Patellofemoral Joint Pain vs Patella Tendinopathy

Video Notes:
Patella Femoral Pain vs Patella Tendinopathy:
Important to differentiate because one will respond to orthoses, but there is no evidence to treat the other with orthoses.


Patella Tendinopathy = Compressive tendinopathy
Does not respond to orthotic therapy as it is a sagittal plane pathology.

Generally in the sporting cohort.
Commonly referred to as “Jumper’s Knee”. Common in sports such as basketball, volleyball, tennis, squash, goal keepers in soccer, where you have to get down very low and explode up.
Or in people with poor form at the gym, generally bringing their knee forward over their toes in a squat which increases the compression of the tendon. So get them to demonstrate a squat in the clinic room.

Pain is very focal. The client will be very clear in pointing exactly to where the pain is along the patella tendon between inferior pole of patella and tibial tuberosity.

High load activity will aggravate symptoms. So generally whilst playing sport and then stops after.

Treatment:
– Heel raises to push weight further forward, increase compliance through the knee and they won’t have to bring their knee further forward.
– Gait retraining to reduce compliance through the knee and increase the compliance through the ankle.
– Isolated isometric leg extensions – building quad strength
– 4-8 weeks of graduated strength program
– K-tape


Patella Femoral Joint Pain (PFJP) = internal rotation and valgus fall of the knee.
Therefore causing an inversion force at the rearfoot, creates a abductory force at the knee coupled with external rotation contributes to PFJP.

Often in a slightly older cohort, 55 year old “Weekend Warrior”, often pre-menopausal women, slightly overweight.

Client will be more vague in describing where exactly the pain is.

Pain in moving from flexion to extension, e.g. going upstairs, raising from a squat, after sitting for long periods and getting up.

Often tight laterally, and lateral structures drag the patella laterally.
Generally soreness on the medial side of the knee cap.
Abductory twist and poor propulsion will increase torsion through the knee and negatively affect symptoms.
But the big things are knee valgus, internal rotation and hyperextension.

Treatment:
– Release lateral thigh – foam rolling, massage, dry needling.
– VMO strength is important, but need to address any strength imbalances through quads. Lateral quads often tight because glutes aren’t working, therefore glute strengthening needed and very important. You’ll typically see plenty of external hip ROM, but very little internal hip ROM.
– use tape to pull patella laterally
– Consider orthoses to address foot posture, externally rotate the knee and improve propulsion. Not a long term intervention. More short-medium term whilst strength is built at proximal end.