SSM Rehabilitation Hospital offers new treatment for Patellofemoral
Pain Syndrome; also useful in treating some back pain (sciatica) issues
An avid cyclist, 20-year-old Brad Kassing had tried
everything to alleviate severe, burning pain in his knees that made his favorite
activity, mountain biking, incredibly painful. His
doctor in North Carolina, where his family lived during Brad’s high school years,
recommended stretching exercises, which didn’t help, so he was referred for a course
of physical therapy.
“It did no good,” said Brad. Even
the simple act of climbing the flight of stairs to therapy became nearly impossible. He rode his bike when he could, but
the horrible burning in his knees couldn’t be ignored.
Brad tried chiropractic care, also without success,
and eventually, at the recommendation of an orthopedic surgeon, underwent surgery
last winter, once on each knee. His
surgeon performed a lateral release and decompression. After
recovery, Brad got back on his bike, only to find the same symptoms return, not
just when riding, but even when walking up a flight of stairs.
Nothing had helped, the pain persisted. It seemed he was out of options. At the young age of 20, Brad was contemplating giving up biking altogether, a passion that would often take him on 11-hour mountain biking treks, and facing the reality of a lifetime of knee problems. That is, until his primary care physician in St. Louis, Richard Vaughn, M.D., referred him for a new physical therapy treatment Dr. Vaughn had recently learned about from SSM Rehabilitation Hospital physical therapist Aaron Robinson.
The
new treatment is a somewhat revolutionary, and not widely known, way of looking
at Brad’s pain, referred to as
patellofemoral pain syndrome. Athletes
often experience patellofemoral pain syndrome, particularly in sports where jumping
and squatting are prevalent, as in basketball or volleyball, but it also affects
a general population.
“Traditionally, the problem is thought to originate
from the knee and decreased strength of the inside quadriceps muscle,” explained
Aaron Robinson, PT, manager and market leader for SSM Rehabilitation Hospital’s St. Charles outpatient
sites. “The theory is that the strength
deficiency causes the kneecap to track, or slide, outside of its track. The
track has plenty of cartilage to provide nutrition, lubrication and shock absorption,
but when it incorrectly slides outside, it causes persistent pain in front of, or
on the inside of, the knee and often deep under the knee cap.”
“Thirteen doctors and physical therapists—everyone until
now—pointed to my knees as the problem,” said Brad.
Aaron focused on Brad’s hip instead. The
approach, a neuromuscular rehabilitation program Aaron had learned about when it
was first introduced in 1998, looks at the problem originating from the hip.
“The reasoning is that the knee only does what the hip
and foot allow it to do, much like a door,” explained Aaron. “If
a door isn’t closing properly, you can’t just look at the side of the door to fix
the problem, but need to look at the hinge itself. The
hip is the ‘hinge’ on which the knee operates. The
hip is the body’s center of gravity, and if it rotates forward too much, it forces
the femur to the inside, displacing the knee cap to the outside, outside of its
track.”
“Brad had some pretty serious issues when he first
came,” said Aaron, who used a series of four different tests to determine Brad would
be a good candidate for the new therapy.
“I made more improvements in my first therapy visit with
Aaron than I had in three years with all the other doctor visits,” said Brad. “I couldn’t smoothly go down from a
step. By the end of the first session,
I could easily do that.”
The treatment Aaron used involves a portable resistance
device, a sort of leg brace that gives resistance to the hamstring muscle. After
fitting Brad for the brace, Aaron prescribed he wear it a couple hours each day
and do hamstring curls. The effect
is that the brace and therapies activate and retrain the hamstring muscle to pull
the hip back, which in turn rotates the knee back out so the patella (kneecap) can
properly slide in its designated track.
“By the time most people with patellofemoral pain syndrome
get to appropriate therapy, they have suffered the pain for many years and have
tired the whole gamut of treatment options, including traditional physical therapy,
just like Brad,” said Aaron. “But if
they are appropriate candidates for this newer therapy, they often experience decrease
in pain with activity and functional improvement on the first visit, and lasting
relief in just six to eight weeks of therapy.”
After three months of outpatient therapy at SSM
Rehabilitation’s Kisker site, Brad was already back on his bike, riding for at least seven
hours without any of his previous pain. In
August, he left
St. Louis
for
Tempe, Arizona
, to attend
Arizona State University
and, as Brad readily admits, to do a lot of great biking.
Aaron brought the new therapy for patellofemoral
pain syndrome to SSM Rehabilitation Hospital, and has trained other SSM Rehabilitation Hospital therapists to use it. It is still not widely used in
St. Louis
, and SSM Rehabilitation Hospital has the most comprehensive program, now offering the treatment at
most outpatient therapy sites. The
treatment also can be helpful in treating some back pain issues.
The brace works to adjust and maintain a person’s pelvic position, relieving pressure
on the lower back, sciatic nerve and patella.
September 2005
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