Standing postural assessment revealed increased femoral
medial rotation and pronated feet (Figure 1). A partial squat
maneuver demonstrated medial collapse with the midpoint of the
right patella moving medial to a vertical reference from the
second toe. While squatting, the patient rated her pain a 4 out of
10 (Figure 2). Stair ambulation was assessed using a step-up and
step-down on a 15-cm box. Medial collapse was observed, and
pain was produced (Figures 3 and 4).
Examination findings suggested that the movement pattern
fault of medial collapse was a contributing factor to her PFPS, and
that she might benefit from neuromuscular training and education
emphasizing an improved movement pattern of the lower
extremity during functional movements.
Patient education regarding her condition and the intervention
options were provided. Goals set mutually with the patient
included: (1) demonstrate the ability to consistently perform a
squat and negotiate stairs without medial collapse; (2) decrease
reported pain on the visual analog scale to no more than 1/10 with
stairs and squatting and (3) independence with a home exercise
program.