Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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25.3.3, Patellofemoral Pain and Rehabilitation

Abstract:


CONTENT: The reader is introduced to the International Classification of Functioning, Disability, and Health (ICF) for the evaluation and treatment of patellofemoral pain. This model is used by the author as the framework throughout the monograph. A review of the anatomy, biomechanics, and pathomechanics of the patellofemoral region as they relate as potential contributors to the generation of patellofemoral pain are emphasized. Factors associated with patellofemoral pain and instability with an emphasis on understanding regional interdependence and its effect on patellofemoral pain are then presented. The Physical Stress Theory is described. Patellar alignment and tracking and the impact of patellofemoral joint reaction force on pain are reviewed. A major section of the monograph covers patient management and outlines the evaluation scheme for classifying patellofemoral pain. Several functional demonstration tests for the lower extremity are reviewed along with common tests and measures that assist in identifying pain generators in the patellofemoral region. Common imaging techniques and a brief section on surgical interventions are covered as well. Physical therapy treatments are discussed including taping, mobilization, and orthotics, along with specific functional therapeutic exercises recommendations. CASE ANALYSES: Two case studies address patellofemoral pain. The first case describes a 17-year-old male with anterior knee pain. The second case describes a 32-year-old female with bilateral anterior knee pain who reports pain over the last two years. Both cases are presented in detail from evaluation to treatment and then to outcomes.

Author:


Cory Manton, PT, DPT, OCS, CSCS

Learning Objectives:

Upon completion of this monograph, the course participant will be able to:

  1. Describe the anatomy of the patellofemoral region.
  2. Identify and discuss the biomechanics, and the pathomechanics of the patellofemoral region, including examples of dysfunctional movement patterns that may contribute to patellofemoral pain.
  3. Discuss the diagnosis and physical therapy classification of patients with patellofemoral pain, including common symptoms, impairments, and activity limitations.
  4. Explain the differential diagnosis process when examining the patellofemoral region.
  5. Provide examples of several functional demonstration tests for the lower extremity.
  6. Identify and discuss tests and measures that can be used to assist the clinician in the identification of pain generators and contributing factors related to patellofemoral pain.
  7. Describe common imaging techniques used to assist in classifying the patient with patellofemoral pain.
  8. Cite examples of current surgical interventions for treatment of patellofemoral pain.
  9. Recognize precautions and contraindications during each phase of rehabilitation following current surgical interventions for patellofemoral pain.
  10. Identify and discuss evidence-based physical therapy interventions for patients with patellofemoral pain that are correlated to impairments and activity limitations.
  11. Describe self-report outcome measures and activity limitation measures that may be used to assess a patient with patellofemoral pain.
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