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Hong QM, Wang HN, Liu XH, Zhou WQ, Zhang X, Luo XB. Home-based exercise program and Health education in patients with patellofemoral pain: a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:896. [PMID: 37980477 PMCID: PMC10657019 DOI: 10.1186/s12891-023-07027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is one of the most common disorders of the knee joint. Home-based exercise is an effective intervention to achieve self-management for chronic diseases. This study evaluated the effects of home-based exercise and health education in patients with PFP. METHODS Patients who had PFP were randomly allocated to an intervention group (IG) or control group (CG). Patients in the IG received a 6-week tailored home-based exercise program with health education via remote support, while patients in the CG group only received health education. Clinical outcomes were compared using the Anterior Knee Pain Scale (AKPS) to measure function and the Visual Analog Scale (VAS) to measure "worst pain" and "pain with daily activity". Muscle strength was measured according to the peak torque of the knee muscles using an isokinetic system. RESULTS Among a total of 112 participants screened for eligibility, 38 were randomized and analyzed, including 19 participants in the intervention group and 19 participants in the control group. There were no significant differences in baseline characteristics between the groups. At 6-week follow-up, the intervention group showed a greater worst pain reduction (between-group difference, -19.3 [95%CI, -23.2 to -15.5]; P < 0.01) and pain with daily activity (between-group difference, -22.9 [95%CI, -28.3 to -17.4]; P < 0.01) than the control group. Similarly, the intervention group had better improvements in AKPS (between-group difference, 9.0 [95%CI, 4.1 to 13.9]; P < 0.01) and knee extensor strength (between-group difference, 20.1 [95%CI, 14.5 to 25.8]; P < 0.01), compared to the control group. No adverse events were reported. CONCLUSION Home-based exercise and health education resulted in less pain, better function, and higher knee muscle strength compared with no exercise in patients with PFP. A large randomized controlled trial with long-term follow-up is required to confirm these findings. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200056224 ( https://www.chictr.org.cn/showproj.aspx?proj=135506 ). Registered on February 1, 2022.
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Affiliation(s)
- Qiao-Mei Hong
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Hao-Nan Wang
- Faculty of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xi-Hui Liu
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Wen-Qi Zhou
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Xiao Zhang
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Xiao-Bing Luo
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China.
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Brightwell BD, Van Wyngaarden JJ, Samaan MA, Matuszewski PE, Jacobs CA, Noehren B. Factors Associated With Long-Term Quadriceps Muscle Function After Surgical Fixation of Lower Extremity Fractures. Phys Ther 2023; 103:pzad108. [PMID: 37581587 PMCID: PMC11009693 DOI: 10.1093/ptj/pzad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/18/2023] [Accepted: 06/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE The long-term performance of the quadriceps femoris muscle and physical function following surgical repair of a lower extremity fracture remains largely undefined. The purpose of this study was to investigate between-limb differences in quadriceps performance 12 months after surgical fixation of a lower extremity fracture. It was hypothesized that the injured limb would be significantly weaker, have a lower rate of torque development (RTD), and that there would be a reduced step-down performance compared to the uninjured limb 12 months after surgery. Additionally, this study sought to identify demographic, surgical, and psychological factors associated with poor quadriceps function 12 months after surgery. METHODS Quadriceps performance was measured bilaterally in 95 participants (49 female), aged 42 (SD = 14.5) years, 12 months after surgical fixation of a lower extremity fracture. Isometric quadriceps strength and RTD were quantified using isometric dynamometry, and a timed step-down test was used to evaluate quadriceps performance. Independent predictor variables from the time of surgery were extracted from participants' medical records. Kinesiophobia was screened at the time of testing. Wilcoxon signed-rank tests and linear regression analyses were used to assess between-limb differences in quadriceps performance and to determine factors associated with quadriceps performance 12 months after surgery. RESULTS Significant between-limb differences in each measure of quadriceps performance were identified (peak torque involved: 1.37 [0.71] Nm × kg-1; uninvolved: 1.87 [0.74] Nm × kg-1; RTD involved: 4.16 [2.75] Nm × kg-1 × s-1; uninvolved: 6.10 [3.02] Nm × kg-1 × × -1; and single-leg step-downs involved: 12.6 [5.0]; uninvolved: 21.7 [14.8]). Female biological sex, external fixation, and kinesiophobia at 12 months were associated with reduced after-surgery quadriceps performance outcomes. CONCLUSION Quadriceps performance is impaired 12 months after surgical repair of a lower extremity fracture, particularly in female participants, in cases requiring external fixation, and in those with higher kinesiophobia 12 months after surgery. IMPACT Because long-term quadriceps weakness negatively impacts functional mobility, targeted strengthening should be emphasized after surgical repair of lower extremity fracture.
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Affiliation(s)
- Benjamin D Brightwell
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Joshua J Van Wyngaarden
- Army-Baylor University Doctoral Program in Physical Therapy, Department of Physical Therapy, Baylor University, San Antonio, Texas, USA
| | - Michael A Samaan
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Paul E Matuszewski
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Cale A Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA
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Glaviano NR, Kim S. Lower extremity muscle volume in females with patellofemoral pain and its relationships to hip and knee torque: A cross-sectional study. Phys Ther Sport 2023; 63:50-57. [PMID: 37506654 DOI: 10.1016/j.ptsp.2023.07.003] [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: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES Compare lower extremity muscle volume in females with patellofemoral pain (PFP) to a cohort of pain-free females and investigate the relationship between thigh and hip muscle volume and torque. DESIGN Cross-sectional. PARTICIPANTS Twenty-one females, 13 with PFP and 8 pain-free controls. MAIN OUTCOME MEASURES We quantified normalized lower extremity muscle volume (cm3/kg*m) via magnetic resonance imaging and isometric hip and thigh torque (Nm/kg) via a multimodal dynamometer. RESULTS Versus pain-free individuals, females with PFP had smaller muscle volume of the anterior hip (P < 0.019; d = 0.97-2.42), deep external rotators (P < 0.006; d = 1.0-3.93), hamstrings (P < 0.009; d = 1.09-2.12), rectus femoris (P < 0.001; d = 1.79), and vastus intermedius (P < 0.001; d = 1.88). There was no difference in muscle volume of the gluteus maximus (P = 0.311; d = 0.22), gluteus medius (P = 0.087; d = 0.87), vastus lateralis (P = 0.22; d = 0.39), and vastus medialis (P = 0.47; d = 0.04). Gluteus maximus volume was moderately correlated to hip abduction torque (r = 0.60; P = 0.03). Vasti muscles and semitendinosus volume were moderately correlated to knee extension (r = 0.57-0.69; P < 0.05) and flexion (r = 0.66; P = 0.01) torque, respectively. CONCLUSION Females with PFP present with lesser thigh and hip muscle volumes, with variability in volumetric profiles across participants. Lower extremity knee extension and hip abduction strength are moderately associated with the vasti and gluteus maximus muscle volume, respectively.
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Affiliation(s)
- Neal R Glaviano
- Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA; Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA.
| | - Sungwan Kim
- Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA; Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
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Milovanović D, Begović N, Bukva B, Dučić S, Vlahović A, Paunović Z, Kadija M, Topalović N, Stijak L. The Influence of the Q-Angle and Muscle Strength on Idiopathic Anterior Knee Pain in Adolescents. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1016. [PMID: 37374224 DOI: 10.3390/medicina59061016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Idiopathic anterior knee pain is a common condition in adolescents and is mostly of unknown cause. The aim of this study was to examine the influence of the Q-angle and muscle strength on idiopathic anterior knee pain. Materials and Methods: Seventy-one adolescents (41 females and 30 males) diagnosed with anterior knee pain were included in this prospective study. The extensor strength in the knee joint and the Q-angle were monitored. The healthy extremity was used as a control. The Student's paired sample t-test was applied for testing the difference. Statistical significance was set at 0.05. Results: There was no statistically significant difference in the Q-angle value between the idiopathic AKP and the healthy extremity (p > 0.05) within the entire sample. A statistically significant higher Q-angle of the idiopathic AKP knee (p < 0.05) was obtained in the female subgroup. No statistically significant difference (p > 0.05) was found in the male subgroup. Within the male subgroup, the strength of the extensors within the knee joint of the healthy extremity had statistically significant higher values than the strength of these muscles in the affected extremity (p < 0.05). Conclusion: A greater Q-angle is a risk factor linked to anterior knee pain within the female population. Decreased muscle strength of knee joint extensors is a risk factor linked to anterior knee pain in both sex subgroups.
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Affiliation(s)
- Darko Milovanović
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, dr Subotića 8, 11000 Belgrade, Serbia
| | - Ninoslav Begović
- School of Medicine, University of Belgrade, dr Subotića 8, 11000 Belgrade, Serbia
- Institute for Mother and Child Health Care of Serbia, Radoja Dakica 6-8, 11070 Belgrade, Serbia
| | - Bojan Bukva
- School of Medicine, University of Belgrade, dr Subotića 8, 11000 Belgrade, Serbia
- University Children's Hospital, Tiršova 10, 11000 Belgrade, Serbia
| | - Siniša Dučić
- School of Medicine, University of Belgrade, dr Subotića 8, 11000 Belgrade, Serbia
- University Children's Hospital, Tiršova 10, 11000 Belgrade, Serbia
| | - Aleksandar Vlahović
- School of Medicine, University of Belgrade, dr Subotića 8, 11000 Belgrade, Serbia
- Institute for Mother and Child Health Care of Serbia, Radoja Dakica 6-8, 11070 Belgrade, Serbia
| | - Zoran Paunović
- School of Medicine, University of Belgrade, dr Subotića 8, 11000 Belgrade, Serbia
- Institute for Mother and Child Health Care of Serbia, Radoja Dakica 6-8, 11070 Belgrade, Serbia
| | - Marko Kadija
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, dr Subotića 8, 11000 Belgrade, Serbia
| | - Nikola Topalović
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Visegradska 26/II, 11000 Belgrade, Serbia
| | - Lazar Stijak
- Department for Anatomy, School of Medicine, University of Belgrade, dr Subotića 8, 11000 Belgrade, Serbia
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Salaffi F, Carotti M, Poliseno AC, Ceccarelli L, Farah S, Di Carlo M, Giovagnoni A. Quantification of sarcopenia in patients with rheumatoid arthritis by measuring the cross-sectional area of the thigh muscles with magnetic resonance imaging. LA RADIOLOGIA MEDICA 2023; 128:578-587. [PMID: 37120660 PMCID: PMC10182126 DOI: 10.1007/s11547-023-01630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To determine the utility of cross-sectional area (CSA) measurements on magnetic resonance imaging (MRI), at the level of the thigh muscles, to estimate muscle mass in discriminating rheumatoid arthritis (RA) patients with sarcopenia from those without. MATERIALS AND METHODS Consecutive female RA patients were enrolled for this cross-sectional study. Patients were assessed for disease activity, radiological damage, handgrip strength, physical performance and for the presence of sarcopenia, identified in accordance with the EWGSOP2 criteria. A 1.5 T MRI machine was used to scan the thigh muscles. A dimensional region growth algorithm (Horos™) was used to segment the muscles CSAs (in cm2) on MR images located 25 cm above the knee joint (MRI-CSA-25). The MRI-CSA-25 was obtained by summing the CSAs of the individual muscles. MRI-CSA-25 was correlated (Pearson's r) with the other variables, and its optimal cut-off point (Youden index) for sarcopenia diagnosis was identified in relation to the EWGSOP2 criteria. RESULTS 32 RA female patients were studied, 34.4% diagnosed as sarcopenic. The mean MRI-CSA-25 was 151.00 cm2 for patient with sarcopenia, 275.57 cm2 for patient without sarcopenia (p < 0.001). MRI-CSA-25 correlated significantly with measures of physical performance, and disease activity, but not with radiological damage or age. The MRI-CSA-25 optimal cut-off point in discriminating sarcopenic patients was identified at 182.00 cm2 (AUC-ROC = 0.894). CONCLUSION MRI-CSA-25 can differentiate sarcopenic versus non-sarcopenic RA patients, representing an imaging biomarker of this condition.
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Affiliation(s)
- Fausto Salaffi
- Clinica Reumatologica, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, 60035, Jesi (Ancona), Italy
| | - Marina Carotti
- Dipartimento di Scienze Radiologiche, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Anna Claudia Poliseno
- Dipartimento di Scienze Radiologiche, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Ceccarelli
- IRCCS AOUBO, Pediatric and Adult Cardio-Thoracovascular, Onchoematologic and Emergencies Radiology Unit, Bologna, Italy
| | - Sonia Farah
- Clinica Reumatologica, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, 60035, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Clinica Reumatologica, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, 60035, Jesi (Ancona), Italy.
| | - Andrea Giovagnoni
- Dipartimento di Scienze Radiologiche, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Souza de Vasconcelos G, Eduarda Chinotti Batista da Silva M, S Nunes G, Viadanna Serrão F. Relationship between kinesiophobia, isometric hip and knee torques to pelvic, hip and knee motion during the single-leg drop jump in women with patellofemoral pain: A cross-sectional study. Knee 2023; 42:264-272. [PMID: 37116339 DOI: 10.1016/j.knee.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Individuals with patellofemoral pain (PFP) have kinesiophobia and hip and knee strength deficits. These factors may be related to kinematic alterations of pelvic, hip and knee during a more demanding functional activity, such as jumping landing. The aim was to investigate the relationships between kinesiophobia and hip/knee torque to pelvic/hip/knee kinematics during the single-leg drop vertical jump in women with PFP. METHOD Thirty women with PFP were assessed with Tampa Scale for Kinesiophobia; isokinetic dynamometry of the hip extensor, hip abductor, and knee extensor; and three-dimensional motion analysis system during the single-leg drop vertical jump. A Pearson correlation matrix was used to investigate relationship among variables. RESULTS Fair correlations were found between increased kinesiophobia and increased peak hip internal rotation angle (r = 0.43; p = 0.018) as well as between greater peak knee extensor torque and greater peak knee flexion (r = 0.41; p = 0.022). Moderate to good correlation was found between increased peak hip abductor torque and increased peak contralateral pelvic drop (r = 0.52; p = 0.003). No other significant correlations were found between variables. CONCLUSIONS Kinesiophobia is associated with hip kinematics, but not with knee kinematics, during the single-leg vertical drop jump in women with PFP. The greater hip abductor torque is associated with greater contralateral pelvic drop. The positive relationship between knee extensor torque and knee flexion indicates that rehabilitation programs involving quadriceps muscle strengthening may assist women with PFP in control knee flexion and improve load absorption during jumping landing.
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Affiliation(s)
- Gabriela Souza de Vasconcelos
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo CEP 13565-905, Brazil.
| | | | - Guilherme S Nunes
- Physiotherapy and Rehabilitation Department, Federal University of Santa Maria (UFSM), Av Roraima 1000, Santa Maria, Rio Grande do Sul CEP 97105-900, Brazil
| | - Fábio Viadanna Serrão
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo CEP 13565-905, Brazil
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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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Fang B, Kim YH, Choi MY. Effects of High-Intensity Aquatic or Bicycling Training in Athletes with Unilateral Patellofemoral Pain Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084675. [PMID: 35457543 PMCID: PMC9028389 DOI: 10.3390/ijerph19084675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Patellofemoral pain syndrome (PFPS) is one of the most common overuse injuries experienced by athletes. It is characterized by pain and functional deficits that lead to decreased performance, thereby limiting sports activity. Therefore, optimal training interventions are required to improve physical fitness and function while minimizing pain due to PFPS. This study aimed to compare and analyze the effects of high-intensity aquatic training (AT) and bicycling training (BT) in male athletes with PFPS. Fifty-four athletes with PFPS were divided into AT and BT intervention groups. Intervention training was conducted three times per week for 8 weeks. Cardiorespiratory fitness was evaluated using the graded exercise test (GXT) based on peak oxygen uptake (VO2 peak), and anaerobic threshold. For the knee strength test, extension and flexion were performed and measured using isokinetic equipment. One-leg hop tests and the Y-balance test (YBT) were performed to evaluate dynamic balance, and the International Knee Documentation Committee (IKDC) scoring system was used for subjective knee evaluation. The GXT, YBT, and IKDC scores were reported according to the group and duration of the intervention. After training, VO2 peak, YBT, knee extension strength, and IKDC score improved significantly in both the AT and BT groups compared with the pre-training values. Furthermore, the AT group exhibited significant improvement compared with the BT group. We demonstrated that AT and BT effectively improved the symptoms and muscle strength of athletes with PFPS who were only able to engage in limited high-intensity field training. AT produced a modestly better effect than BT.
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Affiliation(s)
- Bin Fang
- College of Physical Education, Luoyang Normal University, Luoyang 471934, China;
| | - Yong-hwan Kim
- Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Korea;
| | - Moon-young Choi
- Department of Sports Science Convergence, Dongguk University, Seoul 04620, Korea
- Correspondence: ; Tel.: +82-2-2260-8741; Fax: +82-2-2260-3741
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Rodrigues R, Daiana Klein K, Dalcero Pompeo K, Aurélio Vaz M. Are There Neuromuscular Differences on Proximal and Distal Joints in Patellofemoral Pain People? A Systematic Review and Meta-Analysis. J Electromyogr Kinesiol 2022; 64:102657. [DOI: 10.1016/j.jelekin.2022.102657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/11/2022] [Accepted: 03/16/2022] [Indexed: 12/26/2022] Open
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Karapınar M, Atilla Ayyıldız V, Ünal M, Fırat T. Ultrasound imaging of quadriceps muscle in patients with knee osteoarthritis: The test-retest and inter-rater reliability and concurrent validity of echo intensity measurement. Musculoskelet Sci Pract 2021; 56:102453. [PMID: 34507044 DOI: 10.1016/j.msksp.2021.102453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 08/03/2021] [Accepted: 08/29/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Echo intensity(EI) on ultrasonography images of skeletal muscle reflects muscle composition. OBJECTIVES The primary aim of the study was to investigate the inter-rater and test-retest reliability of EI using grayscale histogram analysis of the cross-sectional area of quadriceps femoris(QF) muscle in patients with knee osteoarthritis(KOA). The secondary aim of the study was to determine the concurrent validity of the Free Hand Tool(FHT) when compared to Rectangular Marquee Tool(RMT) for calculating the region of interest(ROI) in ImageJ. METHODS This study included thirty patients with KOA. Echogenicity of the QF muscle were performed by two different raters. The reliability analysis was applied using intraclass correlation coefficient(ICC), standard error of measurement(SEM) and coefficient of variation(CV). Spearman rank correlation coefficients were calculated for assessing concurrent validity of the FHT to RMT. The Bland-Altman plots was used to show disagreement between tools. Wilcoxon signed-rank test was used for differences in assessments between test/retest sessions, raters, tools. RESULTS The inter-rater and test-retest reliability of the EI using FHT and RMT was found to be excellent (ICCFHT = 0.91-0.95, 0.98-0.99, ICCRMT = 0.91-0.98, 0.91-0.99,respectively). Bland-Altman analysis demonstrated a slight bias when region ROI calculations were collected from RMT or FHT (bias ranging from 2.75 to-2.40 a. u). There were no significant differences between test/retest sessions, raters and tools(p > 0.05). Spearman correlation coefficient showed excellent correlation between tools used for echogenicity assessment of QF muscle(p < 0.001). CONCLUSION EI assessment using ultrasonography in the QF muscle showed excellent reliability. Evaluating muscle echogenicity using both FHT and RMT appears to be reliable and validity for monitoring muscle changes due to KOA.
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Affiliation(s)
- Merve Karapınar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey.
| | - Veysel Atilla Ayyıldız
- Department of Radiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Meriç Ünal
- Sports Medicine Department, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Tüzün Fırat
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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de Vasconcelos GS, Nunes GS, Barton CJ, Munhoz RF, da Silva MECB, Pisani GK, Luz BC, Serrão FV. Adding muscle power exercises to a strength training program for people with patellofemoral pain: protocol of a randomized controlled trial. Trials 2021; 22:777. [PMID: 34742328 PMCID: PMC8572497 DOI: 10.1186/s13063-021-05748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Strong evidence supports the proximal combined with quadriceps strengthening for patellofemoral pain (PFP) rehabilitation. However, most reported rehabilitation programs do not follow specific exercise prescription recommendations or do not provide adequate details for replication in clinical practice. Furthermore, people with PFP have power deficits in hip and knee muscles and it remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. Therefore, this study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles comprising power and strength exercises are greater than those of a program consisting of strength exercises only. Method This study will be a randomized controlled trial that will be conducted at university facilities. A minimum of 74 people with PFP between the ages of 18 and 45 years will be included. The experimental group will engage in a 12-week resistance training program focusing on proximal and knee muscles using power and strength exercises. The control group will engage in a 12-week resistance training program focusing on proximal and knee muscles using strength exercises only. Primary outcomes will be pain intensity and physical function; and secondary outcomes will be kinesiophobia, self-reported improvement, quality of life, peak hip and knee torque, and hip and knee rate of force development. The primary outcomes will be evaluated at baseline, and after 6 weeks, 12 weeks, 3 months, 6 months, and 1 year. The secondary outcomes will be evaluated at baseline and immediately after the interventions. Therapists and participants will not be blinded to group allocation. Discussion This randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for PFP rehabilitation. The study will provide additional knowledge to support rehabilitation programs for people with PFP. Trial registration ClinicalTrials.gov NCT 03985254. Registered on 26 August 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05748-x.
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Affiliation(s)
- Gabriela Souza de Vasconcelos
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil.
| | - Guilherme Silva Nunes
- Physiotherapy and Rehabilitation Department, Federal University of Santa Maria (UFSM), Av Roraima 1000, Santa Maria, Rio Grande do Sul, CEP 97105-900, Brazil
| | - Christian John Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Raquel Fantinelli Munhoz
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil
| | | | - Giulia Keppe Pisani
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil
| | - Bruna Calazans Luz
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil
| | - Fábio Viadanna Serrão
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo, CEP 13565-905, Brazil
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12
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Ferreira AS, de Oliveira Silva D, Ferrari D, Magalhães FH, Pappas E, Briani RV, Pazzinatto MF, de Azevedo FM. Knee and Hip Isometric Force Steadiness Are Impaired in Women With Patellofemoral Pain. J Strength Cond Res 2021; 35:2878-2885. [PMID: 31343549 DOI: 10.1519/jsc.0000000000003215] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Ferreira, AS, de Oliveira Silva, D, Ferrari, D, Magalhães, FH, Pappas, E, Briani, RV, Pazzinatto, MF, and de Azevedo, FM. Knee and hip isometric force steadiness are impaired in women with patellofemoral pain. J Strength Cond Res 35(10): 2878-2885, 2021-The purposes were as follows: to compare knee extension and hip abduction force steadiness and maximal strength between women with patellofemoral pain (PFP) and pain-free women; and to investigate whether maximal strength, self-reported pain during force-matching tasks, self-reported knee function, symptoms duration, and physical activity level are associated with knee extension and hip abduction force steadiness. Thirty women with PFP and 30 pain-free women were recruited. Knee extension and hip abduction maximal voluntary isometric contractions and submaximal isometric force-matching tasks were evaluated using an isokinetic dynamometer. Subjects were asked to match a target force corresponding to 10% of their maximal isometric voluntary contraction while force steadiness was computed as the coefficient of variation (CV) of the exerted force. Women with PFP had significant 36% lower knee extension and 33% lower hip abduction peak strength. They also had significant 70% lower knee extension force steadiness and 60% lower hip abduction force steadiness (i.e., higher CV) than pain-free women. Self-reported pain and self-reported knee function were significantly associated (r = 0.61, p < 0.001; r = -0.35, p = 0.05) and able to predict 41% of the variance of knee extensor force steadiness. Hip abductor maximum strength was significantly associated (r = -0.57; p = 0.001) and able to predict 32% of the variance of hip abductor force steadiness. These findings indicate that muscle impairments in PFP go beyond only low knee and hip muscle strength because women with PFP also present deficits in knee extension and hip abduction force steadiness. Evidence-based treatments aiming at improving force steadiness may be a promising addition to PFP rehabilitation programs.
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Affiliation(s)
- Amanda S Ferreira
- Laboratory of Biomechanics and Motor Control (LABCOM), Physiotherapy Department, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Danilo de Oliveira Silva
- Laboratory of Biomechanics and Motor Control (LABCOM), Physiotherapy Department, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.,La Trobe Sports and Exercise Medicine Research Center (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Deisi Ferrari
- Laboratory of Biomechanics and Motor Control (LABCOM), Physiotherapy Department, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Fernando H Magalhães
- School of Arts, Sciences, and Humanities, University of Sao Paulo, Sao Paulo, Brazil; and
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ronaldo V Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), Physiotherapy Department, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Marcella F Pazzinatto
- Laboratory of Biomechanics and Motor Control (LABCOM), Physiotherapy Department, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.,La Trobe Sports and Exercise Medicine Research Center (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Fábio M de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), Physiotherapy Department, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
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13
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Ferreira AS, de Oliveira Silva D, Barton CJ, Briani RV, Taborda B, Pazzinatto MF, de Azevedo FM. Impaired Isometric, Concentric, and Eccentric Rate of Torque Development at the Hip and Knee in Patellofemoral Pain. J Strength Cond Res 2021; 35:2492-2497. [PMID: 31045684 DOI: 10.1519/jsc.0000000000003179] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ABSTRACT Ferreira, AS, de Oliveira Silva, D, Barton, CJ, Briani, RV, Taborda, B, Pazzinatto, MF, and de Azevedo, FM. Impaired isometric, concentric, and eccentric rate of torque development at the hip and knee in patellofemoral pain. J Strength Cond Res 35(9): 2492-2497, 2021-The aims of this study were to compare maximal muscle strength and rate of torque development (RTD) of knee extensor and hip abductor during isometric, concentric, and eccentric contractions between women with and without patellofemoral pain (PFP). Thirty-eight women with PFP (PFPG) and 38 pain-free women (CG) participated in this study. Isometric, concentric, and eccentric maximal torque and RTD of knee extensor and hip abductor were assessed using an isokinetic dynamometer. Rate of torque development was calculated as the change in torque over the change in time from torque onset to 30, 60, and 90% of the maximal torque (RTD30%, RTD60%, and RTD90%) during isometric, concentric, and eccentric contractions. PFPG had lower isometric, concentric, and eccentric knee extensor maximal torque (29.9, 28.3, and 26.7%) compared with the CG. For knee extensor RTD, PFPG had slower isometric RTD30% (17.8%), RTD60% (21.5%), and RTD90% (23.4%); slower concentric RTD30% (35.7%), RTD60% (29.3%), and RTD90% (28.2%); and slower eccentric RTD30% (20.5%), RTD60% (25.2%), and RTD90% (22.5%) compared with the CG. PFPG had lower isometric, concentric, and eccentric hip abductor maximal torque (28.3, 21.8, and 17%) compared with the CG. For hip abductor RTD, PFPG had slower isometric RTD30% (32.6%), RTD60% (31.1%), and RTD90% (25.4%); slower concentric RTD90% (11.5%); and slower eccentric RTD30% (19.8%), RTD60% (26.4%), and RTD90% (24%) compared with the CG. In conclusion, women with PFP presented deficits in both maximal strength and RTD of knee extensor and hip abductor during isometric, concentric, and eccentric contractions, which highlight the potential importance of addressing different aspects of muscle function through exercise therapy.
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Affiliation(s)
- Amanda S Ferreira
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and
| | - Danilo de Oliveira Silva
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and.,Physiotherapy Department, La Trobe Sports and Exercise Medicine Research Center (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Christian J Barton
- Physiotherapy Department, La Trobe Sports and Exercise Medicine Research Center (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Ronaldo V Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and
| | - Bianca Taborda
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and
| | - Marcella F Pazzinatto
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and.,Physiotherapy Department, La Trobe Sports and Exercise Medicine Research Center (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Fábio M de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and
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14
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Amestoy J, Pérez-Prieto D, Torres-Claramunt R, Sánchez-Soler JF, Leal-Blanquet J, Ares-Vidal J, Hinarejos P, Monllau JC. Patellofemoral Pain After Arthroscopy: Muscle Atrophy Is Not Everything. Orthop J Sports Med 2021; 9:23259671211013000. [PMID: 34262977 PMCID: PMC8246502 DOI: 10.1177/23259671211013000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background It remains unclear as to why patellofemoral pain (PFP) appears in some patients after knee arthroscopy and what influence the quadriceps muscle has on its onset. Purpose To compare muscle thickness, neuromuscular contractility, and quadriceps femoris muscle strength between patients who develop PFP after arthroscopic partial meniscectomy and a control group and to compare functional outcomes between these entities. Study Design Cohort study; Level of evidence, 3. Methods A prospective longitudinal cohort study was carried out on patients scheduled for arthroscopic partial meniscectomy. Patients were excluded if they had preoperative PFP, previous knee surgery, or additional surgical procedures (eg, meniscal repair or microfracture). The following were performed preoperatively: magnetic resonance imaging to quantify muscle thickness, surface electromyography to analyze electrical contractility, and an isokinetic study to assess the strength of the quadriceps femoris muscle. Patients also completed a Lysholm functional questionnaire. Six weeks after the index procedure, patients were questioned about the presence of PFP, and the same tests were repeated. The PFP group included patients who developed anterior knee pain postoperatively, while the control group included those who did not develop pain. Results Of 90 initial study patients, 20 were included in the PFP group (23.8%) and 64 in the control group (76.2%); 6 patients were lost to follow-up. Both study groups were comparable on all of the analyzed preoperative variables. Patients in the PFP group had worse results in terms of muscle thickness (9.67 vs 16.55 cm2), electrical contractility (1226.30 vs 1946.11 µV), and quadriceps strength (12.27 vs 20.02 kg; all P < .001). They also presented worse functional results on the Lysholm score (63.05 vs 74.45; P < .001). Conclusion Patients who developed PFP after arthroscopic partial meniscectomy had more quadriceps femoris muscle atrophy as well as a greater decrease in electrical contractility and muscle strength at 6 weeks postsurgically as compared with a control group. The PFP group also had worse postoperative functional results.
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Affiliation(s)
| | - Daniel Pérez-Prieto
- Department for Orthopedics and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raúl Torres-Claramunt
- Department for Orthopedics and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Francisco Sánchez-Soler
- Department for Orthopedics and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Leal-Blanquet
- Department for Orthopedics and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Ares-Vidal
- Department for Radiology, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Pedro Hinarejos
- Department for Orthopedics and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Carles Monllau
- Department for Orthopedics and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Ho KY, Chen YJ, Farrokhi S, Tsai LC, Liao TC, Haas N, Powers CM. Selective Atrophy of the Vastus Medialis: Does It Exist in Women With Nontraumatic Patellofemoral Pain? Am J Sports Med 2021; 49:700-705. [PMID: 33497254 DOI: 10.1177/0363546520982244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A commonly cited theory related to the pathomechanics of patellofemoral pain (PFP) states that atrophy of the vastus medialis (VM) muscle leads to lateral tracking of the patella. However, isolated atrophy of the VM or atrophy of the quadriceps muscle group as a whole, has not been consistently reported in this population. PURPOSE To compare individual and total quadriceps muscle volumes between women with nontraumatic PFP and women without PFP as measured on magnetic resonance imaging scans. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 52 women with nontraumatic PFP and 64 women without PFP between the ages of 18 and 45 years participated. Magnetic resonance imaging scans of the thigh were obtained from the anterior inferior iliac spine to the tibial plateau. Individual quadriceps muscle cross-sectional area measurements were obtained from each image, and muscle volumes for the VM, vastus lateralis, vastus intermedius, and rectus femoris were calculated. Muscle volume measurements were expressed in absolute values and normalized to body mass. Separate 2-way mixed-factorial analysis of variance (group × muscle) were used to compare absolute and normalized individual muscle volumes between groups. Independent t tests were used to compare absolute and normalized total quadriceps volumes between groups. RESULTS There was no difference in absolute and normalized individual muscle volumes between individuals with and those without PFP. Additionally, absolute and normalized total muscle volumes did not differ between groups. CONCLUSION Our findings do not support the concept of preferential atrophy of the VM or generalized quadriceps atrophy in women with nontraumatic PFP.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, USA
| | - Yu-Jen Chen
- Department of Physical Education, Fu Jen Catholic University, Taipei, Taiwan
| | - Shawn Farrokhi
- DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), Naval Medical Center, San Diego, California, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, Atlanta, Georgia, USA
| | - Tzu-Chieh Liao
- Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan, USA
| | | | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
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16
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Rhode C, Louw QA, Leibbrandt DC, Williams L. Joint position sense in individuals with anterior knee pain. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1497. [PMID: 33824918 PMCID: PMC8008049 DOI: 10.4102/sajp.v77i1.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/17/2020] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Anterior knee pain (AKP) commonly affects both physically active and sedentary individuals and the aetiology is unknown. Altered joint position sense (JPS) impacts accurate motor action and knee joint stability. It is unclear whether people with AKP have altered JPS. OBJECTIVE The aim of our study was to investigate JPS in the knees of individuals with AKP. METHOD A descriptive cross-sectional study measured JPS in 25 participants with unilateral or bilateral AKP. JPS was measured using active JPS testing during single leg squat (SLS) and active knee extension (AKE) in sitting. Target angles (TA) were self-determined based on each participant's capabilities. The absolute error (AE) was the main outcome measure. Impaired JPS was classified as an AE equal to or greater than five degrees. RESULTS There were no significant differences in JPS when comparing the affected and unaffected knees in participants with AKP (p > 0.05). However, a subgroup of participants with altered knee JPS was identified. There was a tendency towards greater knee flexion in the TAs of knees without AKP. CONCLUSION Our results showed that JPS is not significantly more impaired in knees with AKP compared with knees without AKP in a group of individuals with AKP. A subgroup with altered JPS in knees with and without AKP was identified. This finding could be because of compensatory gait patterns and the precision of the Vicon 3D motion analysis system. CLINICAL IMPLICATIONS Joint position sense should be assessed bilaterally in individuals with AKP.
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Affiliation(s)
- Carlyn Rhode
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dominique C Leibbrandt
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leone Williams
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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17
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Dong C, Li M, Hao K, Zhao C, Piao K, Lin W, Fan C, Niu Y, Fei W. Dose atrophy of vastus medialis obliquus and vastus lateralis exist in patients with patellofemoral pain syndrome. J Orthop Surg Res 2021; 16:128. [PMID: 33568152 PMCID: PMC7877190 DOI: 10.1186/s13018-021-02251-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background Whether vastus medialis obliquus atrophy exists in patients with patellofemoral pain syndrome and whether the amount of atrophy differs between the vastus medialis obliquus and vastus lateralis muscles remain unknown. Materials From June 2016 to March 2019, 61 patients with patellofemoral pain syndrome were retrospectively included in the study group, and an age-, sex-, and body mass index-matched cohort of 61 patients with normal knees was randomly selected as the control group. All enrolled subjects had undergone CT scans in the supine position. The cross-sectional areas of the vastus medialis obliquus and the vastus lateralis muscle in the sections 0, 5, 10, 15, and 20 mm above the upper pole of the patella were measured, and the vastus medialis obliquus/vastus lateralis muscle area ratio was evaluated. Results In the study group, the vastus medialis obliquus areas and the vastus lateralis muscle areas in the sections that were 0, 5, 10, 15, and 20 mm above the upper pole of the patella were significantly smaller than the respective areas in the control group (P < 0.05). The vastus medialis obliquus/vastus lateralis muscle area ratio was significantly smaller at the upper pole of the patella (the section 0 mm above the upper pole of the patella) than the corresponding ratio in the control group (P < 0.05). No significant difference was noted between the two groups in the sections 5, 10, 15, and 20 mm above the upper pole of the patella (P > 0.05). Conclusion In patients with patellofemoral pain syndrome, vastus medialis obliquus and vastus lateralis muscle atrophy existed in sections 0–20 mm above the upper pole of the patella, compared with normal controls, and atrophy of the vastus medialis obliquus was more evident than that of the vastus lateralis muscle at the upper pole of the patella. These findings support the rationale for the use of general quadriceps exercise combined with vastus medialis obliquus strengthening exercise as part of the rehabilitation programme for the patients with patellofemoral pain syndrome.
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Affiliation(s)
- Conglei Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Ming Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Kuo Hao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chao Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Kang Piao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Wei Lin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chongyi Fan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Wang Fei
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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18
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Pompeo KD, da Rocha ES, Melo MA, de Oliveira NT, Oliveira DF, Sonda FC, dos Santos PF, Rodrigues R, Vaz MA. Proximal, Local, and Distal Muscle Morphology in Women With Patellofemoral Pain. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320972097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this study was to compare proximal, local, and distal muscle morphology in women with and without patellofemoral pain (PFP). Materials and Methods: Proximal, local, and distal muscle thicknesses (MTs) were obtained with B-mode sonography in healthy (control group [CG], n = 20) and PFP (PFP group, n = 20) women. In addition, muscle mass was measured by the sum of the synergistic MTs. Data were analyzed by independent t-test, Mann-Whitney U test, and effect size. Results: PFP women had smaller gluteus medius ( P = .02, d = 0.7), vastus medialis ( P < .01, d = 1.0), and flexor digitorum brevis ( P < .01, d = 1.0) MT and greater gastrocnemius medialis ( P = .04, d = 0.6) MT than CG. Quadriceps muscle mass ( P = .01, d = 0.8) and foot muscle mass ( P = .008, d = 0.9) were smaller, while plantar flexor muscle mass was greater in the PFP group than in CG ( P = .01, d = 0.8). Conclusion: PFP women have proximal, local, and distal MT alterations in comparison with CG, which may explain possible changes in muscle strength and functionality.
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Affiliation(s)
- Klauber Dalcero Pompeo
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Emmanuel Souza da Rocha
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Mirella Ayres Melo
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | | | - Francesca Chaida Sonda
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Patrícia Freitas dos Santos
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
- Physique Centro de Fisioterapia, Porto Alegre, Brasil
| | | | - Marco Aurélio Vaz
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
- Physique Centro de Fisioterapia, Porto Alegre, Brasil
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19
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Improvements in Lower-Extremity Function Following a Rehabilitation Program With Patterned Electrical Neuromuscular Stimulation in Females With Patellofemoral Pain: A Randomized Controlled Trial. J Sport Rehabil 2020; 29:1075-1085. [DOI: 10.1123/jsr.2019-0278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/24/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022]
Abstract
Context: Patellofemoral pain (PFP) is a challenging condition, with altered kinematics and muscle activity as 2 common impairments. Single applications of patterned electrical neuromuscular stimulation (PENS) have improved both kinematics and muscle activity in females with PFP; however, the use of PENS in conjunction with a rehabilitation program has not been evaluated. Objective: To determine the effects of a 4-week rehabilitation program with PENS on lower-extremity biomechanics and electromyography (EMG) during a single-leg squat (SLS) and a step-down task (SDT) in individuals with PFP. Study Design: Double-blinded randomized controlled trial. Setting: Laboratory. Patients of Other Participants: Sixteen females with PFP (age 23.3 [4.9] y, mass 66.3 [13.5] kg, height 166.1 [5.9] cm). Intervention: Patients completed a 4-week supervised rehabilitation program with or without PENS. Main Outcome Measures: Curve analyses for lower-extremity kinematics and EMG activity (gluteus maximus, gluteus medius, vastus medialis oblique, vastus lateralis, biceps femoris, and adductor longus) were constructed by plotting group means and 90% confidence intervals throughout 100% of each task, before and after the rehabilitation program. Mean differences (MDs) and SDs were calculated where statistical differences were identified. Results: No differences at baseline in lower-extremity kinematics or EMG were found between groups. Following rehabilitation, the PENS group had significant reduction in hip adduction between 29% and 47% of the SLS (MD = 4.62° [3.85°]) and between 43% and 69% of the SDT (MD = 6.55° [0.77°]). Throughout the entire SDT, there was a decrease in trunk flexion in the PENS group (MD = 10.91° [1.73°]). A significant decrease in gluteus medius activity was seen during both the SLS (MD = 2.77 [3.58]) and SDT (MD = 4.36 [5.38]), and gluteus maximus during the SLS (MD = 1.49 [1.46]). No differences were seen in the Sham group lower-extremity kinematics for either task. Conclusion: Rehabilitation with PENS improved kinematics in both tasks and decreased EMG activity. This suggests that rehabilitation with PENS may improve muscle function during functional tasks.
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Ashnagar Z, Hadian MR, Sajjadi E, Kajbafvala M, Olyaei G, Pashazadeh F, Rezasoltani A. Quadriceps architecture in individuals with patellofemoral pain: A systematic review. J Bodyw Mov Ther 2020; 25:248-254. [PMID: 33714504 DOI: 10.1016/j.jbmt.2020.08.007] [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: 02/26/2020] [Revised: 07/18/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To identify differences in architectural parameters (size, fiber/pennation angle, fiber length, and echogenicity) of the quadriceps muscle, as a whole or any individual part of it, using imaging techniques in individuals with patellofemoral pain (PFP) compared to contralateral, asymptomatic limb or separate control group. BACKGROUND Quadriceps muscles imbalance and weakness were proposed as risk factors for developing PFP. Although the muscle architecture (size, pennation/fiber angle and fiber length) is highly associated with skeletal muscle strength, it is not clear whether atrophy or any changes in architectural parameters of the quadriceps are presented in the PFP patients. METHODS Observational studies in which the total size of the quadriceps or individual parts of it were measured using imaging techniques in the PFP patients were included in this review. Electronic databases (PubMed, SCOPUS, PEDro, CINAHL, WOS, and EMBASE) were searched between January 1990 and December 2019 with no restriction of language. Study selection and data extraction and quality assessment were conducted by two independent reviewers. RESULTS Five cross-sectional studies were eligible to include in this review. Three out of five included studies that assessed the total size of the quadriceps and reported no significant differences between the PFP and healthy control group. Two out of five of the studies assessed the total size of the quadriceps between the symptomatic and asymptomatic limb of the PFP patients and reported the statistical difference between limbs. Only one study measured the fiber angle of the VMO muscle at the patella. Controversial results were found between studies that assessed the size of individual parts of the quadriceps. CONCLUSION Due to the controversial results of the included studies, this systematic review failed to draw a conclusion on the role of quadriceps atrophy in PFP pathology. The limitation in PFP literature considering pennation/fiber angle, echogenicity and fiber length of individual parts of the quadriceps muscle, rises the need for research that focuses on the biomechanical properties of the quadriceps in PFP patients.
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Affiliation(s)
- Zinat Ashnagar
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad-Reza Hadian
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elaheh Sajjadi
- Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
| | - Mehrnaz Kajbafvala
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Olyaei
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Iran.
| | - Asghar Rezasoltani
- Faculty of Rehabilitation, Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Motealleh A, Barzegar A, Abbasi L. The immediate effect of lumbopelvic manipulation on knee pain, knee position sense, and balance in patients with patellofemoral pain: A randomized controlled trial. J Bodyw Mov Ther 2020; 24:71-77. [PMID: 32826011 DOI: 10.1016/j.jbmt.2020.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/27/2019] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common musculoskeletal disorder. Quadriceps and core muscle neuromuscular control impairments are frequently associated with PFP. Lumbopelvic manipulation (LPM) has been shown to improve quadriceps and core muscle activation and decrease their inhibition, but changes in balance and knee joint position sense (JPS) after this intervention remain unknown. OBJECTIVE To determine whether LPM decreases knee pain and JPS error and increases balance performance in patients with PFP. DESIGN Randomized controlled trial. SETTING Biomechanics laboratory at a rehabilitation science research center. METHODS Forty-four patients with PFP participated in this study that randomly divided into two equal groups. One group received LPM and the other received sham LPM (positioning with no thrust) in a single session. At baseline and immediately after the intervention, the outcomes of pain using a visual analog scale, balance using the modified star excursion balance test (mSEBT), and JPS at 20° and 60° of knee flexion using a Biodex dynamometer. RESULTS There was a statistically significant improvement in pain, balance control (anterior direction) and JPS in the LPM group immediately after the intervention. In addition, we observed significant differences between groups in pain, balance control (anterior direction) and JPS at 60° of knee flexion immediately after the intervention. CONCLUSION A single session of LPM immediately improved balance control, knee JPS, and pain in patients diagnosed with PFP. CLINICAL REHABILITATION IMPACT Findings suggest that LPM may be used as a therapeutic tool for immediate improvement of symptoms of PFP. However, more research is needed to determine long term results.
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Affiliation(s)
- Alireza Motealleh
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Barzegar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Abbasi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Cao W, Qiu J, Cai T, Yi L, Benardot D, Zou M. Effect of D-ribose supplementation on delayed onset muscle soreness induced by plyometric exercise in college students. J Int Soc Sports Nutr 2020; 17:42. [PMID: 32778175 PMCID: PMC7418385 DOI: 10.1186/s12970-020-00371-8] [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: 11/02/2019] [Accepted: 08/02/2020] [Indexed: 11/22/2022] Open
Abstract
Objective Previous investigations suggest that appropriate nutritional interventions may reduce delayed onset muscle soreness (DOMS). This study examined the effect of D-ribose supplementation on DOMS induced by plyometric exercise. Methods For the purpose of inducing DOMS, 21 untrained male college students performed a lower-limb plyometric exercise session that involved 7 sets of 20 consecutive frog hops with 90-s of rest between each set. Muscle soreness was measured with a visual analogue scale 1-h before, 24-h after, and 48-h after exercise. Subjects were then randomly placed into the D-ribose group (DRIB, n = 11) and the placebo group (PLAC, n = 10) to assure equivalent BMI and muscle soreness. After a 14-d washout/recovery period, subjects performed the same exercise session, with DRIB ingesting a 200 ml solution containing 15 g D-ribose 1-h before, 1-h, 12-h, 24-h, and 36-h after exercise, and PLAC ingesting a calorically equivalent placebo of the same volume and taste containing sorbitol and β-cyclodextrin. Muscle soreness and isokinetic muscle strength were measured, and venous blood was assessed for markers of muscle damage and oxidative stress 1-h before, 24-h and 48-h after exercise. Results In DRIB, muscle soreness after 24-h and 48-h in the second exercise session were significantly lower (p < 0.01) than was experienced in the first exercise session. In the second exercise, blood-related markers of muscle soreness, including creatine kinase, lactate dehydrogenase (LDH), myoglobin and malondialdehyde (MDA) in DRIB after 24-h were lower in DRIB after 24-h than in PLAC (MDA, p < 0.05; rest outcomes, p < 0.01). In addition, LDH and MDA in DRIB were significantly lower (p < 0.01) after 24-h in DRIB than in PLAC. No difference was found in isokinetic muscle strength and oxidative stress markers, including superoxide dismutase and total antioxidant capacity, between DRIB and PLAC after 24-h and 48-h. Conclusion D-ribose supplementation reduces muscle soreness, improves recovery of muscle damage, and inhibits the formation of lipid peroxides. Young adult males performing plyometric exercise are likely to realize a DOMS reduction through consumption of D-ribose in 15 g/doses both before (1-h) and after (1-h, 12-h, 24-h, 36-h) exercise. These results suggest that appropriately timed consumption of D-ribose may induce a similar alleviation of exercise-induced DOMS in the general public.
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Affiliation(s)
- Wei Cao
- Department of Exercise Biochemistry, Exercise Science School, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, China
| | - Junqiang Qiu
- Department of Exercise Biochemistry, Exercise Science School, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, China.
| | - Tianwei Cai
- Department of Exercise Biochemistry, Exercise Science School, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, China
| | - Longyan Yi
- Department of Exercise Biochemistry, Exercise Science School, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, China
| | - Dan Benardot
- Department of Nutrition, Georgia State University, Atlanta, GA, USA.,Center for the Study of Human Health, Emory University, Atlanta, GA, USA
| | - Menghui Zou
- China Athletics College, Beijing Sport University, Beijing, BJ, China
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Glaviano NR, Saliba S. Differences in Gluteal and Quadriceps Muscle Activation During Weight-Bearing Exercises Between Female Subjects With and Without Patellofemoral Pain. J Strength Cond Res 2019; 36:55-62. [DOI: 10.1519/jsc.0000000000003392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ashnagar Z, Kajbafvala M, Hadian MR, Olyaei G, Rezasoltani A, Keshtkar AA, Ansari F, Pashazadeh F. Quadriceps architecture in individuals with patellofemoral pain: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:1277-1282. [PMID: 30451708 DOI: 10.11124/jbisrir-2017-003689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The objective of this review is to identify differences in quadriceps architectural parameters between healthy individuals and those with patellofemoral pain (PFP). INTRODUCTION Patellofemoral pain is one of the most common causes of knee pain among physically active populations. Muscular imbalance may play an important role in patellar malalignment or patellar maltracking. A systematic review will clarify the possible architectural changes of quadriceps muscles in persons with PFP. INCLUSION CRITERIA Eligible observational studies will include individuals younger than 50 years who have been diagnosed with unilateral or bilateral PFP. The comparator will be the contralateral, asymptomatic limb of the individual with PFP or a healthy matched subject. Studies that include measurement of quadriceps muscle size as the primary outcome will be considered. Studies in which participants had coexisting pathology, a history of lower limb surgery or injury, or pain originating from other joints will be excluded. METHODS PubMed/MEDLINE (NLM), Scopus, Embase, Physiotherapy Evidence Database, Web of Science and CINAHL databases and multiple gray literature sources will be searched. Studies published since 1 January 1990 will be considered; there will be no language restriction. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. If possible, meta-analyses will be performed, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.
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Affiliation(s)
- Zinat Ashnagar
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Kajbafvala
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Hadian
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Olyaei
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Asghar Rezasoltani
- Faculty of Rehabilitation, Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ansari
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Iranian EBM Centre: a Joanna Briggs Institute Affiliated Group
| | - Fariba Pashazadeh
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Iranian EBM Centre: a Joanna Briggs Institute Affiliated Group
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Kızılkaya AÖ, Ecesoy H. Ultrasonographic assessment of quadriceps and patellar tendon thicknesses in patients with patellofemoral pain syndrome. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:272-277. [PMID: 31103417 PMCID: PMC6738452 DOI: 10.1016/j.aott.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/28/2019] [Accepted: 04/23/2019] [Indexed: 11/10/2022]
Abstract
Objective The aim of this study was to compare ultrasonographically measured quadriceps and patellar tendon thicknesses between Patellofemoral Pain Syndrome (PFPS) patients and age- and gender-matched healthy controls. Methods Among patients who presented to physical therapy and rehabilitation outpatient clinic in January–December 2016, 61 volunteers (28 men and 33 women; mean age: 30.79 ± 6.55 years) who were eligible considering the inclusion and exclusion criteria were enrolled. 30 were diagnosed with PFPS, and the remaining were age- and gender-matched healthy volunteers. Mean age was 30.03 ± 5.67 years in healthy subjects and 45.2% were of male gender. The patient group had mean age of 31.57 ± 7.37 years and 46.7% of the patients were male. Q angles were measured at standing, supine and sitting positions. Patellar and femoral tendon thicknesses and areas were measured ultrasonographically. Kujala questionnaire were used to evaluate the functional status of the participants. Results No significant difference was detected between groups regarding profession, educational background, and body mass indices (BMI) (p > 0.05). Q angle values were significantly higher in the patient group when compared to controls at standing (17.03 ± 3.84 vs. 13.87 ± 1.75°, p < 0.001), supine (16.20 ± 3.74 vs. 13.45 ± 1.79°, p = 0.001) and sitting (16.50 ± 3.28 vs. 13.71 ± 1.72°, p < 0.001) positions. Kujala score was significantly lower in the PFPS group when compared to controls (70.57 ± 8.37 vs. 98.58 ± 2.05, p < 0.001). Patellar (0.39 ± 0.08 vs. 0.32 ± 0.05 cm, p < 0.001) and quadriceps (0.64 ± 0.10 vs. 0.52 ± 0.09 cm, p < 0.001) tendon thicknesses were significantly higher in the PFPS group when compared to controls. There was no significant difference between groups regarding patellar tendon areas (p > 0.05). Patellar tendon thickness values of ≥0.35 cm were found to have 66.7% sensitivity and 67.7% specificity for PFPS diagnosis in the ROC curve analysis (area under curve: 0.771, 95% confidence interval: 0.655–0.887, p < 0.001). Quadriceps tendon thickness values of ≥0.54 cm were found to have 80% sensitivity and 71% specificity for PFPS diagnosis in the ROC curve analysis (area under curve: 0.824, 95% confidence interval: 0.710–0.939, p < 0.001). In PFPS patients, quadriceps tendon thickness had significant positive correlation with age (r = 0.405, p = 0.027) and BMI (r = 0.450, p = 0.013); and significant negative correlation with Kujala score (r = −0.441, p = 0.015). In the multivariate regression analysis, quadriceps tendon thickness was independently associated with the presence of PFPS (Exp (B): 3.089, 95% confidence interval: 1.344–7.100, p = 0.008). Conclusion Our study demonstrates that ultrasonographically measured patellar and quadriceps tendon thicknesses are significantly higher in subjects with PFPS and particularly, quadriceps tendon thickness may be used for the diagnosis. Level of Evidence Level III, Therapeutic Study.
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Nunes GS, Barton CJ, Viadanna Serrão F. Females with patellofemoral pain have impaired impact absorption during a single-legged drop vertical jump. Gait Posture 2019; 68:346-351. [PMID: 30579038 DOI: 10.1016/j.gaitpost.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/22/2018] [Accepted: 12/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Females with patellofemoral pain (PFP) have been reported to land with altered biomechanics in some, but not all studies. Kinematic alterations previously reported may indicate, and relate to potential impairments in absorbing impact. RESEARCH QUESTION To compare vertical ground reaction force (vGRF) and lower limb kinematics during single-legged drop vertical jumps in females with and without PFP; and establish the relationship between vGRF and kinematics during this task. METHODS Fifty-two physically active females (26 with PFP and 26 controls) participated in the present cross-sectional study. Peak of vGRF was evaluated during landing; and lower limb kinematics in the sagittal and frontal planes during deceleration (landing) and acceleration (take-off) phases were evaluated. RESULTS The PFP group had 11% greater vGRF (p < 0.01); and 13-24% lower hip, knee and ankle excursion in the sagittal plane during acceleration and deceleration phases (p ≤ 0.02) compared to the control group. No significant between group differences (p > 0.05) for hip, knee and ankle excursion in the frontal plane were identified. Greater impact was significantly correlated with reduced knee (r = -0.56), hip (r = -0.50) and ankle (r = -0.41) excursion in the sagittal plane during the acceleration phase in the control group, but not in the PFP group. No significant correlations were found between vGRF and kinematics variables during the deceleration phase in either group. SIGNIFICANCE Impaired ability to absorb load and reduced lower limb movement in the sagittal plane during landing in females with PFP may provide separate treatment targets during rehabilitation.
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Affiliation(s)
- Guilherme S Nunes
- Department of Physiotherapy, São Carlos Federal University, São Carlos, Brazil; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia.
| | - Christian John Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia
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Briani RV, De Oliveira Silva D, Flóride CS, Aragão FA, de Albuquerque CE, Magalhães FH, de Azevedo FM. Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain. PLoS One 2018; 13:e0205553. [PMID: 30304030 PMCID: PMC6179260 DOI: 10.1371/journal.pone.0205553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/27/2018] [Indexed: 12/30/2022] Open
Abstract
The present study aimed at investigating whether the neuromuscular system behaves differently (in terms of force and muscle activity generation) as a function of the task being performed (i.e. maximal voluntary efforts vs stair negotiation) and the presence of patellofemoral pain (PFP) and possible influences of pain intensity. Thirty-eight women with (n = 19) and without PFP (n = 19) had their knee strength (extension joint torque) measured during maximal voluntary isometric contractions (MVIC) and electromyography (EMG) data recorded during both MVIC and stair ascent tasks, which were performed before and after a loading protocol designed to exacerbate pain symptoms. Women with PFP displayed lower levels of vastus medialis (p = 0.002) and vastus lateralis (p = 0.032) EMG activation during MVIC assessments. Conversely, the PFP group showed higher levels of vastus medialis muscle activity during stair climbing (p = 0.007), which happened exclusively after the loading protocol. Similarly, women with PFP displayed lower knee extensor torque only during the MVIC tests performed after the loading protocol, which was moderately correlated with the increase in self-reported pain (p = 0.041, r = 0.37), whereas the changes in EMG activity during stair ascent were not correlated with changes in pain intensity (p = 0.215, r = 0.12). These results suggest that, in comparison to pain-free controls, women with PFP display lower levels of quadriceps EMG activation during maximal contractions, but higher activation during dynamic tasks (stair ascent). In addition, the moderate association between the decrease in knee extensor torque and increase in self-reported pain indicates that care should be taken by clinicians during quadriceps strength evaluation in women with PFP, as misleading outcomes may emerge if the intensity of knee pain is not considered during screening. Additionally, rehabilitation strategies should focus on both restoring neuromuscular control and increasing muscle strength.
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Affiliation(s)
- Ronaldo Valdir Briani
- Physical Therapy Department, School of Science and Technology, São Paulo State University, Presidente Prudente, Sao Paulo, Brazil
- * E-mail:
| | - Danilo De Oliveira Silva
- Physical Therapy Department, School of Science and Technology, São Paulo State University, Presidente Prudente, Sao Paulo, Brazil
| | - Carolina Silva Flóride
- Department of Physical Therapy, State University of West of Parana, Research Laboratory of Human Movement, Cascavel, Paraná, Brazil
| | - Fernando Amâncio Aragão
- Department of Physical Therapy, State University of West of Parana, Research Laboratory of Human Movement, Cascavel, Paraná, Brazil
| | - Carlos Eduardo de Albuquerque
- Department of Physical Therapy, State University of West of Parana, Research Laboratory of Human Movement, Cascavel, Paraná, Brazil
| | | | - Fábio Mícolis de Azevedo
- Physical Therapy Department, School of Science and Technology, São Paulo State University, Presidente Prudente, Sao Paulo, Brazil
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Melo SA, Macedo LDB, Borges DT, Brasileiro JS. Effects of kinesio taping on neuromuscular performance and pain of individuals affected by patellofemoral pain: A randomized controlled trial. Physiother Theory Pract 2018; 36:709-719. [PMID: 29985724 DOI: 10.1080/09593985.2018.1492657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Patellofemoral pain (PFP) is one of the most frequent musculoskeletal dysfunctions in the knee and its treatment is controversial. This study analyzed the effects of Kinesio Taping (KT) immediately and 72 hours after its application on the electromyographic (EMG) activity of the vastus medialis oblique (VMO) muscle, on the isokinetic performance of the quadriceps femoris and on the pain of subjects with PFP. Fifty-four participants were divided into three groups and performed one of the following protocols: (1) control group (CG)-remained at rest; (2) KT tension group (TG)-KT application with tension in the VMO region; and (3) KT without tension group (WTG)-KT application without tension in the same region. VMO and vastus lateralis (VL) EMG activity (RMS and onset), isokinetic performance and pain intensity were evaluated at three moments: before KT application, immediately after and 72 hours after. A mixed model ANOVA was used for statistical analysis with a significance level of 5% (p ≤ 0.05). No differences between the evaluated groups were found in relation to EMG variables and isokinetic performance. A reduction in pain intensity was found in the WTG in comparison to CG, after 72 hours. KT does not alter EMG parameters nor the isokinetic performance of subjects with PFP. However, we noticed reduced pain in the group submitted to the technique without tension 72 hours after its application.
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Affiliation(s)
- Samara Alencar Melo
- Department of Physiotherapy, Federal University of Rio Grande do Norte (UFRN) , Natal, Brazil
| | - Liane de Brito Macedo
- Department of Physiotherapy, Federal University of Rio Grande do Norte (UFRN) , Natal, Brazil
| | - Daniel Tezoni Borges
- Department of Physiotherapy, Federal University of Rio Grande do Norte (UFRN) , Natal, Brazil
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Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review. Sports Med 2018; 46:1797-1808. [PMID: 27142536 DOI: 10.1007/s40279-016-0545-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The patellofemoral (PF) joint is the knee compartment most commonly affected by osteoarthritis (OA). Even mild PF OA is associated with considerable pain and functional limitations. Despite its prevalence and impact, little is understood of the etiology or structural and functional features of PF OA. The clinical symptoms of PF OA, such as anterior knee pain during stair ambulation and squatting, share many similarities with PF pain in adolescents and young adults. PF joint OA is most commonly diagnosed in people aged >40 years, many of whom report a history of PF pain. As such, there is growing evidence that PF pain and PF OA form a continuum of disease. This review explores the possible relationship between the presence of PF pain and the development of PF OA. We review the evidence for altered neuromotor control and biomechanical factors that may be associated with altered PF loading in people with PF pain and PF OA. In doing so, we highlight similarities and differences that may evolve along the continuum. By improving our understanding of the neuromotor and biomechanical links between PF pain and PF OA, we may highlight potential targets for new rehabilitation strategies.
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Female PFP patients present alterations in eccentric muscle activity but not the temporal order of activation of the vastus lateralis muscle during the single leg triple hop test. Gait Posture 2018; 62:445-450. [PMID: 29660632 DOI: 10.1016/j.gaitpost.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/04/2017] [Accepted: 04/06/2018] [Indexed: 02/02/2023]
Abstract
This study aimed to compare the concentric and eccentric activity and the temporal order of peak activity of the hip and knee muscles between women with patellofemoral pain (PFP) and healthy women during the single leg triple hop test (SLTHT). Electromyographic (EMG) and Kinematic data were collected from 14 healthy women (CG) and 14 women diagnosed with PFP (PFG) during a single session of the single leg triple hop test. Integral surface electromyography (iEMG) data of the hip and knee muscles in eccentric and concentric phases and the length of time that each muscle needed to reach the maximal peak of muscle activity were calculated. The iEMG in the eccentric phase was significantly higher (p < 0.05) than the concentric phase, for the gluteus maximus and gluteus medius muscles (CG and PFG) and for the vastus lateralis muscle (PFG). The vastus lateralis muscle was the first muscle to reach the highest peak of activity in the PFG, and the third to reach this peak in the CG. In the present study, the activity of the vastus lateralis muscle during the eccentric phase of the jump was greater than concentric phase, as a temporal anticipation of its peak in activity among women with PFP.
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Hoglund LT, Pontiggia L, Kelly JD. A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study. Pilot Feasibility Stud 2018; 4:70. [PMID: 29636983 PMCID: PMC5889597 DOI: 10.1186/s40814-018-0262-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/22/2018] [Indexed: 01/18/2023] Open
Abstract
Background Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA. Methods Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate. Results At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants' self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P < 0.05). Timed-Up-and-Go time score improved at 6 weeks (P = 0.005). Peak hip external rotator torque increased (P = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention. Conclusions PFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise. Trial registration ClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).
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Affiliation(s)
- Lisa T Hoglund
- 1Department of Physical Therapy, Thomas Jefferson University, 901 Walnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Laura Pontiggia
- 2Department of Mathematics, Physics and Statistics, University of the Sciences, Philadelphia, PA USA
| | - John D Kelly
- 3Department of Sports Medicine and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA USA
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Vora M, Curry E, Chipman A, Matzkin E, Li X. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options. Orthop Rev (Pavia) 2018; 9:7281. [PMID: 29564075 PMCID: PMC5850065 DOI: 10.4081/or.2017.7281] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/08/2017] [Accepted: 10/08/2017] [Indexed: 12/16/2022] Open
Abstract
Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS.
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Affiliation(s)
- Molly Vora
- Boston University School of Medicine, MA
| | - Emily Curry
- Boston University School of Public Health, MA
| | | | | | - Xinning Li
- Boston University School of Medicine, MA
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Abstract
Injuries and disorders of the patellofemoral joint in the adolescent athlete can encompass a wide spectrum of symptomatology and pathology. Anterior knee pain is a common presenting symptom in sports medicine clinics, and can have numerous underlying etiologies. This activity-related pain may be the manifestation of enthesopathy, tendinopathy, fat pad impingement, or numerous other conditions, but is more commonly related to more subtle skeletal and muscular imbalances. Treatment is typically nonoperative in nature, and excellent results are reported with physical therapy. Patellofemoral instability usually has a more dramatic onset in the form of dislocation or subluxation events, commonly experienced during athletics. Concomitant injuries to the patellofemoral articular cartilage are common. Again, treatment is typically nonoperative initially, but recurrent or recalcitrant instability may necessitate reconstructive or realignment procedures. Skeletal maturity often dictates what procedures can be safely attempted.
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Martimbianco ALC, Torloni MR, Andriolo BNG, Porfírio GJM, Riera R. Neuromuscular electrical stimulation (NMES) for patellofemoral pain syndrome. Cochrane Database Syst Rev 2017; 12:CD011289. [PMID: 29231243 PMCID: PMC6486051 DOI: 10.1002/14651858.cd011289.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patellofemoral pain syndrome, now generally referred to as patellofemoral pain (PFP), is one of the most common orthopaedic disorders, characterised by pain in the anterior or retropatellar knee region. Neuromuscular electrical stimulation (NMES) has been proposed generally as a complementary treatment, associated with other interventions such as exercise, or as a single treatment to increase muscle force, reduce knee pain, and improve function. OBJECTIVES To assess the effects (benefits and harms) of neuromuscular electrical stimulation for people with patellofemoral pain. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PEDro, CINAHL, SPORTDiscus, AMED, LILACS, trial registers, conference abstracts, and reference lists. We carried out the search in May 2017. SELECTION CRITERIA We included randomised controlled clinical trials that evaluated the use of NMES for people with PFP. DATA COLLECTION AND ANALYSIS Two review authors independently performed the process of study selection, data extraction, and 'Risk of bias' assessment in duplicate. The primary outcomes were knee pain, knee function, and adverse events. The timing of outcome measurements was up to three months (short term), three to 12 months (medium term), and 12 months and above from trial entry (long term). We calculated risk ratios for dichotomous data and mean differences or standardised mean differences for continuous data. Where appropriate, we pooled data using the fixed-effect model. MAIN RESULTS We included eight randomised clinical trials, reporting results for 345 participants with PFP. The mean ages of trial populations ranged from 25 to 43 years, and the majority (53% to 100%) of participants were female. There was a wide duration of symptoms, with the minimum duration of symptoms for trial inclusion ranging from one to six months. In addition to the study inclusion criteria, studies varied widely in the characteristics of the NMES and its application, and associated co-interventions. We assessed all trials as at high risk of bias in at least one domain, particularly blinding and incomplete outcome data. The results of a laboratory-based trial reporting knee pain immediately after a single 15-minute session of NMES are not reported here as these are of questionable clinical relevance. The seven remaining trials provided evidence for three comparisons. We assessed the overall quality of the evidence, using GRADE, for all primary outcomes for all comparisons as very low, thus we are very unsure of the findings.Four studies compared NMES plus exercise versus exercise alone. Patellar taping was applied as well as exercise to all participants of one study, and patellar taping and ice were also applied in another study. Each trial tested a different multiple-session NMES programme. Pooled data from three studies (118 participants) provided very low-quality evidence that NMES is associated with reduced pain at the end of treatment (ranging from 3 to 12 weeks): mean difference -1.63, 95% confidence interval (CI) -2.23 to -1.02; visual analogue scale (VAS) 0 to 10; higher scores = worse pain. However, this result may not be clinically relevant since the minimal clinically important difference for VAS during activities (1.5 to 2.0, out of 10 points) lies within the 95% CI. We found very low-quality evidence from pooled data from two trials of little effect of NMES on knee function, as measured by two knee function rating systems. We found inconclusive and very low-quality evidence from one trial (29 participants) of little effect of NMES on pain and function at one-year follow-up. None of the four trials reported on adverse effects of treatment.One study (94 participants) compared NMES, applied four hours per day on a daily basis for four weeks, with two types of exercises (isometric and isokinetic). The study did not report on knee pain or adverse events. The study provided very low-quality evidence of no important difference between the two groups in knee function at the end of the four-week treatment. Of note is the potentially onerous NMES schedule in this study, which does not correspond to that typically used in clinical practice.Two studies compared different types of NMES. Simultaneously delivered high-low frequencies NMES was compared with sequentially delivered high-low frequencies NMES in one trial (14 participants) and with fixed frequency NMES in the second trial (64 participants). The studies provided very low-quality evidence of no important differences at the end of the six-week treatment programme between the simultaneous frequencies NMES and the two other NMES programmes in overall knee pain, knee function, or in quadriceps fatigue (an adverse event). AUTHORS' CONCLUSIONS This review found insufficient and inconclusive evidence from randomised controlled trials to inform on the role of NMES for treating people with PFP in current clinical practice. The very low-quality evidence available means that we are uncertain whether or not a multiple-session programme of NMES combined with exercise over several weeks versus exercise alone results in clinically important differences in knee pain and function at the end of the treatment period or at one year. There were no data on adverse effects such as muscle fatigue and discomfort. High-quality randomised clinical trials are needed to inform on the use of NMES for people with PFP. However, professional and stakeholder consensus is required on prioritisation of the research questions for interventions for treating people with PFP, including on the NMES treatment protocol for trials testing NMES.
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Affiliation(s)
- Ana Luiza C Martimbianco
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Maria Regina Torloni
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Brenda NG Andriolo
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Gustavo JM Porfírio
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
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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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Wild CY, Grealish A, Hopper D. Lower Limb and Trunk Biomechanics After Fatigue in Competitive Female Irish Dancers. J Athl Train 2017; 52:643-648. [PMID: 28437130 DOI: 10.4085/1062-6050-52.3.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Because of the increasing popularity of participation in Irish dance, the incidence of lower limb injuries is high among this competitive population. OBJECTIVE To investigate the effects of fatigue on the peak lower limb and trunk angles as well as the peak lower limb joint forces and moments of competitive female Irish dancers during the performance of a dance-specific single-limb landing. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Fourteen healthy, female, competitive Irish dancers (age = 19.4 ± 3.7 years, height = 165.3 ± 5.9 cm, mass = 57.9 ± 8.2 kg). INTERVENTION(S) Participants performed an Irish dance-specific leap before and after a dance-specific fatigue protocol. During each landing movement, 3-dimensional lower limb kinematics (250 Hz) and ground reaction forces (1000 Hz) were collected. Paired t tests were performed to determine the differences (P ≤ .05) in lower limb and trunk biomechanics prefatigue and postfatigue. MAIN OUTCOME MEASURE(S) Peak lower limb and trunk angles as well as peak lower limb joint reaction forces and external moments. RESULTS Compared with the prefatigue trials, dancers landed with reduced ankle plantar flexion (P = .003) and hip external rotation (P = .007) and increased hip-adduction alignment (P = .034) postfatigue. Dancers displayed greater anterior shear (P = .003) and compressive (P = .024) forces at the ankle and greater external knee-flexion moments (P = .024) during the postfatigue compared with the prefatigue landing trials. CONCLUSIONS When fatigued, dancers displayed a decline in landing performance in terms of aesthetics as well as increased ankle- and knee-joint loading, potentially exposing them to a greater risk of injuries.
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Kollock RO, Andrews C, Johnston A, Elliott T, Wilson AE, Games KE, Sefton JM. A Meta-Analysis to Determine if Lower Extremity Muscle Strengthening Should Be Included in Military Knee Overuse Injury-Prevention Programs. J Athl Train 2016; 51:919-926. [PMID: 27031886 PMCID: PMC5224733 DOI: 10.4085/1062-6050-51.4.09] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Knee overuse injuries are the most common musculoskeletal complaints in military trainees and are common in active-duty warfighters. Muscle strengthening is usually recommended; however, research is conflicting in this area, which makes it difficult to develop effective screening, prevention, and training interventions for warfighters. OBJECTIVE To determine if lower extremity muscular weakness contributes to knee overuse injuries and identify specific muscular involvement. DATA SOURCES We searched MEDLINE, PubMed, Web of Science, SPORTDiscus, CINAHL, and Military & Government Collection and reference lists of relevant articles published between January 1, 2000, and January 1, 2013. STUDY SELECTION For inclusion, requirements were uninjured and injured groups; provision of the sample size, means, and standard deviations for all groups; identification of the specific muscles assessed; and clearly defined knee injury. DATA EXTRACTION Sample size, sex, and muscle strength means and standard deviations. DATA SYNTHESIS Twenty-five studies met these criteria. We used the Scottish Intercollegiate Guidelines Network algorithm to determine the appropriate tool for appraising article quality. Unweighted random-effects model meta-analyses were conducted. Separate meta-analyses were performed for the moderators of strength measurement scale (absolute or normalized muscle strength), muscle group, and sex. A weighted random-effects model with a Hedges g effect metric and 95% confidence intervals were used for comparison across studies. CONCLUSIONS Our meta-analysis suggests that individuals with symptoms of a knee overuse injury have lower absolute and normalized hip muscle strength. Specifically, they had lower absolute hip external-rotator, knee-extensor, and knee-flexor strength, as well as lower normalized hip external-rotator, hip-extensor, and hip-abductor strength, compared with asymptomatic control participants. The findings suggest a possible link between lower hip and thigh strength and knee overuse injuries. Further research is needed to determine if weakness is a cause or a result of knee overuse injuries before screening and intervention can be developed for at-risk warfighters.
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Affiliation(s)
- Roger O. Kollock
- Department of Kinesiology and Rehabilitative Sciences, University of Tulsa, OK
| | - Corey Andrews
- Athletic Training Post-Certification Graduate Program, Auburn University, AL
| | - Ashlyn Johnston
- Athletic Training Post-Certification Graduate Program, Auburn University, AL
| | - Teresa Elliott
- Athletic Training Post-Certification Graduate Program, Auburn University, AL
| | - Alan E. Wilson
- School of Fisheries, Aquaculture, and Aquatic Sciences, Auburn University, AL
| | - Kenneth E. Games
- Department of Applied Medicine and Rehabilitation, Indiana State University
| | - JoEllen M. Sefton
- Warrior Research Center, School of Kinesiology, Auburn University, AL
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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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Abstract
Patellofemoral pain is a common knee pathology that affects a wide range of active individuals. These individuals often seek medical care, with 25% of all patients seen in sports medicine clinics being treated for patellofemoral pain. While conservative treatment produce beneficial short-term results, individuals with patellofemoral pain often have long-term pain and decreased quality of life for many years following their diagnosis. One of the challenges for treating this chronic condition is the heterogeneous presentation of impairments across patients, ranging from soft tissue restriction, muscle weakness, altered movement patterns during functional tasks, and weak core stability. Clinicians need to identify these impairments and develop an individualized impairment-based model for treating patients with PFP. The aim of this review it to provide guidance and recommendations for clinicians who treat PFP in hopes to improve long-term outcomes for the conservative treatment of PFP.
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Affiliation(s)
- Neal R Glaviano
- a Department of Kinesiology , University of Virginia Ringgold standard institution , Charlottesville , VA , USA
| | - Susan Saliba
- a Department of Kinesiology , University of Virginia Ringgold standard institution , Charlottesville , VA , USA
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Guney H, Yuksel I, Kaya D, Doral MN. The relationship between quadriceps strength and joint position sense, functional outcome and painful activities in patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc 2016; 24:2966-2972. [PMID: 25869907 DOI: 10.1007/s00167-015-3599-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to investigate how strongly the concentric and eccentric quadriceps strengths were correlated with the joint position sense, functional outcomes and painful activities in patients with patellofemoral pain syndrome (PFPS). METHODS The study included forty-six women diagnosed with unilateral PFPS. Eccentric and concentric quadriceps strengths were recorded at 60 and 180°/s. Active knee joint position sense (JPS) was measured at 20° and 60° of flexion. Functional levels were determined by using Kujala patellofemoral scores. Pain levels during stair descending and ascending, squatting and prolonged sitting were measured using 0-10 cm visual analogue scale. The relationship of isokinetic quadriceps strength with JPS results, Kujala score and pain levels were evaluated using Spearman's correlation coefficient test. RESULTS Eccentric and concentric quadriceps strengths were significantly lower on involved side than uninvolved side. JPS results were poorer on the painful knee when compared to uninvolved side. While eccentric strength correlated with both JPS target angles, concentric strength was correlated only with 20°. Both eccentric and concentric strengths were significantly correlated with Kujala scores and pain levels. CONCLUSION Quadriceps eccentric strength was correlated more to joint position sense than concentric strength. Both eccentric and concentric quadriceps strength related to pain and functional level in PFPS patients.
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Affiliation(s)
- Hande Guney
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey.
| | - Inci Yuksel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey
| | - Defne Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, 34010, Istanbul, Turkey
| | - Mahmut Nedim Doral
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Aksahin E, Yilmaz S, Karasoy I, Duran S, Yuksel HY, Dogan O, Yildirim AO, Bicimoglu A. Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing. Knee Surg Sports Traumatol Arthrosc 2016; 24:2878-2883. [PMID: 25700676 DOI: 10.1007/s00167-015-3533-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 02/04/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the study was to analyse the patellofemoral alignment in the sagittal plane following tibial fracture surgery with intramedullary nailing and its relationship to parapatellar muscle status. METHODS The patellofemoral MRI results of 27 patients (15 males and 12 females) treated with locked intramedullary nailing following tibia shaft fracture were reviewed. The mean age of the patients was 41.8 (±15) years. The patella-patellar tendon angle (P-PT) and the distance between the inferior patellar pole and the tibial tubercle (DP-TT) were evaluated for both the operated extremity and the contralateral normal side. MRI assessment of the infrapatellar fat pad, quadriceps, sartorius, gracilis, semi-membranosus muscles and biceps muscles was also carried out. The correlation between the changes in skeletal muscle mass, the volume of the infrapatellar fat pad and the alterations in the DP-TT distances and P-PT angles were analysed. RESULTS The quadriceps muscle cross-sectional diameter had a mean of 157.2 mm(2) (115.6/319.5) in the operated extremity, and it was 193 mm(2) (77.6/282.2) in the non-operated normal side (p = 0.001). For the Gracilis muscle, the mean was 84.4 mm(2) (19.7/171) at the operated extremity and 75.7 mm(2) (26.9/238.2) on the normal side (p = 0.05). The cross-sectional areas of the semi-membranosus, sartorius and biceps muscles in the operated and non-operated extremity were not noticeably different (n.s). The P-PT angle was 153° (129.7/156.4) in the operated extremity and 145.7° (137.6/163.4) in the non-operated normal extremity (p < 0.05). While DP-TT distance was 11.4 mm (9.4/20.4) in the operated extremity, it was 14.1 mm (7.3/17.1) in the non-operated extremity (p = 0.001). The correlation analyses revealed that the quadriceps hypotrophy negatively correlated (r = -0.4, p = 0.02) with the P-PT angle but positively correlated with the increase in gracilis muscle volume (r = 0.4, p = 0.03). CONCLUSION This study revealed that patellofemoral joint kinematics in the operated extremity was diminished in the sagittal plane correlating with the quadriceps muscle volume loss and gracilis muscle hypertrophy. The modalities focused on both preventing and treating the hypotrophy of the quadriceps muscle following the surgical treatment of tibial fracture, which may help to overcome this quite common pathology.
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Affiliation(s)
- Ertugrul Aksahin
- Orthopedics and Traumatology Department, Ankara Education and Research Hospital, Street 89/3 Bahçelievler/Cankaya, Ankara, 06500, Turkey.
| | - Serdar Yilmaz
- Orthopedics and Traumatology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Ismail Karasoy
- Orthopedics and Traumatology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Semra Duran
- Radiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - H Yalcin Yuksel
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ozgur Dogan
- Orthopedics and Traumatology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - A Ozgur Yildirim
- Orthopedics and Traumatology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Ali Bicimoglu
- Orthopedics and Traumatology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Guney H, Yuksel I, Kaya D, Doral MN. Correlation between quadriceps to hamstring ratio and functional outcomes in patellofemoral pain. Knee 2016; 23:610-5. [PMID: 27184883 DOI: 10.1016/j.knee.2016.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/09/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to investigate the correlation between quadriceps to hamstring (Q:H) ratio and the functional outcomes in Patellofemoral Pain (PFP) patients. METHODS The study included forty-four women diagnosed with unilateral PFP. Eccentric and concentric quadriceps and hamstring strength were recorded. Conventional Q:H ratio was calculated as the concentric quadriceps to concentric hamstring peak torque (Ratio 1). Functional ratios were calculated as the eccentric quadriceps to concentric hamstring peak torque (Ratio 2) and as the concentric quadriceps to eccentric hamstring torque (Ratio 3). Functional levels of the patients were determined by using Kujala scores, hop test and step test. Pain levels during activities were recorded. The relationship among Ratio 1, Ratio 2 and Ratio 3 with functional outcomes and pain levels were evaluated using Spearman's correlation coefficient test. RESULTS Eccentric and concentric quadriceps and hamstring strength were lower on involved side than uninvolved side. Ratio 2 correlated stronger with Kujala score (r=0.69) than Ratio 1 (r=0.49) and Ratio 3 (r=0.30). Step test (r=0.35) and hop test (r=0.38) only correlated with Ratio 2. Pain levels correlated more with Ratio 2 (r values ranged between 0.38 and 0.48). CONCLUSION Eccentric quadriceps to concentric hamstring ratio was observed more related to the functional outcomes and painful activities in patients with PFP. LEVEL OF EVIDENCE III Cross-sectional study.
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Affiliation(s)
- Hande Guney
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100 Ankara, Turkey.
| | - Inci Yuksel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Dogu Akdeniz University, Gazimagosa, Cyprus
| | - Defne Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Uskudar University, 34662 Istanbul, Turkey
| | - Mahmut Nedim Doral
- Department of Orhopaedics and Traumatology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey
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Can ultrasound measurements of muscle thickness be used to measure the size of individual quadriceps muscles in people with patellofemoral pain? Phys Ther Sport 2015; 16:45-52. [DOI: 10.1016/j.ptsp.2014.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/22/2014] [Accepted: 04/10/2014] [Indexed: 11/20/2022]
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Myer GD, Ford KR, Di Stasi SL, Foss KDB, Micheli LJ, Hewett TE. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury? Br J Sports Med 2015; 49:118-22. [PMID: 24687011 PMCID: PMC4182160 DOI: 10.1136/bjsports-2013-092536] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Identifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle. OBJECTIVE We evaluated two unique prospective cohorts with similar populations and methodologies to compare the incidence rates and risk factors associated with patellofemoral pain (PFP) and ACL injury. METHODS The 'PFP cohort' consisted of 240 middle and high school female athletes. They were evaluated by a physician and underwent anthropometric assessment, strength testing and three-dimensional landing biomechanical analyses prior to their basketball season. 145 of these athletes met inclusion for surveillance of incident (new) PFP by certified athletic trainers during their competitive season. The 'ACL cohort' included 205 high school female volleyball, soccer and basketball athletes who underwent the same anthropometric, strength and biomechanical assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury. A one-way analysis of variance was used to evaluate potential group (incident PFP vs ACL injured) differences in anthropometrics, strength and landing biomechanics. Knee abduction moment (KAM) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts. RESULTS KAM during landing above 15.4 Nm was associated with a 6.8% risk to develop PFP compared to a 2.9% risk if below the PFP risk threshold in our sample. Likewise, a KAM above 25.3 Nm was associated with a 6.8% risk for subsequent ACL injury compared to a 0.4% risk if below the established ACL risk threshold. The ACL-injured athletes initiated landing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group. Also, when comparing across cohorts, the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP sample (p<0.05). CONCLUSIONS In adolescent girls aged 13.3 years, >15 Nm of knee abduction load during landing is associated with greater likelihood of developing PFP. Also, in girls aged 16.1 years who land with >25 Nm of knee abduction load during landing are at increased risk for both PFP and ACL injury.
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Affiliation(s)
- Gregory D Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
- The Sports Health and Performance Institute, OSU Sports Medicine, Ohio State University Medical Center, Columbus, Ohio, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Kevin R Ford
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Physical Therapy, School of Health Sciences, High Point University, High Point, North Carolina, USA
| | - Stephanie L Di Stasi
- The Sports Health and Performance Institute, OSU Sports Medicine, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Kim D Barber Foss
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lyle J Micheli
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy E Hewett
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
- The Sports Health and Performance Institute, OSU Sports Medicine, Ohio State University Medical Center, Columbus, Ohio, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Departments of Physiology and Cell Biology, Family Medicine and of Orthopaedic Surgery and Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
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Martimbianco ALC, Torloni MR, Andriolo BNG, Porfirio G, Riera R. Neuromuscular electrical stimulation (NMES) for patellofemoral pain syndrome. Hippokratia 2014. [DOI: 10.1002/14651858.cd011289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ana Luiza C Martimbianco
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63- Vila Clementino São Paulo São Paulo Brazil 04038-000
| | - Maria R Torloni
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63- Vila Clementino São Paulo São Paulo Brazil 04038-000
| | - Brenda NG Andriolo
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63- Vila Clementino São Paulo São Paulo Brazil 04038-000
| | - Gustavo Porfirio
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63- Vila Clementino São Paulo São Paulo Brazil 04038-000
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63- Vila Clementino São Paulo São Paulo Brazil 04038-000
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Bley AS, Correa JCF, Reis ACD, Rabelo NDDA, Marchetti PH, Lucareli PRG. Propulsion phase of the single leg triple hop test in women with patellofemoral pain syndrome: a biomechanical study. PLoS One 2014; 9:e97606. [PMID: 24830289 PMCID: PMC4022617 DOI: 10.1371/journal.pone.0097606] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/22/2014] [Indexed: 01/04/2023] Open
Abstract
Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.
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Affiliation(s)
- Andre Serra Bley
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - João Carlos Ferrari Correa
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Amir Curcio Dos Reis
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Nayra Deise Dos Anjos Rabelo
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Paulo Henrique Marchetti
- Post Graduation Program in Human Movement Science, Universidade Metodista de Piracicaba, UNIMEP, Piracicaba, São Paulo, Brazil
- Faculty of Physical Education (YMCA), Sorocaba, São Paulo, Brazil
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
- * E-mail:
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Tompkins M, Kuenze CM, Diduch DR, Miller MD, Milewski MD, Hart JP. Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability. JOURNAL OF SPORTS MEDICINE (HINDAWI PUBLISHING CORPORATION) 2014; 2014:702358. [PMID: 26464893 PMCID: PMC4590910 DOI: 10.1155/2014/702358] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 06/05/2023]
Abstract
Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL) repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4) knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24-75 months). Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC) and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS) and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO) and vastus lateralis (VL) surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (P = 0.16), Kujala (P = 0.43), Tegner (P = 0.12), or VAS (P = 0.05) scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° (P = 0.96) and 60° (P = 0.99). In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study.
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Affiliation(s)
- Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA
| | - Christopher M. Kuenze
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Mark D. Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Matthew D. Milewski
- Elite Sports Medicine, Connecticut Children's Medical Center, Hartford, CT 06032, USA
| | - Joseph P. Hart
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
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Abstract
This perspective article proposes a conceptual model for the pain experience for individuals diagnosed with knee osteoarthritis (OA). Pain in knee OA is likely a heterogeneous, multifactorial phenomenon that involves not only the OA disease process but also elements specific to patient psychology and pain neurophysiology. The relevant contributions to the pain experience for any individual patient remain difficult, if not impossible, to definitively determine, and the rationale for many clinical treatment decisions arises primarily from a mechanistic understanding of OA pathophysiology. The Osteoarthritis Research Society International (OARSI) recently identified "phenotyping" of OA pain as a research priority to "better target pain therapies to individual patients." This perspective article proposes that contributions from 3 domains--knee pathology, psychological distress, and pain neurophysiology--should be considered equally important in future efforts to understand pain phenotypes in knee OA. Ultimately, characterization of pain phenotypes may aid in the understanding of the pain experience and the development of interventions specific to pain for individual patients.
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