patello femoral symptoms

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ginger -> patello femoral symptoms (January 15, 2006 5:57:00 PM)
Case #1. Ms Jennifer K. 24 y.o. triathlete. 168cms 55 kgs. preparing for half ironman event in feb 06. C'o L patello femoral pain 3 wks , gradual onset, felt at inferior pole3/10, superior pole and medial aspect of patella 6/10. pain increases after long ride ( 2hours + ), mostly felt during run, worse with distance till unable to continue. Able to elicit medial patella/knee pain with half squat .L. Obs. L knee ,some puffiness and extra capsular swelling at initial exam, jan 6th 06, r knee NAD. Hams calves show some loss of flexibility L>R, Possible tight dura L femoral, stretch elicits some patellofemoral pain.( prone hip ext/knee flexion ) Hypomobile L>>R L3, some tenderness at L L2 and L4 with mobilising force eliciting pain to anterior thigh with mobs at L3. Poor recruitment pattern of L>>R VMO. L SIJ immobile, R NAD. No pronation observed in standing ( running not seen), L=R. Treatment #1 3rd Jan. Mobs L L3 15 mins till considerable release felt and no more referred pain elicited to ant. thigh. Stretch L and R femoral dura. Able to squat with no pain to floor. VMO recruitment normalised L=R. Treatment #2, 6th Jan. reports considerable improvemnts to patellofemoral symptoms. No swelling. able to run 6-8 ks without pain, some pain after this distance ( one run am 6th ,stopped when pain felt) Mobs L L3 20 mins, 5 mins each to L L2 and L4 .still relatively hypomobile though less tender , faster resolution with mobs, good signs of improvement to L3 facet joint function, less sensitive with mobs . SIJ mobs ( bodyweight ,standing on sacrum, 2x 3o secs ), full SIJ mobility restored. Further Femoral dural stretches as above, no further stretches needed. Treatment #3 11th Jan. Raced without pain previous sunday, ( olympic distance , podium finish ), no pain with squat, not palpably tender. VMO recruitment NAD. 10 mins mobs L L234. Discharged. This is a typical scenario for patello femoral pain, felt either with or without VMO recruitment difficulty. Medial Knee pain often seen without patello femoral signs respond in the same way , though usually quicker. Hope this is of some interest. I have long ago abandoned patella taping ala Mcconnell, other than as a self help strategy to increase confidence in longer events where the timing of treatment has not permitted full recovery . I don't do any exercise prescription for these people, as it is of little consequence or value. Restoration of L3 function is the only critical issue to allow for full restoration of VMO function and pain free status. This is provided that biomechanical issues have been sorted ( pronation, SIJ dysfunction , leg length difference etc)

nari -> Re: patello femoral symptoms (January 15, 2006 7:08:00 PM)
Ginger I don't necessarily agree totally with the style of mobilisations that you do, but I agree you get results. McConnell's work has been shown to be unnecessarily complicated, and I think from memory, that the taping and exercises have been shown not to match the hype. Particularly with regard to VMO. I ceased using McConnell's method a long time ago because the premise is not right. There can be quite a few reasons for PF pain; but the poor patella is not the cause. Taping works through proprioceptive neuromodulation, as it does for most conditions; it doesn't seem to matter where the tape is. That is, as you say, other things being equal. such as excessive pronation, etc) Nari

FLAOrthoPT -> Re: patello femoral symptoms (January 16, 2006 10:34:00 AM)
curious as to what style of mobs, do you do straight PA mobs in prone, do you do specifric mobs into the restriction away from restriction, FRS type things, etc? I am sure that some people have patella femoral pain mediated at the spine, just not so sure every patient is this way, but I guess in abscence of finding another cause, I can buy it. Ben

ginger -> Re: patello femoral symptoms (January 16, 2006 4:10:00 PM)
Ben, I rarely do straight PA central mobs, that is with my thumb attached to the spinous process, rather a unilateral mobilisation with thumb as close to the joint as possible, in most adults this would be about two to three cms lateral to the spinous process. The method is continuous movements producing pain at the joint, till paravertebral tone and pain is reduced. I haven't seen anyone with PFS in a long time who did not respond to spinal mobs, the strategy I employ that works is, assume it's referred unless proven otherwise. Cheers

FLAOrthoPT -> Re: patello femoral symptoms (January 16, 2006 4:40:00 PM)
now what do you propose you are doing while doing the mob? nourishing the joint, increasing blood flow? decreasing sensitivity in the joint via overloading the nociceptors until they shut down, stretchihng the capsule, pushing paraspinal muscles? Feel free to say all of the above or none of the above. I am always curious as to why people think their mobs work, I personally mainly believe in MET because I think you need to hit the neural component of both the muscle tone fibers and the joint capsule receptors themselves. Still interested, please expound on your technique if you don't mind..that is continous grade 3 ish? with repeated, or continuous holding into end range until end range sinks deeper and deeper...and do you go onto the area of the T-P ? or between the joint spaces? do you position the other joints in max closed positions and open the one you are working on, that is wind up and wind down so to speak? or just in a neutral field? etc, etc? Thanks Ben

ginger -> Re: patello femoral symptoms (January 16, 2006 7:20:00 PM)
Ben just a little short of time to put detail to an answer for you tonight, I'll post more tomorrow, if you go back into the archives you will find in the open forum a post by me called 'the physiology of spinal pain, a theoretical model', this will answer most of your questions, let me know how you get on. Cheers

Nigel Biggs -> Re: patello femoral symptoms (January 18, 2006 4:30:00 AM)
Nari, You say the McConnell sfuff has been shown to be unnecessarily complicated.I'd be interested in any references. Regards, Nigel

nari -> Re: patello femoral symptoms (January 18, 2006 10:04:00 AM)
Nigel, Sorry, I am not at work (extended leave)and cannot access the articles, but if you are able to do a search for McConnell/taping/proprioception you might find the articles which demonstrated that Q angle alteration and taping is not needed, and the pain relief has more to do with a form of neuromodulation than physical alterations. Nari

Mr Baecker -> Re: patello femoral symptoms (February 10, 2006 9:30:00 PM)
dear ginger thanks for sharing your cases! love to hear more! it sounds very interesting what you are describing, reminds me of a physio i know who was working similar, with intermittent pressure on the transversus process. with the idea hunt the pain till its gone. worked pretty good. how do you apply pressure on the sacrum? more on the middle or close to the immobile sij? would love to hear from you.

ginger -> Re: patello femoral symptoms (February 12, 2006 2:11:00 PM)
Mr baecker physio , sacro iliac function is able to restored with minimal effort by applying repeated mobilising forces on the sacrum with your foot. Full bodyweight in my case works well ( I am 80 kgs), place one foot with the other over it , with the pad of the forefoot applied centrally to the sacrum , patient prone. 2 series of 30 second mobs should do it in most cases. Hold onto the wall , effect a maniacle twist to your face and humm softly to add the the effect if you like a little theatre. ( I always keep a straight face though from time to time I'll do a nasal mock bagpipe hornpipe just for the hell of it.) Check function with the "stork " test, details on request. happy jumping.

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