Thomas Locher et Florent Pohu

5 Boulevard de Trèves, 57070 Metz

10 ans d'expérience en thérapie manuelle appliquée aux troubles fontcionnels musculo-squelettiques et viscéraux

Syndrome fémoro-patellaire et ostéopathie

le syndrome fémoro-patellaire se caractérise par des douleurs autour et sur la rotule, surtout à la montée et descente d’escaliers, ainsi qu’à la station assise prolongée jambes pliées à 90° (signe du cinéma).

On attribue ce syndrome à plusieurs facteurs:

  • Une malformation des condyles fémoraux qui sont sensés encadrer et retenir la rotule en restreignant ses déplacements latéraux
  • Une usure du cartilage de conjugaison provoquant un frottement excessif de la rotule sur le fémur
  • Un tonus musculaire trop important du quadriceps qui augmenterai alors la compression de la rotule sur le fémur

Un ostéopathe peut avoir une action antalgique directe en décomprimant la rotule de son rail fémoral ou une action indirecte sur le muscle quadriceps (manipulation du muscle ou du bas du dos quand des douleurs lombaires s’associent aux douleurs de genou).

plusieurs travaux de synthèse scientifique justifient aujourd’hui l’application des manipulations au syndrome fémoropatellaire, en insistant sur la nécessité d’une approche transdisciplinaire.

revue de littérature publiée dans le journal of chiropractic medecine en 2017
Efficacité de la thérapie manuelle combinée à la physiothérapie dans le traitement du syndrome de la douleur fémoro-patellaire : revue systématique

Auteurs : Gemma Victoria Espí-López 1, Anna Arnal-Gómez 1, Mercè Balasch-Bernat 1, Marta Inglés

Objectifs : Le but de cette étude était de mener une revue des essais contrôlés randomisés (ECR) pour déterminer l’efficacité du traitement de la combinaison de la thérapie manuelle (MT) avec d’autres techniques de physiothérapie.

Méthodes : Des recherches systématiques de la littérature scientifique ont été entreprises sur PubMed et la Cochrane Library (2004-2014). Les termes suivants ont été utilisés: «syndrome de la douleur fémoro-patellaire», «physiothérapie», «thérapie manuelle» et «manipulation». Les ECR qui ont étudié les adultes diagnostiqués avec le syndrome de la douleur fémoro-patellaire (PFPS) traités par MT et les approches de physiothérapie ont été inclus. La qualité des études a été évaluée par l’échelle Jadad.

Résultats : Cinq ECR avec une qualité méthodologique acceptable (Jadad ≥ 3) ont été sélectionnés. Les études ont indiqué que la thérapie manuelle combinée à la physiothérapie a un certain effet sur la réduction de la douleur et l’amélioration de la fonction dans le PFPS, en particulier lorsqu’elle est appliquée sur la chaîne cinétique complète et lors du renforcement des muscles de la hanche et du genou.

Conclusions : Les différentes combinaisons de thérapie manuelle et de programmes de physiothérapie (kinésithérapie) analysés dans cette revue suggèrent que donner plus d’importance à la stabilisation proximale et aux traitements de la chaîne cinétique complète dans PFPS aidera à mieux atténuer les symptômes

méta-alanyse publiée en 2018 dans le journal of orthopaedic and sports physical therapy

Efficacité de la thérapie manuelle pour la douleur et la fonction autodéclarée chez les personnes souffrant de douleur fémoro-patellaire: revue systématique et méta-analyse

Auteurs : Brian J Eckenrode, David M Kietrys, J Scott Parrott   

Conception de l’étude Revue systématique de la littérature avec méta-analyse.

Contexte : La prise en charge de la douleur fémoro-patellaire (PFP) peut inclure l’utilisation de techniques de thérapie manuelle (MT) pour l’articulation fémoro-patellaire, les tissus mous environnants et / ou la région lombo-pelvienne.

Objectifs : Déterminer l’efficacité de la MT, utilisée seule ou en tant qu’intervention d’appoint, par rapport au traitement standard ou simulé pour réduire la douleur et améliorer la fonction autodéclarée chez les personnes atteintes de PFP.

Méthodes : Une recherche documentaire électronique a été effectuée dans les bases de données PubMed, Ovid, Cochrane Central Register of Controlled Trials et CINAHL pour des études sur la MT chez les personnes atteintes de PFP. Des études publiées jusqu’en août 2017 comparant la MT (locale ou éloignée au genou), utilisée seule ou en combinaison avec d’autres interventions, à des interventions de contrôle ou de simulation ont été incluses. La douleur et les résultats fonctionnels signalés par les patients ont été recueillis et synthétisés. Les essais ont été évalués via l’outil de risque de biais Cochrane, et une méta-analyse des preuves a été réalisée.

Résultats : Neuf études ont été incluses dans la revue, dont 5 ont été évaluées comme présentant un faible risque de biais. L’utilisation de MT, appliquée à la structure locale du genou, était associée à des changements favorables à court terme dans la fonction autodéclarée et à la douleur chez les personnes atteintes de PFP, par rapport à une intervention de comparaison (contrôle ou simulacre). Cependant, les changements n’étaient cliniquement significatifs que pour la douleur (définie comme une amélioration de 2 cm ou 2 points sur une échelle visuelle analogique ou une échelle numérique d’évaluation de la douleur). Les preuves concernant la manipulation lombo-pelvienne n’étaient pas concluantes pour l’amélioration de la douleur chez les personnes atteintes de PFP, sur la base de 3 études.

Conclusion : Les données de cette revue suggèrent avec prudence que la MT peut être utile à court terme pour diminuer la douleur chez les patients atteints de PFP. Plusieurs études ont intégré la MT dans un programme de traitement complet. Les changements dans la fonction autodéclarée avec l’inclusion de la MT se sont révélés significatifs, mais non cliniquement significatifs. Les limites des études réalisées à ce jour suggèrent que les recherches futures devraient déterminer les techniques optimales et le dosage de MT et effectuer un suivi plus long pour surveiller les effets à long terme. Thérapie de niveau de preuve, niveau 1a.

revue de littérature systématique publiée en 2018 dans le journal clinical rehabilitation

Les effets de la mobilisation conjointe sur les personnes souffrant de douleur fémoro-patellaire : une revue systématique

Auteurs : Dhinu J Jayaseelan 1 2, David A Scalzitti 1, Geoff Palmer 1, Alex Immerman 1, Carol A Courtney 3

Objectif : étudier et synthétiser les effets de la mobilisation articulaire sur les personnes atteintes du syndrome de la douleur fémoro-patellaire.

Sources de données : Cinq bases de données électroniques (CINAHL, Cochrane Central Register of Controlled Trials, PubMed, Scopus et SPORTDiscus) ont été utilisées.

Méthodes d’examen : chaque base de données a été consultée du début au 1er novembre 2017. Des essais contrôlés randomisés portant sur une intervention thérapeutique manuelle, avec ou sans co-interventions, pour les personnes souffrant de douleur fémoro-patellaire ont été inclus. Deux examinateurs ont indépendamment examiné la littérature récupérée et évalué la qualité des études sélectionnées en utilisant l’échelle de notation PEDro. Un troisième examinateur a été utilisé en cas de divergence pour créer un consensus.

Résultats : Au total, 361 articles ont été identifiés lors de la recherche. Douze essais randomisés avec un total de 499 participants ont été sélectionnés pour un examen complet. Des améliorations intra-groupe de la douleur et de la fonction ont été notées pour les groupes de thérapie manuelle. Les améliorations entre les groupes pour les résultats à court terme (trois mois ou moins) étaient plus importantes lorsque la mobilisation articulaire était dirigée vers le complexe du genou et utilisée dans le cadre d’une approche globale.

Conclusion : dans les articles examinés, la mobilisation articulaire semble être la plus efficace pour améliorer la douleur et la fonction lorsqu’elle est associée à d’autres interventions, bien que son effet discret ne soit pas clair en raison de la conception et des rapports des études examinées

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