Re: Patellofemoral pain

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Re: Patellofemoral pain - June 11, 2006 5:07:00 AM

rwillcott

Posts: 425
Joined: March 20, 2006
From: Canada
Status: offline

nari:

Sorry, my mistake with the SLR reference. I meant to say using the PKB to bias defferent branches of the femoral nerve. Magee describes a biasing technique of the saphenous nerve which can cause symptoms similar to PFS. Also, I've been taught palpation of the medial cutanous branch which can be "twanged" to see if that reproduces the knee pain and of course compare to the asymptomatic side.

As for the PKB, I'm not sure I would rely on this test for determining if it is strictly a neural component causing the knee pain. As you know, the PKB is stressing many different structures and is not very specific.

If performing the PKB, I've been taught to perform in sidelying in order to allow the patient to flex and extend the c-spine. The patient is sidelying with the unaffected side down. The bottom leg is in hip and knee flexion with the patient hugging their knee. Start with the patient in slight neck flexion and extend the hip of the affected side. Determine the range, tone and symptoms. Repeat with the patient in slight neck extension and compare the amount of range, tone and symptoms. If there is a difference in either range, tone or symptoms when the neck is placed in slight extension then suspect a lumbar problem. Then of course compare to the unaffected side. I find this is more specific and eliminates other structures that may be causing pain.

Alex and Chris:

Thanks for the article. This is what I was inquiring about. Alex, when I mentioned sub-grouping patients, I was thinking in terms of determining a set of specific symptoms that would increase the likelihood that a PFS patient would benefit from lumbar spine mobs/manips. Similar to the 5 prediction rules for lumbar spine manipulation.

As for the prediction rules for the knee listed above, is hip IR measured in prone? And a difference of 14 degrees or more between both hips? How was navicular drop measured? Were the patients placed in subtalar neutral first and then measured? Why do you think 16 degrees DF was a predicting factor?

Does someone mind e-mailing me a copy of this article?

Thanks for everyones great input!

Rob

(in reply to tf8560)