Patients presenting with patellofemoral pain demonstrate a wide range of potentially causative physical variations in lower limb posture, in joint flexibility related to the hip, knee and ankle, in lower limb muscle strength and tightness and in patellofemoral radiology. Forty-six patients with 60 knees diagnosed with patellofemoral pain were included in this study. Patients were excluded if they presented with anterior knee pain unrelated to the patella or if meniscal pathology was suspected. Inclusion criteria included pain with two of: stair descent, squatting, prolonged sitting, running or kneeling. Assessment included standing lower limb posture; muscle tightness of the quadriceps, hamstrings, iliotibial band and calf; quadriceps and hamstring muscle weakness/isokinetic performance and patellofemoral radiology. Standing lower limb posture was very variable ranging from normal alignment to genu valgus and genu varus. Rotational malalignment, most commonly involving hip internal rotation, was present in 17% of patients. Muscle tightness was seen least frequently in the hamstrings, followed by calf muscle and the iliotibial band tightness. The most common deficits were quadriceps weakness/isokinetic performance and quadriceps tightness. It is unsure whether these features represented the cause or the consequence of patellofemoral pain. X-ray findings ranged from normal to varying degrees of lateralisation in 18% of patients. Joint degeneration was present in 22% of patients ranging from mild to severe, occurring in patients younger than 40 years of age. Patellofemoral pain can be sub-grouped according to physical and radiological characteristics and treatment for each patient should be based on the individual presentation.
Australian Physiotherapy Association (APA) Conference Week : Musculoskeletal Physiotherapy Australia, Sydney, Australia 1-5 October 2009
Australian Journal of Physiotherapy: e-Supplement 2009 APA Conference Week Abstracts / Vol. 55, No. 4, p.23-24