Have you noticed on the fantastic TV coverage of the London Olympics 2012 that many of the athletes have medical tape applied directly to their skin. The Dutch women beach volleyball players even had designer tape and the water-polo team must have had waterproof tape. When I was a young Elf in the mid 80s I remember the popularity of the McConnell technique and the introduction of application of tape for anterior knee pain. My Musculoskeletal Elf colleagues inform me that tape is still a relatively inexpensive intervention and is in frequent use in clinical practice. This left me wondering how effective tape actually is for musculoskeletal conditions.
As we discovered in an earlier blog, DATE, patellofemoral pain syndrome is common in runners. It is also estimated that 25% of people will suffer anterior knee pain at some point. So it was with interest that I noticed a Cochrane review authored by some nice chaps in the UK who coincidentally I worked with in the old days. They assessed the effects, primarily on pain and function, of patellar taping for treating patellofemoral pain syndrome in adults.
Here’s what they did
The authors, from the UK, undertook a comprehensive search of databases up to August 2011. They searched for randomised controlled and quasi-randomised controlled trials comparing taping versus control (no or placebo taping). They excluded trails that investigated the immediate effects of taping focusing instead on longer team effects. They found five small trails involving approximately 200 participants and 216 knees. They assessed risk of bias using the Cochrane Collaborations ‘risk of bias tool’.
Here’s what they found
- All trails included one or more co-interventions given to all participants, this was prescribed exercise in four trials.
- The intensity and length of treatment was very varied from one week to three months.
- There was no difference in pain scores, visual analogue scale (VAS), from four trials (data from 161 knees) at the end of the treatment programmes (mean difference -0.15; 95% CI -1.15 to 0.851)
- Data for other outcomes measuring function and activities of daily living were from single trials only and gave contradictory results.
The Musculoskeletal Elf’s thoughts
Although the immediate effects of tape for patellofemoral pain syndrome have been established it appears from this review that longer term outcomes particularly pain are questionable. The findings of this review are hindered due to heterogeneity of the included studies. This included lack of a consistent definition of patellofemoral pain syndrome, the duration of the condition and the type of tape (elastic or rigid), the direction of pull of the tape (medial, lateral, inferior, superior, rotational, or no directional pull at all) and the number of layers of tape. Furthermore the quality of the included trails was low due to small samples sizes and high risk of bias. Of course there are also many other biomechanical factors contributing to this condition. However if taping is effective it would be an inexpensive intervention and physiotherapists could teach patients to tape themselves.
So here is The Musculoskeletal Elf’s call to action…..are you up for it? Let us know. As most physiotherapists are trained in taping I encourage all you musculoskeletal gurus out there get to together and agree a clear definition for patellofemoral pain syndrome and plan a high quality large scale clinical trial that tests the effects of different types and durations of taping on longer term outcomes of importance to patients.
Do you use taping for patellofemoral pain syndrome or other musculoskeletal conditions? What is your view on this review, will it change your clinical practice? Send us your views on this blog and become part of the Musculoskeletal Elf community.
- Callaghan MJ, Selfe J. Patellar taping for patellofemoral pain syndrome in adults. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD006717. DOI: 10.1002/14651858.CD006717.pub2.