Powers (2003) is a theoretical clinical commentary asking whether altered kinematics at the hip, pelvis, and foot/ankle — not just local patellar mechanics — can drive patellofemoral pain by modifying the Q angle and lateral joint stress through tibial rotation, femoral rotation, and knee valgus.
When evaluating a patient with patellofemoral pain, don't stop at the knee — observe femoral rotation, hip abductor strength, and dynamic valgus during functional tasks like step-downs and squats, because femoral internal rotation beneath a relatively fixed patella can produce apparent lateral maltracking even with a normal-looking patella at rest.
Kinetic chain interventions (gluteal strengthening, foot orthoses) are evidence-informed but should be reserved for patients who actually demonstrate these movement faults on assessment, not prescribed universally.
Powers (2003) is a theoretical clinical commentary asking whether altered kinematics at the hip, pelvis, and foot/ankle — not just local patellar mechanics — can drive patellofemoral pain by modifying the Q angle and lateral joint stress through tibial rotation, femoral rotation, and knee valgus.
When evaluating a patient with patellofemoral pain, don't stop at the knee — observe femoral rotation, hip abductor strength, and dynamic valgus during functional tasks like step-downs and squats, because femoral internal rotation beneath a relatively fixed patella can produce apparent lateral maltracking even with a normal-looking patella at rest.
Kinetic chain interventions (gluteal strengthening, foot orthoses) are evidence-informed but should be reserved for patients who actually demonstrate these movement faults on assessment, not prescribed universally.