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Rathleff MS, Rathleff CR, Stephenson A, Mellor R, Matthews M, Crossley K, Vicenzino B. Adults with patellofemoral pain do not exhibit manifestations of peripheral and central sensitization when compared to healthy pain-free age and sex matched controls - An assessor blinded cross-sectional study. PLoS One 2017; 12:e0188930. [PMID: 29220355 PMCID: PMC5722372 DOI: 10.1371/journal.pone.0188930] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/15/2017] [Indexed: 12/23/2022] Open
Abstract
Patellofemoral Pain (PFP) is highly prevalent among adults and adolescents. Localized mechanical hyperalgesia around the knee and tibialis anterior have been observed in people with PFP, but limited knowledge of potential manifestations of central sensitisation exists. The aims of this study were to study conditioned pain modulation (CPM) and wide-spread hyperalgesia in adults with PFP. This assessor-blinded cross-sectional study design compared CPM and mechanical pressure pain thresholds (PPT) between 33 adults (23 females) diagnosed with PFP and 32 age and sex matched pain-free controls. The investigator taking the PPT measurements was blinded to which participants had PFP. PPTs were reliably measured using a Somedic hand-held pressure algometer at three sites: 1) The centre of the patella, 2) the tibialis anterior muscle and 3) a remote site on the lateral epicondyle. For the assessment of CPM, experimental pain was induced to the contralateral hand by immersion into a cold water bath (conditioning stimulus), and assessment of PPTs (the test stimulus) was performed before and immediately after the conditioning stimulation. On average, the CPM paradigm induced a significant increase in PPTs across the three sites (6.3–13.5%, P<0.05), however there was no difference in CPM between young adults with PFP compared to the control group, (F(1,189) = 0.39, P = 0.89). There was no difference in mechanical PPTs between the two groups (F(1,189) = 0.03, P = 0.86). Contrary to our a-priori hypothesis, we found no difference in CPM or PPT between young adults with PFP and age and sex matched pain-free controls.
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Affiliation(s)
- Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg University, Aalborg, Denmark
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
- * E-mail:
| | | | - Aoife Stephenson
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia
| | - Rebecca Mellor
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia
| | - Mark Matthews
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia
| | - Kay Crossley
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia
- College of Science, Health and Engineering. La Trobe University, Bundoora, Australia
| | - Bill Vicenzino
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia
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302
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Validity of Combining History Elements and Physical Examination Tests to Diagnose Patellofemoral Pain. Arch Phys Med Rehabil 2017; 99:607-614.e1. [PMID: 29128344 DOI: 10.1016/j.apmr.2017.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/14/2017] [Accepted: 10/17/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude patellofemoral pain (PFP). DESIGN Prospective diagnostic study. SETTINGS Orthopedic outpatient clinics, family medicine clinics, and community-dwelling. PARTICIPANTS Consecutive patients (N=279) consulting one of the participating orthopedic surgeons (n=3) or sport medicine physicians (n=2) for any knee complaint. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES History elements and physical examination tests were obtained by a trained physiotherapist blinded to the reference standard: a composite diagnosis including both physical examination tests and imaging results interpretation performed by an expert physician. Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of PFP, and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios with associated 95% confidence intervals (CIs) were calculated. RESULTS Two hundred seventy-nine participants were evaluated, and 75 had a diagnosis of PFP (26.9%). Different combinations of history elements and physical examination tests including the age of participants, knee pain location, difficulty descending stairs, patellar facet palpation, and passive knee extension range of motion were associated with a diagnosis of PFP and used in clusters to accurately discriminate between individuals with PFP and individuals without PFP. Two diagnostic clusters developed to confirm the presence of PFP yielded a positive likelihood ratio of 8.7 (95% CI, 5.2-14.6) and 3 clusters to exclude PFP yielded a negative likelihood ratio of .12 (95% CI, .06-.27). CONCLUSIONS Diagnostic clusters combining common history elements and physical examination tests that can accurately diagnose or exclude PFP compared to various knee disorders were developed. External validation is required before clinical use.
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303
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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.
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304
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Halabchi F, Abolhasani M, Mirshahi M, Alizadeh Z. Patellofemoral pain in athletes: clinical perspectives. Open Access J Sports Med 2017; 8:189-203. [PMID: 29070955 PMCID: PMC5640415 DOI: 10.2147/oajsm.s127359] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Patellofemoral pain (PFP) is a very common problem in athletes who participate in jumping, cutting and pivoting sports. Several risk factors may play a part in the pathogenesis of PFP. Overuse, trauma and intrinsic risk factors are particularly important among athletes. Physical examination has a key role in PFP diagnosis. Furthermore, common risk factors should be investigated, such as hip muscle dysfunction, poor core muscle endurance, muscular tightness, excessive foot pronation and patellar malalignment. Imaging is seldom needed in special cases. Many possible interventions are recommended for PFP management. Due to the multifactorial nature of PFP, the clinical approach should be individualized, and the contribution of different factors should be considered and managed accordingly. In most cases, activity modification and rehabilitation should be tried before any surgical interventions.
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Affiliation(s)
- Farzin Halabchi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mirshahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
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305
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Characteristics and Outcome of Patellofemoral Pain in Adolescents: Do They Differ From Adults? J Orthop Sports Phys Ther 2017; 47:801-805. [PMID: 28870143 DOI: 10.2519/jospt.2017.7326] [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: 02/07/2023]
Abstract
Study Design Case series with 1-year follow-up. Background Most of the recommendations for the diagnosis, treatment, and prognosis of patellofemoral pain (PFP) are based on research performed in adults. The literature suggests that there are potential differences between adolescents and adults with PFP. Objectives To investigate differences in characteristics, symptoms, and prognosis at 1-year follow-up between adolescents and adults with PFP. Methods Data from 64 patients with PFP, assessed at baseline and 1-year follow-up, were used. At baseline, data on demographics, symptoms, and coping strategies were obtained by questionnaire. Physical examination included strength and flexibility measurements of the quadriceps and hamstrings. At 1-year follow-up, a questionnaire was used to collect data on pain, function, and recovery. Differences between adolescents (14-18 years) and adults (18-40 years) were analyzed using regression techniques, adjusted for sex, body mass index, and the presence of bilateral pain. Results Of the 64 patients with PFP included at baseline, 78.1% were available for follow-up. At baseline, adolescents with PFP had a significantly lower body mass index (20.7 versus 24.9 kg/m2) and a greater percentage of bilateral pain (70% versus 43.2%) than adults with PFP. There were no differences in reported pain and symptoms between the 2 groups. In total, 25% of the adolescents regarded themselves as recovered after 1 year, compared to 22.7% of the adults (adjusted P = .725). Conclusion The sample size of the study, in relation to the number of statistical tests performed, urges caution in the interpretation of the results. In contrast to what has been suggested previously, only minor differences seem to exist between adolescents and adults with PFP. In both groups, PFP is clearly not a self-limiting disease, with nearly 75% of those in this study reporting persistent pain at 1-year follow-up. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2017;47(10):801-805. Epub 4 Sep 2017. doi:10.2519/jospt.2017.7326.
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306
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van Middelkoop M, Bennell KL, Callaghan MJ, Collins NJ, Conaghan PG, Crossley KM, Eijkenboom JJFA, van der Heijden RA, Hinman RS, Hunter DJ, Meuffels DE, Mills K, Oei EHG, Runhaar J, Schiphof D, Stefanik JJ, Bierma-Zeinstra SMA. International patellofemoral osteoarthritis consortium: Consensus statement on the diagnosis, burden, outcome measures, prognosis, risk factors and treatment. Semin Arthritis Rheum 2017; 47:666-675. [PMID: 29056348 DOI: 10.1016/j.semarthrit.2017.09.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/30/2017] [Accepted: 09/20/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To present the current status of knowledge in the field of patellofemoral (PF) osteoarthritis (OA) and formulate a research agenda in order to guide future research on this topic. DESIGN A 1-day meeting was organized with the aim to bring together international experts in the field to discuss the current state of knowledge on PF OA. Experts from multiple disciplines were invited based on their scientific publications in the field of PF OA and interest in the subject. Topics discussed include the diagnosis, impact, prognosis, and treatment of PF OA. METHODS Following context-setting presentations, an interactive discussion was held in order to achieve consensus on the PF OA topics of interest: (1) diagnosis and definition; (2) burden; (3) outcome measures; (4) prognosis; (5) risk factors, and (6) treatment. Groups of meeting attendees reviewed the literature on these topics and narratively summarized the current state of knowledge, and each group formulated research agenda items relevant to the specific topics of interest. Each consortium member consequently ranked the importance of all items on a 0-10 Numerical Rating Scale (NRS) (10 = extremely important, to 0 = not at all important). RESULTS After ranking all formulated items on importance, 6 of the 28 research agenda items formulated received an average of 7.5 points on the NRS. The most highly ranked items covered the fields of treatment, diagnosis, and definition of PF OA. CONCLUSIONS We recommend to develop clear clinical criteria for PF OA and to reach consensus on the definition of PF OA by both radiographs and MRI. Additionally, more understanding is necessary to be able to distinguish PF symptoms from those arising from the tibiofemoral joint. More insight is needed on effective treatment strategies for PF OA; specifically, tailoring nonpharmacological treatments to individuals with PF OA, and determining whether isolated PF OA requires different treatment strategies than combined PF and tibiofemoral OA.
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Affiliation(s)
- Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Callaghan
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Joost J F A Eijkenboom
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Rianne A van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kathryn Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Joshua J Stefanik
- Northeastern University, Bouvé College of Health Sciences, Boston , MA
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Orthopaedic Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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307
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Pazzinatto MF, de Oliveira Silva D, Pappas E, Magalhães FH, de Azevedo FM. Is quadriceps H-reflex excitability a risk factor for patellofemoral pain? Med Hypotheses 2017; 108:124-127. [PMID: 29055385 DOI: 10.1016/j.mehy.2017.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/18/2022]
Abstract
Patellofemoral pain (PFP) is one of the most common conditions in orthopedic practice while recent evidence has suggested that it may be a predisposing factor to patellofemoral osteoarthritis. In addition to biomechanical alterations associated with the pathomechanisms underlying PFP, the investigation of neurophysiological alterations has provided novel information in the understanding of the pathophysiology of PFP. For instance, women with PFP present lower amplitude of the vastus medialis (VM) H-reflexes compared to pain-free controls, which suggests that the excitability of spinal reflexes might be a promising tool for discriminating woman with PFP in clinical practice. However, the cross-sectional design of the current research does not inform whether the reduced excitability predisposes to or is the consequence of PFP. Therefore, two hypotheses can be raised: (1) the reduction in excitability of the α-motoneurons is a risk factor for PFP; Or, (2) the reduction in H-reflex excitability is a consequence of PFP due to pain. If the former hypothesis is proven correct, it may help in the early identification of individuals with PFP. If the latter, it may help understand the reduced excitability as a consequence of the long-term pain, which may be interfering in the recovery of individuals with PFP in a long-term basis. In addition, exploring such hypotheses may have direct rehabilitative and prevention implications for PFP and its putative progression to knee osteoarthritis.
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Affiliation(s)
- Marcella Ferraz Pazzinatto
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil.
| | - Danilo de Oliveira Silva
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Evangelos Pappas
- The University of Sydney, Faculty of Health Sciences, Sydney, Australia
| | | | - Fábio Mícolis de Azevedo
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil
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308
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Passigli S, Capacci P, Volpi E. THE EFFECTS OF A MULTIMODAL REHABILITATION PROGRAM ON PAIN, KINESIOPHOBIA AND FUNCTION IN A RUNNER WITH PATELLOFEMORAL PAIN. Int J Sports Phys Ther 2017; 12:670-682. [PMID: 28900573 PMCID: PMC5534157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Multimodal interventions possess the strongest evidence in the long-term management of patellofemoral pain, but despite receiving evidence-based treatments that are initially effective many patients report recurrent or persistent symptoms for years after the initial diagnosis. Untreated psychological factors could be a possible explanation for persistent symptoms and poor treatment outcome. The purpose of this case report was to describe and evaluate the effects of a multimodal rehabilitation program that included pain education, a graded program of lower limb strengthening, and running retraining on pain, kinesiophobia, and function in a runner with patellofemoral pain. CASE DESCRIPTION The subject was a 37-year-old female runner reporting a 12-month history of anterior knee pain with previous failed physiotherapeutic treatment. She discontinued running when symptoms gradually worsened, approximately six months after initial onset. She was advised to avoid painful activities. Clinical examination revealed pain during the performance of a weight-bearing functional task, fear of movement, and functional limitations. Treatment focused on pain education, self-management strategies, and progressive loading of the involved tissues through a graduated program of exercises and running retraining. OUTCOMES Clinically meaningful improvements were seen in pain, kinesiophobia, and function following a 21-week multimodal rehabilitation program. DISCUSSION This case report illustrates several important aspects of clinical reasoning contributing to successful outcomes for a runner with patellofemoral pain. The multimodal rehabilitation program utilized was based upon the neurophysiology of pain (pain education) rather than the tissue pathology model. The findings from this case report may be used to benefit clinicians with similar subject presentations and drive future research into the use of these interventions based upon neurophysiology models of pain in the treatment of patellofemoral pain. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
| | - Pietro Capacci
- Centro Fisioterapico FisioWorld, Bibbiena, Arezzo, Italy
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309
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Salsich GB, Yemm B, Steger-May K, Lang CE, Van Dillen LR. A feasibility study of a novel, task-specific movement training intervention for women with patellofemoral pain. Clin Rehabil 2017; 32:179-190. [PMID: 28750548 DOI: 10.1177/0269215517723055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate whether a novel, task-specific training intervention that focused on correcting pain-producing movement patterns was feasible and whether it would improve hip and knee kinematics, pain, and function in women with patellofemoral pain. DESIGN Prospective, non-randomized, within-group, double baseline, feasibility intervention study. SUBJECTS A total of 25 women with patellofemoral pain were enrolled. INTERVENTION The intervention, delivered 2×/week for six weeks, consisted of supervised, high-repetition practice of daily weight-bearing and recreational activities. Activities were selected and progressed based on participants' interest and ability to maintain optimal alignment without increasing pain. MAIN MEASURES Primary feasibility outcomes were recruitment, retention, adherence, and treatment credibility (Credibility/Expectancy Questionnaire). Secondary outcomes assessing intervention effects were hip and knee kinematics, pain (visual analog scale: current, average in past week, maximum in past week), and function (Patient-Specific Functional Scale). RESULTS A total of 25 participants were recruited and 23 were retained (92% retention). Self-reported average daily adherence was 79% and participants were able to perform their prescribed home program correctly (reduced hip and knee frontal plane angles) by the second intervention visit. On average, treatment credibility was rated 25 (out of 27) and expectancy was rated 22 (out of 27). Hip and knee kinematics, pain, and function improved following the intervention when compared to the control phase. CONCLUSION Based on the feasibility outcomes and preliminary intervention effects, this task-specific training intervention warrants further investigation and should be evaluated in a larger, randomized clinical trial.
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Affiliation(s)
- Gretchen B Salsich
- 1 Program in Physical Therapy, Saint Louis University, St. Louis, MO, USA
| | - Barbara Yemm
- 1 Program in Physical Therapy, Saint Louis University, St. Louis, MO, USA
| | - Karen Steger-May
- 2 Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine E Lang
- 3 Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.,4 Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,5 Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Linda R Van Dillen
- 3 Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.,6 Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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310
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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.
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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
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311
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Abstract
Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS). Older patients usually present with signs of patellofemoral osteoarthritis (PFOA). A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs), passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities.
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Affiliation(s)
- Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Berlin
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312
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Nunes GS, Barton CJ, Serrão FV. Hip rate of force development and strength are impaired in females with patellofemoral pain without signs of altered gluteus medius and maximus morphology. J Sci Med Sport 2017; 21:123-128. [PMID: 28606466 DOI: 10.1016/j.jsams.2017.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/26/2017] [Accepted: 05/15/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare rate of force development (RFD) and isometric muscle strength of the hip abductors and extensors; and the thickness and the amount of non-contractile tissue of the gluteus medius and maximus between females with and without patellofemoral pain (PFP). DESIGN Cross-sectional study. METHODS Fifty-four physically active females (27 with PFP and 27 healthy individuals) were studied. Hip muscle isometric strength and RFD was evaluated using isokinetic dynamometry. RFD was measured until 30%, 60%, and 90% of the maximal isometric torque (MIT). Hip muscle morphology was evaluated using ultrasonography. RESULTS The PFP group possessed slower RFD compared to the control group by 33% for hip abductors until 90%MIT (-0.23%/ms, 95%CI -0.44 to -0.02, ES=0.59); by 51% for hip extensors until 30%MIT (-0.42%/ms, 95%CI -0.66 to -0.18, ES=0.97); and by 55% for hip extensors until 60%MIT (-0.36%/ms, 95%CI -0.60 to -0.12, ES=0.81). The PFP group possessed reduced isometric torque compared to the control group by 10% for hip abduction (-16.0Nm/kg×100, 95% CI -30.2 to -1.9, ES=0.61) and by 15% for hip extension (-30.1Nm/kg×100, 95%CI -51.4 to -8.9, ES=0.76). No significant between group differences for the thickness and the amount of non-contractile tissue of the gluteus medius and maximus were identified. CONCLUSIONS Females with PFP have deficits in isometric strength and RFD in hip abduction and extension. RFD deficits are greater than strength deficits which may highlight their potential importance. Hip muscle strength and RFD deficits do not appear to be explained by muscle thickness or proportion of non-contractile tissue of the gluteal musculature as measured by ultrasound.
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Affiliation(s)
- Guilherme S Nunes
- Department of Physiotherapy, São Carlos Federal University, Brazil; Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Australia.
| | - Christian John Barton
- Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Australia
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Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists. BMC Musculoskelet Disord 2017; 18:181. [PMID: 28482879 PMCID: PMC5422884 DOI: 10.1186/s12891-017-1539-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/27/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is considered one of the commonest forms of knee pain. This study aimed to identify how physiotherapists in the United Kingdom (UK) currently manage patellofemoral pain (PFP), particularly in relation to exercise prescription, and response to pain. METHODS An anonymous survey was designed with reference to previous surveys and recent systematic reviews. Practising UK physiotherapists who treat patients with PFP were invited to take part via an invitation email sent through professional networks, the 'interactive Chartered Society of Physiotherapy (iCSP)' message board, and social media (Twitter). Descriptive statistics were used to analyse the data. RESULTS A total of 99 surveys were completed. Responders reported a wide range of management strategies, including a broad selection of type and dose of exercise prescription. The five most common management strategies chosen were: closed chain strengthening exercises (98%); education and advice (96%); open chain strengthening exercises (76%); taping (70%) and stretches (65%). Physiotherapists with a special interest in treating PFP were statistically more likely to manage patients with orthotics (P = 0.02) and bracing (P = 0.01) compared to physiotherapists without a special interest. Approximately 55% would not prescribe an exercise if it was painful. Thirty-one percent of physiotherapists would advise patients not to continue with leisure and/or sporting activity if they experienced any pain. CONCLUSION Current UK practice in the management strategies of PFP is variable. Further high quality research on which to inform physiotherapy practice is warranted for this troublesome musculoskeletal condition.
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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 and 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
- Manchester Metropolitan University, Manchester, UK
| | | | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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314
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Esculier JF, Bouyer LJ, Dubois B, Fremont P, Moore L, McFadyen B, Roy JS. Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain?A randomised clinical trial. Br J Sports Med 2017; 52:659-666. [DOI: 10.1136/bjsports-2016-096988] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/27/2022]
Abstract
DesignSingle-blind randomised clinical trial.ObjectiveTo compare the effects of three 8-week rehabilitation programmes on symptoms and functional limitations of runners with patellofemoral pain (PFP).MethodsSixty-nine runners with PFP were randomly assigned to one of three intervention groups: (1) education on symptoms management and training modifications (education); (2) exercise programme in addition to education (exercises); (3) gait retraining in addition to education (gait retraining). Symptoms and functional limitations were assessed at baseline (T0), and after 4, 8 and 20 weeks (T4, T8 and T20) using the Knee Outcome Survey of the Activities of Daily Living Scale (KOS-ADLS) and visual analogue scales (VASs) for usual pain, worst pain and pain during running. Lower limb kinematics and kinetics during running, and isometric strength were also evaluated at T0 and T8. The effects of rehabilitation programmes were assessed using two-way analysis of variance.ResultsNo significant group × time interactions (p<0.447) were found for KOS-ADLS and VASs. All three groups showed similar improvements at T4, T8 and T20 compared with T0 (p<0.05). Only the exercises group increased knee extension strength following rehabilitation (group × time: p<0.001) and only the gait retraining group (group × time: p<0.001) increased step rate (+7.0%) and decreased average vertical loading rate (−25.4%).ConclusionEven though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits on symptoms and functional limitations. Appropriate education on symptoms and management of training loads should be included as a primary component of treatment in runners with PFP.Trial registration numberClinicalTrials.gov (NCT02352909).
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315
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Esculier JF, Dubois B, Bouyer LJ, McFadyen BJ, Roy JS. Footwear characteristics are related to running mechanics in runners with patellofemoral pain. Gait Posture 2017; 54:144-147. [PMID: 28292715 DOI: 10.1016/j.gaitpost.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 02/13/2017] [Accepted: 03/06/2017] [Indexed: 02/02/2023]
Abstract
Running footwear is known to influence step rate, foot inclination at foot strike, average vertical loading rate (VLR) and peak patellofemoral joint (PFJ) force. However, the association between the level of minimalism of running shoes and running mechanics, especially with regards to these relevant variables for runners with patellofemoral pain (PFP), has yet to be investigated. The objective of this study was to explore the relationship between the level of minimalism of running shoes and habitual running kinematics and kinetics in runners with PFP. Running shoes of 69 runners with PFP (46 females, 23 males, 30.7±6.4years) were evaluated using the Minimalist Index (MI). Kinematic and kinetic data were collected during running on an instrumented treadmill. Principal component and correlation analyses were performed between the MI and its subscales and step rate, foot inclination at foot strike, average VLR, peak PFJ force and peak Achilles tendon force. Higher MI scores were moderately correlated with lower foot inclination (r=-0.410, P<0.001) and lower peak PFJ force (r=-0.412, P<0.001). Moderate correlations also showed that lower shoe mass is indicative of greater step rate (ρ=0.531, P<0.001) and lower peak PFJ force (ρ=-0.481, P<0.001). Greater shoe flexibility was moderately associated with lower foot inclination (ρ=-0.447, P<0.001). Results suggest that greater levels of minimalism are associated with lower inclination angle and lower peak PFJ force in runners with PFP. Thus, this population may potentially benefit from changes in running mechanics associated with the use of shoes with a higher level of minimalism.
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Affiliation(s)
- Jean-Francois Esculier
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1 V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1 M 2S8, Canada; The Running Clinic, C.P. 1075, Lac-Beauport, QC, G3 B 2J8, Canada.
| | - Blaise Dubois
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1 V 0A6, Canada; The Running Clinic, C.P. 1075, Lac-Beauport, QC, G3 B 2J8, Canada.
| | - Laurent J Bouyer
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1 V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1 M 2S8, Canada.
| | - Bradford J McFadyen
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1 V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1 M 2S8, Canada.
| | - Jean-Sébastien Roy
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1 V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1 M 2S8, Canada.
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316
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Pazzinatto MF, de Oliveira Silva D, Pradela J, Coura MB, Barton C, de Azevedo FM. Local and widespread hyperalgesia in female runners with patellofemoral pain are influenced by running volume. J Sci Med Sport 2017; 20:362-367. [DOI: 10.1016/j.jsams.2016.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/10/2016] [Accepted: 09/11/2016] [Indexed: 11/29/2022]
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317
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Maclachlan LR, Collins NJ, Matthews ML, Hodges PW, Vicenzino B. The psychological features of patellofemoral pain: a systematic review. Br J Sports Med 2017; 51:732-742. [DOI: 10.1136/bjsports-2016-096705] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 12/22/2022]
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318
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Te M, Baptista AF, Chipchase LS, Schabrun SM. Primary Motor Cortex Organization Is Altered in Persistent Patellofemoral Pain. PAIN MEDICINE 2017; 18:2224-2234. [DOI: 10.1093/pm/pnx036] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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319
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Rathleff MS. Patellofemoral pain during adolescence: much more prevalent than appreciated. Br J Sports Med 2017; 50:831-2. [PMID: 27365277 PMCID: PMC4975818 DOI: 10.1136/bjsports-2016-096328] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M S Rathleff
- Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
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320
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Seeley MK, Son SJ, Kim H, Hopkins JT. Walking mechanics for patellofemoral pain subjects with similar self-reported pain levels can differ based upon neuromuscular activation. Gait Posture 2017; 53:48-54. [PMID: 28092813 DOI: 10.1016/j.gaitpost.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/21/2016] [Accepted: 01/09/2017] [Indexed: 02/02/2023]
Abstract
Patellofemoral pain (PFP) is often studied on subjects who are classified using only self-reported data. Neuromuscular activation influences movement mechanics for PFP subjects, but is not likely to be self-reported. We compared lower-extremity mechanics, during a common movement (walking), between two subdivisions of a group of PFP subjects that were similar, based on common self-report tools, but different, based on a common objective measure of quadriceps activation. Our intent was to highlight the importance of objectively considering neuromuscular activation when researching PFP movement mechanics. Thirty similar PFP research subjects (based on four common self-report tools) were divided into two subdivisions, based on different quadriceps central activation ratios (CAR): a quadriceps deficit (QD; CAR <0.95) group and a no quadriceps deficit (NQD; CAR ≥0.95) group. All subjects in both groups performed five walking trials, while common mechanical characteristics were measured: 3D ground reaction force, and 3D joint kinematics and kinetics. Functional statistics were used to compare mechanical characteristics between the groups across the entire stance phase of gait (α=0.05). Numerous differences were found between the two groups for ground reaction force, and joint kinematics and kinetics. For example, the NQD group exhibited 5% greater vertical ground reaction force at peak impact, and 5% less vertical ground reaction force during the unloading portion of stance, relative to the QD group. The results indicate that when researching movement mechanics associated with PFP, it is important to consider objectively-measured neuromuscular activation characteristics that are not likely to be self-reported by PFP subjects.
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Affiliation(s)
| | - S Jun Son
- Brigham Young University, Provo, UT, USA.
| | - Hyunsoo Kim
- West Chester University of Pennsylvania, West Chester, PA, USA.
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321
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Winters M, Bakker EWP, Moen MH, Barten CC, Teeuwen R, Weir A. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. Br J Sports Med 2017; 52:1267-1272. [DOI: 10.1136/bjsports-2016-097037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 12/12/2022]
Abstract
BackgroundThe majority of sporting injuries are clinically diagnosed using history and physical examination as the cornerstone. There are no studies supporting the reliability of making a clinical diagnosis of medial tibial stress syndrome (MTSS).AimOur aim was to assess if MTSS can be diagnosed reliably, using history and physical examination. We also investigated if clinicians were able to reliably identify concurrent lower leg injuries.MethodsA clinical reliability study was performed at multiple sports medicine sites in The Netherlands. Athletes with non-traumatic lower leg pain were assessed for having MTSS by two clinicians, who were blinded to each others’ diagnoses. We calculated the prevalence, percentage of agreement, observed percentage of positive agreement (Ppos), observed percentage of negative agreement (Pneg) and Kappa-statistic with 95%CI.ResultsForty-nine athletes participated in this study, of whom 46 completed both assessments. The prevalence of MTSS was 74%. The percentage of agreement was 96%, with Ppos and Pneg of 97% and 92%, respectively. The inter-rater reliability was almost perfect; k=0.89 (95% CI 0.74 to 1.00), p<0.000001. Of the 34 athletes with MTSS, 11 (32%) had a concurrent lower leg injury, which was reliably noted by our clinicians, k=0.73, 95% CI 0.48 to 0.98, p<0.0001.ConclusionOur findings show that MTSS can be reliably diagnosed clinically using history and physical examination, in clinical practice and research settings. We also found that concurrent lower leg injuries are common in athletes with MTSS.
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322
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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).
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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
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323
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Manske RC, Davies GJ. EXAMINATION OF THE PATELLOFEMORAL JOINT. Int J Sports Phys Ther 2016; 11:831-853. [PMID: 27904788 PMCID: PMC5095938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Patellofemoral pain is one of the leading causes of knee pain in athletes. The many causes of patellofemoral pain make diagnosis unpredictable and examination and treatment difficult. This clinical commentary discusses a detailed physical examination routine for the patient with patellofemoral pain. Critically listening and obtaining a detailed medical history followed by a clearly structured physical examination will allow the physical therapist to diagnose most forms of patellofemoral pain. This clinical commentary goes one step further by suggesting an examination scheme and order in which it should be performed during the examination process. This step-by-step guide will be helpful for the student or novice therapist and serve as review for those that are already well versed in patellofemoral examination.
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324
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Mullaney MJ, Fukunaga T. CURRENT CONCEPTS AND TREATMENT OF PATELLOFEMORAL COMPRESSIVE ISSUES. Int J Sports Phys Ther 2016; 11:891-902. [PMID: 27904792 PMCID: PMC5095942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Patellofemoral disorders, commonly encountered in sports and orthopedic rehabilitation settings, may result from dysfunction in patellofemoral joint compression. Osseous and soft tissue factors, as well as the mechanical interaction of the two, contribute to increased patellofemoral compression and pain. Treatment of patellofemoral compressive issues is based on identification of contributory impairments. Use of reliable tests and measures is essential in detecting impairments in hip flexor, quadriceps, iliotibial band, hamstrings, and gastrocnemius flexibility, as well as in joint mobility, myofascial restrictions, and proximal muscle weakness. Once relevant impairments are identified, a combination of manual techniques, instrument-assisted methods, and therapeutic exercises are used to address the impairments and promote functional improvements. The purpose of this clinical commentary is to describe the clinical presentation, contributory considerations, and interventions to address patellofemoral joint compressive issues.
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325
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Décary S, Ouellet P, Vendittoli PA, Desmeules F. Reliability of physical examination tests for the diagnosis of knee disorders: Evidence from a systematic review. ACTA ACUST UNITED AC 2016; 26:172-182. [PMID: 27697691 DOI: 10.1016/j.math.2016.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
Clinicians often rely on physical examination tests to guide them in the diagnostic process of knee disorders. However, reliability of these tests is often overlooked and may influence the consistency of results and overall diagnostic validity. Therefore, the objective of this study was to systematically review evidence on the reliability of physical examination tests for the diagnosis of knee disorders. A structured literature search was conducted in databases up to January 2016. Included studies needed to report reliability measures of at least one physical test for any knee disorder. Methodological quality was evaluated using the QAREL checklist. A qualitative synthesis of the evidence was performed. Thirty-three studies were included with a mean QAREL score of 5.5 ± 0.5. Based on low to moderate quality evidence, the Thessaly test for meniscal injuries reached moderate inter-rater reliability (k = 0.54). Based on moderate to excellent quality evidence, the Lachman for anterior cruciate ligament injuries reached moderate to excellent inter-rater reliability (k = 0.42 to 0.81). Based on low to moderate quality evidence, the Tibiofemoral Crepitus, Joint Line and Patellofemoral Pain/Tenderness, Bony Enlargement and Joint Pain on Movement tests for knee osteoarthritis reached fair to excellent inter-rater reliability (k = 0.29 to 0.93). Based on low to moderate quality evidence, the Lateral Glide, Lateral Tilt, Lateral Pull and Quality of Movement tests for patellofemoral pain reached moderate to good inter-rater reliability (k = 0.49 to 0.73). Many physical tests appear to reach good inter-rater reliability, but this is based on low-quality and conflicting evidence. High-quality research is required to evaluate the reliability of knee physical examination tests.
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Affiliation(s)
- Simon Décary
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
| | - Philippe Ouellet
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
| | - Pascal-André Vendittoli
- Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada; Department of Surgery, Maisonneuve-Rosemont Hospital, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, University of Montreal Affiliated Hospital, Montreal, Quebec, Canada.
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
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