Case Study: Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome A 23 year old female arrives at the 7th Group Troop Medical Clinic physical therapy office complaining of right knee pain for several weeks. Recently, patient went to sick call, and referred to physical therapy office for additional evaluation. Knee pain is common in the military. Generally, it is expected all service members will experience knee pain at some point during their career. A new recruit that is not accustomed to strenuous physical activity, a seasoned veteran who just recently started experiencing knee pain, administrative or combat soldiers who carry heavy loads, they all experience some sort of knee discomfort during their military career. Discomfort in the knee may last for a short-duration,
Patient states she runs about three times per week, usually four miles or less each time. Patient states even when she does not run, the knee bothers her when sitting in the car for a long period of time, or using the stairs at work. Patient states that she usually just works through it, but it seems the knee is more aggravated than usual. Patient denies ever observing any swelling, but states sometimes after a run that she feels it is a little swollen and sore. Patient states she feels unstable sometimes, but denies feeling or hearing anything that would indicate possible trauma to one of the cruciate ligaments. Patient denies that she feels like the knee catches during flexion or extension of the extremity. Using the examination techniques found in Bates’ Pocket Guide to Physical Examination and History Taking (2007), no obvious deformities, swelling or discoloration is observed. Patient appears to have appropriate range of motion. Patient conducts a squatting movement. Compensation is observed as patient stands back up, but able to bear weight. Both extremities look equal, and no atrophy is observed. Gait appears normal. Nothing remarkable during quick strength test. Evaluation of patella mobility during flexion causes a response in patient due to tenderness, but patella appears in position and intact. Negative findings in draw, sag or external
Patient is encouraged to lessen the distance and time of running. Dry needles are emplaced circumferentially around the patella, with others into quadriceps muscles. Electrical stimulation is applied for 15 minutes. Patient receives a soft-tissue mobilization procedure using a scraping tool. Following the scraping, patient receives instruction on proper movement techniques to improve function. Patient conducts several mini-squats, which only require the patient to lower their body about six inches. The patient receives bands to use at home to assist with stretching. Patient is encouraged to use bands and do mini-squats throughout the day. The patient receives instructions on passive stretching techniques of the quadriceps, hip flexors and gluteal muscles. Patient receives information in order to attend the running class at the Combat Readiness Training Facility. The therapy offers some immediate relief, but long-term relief will require future