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http://sph.sagepub.com/content/6/4/294
The online version of this article can be found at:

DOI: 10.1177/1941738114537793
2014 6: 294 originally published online 9 June 2014 Sports Health: A Multidisciplinary Approach
Scott R. Freedman, Lori Thein Brody, Michael Rosenthal and Justin C. Wise
Patellofemoral Pain Syndrome
Short-Term Effects of Patellar Kinesio Taping on Pain and Hop Function in Patients With

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294
Freedman et al
[ Sports Physical Therapy ]
537793SPHXXX10.1177/1941738114537793Freedman et alSPORTS HEALTH
research-article2014
Short-Term Effects of Patellar Kinesio
Taping on Pain and Hop Function in
Patients With Patellofemoral Pain
Syndrome
Scott R. Freedman, PT, PhD, SCS,*

Lori Thein Brody, PT, PhD, SCS, ATC,

Michael Rosenthal, PT, DSc, SCS, ECS, ATC, CSCS,
||
and Justin C. Wise, PhD

Background: Patellofemoral pain syndrome (PFPS) is the most prevalent orthopaedic condition among physically active
individuals, contributing to an estimated 30% to 40% of all sports medicine visits. Techniques using Kinesio Tape (KT) have
become increasingly popular; however, there has been scant research supporting its use on patients with PFPS.
Hypothesis: The use of patellar KT to treat patients with PFPS will provide a statistically significant improvement in short-
term pain and single-leg hop measures as compared with sham placement of KT.
Study Design: Nonrandomized controlled clinical trial with repeated-measures design.
Level of Evidence: Level 3.
Methods: Forty-nine subjects (41 females, 8 males) between the ages of 12 and 24 years with PFPS participated in this
study. Each subject underwent patellar kinesio taping with both experimental and sham applications while completing
4 functional tasks and the single-leg triple jump test (STJT). The treatment outcome was analyzed using separate paired
ttests to measure improvement on a numeric pain rating scale. A 2-way, 2 2 analysis of variance was used to analyze the
relationship between taping condition (experimental vs sham) and side (involved vs uninvolved) for STJT scores.
Results: Separate paired t tests found step-up, step-down, and STJT pain improvement statistically significant between
taping conditions. The 2-factor analysis of variance yielded a significant main effect for taping condition, but the main effect
for side was not significant. The interaction between taping condition and side was significant. This showed there was little
change in STJT distance between repeated measures performed on the untaped, noninvolved leg. However, subjects STJT
distances were significantly greater for the experimental KT application than the sham application for the involved side.
Conclusion: Patellar kinesio taping provided an immediate and statistically significant improvement in pain and single-leg
hop function in patients with PFPS when compared with a sham application. However, improvement in STJT scores did not
surpass the minimally detectable change value, and therefore, the clinical effectiveness of KT for improving single-leg hop
function was not established in the current study.
Clinical Relevance: Kinesio Tape provides a viable, short-term method to control pain.
Keywords: patellofemoral pain syndrome; kinesio taping; single-leg triple jump test
From

Childrens Healthcare of Atlanta, Sports Medicine Program, Atlanta, Georgia,

Rocky Mountain University of Health Professions, Provo, Utah,

University of Wisconsin
Health Research Park, Madison, Wisconsin,
||
Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, California, and

Department of
Psychology, Oglethorpe University, Atlanta, Georgia
*Address correspondence to Scott R. Freedman, PT, PhD, SCS, Department of Physical Therapy, Mount Saint Marys College, 10 Chester Place, Los Angeles, CA, 90007
(e-mail: [email protected]).
The following authors reported potential conflicts of interest in the development and publication of this article: Lori Thein Brody, PT, PhD, SCS, ATC, Michael Rosenthal, PT,
DSc, SCS, ECS, ATC, CSCS, and Justin C. Wise, PhD, received an honorarium from Rocky Mountain University.
The opinions contained herein are those of the authors and are not to be construed as the official position of the Department of Defense or the Department of the Navy.
DOI: 10.1177/1941738114537793
2014 The Author(s)
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SPORTS HEALTH vol. 6 no. 4
295
P
atellofemoral pain syndrome (PFPS) is the most prevalent
orthopaedic condition among physically active
adolescents and young adults, contributing up to an
estimated 30% to 40% of all sports medicine visits.
2,3,18
Patellar
malalignment along with abnormal patellar tracking are
precursors to PFPS.
14,33,45
There are several risk factors
associated with PFPS development, including lower extremity
muscle weakness, soft tissue tightness, abnormal vastus medialis
obliqus (VMO)/vastus lateralis (VL) reflex timing, lower
extremity anatomical abnormalities, and altered hip/lower
extremity kinematics.
6,9,11,13,31-34,36,37,40,42,44
Moreover, because of
the self-propagating nature common to the disorder, there
appears to be psychological factors associated with the
development of PFPS.
7,19,29,30,44
Because of the variable etiology
and spectrum of pain pathogenesis associated with this
disorder, treatment approaches are numerous.
Patellar taping is a common adjunct in the physical therapy
management of PFPS. Taping is intended to provide a
mechanical shift to the patella, thus decreasing pain and
allowing for early progression of treatment.
11,24,41
Techniques
using Kinesio Tape (KT; Kinesio) differ from traditional taping
applications using nonelastic tape. Kinesio Tape is intended to
mimic the elastic qualities of the skin, providing proper
positional stimulus rather than providing musculoskeletal
support to joint structures.
20
The majority of tape applications
involve techniques detailed by McConnell
24
using nonstretch
tape. The technique is intended to improve patellar orientation
within the trochlear groove, thus improving patellar
tracking.
7,11,24,41
Kinesio Tape is designed to mimic the elastic properties of
skin, stretching 30% to 40% lengthwise.
10,20,21
Furthermore, KT is
water resistant, with a reported wear time of 3 to 5 days.
20
Application of KT to the skin over affected muscle and joint
structures is purported to alleviate pain and facilitate
microcirculation by providing proper positional stimuli through
the skin, influencing interstitial tissue to normalize skin
tension.
20,21
Preliminary evidence suggests that KT may be beneficial in
treating ankle,
27
shoulder,
38
trunk,
46
cervical,
16
and patellar
dislocation
28
pain and improving VMO/VL activation ratios.
8
The
purpose of this study was to investigate the immediate effect of
a generalized patellar KT application in improving pain and
single-leg hop function in patients with PFPS. We hypothesized
that an application of patellar KT would provide statistically
significant improvement in pain and hop function as compared
with a sham application.
MATERIALS AND METHODS
Subjects
Institutional review board approval for this study was obtained
from Childrens Healthcare of Atlanta and from the Rocky
Mountain University of Health Professions. Subjects were
recruited through physician referral with either a diagnosis of
unilateral PFPS or anterior knee pain. An additional 7 subjects
were recruited through local high school and sports club
physical therapy screening without a physicians referral.
All subjects and guardians (if applicable) signed approved
informed consent and assent forms prior to study enrollment.
To be eligible, subjects were between the ages of 12 and 25
years with unilateral anterior knee pain in one or both knees,
lasting greater than 4 weeks, and without a related trauma to
the area. Additional inclusion requirement included 2 or more
of the following pain complaints:
1. ascending/descending stairs
2. squatting
3. sitting with knee bent greater than 15 minutes
4. running, jumping, or hopping
Exclusion criteria were previous patellar subluxation or
dislocation; patellar fracture; knee surgery within the past 2
years; systemic disease; adhesive allergies; diagnosed systemic
soft tissue disorder; neurological impairment that may impede
physical activity; pregnancy; patellar tendonitis; apophyseal
stress syndromes of the knee, including Osgood Schlatter or
Sinding-Larson Johansson; internal derangement or ligamentous
injury of the knee; and infection.
A total of 49 subjects meeting the qualifications for the study
were consecutively selected to participate. The sample size of
49 was determined based on achieving a power of 0.80, an
level of 0.05, and an estimated large effect size.
Numeric Pain Rating Scale
Patients overall assessment of pain was provided using the
numeric pain rating scale (NPRS)
12,23
following performance for
each of 3 functional tasks associated with PFPS (squatting,
ascending, and descending a 12-inch step). Additionally,
subjects reported the maximum pain encountered using the
NPRS on their involved knee following completion of the
single-leg triple jump test (STJT).
Single-Leg Triple Jump Test
The STJT is performed on 1 foot, and the subject is instructed to
complete 3 consecutive hops along a straight line for maximum
distance. The total distance covered for each leg is measured
from the beginning to final standing position in centimeters.
The better of 2 attempts on each leg is used to create an index,
which is the ratio of distance achieved on the involved leg
compared with the uninvolved. The single-leg hop index has
been reported to be a reliable and valid outcome measure
following rehabilitation for anterior cruciate ligament
reconstruction with a minimal detectable change cited as
10.02%.
35
Subjects scored their pain performing the STJT on
their involved lower extremity using the NPRS.
Testing Protocol
The lower extremity evaluation was completed on enrollment.
To improve reliability, all clinical tests and measures were
performed by the primary investigator only, with subjects
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positioned on a treatment table starting with goniometric
measurements, followed by special tests, and concluded with
lower extremity strength measures (see Appendices 1 and 2,
available at http://sph.sagepub.com/content/suppl).
Lower extremity strength measurements were taken using a
handheld dynamometer, with pressure applied through the
device to overcome muscle contraction (ie, break test). The
better of 2 repeated measures was recorded in kilograms.
4
Taping
All subjects received a generalized peripatellar application of KT
(Kinesio Tex Tape; Kinesio) by a certified Kinesio taping
practitioner.
Patellar kinesio taping. With the patient seated and leg
extended, the base of the first Y tape was placed at the front
of the thigh, approximately 2/3 up the length of the femur,
and cut at the level of the tibial tuberosity. Then, with the knee
flexed to 90, the tails were wrapped around the kneecap with
little to no overlap and no additional stretch than that provided
by removing the tape from the backing. A second strip of
identical length was applied in the same fashion, with the base
2/3 down the tibial shaft (Figure 1a).
Sham kinesio taping. Two strips of KT were placed
horizontally both 5 cm above and 5 cm below the patella
superior and inferior borders with the knee flexed to 90. The
approximate length of each strip was equal to the distance
between the medial and lateral femoral condyles. This
placement was chosen to avoid interaction of the KT with
patellar positioning (Figure 1b).
Both taping conditions were applied to the involved knee
only, and order of assignment was randomized a priori using a
random-numbers table. Completion of the second taping
condition and the test battery was completed on the next
consecutive day or within 72 hours of the first test battery.
Subjects were blinded to each taping condition. Prior to tape
application for each testing session, the subject provided the
researcher with a baseline measure of knee pain using the NPRS
to determine whether pain severity influenced outcomes.
Data Collection
Assessment of knee pain for 3 functional tasks (squatting,
ascending steps, descending steps, and STJT) was collected
using the NPRS for each taping condition. A 12-inch foot stool
was used for the step-up and step-down activities. Subjects
were given consistent directions for completion and timing of
the functional tasks. To control for the recovery phase (ie,
stepping back down or up), subjects were cued to return using
their uninvolved leg after each of 10 repetitions. Squatting was
performed with feet shoulder width apart and toes pointing
forward. Subjects knees were required to reach 90 of flexion,
as determined visually, while performing the task. For
consistency across subjects, all 10 repetitions were required to
be completed consecutively and within 15 seconds. The testing
order for each subject was counterbalanced to diminish the
potential of carryover effect between tasks.
Single-Leg Triple Jump Test
Functional testing was performed using the STJT. Testing was
performed twice on each leg, starting with the noninvolved leg.
The distance hopped was recorded using a fixed measuring
tape by the primary investigator only. The greater distance of
the 2 attempts was scored for each leg. Here, once again, we
assessed STJT for each taping condition; however, since taping
was only applied to the involved extremity, the noninvolved
extremity distance was used as a paired control with repeated
measures taken over a 24- to 72-hour period.
Additionally, subjects provided an NPRS of their greatest knee
pain while performing the STJT on their involved leg only for
each taping condition. These data were treated mutually
exclusive from the STJT scores and were analyzed as the fourth
pain assessment task.
Statistical Analysis
Four separate paired t tests were performed comparing
differences in NPRS for 4 functional tasks and taping condition.
Paired t tests were used to compare each individual subjects
pain scores taken at 2 separate times and the associated taping
procedure. Testing each task individually allowed for
identification of statistical significance for taping and each
functional task independently. Additionally, a fifth paired t test
was performed comparing an averaged composite score of the
NPRS and taping condition. A composite score was generated
for each subject and taping condition by adding the NPRS
scores for each of the 4 functional tasks and dividing it by 4.
A 2-way repeated-measures analysis of variance was used to
analyze the relationship between taping condition (experimental
vs sham) and side (involved vs uninvolved) for STJT. The
independent variable was the taping procedure (experimental
vs sham), and the dependent variable was STJT distance
(involved vs uninvolved). Comparison with the noninvolved
Figure 1. (a) Experimental kinesio taping technique.
(b) Sham kinesio taping technique.
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lower extremity served as a paired control and was performed
at the same time as the involved for each taping condition.
Therefore, it was analyzed as a repeated measure taken within a
24- to 72-hour period. Any statistically significant differences
observed between the interactions or main effects were
analyzed further using the Tukey post hoc test.
For all statistical analyses, an alpha level of P < 0.05 was used.
All data were calculated using SPSS, version 19 software (SPSS
for Windows; IBM).
RESULTS
Demographic homogeneity between the 2 recruitment samples
was evident (Table 1). There were no adverse reactions or
debilitating pain preventing subjects from completing the testing
battery.
Test-retest reliability for 10 quantitative examination measures
was determined prior to the beginning of our study. Ten
individuals with PFPS were tested on 2 occasions by the sole
examiner (SRF) 24 to 72 hours apart. Reliability of the paired
test scores was in the acceptable range using Pearson
correlation and ranged from 0.71 to 0.98 (see Appendix 3,
available at http://sph.sagepub.com/content/suppl).
Pain Measures (NPRS)
The change in NPRS between the 2 taping conditions was
statistically significant for 3 of the 4 functional tasks: step up,
t(49) = 2.31, P = 0.025, d = 0.33; step down, t(49) = 2.29, P =
0.026, d = 0.32; and STJT, t(49) = 4.29, P < 0.001, d = 0.61
(Figure 2, Table 2). Change in NPRS while performing the
double-leg squat (t(49) = 0.94, P = 0.35, d = 0.13) was not
Table 1. Baseline characteristics and correlation with outcome measures
Mean SD Composite pain score Outcome hop
Age, y 15.3 3.4 0.027 0.180
1215 (34) 0.092 0.136
1623 (15) 0.141 0.192
Female (%) 42 (84) 0.198 0.214
Baseline pain (NPRS) 2.4 1.9 0.146 0.216
Pain duration, mo 6.4 5.11 0.221 0.254
BMI, kg/m
2
20.7 2.5 0.109 0.115
FABQ (PA) 14.0 5.3 0.084 0.115
FABQ (W) 21.2 6.5 0.055 0.224
WONCA score 2.0 0.5 0.014 0.028
Ankle DF ROM, deg 13.6 6.8 0.095 0.232
90/90 hamstring, deg 24.5 11.5 0.056 0.119
Q angle, deg 13.1 3.5 0.185 0.098
Craig test, deg 10.9 4.1 0.125 0.309
a
Thomas test,
b
% 27(54) 2.5 0.269 0.144
Ober test,
b
% 26 (52) 0.325
a
0.007
J sign,
b
% 20 (40) 0.241 0.053
Theater sign,
b
% 26 (52) 0.267 0.030
Patellar tilt,
b
% 26 (52) 0.245 0.122
BMI, body mass index; DF ROM, dorsiflexion range of motion; FABQ (PA), Fear Avoidance Behavior QuestionnairePhysical Activity sub-scale; FABQ (W),
Fear Avoidance Behavior QuestionnaireWork sub-scale; NPRS, numeric pain rating scale; Q, quadriceps.
a
Correlation is significant at the 0.05 level (2-tailed).
b
Dichotomous variables are expressed as number of positive findings and percentage in parentheses.
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significant between the 2 taping conditions. However, when
NPRS for all 4 tasks were compiled and averaged into a
composite score, a statistically significant effect remained
(t(49)= 3.18, P = 0.003, d = 0.45) between taping conditions.
Cohens d values for the 3 significant tasks (0.32-0.61) indicated
the magnitude of the taping effect was small to moderate, with
triple hop being the largest (0.61).
Hop Scores (STJT)
The 2-factor analysis of variance yielded a significant main
effect for taping condition (F(1, 48) = 8.38, P = 0.006,
2
= 0.14),
indicating that paired lower extremity STJT scores taken during
the experimental KT condition (mean, 369.78; standard
deviation, 81.07) were greater than paired lower extremity
measurements taken during the sham condition (mean, 353.63;
standard deviation, 80.40) (Figure 3). There was no main effect
for side (F(1, 48) = 0.41, P = 0.53,
2
= 0.009), indicating that
the involved and uninvolved lower extremity STJT scores were
similar. The interaction between taping condition and side was
significant (F(1, 48) = 11.27 P = 0.002,
2
= 0.18). This
demonstrated there was little change in STJT distance between
repeated measures performed on the untaped, noninvolved leg
over a 24- to 72-hour period. However, subjects STJT distances
were significantly greater for the experimental KT application
than for the sham application for the involved side.
DISCUSSION
In healthy subjects, KT application brought about a significant
increase in both single-leg hop distance and isokinetic knee
Figure 2. Comparison of mean numeric pain rating score
(NPRS) by intervention for each functional task.
Table 2. Paired t test comparing taping conditions


Paired Differences
Significance
(2-tailed);
Cohens d
95% CI of the
Difference
Mean SD SEM Lower Upper t df
Step-up 0.70000 2.1405
a
0.30271 1.30832 0.09168 2.312 49 0.025
a
; 0.33
Step-down 0.66000 2.03650 0.28801 1.23877 0.08123 2.292 49 0.026
a
; 0.32
Squat 0.26000 1.96718 0.27820 0.81907 0.29907 0.935 49 0.350; 0.61
STJT 1.20000 1.97949 0.27994 1.76256 0.63744 4.287 49 <0.001
a
; 0.13
Composite score
b
0.70420 1.56833 0.22180 1.14991 0.25849 3.175 49 0.003
a
; 0.45
df, degrees of freedom; SEM, standard error of the mean; STJT, single-leg triple jump test.
a
Significant at 0.05.
b
Composite score is an average of all activities.
Figure 3. Comparison of intervention and patellofemoral
pain syndrome (PFPS) involvement for mean single-leg triple
jump test (STJT) distance in centimeters.
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SPORTS HEALTH vol. 6 no. 4
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extension peak torque when compared with patellar bracing.
1

However, a significant decrease in single-leg hop distance
among healthy subjects was shown following medial glide
patellar taping with athletic tape when compared with the
no-tape control condition.
17
Comparing the 2 taping
applications, athletic tape does not possess the elastic properties
unique to KT, allowing it to stretch with the skin and potentially
limiting compressive loads on the patellofemoral joint.
Significantly lower reports of pain have been reported while
performing a stepping task immediately following McConnell
taping as compared with a placebo.
41
However, there is a lack
of consensus regarding the therapists ability to accurately and
consistently assess components of patellar tilt, glide, and
rotation.
39
Furthermore, several studies have refuted the
purported mechanism, reporting an unchanged patellar position
using a variety of techniques, including radiographs,
5
computed
tomography scans,
15
and magnetic resonance imaging.
45
Proving
further merit to this claim, Wilson et al
43
reported on the effects
of patellar taping applied in a medial, neutral, and lateral
directions and found a statistically significant decrease in pain in
patients with PFPS, irrespective of the taping condition.
This contrast between study findings and taping intervention
provides some merit to the purported KT mechanism of
providing proper positional stimuli through the skin requiring
interstitial tissue to normalize, as detailed by Kase et al.
20

Additionally, the elastic qualities of KT are more forgiving,
allowing skin to stretch along with knee flexion.
21
The Ober test and the Craig test had significant correlation with
our outcome measures. Through the anatomical attachments of
the iliotibial band to the superficial oblique layer of the lateral
retinaculum, a shortened iliotibial band can contribute to lateral
patellar displacement and lateral patellofemoral joint stress.
25

Increased femoral anteversion angle, as determined by the Craig
test, had a significant correlation with decreased STJT scores. The
test is intended to be a clinical measure of femoral neck
anteversion (internal femoral rotation). Excessive anteversion can
contribute to lateral patellar displacement and increased
patellofemoral joint pressures in patients with PFPS.
22
Study Limitations
This study compared a generalized KT application with a sham
placement both 5 cm above and 5 cm below the patella. We
assumed this placement was far enough away from the
patellofemoral joint as to neither have an interaction on
patellofemoral function nor facilitate quadriceps inhibition.
Despite being blinded to taping condition, it is difficult to
control for subject bias due to prior exposure or experience
with KT. There was no comparison to McConnell taping or to
matched controls in the current study.
This study only investigated short-term effects of patellar KT;
therefore, long-term inferences cannot be determined. Last, the
study was unable to account for any anti-inflammatory usage
between testing sessions, which potentially could have
influenced pain and/or function.
CONCLUSION
In patients with PFPS, patellar KT produced statistically
significant improvements in short-term pain and STJT
function. Reduction in pain level was found during step-
up, step-down, and triple-hop tasks as compared with a
sham KT application. Despite being statistically significant,
improvement for LSI did not exceed the minimally detectable
clinical change
35
of 10%.
This investigation provides preliminary evidence supporting
the application of patellar KT in the management of patients
with PFPS.
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