Passive Adjuncts

The cornerstone of the treatment of a patient with patellofemoral pain is exercise and active rehabilitation. However, some passive adjuncts may help the rehabilitation process.

In this section, you will find information about evidence-based effect of some passive adjuncts such as taping, foot orthotics and bracing.

Taping the knee of a patient with patellofemoral pain can significantly reduce pain during activities like running, walking on stairs and squatting.

Taping interventions for patellofemoral pain published in the literature vary in terms of application (e.g. tailored, untailored). The important distinction related to tailoring is that lateral patellar tilt, glide and rotation are targeted until a minimum 50% pain reduction during a functional task (e.g. step down) is achieved. Untailored taping tends to involve just one strip of tape that targets lateral glide of the patella. The most effective way to tape can be different for each patient, and research shows that tailoring it to patient’s needs may optimise how much pain reduction they get.

Based on the best evidence available, the following taping technique may be worth trying:

 

At least 1 in 4 people with patellofemoral pain is likely to benefit from foot orthoses.

A simple test can show if the patient is likely to benefit:

Is pain decreased when squatting whilst wearing orthotics?

  • Yes? Get a pair.
  • No? Don’t get them.

Why might shoe inserts help?

shoe-inserts
Type of shoe inserts used in research trials.

Research suggests that shoe inserts will significantly help reduce pain in anywhere between 25 and 50% of people with patellofemoral pain over the first 6-12 weeks of treatment. They may also help in the longer term too.

Traditionally, shoe inserts have been provided to patients because they have flat (pronated) feet. However, there is a lot of debate about whether this is the right approach. In people with patellofemoral pain, having flatter feet does not predict strongly whether or not shoe inserts will help. Equally, shoe inserts can help people who are not considered to have flat feet.

A couple of studies have reported that people with flexible feet measured using a specific device are more likely benefit from shoe inserts if they have patellofemoral pain.

One of the simplest ways to work out if shoe inserts will help is to try them during an activity that normally causes pain. If the inserts immediately reduce pain, then they are likely to help. If they do not immediately reduce pain, they are unlikely to help. It is that simple!

In one study, this test was the strongest predictor of success with shoe inserts given to people with patellofemoral pain. In the same study, the amount of foot movement (pronation) occurring during walking also predicted success, but not as well.

Aren’t shoe inserts expensive?

If shoe inserts are customised specifically for the patient, they can be quite expensive. However, research tells us that this is not necessary for most people with patellofemoral pain.

Less expensive prefabricated shoe inserts (usually less than $100) can be used to treat patellofemoral pain. If the patients complete their rehabilitation exercises getting stronger, shoe inserts may only be needed for a short time.

 

Some patients can have allergies to the tape required, or get tired of taping their knee. In these instances, there are bracing options which aim to achieve similar benefits to the tape.

Additionally, using a medially directed realignment brace while exercising leads to better outcomes in patients with patellofemoral pain than exercise alone after 6 and 12 weeks of treatment.

 

 

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