Sports rehabilitation for patellar dislocation is very common in young athletes between the ages of 16-20 years old. Sports usually associated with this type of injury involve sudden twisting or direct impacts seen in soccer, ice hockey and gymnastics.
By definition patellar dislocation is when the kneecap slips out of its normal position causing intense pain, swelling and reduced mobility.
Patella dislocation can also be the result of a direct fall on the knee joint. There are two types of patellar dislocation (1) completely dislocated where the orthopedist must properly place the patellar back in position called a reduction and (2) partial dislocation where the orthopedist recommends non surgical treatment.
Here we are going to discuss sports rehabilitation for a partial dislocation patellar with the goal of returning the patient back to normal activity within one to three months.
The goal of immobilizing the knee with a brace is to restore the patellar in its proper alignment and provide support. It gives the patient reassurance that the knee cap will stay in its position and not dislocate again.
A neoprene sleeve can be used to provide external compression to reduce the swelling. The patient can start sports rehabilitation with a brace or neoprene sleeve. Bracing also serves to take the weight bearing stress off the patella and assists in improving knee extension which is difficult with this type of injury.
This method helps keep the kneecap in alignment to decrease pain, reestablish normal mobility and stabilize the knee cap. The physical therapist first applies a protective tape called cover roll stretch and then applies thicker taping such as leukotape to place the patellar in proper position.
Once applied the patient feels immediate relief of pain and can perform sports rehabilitation exercises with the tape in place. Patients can be taught McConnell Taping so that it can be applied daily at home.
The physical therapist will start reducing the acute pain and swelling by the application of ice and electrical stimulation to the knee and starting quadriceps setting and straight leg exercises. Using electrical stimulation to re-educate the quadriceps muscle when there is difficulty activating that muscle is often utilized.
Sports rehabilitation exercises and physical therapy must address the tightness of the hamstrings, adductors, iliotibial band and calf musculature. Proper stretching techniques must be instructed to the patient especially if bracing or taping was needed. An important concept in sports rehabilitation here is any knee flexion exercises that requires more than 45 degrees should be avoided in the open kinetic chain stage.
Once the patient tolerates open kinetic chain exercises then it is time to advance to closed chain kinetic exercises such as mini squats, lunges, stationary bike and ambulation on stairs. If the patient states in this phase that the pain is resolved sufficiently then advancement to the final phase should start.
Advanced sports rehabilitation here progresses to jogging, running plyometrics and sports related exercises. Once patients can single leg stand, deep squat and jump they are ready to be discharged.
The kneecap is held in place by the quadriceps muscle tendon therefore to prevent further patellar dislocations the strengthening of this muscle must be maintained. It must be remembered that tight and strong lateral quadriceps is an underlying cause of patellar dislocation. It is highly recommended that strengthening should be geared toward the medial quadriceps and stretching of the lateral quadriceps. Using external supports and taping is also a means to prevent this injury.
Patients who had patellar dislocation and have (1) all pain symptoms resolved (2) normal Range of Motion returned and (3) pre injury strength restored have now completed the sports rehabilitation program.