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TO COMPARE THE EFFECTIVENESS BETWEEN PRE EXERCISE TAPING
AND POST EXERCISE TAPING IN IMPROVING PAIN AND FUNCTIONAL
OUTCOME IN KNEE OSTEOARTHRITIS

Parul R*, Vishal G**, Deepak R***, Monika S****


ABSTRACT
Aim: To compare the effectiveness between pre exercise taping and post exercise taping in improving
pain and functional outcome in knee osteoarthritis. Background: A large body of research has been
conducted to analyze the effect patellar taping in patients with knee osteoarthritis. But non e of the
studies have compared whether pre exercise taping or post exercise taping is beneficial in the
treatment of knee osteoarthritis. Thus in this study it is intended to check the efficacy of pre exercise
taping or post exercise taping to improve the pain and functional outcome of the patient. Methods: A
total of 30 subjects were selected with age group 40-60yrs. diagnosed osteoarthritis of knee. They
were randomly divided into three groups. Each groups having 10 subjects, Group A received
conventional treatment. Group B received conventional treatment and pre-exercise taping and group C
received conventional treatment and post- exercise taping. Result: The comparisons concluded that
for improving WOMAC in knee OA patients, both Group B and Group C are more effective than Group
A. The comparisons concluded that all three treatments are effective for improving pain in knee OA
patients. The significance level was set at p0.05. Conclusion: The Study concludes by stating that
null hypothesis is rejected as results of the study suggest that post exercise taping is more effective than
pre exercise taping and conventional treatment in reducing pain and improving functional outcome in
patients with knee osteoarthritis.
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
39
Key words: Taping, WOMAC scale, Osteoarthritis, knee etc.

INTRODUCTION
Knee osteoarthritis is a major public health
concern worldwide and one of the foremost
causes of chronic disability in older adults.
1
Osteoarthritis (OA) is a chronic degenerative
disorder of multifactorial etiology characterized
by loss of articular cartilage, hypertrophy of
bone at the margins, subchondral sclerosis and
range of biochemical and morphological
alterations of the synovial membrane and joint
capsule. Pathological changes in the late stage
of OA include softening, ulceration and focal
disintegration of the articular cartilage;
synovial inflammation also may occur.
2

Osteoarthritis is usually regarded as a non-
inflammatory disease.
3

Knee osteoarthritis was the most common type
(6% of all adults). The likelihood of developing
osteoarthritis increases with age. Studies have
shown that knee osteoarthritis in men aged 60
to 64 is more commonly found in the right knee
(23%) than in the left knee (16.3%), while its
distribution seems to be more evenly balanced
in women (right knee, 24.2%; left knee,
24.7%). The prevalence of osteoarthritis of the
knee is higher among 70- 74 year-olds, rising
as high as 40%.
4
Osteoarthritis (OA) affects
more than 21 million people in the U.S., with
36% of elderly Americans aged 70 or older
having some degree of radiographic knee OA.
The prevalence of OA continues to grow as the
population ages.
5
Arthritis affects around 3
million people in Australia, representing about
15% of the population.
6
There are a number of
possible causes for this increase in disease
prevalence with age. Metabolic changes in
cartilage that occur with aging do not parallel
the biochemical changes of osteoarthritis, but
they may make cartilage more susceptible to
fatigue fracture. Joints become increasingly
incongruent with age, and this may leave
previously protected areas vulnerable to injury
(more likely in the hip than in the knee). Bone
underneath the articular cartilage may be made
increasingly stiff from microfractures, and this
loss of compliance in bone may make overlying
cartilage susceptible. Finally, neuromuscular
decline occurs in the elderly years, leaving
joints unprotected by the muscles and tendons
that otherwise serve as shock absorbers.
7
The symptoms of OA, such as pain and
stiffness of the joints and muscle weakness, are
serious risk factors for mobility limitation and
impaired quality of life. Indirect evidence
suggests that muscle strength deficits may be
interrelated and that pain may have a
confounding influence on the measurement of
these factors in knee OA. However, these
relationships have never been clearly
evaluated.
8
The quadriceps weakness
commonly associated with osteoarthritis of the
knee is widely believed to result from disuse
atrophy secondary to pain in the involved joint.
However, quadriceps weakness may be an
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40
etiologic factor in the development of
osteoarthritis.
9
There is no single treatment that is known to
cure OA. Most treatments have aimed at
reducing symptoms or slowing the progression
of the disease and its consequences.
10
In knee osteoarthritis acupuncture, capsaicin,
chondroitin, education to aid self-management,
exercise and physiotherapy, glucosamine,
insoles, intra-articular corticosteroids, intra-
articular hyaluronan, joint bracing, knee
replacement, non-steroidal anti-inflammatory
drugs (including topical non-steroidal anti-
inflammatory drugs), opioid analgesics,
osteotomy, simple analgesics, and taping can be
effective.
11

METHODS
Sample
Size: On the basis of inclusion & exclusion
criteria, 35 subjects were selected for the study
out of which only 30 completed the study.
Three patients were allergic to the tape and two
could not complete the duration of the study
Source : 70 osteoarthritis patients visiting the
MMJ physiotherapy clinic, Noida.
Inclusion Criteria
1, 20

Subjects with age group 40-60 years,
diagnosed by orthopedic surgeon with
unilateral osteoarthritis of knee.
WOMAC score more than 57.
Exclusion Criteria
1, 20

Subject having any deformity of hip and
back
Any neurological problems
Patients with back ache with radiating pain
to legs
Any history of fractures, trauma to knee
joint or muscles
Any metallic implants
Wound on/around knee or thigh
Peripheral vascular disease
Any local or systemic infection
Febrile and mentally deficit participants
Pregnancy
Auto immune disease (eg. Rheumatoid
arthritis, ankylosing spondylitis)
Tumors of hip, knee or leg region
Any spinal deformity
Contraindication to exercise therapy
(unstable angina, blood pressure,
myocardial infarction in previous 3 months,
cardiomyopathy, uncontrolled metabolic
disease, recent ECG changes, advanced
COPD)
VARIABLES
Dependent Variable: VAS, WOMAC scale.
Independent Variables: Pre exercise taping,
Post exercise taping, Conventional treatment
Research Design: Experimental study design.
Sampling Method: Simple randomized
sampling method was used for the selection of
patients and divided into 3 groups.
Study duration: 3 weeks.
INSTRUMENTS AND TOOLS
Quadriceps Table
Sports tape
Goniometer
WOMAC scale
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
41
Stepper

PROCEDURE:
Subjects who full filled the inclusion criteria
were randomly divided into three groups, 10
subjects in each group. The subjects were
requested to fill the consent form and the
voluntary participation form before taking part
in the research.
Group A received conventional treatment i.e.
Ultrasonic therapy (dosage 0.8 W/cm
2
), TENS
and Knee Exercises
Group B received conventional treatment i.e.
Ultrasonic therapy, TENS and Knee Exercises
and pre exercise taping ( Mcconnells Taping to
correct lateral patellar shift)
Group C received conventional treatment i.e.
Ultrasonic therapy, TENS and Knee Exercises
and post exercise taping
The subjects were asked to fill the WOMAC
scale and VAS scale before the start of the
treatment, on 5 sitting and on 10 sitting. After
giving the treatment the data was subjected to
statistical analysis.
RESULTS
The age of Group A, Group B and Group C
ranged from 49.50 3.87 yrs, 52.70 5.48 yrs
and 51.10 6.10 yrs, respectively. Pre and post
WOMAC score between the groups (Table 1).

Table 1: Pre and post WOMAC scores (Mean
SD, n=10) of three groups

Comparing the mean WOMAC scores within
the groups ( Fig. 1), the WOMAC score in all
three group decreased (improved) significantly
(p<0.01 or p<0.001) at both day 9 and day 21
(post treatment) as compared to day 1 (pre
treatment). Further, the mean WOMAC scores
in both groups Group B and Group C also
decreased significantly (p<0.001) at day 21 as
compared to day 9; however, not decreased
significantly (p>0.05) in Group A. The
comparisons concluded that for improving
WOMAC in knee OA patients, both Group B
and Group C are more effective than Group A.
WOMAC (score)
0.00
20.00
40.00
60.00
80.00
100.00
day 0 day 9 day 21
Treatment periods
M
e
a
n


S
D
Group A
Group B
Group C

Fig. 1: Comparative mean WOMAC scores
between the groups.

Similarly, comparing the mean WOMAC
scores between the groups ( Fig. 2), the
WOMAC score of three groups did not differed
(p>0.05) at day 0 i.e. found to be statistically
the same. In others words, WOMAC scores of
three groups were comparable. Further, the
mean WOMAC scores of three groups also not
differed (p>0.05) at both day 9 and day 0,
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indicating that all the three treatments are
equally effective for improving WOMAC in
patients with knee OA.

WOMAC (score)
0.00
20.00
40.00
60.00
80.00
100.00
Group A Group B Group C
Treatment groups
M
e
a
n


S
D
day 0
day 9
day 21

Fig. 2: Comparative mean WOMAC scores
within the groups.
VAS (score)
0.00
2.00
4.00
6.00
8.00
10.00
12.00
Group A Group B Group C
Treatment groups
M
e
a
n


S
D
day 0
day 9
day 21

Fig. 3: Comparative mean VAS scores within
the groups.

Table 5: Pre and post VAS scores (Mean SD,
n=10) of three groups

Comparing the mean VAS scores within the
groups (Table 6 and 7), the VAS score in all
three group decreased (improved) significantly
(p<0.001) at both day 9 and day 21 (post
treatment) as compared to day 1 (pre
treatment). Further, the mean VAS scores in all
three groups also decreased significantly
(p<0.001) at day 21 as compared to day 9. The
comparisons concluded that all three treatments
are effective for improving pain in knee OA
patients.

Table 6: For each group, comparison (p value)
of mean VAS scores within groups (i.e. between
periods) by Tukey HSD test


Table 7: For each period, comparison (p value)
of mean VAS scores between the groups by
Tukey HSD test

DISCUSSION
The aim of the study was to compare the effect
of pre exercise taping with post exercise taping
on pain and functional outcome in patients with
knee osteoarthritis. The results of the study
suggest that all the three protocols were equally
effective in improvement of WOMAC score
within the groups but none proved to be
effective within the group. The VAS score also
showed significant improvements on
comparison within the three groups but Group
C i.e., post exercise taping showed significant
improvements when the results were compared
between the groups.
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
43
This suggests a decline, or even loss, in tape
effectiveness, possibly due to decreased tape
tensile strength or reduced adhesiveness to the
skin.
16
An increase in the stability of the body
or extremities, support or protection of the
joint, the correction of the alignment of the
body or limbs, the modification of the
biomechanics of movements and the promotion
of sensor-motor functions like the
proprioception influence and insignificance
sensory input inhibition might be reasons that
have contributed to the effects of elastic
taping
17.
The tape has been suggested to
stimulate neuromuscular pathways via afferent
feedback. Increased afferent stimulus to large-
diameter nerve fibers might reduce pain
perception level due to an input decrease from
the small diameter nerve fibers conducting
nociception. Many clinicians believe that
bracing and taping provide increased cutaneous
stimuli as well as external support to the joint
that they surround. The increased stimulation of
the cutaneous proprioceptors, provided through
direct or indirect contact between the skin and
the brace or tape, would enhance kinaesthetic
and joint position sense awareness and possibly
help prevent injuries.
18
Patellar taping may
enhance the onset of VMO activity, which may
result in improved patellar tracking. They
suggested that this early activation of the VMO
may be caused by cutaneous stimulation
brought by the patellar tape, although the
precise mechanisms for this phenomenon are
unclear. First, some have suggested that the
mechanical advantage of the quadriceps is
maximized because of increased leverage by
the patella via a medial shift as it returns to the
trochlear groove of the femur. Some
hypothesize that the application of patellar
taping may reduce neural inhibition of the
quadriceps and modulate pain via large afferent
fiber input. This may be attributed to the fact
that large afferent fibre input travels more
rapidly to the brain than pain signals, as
described in the gate control theory and
Castels level I pain theory. Herrington
proposed that patellar taping may lead to
altered large fibre afferent input to the dorsal
horn, decreasing the perceived pain that may be
contributing to quadriceps inhibition. With a
reduction in pain, Herrington27 suggested that
there is potential for restoration of quadriceps
function through increased alpha motor neuron
excitation. Many authors reported a significant
reduction in pain via tape application; however,
evidence is scarce to claim that the reduction in
pain is caused by increased alpha motor neuron
excitability.
19
The application of a simple
patellar taping technique covering 50% of skin
over the knee had effects on areas of the brain
associated with sensation, coordination,
decision making, and planning of complex
coordination tasks and the coordination of the
unconscious aspects of proprioception. There
was decreased activity in the anterior cingulate
and the cerebellum, which are the regions of
interest concerned with proprioception, the
decision making and planning of complex,
coordinated tasks, and the coordination of the
unconscious aspects of proprioception. This
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finding indicates a relative decrease in activity
with the tape on, which could be interpreted as
participants perceiving the task to be easier to
perform with the tape and, as a result, the
activity of the cerebellum and anterior cingulate
was less because these areas did not have to
work as hard.
Because of quadriceps weakness in persons
with knee OA, strengthening exercises have
been demonstrated to benefit static and
dynamic muscle strength and also functional
performance during gait and stair climbing. In
general, strengthening exercises improve the
ability to control the forces at the joint during
dynamic movements, thus potentially reducing
the effects of loading and ensuing pain. The
ability to improve the speed of contraction is
also an important consideration to enhance
functional capabilities.
16
Resistance training
program can potentially counteract the
functional limitations seen in knee OA; positive
associations were found between increased
muscle strength and walking self-efficacy,
reduced pain, improved function, and total
WOMAC score.

Deyle et al demonstrated that
manual therapy techniques and exercises
applied by physical therapists for 8 clinical
visits produced a 52% improvement in self-
reports of function, stiffness, and pain as
measured by the Western Ontario and
McMaster Universities Osteoarthritis Index.
13

Future research
Future studies can be done by extending the
duration of the study.
Instrumental errors cannot be ruled out.
More functional variables could be assessed
to measure the effects of taping in patients
with knee osteoarthritis.
Electromyographic studies can be
conducted further to explain the effect of
taping

Relevance to Clinical Practice
Taping is one of the most commonly used
methods in physiotherapy treatment. The study
helps us to identify that application of tape after
the performance of exercise can help to
improve the pain and functional outcome in
patients with knee osteoarthritis.

CONCLUSION
The Study concludes by stating that null
hypothesis is rejected as results of the study
suggest that post exercise taping is more
effective than pre exercise taping and
conventional treatment in reducing pain and
improving functional outcome in patients with
knee osteoarthritis.

ACKNOWLEDGEMENT
The author acknowledges support of staff of
Santosh medical college and Hospital.

CONFLICT OF INTEREST
There is no conflict of interest.

Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
45
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CORRESPONDING AUTHOR:
*MPT (Cardio-Pulmonary), Assistant Professor, Santosh Medical College and Hospital, Ghaziabad,
Uttar Pradesh. Address: Address: D-2, First floor , Adjacent chetak complex, pocket B & E market,
Dilshad garden, Delhi- 95. Email ID: physio.parul@gmail.com
**MPT (Musculoskeletal).Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh
***MPT (Musculoskeletal), Principal, Santosh Medical College and Hospital, Ghaziabad, Uttar
Pradesh.
****MPT (Neurology), Assistant Professor, Santosh Medical College and Hospital, Ghaziabad, Uttar
Pradesh

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