As always, when it comes to considering the best approach to management of an injury, in this case, Patellofemoral dysfunction (anterior knee pain), the needs and demands of the patient need to be considered first and foremost. No two injuries are the same, and by the same token, nor should any two rehabilitation pathways be the same.

Of course there is a large amount of literature in the field regarding the management of this sort of condition, being so common, and there are also a myriad of pre-prescribed progressive programs available. These resources are invaluable when it comes to managing these conditions. One of the best things about Physiotherapy, is the fact that it is an evidence based practice, which means there are reams upon reams of research papers and incredible minds finding out the best way to look after the human body.

The thing to remember though, is that although there are a lot of guidelines available, these approaches will only be truly effective if they are modified to suit the individual.

That means getting to the bottom of the needs of the patient.

Hence, in my prior blog post, I spoke a lot about the importance of asking lots of questions. This is not only vital to diagnose the issue effectively, but critical in learning the needs of the person who has the sore knee.

So that also means as the patient, you need to make sure that you discuss these factors with your Physio. There is no one way to do this, so when you and your Physio are going to commit time and energy to look after that sore knee, you want to be sure that not only is it done efficiently, but that it is done in a way that you will reach the goals you set.

For example, a competitive runner who is suffering from patellofemoral pain inhibiting their racing capacity, who normally trains 8 times a week in the gym and on the track, will have different demands, capabilities and contributing factors to an office worker who walks daily and the only issue is related to walking up and down the stairs at work each day.

These people need to be managed differently, and that comes down to knowing the person.

That aside, if it has come to the stage where the problem has been diagnosed as patellofemoral dysfunction, there will be constants in the management plan as there are with many physiological, musculoskeletal issues.

1. If there is an acute inflammation that is diagnosed, this may need it be managed with things such as analgesia, anti inflammatories and ice. This needs to be discussed with your Physiotherapist or Pharmacist. I do not encourage the use of medication unless the situation is appropriate and all medical factors are considered.

2. Reduce the aggravating factors. This is very important. I am a huge believer in maintaining activity and function as much as possible during recovery. Consideration must be given to the effects of deconditioning if too much time is taken waiting for recovery. However, if there are specific activities that are obviously worsening the issue, these may need to be modified or temporarily avoided to assist in the recovery. If the activity is part of the end goal, I strongly encourage graduated exposure back into that activity to allow for balanced conditioning.

3. Once the contributing biomechanical factors are determined, manage them appropriately.

When it comes to goals, these factors need to be taken into account and the short and long term expectations between patient and Physio have to be clear. This is an injury that can be managed quite effectively by yourself as long as you have a clear understanding of the problem and the treatment plan. This means asking your Physio LOTS of questions. If your Physio isn’t willing to educate you on how to look after yourself, I will be a little concerned.

An example of a goal setting program may be:

IMMEDIATE
– Reduce pain by 25%
– Limit aggravations as much as possible
– Carry out your prescribed exercises according to directions (for example twice a day)

SHORT TERM
– Reduce pain by 50%
– Return to graduated exposure to aggravating activities (for example brisk walking if you are wanting to run again)
– Build strengthening program as required
– Learn how to tape your own knee (if applicable)

MEDIUM TERM
– Eliminate pain
– Build pre injury activities (for example interval jogging on grass if you are wanting to run on the road)
– Correct diagnosed Biomechanical weaknesses

LONG TERM
– Your ultimate goal
– This may be what you were doing before you were injured, or maybe even More!!
– This goal should also include knowing what to do for the long term to keep on top of things

Obviously that is purely a guide, but my intention is to show you that achievable and appropriate goals are so important to make sure you progress through with the minimum of set backs (hopefully none). Because if you set your goals too high or too soon, you may worsen the problem and be disappointed in the lack of achievement. Goal setting also means you can reach milestones and this is always a great way to motivate yourself!

In my next post I am going to go through a couple of case studies and discuss the more specific managements for some of the more commonly seen factors in patellofemoral dysfunction.

Stay Tuned.

Do you have a question, or some ideas?

Find me in the afternoons and evenings at In Clinic Physiotherapy, Mosman Park, Western Australia, or 24/7 at www.inclinicphysiotherapy.com.au

Move Well, Be Well.

James