Anatomically speaking the knee is one of the most complicated joints in the human body, actually made up of two joints in three distinct compartments. The first joint is where the femur (thigh bone) meets the tibia (shin bone) and has two separate inner and outer compartments. The second joint, housed in the third compartment of the knee, is the patellofemoral joint. Here the patella (knee cap) and the femur meet. The patella is in front of the knee joint, embedded in the thigh muscle tendon. It acts as a pulley system allowing the knee to extend and straighten and protecting the area from direct trauma.
Patellofemoral pain syndrome (PFPS) is an umbrella term, you may also hear medical practitioners using terms like patellofemoral joint syndrome, anterior knee pain and chondromalacia patella to describe pain in and around the patella. PFPS is most typical among athletes, but not exclusively, since 25% of the general population will at some stage in their life suffer from patellofemoral pain.
There are numerous possible causes of PFPS including excessive flexibility, wear and tear, injury, as well as weakness of the quadriceps (front thigh muscle) and hip muscles. Therefore, the rehabilitative requirements of PFPS are quite demanding and should address the underlying causes of the pain. AposTherapy can achieve this by reducing the stress on the joint, adjusting how the foot makes contact with the ground and improving muscular coordination around the knee.
Whilst individual experiences of PFPS symptoms vary significantly, most patients complain of a diffused ache in the front of the knee, which is exacerbated by stair climbing and prolonged sitting with the knee flexed – also known as movie-goers knee. Other symptoms include cracking, swelling, tenderness and wasting of the thigh muscles.
Understanding how the patellofemoral joint works helps explain the wide range of symptoms that can appear. Any activity that involves the knee and quadriceps is dependent on the patella moving correctly throughout its full range of motion.
The cause of patellofemoral pain reflects a combination of intrinsic and extrinsic factors acting on the joint. Extrinsic loads are created when the body makes contact with the ground. This can be affected by body mass, speed, the kind of terrain being made contact with, as well as the type of footwear the person is wearing. By adjusting these various elements, the force that passes through the body when the foot strikes the ground (the ground reaction force) can be controlled and consequently the pain moderated.
Intrinsic factors, from within the body itself, however are more variable and not so easily controlled, these include any misalignment of the lower limb while moving. Also taking a toll on the joint is inflexibility or inefficient functioning of the muscles that affect the knee joint, which can include those around the hip, ankle and foot. All these elements can cause the knee cap to slightly shift off-course as it moves, rubbing as opposed to gliding over the femur groove. These various muscular dysfunctions, leading to loss of normal patella movement, have long been regarded as major contributing factors to the development of PFPS. Additional factors from within thepatellofemoral joint itself can also directly disrupt the patellofemoral movement and lead to pain.
Clearly there are a vast number of factors at work in PFPS and as such the management of this disorder requires an integrated treatment approach. Overall, surgery is best avoided, with long-term PFPS treatment focusing on ensuring the patella is optimally aligned, whilst improving lower limb movement. Research has indicated that PFPS patients respond well and quickly to a therapeutic exercise program that incorporates quadriceps and hip muscle strengthening. Ideally, this involves functional rehabilitation in the patients’ own environment, which will also enhance muscle coordination. In fact latest PFPS recommendations stressing the importance of rehabilitation that simulates the patient’s real life routine activities, support the AposTherapy approach where treatment takes place in patients’ own environments, blending into their day-to-day routine.
Most often a clinician will use a combination of physiotherapy together with the prescription of a specific exercise regime. However, this can only be truly effective when strictly adhered to, with an emphasis on correct technique which can sometimes be hard for patients to follow.AposTherapy considers all of the factors influencing patellofemoral knee pain, and offers a unique and convenient treatment option which patients find easy to perform. Patients begin with a comprehensive evaluation including computerised walking analysis, as well as function and quality of life assessments.
AposTherapy considers the PFPS patient’s individual therapy needs and addresses the intrinsic and extrinsic factors affecting the knee, in relation to all the lower limb and back muscles and joints. The first step towards pain relief is to offload the patellofemoral joint. This is achieved by adjusting the position of convex pods, Pertupods, on the base of the unique biomechanical system. AposTherapy can reduce the patient’s symptoms and improve their ability to continue with everyday routine activities, by improving how the muscles affecting the knee joint work. AposTherapy introduces a controllable level of micro-instability. This means that as treatment progresses the neuromuscular control throughout the lower limb improves, since the muscles being used are repeatedly stimulated in the correct joint alignment. Over time the body is able to ‘remember’ these correct movement patterns so that even when the patient is not walking with the system, the optimal patterns of motion have been instilled. This makes the re-occurrence of symptoms much less likely.
AposTherapy offers true functional rehabilitation, easy to perform and fitting seamlessly into the patient’s daily life to redistribute the forces acting on the patellofemoral joint and redress the muscular dysfunction that leads to PFPS.