Management of Patellofemoral Pain Flashcards
(36 cards)
What is PFP commonly associated with?
women more than men and associated post ACL or meniscal injury
common in runners
What is likely etiology for PFP?
repetitive micro traumas caused by:
- posture/alignment- Q angle, pronation
- LE Biomechanics- Hip IR, knee valgus
- neuromuscular factors- weak glutes, quad timing
What is a Wiberg classification?
shape of patella
1- normal
2- lateral facet larger
3- lateral facet largest
When is the patella is greater contact with the femur?
90 degrees flexion
least contact at 0 degrees extension
What happens if superficial oblique soft tissues are tight?
there will be a lateral translation of the patella
What happens if the deep transverse soft tissues are tight?
there will be a lateral tilt of the patella
Which soft tissue in the medial compartment is the biggest passive stabilizer of the patella?
medial patella femoral ligament
What are active soft tissue stabilizers of the patella?
quadriceps
What happens if there is swelling in the knee and its effect on the VMO?
only needs 20-30 ml of fluid to inhibit VMO as a result other quad muscles will pull patella laterally
What is the primary role of the patella?
facilitate knee extension , w/o patella quad would have to work twice as hard
What is typical path of the patella during movement?
lateral “C” shape
What are predisposing factors of PFP?
gender, body weight, activity level, type of activity, biomechanical alignment (hips,feet)
What are risk factors of PFP?
- excessive pronation- increases lateral contact surface on patella
- muscle imbalances- quad and hip muscles
- decreased flexion angles-decreases contact area of patella
Why are muscle imbalances a major risk factor of PFP?
” think of the tracks moving under the train”
train is the patella
What is important to remember about most risk factors of PFP?
most of them are modifiable and should be addressed with prevention program
What is typical PP of PFP?
females, insidious onset, anterior, vague, diffuse pain, limited function, quad weakness, joint crepitus, mild swelling, pain with stairs or standing up, “feels like its giving way”
What anatomical features should PT examine during eval?
Q angle, genu valgum, femoral anteversion, lateral tibial tubercle
consider Q angle changes during dynamic activity
How can you determine VMO weakness?
palplate and observe during quad set firing, will most likely be delayed
What is most likely to cause PFP hips or feet?
most likely hips but feet can as well
What is patella alta?
high unstable patella usually found in females, less then 0.8
What is patella baja?
low patella likely in males causing more compression
What is protocol for patella tendinitis?
NSAIDS, ice, restore ROM, restore flexibility and improve strength
What is protocol for patella tendinosis?
active warm up, friction massage, stretch quad, eccentric strengthening (12 weeks)
What is a common diagnosis with similar to PFP?
ITB syndrome - treated in similar ways
