Patello-Femoral Syndrome including Taping Procedure

 

Knee pain due to rotation of the Patella and consequent grinding as it moves in the Femoral Groove beneath. Pain felt in the centre of the knee beneath the Patella when extending knee under load, for instance, when climbing stairs. Hypothetically, it is possible that it might be accompanied by Ilio-Tibial Friction Syndrome but I am yet to sight a case where both are present simultaneously.

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Tightness in the Ilio-Tibial Band (ITB) pulls the inferior corner of the Patella laterally at the Tibial Tuberosity and/or weakness in the Vastus Medialis Oblique (VMO) allowing the superior medial corner to drop.

 

Generally, an easy but painful fix with massage to release the ITB and strengthening exercises for the VMO. Taping knee to reposition the Patella enables rehab exercises to be carried out pain free. Acute cases will require longer to recover owing to the damaged, inflamed tissue requiring time to heal once treatment and rehab commences. Oral supplementation for joint healing with Collagen, MSM and Vitamin C will aid recovery of acute cases.

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Massage treatment targeting lower back and gluteal region generally and Glute Max and Tensa Fascia Latae (TFL) on the affected side specifically, as well as, rolling the ITB. I will apply Cupping treatment to the lower back and glutes in supine, TFL and distal portion of the ITB side lying. Facilitated stretching on the table beneficial if time permits. Otherwise, direct client to do so as a part of their rehab. Acute cases will require multiple treatment sessions.

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More complex cases are generated by the effects of Short Right Leg Syndrome. Where a prominent Left or Right Lower Limb Mechanism has developed, gluteal musculature on the affected side becomes inactive. The Glute Medius stabilising effect on gait is negated and shunts load to the ispilateral TFL and contra-lateral QL. Consequent strain through the ITB rotating the Patella...its inferior corner being pulled laterally. This is a common contributory factor in Patello-Femoral Syndrome. Use of Heel Lift Treatment may be required in these cases.

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I understand rolling the ITB is controversial where some practitioners consider it to be a large tendon unresponsive to this form of treatment. My experience is otherwise finding consecutive daily high intensity treatments carried out to the limit of the pain threshold does improve tone of the ITB and reduce pain symptoms. I have also had success Dry Needling acute cases along the length of the ITB. Palpating for pain spots, employing 10mm insertion every 20mm or so commencing distally and moving up the thigh until no more pain spots are located. Interestingly, this does not result in a straight line along the ITB but a pattern resembling one complete Sine wave.

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​There are exception cases where the Patella's rotation is in the opposite direction. This is rare and I have only sighted three instances. The superior medial corner of the Patella is elevated and the inferior corner is rotated medially. Resulting from excessive tightness in the VMO due to overuse (extended downhill hiking) or an impact event. Tightness through Gracilis and the VMO, eased with a few minutes massage treatment on the thigh proving to be quick and easy treatment to release the VMO. Orientation of the Patella returned normal and resolved pain symptoms.

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Taping Procedure

 

Applicable where the inferior corner of the Patella has rotated laterally. This covers the majority of cases. I have not required taping where rotation is in the other direction as massage treatment has been sufficient to resolve those exception cases.

 

Using about 100mm of Rock Tape or similar, attach one end to the lateral aspect of the knee over the head of the Fibula aligned across the limb at 90 degrees. The upper edge of the tape should be at or just over the inferior corner of the Patella. Pull medially and then affix the free end of the tape. This pulls the lower corner of the Patella back into alignment, straightening orientation so that it is able to move in the Femoral Groove smoothly and pain free. Relying on this without carrying out appropriate rehab activity is not recommended because in the long term it may cause skin irritation and rash after which there is no fall back strategy to manage the condition.

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