CURRENT CONCEPTS AND TREATMENT OF PATELLOFEMORAL COMPRESSIVE ISSUES

Abstract

Patellofemoral disorders, commonly encountered in sports and orthopedic rehabilitation settings, may result from dysfunction in patellofemoral joint compression. Osseous and soft tissue factors, as well as the mechanical interaction of the two, contribute to increased patellofemoral compression and pain. Treatment of patellofemoral compressive issues is based on identification of contributory impairments. Use of reliable tests and measures is essential in detecting impairments in hip flexor, quadriceps, iliotibial band, hamstrings, and gastrocnemius flexibility, as well as in joint mobility, myofascial restrictions, and proximal muscle weakness. Once relevant impairments are identified, a combination of manual techniques, instrument-assisted methods, and therapeutic exercises are used to address the impairments and promote functional improvements. The purpose of this clinical commentary is to describe the clinical presentation, contributory considerations, and interventions to address patellofemoral joint compressive issues.

Keywords: Flexibility; knee; patellofemoral compression; patellofemoral pain.

Figure 1.

Palpation of the medial facet joint of the patella. The patella should be medially glided to allow for proper palpation of the underside medial facet.

Figure 2.

Modified Thomas Test: evaluation of the hip flexion angle using a goniometer or digital level. The rectus femoris mobility may also be objective with a knee angle measurement.

Figure 3.

Stretching Thomas Test: The Thomas Test maybe transitioned into a manual hip flexor stretch; a rectus femoris stretch maybe included with using leg to increased involved lower extremity flexion angle.

Figure 4.

Half Kneeling Hip Flexor Stretch: Pt high kneels on knee of the lower extremity with the tight hip flexor, with contralateral foot flat on the ground. Pt gentle leans forward until a stretch in felt in the involved LE.

Figure 5.

Ober Test is performed in the sidelying position. To properly lock in the pelvic stability, have the patient grab the table under his lower leg, putting his hip and knee in a flexed position.

Figure 6.

Supine ITB Assessment: The ITB may also be assessed by placing the patient in the supine position and adducting the lower extremity. This angle maybe documented for an objective measurement.