Orthoses & Taping Techniques…
I really hope you’ve enjoyed the first 3 parts of our series exploring how to beat runner’s knee. This short piece will cover the final part of our discussion: treatment adjuncts.
By ‘adjuncts’, we mean any form of passive intervention, requiring no active participation from you as the patient.
In short, adjuncts can be a very useful component of a comprehensive rehabilitation program.
Allow me to stress early-on that these techniques are rarely successful in isolation, shouldn’t be looked to as a long-term solution to your problem. These adjuncts are always best combined with an active intervention (see parts 1 through 3 of this series!).
When using an adjunctive treatment, a clinician should be looking to provide a short-term strategy for reducing pain, to allow for further progression of other treatments.
When thinking about runners knee, the two man adjuncts we will discuss in this post are:
- Orthoses (inserts for your shoes)
- Taping Techniques
Orthoses for Runner’s Knee: Who will benefit?
The answer to this one is slightly challenging. To keep it simple, I would say – some runners – some of the time.
It is not so simple as being inaccurately labeled as having a foot that over-pronates, this is very much a term that we aim to avoid – here’s why.
Despite this, there is no doubting the evidence behind the use of orthoses in patients with runners knee.
The dynamic function of your foot should be factored into the decision as to whether you are likely to benefit from orthoses or not however. If we look to the evidence here, we know that your ‘midfoot width’ is a variable that, if it changes significantly from non weight-bearing to weight-bearing, can predict your likely response.
This is not something that I would advocate you try and measure yourself, but is something that should easily performed by your treating clinician.
I would suggest that clinicians read this excellent paper by Mills et al (2011) for further guidance:
Taping for Runner’s Knee: Who Will Benefit?
The easy answer to this question is – most runners. I often quote 7 out of 10 if I am asked this question by a patient. If we look to the evidence, our current understanding of taping is that we know it is effective, but we are not sure as to why.
Understanding why something works should be of great interest to clinicians and researchers, but please do not let this concern you as a patient. Taping is indicated in the Best Practice Guide for Patellofemoral Pain, published in the BJSM in 2015.
We are also not sure what technique works best. Personally, I prefer flexible tape (sometimes known as kinesio tape), but only because it will allow a greater degree of movement and will generally last longer.
Do not worry about the colour or the brand, a bit like your running shoes; if it is comfortable and it changes your pain, you should be happy. How a clinician applies tape is very person and patient specific and for me it varies dependent on where I think your pain is coming from.
But, if I were asked to demonstrate a technique that would be useful more often than not, I would choose this one:
If taping is successful in changing your runners knee for the better, I would advise that you stick with it for at least the first phase of your rehabilitation (4-6 weeks) and gradually wean off of it from there. If it is not helpful, do not despair; there are lots of other treatments at your disposal.
Take Home Messages
In summary, if you have runners knee, do not be afraid of trying an adjunct. Yes, active rehabilitation should be form the mainstay of your treatment. Yes, adjuncts rarely work in the medium to long term without combining with other treatments.
But, yes, adjuncts can be very useful for changing pain, and this is an undoubted positive. 99% of my patients come to be because of a complaint of pain (and the 1% who do present with no symptoms are usually sent away), so I feel it is my duty to offer them every possible validated tool that I have available in my toolbox.