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