Recommendations for PFPS treatments from the International Patellofemoral Research Retreat were reviewed. The following were interventions can be recommended: manual therapy for soft tissue mobilisations and trigger point dry needling. Further reviewing of the literature also supported the use of foot orthotics in case of overpronation of the foot, which can lead to patellar sheering. Therapeutic exercises – such as stretches for the hip flexors, tensor fascia lata and quadriceps, and strengthening of the hip abductors and external rotators – were also recommended.
PT has similar presentations as PFPS and correct differential diagnosis is critical for the treatment to be effective. Treatment must focus on strengthening of the quadriceps, the gastroc-soleus complex, as well as the hip muscles. Eccentric and isometric exercises should also be considered as part of the exercise therapy. On the other hand, reviewing of running strategies is also recommended as individuals with PT may land with a stiffer knee, and not sufficiently utilise hip flexion. Manual therapy (cross friction massage) may be beneficial, but not more so than therapeutic exercises. Ultrasound is not beneficial, but infrapatellar strapping may have some proprioceptive benefits.
ITBFS treatments include foam rolling of the ITB, as well as stretching of the ITB complex. Therapeutic exercises were recommended; there should be a focus on strengthening the hip abductors to counteract the adduction pull of the leg through running stride. Further reviewing of running strategies is also recommended.
This article highlights three commonly reported injuries with running, especially for those patients with a sudden increase in running mileage.
While the three diagnoses discussed can present with similarities, it is important to correctly diagnose and accurately address the specific exercise and soft tissue needs.
The authors of this article also highlighted a need for a multi-modal approach to therapy and careful consideration of the individual biomechanics for each patient.
> From: Mellinger et al., Ann Transl Med 7 (2019) S249 . All rights reserved to Annals of Translational Medicine. Click here for the online summary.
Expert opinion
This article may be especially well-suited during the 2020 COVID-19 pandemic, as several studies have shown a worldwide increase in runners, partially due to lack of access to gyms and fitness facilities.
Furthermore, the treating clinician should also take into consideration that many runners will also have had an increase in running mileage, due to lack of alternative exercises or activity during the pandemic.
