Physiotherapy Initial Assessment

Physiotherapist Initial Assessment Goals - Patient wants to return to playing amateur football without pain, specifically aiming to be able to run and kick a ball comfortably within 8 weeks. **Subjective** PC Right knee pain, diagnosed as patellofemoral pain syndrome. HPC Presents with a 3-month history of right knee pain, insidious onset, initially mild but has progressively worsened. Pain is dull ache, worse with activity and prolonged sitting. No specific injury event. Has tried rest and over-the-counter pain relief with minimal improvement. Initially, pain was 3/10, now consistently 6/10 with activity. Neuro - No neurological symptoms reported. Aggs - Squatting, climbing stairs, prolonged sitting with knees bent, running. Eases - Rest, icing, gentle stretching of quadriceps. 24hr - Symptoms are mild in the morning, worsen throughout the day with activity, and are most severe in the evening after work. Intermittent nocturnal pain if over-active during the day. Hx injury - Previous left ankle sprain 5 years ago, fully recovered. No prior knee injuries or surgeries. Social Hx - Marketing executive, works from home 3 days a week, 2 days in the office. Work setup at home involves prolonged sitting at a non-ergonomic desk. In the office, uses a sit-stand desk. PA - Plays amateur football once a week (currently unable due to pain), attends gym twice a week focusing on upper body and core. Previously ran 5k twice a week. General Health Sleep - 6-7 hours of good quality sleep per night. Stress - Medium Smoke - No Drink - Yes PMH - No significant past medical history. DH - Nil. Red Flags - None reported. ICE: I - Patient believes the pain is due to overuse from increasing running mileage too quickly before the pain started. C - Concerned about long-term impact on ability to play football and general fitness. Worries it might lead to arthritis. E - Expects to receive exercises to strengthen the knee and advice on returning to sport safely. Investigations - MRI scan of right knee performed 2 weeks ago, reported as showing mild patellofemoral chondrosis, no meniscal tears or ligamentous damage. **Objective** Observation: Mild swelling noted around right patella. Quadriceps muscle bulk appears symmetrical. No obvious deformities. Gait appears normal, but patient reports pain with running. Palpation: Tenderness along medial and lateral patellofemoral facets, and at the infrapatellar tendon insertion. Range of Movement: Full active and passive range of movement in right knee flexion and extension. Pain elicited at end-range flexion. Strength Testing: Quadriceps strength 4/5 on the right, 5/5 on the left (manual muscle testing). Hamstrings and gluteal strength 5/5 bilaterally. Special Tests: Positive patellofemoral grind test on the right, negative McMurray's and Lachman's tests. Functional Assessments: Pain reported with single-leg squat on the right, unable to perform more than 5 repetitions without significant discomfort. Able to hop for short distances but reports pain on landing. HEP: 1. Quadriceps sets 2. Glute bridge 3. Clamshells 4. Wall squats (partial range) **Analysis** Patient presents with classic symptoms of patellofemoral pain syndrome, exacerbated by activity and prolonged knee flexion. Objective findings support this diagnosis, with tenderness, pain on end-range flexion, and a positive patellofemoral grind test. Quadriceps weakness is also contributing to the symptoms. The patient's belief about overuse aligns with the clinical picture. The MRI confirms patellofemoral changes but no significant structural damage requiring surgical intervention. **Plan** FU 2 weeks Rv Pain levels, functional ability (squatting, stair climbing), adherence to HEP, and progression of exercises.