2. INTRODUCTION
Patellofemoral Syndrome –
Anterior knee Pain
Overuse Disorder
Aggravated by one or more activities that involve
loading the patellofemoral joint during weight bearing
on a flexed knee
Diagnosis of exclusion
4. RISK FACTORS
Activities such as Running, Squatting and climbing
upstairs and downstairs
Dynamic Valgus (increases valgus maltracking)
More common in females
Foot abnormalities(rearfoot eversion and pes
pronatus)
Overuse or sudden increase in physical activity level
Patellar Instability
Quadriceps weakness
Trauma
6. HISTORY
Gradual or acute onset (trauma)of anterior knee
pain
Pain area can be peripatellar or retro
patellar(circle sign)
Pain worsens on squatting, running , prolonged
sitting or when ascending or descending steps
Knee giving way or buckling
Exercise history or changes in training
History of trauma
28. TREATMENT
Activity Modification
Pain management – NSAIDs
Ice compression
Muscle Stretching
Hip Strengthening exercises
Quadriceps strengthening- Closed and Open
Kinetic Chain Exercises
Closed Kinetic chain exercises are done with feet
planted to the ground
Like Squat and Leg Press.
Open Chain exercise means the feet change
positions
29. Quadriceps strengthening mainly VMO
Current evidence suggests that VMO cannot be
exercised in isolation
Focused exercises targeting VM strengthening—
1. Straight Leg raise while lying down and foot
pointing laterally
2. While lying down and knee flexed , squeeze the
ball between the knees and bridge lift
3. Squat while squeezing a ball between the knees
Link – VMO Strengthening exercises Dr Jo
30. ADJUNCTIVE TREATMENT
Foot Orthoses- To control over pronation or supination
Bracing and patellar taping- Various studies- Moderate
evidence of support to control rotation of patella
Barefoot running and minimalist shoes- 1 study
showing decreased PFS by 12% in running barefoot
Intraarticular Steroids – very little evidence in favor
Surgery- Patellar alignment, Resurfacing and
Arthroscopy – Effectiveness in various studies is
unclear
31. COMPLICATIONS
Few long term studies suggest General
prognosis of PFS is favorable
At 2 to 8 years, most patients will
generally complaint of mild symptoms
Not all patients return to sporting activity
32. PREVENTION
EXERCISE PROGRAM
Isometric hip abduction against a wall
Forward lunges
Single leg step downs
Single Leg Squats
Stretches for Quadriceps, Iliotibial band ,
hamstrings and calves
33. RETURN TO SPORT OR WORK
BASIC GUIDELINES- Patient should
demonstrate motion equal to that of
uninvolved extremity and strength at
least 80% of the unaffected side
Exclusion means that cannot be attributed to another discrete intra-articular (eg, meniscus tear) or peripatellar (eg, patellar tendinopathy) pathology
Recurvatum means knee bends backwards ie hyperextension at tibiofemoral jointoo high
Alt- Pts born w ih knee cap too high
Grsshopper- lateral patella tilt
Q angle is angle between quadriceps tendon and patellar tendon
Centre of patella to asis and centre to tibial tubercle
Obers test for iliotibial band tightnss
Quad strength tests- single leg sit to stand, step up test, knee flex and ext
Evidence indicates that combining Orthosis with physo has better results