Another looking out of the box study. Supposed part of PF pain is neurologic and stretched femoral nerves. In cases that tested as having “tight” femoral nerves (positive femoral slump test) which was about 1/2 of cases, treatment resulted in over 50% improvement of pain – often immediate
Huang, B. Y., Shih, Y. F., Chen, W. Y., Ma, H. L., Frost, K. L., Bertocci, G., … & Bussmann, J. B.
Predictors for Identifying Patients with Patellofemoral Pain Syndrome Responding to Femoral Nerve Mobilization.
Archives of physical medicine and rehabilitation. May 2015; 96: 920-7
http://www.ncbi.nlm.nih.gov/pubmed/25576086
- 51 cases patellofemoral pain syndrome
- 25 positive femoral stretch test
Procedure:
- lay patient on good side with good knee in flexion. Put neck,and trunk in total flexion
- Bend tested knee in total flexion and extended the hip until symptoms occur.
- Record hip extension angle
- patient “asked to extend the neck and compare the pain level before and after the neck movement.”
More sophisticated version:
Actual treatment: (verbatum)
- The treatment was carried out with the patient lying on the asymptomatic side in a total flexion position, and the therapist performed the hip extension movement with the knee joint kept in flexion until the patient felt soreness or pain.
- This position was held for 2 seconds and then released.
- This tensioning maneuver was repeated in 3 sets of 10 repetitions at each treatment session.
- A total of 6 treatment sessions were performed within 2 weeks
Results:
- 23/25 with positive stretch test responded while 5/25 negatives responded with >50% improvement – often within first treatment
Comment – day after I wrote this, a heavy set patient with chronic pain came in feeling much better except for her right kneecap. Patellar facets and retinaculum above patella were both sore. Had trouble eliciting femoral stretch until I told her to roll up in a ball; femoral nerve stretch with neck extension was then positive and stretch technique was done according to program and resulted in knee feeling much better. Both her and I were impressed