Continuing journal July, this week I am looking at a journal all about PFP or patellofemoral pain. The journal article- Current Concepts in Biomechanical interventions of Patellofemoral Pain. Which was published in 2015 in the International Journal of Sports Physical Therapy. The two professors on the article are Erick Meira and a leading knee specialist Rich Willy.
PFP is a very common injury among runners especially in female runners and it can occur in new runners or runners that have been running for any years. There are many factors that correlate with symptoms such as strength, flexibility, knee tracking and poor balance. Also depression and anxiety can also hinder the recovery for PFP.
In order for PFP to be rehabilitated correctly then there must be a multi faceted approach because often where you feel pain isn’t necessarily the cause of the pain. This article does a wonderful job of discussing each different contributing factor and how best to address and correct each factor. It is a very each journal article to understand and would help any runner to better understand their condition.
- BIOMECHANICAL LOADS: Running produces high loads on the knee, 4-5.5 times body weight. Patients with PFP need to slowly get the knee used to these loads again and exercises should concentrate on high repetitions.
- QUADRICEPS: Patients have quadriceps weakness so quadriceps strengthening should be the foundation of any rehabilitation programme. Increasing the strength of quadriceps have been shown to decrease PFP symptoms and improve load tolerance. Targeted VMO strengthening exercises should be used. Using some kind of tape to support the patella is controversial and depends on the patient. Research shows that tape is best used with in the first 12 weeks of pain. With any exercises it is best to keep the knee below 45 degrees of flexion.
- MOVEMENT RE EDUCATION: Retraining of gait should be implemented and a mirror of visual ques work well especially to control pelvic drop. Increase in cadence has shown to reduce the load on the knee. Changing the gait to a fore foot strike is not always recommended.
- FOOT ORTHOSES: The benefits are unclear.
- PROGRESSIVE RETURN TO SPORT: Returning the patient to normal sporting levels must be done slowly in order to replicate the loading forces on the knee. Run/walk programme is perfect for this. The entire kinetic chain must be addressed so looking at the hip and ankle.
If you have any questions relating to knee pain please get in touch.