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Patellofemoral pain: Challenging current practice - A case report.
Benjamin E Smith1, Paul Hendrick2, Pip Logan2
1Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Outpatients (Level 3), London Road Community Hospital, Derby, DE1 2QY, UK.
Manual Therapy
|September 24, 2015
Summary
This study explored a neurophysiology pain model for patellofemoral pain (PFP). A patient with chronic PFP improved significantly by performing painful exercises, suggesting a novel rehabilitation approach.
Area of Science:
- Sports Medicine
- Pain Management
- Rehabilitation Science
Background:
- Patellofemoral pain (PFP) is prevalent in young individuals, yet optimal long-term management remains unclear.
- Traditional physiotherapy often focuses on structural dysfunctions, potentially overlooking pain neurophysiology.
- A shift towards neurophysiological pain models offers a rationale for alternative assessment and treatment strategies.
Observation:
- A 21-year-old male with a 6-year history of PFP and prior failed physiotherapy was assessed.
- The assessment avoided traditional structural testing and discouraged biomechanical pain models like patellar mal-tracking.
- The patient was instructed to perform a single, uncomfortable exercise twice daily.
Findings:
- The patient experienced an 80% symptom improvement over 7 appointments.
- A 5-month rehabilitation program, designed to elicit pain through gradual exercise and loading, facilitated a return to physical activity.
- This approach challenged conventional advice to avoid painful activities.
Implications:
- This case report suggests that exercise protocols based on neurophysiology models of pain may be effective for PFP.
- Further research is warranted to investigate these novel exercise protocols for patellofemoral pain patients.
- The findings highlight a potential paradigm shift in managing chronic pain conditions like PFP.
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