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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.

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