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Management of Patellofemoral Pain Syndrome
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Dear All
At the Sports and science meeting in Fiji a few months back, some phd physio who has done alot of work in this area was now chansing the gluteus medius as the culpret.
Can't wait for the hyoglossus to be blamed. It will given enough time.
Using Jones' strain counter strain can fix it in 90 seconds. Done it hundreds of times to people in all walks of life wih patellofem pain from a few weeks to years to loss of career due to pain. etc. selling two storey house due to stairs and pain. could go on.
musmed
www.musmed.com.au -
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what is 'Jones strain counter strain'
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Dear All
Jones' strain counterstrain was designed by Lawrence Jones. He was an American Osteopath that found there were many tender points where ligaments or tendons join or cross bones.
You an get his book on Amazon. Itis published by his own company, Jones Publishing.
Jones' points resist all forms of therapy. It does not matter that the sore spot has been rubbed, heated, manipulated, injected etc. It just doen not get better.
There are about 250 Jones' points from the head to the great toe.
What is hard to understand is that the problem is only a Jones' point if the pain is turned off by using his technique/protocol.
Basically the procedure is to place a fingertip on the tender point and then move the joint/limb/head/whatever into flexion/extensio abduction/adduction compression/distraction until the pain stops (CONSTANT feedback from your patient is essential). Once it stops immediately do not move. Hold that place for 90 seconds, return joint etc. to neutral and retest.
There should be a 70+% reduction in pain. Over the following few days it will completely disappear.
I hae posted on my website (pull down on the left hand side) the treatment of sesamoiditis. THis is an unbelievably simple technique that works to the amazement of the patient despite the problem having been there for several years or so.
Have a look. Try it! It works.
Regards
musmed
www.musmd.com.au -
The effect of patellar taping on EMG activity of vasti muscles during squatting in individuals with patellofemoral pain syndrome.
Mostamand J, Bader DL, Hudson Z.
J Sports Sci. 2011 Jan;29(2):197-205.
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The original McConnell article did not go into the mechanics of the McConnell tapping but rather advocated its use. This evidence gives the background information that EMG-activity is significantly reduced in both the vastus medialis and lateralis muscles. With a medial glide of the patella, if the aciton of the vastii muscles are to keep the patella in position during locomotion, the force vector of the vastus medialis is expected to decrease whilst the vastus lateralis force vector should increase due to an increase in moment arm. Perhaps the main reduction is pain due to an over-working v.medialis that is given a period of rest with the tapping?
The interesting point is that McConnel strapping seems to have an immediate effect on most indviduals with medial/ peri patella pain related to mal-tracking.
What are other clinicians thoughts?
Shalom. -
This has been released:
An Update for the Conservative Management of Patellofemoral Pain Syndrome: A Systematic Review of the Literature from 2000 to 2010.
Authors: Bolga LA, Boling MC
Int J Sports Phys Ther. 2011 June; 6(2): 112–125. PMCID: PMC3109895
The PDF of the article is freely available from PubMed:Attached Files:
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An Update for the Conservative Management of Patellofemoral Pain Syndrome - A Systematic Review .PDF
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Cheers for that article, should be an interesting read.
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Hello.
what is happening is what Dr. Lawrence Jones of strain counter strain fame described some 50 + years ago, well before McConnell
You will find the answer in his book.
Retropatellar pain is dime a dozen stuff.
Using a Jones counterstrain technique where the patella is moved laterally and tilted medially and held for 90 seconds works a treat in almost all cases. 0ver 70% of pain is gone and within 3 days it has totally gone.
These souls are restricted in crouching, squatting descending stairs in the majority.
After you apply his techniques, your patient can perform these tasks despite the fact that the pain that has been there from 1 to 20+ years.
Like they say, nothing is new, only the packaging.
I teach this in my workshops and you would be suprised how many emails i get back saying they removed retropatellar pain using this extremely simple technique.
I have read the paper and of course Jones never rated a mention
regards
paul Conneely
www.musmed.com.au -
The effect of taping, quadriceps strengthening and stretching prescribed separately or combined on patellofemoral pain.
Mason M, Keays SL, Newcombe PA.
Physiother Res Int. 2011 Jun;16(2):109-19. doi: 10.1002/pri.486. Epub 2010 Jul 14.
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Patellofemoral knee pain treatment using neuromuscular retraining of the hip musculature in an adolescent female: a case report.
Frounfelter GG, Stutzriem DE.
J Strength Cond Res. 2011 Oct;25(10):2828-34.
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pardon my ignorance is there any link b.w jones point and trigger point?
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There is no direct correlation as to perceived aetiology, but there again..
Most Jones point occur where a tendon or ligament cross or join a bone. Jones thought they were some dysfunction at the neurological level (what ever that meant)
A Jones point is only a Jones point when the pain is turned off using a Jones technique- all revolve around sidebending and rotation of the affected area. Di Giovanni et al added compression and the time needed to produce a &0% reduction in pain went from 90 seconds to 4-6.
A trigger point is in the muscle or fascia of the muscle or periosteum (especially the gluteus medius muscle)
They occur mostly in the middle of the muscle where the motor end plate occurs.
Google Jones' points and there are a few good explanations especially one from his text book.
Travell and Simons is the bible for trigger points.
I was actually teaching Jones' points to the foot and ankle yesterday. They certainly do exist and simple treatment protocols when followed can produce dramatic results.
Regards
paul Conneely
www.musmed.com.au -
Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials.
Collins NJ, Bisset LM, Crossley KM, Vicenzino B.
Sports Med. 2012 Jan 1;42(1):31-49.
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Exercise training to prevent anterior knee pain in military recruits.
Divine J.
Clin J Sport Med. 2012 May;22(3):288-9.
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Bracing and taping techniques and patellofemoral pain syndrome.
Jessee AD, Gourley MM, Valovich McLeod TC.
J Athl Train. 2012;47(3):358-9.
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Effectiveness of different exercises and stretching physiotherapy on pain and movement in patellofemoral pain syndrome: a randomized controlled trial
F Revelles Moyano et al.
Clin Rehabil October 4,
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NEW INSIGHTS IN MUSCLE MORPHOLOGY, MUSCLE ACTIVATION AND FUNCTIONAL OUTCOME IN PATIENTS WITH PATELLOFEMORAL PAIN
ELS PATTYN
Thesis, Univeristy of Ghent; 2012 (PDF)
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Prognostic factors for patellofemoral pain: a multicentre observational analysis
Natalie J Collins, Sita M A Bierma-Zeinstra, Kay M Crossley, Robbart L van Linschoten, Bill Vicenzino, Marienke van Middelkoop
Br J Sports Med doi:10.1136/bjsports-2012-091696
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Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis
Guilherme S. Nunes, Eduardo Luiz Stapait, Michel Hors Kirsten, Marcos de Noronha, Gilmar Moraes Santos
Physical Therapy in Sport (Article in Press)
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Different Relationships Between the Level of Patellofemoral Pain and Quality of Life in Professional and Amateur Athletes
Roy T.H. Cheung, Zhijie Zhang, Shirley P.C. Ngai
PM&R; Available online 29 January 2013
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Patellofemoral Pain Syndrome and Modifiable Intrinsic Risk Factors;
How to Assess and Address?
Farzin Halabchi; Reza Mazaheri; Tohid Seif-Barghi
Asian Journal of Sports Medicine, Volume 4 (Number 2), June 2013, (Full text pdf)
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Neuromuscular Activity and Knee Kinematics in Adolescents with Patellofemoral Pain
Rathleff, Michael S.; Samani, Afshin; Olesen, Jens L.; Roos, Ewa M.; Rasmussen, Sten; Christensen, Birgitte H.; Madeleine, Pascal
Medicine & Science in Sports & Exercise: 21 March 2013
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Long-term effects of medical exercise therapy in patients with patellofemoral pain syndrome: Results from a single-blinded randomized controlled trial with 12 months follow-up
Berit Østerås, Håvard Østerås, Tom Arild Torsensen
Physiotherapy; Available online 10 June 2013
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Closed Kinetic Chain exercises with or without additional hip strengthening exercises in management of Patellofemoral pain syndrome: a randomized controlled trial.
Ismail MM, Gamaleldein MH, Hassa KA
European Journal of Physical and Rehabilitation Medicine [2013]
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Does quadriceps atrophy exist in individuals with patellofemoral pain? A systematic literature review with meta-analysis
Lachlan S. Giles, Kate E. Webster, Jodie A. McClelland, Jill Cook
Journal of Orthopaedic & Sports Physical Therapy, 0, Volume: Early Access
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A review of the management of patellofemoral pain syndrome.
Rixe JA, Glick JE, Brady J, Olympia RP.
Phys Sportsmed. 2013 Sep;41(3):19-28.
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Patellofemoral pain syndrome.
Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann GP, Liebau C.
Knee Surg Sports Traumatol Arthrosc. 2013 Nov 13.
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Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms
Christian Barton, Vivek Balachandar, Simon Lack, Dylan Morrissey
Br J Sports Med doi:10.1136/bjsports-2013-092437
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Effects of step length on patellofemoral joint stress in female runners with and without patellofemoral pain
John D. Willson, Ryan Sharpee, Stacey A. Meardon, Thomas W. Kernozek
Clinical Biomechanics; Available online 30 December 2013 -
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Neurodynamic Responses to the Femoral Slump Test in Patients With Anterior Knee Pain Syndrome
Pei-Ling Lin, PT, MS, Yi-Fen Shih, PT, PhD, Wen-Yin Chen, PT, PhD, Hsiao-Li Ma, MD
Journal of Orthopaedic & Sports Physical Therapy, 2014, Volume: 44 Issue: 5 Pages: 350-357 -
A Prospective Study Evaluating the Effects of Manual Therapy on the Treatment of Patellofemoral Pain
Tang, Conrad
Master Thesis; University of Calgary; 2014
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Individualized Physiotherapy in the Treatment of Patellofemoral Pain
Susan L. Keays, Marjon Mason and Peter A. Newcombe
Physiotherapy Research International; Early View
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The Effect of Stretching and Strengthening on Patellofemoral Pain Syndrome
Heather Hollinger
Honors Thesis Hamline University March 19, 2014
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Effectiveness of Exercise Therapy in Treatment of Patients With Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis
Ron Clijsen, Janine Fuchs and Jan Taeymans
Physical Therapy 31 July 2014 doi: 10.2522/ptj.20130310
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Outcome Predictors for Conservative Patellofemoral Pain Management: A Systematic Review and Meta-Analysis
Simon Lack, Christian Barton, Bill Vicenzino, Dylan Morrissey
Sports Medicine August 2014
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