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Ben Ashworth 2009
PFJ Rehabilitation
Paul Thawley
Ben Ashworth 2009
Introduction
Extremely complex condition
High prevalence
I personally think that Eccentric hip ER is closely linked to lower limb dynamics
Paul Thawley
Ben Ashworth 2009
PFPS Algorithm
Witrouw 2005
Paul Thawley
Ben Ashworth 2009
PFPS Algorithm
Paul Thawley
Ben Ashworth 2009
Management of PFPS
Reduce Pain & Swelling
Taping / Orthoses
Toolbox (MT & ET)
Exercise Prescription
Strengthening
Paul Thawley
Ben Ashworth 2009
Reduction of Swelling
Wilk & Reinhold 2001
VMO ↓ @ 20-30ml
RFem ↓ @ 50-60ml
30-40ml ↓ Quads by 50%
Paul Thawley
Ben Ashworth 2009
Reduction of Pain
Articular, Myofascial& Neural adaptation
Young et al EMG study of acute swollen knees – quads inhibition reduced with LA (30-76%)
Reducing swelling and pain is essential for functional rehabilitation
Paul Thawley
Ben Ashworth 2009
TapingMay! Increase muscle torque (VMO)
May! Offload overactive muscle (ITB / VL)
May! Facilitate earlier VMO activation than VL
May! aid Gluteal facilitation
May! be a placebo
Paul Thawley
Ben Ashworth 2009Paul Thawley
Ben Ashworth 2009
Q-angle
Max area of contact at 90
6.5 x body weight increased > 10° Q-angle
Paul Thawley
Ben Ashworth 2009
Tibial rotations on patella movement
Paul Thawley
May be sports specific linked to activity, neuro muscular or structural in nature.
Ben Ashworth 2009
Soft tissue extensibility
Paul Thawley
Ben Ashworth 2009
Soft tissue extensibility
Lateral retinaculum arises from ITB
Greatest influence @ 20°
Prevent fixed flexion
↑PFJ Forces & muscle work
Paul Thawley
Ben Ashworth 2009
Improved soft tissue mobility
Restore ST flexibility
Med & Lat Retinaculum
Patella mobs
Combined mobilisation & movement
Paul Thawley
Ben Ashworth 2009
Anterior Hip / Groin / Knee
Paul Thawley
Ben Ashworth 2009
Posterior Fascial / Neural Structures
Paul Thawley
Ben Ashworth 2009
Muscle Activation
Paul Thawley
Ben Ashworth 2009
Lower Limb Alignment
Paul Thawley
Ben Ashworth 2009
Q-angleKinetic ChainInfluences
Femoral Anteversion
Genu Valgum
Paul Thawley
Ben Ashworth 2009
Exercise Prescription
Paul Thawley
Ben Ashworth 2009
Exercise Prescription
Paul Thawley
Ben Ashworth 2009
S&C / Exercise Prescription
CKC Vasti
OKC Rec Fem
CKC Glutes & Trunk
Paul Thawley
Ben Ashworth 2009
VMO Exercise Prescription
Paul Thawley
Ben Ashworth 2009
VMO / Lateral Retinacula
Rupture 50% instability @ 0° flexion
Myofascial continuity medially & laterally
VMO / MPFL
ITB / Lat Retinac
Paul Thawley
Ben Ashworth 2009
Proprioception & neuromuscular control
Paul Thawley
Ben Ashworth 2009
Hip Abductor torque
Paul Thawley
Ben Ashworth 2009
PFPS increased lateral load and slower pronation
Increased PFJ load
Reduced Shock absorption
Lateral tib tuberosity and increase Q-angle
Paul Thawley
Ben Ashworth 2009
Correct abnormal mechanics
Paul Thawley
Ben Ashworth 2009Paul Thawley
foot strikes the ground in a toe-to-heel pattern to producean extension moment at the knee
In the PFP group, initial contact of the foot with theground during gait occurred more on the lateral side of thefoot, and the center of pressure shifted more slowly fromthe lateral to the medial side of the foot during foot rollover; thiscould cause less shock absorption in the foot. Consequently,a greater part of the ground-reaction forces are transferred to themore proximal joints, including the knee. This could result ina higher load on the patellofemoral joint and, consequently,overloading of the patellofemoral joint, which would lead topatellofemoral pain.In addition, the more laterally directed pressure suggestsa less pronated position of the foot during the rollover patternduring gait, which could lead to less internal rotation of the
tibia. This could place the tibial tuberosity in a more lateral
A recent study has shownthat subjects with PFP have a delayed onset of gluteusmedius relative to control subjects.
Strength of the gluteal muscles is also decreased in patellofemoralsufferers where hip abductor and external rotator strengthis 26% to 36% lower in females with PFP than age andactivity matched controls
Ben Ashworth 2009
Case Study - Right Lateral Knee Pain
Static Posture: left rearfoot pronation (STJ)
Dynamic Control: ‘poor’ left lower limb stability / control (SL)
Functional Movement (Squat): WB right lower limb
Flexibility: left ankle WBDF
Increased Load through RLL in squat / clean / leg drive
Paul Thawley
Examples of programs