Activity Modification in The Treatment of Patellofemoral Pain
Activity modification plays a vital part of my recommendations. Whilst the vast majority of PFJ problems should be classed as a nuisance but not a worry, activity modification is extremely useful. Why do I recommend activity modification? In a nutshell it changes the stress placed on the joint hence allowing the pain to settle, and can also buy a little time for treatment. Let’s examine this a bit closer:
There are any parameters involved with exercise. For example, take running. There is overall distance, speed, hills, and terrain to name but a few. So it may not be a case of stopping running, but altering some of the aforementioned parameters to decrease the load on the PFJ. Sometimes there may need to be a requirement to have a temporary cessation of running, and I am most likely to recommend this in the presence of inflammation and or bone oedema.
I would never recommend no exercise and so in this situation I am looking to work with the patient to help them find an alternative. In this situation I will be exploring aspects such as whether they like exercising in or outside, alone or in a group etc.
Activity modification does not always relate to sport. Hobbies such as gardening often require activity modification. In this instance I would be suggesting that the patient looks at all the jobs they want to do and with my facilitation work out which are highest stress for the PFJ, and then spread these tasks out. Everything still gets done, but perhaps in a different order, and ultimately in a way that reduces stress to their knee.
Finally stairs are a frequent aggravating factor for patients with PFP. Whilst I thoroughly commend people for using the stairs for exercise, if this genuinely is a clear aggravating movement then the pros of doing repeated stairs may be outweighed by the negatives. In this instance I would look to help the patient re-evaluate how they are getting their exercise.
To summarise, the measures outlined above are not rocket science, but must not be overlooked. With clever activity modification, (often only temporarily) a patient will have quicker resolution of their problem, will hopefully not have had the negative experience of just being told to ‘not’ do something, and ideally will be more understanding about the effects of their daily life on their joint.