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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 2 Patellofemoral Joint Syndrome 2 Patellofemoral Joint Syndrome 3 Patellofemoral Joint Syndrome 4