Champion Sports Training - Patellofemoral (Anterior) Knee Pain

Patellofemoral (Anterior) Knee Pain

· May begin with modalities such as cold pack with interferential electrical stimulation (IF-ES) before exercises to decrease pain and swelling. May also require iontophoresis if tendonitis or reactive plicia is present.

· Perform all exercises with biofeedback over the VMO to ensure proper contraction and increase proprioception of the VMO.

· Patients begin with McConnell taping on the first visit. If the taping is tolerated well, they are instructed in self-taping on the second visit, The patient should be pain-free in the tape before initiating the exercise program.

· The patient is then instructed in open chain-table exercises on the first day. These include QS, straight leg raises, SAQ, hip adduction, flexion, extension and abduction, ankle plantar, and dorsiflexion as well as stretching the quadriceps, hamstrings, tensor, and gastrocnemius. Avoid hamstring stretching if the patient has recurvatum.

· If the patient is pain free with the open-chain exercises, begin closed-chain exercises. These include wall slides, lunges, lateral step-ups, balance board, heel raises, stool laps, hip adduction/SQ in standing, and leg presses.

· If the patient remains pain free with all the above exercises, begin stair-stepper, Fitter, stationary bicycle, and/or Versiclimber for general conditioning and endurance. The patient again receives a cold pack after exercise.

· Exercises are generally performed 3 to 4 times a week with a day's rest for muscle recovery. Repetitions are generally 3 to 4 sets of 10, with increasing resistance as tolerated.

· Allow return to full physical activity while taped if patient is pain free. Perform taping/exercises for approximately 6 weeks. At that time, discontinue the taping and continue the exercises as needed.

Phase 1: 1 to 2 days

· Use a knee immobilizer if acutely symptomatic.

· Use ice, IF-ES, and oral antiinflammatories to decrease inflammation and pain.

· Begin QS, straight leg raises, and VMO exercises when pain permits.

· Perform hip adductor/abduction, flexion, and extension exercises.

· Remove immobilizer.

· Fit a patella-stabilizing brace or use McConnell taping.

· Continue ice, IF-ES, especially following exercise.

· Continue oral antiinflammatories if needed.

· Perform straight leg raises, QS, VMO exercises, short arc extensions.

· Begin flexibility exercises for quadriceps, hamstrings, iliotibial band, gastrocnemius, soleus.

· The authors add closed-chain exercises to Griffin's original protocol at this point. This includes lunges, wall slides, lateral stepups, minisquats, etc. (see previous protocol).

· Start to use bicycle with seat elevated, swim (crawl only), use stair-stepper (small steps done rapidly).

· Begin advanced isotonic exercises for hip flexors, extensors, abductors, adductors, as well as muscle of the lower leg and foot, increasing weight as tolerated, doing 3 sets to 10 and increasing weight by 2 lb.

· Continue using brace or taping.

· Continue quadriceps isotonics from 30 degrees to 0 degrees, increasing weight as tolerated.

· Advance hamstring strengthening exercises.

· Continue bicycling, swimming, stairstepping, or walking for cardiovascular and muscle endurance; increase duration, then speed.

· Continue flexibility exercises.

· Progress closed-chain -activities.

· Add slow return to running if desired; increase distance, then speed.

· Warm up well.

· Use ice following workout.

· Continue aerobic cross training.

· Start to jump, cut, do half squats, kick, and other sport-specific skills if applicable. Wear brace or tape for sport participation if desired. Tape up to 6 weeks, then discontinue. Continue brace as needed.