PFPS REHABILITATION

PATELLOFEMORAL PAIN SYNDROME CONCEPTS IN ASSESSMENT AND REHABILITATION

By Rachele Quested, Bphty (Hons), MCSP Illiotibial tract

Vastus lateralis

Patellofemoral pain syndrome (PFPS) is a relatively common condition characterised by pain experienced anteriorly to the knee joint during activities such as stair climbing and descending, running, walking uphill, squatting and prolonged sitting.

The patient is usually from an active pop- ulation and finds the pain limits many aspects of their daily function.

These symptoms may coexist with other diagnosed patellofemoral joint (PFJ) or tibiofibular joint (TFJ) pathology, but to state a patient suffers from PFPS the diag- nosis must be made in the absence of any concurrent joint pathology.

The approach outlined here is based on current theories, an extensive literature review and experience and has, at the core, a McConnell approach.

Figure 1: Patellofemoral knee joint

This should include: ● static and dynamic postures from the thoraco-lumbar region down to the foot and ankle ● lower limb alignment and symmetry, patella shape and position ● general muscle tone and willingness to move.

For further

reference please refer to the previous arti- cle on page 9.

Physiotherapy assessment Observation As always with the physical examination, assessment begins with observation.

It is also important to ascertain whether there are any increased stresses being imposed on the PFJ by problems distally or proximally.

This could arise for exam-

ple from a sacroiliac joint dysfunction or an old stiff talocrural joint.

If a patient

is complaining of unilateral symptoms it is more likely that there may be some-

When looking at activation patterns, the relationship between gluteus medius (Gm)

SportEX 15 Figure 2: Passive stabilisers of the patella thing like this lurking in the background.

Muscle balance, again from the spine to the foot and ankle, is also of paramount importance in the assessment.

Under

muscle imbalance comes flexibility, activation and strength.

Obtaining an idea of length of the ham- strings, iliotibial band (ITB), rectus femoris (RF), iliopsoas, adductor, calf muscles and posterior hip structures gives a good idea of overall lower limb tightness.

Biceps femoris

Lateral patellar retinaculum

Patella

Lateral collateral ligament

Lateral retinaculum

Medial retinaculum

Illiotibial tract

©1999 Primal Pictures Ltd

©1999 Primal Pictures Ltd