Communication with the surgeon and a consistent message to the patient are essential

Figure 63-1 Assessment algorithm. The patient is assessed initially at the anthropomorphic level and then at more demanding levels if safe and reliable performance is observed. (Davies GD, Wilk K, Ellenbecker TS: Assessment of strength. In Malone TR, McPoil T, Nitz AJ [eds]: Orthopaedic and Sports Physical Therapy, 3rd ed. St. Louis, Mosby Year Book, 1997, pp 225-227.)

Figure 63-1 Assessment algorithm. The patient is assessed initially at the anthropomorphic level and then at more demanding levels if safe and reliable performance is observed. (Davies GD, Wilk K, Ellenbecker TS: Assessment of strength. In Malone TR, McPoil T, Nitz AJ [eds]: Orthopaedic and Sports Physical Therapy, 3rd ed. St. Louis, Mosby Year Book, 1997, pp 225-227.)

roots to Lieb and Perry,2 who described the important function of the vastus medialis obliquus in patellar alignment. Unfortunately, since 1968, many patients have received terminal extension exercises to "isolate the vastus medialis obliquus" while other approaches may have been more beneficial. Recent data demonstrate that we cannot selectively train the vastus medialis obliquus but rather strengthen the quadriceps as a group.3-5

It is important to recognize that patellofemoral conditions are multifactorial and the assessment provides the information that allows the proper grouping of the patient into a treatment or rehabilitation protocol. Four patient groups are outlined in Figure 63-3 as a rehabilitation classification of patellofemoral patients. This process is built on assessment (allowing classification) and then the application of a specific rehabilitation protocol. The four areas are ligamentous instability, tension, friction, and compression with specific rehabilitation pearls to assist with each classification. It is important that clinicians recognize that their level of successful outcomes should be greater than 80% generally in patellofemoral patients, but not necessarily within each individual class.

The rehabilitation "protocol" for each of these classes is quite different. Tables 63-1 through 63-4 respectively outline the clinical approach for each class. This is based on the concept of what we control as clinicians and what is affecting the patient's response to exercise. These factors are initiated through answering the question: What do we control?

The factors that we control include range of motion (ROM) of contact (patellofemoral and tibiofemoral), length of time (and) level of pressure applied to the surface, activation type, c

Range of motion

Strength (isolated-"turning on the system'-integrated later in sequence)

Weight-bearing progression (partial, bilateral, unilateral)

Balance activities (stable-single plane, single plane moving, multiple planes)

Weight-loading progression to above and lastly adding perturbations

Functional activities including core strengthening and strength/power programs

Walking, steps (shorter to higher), jumping, hopping, ...sequence c

Job-related functional tasks (typical patient)

Straight jogging (not in meniscus patients)

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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