History: 

Patient is a 45 year old male complaining of recent lateral knee pain when running, which is worse after cycling. Patient reports knee pain off and on over the last 10 years since he started running. He has had therapy previously with good results, but knee pain always returns. The most recent onset started this past Tri season, while training for a ½ ironman. He first noticed the pain the day after a 10 mile run, getting up from his desk at work. Then again during his next run. He continued to train till it got to the point where he had to cut a run short or skip a work out. He added more swim days and the pain in his knee did decreases with less running. Recent pain has gotten worse, and is limiting his distance running and is now bothering him walking into work or after sitting at his desk, but usually only after a long workout.

Examination: 

Patient was diagnosed with IT band syndrome by referring physician, but clinically presented with patellofemoral syndrome.

Treatment:

Initial examination included dynamic patellar taping to unload quadriceps, HS stretching and ST mobilization, gluteal and quadriceps strengthening at end of range, and restriction of activity. Manual therapy included medial glides of patella and HS and gastrocnemius cross friction mobilization. Patient’s hip and ankle were clear of mobility limitationsTreatment progressed to Vastus Lateralis TrDN, closed chain/functional hip strengthening, including eccentric quadriceps strengthening and lateral step downs and progressed to a single limb squat. As pain subsided, education for gradual return to activity, running technique, and proper brick workout completion was included.

Outcome:

Patient was seen for 15 visits. Patient’s poor initial progress was due to poor compliance with activity restrictions and patient’s dependence on dynamic tape. Once TrDN was implemented and patient was able to run without pain for a short distance without dynamic tape, he began to buy in to the treatment plan. Patient progressed well the last 4 weeks. Patient returned fully to activity, and completed Olympic triathlon two weeks after DC.

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