McConnell Test: Purpose, Procedure, and Clinical Significance for Knee Pain

What is McConnell test for?

The McConnell test is a clinical assessment primarily used to help diagnose Patellofemoral Pain Syndrome (PFPS) by identifying if abnormal patellar tracking or malalignment is a contributing factor to anterior knee pain.

Understanding the McConnell Test

Named after Australian physiotherapist Jenny McConnell, the McConnell test is not a measure of strength or endurance, but rather a diagnostic maneuver. It is designed to assess the influence of patellar position on anterior knee pain, a common complaint among athletes and active individuals. The test directly addresses the mechanics of the patellofemoral joint, which is the articulation between the kneecap (patella) and the thigh bone (femur).

The Purpose: Diagnosing Patellofemoral Pain Syndrome (PFPS)

The primary purpose of the McConnell test is to differentiate the various potential causes of anterior knee pain, specifically honing in on those cases where the patella's position or movement relative to the femur is a significant pain generator.

• Key Principles: The test operates on the principle that if pain originating from the patellofemoral joint is due to poor patellar tracking (e.g., excessive lateral glide or tilt), manually correcting this position should alleviate or significantly reduce the pain. This temporary correction is typically achieved by applying manual pressure or using specific adhesive tape (McConnell taping) to medially glide and/or tilt the patella.
• Mechanism of Action: When the patella tracks improperly, it can lead to increased stress and uneven loading on the articular cartilage surfaces of the patella and femur. This can irritate the underlying subchondral bone, synovium, or retinacular structures, leading to pain. By manually repositioning the patella more medially, the test aims to normalize the contact pressures within the patellofemoral joint, thereby reducing the painful stimuli if maltracking is indeed the primary issue.

How the Test is Performed

The McConnell test typically involves assessing pain during an isometric quadriceps contraction, then reassessing pain after the patella has been manually repositioned.

• Patient Positioning: The patient is usually seated with their knee flexed to 90 degrees, or supine with the knee extended. The examiner stands beside the patient.
• Execution:
  1. Baseline Pain Assessment: The examiner asks the patient to perform an isometric quadriceps contraction (e.g., pushing their heel into the examination table or extending their knee against resistance) at various angles of knee flexion (commonly 0, 30, 60, and 90 degrees). The patient reports any pain experienced and its intensity.
  2. Patellar Repositioning: While the patient relaxes, the examiner manually glides the patella medially and/or tilts it to correct any observed lateral malalignment. This repositioning can be maintained by the examiner's hand or by applying McConnell taping.
  3. Re-assessment: With the patella held in the corrected position, the patient is again asked to perform the isometric quadriceps contraction at the same knee flexion angles.
  4. Comparison: The patient's pain levels from the baseline contraction are compared to the pain levels experienced with the patella repositioned.
• Interpretation: A positive McConnell test is indicated by a significant reduction or complete abolition of pain during the isometric contraction when the patella is held in a medially corrected position. This suggests that patellar maltracking is a contributing factor to the patient's anterior knee pain.

Clinical Significance and Limitations

The McConnell test is a valuable tool within a comprehensive musculoskeletal assessment, but it's important to understand its place and limitations.

• Advantages:
  • Simple and Non-Invasive: It can be performed quickly in a clinical setting without special equipment.
  • Immediate Feedback: Provides immediate information about the potential role of patellar position in pain generation.
  • Guides Treatment: A positive test strongly suggests that interventions aimed at improving patellar tracking (e.g., McConnell taping, vastus medialis obliquus (VMO) strengthening, addressing lateral retinaculum tightness) may be beneficial.
• Disadvantages/Considerations:
  • Subjectivity: The test relies on the patient's subjective report of pain reduction, which can be influenced by various factors.
  • Not Definitive: A positive test indicates a component of patellar maltracking but does not rule out other contributing factors to PFPS, such as hip muscle weakness, foot biomechanics, or training errors.
  • Requires Skill: Proper execution of the patellar glide and understanding of patellar anatomy are crucial for accurate results.
  • Limited Diagnostic Specificity: While helpful, it doesn't pinpoint the underlying cause of the maltracking (e.g., muscle imbalance, structural variations).

Beyond the Test: Management of PFPS

If the McConnell test is positive, it guides clinicians toward interventions that focus on optimizing patellar mechanics. Common strategies for managing PFPS often include:

• McConnell Taping: Application of rigid athletic tape to hold the patella in a corrected position during activity.
• Therapeutic Exercise: Strengthening the vastus medialis obliquus (VMO) to improve medial patellar pull, and strengthening hip abductors and external rotators to control femoral rotation.
• Flexibility Training: Stretching tight structures like the lateral retinaculum, iliotibial band, hamstrings, and quadriceps.
• Activity Modification: Adjusting training loads, surfaces, and footwear to reduce stress on the patellofemoral joint.
• Orthotics: Addressing foot biomechanics with custom or off-the-shelf orthotics if overpronation is a contributing factor.

Conclusion

The McConnell test serves as an important diagnostic aid in the assessment of anterior knee pain, particularly for individuals suspected of having Patellofemoral Pain Syndrome. By transiently correcting patellar position, it helps clinicians identify if abnormal patellar tracking is a significant source of pain. While not a standalone diagnostic tool, a positive McConnell test provides valuable insights that can effectively guide targeted rehabilitation strategies, ultimately leading to more effective management of patellofemoral pain.