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Patellar Femoral Pain Syndrome
What it is: generic term for pain on the anterior portion of the knee
- Patella dysplasia
- Femoral condyle dysplasia
- Hip anteversion & tibial torsion
- Foot over pronation
- Coxa vara & increased genu valgum
- Increased Q-angle
- Patella squinting
- IT band tightness
- Lateral retinaculum tight
- Medial retinaculum tight
- Weak VMO vs. VL
- Lateral pull of Biceps femoris, tensor fascia lata & gluteus maximus
- Hip abductor weakness as well as hip external rotator weakness
- Patello-femoral ligament laxity
- Dull, aching pain localized to medial/lateral side
- Anterior knee and/or lateral knee pain
- Localized edema possible
- Pain increased with prolonged sitting, squatting, stair climbing
- Weight bearing activities
Conservative treatment:
- Strengthening/retraining
- Closed kinetic chain w/ biofeedback
- Strengthening focused on:
- Quads, glute medius, abductors, and external rotators
- Flexibility
- Iliotibial band, hamstrings, quadriceps femoris
-Foot orthotics
- McConnel Taping
-Bracing
-Patellar “sparing” activties
Surgical Intervention:
-Lateral retinaculum release
-Proximal alignment procedure
-Distal realignment procedure
-
All borders of patella should be palpated
- Patellar apprehension test
- Ober’s, Ely’s, Thomas test
- Compression of patella
- Retinacula Test
- Lateral step-down test
-Genu valgum
-Genu varum
-Genu recurvatum
Forefoot varus
Excessive subtalar supination
Toeing in
Ipsilateral pelvic lateral rotation
Excessive anterior pelvic tilt, Ankle plantar flexion, Excessive lateral angulation of the tibia, Medial tibial torsion, Excessive hip abduction
Proprioception training, Awareness of knee terminal extension, Biomechanical corrections, Muscular control, Balance of firing between hamstrings and gastrocnemius in conjunction with quads, Weight bearing exercises, Eccentric and concentric control, Gait training, Functional activities
Posterior pelvic tilt, Flexed trunk posture, Excessive thoracic kyphosis
Goniometry measurement of knee extension, Gait analysis, Postural assessment