Archive for the ‘music’ tag
Club Vol
Patellofemoral Syndrome by Jon Tobey
Patellofemoral Syndrome by Jon Tobey
Patellofemoral syndrome (PFS) is one of the most common causes of knee pain in active patients and stems from problems with the patella as it moves over the front of the knee. (Harmon, Labotz & Rubin, 2004) Patellofemoral syndrome is usually caused by the overuse of the knees or and is often caused by people who become involved in an activity and do too much too soon. Also if a person does not have adequate flexibility and strength in their upper leg and hip muscles and they have poor alignment of the leg bones this can also cause this type of disorder. (Harmon, Labotz & Rubin, 2004)
The normal alignment of the patella in the frontal plane is described as having a 15-degree Q-angle. (Colby & Kisner, 507) Patients with PFS have abnormal tracking of the knee cap toward the lateral side of the femur instead of in a straight line over the end of the femur. This causes the patella to grate along the femur resulting in pain and inflammation of the knee. (Sheil, 2006) Patella tracking problems is often caused by an increased Q-angle, muscle and fascial tightness, lax medial capsular retinaculum or insufficient vastus medialus obliquis.
One of the major signs of patellofemoral syndrome is the knee pain that develops with this disorder. A patient will often experience pain that feels like it is behind the knee cap, this pain usually is brought on by activity involving the musculature around the patella or sitting for a prolonged period of time. Another symptom is swelling in the patella area, which patients often refer to as tightness in the knee area. At times patients with this disorder also experience times where their knees give out on them, this is usually due to the disuse of the musculature surrounding the patella. (Sheil, 2006) A series of tests should be provided for a patient with these signs and symptoms to assess the disorder. A stance and gait test should be done to get an overall impression of the lower-limb alignment, a seated exam should be performed to assess vastus medialus obliquus bulk and patellar position, and a supine exam should also be performed to assess the active and passive range of motion of the knee and hip. The patellar glide test and patellar tilt test may also be used to assess the movement of the patella and test retinacular tightness or laxity. (Harmon, Labotz & Rubin, 2004)
One of the major medical treatments that patients with patellofemoral syndrome first use is a nonsteroidal anti-inflammatory drug to decrease swelling and provide relief of the area. The patient will also be involved in a rehabilitation program in order to correct the alignment of the patella. If the rehabilitation does not correct the issue the patient will then have surgery. One of the most common techniques used for patellofemoral syndrome is a lateral release, which involves a division of the lateral patellar retinaculum. Studies reveal that between 17% and 92% of patients report satisfactory results after lateral release, a highly variable outcome. Articular cartilage debridement is another surgery used to correct malalignments. A patient is often referred to a physical therapist if they cannot participate in a home exercise program and after surgery patients often are referred to an orthopedist for an evaluation and treatment. (Harmon, Labotz & Rubin, 2004)
In the case of nonoperative management of patellofemoral syndrome there are two phases used to help rehabilitate the paellofemoral joint. The first phase is the protection phase. During this phase rest, gentle motion and muscle setting exercises in pain free postitions will be used to treat the joint. A brace or tape may be used during this phase to reduce irritating forces and relieve the irritating stress to the joint. (Colby & Kisner, 523) The Second and last phase begins when there are no signs of swelling of the joint. This phase is called the controlled motion and return to function phase. During this phase the patient will begin to increase flexibility of the lateral fascia and insertion of the IT band along with stretching other tight structures. They will train and strengthen functional control of the knee extension in nonweight-bearing positions and also in weight-bearing positions. Also any biomechanical stresses that need to be modified like foot pronation will be adjusted during this phase, and last functional activities will added to the phase. During the controlled motion and return to function phase a friction massage around the lateral aspect of the patella is used to increase flexibility. (Colby & Kisner, 524)
Patellofemoral Syndrome Exercises
Cardiovascular exercise is important for patients with patellofemoral syndrome. Cardiovascular exercise should only be performed if swelling and pain in the knee is minor or nonexistent. Activities that have minimal to no impact will be used in order to attain cardiovascular health without stressing the knee. Activities that also are non-weight bearing are good for patients with patellofemoral syndrome.
A) Water walking: 20-30 minutes a day, 3x a week. This exercise will help the patient gain cardiovascular health without bearing their full weight on the knee. The exercise should be done continuously at a pace that is maintainable for 20-30 minutes.
B) Water aerobics: 30-45 minutes a day, 2x a week. Water aerobics will help the patient do multiple types of water exercises while working out aerobically. This aerobic program will increase cardiovascular endurance and also muscle endurance in the patient without bearing full weight on the knee.
The patient will need to increase their flexibility and range of motion, this may help correct the faulty mechanics that caused the injury. Having full range of motion in the muscles surrounding the knee is extremely important to prevent future injuries. Joint tracking and patellar alignment exercises may also be used to correct alignment and flexibility issues.
A) Patellar mobilization medial glide: The patient will be side lying, stabilize the femoral condyles with one hand under the femur and glide the patella medially with the other hand. To progress the stretching, position the knee in greater flexion. (Colby & Kisner, 524)
B) Medial tipping of the patella: With the patient supine place the thenar eminence at the base of the hand over the medial aspect of the patella. A direct posterior force tips the patella medially. A friction massage can be applied to the lateral border with other hand while in this position. (Colby & Kisner, 524)
C) Self stretch of the IT band: With the patient side lying with a belt or sheet strapped around the ankle and the other end over the shoulder and held in the hand. The hip is positioned in extension, adduction, and slight lateral rotation and the knee in flexion. First flex the knee and abduct the hip, then extend the hip, the femur is then adducted with slight lateral rotation until tension is felt in the IT band along the lateral knee. This position is maintained for 20-30 minutes. (Colby & Kisner, 524)
When training a patient to increase muscular endurance and strength it is important to do so in nonweight-bearing positions to reduce stress and compressive forces on the patellofemoral joint. These exercises are important to increase the musculature around the joint to reduce the pressure on the joint, especially the vastus medialis obliqus since this is the muscle of the quadriceps that influences the tracking of the patella. While doing these exercises ranges where pain is felt should be noted and avoided.
A) Quadriceps setting in pain free positions: The patient will set the quads with the knee in various positions while focusing on tension development in the vastus medialis obliquis. Be sure to identify pain free positions. Hold for 10 seconds, 10-15 reps, 3 sets. (Colby & Kisner, 525)
B) Quad sets with straight leg raising: The patient will set the quads with the knee in various postitions while performing straight leg raises. The patient will focus on the tension development in the vastus medialis obliquis. This exercise will increase activity in the vastus medialis obliquis. Hold for 10 seconds, 6-10 reps, 3 sets. (Colby & Kisner, 525)
C) Short arc terminal extension: lying prone and a rolled towel under their knee the patient will begin with their knee flexed around 20 degrees and hold. Strengthening in terminal extension trains the muscle to function where it is least efficient because of the shortened position. A weight can be added to the ankle to progress. (Colby & Kisner, 525)
D) Hamstring setting exercises: With the patient lying supine or longsitting with the knee in extension or slight flexion over a towel roll. Have the patient contract the knee flexors just enough to feel tension developing in the muscle group by gently pushing the heel into the treatment table and holding the contraction. Hold for 10 seconds, 10-15 repetitions, 3 sets. (Colby & Kisner, 552)
E) Multiple angle isometric exercises: With the patient lying supine or longsitting, apply either a manual or mechanical resistance to a static hamstring muscle contraction with the knee flexed to several positions in the ROM. Avoid maximum torque in 60 and 75 degrees, as this is the point of the greatest patellar stress. Hold for 10 seconds, 6 reps, 3 sets. (Colby & Kisner, 552)
After the patient has developed proper muscle strength and endurance without signs of pain they will move on to functional training activities. These activities will allow them to return to normal activities that they are involved in, in daily life. These activities will help them regain balance, stabilization and function of the patellofemoral joint and surround muscles.
A) Chair scooting: With the patient sitting on a rolling stool or chair. Have the patient walk forward to use the hamstrings or walk backwards to utilize the quadriceps. Progress patient by having them steer around objects or pull against a resistance. (Colby & Kisner, 554)
B) Uneven surface walking: During this exercise the patient will walk on an uneven surface to work on the stabilizer muscles surrounding the patellofemoral joint. The patient can also walk against resistance and in different directions to work on these stabilizer muscles. (Colby & Kisner, 556)
References
Colby, L.A. Kisner, C (2002) Therapeutic Exercise foundations and Techniques. F.A. Davis Co. Philadelphia.
Harmon, K. Rubin,A. and Labotz,M. (2004) Coping with Patellofemoral Syndrome. Physician & Sportsmedicine Vol. 32 (7) p30-31. http://web.ebscohost.com/ehost/detail?vid=7&hid=112&sid=13d84ba7-5aac-4400-a85d-eb8114779f3e@sessionmgr102
Harmon, K. Rubin,A. and Labotz,M. (2004) Patellofemoral Syndrome. Physician & Sportsmedicine Vol. 32 (7) p22-29.
Shiel, William. (2006) Patellofemoral Syndrome. Medicine Net. http://www.medicinenet.com/patellofemoral_syndrome/article.htm
About the Author
Jon Tobey is a Certified Personal Trainer and Nutrition Coach at the Salem Athletic Club in Salem, NH. He specializes in Weight Loss, Toning and group training including: Boxing Boot Camp and regular Boot Camp Training.
http://www.sac-nh.com/specialized_programs.php
http://www.sac-nh.com/contact_tobey.php
AE86 Club Vol.8
|
|
Glee: The Music, Volume 1 $6.50 CD > BRAZILIAN MUSIC > MPB – BRAZILIAN POPULAR MUSIC… |
|
|
Glee: The Music, Volume 2 $7.23 Other… |
|
|
Glee: The Music, Volume 4 $8.36 Empire State of Mind (Glee Cast Version)Billionaire (Glee Cast Version)Me Against the Music (Glee Cast Version)Stronger (Glee Cast Version)Toxic (Glee Cast Version)The Only Exception (Glee Cast Version)I Want to Hold Your Hand (Glee Cast Version)One of Us (Glee Cast Version)River Deep, Mountain High (Glee Cast Version)Lucky (Glee Cast Version)One Love (People Get Ready) (Glee Cast Version)Teenage … |
|
|
Mickey Mouse Club Volume 10: Talent Roundup Day $5.99 … |
|
|
Mickey Mouse Club Volume 7 $49.99 … |
|
|
The Mickey Mouse Club, Vol 9 Featuring Circus Day $13.95 Volume 9 — When THE MICKEY MOUSE CLUB made its TV debut on October 3, 1955, it became an instant phenomenon and made an indelible impression on an entire generation of young fans. Now, the show America grew up with is available on videocassette for new generations to enjoy! Each volume includes three episodes featuring the best of the Mouseketeers. Remember “Circus Day”?…Enjoy a real three-ring… |
|
|
Midsomer Murders: Set 17 $32.97 Studio: Acorn Media Release Date: 02/22/2011 Run time: 400 minutes Rating: Nr… |
|
|
The Little Rascals: The Complete Collection $45.00 Studio: Genius Products Inc Release Date: 10/28/2008 Run time: 1372 minutes… |
|
|
Teenage Mutant Ninja Turtles – Original Series (Volume 3) $7.07 Studio: Lions Gate Home Ent. Release Date: 12/06/2005… |
|
|
Samsung Galaxy Tab 7.0 HDMI Multi-Media Desktop Dock $49.99 Charge your Galaxy Tab™ conveniently at your desk while checking email, listening to music via the 3.5 mm stereo line-out port, or just taking in your favorite photos in digital picture frame mode with the Samsung ECRD980BEGSTA HDMI Multi-Media Dock. It features HDMI output to view HD content on HDTV up to 1080p (optional HDMI cable required), 30 pin connector to tablet for charging, video, … |