of the knee), and the kinds of activities the person
conducts.
The more inactive an individual is, the more
likely he or she is to develop patellofemoral syn-
drome. However, most doctors do not believe this
condition is one of overuse. Some experts believe
an imbalance of STRENGTHamong the four parts of
the quadriceps permits dysfunctional tracking of
the patella, contributing to the syndrome. Most
athletic activities that use the quadriceps, such as
running and bicycling, strengthen the lateral
(outer) muscles more than the medial, pulling the
patella off track.
Symptoms and Diagnostic Path
The main symptom of patellofemoral syndrome is
PAINgoing down steps or downhill and when sit-
ting for long periods of time with the knees bent
(flexed). The characteristic and specific nature of
these symptoms allow the doctor to make a
straightforward clinical diagnosis. X-rays and
other diagnostic imaging procedures are not nec-
essary unless there is reason to suspect another
reason for the symptoms.
Treatment Options and OutlookTreatment often combines one of the NONSTEROIDAL
ANTI-INFLAMMATORY DRUGS (NSAIDS) to relieve
INFLAMMATIONand pain with PHYSICAL THERAPYto
strengthen the quadriceps, particularly the medial
(inner) muscles of this group. Most people experi-
ence relief from this treatment approach within
two weeks and can return to their regular activi-
ties, including most sports, in four to six weeks.
Risk Factors and Preventive MeasuresWomen, particularly those in their late teens and
early 20s who are inactive, are more likely than
men to develop patellofemoral syndrome.
Researchers do not know why this is. Exercises to
maintain balanced strength in the quadriceps MUS-
CLE appears to prevent further occurrences of
symptoms. A soft knee brace that holds the patella
in position may also help maintain proper tracking
of the patella. Some athletic trainers advocate
wrapping or taping the knee before participation
in an athletic event, which accomplishes a similar
purpose.
See also KNEE INJURIES.
physical therapy A therapeutic approach to
maintain or improve the biomechanics of the
body. Physical therapy employs many modalities
(types of treatments) including passive and active
range of motion exercises, THERAPEUTIC MASSAGE,
hydrotherapy, therapeutic ULTRASOUND, heat and
cold, strengthening exercises, FLEXIBILITYexercises,
and balance exercises. In the United States physi-
cal therapy requires a doctor’s prescription. The
doctor may prescribe physical therapy for people
recovering from serious injury, surgery, or STROKE.
Physical therapy also is helpful for conditions of
impaired motor function such as CEREBRAL PALSY
and PARKINSON’S DISEASE.
See also OCCUPATIONAL THERAPY; QUALITY OF LIFE;
STRENGTH.plantar fasciitis INFLAMMATIONof the FASCIAalong
the bottom of the foot (plantar surface). Fascia is a
thin, tough sheet of connective tissue that covers
and connects the muscles, tendons, and other
connective tissue structures throughout the body.
It becomes irritated and inflamed with overuse.
Plantar fasciitis develops with repeated stretching
of the plantar fascia such as may occur with
extensive walking or prolonged standing on a
hard surface such as concrete. People whose jobs
require walking on hard surfaces, such as mail
carriers and police patrol officers, are particularly
vulnerable to plantar fasciitis. Excessive body
weight contributes to the stress the plantar fascia
experiences, as do overly flat shoes, exacerbating
the inflammation.
The pain of plantar fasciitis is distinctly charac-
teristic; the doctor usually makes the diagnosis on
the basis of symptoms. The PAINbegins in the heel
and is most significant when returning to the feet
after being off of them for a while, such as when
first getting out of bed in the morning or after an
extended work break. Immediate ice to the area of
pain helps suppress the inflammation; NON-
STEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDS) block
the inflammatory response and relieve pain. Shoes
with cushioned soles and insoles, shock-absorbing
floor mats, and shoe orthotics to hold the foot in
the best position for the individual are among the
methods that reduce the risk for plantar fasciitis.
Stretching exercises to loosen the fascia further
relieve pressure. Most people recover from anplantar fasciitis 349