Why McConnell Patellar Taping Works

patellar tapingOne of the most common, yet least understood, treatment technique for patellofemoral pain may be patellar taping, or also referred to as McConnell taping.  First introduced in 1984 by  Jenny McConnell, a physical therapist in Australia, patellar taping has become increasingly popular.  The original intent of performing patellar taping was to alter the tilt and position of the patella, most commonly by shifting a laterally displaced patella more medially to correct patellofemoral “tracking” problems.

To date, numerous research has been conducted on the efficacy of patellofemoral taping with conflicting results.  For every study that shows altered patella kinematics, enhanced EMG and muscle function, improved dynamic alignment, and decreased patellofemoral joint reaction forces, there seems to be another study that shows just the opposite.  One thing is certain, though, most studies do tend to agree that patellar taping decreases pain in patellofemoral pain syndrome patients (PFPS).  The question is, why?

Patellar Taping – A Possible Reason as to Why it Works?

A study was published earlier this year that I think explains the mechanism by which patellar taping may work.  Actually, the authors of the study didn’t mention this mechanism at all in the paper and it really wasn’t what they studied, but after I read the article, I had one of those “Ah-Ha” moments!  I’ll explain later, but first let’s discuss the article.

McConnell Taping and Dynamic MRI

A recent study by Derasari et al in the Journal of Physical Therapy sought to examine patellar kinematics in patellofemoral pain patients after McConnell taping using dynamic MRI.  This is the first study to assess patellofemoral kinematics in 6-degrees-of-freedom during active knee extension.

14 subjects that had PFPS for greater 1 year were included in the study and underwent dynamic MRI during active knee extension with and without patellar taping.   Standard McConnell taping was apply in the lateral-to-medial direction in an attempt to glide the patella medially, such as in this photo:

McConnell Taping

Results of the study showed that patellar taping produced a significant shift of the patella in the inferior direction, not medial.  In fact, the study demonstrated that not all patients with PFPS had a laterally displaced patella to begin with, some were medially displaced.  However (and this is when the light bulb went off for me), those with a medially displaced patella actually saw a lateral shift in patella position after taping, even though the tape was applied in the standard lateral-to-medial direction.  The patella shifted against the tape direction!  This is also probably why there is so much conflicting research in the literature.

Why Patellar Taping Really Works

This study was a big “Ah-Ha” moment for me, and I think we may have found a viable reason to explain why patellofemoral taping works.  Think about it, patellar taping in the lateral-to-medial direction did cause a medial shift in the patella for those that were laterally displaced, but it produced just the opposite in people that were medially displaced, the patella actually moved against the direction of taping. Why?

After reading this study I think that taping doesn’t shift the patella in one direction, what it does is compress the patellofemoral joint.  Take a look at the figures below.  The figure on the left shows a patellofemoral joint with a laterally displaced patella, it does not sit centered within the trochlea groove.  The figure to the right is that same knee, but now with patellar tape (orange line) applied.  As you can see, it centers the patella within the groove but compressing it, the patella glides against the ridge of the trochlea:

patellfemoral joint patellar tape

The same holds true for the medially displaced patella, even if you tape in the lateral-to-medial direction, it doesn’t matter, the patellar actually shifts laterally in this case because again is glides with the trochlea groove:

image patellofemoral tape

imageThis essentially causes a “centering effect” of the patellofemoral joint by compressing it within the trochlea groove.  Subsequently, this “centering effect” increases the patellofemoral contact area, which likely has a significant impact on pain.

It is well documented that a displaced patella causes the patellofemoral contact area to decrease, causing the same amount of force to be applied to a more focal area.  By centering the patella within the trochlea, this force is distributed across a larger surface area and stress on the cartilage is decreased (for more information on this, subscribe to my newsletter and read my free eBook Solving the Patellofemoral Mystery).  As you can see in the below figures, if the same amount of force is applied to a larger area of contact, the force is distributed more evenly across the cartilage:

image image

Obviously, more research needs to be conducted, but this hypothesis seems to have some potential validity and may explain why why patellar taping works and why there is so much conflict in the literature.  If you like this kind of thing like I do, read my eBook Solving the Patellofemoral Mystery, free to all my newsletter subscribers.

Based on your experience, do you agree?  Think differently?  Why do you think patellar taping works?

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28 Responses to “Why McConnell Patellar Taping Works”

  1. Very interesting post. I do have a question though. I use McConnell taping only to prove to my patient that they have a shifted patella. I have them squat without the tape and ask about their pain. I then apply the lateral to medial tape and if their pain abolishes then they immediatley see me as being a genious haha. However, my treatment then focuses on hip muscle strengthening. I focus a lot of my efforts on glut med, min, and max to help take stress off the TFL and IT band to prevent it from "pulling" the patella laterally. I assume this approach would not work with those with a medially shifted patella, correct? Would the rehab protocoal differ based on the side of the patella shift?

    Thanks for another great post Mike!

    • Great chatter all the way around on this topic. I think it is unlikely that you can explain the benefits from EITHER a NM standpoint or a biomechanical standpoint. However, being someone who thinks much more biomechanically than anything, I do believe that Mike’s theory is very valid here. Think about how little pressure it takes to manual center the patella with the leg extended. In theory, it should take even less as the knee starts to bend as the natural mechanics of the joint should allow the patella center. I think of it as just a little “kick” in the right direction. Again speaking biomechanically, I feel that the taping simply helps thepatella to keep up with femur as it moves into the IR/ADD position. I personally like the approach of addressing these patients more with hip strengthening, addressing foot/ankle malalignment, & motor re-education. I use taping more for the patients that need that little extra help.

  2. Great post, Mike. I think your hypothesis makes a lot of sense. I had always been under the impression that the alignment theory of why taping works had been disproved and therefore I would explain it from more of a neuromuscular point of view. For example that the tape somehow stimulates the vmo to contract with greater efficiency and/or coordination.

    But I think you point out evidence that there is more of a structural effect than I thought. I am also a fan of taping shoulders with a McConnell technique that probably works in a similar way as the technique involves compressing the humeral head into the glenoid.

    Of course joint compression does cause a neurological response of muscle facilitation or inhibition so it's likely that McConnell taping works at both a structural and neuromuscular level. Perhaps another reason the research has been so variable is that the neurological response to compression can different from person to person?

  3. Is it the compression or just the simple fact that when we put something tight and stretchy on the skin we can see improved neurally based motor control. So the neuromuscular changes may come about no matter how you put the tape on or if it truly compresses or not.

    I thought it was kind of strange in the study with the MRI looking at knee extension in sitting (if I read it right). I realize this may be due to probably getting a good MRI view, but don't most PFD patient have pain with an activity such going up stairs or similar activity, usually not sitting with plain knee extension. I'm not sure but is it possible that the motor contol needed to perform a seated knee extension compared to a step up is entirely different. Research has shown that for example with low back pain, people's motor control of muscles change with pain present, even the anticipation of pain can change the motor plan the brain sends down to the muscles. So not sure what this study tells us with those thoughts in mind.

  4. @Kory, the tape may have some motor control effect, but this study seems to imply that the tape provides compression and a centering effect, i dont think motor control changes would have the patellar sit more inferiorly.

    @Jesse – remember that a lot goes into the rehand of PF patients, training the hip would still be good even if patella sits medial as it helps control the knee eccentrically.

  5. @ Carl, yes you should assess lumbar and this could be a source of PFPS symptoms.

  6. According to the theories of Kinesiotaping, if you put the tape from lateral to medial, you will bring "the medial" to "the lateral".
    This can be another explanation, but yours seems to be also a good expanation.

    Excuse my poor english again..

  7. how much compressionforce can a simple tape generate 1 or 2 kg's? or maybe even less.
    this seen in relation to normal pf joint compression forces during painful activities like stairclimbing which would reach more then a 100kg's per square cm if i'm correct would be insignifigant don't you think!
    I agree with Kory it's way more likely that there will be altered neurodynamics due to stretch of skin nerves. it's way more logical that altered motor activity is the cause of pf shift simply because the controling muscle can create enough force to shift the pat.

  8. @Marcel don't think of it as the tape's compression causing anything other than a more centralized joint. Imagine the same 100 lbs of force applied so a smll spot of the patella vs. A larger area being spread out.

  9. There are two studies, the one by Wilson et al in JOSPT (2003) and then another by MacGregor et al in the Journal of Orthopedic Research (2005) that support a neuromuscular effect of taping over a biomechanical effect of improved patellar position.

    The former found that lateral and neutral taping of the patella was significantly more effective in reducing pain than medial taping. The MacGregor study found increased VMO activity due to the stretch of the skin over the knee, which was greatest with lateral stretch.

    These results shed doubt on the the direct biomechanical effects of taping.

  10. I would agree with John that your getting a neuromuscular effect rather than biomechanical effect of patellar repositioning. On a side note I use KineasioTex and have found it works a lot better than traditional coverall and leukotape.

  11. Todd,
    I also use kinesiotape almost exclusively now and have found it much easier to work with and more effective in general than the leukotape/cover roll combination.

    It's also cheaper. ;)

  12. Mike,

    This really hit me as well. I defiantly think you're on to something here. While there's no doubt there is a corresponding neuromuscular effect, the compression is the catalyst behind the tracking correction. And remember Occam's razor – tape does compress, very well in fact, which is why it is so effective for edema, posture, immobilization, etc. We've seen hundreds of similar results when using rocktape on PF. Thanks for putting a point on it!

  13. Greg,

    How can you say that it's the compression that is the "catalyst" behind the "tracking correction" when there's evidence that the stretch alone provides beneficial effects on pain and neuromuscular recruitment patterns in patients with PFD?

    If you're using Occam's razor, then you have to use the most parsimonious explanation based on the available evidence, and that explanation seems to be a neuromuscular one (skin stretch), not a biomechanical one (joint compression).

    I'm using a much less compressive taping technique and have found-anecdotally- that there's no difference in pain reduction. Using Occam's razor, how would you explain this result?

  14. @ John and @ Todd, I am aware of the studies you mention and agree there is a NM component, there are plenty of studies that show this. However, I question if "lateral" or "medial" or "neutral" taping really does what we are saying it does. I think this study shows that the patella does not necessarily reposition because of the direction of tape, it is because it compresses it within the groove. There is biomechanical evidence that this happens.

    Let me throw this back at you too – perhaps the NM effect is more related to the fact that the patella is now compressed and more within the groove, allowing the muscles and VMO:VL ratio etc to work more efficiently? Perhaps the NM benefit is from the biomechanical alteration, not the actual tape?!? I don't know, just trying to play devil's advocate. This is true in other joints, cuff muscles function better when the joint is aligned etc.

    I wouldnt discount the biomechanical effect, because this has been proven that the tape does this and really it is hard to say why the NM effect occurs – was it the tape or the altered position.

  15. Good call too on the kinesiotape vs. leuko/cover roll combo, I agree. Has anyone used Greg's Rock Tape and can compare between that and kinesiotape?

  16. Corey Lichtman, DC, CSCS December 17, 2010 at 12:55 pm

    I use RockTape daily. Lately I have been taping a lot of knees with patellar dysfunction. Primarily lateral subluxations with tight ITB and medial collateral ligament irritation. I tape the ITB, then facilitate the VMO and pull the patella medial with RockTape. The patients report no pain immediately with a feeling of the knee feeling lighter. We do retraining taped, and within a week she is starting to workout again. We are still taping for function through the early stage of proprioception and rehab.

  17. I agree with a previous poster, as soon as the quadriceps contract the force of compression will pull the patella back into the groove if all which is required is compression. The magnitude from the quads would far outweight that from tape.

    • I would agree, but perhaps it shears its way to the center when the quad is contracted versus a more gentle centralization with the tape? I dont really know, just thinking out loud. It looks like tape centers the joint and that tape reduces pain, not sure exactly why, but maybe we are getting closer…

  18. Hi all. Interesting debate. Both views seem to hold some truth. Patellar taping may work via stimulation of cutaneous propioceptors (Macgregor et al, J Orthop Res 2005) and it may work also by altering the faulty mechanics of the patella (Derasari et al, Phys Ther 2010). It seems that it works in any direction it is applied eg. medial, lateral, “rotational”. Unloading the soft tissues around the patella (fat pad, pes anserina) seems to also work in relieving pain (one point here in favour of cutaneous stimulation???) (Hinmann RS et al BMJ 2003). It seems to work regardless of the tape used (I have used Ktape, regular tape, even tensoplast and gotten the same result). However, it seems the biomechanical effects doesn´t last long as tape wears off with exercise (Pfeiffer RP et al AJSM 2004) but the pain relieving effects last longer. Now I wonder, if it works via compression, wouldn´t a manual mobilization technique that gently compresses the patella work in the same way that taping does? What do you think?

  19. As someone who has patella alta and patellar instability – I swear by taping. It works like a charm.

    My personal experience tells me that taping helps with pain because it allows me to simply move normally and use the “right” muscles because the patella is sitting in a better position.

    I’ve had one kneecap surgically repositioned (lowered and moved medially with a patellar tendon transfer), and the other one hasn’t been (yet!). My surgery knee recruits the VMO in a dramatically different and better way. My non surgery knee recruits my lateral quad first (ouch!).

    As soon as I tape, I extend my leg more, use my glutes more. The slight repositioning of the kneecap helps my VMO fire and simply walk better. In other words, I use the right muscles to move, and that helps control pain.

    Just my two cents as a tape-addict.

    Hooligan

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