In anterior knee pain, patellofemoral pain syndrome (PFPS) is one of the most common causes, especially in adolescents and particularly in adolescent girls, where there is a strong emotional component.
The diagnosis of patellofemoral disorder
This syndrome is multifactorial and requires a complete analysis of the lower limb as well as a dynamic study of walking and running. The study of the posture will give us precious information. The history and the clinical examination allow us to make the diagnosis, knowing that very often the radiological imaging is normal.
It is probably the pathology whose conservative treatment is most undeniably dedicated to physiotherapy.
However, a literature review of the numerous clinical studies of conservative treatments does not determine a standard treatment.
Nevertheless, it appears to Brosseau et al (2001) that ultrasound has no beneficial effect on the SDFP, and other authors have more recently shown the beneficial effect of physical exercise in open or closed kinetic chains, with a preference for isometric type muscle work.
Electro neuro stimulation has had its followers, but it is little or poorly used in the end, especially since if the muscles stimulated by electro-induction are not reafferented, the increase in force is not or only slightly functional or requires reathletisation which is often incompatible with a PPDS.
Treatment with Allyane neuromotor reprogramming
Why use this method?
It is precisely in this context that the interest of neuromotor reprogramming (NMR) arises. This is particularly effective in PPFS with dynamic valgus, which helps to increase the lateralization of the patella.
One of the key chiefs of the quadriceps is the vastus medialis obliquus (VMO). Why? Because its horizontal fibres create a medial force vector on the patella, especially in the last degrees of knee extension.
With a high percentage of postural fibres, the VMO is particularly affected by antalgic flaccidity or by inactivity in its articular sector. Because of its innervation by the saphenous nerve, which is different from the other chiefs of the quadriceps, it tends to behave like a dysfunctional muscle within a quadriceps which often presents a normal concentric or eccentric force during tests, particularly in athletes.
A dysfunctional VMO in the first instance, then deafferented in the second instance - preceding a specific amyotrophy later on - will induce a delay in contraction in relation to the quadriceps and in particular the vastus lateralis. This will lead to early lateralization of the patella and in the short term to PFDS, especially if other aggravating factors such as dynamic valgus, a retracted iliotibial band or a flat foot are present.
How does the Allyane method work?
Awareness of the gesture
During an Allyane session, the patient must first become aware of the elective contraction of his VMO.
Classically, the patient is asked to combine resisted knee extension with hip adduction by squeezing a cushion. In RNM, it is desirable to propose to the patient lying on a massage table, a resisted elevation of the leg in extension up to 45º, foot in slight external rotation. This allows the patient to be more selectively aware of their VMO without being sensory disturbed by the contraction of the adductors.
After several contractions on the healthy side, he must not only produce the mental image of the contraction of his VMO, but also that of the quality of the muscle recruitment from the beginning of the elevation of the lower limb.
Listening to low frequency sounds
Once this sensation is acquired, the patient lies down with the Alphabox headset generating low frequency pulsed sounds, which will allow him to go into alpha brain activity mode while hyper-activating his motor areas.
First of all, he will deprogram his SDFP. He will reproduce the motor image of the proprioceptive sensations of his painful knee with a VMO that is not very reactive, with a slight latency time when it is put under tension. Then, accompanied by the therapist, he will continue this specific mental imagery work by erasing this gesture and the considered body zones. At this point, the operator sends a referent sound chosen by the patient. This is the deprogramming or erasing phase.
He then reprograms by producing a mental image of the proprioceptive sensations acquired on his healthy VMO during a virtual explosive extension of the pathological knee. When he has visualized this sensation correctly, the practitioner sends the referent sound again. This is the reprogramming phase.
End of session analysis
The operator then tests the affected VMO in real life by applying a 45º resisted extension of the leg and the response is significantly improved, sometimes even superior to the healthy side. This can be demonstrated by appropriate dynamometric analysis.
We then have a reafferented VMO which will be optimised by re-education, electro-stimulation or reathletisation which will be much more effective from that moment on.
I often suggest a second Allyane session of RNM at one month to correct the dynamic valgus during the unipodal jump if necessary.
Sports physiotherapist, osteopath, physical trainer and tennis coach. He was the first private physiotherapist on the professional tennis circuit in 1985. His multidisciplinarity and his perfect knowledge of high level sport have made him a true specialist in the prevention of injuries and the return to competition. During 30 years on the WTA and ATP circuit, he has followed many players and in particular Nathalie Tauziat, Guy Forget, Sergi Bruguera, Carlos Moya and Roger Federer. Author of numerous publications on pubalgia, electroneurostimulation and laterals including "l'oeil directeur", a best-selling book for tennis and football, he left the ATP professional circuit in 2015 to transmit and develop in Lyon, the neuromotor reprogramming protocols for Allyane until 2019. Consultant in football, teacher in many Spanish universities, to date, he develops and teaches neuromotor reprogramming on Spain and Latin American countries.