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Legacy update log for the patellofemoral pain syndrome tutorial

This is a listing of older updates made to the patellofemoral pain syndrome tutorial. They are provided for historical interest only, a “paper trail” demonstrating how the document has been maintained. Newer updates are listed in the tutorial itself.

2015Science update: Added strong evidence from Freedman et al that Q-angles aren’t worth measuring. [Section: Q is for quadriceps: the dubious role of the Q-angle.]

2015Minor update: Added an interesting subsection about “fabella syndrome.” [Section: Under pressure.]

2014Correction: Reduced confidence in the results of a major study of special footwear (Knapik, the subject of the last update). Later removed the reference altogether. [Section: What about pronating?]

2014New section: A short new section, finally, on PRP injections. I’ve also published a more detailed free article about this. [Section: Regenerative medicine? Platelet-rich plasma injections and stem cell therapy.]

2014Minor update: General editing, plus a stronger and clearer statement about targeting the vastus medialis. [Section: Is one part of the quadriceps — the vastus medialis — more important?]

2014Minor update: General editing and polish, now that the dust has settled from the 2nd edition launch. [Section: If exercise works, how does it work?]

2014Minor update: General editing and polish, now that the dust has settled from the 2nd edition launch. [Section: Does exercise work?]

2014Major update: Extensive revision for the 2nd edition. [Section: How do you exercise without pissing off your knees?]

2014Major update: Extensive revision for the 2nd edition. [Section: Is one part of the quadriceps — the vastus medialis — more important?]

2014New section: A new section for the 2nd edition. [Section: If exercise works, how does it work?]

2014New section: A new section for the 2nd edition. [Section: Does exercise work?]

2014New section: A new section for the 2nd edition. [Section: Then exercise: The long term solution.]

2014New section: A new section for the 2nd edition. [Section: Pain is weird: the surprisingly fallible role of the brain in all this.]

2014Updated: Significant revision and expansion for the 2nd edition. [Section: Females versus males: is there really a difference?]

2014New edition: Major revision of the book with the help of, Tony Ingram, PT, MSo. The new edition has a few new sections, a strong new focus on the value of judicious exercise therapy, and updated and expanded citations for many key points. Read more about the 2nd edition.

2013Science update: Added another bad-news citation, and type of evidence. [Section: What about pronating?]

2013Science update: Added a bad-news citation. Sorry about that. [Section: Taping and strapping.]

2013New section: Intriguing new evidence of circulatory impairment in PFPS patients. [Section: Like getting blood from a bone.]

2013New section: No notes. Just a new section. [Section: “Maybe you’re just not built for running”.]

2013Science update: Added some science, to start building an evidence-based case for resting. [Section: The art of rest: the challenge and the opportunity for patients who have supposedly “tried everything”.]

2013Science update: Another good news science update: more about how surprisingly well knees handle running. [Section: Assault on the conventional wisdom about patellofemoral pain syndrome.]

2013Science update: Added a new study to the pile of evidence that abnormalities are common in healthy people and vice versa. [Section: Patellofemoral Tracking Syndrome.]

2013Science update: A particularly “good news” science update about how running is, counterintuitively, actually pretty good for joints — not hard on them. [Section: Assault on the conventional wisdom about patellofemoral pain syndrome.]

2013Minor update: Added a reader anecdote about stretching the IT band helping her anterior knee pain. [Section: Tight IT bands.]

2013Minor update: Apt aging joints humour added, via comedian Louis CK. [Section: Assault on the conventional wisdom about patellofemoral pain syndrome.]

2013Minor update: Upgraded risk and safety information about Voltaren Gel. [Section: You and “vitamin I”: anti-inflammatory meds, especially Voltaren® Gel.]

2012Science update: The writing was on the wall, but a new comprehensive review of knee lube jobs has confirmed that knee lube jobs are all washed. The section now reflects that. [Section: Should you get a lube job? Artificial synovial fluid injections.]

2012Science update: Two new studies of the connection between knee pain and the inner thigh muscles, showing … modest correlations of dubious significance. [Section: Weak and uncoordinated muscles, perhaps?]

2012Minor update: Some customizing of “brain wrangling” for patellofemoral pain syndrome. [Section: Brain wrangling: what to do about sensitization.]

2012Science update: Weak but interesting new evidence on natural running and injury prevention. [Section: Should you run naked? On faddish running styles and running shoes (or the lack thereof).]

2012Major update: Greatly expanded. Now offers a comprehensive summary of all treatment options: the good, the bad and the ugly. [Section: Other Treatments: What else can you do about PFPS?]

2012New section: New standard section I’m introducing to most of the tutorials to “manage expectations.” Too many readers assume there’s going to be a specific miracle treatment plan. [Section: So what’s the plan? Some expectations for management.]

2012New section: An important new section created as a direct response to reader demand. [Section: Now what?: An action-oriented summary of recommendations.]

2012Medium update: Added a few paragraphs about foam rolling and trying to “elongate” the IT band. [Section: Quadriceps massage.]

2012Science update: A minor but interesting new item about high heels. [Section: Hitting the road: shoes, surfaces, impact, and the spring in your step.]

2012New section: No notes. Just a new section. [Section: Brain wrangling: what to do about sensitization.]

2012Minor update: Another nice swimming update: I added some excellent perspective from an experienced competitive swimmer. [Section: The art of rest: the challenge and the opportunity for patients who have supposedly “tried everything”.]

2012Minor update: Very simple swimming tip added. Hat tip to reader Eric C. [Section: The art of rest: the challenge and the opportunity for patients who have supposedly “tried everything”.]

2012Updated: Answered some common reader concerns about planning. [Section: Jan’s Phase I: Preparation (July and August).]

2012Updated: Bone scans and the reason for getting them are now described much more thoroughly. Added some new science confirming that many PFPS knees are “hot.” [Section: Hot kneecaps! Should you get an x-ray, MRI, or bone scan?]

2012Major update: Expanded and heavily edited. In particular, the concept of a “diagnosis of exclusion” is now explained thoroughly. [Section: Eliminate other concerns.]

2011New section: No notes. Just a new section. [Section: How do you exercise without pissing off your knees?]

2011New section: Not a beefy update: just a few quick thoughts about heat. [Section: Heat (very briefly).]

2011Minor update: Addressed some common fears about the threat of getting out of shape while resting. [Section: 1. Common Resting Pitfall No. 1: The runner’s natural stubbornness.]

2011Minor update: Added reference to Kong et al, about the effect of shoe wear. [Section: Hitting the road: shoes, surfaces, impact, and the spring in your step.]

2011New section: Expanded the section so much that it’s effectively new. It was just a single paragraph about orthotics. Now it is a much more thorough discussion of orthotics, shoes, and impact reduction. [Section: Orthotics.]

2011Minor update: Added a reference about the poor overall quality of online information about common injuries. See Starman. [Section: Introduction.]

2011Minor update: Added an item about swimming to the “activities that may strain the knee” chart. [Section: The art of rest: the challenge and the opportunity for patients who have supposedly “tried everything”.]

2011Major update: Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really been cleaned up in general, making it significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement.

2011New section: Finally, long overdue, a new section on this topic (for all the running injury tutorials, in fact). [Section: Should you run naked? On faddish running styles and running shoes (or the lack thereof).]

2011Important new info: Where’s the fire? Recently I published a major new article about repetitive strain injuries, in which I explain that these injuries are rarely actually inflamed. Instead of being “on fire,” excessively stressed tissues tend to break down without inflammation — a kind of rot. For the full scoop on inflammation and repetitive strain injuries, see: Repetitive Strain Injuries Tutorial: Five surprising and important facts about repetitive strain injuries like carpal tunnel syndrome, tendinitis, or iliotibial band syndrome.

2010New section: New short section for both this book and the iliotibial band syndrome book covering potentially confusing alternative diagnoses, such as popliteal artery entrapment syndrome (PAES). [Section: Other possible diagnoses and sources of diagnostic confusion.]

2010New section: Brief new section — just a note, really, but quite important to some readers. [Section: About patellofemoral pain in teens.]

2010Minor update: Added some data on the incidence of PFPS in cyclists. [Section: Treating for inflammation: is there any point?]

2010New cover: At last! E-book finally has a “cover.”

2010New section: No notes. Just a new section. [Section: Glucosamine, chondroitin sulfate and other “nutraceuticals” have failed every large, fair test.]

2010Major improvements: Substantial changes related to new science summarized in Am I wrong? An update on the conventional wisdom. [Section: A Modern Perspective: Patellofemoral pain as “the itch you can’t scratch”.]

2010Major improvements: Substantial changes related to new science summarized in Am I wrong? An update on the conventional wisdom. [Section: Weak and uncoordinated muscles, perhaps?]

2010Major improvements: Substantial changes related to new science summarized in Am I wrong? An update on the conventional wisdom. [Section: Misc other possible biomechanical bogeymen.]

2010New section: A flurry of substantive updates and re-writing today inspired by some new scientific papers. [Section: Am I wrong? An update on the conventional wisdom.]

2010New section: No notes. Just a new section. [Section: Steroid injections are powerful, but where would you put the needle?]

2010New section: No notes. Just a new section. [Section: Prolotherapy is not relevant to patellofemoral pain syndrome.]

2010Minor update: Miscellaneous upgrades, and a nice anecdote from a reader [Section: Other Treatments: What else can you do about PFPS?]

2010Minor update: Added thoughts about the effect of and some other minor updates. [Section: The art of rest: the challenge and the opportunity for patients who have supposedly “tried everything”.]

2009Another new section, practically on top of the last one, , along with a substantial new article offering more detail about ultrasound in general, Does Ultrasound Therapy Work?. I put a considerable amount of research into this topic, and so there are also 34 new records in the bibliography for ultrasound.

2009Updated the tutorial this morning with a new section, “

2009Added much more discussion of the study of patellar alignment assessment originally added back in June, in the section .

2009Today I’ve been adding information to most of my tutorial about Voltaren® Gel, an anti-inflammatory ointment. In the case of this tutorial, this required a full re-write of all of the information about inflammation. So there are three “like new” treatment sections today:

And you can read about Voltaren in a free article as well as here in the tutorial. But the tutorial covers the topic specifically as it relates to patellofemoral pain syndrome, which is quite different than the general subject.

2009Added information about an interesting reference to a study showing that clinicians can’t agree on patellar tracking syndrome diagnoses (poor inter-rater reliability) — which I always knew, but it’s nice to see some strong scientific evidence of it.

2009New section: “

2009The visual design of the site was upgraded over the past several days. Although this is not an update to the content of this tutorial, it is nevertheless a significant upgrade for all of them — like publishing new editions of books with better typesetting and layout. The new design is even cleaner and reader-friendly; it now looks that good in most web browsers; and pages load as much as 50% faster. Many under-the-hood improvements will make it much easier for me to improve tutorial content. The tutorials are now well-oiled machines of digital publishing goodness, vastly superior to the low-production values of most eBooks. More information about the upgrade is published on the front page.

2009Major restructuring and editing of several sections related to therapies based on the assumption of a tracking problem. See the new section, “.” Particularly noteworthy was the addition of important new evidence from a 2008 paper in American Journal of Sports Medicine showing that a combination of strengthening, stretching and coordination exercises were ineffective at preventing patellofemoral pain syndrome.

2009Added a small new section about Traumeel, a popular but questionable remedy that I often get asked about. See the section, “,” or the free article, Does Arnica Gel Work for Pain?.

2008The New England Journal of Medicine just published two fascinating new papers about knee pain, knee osteoarthritis, and knee surgery. I was really pleased to see these papers, because they provide clear and definite scientific support for many key points I’ve made in this tutorial. Kirkley et al’s paper about surgery for osteoarthritis and Englund et al’s fascinating findings about torn menisci have been added to the tutorial.

2008Added some evidence to the pile concerning alleged knee pain differences between men and women.

2008Added information about Kinesio Taping® to the section “.”

2008Revised the first several sections quite thoroughly to make them more clear and readable.

2007Polishing more or less complete.

2007Addition of several new sections, a table of contents (finally), and several new images and pull quotes to make it nicer and clearer to read.

2007Release of major new version of the article, almost three times as long. All traces of “structuralism” have been removed. Much more detailed and useful exploration of the causes of PFPS has been added, as well as many vital new sections of self-treatment. Many more improvements to the document are due over the next couple weeks as this version gets polished.

2007Expanded several of the introductory sections, added the humourous “graphical definition” of PFPS, and expanded the explanation of patellofemoral tracking syndrome and added the “wide hips” diagram. Added detailed treatment section on , with numerous new footnotes. More major changes are due shortly.

2007Added section to aid readers in determining the difference between these similar conditions.

2007Major changes underway working towards a full revision. Started by converting footnotes to new database-driven format. You can now link from footnotes to the database for more complete information about references.