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Yalfani A, Ahadi F, Ahmadi M, Asgarpoor A. Relationship between exacerbating patellofemoral pain and dynamic knee valgus in females with patellofemoral pain after a patellofemoral joint loading protocol: A cross-sectional. Phys Ther Sport 2024; 67:13-18. [PMID: 38428188 DOI: 10.1016/j.ptsp.2024.02.003] [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: 12/12/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The aim of the present study is to 1) the effect of exacerbating patellofemoral pain (PFP) on dynamic knee valgus (DKV) 2) the relationship between exacerbating PFP and DKV in females with patellofemoral pain. DESIGN Cross-sectional study. METHODS Sixty women with PFP were recruited from the orthopedic clinics. We evaluated pain intensity and DKV in two conditions without (condition 1) and with (condition 2) PFJ loading during the single-leg squat (SLS) task. The MANOVA test was used to compare pain intensity and DKV angle between the two conditions. Furthermore, the Pearson correlation was used to examine the correlation between pain intensity with DKV angle. RESULTS The MANOVA analysis showed that pain intensity (P < 0.000, η2 = 0.623) and DKV angle (P < 0.000, η2 = 0.544) with a medium effect size significantly increased after PFJ loading. Furthermore, an excellent positive correlation was observed between an increase in pain intensity and DKV angle (P < 0.000, r = 0.840). CONCLUSION It seems that after the PFJ loading protocol and the subsequent pain exacerbation, the neuromuscular biomechanics of the lower limb are deficits. As a result, the stabilizing muscles activation decreases and increases the lower limb movement in the frontal plane.
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Affiliation(s)
- Ali Yalfani
- Professor, Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-ali Sina University, Hamedan, Iran.
| | - Fatemeh Ahadi
- Professor, Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-ali Sina University, Hamedan, Iran.
| | - Mohamadreza Ahmadi
- Professor, Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-ali Sina University, Hamedan, Iran.
| | - Azadeh Asgarpoor
- Professor, Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-ali Sina University, Hamedan, Iran.
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Yalfani A, Ahmadi M, Asgarpoor A. The effect of kinetic factors of dynamic knee valgus on patellofemoral pain: A systematic review and meta-analysis. J Bodyw Mov Ther 2024; 37:246-253. [PMID: 38432813 DOI: 10.1016/j.jbmt.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/06/2023] [Indexed: 03/05/2024]
Abstract
The speculation of dynamic knee valgus (DKV) correlates with kinetic changes in the frontal plane that increased loading patellofemoral joint (PFJ). Therefore, it is the purpose of this systematic review and meta-analysis study is the effect of kinetic factors DKV on patellofemoral pain (PFP). The search strategy was carried out in the electronic databases of Cochrane Library, PubMed, Springer Link, Science Direct, Scopus. Studies limited to the period 2000 to 2020 were extracted. The quality of study was assessment by modified Downs and Black checklist. Mean and standard deviation were also used to calculate the effect size. There were selected 8 articles for the systematic review and Meta-analysis. The results showed that in PFP patients compared to healthy individuals have increase knee abduction moment (SMD = 0.75; 95% CI = [0.47 to 1.02]) and impulse (SMD = 0.79; 95% CI = [0.50 to 1.07]). Furthermore, PFP patients compared to healthy individuals have decrease onset (SMD = -0.60; 95% CI = [-1.03 to -0.17]) and during (SMD = -0.93; 95% CI = [-1.57 to -0.29]) gluteus medius (GMED); vis-à-vis, PFP patients compared to healthy individuals have increase onset (SMD = 0.10; 95% CI = [-0.34 to 0.54]) and during (SMD = 0.29; 95% CI = [-0.15 to 0.73]) adductors longus (AL). As a result; PFP patients compared to healthy individuals show decrease co-contraction GMED/AL (SMD = -1.03; 95% CI = [-1.83 to -0.24]). The kinetic factors of DKV of leading to PFJ contact area decreases and the loading in a smaller contact area on PFJ in the outer part of the patella. Eventually, this abnormal distribution of contact pressure leads to etiology and osteoarthritis of the PFP.
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Affiliation(s)
- Ali Yalfani
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran.
| | - Mohamadreza Ahmadi
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Azadeh Asgarpoor
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
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Wang X, Liu H, Dong Z, Chen X, Xu C, Ji G, Kang H, Wang F. Contact area and pressure changes of patellofemoral joint during stair ascent and stair descent. BMC Musculoskelet Disord 2023; 24:767. [PMID: 37770867 PMCID: PMC10537124 DOI: 10.1186/s12891-023-06882-0] [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: 01/29/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE To investigate the differences of patellofemoral joint pressure and contact area between the process of stair ascent and stair descent. METHODS The finite element models of 9 volunteers without disorders of knee (9 males) to estimate patellar cartilage pressure during the stair ascent and the stair descent. Simulations took into account cartilage morphology from magnetic resonance imaging, joint posture from weight-bearing magnetic resonance imaging, and ligament model. The three-dimension models of the patella, femur and tibia were developed with the medical image processing software, Mimics 11.1. The ligament was established by truss element of the non-linear FE solver. The equivalent gravity direction (-z direction) load was applied to the whole end of femur (femoral head) according to the body weight of the volunteers, and the force of patella was observed. A paired-samples t-test or Wilcoxon rank sum test to make comparisons between stair ascent and stair descent. Statistical analyses were performed using SPSS 22.0 using a P value of 0.05 to indicate significance. RESULTS During the stair descent (knee flexion at 30°), the contact pressure of the patella was 2.59 ± 0.06Mpa. The contact pressure of femoral trochlea cartilage was 2.57 ± 0.06Mpa. During the stair ascent (knee flexion at 60°), the contact pressure with patellar cartilage was 2.82 ± 0.08Mpa. The contact pressure of the femoral trochlea cartilage was 3.03 ± 0.11Mpa. The contact area between patellar cartilage and femoral trochlea cartilage was 249.27 ± 1.35mm2 during the stair descent, which was less than 434.32 ± 1.70mm2 during the stair ascent. The area of high pressure was located in the lateral area of patella during stair descent and the area of high pressure was scattered during stair ascent. CONCLUSION There are small change in the cartilage contact pressure between stair ascent and stair descent, indicating that the joint adjusts the contact pressure by increasing the contact area.
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Affiliation(s)
- Xiaomeng Wang
- Foot and Ankle Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huixin Liu
- Ultrasound medicine department, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenyue Dong
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaobo Chen
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenyue Xu
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gang Ji
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huijun Kang
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Wang
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Wang B, Mao Z, Guo J, Yang J, Zhang S. The non-invasive evaluation technique of patellofemoral joint stress: a systematic literature review. Front Bioeng Biotechnol 2023; 11:1197014. [PMID: 37456733 PMCID: PMC10343958 DOI: 10.3389/fbioe.2023.1197014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction: Patellofemoral joint stress (PFJS) is an important parameter for understanding the mechanism of patellofemoral joint pain, preventing patellofemoral joint injury, and evaluating the therapeutic efficacy of PFP rehabilitation programs. The purpose of this systematic review was to identify and categorize the non-invasive technique to evaluate the PFJS. Methods: Literature searches were conducted from January 2000 to October 2022 in electronic databases, namely, PubMed, Web of Science, and EBSCO (Medline, SPORTDiscus). This review includes studies that evaluated the patellofemoral joint reaction force (PJRF) or PFJS, with participants including both healthy individuals and those with patellofemoral joint pain, as well as cadavers with no organic changes. The study design includes cross-sectional studies, case-control studies, and randomized controlled trials. The JBI quality appraisal criteria tool was used to assess the risk of bias in the included studies. Results: In total, 5016 articles were identified in the database research and the citation network, and 69 studies were included in the review. Discussion: Researchers are still working to improve the accuracy of evaluation for PFJS by using a personalized model and optimizing quadriceps muscle strength calculations. In theory, the evaluation method of combining advanced computational and biplane fluoroscopy techniques has high accuracy in evaluating PFJS. The method should be further developed to establish the "gold standard" for PFJS evaluation. In practical applications, selecting appropriate methods and approaches based on theoretical considerations and ecological validity is essential.
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Botta AFB, Waiteman MC, Ducatti MHM, Garcia CLG, Farinelli LALB, Bazett-Jones DM, Briani RV, de Azevedo FM. Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features. Front Sports Act Living 2023; 4:1081943. [PMID: 36713948 PMCID: PMC9875135 DOI: 10.3389/fspor.2022.1081943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
Background This is a protocol for a prospective longitudinal study that aims to investigate: (1) group-by-time changes over a minimum of 15 months follow-up in patellofemoral pain (PFP) symptoms, biomechanical, muscle function, pain processing, and psychological features; (2) the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, health-related quality of life (HRQOL), and physical activity level. Methods Individuals with PFP (n = 144) and control individuals (n = 85) without PFP were assessed at baseline. Outcomes assessed included: 3D kinematics and kinetics during single leg squat, step-down and single leg hop; maximal torque and rate of torque development of hip abductors and knee extensors/flexors; force steadiness of hip abductors and knee extensors; anterior and lateral trunk endurance; pressure pain thresholds at the center of patella and contralateral shoulder; kinesiophobia (Tampa Scale for Kinesiophobia); pain catastrophizing (Pain Catastrophizing Scale); worst self-reported pain (Visual Analogue Scale); physical performance measures (Single Leg Hop Test and Forward Step-Down Test); self-reported function (Anterior Knee Pain Scale); HRQOL (Medical Outcome Short-Form 36), and physical activity level (Baecke's Questionnaire). Follow-up assessments will be identical to the baseline and will be performed after a minimum of 15 months. Generalized linear mixed model (GLMM) will be used to investigate group-by-time differences. Linear regression models will be used to determine the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, HRQOL, and physical activity level. Discussion Physical and non-physical features have been previously associated with PFP. However, the present study will be the first to investigate their integrated evolution as part of the natural history of PFP and its progression. In doing so, we will be able to determine their behavior in the long-term, as well as how they prospectively associate with each other and with clinical outcomes. Ultimately, this will provide a greater understanding of predictors of long-term outcome and possible targets for interventions.
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Affiliation(s)
- Ana Flavia Balotari Botta
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil,Correspondence: Ana Flavia Balotari Botta
| | - Marina Cabral Waiteman
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Matheus Henrique Maiolini Ducatti
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Carmen Lúcia Gomes Garcia
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Lucca André Liporoni Bego Farinelli
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | | | - Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Sao paulo, Brazil
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Influence of painful overloading using stair ascending in quadriceps neuromuscular function of women with patellofemoral pain syndrome. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-022-01020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Waiteman MC, Chia L, Ducatti MHM, Bazett-Jones DM, Pappas E, de Azevedo FM, Briani RV. Trunk Biomechanics in Individuals with Knee Disorders: A Systematic Review with Evidence Gap Map and Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:145. [PMID: 36503991 PMCID: PMC9742076 DOI: 10.1186/s40798-022-00536-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The trunk is the foundation for transfer and dissipation of forces throughout the lower extremity kinetic chain. Individuals with knee disorders may employ trunk biomechanical adaptations to accommodate forces at the knee or compensate for muscle weakness. This systematic review aimed to synthesize the literature comparing trunk biomechanics between individuals with knee disorders and injury-free controls. METHODS Five databases were searched from inception to January 2022. Observational studies comparing trunk kinematics or kinetics during weight-bearing tasks (e.g., stair negotiation, walking, running, landings) between individuals with knee disorders and controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and evidence gap maps were created. RESULTS A total of 81 studies investigating trunk biomechanics across six different knee disorders were included (i.e., knee osteoarthritis [OA], total knee arthroplasty [TKA], patellofemoral pain [PFP], patellar tendinopathy [PT], anterior cruciate ligament deficiency [ACLD], and anterior cruciate ligament reconstruction [ACLR]). Individuals with knee OA presented greater trunk flexion during squatting (SMD 0.88, 95% CI 0.58-1.18) and stepping tasks (SMD 0.56, 95% CI 0.13-.99); ipsilateral and contralateral trunk lean during walking (SMD 1.36; 95% CI 0.60-2.11) and sit-to-stand (SMD 1.49; 95% CI 0.90-2.08), respectively. Greater trunk flexion during landing tasks in individuals with PFP (SMD 0.56; 95% CI 0.01-1.12) or ACLR (SMD 0.48; 95% CI 0.21-.75) and greater ipsilateral trunk lean during single-leg squat in individuals with PFP (SMD 1.01; 95% CI 0.33-1.70) were also identified. No alterations in trunk kinematics of individuals with TKA were identified. Evidence gap maps outlined the lack of investigations for individuals with PT or ACLD, as well as for trunk kinetics across knee disorders. CONCLUSION Individuals with knee OA, PFP, or ACLR present with altered trunk kinematics in the sagittal and frontal planes. The findings of this review support the assessment of trunk biomechanics in these individuals in order to identify possible targets for rehabilitation and avoidance strategies. TRIAL REGISTRATION PROSPERO registration number: CRD42019129257.
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Affiliation(s)
- Marina C. Waiteman
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - Lionel Chia
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,Cleveland Guardians Baseball Company, Cleveland, OH USA
| | - Matheus H. M. Ducatti
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - David M. Bazett-Jones
- grid.267337.40000 0001 2184 944XSchool of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH USA
| | - Evangelos Pappas
- grid.1007.60000 0004 0486 528XSchool of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, NSW Australia
| | - Fábio M. de Azevedo
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - Ronaldo V. Briani
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
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de Albuquerque CE, Bibin F, Bussarolo JM, Dalmolin EB, Ricardo Flor Bertolini G, Nuñez SC. The influence of iliotibial tract thickness on clinical outcomes in women with patellofemoral pain. Knee 2022; 39:319-324. [PMID: 36347136 DOI: 10.1016/j.knee.2022.10.007] [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: 11/09/2021] [Revised: 09/12/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The assessment of iliotibial tract thickness by ultrasonography may help identify a key, previously unexplored factor that may contribute directly to the homeostasis imbalance of the femoropatellar joint in people with patellofemoral pain (PFP). OBJECTIVES To compare the iliotibial tract thickness of people with PFP and asymptomatic people; and to correlate the iliotibial tract thickness with self-reported pain and function of people with PFP. METHODS Eighty women, separated into two groups: PFP group (n = 40) and control group consisting of asymptomatic participants (CG; n = 40). The participants answered the Anterior Knee Pain Scale (AKPS) questionnaire, to identify the self-reported knee function; they evaluated the pain in millimeters by the Visual Analog Scale for pain (VAS). For the imaging evaluation, an ultrasound was used, with a linear transducer at the distal portion of the iliotibial tract (coronal plane), with the participants positioned in dorsal decubitus, with 20° of knee flexion. The iliotibial band was visualized in its long axis, and three sequential images were recorded between the lateral femoral condyle and the lateral tibial condyle. The measurements were normalized and correlated. RESULTS The groups had no differences (P > 0.001) between participants for: age/weight/height/IMC. Participants in the PFP group had moderate levels of pain (58 + 2.1 mm), considerable self-reported functional limitation (d = 3.05) and greater iliotibial tract thickness compared with the CG (d = 2.41). CONCLUSION The iliotibial tract of women diagnosed with PFP have greater thickness compared with asymptomatic women. There was no association between iliotibial tract thickness and subjective measures of pain and function.
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Affiliation(s)
| | - Fernanda Bibin
- Universidade Estadual do Oeste do Paraná, Cascavel, Paraná, Brazil
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Central vs. Peripheral Vision during a Singe-Leg Drop Jump: Implications of Dynamics and Patellofemoral Joint Stress. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Landing on a single-leg without receiving direct visual information (e.g., not looking at the ground) may increase the risk of injury. We examined whether visual focus contributed to the changing lower-extremity dynamics and patellofemoral joint stress during a single-leg drop jump task. Twenty healthy volunteers visited the laboratory for three separate sessions. During each session, participants randomly performed either of two types of a single-leg drop jump task from a 30 cm high wooden box. Subsequently, participants looked at the landing spot (central vision condition) or kept their heads up (peripheral vision condition) when performing the task. Sagittal and frontal plane lower-extremity joint angles and joint moments (in the ankle, knee, and hip), including the vertical ground reaction force, and patellofemoral joint stress during the first landing phase (from initial contact to peak knee flexion) were compared. Greater ankle inversion and hip adduction were observed when landing with the peripheral vision condition. However, the magnitudes were negligeable (Cohen’s d effect size <0.35). No statistical difference was observed in other comparisons. Landing on a single-leg from a 30 cm height without receiving full visual attention (peripheral vision condition) does not increase the risk of lower-extremity traumatic and overuse injuries.
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Wang Y, Qie S, Li Y, Yan S, Zeng J, Zhang K. Intersegmental Coordination in Patients With Total Knee Arthroplasty During Walking. Front Bioeng Biotechnol 2022; 10:839909. [PMID: 35284409 PMCID: PMC8908033 DOI: 10.3389/fbioe.2022.839909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Precise identification of deficient intersegmental coordination patterns and functional limitations is conducive to the evaluation of surgical outcomes after total knee arthroplasty (TKA) and the design of optimal personalized rehabilitation protocols. However, it is still not clear how and when intersegmental coordination patterns change during walking, and what functional limitations are in patients with TKA. This study was designed to investigate lower limb intersegmental coordination patterns in patients with knee osteoarthritis before and after TKA and identify how intersegmental coordination of patients is altered during walking before and after TKA. It was hypothesized that 6-month after TKA, intersegmental coordination patterns of patients are improved compared with that before TKA, but still do not recover to the level of healthy subjects. Gait analysis was performed on 36 patients before and 6-month after TKA and on 34 healthy subjects. Continuous relative phase (CRP) derived from the angle-velocity phase portrait was used to measure the coordination between interacting segments throughout the gait cycle. Thigh-shank CRP and shank-foot CRP were calculated for each subject. Statistical parametric mapping (SPM), a one-dimensional analysis of the entire gait cycle curve, was performed directly to determine which periods of the gait cycle were different in patients and healthy subjects. Six-month after TKA, thigh-shank CRP was significantly higher during 5–12% of the gait cycle (p = 0.041) and lower during 44–95% of the gait cycle (p < 0.001) compared with healthy subjects, and was significantly higher during 62–91% of the gait cycle (p = 0.002) compared with pre-operation. Shank-foot CRP was significantly lower during 0–28% of the gait cycle (p < 0.001) and higher during 58–94% of the gait cycle (p < 0.001) compared with healthy subjects, and was significantly lower during 3–18% of the gait cycle (p = 0.005) compared with pre-operation. This study found that patients exhibited altered intersegmental coordination during the loading response and swing phase both before and after TKA. Six-month after TKA, the thigh-shank coordination was partially improved compared with pre-operation, but still did not recover to the level of healthy subjects, while there was no improvement in the shank-foot coordination pattern after TKA compared with pre-operation. CRP combined with SPM methods can provide insights into the evaluation of surgical outcomes and the design of rehabilitation strategy.
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Affiliation(s)
- Yingpeng Wang
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shuyan Qie
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yingqi Li
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Songhua Yan
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Jizhou Zeng
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- *Correspondence: Kuan Zhang, ; Jizhou Zeng,
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- *Correspondence: Kuan Zhang, ; Jizhou Zeng,
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Hart HF, Patterson BE, Crossley KM, Culvenor AG, Khan MCM, King MG, Sritharan P. May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions-a systematic review and meta-analysis. Br J Sports Med 2022; 56:521-530. [PMID: 35115309 DOI: 10.1136/bjsports-2021-104686] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To systematically review and synthesise patellofemoral joint reaction force (PFJRF) in healthy individuals and those with patellofemoral pain and osteoarthritis (OA), during everyday activities, therapeutic exercises and with physical interventions (eg, foot orthotics, footwear, taping, bracing). DESIGN A systematic review with meta-analysis. DATA SOURCES Medline, Embase, Scopus, CINAHL, SportDiscus and Cochrane Library databases were searched. ELIGIBILITY CRITERIA Observational and interventional studies reporting PFJRF during everyday activities, therapeutic exercises, and physical interventions. RESULTS In healthy individuals, the weighted average of mean (±SD) peak PFJRF for everyday activities were: walking 0.9±0.4 body weight (BW), stair ascent 3.2±0.7 BW, stair descent 2.8±0.5 BW and running 5.2±1.2 BW. In those with patellofemoral pain, peak PFJRF were: walking 0.8±0.2 BW, stair ascent 2.5±0.5 BW, stair descent 2.6±0.5 BW, running 4.1±0.9 BW. Only single studies reported peak PFJRF during everyday activities in individuals with patellofemoral OA/articular cartilage defects (walking 1.3±0.5 BW, stair ascent 1.6±0.4 BW, stair descent 1.0±0.5 BW). The PFJRF was reported for many different exercises and physical interventions; however, considerable variability precluded any pooled estimates. SUMMARY Everyday activities and exercises involving larger knee flexion (eg, squatting) expose the patellofemoral joint to higher PFJRF than those involving smaller knee flexion (eg, walking). There were no discernable differences in peak PFJRF during everyday activities between healthy individuals and those with patellofemoral pain/OA. The information on PFJRF may be used to select appropriate variations of exercises and physical interventions.
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Affiliation(s)
- Harvi F Hart
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia .,Department of Physical Therapy, Western University, London, Ontario, Canada
| | - Brooke E Patterson
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Michaela C M Khan
- Motion Analysis and Biofeedback Laboratory, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew G King
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
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Khuu A, Loverro KL, Lewis CL. Muscle Activation During Single-Legged Squat Is Affected by Position of the Nonstance Limb. J Athl Train 2022; 57:170-176. [PMID: 33887761 PMCID: PMC8876880 DOI: 10.4085/1062-6050-0019.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONTEXT The single-legged squat (SLS) is appropriate for targeting activation, strengthening, and neuromuscular retraining of the gluteus maximus, gluteus medius, and quadriceps. However, the effects of different nonstance-limb positions on muscle activity have not been fully evaluated. OBJECTIVE To compare the muscle activity of selected stance-limb hip muscles during the SLS using 3 nonstance-limb positions: in front (SLS-Front), in the middle (SLS-Middle), and in back (SLS-Back). DESIGN Controlled laboratory study. SETTING Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 17 healthy adults (8 men, 9 women; age = 22.6 ± 3.6 years, height = 173.3 ± 10.7 cm, mass = 71.2 ± 11.0 kg) participated. MAIN OUTCOME MEASURE(S) Surface electromyographic data of the gluteus maximus, gluteus medius, lateral hamstrings, medial hamstrings, rectus femoris, and tensor fascia lata (TFL) as well as kinetic data of the hip and knee were collected while participants performed the 3 SLS tasks. Mean muscle-activation levels during the descent and ascent phases for the selected hip muscles and hip and knee kinetics in all 3 planes were compared for the 3 tasks. Each variable of interest was analyzed using a separate linear regression model with a generalized estimating equations correction. RESULTS Muscle-activation levels of the gluteus maximus, gluteus medius, medial hamstrings, rectus femoris, and TFL for the stance limb during descent (P ≤ .04) and the medial hamstrings and TFL during ascent (P ≤ .002) were different among the SLS tasks. The greatest number of differences occurred between SLS-Front and SLS-Back. During descent, gluteal muscle activity was greater in SLS-Front (P ≤ .03) and SLS-Middle (P = .03) than in SLS-Back. For both phases, TFL activity was greater during SLS-Front than during both SLS-Middle and SLS-Back (P ≤ .006). Kinetic differences at the hip and knee between SLS tasks were also observed (P values ≤ .02). CONCLUSIONS The 3 SLS tasks had different muscle-activation and kinetic profiles. Clinicians and researchers can vary nonstance-limb position during the SLS to manipulate muscle-activation levels and tailor the exercise to assist with goals at different stages of rehabilitation.
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Affiliation(s)
- Anne Khuu
- Department of Physical Therapy and Athletic Training, Boston University, MA
| | - Kari L. Loverro
- Department of Physical Therapy and Athletic Training, Boston University, MA
,Combat Capabilities Development Command Soldier Center, Natick, MA
| | - Cara L. Lewis
- Department of Physical Therapy and Athletic Training, Boston University, MA
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Waiteman MC, Botta AFB, Perez VO, de Oliveira Silva D, Pazzinatto MF, Magalhães FH, de Azevedo FM, Briani RV. Relationship between vastus medialis Hoffmann reflex excitability and knee extension biomechanics during different tasks in women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2022; 91:105544. [PMID: 34896835 DOI: 10.1016/j.clinbiomech.2021.105544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impaired knee extension biomechanics and spinal excitability have been reported in women with patellofemoral pain, but their relationship has not been explored. A significant relationship between them could indicate the need for investigating the potential benefits of disinhibitory interventions for women with patellofemoral pain. Thus, this study aimed to investigate the relationship between vastus medialis Hoffmann reflex and (1) maximal isometric, concentric and eccentric knee extensor strength and rate of torque development; (2) knee extensor torque steadiness; and (3) knee extensor moment during functional tasks; in women with patellofemoral pain. METHODS Spinal excitability of twenty-four participants was assessed by the amplitude of maximal vastus medialis Hoffmann reflex. Knee extensor strength, rate of torque development and torque steadiness were assessed using an isokinetic dynamometer. Knee extensor moment during step-down and stair descent tasks were obtained using a three-dimensional motion analysis system. FINDINGS A moderate negative relationship was found between vastus medialis Hoffmann reflex and knee extensor torque steadiness (r = -0.35; p = 0.05); whereas a moderate positive relationship was found with maximal isometric knee extensor strength (r = 0.37; p = 0.044). No significant relationships were found between vastus medialis Hoffmann reflex and the other variables. INTERPRETATION Our findings provide insight on the relationship between spinal excitability and neuromuscular control of maximal and submaximal isometric torque production in women with patellofemoral pain. Conversely, spinal excitability does not seem to be related with dynamic torques and moments of the knee extensors in women with patellofemoral pain.
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Affiliation(s)
- Marina Cabral Waiteman
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Ana Flavia Balotari Botta
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Vitória Ozores Perez
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Danilo de Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Marcella Ferraz Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Fernando Henrique Magalhães
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil; School of Arts, Sciences, and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
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Waiteman MC, de Oliveira Silva D, Azevedo FM, Pazzinatto MF, Briani RV, Bazett-Jones DM. Women with patellofemoral pain and knee crepitus have reduced knee flexion angle during stair ascent. Phys Ther Sport 2020; 48:60-66. [PMID: 33373904 DOI: 10.1016/j.ptsp.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To compare trunk and knee biomechanics of women with and without patellofemoral pain (PFP) and knee crepitus during stair ascent. DESIGN Cross-sectional. SETTING Laboratory-based study. PARTICIPANTS 29 women with PFP and knee crepitus (PFPCrepitus); 28 women with PFP and no knee crepitus (PFPNOCrepitus); 17 pain-free women with knee crepitus (Pain-freeCrepitus); and 29 pain-free women without knee crepitus (Pain-freeNOCrepitus). MAIN OUTCOME MEASURES Peak trunk flexion, peak knee flexion, mean knee angular velocity, knee extensor moment at peak knee flexion, peak and impulse of the knee extensor moment. RESULTS PFPCrepitus group performed the stair ascent task with reduced peak knee flexion compared to Pain-freeCrepitus (p = 0.04; Effect size = -0.85) and Pain-freeNOCrepitus (p = 0.03; Effect size = -0.75). No significant differences among groups were found for peak trunk flexion (p = 0.979), knee angular velocity (p = 0.420), knee extensor moment at peak knee flexion (p = 0.933), peak (p = 0.290) and impulse (p = 0.122) of the knee extensor moment. CONCLUSION Women with concomitant PFP and knee crepitus demonstrated reduced knee flexion during stair ascent, but no significant differences for trunk flexion and knee extensor moment variables were found.
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Affiliation(s)
- Marina Cabral Waiteman
- Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; University of Toledo, School of Exercise and Rehabilitation Sciences, Toledo, OH, USA.
| | - Danilo de Oliveira Silva
- Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; La Trobe Sports and Exercise Medicine Research Centre (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia.
| | - Fábio M Azevedo
- Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil.
| | - Marcella F Pazzinatto
- Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; La Trobe Sports and Exercise Medicine Research Centre (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia.
| | - Ronaldo V Briani
- Sao Paulo State University (UNESP), School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; La Trobe Sports and Exercise Medicine Research Centre (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia.
| | - David M Bazett-Jones
- University of Toledo, School of Exercise and Rehabilitation Sciences, Toledo, OH, USA.
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Bonacci J, Fox A, Hall M, Fuller JT, Vicenzino B. Effect of gait retraining on segment coordination and joint variability in individuals with patellofemoral pain. Clin Biomech (Bristol, Avon) 2020; 80:105179. [PMID: 32980619 DOI: 10.1016/j.clinbiomech.2020.105179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/26/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait retraining is advocated for the management of patellofemoral pain. This case series examined changes in lower limb variability following 6-weeks of gait retraining in individuals with patellofemoral pain. METHODS Six runners with patellofemoral pain completed a 6-week physiotherapist-guided gait retraining program using minimalist footwear and increased cadence. Approximate entropy joint variability and segment coordination variability were calculated across the entire gait cycle during running at baseline, 6 and 12 weeks and compared using repeated measures analysis of variance and the standardised mean difference (SMD). FINDINGS Compared to baseline, there were large increases in hip joint transverse plane kinematic variability at 6 (SMD = 1.7) and 12 weeks (SMD = 1.3). Moderate increases in hip joint frontal plane and knee joint sagittal plane kinematic variability were also observed at 6 (SMD = 1.1 & 0.96) and 12 weeks (SMD = 1.1 & 0.89). Knee joint frontal plane and hip joint transverse plane kinetic variability demonstrated large increases from baseline at 6 (SMD = 1.3 & 0.9) and 12 weeks (SMD = 0.9 & 1.0). There was no main effect of time for segment coordination variability. All participants had clinically meaningful improvements in pain (visual analogue change score > 20 mm). INTERPRETATION Gait retraining increased joint kinematic and kinetic variability in those with patellofemoral pain and these changes persisted over 12 weeks. Increased variability was observed in joint kinematics and kinetics known to influence patellofemoral joint stress, which may vary patellofemoral joint loading patterns and partly explain the clinical effect.
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Affiliation(s)
- Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - Aaron Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Joel T Fuller
- Facullty of Medicine and Health Sciences, Macquarie University, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, Physiotherapy, University of Queensland, Australia
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Kernozek T, Schiller M, Rutherford D, Smith A, Durall C, Almonroeder TG. Real-time visual feedback reduces patellofemoral joint forces during squatting in individuals with patellofemoral pain. Clin Biomech (Bristol, Avon) 2020; 77:105050. [PMID: 32464430 DOI: 10.1016/j.clinbiomech.2020.105050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/24/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elevated patellofemoral joint forces appear to contribute to the development of patellofemoral pain. As a result, treatment of patellofemoral pain often includes movement retraining intended to reduce patellofemoral joint forces. Real-time visual feedback has been shown to be effective for retraining running kinematics; however, we are not aware of a previous study that has examined the influence of real-time visual feedback on patellofemoral joint mechanics during a squat. METHODS Twenty individuals with patellofemoral pain completed squats before (baseline) and immediately after (post-feedback) completing a real-time visual feedback training session. During the session, participants received visual feedback related to their patellofemoral joint forces (estimated via a musculoskeletal model) during squatting and were asked to alter their movement pattern to minimize these forces. Patellofemoral joint forces and hip, knee, and ankle joint mechanics were compared for the baseline and post-feedback trials in order to examine how feedback influenced squat performance. FINDINGS Participants demonstrated a 14.4% reduction in patellofemoral joint forces following the feedback session. They appeared to achieve this reduction in patellofemoral joint forces by squatting with less knee flexion (97.26 ± 17.11° vs. 102.96 ± 16.55°) and lower knee extension moments (0.10 ± 0.02 Nm/bodyweight vs. 0.11 ± 0.02 Nm/bodyweight) and quadriceps forces (4.06 ± 0.87 bodyweights vs. 4.67 ± 0.98 bodyweights). INTERPRETATION Real-time visual feedback appears to be effective for reducing patellofemoral joint forces during squatting in individuals with patellofemoral pain. As a result, training of this nature may be beneficial when treating patellofemoral pain.
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Affiliation(s)
- Thomas Kernozek
- La Crosse Institute for Movement Science, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA.
| | - Michael Schiller
- La Crosse Institute for Movement Science, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
| | - Drew Rutherford
- La Crosse Institute for Movement Science, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
| | - Amanda Smith
- La Crosse Institute for Movement Science, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
| | - Chris Durall
- Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Student Health Center, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
| | - Thomas Gus Almonroeder
- La Crosse Institute for Movement Science, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
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17
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Bonacci J, Fox A, Hall M, Fuller JT, Vicenzino B. Footwear and Cadence Affect Gait Variability in Runners with Patellofemoral Pain. Med Sci Sports Exerc 2020; 52:1354-1360. [PMID: 32028455 DOI: 10.1249/mss.0000000000002267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the effects of increased cadence and minimalist footwear on lower-limb variability in runners with patellofemoral pain (PFP). METHODS Fifteen (12 female, 3 male) runners with PFP ran on an instrumented treadmill with three-dimensional motion capture in three randomly ordered conditions: (i) standard shoe at preferred cadence, (ii) standard shoe +10% cadence, and (iii) minimalist shoe at preferred cadence. Vector coding was used to calculate coordination variability between strides for select lower-limb joint couplings. Approximate entropy was calculated to assess continuous variability for segment kinematic and kinetic data and compared between conditions using repeated-measures ANOVA. One-dimensional statistical parametric mapping repeated-measures ANOVA was performed on the coordination variability data. Cohen's d effect size was calculated for all comparisons. RESULTS Larger approximate entropy values (i.e., greater variability) were observed for the standard shoe +10% cadence versus the standard shoe at preferred cadence for hip flexion/extension (P < 0.001; d = 1.12), hip adduction/abduction (P < 0.001; d = 0.99) and ankle dorsiflexion/plantarflexion (P < 0.001; d = 1.37) kinematics, and knee flexion/extension moments (P < 0.001; d = 0.93). Greater variability was also observed in the minimalist shoe versus the standard shoe at preferred cadence for hip internal/external rotation moments (P < 0.001; d = 0.76), knee adduction/abduction moments (P < 0.001; d = 0.51), and knee internal/external rotation moments (P < 0.001; d = 1.02). One-dimensional statistical parametric mapping repeated-measures ANOVA revealed no significant differences in coordination variability between running conditions. CONCLUSIONS Greater hip and knee kinematic and kinetic variability observed with either increased cadence or minimalist footwear may be beneficial for those with PFP.
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Affiliation(s)
- Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Aaron Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, AUSTRALIA
| | - Joel T Fuller
- Faculty of Medicine and Health Science, Macquarie University, AUSTRALIA
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, Physiotherapy, University of Queensland, AUSTRALIA
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Briani RV, Waiteman MC, de Albuquerque CE, Gasoto E, Segatti G, Oliveira CB, de Azevedo FM, de Oliveira Silva D. Lower Trunk Muscle Thickness Is Associated With Pain in Women With Patellofemoral Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2685-2693. [PMID: 30815915 DOI: 10.1002/jum.14973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To compare trunk muscle thickness of women with and without patellofemoral pain (PFP) and to assess the association of trunk muscle thickness with self-reported pain of women with PFP. METHODS Forty-four women were recruited and divided into 2 groups: a PFP group (n = 22) and a pain-free group (n = 22). The thickness of the following trunk muscles was obtained by B-mode ultrasound imaging: transversus abdominis, obliquus internus (OI), obliquus externus (OE), rectus abdominis, and multifidus. Self-reported pain was measured on a visual analog scale. RESULTS The 44 participants were 18 to 35 years old. Women with PFP had lower thickness of the OI and OE than pain-free women, with moderate or large effect sizes ranging from -0.78 to -0.98, which was negatively related to self-reported pain correlations (r = -0.53 to -0.40). The contraction ratios of the OI and OE were also lower in women with PFP than in pain-free women (P < .05). No differences between groups were found for the transversus abdominis, multifidus, and rectus abdominis, with also no correlation with self-reported pain. CONCLUSIONS Lower thickness of the OI and OE is present in women with PFP, which is related to self-reported pain. These findings might help in understanding the alterations in trunk biomechanics of individuals with PFP and the mechanisms by which interventions targeting trunk muscle strength are beneficial to individuals with PFP.
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Affiliation(s)
- Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University, Presidente Prudente, Sao Paulo, Brazil
| | - Marina Cabral Waiteman
- Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University, Presidente Prudente, Sao Paulo, Brazil
| | | | - Eduardo Gasoto
- Laboratory of Human Movement Research, State University of West Parana, Cascavel, Brazil
| | - Gabriel Segatti
- Laboratory of Human Movement Research, State University of West Parana, Cascavel, Brazil
| | - Crystian Bitencourt Oliveira
- Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University, Presidente Prudente, Sao Paulo, Brazil
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University, Presidente Prudente, Sao Paulo, Brazil
| | - Danilo de Oliveira Silva
- Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University, Presidente Prudente, Sao Paulo, Brazil
- La Trobe Sports and Exercise Medicine Research Center, School of Allied Health, LaTrobe University, Bundoora, Victoria, Australia
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Dos'Santos T, McBurnie A, Comfort P, Jones PA. The Effects of Six-Weeks Change of Direction Speed and Technique Modification Training on Cutting Performance and Movement Quality in Male Youth Soccer Players. Sports (Basel) 2019; 7:sports7090205. [PMID: 31489929 PMCID: PMC6783855 DOI: 10.3390/sports7090205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022] Open
Abstract
Cutting manoeuvres are important actions associated with soccer performance and a key action associated with non-contact anterior cruciate ligament injury; thus, training interventions that can improve cutting performance and movement quality are of great interest. The aim of this study, therefore, was to determine the effects of a six-week change of dire[ction (COD) speed and technique modification training intervention on cutting performance and movement quality in male youth soccer players (U17s, n = 8) in comparison to a control group (CG) (U18s, n = 11) who continued ‘normal’ training. Cutting performance was assessed based on completion time and COD deficit, and the field-based cutting movement assessment score (CMAS) qualitative screening tool was used to assess cutting movement quality. Significant main effects for time (pre-to-post changes) (p ≤ 0.041, η2 = 0.224–0.839) and significant interaction effects of time and group were observed for cutting completion times, COD deficits, and CMASs. Improvements in completion time (p < 0.001, g = 1.63–1.90, −9% to −11% vs. −5% to 6%) and COD deficit (p ≤ 0.012, g = −1.63 to −2.43, −40–52% vs. −22% to −28%) for the COD intervention group (IG) were approximately two-times greater than the CG. Furthermore, lower CMASs (i.e., improved cutting movement quality) were only observed in the IG (p ≤ 0.025, g = −0.85 to −1.46, −23% to −34% vs. 6–19%) compared to the CG. The positive changes in CMASs were attributed to improved cutting technique and reduced incidences of high-risk deficits such as lateral trunk flexion, extended knee postures, knee valgus, hip internal rotation, and improved braking strategies. The results of this study indicate that COD speed and technique modification training, in addition to normal skills and strength training, improves cutting performance and movement quality in male youth soccer players. Practitioners working with male youth soccer players should implement COD speed and technique modification training to improve cutting performance and movement quality, which may decrease potential injury-risk.
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Affiliation(s)
- Thomas Dos'Santos
- Directorate of Sport, Exercise & Physiotherapy, University of Salford, Salford, Greater Manchester M6 6PU, UK.
| | - Alistair McBurnie
- Directorate of Sport, Exercise & Physiotherapy, University of Salford, Salford, Greater Manchester M6 6PU, UK.
| | - Paul Comfort
- Directorate of Sport, Exercise & Physiotherapy, University of Salford, Salford, Greater Manchester M6 6PU, UK.
| | - Paul A Jones
- Directorate of Sport, Exercise & Physiotherapy, University of Salford, Salford, Greater Manchester M6 6PU, UK.
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