Abstract
Patellofemoral pain is one of the most common diagnoses seen in the orthopedic setting, with females presenting more than men. This case report details the implementation of a rehabilitation program for an active female with complaints of patellofemoral pain, utilizing a comprehensive anterior knee pain algorithm. The patient was a 59-year-old female, otherwise healthy and active, but presenting to physical therapy with a history of insidious anterior knee pain. Following a fall the patient suffered a Jones fracture of the right foot and was prescribed a walking boot with instructions for non-weight bearing for 6 weeks. Following discharge from the boot the patient noticed knee pain. At initial evaluation, primary findings included: inadequate pelvic control, crepitus with active knee extension, navicular drop and forefoot abduction of the right foot, and weakness of the right knee flexors, extensors, and abductors. Outcome measures including the numeric pain rating scale, Kujala scale for patellofemoral pain, and the Lower Extremity Functional Scale. Research has shown that anterior knee pain may be the result of biomechanical changes in both proximal and distal structures surrounding the knee; therefore an algorithm was developed to encompass the many causative factors, evaluative techniques, and treatment options for individuals presenting with this particular condition. Treatment consisted of therapeutic exercises targeting the hip abductors and external rotators to establish normal pelvic control during dynamic activities. Stretching exercises focused on elongation of the quadriceps musculature and the gastrocnemius and soleus. Following 9 visits the patient demonstrated improved dynamic control of the hip, normal strength values for hip musculature, and no pain with activities. Scores on the NDI improved 70-80%, and the Kujala scale score improved by 31 points. This case example demonstrates the effectiveness of an anterior knee pain algorithm in the treatment of knee pain, utilizing a regional interdependence approach.