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Designing a Rehabilitation Programme for the Patient with Patellofemoral Pain

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Patellofemoral Pain, Instability, and Arthritis

Abstract

Patellofemoral pain (PFP) is a highly prevalent condition, affecting up to 23% of the general and 28% of the adolescent population [1]. Recent evidence suggests that patellofemoral joint (PFJ) osteoarthritis is a sequelae of PFP [2, 3] challenging the traditional notion that adolescent anterior knee pain is a benign pathology. Furthermore, high levels of depression and anxiety are reported amongst patients suffering PFP [4]. It is therefore concerning that despite the implementation of evidence-based interventions including exercise therapy, the prognosis of this condition remains poor, with 40–56% of patients reporting ongoing symptoms 1–2 years following conservative treatment [5, 6]. It is estimated that over 50% of people with the condition will report symptoms continuing beyond 5 years following diagnosis [7]. In addition, those patients who complain of high base levels of pain and longer duration of symptoms are typically found to have the most unfavourable recovery [5]. These poor long-term outcomes highlight that despite PFP populations being widely investigated, at present the answers on how best to manage these patients are lacking. With this in mind, how then does the treating clinician go about designing a successful rehabilitation programme for these patients? This chapter reviews current evidence in this field and discusses biomechanical principles to help guide how this might be achieved. We note that growing evidence highlights the importance of also considering psychological factors affecting this population [4], and these are discussed in a separate chapter.

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Authors and Affiliations

  1. Fortius Clinic, London, UK

    Joanna Stephen, Simon Ball & Sam Church

  2. Mechanical Engineering, Imperial College London, London, UK

    Joanna Stephen

  3. Physiotherapist, Exercise Engineers, London, UK

    Joanna Stephen & Caroline Ephgrave

  4. Chelsea and Westminster Hospital, London, UK

    Simon Ball

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  1. Joanna Stephen
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  2. Caroline Ephgrave
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  3. Simon Ball
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  4. Sam Church
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Correspondence to Joanna Stephen .

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Editors and Affiliations

  1. Lyon-Ortho-Clinic, Lyon, France

    David Dejour

  2. Istituti Ortopedico Rizzoli Clinica, Ortopedica Traumatologica III, Bologna, Italy

    Stefano Zaffagnini

  3. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Elizabeth A. Arendt

  4. Department of Paediatric Surgery, University of Tampere, Tampere, Finland

    Petri Sillanpää

  5. Clinic Diakonissen LinzOrthopädie & Sportchirurgie Linz, Puchenau, Austria

    Florian Dirisamer

34.1 Electronic Supplementary Materials

The pelvis is seen to tilt over the hip in a true anterior posterior pelvic tilt (MOV 15488 kb)

The rib cage is drawn down to the pelvis rather than the pelvis going up to the rib cage (MOV 15348 kb)

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Stephen, J., Ephgrave, C., Ball, S., Church, S. (2020). Designing a Rehabilitation Programme for the Patient with Patellofemoral Pain. In: Dejour, D., Zaffagnini, S., Arendt, E., Sillanpää, P., Dirisamer, F. (eds) Patellofemoral Pain, Instability, and Arthritis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61097-8_34

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