An investigation of the biomechanical efficacy and clinical effectiveness of patello-­‐femoral taping in elite and experienced cyclists
Abstract Please write a brief description of your work, or copy an abstract you have included in the Thesis Considering that Patello-Femoral Pain (PFP) is responsible for over 25% of all road cycling related injury and over 65% of injuries in the lower limb, alongside trauma related pain it remains the main injury affecting experienced and elite cyclists and is commonly treated using taping. Taping can broadly be categorised into ‘McConnell’ and ‘Kinesiology type tape’ (KTT) as these are seen as recognised clinical approaches in dealing with patella tracking and pain issues. The aim was to collect specific data to inform and develop a study into current taping techniques used in cycling related knee pain. An online questionnaire determined the techniques used by clinicians treating elite and experienced cyclists. Recruitment was through professional networking and the social network Twitter™. The questionnaire indicated a clear preference for the use of KTT. A specific taping technique was identified for use in a laboratory-based study. Respondents indicated their rationale for using tape, which included pain reduction, neuro-muscular adaptation, placebo and altered biomechanics. A subsequent study then investigated the interventions, KTT, neutral tape and no taping, alongside comparing asymptomatic (n=12) and symptomatic (n=8) cyclists. Each cyclist conducted three separate and randomised intervention tests at three powers (100W,200W,300W) on a static trainer. Kinematic data were collected using a 10-camera Oqus 3 motion analysis system. Reflective markers were placed on the foot, shank, thigh and pelvis using the CAST technique. This study showed significant differences in the knee, ankle and hip kinematics between cyclists with and without knee pain. The knee had increased ROM (coronal) in those with knee pain (p=0.005 or 18% change) whereas in the hip, those with knee pain had less movement (p=0.001 or 26% change). The ankle however had an increase in movement (transverse) in those with knee pain (p=0.034 or 14% change). Significant differences in hip, knee and ankle kinematics on the application of KTT were found, however these had no identifiable pattern that suggested any clinical indication. Interestingly, similar levels of differences were also found with the neutral taping application, which indicated that a specific technique might not be critical. It was also noted that 200 watts of power produced the most pain response during testing (33% change) which may have a practical application to future taping related clinical testing. If we are looking to establish a biomechanical change using KTT, ROM may indeed be reduced, however individuals had different patterns of movement, which did not appear to indicate a consistent or predictable effect. This may mean that pain reduction is more likely through a mechanism of neuromuscular adaptation or proprioception. It appears unclear whether a specific technique of application is fundamental to outcome. The hip, knee and ankle variants may aid clinical application when treating cycling related knee pain through screening and testing. This variation in movement may be linked to increased patello-femoral (PF)/tibio-femoral contact areas and PF stress when significant power is applied during cycling. The findings indicated a proximal to distal relationship, which is in line with current evidence and has implications to rehabilitation. Taping reduced pain, however it is likely that this effect is not what the anecdotal rhetoric presumes. If the intent is to use the tape to elicit specific biomechanical changes then this is difficult to substantiate and measure. If the expectations are purely around pain then it is likely that pain will be decreased using KTT, albeit short term. Further work is clearly required in the area of PFP and cycling.
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