Dynamic Stabilization of the Patellofemoral Joint: Stabilization from above & below

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1 Dynamic Stabilization of the Patellofemoral Joint: Stabilization from above & below Division Biokinesiology & Physical Therapy Co Director, oratory University of Southern California Movement Performance Institute Los Angeles, CA Proximal factors Dynamic Q Angle Femoral adduction Femoral internal rotation Distal factors Pronation Tibial internal rotation Control of Hip Adduction & Internal Rotation

2 Half of the PFJ is the Femur!! Females with PFP Have Weak Hip Muscles: A Systematic Review Prins & van der Wurf, Austr J Physiother, studies evaluated Conlcusion: Strong evidence that females with PFP have impaired strength of the hip extensors, abductors and external rotators Paradigm shift in the treatment of PFP Control of femoral rotation and adduction Emphasis on gluteus maximus & medius strengthening

3 Gluteus Maximus: The Tri planar Muscle Extensor Abductor External Rotator

4 Greater Utilization of the Hip Extensors is Associated with Decreased Knee Valgus Moments & Angles Pollard et al, Clin Biomech, 2010 Pre training

5 Post training Hip Strengthening & PFP Case Series (N=2) Excessive hip adduction, IR during a step down 14 week intervention of hip, pelvis, trunk strengthening Outcome variables Pain, muscle strength, LE kinematics Mascal et.al., JOSPT, 2003 Hip Strengthening & PFP Results Pain Improved kinematics hip adduction, IR 70% in Glut Med strength 83% in Glut Max strength Mascal et.al., JOSPT, 2003

6 Hip Strengthening as a Treatment for Patellofemoral Pain Nakagawa et al. Clin Rehab, 2009 Fukada et al. JOSPT, 2010 The combined use of hip and quadriceps strengthening was better than quadriceps strengthening alone. The influence of hip muscle strengthening on PFP has not been evaluated in isolation Femoral strapping to improve lower limb alignment & control (DJ Orthopaedics) Pain Response Strap vs. No strap (N=20) p <.001 p =.002 p =.001 No Strap Strap Drop Jump Running Step Down

7 Hip Internal Rotation Strap vs. No strap (N=20) p=0.001 p< p< ER - / IR no strap strap Drop Jump Running Step Down 0 degrees No strap Strap Lateral Patella Displacement during Single Leg Squat (N=15) PFP strap PFP deg 15 deg 30 deg 45 deg

8 Latera; Patellar Tilt During Single Leg Squat (N=15) PFP strap PFP deg 15 deg 30 deg 45 deg What about Orthotics?

9 Can Orthotics Change Lower Extremity Kinematics? Medial wedging changed frontal & transverse plane knee kinematics 1 2 Nester et al., Gait & Posture, 2003 Eng & Pierrynowski, Phys Ther, 1994 Over the counter orthotic caused a 2 decrease in hip internal rotation Jenkins et al., J Appl Biomech, 2009 Orthotics as a Treatment for Patellofemoral Pain Collins et al. Br J Sports Med, 2009 (N=179) The use of orthotics was no better than physical therapy The combined use of orthotics and physical therapy was no better than physical therapy or the orthotic intervention alone. Musculoskeletal Biomechanics Research Laboratory University of Southern California

10 Questions?

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