Friday, August 3, 2018

PT Pathologies: Patellofemoral Syndrome

Patellofemoral syndrome is characterized by pain around the patella, or kneecap, particularly when walking up and down stairs, running, or sitting for long periods of time.  This pain can range from a dull ache under and around the kneecap, or the knee may grind or pop when performing activities.

The cause of patellofemoral syndrome is the irritation of the cartilage on the backside of the patella.  There is a grove at the distal end of the femur the patella moves up and down on as the person moves.  A tendon comes off the quadriceps, the main muscle in the thigh, which attaches to the top of the tibia.  The patella floats within that area.  When the vastus medialis oblique (VMO) gets weakened, the IT band will tighten and pull the patella out of the groove, causing friction and discomfort.  Patellofemoral syndrome is most common in young, female athletes due to the rapid rate of growth weakening the VMO.  Xray, MRI, anthrogram and arthroscopy can all be used as diagnosis tools to look at the surrounding cartilage of the knee.

Treatment options for patellofemoral syndrome consist of rest, ice, taping, a knee sleeve, NSAIDS, physical therapy and surgery.  An important part of physical therapy is strengthening the quadriceps and hips, and stretching the ITB, hamstrings and calf muscles.  Great exercises for this pathology include the 4 way hip exercise that includes, straight leg raises, SL hip abductions, SL adductions and hip extensions.  The VMO can be strengthened by external rotation of the hip with straight leg raise. Keeping up with these exercises combined with lower extremity stretches focusing on the ITB for 20 minutes a day can improve symptoms in approximately 6 weeks.  As the exercises get easier, more reps or weight can be added to increase difficulty.

In Summary:

  • Causes damage to the articular cartilage of the patella ranging from softening to complete cartilage destruction resulting in exposure of subchondral bone.
  • Etiology is unknown, however, it is extremely common during adolescence, is more prevelant in females than males and has a direct association with activity level
  • Management includes controlling edema, stretching, strengthening, improving range of motion and activity modification.

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