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Table 1 Physiotherapy program (adapted from Crossley et al, 2002).

From: Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

Intervention

Dose

Patellar mobilisation:

 

I. Passive patellar medial glide and tilt combined with transverse friction massage of the lateral retinaculum

4 × 30 seconds

Stretches:

 

I. Hamstring stretches

3 × 20 seconds; bilateral

II. 'Figure 4' anterior hip stretch (Figure 3)

3 × 20 seconds; bilateral

Patellar taping:

 

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:

 

I. Hip external rotation retraining (Figure 4)

3 × 20 seconds; bilateral

II. Vasti retraining (with EMG biofeedback):

 

   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:

 

I. Self-mobilisation of the affected patella

As above; twice daily

II. Patellar taping (as above)

 

III. Stretches (as above)

 

IV. Exercises (as above)

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