutday,improvedreportedfunc=onintaping

group

ErnstJOSPT1999

Lateraltomedialtapingcomparedtosham Gait

Improvedkneeextensormomentandpowerintaping

group

PatellofemoralTaping•  AminakaN,GribblePA(2005)AsystemaOcreviewoftheeffectsoftherapeuOctapingonpatellofemoralpainsyndrome.JAthlTrain40(4):341-351.•  Conflic=ngevidence

•  LesherJDetal(2006)DevelopmentofaclinicalpredicOonruleforclassifyingpaOentswithPFPsyndromewhorespondtopatellartaping.JOSPT36(11):854-866– (+)patellar=lt,>5°=bialvarusangula=on

– 83%likelihoodof50%reduc=oninpainw/steptest,squaZng

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TapingBasics• Applytapetoclean,dryskin(nolo3on)• 1stapplycoverroll(whitetape)– Protec=vebarrierfortheskin

• 2ndapplyleukotape(browntape)– Thistapecreatesthe“ac=on”bypullingthejoint/muscle

• TaketapeOFFif:– Skinorjointbecomesirritated

– Painincreases– Tapeisfallingoff

• Leavetapeonx3-4hours(canbe1-2daysifhelpful&tolerated-cau3ousandobservantwiththis!!)

– Wrapinsaranwrapwhilebathingtoextendlife5©MonsonOrthopaedicConsulOng,LLC2016

In-ClinicTrial•  Reproducesymptomswithameasured,pain-genera=ngac=vity

•  8”step-downheeltapx3

•  Specifypain:

»  Loca=on

»  Intensity(NPS)

»  Timingofonset

•  Applytapetechnique

•  Re-testprovoca=veac=vityandre-assesssymptomresponse

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MedialGlide•  Improvetracking,reducelateraloverload,reducelateralsubluxa7on

–  Applytapelateraltomedialacrossproximal2/3rdofpatella

•  Anchorapprox.3-4cmbelowlateralborder

–  Translatethepatellamedialintothecentralaspectofthegroove,keepingthetapetaut

–  Gatherposteromedialsoh=ssueandanchortapew/opullingmore

7©MonsonOrthopaedicConsulOng,LLC2016

MedialTilt

•  Reducelateraloverload– Anchortapeatlateralaspectofpatella(atproximal2/3)

– Usethumb&pullofthetapeto=ltthepatellamedially

– Gatherposteromedialsoh=ssueandanchortape,withoutpullingmore

8©MonsonOrthopaedicConsulOng,LLC2016

PatellarUnloadingTechnique•  UnloadgeneralPFjointcompression(Adddirec7onalelementsasappropriate)

–  2stripsoftape:1anchoredatmedialknee,1atlateralknee(alignedattheproximal2/3ofpatella)

–  Gatherthetapeoverthepatellaandcreateanupwardpull

–  Cinchthetapetogetherallthewaydowntothepatellawhilemaintainingupwardpull

–  Anchortapetomedialsidew/orw/otransla=onalpull(persx’s)

9©MonsonOrthopaedicConsulOng,LLC2016

“Reverse”(lateralglide)Technique

•  Torelievepainfromincreasedmedialcontactforces

–  “Over-release”w/historyofbroadlateralre=nacularrelease

–  “Medialfacetoverload”duesuspicionof:•  Over-constrainedMPFLgrah•  Over-medializedw/osteotomyprocedure

– THISWILLNOTBEAHIGHFREQUENCYTECHNIQUE!!

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LateralGlide:“ReverseTaping”

–  Anchorjustdownfromthemedialborderofpatella&laytapeacrosstheproximal2/3orpatella

–  Gentlytranslatethepatellainalateraldirec=ontocenteritinthegroovewithfingers,keepingtapetaut

–  Anchortapearoundposterolateralaspectofkneewithoutpullingmore

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InfrapatellarFatPadUnloading

•  “V”Technique:

•  (2stripsoftape):kneeslightlyflexed

•  Anchorthetapeat=bialtubercle(outlined)&pullitdiagonallyup&aroundthebackoftheknee(tapelineshouldbeinferiortothemarginofthefatpad)

•  Pulltheiinfrapatellarskin&fatpadupward&inwardtowardthepatellaasyoufirmlypullthetapetowardtheanchorsitesaroundthebacksideoftheknee(apply1stripata=me)–anchorabovethepoplitealcrease

12©MonsonOrthopaedicConsulOng,LLC2016

BusinessDetails

•  BillingforTapingTechniques• Whatwasyourpurposefortaping?

»  Stabiliza=on»  Neuromuscularre-educa=on»  Paincontrol

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TapingLab

•  Medialglide•  Medial3lt

•  “Reverse”lateralglide•  Patellarunloading

•  Infrapatellar“V”fatpadunloading

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