REHABILITATION
A POSTURAL APPROACH TO THE MANAGEMENT OF
PATELLOFEMORAL PAIN SYNDROME
By Sudhir Daya MCSP, Ashley Shepherd MCSP, Sarah Upjohn MA MCSP
INTRODUCTION This article presents an alternative approach to managing patellofemoral pain syndrome (PFPS). It incorporates princi- ples based on the Alexander technique, with evidence from the fields of behav- iour, motor learning and sports science.
This approach provides: ■ a greater understanding of how the body is designed to function efficiently of increasing awareness of
■ a method
how subconscious habitual movement patterns and postures impose adverse biomechanical stress on joints and soft tissues, therefore interfering with effi- cient functional use
■ an educational and therapeutic process.
The objective is always that with the knowledge and feel of biomechanics and behaviour, patients are able to identify for
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themselves habitual movements and pos- tures that are causing their symptoms. They can then make changes to their movement patterns or posture to reduce adverse biomechanical load and therefore reduce, resolve or prevent symptoms.
Biomechanical forces, generated by some- one’s habitual ‘use’ of themselves over a number of years (or decades) can predis- pose a patient to injury, adversely affect their performance, and produce patholog- ical changes and pain (1).
This is illustrated in the cycle below: Use
(how someone habitually moves, and the postures they habitually adopt)
Change anywhere within this cycle will affect the entire cycle, and can be posi- tive or negative, beneficial or detrimental, healing or harming.
Structure
(soft tissue, joint etc)
Function
(strength, performance available, etc)
Figure 1: Relationship between use, structure and function
We take the view that pain, muscle weak- ness, and soft tissue shortening are symp- tomatic of habitual misuse. Treating these clinical features is symptom management only, and although this is clearly impor- tant, it does not address the cause, and inevitably the patient will suffer a recur- rence of their injury or symptoms. In order to treat the cause, you have to identify movements and postures that are using muscles in shortened or lengthened posi- tions, or that are creating adverse biome- chanical stress. Only then can you help the patient to adopt aligned and balanced movement patterns and postures. This is done by engaging the conscious brain to become aware of movement.
A NEUROLOGICAL PERSPECTIVE With this as a background, we will now
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