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