History

• 38 year-old female executive, complaining of "aching" under the kneecap

• 3 mos. history of anterior knee pain. No traumatic episode. Recent increase in gym workouts. Pain has changed from "catch" up/down stairs and with squats to dull ache after most workouts lasting for 1-2 hours.

• Normal plan film from her primary care physician. Also prescribed a course of anti-inflammatory medications. These had improved the pain from a 5/10 to a 3-4/10 after workouts.

• She sought out physical therapy after doing online research. She had no other co-morbidities.

Examination

• Full knee ROM.

• Normal: Ligament testing,  Palpation of the joint line, Patella mobility was normal.

• Her pain was reproduced with: Compression of the patella-femoral joint and Squatting.

• Single-leg stance revealed a loss of lateral hip control bilaterally. The client was unable to do a functional squat.

Summary

Several contributing factors were identified, but weakness of the gluteal medius and corresponding loss of lateral hip control, resulting in patella-femoral torsion was the main hypothesis.

Treatment

4 week, 8 visit program resulted in complete resolution of her symptoms. Treatment included: "hands-on" patella mobilization, iliotibial band and lateral retinaculum soft tissue release, progressive strengthening of her gluteal medius and gluteal maximus-initially starting in isolated positions and progressed to functional activities.

Outcome

The client had improved single-leg stance. Patella compression was pain free. They were discharged with a customized exercise program.

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