Lower Limb Injuries

The primary stability features of the hip femoroacetabular joint (FAJ) include bone congruence, acetabulum in a strong pelvic ring, labrum (deepens socket), strong capsule reinforced by ligaments, vacuum effect, short stabilizers posteriorly, and iliopsoas anteriorly.

The primary mobility features of the hip femoroacetabular joint (FAJ) include ball and socket bone structure, 3 degrees of freedom, capsule, large prime movers, and trunk control to optimize acetabulum orientation.

The clinical stability of the hip joint is primarily achieved via active structures at the joint; therefore, treatment for any joint injury must address the active stabilizers and optimize load through the joint.

Potential bone and joint pathologies at the femoroacetabular joint (FAJ) include femoral neck fractures, FAI impingement (CAM lesion and Pincer), Perthes disease, and symptomatic femoroacetabular impingement (FAI).

The symptom criteria for diagnosing symptomatic femoroacetabular impingement (FAI) include symptoms of hip/groin pain, physical impairment including positive impingement tests, and positive imaging findings.

The physical tests used for assessing symptomatic femoroacetabular impingement (FAI) include the hip quadrant test, passive range of motion (PROM) of hip internal rotation at 90 degrees (looking for pain), and the FABER test.

The physical impairments associated with symptomatic femoroacetabular impingement (FAI) include reduced muscle strength (especially in abductors), reduced dynamic single-leg stance control, and reduced side bridge performance.

The management options for symptomatic femoroacetabular impingement (FAI) include conservative treatment (moderate evidence), surgery (evidence is mixed), and the choice ultimately depends on the patient's preference.

Exercise therapy, combined interventions with foot orthoses, patellar taping, or manual therapy, and combining hip and knee exercises are recommended to reduce pain in PFPS.

Pain and tenderness at the inferior pole of the patella, with no joint swelling but thickening of the tendon.

Unloading and rest for the reactive stage and progressive loading rehabilitation for the degenerative stage.

Isometric exercises have been found to reduce tendon pain immediately and increase maximum voluntary isometric contraction for people with patellar tendinopathy.

Tendon pain, impaired performance, swelling of the tendon, and intratendinous changes.

Exercise therapy has a strong pain-reducing effect and decreases activity limitations in people with PFPS.

No, patellofemoral, knee, and lumbar mobilizations are not recommended in isolation for PFPS.

The treatment plan includes stages for pain relief, isometric exercises, isotonic strength endurance, energy storage exercises, energy storage and release exercises, and return to play.

No, no strong evidence supports one type of exercise over another for PFPS, comparing open chain quads, closed chain quads, and hip strengthening.

Foot orthoses are recommended to reduce pain in the short term for PFPS.

Combining hip and knee exercises is recommended to reduce PFPS and improve function.

Exercise therapy is recommended to reduce pain in the short, medium, and long terms and improves function in the medium and long term.

The primary role of the patella is to increase the lever arm of the quads, allowing flexion and extension to occur with less quads force.

Typical symptoms of PFPS include anterior knee ache, exacerbated with loading, prolonged sitting, crepitus, giving way, swelling, and locking.

Patella's anatomy, function, and pathology are crucial factors in developing PFPS, as unusual patella shapes are more likely to develop the syndrome.

Patella tracking within the trochlea groove and the movement of the femur underneath the patella significantly influence PFJ stress.

Common lower limb alignment with PFPS includes femur and tibia internal rotation, knee valgus, and ankle pronation, emphasized with squat.

Evidence suggests that hip muscle weakness may result from PFPS rather than cause it, and reduced hamstring length increases PFJ stress.

Psychosocial features of PFPS, including anxiety, depression, fear of movement, and reduced quality of life, are associated with the condition.

General principles of PFPS management include education, active rehabilitation, passive interventions, and assessment and treatment of altered pain processing and psychosocial features.

Assessment for PFPS involves subjective and objective measures, including location, onset, type, aggravating factors of pain, observation of dynamic activities, and altered pain processing signs.

Lateral patella translation is the most common tracking in those with PFPS, due to passive and active structures such as ligaments and muscles.

PFJ contact forces increase with knee flexion, and PFJ reaction forces measure the compression of the patella against the femur.

PFPS, or patellofemoral pain syndrome, is the most common condition presenting to sports medicine.