Patellofemoral Pain and the benefits of physical therapy (and strength training).

In my last post I discussed the topic of Patellofemoral Pain and Tendionopathy. Specifically, I mentioned the special communication that was put out in the November, 2007 issue of Medicine and Science in Sports and Exercise.

Over the past year, I have been collecting articles, reading and researching this topic of injury prevention for runners and strength training. The special communication has once again peaked my interest and I thought I'd share a brief synopsis of a few articles that I have reviewed lately.

The next few posts will all be short reviews of articles discussing Patellofemoral Pain. Here's the first article:

Source:

Crossley, K, Bennell, K, Green, S, et. al. (2002). Physical therapy for patellofemoral pain. A randomized, double-blinded, placebo-controlled trial. The American Journal of Sports Medicine, Vol. 30, No. 6. Pgs 857-865.

1. One of the first things I found interesting was that in the introduction they say that patellofemoral pain is the most common diagnosis cited by many authors. And that while it is a common issue to be seen and treated, the "pathologic origin of this disorder is not clearly understood."

2. The jargon is wide ranging describing this issue. Patellofemoral Pain, Chondromalacia Patellae, Anterior Knee Pain, Patellar Malalignment, and Patellofemoral Arthralgia have all been used synonymously.

3. "The rationale behind the use of physical therapy for alleviation of patellofemoral pain includes restoration of patellar alignment through active or passive interventions, including quadriceps muscle-strengthening exercises, stretching, patellar taping or bracing, biofeedback, and use of corrective foot orthoses."

4. The purpose of the trial was to find out if physical therapy was effective in managing and treating patellofemoral pain in comparison to a placebo group.

5. The physcial therapy used consisted of: patellar taping, biofeedback of vastus medialis oblique (VMO, which is the quad muscle on the inside of your leg), gluteal muscle strengthening exercises and stretching.

The exercises that they uses were the following:

• isometric VMO contraction at 90 degrees -- basically a leg extension done isometrically at 90 degrees
• squats to 40 degrees with isometric gluteal muscle contraction (4 sets of 10 reps)
  
• isometic hip abduction standing against a wall (4 sets of 15 seconds)

added exercise after 2 weeks:

• step downs -- stand on step and slowly lower leg in front (3 sets of 5 or 10)
• increase the hip abduction to 30 seconds.

6. They were instructed to do these exercises 2x a day while in the program.

7. They concluded that there was a significant difference between the two groups in three measurements: worst pain, usual pain and anterior knee pain scale. But there was no difference between groups in the functional index questionnaire.

My thoughts:

As many of the articles that I find, this article discusses the rehabilitation of knee pain not the prevention of knee pain. But there are some interesting insights that I feel I can pull from this article:

The exercises that they chose strengthened the gluts and hip abduction. This is a common theme that I have seen in runners that end up developing the worst knee issues - they have weak glut and hip abduction.

One easy way to see how stong and stable your hips are (those two mucles groups involved) is to stand on one leg and try to do a 2 or 3 inch squat. Make sure you are not holding onto any table, chair or wall for balance. Can you do it? Does your knee try to cave in towards your other leg or push out away from you midline?

If it appears that you can't balance or do the squat, it might be that you are a little weak.

Now relate this to running. Each gait cycle you have to do a very small version of the single leg squat. You flex and extend at the hip, your knee flexes and extends, your foot dorsiflexes and then you plantar flex to toe off. What happens if each time you go through this cycle your leg isn't strong enough to carry through the movement and your hip or knee has to adapt?

Let's do a quick calculation: Let's say each leg goes through this cycle 90 times a minute (the 90 rpm cycle many coaches suggest today), you run for 1 hour (60 minutes). That equals 5,400 times each leg will make that movement. Now go run a marathon!

My thoughts are obviously an attempt to make a somewhat educated discussion based upon my experience and the knowledge gained from this article. As I continue to be aware of the issue of injury in runners, I continue to be more convinced that some runners will benefit by including strength training in there regular programs. For no other reason then they will be able to handle more miles without injury.

One of the biggest questions becomes, What exercises should I do? One place to start would be with a post I wrote some time ago called, Improve Muscle Imbalances with Strength Training - Hip Stabilizers. I plan to update that post soon, but I still believe it is a good starting place.

Next Post:

I plan on looking at an article called "Hip Strength in Females With and Without Patellofemoral Pain."