Assessment of Patellofemoral Pain

The Assessment

Assessment of any injury should include questions concerning the patients general health, previous injuries and current injury. The aim of these questions is to determine which structure may be causing the pain and what treatment is appropriate.

The therapist will then perform a physical assessment to help determine which structures are causing the pain and what might have contributed to the development of the injury.

1. Observation

• The therapist will look at the patient, usually in both a standing and either sitting or lying position.
• This can help to determine any postural problems such as fallen or high arches, knee rotation or leg length differences.

2. Palpation

• The therapist will feel around the whole of the knee joint for any tender or painful areas. They may also palpate the quadricep muscles and ITB for tightness.
• They should glide the patella medially and laterally (to the inside and outside), assessing for range of motion and discomfort

3. Range of motion

• The therapist will assess the length of the quadriceps, hamstrings, calf and groin muscles. This is done by taking the muscles to their fully stretched position.
• For example, to test the quads, the patient lays on their front and the therapist bends the knee towards the buttocks as far as is comfortable. A normal range of motion is at least 120 degrees at the knee.
• To test the hamstrings, the patient lies on their back and the therapist lifts the straight leg up as high as is comfortable. A normal range is at least 80 degrees

4. Obers test

• Obers test is used to assess the tightness of the IT band. The patient is in a side-lying position, with the leg to be tested on top. The therapist will stabilise the pelvis with one hand, whilst they extend the hip with the other.
• They will then allow the hip to fall down towards the table (abduction). A positive result is noted if the leg moves down less than 10 degrees from horizontal

5. Functional tests

• Functional tests can be used to reproduce a patients pain. A good example is a squat.
• The therapist should ask the patient to perform three squats, looking for alignment, posture and pain. If patellofemoral pain syndrome is suspected, then the therapist should tape the knee to prevent lateral glide before asking the patient to perform the squats again.
• If lateral gliding is an issue, taping should improve the pain by at least 50%.
• There are plenty of other tests that may be used, depending on each individuals circumstances. These are just the building blocks of a good assessment.