Knee

APPLICATION OF NMT DURING ISOKINETIC RE-EDUCATION OF THE KNEE IN PATELLOFEMORAL SYNDROME

Pierluigi di Tonto
Faculty of Motor Science Parthenope University
Naples, Italy
31/3/2010

Of the 36 cases treated, where 18 were without tape and 18 were with taping, it was seen that the first group was not able to continue the cycle due to the onset of pain symptoms, while the second group succeeded and resolution of the problem was verified in a final test. There was neither pain during the different circumstances when it occurred previously nor upon palpation. In conclusion, the use of NeuroMuscular Taping to give the patellofemoral articulation true stability enabled the muscles to develop their maximum power, allowing them to perform optimally and recover their previous deficit over a short period of time.

Patellofemoral syndrome refers to a combination of signs and symptoms affecting the knee. The main symptom is pain, which occurs for the most part when ascending or descending stairs, when performing movements while squatting, or when the knee has been kept bent for a prolonged period.

At times this may manifest as a joint “lock-up,” which is however a pseudo-lock-up, in the sense that one notices difficulty in extending the knee without there being any true mechanical obstacle. The most frequent clinical sign is exacerbation of the pain upon pressure on the articular facet and at times the occurrence of articular effusion, which may be minimal, in the absence of trauma. The patellofemoral articulation is a joint between the two cartilage surfaces of the anterior part of the femur and on the patella. During flexion and extension movements of the knee, the patella slides over the anterior portion of the femur’s distal epiphysis within a groove called the trochlear groove of the femur.

This groove ensures that sliding between the two surfaces occurs with as little friction as possible by improving congruency. The mechanical force exerted on the patella is actually quite great and this bone is subjected to a great deal of mechanical stress. Just consider that the mechanical load put upon the patella during the act of ascending or descending stairs is at least three times the body weight of the person performing the action. The function of the patella is to act as a fulcrum in the contraction of the group of extensor muscles of the thigh, the femoral quadriceps muscles, for the purpose of amplifying their power by over 50%.

The sliding of the patella on the femur is ensured by a group of muscles and tendons that maintain this bone centered in its groove. The extensor muscles of the thigh (especially the vastus medialis) are the main participants in this centering action, along with the patella’s own ligaments (alar ligaments). When the centering forces of the patella are not coordinated or well balanced, a shift of the patella is caused, generally lateral, called “PATELLAR TILT,” which causes a concentration of friction on a small part of the patella. The principal causes of PATELLAR TILT are either osseous or muscular.

Functional application of NeuroMuscular Taping

There are predisposing conditions, such as the lateral displacement by a broader female pelvis of the body weight load that the knee must support. Muscular causes include all of those weaknesses in the vastus medialis muscle that prevent muscle contraction from counteracting the lateral forces acting upon the patella. Among the osseous causes on the other hand, are to be numbered all of the malformations of the femur’s distal epiphysis (hypoplasia of the external condyle of the distal epiphysis of the femur) and any knee axis defects. To evaluate the magnitude of the forces acting laterally on the patella, calculation of the “Q” angle is performed. The Q angle is formed by the intersection of the line that represents the force vector of the femoral quadriceps muscle, which generally corresponds to the anatomical axis of the femur, with that which runs along the patellar tendon. The intersection of these two lines defines the angle called the “Q ANGLE.”

If this angle is greater than 10° in men and 15° in women there is then excessive lateral traction of the patella. This concentration of the load on the lateral surface of the patella and on the lateral femoral trochlea causes a progressive wear of the joint cartilage, which then causes “patellofemoral syndrome.”

Initially, this is a simple inflammation of the cartilage. However, this later turns into arthrosis of this joint. If the cause is muscular, then the thigh muscles need to be strengthened in order to rebalance the forces exerted on the patella. The method of strengthening the thigh muscles is through the use of isokinetic equipment, with specific programs depending on the muscular deficit of the affected limb. However, this is not always possible, in view of the recurrence of pain during the initial sessions. Research has, however, provided a possible solution right from the outset of the strengthening program, through the use of NeuroMuscular Taping.

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