Top 5 Fridays! 5 Points About Patellofemoral Pain

Patellofemoral Pain (forget the syndrome) - let's just call it knee pain, can have many things that trigger it. @physicaltherapyresearch  on instagram recently did a great post series about it below. Give them a follow for more amazing and informative posts. 

🔬📚 Effect of Taping Techniques on Patellofemoral Pain Syndrome 💡 Patellofemoral pain syndrome (PFPS) is a musculoskeletal problem characterized by anterior knee pain with ascending and descending stairs, squatting, running, or prolonged sitting, due to increased compressive loading. 💡 Physical therapy regimens can include knee-taping techniques to reduce pain, restore muscular balance, and reestablish functional activities. . 💡 Logan et al., (2017) systematically reviewed the literature to provide clinical recommendations regarding appropriate use of taping for pain modulation or performance enhancement. 🔬🔬 RESULTS: 235 participants from 5 studies were included. Follow-up time ranged from 45 minutes after taping application to 1 year after intervention. . 🔬 Taping strategies included: (A) Kinesiology taping (B) McConnell 🔬 Taping alone does not significantly reduce pain. There is evidence, however, that knee taping, including placebo taping, combined with exercise provides superior reduction in pain compared with exercise alone. . 🔬 Rehabilitation programs should be multifactorial, with an emphasis on exercise therapy and education, while utilizing adjuncts, such as knee taping, to complement the treatment regimen. . 🔬 Groups including exercise were consistently superior, regardless of whether exercise was coupled with tension or placebo taping. 🔬 Taping may be best utilized as a complement to traditional exercise therapy. 💥💥 LIMITATIONS: Only 5 level 1 RCTs included, inducing potential bias in validity. 💥 Lack of blinding of the treating therapist or patient, leading to performance bias among patients or assessment bias. 💥 Lack of intention-to-treat analyses to enable more reliable estimates of true treatment effectiveness. 💥 The strength of this study would be bolstered if more consistent functional outcome measures were available for analysis. 💭💭 CONCLUSIONS: Knee taping can be an adjunct to traditional exercise therapy. Evidence does not support knee taping utilized in isolation for patellofemoral pain. 📚📚 SOURCE: Logan et al. 2017. Systematic Review of the Effect of Taping Techniques on Patellofemoral Pain Syndrome. Sage.

A post shared by Dalton Urrutia (@physicaltherapyresearch) on Nov 1, 2018 at 1:06am PDT

🔬📚(1/5) Patellofemoral Pain Pathomechanics: Dynamic Valgus 💡 Many factors are involved in PFPS. Over the next few posts I will be covering these factors, including: Pathomechanics Muscular dysfunction Foot Disorder Neurophysiological Psychological 💥💥 A key factor in PFPS development is dynamic knee valgus which leads to lateral patellar maltracking. . 💥 (A) Causes of dynamic valgus malalignement can lead to . (B) Lateral patella maltracking and may arise: 1. Proximally by internal rotation of the femur due to weakness of the hip muscles. 2. Distally by internal rotation of the tibia, or both. 3. Foot abnormalities might be cause for internal rotation of the tibia. 💥 Dynamic valgus malalignment influences patellar tracking because the lateral quadriceps force vector subsequently leads to lateralization of the patella. 🔬🔬 ASSESSMENT: (C) One-legged squats are clinically used to visualize dynamic valgus and can identify people with poor hip muscle function. 🔬 Participants are instructed to squat down on one leg as far as possible five times consecutively, in a slow, controlled manner. 🔬 Based on five functional criteria: 1. Balance 2. Trunk posture 3. Pelvis posture 4. Hip adduction 5. Knee valgus 🔬 Performance is rated as good, fair, or poor. 🔬 Crossley et al (2016), showed that the good performers exhibited greater hip abduction torque and the test can be clinically used to evaluate hip muscle function in patients with PFP. . 🙌🏼🙌🏼 TREATMENT: Evidence suggests patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program Including: Short-term pain relief with NSAIDs Exercise programs targeting lower extremity, hip, and trunk musculature, Medially directed tape or braces Foot orthoses in patients with additional foot abnormalities. . 📚📚 SOURCE: Petersen et al. 2017. Patellofemoral pain in athletes. J Spts Med. 8: 143–154.

A post shared by Dalton Urrutia (@physicaltherapyresearch) on Nov 4, 2018 at 10:27pm PST

🔬📚(2/5) Patellofemoral Pain: Muscular Dysfunction 💡 Many factors are involved in PFPS. Over the next few posts I will be covering these factors, including: 💡 (1)Pathomechanics (2)Muscular dysfunction (3)Foot Disorders (4)Neurophysiological . (5)Psychological 💡 There is strong evidence that muscular imbalances play a key role in the pathogenesis of PFP. 💭 KNEE(A): Imbalance in the activation of m. vastus medialis obliquus and m. vastus lateralis correlates with lateral patellar tracking in PFP patients. 💭 Multiple studies have shown that quadriceps muscle size, strength, and force are impaired in patients with PFOA and quadriceps weakness is considered a risk factor for PFOA. 🏃🏃 HIP(B): However, several studies have focused on and shown dynamic valgus malalignment does not arise in the knee joint but rather through internal rotation of the femur owing to dysfunction of hip external rotators and abductors (m. gluteus medius and minimus). 💡💡 ITB (C): Other muscular abnormalities detected in PFP patients affect the iliotibial tract (m. tensor fascia latae) and the hamstrings. 💡 The influence of the iliotibial tract on patellar tracking may be anatomically explained by Kaplan’s bers, which connect the iliotibial tract to the patella. 💥💥 HAMSTRINGS (D): Also studies have show hamstrings may play a role via greater joint contact forces and joint stresses than healthy subjects via: 1. Hamstring ‘tightness’ 2. Early Lateral vs Medial hamstring activation during isometric exercises. 3. Greater co-contraction of the quadriceps and hamstrings 💥 Although several muscular imbalances have been observed in patients with PFP, altered hip muscle function is considered the main cause of dynamic valgus malalignment in PFP patients. 📚📚 SOURCE: Petersen et al. 2017. Patellofemoral pain in athletes. J Spts Med. 8: 143–154.

A post shared by Dalton Urrutia (@physicaltherapyresearch) on Nov 6, 2018 at 1:18am PST

🔬📚(3/5) Patellofemoral Pain: Foot Disorders 💡 Many factors are involved in PFPS. Over the next few posts I will be covering these factors, including: 💡 (1) Pathomechanics (2) Muscular dysfunction (3) Foot Disorders (4) Neurophysiological . (5) Psychological 💡 My previous post I discussed muscle dysfunction in relation to patellofemoral pain and how altered hip musculature is considered the main contributor to dynamic valgus malalignment in PFP patients. 💡 However, hip muscle dysfunction is not the only contribution to dynamic knee valgus. . 💭💭 Strong evidence suggests foot disorders/deformities can contribute to functional valgus and cause internal rotation of the tibia in patients with PFPS. 💭 A systematic review by Mølgaard et al. (2011), described the kinematic gait characteristics of patients with PFPS and included: 💭 1. Increased rear-foot eversion at heel strike 2. Delayed timing of peak rearfoot eversion 3. Reduced rear-foot eversion range. 💭 Increased navicular drop was also found in high-school students with PFP. 💥💥 Other studies have shown PFP patients had greater forefoot abduction (duck feet). 🔬🔬 In conclusion, evidence, within PFP patients, supports rearfoot and forefoot abnormalities contribute to the pathogenesis of dynamic knee valgus. . 🔬 This could be a chicken-or-egg story though, do foot abnormalities contribute to dynamic knee valgus, or does foot dysfunction arise following dynamic valgus? . 🔬 Thoughts? Comment below! 📚📚 SOURCE: Petersen et al. 2017. Patellofemoral pain in athletes. J Spts Med. 8: 143–154.

A post shared by Dalton Urrutia (@physicaltherapyresearch) on Nov 6, 2018 at 10:39pm PST

📚🔬(4/5) Patellofemoral Pain: Neurophysiological 💡 Many factors are involved in PFPS. Over the next few posts I will be covering these factors, including: 💡 (1) Pathomechanics (2) Muscular dysfunction (3) Foot Disorders (4) Neurophysiological . (5) Psychological 💡 The exact source of the pain experienced by patients with PFP is unclear. However there are sites of higher likelihood, including: . 💥💥 RETINACULAR INNERVATION: Peterson et al. (2014), showed the site of pain most likely develops in 1. Insertions of the extensor muscles 2. Within the subchondral bone. 💥 (A) In an experimental arthroscopy performed using local skin anesthesia, a patient experienced strong pain when the probe touched Retinacula Hoffas fat pad Peripatellar synovium. 💥 Several neurotransmitters have been found within these structures, including: Substance P Neuro lament protein S-100 protein Neural growth factor 💥 Suggesting Retinacular innervation may play a key role in the development of anterior knee pain. . 💥 (B) However, there is also evidence the pain may originate in the Subchondral bone. A PET CT study by Kettunen et al. (2005), demonstrated increased metabolic bone activity in patients with PFP. 💭💭 While the site of pain is an important factor to understand the pathology involved in PFPS, more than just anatomy contributes to this condition. The next post will cover the psychological involvement in PFPS. 🎥🎥🎥 Turn on post notifications to make sure you don’t miss it! 📚📚📚 SOURCE: Petersen et al. 2017. Patellofemoral pain in athletes. J Spts Med. 8: 143–154.

A post shared by Dalton Urrutia (@physicaltherapyresearch) on Nov 8, 2018 at 1:15am PST

Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

Learn more online!

Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...