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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 29 a comprehensive history in conjunction with some basic physical examination procedures are still the most accurate means of identifying the problem. 4 The most helpful physical examination factors include: • Pain around the patella with palpation • Increased pain during palpation with the extensor muscles under load (such as palpation during a partial squat) • Pain with squatting or going up or down stairs Keep in mind that other problems around the knee may have similar signs and symptoms. These conditions include patellar tendinosis, joint pathology, plica syndromes, Osgood-Schlatter's disease, or pain from peripheral nerve or nerve root compression. TREATMENT The most common treatments for PFPS are conservative and noninvasive. In traditional orthopedic treatments, patellar taping and bracing are common. They seem to be more effective in the short term as opposed to more chronic cases. Improving strength balance within the quadriceps is also a core component of physical therapy treatment. Massage can clearly play a role in treating patellar tracking disorders, especially in reducing hypertonicity of the tissues around the patella. Reducing hypertonicity helps restore muscular balance. The soothing effects of gliding massage strokes on a painful knee should not be undervalued either. Effective approaches may combine techniques with a broad context surface such as the full palm or hand, along with more specifi c stripping techniques using the thumb, fi nger, or perhaps a pressure tool. I have also found performing these techniques during active movement of the knee enhances their effectiveness. You can see an active engagement technique for the patellar retinaculum in the video that accompanies this article. Anterior knee pain is a common complaint for numerous clients. It is likely to occur with any individual engaged in high activity levels. Understanding the biomechanical role of the patella and surrounding tissues can help you target your treatment for the best results. Developing a better understanding of patellofemoral function also illustrates an excellent opportunity for you to work with other health professionals to achieve the best results for the client. Notes 1. Alexandra Hott et al., "Predictors of Pain, Function, and Change in Patellofemoral Pain," American Journal of Sports Medicine 48, no. 2 (2020): 351–8, https://doi.org/10.1177/0363546519889623. 2. Marcus A. Rothermich et al., "Patellofemoral Pain: Epidemiology, Pathophysiology, and Treatment Options," Clinics in Sports Medicine 34, no. 2 (2015): 313–27, https://doi.org/10.1016/j. csm.2014.12.011. 3. Guilherme S. Nunes et al., "Clinical Test for Diagnosis of Patellofemoral Pain Syndrome: Systematic Review with Meta- Analysis," Physical Therapy in Sport 14, no. 1 (2013): 54–9, https:// doi.org/10.1016/j.ptsp.2012.11.003. 4. Richard W. Willy et al., "Patellofemoral Pain Clinical Practice Guidelines Linked to the International Classifi cation of Functioning, Disability and Health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association," Journal of Orthopaedic & Sports Physical Therapy 49, no. 9 (2019): CPG1–CPG95, https://doi.org/10.2519/ jospt.2019.0302. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at academyofclinicalmassage.com. Lateral movement of patella. 5 TECHNIQUE VIDEO: "ACTIVE ENGAGEMENT- PATELLAR RETINACULUM" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch!