Houston Methodist. Leading Medicine

Knee News

Use of SI Joint Manipulation for Patellofemoral Pain Syndrome

A common cause of knee pain in young athletes is called patellofemoral pain syndrome (PFPS). The patella (kneecap) moves up and down over the femur (thigh bone). This motion occurs along a specific track of cartilage along the back of the patella over the end of the femur bone. Pain with PFPS can occur when the patella gets off track and moves unevenly.

Studies have shown that lumopelvic manipulation of the sacroiliac joint (SIJ) can restore function of the quadriceps muscle. The quadriceps muscle along the front of the thigh pulls on the patella to straighten the knee. This muscle plays an important role in the development of PFPS.

The focus of this study was the effect of SIJ manipulation on PFPS symptoms. The researchers were a group of military physical therapists (PTs). A second goal of the study was to identify patients with PFPS who might benefit from SIJ manipulation.

Finding common factors that predict the outcomes of treatment is an important research goal. If PTs can recognize PFPS patients who would benefit from SIJ manipulation, faster and better outcomes from treatment might be possible. After studying 50 men and women with PFPS using lumbopelvic manipulation, here's what they found :

  • Less than half the group (45 per cent) had a successful result
  • Of those who did have improvement, there were five predictors of success (hip
    motion, ankle motion, foot position, no stiffness with sitting, squatting as the most painful activity)
  • Hip range-of-motion (internal rotation) was the best predictor of treatment
    success. A difference of more than 14 degrees from one side to the other was significant.
  • Weakness of the hip internal rotator and abductor muscles was also present in
    those patients who had a successful result with SIJ manipulation

    The focus on hip position, strength, and function was consistent with other studies pointing to a problem in the lumbopelvic region associated with PFPS. These findings may help guide PTs when planning the best treatment for each patient with PFPS.

    Successful rehabilitation should pay attention to the lumbopelvic region. Future studies may show other (possibly more important) predictive factors to help guide the treatment approach.


    Christine A. Iverson, PT, DPT, et al. Lumbopelvic Manipulation for the Treatment of Patients with Patellofemoral Pain Syndrome: Development of a Prediction Rule. In Journal of Orthopaedic & Sports Physical Therapy. June 2008. Vol. 38. No. 6. Pp. 297-312.

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    *Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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