Monday, October 6, 2008

Lumbopelvic Manipulation for the Treatment of Patients With Patellofemoral Pain Syndrome: Development of a Clinical Prediction Rule/ JOSPT June '08

Isolated Knee Pain: A case report highlighting regional interdependence/JOSPT Oct. '08

Utility of the frontal plane projection angle in Females with Patellofemoral Pain/JOSPT Oct. '08

Diagnosis & Treatment of Movement Impairment Syndromes, Shirley Sahrmann '02/pp107-108

The physical therapy profession has embraced the Australian school, and manipulation articles are abundant. There is a plethora of research supporting manipulation as a treatment for PFSS. So, I thought I would throw my 2 cents in.

"Global Interdependence"= The kinetic link principle, just like "stretch-shortening cycle training"= plyometrics.

The concept is that the lumbopelvic orientation to the lower extremity is causing abnormal forces at the knee. By correcting it, normal alignment is restored and pain is spontaneously removed.

Me, being the pragmatist, would like to know what caused these dysfunctions in the first place. What came first, the chicken or the egg? Are the lumbopelvic structures simply reacting to abnormal forces coming from the feet, ankles, tibia, femur? I'm not the only one who thinks so. Here's an excerpt from Shirley Sahrmann:

"Extensive information is available from practitioners who ascribe to dysfunction of the SI joint as a common cause of back pain. However, I do not support this premise. Although many individuals have pain in the SI region, I propose that the pain does not arise from the motion of the joint. Rather, pain in the SI region is a result of the tissues that attach to this area (with the exception of pregnancy)."

It is common with athletes who have PFSS to exhibit excessive femoral IR at ground contact. In the 3rd article above, the authors found that as a coping strategy, some of the athletes were subconsciously posteriorly rotating their contralateral pelvis during functional tests to create more external rotation of the ipsilateral femur. Now picture that happening a few million times during running or jumping sports. Would not the pelvis adjust? Maybe an upslip of the R SP? An outflare of the L ilium? A sacral torsion?

As far as I've seen, the longest follow up has been 4 months pain free. What would be the treatment if they returned with pain? More manipulation?...would all that manipulation in the long term create hypermobility? (I've heard this anecdotally, but I've seen no research supporting it).

Anyway, I know some of my fellow ATC's are also chiropractors/manipulative P.T.'s. I would really enjoy your input.


Jerimiah said...

I am a physical therapist assistant, and from my limited experience I would agree with you none of this stuff just happens. There is rarely one fix to a movement dysfunction, it takes a concert of mobilization, strengthening, stretching, and neuromuscular re-education. It is often impossible to initially know which symptom is the cause and which is the result the key is working to fix both and going where the body takes you. It will often tell you which is causing in the way it is responding to the stimulus given.

JH said...

My experience has been that dysfunctions in general are gang related crimes against the body not an individual criminal.