Patellar pain

 Patellar pain
sports training base in Kunming Li Hongbiao
sports medicine clinics administer patellofemoral pain syndrome is a challenging thing. In part because of the patellofemoral pain syndrome in etiology and treatment lack of consensus. analysis of the reasons include the excessive use, the local load is too large patellofemoral joint, biomechanical problems, muscle dysfunction, and other reasons. patellofemoral pain syndrome, initial treatment plan should include: training and strong quadriceps the regulation of temporary movement of the load. and checked after the coordination of the training received. Sports shoes are also an important aspect of inspection. whether to change the device with arch support biomechanics of the foot is also worth considering aspects of the state. patellofemoral joint pain syndrome is defined as the physical and biomechanical changes of the partial result of the deep patellofemoral pain. This should be the same injury with acute patellar patellar cartilage debris under the strict identification. patellofemoral pain syndrome patients with anterior knee pain is the typical performance is movement pain, the moment when the stairs and downhill increased pain. when sitting longer excited when the pain appears. unilateral and bilateral knee joint may be involved. At present, the disease lack of consensus on the causes and treatment.
Pathophysiology and Epidemiology:
concave in the distal femur articular surface of the patellofemoral joint there are many external forces that can make the patellar stability and to ensure that the sliding patella normal. common mistakes the concept of up and down movement of the patella is only one-way joints, in fact, the patella can) tilt and rotation. Therefore, the patella and femur under different flexion point of contact, repeated exposure to these areas, and sometimes discordant patella slip to the often observed by the naked eye. What causes patellofemoral pain syndrome, biomechanical researchers study the mechanism of stimulating motivation and interest. has a lot of the hypothesis to explain the patellofemoral pain syndrome, the pathophysiology and epidemiology, including biomechanics, muscle and excessive use of the factor. Generally speaking, the literature and clinical experience support the epidemiological patellofemoral pain syndrome is the theory of multiple factors.
excessive over-training and training Load: Because the angle of knee flexion will increase the differences between the patella and the femoral pressure. patellofemoral pain syndrome is often considered the damage caused by excessive use of disease. However, we prefer to define it as load. upstairs, down the mountain, walking on uneven pavement are prone to occur in patients with patellofemoral pain syndrome or aggravate the symptoms, once symptoms develop, when the sitting posture in patients with longer periods of time when the patellofemoral joint pain occurs, (known as the main reason for disease, although there are many assumptions, we discuss the following:
(a) the impact of flatfoot factors: Flat feet and arch settlement terms are used interchangeably, technically speaking, a combination of arch subsidence valgus, high instep, foot abduction issues. This problem often occurs in the absence of the central arch of the foot support of patients. led to the tibia and femur (femur before the ramp) and internal rotation to add. disrupted the patellofemoral joint mechanics, this doctrine by those who received orthopedic orthopedic patients with arch support confirmed.
(b) the impact of the high arch of the foot: the arch, compared with normal, high arch in the human body is not able to provide to the foot touch the ground adequate buffering capacity. patellofemoral pressure to accept too much stimulus, especially in the running when wearing the correct sports shoes, such as the professional use of running shoes to provide cushion, support for good enough, this is enough useful way of protection. These related to sports medicine knowledge to doctors, physical therapists, the famous brand sports equipment store sales professional advice.
(c) Q angle (Q Angle) of factors: some survey I believe the Q angle is too large patellofemoral pain syndrome induced causes. Some have questioned this view. Some studies have shown that in symptomatic and asymptomatic knee Q angles are similar. There are reports of 40 bit unilateral patellofemoral pain were observed and concluded that: they have symptoms of the knee and no symptoms of knee angle compared Q, Q angle in degrees is not much difference! normal Q angle range is 10-22 degrees, there are studies that tested different doctors value of Q angle error will exist. Therefore, doctors should be wary of over-emphasized that the mechanical changes or lead to any treatment of patients believed their pain relief, the result of no avail .
(d) muscle of factors: muscle weakness and lack of flexibility led to patellofemoral pain syndrome causes. quadriceps weakness is our greatest area of concern, however, the potential impact of each reasons should be carefully assessed and the correct measures to better guide the conservative treatment of the most significant.
treatment: long-term clinical observation of a large number of cases by patellofemoral pain syndrome derived standard of care measures are as follows:
Sports and Physical Therapy: As the muscle weakness (in the table (a) muscle weakness listed in the issue) to the muscles of the exercise therapy. quadriceps strength training is recommended by many therapists, the main method. the movement of the patella in the quadriceps muscle plays an important role. hip, femoral group of muscles, triceps muscles and also the importance of iliotibial tract was given sufficient attention. These decisions are dependent on the correct check derived from. We recommend that patients exercise therapy 20 minutes a day. The best physical therapist in monitoring the help of the best. Patients can also be prescribed in the physical therapist in their own home under the guidance of the rehabilitation movement treatment. rehabilitation is a certain amount of time needed to ensure recovery of the body, the patient should not be so anxious! If, six weeks of rehabilitation in patients with exercise therapy, no improvement in function or symptoms doctors need to go back there again re-evaluated. Doctors and communication between the therapist is very important, but we see in many of the health care environment is the lack of such effective communication. Doctors have regular dialogue through the exchange of written medical records we recommend way.
relative rest: the first patients to reduce the activities of the knee, or at least reduced the exercise load. theory patellofemoral pain syndrome is the excessive use or excessive load caused. with movement lag pain (movie-goer's sign) in patients with leg stretching from the regular activities and walking to benefit., if the patient is a runner or the impact of activities involved, we recommend them for energy aerobics, swimming and the impact of other non-sports. or go to the club in a non-impact aerobic cycling exercise, this activity popular at the club popularity.
ice and anti-inflammatory drug use:
ice is the safest anti-inflammatory drugs, but must follow the principles! the end of the exercise 10 to 20 minutes after the ice is reasonable. The usual complaint is that the ice on the knee fixed inconvenience to the help of a simple elastic bandage wrapped ice can solve this problem. choose to use ice packs on the career of professional athletes is a good choice. iced gel, put ice in a plastic bag or frozen peas, corn topical joint pain can be very good therapeutic methods. patellofemoral pain syndrome patients often can not get through the administration of anti-inflammatory analgesic benefits of the final. taking anti-inflammatory drugs are one of the measures to treat the disease, anti-inflammatory analgesic drawback is their potential side effects, ice and exercise therapy than are people more concerned about rehabilitation. taking anti-inflammatory drugs is worth the convenience of patients to make informed choices.
support the knee and knee external fixation:
stent patients with knee knee is controversial. Typically, the knee of the stent is a surface movement. knee support for lateral subluxation of the patients, is a good protector. This can be obtained through observation and touch confirmed. simple elastic knee patella can also provide protection. This need to be further confirmed. Remember, the patient's knee with the knee support can not replace physical exercise therapy.
fixed knee: patellar tendon at an angle of fixation is to reduce the pain for good. The results we see different results. Many physical therapists recognized is McConnell taping. taping in patients treated with methods to obtain the effect is called McConnell taping than patients with good results. Therefore, patient selection is important, the correct way of treatment for patients with knee support bands is obtained in the short term good pain relief effect, with the fixation of the knee support is often a physical therapist trained professor of patients so that patients themselves can eventually master this method to relieve pain.
patellofemoral pain syndrome etiology and Pathophysiology:
etiology pathophysiology

quadriceps weakness Weakness of the quadriceps
strong quadriceps training is often recommended by doctors to patients, The the vastus medialis, vastus medialis obliquus (VMO), vastus intermedius, vastus lateralis and rectus femoris. Weakness may adversely affect the patellofemoral mechanism. Quad-muscle strengthening is often recommended.
shares, especially the middle of the weakness of the quadriceps muscle (VMO) dysplasia Weakness of the medial quadiceps, specifically VMO dysplasia
VMO weakness lead to lateral patellar sliding too far. Although the role of VMO is controversial. But the stronger quadriceps training is recommended training programs. However, quadriceps training separately is difficult. Most patients will be very easy to complete the muscle training. though the role of the VMO is controversial ,18-20 VMO strengthening is often recommended.6, 7, 11,15,16 However, the VMO is a difficult muscle to isolate, 21 and most patients find general quadriceps strengthening easier to accomplish.
Tight iliotibial bands
iliotibial iliotibial band tension can cause tension in the patella receiving excessive lateral force, the rotating tibial extreme, so out of balance the patellofemoral joint mechanics. This led to extreme lateral movement of the patella. A tight iliotibial band places excessive lateral force on the patella and can also externally rotate the tibia, upsetting the balance of the patellofemoral mechanism.22, 23 This problem can lead to excessive lateral tracking of the patella.
Tight hamstring muscles hamstring muscles hamstring strain
is the function of knee flexion. tight hamstring put on the back of the knee muscle force. causes the pressure between the patella and femur to increase. The hamstring muscles flex the knee. Tight hamstrings place more posterior force on the knee, causing pressure between the patella and femur to increase
Weakness or tightness of the hip muscles (adductors, abductors, external rotators) hip muscle weakness or tension (adduction, hip abduction and rotation)
the quadriceps and adductor muscle of the same origin, living in this anatomical Science on principle, therefore, strong adductor muscle training to help knee extension movements. abductor muscle (gluteal muscle) of the strong to help stabilize the pelvis. external rotation of hip joint dysfunction will increase plantar flexion level. simple muscle stretching can help improve the efficiency of muscle work. The VMO originates on the adductor magnus tendon. This is the anatomic basis for recommending adductor strengthening.11, 14,16 Abductor (gluteus medius) strengthening helps to stabilize the pelvis . Dysfunction of the hip external rotators results in compensatory foot pronation; a simple stretch can improve muscular efficiency.4
Tight calf muscles tense
triceps muscle of calf triceps muscle of calf tension lead to compensation for Qu Zhe foot movements, hamstrings as tight as to increase the force behind the knee. Tight calves can lead to compensatory foot pronation and, like tight hamstrings, can increase the posterior force on the knee.11, 15,16
sports shoes Impact: professional sports shoes and running shoes in the past ten years to obtain very rapidly. Because of inadequate knowledge of shoes and sports shoes lead us to the choice of professional errors, the quality of professional shoes and shoe brand is more than life important. very heard of the new statement shoe of patients can reduce their knee pain. most of the runners in the use of their shoes after 300-500 miles on his shoes. sports medicine doctors can make use of the damaged ones to determine how the hole Select orthopedic support devices in patients is very useful.
orthopedic orthotics arch support with the use of: arch support with a lot of lower limb orthopedic orthoses in patients with symptomatic benefit, but also include patellofemoral pain syndrome patients. Although the reason is not very adequate. arch support device can improve lower extremity biomechanics, prevention of over-staying flat foot arch and the arch of the foot for those who have flat feet normal terms can provide a wide support surface .
arch support device is a reasonable choice for use with good support at the initial stage. relatively cheap, and orthopedic arch support orthosis device results in poor state an alternative choice, shortcomings is it expensive.
surgery: Surgery is patellofemoral pain syndrome patients the final choice of treatment. true chondromalacia patella cartilage chips may be due to causes, need for surgical intervention. the removal of brittle tablets, the symptoms in remission, but unfortunately, chondromalacia patella problem appears again.
If knee pain is caused because of excessive lateral sliding, then the need for lateral organization of a . This is because the lateral width of the tension too tight tensor fascia, iliotibial tract tension or weakness of the quadriceps due to meat, to affix the patellar knee support sticky paste, so the middle is a sliding patella reliable measures, the disadvantage is fixed Chen repetitive movements and materials of the high. Before the operation, some patients wear orthotics or arch support material is another measure. for lateral support on the part with the lysis were valid. to remind doctors of the problem is not to over-treatment for some patients.
I observed in the clinical part of patellofemoral pain syndrome patients before seeking medical treatment there is often a wait and see period for some of patellofemoral pain syndrome of young children is normal skeletal muscle development, living in these reasons, the traditional method of treatment is first recommended for those younger patients.
Radiology imaging: such as of osteochondritis, infection, the imaging examination of osteophytes can be considered. Generally speaking, an accepted treatment for 6 weeks of strictly no improvement in symptoms, while accepting the plain film examination before treatment should have a reasonable period.
Recommended treatment: the initial treatment of patellofemoral pain syndrome of the traditional methods are: 1, the patient temporarily change sport, and the relative rest .2, .3 quadriceps strength of intensive training, assess the patient's own .4 shoes, ice treatment, especially after exercise.
program we recommend the choice of treatment should be individualized principle. during the inspection of local muscle on the hip muscles, iliotibial , triceps muscle, femoral muscle strength training and stretching group training is a must! necessary to consider the implementation of orthopedic orthoses on patients. patient education must be carried out, should be given to the treatment of patients with a realistic expectation. For the patellar femoral pain syndrome epidemiology and treatment of people still inaccurate. Fortunately, in particular those patients and to maintain strict compliance with principles of treatment of patients who have been in some traditional methods of treatment of the symptoms of knee pain and get better. We are looking forward to the further development of these studies.