EFFECT OF KINESIO TAPING WITH OPEN KINETIC CHAIN VERSUS CLOSED KINETIC CHAIN EXERCISE IN PATELLOFEMORAL PAIN SYNDROME

Vijeshrajian George 1 , Vincentjeyaraj. D 2 And Sivakumar. V. P. R 3 . 1. Student, SRM College of Physiotherapy. 2. Assistant Professor, SRM College of Physiotherapy. 3. Dean, SRM College of Physiotherapy. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Patellofemoral Pain Syndrome:-
Patellofemoral pain syndrome is a common problem in third and fourth decades of life, characterized by retropatellar pain when ascending and descending stairs, squatting and sitting with flexed knees [1]. After 50 years of age the incidence and prevalence of patellofemoral joint arthritis is more rapidly in women than in men. The incidence rate of patellofemoral pain syndrome among athletes is 25%, which is higher than that of the general population. 10-19% of all athletes have patellofemoral pain and women experience this about 25% in their entire life [5].
Patellofemoral pain syndrome is caused by repetitive stress on the musculotendinous structures which surround the knee and is aggravated in athletes by cycling and running. Symptoms include pain around and anterior to patella, crepitus, tracking, swelling, instability along with stiffness. The symptoms often occur in athletes because of increased intra-articular stress on the patellofemoral joint and are often caused by abnormal biomechanics of athletes, particularly during drop landing [3].
The abnormal position and maltracking of patella could be caused by imbalanced force of muscle pull on patella leads to patellar tracking, during knee flexion and extension with over loading of the joint [7]. Weakness of vastusmedialisobliqus was suggested to cause abnormal patellar tracking in patellofemoral pain syndrome [6]. An imbalance in muscle activities of vastusmedialisobliqus and vastuslateralis muscles leads to lateral patellar tracking during knee extension.Vastusmedialisobliqus is a patellar stabilizer and the weakening of this muscle has been reported to be a predisposing factor of patellofemoral pain syndrome [44].
The quadriceps activates the dynamic patellar movement, and the vastusmedialis oblique (VMO) and vastuslateralis (VL) enable the patella to stabilize during tracking [8].The factors causing patellofemoral pain syndrome include weakness and imbalance of quadriceps muscle, malalignment of lower limb, stiffness of soft tissue and increase in Q-Angle of quadriceps muscle [9]. Q-angle is an angle formed by a line drawn from the Anterior Superior Iliac Spine (ASIS) to mid of patella and a second line drawn from middle of patella to tibial tubercle. Increased Q-angle is a biomechanical factor observed in patellofemoral pain syndrome[11].
Q-angle creates a lateral force on patella and exposes it to lateral displacement during activation of quadriceps. An increase in Q-angle may increase a lateral pull of patella, causing patella to glide on the lateral ridge of femoral groove and produce pain [10].
Current treatment protocols continue to employ kinetic chain exercises despite that there is greater evidence to support the use of kinetic chain exercises to produce optimal activation of the Vastusmedialisobliques. During the activation of open kinetic chain exercise the quadriceps muscle acts isolately, thus favoring the increase in the forces of the patellofemoral compression. The closed kinetic chain exercise generate co-contraction producing higher stability of the joint [12].The open kinetic chain is a movement in which the distal end of the extremity is not fixed to 1117 a relatively stable surface. In closed kinetic chain, movement of a joint cannot occur without causing predictable movements in the other joints of the extremity [13].
Kinesio taping is an organized wrapping technique using Kinesio tape proposed by kase, is claimed to be able to reduce pain, swelling and muscle spasms, as well as to prevent sports injury [14].Kinesio taping is relatively a new technique that has become popular with athletes and clinicians alike in the treatment of musculoskeletal pathologies. It is theorized that the use of Kinesio tape can enhance joint stability by providing support to or affected muscles. The tape can be worn for 3-5 days [18]. Therapeutic effects of knee taping include minimizing pain, increasing muscle strength, improving gait pattern and enhancing functional outcome of patients with sports injury, osteoarthritis and patellofemoralpain [15].
Various conservative treatments, including muscle strengthening exercise, muscle stretching, electrotherapy, knee bracing and patellar taping exist to treat patellofemoral pain syndrome 16 . Physical exercise have long been reported to be effective in strengthening the muscles and soft tissues. It has also been reported that a supervised physical therapy program could reduce pain and improve functions in patients with patellofemoral pain syndrome [17].Although few investigations evaluated patellar pain related impairments in knee joint. Limited studies have detected the combination of open and closed kinetic exercises for quadriceps strengthening [32].The purpose of this study was to compare the effectiveness of Kinesio taping with open and closed kinetic chain exercise in order to relieve pain and improve function of the knee joint activities.

Aim Of The Study:-
The aim of the study is to find out the efficacy of kinesio taping (Neutral) with open versus closed kinetic chain exercise in patellofemoral pain syndrome and to improve the knee Range of motion, muscle strength (Quadriceps) and functional activity of the joint.

Need For The Study:-
Individuals with patellofemoral pain must often overcome variety of problems such as joint pain, stiffness, limitations in joint motion, decreased quadriceps muscle strength and functional limitations, that prevent them from participating in regular activity. Many researchers compared the taping techniques in patellofemoral pain syndrome and concluded that taping is beneficial. Effect of kinesio taping (Neutral) with open versus closed kinetic chain exercise is currently unclear. Hence the need of the study is to evaluate the benefits of kinesio taping (Neutral) with open and closed kinetic chain exercises in patellofemoral pain syndrome.

Procedure:-
This Study was held in SRM Medical college hospital and research centre, SRM physiotherapy Department Kattankulathur. The subjects were included on basis of inclusion and exclusion criteria .30 Subjects were taken on the diagnosis of patellofemoral pain involving the patellofemoral compartment depending on clarks sign. The subjects were assessed according to the assessment chart (Annexure II) and those who satisfied the inclusion criteria were recruited in the study. The subjects were explained in detail about the procedure and informed consent was obtained.
The different types of exercise protocol were explained to the participants. Consent form and pre study information was clearly explained to each participant, prior to the study. The subjects were alternately been placed in each group. 30 subjects were allocated in to two group, i.e Group-A (Open kinetic chain exercise) and Group-B (Closed kinetic chain exercise). Each group has 15 subjects.
The participants were assessed with pre-test which includes pain by Visual analogue scale, flexion and extension of knee joint by universal goniometer, muscle strength by manual muscle testing and functional activity by Western Ontario McMaster Universities Osteoarthritis(WOMAC Index). The participants were blinded to which group they enrolled to.
The neutral Kinesio taping was applied to each patient three day once. The exercises where taught to the participants according to their group. Each exercise was asked to follow 3 sets with 10 repetition per set. The conventional physiotherapy includes interferential therapy . At the end of the session the post test was taken.
At the end of 2 nd week the post test were measured to conform the improvement of pain and functional ability of both the Group. The pre and post test values of Group-A and Group-B were compared finally to find the effectiveness of neutral Kinesio taping in open and closed kinetic chain exercises. The post test values of the both groups were further compared to find the significant results of subjects with patellofemoral pain syndrome.
1119 Data Analysis:-The statistical package for social sciences (SPSS) software version 20.0 was used for data analysis. The statistical tool used in this study were paired" test, Independent t-test. Paired" test was used for analysis of pre-test and posttest means within the groups. The collected data were tabulated and analyzed using descriptive statistics. Whereas independent t-test was used for analysis of comparison between the 2 groups.     Table-3

Discussion:-
Open and closed kinetic exercises have been used by investigators as a rehabilitation protocol for patients with patellofemoral pain syndrome. The aim of the current study was to compare the effectiveness of Open and closed kinetic chain exercise along with Kinesio taping (Neutral) in subjects with patellofemoral pain syndrome.
The result of the current study revealed that both Group-A and Group-B demonstrated a significant increase in overall functions as measured by reduction of WOMAC Index (Western Ontario and McMaster Universities Osteoarthritis) and reduction in pain measured by Visual analogue scale. Although both Groups revealed a significant reduction in the reported pain after undergoing closed and open kinetic chain exercise protocol, the issues of specificity of training and reports lead one to expect that the closed kinetic chain would demonstrate more functional benefits during various activities than the open kinetic chain group. Since the Closed kinetic chain exercises contain more eccentric muscle work, and because it is known that eccentric exercise develops more tension in the muscle and there by obtains a greater training effect. This may be the primary factor in improving function and reducing pain more significant than the Open kinetic chain group.
Many researchers compared the taping techniques in patellofemoral pain syndrome ; Many researchers concluded that taping techniques is beneficial in patellofemoral pain syndrome.
McConnell et al.., concluded that the mechanism of pain relief by taping may be by relieving pressure on the damaged lateral facet of the patellofemoral joint and improving tracking of patella and function of the quadriceps mechanism. week study. The above exposed statement suggests that both the open kinetic chain and closed kinetic chain exercise can be employed to treat the patellofemoral pain syndrome.
In another study Bockrath K et al., (1993) stated Neutral taping is effective in placeing the patella in neutral. The underlying goal of taping is multifaceted and intended to correct the position of patella, increase vastusmedialis oblique activation and stretch the tight lateral structures of patella leading to pain reduction and facilitating strengthening exercises of the quadriceps 43 . Stiene et al, reported excellent results releated to the pain and functionality after treating individuals reporting patellofemoral pain, and concluded that after an eight week treatment, the Closed kinetic chain exercises were more effective than the Open kinetic chain exercises in the functional recovery of individual bearers of patellofemoral disorder.
Hence the current study concluded that Neutral taping of patella is a simple, safe way of providing pain relief which can be followed by open and closed kinetic chain exercise, it can also be implemented to the usual orthopaedic rehabilitation of patients with patellofemoral pain syndrome.