Patellofemoral Pain CPG

Question 1

Patellofemoral Pain CPG: Diagnosis

Answer 1

A level: use reproduction of pain with squatting and other functional activities that load the PFJ: stairs
B level: 1 retro or peripatellar pain. 2 pain with squating, stairs, sitting, flexed PFJ. 3 exclusion of all other conditions
C level: patellar tilt test

Question 2

Patellofemoral Pain CPG: Classificiation

Answer 2

Expert opinion

1. Overuse/overload: hx of load increase
2. Muscle performance deficits: weak hip and quad
3. Movement coordination deficits: poorly controled knee valgus during dynamic tasks
4. Mobility impairments: hypermobility of foot, flecibility deficit of hamstring, quad, gastroc, soleus, lat retinaculum, ITB

Question 3

Patellofemoral Pain CPG: Exam: Outcome measures: activity limitations/self-report measures

Answer 3

A level
Anterior knee pain scale (AKPS)
Knee injury and OA outcome score - PF (KOOS-PF)
Visual analog scale (VAS)
Eng and Pierrynowski Questionnaire (EPQ)

Question 4

Patellofemoral Pain CPG: Exam: activity limitations/physical performance measures

Answer 4

B level
Tests that reproduce pain and assess coordination:
squatting, step downs, single leg squats

Question 5

Patellofemoral Pain CPG: Exam: activity limitations/physical impairment measures

Answer 5

C level
Measure of patellar provocation
patellar mobility
foot position
hip and thigh muscle strength
muscle length

Question 6

Patellofemoral Pain CPG: Interventions: specific modes of exercise therapy

Answer 6

A level
hip (post-lat) and knee targeted exercises
WB and NWB
early stage preference for hip targeted

Question 7

Patellofemoral Pain CPG: Interventions: Patellar taping

Answer 7

B level
Tailored patellar taping combined with exercise.
Short term - 4 wks

Question 8

Patellofemoral Pain CPG: Intervention: patellofemoral knee orthoses - bracing

Answer 8

B level

AGAINST bracing

Question 9

Patellofemoral Pain CPG: Interventions: Foot orthoses

Answer 9

A level

prefab foot orthotics for greater than normal pronation for 6 wks, combined with exercise

Question 10

Patellofemoral Pain CPG: Internvetions: Biofeedback

Answer 10

B level: don’t use EMG biofeedback for VMO actication

B level: don’t use visual feedback on LE alignment during kin and knee targeted exercises

Question 11

Patellofemoral Pain CPG: Interverntions: Running gait retraining

Answer 11

C level: forefoot strike, increase cadence, reduce peak hip add

Question 12

Patellofemoral Pain CPG: Interventions: BFR training plus high rep knee targeted exercise therapy

Answer 12

F level: can use BFR plus high rep knee exercises for those with painful resisted knee extension

Question 13

Patellofemoral Pain CPG: Interventions: Needling

Answer 13

A level: don’t use dry needling

C level: could use acupuncture to decrease pain

Question 14

Patellofemoral Pain CPG: Interventions: manual as a stand alone

Answer 14

A level: don’t use manual as a stand alone tx

Question 15

Patellofemoral Pain CPG: Interventions: Pt ed

Answer 15

F level: you can give specific pt ed on load management, BW management when appropriate, importance of adherence to active tx like exercise, biomechanics, evidence for tx options

Question 16

Patellofemoral Pain CPG: Interventions: combined interventions

Answer 16

A level: should combine PT interventions