& Address: Patellofemoral
by Whitney Lowe
Because a significant
part of the problem with PFPS appears to be pain originating from
the soft tissues around the knee, massage is helpful. Changes
may not be immediate as you are trying to alter biomechanical
patterns that have been established for some time; however, the
client should feel some improvement in symptoms within about three
to four sessions.
tension in the quadriceps is an important factor in PFPS, so massage
methods aimed at reduction of tension in these muscles are helpful,
such as compressive effleurage and deep longitudinal stripping
(see Figure 1). The latter is particularly beneficial if the stripping
is emphasized along the vastus lateralis to decrease its contribution
to lateral patellar tracking.
multi-directional friction techniques around the retinaculum will
also be very helpful (see Figure 2). Special attention should
be paid to any area that the client reports greater pain, especially
if that pain is consistent with the pain the client has been feeling
when doing activity.
fascial elongation methods applied to the quadriceps, and especially
to the vastus lateralis are also helpful. Pin-and-stretch techniques
are particularly effective here (see Figure 3). In later stages,
adding resistance to the eccentric action of the quadriceps during
their elongation can enhance the active techniques further.
Additional eccentric load can be
added with resistance bands, weights, or with the practitioner's
hand (see Figures 4 and 5). Stretching the quadriceps group is
also very important during the rehabilitation process.
to its pathology, PFPS will respond very well to massage. However,
in order to derive the best therapeutic benefit from massage applications,
the practitioner needs to understand patellofemoral mechanics
and the role played by soft tissues. When the anatomy, biomechanics
and massage options are understood, it is much easier to construct
a beneficial approach to addressing PFPS.