The Guru believes the McConnell approach to PFJ pain is right on!

September 8, 2014

Hi, I have noticed that many people ask you physio questions online (having researched many physio “Ask the Guru” sites and your website keeps popping up). I am in search of real/honest professional physiotherapy advice please.

I have severe Femoral Patella knee pain (both knees) and back/neck pain but I am very concerned about my knee pain (the back/neck pain is from various fractured areas in my ankles, feet, sacrum, vertebrae and spinal damage from sport, birth and/or falling down stairs etc. which is fixable to a degree, sort of as some of the damage was not addressed by professionals and is now permanently healed out of place).

I have had a few physios; one at the start of the year used Jenny McConnell’s taping method (the diamond, as the circles didn’t work for me), and he trained directly with her so I know he was doing it correctly (this helped but I don’t have access to him anymore); and another physio that doesn’t really believe in taping but in strengthening the bum/thigh muscles (my current physio) as such I don’t self-tape either.  I respect both gentlemen enormously and am absolutely not having a whinge about either of them (I think they are both terrific, highly trained professional men), but this pain is ongoing 24/7, even when trying to sleep and has been for well over a year (with physio assistance but much less than prior to physio intervention).  My Femoral Patella pain was brought on by incorrect medication being prescribed to me and me having severe reactions to the drug creating complications to my muscles and knees.  I am currently 51yrs old.  The intensity of pain alters daily but my inability to go up/down stairs and slopes/hills is a daily problem that affects my work, private life and mental happiness.  I exercise daily with walking and various versions of physio exercises being “The Bridge”, “The Stork” or “Flamingo” (I forget which bird it is), gentle squats and other stuff, plus I take slow release Panadol and Aspirin for anti-inflammation and pain relief purposes (as suggested by my Specialists).

Do you have any suggestions on what else I may do or request to be done from my physio please?  I am not medically trained and therefore I don’t know what to ask/tell him.  I will again discuss this with my physio but as I don’t show pain it is difficult for them/him to see what is going on.  I use words but as I say, unfortunately I don’t show pain and I am very flexible so I bend on-call and pretty well.  If you have any suggestions I would greatly appreciate your help/advice as this pain is really getting me down and I used to be extremely active.  It would be great to have my life back.  Thank you.



September 8, 2014

Hi Julia

Thanks for the really detailed message – you’re not alone in what you’ve got or are feeling.

First up, is that I think the McConnell approach to PFJ pain is still the holy grail. She started her research in the ’80″s and is still at the top of the tree. Unfortunately, your other physio who doesn’t believe in taping is missing a sitter. What he in essence is saying “I’m not good at taping, some I’m going to dismiss it!” Shame on him – tape is a great pain reliever. No more, no less. The taper, though, has to be spot on. The wrong tape for the right thing will provide no relief. The right tape for the right thing is brill…horses for courses, but tape does work.

PFJ pain can be 2 if not 3 fold. Firstly, the McConnell approach is about altering and optimising how the knee cap moves on the front of your femur. Control (rather than strength) of your gluts and foot posture (or orthotics) can help provide relief. Secondly, a surgeon called Scott Dye in the States correctly identified that PFJ pain can also be due to highly irritated/inflamed synovial tissue that sits around the back of the knee cap. These 2 approaches daisy chain with each other – poor mechanics causing irritation and pain. A painful knee causing poor mechanics and poor patella tracking.

Finally, is the idea of central pain sensitisation. Imagine that I keep poking you in the eye – day in, day out. After a good few months I stop, however the pain may continue for months despite me stopping. The way you’ve coped with me poking you in the eye is still engrained in your brain so you don’t change what you do and the pain continues. Your brain has got used to this continual bombardment of pain signals and so it becomes normal, despite all being well.

You sound like you’ve got a combination all of all 3 – not just a single entity. The pain you feel at night is atypical of PFJ pain (but not necessarily for infrapatella fat pad pain) as the kneecap shouldn’t rest on the femur when your leg is out straight. It can be indicative of an inflammatory reaction and it most certainly can be due to “brain” sensitivity issue.

I think you possibly need to be taped to see if it can decrease your pain – so the taper has to be first class. I think you’re pain needs classifying – is it PFJ, fat pad, saphenous nerve, centrally maintained etc. So what’s driving what? Is your poor control causing your knee to track poorly? Do you have great control but your knee is painful due to over sensitised tissue – either in the knee or is your brain just firing off abhorrent signals? What about the rest of your body – how does this compensate? Can you recruit your gluts or don’t you have the ability to get the rest of your body into an optimal position (stiff thoracic spine, tight front of your hips) to make them work? I’m sure you don’t need to get stronger, yet but you do need control, especailly if you’re are super bendy. You also need to do the right exercises, not just exercises and so care and correct form are key

Sorry this has turned out to be a marathon, but I’m sure there is lots left to do – in a positive way!

There’s a guy called Ben who’s the head honco in Jenny’s practice in Syndey, he’s your man to talk to…I think/hope you’re in Oz!

The Guru

Six Physio

Guru Responded

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