Short-term effectiveness of an intervention targeting lower limb range of motion on pain and disability in patellofemoral pain patients: A randomized, non-concurrent multiple-baseline study

Impaired hemodynamics of the patella in patients with patellofemoral pain: A case-control study

Purpose

According to the homeostasis model, patellofemoral pain (PFP) arises as a consequence of disturbed homeostasis of anterior structures of the knee due to vascular insufficiency. Near-infrared spectroscopy (NIRS) allows to measure changes of concentrations (µmol/cm2) of (de)-oxygenated hemoglobine (HHb and O2Hb). The aim was to study differences in patellar hemodynamics between patients and healthy controls.

Methods

Hemodynamics of patients (n = 30 [female = 20, age = 21.5, BMI = 22.9]) and controls (n = 30 (female = 18, age = 21.4, BMI = 22.4]) were evaluated for two activities ('Prolonged Sitting' and 'Stair Descent'). Blinding for health status was implemented.

Results

During 'Prolonged Sitting', PFP patients exhibited smaller decreases in mean changes for HHb (PFP [M = -1.5 to -1.9], healthy controls [M = -2.0 to -2.3]) and O2Hb (PFP [M = -2.0 to -3.2], healthy controls [M = -3.4 to -4.1]). However, these differences were statistically non-significant (p = 0.14-0.82 and p = 0.056-0.18, respectively). Conversely, for 'Stair Descent', PFP patients showed statistically significant smaller decreases in mean changes for HHb (PFP [M = -1.9, SD = 1.8], healthy controls [M = -2.5, SD = 1.7], p = 0.043) and O2Hb (PFP [M = -3.2, SD = 3.2], healthy controls [M = -4.9, SD = 2.7], p = 0.004).

Conclusions

The differences suggest potential impairment in patellar hemodynamics in PFP patients, providing support for the homeostasis model. Evidence-based treatment strategies targeting patellar hemodynamics should be further refined and subjected to evaluation in clinical trials.

Level of Evidence

Level III.

Patients with patellofemoral pain have lower soft tissue flexibility of the kinetic chain compared to healthy controls: A case-control study

INTRODUCTION

Patellofemoral pain (PFP) is a common musculoskeletal condition. Lower limb range of motion (LLROM) evaluates soft tissue flexibility over multiple joints as part of the kinetic chain. The aims were to study: 1) the reliability of a new LLROM test; 2) differences in LLROM between PFP patients and controls; and 3) the relationship between LLROM and pain-free knee function.

METHODS

Patients with PFP and matched controls were recruited from a university campus and private physiotherapy clinics, while observers were blinded for health status. Testing LLROM for maximal knee flexion and hip adduction and the sum of these (total ROM) were performed. Measures of reliability (ICC2,1) were established. Univariate linear regression between LLROM and health status and multivariate analysis between LLROM and knee function were performed.

RESULTS

Patients (n = 32 (7 male/25 female, age = 22, BMI = 22.7)) and controls (n = 32 (7 male/25 female, age = 20, BMI = 22.3)) were included. The ICC's for intra- and interobserver reliability ranged from 0.83 (95%CI 0.30-0.93) to 0.89 (0.72-0.95). Symptomatic legs had 7°(3-11, p = 0.014) lower knee flexion, 6°(4-8, p ≤ 0.001) lower hip adduction and 13°(8-17, p ≤ 0.001) lower total ROM than non-symptomatic legs. Multivariate analysis revealed an association between total ROM and pain-free knee function (R2 = 0.438, F = 6.544, p ≤ 0.001).

CONCLUSIONS

The new LLROM test was found to be reliable. Patients with PFP had lower LLROM, which was associated with impaired pain-free knee function. Whether improving soft tissue flexibility results in enhanced pain-free knee function should be the subject of future research.

Computerized working memory training in males with Duchenne muscular dystrophy: A single case experimental design study

Learning disabilities (LDs) and working memory problems (WM) are common brain-related comorbidities in Duchenne muscular dystrophy (DMD). Despite growing evidence on the efficacy of computerized WM training in children with LDs, research in DMD is lacking. This exploratory study assessed whether training (1) improves dystrophin-associated WM problems in DMD, (2) effects are present at post-intervention, 3 and 8 months follow-up, and (3) improves problems that arise from their LDs. A single case non-concurrent multiple baseline across patients design evaluated the target behaviour i.e. parental reports of WM problems of four DMD participants with LDs. Additionally, participants completed cognitive tests of verbal and visual WM, academics, attention, processing speed and fluid reasoning. Parents and teachers completed behavioural questionnaires. Testing and questionnaires were administered at baseline, post-intervention (T2), 3 (T3) and 8 (T4) months follow-up. Positive effects on target behaviour were found for three of four participants, but parental bias cannot be ruled out. Short and long-term, near-and far transfer effects were found for verbal and visual WM (T2:n = 2, T3&T4:n = 1), reading (T2:n = 4,T3:n = 3,T4:n = 2), arithmetic (all T:n = 1), processing speed (all T:n = 4) and fluid reasoning (T2:n = 1,T3&T4:n = 2). Behavioural questionnaires displayed minimal changes (T2:n = 1,T3&T4:n = 2). Promising WM training results are shown in DMD that merit further research.

Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester

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.

Mobilization With Movement as Therapy to Reduce Knee Pain and Increase Knee Range of Motion

CLINICAL SCENARIO

Knee pain and limited knee range of motion (ROM) are among the most common conditions found in individuals who report lower body health-related issues. Factors such as weight gain, lack of mobility, balance issues, and pain can lead to a more sedentary lifestyle, which, in turn, causes knee stiffness or knee limited ROM. As a result, the patient will be at higher risk of osteoporosis, patellofemoral pain syndrome, reduced quadriceps strength, heart disease, and even depression.

CLINICAL QUESTION

Is mobilization with movement (MWM) an effective method of treatment for reducing knee pain and increasing knee ROM in individuals being treated for knee pain and limited knee ROM?

SUMMARY OF KEY FINDINGS

(1) The literature searched were peer-reviewed articles that investigated the effects of MWM as a therapy to reduce knee pain and increase knee ROM. (2) MWM was shown to be an effective treatment for reducing knee pain and increasing knee ROM.

CLINICAL BOTTOM LINE

There is conclusive evidence that MWM is an effective method of treatment for reducing knee pain and increasing knee ROM in individuals who experience knee pain and knee limited ROM.

STRENGTH OF RECOMMENDATION

Grade ("A") evidence exists showing that MWM therapy results are greater when performed either alone or in combination with a current conventional therapy for decreasing knee pain and increasing knee ROM.