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PFJ Rehabilitation

PFJ Rehabilitation. Paul Thawley. Introduction. Extremely complex condition High prevalence I personally think that Eccentric hip ER is closely linked to lower limb dynamics. Paul Thawley. PFPS Algorithm. Witrouw 2005. Paul Thawley. PFPS Algorithm. Paul Thawley. Management of PFPS.

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PFJ Rehabilitation

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  1. PFJ Rehabilitation Paul Thawley

  2. Introduction Extremely complex condition High prevalence I personally think that Eccentric hip ER is closely linked to lower limb dynamics Paul Thawley

  3. PFPS Algorithm Witrouw 2005 Paul Thawley

  4. PFPS Algorithm Paul Thawley

  5. Management of PFPS Reduce Pain & Swelling Taping / Orthoses Toolbox (MT & ET) Exercise Prescription Strengthening Paul Thawley

  6. Reduction of Swelling VMO ↓ @ 20-30ml RFem ↓ @ 50-60ml 30-40ml ↓ Quads by 50% Wilk & Reinhold 2001 Paul Thawley

  7. 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

  8. Taping May! 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

  9. Paul Thawley

  10. Q-angle Max area of contact at 90 6.5 x body weight increased > 10° Q-angle Paul Thawley

  11. Tibial rotations on patella movement May be sports specific linked to activity, neuro muscular or structural in nature. Paul Thawley

  12. Soft tissue extensibility Paul Thawley

  13. Soft tissue extensibility Lateral retinaculum arises from ITB Greatest influence @ 20° Prevent fixed flexion ↑PFJ Forces & muscle work Paul Thawley

  14. Improved soft tissue mobility Restore ST flexibility Med & Lat Retinaculum Patella mobs Combined mobilisation & movement Paul Thawley

  15. Anterior Hip / Groin / Knee Paul Thawley

  16. Posterior Fascial / Neural Structures Paul Thawley

  17. Muscle Activation Paul Thawley

  18. Lower Limb Alignment Paul Thawley

  19. Q-angle Kinetic Chain Influences Femoral Anteversion Genu Valgum Paul Thawley

  20. Exercise Prescription Paul Thawley

  21. Exercise Prescription Paul Thawley

  22. S&C / Exercise Prescription CKC Vasti OKC Rec Fem CKC Glutes & Trunk Paul Thawley

  23. VMO Exercise Prescription Paul Thawley

  24. VMO / Lateral Retinacula Rupture 50% instability @ 0° flexion Myofascial continuity medially & laterally VMO / MPFL ITB / Lat Retinac Paul Thawley

  25. Proprioception & neuromuscular control Paul Thawley

  26. Hip Abductor torque Paul Thawley

  27. PFPS increased lateral load and slower pronation Increased PFJ load Reduced Shock absorption Lateral tib tuberosity and increase Q-angle Paul Thawley

  28. Correct abnormal mechanics Paul Thawley

  29. foot strikes the ground in a toe-to-heel pattern to produce an extension moment at the knee In the PFP group, initial contact of the foot with the ground during gait occurred more on the lateral side of the foot, and the center of pressure shifted more slowly from the lateral to the medial side of the foot during foot rollover; this could cause less shock absorption in the foot. Consequently, a greater part of the ground-reaction forces are transferred to the more proximal joints, including the knee. This could result in a higher load on the patellofemoral joint and, consequently, overloading of the patellofemoral joint, which would lead to patellofemoral pain. In addition, the more laterally directed pressure suggests a less pronated position of the foot during the rollover pattern during 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 shown that subjects with PFP have a delayed onset of gluteus medius relative to control subjects. Strength of the gluteal muscles is also decreased in patellofemoral sufferers where hip abductor and external rotator strength is 26% to 36% lower in females with PFP than age and activity matched controls Paul Thawley

  30. 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 Examples of programs Paul Thawley

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