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This is Brent of the Brookbush Institute and in this video
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we're going to do the eccentric step-down
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test, which is possibly the only patella femoral pain syndrome test I use on a
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regular basis. I'm going to have my friend Melissa come out, she's going to help me
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demonstrate. Now the reason I only use this test for patella femoral pain
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syndrome is because essentially functional-patterns; squats, step ups and
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lunges, and this eccentric step down test are actually more reliable than
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all of the other special tests for patellofemoral pain syndrome. They either
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lack sensitivity or they lack specificity, it's just not a good look
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for special tests at the knee. So we can go right back to okay Melissa you came
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in and you complained about left knee pain, all we really need to do as
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practitioners is find a concordant sign, something that provokes her symptoms. Why
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do we need that, because we're going to assess, address and reassess. One of the
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things I use often is this eccentric step-down test because it is so
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provocative, and any of you who have had some flared up knees, you get knee
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pain like I do, you know that stepping up stairs is okay, stepping down
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stairs especially slowly can be really really tough on days that your knees
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really really hurt. So I'm going to have Melissa go ahead and step up and to
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increase the reliability of this test, we want to make sure we do it the same
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way every time. I do find that 12-inch steps are a little mean, I know a lot of
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people who go straight for the plyo box, usually plyo boxes start at
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12 inches. I would start maybe something more like this that's like 8 or 10
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inches. We want to provoke knee pain we don't want to flare
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somebody up. The other thing I'm going to have Melissa do is put her hands on her
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hips and then I'm going to give her this cue -I want you, if we're testing the
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left side now she's going step forward with her right leg. So the knee
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that's left behind is the one we're testing, I want you to step down as
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slowly and smoothly as you can.
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How does that feel? That's her pain, yeah that's the symptoms she was talking
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about when she came in, and that's perfect now we have a concordance sign.
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Especially an athlete like Melissa, let's say she was having knee pain two
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miles into her runs, she might squat and not have knee pain. Can you show me a squat?
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Just do an overhead squat, there we go, cool does that hurt?
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Nope she has no pain, can you give me a lunge?
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Sure how's that feel? Other leg, all right that's fine. How about a step up?
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Yep that's okay, and you get this a lot with athletes, but again this is why we
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came back to the eccentric step-down test. Hands on your hips, step forward
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with your right leg, how does that feel? That's pain. Now you can see why
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this test keeps creeping its way back into my assessments, because if I had
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done a squat with her and I did a bunch of therapeutic interventions, and once
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again she's the type of person who's complaining about knee pain two-miles,
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three-miles into her workouts, how am I supposed to know if I did a good job?
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What just wait for her to come back the next session and go oh I still hurt. We
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want something that will provoke her pain now, that I can do some interventions
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and reassess right now. Alright so give this a try, eight- or ten-inch step,
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maybe you could even go lower, maybe have a six-inch step ready. These type of
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steps come in really handy, maybe not jump straight for the 12-inch