In anterior knee pain, the patellofemoral pain syndrome (PFPS) is one of the most frequent causes, especially among adolescents and particularly adolescent girls, where there is a strong emotional component.
Diagnosis of patellofemoral pain syndrome
This syndrome is multifactorial and requires a complete analysis of the lower limb as well as a dynamic study of gait and running. Postural analysis will provide valuable information. The patient's history and clinical examination allow for diagnosis, although radiological imaging is very often normal.
Taking charge
This is probably the pathology whose conservative treatment is most undeniably dedicated to physiotherapy.
However, a review of the literature of numerous clinical studies of conservative treatments does not determine a standard treatment.
However, it appears for Brosseau et al. (2001) that ultrasound has no beneficial effect on the SDFP, and other authors more recently show the beneficial effect of physical exercise in open or closed kinetic chain, with a preference for isometric type muscle work.
Electro-neurostimulation has had its followers but it is ultimately little or poorly used, especially since if the muscles stimulated by electro-induction are not reafferented, the increase in strength is not very functional or requires re-athleticization which is often incompatible with a SDFP.
The treatment with Allyane neuromotor reprogramming
Why use this method?
It is precisely in this context that the benefit of neuromotor reprogramming (NMR) arises. This is particularly effective in patellofemoral pain syndrome with dynamic valgus, which helps to increase patellar lateralization.
One of the key heads of the quadriceps is the vastus medialis oblique (VMO). Why? Because its horizontal fibers create a medial force vector on the patella, especially in the last degrees of knee extension.
With a high percentage of postural fibers, the VMO is particularly affected by an antalgic flexion contracture or by inactivity in its articular sector. Due to its innervation by the saphenous nerveUnlike the other heads of the quadriceps, it tends to behave like a dysfunctional muscle within a quadriceps that often shows normal concentric or eccentric strength during testing, particularly in athletes.
A dysfunctional VMO, initially followed by deafferentation—preceding specific muscle atrophy later on—will induce a delay in contraction relative to the quadriceps, and particularly the vastus lateralis. This will lead to early lateralization of the patella and, in the short term, patellofemoral pain syndrome (PFPS), especially if other aggravating factors such as dynamic valgus, iliotibial band retraction, or flat feet are present.
How does the Allyane method work?
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Awareness of the gesture
During an Allyane session, the patient will initially have to, to become aware of the elective contraction of one's VMO.
Traditionally, the patient is asked to perform a resisted knee extension combined with hip adduction by squeezing a cushion. In manual therapy, it is preferable to have the patient, lying on a massage table, perform a resisted leg raise in extension. up to 45º, The foot is in slight external rotation. This allows for a more selective awareness of its VMO without being disturbed at the sensory level by the contraction of the adductors.
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Mental imagery
After several contractions on the healthy side, he must not only produce the mental image of the contraction of its VMO, but also that of the quality of muscle recruitment from the very beginning of the elevation of the lower limb.
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Listening to low-frequency sounds
Once this sensation is acquired, the patient remains lying down with the Alphabox headphones generating pulsed low-frequency sounds, which will allow him to enter alpha mode of brain activity while hyper-activating his motor areas.
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Removal phase
First, he will reprogram his temporomandibular joint dysfunction (TMD). He will reproduce the motor image of the proprioceptive sensations in his painful knee with a relatively unresponsive motor visualization (MVD), with a slight latency when tension is applied. Then, guided by the therapist, he will continue this specific mental imagery work by erasing this movement and the associated body areas. At this point, the therapist will send a reference sound chosen by the patient. This is the reprogramming or erasure phase.
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Rescheduling
Then, the patient reprograms by producing a mental image of the proprioceptive sensations acquired on their healthy VMO (ventilatory muscle) during a virtual explosive extension of the affected knee. Once this sensation has been correctly visualized, the practitioner sends the reference sound again. This is the reprogramming phase.
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End-of-session analysis
The operator then tests the affected VMO in real-world conditions by eliciting a resisted extension of the leg to 45°, and the response is significantly improved, sometimes even superior to the unaffected side. This can be objectively demonstrated by appropriate dynamometric analysis.
We then have a reafferented VMO which will be optimized by rehabilitation, electrostimulation or reathlete training which will from this point onwards have a much better effectiveness.
What's next?
I often suggest a second Allyane RNM session a month later to correct, during the single-leg jump, the dynamic valgus if necessary.