Patellofemoral Dysfunction

[tedclg]

Quick question - if someone has had Patellofemoral Dysfunction for 7 years and it has not been treated during that time, what are the chances that treatment will reverse it completely in approx. 6 months?

[sdkashif]

It is possible that the underlying cause is not properly managed. Have a look over a quick review over patellofemoral Dysfunction.

Patellofemoral pain with malalignment or Biomechanical dysfunction.

This include problems that cause an increased functional Q angle such as femoral anteversion, external tibial torsion, genu valgum and foot hyper pronation. There may be a tight lateral retinaculum, weak VMO, Patella Alta, Patella baja, dysplastic femoral trachlea. There is usually abnormal patellar tracking andf there may be descordent firing of quadriceps.

Patellofemoral Pain with out Malalignment.

These include many subcategories that cause anterior knee pain.

Soft Tissue Lesions which include Plica Syndrome, Fat Pad Syndrome, Tendinitis of patellar or quadriceps tendons, Iliotibial band friction syndrome, prepatellar bursitis.

Tight Medial and lateral retinacula or patellar pressure syndrome.

Osteochondritis Dissecans or patella or femoral trochlea.

Traumatic Patellar chonromalacia.

Patellofemoral Osteoarthritis.

Apophysitis.

Symptomatic Bipartite patella.

Trauma.


Common Impairments:

Impairments that may be associated with patellofemoral Dysfunction include:

Weakness, inhibition, or poor recruitment or timing of vastus medialis oblique

Overstretched medial retinaculum

Restricted lateral retinaculum, IT band or fascial structures around the patella

Decreased medial gliding or medial tipping of patella

Pronated foot

Pain in the retron patellar region

Tight gastrocnemius, soleus, hamstring or rectus femoris muscles

Irritated patellar tendon or subpatellar fat pad

Patellar crepitus, swelling or locking

Management:

Protection Phase:

When symptoms are acute treat as any joint problem with modalities, rest, gentle motion and muscle setting exercies in pain free range or positions. Pain and joint effusion inhibit the quadriceps so it is imperative to reduce the irritating forces. Splinting the patella with a brace a tap may unload the joint and relieve the irritating forces.


Controlled Motion and Return To Function Phase:

When the signs of inflammations are no longer present, mamangementis directed towards corecting the biomechnical forces that may be contributing to the impairments. Suggestions for correcting the faulty patellar alignment or tracking follow.

Increase flexibility of lateral fascia and insertion of IT Band.

Use tap to realign the patella and apply a prolonged stretch as well as maitain alignment of patella for non stressful training.

Identify any tightened muscles that could be contributing to faulty mechanics and establish a stretching programme. Increase the knee flexion and extension by stretching exercises emphasize the muscles that cross two joints.

Train and strengthen the function control of Knee extension in the Non weight bearing position.

As a progression train and strengthen the function control of knee extension in the partial weight bearing and full weight bearing positions.

Modify the biomechanical stresses. If the pateint has a foot pronation, a foot orthosis may relive it. Assess lower limb Mechanics and modify any faulty patterns.

Educate the patient. Untill the knee is symptom free, the patient should avoids the positions and activities that provoke the condition.

Avoid stair climbing and descending untill muscles are strengthened to a level at which they can function without symptoms.

The patient should not sit with bent excessively for long periods.

Use a home exercise programme to reinforce the training and instruct patient how to safely progress.

[ginger]

Patello femoral dyfunction and pain are most commonly referred events from L3.
Percieving this problem as the sequelae of complex local knee biomechanics is just time wasting and certainly frustrating. Restoring normal movements to L3 facet joints with Continuous Mobilsation , will quickly elimininate every feature of this problem , in one to three treatments ( with no attention to the knee at all ). See Rehabedge under manual therapies section for more on Continuous Mobilisation . PFS is a referred problem from the lumbar spine, what you need is a physiotherapist who is trained in spinal facet joint mobilisation, the best are usually Kiwi, Aussie or Canadian. Good luck.