Conservative management of patellofemoral dysfunction.

Treating PFD starts with a thorough evaluation so that an accurate diagnosis can be made and a specific treatment plan established. A standardized, cookbook treatment approach can be avoided by adapting each rehabilitation program to the patient's specific needs without creating additional symptoms. Although many different strengthening modes have been used over the years, current trends are oriented less toward strength of the quadriceps and VMO and more toward improving VMO control of the patella. Functional strengthening modes are replacing more traditional methods. Improved lateral retinacular mobility and muscular flexibility enhance tracking of the patella and this in turn is facilitory to the VMO. Patient awareness of symptoms throughout the rehabilitation process helps avoid inappropriate activities. Although the therapeutic exercise components are of primary importance, other adjunct treatments may also be helpful. Medication and icing may facilitate better VMO activity by controlling inflammation. Patellar taping assists patellar tracking, which provides for better patellofemoral stability and reduced mechanical stress. While EMS may provide some strengthening effect to weakened musculature, BFB provides the patient with a way to monitor and enhance their own exercise efforts and improve motor learning for functional activities. Education of the patient to the etiology, biomechanics, treatment, and prevention of PFD enhances the short-term acquisition of rehabilitation skills, long-term patterns of motor control, and provides a lasting knowledge base with which the patient can functionally progress with minimum symptoms.