PFPS

Question 1

What is PFPS?

Answer 1

An umbrella term used for pain in the PFJ or adjacent tissues. It is a chronic condition with a reoccurrence of 40% after 2 years.

Question 2

What is the cause of PFPS?

Answer 2

Multifactorial Nature:
Most likely brought on by overuse of PFJ with Biomechanical abnormalities, weakness, imbalance or dysfunction.

Question 3

Clinically reason possible explanations for the following phenomena:
Pain when sitting with a flexed knee (cinema sign)

Answer 3

Due to tightness in quadriceps, sitting in this position for a prolonged time compressed the painful PFJ.

Question 4

Explain how the biomechanical issue of over-pronation or supination of the foot may explain the development of PFPS?

Answer 4

Pronation causes a compensatory internal rotation of the tibia.
Supination provides less cushioning and increased PFJ stress during the ground strike.

Question 5

What is the relationship between PFPS patients and strength of Lower Limb musculature.

Answer 5

Patients with PFPS often show reduced hip abductor strength.
Furthermore they show an increase in hip adduction during running.

Question 6

What is the Clinical Presentation of PFPS?

Answer 6

Anterior Knee Pain.
Aggravated by activities which increase PFJ stress (stairs, sitting with bent knees, kneeling, squatting).

Question 7

What is the diagnosis of PFPS?

Answer 7

• Retro or Peri Patellar pain with exclusion of all other Tibiofemoral Pathologies.
• Reproduced pain during squatting or PFJ loading.

Question 8

Clinically reason possible explanations for the following phenomena:
Pain walking downhill

Answer 8

Loads PFJ with excessive force

Question 9

Clinically reason possible explanations for the following phenomena:
Pain whilst walking uphill

Answer 9

Tight calf muscles and impaired gluteal control

Question 10

Clinically reason possible explanations for the following phenomena:
Pain when wearing high heels

Answer 10

Increased Load on PFJ and increased distal instability

Question 11

Clinically reason possible explanations for the following phenomena:
Pain when sitting with crossed legs

Answer 11

Tightness in ITB, Glut max and TFL.

Question 12

What age group is affected by PFPS?

Answer 12

All ages.

Question 13

What possible interventions exist for the management of PFPS:

Answer 13

Strengthening Quads & Glutes
Education - including special NPRS scale
Patellar Taping
Foot orthosis
Manual Therapy

Question 14

Why is the Spanish Squat such a good exercise

Answer 14

It offsets the tibia so soft tissues of the knee are less stretched and there is less force through the PFJ as a result.

Question 15

What is the NPRS scale for PFPS?

Answer 15

0-2 is good, 3+ will exacerbate pain.

Question 16

What is the front line interventions for PFPS?

Answer 16

Education including activity modification and appropriate rest.
Exercise therapy - strengthening quads and glutes.

Question 17

What is the best exercise for rehabilitation of PFPS, Closed vs Open chain?

Answer 17

Trick Question.
Research has found no significant differences between open and closed chain exercises with respects to functional outcomes.

Question 18

When may foot orthosis be relevant to give a patient suffering from PFPS?

Answer 18

If they show pes planus (low arch) or pes cavus (high arch)

Question 19

Patellar Tendinitis is a DD for PFPS, how would you tell between the two?

Answer 19

Tendinitis = localised pain to inferior pole of patella vs PFPS = Diffuse pain les TOP of patella tendon.