Intervention | Dose |
---|---|
Patellar mobilisation: | Â |
I. Passive patellar medial glide and tilt combined with transverse friction massage of the lateral retinaculum | 4 × 30 seconds |
Stretches: | Â |
I. Hamstring stretches | 3 × 20 seconds; bilateral |
II. 'Figure 4' anterior hip stretch (Figure 3) | 3 × 20 seconds; bilateral |
Patellar taping: | Â |
I. Taping of the patella: | Daily application for 6 weeks |
   1. Medial tilt and posterior tilt |  |
   2. Medial glide and posterior tilt |  |
   3. Fat pad unloading |  |
   4. Medial rotation |  |
Exercises: | Â |
I. Hip external rotation retraining (Figure 4) | 3 × 20 seconds; bilateral |
II. Vasti retraining (with EMG biofeedback): | Â |
   i. Isometric VMO contraction in sitting | 3 × 10 repetitions (affected); |
 | 1 × 10 repetitions (unaffected) |
   ii. Inner range knee flexion in standing | 3 × 10 repetitions |
   iii. Step downs (when able to perform 5 pain-free repetitions): |  |
a) Slow eccentric lowering on affected leg from 10 cm step | 3 × 10 repetitions |
b) Increased step height (20 cm step) | 3 × 10 repetitions |
c) Alternating speed (down slow, up fast; down fast, up slow) | 3 × 10 repetitions |
Home exercise program: | Â |
I. Self-mobilisation of the affected patella | As above; twice daily |
II. Patellar taping (as above) | Â |
III. Stretches (as above) | Â |
IV. Exercises (as above) | Â |