Phase I – Inflammatory Phase:
- Modalities to control inflammation
- Prescription anti-inflammatories
- Ice
- Clinical modalities as needed
- Evaluate and treat lumbar, sacral, and pelvic dysfunction
- Evaluate for corrective orthotics
- Implement appropriate, selective stretching
- Iliotibial band
- Hamstrings
- Quadriceps
- Gastrocnemius/soleus
- Piriformis
- Apply appropriate patella mobilizations
- Evaluate lateral retinaculum and apply patellar tilt mobilization when indicated
- Begin early VMO/quadriceps strengthening
- Quad setting
- Multi-plane straight leg raising
- Open kinetic chain multi-plane hip strengthening
- Cardiovascular exercise
- Stationary bike
- Treadmill walking
Phase II – Subacute and Early Strengthening Phase:
- Continue with appropriate Phase I activities
- Advance strengthening
- Proprioception
- Closed kinetic chain squat program
- Closed kinetic chain unilateral squats, dip, and step-up progression
- Closed kinetic chain multi-plane hip strengthening
- Advance intensity and duration of biking and treadmill walking program
Phase III – Advanced Strengthening:
- Advance closed kinetic chain strengthening as appropriate
- Begin gym strengthening, using caution with leg extensions
- Begin light jogging progressing as tolerated
Phase IV – Return to Sports Program:
- Continue with Phase III program
- Re-evaluate with physician and therapist
- Advance to return to sport program as motion, strength, and endurance allow
This protocol is intended to provide a general guideline to treating patellofemoral dysfunction. Progress should be modified on an individual basis.
