{"id":574,"date":"2010-03-25T19:25:07","date_gmt":"2010-03-26T02:25:07","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=574"},"modified":"2010-03-25T19:25:07","modified_gmt":"2010-03-26T02:25:07","slug":"patellofemoral-pain-a-research-update","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=574","title":{"rendered":"Patellofemoral Pain &#8211; A Research Update"},"content":{"rendered":"<p>Anterior knee pain, aka chondromalacia, patellofemoral pain (PFP) and patellofemoral pain syndrome (PFPS), may be the most difficult condition to remedy in the clinic or gym.\u00a0 There is always debate and speculation when it comes to taping, bracing, orthotics and exercise.<\/p>\n<p>In the latest edition of the <em>JOSPT<\/em>, there was a summary from the findings presented at an international retreat held in the spring of 2009 in Maryland.\u00a0 The publication covered the keynote addresses and podium presentations.<\/p>\n<p>Before I give you the quick and dirty details, I want to emphasize a key point that was made and one I happen to wholeheartedly agree with.\u00a0 It is this:<\/p>\n<p>When assessing and evaluating those with PFPS, it is important to recognize that these patients\/clients do not necessarily fit under one broad classification system.\u00a0 The anterior knee pain\u00a0issue is multi-factorial and not every person has the same issues or abnormalities.\u00a0 <strong>As such, the exercise prescription\u00a0most likely will\u00a0need to be tweaked accordingly for best results.<\/strong><\/p>\n<p>Okay, now on to the highlights that may impact your training\/rehab.\u00a0 Some researchers from Belgium have been conducting prospective studies looking at intrinsic risk factors for developing PFPS.\u00a0 They looked at physical education students and novice runners.\u00a0 Major findings are included below:<\/p>\n<p><span style=\"text-decoration: underline;\">Study #1 <\/span><\/p>\n<p>There were 4 variables identified as risk factors:<\/p>\n<ul>\n<li>Decreased flexibility of the quadriceps<\/li>\n<li>Decreased explosive strength of the quadriceps<\/li>\n<li>Altered neuromuscular coordination b\/w the vastus lateralis (VL) and vastus medialis oblique (VMO)<\/li>\n<li>Hypermobility of the patella<\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline;\">Study #2<\/span><\/p>\n<ul>\n<li>More laterally directed plantar pressure distribution at initial (foot) contact during walking and more laterally directed rollover are risk factors for developing PFPS<\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline;\">Study #3<\/span><\/p>\n<ul>\n<li>Unable to link hip muscle strength (or weakness) to increasing risk for PFPS<\/li>\n<li>No apparent\u00a0correlation with\u00a0frontal plane motion of the knee and hip strength (so hip weakness will not automatically cause knee pain)<\/li>\n<\/ul>\n<p>Finally, what does this mean for therapists and fitness pros?\u00a0 It means&#8230;&#8230;.<\/p>\n<ol>\n<li>They should address the 4 intrinsic risk factors by stretching and strengthening the quads, with a particular emphasis on balancing the VMO strength in relation to VL strength.\u00a0 This is not new information.\u00a0 Spending time on closed chain terminal range strengthening is important.\u00a0<\/li>\n<li>Second, keenly observing a dynamic disturbance in foot alignment at contact is important\u00a0 for predicting PFPS and will undoubtedly impact dynamic training protocols for the entire kinetic chain.\u00a0<\/li>\n<li>Lastly, continue to strengthen the hip even though the final study revealed no apparent link.\u00a0 However, perhaps focus more on this when there\u00a0is a definitive weakness side-to-side that has been identified.\u00a0 So, don&#8217;t fall back on the weak gluteus medius by default; rather use dysfunction as a driver for exercise inclusion.<\/li>\n<\/ol>\n<p>PFPS is and will continue to be a difficult problem to treat and remedy with exercise.\u00a0 Further research is needed to determine and evaluate more specific gender differences, kinetic chain links, the efficacy of taping\/bracing, and the most effective classification and treatment algorithms for those of us in the trenches.\u00a0 In the meantime, listen to the body and use the best available science and information to move forward with your\u00a0training.\u00a0<\/p>\n<p><em>Reference: JOSPT March 2010<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Anterior knee pain, aka chondromalacia, patellofemoral pain (PFP) and patellofemoral pain syndrome (PFPS), may be the most difficult condition to remedy in the clinic or gym.\u00a0 There is always debate and speculation when it comes to taping, bracing, orthotics and exercise. In the latest edition of the JOSPT, there was a summary from the findings [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[32,31,8,26],"tags":[77,52,78,79,75,76],"class_list":["post-574","post","type-post","status-publish","format-standard","hentry","category-arthritis","category-knee","category-rehab","category-training","tag-chondromalacia","tag-knee-pain","tag-knee-pain-exercises","tag-knee-rehab","tag-patellofemoral-knee-pain","tag-pfp"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.10 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Patellofemoral Pain - A Research Update - Brian Schiff&#039;s Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.brianschiff.com\/?p=574\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patellofemoral Pain - A Research Update - Brian Schiff&#039;s Blog\" \/>\n<meta property=\"og:description\" content=\"Anterior knee pain, aka chondromalacia, patellofemoral pain (PFP) and patellofemoral pain syndrome (PFPS), may be the most difficult condition to remedy in the clinic or gym.\u00a0 There is always debate and speculation when it comes to taping, bracing, orthotics and exercise. 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