potential patellofemoral pain syndrome?

Hi all, this will be my first post on the website so i was looking for some feedback on my issue! I'm an Exercise science student with hopes of progressing on to complete a MSc in Musculoskeletal Physiotherapy

So in early November of last year, i received trauma to my right knee during a game of hurling (native sport) with a fibre glass stick. my knee effectively replaced where the ball was when the stick was in motion so it was quite a severe blow, not much else can be said about it.

At first it was misdiagnosed by a local physio as my quadriceps had 'gone to sleep' so i was issued a rehab programme to get them firing right again (ex. ball wall squats, seated knee ext, etc)

however, my pain persisted and saw no signs of improvement so i went for a second opinion from a trainee orthopaedic surgeon who booked my in for an x-ray. it was confirmed then that it was indeed a lateral patellar fracture. i have included an image of the xray just for reference.

it was from there that i went through a process of wearing a don-joy knee brace fixed at 15 degrees flexion and was told to rest easy and refrain from any weight bearing exercise on the joint and the likes.

so christmas came and went and i rested as best i could. following a prognosis examination of my knee i was told i had full ROM and was clear to start training and even go skiing on the knee.

HOWEVER, to date i still feel a lot of anterior pain through my knee and feel quite unstable in eccentric loading during running or stairs descent. I have also noticed quite a bit of atrophy in my VL/VMO as opposed to my left leg (no pathology). when palpating my patellar it is very tender and sore still and does not feel similar in shape to my other knee, i suppose this is normal as to what ever way the bone has reset itself.

I must note that i have not officially had a physio exam it since november yet have had several opinions from different professionals and i am getting mixed reviews.

I'm assuming that i have developed PFPS because i am showing clear symptoms of this but I wanted to get your opinions on this and possibly suggestions for rehab programmes/ length of rehab as the 2013 season in my sport is closing in.

Sorry for the long post but really appreciate the time you guys would take to read this and post back!

AndyAttachment 1117

alombard91,

I would suggest you start with a Thomas Test to give some insight into some of the muscle length relationships around the knee. I would also do Ober's Test as well. I wouldn't be surprised if you have some short muscles around the knee and or hip after being in a restricted brace. Lengthening these muscles in theory should decrease the tension around the knee and allow you get some decompression and hopefully pain relief to follow.

Thomas test: The Thomas test video from Structure and Function of the Hip and Pelvis CEC course - YouTube

Obers TEST: Ober's Test - YouTube

These tests will definitely give you something to work on if you find a few positive findings. Being an exercise science student im sure you can figure out what to do with positive findings of these tests.

I would also consider some taping methods to see if that can offer some relief and provide some decreased tension around the patellofemoral joint. Jenny McConnel taping is quite effective when indicated.

All best, let me know how it goes mate.

Rory

Hi rory,

Your advice really helped, I'm currently still Taping it and alongside this im compiled a solid rehab which seems to be going well,


Thanks for your advice!

Andy

alombard91, given your detailed description of the injury cause, there are a number of possible scenarios, however i suspect that the underlying problem has now become stagnation of your body's original healing response. Bear in mind that there may be damage to the bursa, cartilage and meniscus and bruising to the femur, patella, fibular or all three (irrespective of what may or may not have been flagged by the x-ray), you may like to work on medium strength stripping massage to all the muscles which support the knee but especially working behind the knee to remove fluid (the lateral collateral and medial collateral ligaments will also need particular attention). To be honest ideally I would recommend moxa as this is excellent at relieving inflammation, bruising and fluid build up and stimulating blood flow (and hence healing) however finding a proficient therapist may be challenging!! good luck, I'd be interested to see how you progress.

Finally the pain experienced in stair descent also suggests that there may be some cartilage damage either partial tear or bruising, but either way moxa again would be my recommendation......

If I can add my two cents worth. I agree in part with both observations above. The big thing here is the bone and tissue damage and that this happened to your patella. You only have one so rehab slowly or you could be left with an irregular joint surface and subsequent early onset arthrosis later in life. You have broken bone and so this will take 12 months to get back to full strength. This means any loading should be considerate of that reduction until it is achieved.

I would suggest a followup x-ray (skyline view) to see how the joint surface looks as this would give you an idea at a low cost. Restoring full functional range and synnergy by doing leg work on something like a Pilates reformer, building into working with a jump-board on the same, would be a sensible progression if you have access to it. Eat really well and match that with what those tissues are looking for as they remodel. Be very mindful of any post-exercise discomfort that begins to increase in intensity as you so not want to escalate any aggravation during the rehab process.

If you do get any review x-ray then do post us for us to take a look at. Best of luck with the rehab.