Download Patellofemoral Joint Syndrome

Patellofemoral Joint Syndrome
Anatomy:
The patella (kneecap) is the moveable bone on the front of the
knee. This unique bone is wrapped inside a tendon that
connects the large muscles on the front of the thigh (quadriceps)
to the tibia (shinbone). The large quadriceps tendon together
with the patella is called the quadriceps/extensor mechanism.
Tightening up the quadriceps muscles places a pull on the
tendons of the quadriceps mechanism. This action causes the
knee to straighten. The patella acts like a fulcrum to increase the
force of the quadriceps muscles. The underside of the patella is
covered with articular cartilage, the smooth, slippery coverying
found on the joint surfaces. This covering helps the patella glide
(or track) in a special groove (femoral groove) made by the
femur (thigh bone). Two muscles of the thigh attach to the
patella and help control its position in the femoral groove as the
leg straightens. These muscles are the vastus medialis obliquus
(VMO) and the vastus lateralis (VL). The VMO runs along the
inside of the thigh, and the VL lies along the outside of the thigh.
If the timing between these two muscles is off, the patella may
be pulled off track.
Causes/Mechanisms of Injury:
• Improper tracking of patella in the intercondylar groove of the femur during flexion and
extension
• Subtler pronation and pes planus causing tibial internal rotation
• Hip internal rotation
• Muscle weakness of VMO, hip abductors and hip external rotators
• Muscle tightness of IT-band, TFL, piriformis, lateral patella retinaculum
• Increased Q-angle due to weak abductors
• Overweight and obesity
• Trauma
• Hypermobility of the patella
• Repetitive kneeling, squatting or stair climbing
Symptoms:
A dull, aching pain usually occurs under or around the front of the patella (kneecap) where it
connects with the lower end of the femur (thighbone). Pain occurs when walking up or down
stairs, kneeling, squatting, and sitting with a bent knee for long periods of time. Some people may
report a sensation like the patella is slipping. The knee may grind, or you may hear a crunching
sound when you squat or go up and down stairs. If there is a considerable amount of wear and
tear, you may feel popping or clicking as you bend your knee. The knee may swell with heavy use
and become stiff and tight.
Norman
2475 Boardwalk
Norman, OK 73069
PH (405) 447-1991
Newcastle
2340 N.W. 32nd
Newcastle, OK 73065
PH (405) 392-3322
www.TherapyInMotion.net
Purcell
2132 N. Green Ave
Purcell, OK 73080
PH (405) 527-1500
Patellofemoral Joint Syndrome
Treatment/Management:
• Myofascial release lateral knee structures
• Joint mobilization of patella, femur, tibia, fibula
• Orthotics
• McConnel taping and bracing
• Neuromuscular stimulation of the VMO
• Correcting LE Poor biomechanics
Exercises/Post Op Protocol:
• Stretch – ITB, TFL, Piriformis, hamstring, gastrocnemius and soleus, lateral patellar
retinaculum
• Multiplanar
o ITB/Hamstrings/Calves
o TFL/Piriformis
o Quadriceps/Psoas
o Peroneals/Quadratus Lumborum/TFL/ITB
• Strengthen – VMO, quadriceps, hip abductors, extensors, external rotators, and core
• Functional Exercises
• Wall/ball squat with theraband on foam
• Single-leg squat with reaching posterior and lateral
• Theraband monster walk with trunk rotation
• Medicine ball single leg quad-dips
• Medicine ball knee dives
• Step up and down with theraband resistance in mirror
• Bosu plus water ball switch ups
• AVOID – open chain knee extension, pain, popping and grinding, incline walking, deep
squat’s and stairs
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