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Eckenrode BJ, Kietrys DM, Brown A, Parrott JS, Noehren B. Effects of high frequency strengthening on pain sensitivity and function in female runners with chronic patellofemoral pain. Phys Ther Sport 2024; 67:31-40. [PMID: 38471409 DOI: 10.1016/j.ptsp.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the effects of a high frequency strengthening program on function, pain, and pain sensitization in female runners with chronic patellofemoral pain (PFP). DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Thirty female runners (mean age 32 ± 8.1 years) with chronic PFP completed an 8-week home strengthening program. MAIN OUTCOME MEASURES Variables assessed at baseline, 8-weeks, and 12 weeks included single leg step down test (SLSD), pain, Anterior Knee Pain Scale (AKPS), University of Wisconsin Running Injury and Recovery Index (UWRI), and quantitative sensory testing. RESULTS There was large and statistically significant improvement at 8 and 12 weeks for average knee pain (ηp2 = 0.334, p < 0.001), worst knee pain (ηp2 = 0.351, p < 0.001), SLSD (ηp2 = 0.161, p = 0.001), AKPS (ηp2 = 0.463, p < 0.001), and UWRI (ηp2 = 0.366, p < 0.001). A medium to large effect and statistically significant improvement in pressure pain threshold testing was found for all local and remote structures (ηp2 range, 0.110 to 0.293, range p < 0.001 to p = 0.009) at 8 and 12 weeks. CONCLUSIONS There was a significant decrease in local and remote hyperalgesia via mechanical and thermal pain sensitivity testing in female runners with chronic PFP. There was a large effect and significant improvement in self-reported pain and function.
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Affiliation(s)
- Brian J Eckenrode
- Arcadia University, Department of Physical Therapy, Glenside, PA, 19038, USA.
| | - David M Kietrys
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences, Blackwood, NJ, 08012, USA
| | - Allison Brown
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences Newark, NJ, 07101, USA
| | - J Scott Parrott
- Rutgers School of Health Professions, Department of Interdisciplinary Studies, Blackwood, NJ, 08012, USA
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, KY, 40536, USA
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2
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Kochar SS, Fating T, Patil S. Efficacy of Isometric Exercises and Somatosensory Training for Pain, Proprioception, and Balance in Runners with Patellofemoral Pain Syndrome. Cureus 2024; 16:e56163. [PMID: 38618329 PMCID: PMC11015899 DOI: 10.7759/cureus.56163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Background A significant cause of knee pain is patellofemoral pain syndrome (PFPS). Young adults are the most common population to be impacted, and this condition appears to affect both sexes. Patellofemoral joint (PFJ) compression, which is felt around the patella during any physical or athletic activity, usually causes patients to experience pain in the anterior part of the knee. Physiotherapy is essential for patients suffering from this illness, as it can improve their everyday activities and ability to return to their sport. Methodology The study's main goal was to evaluate the effectiveness of somatosensory training and isometric exercises for pain, proprioception, and balance in runners with PFPS. Before- and after-test approaches were used in the investigation. Eighty-five people made up the study, with the inclusion and exclusion criteria used to determine eligibility. Isometric exercises and somatosensory training were given to every individual; the group was not randomly assigned. The patient's diagnosis was made using the patellar grind test. Participants received 30-45 minutes of isometric exercises and 15 minutes of somatosensory training every four days. The visual analog scale, joint position sense test, and Y-balance test were taken as outcome measures to measure PFPS before and after the intervention. Results The result revealed significant (p=0.0001) improvement in PFPS following the intervention. Both the isometric exercises and somatosensory training were found to be significant in reducing the intensity of the pain and improving the proprioception and balance of the individuals. Conclusion Both treatment approaches were beneficial in lowering pain in the joints, developing balance, and helping the patient perceive the position of the joint. Individuals can use both therapy methods to improve their running abilities, and they should become ingrained in daily practice.
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Affiliation(s)
- Shraddha S Kochar
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubhangi Patil
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lee JH, Rhim HC, Jang KM. Effect of Adding Kinesio Taping to Exercise Therapy in the Treatment of Patellofemoral Pain Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040754. [PMID: 37109711 PMCID: PMC10142653 DOI: 10.3390/medicina59040754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Patellar taping has been widely used for the primary or adjunctive treatment of patellofemoral pain syndrome (PFPS); however, there are limited data in terms of functional outcomes. This study aimed to investigate whether there is any beneficial effect of adding Kinesio Taping® (KT) to exercise therapy in the treatment of PFPS. Materials and Methods: Twenty patients (27.5 ± 5.4 years) with PFPS who applied KT and 19 patients (27.3 ± 7.4 years) who did not were included in this study. Quadriceps muscle strength and acceleration time (AT) were assessed using an isokinetic device. Patient-reported outcomes were evaluated using the Kujala anterior knee pain scale (AKPS). Both groups underwent one-month exercise therapy. Results: There was no significant difference in quadriceps strength, AT, and AKPS at baseline and at 1 month between the taping and non-taping groups (p > 0.05). However, for quadriceps muscle strength, the effect of time*group interaction was statistically significant (F(1.37) = 4.543, p < 0.05, partial eta squared 0.109), showing that improvement in the quadriceps strength was higher in the non-taping group than that in the taping group. Conclusions: Adding KT to exercise therapy did not elicit extra benefits in quadriceps muscle strength and AT, and AKPS among PFPS with abnormal patellar tracking at one month.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA 02115, USA
| | - Ki-Mo Jang
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
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Preszler JA, McInnis KC, Baute L, Tanaka MJ. Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester. Phys Ther Sport 2023; 60:34-46. [PMID: 36641951 DOI: 10.1016/j.ptsp.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization. CLINICAL QUESTION What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy? KEY RESULTS We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team. CLINICAL APPLICATION The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.
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Affiliation(s)
- Jamie A Preszler
- Department of Sports Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
| | - Kelly C McInnis
- Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Baute
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Bethel J, Killingback A, Robertson C, Adds PJ. The effect of stretching exercises on the fibre angle of the vastus lateralis and vastus medialis oblique: an ultrasound study. J Phys Ther Sci 2022; 34:161-166. [PMID: 35221521 PMCID: PMC8860688 DOI: 10.1589/jpts.34.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/25/2021] [Indexed: 01/06/2023] Open
Abstract
[Purpose] To investigate the effects of a seven-week quadriceps stretching program on
the muscle fibre orientation of the vastus medialis oblique and vastus lateralis in the
lower limbs by ultrasound imaging. [Participants and Methods] Twenty-seven healthy,
physically fit, asymptomatic females and males (age 21.5 ± 1.3, Tegner activity level
score ≥4) were recruited. Their initial vastus medialis oblique and vastus lateralis fibre
angles were determined using ultrasound. They then undertook a seven-week quadriceps
stretching program, 3 sets of stretches to be performed on both lower limbs, 3 times a
week on 3 separate days. One volunteer was assigned as an intra-rater control and did not
take part in the stretching program. The vastus lateralis and vastus medialis oblique
fibre angles were measured again on completion of the exercise regime. [Results] A
statistically significant decrease in muscle fibre angle was observed in both the right
and left vastus medialis oblique, and the right and left vastus lateralis. [Conclusion] A
7-week stretching program can result in a significant decrease in muscle fibre angle in
both the vastus medialis oblique and the vastus lateralis. This can help in understanding
the effects of prescribed stretching exercises on athletic patients with PFP.
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Affiliation(s)
- Jordan Bethel
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London: Cranmer Terrace, London SW17 0RE, UK
| | | | | | - Philip J Adds
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London: Cranmer Terrace, London SW17 0RE, UK
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Robison HJ, Simon JE, Nelson EJ, Morris SN, Wasserman EB, Docherty CL. Secondary School Socioeconomic Status and Athletic Training Practice Characteristics. J Athl Train 2021; 57:418-424. [PMID: 34478545 DOI: 10.4085/1062-6050-0726.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Socioeconomic status (SES) is a significant predictor of morbidity and mortality across health outcomes. Limited information exists on how school SES impacts athletic training practice when a certified athletic trainer (AT) is present at secondary schools. OBJECTIVE To describe contact frequencies and service rates provided by ATs for injuries among secondary school student athletes and how these differ by school SES. DESIGN Cross-sectional study Setting: Athletic training room (ATR) visit days and AT services were collected from 77 secondary schools. Schools were separated into three school SES groups: affluent (n=31), average (n=29), and disadvantaged (n=17). PATIENTS OR OTHER PARTICIPANTS Secondary school student-athletes participating in 12 boys' and 11 girls' sports who visited the ATR during the 2014-2015 through 2018-2019 academic years and received athletic or non-athletic injury care. MAIN OUTCOME MEASURES Contact frequencies expressed as ATR visit days per injury, AT services per injury, and AT services per ATR visit day. Rates for service type utilized were expressed as the total count over reported athlete-exposures. RESULTS ATs documented 1,191 services. Affluent and average SES school communities provided greater contact frequencies for injury related care compared to disadvantaged school communities, particularly by AT services/injury (7.10±13.08 versus average: 9.30±11.60 and affluent: 9.40±12.20; p=0.020). Affluent school communities provided greater rates of services in five of the eleven service groups reported. No significant differences were observed among school SES groups in therapeutic exercises. CONCLUSIONS Our findings reflect that AT practice characteristics may differ by school SES, but these differences do not appear to result in less medical care. Given the complexity and widespread effects of SES, future investigations should utilize a complex method to determine SES as well as aim to identify how SES may impact secondary school student athletes outside of AT practice characteristics.
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Affiliation(s)
| | | | - Erik J Nelson
- Assistant Professor, Indiana University-Bloomington,
| | - Sarah N Morris
- Biostatistician, Datalys Center for Sports Injury Research and Prevention,
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Lee JH, Jang KM, Kim E, Rhim HC, Kim HD. Static and Dynamic Quadriceps Stretching Exercises in Patients With Patellofemoral Pain: A Randomized Controlled Trial. Sports Health 2021; 13:482-489. [PMID: 33615901 DOI: 10.1177/1941738121993777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Limited data are available on the effect of stretching exercise in patients with patellofemoral pain (PFP) who have inflexible quadriceps, which is one of the various causes of PFP syndrome. This study compares quadriceps flexibility, strength, muscle activation time, and patient-reported outcomes after static and dynamic quadriceps stretching exercises in patients with PFP who had inflexible quadriceps. HYPOTHESIS Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes would improve with dynamic quadriceps stretching as compared with static quadriceps stretching exercises. STUDY DESIGN Randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS Of the 44 patients included in the study, 20 performed static stretching and 24 performed dynamic stretching. Quadriceps flexibility was assessed by measuring the knee flexion angle during knee flexion in the prone position (the Ely test). Muscle strength and muscle activation time were measured using an isokinetic device. The patient-reported outcomes were evaluated using the visual analogue scale for pain and anterior knee pain scale. RESULTS No significant differences in quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in the involved knees were found between the 2 groups (P values > 0.05). CONCLUSION Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in patients with PFP who had inflexible quadriceps showed no significant differences between the static and dynamic quadriceps stretching exercise groups. CLINICAL RELEVANCE Both static and dynamic stretching exercises may be effective for improving pain and function in patients with PFP who have inflexible quadriceps.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Republic of Korea.,Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea.,Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Eunseon Kim
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Hye Chang Rhim
- Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Hyeong-Dong Kim
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Republic of Korea
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8
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The Effect of Diacutaneous Fibrolysis on Local and Widespread Hyperalgesia and Muscle Length in Patients With Patellofemoral Pain Syndrome: Secondary Analysis of a Pretest-Posttest Clinical Trial. J Sport Rehabil 2021; 30:804-811. [PMID: 33596548 DOI: 10.1123/jsr.2020-0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/27/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Localized and widespread hyperalgesia has been observed in patients with patellofemoral pain. Diacutaneous fibrolysis (DF) has shown to be effective in reducing pain in several musculoskeletal conditions including patellofemoral pain syndrome, but no studies have evaluated the effects of this technique in reducing localized and widespread hyperalgesia. OBJECTIVE To assess the effect of DF on the pressure pain threshold and muscle length tests in patients with patellofemoral pain syndrome. DESIGN A single-group, pretest-posttest clinical trial. SETTING University of Zaragoza. PARTICIPANTS Forty-six subjects with patellofemoral pain (20 males and 26 females: age 27.8 [6.9] y). INTERVENTION Three sessions of DF. MAIN OUTCOME MEASURES Pressure pain threshold using a handheld pressure algometer (4 sites around the knee, on tibialis anterior muscle, and one remote site on the upper contralateral limb); muscle length test of the iliotibial band, rectus femoris, and hamstring muscles; and patient-perceived treatment effect score. RESULTS The application of 3 sessions of DF significantly increased the pressure pain threshold in all sites at posttreatment evaluation (P < .001) and at a 1-week follow-up (P < .001). A significant increase in muscle length was also observed at the posttreatment evaluation (P < .001) and 1-week follow-up (P < .001). Ninety-seven percent of the patients reported subjective improvement at posttreatment and at 1-week follow-up. CONCLUSION This study found that local and widespread hyperalgesia was significantly reduced after 3 sessions of diacutaneous fibrolysis and at the 1-week follow-up. A significant improvement on muscle length tests was also observed, with high clinical satisfaction among patients.
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Ophey MJ, Crooijmans GAHM, Frieling SMW, Kardos DMA, van den Berg R, Kerkhoffs GMMJ, Tak IJR. Short-term effectiveness of an intervention targeting lower limb range of motion on pain and disability in patellofemoral pain patients: A randomized, non-concurrent multiple-baseline study. J Bodyw Mov Ther 2020; 26:300-308. [PMID: 33992263 DOI: 10.1016/j.jbmt.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/03/2020] [Accepted: 12/19/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Patellofemoral pain (PFP) is a common and often long-standing musculoskeletal condition. Evidence of the effectiveness of interventions addressing soft tissue flexibility is conflicting and of inconsistent scientific quality. However, reduced soft tissue flexibility can negatively affect patellofemoral joint kinematics. Lower limb range of motion (LLROM) reflects soft tissue flexibility throughout the kinetic chain. The aim was to evaluate the short-term effectiveness of an intervention targeting LLROM on pain and disability in patients with PFP. METHODS A randomized, non-concurrent, multiple-baseline single-case design with a two-week intervention phase and baseline and postintervention phase with varying length was conducted. Eight participants (5 females, 3 males) of age 19(±1.6) years, weekly sports participation 12(±3.1) hours and 17(±14) months symptom duration were included. The Anterior Knee Pain Scale - Dutch Version (AKPS-DV) and the Patient Specific Complaint Scale (PSCS) were administered twice a week. After allocating participants to one of four subgroups of reduced LLROM the intervention was applied. The intervention consisted of soft tissue techniques (mobilization, taping, and stretching). RESULTS Participant 3 and 6 showed a medium and small but statistically significant positive effect on the AKPS-DV. Participant 2 showed a large and statistically significant positive effect on the PSCS. CONCLUSIONS This study provides moderate evidence that an intervention targeting LLROM in patients with PFP reduces pain and disability in the short-term. Further research is needed to evaluate the long-term effectiveness and optimize individual treatment outcomes.
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Affiliation(s)
- Martin J Ophey
- IJsveldFysio - Private Physical Therapy Clinic, Nijmegen, the Netherlands; Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands; ESP Science and Education, Vienna, Austria.
| | - Gwen A H M Crooijmans
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Sophie M W Frieling
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Donja M A Kardos
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Robert van den Berg
- ESP Science and Education, Vienna, Austria; FH Burgenland - University of Applied Science, Physical Therapy Department, Pinkafeld, Austria; AIM - Austrian Institute of Management, Advanced Physiotherapy & Management, Eisenstadt, Austria
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS) / IOC Research Center of Excellence, Amsterdam, the Netherlands; Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands
| | - Igor J R Tak
- ESP Science and Education, Vienna, Austria; Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS) / IOC Research Center of Excellence, Amsterdam, the Netherlands; Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands
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Cupler ZA, Alrwaily M, Polakowski E, Mathers KS, Schneider MJ. Taping for conditions of the musculoskeletal system: an evidence map review. Chiropr Man Therap 2020; 28:52. [PMID: 32928244 PMCID: PMC7491123 DOI: 10.1186/s12998-020-00337-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background Taping is a common treatment modality used by many rehabilitation providers. Several types of tapes and taping methods are used in the treatment of musculoskeletal dysfunction and pain. Purpose To summarize and map the evidence related to taping methods used for various joints and conditions of the musculoskeletal system, and to provide clinicians and researchers with a user-friendly reference with organized evidence tables. Data sources The PEDro, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register for Controlled Trials, PubMed, and PROSPERO databases were searched from inception through October 31, 2019. Study selection Eligible studies were selected by two independent reviewers and included either systematic reviews (SRs) or randomized controlled trials (RCTs) and included a musculoskeletal complaint using a clinical outcome measure. Data extraction Data was extracted by two investigators independently. Risk of bias and quality were assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) for SRs or the Physiotherapy Evidence Database (PEDro) scale for RCTs. The protocol was registered with PROSPERO (CRD42019122857). Data synthesis Twenty-five musculoskeletal conditions were summarized from forty-one SRs and 127 RCTs. There were 6 SRs and 49 RCTs for spinal conditions. Kinesio tape was the most common type of tape considered. Four evidence tables representing the synthesized SRs and RCTs were produced and organized by body region per condition. Limitations Inclusion of only English language studies. Also, the heterogeneous nature of the included studies prevented a meta-analysis. Conclusions There is mixed quality evidence of effectiveness for the different types of taping methods for different body regions and conditions. All of the SRs and RCTs found during our search of the taping literature have been organized into a series of appendices. A synthesis of the results have been placed in evidence tables that may serve as a useful guide to clinicians and researchers.
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Affiliation(s)
- Zachary A Cupler
- Physical Medicine & Rehabilitation Services, Butler VA Healthcare System, 353 N. Duffy Road, Butler, Pennsylvania, USA.
| | - Muhammad Alrwaily
- Division of Physical Therapy, School of Medicine, West Virginia University, Morgantown, West Virginia, USA.,Department of Physical Therapy, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Emily Polakowski
- Private Practice, Independence Physical Therapy, Mystic, Connecticut, USA
| | - Kevin S Mathers
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Michael J Schneider
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lee JH, Jang KM, Kim E, Rhim HC, Kim HD. Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial. Sports Health 2020; 13:49-56. [PMID: 32790575 DOI: 10.1177/1941738120932911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) syndrome is closely associated with muscle tightness. However, studies regarding the effects of stretching exercises on PFP patients with inflexible hamstrings are scarce. The aim of the study was to compare the effects between static and dynamic hamstring stretching in patients with PFP who have inflexible hamstrings. HYPOTHESIS Compared with static hamstring stretching, dynamic hamstring stretching will improve the parameters of hamstring flexibility, knee muscle strength, muscle activation time, and clinical outcomes in this patient population. STUDY DESIGN Prospective randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS A total of 46 patients (25, static stretching; 21, dynamic stretching) participated. Hamstring flexibility was assessed according to the popliteal angle during active knee extension. Muscle strength and muscle activation time were measured using an isokinetic device. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain and the anterior knee pain scale (AKPS). RESULTS There were no differences in hamstring flexibility and knee muscle strength of the affected knees between the groups (P > 0.05). Significantly improved muscle activation time and clinical outcomes of the affected knees were observed in the dynamic stretching group compared with the static stretching group (all Ps < 0.01 for hamstring, quadriceps, VAS, and AKPS). CONCLUSION In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises. CLINICAL RELEVANCE Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Korea.,Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eunseon Kim
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Hye Chang Rhim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyeong-Dong Kim
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Korea
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Abstract
OBJECTIVE To evaluate the effect of education interventions compared with any type of comparator on managing patellofemoral pain (PFP). DESIGN Intervention systematic review. PROSPERO identifier: CRD42018088671. LITERATURE SEARCH MEDLINE, Embase, CINAHL, and Web of Science were searched for studies evaluating the effect of education on clinical and functional outcomes in people with PFP. STUDY SELECTION CRITERIA Two reviewers independently assessed studies for inclusion and quality. We included randomized controlled trials on PFP where at least 1 group received an education intervention (in isolation or in combination with other interventions). DATA SYNTHESIS Available data were synthesized via meta-analysis where possible; data that were not appropriate for pooling were synthesized qualitatively. Interpretation was guided by the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Nine trials were identified. Low-credibility evidence indicated that health education material alone was inferior to exercise therapy for pain and function outcomes. Low- and very low-credibility evidence indicated that health professional-delivered education alone produced outcomes similar to those of exercise therapy combined with health professional-delivered education for pain and function, respectively. CONCLUSION Health professional-delivered education may produce similar outcomes in pain and function compared to exercise therapy plus health professional-delivered education in people with PFP. J Orthop Sports Phys Ther 2020;50(7):388-396. Epub 29 Apr 2020. doi:10.2519/jospt.2020.9400.
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Sisk D, Fredericson M. Update of Risk Factors, Diagnosis, and Management of Patellofemoral Pain. Curr Rev Musculoskelet Med 2019; 12:534-541. [PMID: 31773479 DOI: 10.1007/s12178-019-09593-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Patellofemoral pain is the most common cause of anterior knee pain. The purpose of this review is to examine the latest research on risk factors, physical examination, and treatment of patellofemoral pain to improve accuracy of diagnosis and increase use of efficacious treatment modalities. RECENT FINDINGS The latest research suggests patellofemoral pain pathophysiology is a combination of biomechanical, behavioral, and psychological factors. Research into targeted exercise therapy and other conservative therapy modalities have shown efficacy especially when used in combination. New techniques such as blood flow restriction therapy, gait retraining, and acupuncture show promise but require further well-designed studies. Patellofemoral pain is most commonly attributed to altered stress to the patellofemoral joint from intrinsic knee factors, alterations in the kinetic chain, or errors in training. Diagnosis can be made with a thorough assessment of clinical history and risk factors, and a comprehensive physical examination. The ideal treatment is a combination of conservative treatment modalities ideally individualized to the risk factors identified in each patient. Ongoing research should continue to identify biomechanical risk factors and new treatments as well as look for more efficient ways to identify patients who are amenable to treatments.
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Affiliation(s)
- Daniel Sisk
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA.
| | - Michael Fredericson
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
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Ophey MJ, Bosch K, Khalfallah FZ, Wijnands AMMP, van den Berg RB, Bernards NTM, Kerkhoffs GMMJ, Tak IJR. The decline step-down test measuring the maximum pain-free flexion angle: A reliable and valid performance test in patients with patellofemoral pain. Phys Ther Sport 2019; 36:43-50. [PMID: 30641448 DOI: 10.1016/j.ptsp.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Patients with patellofemoral pain (PFP) experience pain while descending stairs. To date no reliable and valid performance-test exists to assess the maximum pain-free knee flexion angle (MPFFA) as outcome measure during a step-down task. Therefore, the intra- and inter-observer reliability and construct validity of the decline step-down test (DSDT) measuring the MPFFA in patients with PFP were evaluated. DESIGN Reliability and construct validity. SETTING Private practices in Nijmegen and Utrecht, the Netherlands. PARTICIPANTS Patients with PFP. MAIN OUTCOME MEASURES The reliability was assessed by repeated measurements of the MPFFA during the DSDT. The construct validity was assessed by correlating the measurements on the DSDT with the Anterior Knee Pain Scale Dutch Version (AKPS-DV) based on a pre-set hypothesis. RESULTS Thirty-two participants (forty-eight knees) were eligible for inclusion. The intraclass correlation coefficient (ICC) for intra-observer reliability was ICC2,1 = 0.83 and ICC2,1 = 0.85 for inter-observer reliability. The 95% limits of agreement (LoA) showed a width of 27.56° for intra-observer reliability and a width of 24.42° for inter-observer reliability. There was an average positive correlation between the DSDT and the total score on the AKPS-DV (rs = 0.31, p = 0.030). CONCLUSION The DSDT measuring the MPFFA is reliable and valid in patients with PFP.
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Affiliation(s)
- Martin J Ophey
- Nexus - Institute for Physical Therapy Education, Gennep, the Netherlands; IJsveldFysio - Private Practice for Physical Therapy, Nijmegen, the Netherlands; European Sports Physical Therapy Education Network, Vienna, Austria.
| | - Karlijn Bosch
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Fatos Z Khalfallah
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Ap M M P Wijnands
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | | | - Nol T M Bernards
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Gino M M J Kerkhoffs
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands
| | - Igor J R Tak
- European Sports Physical Therapy Education Network, Vienna, Austria; Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, the Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands
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Ghourbanpour A, Talebi GA, Hosseinzadeh S, Janmohammadi N, Taghipour M. Effects of patellar taping on knee pain, functional disability, and patellar alignments in patients with patellofemoral pain syndrome: A randomized clinical trial. J Bodyw Mov Ther 2018; 22:493-497. [DOI: 10.1016/j.jbmt.2017.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cardoso RK, Caputo EL, Rombaldi AJ, Del Vecchio FB. Effects of strength training on the treatment of patellofemoral pain syndrome - a meta-analysis of randomized controlled trials. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.002.ar02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract Introduction: Palletofemoral pain syndrome (PFPS) is anterior knee pain that affects around 25% of the population at some point in their lives. Muscle weakness is one of the main causal factors related to PFPS. Objective: Conduct a quantitative analysis on the effectiveness of strength training at reducing pain in PFPS sufferers. Methods: An electronic search was conducted on the MEDLINE, Pubmed, EMBASE, Lilacs and Scielo databases for studies published between January 2005 and September 2014. The following descriptors were used: “patellofemoral pain syndrome”, “patellofemoral pain”, “retropatellar pain”, “exercise”, “exercise therapy”, “strength”, “rehabilitation”. Only randomized controlled trials (RCTs) that compared the effects of strength training to no exercise in terms of reducing pain among PFPS sufferers were included. Data were extracted by two independent authors using predefined quality indicators. Results: A total of 39 RCTs were initially identified in the search. However, only five met the inclusion criteria. Strength training exhibited a positive effect on PFPS (SMD = 0.85, CI: 0.45-1.25). However, high heterogeneity was observed between the studies (p < 0.05; I 2 = 68.3%). Conclusion: Strength training showed a statistically positive response in the treatment of PFPS.
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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.
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Crossley KM, van Middelkoop M, Callaghan MJ, Collins NJ, Rathleff MS, Barton CJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med 2016; 50:844-52. [PMID: 27247098 PMCID: PMC4975825 DOI: 10.1136/bjsports-2016-096268] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Michael J Callaghan
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Melbourne, Victoria, Australia
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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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.
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Khoshkhoo M, Killingback A, Robertson CJ, Adds PJ. The effect of exercise on vastus medialis oblique muscle architecture: An ultrasound investigation. Clin Anat 2016; 29:752-8. [PMID: 26940378 DOI: 10.1002/ca.22710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 02/28/2016] [Accepted: 02/28/2016] [Indexed: 11/09/2022]
Abstract
The vastus medialis oblique (VMO) is thought to be implicated in patellofemoral pain (PFP), and weakness in this portion of the vastus medialis muscle may lead to PFP. Management includes physiotherapy to strengthen the VMO. Although this intervention has been shown to be effective, the effects on the architecture of the muscle have not been investigated. This study aims to determine the changes in VMO architecture following a program of strengthening exercises. Twenty-one male participants underwent an initial ultrasound scan to measure the fiber angle and the insertion level of the VMO on the patella. Each subject then undertook a 6-week quadriceps femoris strengthening program; the scan and measurements were then repeated. A significant increase in VMO fiber angle and insertion length was observed. Average fiber angle increased by 5.24°; average insertion length increased by 2.7 mm. There was found to be a significant negative correlation between the initial values and the degree of change. Pearson's coefficient of correlation for measurements of patella length taken before and after exercise was 0.921, indicating a high degree of reliability. There was a significant positive correlation between fiber angle change and declared level of compliance (R(2) = 0.796). The results reported here indicate that physiotherapy leads to a significant change in VMO morphology. Given the inverse correlation noted between initial architectural parameters and the degree of change, we suggest that patients who would benefit most from physiotherapy can be identified in clinic using a simple ultrasound technique. Clin. Anat. 29:752-758, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- M Khoshkhoo
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London, London, United Kingdom
| | - A Killingback
- Department of Medical Physics and Clinical Engineering, St George's Healthcare NHS Trust, London, United Kingdom
| | - C J Robertson
- Wimbledon Clinics, Wimbledon, London, United Kingdom
| | - P J Adds
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London, London, United Kingdom
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Additional Effects of an Individualized Risk Factor-Based Approach on Pain and the Function of Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial. Clin J Sport Med 2015; 25:478-86. [PMID: 25654629 DOI: 10.1097/jsm.0000000000000177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of adding risk factor-based approach (including appropriate exercises and orthoses) to routine quadriceps strengthening exercise with respect to pain and function in patients with patellofemoral pain syndrome (PFPS). DESIGN A parallel group nonblinded randomized controlled trial with 12-week follow-up. SETTING An outpatient Sports Medicine Clinic of Tehran University of Medical Sciences, Tehran, Iran. PARTICIPANTS Patients (both sexes, 18-40 years) with clinically diagnosed PFPS of the duration over 2 months. INTERVENTION The intervention group received an individualized program, including exercise therapy plus risk factor modification, and was instructed to practice the tailored interventions at home for 12 weeks. The control group received an exercise program, only focusing on quadriceps strengthening. MAIN OUTCOME MEASURES The primary outcomes were pain severity during the activities of daily living (0- to 100-point visual analog scale), and function (0- to 100-point Kujala patellofemoral score) at a 12-week follow-up. RESULTS A total of 53 participants completed the trial: 26 in the intervention and 27 in the control group. After 12 weeks, both groups showed improvements in pain and function, but the changes were significantly greater in the intervention group with regard to pain [adjusted difference, -14.90; 95% confidence interval (CI), -5.86 to -23.93, P = 0.002], and function (adjusted difference, 6.82; 95% CI, 2.54-11.10, P = 0.002). CONCLUSIONS Assessment and modification of the risk factors may add to the treatment effects on pain and function at a 12-week follow-up in patients with PFPS. These findings may lead to a more comprehensive clinical approach to this very common problem. CLINICAL RELEVANCE It seems that incorporating risk factor assessment into our clinical practice may add to treatment effects with regard to pain and function in patients with PFPS.
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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]
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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.
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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
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Huang BY, Shih YF, Chen WY, Ma HL. Predictors for identifying patients with patellofemoral pain syndrome responding to femoral nerve mobilization. Arch Phys Med Rehabil 2015; 96:920-7. [PMID: 25576086 DOI: 10.1016/j.apmr.2015.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/19/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the predictors for successful neurodynamic management in patients with patellofemoral pain syndrome. DESIGN Prospective cohort, prediction rule study. SETTING Hospital. PARTICIPANTS Patients with patellofemoral pain syndrome (N=51) underwent clinical examination and measurement of physical parameters, including femoral slump test, lower-extremity alignment, flexibility and muscle strength, and functional level. INTERVENTION Patients received 6 treatment sessions of femoral nerve mobilization within 2 weeks. MAIN OUTCOME MEASURES Pain level during functional testing was assessed before and after the first and sixth session of treatment. Patients were then grouped into responder and nonresponder groups. Criteria for the responder group was a pain score decrease ≥50% or Global Rating Scale score ≥4. Chi-square and independent t tests were used to identify potential variables with a significance level of .10, and stepwise logistic regression was used to find predictors with a significance level of .05. RESULTS Twenty-five patients responded to the initial treatment (immediate effect), and 28 patients responded after 6 sessions (longer-term effect). A positive femoral slump test was identified as the predictor for the immediate treatment effect. The prediction factors for the longer-term effect included responding to femoral nerve mobilization the first time and a bilateral difference in hip extension angles. Application of the clinical predictors improved the success rate to 90% for 1 treatment session and 93% for 6 treatment sessions. CONCLUSIONS Clinicians could use the positive femoral slump test and a bilateral difference in hip extension angles during the femoral slump test to determine whether or not patients with patellofemoral pain syndrome might benefit from femoral nerve mobilization.
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Affiliation(s)
- Bing-Yao Huang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; Department of Rehabilitation, Daqian General Hospital, Miaoli, Taiwan
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Li Ma
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan
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Outcome Predictors for Conservative Patellofemoral Pain Management: A Systematic Review and Meta-Analysis. Sports Med 2014; 44:1703-16. [DOI: 10.1007/s40279-014-0231-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Petersen W, Ellermann A, Rembitzki IV, Scheffler S, Herbort M, Sprenker FS, Achtnich A, Brüggemann GP, Best R, Hoffmann F, Koppenburg AG, Liebau C. The Patella Pro study - effect of a knee brace on patellofemoral pain syndrome: design of a randomized clinical trial (DRKS-ID:DRKS00003291). BMC Musculoskelet Disord 2014; 15:200. [PMID: 24917049 PMCID: PMC4089925 DOI: 10.1186/1471-2474-15-200] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is a frequent cause of anterior knee pain predominantly affecting young female patients who do not have significant chondral damage. Development of PFPS is probably multifactorial, involving various knee, hip, and foot kinematic factors. Biomechanical studies have described patellar maltracking and dynamic valgus (functional malalignment) in patients with patellofemoral pain syndrome. The literature provides evidence for short-term use of nonsteroidal anti-inflammatory drugs; short-term medially directed taping; and exercise programs focusing on the lower extremity, hip, and trunk muscles. Evidence supporting the use of patellar braces is limited because previous studies have been low quality. The aim of this article is to publish the design of a prospective randomized trial that examines the outcomes of patients with PFPS after treatment with a new patellar brace (Patella Pro) that applies medially directed force on the patella. METHODS/DESIGN For this multicenter trial, 156 patients (adolescents and young adults) with PFPS were recruited from orthopedic practices and orthopedic hospitals and randomly allocated to 3 months of supervised physiotherapy in combination with the Patella Pro brace or supervised physiotherapy alone. The primary outcome measures are pain (numerical analog scale); knee function (Kujala score and Knee Injury and Osteoarthritis Outcome Score); and self-reported perception of recovery at baseline, 6 weeks, 3 months, and 1 year. DISCUSSION Only limited evidence for the use of a patellar brace for the treatment of PFPS exists in the literature. Disputable evidence for the use of orthoses for PFPS patients has been presented in one meta-analysis, in which only one of three studies found the effect of a medially directed patellar brace to be significant. Because of these low-quality studies, the authors concluded that this evidence should be regarded as limited, and we feel there is a need for further well-designed studies to evaluate the effect of patellar bracing on PFPS-related pain. The Patella Pro study is a prospective randomized trial in which supervised physiotherapy in combination with a patellar brace is compared with supervised physiotherapy alone. This trial started in April 2012 and finished in October 2013. TRIAL REGISTRATION DRKS-ID:DRKS00003291, January 3rd, 2012.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar Theyß Strasse 27-31, Berlin D-14193, Germany.
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Kooiker L, Van De Port IGL, Weir A, Moen MH. Effects of physical therapist-guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther 2014; 44:391-402, B1. [PMID: 24766358 DOI: 10.2519/jospt.2014.4127] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE To summarize the evidence for physical therapist-guided quadriceps-strengthening exercises as a treatment for patellofemoral pain syndrome. BACKGROUND Although quadriceps strengthening is often included in the plan of care for patellofemoral pain syndrome, a systematic review published in 2003 found only limited evidence that exercise was more effective than no exercise for this common condition. METHODS The PubMed, Embase/MEDLINE, and Cochrane Central Register of Controlled Trials databases, from inception to January 9, 2014, were searched for randomized controlled trials comparing the use of quadriceps-strengthening exercises to interventions consisting of advice/information or a placebo. Outcomes of interest were pain measures and function, as measured with self-report questionnaires. The methodological quality of the randomized controlled trials was assessed with the Physiotherapy Evidence Database scale. Results were summarized using a best-evidence synthesis and graphically illustrated using forest plots without meta-analysis. RESULTS Seven studies were included in the literature review. These studies reported strong evidence that isolated quadriceps strengthening is more effective in reducing pain and improving function than advice and information alone. In addition, compared to advice and information or placebo, there was strong evidence that quadriceps-strengthening exercises combined with other interventions may be more effective in reducing pain immediately postintervention and after 12 months, but not in improving function. CONCLUSION The literature provides strong evidence for the use of quadriceps-strengthening exercises, with or without other interventions, for the treatment of patellofemoral pain syndrome.
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Affiliation(s)
- Laura Kooiker
- Clinical Health Sciences, Physiotherapy Sciences, Utrecht University, Utrecht, the Netherlands
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Keays SL, Mason M, Newcombe PA. Individualized Physiotherapy in the Treatment of Patellofemoral Pain. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2014; 20:22-36. [DOI: 10.1002/pri.1593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 02/20/2014] [Accepted: 03/11/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Susan L. Keays
- School of Health and Sports Sciences; The University of the Sunshine Coast; Queensland Australia
- Private Practice; Sunshine Coast; Queensland Australia
| | - Marjon Mason
- Private Practice; Sunshine Coast; Queensland Australia
| | - Peter A. Newcombe
- School of Psychology and School of Social Work and Human Services; The University of Queensland; Queensland Australia
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Barton C, Balachandar V, Lack S, Morrissey D. Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms. Br J Sports Med 2013; 48:417-24. [DOI: 10.1136/bjsports-2013-092437] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rixe JA, Glick JE, Brady J, Olympia RP. A review of the management of patellofemoral pain syndrome. PHYSICIAN SPORTSMED 2013; 41:19-28. [PMID: 24113699 DOI: 10.3810/psm.2013.09.2023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Patellofemoral pain syndrome (PFPS) is one of the most frequently diagnosed knee conditions in the primary care, orthopedic, and sports medicine settings. Although strength training and stretching programs have traditionally been the mainstay of patient treatment, there are no consensus recovery protocols for runners experiencing PFPS. The purpose of our review is to examine recent literature regarding the efficacy of various treatment modalities in the management of patients with PFPS. METHODS Our review included 33 articles from a PubMed literature search using the search term PFPS treatment. The search was limited to randomized controlled trials, crossover case-controlled studies, and cohort studies with ≥ 10 participants, with trial data that were published within the last 5 years. RESULTS Strength training and stretching exercises continue to be strongly supported by research as effective treatment options for runners with PFPS. Recent studies have confirmed that quadriceps and hip strengthening combined with stretching in a structured physiotherapy program comprise the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS. As previous studies have shown, therapies such as proprioceptive training, orthotics, and taping may offer benefits as adjunctive therapies but do not show a significant benefit when they are used alone in patients with PFPS. Additionally, recent research has confirmed that surgical and pharmacologic therapies are not effective for the management of patients with PFPS. CONCLUSION A large number of athletes are impacted by PFPS every year, particularly young runners. Sports medicine researchers have investigated many possible therapies for patients with PFPS; however, no clear guidelines have emerged regarding the management of the syndrome. Our review analyzes recent literature on PFPS and identifies specific treatment recommendations. The most effective and strongly supported treatment modality for patients with PFPS is a combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group. Adjunctive therapies, including taping, biofeedback devices, and prefabricated orthotic inserts, may provide limited additive benefits in select populations. Surgery should be avoided in all patients with PFPS.
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Smith TO, McNamara I, Donell ST. The contemporary management of anterior knee pain and patellofemoral instability. Knee 2013; 20 Suppl 1:S3-S15. [PMID: 24034593 DOI: 10.1016/s0968-0160(13)70003-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/15/2013] [Accepted: 08/15/2013] [Indexed: 02/02/2023]
Abstract
In this review the evidence for the management of patients with patellofemoral disorders is presented confined to anterior knee pain and patellar dislocation (excluding patellofemoral arthritis). Patients present along a spectrum of these two problems and are best managed with both problems considered. The key to managing these patients is by improving muscle function, the patient losing weight (if overweight), and judicious use of analgesics if pain is an important feature. Hypermobility syndrome should always be looked for since this is a prognostic indicator for a poor operative outcome. Operations should be reserved for those with correctable anatomical abnormalities that have failed conservative therapy. The current dominant operation is a medial patellofemoral ligament reconstruction.
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Affiliation(s)
- Toby O Smith
- Norwich Medical School and School of Rehabilitation Sciences, University of East Anglia, Norwich, NR4 7TJ UK
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Eapen C, Nayak CD, Pazhyaottyil Zulfeequer C. Effect of eccentric isotonic quadriceps muscle exercises on patellofemoral pain syndrome: an exploratory pilot study. Asian J Sports Med 2012; 2:227-34. [PMID: 22375243 PMCID: PMC3289225 DOI: 10.5812/asjsm.34747] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 06/17/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose There is a decrease in quadriceps muscle strength in subjects with patellofemoral pain syndrome. Various types of strengthening exercises of the quadriceps are done as part of its management, but the effect of isotonic eccentric quadriceps muscle exercises on patellofemoral pain syndrome has not been studied. Hence the aim of this exploratory pilot study was to evaluate the effect of eccentric quadriceps training in patients with patellofemoral pain. Methods Twenty patients (12 female and 8 male, mean ages, 27.50 +/- 6.6 years) with patellofemoral pain syndrome were treated. The eccentric training of the quadriceps was given using a Baltimore Therapeutic Equipment (BTE) Primus machine. The main outcome measures used were percentage time on target as shown by the BTE primus machine, SF-36 Health questionnaire and patellofemoral pain severity scale. Statistical analysis was performed using SPSS 13. Results All the outcome measures showed significant improvements (P<0.05). Percentage time on target improved with a mean difference of 23.6, the SF-36 questionnaire showed an improvement in physical component score, mental component score and bodily pain with a mean difference of 10.9, 2.6 and 29.2 respectively and pain score when taken using patellofemoral severity scale also improved with a mean difference of 3.4. Conclusion Isotonic eccentric training of quadriceps muscles was found to be effective in reducing pain and improving the functional status of patients with patellofemoral pain syndrome and can be suggested as part of the treatment.
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Affiliation(s)
- Charu Eapen
- Corresponding Author: Address: Department Physiotherapy, KMC Mangalore, 575003 Manipal University, India. E-mail:
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Abstract
BACKGROUND Patellofemoral pain syndrome refers to the clinical presentation of knee pain related to changes in the patellofemoral joint. Patellofemoral pain syndrome usually has a gradual onset of pain with none of the features associated with other knee diseases or trauma. It is often treated by physiotherapists, who use a variety of techniques including patellar taping. This involves the application of adhesive sports medical tape applied directly to the skin over the patella on the front of the knee. Patients often report an instantaneous improvement in pain and function after the tape is applied, but its longer term effects are uncertain. OBJECTIVES The objective was to assess the effects, primarily on pain and function, of patellar taping for treating patellofemoral pain syndrome in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, PEDro, SPORTDiscus, AMED, reference lists of articles, trial registers and conference proceedings. All were searched to August 2011. SELECTION CRITERIA Randomised controlled trials and quasi-randomised controlled trials testing the effects of patellar taping on clinically relevant outcomes, pain and function, in adults with patellofemoral pain syndrome. We excluded studies testing only the immediate effects of tape application. DATA COLLECTION AND ANALYSIS Both review authors independently performed study selection, data extraction and assessment of risk of bias. Trialists were contacted for more information. Data were pooled where possible. MAIN RESULTS Five small heterogeneous randomised controlled trials, all at high risk of performance bias and most at risk of at least one other type of bias, were included. These involved approximately 200 participants with a diagnosis of patellofemoral pain syndrome. All compared taping versus control (no or placebo taping) and all included one or more co-interventions given to both taping and control group participants; this was prescribed exercise in four trials. The intensity and length of treatment was very varied: for example, length of treatment ranged from one week in one trial to three months in another. A meta-analysis of the visual analogue scale (VAS) pain data (scale 0 to 10: worst pain), measured in different ways, from four trials (data from 161 knees), found no statistically or clinically significant difference between taping and non taping in pain at the end of the treatment programmes (mean difference (MD) -0.15; 95% confidence interval (CI) -1.15 to 0.85; random-effects model used given the significant heterogeneity (P < 0.0001)). Data for other outcomes measuring function and activities of daily living were from single trials only and gave contradictory results. AUTHORS' CONCLUSIONS The currently available evidence from trials reporting clinically relevant outcomes is low quality and insufficient to draw conclusions on the effects of taping, whether used on its own or as part of a treatment programme. Further research involving large, preferably multi-centre, good quality and well reported randomised controlled trials that measure clinically important outcomes and long-term results is warranted. Before this, consensus is required on the diagnosis of patellofemoral pain syndrome, the standardisation of outcome measurement and an acceptable approach for patellar taping.
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