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Recovery for patellofemoral syndrome

Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor


Recovery from patellofemoral syndrome

When the knee moves, the patella slides to stay in contact with the lower edge of the femur (trochlear groove). Normally, this movement has almost no friction: the friction between these two joint surfaces is about 20% of the ice friction sliding on the ice. If the joint surface of the patella or femur (articular cartilage) becomes soft or irregular, the friction will increase. As a result, the patient will experience squeaking and crackling when mobilizing the knee. This pathology, in which we have patellofemoral crepitations, is called patellofemoral chondromalacia or patellofemoral osteoarthritis.

The force, or pressure, with which the patella presses on the femur is 1.8 greater than its weight at each step when we walk on a flat surface. When we climb the stairs, the force is 3.5 times greater, and when we go down the stairs it will be 5 times greater than our weight.

Symptoms of femur-patellar chondromalacia are mainly pain in the front of the knee that can be aggravated by climbing or descending stairs, sitting for long periods (for example, on film), or when bending the knee.

Treatment

The best treatment for patellofemoral chondromalacia is to avoid activities that compress the patella on the femur. This means avoiding climbing and descending stairs, deep knee flexions, kneeling, and aerobic exercises. Do not wear heeled shoes.

A knee protector that has a special hole for the patella can help. Applying ice packs for 20 minutes after performing the exercises also helps.

Sports that can aggravate patellar tendonitis and patellofemoral chondromalacia: volleyball, basketball, football, long-distance running, squash, rugby, and weightlifting.

Sports that can not cause symptoms: cycling (it is best to position your saddle in a position as high as possible and avoid hill climbing), skiing, tennis.

Sports that are the easiest for the knees: swimming, walking (also avoid hill climbing), and cross-country skiing.

Do not perform the following exercises:

  • Lunges
  • Squats
  • Stepper devices
  • Weight extension devices
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The following exercises are OK if they do not cause pain or swelling
  • Extension limb lifting exercises
  • Medical bicycle (saddle up, minimum resistance)
  • Foot press (do not allow knees to bend more than 90 degrees)
  • Quadriceps muscle exercises

Exercise program

The next exercise program should be followed under the close supervision of a doctor or physiotherapist. For extended limb lifting exercises or short lifts, you can add ankle weights to increase the endurance of the exercises and increase strength. Start with 500 mg and gradually increase to 500 mg per week until you reach 2.5 kg. The exercises should be performed daily until the ankle weights are added. At this time, the straight leg lifting exercises, short lifts, and sliding on the wall should be performed every 2 days, the stretching exercises being performed daily. When you can perform straight leg lifts and short lifts with weights of 2.5 kg, continue them only twice a week.

Extension of the limb - Contract the quadriceps muscle so that the knee is flat, straight, and fully extended. Try to lift the entire operated limb off the bed or floor plane.
If you can keep your knee straight up to about 45 degrees, pause for a second and then gently lower your foot back on the bed. Relax and repeat.
If your knee bends as you try to lift your limb, do not continue with these exercises. Try the quadriceps exercises again until you can lift the limb without bending the knee.



Short lifts
With your knee bent over a rolled towel or blanket, lift your leg so that your knee is fully extended. Keep your knee locked in extension for 5 seconds, then lower gently. Repeat 20 times.

Slips on the wall
Stand up straight with your back and bottom touching the wall. Place your feet 30 cm away from each other and 6 cm away from the wall. Bend your knee and slide along the wall until your knees are bent at 45 degrees. Hold this position for 5 seconds and then return to the starting position. Perform 3 sets of 10-15 repetitions.


Hamstring stretching
Perform these exercises in the position in the next figure. Bend forward at the hip, keeping the knee fully extended, until you feel a slight stretch in the back of the thigh and knee. Hold the stretching position for 15-20 seconds and repeat 3-5 times.

Stretching the quadriceps - This exercise is performed as in the adjacent position. Perform a movement near the heel. When you feel a stretch in the front of the thigh and knee, hold the position for 15-20 seconds for 3-5 repetitions.

Hip and thigh stretching - Cross your left/right leg in front of the other. Lean-to the left/right, leaving the prominence of the right/left hip out. When you feel a slight stretch on the outer side of the hip, hold this position for 15-20 seconds for 3 or 5 repetitions.

NB: All progressions are approximations and should only be used as guidance. Progression will be based on the individual condition of the patient, which is assessed throughout the treatment process.

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