Patellofemoral Dysfunction

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INJURY TITLE

Patellofemoral Dysfunction

 

INJURY OVERVIEW

One of the most common conditions seen in physiotherapy clinics.  There has been a significant debate regarding the cause of this pain and indeed its name has changed many times over the years.  This problem affects athletes and everyday people of all ages.  However, more often than not the symptoms tend to be more severe in the older population.  Perhaps this is because the root causes have gone without investigation for a longer period of time.

 

INJURY IN-DEPTH INFORMATION

It used to be thought that pain was purley down to poor alignment of the kneecap against the femur (thigh bone).  This poor alignment leads to wearing of the cartilage underneath the kneecap and then lead to pain.  However, it has been shown time and time again that the correlation between cartilage wearing (in this instance) and pain is very poor.

 

It is now considered that mechanical stresses can lead to a chemical type irritation of nerve endings around the  front of the knee.  In particular, there is a covering layer to the knee called ‘synovium’ and this has an abundant nerve supply.  If this were to become inflamed, normal activities would aggravate it and symptoms would go on and on.

 

However, it must be noted that a lot of people have poorly aligned kneecaps and they never experience pain whilst others with well aligned kneecaps can suffer.

 

COMMON SIGNS & SYMPTOMS

  • Knee pain on going up and down stairs
  • Pain on walking/ running
  • Difficulty crouching down

 

HOW IS IT ASSESSED

  • Clinical assessment of the knee to check and clear other structures as the cause of pain.
  • Knee strength is tested (and its impact upon pain)
  • Functional tasks like stairs use and walking.
  • Biomechanical tests (hip strength, foot biomechanics, congenital leg differences like tibial torsion)
  • Soft tissue tightness
  • Radiology – X-ray, U/S and MRI

 

 

 

GENERAL TREATMENT

  • Aim to reduce pain and inflammation
  • Correcting patellar position
  • Muscular strengthening
  • Biomechanical correction (? Orthotics)
  • Manual therapy
  • Stretching
  • Acupuncture
  • Injection therapy
  • Possible surgery

 

Exercise Videos: i.e.

  • Rotator cuff strengthening
  • Pec stretch
  • etc

 

WHICH HEALTH PROFESSIONAL TO CONSULT

PHYSIO     X

MEDIC     X

PODIATRY     X

Put an ‘X’ next to each health professional that most commonly deals with this injury.

i.e. tennis elbow would be Physio and Medic as injections are common, whereas for muscular LBP it would be Physio and not Medic as they would just refer them to a Physio.

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