51
|
Chen S, Chang WD, Wu JY, Fong YC. Electromyographic analysis of hip and knee muscles during specific exercise movements in females with patellofemoral pain syndrome: An observational study. Medicine (Baltimore) 2018; 97:e11424. [PMID: 29995792 PMCID: PMC6076041 DOI: 10.1097/md.0000000000011424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hip muscle strengthening and knee extensor strengthening are common training exercises for patellofemoral pain syndrome (PFPS). PFPS engendered by insufficient hip abductor and external rotator muscle strength has been of interest, but these exercise movements may increase the lateral vector force of the patella warrants clarification. So, the purpose of this study was to assess muscular activations of vastus lateralis (VL), vastus medialis oblique (VMO), and gluteus medius muscles in electromyographic analysis during hip abduction and external rotator movements and open and closed kinetic chain knee extension movements.The gluteus medius, VMO, and VL muscles, in addition to the ratio of the VL and VMO muscles, were assessed through surface electromyography in 4 movements. Each muscle's amplitude expressed as a percent of maximum voluntary contraction (MVC). The differences on MVC at the terminal joint angle and during the movements were compared.Thirty female patients with PFPS were recruited. During hip abduction and external rotation movements, the MVC of the gluteus medius muscle increased, and those of the VMO and VL muscles increased in the open and closed kinetic chain knee extension movements. The MVCs of VL in the hip abduction and external rotation movements were significantly higher than those of the VMO muscle (P < .05). The ratios of the VL and VMO muscles in the open and closed kinetic chain knee extension movements approached 1, and they were significantly higher than those in the hip abduction and external rotation movements (P < .05). The highest MVC of the VMO muscle was observed at the terminal joint angle in the closed kinetic chain knee extension movement.Selective gluteus medius muscle activation was induced during the hip abduction and external rotation movements, accompanied by an increase in VL muscle activation. In open and closed kinetic chain knee movements, the ratios of the VL and VMO muscles approached 1. More selective VMO muscle activation was induced during the closed kinetic chain knee movements.
Collapse
Affiliation(s)
| | - Wen-Dien Chang
- Department of Sports Medicine, China Medical University, Taichung, Taiwan (R.O.C)
- Department of Sport Performance, National Taiwan University of Sport, Taichung, Taiwan (R.O.C)
| | - Jhih-Yun Wu
- Department of Sports Medicine, China Medical University, Taichung, Taiwan (R.O.C)
| | - Yi-Chin Fong
- Department of Sports Medicine, China Medical University, Taichung, Taiwan (R.O.C)
| |
Collapse
|
52
|
Patellar Dislocations: Review of Current Literature and Return to Play Potential. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
53
|
Effectiveness of Manual Therapy for Pain and Self-reported Function in Individuals With Patellofemoral Pain: Systematic Review and Meta-analysis. J Orthop Sports Phys Ther 2018; 48:358-371. [PMID: 29308698 DOI: 10.2519/jospt.2018.7243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic literature review with meta-analysis. Background Management of patellofemoral pain (PFP) may include the utilization of manual therapy (MT) techniques to the patellofemoral joint, surrounding soft tissues, and/or lumbopelvic region. Objectives To determine the effectiveness of MT, used alone or as an adjunct intervention, compared to standard treatment or sham for reducing pain and improving self-reported function in individuals with PFP. Methods An electronic literature search was conducted in the PubMed, Ovid, Cochrane Central Register of Controlled Trials, and CINAHL databases for studies investigating MT for individuals with PFP. Studies published through August 2017 that compared MT (local or remote to the knee), used alone or in combination with other interventions, to control or sham interventions were included. Patient-reported pain and functional outcomes were collected and synthesized. Trials were assessed via the Cochrane risk-of-bias tool, and a meta-analysis of the evidence was performed. Results Nine studies were included in the review, 5 of which were rated as having a low risk of bias. The use of MT, applied to the local knee structure, was associated with favorable short-term changes in self-reported function and pain in individuals with PFP, when compared to a comparison (control or sham) intervention. However, the changes were clinically meaningful only for pain (defined as a 2-cm or 2-point improvement on a visual analog scale or numeric pain-rating scale). The evidence regarding lumbopelvic manipulation was inconclusive for pain improvement in individuals with PFP, based on 3 studies. Conclusion The data from this review cautiously suggest that MT may be helpful in the short term for decreasing pain in patients with PFP. Several studies integrated MT into a comprehensive treatment program. Changes in self-reported function with the inclusion of MT were shown to be significant, but not clinically meaningful. The limitations in the studies performed to date suggest that future research should determine the optimal techniques and dosage of MT and perform longer follow-up to monitor long-term effects. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(5):358-371. Epub 6 Jan 2018. doi:10.2519/jospt.2018.7243.
Collapse
|
54
|
Hoglund LT, Pontiggia L, Kelly JD. A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study. Pilot Feasibility Stud 2018; 4:70. [PMID: 29636983 PMCID: PMC5889597 DOI: 10.1186/s40814-018-0262-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/22/2018] [Indexed: 01/18/2023] Open
Abstract
Background Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA. Methods Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate. Results At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants' self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P < 0.05). Timed-Up-and-Go time score improved at 6 weeks (P = 0.005). Peak hip external rotator torque increased (P = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention. Conclusions PFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise. Trial registration ClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).
Collapse
Affiliation(s)
- Lisa T Hoglund
- 1Department of Physical Therapy, Thomas Jefferson University, 901 Walnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Laura Pontiggia
- 2Department of Mathematics, Physics and Statistics, University of the Sciences, Philadelphia, PA USA
| | - John D Kelly
- 3Department of Sports Medicine and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA USA
| |
Collapse
|
55
|
Saad MC, Vasconcelos RAD, Mancinelli LVDO, Munno MSDB, Liporaci RF, Grossi DB. Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises. Braz J Phys Ther 2018; 22:408-416. [PMID: 29661570 DOI: 10.1016/j.bjpt.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/14/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics. METHODS A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention. RESULTS All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities. CONCLUSION Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/).
Collapse
Affiliation(s)
- Marcelo Camargo Saad
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil; Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
| | | | | | - Matheus Soares de Barros Munno
- Curso de Fisioterapia,Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rogério Ferreira Liporaci
- Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Débora Bevilaqua Grossi
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| |
Collapse
|
56
|
Impairment-Based Rehabilitation Following Hip Arthroscopy: Postoperative Protocol for the HIP ARThroscopy International Randomized Controlled Trial. J Orthop Sports Phys Ther 2018; 48:336-342. [PMID: 29607764 DOI: 10.2519/jospt.2018.8002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis The number of hip arthroscopies for the management of femoroacetabular impingement syndrome and other hip intra-articular conditions has grown exponentially in the last decade. Postoperative rehabilitation is part of the treatment algorithm, although there is a lack of high-quality studies on the efficacy of both surgery and postoperative rehabilitation programs. It is known that impairments can be present up to 2 years after hip arthroscopy, with individuals exhibiting reduced function and quality of life when compared to those of similar age, highlighting a need to improve postoperative care. Postoperative rehabilitation programs aim to improve hip function; however, the description of interventions as well as criteria for progression are lacking in the literature. The aim of this clinical commentary was to present a targeted clinical rehabilitation approach for individuals undergoing hip arthroscopy. J Orthop Sports Phys Ther 2018;48(4):336-342. doi:10.2519/jospt.2018.8002.
Collapse
|
57
|
The Influence of Exercise Dosing on Outcomes in Patients With Knee Disorders: A Systematic Review. J Orthop Sports Phys Ther 2018; 48:146-161. [PMID: 29320945 DOI: 10.2519/jospt.2018.7637] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Therapeutic exercise is commonly used to treat individuals with knee disorders, but dosing parameters for optimal outcomes are unclear. Large variations exist in exercise prescription, and research related to specific dosing variables for knee osteoarthritis, patellar tendinopathy, and patellofemoral pain is sparse. Objectives To identify specific doses of exercise related to improved outcomes of pain and function in individuals with common knee disorders, categorized by effect size. Methods Five electronic databases were searched for studies related to exercise and the 3 diagnoses. Means and standard deviations were used to calculate effect sizes for the exercise groups. The overall quality of evidence was assessed using the Physiotherapy Evidence Database scale. Results Five hundred eighty-three studies were found after the initial search, and 45 were included for analysis after screening. Physiotherapy Evidence Database scale scores were "fair" quality and ranged from 3 to 8. For knee osteoarthritis, 24 total therapeutic exercise sessions and 8- and 12-week durations of exercise were parameters most often associated with large effects. An exercise frequency of once per week was associated with no effect. No trends were seen with exercise dosing for patellar tendinopathy and patellofemoral pain. Conclusion This review suggests that there are clinically relevant exercise dosing variables that result in improved pain and function for patients with knee osteoarthritis, but optimal dosing is still unclear for patellar tendinopathy and patellofemoral pain. Prospective studies investigating dosing parameters are needed to confirm the results from this systematic review. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(3):146-161. Epub 10 Jan 2018. doi:10.2519/jospt.2018.7637.
Collapse
|
58
|
Stickley CD, Presuto MM, Radzak KN, Bourbeau CM, Hetzler RK. Dynamic Varus and the Development of Iliotibial Band Syndrome. J Athl Train 2018; 53:128-134. [PMID: 29373059 DOI: 10.4085/1062-6050-122-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Although the risk of osteoarthritis development after acute knee injury has been widely studied, the long-term consequences of knee overuse injury are not well understood. OBJECTIVE To identify the relationship between gait-related risk factors associated with osteoarthritis and the development of iliotibial band syndrome (ITBS) in members of a single University Army Reserve Officers' Training Corps unit. DESIGN Prospective cohort study. SETTING Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS Sixty-eight cadets undergoing standardized physical fitness training. INTERVENTION(S) Three-dimensional lower extremity kinematics (240 Hz) and kinetics (960 Hz) were collected for 3 bilateral trials during shod running at 4.0 m/s ± 10%. Injury tracking was conducted for 7 months of training. MAIN OUTCOME MEASURE(S) Biomechanical variables, including varus thrust and knee-adduction moment, were compared between the injured and control groups. RESULTS Twenty-six cadets with no history of overuse injury served as the control group, whereas 6 cadets (7 limbs) who developed ITBS that required them to modify their training program or seek medical care (or both) served as the injured group. Maximum varus velocity was higher ( P = .006) and occurred sooner during stance ( P = .04) in the injured group than in the control group, indicating greater varus thrust. Maximum knee-varus angle and maximum knee-adduction moment were higher ( P = .02 and P = .002, respectively) and vertical stiffness was lower ( P = .03) in the injured group. CONCLUSIONS Measures of dynamic varus stability appeared to be altered in individuals who developed ITBS. Biomechanical knee variables previously identified as increasing the risk for knee osteoarthritis were also associated with the development of ITBS in healthy adults.
Collapse
Affiliation(s)
- Christopher D Stickley
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu
| | - Melanie M Presuto
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu.,United States Air Force Academy, Colorado Springs, CO
| | - Kara N Radzak
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu.,University of Nevada, Las Vegas
| | - Christina M Bourbeau
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu.,Vail Summit Orthopaedics, CO
| | - Ronald K Hetzler
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu
| |
Collapse
|
59
|
Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2018; 48:19-31. [PMID: 29034800 DOI: 10.2519/jospt.2018.7365] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review with meta-analysis. Background The addition of hip strengthening to knee strengthening for persons with patellofemoral pain has the potential to optimize treatment effects. There is a need to systematically review and pool the current evidence in this area. Objective To examine the efficacy of hip strengthening, associated or not with knee strengthening, to increase strength, reduce pain, and improve activity in individuals with patellofemoral pain. Methods A systematic review of randomized and/or controlled trials was performed. Participants in the reviewed studies were individuals with patellofemoral pain, and the experimental intervention was hip and knee strengthening. Outcome data related to muscle strength, pain, and activity were extracted from the eligible trials and combined in a meta-analysis. Results The review included 14 trials involving 673 participants. Random-effects meta-analyses revealed that hip and knee strengthening decreased pain (mean difference, -3.3; 95% confidence interval [CI]: -5.6, -1.1) and improved activity (standardized mean difference, 1.4; 95% CI: 0.03, 2.8) compared to no training/placebo. In addition, hip and knee strengthening was superior to knee strengthening alone for decreasing pain (mean difference, -1.5; 95% CI: -2.3, -0.8) and improving activity (standardized mean difference, 0.7; 95% CI: 0.2, 1.3). Results were maintained beyond the intervention period. Meta-analyses showed no significant changes in strength for any of the interventions. Conclusion Hip and knee strengthening is effective and superior to knee strengthening alone for decreasing pain and improving activity in persons with patellofemoral pain; however, these outcomes were achieved without a concurrent change in strength. Level of Evidence Therapy, level 1a-. J Orthop Sports Phys Ther 2018;48(1):19-31. Epub 15 Oct 2017. doi:10.2519/jospt.2018.7365.
Collapse
|
60
|
How can we implement exercise therapy for patellofemoral pain if we don’t know what was prescribed? A systematic review. Br J Sports Med 2017; 52:385. [DOI: 10.1136/bjsports-2017-097547] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 12/21/2022]
Abstract
ObjectiveTo evaluate the completeness of exercise prescription in randomised controlled trials (RCTs) for patellofemoral pain (PFP), identify which elements are most frequently missing and supplement recommendations based on additional data from authors.DesignSystematic review.Data sourcesAll studies included in the most recent Cochrane review were evaluated. Additionally, the Cochrane search was updated in June 2016 in Cochrane, MEDLINE, EMBASE, PEDro, CINAHL and AMED databases. Two raters independently assessed completeness of reporting using the Toigo and Boutellier mechanobiological exercise descriptors, and Template for Intervention Description and Replication (TIDieR) checklist. Authors were also contacted to provide additional information.Eligibility criteria for selecting studiesRCTs of exercise interventions for PFP.ResultsWe included 38 RCTs. The level of exercise prescription detail was low, with no study providing complete information. The most commonly reported exercise descriptors were the ’duration of the experimental period' (n=38/38) and ’number of exercise interventions' (n=35). From TIDieR, the most commonly reported items were the ’intervention name' (n=38) and ’rationale' (n=36).The least reported items from the exercise descriptors were ’volitional muscular failure', ’temporal distribution of contraction modes', ’time under tension' and ’recovery between exercise sessions' (all n=2/38). From TIDieR, the least reported item was ‘How well (fidelity and adherence)’ (n=3/38).36 authors were contacted, with 22 replies and 13 providing additional exercise prescription details .ConclusionExercise prescriptions in RCTs with proven efficacy for PFP are poorly reported, impairing their implementation in clinical practice.PROSPERO registration numberCRD42016039138.
Collapse
|
61
|
Ahmed Hamada H, Hussein Draz A, Koura GM, Saab IM. Carryover effect of hip and knee exercises program on functional performance in individuals with patellofemoral pain syndrome. J Phys Ther Sci 2017; 29:1341-1347. [PMID: 28878459 PMCID: PMC5574328 DOI: 10.1589/jpts.29.1341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study was carried out to investigate the carryover effect of hip and knee
exercises program on functional performance (single legged hop test as functional
performance test and Kujala score for functional activities). [Subjects and Methods]
Thirty patients with patellofemoral pain syndrome were randomly assigned into two equal
groups. Group (A) consisted of 15 patients undergoing hip strengthening exercises for four
weeks then measuring all variables followed by additional four weeks of knee exercises
program then measuring all variables again. Group (B): consisted of 15 patients undergoing
knee exercises program for four weeks then measuring all variables followed by additional
four weeks of hip strengthening exercises then measuring all variables. Functional
abilities and knee muscles performance were assessed using Kujala questionnaire and single
legged hop test respectively pre and after the completion of the first 4 weeks then after
8 weeks for both groups. [Results] Significantly increase in Kujala questionnaire in group
A compared with group B was observed. While, there were significant increase in single
legged hop performance test in group B compared with group A. [Conclusion] Starting with
hip exercises improve the performance of subjects more than functional activities while
starting with knee exercises improve the functional activities of subjects more than
performance.
Collapse
Affiliation(s)
| | | | | | - Ibtissam M Saab
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Lebanon
| |
Collapse
|
62
|
Drew BT, Conaghan PG, Smith TO, Selfe J, Redmond AC. The effect of targeted treatment on people with patellofemoral pain: a pragmatic, randomised controlled feasibility study. BMC Musculoskelet Disord 2017; 18:338. [PMID: 28778218 PMCID: PMC5545020 DOI: 10.1186/s12891-017-1698-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/24/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Targeted treatment, matched according to specific clinical criteria e.g. hip muscle weakness, may result in better outcomes for people with patellofemoral pain (PFP). However, to ensure the success of future trials, a number of questions on the feasibility of a targeted treatment need clarification. The aim of the study was to explore the feasibility of matched treatment (MT) compared to usual care (UC) management for a subgroup of people with PFP determined to have hip weakness and to explore the mechanism of effect for hip strengthening. METHODS In a pragmatic, randomised controlled feasibility study, 24 participants with PFP (58% female; mean age 29 years) were randomly allocated to receive either MT aimed specifically at hip strengthening, or UC over an eight-week period. The primary outcomes were feasibility outcomes, which included rates of adherence, attrition, eligibility, missing data and treatment efficacy. Secondary outcomes focused on the mechanistic outcomes of the intervention, which included hip kinematics. RESULTS Conversion to consent (100%), missing data (0%), attrition rate (8%) and adherence to both treatment and appointments (>90%) were deemed successful endpoints. The analysis of treatment efficacy showed that the MT group reported a greater improvement for the Global Rating of Change Scale (62% vs. 9%) and the Anterior Knee Pain Scale (-5.23 vs. 1.18) but no between-group differences for either average or worst pain. Mechanistic outcomes showed a greatest reduction in peak hip internal rotation angle for the MT group (13.1% vs. -2.7%). CONCLUSION This feasibility study indicates that a definitive randomised controlled trial investigating a targeted treatment approach is achievable. Findings suggest the mechanism of effect of hip strengthening may be to influence kinematic changes in hip function in the transverse plane. TRIAL REGISTRATION This study was registered retrospectively. ISRCTN74560952 . Registration date: 2017-02-06.
Collapse
Affiliation(s)
- Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK.
- NIHR Leeds Biomedical Research Centre, Leeds, UK.
| |
Collapse
|
63
|
Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain. Pilot Feasibility Stud 2017; 4:24. [PMID: 28748107 PMCID: PMC5520346 DOI: 10.1186/s40814-017-0167-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis. The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful. High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation. Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain. Method This is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8–10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self-management. Baseline assessment will include demographic data, average pain within the last week (VAS), fear avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach. Discussion This study will evaluate the feasibility of running a definitive large-scale trial on patients with patellofemoral pain, within the NHS in the UK. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from this study will inform the design of a multicentre trial. Trial registration ISRCTN35272486.
Collapse
Affiliation(s)
- Benjamin E Smith
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK.,Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
64
|
Van Cant J, Pitance L, Feipel V. Hip abductor, trunk extensor and ankle plantar flexor endurance in females with and without patellofemoral pain. J Back Musculoskelet Rehabil 2017; 30:299-307. [PMID: 27689604 DOI: 10.3233/bmr-150505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous studies have reported strength deficit in hip abduction, extension and external rotation in females with patellofemoral pain (PFP) when compared with healthy control; however, there is conflicting evidence for a decrease in hip muscle endurance. Therefore, it seems important to evaluate hip muscle endurance in females with PFP. Moreover, trunk extensor and ankle plantar flexor endurance have not yet been evaluate in females with PFP. OBJECTIVE To compare hip abductor, trunk extensor and ankle plantar flexor endurance between females with and without PFP. METHODS Twenty females with PFP (mean age, 21.1 years) and 76 healthy females (mean age, 20.5 years) were recruited. Subject performed three endurance clinical tests: (1) The hip abductor isometric endurance test, (2) The Sorensen test and (3) The heel rise test. Group differences were assessed using an independent t tests, or Mann-Whitney U tests for non-normally distributed data. RESULTS Subjects with PFP exhibited significantly lower hip abductor, trunk extensor and ankle plantar flexor endurance than healthy controls. On average, subjects with PFP had deficits of 16% in hip abduction, 14% in trunk extension and 26% in ankle plantar flexion. CONCLUSION Females with PFP exhibited diminished hip abductor, trunk extensor and ankle plantar flexor endurance compared to healthy controls.
Collapse
Affiliation(s)
- Joachim Van Cant
- Department of Physical Therapy, Institut Parnasse-ISEI, Brussels, Belgium.,Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurent Pitance
- CARS institute, Faculty of Motor Sciences, Université Catholique de Louvain, Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
65
|
Zwolski C, Quatman-Yates C, Paterno MV. Resistance Training in Youth: Laying the Foundation for Injury Prevention and Physical Literacy. Sports Health 2017; 9:436-443. [PMID: 28447880 PMCID: PMC5582694 DOI: 10.1177/1941738117704153] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
CONTEXT The rising incidence of physical activity- and sports-related injuries has prompted the present-day investigation of resistance training as a potential means of injury prevention and physical literacy development among youth. EVIDENCE ACQUISITION Relevant studies on the topics of athlete development, physical literacy, resistance training, and injury prevention in children and adolescents were reviewed (PubMed and Sports Discus, 1982-2016). Recommendations from consensus guidelines and position statements applicable to resistance training and injury prevention in youth, in addition to young athlete development, were reviewed. Additionally, hand searches, expert requests, article reference lists, and gray literature were utilized and reviewed for pertinent content. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Youth throughout the physical activity spectrum are at risk for physical activity- and sports-related injury. Of highest priority are early specializers, physically inactive youth, and young girls, owing to increased injury rates. Resistance training among these at-risk populations has been shown to reduce injury risk by up to 68% and improve sports performance and health measures, in addition to accelerating the development of physical literacy. Recent recommendations, position statements, and national initiatives advocate for the incorporation of resistance training with qualified instruction among these groups. CONCLUSION Resistance training in addition to free play and other structured physical activity training can serve as a protective means against injury and a positive catalyst for the development of physical literacy to offset the impact of diminishing physical activity and early sport specialization in today's youth.
Collapse
Affiliation(s)
- Christin Zwolski
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Catherine Quatman-Yates
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mark V. Paterno
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| |
Collapse
|
66
|
Matthews M, Rathleff MS, Claus A, McPoil T, Nee R, Crossley K, Kasza J, Paul S, Mellor R, Vicenzino B. The Foot Orthoses versus Hip eXercises (FOHX) trial for patellofemoral pain: a protocol for a randomized clinical trial to determine if foot mobility is associated with better outcomes from foot orthoses. J Foot Ankle Res 2017; 10:5. [PMID: 28138341 PMCID: PMC5264284 DOI: 10.1186/s13047-017-0186-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/10/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent, often recalcitrant and multifactorial knee pain condition. One method to optimize treatment outcome is to tailor treatments to the patient's presenting characteristics. Foot orthoses and hip exercises are two such treatments for PFP with proven efficacy yet target different ends of the lower limb with different proposed mechanisms of effect. These treatments have not been compared head-to-head, so there is a dearth of evidence for which to use clinically. Only foot orthoses have been explored for identifying patient characteristics that might predict a beneficial effect with either of these two treatments. Preliminary evidence suggests patients will do well with foot orthoses if they have a midfoot width in weight bearing that is ≥ 11 mm more than in non-weight bearing, but this has yet to be verified in a study that includes a comparator treatment and an adequate sample size. This trial will determine if: (i) hip exercises are more efficacious than foot orthoses, and (ii) greater midfoot width mobility will be associated with success with foot orthoses, when compared to hip exercises. METHODS Two hundred and twenty participants, aged 18-40 years, with a clinical diagnosis of PFP will be randomly allocated with a 1:1 ratio to receive foot orthoses or progressive resisted hip exercises, and stratified into two subgroups based on their presenting midfoot width mobility (high mobility defined as ≥11 mm). The primary outcome will be a 7-point Likert scale for global rating of change. All analyses will be conducted on an intention-to-treat basis using regression models. DISCUSSION This trial is designed to compare the efficacy of foot orthoses versus hip exercise, as well as to determine if high midfoot width mobility is associated with better outcomes with foot orthoses when compared to hip exercises. Results of this trial will assist clinicians in optimising the management of those with PFP by testing whether a simple measure of midfoot width mobility can help to determine which patients are most likely to benefit from foot orthoses. TRIAL REGISTRATION This trial is registered on the Australian New Zealand Clinical Trials Register (ACTRN12614000260628).
Collapse
Affiliation(s)
- Mark Matthews
- The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg, Denmark
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Andrew Claus
- The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia
| | - Tom McPoil
- School of Physical Therapy, Rueckert-Hartman College for Health Professions, Regis University, Denver, USA
| | - Robert Nee
- School of Physical Therapy, Pacific University, Hillsboro, USA
| | - Kay Crossley
- La Trobe University, School of Allied Health, College of Science, Health and Engineering, Melbourne, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Sanjoy Paul
- Clinical Trials and Biostatistics Centre, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Rebecca Mellor
- The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia
| |
Collapse
|
67
|
Thomson C, Krouwel O, Kuisma R, Hebron C. The outcome of hip exercise in patellofemoral pain: A systematic review. ACTA ACUST UNITED AC 2016; 26:1-30. [DOI: 10.1016/j.math.2016.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/10/2016] [Accepted: 06/06/2016] [Indexed: 12/31/2022]
|
68
|
Relationship of Hip and Trunk Muscle Function with Single Leg Step-Down Performance: Implications for Return to Play Screening and Rehabilitation. Phys Ther Sport 2016; 22:66-73. [DOI: 10.1016/j.ptsp.2016.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 04/26/2016] [Accepted: 05/12/2016] [Indexed: 01/19/2023]
|
69
|
Abstract
Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain.
Collapse
|
70
|
Abstract
Patellofemoral pain is a common knee pathology that affects a wide range of active individuals. These individuals often seek medical care, with 25% of all patients seen in sports medicine clinics being treated for patellofemoral pain. While conservative treatment produce beneficial short-term results, individuals with patellofemoral pain often have long-term pain and decreased quality of life for many years following their diagnosis. One of the challenges for treating this chronic condition is the heterogeneous presentation of impairments across patients, ranging from soft tissue restriction, muscle weakness, altered movement patterns during functional tasks, and weak core stability. Clinicians need to identify these impairments and develop an individualized impairment-based model for treating patients with PFP. The aim of this review it to provide guidance and recommendations for clinicians who treat PFP in hopes to improve long-term outcomes for the conservative treatment of PFP.
Collapse
Affiliation(s)
- Neal R Glaviano
- a Department of Kinesiology , University of Virginia Ringgold standard institution , Charlottesville , VA , USA
| | - Susan Saliba
- a Department of Kinesiology , University of Virginia Ringgold standard institution , Charlottesville , VA , USA
| |
Collapse
|
71
|
Stephen JM, Urquhart DWJ, van Arkel RJ, Ball S, Jaggard MKJ, Lee JC, Church JS. The Use of Sonographically Guided Botulinum Toxin Type A (Dysport) Injections Into the Tensor Fasciae Latae for the Treatment of Lateral Patellofemoral Overload Syndrome. Am J Sports Med 2016; 44:1195-202. [PMID: 26903213 DOI: 10.1177/0363546516629432] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain in the anterior and lateral parts of the knee during exercise is a common clinical problem for which current management strategies are often unsuccessful. PURPOSE To investigate the effect of an ultrasound-guided botulinum toxin (BT) injection into the tensor fasciae latae (TFL), followed by physical therapy, in patients classified with lateral patellofemoral overload syndrome (LPOS) who failed to respond to conventional treatment. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 45 patients (mean ± SD age, 32.4 ± 8.6 years) who met the inclusion criteria of (1) activity-related anterolateral knee symptoms, (2) symptoms lasting longer than 3 months, (3) a pathological abnormality confirmed by magnetic resonance imaging, and (4) previous failed physical therapy received an ultrasound-guided injection of BT into the TFL followed by physical therapy. Patient-reported outcomes were collected at 5 intervals: before the injection; at 1, 4, and 12 weeks after the injection; and at a mean 5 years after the injection. In 42 patients, relative iliotibial band (ITB) length changes were assessed using the modified Ober test at the first 4 time points. A computational model was run to simulate the effect of TFL weakening on gluteus medius (GMed) activity. Statistical analysis was undertaken using 1-way analysis of variance and paired t tests with Bonferroni post hoc correction. RESULTS There was a significant improvement in Anterior Knee Pain Scale scores from before the injection (61 ± 15) to 1 (67 ± 15), 4 (70 ± 16), and 12 weeks (76 ± 16) after the injection and in 87% of patients (39/45 patients available for follow-up) at approximately 5 years (from 62.9 ± 15.4 to 87.0 ± 12.5) after the injection (all P < .010). A significant effect on the modified Ober test was identified as a result of the intervention, with an increase in leg drop found at 1 (3° ± 5°), 4 (4° ± 5°), and 12 (7° ± 6°) weeks after the injection compared with before the injection (all P < .010). Simulating a progressive reduction in TFL strength resulted in corresponding increases in GMed activity during gait. CONCLUSION An injection of BT into the TFL, combined with physical therapy, resulted in a significant improvement of symptoms in patients with LPOS, which was maintained at 5-year follow-up. This may result from reduced lateral TFL/ITB tension or to an increase in GMed activity in response to inhibition of the TFL.
Collapse
Affiliation(s)
- Joanna M Stephen
- Mechanical Engineering Department, Imperial College London, London, UK Fortius Clinic, London, UK
| | | | | | - Simon Ball
- Fortius Clinic, London, UK Chelsea and Westminster Hospital, London, UK
| | | | - Justin C Lee
- Fortius Clinic, London, UK Chelsea and Westminster Hospital, London, UK
| | | |
Collapse
|
72
|
|
73
|
Three-Year Outcome After a 1-Month Physiotherapy Program of Local and Individualized Global Treatment for Patellofemoral Pain Followed by Self-Management. Clin J Sport Med 2016; 26:190-8. [PMID: 26327289 DOI: 10.1097/jsm.0000000000000226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The main aim of this study was to assess whether improvements after a 1-month patellofemoral pain (PFP) program addressing local and global deficits were maintained for 3 years. DESIGN This prospective cohort study comprised 4 treatment phases including a randomized trial during week 1. SETTING The study was conducted in a private physiotherapy practice. PATIENTS Thirty-seven patients (55 knees) from an original cohort of 41 patients (60 knees) with PFP were followed for 3 years after referral by doctors to participate in this study. INTERVENTIONS Patients received 4 treatments: local treatment focusing on quadriceps strengthening, quadriceps stretching, and taping for fortnight 1, supplemented with individualized global treatment focusing on lower limb posture and movement patterns for fortnight 2, followed by ongoing self-management. MAIN OUTCOME MEASURES Seven outcome measures, assessed at 4 time points, were quadriceps strength, quadriceps length, eccentric knee control, and 4 pain measures. Long-term measures included return to sporting activity, pain recurrence, exercise compliance, and Kujala score. RESULTS Improvements after fortnight 1 (P < 0.001) and fortnight 2 (P < 0.05) were maintained over 3 years for 6 of 7 measures. On testing, 73% were pain free and the remaining 27% had less pain than pretreatment. Kujala scores improved 27%. Eighty-two percent resumed any sport stopped and 54% of patients started new sports/activities. Patellofemoral pain recurred in 7% and 89% of patients was still exercising 3 years posttreatment. CONCLUSIONS Significant improvements after physiotherapy, incorporating local and individually targeted treatment, were maintained for 3 years in a compliant cohort.
Collapse
|
74
|
Neal BS, Barton CJ, Gallie R, O'Halloran P, Morrissey D. Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis. Gait Posture 2016; 45:69-82. [PMID: 26979886 DOI: 10.1016/j.gaitpost.2015.11.018] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/14/2015] [Accepted: 11/28/2015] [Indexed: 02/02/2023]
Abstract
Patellofemoral pain (PFP) is the most prevalent running pathology and associated with multi-level biomechanical factors. This systematic review aims to guide treatment and prevention of PFP by synthesising prospective, observational and intervention studies that measure clinical and biomechanical outcomes in symptomatic running populations. Medline, Web of Science and CINAHL were searched from inception to April 2015 for prospective, case-control or intervention studies in running-related PFP cohorts. Study methodological quality was scored by two independent raters using the modified Downs and Black or PEDro scales, with meta-analysis performed where appropriate. 28 studies were included. Very limited evidence indicates that increased peak hip adduction is a risk factor for PFP in female runners, supported by moderate evidence of a relationship between PFP and increased peak hip adduction, internal rotation and contralateral pelvic drop, as well as reduced peak hip flexion. Limited evidence was also identified that altered peak force and time to peak at foot level is a risk factor for PFP development. Limited evidence from intervention studies indicates that both running retraining and proximal strengthening exercise lead to favourable outcomes in both pain and function, but only running retraining significantly reduces peak hip adduction, suggesting a possible kinematic mechanism. Put together, these findings highlight limited but coherent evidence of altered biomechanics which interventions can alter with resultant symptom change in females with PFP. There is a clear need for high quality prospective studies of intervention efficacy with measurement of explanatory mechanisms.
Collapse
Affiliation(s)
- Bradley S Neal
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom
| | - Christian J Barton
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom; Complete Sports Care, Melbourne, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Rosa Gallie
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom
| | - Patrick O'Halloran
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom.
| |
Collapse
|
75
|
Telles G, Cristovão DR, Belache FATC, Santos MRA, Almeida RSD, Nogueira LAC. The effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain. J Bodyw Mov Ther 2016; 20:844-850. [PMID: 27814865 DOI: 10.1016/j.jbmt.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 02/04/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
Anterior knee pain is a common complaint and can cause difficulty with its inability to bear weight. The aim of the study was to analyse the effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain. A clinical trial with 18 patients with a clinical diagnosis of anterior knee pain was conducted. One group (E) with nine individuals was treated with hip muscle strengthening exercises; another group (EM), with nine individuals, had myofascial techniques added. To quantify the results, the Numeric Pain Rating Scale (NPRS) and the Lower Extremity Functional Scale (LEFS) were used. The E group showed an improvement in pain (p = 0.02), but not in the mean degree of disability. The EM group showed an improvement in pain (p = 0.01), as well as the degree of disability (p = 0.008). The effect size analysis showed that participants of the EM group had a greater impact on clinical pain and disability (Cohen's d = .35 and .30, respectively). The addition of myofascial techniques should be considered to improve the functionality of the lower limbs and reduce pain in patients with anterior knee pain.
Collapse
Affiliation(s)
- Gustavo Telles
- Physical Therapy of Hospital Universitário Gaffrée e Guinle and Delfim Physical Therapy Service, Rio de Janeiro, Brazil
| | - Delmany R Cristovão
- Physical Therapy of Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, Brazil
| | | | | | - Renato Santos de Almeida
- Physical Therapy of Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, Brazil; Centro Universitário Serra dos Órgãos (UNIFESO), Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Postgraduation Progam - Reabilitation Science of Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil; Physical Therapy Department at Instituto Federal do Rio de Janeiro (IFRJ), Brazil.
| |
Collapse
|
76
|
Şahin M, Ayhan FF, Borman P, Atasoy H. The effect of hip and knee exercises on pain, function, and strength in patientswith patellofemoral pain syndrome: a randomized controlled trial. Turk J Med Sci 2016; 46:265-77. [PMID: 27511483 DOI: 10.3906/sag-1409-66] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/14/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The role of hip muscles in the rehabilitation of patellofemoral pain syndrome has recently received interest. The aim of this study was to compare the efficiencies of hip exercises alongside knee exercises versus only knee exercises on pain, function, and isokinetic muscle strength in patients with this syndrome. MATERIALS AND METHODS Fifty-five young female patients (mean age: 34.1 ± 6.2 years; mean BMI: 25.9 ± 3.9 kg/m2) with patellofemoral pain syndrome were included. The patients were randomized into groups of hip-and-knee exercises and knee-only exercise programs for 6 weeks with a total of 30 sessions at the clinic. Both groups were evaluated before therapy, after 6 weeks of a supervised exercise program, and after 6 weeks of an at-home exercise program. The outcome measures were muscle strength, pain, and both subjective and objective function. RESULTS The improvements of the patients in the hip-and-knee exercise group were better than in patients of the knee-only exercise group in terms of scores of pain relief (P < 0.001) and functional gain (P = 0.002) after 12 weeks. CONCLUSION We suggest additional hip-strengthening exercises to patients with patellofemoral pain syndrome in order to decrease pain and increase functional status.
Collapse
Affiliation(s)
- Mehtap Şahin
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Fikriye Figen Ayhan
- Department of Physical Therapy and Rehabilitation, School of Health Sciences, Uşak University, Uşak, Turkey
| | - Pınar Borman
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hüseyin Atasoy
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
77
|
Plastaras C, McCormick Z, Nguyen C, Rho M, Nack SH, Roth D, Casey E, Carneiro K, Cucchiara A, Press J, McLean J, Caldera F. Is Hip Abduction Strength Asymmetry Present in Female Runners in the Early Stages of Patellofemoral Pain Syndrome? Am J Sports Med 2016; 44:105-12. [PMID: 26566993 DOI: 10.1177/0363546515611632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The current literature indicates that hip abduction weakness in female patients is associated with ipsilateral patellofemoral pain syndrome (PFPS) as part of the weaker hip abductor complex. Thus, it has been suggested that clinicians should consider screening female athletes for hip strength asymmetry to identify those at risk of developing PFPS to prevent the condition. However, no study to date has demonstrated that hip strength asymmetry exists in the early stages of PFPS. PURPOSE To determine whether hip abduction strength asymmetry exists in female runners with early unilateral PFPS, defined as symptoms of PFPS not significant enough to cause patients to seek medical attention or prevent them from running at least 10 miles per week. STUDY DESIGN Controlled laboratory study. METHODS This study consisted of 21 female runners (mean age, 30.5 years; range, 18-45 years) with early unilateral PFPS, who had not yet sought medical care and who were able to run at least 10 miles per week, and 36 healthy controls comparably balanced for age, height, weight, and weekly running mileage (mean, 18.5 mi/wk). Study volunteers were recruited using flyers and from various local running events in the metropolitan area. Bilateral hip abduction strength in both a neutral and extended hip position was measured using a handheld dynamometer in each participant by an examiner blinded to group assignment. RESULTS Patients with early unilateral PFPS demonstrated no significant side-to-side difference in hip abduction strength, according to the Hip Strength Asymmetry Index, in both a neutral (mean, 83.5 ± 10.2; P = .2272) and extended hip position (mean, 96.3 ± 21.9; P = .6671) compared with controls (mean, 87.0 ± 8.3 [P = .2272] and 96.6 ± 16.2 [P = .6671], respectively). Hip abduction strength of the affected limb in patients with early unilateral PFPS (mean, 9.9 ± 2.2; P = .0305) was significantly stronger than that of the weaker limb of control participants (mean, 8.9 ± 1.4; P = .0305) when testing strength in a neutral hip position; however, no significant difference was found when testing the hip in an extended position (mean, 7.0 ± 1.4 [P = .1406] and 6.6 ± 1.5 [P =.1406], respectively). CONCLUSION The study data show that early stages of unilateral PFPS in female runners is not associated with hip abduction strength asymmetry and that hip abduction strength tested in neutral is significantly greater in the affected limb in the early stages of PFPS compared with the unaffected limb. However, when tested in extension, no difference exists. Further studies investigating the early stages of PFPS are warranted. CLINICAL RELEVANCE Unlike patients with PFPS seeking medical care, early PFPS does not appear to be significantly associated with hip abduction strength asymmetry.
Collapse
Affiliation(s)
- Christopher Plastaras
- Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zack McCormick
- Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | | | - Monica Rho
- Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | - Susan Hillary Nack
- Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | - Dan Roth
- Centers for Pain Relief, Fort Wayne, Indiana, USA
| | - Ellen Casey
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Kevin Carneiro
- Physical Medicine & Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew Cucchiara
- Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joel Press
- Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | - Jim McLean
- Deceased Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | - Franklin Caldera
- Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
78
|
Fernandes de Jesus J, de Almeida Novello A, Bezerra Nakaoka G, Curcio Dos Reis A, Fukuda TY, Fernandes Bryk F. Kinesio taping effect on quadriceps strength and lower limb function of healthy individuals: A blinded, controlled, randomized, clinical trial. Phys Ther Sport 2015; 18:27-31. [PMID: 26708093 DOI: 10.1016/j.ptsp.2015.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 10/14/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyze kinesio taping (KT) effect on quadriceps strength and lower limb function over a 7-day period. DESIGN Blind randomized clinical trial. SETTING Hospital's Physical Therapy Department. PARTICIPANTS Sixty healthy individuals (30 men and 30 women) were randomly distributed into three groups: Control--without KT application; Placebo--placebo KT application and Experimental--A KT application designed to stimulate quadriceps femoris activity. MAIN OUTCOME MEASURES The quadriceps strength was measured using a manual dynamometer whereas lower limb function was assessed using the Single Hop Test for Distance. Evaluations occurred at five time-points: baseline; immediately, 3 and 5 days after KT application; and 72 h post KT withdrawal. RESULTS There was no significant interaction between time-points and groups for muscle strength: dominant (P = 0.13) and non-dominant (P = 0.41) and lower limb function: dominant (P = 0.09) and non-dominant (P = 0.53); but lower limb function within-group comparisons showed improvements in all groups at the evolution of all time-points analyzed for both limbs (P = 0.001). This is possibly due to a learning effect as the participants became more familiar with executing the assessment tests. CONCLUSION KT did not improve quadriceps strength and lower limb function of healthy individuals and its application with these objectives should be reconsidered.
Collapse
Affiliation(s)
- Julio Fernandes de Jesus
- Universidade Federal de São Paulo (UNIFESP), Rua Sena Madureira, 1500, CEP 04021-001 São Paulo, Brazil.
| | - Aline de Almeida Novello
- Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Cesário Mota Jr., 112, CEP 01221-020 São Paulo, Brazil
| | - Gustavo Bezerra Nakaoka
- Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Cesário Mota Jr., 112, CEP 01221-020 São Paulo, Brazil
| | - Amir Curcio Dos Reis
- Universidade Nove de Julho (UNINOVE), Rua Guaranésia, 425, CEP 02112-000 São Paulo, Brazil
| | - Thiago Yukio Fukuda
- Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Cesário Mota Jr., 112, CEP 01221-020 São Paulo, Brazil
| | - Flavio Fernandes Bryk
- Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Cesário Mota Jr., 112, CEP 01221-020 São Paulo, Brazil; Universidade Cruzeiro do Sul, Av. Dr. Ussiel Cirilo, 225, CEP 08060-070 São Paulo, Brazil
| |
Collapse
|
79
|
Hilibrand MJ, Hammoud S, Bishop M, Woods D, Fredrick RW, Dodson CC. Common injuries and ailments of the female athlete; pathophysiology, treatment and prevention. PHYSICIAN SPORTSMED 2015; 43:403-11. [PMID: 26458108 DOI: 10.1080/00913847.2015.1092856] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
With increasing numbers of women competing in high school and collegiate athletics, it is important that physicians become familiar with injury patterns and medical conditions unique to the female athlete. Observations and clinical data have elucidated unique biomechanical, anatomic and hormonal factors that predispose skeletally mature female athletes to anterior cruciate ligament (ACL) injuries, patellofemoral disorders and lower extremity stress fractures. Additionally, younger female athletes are particularly at risk of developing components of the "Female Athlete Triad" (more recently included under the syndrome of "Relative Energy Deficiency in Sport" [RED-S]): disordered eating, amenorrhea and osteoporosis. An understanding of the pathophysiology of these conditions has led to the development of programs that can treat their underlying causes, decrease susceptibility to injury, and improve the long-term health of the female athlete. This paper is intended to provide physicians with a review of the sex-specific etiology, prevention and treatment of injuries common to the female athlete.
Collapse
Affiliation(s)
- Miryl J Hilibrand
- a Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia, PA, USA
| | - Sommer Hammoud
- a Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia, PA, USA.,b The Rothman Institute , Philadelphia PA 19107, USA
| | - Meghan Bishop
- c Department of Orthopaedic Surgery, Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia, PA, USA
| | - Daniel Woods
- d Orthopedic Sports Medicine, Orlin & Cohen Orthopedic Associates , Long Island, NY, USA
| | - Robert W Fredrick
- a Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia, PA, USA.,b The Rothman Institute , Philadelphia PA 19107, USA
| | - Christopher C Dodson
- a Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia, PA, USA.,b The Rothman Institute , Philadelphia PA 19107, USA
| |
Collapse
|
80
|
Kamonseki DH, Gonçalves GA, Yi LC, Júnior IL. Effect of stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized controlled single-blind clinical trial. ACTA ACUST UNITED AC 2015; 23:76-82. [PMID: 26654252 DOI: 10.1016/j.math.2015.10.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 10/12/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the effect of stretching with and without muscle strengthening of the foot alone or foot and hip on pain and function in patients with plantar fasciitis. DESIGN Single blind randomized controlled trial. METHOD Eighty-three patients with plantar fasciitis were allocated to one of three treatment options for an eight-week period: Foot Exercise Group (FEG - extrinsic and intrinsic foot muscles), Foot and Hip Exercise Group (FHEG - abductor and lateral rotator muscles) and Stretching Alone Exercise Group (SAEG). MAIN MEASURES A visual analog scale for pain, the Foot and Ankle Outcome Score and the Star Excursion Balance Test. All evaluations were performed before treatment and after the last treatment session. RESULTS Improvements were found in all groups regarding the visual analog scale, the pain, activities of daily living, sports and recreation, quality of life (p < 0.001) and other symptoms (p < 0.01) subscales of the Foot and Ankle Outcome Score as well as posterolateral movement, posteromedial movement and composite score (p < 0.001) on the Star Excursion Balance Test. No time-group interactions were found for any of the variables (p > 0.05). CONCLUSIONS All three exercise protocols analyzed led to improvements at eight-week follow-up in pain, function and dynamic lower limb stability in patients with plantar fasciitis.
Collapse
Affiliation(s)
- Danilo H Kamonseki
- Department of Bioscience, Universidade Federal de São Paulo, Santos, SP, Brazil.
| | - Geiseane A Gonçalves
- Department of Bioscience, Universidade Federal de São Paulo, Santos, SP, Brazil.
| | - Liu C Yi
- Department of Bioscience, Universidade Federal de São Paulo, Santos, SP, Brazil.
| | - Império Lombardi Júnior
- Department of Human Movement Sciences, Universidade Federal de São Paulo, Santos, SP, Brazil.
| |
Collapse
|
81
|
Outcomes following Hip and Quadriceps Strengthening Exercises for Patellofemoral Syndrome: A Systematic Review and Meta-Analysis. Sports (Basel) 2015. [DOI: 10.3390/sports3040281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
82
|
Gausden EB, Fabricant PD, Taylor SA, McCarthy MM, Weeks KD, Potter H, Shubin Stein B, Green DW. Medial Patellofemoral Reconstruction in Children and Adolescents. JBJS Rev 2015; 3:01874474-201510000-00002. [DOI: 10.2106/jbjs.rvw.n.00091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
83
|
Ford KR, Nguyen AD, Dischiavi SL, Hegedus EJ, Zuk EF, Taylor JB. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus. Open Access J Sports Med 2015; 6:291-303. [PMID: 26346471 PMCID: PMC4556293 DOI: 10.2147/oajsm.s72432] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.
Collapse
Affiliation(s)
- Kevin R Ford
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Anh-Dung Nguyen
- Department of Athletic Training, School of Health Sciences, High Point University, High Point, NC, USA
| | - Steven L Dischiavi
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Eric J Hegedus
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Emma F Zuk
- Department of Athletic Training, School of Health Sciences, High Point University, High Point, NC, USA
| | - Jeffrey B Taylor
- Department of Physical Therapy, High Point University, High Point, NC, USA
| |
Collapse
|
84
|
Alba-Martín P, Gallego-Izquierdo T, Plaza-Manzano G, Romero-Franco N, Núñez-Nagy S, Pecos-Martín D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. J Phys Ther Sci 2015; 27:2387-90. [PMID: 26311988 PMCID: PMC4540887 DOI: 10.1589/jpts.27.2387] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to analyze the effectiveness of conservative treatment of patellofemoral pain syndrome with physical exercise. [Subjects and Methods] A computer-based review conducted of four databases (PubMed, the Cochrane Library, PEDro, and the University Library) was completed based on the inclusion criteria of patellofemoral pain syndrome patients treated with physical exercise methods and examination with self-reported pain and/or functional questionnaires. [Results] The findings of ten clinical trials of moderate to high quality were evaluated to determine the effectiveness of physical exercise as conservative management for patellofemoral pain syndrome. [Conclusion] The intervention programs that were most effective in relieving pain and improving function in patellofemoral pain syndrome included proprioceptive neuromuscular facilitation stretching and strengthening exercises for the hip external rotator and abductor muscles and knee extensor muscles.
Collapse
Affiliation(s)
| | | | - Gustavo Plaza-Manzano
- Rehabilitation and Physical Medicine Department, Medical Hydrology, Complutense University, Spain
| | | | | | | |
Collapse
|
85
|
|
86
|
Lack S, Barton C, Sohan O, Crossley K, Morrissey D. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis. Br J Sports Med 2015; 49:1365-76. [PMID: 26175019 DOI: 10.1136/bjsports-2015-094723] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Proximal muscle rehabilitation is commonly prescribed to address muscle strength and function deficits in individuals with patellofemoral pain (PFP). This review (1) evaluates the efficacy of proximal musculature rehabilitation for patients with PFP; (2) compares the efficacy of various rehabilitation protocols; and (3) identifies potential biomechanical mechanisms of effect in order to optimise outcomes from proximal rehabilitation in this problematic patient group. METHODS Web of Knowledge, CINAHL, EMBASE and Medline databases were searched in December 2014 for randomised clinical trials and cohort studies evaluating proximal rehabilitation for PFP. Quality assessment was performed by two independent reviewers. Effect size calculations using standard mean differences and 95% CIs were calculated for each comparison. RESULTS 14 studies were identified, seven of high quality. Strong evidence indicated proximal combined with quadriceps rehabilitation decreased pain and improved function in the short term, with moderate evidence for medium-term outcomes. Moderate evidence indicated that proximal when compared with quadriceps rehabilitation decreased pain in the short-term and medium-term, and improved function in the medium term. Limited evidence indicated proximal combined with quadriceps rehabilitation decreased pain more than quadriceps rehabilitation in the long term. Very limited short-term mechanistic evidence indicated proximal rehabilitation compared with no intervention decreased pain, improved function, increased isometric hip strength and decreased knee valgum variability while running. CONCLUSIONS A robust body of work shows proximal rehabilitation for PFP should be included in conservative management. Importantly, greater pain reduction and improved function at 1 year highlight the long-term value of proximal combined with quadriceps rehabilitation for PFP.
Collapse
Affiliation(s)
- Simon Lack
- Centre for Sports and Exercise Medicine, Queen Mary University of London, UK
| | - Christian Barton
- Centre for Sports and Exercise Medicine, Queen Mary University of London, UK Complete Sports Care, Melbourne, Australia Pure Sports Medicine, London, UK Lower Extremity Gait Studies, Health Sciences, La Trobe University, Bundoora, Australia
| | - Oliver Sohan
- Centre for Sports and Exercise Medicine, Queen Mary University of London, UK
| | - Kay Crossley
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbance, Queensland, Australia
| | - Dylan Morrissey
- Centre for Sports and Exercise Medicine, Queen Mary University of London, UK Physiotherapy Department, Bart's Health NHS Trust, London, UK
| |
Collapse
|
87
|
Santos TRT, Oliveira BA, Ocarino JM, Holt KG, Fonseca ST. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Braz J Phys Ther 2015; 19:167-76. [PMID: 26039034 PMCID: PMC4518569 DOI: 10.1590/bjpt-rbf.2014.0089] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 12/08/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which
may limit the performance of functional activities. The influence of hip joint
motion on the development of this syndrome has already been documented in the
literature. In this regard, studies have investigated the effectiveness of hip
muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1) to summarize the literature related to
the effects of hip muscle strengthening on pain intensity, muscle strength, and
function in individuals with PFPS and (2) to evaluate the methodological quality
of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the
following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The
selected studies had to distinguish the effects of hip muscle strengthening in a
group of patients with PFPS, as compared to non-intervention or other kinds of
intervention, and had to investigate the following outcomes: pain, muscle
strength, and function. The methodological quality of the selected studies was
analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle
strengthening was effective in reducing pain. However, the studies disagreed
regarding the treatments' ability to improve muscle strength. Improvement in
functional capabilities after hip muscle strengthening was found in five
studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and
improving functional capabilities in patients with PFPS, despite the lack of
evidence for its ability to increase muscle strength.
Collapse
Affiliation(s)
- Thiago R T Santos
- Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bárbara A Oliveira
- Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Juliana M Ocarino
- Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Kenneth G Holt
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, United States
| | - Sérgio T Fonseca
- Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
88
|
Dorey C, Williams JM. Strengthening the hip muscles in individuals with patellofemoral pain: what can be learned from the literature? PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
89
|
Morelli KM, Carrelli M, Nunez MA, Smith CA, Warren GL. Addition of hip exercises to treatment of patellofemoral pain syndrome: A meta-analysis. World J Meta-Anal 2015; 3:118-124. [DOI: 10.13105/wjma.v3.i2.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/13/2015] [Accepted: 04/02/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine if the addition of hip-strengthening exercises decreases pain and improves function in patients with patellofemoral pain syndrome.
METHODS: The authors completed a systematic review searching eight databases (i.e., PubMed, Cochrane, CINHAL, MEDLINE, SportsDiscus, EMBASE, APTA Hooked on Evidence, and PEDro). Two independent reviewers screened and excluded studies if they did not meet the following inclusion criteria: subjects had a primary diagnosis of patellofemoral pain syndrome (PFPS), intervention group included hip-strengthening exercises, control group included a traditional physical therapy intervention, study included outcome measures of pain and/or function, study used a randomized controlled trial design, PEDro score was ≥ 7, and study was published in a peer-reviewed journal. Primary outcome measures were subjective scales of pain and function. These measures were converted to standardized mean difference [effect size (ES)], and a random-effects model was used to calculate the overall ES.
RESULTS: Two hundred eighty-three studies were screened for inclusion in our meta-analysis. Nine studies were deemed suitable for data extraction and analysis. A total of 426 subjects were used in the nine studies. Overall, there was a significant positive effect of hip-strengthening exercises on measures of pain and function in subjects with PFPS (ES = 0.94, P = 0.00004). None of the individual studies had a negative ES, with study ES ranging from 0.35 to 2.59. Because of the high degree of between-study variance (I2 = 76%; Q = 34.0, P < 0.001), subgroup meta-analyses and meta-regressions were performed. None of the potential moderator variables that were investigated (e.g., outcome type, hip region targeted, duration of treatment) could explain a significant amount of the between-study variance in ES (P≥ 0.23).
CONCLUSION: Overall, the addition of hip-strengthening exercises to traditional physical therapy produced greater improvements in measures of pain and function.
Collapse
|
90
|
High eccentric hip abduction strength reduces the risk of developing patellofemoral pain among novice runners initiating a self-structured running program: a 1-year observational study. J Orthop Sports Phys Ther 2015; 45:153-61. [PMID: 25627149 DOI: 10.2519/jospt.2015.5091] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Observational prospective cohort study with 1-year follow-up. OBJECTIVES To investigate the relationship between eccentric hip abduction strength and the development of patellofemoral pain (PFP) in novice runners during a self-structured running regime. BACKGROUND Recent research indicates that gluteal muscle weakness exists in individuals with PFP. However, current prospective research has been limited to the evaluation of isometric strength, producing inconsistent findings. Considering that hip muscles, including the gluteus maximus and medius, activate eccentrically to control hip and pelvic motion during weight-bearing activities such as running, the potential link between eccentric strength and PFP risk should be evaluated. METHODS Eight hundred thirty-two novice runners were included at baseline, and 629 participants were included in the final analysis. Maximal eccentric hip abduction strength was measured using a handheld dynamometer prior to initiating a self-structured running program. The diagnostic criteria to classify knee pain as PFP were based on a thorough clinical examination. Participants were followed for 12 months and training characteristics were gathered with a global positioning system. RESULTS Results from the unadjusted generalized linear regression model for cumulative risk at 25 and 50 km indicated differences in cumulative risk of PFP between high strength, normal strength, and low strength (P<.05), with higher strength associated with reduced risk. CONCLUSION Findings from this study indicate that, among novice runners, a level of peak eccentric hip abduction strength that is higher than normal may reduce the risk of PFP during the first 50 km of a self-structured running program.
Collapse
|
91
|
Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med 2015; 49:923-34. [DOI: 10.1136/bjsports-2014-093637] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 11/04/2022]
|
92
|
Hott A, Liavaag S, Juel NG, Brox JI. Study protocol: a randomised controlled trial comparing the long term effects of isolated hip strengthening, quadriceps-based training and free physical activity for patellofemoral pain syndrome (anterior knee pain). BMC Musculoskelet Disord 2015; 16:40. [PMID: 25879452 PMCID: PMC4342827 DOI: 10.1186/s12891-015-0493-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 02/03/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS), also known as Anterior Knee Pain, is a common cause of recurrent or chronic knee pain. The etiology is considered to be multifactorial but is not completely understood. At the current time the leading theory is that pathomechanics in the patellofemoral joint leads to PFPS. Traditionally, conservative treatment has focused on improving strength and timing in the quadriceps muscles. In recent years, evidence has been accumulating to support the importance of hip control and strengthening in PFPS. Two recent studies have shown promising results for hip strengthening as an isolated treatment for PFPS. The aim of this randomised controlled trial (RCT) is to compare isolated hip strengthening to traditional quadriceps-based training and a control group with free physical activity. METHODS/DESIGN An observer-blinded RCT will be performed. We intend to include 150 patients aged 16-40 years, referred from primary care practitioners to the department of Physical Medicine and Rehabilitation in Kristiansand, Norway for PFPS with more than three months duration. Patients meeting the inclusion criteria will be randomised using opaque sequentially numbered sealed envelopes to one of three groups: isolated hip strengthening, quadriceps based training, or a control group (free physical activity). All groups will receive standardized information about PFPS formulated with the intention to minimize fear avoidance and encourage self-mastery of symptoms. Standardized exercises will be performed under supervision of a study physiotherapist once per week in addition to home training two times per week for a total of six weeks. The primary outcome measure will be the Anterior Knee Pain Score (AKPS) at three and 12 months. Secondary outcome measures will include Visual analogue scale (VAS) for pain, hip abductor and quadriceps strength, the generic EuroQol (EQ-5D), Hopkins Symptom Checklist (HSCL), Knee self-efficacy score and Tampa score for Kinesiophobia. DISCUSSION This trial will help to elucidate the role of hip and quadriceps strengthening in the treatment of PFPS. Information as to the role of anxiety and depression, kinesiophobia and self-efficacy will be collected, also as regards prognosis and response to exercise therapy. TRIAL REGISTRATION ClinicalTrials.gov reference: NCT02114294.
Collapse
Affiliation(s)
- Alexandra Hott
- Department of Physical Medicine and Rehabilitation, Sorlandet Hospital Kristiansand, PO box 416, 4604, Kristiansand, Norway.
| | - Sigurd Liavaag
- Department of Orthopedic Surgery, Sorlandet Hospital Arendal, PO box 783 Stoa, 4809, Arendal, Norway.
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital-Ullevål, PO box 4956, Nydalen, 0424, Oslo, Norway.
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital-Ullevål, PO box 4956, Nydalen, 0424, Oslo, Norway.
| |
Collapse
|
93
|
Effects of compliance on trunk and hip integrative neuromuscular training on hip abductor strength in female athletes. J Strength Cond Res 2015; 28:1187-94. [PMID: 24751656 DOI: 10.1097/jsc.0000000000000228] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent studies demonstrate the link between reduced hip abductor strength and increased risk for knee injury such as patellofemoral pain syndrome in women athletes. Meta-analytic reports indicate that the efficacy of integrative neuromuscular training (INT) is associated with compliance to the prescribed programming. Thus, the purpose was to investigate the compliance effects of a trunk and hip-focused INT exercises on hip abductor strength in young women athletes. In a controlled laboratory study design, 21 high school women volleyball players (mean age = 15.6 ± 1.4 years, weight = 64.0 ± 7.4 kg, height = 171.5 ± 7.0 cm) completed isokinetic hip abductor strength testing in pre- and postintervention, which consisted of 5 phases of supervised progressive trunk and hip-focused INT exercises twice a week for 10 weeks. The compliance effects were analyzed based on the changed hip abductor strength values between pre- and postintervention and 3 different compliance groups using 1-way analysis of variance and Pearson's correlation coefficients. The participants in the high-compliance group demonstrated significant hip abductor peak torque increases compared with noncompliance group (p = 0.02), but not between moderate-compliance and noncompliance groups (p = 0.27). The moderate correlation coefficient value (r = 0.56) was recorded between the isokinetic hip abductor peak torque changes and the 3 compliance groups. Because of the observed significant effects and moderate linear association, the effectiveness of a trunk and hip-focused INT protocol to improve hip abduction strength seems dependent on compliance. Compliance of trunk and hip-focused INT is an important aspect of increasing hip abductor strength increase in young women athletes.
Collapse
|
94
|
van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma‐Zeinstra SMA, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev 2015; 1:CD010387. [PMID: 25603546 PMCID: PMC10898323 DOI: 10.1002/14651858.cd010387.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is a common knee problem, which particularly affects adolescents and young adults. PFPS, which is characterised by retropatellar (behind the kneecap) or peripatellar (around the kneecap) pain, is often referred to as anterior knee pain. The pain mostly occurs when load is put on the knee extensor mechanism when climbing stairs, squatting, running, cycling or sitting with flexed knees. Exercise therapy is often prescribed for this condition. OBJECTIVES To assess the effects (benefits and harms) of exercise therapy aimed at reducing knee pain and improving knee function for people with patellofemoral pain syndrome. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 4), MEDLINE (1946 to May 2014), EMBASE (1980 to 2014 Week 20), PEDro (to June 2014), CINAHL (1982 to May 2014) and AMED (1985 to May 2014), trial registers (to June 2014) and conference abstracts. SELECTION CRITERIA Randomised and quasi-randomised trials evaluating the effect of exercise therapy on pain, function and recovery in adolescents and adults with patellofemoral pain syndrome. We included comparisons of exercise therapy versus control (e.g. no treatment) or versus another non-surgical therapy; or of different exercises or exercise programmes. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Where appropriate, we pooled data using either fixed-effect or random-effects methods. We selected the following seven outcomes for summarising the available evidence: pain during activity (short-term: ≤ 3 months); usual pain (short-term); pain during activity (long-term: > 3 months); usual pain (long-term); functional ability (short-term); functional ability (long-term); and recovery (long-term). MAIN RESULTS In total, 31 heterogeneous trials including 1690 participants with patellofemoral pain are included in this review. There was considerable between-study variation in patient characteristics (e.g. activity level) and diagnostic criteria for study inclusion (e.g. minimum duration of symptoms) and exercise therapy. Eight trials, six of which were quasi-randomised, were at high risk of selection bias. We assessed most trials as being at high risk of performance bias and detection bias, which resulted from lack of blinding.The included studies, some of which contributed to more than one comparison, provided evidence for the following comparisons: exercise therapy versus control (10 trials); exercise therapy versus other conservative interventions (e.g. taping; eight trials evaluating different interventions); and different exercises or exercise programmes. The latter group comprised: supervised versus home exercises (two trials); closed kinetic chain (KC) versus open KC exercises (four trials); variants of closed KC exercises (two trials making different comparisons); other comparisons of other types of KC or miscellaneous exercises (five trials evaluating different interventions); hip and knee versus knee exercises (seven trials); hip versus knee exercises (two studies); and high- versus low-intensity exercises (one study). There were no trials testing exercise medium (land versus water) or duration of exercises. Where available, the evidence for each of seven main outcomes for all comparisons was of very low quality, generally due to serious flaws in design and small numbers of participants. This means that we are very unsure about the estimates. The evidence for the two largest comparisons is summarised here. Exercise versus control. Pooled data from five studies (375 participants) for pain during activity (short-term) favoured exercise therapy: mean difference (MD) -1.46, 95% confidence interval (CI) -2.39 to -0.54. The CI included the minimal clinically important difference (MCID) of 1.3 (scale 0 to 10), indicating the possibility of a clinically important reduction in pain. The same finding applied for usual pain (short-term; two studies, 41 participants), pain during activity (long-term; two studies, 180 participants) and usual pain (long-term; one study, 94 participants). Pooled data from seven studies (483 participants) for functional ability (short-term) also favoured exercise therapy; standardised mean difference (SMD) 1.10, 95% CI 0.58 to 1.63. Re-expressed in terms of the Anterior Knee Pain Score (AKPS; 0 to 100), this result (estimated MD 12.21 higher, 95% CI 6.44 to 18.09 higher) included the MCID of 10.0, indicating the possibility of a clinically important improvement in function. The same finding applied for functional ability (long-term; three studies, 274 participants). Pooled data (two studies, 166 participants) indicated that, based on the 'recovery' of 250 per 1000 in the control group, 88 more (95% CI 2 fewer to 210 more) participants per 1000 recovered in the long term (12 months) as a result of exercise therapy. Hip plus knee versus knee exercises. Pooled data from three studies (104 participants) for pain during activity (short-term) favoured hip and knee exercise: MD -2.20, 95% CI -3.80 to -0.60; the CI included a clinically important effect. The same applied for usual pain (short-term; two studies, 46 participants). One study (49 participants) found a clinically important reduction in pain during activity (long-term) for hip and knee exercise. Although tending to favour hip and knee exercises, the evidence for functional ability (short-term; four studies, 174 participants; and long-term; two studies, 78 participants) and recovery (one study, 29 participants) did not show that either approach was superior. AUTHORS' CONCLUSIONS This review has found very low quality but consistent evidence that exercise therapy for PFPS may result in clinically important reduction in pain and improvement in functional ability, as well as enhancing long-term recovery. However, there is insufficient evidence to determine the best form of exercise therapy and it is unknown whether this result would apply to all people with PFPS. There is some very low quality evidence that hip plus knee exercises may be more effective in reducing pain than knee exercise alone.Further randomised trials are warranted but in order to optimise research effort and engender the large multicentre randomised trials that are required to inform practice, these should be preceded by research that aims to identify priority questions and attain agreement and, where practical, standardisation regarding diagnostic criteria and measurement of outcome.
Collapse
Affiliation(s)
- Rianne A van der Heijden
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Nienke E Lankhorst
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Robbart van Linschoten
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Sita MA Bierma‐Zeinstra
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Marienke van Middelkoop
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | | |
Collapse
|
95
|
Abstract
Patellar instability is a common injury that can result in significant limitations of activity and long-term arthritis. There is a high risk of recurrence in patients and operative management is often indicated. Advances in the understanding of patellofemoral anatomy, such as knowledge about the medial patellofemoral ligament, tibial tubercle-trochlear groove distance, and trochlear dysplasia may allow improved surgical management of patellar instability. However, techniques such as MPFL reconstruction are technically demanding and may result in significant complication. The role of trochleoplasty remains unclear.
Collapse
Affiliation(s)
- Jason L Koh
- Orthopaedic Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen's 2505, Evanston, IL, USA; Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine & Biological Sciences, 5841 S. Maryland Avenue, Rm. P207, MC 3079, Chicago, IL 60637, USA.
| | - Cory Stewart
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine & Biological Sciences, 5841 S. Maryland Avenue, Rm. P207, MC 3079, Chicago, IL 60637, USA
| |
Collapse
|
96
|
Effectiveness of exercise therapy in treatment of patients with patellofemoral pain syndrome: systematic review and meta-analysis. Phys Ther 2014; 94:1697-708. [PMID: 25082920 DOI: 10.2522/ptj.20130310] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE This systematic review and meta-analysis was accomplished to determine whether exercise therapy is an effective intervention to reduce pain and patient-reported measures of activity limitations and participation restrictions (PRMALP) in patients with patellofemoral pain. DATA SOURCES AND STUDY SELECTION Randomized controlled trials in English and German languages published in the MEDLINE, Physiotherapy Evidence Database (PEDro), International Clinical Trials Registry Platform, and Cochrane databases were searched. Eligibility was assessed in 2 stages. The methodological quality of the studies was rated using the PEDro scale. Data were pooled using random-effects meta-analysis, allowing for variability among studies. For clinical use, overall estimates were re-expressed in the original visual analog scale scores. Significance was set at 5%. DATA EXTRACTION AND DATA SYNTHESIS Fifteen studies, with a total of 748 participants, were included and pooled for the meta-analysis. Six studies compared the effect of exercise therapy with a control group receiving neither exercise therapy nor another intervention. Four studies compared the effect of exercise therapy versus additive therapy, and 5 studies compared different exercise interventions. In both comparisons, exercise therapy resulted in strong pain reduction and improvement of PRMALP effects. Significant short-term effects (≤12 weeks) of exercise therapy were found for pain and PRMALP, whereas long-term effects (≥26 weeks) were observed for PRMALP only. LIMITATIONS AND CONCLUSION The 15 studies included in this analysis were of variable quality. Large-scale, high-quality randomized controlled trials are needed to further the evaluation of the possible effects of different exercise therapy modalities on patellofemoral pain. This meta-analysis presents evidence that exercise therapy has a strong pain-reducing effect and decreases PRMALP in patients with patellofemoral pain. However, the question of which exercise modality yields the strongest reducing effect on pain and PRMALP remains unanswered.
Collapse
|
97
|
Factors associated with visually assessed quality of movement during a lateral step-down test among individuals with patellofemoral pain. J Orthop Sports Phys Ther 2014; 44:937-46. [PMID: 25347229 DOI: 10.2519/jospt.2014.5507] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE To determine what physical measures are associated with visually assessed quality of movement among patients with patellofemoral pain (PFP). BACKGROUND An altered movement pattern has been implicated as a risk factor for PFP. An understanding of physical measures associated with an altered movement pattern could potentially help guide prevention and management efforts in patients with PFP. METHODS Seventy-nine (40 women) Israel Defense Forces soldiers referred to physical therapy with a diagnosis of PFP were included. Movement pattern was assessed visually during a lateral step-down test and rated as "good" or "moderate," based on previously established criteria. Weight-bearing and non-weight-bearing ankle dorsiflexion (DF) range of motion (ROM); hip internal and external rotation ROM; and hip abduction, hip external rotation, and knee extension strength were also assessed. Differences in physical measures between those with good versus moderate quality of movement were assessed. RESULTS Weight-bearing DF ROM was more limited among participants with a moderate quality of movement compared to those with a good quality of movement (P<.01). Among men, non-weight-bearing DF ROM was more limited in those with a moderate quality of movement as well (P<.01). In addition, quality of movement was associated with weight-bearing DF ROM for both women (r = -0.39, P = .01) and men (r = -0.46, P<.01), and with non-weight-bearing DF ROM for men (r = -0.66, P<.01). When the subgroup of participants who exhibited more than 25° of non-weight-bearing DF ROM was assessed, those with a good quality of movement displayed greater hip external rotator and knee extensor muscle strength compared with those with a moderate quality of movement (P<.01). CONCLUSION Ankle DF ROM should be assessed when patients with PFP demonstrate a lower quality of movement during a lateral step-down test. Lower hip muscle strength may be associated with lower quality of movement among patients with relatively greater ankle DF ROM.
Collapse
|
98
|
Rathleff MS, Roos EM, Olesen JL, Rasmussen S. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial. Br J Sports Med 2014; 49:406-12. [DOI: 10.1136/bjsports-2014-093929] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
99
|
Ferber R, Bolgla L, Earl-Boehm JE, Emery C, Hamstra-Wright K. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. J Athl Train 2014; 50:366-77. [PMID: 25365133 DOI: 10.4085/1062-6050-49.3.70] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized controlled trials have, to our knowledge, directly compared HIP and KNEE programs. OBJECTIVE To compare PFP pain, function, hip- and knee-muscle strength, and core endurance between KNEE and HIP protocols after 6 weeks of rehabilitation. We hypothesized greater improvements in (1) pain and function, (2) hip strength and core endurance for patients with PFP involved in the HIP protocol, and (3) knee strength for patients involved in the KNEE protocol. DESIGN Randomized controlled clinical trial. SETTING Four clinical research laboratories in Calgary, Alberta; Chicago, Illinois; Milwaukee, Wisconsin; and Augusta, Georgia. PATIENTS OR OTHER PARTICIPANTS Of 721 patients with PFP screened, 199 (27.6%) met the inclusion criteria (66 men [31.2%], 133 women [66.8%], age = 29.0 ± 7.1 years, height = 170.4 ± 9.4 cm, weight = 67.6 ± 13.5 kg). INTERVENTION(S) Patients with PFP were randomly assigned to a 6-week KNEE or HIP protocol. MAIN OUTCOME MEASURE(S) Primary variables were self-reported visual analog scale and Anterior Knee Pain Scale measures, which were conducted weekly. Secondary variables were muscle strength and core endurance measured at baseline and at 6 weeks. RESULTS Compared with baseline, both the visual analog scale and the Anterior Knee Pain Scale improved for patients with PFP in both the HIP and KNEE protocols (P < .001), but the visual analog scale scores for those in the HIP protocol were reduced 1 week earlier than in the KNEE group. Both groups increased in strength (P < .001), but those in the HIP protocol gained more in hip-abductor (P = .01) and -extensor (P = .01) strength and posterior core endurance (P = .05) compared with the KNEE group. CONCLUSIONS Both the HIP and KNEE rehabilitation protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulted in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol.
Collapse
Affiliation(s)
- Reed Ferber
- Faculty of Kinesiology, University of Calgary, AB, Canada
| | | | | | | | | |
Collapse
|
100
|
Scattone Silva R, Serrão FV. Sex differences in trunk, pelvis, hip and knee kinematics and eccentric hip torque in adolescents. Clin Biomech (Bristol, Avon) 2014; 29:1063-9. [PMID: 25190109 DOI: 10.1016/j.clinbiomech.2014.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adolescents have a high incidence of knee joint dysfunctions, with up to 28% of adolescents reporting knee pain. Although adolescent females have a greater incidence of knee injuries in comparison to males, few studies conducted biomechanical evaluations in this population aiming to identify sex differences. If trunk and/or lower limb biomechanical impairments are identified in female adolescents, the implementation of early interventions for injury prevention will be better justified. The purpose of this study was to compare the trunk, pelvis, hip and knee kinematics during a single-leg squat task, as well as the isokinetic eccentric hip torque, between male and female healthy adolescents. METHODS Forty-four healthy adolescents were divided into two groups, group of males (n=22) and group of females (n=22). Kinematics during single-leg squat were assessed using a electromagnetic tracking system. For the evaluation of eccentric hip torque in the three planes an isokinetic dynamometer was used. Group differences were assessed using a one-way multivariate analysis of variance. FINDINGS Results showed that adolescent females presented greater hip adduction, hip external rotation and knee abduction, as well as smaller trunk flexion during single-leg squat in comparison to males. Additionally, adolescent females showed smaller isokinetic eccentric hip torque normalized by body mass in all planes in comparison to males. INTERPRETATION These sex differences in terms of trunk/lower limb kinematics and eccentric hip torque generation might play an important role in the greater incidence of overuse knee injuries observed in adolescent females.
Collapse
Affiliation(s)
- Rodrigo Scattone Silva
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, SP, Brazil
| | - Fábio Viadanna Serrão
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, SP, Brazil.
| |
Collapse
|