Ben Ashworth 2009 PFJ Rehabilitation Paul Thawley

Ben Ashworth 2009 Introduction Extremely complex condition High prevalence I personally think that Eccentric hip ER is closely linked to lower limb dynamics Paul Thawley

Ben Ashworth 2009 PFPS Algorithm Witrouw 2005 Paul Thawley

Ben Ashworth 2009 PFPS Algorithm Paul Thawley

Ben Ashworth 2009 Management of PFPS Reduce Pain & Swelling Taping / Orthoses Toolbox (MT & ET) Exercise Prescription Strengthening Paul Thawley

Ben Ashworth 2009 Reduction of Swelling Wilk & Reinhold 2001 VMO 20-30ml RFem 50-60ml 30-40ml ↓ Quads by 50% Paul Thawley

Ben Ashworth 2009 Reduction of Pain Articular, Myofascial & Neural adaptation Young et al EMG study of acute swollen knees – quads inhibition reduced with LA (30-76%) Reducing swelling and pain is essential for functional rehabilitation Paul Thawley

Ben Ashworth 2009 Taping May! Increase muscle torque (VMO) May! Offload overactive muscle (ITB / VL) May! Facilitate earlier VMO activation than VL May! aid Gluteal facilitation May! be a placebo Paul Thawley

Ben Ashworth 2009 Paul Thawley

Ben Ashworth 2009 Q-angle Max area of contact at x body weight increased > 10° Q-angle Paul Thawley

Ben Ashworth 2009 Tibial rotations on patella movement Paul Thawley May be sports specific linked to activity, neuro muscular or structural in nature.

Ben Ashworth 2009 Soft tissue extensibility Paul Thawley

Ben Ashworth 2009 Soft tissue extensibility Lateral retinaculum arises from ITB Greatest 20° Prevent fixed flexion ↑PFJ Forces & muscle work Paul Thawley

Ben Ashworth 2009 Improved soft tissue mobility Restore ST flexibility Med & Lat Retinaculum Patella mobs Combined mobilisation & movement Paul Thawley

Ben Ashworth 2009 Anterior Hip / Groin / Knee Paul Thawley

Ben Ashworth 2009 Posterior Fascial / Neural Structures Paul Thawley

Ben Ashworth 2009 Muscle Activation Paul Thawley

Ben Ashworth 2009 Lower Limb Alignment Paul Thawley

Ben Ashworth 2009 Q-angle Kinetic Chain Influences Femoral Anteversion Genu Valgum Paul Thawley

Ben Ashworth 2009 Exercise Prescription Paul Thawley

Ben Ashworth 2009 Exercise Prescription Paul Thawley

Ben Ashworth 2009 S&C / Exercise Prescription CKC Vasti OKC Rec Fem CKC Glutes & Trunk Paul Thawley

Ben Ashworth 2009 VMO Exercise Prescription Paul Thawley

Ben Ashworth 2009 VMO / Lateral Retinacula Rupture 50% 0° flexion Myofascial continuity medially & laterally VMO / MPFL ITB / Lat Retinac Paul Thawley

Ben Ashworth 2009 Proprioception & neuromuscular control Paul Thawley

Ben Ashworth 2009 Hip Abductor torque Paul Thawley

Ben Ashworth 2009 PFPS increased lateral load and slower pronation Increased PFJ load Reduced Shock absorption Lateral tib tuberosity and increase Q-angle Paul Thawley

Ben Ashworth 2009 Correct abnormal mechanics Paul Thawley

Ben Ashworth 2009 Paul Thawley foot strikes the ground in a toe-to-heel pattern to produce an extension moment at the knee In the PFP group, initial contact of the foot with the ground during gait occurred more on the lateral side of the foot, and the center of pressure shifted more slowly from the lateral to the medial side of the foot during foot rollover; this could cause less shock absorption in the foot. Consequently, a greater part of the ground-reaction forces are transferred to the more proximal joints, including the knee. This could result in a higher load on the patellofemoral joint and, consequently, overloading of the patellofemoral joint, which would lead to patellofemoral pain. In addition, the more laterally directed pressure suggests a less pronated position of the foot during the rollover pattern during gait, which could lead to less internal rotation of the tibia. This could place the tibial tuberosity in a more lateral A recent study has shown that subjects with PFP have a delayed onset of gluteus medius relative to control subjects. Strength of the gluteal muscles is also decreased in patellofemoral sufferers where hip abductor and external rotator strength is 26% to 36% lower in females with PFP than age and activity matched controls

Ben Ashworth 2009 Case Study - Right Lateral Knee Pain Static Posture: left rearfoot pronation (STJ) Dynamic Control: ‘poor’ left lower limb stability / control (SL) Functional Movement (Squat):  WB right lower limb Flexibility:  left ankle WBDF Increased Load through RLL in squat / clean / leg drive Paul Thawley Examples of programs