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Chondromalacia-Patellofemoral-Pain

                  Chondromalacia-Patellofemoral-Pain


 Today I wanted to talk about patellofemoral pain and chondromalacia some great self-help techniques and treatments and exercises you can do for this problem sneaks have a hard time pronouncing so we're today going to show you generally with patellofemoral pain a syndrome is what they call it you're having pain on the front part of the knee.

 Here a lot of times around the kneecap it often catches it doesn't usually, lock but you might get this catching sensation you might also get some grinding sure and here's some popping even oftentimes going up and particularly downstairs yeah very good point.


patellofemoral pain


How to tighten the  kneecap


On hilly surfaces worse going down the stresses on your knee is higher going down I just saw a study on that yeah I believe it so what you're gonna want to do is also what we call the moviegoers sign by the way if you're watching a movie and your knees are bent like this you know for a long period of time you start having to increase pain with that.

One test that we do, by the way, is called Clark's sign or I think it's a patellar grinding tester do you want to just roll up your pant leg or do I ever Bob so let's go ahead and get this stool over here.

Just know I would do this he would be laying flat on the bed, okay but what I do is I usually tell him to first, go ahead and tighten the knee or push the knee down into the bed yep like that and I tell them to do it very slowly, okay and then I go ahead and I put my hand right here yep relax first okay and then I go ahead and now tighten the knee.


Kneecap on chondromalacia


So now I'm pulling my kneecap it's gonna go up towards my stomach and if that's positive it's gonna be painful okay all right now that's painful and some people is it painful on you no, but it feels a little weird yeah but it like maybe it's gonna hurt but it really didn't the correlation is a little questionable sometimes it's but it's to me at least one of the signs the other signs is what later I'm going to show you how to tape it.

If the taping feels better to me that's often a good sign that its patellofemoral center-right patellofemoral syndrome or chondromalacia is that you got the knee cap here and it normally.

Let's go on this site I took the knee cap off on this side you see this little the canal here the knee cap doesn't just stay static it actually is moving up and down in this little canal here is that called the femoral groove yep mm-hmm so as we're going it's moving up along in the femoral groove here and what it happens with patellofemoral syndrome quite often is that it gets a little bit off-track.

It's not gliding as it should it's not lined up like it should and you can see these are sharp edges here oh yeah so if you if the patella which is a little bit soft underneath it, as it gets over on the side where you can actually wear out the underside of the patella and that's the chondromalacia part of it.

I mean softening of the kneecap so what we want to do is get it back into the groove here and have it stays there so it can calm down and not give you so much pain or give you that grinding or that catching right you know that's a joint that actual cartilage and you what that's large surfaces rubbing against each other as opposed to that edge.

 Bob was talking about how they used to think that if your knee was a little bit bent like this that cue angle there like on women that that causes this but now they find out that's really not the case, okay but they are finding out that you if you have flat feet that do tend to kind of contribute to it so the flat feet when you put weight it changes our mechanics so that you're more it's not tracking right all so they don't like the hip to be internally rotated.

When you're doing sports you don't want your leg in like this that can predispose you to causing the knee pain sure and not traveling the way it should all right let's talk about the first treatments for a new veneer bread so the first the thing we're gonna do is you're just going to make sure your I see I mean holy ice pack cold pack after you've been doing sports.

With a straight knee, you're not gonna have it bent I'm assuming so that there's less stress on it if they're at all well or maybe in the loose pack a position I'll share every slight flexion without go ahead and do it in that way the next thing I want to do is I want you to go ahead and start stretching that the patella okay.

So you're actually gonna go ahead and here's your kneecap and you're gonna actually you can do it on yours and I can do it on mine but you're gonna go ahead what you know it's got to be relaxed - you're usually laying flat and you're gonna go ahead and you're gonna push the patella so here's the kneecap I'm gonna push it down I'm gonna push it up and I'm also going to push it towards the other knee.

So I actually do you see you got to be relaxed to do this but you see I'm pushing down you're gonna feel it you want to feel the kneecap actually move and then you're gonna also push up yeah if they can get it to view this way this kind of higher cut my skin's moving all over but you know when I was a PT student.

I had no idea that the kneecap moved this much, yeah if your quads are completely relaxed it really you can really move your kneecap around quite a bit well and that's the problem is some of you who have this may not be able to move your kneecap it may be very tight these structures you know the quad may be tight the patellar tendon may be tight the IT band as it comes in here maybe a little tight the lateral structures so that's where you're starting to do is you're starting to do these stretches.

You can do this I have a girl right now who's doing this and she's in class and she's doing this wall sure she's listening - oh you told her if you're getting bored of class yeah mobile I actually I do with some straight leg raises because we're gonna ever do some strengthening too now the probably the most standard treatment that therapists do now for patellofemoral syndrome is the McConnell taping sure so glad you want to stay yes I do so what we're doing with this is very simple.

We're going to take the kneecap and now I know all the therapists appear soft is going to be screaming at me here well the kneecap could be tilted it could be rotated but I have found out that with most people if they just try and push the kneecap over and tape it over towards the other kneecap and and and see if it feels better why not just try that first try the simple remedy first and this is for four people at home this is what all you really can do and if it works if it doesn't work knock it off no harm is done you just a cost of a little bit of tape and hey why not give it a try.


Taping technique on the knee

Normally what we do is and sometimes you know it's like if you get a Meccano taping technique there's actually material that wipes they can do beforehand free wipe yep and because of the skin can get very irritated with this taping sir some people are more participant this girl I had she was keeping her tape on for a week and a trainer had told her to do this sir.

I took it off it was red the skin is starting to break down yeah so nobody can keep this tape on for a week they all really recommend 24 hours I've seen some go 48 mm-hmm but if you're allergic to it, you're probably gonna start turning red within a few hours so if that happens to get the tape off right away and that's not an option to you even if you're not allergic to it you can build up kind of the allergy to it over and the right reaction to it over time because I've seen people that I tape for weeks and then by the fifth week, it starts getting irritated.

Usually, you hope you don't the goal that long right so I put an underlying underlayment tape down first this is hyper allergenic and I'm not really doing anything with that mm-hmm but the other piece of tape what I'm doing is sometimes I'll pull that a little by me sometimes well I usually do now sometimes if you got you to know somewhat hairy legs.

You might want to shave but I'm not shaving my legs he's yeah he does that on his own personal time so what I do here now is I usually push the kneecap over so I'm pushing it over towards the other knee that's using the direction you want to try and I'll put the tape right on the edge of the kneecap sir and I'll push it over.

While I'm pushing it over I'll pull on the tape at the same time and you actually might get a little wrinkled up in there in the skin and that's fine and I usually like to do a double one Brad okay I'll sometimes make mine a little bit longer just so yeah that's more sticky and it is less apt to I agree that should go around here and sometimes I'll put some tape over the top of it to stop the edges.

I push over I'm on the edge of the kneecap I'm pushing pretty good on my breath and then I pull and rapid and the test you know this is a good test a lot of times what we'll do and I both will have somebody walk upstairs without the tape on and they'll say how bad was the pain they'll say maybe it was a 5 out of 10.

We put the tape on we haven't gone up and down the stairs and we haven't check it and a lot of times the pain has decreased right it may go down as much as one or two or they say oh that's clearly better then you know you're on the right track all right other things you can do if you have flat feet you may want to get arch support because that might help a bit sure but let's go into some of the strengthening exercises.

One of the first ones I'm gonna have people do it I'm gonna go just go ahead and good old straight leg raises so you can go ahead and I'm strengthening this one here I'm just gonna go ahead and lift up like this and I'm going ahead and we're getting to some strengthening of the quad times on this it's more comfortable lay down sure you can lay down flat but a lip head will fall off the back of it the latest research is they want it you want to strengthen the knee extension Sten sirs the hip abductors.

 So I'm gonna lay on my side and I'm gonna just bend this leg and I 'ma work on doing these which you can do with weight or you can do without weight or working these muscles up here and the hip external rotators so I'm going to do clamshells I'm putting my knees together like this and I'm going like this there you go so I want you turn this way so they can see it from both directions oh you're gonna be the wrong leg and it's going to be by Mike but so yeah here's hip abductors and here's clamshells hip external rotators and normally he can't because he's gonna be gone his mic box there but you lay down flat with a pillow and be comfortable.

I usually try to teach people how to hop eventually and that is you know when they're staying like that you don't want to hop and land like this they want to learn to land correctly like this once the knee pain has gone away right so because all the knees don't get in towards each go to the side and back forward and back keeping the knees you know these are going out going past the feet they're in they're staying in that good athletic position so those are some of the things to keep in mind and when you go over back to athletics remember you know you're gonna start off gradually run on flat surfaces, not hills.

The nice knee cap right here first phase a rehabilitation for patella femoral pain syndrome injury is focused on controlling inflammation and pain regaining range of motion minimizing weakness and initiating neuromuscular control training consult with your physician and physical therapist for precautions before doing any exercises.


Exercise Techniques

The following are examples of exercises for phase 1 you should continue to see your physical therapist for the full protocol and treatment please consult with your physical therapist if you have increased pain or have any other questions during this phase your physical therapist will determine if you would benefit from a McConnel taping technique to assist with proper tracking of your knee cap this technique will allow you to strengthen and increase the motion in your knee with much less phase.

One exercise once it is performed in a sitting position with the involved leg straight out in front of you roll up the towel and place it under your involved knee tighten the muscles on the top of your thigh by pushing your knee down towards the towel focus on tightening your thigh muscles without tightening your glutes hold each repetition for five seconds.

Repeat 10 times perform three sets exercise - this exercise is performed in a lying down position with the involved knee straight and uninvolved knee bent to about 90 degrees tighten the thigh muscles of the involved knee and slowly lift your leg from the bed make sure you keep your knee as straight as possible as you lift and lower your leg.

Repeat this exercise 10 times perform 3 sets exercise three first tie a bedsheet or a towel around the ankle of your involved leg then lie down on your stomach pull slowly on the bedsheet so that your knee bends to the point where you feel a gentle stretch in the front part of your thigh the stretch should be pain-free hold the stretch for 30 seconds.

Repeat three times exercise number four in a standing position place the foot of the involved the leg on the top of a stool slowly lean forward keeping your back straight until if the stretch is felt in the back of your thigh. You should only feel a gentle stretch without any pain in your knee hold the stretch for 30 seconds repeats three times.

Consultation with therapist

Please consult with your physical therapist prior to advancing to face to face to continue with the same goals and exercises as phase 1 phase 2 focuses on restoring full range of motion normalizing walking and increasing strength neuromuscular control readiness for progression from one face to the next is determined by your physical therapist.

The following are examples of exercise for phase 2 you should continue to see your physical therapist for the full protocol and treatment, please consult with your physical therapist if you have increased pain or have any other questions phase 2 exercise 1 this exercise is performed standing with your back against the wall and feet position at least one foot away from the wall slowly slide down the wall so your knees are bent to about 45 degrees then slide back upkeep knees in line with your feet and hips not allowing them to touch as you lower down or push up.

Stay within a pain-free range repeat this exercise 10 times perform 3 sets exercise number two you will need a towel that is folded for this exercise place the towel in between the wall and your uninvolved knee press the side of the uninvolved leg into the towel then your involved knee slightly and squeeze buttocks hold up to 5 seconds.

Repeat 10 times perform 3 sets this exercise should be felt on the standing legs gluts exercise number 3 standing in front of a step lift involve leg on to step and slowly step-up to step down you will lower uninvolved leg first and slowly descend step make sure you keep knees in line with your feet and hips do not let the knee move in towards the other knees while stepping repeat this exercise 10 times.

Perform 3 sets exercise number 4 while standing with feet together tie the band around knees sit back in a slight squat position and take a step out to the side do not allow your feet to touch as you step to make sure your knees are aligned and that they do not pass your toes as you move take fifteen steps out to the side. 

Repeat three times please consult with your physical therapist prior to advancing phase 3 continues with the same goals and exercises as phase 1 and 2 but with the added goals of functional retraining progression from the single plane towards multiplanar closed chain exercises biometric exercises as well as increasing resistant training and beginning and running progression the following are examples of exercises for phase 3.

You should continue to see you're a physical therapist for the full protocol and treatment please consult with your physical therapist if you have increased pain or have any other questions phase 3.


movement legs


Exercise 1 step forward with involving leg into a lunge position keeping the knee in line with your toes without letting the knee move inwards or outwards do not let your knee go forward past your toes repeat 10 times next lunch in a forward diagonal location repeat 10 times then perform lunch directly to the side.

Repeat 10 times do three sets of this cycle exercise to start with your feet hip-width apart squat down while reaching arms backward jump forward over the line and then jump back over the line to starting position focus on a soft landing and do not let your knees go inwards towards each other or allow your knees to pass your toes when landing or jumping repeat side-to-side repeat this exercise 10 times perform 3 sets. 

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