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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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Alsaleh SA, Murphy NA, Miller SC, Morrissey D, Lack SD. Local neuromuscular characteristics associated with patellofemoral pain: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2021; 90:105509. [PMID: 34678670 DOI: 10.1016/j.clinbiomech.2021.105509] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Local neuromuscular deficits have been reported in people with patellofemoral pain. We synthesised the neuromuscular characteristics associated with patellofemoral pain to help identify interventional targets and potential mechanisms. METHODS Five databases were searched for local neuromuscular characteristics in case-control studies. Electromyography, flexibility, muscle performance and cross-sectional area data were derived from functional or isolated task investigations and synthesised accordingly. An evidence gap map was constructed. FINDINGS Sixty-seven studies were included. In functional tasks, electromyographic investigations showed moderate evidence of small effect for vastus medialis onset-delays relative to vastus lateralis (0.44 [0.03, 0.85]) during stepping/stair negotiation tasks, and higher biceps femoris mean excitation amplitudes (0.55 [0.06, 1.04]) in single-leg triple-hop test. In isolated tasks, we found moderate evidence of medium effect for lower Hoffman-reflex amplitude of vastus medialis (-1.12 [-1.56, -0.67]). Muscle performance investigations showed; strong evidence with medium and small effects for lower extensors concentric (-0.61 [-0.81, -0.40]) and eccentric (-0.56 [-0.79, -0.33]) strength, and moderate evidence of medium effect of lower isometric (-0.64 [-0.87, -0.41]) strength, moderate evidence with small effect for rate of force development to 30% (-0.55[-0.89, -0.21]), 60% (-0.57[-0.90, -0.25]) and medium effect to 90% (-0.76[-1.43, -0.10]) of maximum voluntary contraction, and small effect for lower flexors concentric strength (-0.46 [-0.74, -0.19]) and extensors total work (-0.48 [-0.90, -0.07]). Flexibility investigations showed tighter hamstrings (-0.57 [-0.99, -0.14]). INTERPRETATION Differences within quadriceps and hamstrings motor-control, hamstrings tightness, and quadriceps and hamstrings weakness are associated with patellofemoral pain, and can be used to guide investigations of treatment effects.
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Affiliation(s)
- S A Alsaleh
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom; Medical Services Authority, Ministry of Defence, Kuwait.
| | - N A Murphy
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom
| | - S C Miller
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom
| | - D Morrissey
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, UK
| | - S D Lack
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom; Pure Sports Medicine, London, UK
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Paczesny L, Zabrzynski J, Kentzer R, Gryckiewicz S, Lewandowski B, Szwedowski D, Kruczynski J. A 10-Year Follow-up on Arthroscopic Medial Plica Syndrome Treatments with Special Reference to Related Cartilage Injuries. Cartilage 2021; 13:974S-983S. [PMID: 31810387 PMCID: PMC8808933 DOI: 10.1177/1947603519892310] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the factors that can affect long-term results of arthroscopic resection of medial synovial plica of the knee. DESIGN A total of 52 knees in 50 consecutive patients with medial plica syndrome (MPS) were enrolled to prospective study. Preoperatively the age, gender, level of activity, symptoms' duration, Lysholm knee scoring scale (LKSS), Q angle, range of motion (ROM), and quadriceps output torque (QOT) were recorded. The plica was then arthroscopically excised while plica morphological type and cartilage lesions (International Cartilage Repair Society [ICRS] classification) were registered. The postoperative evaluation was done after 1 month, 3 months, 6 months, 3 years, and 10 years. The final assessment after 10 years covered LKSS, ROM, QOT, and was enriched with functional tests: the single leg squat test (SLS), the modified Ober test (MO), and the manual palpation of the vastus medialis obliquus (VMO). RESULTS The mean LKSS increased from 52 (15-85, SD 16.479) preoperative to 80 (48-100, SD 15.711) at final follow-up examination. A significant negative correlation was found between LKSS and the patients' age. Cartilage lesions higher than ICRS 1 significantly decreased the final LKSS. Results were significantly better in the subgroups with normal outcome of functional tests. CONCLUSIONS Clinical results of arthroscopic plica resection are better in patients without coexisting cartilage lesions. Poor neuromuscular control may contribute to abnormal patella tracking, leading to both medial plica irritation and further cartilage deterioration.
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Affiliation(s)
- Lukasz Paczesny
- Orvit Clinic, Citomed Healthcare Center,
Torun, Poland,Lukasz Paczesny, Orvit Clinic, Citomed
Healthcare Center, Sklodowskiej 73, Torun, 87-100, Poland.
| | - Jan Zabrzynski
- Orvit Clinic, Citomed Healthcare Center,
Torun, Poland,Department of Orthopedic Surgery,
Multidisciplinary Hospital, Inowroclaw, Poland
| | | | | | | | - Dawid Szwedowski
- Orthopaedic Arthroscopic Surgery
International (OASI) Bioresearch Foundation, Milan, Italy,Department of Orthopaedics and Trauma
Surgery, Provincial Polyclinical Hospital, Torun, Poland
| | - Jacek Kruczynski
- Department of General Orthopaedics,
Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, Poznan,
Poland
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Grant C, Fick CN, Welsh J, McConnell J, Sheehan FT. A Word of Caution for Future Studies in Patellofemoral Pain: A Systematic Review With Meta-analysis. Am J Sports Med 2021; 49:538-551. [PMID: 32816535 PMCID: PMC9906796 DOI: 10.1177/0363546520926448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar maltracking is widely accepted as an underlying mechanism of patellofemoral pain. However, methodological differences in the literature hinder our ability to generate a universal quantitative definition of pathological patellofemoral kinematics (patellar maltracking) in patellofemoral pain, leaving us unable to determine the cause of patellofemoral pain. PURPOSE To systematically review the literature to provide evidence regarding the influence of confounding variables on patellofemoral kinematics. STUDY DESIGN Systematic review and random effects meta-analysis of control-case studies. METHODS A literature search of case-control studies that evaluated patellofemoral kinematics at or near full extension and were written in English was conducted using Embase, PubMed, Scopus, and Web of Science up to September 2019. Cases were defined as patients with patellofemoral pain. Studies were eliminated if they lacked quantitative findings; had a primary aim to assess therapy efficacy; or included participants with osteoarthritis and/or previous trauma, pathology, or surgery. A quality assessment checklist was employed to evaluate each study. Meta-analyses were conducted to determine the influence of confounding variables on measures of patellofemoral kinematics. RESULTS Forty studies met the selection criteria, with quality scores ranging from 13% to 81%. Patient characteristics, data acquisition, and measurement methods were the primary sources of methodological variability. Active quadriceps significantly increased lateral shift (standardized mean difference [SMD]shift = 0.33; P = .0102) and lateral tilt (SMDtilt = 0.43; P = .006) maltracking. Individuals with pain secondary to dislocation had greater effect sizes for lateral maltracking than had those with isolated patellofemoral pain (ΔSMDshift = 0.71, P = .0071; ΔSMDtilt = 1.38, P = .0055). CONCLUSION This review exposed large methodological variability across the literature, which not only hinders the generalization of results, but ultimately mitigates our understanding of the underlying mechanism of patellofemoral pain. Although our meta-analyses support the diagnostic value of maltracking in patellofemoral pain, the numerous distinct methods for measuring maltracking and the limited control for cofounding variables across the literature prohibit defining a single quantitative profile. Compliance with specific standards for anatomic and outcome measures must be addressed by the scientific and clinical community to establish methodological uniformity in this field.
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Affiliation(s)
- Camila Grant
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Cameron N. Fick
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Judith Welsh
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Jenny McConnell
- Centre for Health Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Frances T. Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA,Address correspondence to Frances T. Sheehan, PhD, Department of Rehabilitation Medicine, National Institutes of Health, 6707 Democracy Blvd, Suite 856. Bethesda, MD 20817, USA ()
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Sex differences in neuromuscular control of quadriceps. Eur J Appl Physiol 2020; 120:2193-2202. [PMID: 32712701 DOI: 10.1007/s00421-020-04443-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patellofemoral pain syndrome (PFPS) is twice as prevalent in females as males, yet a few studies have evaluated differences in quadriceps muscle control between sexes or across force levels. This study investigated sex differences in quadriceps EMG onset times and amplitude at different force levels during isometric knee extension in asymptomatic males and females and in females with PFPS. METHODS Thirteen healthy males, 12 healthy females, and 10 females with PFPS performed isometric knee extension ramp contractions at 25%, 50%, and 75% of maximal voluntary contraction (MVC). Surface EMG was recorded from the vastus lateralis (VL), vastus medialis oblique (VMO), vastus medialis (VM), and rectus femoris (RF). RESULTS Healthy females showed delayed VL (222 ± 67 ms, p = 0.002), VMO (357 ± 101 ms, p = 0.001), and VM (258 ± 62 ms, p < 0.001) recruitment in comparison with healthy males. Healthy males activated the VL earlier than the VM (156 ± 51 ms, p = 0.02) and RF (379 ± 74 ms, p < 0.001), and at a similar time as the VMO; healthy females activated the VL earlier than the VM (192 ± 53 ms, p = 0.004) and VMO (239 ± 73 ms, p = 0.01). A lower VMO:VL activation ratio was found at 25% MVC (p < 0.001) than at higher force levels. CONCLUSIONS Delayed activation of the VMO relative to the VL has been proposed as a risk factor for PFPS. This study confirms a delay in VMO onset time in females.
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Felicio LR, de Carvalho CAM, Dias CLCA, Vigário PDS. Electromyographic activity of the quadriceps and gluteus medius muscles during/different straight leg raise and squat exercises in women with patellofemoral pain syndrome. J Electromyogr Kinesiol 2019; 48:17-23. [PMID: 31185341 DOI: 10.1016/j.jelekin.2019.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/30/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022] Open
Abstract
Patellofemoral pain syndrome (PPS) is characterized by anterior knee pain and affects young female adults. Physiotherapy is the most indicated treatment. The objective of the study was to analyze electromyographic activity of the quadriceps and gluteus medius muscles during different open and closed kinetic chain exercises in women with PPS. Twenty-two clinically healthy women and 24 women with symptomatic PPS were assessed through surface electromyography of the quadriceps and gluteus medius during the following exercises: straight leg raise with and without lateral hip rotation; squats; squats with adduction and hip abduction; and squats combined with lateral hip rotation. When comparing the groups, only the quadriceps muscle showed higher activity in the PPS group. In the comparisons between the exercises, in relation to gluteus medius and quadriceps muscle activity, the straight leg raise and straight leg raise with lateral hip rotation exercises showed more activity than squats in both groups. Among the squats, squats with adduction generated more gluteus medius activity in both groups, and no difference was noted among the squats for the quadriceps muscle. Therefore, rehabilitation programs that include exercises such as straight leg raises, straight leg raises with lateral hip rotation, and squats with adduction may be used for PPS patients.
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Babadi N, Roostayi MM, Rahimi A, Baghban AA, Sarmadi A, Roostaei H. The effect of different hip rotation angles on electromyography activity of the quadriceps muscle during closed kinetic chain tasks in healthy females. J Phys Ther Sci 2018; 30:1112-1116. [PMID: 30154611 PMCID: PMC6110206 DOI: 10.1589/jpts.30.1112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/30/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate electromyographic activity of the
quadriceps muscle in different positions of hip rotation (while standing on the toes) in
healthy females. [Participants and Methods] The study was conducted on 35 healthy females.
Electromyographic activity of the rectus femoris, vastus medialis oblique, and vastus
lateralis muscles were recorded with the hip in a neutral position as well as different
angles of internal and external rotation (15, 30, and 45 degrees (°)) while the
participants were standing on their toes. [Results] There was a significant difference of
15° in external rotation, a neutral position, 15° of internal rotation, and at the end of
an internal rotation position. Paired comparison between muscle activity using Bonferroni
showed that vastus lateralis activity in 15° of external rotation, a neutral position, 15°
of internal rotation, and at the end of a position of internal rotation was more than that
of rectus femoris muscle. [Conclusion] The present study showed that average vastus
lateralis activity was the highest in all positions. However, the positions studied in the
current study did not lead to an increase in muscle activity of the vastus medialis
oblique as a medial dynamic stabilizer compared to vastus lateralis.
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Affiliation(s)
- Neda Babadi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran, Iran
| | - Mohammad Mohsen Roostayi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran, Iran
| | - Abbas Rahimi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences: Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Iran
| | | | - Hosnieh Roostaei
- School of Sport Medicine and Health, Tehran University of Medical Sciences, Iran
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Peng YL, Tenan MS, Griffin L. Hip position and sex differences in motor unit firing patterns of the vastus medialis and vastus medialis oblique in healthy individuals. J Appl Physiol (1985) 2018; 124:1438-1446. [DOI: 10.1152/japplphysiol.00702.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Weakness of the vastus medialis oblique (VMO) has been proposed to explain the high prevalence of knee pain in female subjects. Clinicians commonly use exercises in an attempt to preferentially activate the VMO. Recently, our group found evidence to support clinical theory that the VMO is neurologically distinct from the vastus medialis (VM). However, the ability to voluntarily activate these muscle subsections is still disputed. The aim of this study was to determine if VM and VMO activation varies between sexes and if control of the two muscles is different between rehabilitation exercises. Thirteen men and 13 women performed isometric straight leg raises in two hip positions, neutral hip rotation and 30 degrees lateral hip rotation. Bipolar intramuscular fine-wire electrodes were inserted into the VM and VMO to obtain motor unit recruitment thresholds and initial firing rates at recruitment. Linear mixed models and Tukey post hoc tests were used to assess significant differences in 654 motor units. Women demonstrated faster motor unit firing rate at recruitment, 1.18 ± 0.56 Hz higher than men. Motor units fired 0.47 ± 0.19 Hz faster during neutral hip rotation compared with lateral hip rotation. The VMO motor units were recruited 2.92 ± 1.28% earlier than the VM. All motor units were recruited 3.74 ± 1.27% earlier during neutral hip rotation than lateral hip rotation. Thus the VM and the VMO can be activated differentially, and their motor unit recruitment properties are affected by sex and hip position. NEW & NOTEWORTHY This is the first study to reveal differential activation of the vastus medialis oblique from the vastus medialis in clinical exercise protocols. Our research group used fine-wire electrodes to examine EMG signals of the vastus medialis oblique and vastus medialis to avoid possible cross talk. We also consider the effect of sex on motor unit firing patterns because of higher prevalence of knee pain in women, and yet few studies evaluating the sex differences in neuromuscular control.
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Affiliation(s)
- Yi-Ling Peng
- Department of Kinesiology, University of Texas at Austin, Austin, Texas
| | - Matthew S. Tenan
- Human Research & Engineering Directorate, U.S. Army Research Laboratory, Aberdeen Proving Ground, Maryland
| | - Lisa Griffin
- Department of Kinesiology, University of Texas at Austin, Austin, Texas
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Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. JOURNAL OF SPORTS MEDICINE 2017; 2017:4721548. [PMID: 28913413 PMCID: PMC5585614 DOI: 10.1155/2017/4721548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/19/2017] [Accepted: 05/28/2017] [Indexed: 11/24/2022]
Abstract
Background There is no consensus on whether closed kinetic chain (CKC) or open kinetic chain (OKC) exercises should be the intervention of choice following an anterior cruciate ligament (ACL) injury or reconstruction. Methods A systematic search identified randomized controlled trials of OKC versus CKC exercise training in people who had undergone ACL reconstructive surgery. All published studies in this systematic review were comparisons between OKC and CKC groups. Results Seven studies were included. Lysholm knee scoring scale was not significantly different between OKC and CKC exercise patients: MD: −1.03%; CI: −13.02, 10.95; p value = 0.87 (Chi2 = 0.18, df = 1, and p value = 0.67). Hughston clinic questionnaire scores were not significantly different between OKC and CKC exercise patients: MD: −1.29% (−12.02, 9.43); p value = 0.81 (Chi2 = 0.01, df = 1, and p value = 0.93). Conclusions While OKC and CKC may be beneficial during ACL surgical rehabilitation, there is insufficient evidence to suggest that either one is superior to the other.
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Freddolini M, Placella G, Gervasi GL, Morello S, Cerulli G. Quadriceps muscles activity during gait: comparison between PFPS subjects and healthy control. Musculoskelet Surg 2017; 101:181-187. [PMID: 28233257 DOI: 10.1007/s12306-017-0469-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of the study was to evaluate if during a common activity as walking, altered quadriceps muscular activity may be present in patellofemoral pain syndrome (PFPS) patients. METHODS Forty subjects with clinically diagnosed PFPS and forty healthy males matching in age, weight, height and level of sport activity were enrolled in the study. Subjects were asked to walk on an instrumented walking path at their self-selected speed. Force platform and motion tracking system were used for the analysis of the gait. Wireless surface EMG probes were used to evaluate quadriceps muscles activity. Rectus femoris, vastus medialis and lateralis activity percentage, onset and offset time, walking speed, cadence, step length, stride length, knee ROM during gait were measured and reported. Tegner activity questionnaire was reported. RESULTS Patient group showed a significant increasing in all quadriceps muscles activity when compared to the control (p < 0.05). In particular, for VM and VL muscle onset time was anticipated and offset time was postponed in PFPS group when compared with healthy group (p < 0.05). Knee range of motion during walking was significantly decreased in the patient group. CONCLUSIONS Young athletes with PFPS showed increased length of quadriceps muscles activity and reduced functional knee Rom while walking, comparing with healthy subjects, in particular muscular onset was anticipated in respect of the loading response event of the gait. Nonetheless, walking parameters were not affected by these alterations.
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Affiliation(s)
- M Freddolini
- Institute of Orthopedic and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Largo Francesco Vito, 1, 00168, Rome, Italy.
- Biomechanics Division, Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', via Einstein 12/L, 52100, Arezzo, Italy.
| | - G Placella
- Institute of Orthopedic and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - G L Gervasi
- Institute of Orthopedic and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Largo Francesco Vito, 1, 00168, Rome, Italy
- Biomechanics Division, Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', via Einstein 12/L, 52100, Arezzo, Italy
| | - S Morello
- Orthopaedics and Traumatology Clinic, 'P. Giaccone' Hospital, University of Palermo, Via del Vespro, 131, 90127, Palermo, Italy
| | - G Cerulli
- Institute of Orthopedic and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Largo Francesco Vito, 1, 00168, Rome, Italy
- Biomechanics Division, Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', via Einstein 12/L, 52100, Arezzo, Italy
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11
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Rosen AB, Ko J, Simpson KJ, Brown CN. Patellar tendon straps decrease pre-landing quadriceps activation in males with patellar tendinopathy. Phys Ther Sport 2017; 24:13-19. [PMID: 28160657 DOI: 10.1016/j.ptsp.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/15/2016] [Accepted: 09/12/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if patellar tendon straps altered quadriceps' muscle activity during a drop-jump landing in males with and without patellar tendinopathy. DESIGN Case-control. SETTINGS Biomechanics Research Laboratory. PARTICIPANTS Twenty recreationally-active males participated: ten (age = 21.3 ± 2.4 years, height = 182.8 ± 5.3 cm, mass = 81.7 ± 8.6 kg) with patellar tendinopathy; ten (age = 22.0 ± 1.6 years, height = 185.7 ± 4.5 cm, mass = 82.2 ± 9.8 kg) were healthy with no history of tendinopathy. MAIN OUTCOME MEASURES Electromyography (EMG) data for the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) muscles were collected. Five 2-legged 40 cm drop-jumps were performed wearing a patellar tendon strap and 5 with no-strap in a counterbalanced order. Root-mean square EMG (REMG) values of the VM, RF, and VL were averaged for a pre-landing and post-landing interval. Multiple mixed-model two-way ANOVAs were performed to determine the effect of tendinopathy and strapping condition on REMG values for each muscle. RESULTS For the pre-landing interval, all participants displayed lesser VL EMG activation (0.44 ± 0.19%, 0.53 ± 0.27%, respectively; p = 0.007, d = 0.39) in the no-strap compared with the strap condition. CONCLUSIONS When wearing a strap, all participants demonstrated lower VL activation prior to landing which may be helpful in reducing tensile stress at the tendon. These effects may be clinically important in modulating pain in those with patellar tendinopathy.
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Affiliation(s)
- Adam B Rosen
- University of Nebraska at Omaha, School of Health, Physical Education and Recreation, 6001 Dodge St, Omaha, NE, 68182, USA.
| | - Jupil Ko
- Northern Arizona University, Department of Physical Therapy and Athletic Training, 435 N 5th St, Phoenix, AZ, 85004, USA
| | - Kathy J Simpson
- University of Georgia, Department of Kinesiology Biomechanics Laboratory, 330 River Rd, Athens, GA, 30602, USA
| | - Cathleen N Brown
- Oregon State University, Department of Athletic Training and Kinesiology, Langton Hall 220, Corvallis, OR, 97331, USA
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Drew BT, Redmond AC, Smith TO, Penny F, Conaghan PG. Which patellofemoral joint imaging features are associated with patellofemoral pain? Systematic review and meta-analysis. Osteoarthritis Cartilage 2016; 24:224-36. [PMID: 26471209 DOI: 10.1016/j.joca.2015.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/06/2015] [Accepted: 09/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To review the association between patellofemoral joint (PFJ) imaging features and patellofemoral pain (PFP). DESIGN A systematic review of the literature from AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro, EMBASE and SPORTDiscus was undertaken from their inception to September 2014. Studies were eligible if they used magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US) or X-ray (XR) to compare PFJ features between a PFP group and an asymptomatic control group in people <45 years of age. A pooled meta-analysis was conducted and data was interpreted using a best evidence synthesis. RESULTS Forty studies (all moderate to high quality) describing 1043 people with PFP and 839 controls were included. Two features were deemed to have a large standardised mean difference (SMD) based on meta-analysis: an increased MRI bisect offset at 0° knee flexion under load (0.99; 95% CI: 0.49, 1.49) and an increased CT congruence angle at 15° knee flexion, both under load (1.40 95% CI: 0.04, 2.76) and without load (1.24; 95% CI: 0.37, 2.12). A medium SMD was identified for MRI patella tilt and patellofemoral contact area. Limited evidence was found to support the association of other imaging features with PFP. A sensitivity analysis showed an increase in the SMD for patella bisect offset at 0° knee flexion (1.91; 95% CI: 1.31, 2.52) and patella tilt at 0° knee flexion (0.99; 95% CI: 0.47, 1.52) under full weight bearing. CONCLUSION Certain PFJ imaging features were associated with PFP. Future interventional strategies may be targeted at these features. PROSPERO REGISTRATION NUMBER CRD 42014009503.
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Affiliation(s)
- B T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - A C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - F Penny
- Physiotherapy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
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Werner S. Anterior knee pain: an update of physical therapy. Knee Surg Sports Traumatol Arthrosc 2014; 22:2286-94. [PMID: 24997734 DOI: 10.1007/s00167-014-3150-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/19/2014] [Indexed: 02/07/2023]
Abstract
Anterior knee pain is one of the most common knee problems in physically active individuals. The reason for anterior knee pain has been suggested to be multifactorial with patella abnormalities or extensor mechanism disorder leading to patellar malalignment during flexion and extension of the knee joint. Some patients complain mostly of non-specific knee pain, while others report patellar instability problems. The patients present with a variety of symptoms and clinical findings, meaning that a thorough clinical examination is the key for optimal treatment. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. However, irrespective of whether pain or instability is the major problem, hypotrophy and reduced activity of the vastus medialis are often found, which result in an imbalance between vastus medialis and vastus lateralis. This imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease loading of the patello-femoral joint. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least 3 months before considering other treatment options.
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Affiliation(s)
- Suzanne Werner
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,
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14
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Felicio LR, Camargo ACS, Baffa ADP, Bevilaqua-Grossi D. Influence of exercises on patellar height in women with patellofemoral pain syndrome. ACTA ORTOPEDICA BRASILEIRA 2014; 22:82-5. [PMID: 24868185 PMCID: PMC4031251 DOI: 10.1590/1413-78522014220200748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 10/30/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE: To evaluate the patellar height of volunteers with and without patellofemoral pain syndrome (PPS) during maximal voluntary isometric contraction (MVIC) in open kinetic chain (OKC) and closed kinetic chain (CKC) exercises. METHODS: Twenty healthy women, and nineteen women with patellofemoral pain syndrome were evaluated and subjected to nuclear magnetic resonance imaging during rest and MVIC in OKC and CKC at 15°, 30°, and 45° knee flexion. The patellar height was assessed by the K-Pacs program,using the Insall-Salvati index. For each exercise and knee position, patellar height was measured three times and the procedure was repeated after seven days. RESULTS: These data did not confirm our hypothesis that OKC exercises promote increased patellar height. CONCLUSION: Patellar height is not associated with PPS and suggests that CKC exercises lead an increased patellar height during knee position at 15º and 45º flexion for the PPS group. Level of Evidence II, Comparative Prospective.
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15
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Egloff C, Sawatsky A, Leonard T, Fung T, Valderrabano V, Herzog W. Alterations in patellofemoral kinematics following vastus medialis transection in the anterior cruciate ligament deficient rabbit knee. Clin Biomech (Bristol, Avon) 2014; 29:577-82. [PMID: 24703827 DOI: 10.1016/j.clinbiomech.2014.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cruciate ligament deficiency and quadriceps muscle weakness are considered to be important risk factors for aberrant patellar tracking and subsequent patellofemoral osteoarthritis. However, data from in vivo experiments looking at dynamic patellar joint kinematics and muscle force are scarce. Therefore, the purpose of this study was to evaluate the effects of anterior cruciate ligament transection and loss of vastus medialis force on patellar tracking in the rabbit knee in vivo. METHODS Eight skeletally mature New Zealand White Rabbits, weighing 6.0kg (0.6kg standard deviation) were used. The experimental trials consisted of active, concentric and eccentric movements of the knee joint. Measurements were performed with the intact, the anterior cruciate ligament deficient, and the vastus medialis transected knee. Patellofemoral kinematics (shift, rotation) were quantified from high speed video. FINDINGS Following anterior cruciate ligament transection, patellar tracking occurred more laterally, and caused a significant lateral rotation of the patella. The addition of vastus medialis transection did not alter patellar tracking or rotation significantly for any of the force-matched experimental conditions. INTERPRETATION The loss of the anterior cruciate ligament results in lateral patellar shift and rotation while the loss of vastus medialis muscle force does not affect patellar tracking or rotation in the anterior cruciate ligament deficient knee. We suggest that the current results should be considered carefully in future interpretations of knee extensor imbalance. More research is needed to describe the contribution of vastus medialis muscle strength to medial patellofemoral stability and confirm these results in the human knee.
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Affiliation(s)
- Christian Egloff
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Orthopaedic Department, University Hospital, University of Basel, Basel, Switzerland.
| | - Andrew Sawatsky
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Tim Leonard
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Tak Fung
- Statistics, Information Technologies, University of Calgary, Calgary, Alberta, Canada
| | - Victor Valderrabano
- Orthopaedic Department, University Hospital, University of Basel, Basel, Switzerland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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