Knee P! with Muscle Function, Movement Coordination and Mobility Impairments

Question 1

With this, what is the age range that this occurs, with the highest prevalance?

Answer 1

12 to 19 years old

This is not a self-limiting condition

Question 2

What is the MOI for these patients?

Answer 2

Insidious onset
- Gradual onset of Sx

Question 3

Where would these patients feel the pain?

Answer 3

• Retro patellar or Peripatellar pain
• Pain quality poorly described

Retro patellar refers to pain arising from pressure on the back of the patella

Question 4

What are the Agg/Ease factors for these patients?

Answer 4

Agg
- Squatting
- Ascending/Descending stairs

Ease
- Decrease load/rest

Question 5

With these patients, what are Objective Findings that you may see?

Answer 5

• Reproduction of retropatellar or peripatellar pain with squatting, stair climbing, prolonged sitting
• (+) Patellar Tilt Test
• Exclusion of other possible sources of Anterior Knee Pain

Question 6

With these patients, what Objective Findings would we see with Patellofemoral pain with Muscle Performance Deficits?

Answer 6

• HipSIT: Hip Stability Isometric Test
• LE Strength Decreased:
  -Hip Abductors
  -Hip ERs
  -Quads
  -Hamstings

This is the HipSIT test

The HipSIT test evaluates the strength of the hip posterolateral stabilizers in a position that favors greater activation of the Glute Max and Med and lower activation of the TFL. (positioned in 45° hip flexion and 90° knee flexion in sidelying)

Question 7

With these patients, with objective findings, what test can we do for Overuse/Overload? What would it reproduce?

Answer 7

• Eccentric Step-down Test
• Reproduction of Anterior Knee Pain

Question 8

If there is an absence of increased load from the subjective Hx and they are complaining of the peri/retropatellar knee pain what can the primary impairment be related to? How can this be identified, what test?

Answer 8

Patellofemoral Pain with Movement Coordination Deficit

Can be identifed by:
- Dynamic valgus on lateral step down Test
- Frontal plane valgus during single leg squat Test

Question 9

With Patellofemoral pain with Mobilty Deficits, what Objective Finds would we see?

Answer 9

AROM
- Hip IR and ER limited

We would do Foot Mobility Testing

Hypomobility
- Patellar Tilt Test of Lateral Pateller Retinaculum

MLTs
- Hamstrings - SLR
- Gastroc
- Soleus
- Quads
- IT : Ober’s Test

Question 10

With these patients, what would be done for Interventions?

Answer 10

• Exercise therapy with combined hip and knee targeted exercises
• Patellar taping
• Foot orthoses - short-term use
• Patellar Mobilizations with exercise
• Lower limb stretching
• Patient education
• Run gait rand movement retraining

Question 11

With these patients, what Interventions do we not do?

Answer 11

• EMG based biofeedback to Medial Vastii
• Visual feedback
• Dry needling
• Biophysical Agents:
  -Ultrasound, Cryotherapy, Phonphoresis, Lontophoresis, Laser
  -Electrical Stim