Recently I attended Claire Robertson’s course ‘Patellofemoral Pain Syndrome Uncovered’, and left not only impressed by Claire’s enthusiasm in this field, but it was also a gentle reminder of how important regular CPD events are. Aside from the clinically relevant course content, the practical nature of this course also provided a great networking opportunity, and a chance to bounce ideas off fellow practitioners, something that proves invaluable for a lone working private practice Physiotherapist like myself. I would like to give a brief overview of the course but for those of you looking to know all of the nitty gritty details of the course then I am afraid you will just have to attend and see for yourself! (As I am reliably informed Claire will have me ‘whacked’ for dishing out all of her trade secrets!)
Claire qualified in 1994 and has worked in the NHS and private practice and is currently a Senior Lecturer at St.George’s University of London as well as Consultant Physiotherapist running a specialist patellofemoral clinic at Wimbledon Clinics. In addition to this Claire is continually involved in publishing ongoing research on PFPS, and so is a very busy woman, but who better to look to for some advice on PFPS then!
To begin the day Claire stressed the importance of clinical reasoning and using all of the evidence available to us in order to do this, believing that a thorough subjective assessment (something that is often rushed by some clinicians) can provide a fantastic base for our treatment. Claire then went on to provide some thoughts on PFPS and the knee itself:
PFPS is also known as anterior knee pain, however this is not a very accurate term as PFPS can refer all over the knee as well as into the posterior aspect. Is chondromalacia patellae clinically relevant? Quite often people are diagnosed with it however it can only be diagnosed after a scan or arthroscopy, but is it actually a patient’s source of pain of just a normal finding in most knees?
Claire also talked about how imaging is mostly unhelpful in PFPS, with x-rays mainly used for excluding fractures and assessing for OA, and by nature an x-ray can only provide static information, which is often insufficient when considering the complex changes at the knee during movement. And so therefore a thorough subjective assessment, i.e. ‘LISTENING TO WHAT THE PATIENT SAYS!!’ along with visualising joint loading, patellofemoral contact pressures and the traction/torsion/compression placed on surrounding soft tissue structures helps us build a picture of what is going on in PFPS.
It’s amazing to me how much we as Physiotherapists seem to neglect how valuable the subjective assessment is, instead believing our own ‘superior knowledge’ will eventually win the day! But the more we take in what a patient says, the easier our lives become, and Claire echo’s this, aiming to utilise the subjective assessment to signpost our objective assessment. Does the patient have a ‘cinema sign’ which is pain sat with knee flexed for long periods of time (and often exacerbated by a particularly poor film, with Ben Affleck being one of the biggest contributors to PFPS!). Does the patient have pain walking uphill? Pain altering with footwear? Worse ascending or descending stairs? Answers to these questions leads us to what Claire called the “Shopping Bag of Risk”, that one or two risk factors for PFPS may be present without pain, and it’s when these factors come together that we get the increased risk of PFPS.
Claire also had some fascinating views on joint crepitus and how it relates to patients beliefs and perceived pain, I won’t share these fully with you but Claire’s research is very interesting, so I implore you to attend the course to find out more! As previously mentioned there was a high degree of practicality to this course, ranging from surface marking of the patella, observation, palpation, special tests and exercise prescription. Again I won’t go into too much detail as you will have to attend the course to find out, but all very clinically relevant skills that we should all be using when considering PFPS patients.
Claire spent a lot of time focussing on the relevance of the fat pad in the knee, an area I must admit is somewhere I had previously overlooked more often than not. In addition to this Claire stressed the importance of pelvic control, gluteal function and quads function, and how this relates to perceived PFPS and patient function. Claire has her own preferential take on specific exercise prescription too, particularly when it comes to gluteal strengthening, and it is here where she draws on her countless experience to provide simple, yet enormously effective exercises aimed at recruiting both Glute Med and Glute Max in particular. (It was also during this session I also realised just how poor my gluteal function was!)
And of course it would not be a course on knee pain without the discussion on the effect of the ITB and VMO and again these are complex areas which Claire manages to simplify when it comes to assessment and treatment of PFPS in your patients. And it is in relation to the VMO where Claire’s latest body of research regarding fibre angles and insertion ratio into the patella that leaves you wanting more. At present her research is ongoing but is already producing profound results which may change the way we as therapists think and treat VMO, so for that alone I urge you to attend her course and watch this space for her next publishing.
To finish the day we rounded off with some general knee taping techniques and discussions around orthotic devices, always a hot topic! But once again Claire leaves you feeling confident in being able to clinically reason your way through any presented problem. By now I am sure you know my feelings regarding this course and its usefulness, but just to concisely conclude I highly recommend this course to all practitioners regardless of your chosen disciplines. Yes it is highly MSK based but it is also valuable information when considering complete function during gait and above all it is bloody interesting!!!