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Patellar Subluxation Syndrome Physiotherapy



Patellar subluxation syndrome refers to a painful knee injury that is concerned specificly with our kneecap (patella bone). Patellar subluxation is more common than patellar dislocation and can be just as disabling.

In this condition, the patella repetitively subluxates and places strain on the medial restraints and excessive stress/tension on the patellofemoral joint.

Patellar subluxation can be caused by osseous abnormalities, such as incorrect articulation of the

  • femoral groove with the patella
  • trochlear dysplasia
  • or patella alta

which is a distance of greater than 20 mm between the tibial tubercle and the trochlear groove.

It can also happen due to soft-tissue abnormalities, such as

Symptoms are regulated by the amount of activity. Such pain is commonly caused and/or aggravated by

  • running
  • jumping
  • sports and activities that place large forces on the patellofemoral joint

Signs and symptoms

Symptoms usually include:

  • Knee buckles and can no longer support your weight
  • Kneecap slips off to the side
  • Knee catches during movement
  • Pain in the front of the knee that increases with activity
  • Pain when sitting
  • Stiffness
  • Creaking or cracking sounds during movement
  • Swelling

Patellar subluxation was once thought to occur mainly in women, due to the frequency of genu valgum and lax ligaments. However, now the frequency of this condition in any athletic person, man or woman, is apparent.

Diagnosis

Diagnosis of patellar subluxation is typically done with a combination of

  • physical assessment
  • x-ray

Treatment

Conservative Treatment

Conservative treatment in primary acute LPD (lateral patellar dislocation) is the therapy of choice (mostly don't require surgical knee correction unless severe case).

It includes a multimodal approach with behavioural education of the patient, knee physiotherapy, braces, weight reduction and pain medication.

Physiotherapy especially focuses on muscle strengthening and proprioceptive exercises.

  • The vastus medialis oblique muscle is described to have an important role in functional stabilization of the patella against lateral vector force.
  • Proprioceptive exercises and strengthening of the hip abductors and positioning of the foot are crucial, especially indicated in patient with miserable malalignment syndrome or medial collapse.

Several patellar braces or taping methods exist to improve return to sport. They may however not alter medial or lateral displacement, but can be helpful as a diagnostic tool for occult patellofemoral instability.

Surgical Treatment Options

Increasing age is associated with decreased physical activity after surgical stabilization, and therefore in growing and very active athletes early surgical treatment intervention needs to be considered.

Reconstruction of the MPFL (medial patellofemoral ligament) in patients with minor trochlear dysplasia is technically possible without interfering with distal growth plate of the femur, however, large studies are missing. Osseous articular correction before epiphyseal closure is contraindicated.

In adult patients with recurrent LPD and without trochlear dysplasia or type A or C according to Dejour classification, MPFL reconstruction alone might be beneficial, in which unchanged osseous or dynamic instability will be compensated.

Patients with an important supra-trochlear spur as in type B and D trochlear dysplasia and chronic instability are more reluctant to conservative and softtissue surgical treatment options. In such cases sulcus-deepening trochleoplasty should be performed.

Typically, post-surgical results are more favourable when instability was the main symptom. Hence, in such patients low-pivoting physical activity may be re-achieved.

Knee Physiotherapy

An effective rehabilitation program reduces the chances of re-injury and of other knee-related problems such as patellofemoral pain syndrome and osteoarthritis.

Typically patella dislocations are initially immobilized for the first 2–3 weeks to allow the stretched structures to heal.

Rehabilitation focuses on maintaining strength and range of motion to reduce pain and maintain the health of the muscles and tissues around the knee joint.

The objective to any good rehabilitation program is to

A common physiotherapy plan is to strengthen the

  • hip abductors
  • hip external rotators
  • and quadricep muscles

Commonly used exercises include isometric quadricep sets, side lying clamshells, leg dips with internal tibial rotation, etc.

The idea is that because the medial side is most often stretched by the more common lateral dislocation, medial strengthening will add more stabilizing support.

With progression more intense range of motion exercises are incorporated.

Our senior physiotherapists will also use treatment modalities such as



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book your physio appointment or enquire now

Email questions and your preferred physiotherapy timings to nigel@phoenixrehabgroup.com or

WhatsApp / SMS your name, preferred date, time and enquiries to +6588001830

Clinic Locations: See how to get to us here

Phoenix Rehab physio Services

Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.



HAND THERAPY &  SPLINTING

Patients who sustained injuries to their elbows, forearms, hands, wrists (sprains and fractures) and fingers, and requires Hand Therapy to increase the function of their hand following injuries or post-operations as well as custom made hand splints.

Commonly treated hand pain injuries includes



CLINICAL PILATES & WELLNESS PILATES

Clinical Pilates is a form of physical exercise that focuses on

  • posture
  •  core stability
  • balance
  • control
  • strength
  • flexibility and
  • breathing

It is a system of safe and effective exercises, which meet specific individual needs, to treat a wide range of injuries and conditions.

You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.



TRADITIONAL CHINESE MEDICINE (TCM)



DEEP TISSUE RELEASE & SPORTS MASSAGE THERAPY

Sports and deep tissue release massage helps to increase nutrient-rich blood flow to tired, tight and tense muscles to

  • accelerate recovery and
  • shorten downtime / recovery period required

It also prevents muscles from scar tissue micro-tears (and potential ruptures), and increases muscle performance.

Done regularly, it will keeps your muscles healthy and fit with body/movement-confidence. Read the benefits of regular deep tissue release therapy here.



ALTERNATIVE THERAPIES

All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).

See our entire team here with introductions and their specializations.

At the first session, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover as well as provide treatment in the same session.

Follow up sessions are inline to provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

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We do not rely on advertising - instead, we prefer and appreciate the goodwill and positive reinforcement from patients. When you have the chance, please tell your family, friends and physicians about the positive results and experience you have had in our physio clinics.

book your physio appointment or enquire now

Email questions and your preferred physiotherapy timings to nigel@phoenixrehabgroup.com or

WhatsApp / SMS your name, preferred date, time and enquiries to +6588001830

Clinic Locations: See how to get to us here