Evidence-Based Patellofemoral Pain Management: The McConnell Taping Approach

Introduction: The Clinical Challenge of Patellofemoral Pain

Patellofemoral pain (PFP) is one of the most common causes of anterior knee pain in both athletic and general populations. It often presents as diffuse discomfort around or behind the patella, exacerbated by activities such as stair climbing, squatting, prolonged sitting, or running. Despite its prevalence, PFP can be frustratingly resistant to treatment, particularly when interventions fail to address the underlying biomechanical causes of patellar maltracking.

The McConnell Taping Approach, developed in the mid-1980s, has become a cornerstone of evidence-based rehabilitation for patellofemoral dysfunction. This method combines targeted patellar taping with individualized exercise prescription to reduce pain, correct malalignment, and restore functional control of the knee.

The Origins of the McConnell Taping Method

In 1986, I published a study detailing a multimodal program for treating chondromalacia patellae (now referred to as PFP). This program included patellar taping to improve alignment, quadriceps retraining by specifically targeting the vastus medialis obliquus (VMO) stretching of tight lateral structures improving gluteal activation and foot function. Long-term results showed that 96% of patients remained pain-free at one-year follow-up, a significant improvement over conventional treatments available at the time.

Taping was introduced not as a cure, but as a means to immediately reduce pain and allow for pain-free movement and muscle re-education. Since then, the technique has been widely adopted and further studied in clinical trials and imaging research.

Understanding the Biomechanics of Maltracking

A key contributor to patellofemoral pain is the lateral maltracking of the patella during knee flexion. Factors that exacerbate this include:

• Delayed or diminished activation of the VMO relative to the vastus lateralis (VL)

• Tightness in the lateral retinaculum or iliotibial band

• Excessive femoral internal rotation, often due to poor gluteal control

• Foot overpronation, causing an increased valgus vector force at the knee and therefore increasing patellar stress

When maltracking persists, the patella fails to engage optimally in the trochlear groove, increasing stress on subchondral bone and surrounding tissues such as the synovial plica and infrapatellar fat pad.

How McConnell Taping Works

The McConnell taping technique uses rigid, non-elastic tape (typically a product such as McConnell Therapeutics Rigid Tape) applied over a protective underlay (such as McConnell Therapeutics Under Tape) to reposition the patella medially often with a lateral tilt correction to stretch the deep lateral retinacular fibres. The goals of taping are to:

• Decrease nociceptive input from irritated peripatellar structures

• Restore more neutral alignment of the patella during dynamic activities

• Enhance proprioceptive feedback, potentially improving motor control

Taping has been shown to provide immediate pain relief during provocative activities such as squatting or stair descent. Additionally, surface EMG studies have demonstrated earlier activation of the VMO and a more balanced quadriceps and gluteal recruitment pattern in taped knees.

Supporting Evidence: What the Research Shows

Several studies have substantiated the effects of McConnell taping:

• McConnell (1986): A long-term case series demonstrated that a combination of taping and exercise yielded a 96% success rate in resolving chondromalacia-related knee pain.

• Crossley et al. (2002): In a randomized controlled trial, patellar taping combined with exercise produced significantly greater improvements in pain and function compared to exercise alone.

• Cowan et al. (2000): Demonstrated that patellar taping improved VMO activation timing in subjects with PFP.

• Djordjevic et al. (2012): Found that medially directed tape significantly reduced pain and altered patellar position during weight-bearing tasks.

• Edmonds et al (2016): Found that taping to unload an inflamed fat pad in patients with knee OA, shifted the muscle activation from the quads to the gluteals during weight bearing as well as improved knee joint loading

These findings confirm that taping is not merely a symptomatic intervention. It influences underlying neuromuscular control and joint biomechanics.

Clinical Integration: Taping and Targeted Rehabilitation

Effective use of the McConnell approach requires more than just tape. A comprehensive rehabilitation plan should include:

• Quadriceps retraining, focusing on VMO endurance and timing

• Hip muscle control and strengthening, particularly gluteus medius and maximus

• Stretching tight structures, as assessed by the physio. This could include the lateral structures (ITB, lateral retinaculum), anterior hip structures, and/or hamstrings.

• Gait and movement retraining to address faulty biomechanics

• Foot orthotics or footwear adjustment, where indicated

Taping facilitates this process by reducing pain and restoring more normal kinematics during rehabilitation exercises.

 Video Demonstration

To view a demonstration of the McConnell taping technique and clinical rationale, watch Jenny McConnell explain the method here: https://www.youtube.com/watch?v=WbHXYnwUwws&t=10s

Final Thoughts: A Proven, Patient-Centred Approach

Patellofemoral pain can be a challenging condition, but with a systematic assessment and an evidence-based plan, outcomes can be significantly improved. The McConnell Taping Approach empowers clinicians to reduce symptoms quickly and build a strong foundation for long-term recovery.

For clinicians seeking clinically validated tools for this method, the McConnell Therapeutics taping system is based directly on the protocols developed through this body of research. Register for clinic access.

References

1. McConnell, J. (1986). The management of chondromalacia patellae: a long term solution. *Aust J Physiother*, 32(4), 215–223.

2. Crossley, K., Cowan, S., Bennell, K., & McConnell, J. (2002). Patellar taping and vasti muscle activity in people with patellofemoral pain. *Med Sci Sports Exerc*, 34(6), 818–823.

3. Cowan, S.M., Bennell, K.L., & Crossley, K.M. (2000). Patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome. *Clin J Sport Med*, 10(4), 238–243.

4. Djordjevic, O.C., Vukicevic, D., Katunac, L., & Kukolj, M. (2012). Effect of patellar taping on pain and patellar alignment in patients with patellofemoral pain syndrome: a randomized controlled study. *Phys Ther Sport*, 13(4), 243–248.

5. Edmonds DW, McConnell J, Ebert JR, Ackland TR, Donnelly CJ. 2016 Biomechanical, neuromuscular and knee pain effects following therapeutic knee taping among patients with knee osteoarthritis during walking gait. Clin Biomech 39:38-43