Jenny McConnell

This article is based on a paper given at the MTAA IVth National Conference held in Brisbane in May, 1985.

Patellofemoral pain syndrome can be a dif­ficult condition to manage effectively. The suc­cess rate of most treatment regimes has been poor and in the long term the condition fre­quently recurs.

The author has developed a treatment pro­gramme which has a ninety-six per cent success rate. Long term follow up of patients, after twelve months demonstrated that all patients reviewed have remained pain free.

The programme involves two major compo­nents: a thorough understanding of the me­chanics of the patellofemoral joint so that an adequate assessment of the patient’s lower limb can be made, and context specific training of certain muscles which contribute to patellar alignment. This training must be relatively pain free so that muscle control can be enhanced.

Patellofemoral pain is a common, yet poorly managed condition present­ing to physiotherapists and other prac­titioners. The incidence in the general population is reported to be as high as one in four with this proportion in­creasing in the athletic population (Levine 1979, Outerbridge 1964). The condition, which generally has an in­sidious onset, is characterized by a dif­fuse ache in the vicinity of the patella (Levine 1979, Malek and Magine 1981, Outerbridge 1964). It is often given the diagnosis of chondromalacia patellae, but this diagnosis is only appropriate if softening and fissuring of the un­dersurface of the patella has been vis­ualized either directly during surgery or arthroscopy or indirectly by means of an arthrogram (Devereaux and Lachmann 1984, Ficat and Hungerford 1977). In fact, many patients with se­vere pain and functional disability do not have any pathological findings (Andrish 1985). Their pain, which is often exacerbated by sporting activi­ties, stair climbing and prolonged sit­ting with flexed knees (‘movie goers knee’) can be extremely difficult to treat (Levine 1979, Micheli and Stanitski 1981). Thus results of management, whether it be conservative or surgical, are equivocal and much confusion abounds for the practitioner as to the most expedient method/methods of di­minishing the patient’s symptoms so that sporting and other recreational pursuits can be resumed as quickly as possible.

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