Thursday, January 18, 2007

Patellofemoral pain - a different perspective...

The January 2007 issue of BioMechanics magazine (go to www.biomech.com - go to archives and search patellofemoral) had an article titled - "Patellofemoral pain research refocuses on the hip" by Jordana Bieze Foster and it has some great information on the concepts on tracking of the patella and the real cause of this problem.

Tip - It's not the patella tracking laterally. We (I have a bachelor's in Sportsmedicine) in rehab have been told and have been treating patellofemoral pain and tracking as a knee problem related to the patella being "pulled" laterally by the quad muscle.

Well - be prepared to re-think that.

Under weight bearing MRI study it turns out that the knee cap (patella) does not track laterally. It is the femur that is medially rotating due to lack of strength and control at the HIP.

That's right - the hip once again is or should be the focal point for addressing a knee issue.

Another great article on the site is from the July 2006 issue of BioMechanics by Jim Lundy, DPT, CSCS titled - "Gluteus Medius stimulates lower extremity movement". This really goes well with the Patellofemoral article in understanding the function of the Glute Medius.

Hip stability and control is key to proper functioning of the body. If you do not focus here and address the hip - you are missing a BIG piece of the picture.

8 comments:

Randy said...

Interesting article...my uncle waited years to have his hip replaced and the compensating gait he developed to minimize the arthritic hip pain wrecked his knee such that it had to be replaced shortly after he recovered from his hip replacement...not the same thing exactly but maybe a worse case scenario.

My patellae laterally track but not as bad as they used to...I attribute that to KB swings and snatches... I never put much stock in the weak medial vastus explanation...I couldn't walk around squeezing a ball between my knees all day anyway not that that remedy worked for me anyway.

What ramifications for treatment/prevention do you see in terms of exercise prescription?

Brett Jones said...

Randy,
It feeds back into our Squat discussion - I posted a brief list of exercise and stretching recommendations on the forum and will post a blog on it tomorrow.
Glute Medius and hip rotators are the focus.
But in the end - a good squat and SLDL goes a long way.

Mark Reifkind said...

great information brett, good good stuff.love to get the study validation for things I know from experience to be true.

kevin perrone said...

Since I've been doing Zhealth, I've had quite a few people who had patellofemoral pain and in all of those cases either they had an inhibited hamstring or glute med. and although they both deal with the hip it was resolved by addressing the feet. The compensations that the body develop can be fascinating.

Brett Jones said...

Rif,
Research tends to validate or question what we already know - nice when it is validation.
Kevin,
The feet are huge in this and pronation and previous ankle/foot injury being a major issue.
Great stuff.

Geoff Neupert said...

Here's a question: What about patello-femoral pain due to laterally tracking patella AND loss of internal rotation (read: negative hip IR)?

Brett Jones said...

Geoff,
If I am understanding the question correctly "medial" rotation of the hip is decreased and you have a "lateral" patella?
Beyond 90 degrees of hip motion - the deep 6 internal rotators become abductors so restricted deep 6 + a weak or inhibited Glute Medius would really create medial rotation of the femur.
Foot position would probably be pronation.
Is the lateral tracking of the patella weight bearing or unweighted?

Geoff said...

Former condition: Lateral tracking patella; negative M/IR of femur; valgus knee and ankle; foot pronation.

Current condition: lateral tracking patella; positive m/IR of femur; neutral knee ankle and foot. Can make Gl.med. strong or weak at will, based on active joint mobilization. Deep 6 IRs fine.

Lateral tracking patella weighted and unweighted.

Weird, huh?

Think it's all just due to myofascial winding.

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