Medical exercise specialists - can you recognize PFS?

4 early signs your client has patello-femoral syndrome

Patello-Femoral Syndrome (PFS) can easily ruin a post rehab program and you may never pick up on the early signs. PFS is a very common development in clients with knee pathologies, especially in those clients having recently undergone a recent knee surgery and/or with chronic effusion (swelling) of the knee. Low grade anterior knee usually appears in these clients. It may show up after sitting and watching a full length movie in the theater or sitting during a coast to coast flight. The pain gradually increases to the point of limiting range of motion and function. Activities involving knee flexion or extension cause severe pain and make further rehabilitation almost impossible. Early signs of PFS include: 1) vague anterior knee pain; 2) the feeling of the knee giving way on stairs; 3) low grade swelling in the knee and 4) an underdeveloped vastus medialis. These are the four early signs of PFS. If you see any one of these signs, avoid continued resisted knee extension or flexion and encourage the client to ice the knee and perform standing terminal knee extension exercise to recruit/activate the vastus medialis. If the pain is severe and limits function, refer the client back to their physical therapist, chiropractor or physician.

Remember, PFS is always lurking for the client with chronic knee pain and effusion. The best way to manage PFS is prevention. With all clients suffering from knee disorders insert standing terminal knee extension (STKE) into the post rehab program as soon as the client is able to tolerate the exercise. Start with sets of 15 reps and gradual work up to 25-50 reps. STKE prepares the quadriceps for walking, absorbing the compression forces associated weight-bearing and the medialis for controlling the tracking of the knee. Calculate the number of steps you client takes with a standard daily activity such as walking to the rest room. Use this number as the basis for the STKE sets and reps. All the reps shouldn't be completed at once but through a series of sets over the course of the post rehab session. Click the link below to see a demonstration of the standing terminal knee extension exercise.

Dr Mike