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Conférence de Alfio Albasini aux JFK 2011

Conférence de Alfio Albasini aux JFK 2011

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    Albasini jfk2011 Albasini jfk2011 Presentation Transcript

    • Alfio Albasini PT, PostGradManipTherapAdjunct Fellow, Università Svizzera Italiana (USI) Member of CEC, Otto Bock Healthcare International Presenter, McConnell & NDS alfioalbasini@ticino.com Switzerland
    • Jenny McConnell  McConnell J, The management of chondromalacia patellae: a long term solution. Aust J Physiother 1986, 32:215-23.
    • Original Hypothesis shifting mechanically the patella medially with the tape (medial glide) would correct the patella position,stretch the tight lateral structures, increase the activity of the VMO muscle, decrease pain thus allowing the patient to start strengthening the 4-ceps with specific exercises.
    • Assessment of patella malalignmentHerrington LC, Man Ther, 2002;7:163-167
    • Medial Glide of the Patella
    • Effect of taping the patella onpatellofemoral pain sufferers reduces pain (Bockrath et al 1991, Conway et al 1992, Cushnagen et al 1994, Cerny 1995, Powers et al 1997, Gilleard et al 1998, Crossley et al 2000, Hinmann et al 2003 Whittingham et al 2004, ).
    • Efficacy on Knee Tape in the management ofosteoarthritis of the knee: blinded randomisedcontrolled trial  Hypothesis: taping decrease P in OA pat also after treatment ???  87 patients with symptoms of knee osteoarthritis  Therapeutic Tape: medial glide, lat. Tilt , AP Tilt and Hoffa Fat pad Control Tape and No Tape  Three weeks duration and follow up after three weeks of stop of treatment Rana S Hinman, Kay M Crossley, Jenny McConnell, Kim L Bennell, BJM 2003;327:135
    • Efficacy on Knee Tape in the management ofosteoarthritis of the knee: blinded randomisedcontrolled trialChange in P after 3 weeks: Therapeutic Tape 73% of improvement Control Tape 49 % No Tape 10% Benefit of therapeutic tape was maintained also after three weeks follow upRana S Hinman, Kay M Crossley, Jenny McConnell, Kim LBennell, BJM 2003;327:135
    • Acute effects of patella taping onpatella position 12 asymptomatic subjects  6 male, 6 female  Age 20.4(+/- 1.2) years Pre-post ultrasound measurements Intervention: patella medial tilt tapeHerrington, L. (2009) The effect of patella taping on patella position measuredusing ultrasound scanning The Knee (under review)
    • No tape With tape in-situ Deep lateral retinaculumPatella Patella Lateral femoral Lateral femoral condyle condyleNoteDistance between patella & lateral femoral condyle (red line) increases withtape; patella is tilted mediallyOrientation of deep lateral retinaculum changes (solid line) Herrington, L. (2009) The effect of patella taping on patella position measured using ultrasound scanning The Knee (under review)
    • Results Patella taping P=0.0032 12 10 8 Patella position (mm) 6 4 2 0 Pre PostHerrington, L. (2009) The effect of patella taping on patella position measuredusing ultrasound scanning The Knee (under review)
    • 1. Patellofemoral pain syndrome: clinical features2. Pathomecanical hypotheses: local-, proximal-, distal factors3. Predicting success with multimodal treatment approach4. Clinical efficacy
    • Patellofemoral pain syndrome: clinical features Etiology of PFPS is multifactorial in nature One of the most prevalent conditions in active people (7- 15%), rates at sports medicine betw. 2- 30% 25% have symptoms 16 years later (Nimon et al 1998)
    • Pathomecanical hypotheses:
    • Pathomecanical hypotheses:local factors Maltracking of the patella
    • Pathomecanical hypotheses:local factors: VMOVastus Medialis Oblique (VMO) insufficiency, important stabilizer (Elias et al 2009) Timing Endurance Magnitude 25 msVMO VL
    • Pathomecanical hypothesesproximal factors 1: hip Evidence suggests that patients with PFPS demonstrate altered hip kinematic in the frontal and traverse plane during various taks (Souza et al 2009) Females with PFPS demonstrate hip abduction & external rotation weakness (Bolgla et al 2008) Some individual with PFPS have delayed gluteus medius activity during steping tasks (Cowan et al 2009)
    • Pathomecanical hypothesesproximal factors 1: hip (Powers et al., J Orthop Sports Phys Ther, 2003; Doucette & Child; J Orthop Sports Phys Ther, 1996)
    • Altered hip and trunk musclefunction in individuals with PFP
    • Altered hip and trunk musclefunction in individuals with PFP
    • Pathomecanical hypothesesproximal factors 2 : trunk
    • Pathomecanical hypotheses distal factors:footPronated Foot on Limb Alignment
    • Interventions: Taping of the Foot
    • Interventions: Foot orthoses Vicenzino, Collins, Crossley et al (2008), BMC Musculoskelet Disord, 9:27
    • Taping the foot or using orthoses, effectiveness ?  Bill Vicenzino’s work  179 participants (100 women) 18-40 y.o. with PFPS > 6/52 without Tretament preceeding the test 12/12  6/52 PT, flat inserts, foot orthoses, combination of foot orth. & PT  Foot orthoses improvement in short term; no difference if added to PTFoot orthoses and physiotherapy in the treatment of patellofemoral painSyndrome: randomised clinical trial, Colling et al BMJ 2008; 337: a1735
    • Take home message PFPS does not have a homogenous presentations PFPS is only one part of the problem Not every patient with PFPS has the same “abnormalities” Standard treatment for PFPS does not exist Clinician should incorporate the information gained from their clinical assessment of each patient & Use clinical reasoning to ensure that the treatment is patient specific
    • What about the shoulder ? The effect of tape on glenohumeral rotation range of motion in elite junior tennis players 11 male (mean age 16.8±1.3 years) and 10 female (mean age 14.9±0.8 years) elite junior tennis players Two measurements of passive external rotation and internal rotation ROM were made using a universal goniometer with an attached spirit- level under three randomly ordered conditions  Control  Tape  Sham Tape
    • THANK YOUalfioalbasini@ticino.com