wk 9- knee pain Flashcards
knee pathology of bone
stress fracture of patella
knee pathology of soft tissue
patella tendinopathy
ITB friction syndrome
quad tendinopathy
infrapatella bursitis
fat pad impingement
os goods schlatters diease
bakers cyst
knee pathology of joint
patellofemoral pain
medial compartment OA
knee pathology of nerves
referred pain
patellofemoral pain syndrome
pain around or behind the patella in the absence of other pathologyies
can involve structures like
cartilage
bone
retinaculum
fat pad
what does the patella do during extension flexion
extension- patella sits laterally to trochlea
flexion -patella moves medially to lie withinintercondylar notch
130deg of flexion- moves laterally
movement is controlled by VMO and vastus lateralis and should stay within trochlea groove
when is PFJP aggrevated
squatting, walking up stairs, running, bounding, when the knee is flexed with load going through it
intrinsic and extrinisic risk factors of PFJP
ext:
1. GRF
2. surface/footwear
3. speed/mass
4. type of movement
intrin:
1. increased hip internal rotation
2. increased hip aduction
3.increased knee valgus
4. increased tibial external rotation
5. pronated foot type
6. lack of sagittal plane motions
7. inadequate flexibility of knee
8. trunk contralateral drop/anterior lean
9. patella positioning
key features of PFJP
onset during
running, steps/stairs, hills, weightbearing activities with knee flexion
vague pain
may click or have crepitus
quad contraction may be painful
restricted medial glide
functional testing: squats, stairs
taping should decrease pain
imaging for PFJP
x ray - skyline patella,knee 30eg flexion
CT
MRI
management options for PFJP
- rest
- exercise
-Quads retraining: (contract VMO, palpating or taping for sensory feedback helps)
-hip retraining: strengthen abductors, external rotations and extensors to control medial knee
-strengthening and endurance to imrpove function and pain - taping- reduces pain, helps activate VMO, positioning of patella- medial glide taping
- manual therapy
- foot orthoses- prefab
- bracing-maintains medial glide
patellar tendinopathy features
common in basketballers, long and high jumpers
onset during, change of direction, cutting and jumping activities
inferior pole of patella pain
no swelling, no clicking, no crepitus
normal ROM and movement
quad contraction painful
taping doesnt help
imaging for patella tendinopathy
US
MRI
management of patella tendinopathy
- deload/rest
- improve landing technique
- biomechical correction (ankle ROM, flexibility in hamstring, calf and quad, weakness of glutes, quad and cal)
- progressively load tendon with strength 4 stages protocol
isometric 1 month
isotonic 2 months
energy storage 1 month
energy storge and release 2 months
sport specific 6 months of rehab point - surgery - only if conservative failed
recovery can take between 3-6months or up to a year for long standing cases/return to sport
additional treamtent options for patella tendinopathy for biomechanical correction
- soft tissue therapy of quads, hammy and calf muscles
-friction massage
-myofascial release
-trigger point
