Interventions for PFP

Question 1

interventions

Answer 1

targeted towards pain and impairments

- exercise, taping, bracing, foot orthoses and combined interventions

Question 2

exercise therapy

Answer 2

• Exercise is recommended to reduce pain in the short,
  medium and long term, and improve function in the medium and long term
• Combining hip and knee exercises is recommended to reduce pain and improve function in the short, medium and long term – preferable to knee exercises alone

Question 3

exercise therapy **

Answer 3

combining hip and knee exercises is recommened to reduce pain and improve function in the short, medium and long term - preferable ti knee exercises alone

• improve hip extensors, external rotator and abductors
• improve function of quadriceps

Question 4

vasti retraining

Answer 4

If there is a vasti dysfunction, strengthening alone may not correct the dysfunction
… vasti retraining may be required

Question 5

joint stress and pathology

Answer 5

higher stress during leg extension (OKC) - 0-30˚
higher stress during squat (CKC) - 60-90˚
135˚ - on the sides of sesamoid bone

• 45-90 = open chain exercises
  0-45 = leg press or squat

Question 6

Changing hip & lower limb kinematics…

Answer 6

• Hip strengthening +SLSq retraining > Improved hip strength Reduced hip adduction during SLSq
  No change in hip adduction during running
• running gait retraining > Reduced hip adduction during running, Reduced knee pain

Question 7

combined interventions

Answer 7

Combined interventions are recommended to reduce pain in the short and medium term

Question 8

combined interventions

- patellar taping

Answer 8

medial glide and fat pad deload
- reduce pain (but not in long term),
- change patellar alignment ( patellar taping can immediately reduce lateral patellar displacement and tilt in people with PFJ OA)
and compression force
- alter vasti activation
- patellar taping reduced PFJ reaction force during single leg squat in people with AKP

Question 9

Foot orthosis

Answer 9

Foot orthoses are recommended to reduce pain in the short term
- less comfortable orthoses can increase hip add. and vastus lateralis in those with PFP with gait

• more mobile foot better with orthotics (Midfoot width difference > 11mm)

Question 10

Foot orthoses: predictor of success

Answer 10

AIM:
- determine whether prefabricated foot orthoses exert different effects on knee load during walking in people with patellofemoral pain and mobile feet, compared to those with less mobile feet

Question 11

Foot orthoses: predictor of success

2

Answer 11

• In PFP, prefabricated foot orthoses impart beneficial changes in frontal plane knee load during walking in those with more mobile feet
• direction of change is favourable in increased dynamic knee valgus patients
• Biomechanical factors may play a role in therapeutic outcomes of foot orthoses for PFP
  … but only in those with more mobile feet