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Outpatient rehabilitation for a patient with patellofemoral pain syndrome
A patient with right patellofemoral pain syndrome was seen for physical therapy treatment for 10 sessions over the course of two months at an outpatient physical therapy clinic. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. The patient was evaluated at the initial encounter with manual muscle test, active range of motion, functional tests, and special tests for knee pathology. Based on this evaluation, a plan of care was established. Main goals for the patient were to: increase walking distance; improve mobility; increase strength in lower extremity muscles which included the right hip and knee extensors, hip abductors, external rotators, and knee flexors; perform housework and basic home maintenance without pain; and regain functional independence. The main interventions included manual therapy, task-specific training, isometric/concentric/eccentric strengthening exercises, and functional training. The independent home exercise program (I-HEP) incorporated strength, stretching and walking program with progression to continue a path of becoming more physically active. The patient had an overall improvement in pain inducing functional activities. By the end of the 5 weeks, she was able to ascend/descend more than 12 steps, perform a squat past 90°, and walk more than 4 miles all without pain. The patient also improved her score in the Lower Extremity Functional Scale from 56/80 to 71/80 surpassing the minimal clinically important difference score of 9. She was discharged to her home with an I-HEP after reaching all of her goals.