Table 1

Physiotherapy program (adapted from Crossley et al, 2002).
Intervention
 Dose
Patellar mobilisation:
I. Passive patellar medial glide and tilt combined with transverse friction massage of the lateral retinaculum
 4 × 30 seconds


Stretches:
I. Hamstring stretches
 3 × 20 seconds; bilateral
II. 'Figure 4' anterior hip stretch (Figure 3)
 3 × 20 seconds; bilateral


Patellar taping:
I. Taping of the patella:
 Daily application for 6 weeks
     1. Medial tilt and posterior tilt
     2. Medial glide and posterior tilt
     3. Fat pad unloading
     4. Medial rotation


Exercises:
I. Hip external rotation retraining (Figure 4)
 3 × 20 seconds; bilateral
II. Vasti retraining (with EMG biofeedback):
     i. Isometric VMO contraction in sitting
 3 × 10 repetitions (affected);

1 × 10 repetitions (unaffected)
     ii. Inner range knee flexion in standing
 3 × 10 repetitions
     iii. Step downs (when able to perform 5 pain-free repetitions):
          a) Slow eccentric lowering on affected leg from 10 cm step
 3 × 10 repetitions
          b) Increased step height (20 cm step)
 3 × 10 repetitions
          c) Alternating speed (down slow, up fast; down fast, up slow)
 3 × 10 repetitions


Home exercise program:
I. Self-mobilisation of the affected patella
 As above; twice daily
II. Patellar taping (as above)
III. Stretches (as above)
IV. Exercises (as above)

Vicenzino et al. BMC Musculoskeletal Disorders 2008 9:27   doi:10.1186/1471-2474-9-27