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Six Treatments Have Positive Effects at 3 Months for People With Patellofemoral Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:750-768. [PMID: 36070427 DOI: 10.2519/jospt.2022.11359] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To determine the effects of nonsurgical treatments on pain and function in people with patellofemoral pain (PFP). DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: We searched MEDLINE, Web of Science, and Scopus databases from their inception until May 2022 for interventional randomized controlled trials (RCTs) in people with PFP. STUDY SELECTION CRITERIA: We included RCTs that were scored ≥7 on the PEDro scale. DATA SYNTHESIS: We extracted homogenous pain and function data at short- (≤3 months), medium- (>3 to ≤12 months) and long-term (>12 months) follow-up. Interventions demonstrated primary efficacy if outcomes were superior to sham, placebo, or wait-and-see control. Interventions demonstrated secondary efficacy if outcomes were superior to an intervention with primary efficacy. RESULTS: We included 65 RCTs. Four interventions demonstrated short-term primary efficacy: knee-targeted exercise therapy for pain (standardized mean difference [SMD], 1.16; 95% CI: 0.66, 1.66) and function (SMD, 1.19; 95% CI: 0.51, 1.88), combined interventions for pain (SMD, 0.79; 95% CI: 0.26, 1.29) and function (SMD, 0.98; 95% CI: 0.47, 1.49), foot orthoses for global rating of change (OR = 4.31; 95% CI: 1.48, 12.56), and lower-quadrant manual therapy for function (SMD, 2.30; 95% CI: 1.60, 3.00). Two interventions demonstrated short-term secondary efficacy compared to knee-targeted exercise therapy: hip-and-knee-targeted exercise therapy for pain (SMD, 1.02; 95% CI: 0.58, 1.46) and function (SMD, 1.03; 95% CI: 0.61, 1.45), and knee-targeted exercise therapy and perineural dextrose injection for pain (SMD, 1.34; 95% CI: 0.72, 1.95) and function (SMD, 1.21; 95% CI: 0.60, 1.82). CONCLUSIONS: Six interventions had positive effects at 3 months for people with PFP, with no intervention adequately tested beyond this time point. J Orthop Sports Phys Ther 2022;52(11):750-768. Epub: 8 September 2022. doi:10.2519/jospt.2022.11359.
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Magnusdottir EH, Johannsdottir KR, Majumdar A, Gudnason J. Assessing Cognitive Workload Using Cardiovascular Measures and Voice. SENSORS (BASEL, SWITZERLAND) 2022; 22:6894. [PMID: 36146251 PMCID: PMC9502693 DOI: 10.3390/s22186894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Monitoring cognitive workload has the potential to improve both the performance and fidelity of human decision making. However, previous efforts towards discriminating further than binary levels (e.g., low/high or neutral/high) in cognitive workload classification have not been successful. This lack of sensitivity in cognitive workload measurements might be due to individual differences as well as inadequate methodology used to analyse the measured signal. In this paper, a method that combines the speech signal with cardiovascular measurements for screen and heartbeat classification is introduced. For validation, speech and cardiovascular signals from 97 university participants and 20 airline pilot participants were collected while cognitive stimuli of varying difficulty level were induced with the Stroop colour/word test. For the trinary classification scheme (low, medium, high cognitive workload) the prominent result using classifiers trained on each participant achieved 15.17 ± 0.79% and 17.38 ± 1.85% average misclassification rates indicating good discrimination at three levels of cognitive workload. Combining cardiovascular and speech measures synchronized to each heartbeat and consolidated with short-term dynamic measures might therefore provide enhanced sensitivity in cognitive workload monitoring. The results show that the influence of individual differences is a limiting factor for a generic classification and highlights the need for research to focus on methods that incorporate individual differences to achieve even better results. This method can potentially be used to measure and monitor workload in real time in operational environments.
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Affiliation(s)
- Eydis H. Magnusdottir
- Center for Analysis and Design of Intelligent Agents, Reykjavik University, 101 Reykjavik, Iceland
| | - Kamilla R. Johannsdottir
- Center for Analysis and Design of Intelligent Agents, Reykjavik University, 101 Reykjavik, Iceland
| | - Arnab Majumdar
- The Lloyd’s Register Foundation Transport Risk Management Centre, Imperial College, London SW7 2AZ, UK
| | - Jon Gudnason
- Center for Analysis and Design of Intelligent Agents, Reykjavik University, 101 Reykjavik, Iceland
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Knee osteoarthritis pain and stretching exercises: a systematic review and meta-analysis. Physiotherapy 2022; 114:16-29. [DOI: 10.1016/j.physio.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/23/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022]
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Lotfi H, Moghadam AN, Shati M. Electromyography Activity of Vastus Medialis Obliquus and Vastus Lateralis Muscles During Lower Limb Proprioceptive Neuromuscular Facilitation Patterns in Individuals with and without Patellofemoral Pain Syndrome. Phys Ther Res 2022; 24:218-224. [PMID: 35036255 DOI: 10.1298/ptr.e10094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Exercise therapy to strengthen quadriceps muscle is recommended in rehabilitation program for people with patellofemoral pain syndrome (PFPS). This study aimed to investigate the electromyography (EMG) activity of vastus medialis obliquus (VMO), vastus lateralis (VL) and VMO/VL ratio during PNF in individuals with and without PFPS. METHODS 26 persons with PFPS and 26 healthy subjects participated to study. All subjects performed PNF patterns (Flexion-Adduction-External Rotation (D1FL), Extension-Adduction-External Rotation (D2EX), D1FL+ load, D2EX+ load) and straight leg raise (SLR). The normalized EMG activity of VMO, VL and VMO/VL ratio were measured and analyzed using repeated measure ANOVA. RESULTS There were significant main effects of group and exercises for the both VMO and VL (p<0.05). It was found that except SLR and D2EX, in the other motions PFPS group had lower VMO activity compared to healthy group (p<0.05). For VL except SLR, in the other motions PFPS group had lower VL activity too (p<0.05). The PNF patterns activated VMO more than SLR, however it was not significant (p>0.05). Also; there weren't any significant difference between the two groups in VMO/VL activation ratios. Also, performing the PNF patterns with load increased VMO and VL muscles activity significantly (p<0.05). It also found that in PFPS group the VMO/VL ratio values in PNF patterns were significantly more than SLR and the highest VMO/VL ratio value (0.96) was found during D2EX. CONCLUSION The PNF patterns due to provide optimal VMO/VL ratio value than SLR and proper balance between these two muscles can be recommended in rehabilitation of individuals with PFPS.
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Affiliation(s)
- Hiva Lotfi
- MSc of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Iran
| | - Afsun Nodehi Moghadam
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Iran
| | - Mohsen Shati
- Department of aging, University of Social Welfare and Rehabilitation Sciences, Iran
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Wu Z, Zou Z, Zhong J, Fu X, Yu L, Wang J, Wang X, Wu Q, Hou X. Effects of whole-body vibration plus hip-knee muscle strengthening training on adult patellofemoral pain syndrome: a randomized controlled trial. Disabil Rehabil 2021; 44:6017-6025. [PMID: 34346273 DOI: 10.1080/09638288.2021.1954703] [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] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate whether whole-body vibration (WBV) plus hip-knee muscle strengthening is more efficient in relieving pain and improving function than hip-knee strengthening alone. METHODS Thirty-six participants with patellofemoral pain syndrome (PFPS) were recruited and randomly allocated to either the (1) hip-knee strengthening only (HK group, n = 18) or (2) WBV plus hip-knee strengthening group (WHK group, n = 18). All participants attended 18 physiotherapy sessions (3 sessions/week, 40 min/session) over 6 weeks. Data on symptoms, function, surface electromyography (sEMG) signals from the vastus medialis and gluteus medius, and quality of life were evaluated at baseline (T0), 6 weeks after (T6), and the 12-week follow-up (T18). RESULTS Significant group × time interactions were found for the VAS score (p < 0.001) and vastus medialis performance (p ≤ 0.015). The WHK group exhibited a greater pain relief than did the HK group at T18 (p ≤ 0.014). The WHK group exhibited significantly larger improvements in the RMS value than did the HK group at T6 (p ≤ 0.011). CONCLUSIONS The present study shows that 6 weeks of WBV plus hip-knee strengthening can improve vastus medialis performance and maintain long-term pain relief to a significantly greater extent than can hip-knee strengthening alone.IMPLICATIONS FOR REHABILITATIONThe present study shows that 6 weeks of WBV plus hip-knee strengthening can improve vastus medialis performance and maintain long-term pain relief to a significantly greater extent than can hip-knee strengthening alone.
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Affiliation(s)
- Zhangxiang Wu
- Guangzhou Sports University, Guangzhou, China.,Department of Rehabilitation Medicine, People's Hospital of Longhua, Shenzhen, China
| | - Zhi Zou
- Guangzhou Sports University, Guangzhou, China
| | - Jiugen Zhong
- Guangzhou Sports University, Guangzhou, China.,Shanghai Sports University, Shanghai, China
| | - Xinbo Fu
- Guangzhou Sports University, Guangzhou, China
| | - Ligen Yu
- Guangzhou Sports University, Guangzhou, China
| | - Jinzhu Wang
- Guangzhou Sports University, Guangzhou, China
| | - Xin Wang
- Guangzhou Sports University, Guangzhou, China
| | - Qianwen Wu
- Guangzhou Sports University, Guangzhou, China
| | - Xiaohui Hou
- Guangzhou Sports University, Guangzhou, China.,Shanghai Sports University, Shanghai, China
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Doğan A, Şengül İ, Aşkın A, Tosun A. Effect of static knee joint flexion on vastus medialis obliquus fiber angle in patellofemoral pain syndrome: An ultrasonographic study. PM R 2021; 14:802-810. [PMID: 34165244 DOI: 10.1002/pmrj.12655] [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: 01/06/2021] [Revised: 05/30/2021] [Accepted: 06/11/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In patients with patellofemoral pain syndrome, the vastus medialis obliquus muscle fiber angle measured by ultrasound at knee extension was found to be different from that in healthy individuals. An important feature of patellofemoral pain syndrome is the increase in pain severity during activities that require knee flexion. OBJECTIVE To investigate whether there was an ultrasonographic change in the vastus medialis obliquus fiber angle by flexing the knee joint in patients with patellofemoral pain syndrome compared to healthy pain-free individuals. DESIGN A cross-sectional clinical study. SETTING An outpatient clinic of a tertiary care hospital. PARTICIPANTS Forty-seven patients with patellofemoral pain syndrome (median age of 40 years) and 43 healthy volunteers (median age of 39 years) were included in the study. INTERVENTIONS No intervention. MAIN OUTCOME MEASURES Vastus medialis obliquus fiber angle measured by ultrasonography at three different positions of knee joint including extension, 30° of flexion, and 45° of flexion. RESULTS There was no significant change in the vastus medialis obliquus fiber angle with knee flexion in both groups (p > .05 for each group). However, the median vastus medialis obliquus fiber angle values in the group with patellofemoral pain syndrome were significantly lower at all knee joint angles than those in the comparison group (p < .05 at all knee joint angles). CONCLUSIONS Although the vastus medialis obliquus fiber angle does not change with static knee flexion, the lower angle of the vastus medialis obliquus fiber in those with patellofemoral pain syndrome implicitly suggests that vastus medialis obliquus dysfunction may exist.
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Affiliation(s)
- Ali Doğan
- Department of Physical Medicine and Rehabilitation, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - İlker Şengül
- Department of Physical Medicine and Rehabilitation, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ayhan Aşkın
- Department of Physical Medicine and Rehabilitation, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Aliye Tosun
- Department of Physical Medicine and Rehabilitation, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
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The Effect of Diacutaneous Fibrolysis on Local and Widespread Hyperalgesia and Muscle Length in Patients With Patellofemoral Pain Syndrome: Secondary Analysis of a Pretest-Posttest Clinical Trial. J Sport Rehabil 2021; 30:804-811. [PMID: 33596548 DOI: 10.1123/jsr.2020-0176] [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: 04/21/2020] [Revised: 08/27/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Localized and widespread hyperalgesia has been observed in patients with patellofemoral pain. Diacutaneous fibrolysis (DF) has shown to be effective in reducing pain in several musculoskeletal conditions including patellofemoral pain syndrome, but no studies have evaluated the effects of this technique in reducing localized and widespread hyperalgesia. OBJECTIVE To assess the effect of DF on the pressure pain threshold and muscle length tests in patients with patellofemoral pain syndrome. DESIGN A single-group, pretest-posttest clinical trial. SETTING University of Zaragoza. PARTICIPANTS Forty-six subjects with patellofemoral pain (20 males and 26 females: age 27.8 [6.9] y). INTERVENTION Three sessions of DF. MAIN OUTCOME MEASURES Pressure pain threshold using a handheld pressure algometer (4 sites around the knee, on tibialis anterior muscle, and one remote site on the upper contralateral limb); muscle length test of the iliotibial band, rectus femoris, and hamstring muscles; and patient-perceived treatment effect score. RESULTS The application of 3 sessions of DF significantly increased the pressure pain threshold in all sites at posttreatment evaluation (P < .001) and at a 1-week follow-up (P < .001). A significant increase in muscle length was also observed at the posttreatment evaluation (P < .001) and 1-week follow-up (P < .001). Ninety-seven percent of the patients reported subjective improvement at posttreatment and at 1-week follow-up. CONCLUSION This study found that local and widespread hyperalgesia was significantly reduced after 3 sessions of diacutaneous fibrolysis and at the 1-week follow-up. A significant improvement on muscle length tests was also observed, with high clinical satisfaction among patients.
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Dong C, Li M, Hao K, Zhao C, Piao K, Lin W, Fan C, Niu Y, Fei W. Dose atrophy of vastus medialis obliquus and vastus lateralis exist in patients with patellofemoral pain syndrome. J Orthop Surg Res 2021; 16:128. [PMID: 33568152 PMCID: PMC7877190 DOI: 10.1186/s13018-021-02251-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background Whether vastus medialis obliquus atrophy exists in patients with patellofemoral pain syndrome and whether the amount of atrophy differs between the vastus medialis obliquus and vastus lateralis muscles remain unknown. Materials From June 2016 to March 2019, 61 patients with patellofemoral pain syndrome were retrospectively included in the study group, and an age-, sex-, and body mass index-matched cohort of 61 patients with normal knees was randomly selected as the control group. All enrolled subjects had undergone CT scans in the supine position. The cross-sectional areas of the vastus medialis obliquus and the vastus lateralis muscle in the sections 0, 5, 10, 15, and 20 mm above the upper pole of the patella were measured, and the vastus medialis obliquus/vastus lateralis muscle area ratio was evaluated. Results In the study group, the vastus medialis obliquus areas and the vastus lateralis muscle areas in the sections that were 0, 5, 10, 15, and 20 mm above the upper pole of the patella were significantly smaller than the respective areas in the control group (P < 0.05). The vastus medialis obliquus/vastus lateralis muscle area ratio was significantly smaller at the upper pole of the patella (the section 0 mm above the upper pole of the patella) than the corresponding ratio in the control group (P < 0.05). No significant difference was noted between the two groups in the sections 5, 10, 15, and 20 mm above the upper pole of the patella (P > 0.05). Conclusion In patients with patellofemoral pain syndrome, vastus medialis obliquus and vastus lateralis muscle atrophy existed in sections 0–20 mm above the upper pole of the patella, compared with normal controls, and atrophy of the vastus medialis obliquus was more evident than that of the vastus lateralis muscle at the upper pole of the patella. These findings support the rationale for the use of general quadriceps exercise combined with vastus medialis obliquus strengthening exercise as part of the rehabilitation programme for the patients with patellofemoral pain syndrome.
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Affiliation(s)
- Conglei Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Ming Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Kuo Hao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chao Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Kang Piao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Wei Lin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chongyi Fan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Wang Fei
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Hot and cold knees: exploring differences in patella skin temperature in patients with patellofemoral pain. Physiotherapy 2020; 108:55-62. [PMID: 32711228 DOI: 10.1016/j.physio.2020.04.007] [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: 12/09/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the distribution of patella skin temperature (Tsk) measurements and to explore the presence of temperature subgroups in patellofemoral pain (PFP) patients. DESIGN Cross-sectional observational study design. PARTICIPANTS One dataset of 58 healthy participants and 232 PFP patients from three different datasets. MAIN OUTCOME MEASURES Patella skin temperature, measured by physiotherapists using a low cost hand held digital thermometer. The distribution of patella skin temperature was assessed and compared across datasets. To objectively determine the clinically meaningful number of subgroups, we used the average silhouette method. Finite mixture models were then used to examine the presence of PFP temperature subgroups. Receiver operating characteristic curves were used to estimate optimal patella Tsk thresholds for allocation of participants into the identified subgroups. RESULTS In contrast to healthy participants, the patella skin temperature had an obvious bimodal distribution with wide dispersion present across all three PFP datasets. The fitted finite mixture model suggested three temperature subgroups (cold, normal and hot) that had been recommended by the average silhouette method with discrimination cut-off thresholds for subgroup membership based on receiver operating curve analysis of Cold=<30.0°C; Normal 30.0-35.2°C; Hot ≥35.2°C. CONCLUSION A low cost hand held digital thermometer appears to be a useful clinical tool to identify three PFP temperature subgroups. Further research is recommended to deepen understanding of these clinical findings and to explore the implications to different treatments.
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Twelve-Week Gait Retraining Reduced Patellofemoral Joint Stress during Running in Male Recreational Runners. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9723563. [PMID: 32258162 PMCID: PMC7109573 DOI: 10.1155/2020/9723563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/02/2020] [Accepted: 03/06/2020] [Indexed: 12/01/2022]
Abstract
Purpose To explore the changes in knee sagittal angle and moment and patellofemoral joint (PFJ) force and stress before and after 12-week gait retraining. Methods A total of 30 healthy male recreational runners were randomized into a control group (n = 15) who ran in their original strike pattern using minimalist shoes or experimental group (n = 15) who ran in a forefoot strike pattern using minimalist shoes during the 12-week gait retraining. The kinematic and kinetic data of the dominant leg of the participants during the 12 km/h running were collected by 3D motion capture systems and 3D force platforms. Besides, the biomechanical property of the PFJ was calculated on the basis of the joint force model and the regression equation of the contact area. Results After the 12-week gait retraining, 78% of the rearfoot strikers turned into forefoot strikers. Peak knee extension moment and peak PFJ stress decreased by 13.8% and 13.3% without altering the running speed, respectively. Meanwhile, no changes in maximum knee flexion angle/extension moment and PFJ force/stress were observed for the control group. Conclusion The 12-week gait retraining effectively reduced the PFJ stress, thereby providing a potential means of reducing the risk of patellofemoral pain syndrome while running.
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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: 19] [Impact Index Per Article: 3.8] [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.
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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
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Yosmaoğlu HB, Selfe J, Sonmezer E, Sahin İE, Duygu SÇ, Acar Ozkoslu M, Richards J, Janssen J. Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment? Sports Health 2019; 12:170-180. [PMID: 31750786 DOI: 10.1177/1941738119883272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain. HYPOTHESIS Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment. STUDY DESIGN Prospective crossover intervention. LEVEL OF EVIDENCE Level 3. METHODS Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions. RESULTS In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the "weak and pronated foot" and the "weak and tight" subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the "strong" subgroup (P = 0.006). CONCLUSION Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment. CLINICAL RELEVANCE Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.
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Affiliation(s)
- Hayri Baran Yosmaoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Baskent University, Ankara, Turkey
| | - James Selfe
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Emel Sonmezer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Baskent University, Ankara, Turkey
| | - İlknur Ezgi Sahin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Baskent University, Ankara, Turkey
| | - Senay Çerezci Duygu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Baskent University, Ankara, Turkey
| | - Manolya Acar Ozkoslu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Baskent University, Ankara, Turkey
| | - Jim Richards
- Allied Health Research Unit, School of Health Sciences, University of Central Lancashire, Preston, UK
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The Effect of Diacutaneous Fibrolysis on Patellar Position Measured Using Ultrasound Scanning in Patients With Patellofemoral Pain Syndrome. J Sport Rehabil 2019; 28:564-569. [DOI: 10.1123/jsr.2017-0272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 11/18/2022]
Abstract
Context: Tightness or lack of flexibility of several muscles of the thigh has been associated with patellofemoral joint pain. A tight iliotibial band can lead to laterally located patella and an abnormal patellar tracking pattern. Diacutaneous fibrolysis (DF) is commonly used to reduce muscle tightness, but no studies have evaluated the effects of this technique in the treatment of patients with patellofemoral pain syndrome. Objective: To assess the effect of DF on patellar position in patients with patellofemoral pain syndrome. Design: A single-group, pretest–posttest clinical trial. Setting: University of Zaragoza. Participants: A total of 46 subjects with patellofemoral pain (20 males, 26 females; age: 27.8 [6.9] y). Intervention: Three sessions of DF. Main Outcome Measures: Patellar position measurement using real-time ultrasound scanning; pain intensity measured with visual analog scale and function measured with the Anterior Knee Pain Scale. Results: The application of 3 sessions of DF significantly increased the patellar position at posttreatment evaluation (P < .001) and at 1-week follow-up (P < .001). There was not a significant difference on patellar position between posttreatment and follow-up measurements (P = .28). There were also a statistically significant decrease in pain and increase in function at posttreatment and at 1-week follow-up measurements (P < .001). Conclusion: This study found that patellar position, pain intensity, and function were significantly improved after 3 sessions of DF and at 1-week follow-up.
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Bolgla LA, Boling MC, Mace KL, DiStefano MJ, Fithian DC, Powers CM. National Athletic Trainers' Association Position Statement: Management of Individuals With Patellofemoral Pain. J Athl Train 2018; 53:820-836. [PMID: 30372640 DOI: 10.4085/1062-6050-231-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE: To present recommendations for athletic trainers and other health care providers regarding the identification of risk factors for and management of individuals with patellofemoral pain (PFP). BACKGROUND: Patellofemoral pain is one of the most common knee diagnoses; however, this condition continues to be one of the most challenging to manage. Recent evidence has suggested that certain risk factors may contribute to the development of PFP. Early identification of risk factors may allow clinicians to develop and implement programs aimed at reducing the incidence of this condition. To date, clinicians have used various treatment strategies that have not necessarily benefitted all patients. Suboptimal outcomes may reflect the need to integrate clinical practice with scientific evidence to facilitate clinical decision making. RECOMMENDATIONS: The recommendations are based on the best available evidence. They are intended to give athletic trainers and other health care professionals a framework for identifying risk factors for and managing patients with PFP.
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Affiliation(s)
- Lori A Bolgla
- Department of Physical Therapy, Augusta University, GA
| | - Michelle C Boling
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville
| | | | | | | | - Christopher M Powers
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
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15
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Coburn SL, Barton CJ, Filbay SR, Hart HF, Rathleff MS, Crossley KM. Quality of life in individuals with patellofemoral pain: A systematic review including meta-analysis. Phys Ther Sport 2018; 33:96-108. [DOI: 10.1016/j.ptsp.2018.06.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/22/2018] [Indexed: 12/16/2022]
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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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Wu CC, Chen MC, Tseng PY, Lu CH, Tuan CC. Patellar malalignment treated with modified knee extension training: An electromyography study. Gait Posture 2018; 62:440-444. [PMID: 29656221 DOI: 10.1016/j.gaitpost.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/29/2018] [Accepted: 04/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellar malalignment (PM) in most patients is ascribed to an imbalance of peripatellar soft tissue tension. RESEARCH QUESTION Conservative treatment of PM initially with enforced training of the vastus medialis obliquus (VMO) has been widely applied. Non-operative techniques for treatment of PM require continuing development. METHODS Thirty healthy young adults participated in the study. Two surface electromyography (EMG) electrodes were placed on the skin of the dominant lower thigh in each subject: one on the center of the muscle belly of the VMO and the other on the symmetric location of the vastus lateralis (VL). Maximum of knee extension action (from various angles of knee flexion to full extension) was initiated. Tests were conducted with knee flexion decreasing by 10° at each step. Each action was repeated three times, and the average value was calculated. The root mean square value of excited muscles in the EMG was recorded. The ratio of the VMO to the VL (VMO/VL) was used to indicate the effectiveness of the treatment. The knee position varied from 90° flexion initially, decreasing by 10° at each step. RESULTS Nine sets of values were obtained. All extension actions were effective (VMO/VL >1; range, 1.23-1.35). The maximal value was observed at 60° flexion (VMO/VL = 1.35). Differences were not significant among the nine groups (p = 0.08, ANOVA). SIGNIFICANCE Using the described knee extension training for conservative treatment of PM may be an effective alternative. The technique is simple, and the results of our experimental tests are encouraging. This method may become another popular and effective technique for treating PM.
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Affiliation(s)
- Chi-Chuan Wu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan.
| | - Mei-Chuan Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Po-Yuan Tseng
- Graduate Institute of Electronics Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chi-Heng Lu
- Graduate Institute of Electronics Engineering, National Taipei University of Technology, Taipei, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan
| | - Chiu-Ching Tuan
- Graduate Institute of Electronics Engineering, National Taipei University of Technology, Taipei, Taiwan
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18
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Saad MC, Vasconcelos RAD, Mancinelli LVDO, Munno MSDB, Liporaci RF, Grossi DB. Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises. Braz J Phys Ther 2018; 22:408-416. [PMID: 29661570 DOI: 10.1016/j.bjpt.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/14/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics. METHODS A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention. RESULTS All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities. CONCLUSION Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/).
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Affiliation(s)
- Marcelo Camargo Saad
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil; Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
| | | | | | - Matheus Soares de Barros Munno
- Curso de Fisioterapia,Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rogério Ferreira Liporaci
- Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Débora Bevilaqua Grossi
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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19
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Forecasting of rehabilitation treatment in sufferers from lateral displacement of patella using artificial intelligence. SPORT SCIENCES FOR HEALTH 2018. [DOI: 10.1007/s11332-017-0397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Gulati A, McElrath C, Wadhwa V, Shah JP, Chhabra A. Current clinical, radiological and treatment perspectives of patellofemoral pain syndrome. Br J Radiol 2018; 91:20170456. [PMID: 29303366 DOI: 10.1259/bjr.20170456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Anterior knee pain in active young adults is commonly related to patellofemoral pain syndrome, which can be broadly classified into patellar malalignment and patellar maltracking. Imaging is performed to further elucidate the exact malalignment and maltracking abnormalities and exclude other differentials. This article details the role of the stabilizers of the patellofemoral joint, findings on conventional and multimodality imaging aiding in patellofemoral pain syndrome diagnosis and characterization, and current perspectives of various treatment approaches.
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Affiliation(s)
- Aishwarya Gulati
- 1 Department of Radiology, Dr Gulati Imaging Institute , Hauz Khas, New Delhi , India
| | - Christopher McElrath
- 2 Department of Orthopaedic Surgery, UT Southwestern Medical Center , Dallas, TX , United States
| | - Vibhor Wadhwa
- 3 Department of Radiology, University of Arkansas for Medical Sciences , Little Rock, AR , United States
| | - Jay P Shah
- 2 Department of Orthopaedic Surgery, UT Southwestern Medical Center , Dallas, TX , United States
| | - Avneesh Chhabra
- 2 Department of Orthopaedic Surgery, UT Southwestern Medical Center , Dallas, TX , United States.,4 Department of Radiology, UTSouthwestern Medical Center , Dallas, TX , United States
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21
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Maclachlan LR, Collins NJ, Matthews ML, Hodges PW, Vicenzino B. The psychological features of patellofemoral pain: a systematic review. Br J Sports Med 2017; 51:732-742. [DOI: 10.1136/bjsports-2016-096705] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 12/22/2022]
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22
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Lee PYF, Nixion A, Chandratreya A, Murray JM. Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain. Surg J (N Y) 2017; 3:e9-e16. [PMID: 28825013 PMCID: PMC5553487 DOI: 10.1055/s-0037-1598047] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/06/2016] [Indexed: 11/25/2022] Open
Abstract
Synovial plica syndrome (SPS) occurs in the knee, when an otherwise normal structure becomes a source of pain due to injury or overuse. Patients may present to general practitioners, physiotherapists, or surgeons with anterior knee pain with or without mechanical symptoms, and the diagnosis can sometimes be difficult. Several studies have examined the epidemiology, diagnosis, and treatment of SPS. We review these resources to provide an evidence-based guide to the diagnosis and treatment of SPS of the knee.
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Affiliation(s)
- Paul Yuh Feng Lee
- South Wales Orthopaedic Research Network, WelshBone, Cardiff, Wales, United Kingdom
| | - Amy Nixion
- South Wales Orthopaedic Research Network, WelshBone, Cardiff, Wales, United Kingdom
| | - Amit Chandratreya
- Department of Orthopaedic Surgery, ABMU LHB, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | - Judith M Murray
- Department of Orthopaedic Surgery, Royal Glamorgan Hospital, Llantrisant, Wales, United Kingdom
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Espí-López GV, Arnal-Gómez A, Balasch-Bernat M, Inglés M. Effectiveness of Manual Therapy Combined With Physical Therapy in Treatment of Patellofemoral Pain Syndrome: Systematic Review. J Chiropr Med 2016; 16:139-146. [PMID: 28559754 DOI: 10.1016/j.jcm.2016.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/18/2016] [Accepted: 10/07/2016] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES The purpose of this study was to conduct a review of randomized controlled trials (RCTs) to determine the treatment effectiveness of the combination of manual therapy (MT) with other physical therapy techniques. METHODS Systematic searches of scientific literature were undertaken on PubMed and the Cochrane Library (2004-2014). The following terms were used: "patellofemoral pain syndrome," "physical therapy," "manual therapy," and "manipulation." RCTs that studied adults diagnosed with patellofemoral pain syndrome (PFPS) treated by MT and physical therapy approaches were included. The quality of the studies was assessed by the Jadad Scale. RESULTS Five RCTs with an acceptable methodological quality (Jadad ≥ 3) were selected. The studies indicated that MT combined with physical therapy has some effect on reducing pain and improving function in PFPS, especially when applied on the full kinetic chain and when strengthening hip and knee muscles. CONCLUSIONS The different combinations of MT and physical therapy programs analyzed in this review suggest that giving more emphasis to proximal stabilization and full kinetic chain treatments in PFPS will help better alleviation of symptoms.
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Affiliation(s)
| | - Anna Arnal-Gómez
- Physiotherapy Department, University of Valencia, Valencia, Spain
| | | | - Marta Inglés
- Physiotherapy Department, University of Valencia, Valencia, Spain
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Abstract
Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain.
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Telles G, Cristovão DR, Belache FATC, Santos MRA, Almeida RSD, Nogueira LAC. The effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain. J Bodyw Mov Ther 2016; 20:844-850. [PMID: 27814865 DOI: 10.1016/j.jbmt.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 02/04/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
Anterior knee pain is a common complaint and can cause difficulty with its inability to bear weight. The aim of the study was to analyse the effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain. A clinical trial with 18 patients with a clinical diagnosis of anterior knee pain was conducted. One group (E) with nine individuals was treated with hip muscle strengthening exercises; another group (EM), with nine individuals, had myofascial techniques added. To quantify the results, the Numeric Pain Rating Scale (NPRS) and the Lower Extremity Functional Scale (LEFS) were used. The E group showed an improvement in pain (p = 0.02), but not in the mean degree of disability. The EM group showed an improvement in pain (p = 0.01), as well as the degree of disability (p = 0.008). The effect size analysis showed that participants of the EM group had a greater impact on clinical pain and disability (Cohen's d = .35 and .30, respectively). The addition of myofascial techniques should be considered to improve the functionality of the lower limbs and reduce pain in patients with anterior knee pain.
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Affiliation(s)
- Gustavo Telles
- Physical Therapy of Hospital Universitário Gaffrée e Guinle and Delfim Physical Therapy Service, Rio de Janeiro, Brazil
| | - Delmany R Cristovão
- Physical Therapy of Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, Brazil
| | | | | | - Renato Santos de Almeida
- Physical Therapy of Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, Brazil; Centro Universitário Serra dos Órgãos (UNIFESO), Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Postgraduation Progam - Reabilitation Science of Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil; Physical Therapy Department at Instituto Federal do Rio de Janeiro (IFRJ), Brazil.
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Selfe J, Janssen J, Callaghan M, Witvrouw E, Sutton C, Richards J, Stokes M, Martin D, Dixon J, Hogarth R, Baltzopoulos V, Ritchie E, Arden N, Dey P. Are there three main subgroups within the patellofemoral pain population? A detailed characterisation study of 127 patients to help develop targeted intervention (TIPPs). Br J Sports Med 2016; 50:873-80. [PMID: 26834185 PMCID: PMC4975826 DOI: 10.1136/bjsports-2015-094792] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/04/2022]
Abstract
Background Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. Method The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. Results 130 participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean body mass index 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7–60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive and patients frequently fell into multiple subgroups. Using hierarchical clustering and latent profile analysis three subgroups were identified using 6 of the 7 clinical tests. These subgroups were given the following nomenclature: (1) ‘strong’, (2) ‘weak and tighter’ and (3) ‘weak and pronated foot’. Conclusions We conclude that three subgroups of patellofemoral patients may exist based on the results of six clinical tests which are feasible to perform in routine clinical practice. Further research is needed to validate these findings in other data sets and, if supported by external validation, to see if targeted interventions for these subgroups improve patient outcomes.
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Affiliation(s)
- James Selfe
- University of Central Lancashire, Preston, Lancashire, UK
| | - Jessie Janssen
- University of Central Lancashire, Preston, Lancashire, UK
| | - Michael Callaghan
- Institute for Inflammation and Repair, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Erik Witvrouw
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chris Sutton
- University of Central Lancashire, Preston, Lancashire, UK
| | - Jim Richards
- University of Central Lancashire, Preston, Lancashire, UK
| | - Maria Stokes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | | | | | | | - Elizabeth Ritchie
- Department of Physiotherapy, Harrogate & District NHS Foundation Trust, Harrogate District Hospital, Harrogate, North Yorkshire, UK
| | - Nigel Arden
- University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Paola Dey
- University of Central Lancashire, Preston, Lancashire, UK
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Rehabilitation following first-time patellar dislocation: a randomised controlled trial of purported vastus medialis obliquus muscle versus general quadriceps strengthening exercises. Knee 2015; 22:313-20. [PMID: 25921095 DOI: 10.1016/j.knee.2015.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/19/2015] [Accepted: 03/31/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND We aimed to define whether distal vastus medialis (VM) muscle strengthening improves functional outcomes compared to general quadriceps muscle strengthening following first-time patellar dislocation (FTPD). METHODS Fifty patients post-FTPD were randomised to either a general quadriceps exercise or rehabilitation programme (n=25) or a specific-VM exercise and rehabilitation regime (n=25). The primary outcome was the Lysholm knee score, and secondary outcomes included the Tegner Level of Activity score, the Norwich Patellar Instability (NPI) score, and isometric knee extension strength at various knee flexion ranges of motion. Outcomes were assessed at baseline, six weeks, six months and 12months. RESULTS There were statistically significant differences in functional outcome and activity levels with the Lysholm knee score and Tegner Level of Activity score at 12months in the general quadriceps exercise group compared to the VM group (p=0.05; 95% confidence interval (CI): -14.0 to 0.0/p=0.04; 95% CI: -3.0 to 0.0). This did not reach a clinically important difference. There was no statistically significant difference between the groups for the NPI score and isometric strength at any follow-up interval. The trial experienced substantial participant attrition (52% at 12months). CONCLUSIONS Whilst there was a statistical difference in the Lysholm knee score and Tegner Level of Activity score between general quadriceps and VM exercise groups at 12months, this may not have necessarily been clinically important. This trial highlights that participant recruitment and retention are challenges which should be considered when designing future trials in this population. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Atrophy of the Quadriceps Is Not Isolated to the Vastus Medialis Oblique in Individuals With Patellofemoral Pain. J Orthop Sports Phys Ther 2015; 45:613-9. [PMID: 26110547 DOI: 10.2519/jospt.2015.5852] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. Objectives To determine if quadriceps atrophy was present in people with patellofemoral pain (PFP), and whether the vastus medialis oblique (VMO) was selectively involved. BACKGROUND Despite the lack of research investigating individual quadriceps muscle size in individuals with PFP, it has been suggested that selective atrophy of the VMO relative to the vastus lateralis could be associated with PFP. METHODS The quadriceps muscle sizes of 35 participants with PFP (22 with unilateral and 13 with bilateral symptoms) and 35 asymptomatic control participants matched for age and sex were measured using real-time ultrasound. The thicknesses of the VMO, vastus lateralis, vastus medialis, rectus femoris, and vastus intermedius were measured. Paired-samples t tests were used to compare muscle thickness between limbs in those with unilateral PFP, and independent t tests were used to compare muscle thickness between groups with and without PFP. Results In those with unilateral PFP, the thickness of all portions of the quadriceps muscle was statistically smaller in the symptomatic compared to the asymptomatic limb: VMO (P = .038), vastus medialis (P<.001), vastus lateralis (P = .005), vastus intermedius (P = .013), and rectus femoris (P = .045). No difference was found in thickness of any of the portions of the quadriceps on the affected side of people with PFP compared to asymptomatic controls: VMO (P = .148), vastus medialis (P = .474), vastus lateralis (P = .122), vastus intermedius (P = .466), and rectus femoris (P = .508). CONCLUSION Atrophy of all portions of the quadriceps muscles is present in the affected limb of people with unilateral PFP. There was no atrophy of the quadriceps in individuals with PFP compared to those without pathology. Selective atrophy of the VMO relative to the vastus lateralis was not identified in people with PFP.
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Alba-Martín P, Gallego-Izquierdo T, Plaza-Manzano G, Romero-Franco N, Núñez-Nagy S, Pecos-Martín D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. J Phys Ther Sci 2015; 27:2387-90. [PMID: 26311988 PMCID: PMC4540887 DOI: 10.1589/jpts.27.2387] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to analyze the effectiveness of conservative treatment of patellofemoral pain syndrome with physical exercise. [Subjects and Methods] A computer-based review conducted of four databases (PubMed, the Cochrane Library, PEDro, and the University Library) was completed based on the inclusion criteria of patellofemoral pain syndrome patients treated with physical exercise methods and examination with self-reported pain and/or functional questionnaires. [Results] The findings of ten clinical trials of moderate to high quality were evaluated to determine the effectiveness of physical exercise as conservative management for patellofemoral pain syndrome. [Conclusion] The intervention programs that were most effective in relieving pain and improving function in patellofemoral pain syndrome included proprioceptive neuromuscular facilitation stretching and strengthening exercises for the hip external rotator and abductor muscles and knee extensor muscles.
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Affiliation(s)
| | | | - Gustavo Plaza-Manzano
- Rehabilitation and Physical Medicine Department, Medical Hydrology, Complutense University, Spain
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van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma‐Zeinstra SMA, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev 2015; 1:CD010387. [PMID: 25603546 PMCID: PMC10898323 DOI: 10.1002/14651858.cd010387.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is a common knee problem, which particularly affects adolescents and young adults. PFPS, which is characterised by retropatellar (behind the kneecap) or peripatellar (around the kneecap) pain, is often referred to as anterior knee pain. The pain mostly occurs when load is put on the knee extensor mechanism when climbing stairs, squatting, running, cycling or sitting with flexed knees. Exercise therapy is often prescribed for this condition. OBJECTIVES To assess the effects (benefits and harms) of exercise therapy aimed at reducing knee pain and improving knee function for people with patellofemoral pain syndrome. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 4), MEDLINE (1946 to May 2014), EMBASE (1980 to 2014 Week 20), PEDro (to June 2014), CINAHL (1982 to May 2014) and AMED (1985 to May 2014), trial registers (to June 2014) and conference abstracts. SELECTION CRITERIA Randomised and quasi-randomised trials evaluating the effect of exercise therapy on pain, function and recovery in adolescents and adults with patellofemoral pain syndrome. We included comparisons of exercise therapy versus control (e.g. no treatment) or versus another non-surgical therapy; or of different exercises or exercise programmes. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Where appropriate, we pooled data using either fixed-effect or random-effects methods. We selected the following seven outcomes for summarising the available evidence: pain during activity (short-term: ≤ 3 months); usual pain (short-term); pain during activity (long-term: > 3 months); usual pain (long-term); functional ability (short-term); functional ability (long-term); and recovery (long-term). MAIN RESULTS In total, 31 heterogeneous trials including 1690 participants with patellofemoral pain are included in this review. There was considerable between-study variation in patient characteristics (e.g. activity level) and diagnostic criteria for study inclusion (e.g. minimum duration of symptoms) and exercise therapy. Eight trials, six of which were quasi-randomised, were at high risk of selection bias. We assessed most trials as being at high risk of performance bias and detection bias, which resulted from lack of blinding.The included studies, some of which contributed to more than one comparison, provided evidence for the following comparisons: exercise therapy versus control (10 trials); exercise therapy versus other conservative interventions (e.g. taping; eight trials evaluating different interventions); and different exercises or exercise programmes. The latter group comprised: supervised versus home exercises (two trials); closed kinetic chain (KC) versus open KC exercises (four trials); variants of closed KC exercises (two trials making different comparisons); other comparisons of other types of KC or miscellaneous exercises (five trials evaluating different interventions); hip and knee versus knee exercises (seven trials); hip versus knee exercises (two studies); and high- versus low-intensity exercises (one study). There were no trials testing exercise medium (land versus water) or duration of exercises. Where available, the evidence for each of seven main outcomes for all comparisons was of very low quality, generally due to serious flaws in design and small numbers of participants. This means that we are very unsure about the estimates. The evidence for the two largest comparisons is summarised here. Exercise versus control. Pooled data from five studies (375 participants) for pain during activity (short-term) favoured exercise therapy: mean difference (MD) -1.46, 95% confidence interval (CI) -2.39 to -0.54. The CI included the minimal clinically important difference (MCID) of 1.3 (scale 0 to 10), indicating the possibility of a clinically important reduction in pain. The same finding applied for usual pain (short-term; two studies, 41 participants), pain during activity (long-term; two studies, 180 participants) and usual pain (long-term; one study, 94 participants). Pooled data from seven studies (483 participants) for functional ability (short-term) also favoured exercise therapy; standardised mean difference (SMD) 1.10, 95% CI 0.58 to 1.63. Re-expressed in terms of the Anterior Knee Pain Score (AKPS; 0 to 100), this result (estimated MD 12.21 higher, 95% CI 6.44 to 18.09 higher) included the MCID of 10.0, indicating the possibility of a clinically important improvement in function. The same finding applied for functional ability (long-term; three studies, 274 participants). Pooled data (two studies, 166 participants) indicated that, based on the 'recovery' of 250 per 1000 in the control group, 88 more (95% CI 2 fewer to 210 more) participants per 1000 recovered in the long term (12 months) as a result of exercise therapy. Hip plus knee versus knee exercises. Pooled data from three studies (104 participants) for pain during activity (short-term) favoured hip and knee exercise: MD -2.20, 95% CI -3.80 to -0.60; the CI included a clinically important effect. The same applied for usual pain (short-term; two studies, 46 participants). One study (49 participants) found a clinically important reduction in pain during activity (long-term) for hip and knee exercise. Although tending to favour hip and knee exercises, the evidence for functional ability (short-term; four studies, 174 participants; and long-term; two studies, 78 participants) and recovery (one study, 29 participants) did not show that either approach was superior. AUTHORS' CONCLUSIONS This review has found very low quality but consistent evidence that exercise therapy for PFPS may result in clinically important reduction in pain and improvement in functional ability, as well as enhancing long-term recovery. However, there is insufficient evidence to determine the best form of exercise therapy and it is unknown whether this result would apply to all people with PFPS. There is some very low quality evidence that hip plus knee exercises may be more effective in reducing pain than knee exercise alone.Further randomised trials are warranted but in order to optimise research effort and engender the large multicentre randomised trials that are required to inform practice, these should be preceded by research that aims to identify priority questions and attain agreement and, where practical, standardisation regarding diagnostic criteria and measurement of outcome.
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Affiliation(s)
- Rianne A van der Heijden
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Nienke E Lankhorst
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Robbart van Linschoten
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Sita MA Bierma‐Zeinstra
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
| | - Marienke van Middelkoop
- Erasmus Medical CenterDepartment of General PracticeBurg Jacobplein 51RotterdamNetherlands3015CA
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Bolgla LA, Earl-Boehm J, Emery C, Hamstra-Wright K, Ferber R. Comparison of hip and knee strength in males with and without patellofemoral pain. Phys Ther Sport 2014; 16:215-21. [PMID: 25869422 DOI: 10.1016/j.ptsp.2014.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/06/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The primary purpose of this study was to compare hip strength in males with and without patellofemoral pain (PFP). The secondary purpose was to compare knee strength in males with and without PFP. DESIGN Secondary analysis of cross-sectional data for males with and without PFP from a larger randomized controlled trial examining hip and core versus knee-muscle strengthening for the treatment of PFP. SETTING Laboratory setting. PARTICIPANTS Sixty-six males with PFP and 36 controls. MAIN OUTCOME MEASURES Peak isometric force for the hip abductors, external rotators, internal rotators, extensors, and knee extensors expressed as a percentage of body mass (%BM). RESULTS No differences existed with respect to any of the hip strength measures (P > .05). Males with PFP demonstrated almost 17% less knee extensor strength than controls (mean difference = 7.3 %BM; 95% confidence interval, 1.3-13.4 %BM; t = 2.41; P = .02). CONCLUSIONS Unlike females, males with PFP did not demonstrate hip muscle weakness. However, differences did exist with knee extensor strength. These data provide preliminary evidence for the potential need for sex-specific interventions for individuals with PFP.
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Affiliation(s)
- Lori A Bolgla
- EC-1334, Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, GA 30912, USA.
| | - Jennifer Earl-Boehm
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Carolyn Emery
- Faculties of Kinesiology and Medicine, University of Calgary, Calgary, AB, Canada
| | - Karrie Hamstra-Wright
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Reed Ferber
- Faculties of Kinesiology and Nursing, University of Calgary, Calgary, AB, Canada
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Green A, Liles C, Rushton A, Kyte DG. Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: a systematic review. ACTA ACUST UNITED AC 2014; 19:517-26. [PMID: 24997774 DOI: 10.1016/j.math.2014.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/14/2014] [Accepted: 05/21/2014] [Indexed: 02/03/2023]
Abstract
This systematic review investigated the measurement properties of disease-specific patient-reported outcome measures used in Patellofemoral Pain Syndrome. Two independent reviewers conducted a systematic search of key databases (MEDLINE, EMBASE, AMED, CINHAL+ and the Cochrane Library from inception to August 2013) to identify relevant studies. A third reviewer mediated in the event of disagreement. Methodological quality was evaluated using the validated COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) tool. Data synthesis across studies determined the level of evidence for each patient-reported outcome measure. The search strategy returned 2177 citations. Following the eligibility review phase, seven studies, evaluating twelve different patient-reported outcome measures, met inclusion criteria. A 'moderate' level of evidence supported the structural validity of several measures: the Flandry Questionnaire, Anterior Knee Pain Scale, Functional Index Questionnaire, Eng and Pierrynowski Questionnaire and Visual Analogue Scales for 'usual' and 'worst' pain. In addition, there was a 'Limited' level of evidence supporting the test-retest reliability and validity (cross-cultural, hypothesis testing) of the Persian version of the Anterior Knee Pain Scale. Other measurement properties were evaluated with poor methodological quality, and many properties were not evaluated in any of the included papers. Current disease-specific outcome measures for Patellofemoral Pain Syndrome require further investigation. Future studies should evaluate all important measurement properties, utilising an appropriate framework such as COSMIN to guide study design, to facilitate optimal methodological quality.
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Affiliation(s)
- Andrew Green
- The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK.
| | - Clive Liles
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Derek G Kyte
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Kooiker L, Van De Port IGL, Weir A, Moen MH. Effects of physical therapist-guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther 2014; 44:391-402, B1. [PMID: 24766358 DOI: 10.2519/jospt.2014.4127] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE To summarize the evidence for physical therapist-guided quadriceps-strengthening exercises as a treatment for patellofemoral pain syndrome. BACKGROUND Although quadriceps strengthening is often included in the plan of care for patellofemoral pain syndrome, a systematic review published in 2003 found only limited evidence that exercise was more effective than no exercise for this common condition. METHODS The PubMed, Embase/MEDLINE, and Cochrane Central Register of Controlled Trials databases, from inception to January 9, 2014, were searched for randomized controlled trials comparing the use of quadriceps-strengthening exercises to interventions consisting of advice/information or a placebo. Outcomes of interest were pain measures and function, as measured with self-report questionnaires. The methodological quality of the randomized controlled trials was assessed with the Physiotherapy Evidence Database scale. Results were summarized using a best-evidence synthesis and graphically illustrated using forest plots without meta-analysis. RESULTS Seven studies were included in the literature review. These studies reported strong evidence that isolated quadriceps strengthening is more effective in reducing pain and improving function than advice and information alone. In addition, compared to advice and information or placebo, there was strong evidence that quadriceps-strengthening exercises combined with other interventions may be more effective in reducing pain immediately postintervention and after 12 months, but not in improving function. CONCLUSION The literature provides strong evidence for the use of quadriceps-strengthening exercises, with or without other interventions, for the treatment of patellofemoral pain syndrome.
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Affiliation(s)
- Laura Kooiker
- Clinical Health Sciences, Physiotherapy Sciences, Utrecht University, Utrecht, the Netherlands
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Rittig-Rasmussen B, Kasch H, Fuglsang-Frederiksen A, Svensson P, Jensen T. Effect of training on corticomotor excitability in clinical neck pain. Eur J Pain 2014; 18:1207-16. [DOI: 10.1002/j.1532-2149.2014.487.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2014] [Indexed: 12/14/2022]
Affiliation(s)
| | - H. Kasch
- Department of Neurology; Aarhus University Hospital; Denmark
| | | | - P. Svensson
- Clinical Oral Physiology; Department of Dentistry; Aarhus University; Denmark
- Department of Oral Maxillofacial Surgery; Aarhus University Hospital; Denmark
| | - T.S. Jensen
- Danish Pain Research Center; Aarhus University Hospital; Denmark
- Department of Neurology; Aarhus University Hospital; Denmark
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Witvrouw E, Callaghan MJ, Stefanik JJ, Noehren B, Bazett-Jones DM, Willson JD, Earl-Boehm JE, Davis IS, Powers CM, McConnell J, Crossley KM. Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. Br J Sports Med 2014; 48:411-4. [DOI: 10.1136/bjsports-2014-093450] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khayambashi K, Fallah A, Movahedi A, Bagwell J, Powers C. Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial. Arch Phys Med Rehabil 2014; 95:900-7. [PMID: 24440362 DOI: 10.1016/j.apmr.2013.12.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 12/13/2013] [Accepted: 12/28/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare the efficacy of posterolateral hip muscle strengthening versus quadriceps strengthening in reducing pain and improving health status in persons with patellofemoral pain (PFP). DESIGN Comparative control trial. SETTING Rehabilitation facility. PARTICIPANTS Persons with a diagnosis of PFP (N=36; 18 men, 18 women). INTERVENTIONS Patients were alternately assigned to a posterolateral hip muscle strengthening group (9 men and 9 women) or a quadriceps strengthening group (9 men and 9 women). The posterolateral hip muscle strengthening group performed hip abductor and external rotator strengthening exercises, whereas the quadriceps strengthening group performed quadriceps strengthening exercises (3 times a week for 8wk). MAIN OUTCOME MEASURES Pain (visual analog scale [VAS]) and health status (Western Ontario McMaster Universities Osteoarthritis Index [WOMAC]) were assessed at baseline, postintervention, and 6-month follow-up. RESULTS Significant improvements in VAS and WOMAC scores were observed in both groups from baseline to postintervention and baseline to 6-month follow-up (P<.001). Improvements in VAS and WOMAC scores in the posterolateral hip exercise group were superior to those in the quadriceps exercise group postintervention and at 6-month follow-up (P<.05). CONCLUSIONS Although both intervention programs resulted in decreased pain and improved function in persons with PFP, outcomes in the posterolateral hip exercise group were superior to the quadriceps exercise group. The superior outcomes obtained in the posterolateral hip exercise group were maintained 6 months postintervention.
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Affiliation(s)
| | - Alireza Fallah
- College of Sport Sciences, University of Isfahan, Isfahan, Iran
| | | | - Jennifer Bagwell
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | - Christopher Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA.
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Return to sport after patellar dislocation or following surgery for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 2014; 22:2320-6. [PMID: 25047793 PMCID: PMC4169614 DOI: 10.1007/s00167-014-3172-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/03/2014] [Indexed: 02/06/2023]
Abstract
Patellofemoral instability may occur in a young population as a result of injury during sporting activities. This review focuses on return to sport after one episode of dislocation treated no operatively and as well after surgery for chronic patellofemoral instability. With or without surgery, only two-thirds of patients return to sports at the same level as prior to injury. A high-quality rehabilitation programme using specific exercises is the key for a safe return to sporting activities. To achieve this goal, recovery of muscle strength and dynamic stability of the lower limbs is crucial. The focus should be directed to strengthen the quadriceps muscle and pelvic stabilizers, as well as lateral trunk muscle training. Patient education and regularly performed home exercises are other key factors that can lead to a successful return to sports. The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability. Level of evidence IV.
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Does quadriceps atrophy exist in individuals with patellofemoral pain? A systematic literature review with meta-analysis. J Orthop Sports Phys Ther 2013; 43:766-76. [PMID: 24175596 DOI: 10.2519/jospt.2013.4833] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES To investigate whether quadriceps atrophy is present in the affected limb of individuals with patellofemoral pain (PFP). BACKGROUND PFP is a common condition. Atrophy of the quadriceps femoris, in particular the vastus medialis obliquus, is often assumed to be present by clinicians, and its resolution may underpin the reported effectiveness of quadriceps strengthening intervention in PFP rehabilitation. METHODS A systematic search of the literature was conducted to identify studies that measured the size of the quadriceps in individuals with PFP. Meta-analyses were performed to determine whether quadriceps size in limbs with PFP differed from that in comparison limbs. Separate meta-analyses were performed for quadriceps size measured as girth and quadriceps size measured with imaging (thickness, cross-sectional area, and volume). RESULTS Ten studies were included in this review. The meta-analysis of girth measurements (3 studies) found no atrophy in limbs with PFP (P = .638). The meta-analyses for imaging techniques (thickness, cross-sectional area, or volume measurements) showed atrophy in the limb with PFP compared to both the asymptomatic limb (3 studies) (P = .036) and limbs from a comparison group (3 studies) (P = .001). The single study that compared the vastus medialis obliquus and vastus lateralis in individuals with PFP found atrophy of both the vastus medialis obliquus and vastus lateralis but no significant difference in the amount of atrophy between them (P = .179). CONCLUSION Quadriceps muscle atrophy was shown to be present in PFP when analyzed by imaging, but not by girth measures. Insufficient data were available to determine if there was greater atrophy of the vastus medialis obliquus than the vastus lateralis. These findings support the rationale for use of quadriceps strengthening as part of a rehabilitation program for PFP.
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Selfe J, Callaghan M, Witvrouw E, Richards J, Dey MP, Sutton C, Dixon J, Martin D, Stokes M, Janssen J, Ritchie E, Turner D. Targeted interventions for patellofemoral pain syndrome (TIPPS): classification of clinical subgroups. BMJ Open 2013; 3:e003795. [PMID: 24065700 PMCID: PMC3787410 DOI: 10.1136/bmjopen-2013-003795] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Patellofemoral pain (PFP) can cause significant pain leading to limitations in societal participation and physical activity. An international expert group has highlighted the need for a classification system to allow targeted intervention for patients with PFP; we have developed a work programme systematically investigating this. We have proposed six potential subgroups: hip abductor weakness, quadriceps weakness, patellar hypermobility, patellar hypomobility, pronated foot posture and lower limb biarticular muscle tightness. We could not uncover any evidence of the relative frequency with which patients with PFP fell into these subgroups or whether these subgroups were mutually exclusive. The aim of this study is to provide information on the clinical utility of our classification system. METHODS AND ANALYSIS 150 participants will be recruited over 18 months in four National Health Services (NHS) physiotherapy departments in England. INCLUSION CRITERIA adults 18-40 years with PFP for longer than 3 months, PFP in at least two predesignated functional activities and PFP elicited by clinical examination. EXCLUSION CRITERIA prior or forthcoming lower limb surgery; comorbid illness or health condition; and lower limb training or pregnancy. We will record medical history, demographic details, pain, quality of life, psychomotor movement awareness and knee temperature. We will assess hip abductor and quadriceps weakness, patellar hypermobility and hypomobility, foot posture and lower limb biarticular muscle tightness. The primary analytic approach will be descriptive. We shall present numbers and percentages of participants who meet the criteria for membership of (1) each of the subgroups, (2) none of the subgroups and (3) multiple subgroups. Exact (binomial) 95% CIs for these percentages will also be presented. ETHICS AND DISSEMINATION This study has been approved by National Research Ethics Service (NRES) Committee North West-Greater Manchester North (11/NW/0814) and University of Central Lancashire (UCLan) Built, Sport, Health (BuSH) Ethics Committee (BuSH 025). An abstract has been accepted for the third International Patellofemoral Pain Research Retreat, Vancouver, September 2013.
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Affiliation(s)
- James Selfe
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - Michael Callaghan
- Centre for Rehabilitation Science, Manchester University, Manchester, UK
| | - Erik Witvrouw
- Department of Rehabilitation, Ghent University, Ghent, Belgium
- Aspetar, Doha, Qatar
| | - James Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - Maria Paola Dey
- Postgraduate Medicine and Dentistry, University of Central Lancashire, Preston, UK
| | - Chris Sutton
- School of Health, University of Central Lancashire, Preston, UK
| | - John Dixon
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Denis Martin
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Maria Stokes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jessie Janssen
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - Elizabeth Ritchie
- Department of Physiotherapy, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - David Turner
- Health Economics Group, University of East Anglia, Norwich, UK
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Rixe JA, Glick JE, Brady J, Olympia RP. A review of the management of patellofemoral pain syndrome. PHYSICIAN SPORTSMED 2013; 41:19-28. [PMID: 24113699 DOI: 10.3810/psm.2013.09.2023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Patellofemoral pain syndrome (PFPS) is one of the most frequently diagnosed knee conditions in the primary care, orthopedic, and sports medicine settings. Although strength training and stretching programs have traditionally been the mainstay of patient treatment, there are no consensus recovery protocols for runners experiencing PFPS. The purpose of our review is to examine recent literature regarding the efficacy of various treatment modalities in the management of patients with PFPS. METHODS Our review included 33 articles from a PubMed literature search using the search term PFPS treatment. The search was limited to randomized controlled trials, crossover case-controlled studies, and cohort studies with ≥ 10 participants, with trial data that were published within the last 5 years. RESULTS Strength training and stretching exercises continue to be strongly supported by research as effective treatment options for runners with PFPS. Recent studies have confirmed that quadriceps and hip strengthening combined with stretching in a structured physiotherapy program comprise the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS. As previous studies have shown, therapies such as proprioceptive training, orthotics, and taping may offer benefits as adjunctive therapies but do not show a significant benefit when they are used alone in patients with PFPS. Additionally, recent research has confirmed that surgical and pharmacologic therapies are not effective for the management of patients with PFPS. CONCLUSION A large number of athletes are impacted by PFPS every year, particularly young runners. Sports medicine researchers have investigated many possible therapies for patients with PFPS; however, no clear guidelines have emerged regarding the management of the syndrome. Our review analyzes recent literature on PFPS and identifies specific treatment recommendations. The most effective and strongly supported treatment modality for patients with PFPS is a combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group. Adjunctive therapies, including taping, biofeedback devices, and prefabricated orthotic inserts, may provide limited additive benefits in select populations. Surgery should be avoided in all patients with PFPS.
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Abstract
SYNOPSIS Altered knee joint biomechanics and excessive joint loading have long been considered as important contributors to the development and progression of knee osteoarthritis. Therefore, a better understanding of how various treatment options influence the loading environment of the knee joint could have practical implications for devising more effective physical therapy management strategies. The aim of this clinical commentary was to review the pertinent biomechanical evidence supporting the use of treatment options intended to provide protection against excessive joint loading while offering symptomatic relief and functional improvements for better long-term management of patients with knee osteoarthritis. The biomechanical and clinical evidence regarding the effectiveness of knee joint offloading strategies, including contralateral cane use, laterally wedged shoe insoles, variable-stiffness shoes, valgus knee bracing, and gait-modification strategies, within the context of effective disease management is discussed. In addition, the potential role of therapeutic exercise and neuromuscular training to improve the mechanical environment of the knee joint is considered. Management strategies for treatment of joint instability and patellofemoral compartment disease are also mentioned. Based on the evidence presented as part of this clinical commentary, it is argued that special considerations for the role of knee joint biomechanics and excessive joint loading are necessary in designing effective short- and long-term management strategies for treatment of patients with knee osteoarthritis. LEVEL OF EVIDENCE Therapy, level 5.
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Smith TO, McNamara I, Donell ST. The contemporary management of anterior knee pain and patellofemoral instability. Knee 2013; 20 Suppl 1:S3-S15. [PMID: 24034593 DOI: 10.1016/s0968-0160(13)70003-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/15/2013] [Accepted: 08/15/2013] [Indexed: 02/02/2023]
Abstract
In this review the evidence for the management of patients with patellofemoral disorders is presented confined to anterior knee pain and patellar dislocation (excluding patellofemoral arthritis). Patients present along a spectrum of these two problems and are best managed with both problems considered. The key to managing these patients is by improving muscle function, the patient losing weight (if overweight), and judicious use of analgesics if pain is an important feature. Hypermobility syndrome should always be looked for since this is a prognostic indicator for a poor operative outcome. Operations should be reserved for those with correctable anatomical abnormalities that have failed conservative therapy. The current dominant operation is a medial patellofemoral ligament reconstruction.
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Affiliation(s)
- Toby O Smith
- Norwich Medical School and School of Rehabilitation Sciences, University of East Anglia, Norwich, NR4 7TJ UK
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TRAK ontology: Defining standard care for the rehabilitation of knee conditions. J Biomed Inform 2013; 46:615-25. [DOI: 10.1016/j.jbi.2013.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/23/2013] [Accepted: 04/25/2013] [Indexed: 11/24/2022]
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Botanlioglu H, Kantarci F, Kaynak G, Unal Y, Ertan S, Aydingoz O, Erginer R, Unlu MC, Mihmanli I, Babacan M. Shear wave elastography properties of vastus lateralis and vastus medialis obliquus muscles in normal subjects and female patients with patellofemoral pain syndrome. Skeletal Radiol 2013; 42:659-66. [PMID: 22996306 DOI: 10.1007/s00256-012-1520-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/09/2012] [Accepted: 08/30/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of our study was to define and compare the mechanical properties of the vastus lateralis (VL) and vastus medialis obliquus muscles (VMO) by the way of quantitative shear-wave elastography in male and female healthy control (HC) subjects, and in female patients with patellofemoral pain syndrome (PFPS). MATERIALS AND METHODS Twenty-two healthy volunteers (11 male and 11 female) and 11 female patients with anterior knee pain were included in the study. The SWE examinations for VL and VMO were performed while the subjects were performing open kinetic chain exercises in neutral and 30° hip abduction. The contraction capacity (CC) and contraction ratio (CR) values were determined in resting and contraction phases in both hip positions. RESULTS The mean elasticity values in the CC for VL and VMO muscles were significantly higher in male HC subjects when compared to female HC subjects (p < 0.05). The CR of the VL muscle in female patients with PFPS was not significantly different than the female HC group. The CR for the VMO muscle was significantly lower in female patients with PFPS when compared to female HC subjects (p < 0.05). CONCLUSIONS We found a significant VMO weakness, and this method may provide quantitative data that might influence the diagnosis of muscle weakness, in female patients with PFPS.
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Affiliation(s)
- Huseyin Botanlioglu
- Cerrahpasa Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Kocamustafapasa, Istanbul, 34303, Turkey.
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Muscle activation of vastus medialis obliquus and vastus lateralis during a dynamic leg press exercise with and without isometric hip adduction. Phys Ther Sport 2013; 14:44-9. [DOI: 10.1016/j.ptsp.2012.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/21/2011] [Accepted: 02/22/2012] [Indexed: 11/27/2022]
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Wasielewski NJ, Parker TM, Kotsko KM. Evaluation of electromyographic biofeedback for the quadriceps femoris: a systematic review. J Athl Train 2013; 46:543-54. [PMID: 22488142 DOI: 10.4085/1062-6050-46.5.543] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To critically review evidence for the effectiveness of electromyographic biofeedback (EMGB) of the quadriceps femoris muscle in treating various knee conditions. DATA SOURCES Databases used to locate randomized controlled trials included PubMed (1980-2010), Cumulative Index of Nursing and Allied Health Literature (CINAHL, 1995-2007), Web of Science (1986-2010), SPORTDiscus (1990-2007), and Physiotherapy Evidence Database (PEDro). Key words were knee and biofeedback. STUDY SELECTION The criteria for selection were clinical randomized controlled trials in which EMGB of the quadriceps femoris was used for various knee conditions of musculoskeletal origin. Trials were excluded because of research designs other than randomized controlled trials, articles published in a non-English language, inclusion of healthy research participants, inability to identify EMGB as the source of clinical improvement, and lack of pain, functional outcome, or quadriceps torque as outcome measures. DATA EXTRACTION Twenty specific data points were abstracted from each clinical trial under the broad categories of attributes of the patient and injury, treatment variables for the EMGB group, treatment variables for the control group, and attributes of the research design. DATA SYNTHESIS Eight trials yielded a total of 319 participants with patellofemoral pain syndrome (n = 86), anterior cruciate ligament reconstruction (n = 52), arthroscopic surgery (n = 91), or osteoarthritis (n = 90). The average methodologic score of the included studies was 4.6/10 based on PEDro criteria. Pooled analyses demonstrated heterogeneity of the included studies, rendering the interpretation of the pooled data inappropriate. The EMGB appeared to benefit short-term postsurgical pain or quadriceps strength in 3 of 4 postsurgical investigations but was ineffective for chronic knee conditions such as patellofemoral pain and osteoarthritis in all 4 studies. Because the findings are based on limited data, caution is warranted until more randomized controlled trials are conducted to support or refute the general trends observed in this report.
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Affiliation(s)
- Noah J Wasielewski
- Department of Exercise Science, Bloomsburg University of Pennsylvania, 400 East Second Street, Bloomsburg, PA 17815-1301, USA.
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Moyano FR, Valenza MC, Martin LM, Caballero YC, Gonzalez-Jimenez E, Demet GV. Effectiveness of different exercises and stretching physiotherapy on pain and movement in patellofemoral pain syndrome: a randomized controlled trial. Clin Rehabil 2012; 27:409-17. [DOI: 10.1177/0269215512459277] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare the effectiveness of proprioceptive neuromuscular facilitation combined with exercise, classic stretching physiotherapy intervention, and educational intervention at improving patient function and pain in patients with patellofemoral pain syndrome. Design: Randomized, controlled, blind trial over four months. Setting: Urban population, Spain. Participants: Patients undergoing primary care for retropatellar pain. Intervention: Subjects were allocated on three different treatment options: a proprioceptive neuromuscular facilitation and aerobic exercise group, a classic stretching group, and a control treatment were applied over four months under the supervision of a physiotherapist. Main outcome: Knee Society Score, pain reported (Visual analogue scale) and knee range of motion. Assessments were completed at baseline and after four months. Results: 74 patients were enrolled in the study and distributed between groups. Both the proprioceptive neuromuscular facilitation and classic stretching group showed significant changes in all variables after four months intervention ( p < 0.001). The difference in mean Kujala knee score changes between groups (classic stretching group vs. proprioceptive neuromuscular facilitation group vs. control group) at four months was −24.05 (95% confidence interval (CI) −30.19, −17.90), p ≤ 0.001; vs. −39.03 (95% confidence interval (CI) −42.5, −35.5), p ≤ 0.001; vs. −0.238 (95% confidence interval (CI) −1.2, 0.726), p = 0.621, respectively. Conclusions: A proprioceptive neuromuscular facilitation intervention protocol combined with aerobic exercise showed a better outcome than a classic stretching protocol after four months.
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Affiliation(s)
| | - MC Valenza
- Department of Physiotherapy, University of Granada, Granada, Spain
| | - L Martin Martin
- Department of Physiotherapy, University of Granada, Granada, Spain
| | | | | | - G Valenza Demet
- Department of Physiotherapy, University of Granada, Granada, Spain
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Eapen C, Nayak CD, Pazhyaottyil Zulfeequer C. Effect of eccentric isotonic quadriceps muscle exercises on patellofemoral pain syndrome: an exploratory pilot study. Asian J Sports Med 2012; 2:227-34. [PMID: 22375243 PMCID: PMC3289225 DOI: 10.5812/asjsm.34747] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 06/17/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose There is a decrease in quadriceps muscle strength in subjects with patellofemoral pain syndrome. Various types of strengthening exercises of the quadriceps are done as part of its management, but the effect of isotonic eccentric quadriceps muscle exercises on patellofemoral pain syndrome has not been studied. Hence the aim of this exploratory pilot study was to evaluate the effect of eccentric quadriceps training in patients with patellofemoral pain. Methods Twenty patients (12 female and 8 male, mean ages, 27.50 +/- 6.6 years) with patellofemoral pain syndrome were treated. The eccentric training of the quadriceps was given using a Baltimore Therapeutic Equipment (BTE) Primus machine. The main outcome measures used were percentage time on target as shown by the BTE primus machine, SF-36 Health questionnaire and patellofemoral pain severity scale. Statistical analysis was performed using SPSS 13. Results All the outcome measures showed significant improvements (P<0.05). Percentage time on target improved with a mean difference of 23.6, the SF-36 questionnaire showed an improvement in physical component score, mental component score and bodily pain with a mean difference of 10.9, 2.6 and 29.2 respectively and pain score when taken using patellofemoral severity scale also improved with a mean difference of 3.4. Conclusion Isotonic eccentric training of quadriceps muscles was found to be effective in reducing pain and improving the functional status of patients with patellofemoral pain syndrome and can be suggested as part of the treatment.
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Affiliation(s)
- Charu Eapen
- Corresponding Author: Address: Department Physiotherapy, KMC Mangalore, 575003 Manipal University, India. E-mail:
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Abstract
Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in orthopaedic practice. The mission of the second International Patellofemoral Pain Research Retreat was to bring together scientists and clinicians from around the world who are conducting research aimed at understanding the factors that contribute to the development and, consequently, the treatment of PFP. The format of the 2.5-day retreat included 2 keynote presentations, interspersed with 6 podium and 4 poster sessions. An important element of the retreat was the development of consensus statements that summarized the state of the research in each of the 4 presentation categories. In this supplement, you will find the consensus documents from the meeting, as well as the keynote addresses, schedule, and platform and poster presentation abstracts.
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