Evaluation eines klinischen Protokolls zur Klassifizierung und Behandlung von Patienten mit patellofemoralem Schmerzsyndrom

Zusammenfassung

Mit einer Prävalenz von bis zu 25 % bei jungen Erwachsenen und Sportlern ist das patellofemorale Schmerzsyndrom (PFS) eines der häufigsten Beschwerdebilder der Knieregion. Aufgrund der Vielzahl an ätiologischen Faktoren sind physiotherapeutische und sportmedizinische Diagnostik ebenso wie die Behandlung sehr komplex.

Das Ziel der vorliegenden Arbeit war es, ein strukturiertes Untersuchungs- und Behandlungsprotokoll zu erstellen und hinsichtlich seiner Anwendbarkeit zu evaluieren. Die Ergebnisse der Untersuchung zeigen, dass dieses Protokoll bei Patienten mit PFS anwendbar ist und sich die Schmerzintensität und Alltagsfunktionen der Patienten verbesserten.

Abstract

With a prevalence of up to 25 % in young adults and athletes the patellofemoral pain syndrome (PFPS) is one of the most common clinical knee disorder. Due to the multitude etiologic factors appropriate clinical physiotherapeutic and sports medical diagnosis as well as effective long-term treatment turn out to be very complex.

The aim of this study was to develop a structured clinical classification and treatment protocol and evaluate its feasibility and practicability. The study shows that the protocol was easy to apply in daily practice. Patients also improved regarding pain intensity and individual impairments in daily activities.

patellofemorales Schmerzsyndrom - Physiotherapie - Rehabilitation - Fallstudien

patellofemoral pain syndrome - physiotherapy - rehabilitation - case reports

Literatur

• 1 Beurskens A J, Vet H C, Köke A J et al. A patient-specific approach for measuring functional status in low back pain.  J Manipulative Physiol Ther. 1999;  22 144-148
• 2 Bizzini de M, Childs J D, Piva S R. A systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome.  Journal of Orthopaedics and Sports Physical Therapy. 2003;  33 4-20
• 3 Boling M C, Bolgla L A, Mattacola C G et al. Outcomes of a Weight-Bearing Rehabilitations Program for Patients Diagnosed with Patellofemoral Pain Syndrome.  Archives of Physical Medicine and Rehabilitation. 2006;  87 1428-1435
• 4 Braun S M, Kleynen M, Schols J M et al. Using mental practice in stroke rehabilitation; a framework.  Clin Rehabil. 2008;  22 579-591
• 5 Childs J D, Piva S R, Fritz J M. Responsiveness of the Numeric Pain Rating Scale in Patients with Low Back Pain.  Spine. 2005;  30 1331-1334
• 6 Cichanowski H R, Schmitt J S, Johnson R J et al. Hip Strength in Collegiate Female Athletes with Patellofemoral Pain.  Medicine & Science in Sports & Exercise. 2007;  39 1227-1232
• 7 Clark D, Downing N, Mitchell J et al. Physiotherapy for anterior knee pain: a randomised controlled trial.  Annals of the Rheumatic Diseases. 2000;  59 700-704
• 8 Crossley K, Bennell K, Green S et al. Physical Therapy for Patellofemoral Pain. A Randomized, Double-Blinded, Placebo-Controlled Trial.  The American Journal of Sports Medicine. 2002;  30 857-865
• 9 Crossley K, Bennell K, Cowan S M et al. Analysis of Outcome Measures for Persons with Patellofemoral Pain: Which Are Reliable and Valid?.  Archives of Physical Medicine and Rehabilitation. 2004;  85 815-822
• 10 Dixit S, Difiori J P. Management of Patellofemoral Pain Syndrome.  American Family Physician. 2007;  75 194-202
• 11 Downie W W, Leatham P A, Rhind V M et al. Studies with pain rating scales.  Ann Rheum Dis. 1978;  37 378-381
• 12 Duffey M J, Martin D F, Cannon D W et al. Etiologic factors associated with anterior knee pain in distance runners.  Med Sci Sports Exerc. 2000;  32 1825-1832
• 13 Dye S F, Stäubli H U, Biedert R M et al. The mosaic of pathophysiology causing patellofemoral pain: therapeutic implications.  Operative Techniques in Sports Medicine. 1999;  7 46-54
• 14 Eng J J, Pierrynowski M R. The effects of foot orthotic on threedimensional lower-limb kinematics during walking and running.  Phys Ther. 1994;  74 836-844
• 15 Fredericson M, Powers C M. Practical Management of Patellofemoral Pain.  Clinical Journal of Sport Medicine. 2002;  12 36-38
• 16 Goldberg B. Chronic anterior knee pain in adolescent.  Pediatric Annals. 1991;  20 186-193
• 17 Handfield T, Kramer J. Effect of McConnell taping on perceived pain and knee extensor torques during isokinetic exercise performed by patients with patellofemoral pain.  Physioth Can Winter. 2004;  4 39-44
• 18 Heintjes E, Berger M Y, Bierma-Zeinstra S MA et al. Exercise therapy for patellofemoral pain syndrome.  Cochrane Database of Systematic Reviews. 2003;  , Issue 4. CD 003 472 DOI: 10.1002 / 14 651858.CD 003 472
• 19 Herrington L, Payton C J. Effects of corrective taping of the patella on patients with patellofemoral pain.  Physioth. 1997;  83 566-572
• 20 Holmes S W Jr, Clancy W G Jr. Clinical classification of patellofemoral pain and dysfunction.  J Orthop Sports Phys Ther. 1998;  28 299-306
• 21 Jensen M P, McFarland C A. Increasing the reliability and validity of pain intensity measurement in chronic pain patients.  Pain. 1993;  55 195-203
• 22 Klingman R E, Liaos S M, Harding K M. The Effect of Subtalar Joint Posting on Patella Glide Position in Patients with Excessive Rearfoot Pronation.  Journal of Orthopaedic & Sports Physical Therapy. 1997;  25 185-191
• 23 Knoche J, Prümmer P. PSK-D: ein Assessment für Patienten mit chronischen Sprunggelenksbeschwerden [Bachelorarbeit]. Hogeschool Zuyd. Heerlen; 2009
• 24 Mascal C L, Landel R, Powers C. Management of Patellofemoral Pain Targeting Hip, Pelvis, and Trunk Muscle Function: 2 Case Reports.  Journal of Orthopaedic & Sports Physical Therapy. 2003;  33 642-660
• 25 McClinton S, Donatell G, Weir J et al. Influence of Step Height on Quadriceps Onset Timing and Activation during Stair Ascent in Individuals with Patellofemoral Pain Syndrome.  Journal of Orthopaedic & Sports Physical Therapy. 2007;  37 239-244
• 26 McConnell J, Bennell K L. Conservative management of anterior knee pain: The McConnell program. In : S anchez-Alfonso V Anterior knee pain and patella instability.. London: Springer; 2006
• 27 Messier S P, Davis S E, Curl W W et al. Etiologic factors associated with patellofemoral pain in runners.  Med Sci Sports Exerc. 1991;  23 1008-1015
• 28 Ng G YF, Cheng J MF. The effects of patella taping on pain and neuromuscular performance with patellofemoral pain syndrome.  Clinical Rehabilitation. 2002;  16 821-827
• 29 Nimon G, Murray D, Sandow M et al. Natural history of anterior knee pain: a 14- to 20-year follow-up of nonoperative management.  J Pediatr Orthop. 1998;  18 118-122
• 30 Paxton E W, Donald C F, Stone M L et al. The Reliability and Validity of Knee-Specific and General Health Instruments in Assessing Acute Patellar Dislocation Outcomes.  The American Journal of Sports Medicine. 2003;  31 487-492
• 31 Powers C M. Patellar kinematics. Part II: the influence of the depth of the trochlear groove in subjects with and without patellofemoral pain.  Phys Ther. 2000;  80 965-973
• 32 Reese N B, Bandy W D. Use of an inclinometer to measure flexibility of the iliotibial band using the Ober test and the modified Ober test: Differences in magnitude and reliability of measurements.  The Journal of orthopaedic and sports physical therapy. 2003;  33 326-330
• 33 Salsich G B, Perman W H. Patellofemoral joint contact area is influenced by tibiofemoral rotation alignment in individuals who have patellofemoral pain.  J Orthop Sports Phys Ther. 2007;  37 521-528
• 34 Schädler S, Kool J, Lüthi H. et al .Assessments in der Neurorehabilitation. Bern: Huber; 2006
• 35 Scharf W, Weinstabl R, Orthner E. Anatomische Unterscheidung und klinische Bedeutung zweier Anteile des Musculus vastus medialis.  Acta Anatomica. 1985;  123 108-111
• 36 Summers S. Evidence-Based Practice. Part 2: Reliability and Validity of Selected Acute Pain Instruments.  Journal of Perianesthesia Nursing. 2001;  16 5-40
• 37 Tyler T F, Nicholas S J, Mullaney M J et al. The Role of Hip Muscle Function in the Treatment of Patellofemoral Pain Syndrome.  American Journal of Sports Medicine. 2006;  34 630-636
• 38 Ward S R, Powers C M, Fredericson M et al. The influence of medial femoral rotation on lateral patellar tilt during weight bearing and non weight bearing movements.  Med Sci Sports Exerc. 2002;  34 S160
• 39 Westaway M D, Stratford P W, Binkley J M. The Patient-Specific Functional Scale: Validation of lts Use in Persons with Neck Dysfunction.  Journal of Orthopaedic & Sports Physical Therapy. 1998;  27 331-338
• 40 Whitelaw G P, Rullo D J, Markowitz H D et al. A conservative approach to the anterior knee pain.  Clinical Orthopaedics. 1987;  246 234-237
• 41 Witvrouw E, Werner S, Mikkelsen C et al. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment.  Knee Surgery, Sports Traumatology, Arthroscopy. 2005;  13 122-130
• 42 World Medical Association (WMA) .Declaration of Helsinki 2000. http://www.wma.net
• 43 http://www.drk-schmerz-zentrum.de/content/ 07_infos/ 7 – 6_schmerztagebuecher.php