In clinical practice, we can find people who attend our clinics suffering from various problems, but rarely come for problems unrelated to their feet. One issue to be addressed today is patellofemoral syndrome or syndrome of the corridor.
------------------------------------------------ ------------------------------------------------
patellofemoral syndrome is a multifactorial problem, which as its name suggests it occurs in the joint between the back of the patella and anterior femur.
in the literature are many causes as the etiology of this syndrome among which we can find the increased Q angle, tension and shortening in the posterior chain of the lower limb in both hamstrings as gastrocnemius tension in the anterior structures of the hip, where we have the iliac psoas and the rectus femoris, pronated, high or low patella, medial obliculo failure of the vast, poor activation of the posterior fibers of gluteus medius. These factors produce a change in pressure between the patella and femur.
This condition is well treated by physical treatment. The treatment will be aimed at two objectives: 1 º Download
pathological stress that occurs in the soft tissues around the patellofemoral joint, to optimize the position of the patella and reduce overhead.
2 º Improving the mechanics of the lower limb, because if it works well, there will be improvement in the patient's symptoms.
Performing stretching tight lateral structures and changing the activation pattern of vastus medialis oblique, should decline the tendency of the patella to move laterally and should improve this position.
To stretch the side structures, can be done passively by massaging the lateral retinaculum and iliotibial band.
The most effective way to stretch an adaptive shortening of the tissues of the retinaculum is using tape to cause permanent elongation of tissues. This is based on the phenomenon of creep (creep phenomenom). This phenomenon occurs in viscoelastic materials when a small but constant load is applied. It has been widely documented that the length of the soft tissues may be increased with a prolonged stretch.
(which, this could be of interest when dealing with such common diseases as the gastrocnemius equinus through night splints or bandages simply functional)
The magnitude of the increase of displacement depends on the duration of application of stretch, so if applied for long periods, the increase in the elongation is higher.
Sobre el efecto que el tape produce sobre la patela hay diversas opiniones en la literatura:
- Algunos investigadores creen que el tape cambia el ángulo de la articulación patelo-femoral y el desplazamiento lateral de la patela, pero que el ángulo de congruencia no cambia.(Roberts.1989).
- Otros han coincidido en no encontrar cambios en el ángulo de congruencia cuando la patela está con el tape, pero el ángulo de congruencia es medido con 45º de flexión de rodilla, y pequeños cambios en la posición de la patela deberían haber ocurrido antes (Bockrath,1992)
Un estudio más reciente medido sobre pacientes asintomáticos, ha demostrado a medial displacement tape was effective in the medial movement of the patella (p = 0.003) but not effective in maintaining the position with intense exercise (p <0,001).
But with the tape were preventing change which side of the patella occurs with exercise (p = 0.016).
The patellar tapping is unique for each person, as well as the corrective to this cause, placement and voltage is measured individually for each person, based on evaluation patellar position.
Each strip of tape that we place should be reassessed periodically based on the symptoms that appear with the activity. By placing the tape, the patient should experience an improvement right away, otherwise you will have to re-examine what we have done well.
This treatment is very useful for soft tissue release tension and improve the symptomatology of the patellofemoral joint but not for injuries inside the knee. A
guidelines to follow depending on where you locate the trouble, and how to evaluate where to place the tape. Be placed in both the medial and lower than average and sometimes in both positions.
To reduce download the stress of the plantar fat area as well as irritation of the pes ananserinus enthesitis, irritation of the iliotibial band, can make a bandage with tape in the form of V, where the summit will go on the tibial tubercle and both bands will tour the lateral side of the head to be inserted into the femoral condyles. The knee should be minimal bending.
In a study (Cushnage, 1994) with persons 70 years with osteoarthritis, they put 3 bands of tape, one medial, one lateral and one central and 4 days to appreciate the symptoms.
The most positive result was taken with the bands that conseguiron medials symptoms improve by 25%.
The tape lasts throughout the day every day until the patient has learned to activate the VMO (vastus medialis oblique) at the right time. May be suspended at any time.
Once the skill, the tape carefully removed p or night, allowing the skin to recover. The tape can cause destruction of the skin through touch or as
a consequence of an allergic reaction. The p skin repair and care is essential.
a consequence of an allergic reaction. The p skin repair and care is essential.
The patient should be trained never to have pain or swelling as it is shown that under these conditions produces an inhibitory effect of muscle activity.
If the patient returns to experience pain, you must set the tape.
has been shown that cuadripces is a major etiological entity in this disease causing lateral displacement of the patella (in contrast to the VMO) and should have good elasticity and work it with isometric exercises to strengthen it.
The foot and its importance in this syndrome.
In patients with prolonged pronation (pronation not, that's another debate, time vs. quantity) in the midstance phase, they should "teach" how to work the muscles of your feet supinating. This should improve the stability of the foot to push off (off) and reduce the increased valgus vector force created in the knee as a result of the pronated foot.
training position is to support medium, which is sent to raise the bow while keeping the hallux against the ground and then raise on 1 MTT and hallux soil.
The mission of this exercise is to enhance the anterior tibial muscle, posterior and peroneus longus. If you are unable to perform the exercise correctly will require a brace to treat plantar muscle imbalance and / or causes that produce pathomechanics hiperopronación pronation or maintained.
In short, patellofemoral syndrome may be due to various etiologies in which the state will be as important muscle of all lower limb as mechanical causes.
muscle gain importance in the vastus medialis oblique and cuadripces, but can not be ruled that a tight hamstring and gastrocnemius may cause mechanical disturbance and subsequent patellofemoral symptoms.
tape treatments are usually effective, and in cases produced by pathomechanics will be useful training, physiotherapy and orthotics plantar.
0 comments:
Post a Comment