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Sannasi R, Rajashekar A, Hegde NS. Association of patellofemoral pain syndrome (PFPS) with quadratus lumborum and lower limb muscle tightness a cross-sectional study. J Orthop 2023; 42:1-5. [PMID: 37416861 PMCID: PMC10319640 DOI: 10.1016/j.jor.2023.06.007] [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: 02/18/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is characterized by peripatellar or retro patellar pain, as a result of changes in the physical and biochemical components of the patellofemoral joint. The main contributory factor is being the excessive load on the patellofemoral joint. The change in the flexibility of lower limb muscles is one of the factors for developing PFPS. Objective To find the association of quadratus lumborum (QL) and lower limb muscles tightness in patients with unilateral PFPS. Materials and methods 50 PFPS participants (21 male and 29 female) were included and assessed for muscle tightness on both affected and unaffected side. The QL, rectus femoris, hamstring, iliotibial band (ITB) and gastrocnemius tightness were measured using inch tape and mobile inclinometer. A Chi Square test and phi crammer's v criteria were used to check the association and the strength of it. Results A significant association was found between tightness of rectus femoris (PFPS-right Chi 19.99 p < 0.001; Phi-0.632, PFPS-left Chi-5.52 p = 0.019 and Phi- 0.332), gastrocnemius (PFPS-right Chi 8.78 p = 0.003; Phi-0.419, PFPS-left Chi- 11.41 p = 0.001; Phi- 0.478), iliotibial band (PFPS-right Chi 7.83 p = 0.005; Phi-0.396, PFPS left Chi-3.68 p = 0.055; Phi- 0.27). There was no significant association of hamstring tightness (PFPS-right Chi - 3.68 p = 0.055; Phi-0.055, PFPS left Chi-1.11 p = 0.291; Phi- 0.019) and QL (PFPS right Chi - 1.10 p = 0.293; Phi-0.293, PFPS left Chi-0.79 p = 0.372; Phi- 0.372). Conclusion PFPS was associated with tightness of rectus femoris, gastrocnemius, ITB and no association found between hamstring and QL muscle tightness and PFPS.
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Preszler JA, McInnis KC, Baute L, Tanaka MJ. Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester. Phys Ther Sport 2023; 60:34-46. [PMID: 36641951 DOI: 10.1016/j.ptsp.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization. CLINICAL QUESTION What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy? KEY RESULTS We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team. CLINICAL APPLICATION The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.
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Affiliation(s)
- Jamie A Preszler
- Department of Sports Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
| | - Kelly C McInnis
- Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Baute
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Valera-Calero JA, Varol U, Plaza-Manzano G, Fernández-de-las-Peñas C, Agudo-Aguado A. Regression Model Decreasing the Risk of Femoral Neurovascular Bundle Accidental Puncture. Tomography 2022; 8:2498-2507. [PMID: 36287807 PMCID: PMC9611046 DOI: 10.3390/tomography8050208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Although most of the adverse events derived from dry needling are minor, avoiding potential hazards for patients including accidental invasion of vessels, ganglia, and nerves is essential to ensure patients’ safety. We aimed to investigate the contribution of predictors explaining the variance of sartorius muscle depth limit at proximal third and middle thigh as these locations lead to an augmented risk of neurovascular bundle invasion during dry needling application. A diagnostic study was conducted on 84 subjects to calculate the accuracy of a prediction model for sartorius depth, as assessed with ultrasound imaging, based on sex, age, height, weight, body mass index (BMI), thigh perimeter, and length. After calculating a correlation matrix, a multiple linear regression analysis was performed to detect those variables contributing to the sartorius deep limit in both locations. Although males showed greater thigh perimeter than women (p < 0.001), the deep limit of the sartorius muscle was significantly more superficial for both the proximal third (p = 0.003) and the mid-third (p = 0.004) points. No side-to-side anthropometric differences were found (p > 0.05). In addition, we found sartorius muscle depth to be associated with the proximal and mid-third girth, gender, height, and BMI (all, p < 0.01). Gender, proximal-third girth, and BMI explained 51.1% and 42.6% of the variance for the sartorius deep limit at the proximal and the mid-third, respectively. This study analyzed whether anthropometric features could predict sartorius muscle depth in healthy participants for assisting clinicians in choosing the optimal needle length to avoid accidental femoral bundle puncture.
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Affiliation(s)
- Juan Antonio Valera-Calero
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Madrid, Spain
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Madrid, Spain
| | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-913-941-545
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Adolfo Agudo-Aguado
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Madrid, Spain
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Ebrahimi N, Rojhani-Shirazi Z, Yoosefinejad AK, Nami M. The effects of virtual reality training on clinical indices and brain mapping of women with patellofemoral pain: a randomized clinical trial. BMC Musculoskelet Disord 2021; 22:900. [PMID: 34696764 PMCID: PMC8544183 DOI: 10.1186/s12891-021-04785-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Virtual reality training (VRT) is a new method for the rehabilitation of musculoskeletal impairments. However, the clinical and central effects of VRT have not been investigated in patients with patellofemoral pain (PFP). To comprehensively assess the effects of VRT on clinical indices and brain function, we used a randomized clinical trial based on clinical and brain mapping assessment. Methods Twenty-six women with PFP for more than 6 months were randomly allocated to 2 groups: intervention and control. The intervention consisted of lifestyle education + 8 weeks VRT, in 24 sessions each lasting 40 min of training, whereas the control group just received lifestyle education. The balance was the primary outcome and was measured by the modified star excursion balance test. Secondary outcomes included pain, function, quality of life, and brain function which were assessed by visual analogue scale, step down test and Kujala questionnaire, SF-36, and EEG, respectively. Pre-intervention, post-intervention and follow-up (1 month after the end of the intervention) measurements were taken for all outcome measures except EEG, which was evaluated only at pre-intervention and post-intervention). Analyses of variance was used to compare the clinical outcomes between the two groups. The independent t-test also was used for between group EEG analyses. Results Balance score (P < 0.001), function (P < 0.001), and quality of life (P = 0.001) improved significantly at post-intervention and 1 month follow-up in the VRT group compared with the control group. VRT group showed a significantly decreased pain score (P = 0.004). Alpha (P < 0.05) and theta (P = 0.01) power activity also increased in the brain of the VRT group. Conclusion This study demonstrated that long term VRT was capable of improving both clinical impairments and brain function in patients with PFP. Therefore, therapists and clinicians can use this method as a more holistic approach in the rehabilitation of PFP. Trial registration IRCT, IRCT20090831002391N40. Registered 23 / 10 / 2019.
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Affiliation(s)
- Naghmeh Ebrahimi
- Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Chamran Blvd., Abiverdi 1Street, P.O. Box: 71345-1733, Shiraz, Iran
| | - Zahra Rojhani-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Chamran Blvd., Abiverdi 1Street, P.O. Box: 71345-1733, Shiraz, Iran.,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Chamran Blvd., Abiverdi 1Street, P.O. Box: 71345-1733, Shiraz, Iran. .,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Nami
- Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, 084301103, Panama.,Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, 71348-14336, Iran.,Dana Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, 71364-76172, Iran.,Academy of Health, Senses Cultural Foundation, Sacramento, CA, 66006, USA.,Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Pardis, Tehran, 1658344575, Iran
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Valera-Calero JA, Sánchez-Mayoral-Martín A, Varol U. Short-term effectiveness of high- and low-intensity percutaneous electrolysis in patients with patellofemoral pain syndrome: A pilot study. World J Orthop 2021; 12:781-790. [PMID: 34754834 PMCID: PMC8554351 DOI: 10.5312/wjo.v12.i10.781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/03/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unilateral patellofemoral pain syndrome (PFPS) is the most frequently diagnosed knee condition in populations aged < 50 years old. Although the treatment of myofascial trigger points (MTrPs) is a common and effective tool for reducing pain, previous studies showed no additional benefits compared with placebo in populations with PFPS. Percutaneous electrolysis is a minimally invasive approach frequently used in musculotendinous pathologies which consists of the application of a galvanic current through dry needling (DN). AIM To evaluate changes in sensitivity, knee pain perception and perceived pain during the application of these three invasive techniques. METHODS A triple-blinded, pilot randomized controlled trial was conducted on fifteen patients with unilateral PFPS who were randomized to the high-intensity percutaneous electrolysis (HIPE) experimental group, low-intensity percutaneous electrolysis (LIPE) experimental group or DN active control group. All interventions were conducted in the most active MTrP, in the rectus femoris muscle. The HIPE group received a 660 mA galvanic current for 10 s, the LIPE group 220 mA × 30 s and the DN group received no galvanic current. The MTrP and patellar tendon pain pressure thresholds (PPTs) and subjective anterior knee pain perception (SAKPP) were assessed before, after and 7 d after the single intervention. In addition, perceived pain during the intervention was also assessed. RESULTS Both groups were comparable at baseline as no significant differences were found for age, height, weight, body mass index, PPTs or SAKPP. No adverse events were reported during or after the interventions. A significant decrease in SAKPP (both HIPE and LIPE, P < 0.01) and increased patellar tendon PPT (all, P < 0.001) were found, with no differences between the groups (VAS: F = 0.30; η2 = 0.05; P > 0.05; tendon PPT immediate effects: F = 0.15; η2 = 0.02; P > 0.05 and tendon PPT 7-d effects: F = 0.67; η2 = 0.10; P > 0.05). A significant PPT increase in rectus femoris MTrP was found at follow-up in both the HIPE and LIPE groups (both, P < 0.001) with no differences between the groups (immediate effects: F= 1.55; η2 = 0.20; P > 0.05 and 7-d effects: F = 0.71; η2 = 0.10; P > 0.05). Both HIPE and LIPE interventions were considered less painful compared with DN (F = 8.52; η2 = 0.587; P < 0.01). CONCLUSION HIPE and LIPE induce PPT changes in MTrPs and patellar tendon and improvements in SAKPP, and seem to produce less pain during the intervention compared with DN.
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Affiliation(s)
| | | | - Umut Varol
- Business Analytics and Big Data, IE School of Human Sciences and Technology, Madrid 28006, Spain
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