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Physical therapy for patella femoral complaints.

Patella femoral pain syndrome is a collective term for several complaints on the front of the knee, around the patella, or kneecap. The pain is at the front of the knee and is triggered by activities such as climbing stairs, cycling or sitting for longer periods of time with a flexed knee (driving a car or sitting at a desk). The symptoms often develop gradually. Patella femoral pain syndrome is more common in young women at puberty. The reason for this is still unclear but it probably has to do with hormonal changes in the body along with overloading of the knee. That is, the load on the knee has been (temporarily) greater than its load capacity. Some examples are the start of the season, untrained, but also, for example, due to illness or simply an extended vacation. The result is sensitivity of the knee. Previous injuries to the knee also often play a role in the development of patella femoral complaints. The symptoms are often intermittent. Pain-free periods alternate with provoked complaints. Often the complaints are on one side. In some cases also on both sides. However, one side is often more painful than the other knee.

Trochantor major syndrome
Anatomy and function of the knee joint

A joint is a place in the body where two pieces of bone come together. In the knee, this is the femur(upper leg) and the tibia(lower leg). The patella(kneecap) also forms a joint with the femur. Between these bone parts is cartilage which has a very smooth surface so it can move smoothly. To properly control the knee joint, there are different types of ligaments in and around the knee. On the inside and outside are the collateral ligaments. Between the femur and the tibia is the inner and outer meniscus it acts as a shock absorber between these two bone parts. Inside the knee is the anterior and posterior cruciate ligament. The anterior cruciate ligament provides passive stability. Tires, bones, capsules and the position of joints provide passive stability you have no control over. Active stability is controlled by muscles and tendons. So you do have control over this. Active and passive stability together determine how stable a joint is.


Diagnosis of patellar femoral pain syndrome

The diagnosis is often made based on the information from the interview, current symptoms and additional physical examination. Imaging studies such as an X-ray or MRI are not necessary and do not add anything. Various risk factors that may be perpetuating the symptoms are also identified. Risk factors in patellar femoral pain syndrome are:

  • Reduced strength of the hip muscles
  • Abnormal position of the knee
  • Reduced strength of the upper leg muscles
  • Decreased general fitness
  • Previous knee injury

We use various physical tests to assess the function or pain provocation of the patella femoral joint:

Lateral and medial glide test: tij during this test, the physical therapist moves the kneecap from left to right. The patient has the knee in a stretched position on the bench. The degree of mobility of the kneecap is charted. 

Patella apprehension: the kneecap is pushed to the outside by the examiner. In patella femoral complaints, this is often experienced as unpleasant. The person will want to stop this by tightening the muscles vigorously. 

Patella tilt: dhe person lies supine on the couch. The physical therapist tilts the kneecap inward. Thus, the kneecap comes up toward the outside and will provide compression to the inside of the knee. In particular, the structures running on the outside of the knee are tested for stiffness. 

Decline squat test: While the person is standing on an incline on two legs, a squat is performed. The test is positive with recognizable knee pain. The incline puts more pressure on the kneecap resulting in faster provocation of the area to be examined than when a squat is made without an incline.

Kevin van Geel
Treatment of patellar femoral pain syndrome

Successful rehabilitation consists of several stages and steps. Proper strength, stability and control of the knee is necessary to safely return to your daily activities and sports. Exercise therapy is most effective in the treatment of patella femoral complaints. There must be proper coordination between adequate rest, adjustments in daily activities and training. Often structural improvement is noticeable within 12 weeks. In a few cases, taping the kneecap will help. This is primarily a short-term effect. During the first phase of treatment, continued exercise is not recommended. Some pain may even be felt during exercise but should subside again at rest. An average pain score of 3 on a scale of 0-10 is acceptable. However, the pain should not increase from day to day. So if you have more pain during the day as a result of the treatments, a step back should be taken. Over time as the leg strengthens, picking up your sport again is possible. In the meantime there is more of a build-up in strength and function of the muscles around the knee. The final phase focuses mainly on maximum strength, jumping power and explosiveness. This is all necessary to quickly change direction within your sport. Competitive fitness is also worked toward so that you can continue to perform under fatigue. The quality of movement must remain good under these conditions.

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