1
|
Bartsch A, Anderson FL, Fredericson M, Sherman SL. Biomechanical and Biological Factors of Sexual Dimorphism in Anterior Knee Pain: Current Concepts. J ISAKOS 2024:S2059-7754(24)00101-9. [PMID: 38908481 DOI: 10.1016/j.jisako.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/24/2024]
Abstract
Female gender is one of the commonly mentioned risk factors for anterior knee pain (AKP), among a spectrum of other factors including anatomical, biomechanical, hormonal, behavioral, and psychological elements contributing to its development. Despite the focus on individual risk factors, there's a notable gap in comprehending how gender influences and interacts with other risk factors. The objective of this review was to identify and emphasize the connections between these interactions, gender-related risk factors for AKP, and the potential mechanisms that explain their associations with other risk factors, aiming to aid in the creation of precise prevention and treatment approaches. Gender influences the majority of risk factors for AKP, including anatomical, biomechanical, hormonal, behavioral, and psychological factors. Women have on average smaller patellae, higher patellofemoral cartilage stress and for AKP, disadvantageous trochlear morphology, ligament and muscle composition and unfavorable neuromuscular control pattern. In contrast, men show on average an increased ability to strengthen their hip external rotators, which are both protective against AKP. Particularly in kinetic and kinematic analysis, men have been shown to have a distinctly different risk factor profile than women. Sex hormones may also play a role in the risk of AKP, with estrogen potentially influencing ligamentous laxity, increasing midfoot loading and affecting neuromuscular control of the lower extremities and testosterone positively affecting muscle mass and strength. The higher incidence of AKP in women is likely due to a combination of slightly increased risk factors. Although all risk factors can be present in both men and women and the holistic evaluation of each individual's risk factor composition is imperative regardless of gender, knowing distinctive risk factors may help with focused evaluation, treatment, and implementing preventive measures of AKP.
Collapse
Affiliation(s)
- Anna Bartsch
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063 USA; Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063 USA; Department of Orthopedics and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Forrest L Anderson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063 USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063 USA; Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063 USA
| | - Seth Lawrence Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063 USA.
| |
Collapse
|
2
|
Mazzella N, Trowell D, Fox A, Saunders N, Vicenzino B, Bonacci J. Gait biomechanics do not differ between adolescents with and without patellofemoral pain. Scand J Med Sci Sports 2024; 34:e14587. [PMID: 38379205 DOI: 10.1111/sms.14587] [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: 09/14/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To determine if adolescents with patellofemoral pain exhibit different biomechanical characteristics to asymptomatic adolescents during walking and running. METHODS Twenty-eight adolescents with patellofemoral pain (16 male, 12 female, mean [SD] age: 14.3 [1.7] years) and 24 asymptomatic adolescents (13 male, 11 female, mean [SD] age: 14.1 [1.6] years) participated. Participants walked and ran on an instrumented treadmill in a standardized athletic shoe. Continuous hip, knee, and ankle joint angles and moments, and frontal plane pelvic motion were compared between groups using one-dimensional statistical parametric mapping independent t-tests (alpha <0.05). Cadence and stride length were compared between groups using independent t-tests. RESULTS During walking, adolescents with patellofemoral pain had a higher hip extension moment at 7%-8% of the gait cycle (p = 0.04) and walked with a shorter stride length (mean difference [95% confidence interval] = -0.07 [-0.1, -0.01] m). There were no other differences between groups during walking. During running, adolescents with patellofemoral pain had greater knee flexion than asymptomatic adolescents at 35%-40% of the gait cycle (p = 0.04) and ran with a higher cadence (mean difference [95% confidence interval] = 5.8 [2.0, 9.5] steps/min). There were no other statistically significant differences between groups during running. CONCLUSIONS Adolescents with patellofemoral pain demonstrate few biomechanical differences to asymptomatic adolescents during walking and running. The identified differences are likely of limited clinical importance. Biomechanical alterations which have been previously associated with patellofemoral pain in adults, may not need to be the target of management of adolescent patellofemoral pain.
Collapse
Affiliation(s)
- Natalie Mazzella
- Centre for Sport Research, Deakin University, Waurn Ponds, Victoria, Australia
| | - Danielle Trowell
- Centre for Sport Research, Deakin University, Burwood, Victoria, Australia
| | - Aaron Fox
- Centre for Sport Research, Deakin University, Waurn Ponds, Victoria, Australia
| | - Natalie Saunders
- Centre for Sport Research, Deakin University, Burwood, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Jason Bonacci
- Centre for Sport Research, Deakin University, Waurn Ponds, Victoria, Australia
| |
Collapse
|
3
|
Freiberger C, Thomas CM, Lupica GM, O'Connell S, Stamm MA, Mulcahey MK. Hip Range of Motion During Passive and 1-Leg Exercises Is Greater in Women: A Meta-analysis and Systematic Review. Arthroscopy 2024; 40:495-512.e3. [PMID: 37116553 DOI: 10.1016/j.arthro.2023.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To summarize sex-related differences in hip range of motion (ROM), including flexion, extension, abduction, adduction, internal rotation, and external rotation. METHODS We performed a systematic search of 3 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and Embase). The search terms were as follows: hip, pelvis, range of motion, kinematic, men, and women. Included studies reported sex-specific data on hip ROM in healthy, uninjured adults. To generate hip ROM mean differences, a DerSimonian-Laird random-effects model was used. Effect sizes were pooled for each exercise. Subgroup analyses compared hip ROM by physical activity group: passive ROM, 1-leg hop or jump, 2-leg hop or jump, 2-leg drop or landing, 1-leg squat, 2-leg squat, walking, and jogging/running. Positive effect sizes represent greater ROM in women. RESULTS Thirty-eight studies with 3,234 total subjects were included; of these subjects, 1,639 were women (50.1%). The mean age was 25.3 years. An effect difference was considered statistically significant if P < .05 and clinically significant if the mean difference was greater than 4.0°. Women showed statistically and clinically significantly greater hip flexion in passive ROM (mean difference, 6.4°) and during the 1-leg hop or jump exercise (mean difference, 6.5°). Women also showed statistically and clinically significantly greater hip adduction during the 1-leg hop or jump (mean difference, 4.5°) and 1-leg squat (mean difference, 4.4°) exercises, as well as statistically and clinically significantly greater hip internal rotation in passive ROM (mean difference, 8.2°). In contrast, men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise (mean difference, -9.1°). No clinically significant differences in extension, abduction, or external rotation were found between women and men. CONCLUSIONS On average, women showed statistically and clinically significantly greater flexion, adduction, and internal rotation during passive and 1-leg exercises whereas men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise. LEVEL OF EVIDENCE Level IV, meta-analysis and systematic review of Level II-IV studies.
Collapse
Affiliation(s)
- Christina Freiberger
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Christina M Thomas
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Gregory M Lupica
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Samantha O'Connell
- Office of Academic Affairs and Provost, Tulane University, New Orleans, Louisiana, U.S.A
| | - Michaela A Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A..
| |
Collapse
|
4
|
Kim S, Glaviano NR, Park J. Sex Differences in Knee Extensor Neuromuscular Function in Individuals With and Without Patellofemoral Pain. Sports Health 2023:19417381231209318. [PMID: 37978417 DOI: 10.1177/19417381231209318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Impaired knee extensor neuromuscular function has been frequently observed in individuals with patellofemoral pain (PFP); however, few researchers have aimed to understand the influence of sex on knee extensor neuromuscular function in this pathological population. The authors aimed to determine whether there are differences in knee extensor neuromuscular function between sexes in individuals with and without PFP. HYPOTHESIS Women with PFP would exhibit greater deficits in knee extensor neuromuscular function than men with PFP, compared with sex-matched individuals without PFP. STUDY DESIGN Cross-sectional, case-control study. LEVEL OF EVIDENCE Level 4. METHODS A total of 110 individuals were classified into 4 groups: women with PFP (n = 25); men with PFP (n = 30); women without PFP (n = 25); and men without PFP (n = 30). Knee extensor strength (isometric peak torque [PT]), activation (central activation ratio), early, late, and total phase rate of torque development (RTD0-100, RTD100-200, and RTD20-80%), and endurance (isokinetic average PT) were assessed using an isokinetic dynamometer. Group differences were assessed using a 2-way multivariate analysis of variance (sex by PFP). RESULTS Both women and men with PFP exhibited lower knee extensor strength, activation, early, late, and total phase RTD, and endurance versus sex-matched individuals without PFP (P < 0.05 for all comparisons). Women with PFP exhibited lower early phase (7.91 ± 2.02 versus 9.78 ± 2.43 N·m/s/kg; P < 0.01; Cohen d = 0.83), late phase (5.34 ± 1.02 versus 7.28±2.28 N·m/s/kg; P < 0.01; Cohen d = 1.37), and total phase (7.40 ± 2.57 versus 8.72 ± 2.57 N·m/s/kg; P = 0.03; Cohen d = 0.51) RTD than men with PFP. CONCLUSION Compared with sex-matched pain-free individuals, women with PFP displayed lower RTD than men with PFP. Clinicians should note that among individuals with PFP, women are more likely to experience a greater impairment in their knee extensor torque-generating capacity than men. CLINICAL RELEVANCE Additional treatment strategies that effectively improve the ability to rapidly generate torque should be developed and implemented, especially when treating women with PFP.
Collapse
Affiliation(s)
- Sungwan Kim
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| |
Collapse
|
5
|
Bazett-Jones DM, Neal BS, Legg C, Hart HF, Collins NJ, Barton CJ. Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis. Sports Med 2023; 53:519-547. [PMID: 36334239 DOI: 10.1007/s40279-022-01781-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments. OBJECTIVE We aimed to systematically review and synthesize the evidence for biomechanical variables (spatiotemporal, kinematic, kinetic) during walking and running in people with PFP compared with pain-free controls, and determine if biomechanical variables contribute to the development of PFP. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All study designs (prospective, case-control [± interventional component, provided pre-intervention data were reported for both groups], cross-sectional) comparing spatiotemporal, kinematic, and/or kinetic variables during walking and/or running between people with and without PFP. RESULTS We identified 55 studies involving 1300 people with PFP and 1393 pain-free controls. Overall pooled analysis identified that people with PFP had slower gait velocity [moderate evidence, standardized mean difference (SMD) - 0.50, 95% confidence interval (CI) - 0.72, - 0.27], lower cadence (limited evidence, SMD - 0.43, 95% CI - 0.74, - 0.12), and shorter stride length (limited evidence, SMD - 0.46, 95% CI - 0.80, - 0.12). People with PFP also had greater peak contralateral pelvic drop (moderate evidence, SMD - 0.46, 95% CI - 0.90, - 0.03), smaller peak knee flexion angles (moderate evidence, SMD - 0.30, 95% CI - 0.52, - 0.08), and smaller peak knee extension moments (limited evidence, SMD - 0.41, 95% CI - 0.75, - 0.07) compared with controls. Females with PFP had greater peak hip flexion (moderate evidence, SMD 0.83, 95% CI 0.30, 1.36) and rearfoot eversion (limited evidence, SMD 0.59, 95% CI 0.03, 1.14) angles compared to pain-free females. No significant between-group differences were identified for all other biomechanical variables. Data pooling was not possible for prospective studies. CONCLUSION A limited number of biomechanical differences exist when comparing people with and without PFP, mostly characterized by small-to-moderate effect sizes. People with PFP ambulate slower, with lower cadence and a shortened stride length, greater contralateral pelvic drop, and lower knee flexion angles and knee extension moments. It is unclear whether these features are present prior to PFP onset or occur as pain-compensatory movement strategies given the lack of prospective data. TRIAL REGISTRATION PROSPERO # CRD42019080241.
Collapse
Affiliation(s)
- David M Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, The University of Toledo, Toledo, OH, USA.
| | - Bradley S Neal
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, Essex, UK.,Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Christopher Legg
- Physiotherapy Department, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Harvi F Hart
- School of Physical Therapy and Bone and Joint Institute, Western University, London, ON, Canada
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia.,Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| |
Collapse
|
6
|
Gaudette LW, Bradach MM, de Souza Junior JR, Heiderscheit B, Johnson CD, Posilkin J, Rauh MJ, Sara LK, Wasserman L, Hollander K, Tenforde AS. Clinical Application of Gait Retraining in the Injured Runner. J Clin Med 2022; 11:6497. [PMID: 36362725 PMCID: PMC9655004 DOI: 10.3390/jcm11216497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 06/22/2024] Open
Abstract
Despite its positive influence on physical and mental wellbeing, running is associated with a high incidence of musculoskeletal injury. Potential modifiable risk factors for running-related injury have been identified, including running biomechanics. Gait retraining is used to address these biomechanical risk factors in injured runners. While recent systematic reviews of biomechanical risk factors for running-related injury and gait retraining have been conducted, there is a lack of information surrounding the translation of gait retraining for injured runners into clinical settings. Gait retraining studies in patients with patellofemoral pain syndrome have shown a decrease in pain and increase in functionality through increasing cadence, decreasing hip adduction, transitioning to a non-rearfoot strike pattern, increasing forward trunk lean, or a combination of some of these techniques. This literature suggests that gait retraining could be applied to the treatment of other injuries in runners, although there is limited evidence to support this specific to other running-related injuries. Components of successful gait retraining to treat injured runners with running-related injuries are presented.
Collapse
Affiliation(s)
- Logan W. Gaudette
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Molly M. Bradach
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - José Roberto de Souza Junior
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
- Graduate Program of Sciences and Technologies in Health, University of Brasilia, Brasilia 72220-275, DF, Brazil
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Caleb D. Johnson
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
- United States Army Research Institute for Environmental Medicine, Military Performance Division, Natick, MA 01760, USA
| | - Joshua Posilkin
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA 92182, USA
| | - Lauren K. Sara
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Lindsay Wasserman
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Medicine, MSH, Medical School Hamburg, 20457 Hamburg, Germany
| | - Adam S. Tenforde
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| |
Collapse
|
7
|
Luz BC, Dos Santos AF, Serrão FV. Are Altered Kinematics in Runners With Patellofemoral Pain Sex Specific? Sports Health 2022; 14:822-828. [PMID: 35596521 DOI: 10.1177/19417381221088582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Altered kinematics have been frequently observed in runners with patellofemoral pain (PFP), and few studies have aimed to understand the influence of sex on kinematics of this population. The aim of this study was to investigate whether altered hip and knee kinematics in runners with PFP are sex specific. HYPOTHESIS Kinematics will be different between female and male runners with and without PFP. STUDY DESIGN Case-control study. LEVEL OF EVIDENCE Level 2. METHODS Eighty-four runners were divided into 4 groups: 42 runners with PFP (20 women, 22 men) and 42 asymptomatic runners (21 women, 21 men). Three-dimensional gait analyses of the hip in the frontal and transverse plane and the knee in the frontal plane were analyzed at self-selected running speed on a treadmill. One-way analysis of covariance was used to test for differences in kinematic variables between groups. RESULTS Women with PFP ran with a significantly greater peak hip adduction compared with men with PFP (mean difference [MD] = 4.45°; P = 0.00; effect size [ES] = 0.58) and male control subjects (MD = 4.2°; P = 0.01; ES = 0.54) and greater hip adduction range of motion (ROM) than men with PFP (MD = 3.44°; P = 0.01; ES = 0.49). No significant differences were identified between women with and without PFP. Female control subjects ran with greater peak hip adduction than men with PFP (MD = 5.46°; P < 0.01; ES = 0.58) and male control subjects (MD = 5.21°; P < 0.01; ES = 0.55); greater hip adduction ROM than men with PFP (MD = 4.02°; P = 0.00; ES = 0.52) and male control subjects (MD = 2.91°;P = 0.04; ES = 0.36); and greater peak knee abduction than men with PFP (MD = 3.35°; P = 0.02; ES = 0.44) and male control subjects (MD = 3.69°; P = 0.01; ES = 0.4). CONCLUSION Women have greater hip adduction than men regardless of the presence of PFP. There were no kinematics difference between women with and without PFP. Comparisons of hip internal rotation between all groups were nonsignificant. CLINICAL RELEVANCE Altered hip and knee kinematics does not appear to be sex specific in runners with PFP.
Collapse
Affiliation(s)
- Bruna Calazans Luz
- Department of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | | | | |
Collapse
|
8
|
Lower Extremity Kinetics and Kinematics in Runners with Patellofemoral Pain: A Retrospective Case–Control Study Using Musculoskeletal Simulation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patellofemoral pain (PFP) is a common atraumatic knee pathology in runners, with a complex multifactorial aetiology influenced by sex differences. This retrospective case–control study therefore aimed to evaluate lower limb kinetics and kinematics in symptomatic and control male and female runners using musculoskeletal simulation. Lower extremity biomechanics were assessed in 40 runners with PFP (15 females and 25 males) and 40 controls (15 females and 25 males), whilst running at a self-selected velocity. Lower extremity biomechanics were explored using a musculoskeletal simulation approach. Four intergroup comparisons—(1) overall PFP vs. control; (2) male PFP vs. male control; (3) female PFP vs. female control; and (4) male PFP vs. female PFP—were undertaken using linear mixed models. The overall (stress per mile: PFP = 1047.49 and control = 812.93) and female (peak stress: PFP = 13.07 KPa/BW and control = 10.82 KPa/BW) comparisons showed increased patellofemoral joint stress indices in PFP runners. A significantly lower strike index was also shown in PFP runners in the overall (PFP = 17.75% and control = 33.57%) and female analyses (PFP = 15.49% and control = 40.20%), revealing a midfoot strike in control, and a rearfoot pattern in PFP runners. Peak rearfoot eversion and contralateral pelvic drop range of motion (ROM) were shown to be greater in PFP runners in the overall (eversion: PFP = −8.15° and control = −15.09°/pelvic drop ROM: PFP = 3.64° and control = 1.88°), male (eversion: PFP = −8.05° and control = −14.69°/pelvic drop ROM: PFP = 3.16° and control = 1.77°) and female (eversion: PFP = 8.28° and control = −15.75°/pelvic drop ROM: PFP = 3.64° and control = 1.88°) PFP runners, whilst female PFP runners (11.30°) exhibited a significantly larger peak hip adduction compared to PFP males (7.62°). The findings from this investigation highlight biomechanical differences between control and PFP runners, as well as demonstrating distinctions in PFP presentation for many parameters between sexes, highlighting potential risk factors for PFP that may be addressed through focused intervention modalities, and also the need, where appropriate, for sex-specific targeted treatment approaches.
Collapse
|
9
|
Willwacher S, Kurz M, Robbin J, Thelen M, Hamill J, Kelly L, Mai P. Running-Related Biomechanical Risk Factors for Overuse Injuries in Distance Runners: A Systematic Review Considering Injury Specificity and the Potentials for Future Research. Sports Med 2022; 52:1863-1877. [PMID: 35247202 PMCID: PMC9325808 DOI: 10.1007/s40279-022-01666-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology. OBJECTIVE To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. DESIGN Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). DATA SOURCES PubMed. Connected Papers. The search was performed in February 2021. ELIGIBILITY CRITERIA English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running. RESULTS Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs. CONCLUSION This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
Collapse
Affiliation(s)
- Steffen Willwacher
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Markus Kurz
- grid.29050.3e0000 0001 1530 0805Department of Quality Technology & Mechanical Engineering, Mid Sweden University, Östersund, Sweden
| | - Johanna Robbin
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Matthias Thelen
- grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Joseph Hamill
- grid.266683.f0000 0001 2166 5835Biomechanics Laboratory, University of Massachusetts, Amherst, MA USA
| | - Luke Kelly
- grid.1003.20000 0000 9320 7537School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD Australia
| | - Patrick Mai
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| |
Collapse
|
10
|
Leibbrandt D, Louw Q. Assessing biomechanics and associated factors in individuals with patellofemoral pain in a clinical setting: A qualitative study based on interviews with expert clinicians. Knee 2022; 34:178-186. [PMID: 34933238 DOI: 10.1016/j.knee.2021.11.015] [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: 08/23/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the perspectives of ten clinicians from different medical disciplines with experience in managing PFP on how to conduct biomechanical assessments in individuals with PFP in a clinical setting. METHODS An explorative qualitative design was used to explore the perspectives of ten clinicians with at least five years of experience managing patients with patellofemoral pain. A series of semi-structured interviews were done over Zoom video chat. The participants were from six different medical disciplines (physiotherapy, biokinetics, podiatry, sport science, sports medicine, orthopaedic surgery). Data was analysed thematically. RESULTS Four main themes emerged from the data. These were: 1) biomechanical contributing factors that clinicians routinely screen for in patients with PFP; 2) relevant functional activities for biomechanical screening in patients with PFP; 3) conducting gait analysis assessments in a clinical setting; and 4) challenges of biomechanical assessment in patients with PFP. The clinicians expressed conflicting opinions on the usefulness of clinical gait analysis. The clinicians questioned the clinical applicability of some of the biomechanical factors identified as important in the evidence. CONCLUSIONS It is important for clinicians to include the biomechanical assessment of functional activities linked to pain when managing patients with PFP. However, some of the biomechanical factors identified in the evidence are too difficult to observe without 3D movement analysis equipment and should not be considered clinically relevant. Expert clinical opinion is important to provide contextual information when addressing biomechanics in individuals with PFP.
Collapse
Affiliation(s)
- Dominique Leibbrandt
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa.
| | - Quinette Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| |
Collapse
|
11
|
Martinez-Cano JP, Ramos-Rivera JC, Gómez-García J, Casas–Barragán GA, Rosales MC, Escobar-Gonzalez SS. Anterior knee pain in runners after a half-marathon race. J Clin Orthop Trauma 2021; 23:101640. [PMID: 34733605 PMCID: PMC8545678 DOI: 10.1016/j.jcot.2021.101640] [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: 06/11/2021] [Revised: 09/20/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Anterior knee pain has been associated with sports activity, especially long-distance running and endurance sports. It is important to determine the incidence of anterior knee pain (AKP) in runners after a half-marathon race and identify possible risk factors associated. METHODS Cross-sectional study where runners from a half marathon race were randomly invited to participate. Participants were recruited at the race kit pickup site the day before the race. Eligible participants completed a survey regarding demographic information, running experience and training details. An orthopedic surgeon performed a physical examination and recorded the medical history. At the finish line, the participants were evaluated again for possible new injuries. RESULTS A total of 205 runners were included in the study, with a 98.5% follow-up rate (n = 203). 24% of runners had an injury at the end of the race (n = 49). Anterior knee pain was the most frequent injury (n = 12), followed by iliotibial band syndrome (n = 10), muscle cramps (n = 7) and hamstring tears (n = 4). Anterior knee pain had a statistically significant association with insufficient stretching of the hamstrings (p = 0.048) and finishing the race in more than 2 h (p = 0.014). CONCLUSIONS Anterior knee pain was the most frequent new injury in the half-marathon runners after the competition. Spending more than 2 h to finish the race and stretching the hamstrings by less than 70° in the supine position were risk factors for anterior knee pain.
Collapse
Affiliation(s)
- Juan Pablo Martinez-Cano
- Fundación Valle del Lili, Departamento de Ortopedia, Cra 98 No. 18 - 49, Cali, 760032, Colombia
- Universidad Icesi, Calle 18 No. 122 – 135, Cali, Colombia
| | - Juan Carlos Ramos-Rivera
- Universidad Icesi, Calle 18 No. 122 – 135, Cali, Colombia
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No. 18 – 49, Cali, 760032, Colombia
| | | | | | - Maria Cecilia Rosales
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No. 18 – 49, Cali, 760032, Colombia
| | - Sara Sofia Escobar-Gonzalez
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No. 18 – 49, Cali, 760032, Colombia
| |
Collapse
|
12
|
Scholes MJ, Crossley KM, King MG, Schache AG, Kemp JL, Semciw AI, Sritharan P, Heerey JJ, Mentiplay BF. Running biomechanics in football players with and without hip and groin pain. A cross-sectional analysis of 116 sub-elite players. Phys Ther Sport 2021; 52:312-321. [PMID: 34742030 DOI: 10.1016/j.ptsp.2021.10.011] [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: 08/03/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Examine whether football players with hip and/or groin (hip/groin) pain have impaired running biomechanics when compared to pain-free players, analysing men and women independently. DESIGN Cross-sectional. SETTING Biomechanics laboratory. PARTICIPANTS Seventy-eight (62 men, 16 women) football players with >6months of hip/groin pain and a positive flexion-adduction-internal rotation test and 38 (25 men, 13 women) asymptomatic players. MAIN OUTCOME MEASURES Pelvis angles and hip, knee, and ankle joint angles and moments were analysed during the stance phase of overground running at 3-3.5 m⋅s-1. Continuous joint angle and moment data were compared between symptomatic and asymptomatic football players of the same sex using statistical parametric mapping. Joint moment impulses (area under the curve) were compared between groups using linear regression models. RESULTS Symptomatic football players did not display significant differences in pelvis angles or lower-limb joint angles, moments, or moment impulses during the stance phase of running, when compared to asymptomatic players of the same sex. CONCLUSION Our large sample of football players with hip/groin pain who were still participating in competitive sport displayed similar running biomechanics to asymptomatic players. Impaired running biomechanics might exist in people with worse hip/groin pain, warranting future investigation.
Collapse
Affiliation(s)
- Mark J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Prasanna Sritharan
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| |
Collapse
|
13
|
Aristizábal Pla G, Hollville E, Schütte K, Vanwanseele B. The Use of a Single Trunk-Mounted Accelerometer to Detect Changes in Center of Mass Motion Linked to Lower-Leg Overuse Injuries: A Prospective Study. SENSORS 2021; 21:s21217385. [PMID: 34770692 PMCID: PMC8588413 DOI: 10.3390/s21217385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
Movement dynamics during running was previously characterized using a trunk-mounted accelerometer, and were associated with a history of overuse injuries. However, it remains unknown if these measures are also linked to the development of overuse injuries. The aim of this study was therefore to determine how movement dynamics alter in response to fatigue, and the possible link with developing lower-leg overuse injuries during a six-month follow-up period. Two hundred and eight movement science university students completed a 12-min all-out run while wearing a trunk-mounted accelerometer. Dynamic stability, dynamic loading and spatiotemporal measures were extracted from the accelerometer. Participants sustaining an injury within the 6-month period demonstrated significantly higher RMS ratio values in the vertical direction and lower RMS ratio values in the anteroposterior direction, and lower impact acceleration values in the anteroposterior direction in an unfatigued state compared to the uninjured group. They also demonstrated an increase in dynamic loading in the horizontal plane during the run. In addition, with running fatigue both groups exhibited changes in dynamic stability and loading measures. These results show the potential of using a single trunk-mounted accelerometer to detect changes in movement dynamics that are linked to lower-leg overuse injuries.
Collapse
Affiliation(s)
- Gerard Aristizábal Pla
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium; (G.A.P.); (E.H.); (K.S.)
- Department of Kinesiology, UMASS Amherst Amherst, University of Massachusetts Integrative Locomotion Lab, Amherst, MA 01003, USA
| | - Enzo Hollville
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium; (G.A.P.); (E.H.); (K.S.)
| | - Kurt Schütte
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium; (G.A.P.); (E.H.); (K.S.)
| | - Benedicte Vanwanseele
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium; (G.A.P.); (E.H.); (K.S.)
- Correspondence:
| |
Collapse
|
14
|
Trunk muscle endurance in individuals with and without patellofemoral pain: Sex differences and correlations with performance tests. Phys Ther Sport 2021; 52:248-255. [PMID: 34656829 DOI: 10.1016/j.ptsp.2021.09.012] [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: 08/17/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare trunk muscle endurance among females and males with and without patellofemoral pain (PFP), and to investigate the correlations between trunk muscle endurance and performance of the single leg hop test (SLHT) and forward step-down test (FSDT). DESIGN Cross-sectional. SETTING Laboratory-based study. PARTICIPANTS 110 females and 38 males with PFP, 61 females and 31males without PFP. MAIN OUTCOME MEASURES Anterior and lateral trunk muscle endurance were assessed with the prone and bilateral side-bridge tests, respectively. Performance during the SLHT and FSDT was also assessed. RESULTS Lower anterior and lateral trunk muscle endurance were identified in females (p < .001; d = -0.74 to -0.86), but not in males (p ≥ .806; d = -0.04 to 0.05) with PFP as compared to sex-matched controls. Moderate to large, positive correlations between anterior and lateral trunk muscle endurance with performance in the SLHT and FSDT were identified in females (r = .27 to .50; p < .004) and males (r = 0.27 to 0.59; p < .031) with PFP and females without PFP (r = 0.26 to 0.40; p < .044). CONCLUSION Our findings highlight that assessing trunk muscle endurance is advised in females with PFP. Trunk muscle endurance of individuals with PFP may have a role in the performance of hopping and stepping down tasks.
Collapse
|
15
|
Patellofemoral kinematics in patellofemoral pain syndrome: The influence of demographic factors. J Biomech 2021; 130:110819. [PMID: 34749164 DOI: 10.1016/j.jbiomech.2021.110819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022]
Abstract
Due to the multifactorial nature of patellofemoral pain, it is often difficult to identify an individual patient's exact cause of pain. Understanding how demographic variability influences these various factors will support improved consensus in regards to the etiology of PF pain. Thus, in this retrospective study, we tested the hypothesis that sex, height, weight, body mass index (BMI), and age influence the determination of between-groups differences in PF kinematics. We included 41 skeletally mature patients with patellofemoral pain and 79 healthy controls. Three-dimensional patellofemoral kinematics were quantified from dynamic magnet resonance images. We ran multiple regression analyses to determine the influence of demographic covariates (age, sex, height, weight, and BMI) on patellofemoral kinematics. Patellar shift was significantly influenced by weight (p = 0.009) and BMI (p = 0.009). Patellar flexion was influenced by height (p = 0.020) and weight (p = 0.040). Patellar tilt and superior displacement were not influence by demographic variables. Age and sex did not influence kinematics. This study supports the hypothesis that demographic parameters influence PF kinematics. The fact that weight, a modifiable measure, influences both patellar shift and flexion has strong implications for future research and clinical interventions. Clinically, weight loss may have a dual benefit of reducing joint stress and maltracking in patients who are overweight and experiencing patellofemoral pain. The influence of key demographics on patellofemoral kinematics, reinforces the clear need to control for population characteristics in future studies. As such, going forward, improved demographic matching between control and patient cohorts or more advanced statistical techniques that compensate for confounding variables are necessary.
Collapse
|
16
|
Three-dimensional joint kinematic and two-dimensional quality of movement comparison between lateral and forward step-downs. Phys Ther Sport 2021; 52:162-167. [PMID: 34536631 DOI: 10.1016/j.ptsp.2021.09.005] [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: 05/28/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES While lateral and forward step-down tasks are commonly used, they may have different kinematic and performance demands that could influence clinical assessment and rehabilitation. Therefore, the purpose of this study was to compare 3D lower extremity kinematics and 2D quality of movement between the tasks. DESIGN Cross-sectional comparative study. SETTING Research laboratory. PARTICIPANTS Thirty healthy adults (18 females, age = 23.2 ± 1.4 years, BMI = 23.9 ± 2.2 kg/m2). MAIN OUTCOME MEASURES Participants underwent 3D and 2D motion analysis. 3D variables were peak hip, knee, and ankle angles. Dichotomous clinical criteria were used for 2D assessment. An alpha level of 0.05 was used for statistical analyses. RESULTS In the sagittal plane, the forward step-down averaged 7° more knee flexion (p < 0.001, d = 2.30) and 4° more ankle dorsiflexion (p < 0.001, d = 1.72), but 2° less hip flexion (p = 0.001, d = 0.64). In the frontal plane, forward step-downs averaged 1° more hip adduction (p = 0.006, d = 0.54) and 1° more ankle eversion (p < 0.001, d = 1.04). The forward step-down elicited 2D movement faults more often (p = 0.003). CONCLUSIONS The increased knee flexion and ankle dorsiflexion demands of the forward step-down were accompanied by increases in frontal plane aberrations. The forward step-down may be more challenging for individuals with reduced tolerance to loaded knee flexion and/or limited ankle mobility.
Collapse
|
17
|
Losciale J, Wayman K, Mansfield CJ, Rethman KK, Briggs MS. A preliminary analysis of physical therapist agreement regarding the perceived impairments in cases of runners with knee pain. Physiother Theory Pract 2021; 38:2938-2948. [PMID: 34315318 DOI: 10.1080/09593985.2021.1946876] [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: 10/20/2022]
Abstract
Background: There is a scarcity of evidence describing how physical therapists use data from clinical examinations to inform the treatment of runners with knee pain.Objective: Our purpose was to examine the between physical therapist agreement on the selection of perceived impairments in runners with knee pain.Methods: Twelve physical therapists reviewed two cases of runners with knee pain. The cases included clinical subjective information, objective data, and review of videos of each participant running. Each rater selected up to three perceived impairments (from a list of eight) that each physical therapist would address at the next physical therapy session. Percent agreement was calculated to determine the between rater agreement on each individual perceived impairment selection and Fleiss Kappa was calculated for each unique combination of three perceived impairments per case.Results: Twelve raters with 51 (18-156) months of clinical experience participated. Percent agreement ranged from 8%-100% for both cases for individual impairments. When assessing the unique combination of three impairments selected, inter-rater agreement was less than what is expected due to chance alone (κ = -0.09, p = .92; κ = -0.09, p = .98) for both cases.Conclusion: The 12 physical therapists demonstrated poor to excellent levels of agreement when selecting an individual perceived impairment. Agreement was worse than chance when selecting a combination of three unique impairments.
Collapse
Affiliation(s)
- Justin Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Wayman
- Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Cody J Mansfield
- Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, OH, USA.,School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH, USA.,Ambulatory Rehabilitation, Ohio State Sports Medicine Care Point Gahanna, The Ohio State University Wexner Medical Center, Gahanna, OH, USA
| | - Katherine K Rethman
- Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew S Briggs
- Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, OH, USA.,School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH, USA.,Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
18
|
Kwan LYA, Killingback A, Robertson C, Adds P. Ultrasound investigation into the relationship between hip adduction and the patellofemoral joint. J Phys Ther Sci 2021; 33:511-516. [PMID: 34219955 PMCID: PMC8245268 DOI: 10.1589/jpts.33.511] [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] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Patellofemoral pain (PFP) is a common musculoskeletal complaint. It has been
suggested that hip adduction creates a load on the iliotibial band and causes lateral
displacement of the patella (patella tilt). However, data gathered in a previous study
were derived from a small sample of males, while the condition predominantly affects
females. We assessed the relationship between hip adduction and patellar position with a
larger sample size, including males and females. [Participants and Methods] Forty healthy,
asymptomatic females and males (age 21.5 ± 1.3 years) were recruited. Their knees were
passively flexed by 20°. Using ultrasound, the distance between the lateral edge of the
patella and the lateral condyle of the femur was measured in the neutral position and at
20° adduction. [Results] Hip adduction produced a smaller patella-lateral femoral condyle
measurement than in the neutral position. The mean difference in the patella-condyle
distance between the neutral position and 20° hip adduction was 0.18 cm. No statistically
significant difference was found between the right and left limbs, genders, Tegner scores,
or BMI of the study participants. [Conclusion] The results of the study showed that hip
adduction causes lateral displacement of the patella. Ultrasound is an effective means of
assessing patella tilt.
Collapse
Affiliation(s)
- Lok Yin Ada Kwan
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London: Cranmer Terrace London SW17 0RE, UK
| | | | | | - Philip Adds
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London: Cranmer Terrace London SW17 0RE, UK
| |
Collapse
|
19
|
Barton CJ, De Oliveira Silva D, Morton S, Collins NJ, Rathleff MS, Vicenzino B, van Middelkoop M, Crossley KM, Callaghan MJ, Selfe J, Holden S, Lack S, Macri EM, Bazett-Jones DM, Earl-Boehm JE, Riel H, Powers CM, Davis IS, Morrissey D. REPORT-PFP: a consensus from the International Patellofemoral Research Network to improve REPORTing of quantitative PatelloFemoral Pain studies. Br J Sports Med 2021; 55:1135-1143. [PMID: 34127482 DOI: 10.1136/bjsports-2020-103700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 12/12/2022]
Abstract
Patellofemoral pain is a common and often debilitating musculoskeletal condition. Clinical translation and evidence synthesis of patellofemoral pain research are compromised by heterogenous and often inadequately reported study details. This consensus statement and associated checklist provides standards for REPORTing of quantitative PatelloFemoral Pain (REPORT-PFP) research to enhance clinical translation and evidence synthesis, and support clinician engagement with research and data collection. A three-stage Delphi process was initiated at the 2015 International Patellofemoral Research Network (iPFRN) retreat. An initial e-Delphi activity (n=24) generated topics and items, which were refined at the 2017 iPFRN retreat, and voted on prior to and following the 2019 iPFRN retreat (n=51 current and past retreat participants). Voting criteria included 'strongly recommended' (essential), 'recommended' (encouraged) and uncertain/unsure. An item was included in the checklist if ≥70% respondents voted 'recommended'. Items receiving ≥70% votes for 'strongly recommended' were labelled as such. The final REPORT-PFP checklist includes 31 items (11 strongly recommended, 20 recommended), covering (i) demographics (n=2,4); (ii) baseline symptoms and previous treatments (n=3,7); (iii) outcome measures (2,4); (iv) outcomes measure description (n=1,2); (v) clinical trial methodology (0,3) and (vi) reporting study results (n=3,0). The REPORT-PFP checklist is ready to be used by researchers and clinicians. Strong stakeholder engagement from clinical academics during development means consistent application by the international patellofemoral pain research community is likely. Checklist adherence will improve research accessibility for clinicians and enhance future evidence synthesis.
Collapse
Affiliation(s)
- Christian J Barton
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia .,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Danilo De Oliveira Silva
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Morton
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Natalie J Collins
- Physiotherapy, The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Centre for General Practice, Aalborg University, Aalborg, Denmark.,Department of Occupational therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Bill Vicenzino
- Physiotherapy, The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC Medical University Center, Rotterdam, The Netherlands
| | - Kay M Crossley
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J Callaghan
- Medical Department, Manchester United Football Club Ltd, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Sinead Holden
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Centre for General Practice, Aalborg University, Aalborg, Denmark
| | - Simon Lack
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Pure Sports Medicine, London, UK
| | - Erin M Macri
- Department of Orthopaedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jennifer E Earl-Boehm
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Henrik Riel
- Centre for General Practice, Aalborg University, Aalborg, Denmark
| | | | - Irene S Davis
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Physiotherapy Department, Barts Health NHS Trust, London, UK
| |
Collapse
|
20
|
Estimating Lower Extremity Running Gait Kinematics with a Single Accelerometer: A Deep Learning Approach. SENSORS 2020; 20:s20102939. [PMID: 32455927 PMCID: PMC7287664 DOI: 10.3390/s20102939] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Abstract
Abnormal running kinematics are associated with an increased incidence of lower extremity injuries among runners. Accurate and unobtrusive running kinematic measurement plays an important role in the detection of gait abnormalities and the prevention of injuries among runners. Inertial-based methods have been proposed to address this need. However, previous methods require cumbersome sensor setup or participant-specific calibration. This study aims to validate a shoe-mounted accelerometer for sagittal plane lower extremity angle measurement during running based on a deep learning approach. A convolutional neural network (CNN) architecture was selected as the regression model to generalize in inter-participant scenarios and to minimize poorly estimated joints. Motion and accelerometer data were recorded from ten participants while running on a treadmill at five different speeds. The reference joint angles were measured by an optical motion capture system. The CNN model predictions deviated from the reference angles with a root mean squared error (RMSE) of less than 3.5° and 6.5° in intra- and inter-participant scenarios, respectively. Moreover, we provide an estimation of six important gait events with a mean absolute error of less than 2.5° and 6.5° in intra- and inter-participants scenarios, respectively. This study highlights an appealing minimal sensor setup approach for gait analysis purposes.
Collapse
|
21
|
Effect of neuromuscular training augmented with knee valgus control instructions on lower limb biomechanics of male runners. Phys Ther Sport 2020; 43:89-99. [PMID: 32135451 DOI: 10.1016/j.ptsp.2020.02.009] [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: 11/27/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine if combining neuromuscular training (NMT) with knee valgus control instructions (VCIs) can affect lower limb biomechanics and injury incidence in male novice runners and assess over 1-year follow-up. DESIGN Controlled laboratory Study. SETTING University research laboratory. PARTICIPANTS 60 male novice runners randomly assigned into NMT (n = 20), NMT plus VCIs (n = 20), and sham (n = 20). MAIN OUTCOME MEASURES Kinematic and kinetic were measured at pre- and post-test and 1-year follow-up. Injury incidence assessed at pre-test and 1-year follow up. RESULTS There were significant between-group differences in kinetics after 6 weeks in NMT plus VCIs group. No significant differences were observed between NMT and NMT plus VCIs in kinematic variables. No significant change was seen in the sham in all variables. At 1-year follow-up, the minimal changes were seen in kinetic variables. Reduction reported running-related injuries were 31.58% in the NMT alone group, 65.52% in NMT plus VCIs group. In sham, it increased to 13.46%. CONCLUSIONS NMT plus VCIs was effective to reduce kinetics and improve kinematics in novice runners. Also, it could reduce injury incidence. This protocol may be an option for both athletic trainers and coaches for preventing of lower limbs' injury in male runners.
Collapse
|
22
|
Sisk D, Fredericson M. Update of Risk Factors, Diagnosis, and Management of Patellofemoral Pain. Curr Rev Musculoskelet Med 2019; 12:534-541. [PMID: 31773479 DOI: 10.1007/s12178-019-09593-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Patellofemoral pain is the most common cause of anterior knee pain. The purpose of this review is to examine the latest research on risk factors, physical examination, and treatment of patellofemoral pain to improve accuracy of diagnosis and increase use of efficacious treatment modalities. RECENT FINDINGS The latest research suggests patellofemoral pain pathophysiology is a combination of biomechanical, behavioral, and psychological factors. Research into targeted exercise therapy and other conservative therapy modalities have shown efficacy especially when used in combination. New techniques such as blood flow restriction therapy, gait retraining, and acupuncture show promise but require further well-designed studies. Patellofemoral pain is most commonly attributed to altered stress to the patellofemoral joint from intrinsic knee factors, alterations in the kinetic chain, or errors in training. Diagnosis can be made with a thorough assessment of clinical history and risk factors, and a comprehensive physical examination. The ideal treatment is a combination of conservative treatment modalities ideally individualized to the risk factors identified in each patient. Ongoing research should continue to identify biomechanical risk factors and new treatments as well as look for more efficient ways to identify patients who are amenable to treatments.
Collapse
Affiliation(s)
- Daniel Sisk
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA.
| | - Michael Fredericson
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| |
Collapse
|
23
|
Dingenen B, Malliaras P, Janssen T, Ceyssens L, Vanelderen R, Barton CJ. Two-dimensional video analysis can discriminate differences in running kinematics between recreational runners with and without running-related knee injury. Phys Ther Sport 2019; 38:184-191. [DOI: 10.1016/j.ptsp.2019.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 02/04/2023]
|