Decline Step Down Test | Patellofemoral Pain

One of the hallmark symptoms of patients with PFPS is anterior knee pain while descending stairs. In other posts, we have discussed diagnostic test clusters for the condition that have been shown to have little to no value. To evaluate treatment effects different patient-related outcome measures such as the anterior knee pain scale have been described but they may not reflect the disability of all patient populations. Therefore, Ophey et al. (2019) wanted to investigate the intra- and inter-observer reliability and construct validity of the decline step-down test measuring the maximal pain-free flexion angle in patients with Patellofemoral Pain. They found perfect inter and intra-rater reliability and construct validity compared with the anterior knee pain scale was average though statistically significant, which is why we give it a moderate clinical value.

To conduct the test, the patient is lying supine with the knees extended. Position yourself next to the patient on the involved side and place the web space of the thumb on the superior border of the patella. Then ask your patient to contract the quadriceps as if they were to extend the knee while you apply downward and inferior pressure on the patella.

Pain with movement of the patella or the inability to complete the test is indicative of patellofemoral dysfunction and is considered a positive test.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

• • Name*
• • Email*

Δ

Other common orthopedic tests to assess for patellofemoral pain syndrome are:

• Patellar Apprehension Test
• Moving Patellar Apprehension Test
• Clarke’s Sign

References

Ophey, M. J., Bosch, K., Khalfallah, F. Z., Wijnands, A. M., van den Berg, R. B., Bernards, N. T., … & Tak, I. J. (2019). The decline step-down test measuring the maximum pain-free flexion angle: A reliable and valid performance test in patients with patellofemoral pain. Physical Therapy in Sport, 36, 43-50.