Ângulo‐q na dor patelofemoral: relação com valgo dinâmico de joelho, torque abdutor do quadril, dor e função

Relationship between exacerbating patellofemoral pain and dynamic knee valgus in females with patellofemoral pain after a patellofemoral joint loading protocol: A cross-sectional

OBJECTIVE

The aim of the present study is to 1) the effect of exacerbating patellofemoral pain (PFP) on dynamic knee valgus (DKV) 2) the relationship between exacerbating PFP and DKV in females with patellofemoral pain.

DESIGN

Cross-sectional study.

METHODS

Sixty women with PFP were recruited from the orthopedic clinics. We evaluated pain intensity and DKV in two conditions without (condition 1) and with (condition 2) PFJ loading during the single-leg squat (SLS) task. The MANOVA test was used to compare pain intensity and DKV angle between the two conditions. Furthermore, the Pearson correlation was used to examine the correlation between pain intensity with DKV angle.

RESULTS

The MANOVA analysis showed that pain intensity (P < 0.000, η2 = 0.623) and DKV angle (P < 0.000, η2 = 0.544) with a medium effect size significantly increased after PFJ loading. Furthermore, an excellent positive correlation was observed between an increase in pain intensity and DKV angle (P < 0.000, r = 0.840).

CONCLUSION

It seems that after the PFJ loading protocol and the subsequent pain exacerbation, the neuromuscular biomechanics of the lower limb are deficits. As a result, the stabilizing muscles activation decreases and increases the lower limb movement in the frontal plane.

Effects of hip abductor with external rotator strengthening versus proprioceptive training on pain and functions in patients with patellofemoral pain syndrome: A randomized controlled trial

BACKGROUND

Strengthening the hip muscles, particularly the abductors and rotators, has been reported beneficial for treating Patellofemoral pain syndrome (PFPS). Proprioceptive training (PT) is also shown to improve musculoskeletal pain and function in PFPS. The most appropriate treatment from these 2 is unclear. This study aimed to compare the effects of hip abductors and external rotator strengthening exercises along with conventional physical therapy (CPT) vs the proprioceptive training of the knee along with CPT in patients with PFPS.

METHODS

Forty-five participants were divided into 3 groups, experimental group 1 (EG 1), experimental group 2 (EG 2), and control group (CG), with fifteen participants in each group. EG 1 received hip abductor and external rotator strengthening exercises in addition to CPT. EG 2 received proprioceptive training and CPT. CG received CPT alone. Intervention programs lasted for 4 weeks. The pain was measured by Kujala Anterior Knee Pain Scale (AKPS). The study was registered retrospectively in the protocol registration and results system (clinicaltrials.gov, ID: NCT05698797 on 26/01/2023).

RESULTS

AKPS scores significantly (P < .001) improved in all 3 groups. A significant (P < .05) difference was also observed between all 3 groups. The greatest improvement was observed in EG 1, followed by EG 2 and CG.

CONCLUSION

The addition of hip abductor and external rotator strengthening exercises to a 4-week CPT program showed a more significant improvement in AKPS scores than the addition of proprioceptive training in patients with PFPS.

The effects of the Posterior X Taping versus augmented feedback on lower-extremity kinematic and muscle activity pattern during unilateral weight-bearing activities in men with tibiofemoral varus malalignment

PURPOSE

Tibiofemoral Varus Malalignment (TFRV) contributes to overuse injuries by altering lower limb biomechanics. Both Posterior X Taping (PXT) and Real Time Feedback (RTF), have each been recommended for subjects with TFRV as they are thought to enhance control of excessive tibiofemoral rotations. This paper evaluates this claim.

METHODS

A total of recreational male 24 athletes with TFRV participated in the current study. Kinematic and electromyography variables of lower extremity were synchronously ​recorded on five consecutive repetitions of the single-legged-squat (SLS) and forward-step-down) FSD) tasks before and after applications of PXT and RTF.

RESULTS

The subjects at post-intervention in RTF group exhibited decreased hip adduction during FSD, and decreased hip adduction and internal rotation during eccentric and concentric phases of the SLS; Additionally, we observed increased gluteus medius activity during eccentric phase of the SLS and FSD tasks. In contrast, subjects at the post-intervention in PXT group exhibited decreased tibiofemoral external rotation and increased ankle external rotation during all the phases of both SLS and FSD tasks.

CONCLUSION

These results suggest that the PXT and RTF interventions are recommended to immediately improve the functional defects of the subjects with TFRV during SLS and FSD tasks.

Patellofemoral Pain, Q-Angle, and Performance in Female Chinese Collegiate Soccer Players

Background and objective: Female sports injuries have been neglected by science, and few relevant studies have considered female subjects. Knee pain in female soccer players is more common than in male soccer players. The number of days of absence from training and competition has been shown to be higher in females than males. The reporting of knee pain is common in female soccer players, but whether knee pain is associated with morphological features is unclear. The Q-angle of the knee has been hypothesized to be a causal factor in knee pain. Asian females have shown higher levels of valgus than non-sporting Caucasian populations, but no data exist for female Chinese players. The aim of our study was to investigate whether there are associations between knee pain, the Q-angle of the lower limb, jump performance, play time, and perceived exertion in female Chinese collegiate soccer players. Materials and Methods: We measured the Q-angle, patellofemoral/anterior knee pain (SNAPPS questionnaire), and CMJ and SJ performance of 21 subjects (age: 20.09 ± 1.13 years, weight: 56.9 ± 6.26 kg, height: 164.24 ± 4.48 cm, and >10 years of practice) before and after a match; Borg scale and play time results were also recorded. Results: We found that our studied group had higher Q-angles in comparison to other ethnic groups reported in the literature, as well as an association of the Q-angle with the age, height, and weight of the players; however, contrary to other studies, we did not find any association between the Q-angle and knee pain, jumps, play time, or perceived exertion. Knee pain was not associated with any of the measured variables. Conclusions: Female Chinese soccer players showed higher Q-angles than players of other ethnic groups, a result that was associated with anthropometrics. The Q-angle was not found to be associated with knee pain, for which the sole determinant was body height.

Knee pain in young sports players aged 6-15 years: a cross-sectional study in Japan

BACKGROUND

Knee is the most commonly injured part of the body in young athletes. Knee pain in several studies have been seen to be more prevalent in active adolescents compared to inactive, although common in both groups. Nevertheless, few studies with large sample size have been published reporting the difference of the prevalence of knee pain for each sport among young sports players. This study investigated the point prevalence of knee pain among young sports players aged 6-15 years old according to age, sex, and sports discipline. Furthermore, this study investigated the association between knee pain and sports discipline among young sports players.

METHODS

A cross-sectional study was conducted using a self-reported questionnaire on young sports players aged 6-15 years from the Miyagi Amateur Sports Association. Multivariable logistic regression models were used to examine the association between knee pain and sports discipline and were adjusted for age, sex, body mass index (BMI), training days per week, and training hours per weekday and weekend.

RESULTS

A total of 7234 young sports players were included. The point prevalence of knee pain was 10.9%. Females (13.3%) had more knee pain than males (9.8%). Young, 13-year-old sports players had the highest prevalence of knee pain (19.1%). The multivariable analysis showed that the highest odds ratio [95% confidence interval] was observed for handball players (2.42 [1.01-5.81]). In addition, hand ball, mini-basketball (odds ratio 1.85; 95% CI 1.38-2.47), and basketball (odds ratio 1.66; 95% CI 1.23-2.26) were significantly associated with knee pain, compared with football. The lowest odds ratio was observed for swimming (0.34 [0.05-2.54]), followed by karate (odds ratio 0.38; 95% CI 0.16-0.89) and baseball (odds ratio 0.47; 95% CI 0.35-0.64).

CONCLUSION

The prevalence of knee pain among young athletes differed according to age, sex, and sports discipline. Their parents and clinicians should recognize this information to manage knee pain among young sports players.

Reliability of 2D kinematics during landing of volleyball athletes after exhaustion

INTRODUCTION

It is possible to quantify changes in movement patterns through kinematic analysis of landing, especially to quantify changes in pre and post exhaustion situations, however the reliability of this post exhaustion analysis is not known.

OBJECTIVE

To verify the inter and intra-examiner reliability of two-dimensional kinematic analysis during the landing of a vertical jump of volleyball athletes, pre and post exhaustion protocol.

EXPERIMENTAL

Thirty volleyball athletes were recruited, and kinematic analysis was performed during landing, pre and post exhaustion protocol. The angular measurements analyzed were: 1) frontal plane: knee valgus and 2) sagittal plane: anterior trunk inclination, knee flexion and tibiotarsal angle, performed by two examiners. The reliability calculation used the intraclass correlation coefficient (ICC), in addition to the error of measurement (SEM), the coefficient of variation (CV) and the minimum detectable difference (MDD).

RESULTS

Regarding reliability: ICC = 0.95-0.98 (pre) and ICC = 0.83-0.98 (post exhaustion). The CV presented heterogeneous values for the knee valgus and the inclination of the trunk, both pre and post protocol. The SEM from all angles presented values that varied from 0.74°-2.33° and the MDD ranged from 2.55°-5.54° pre protocol and 2.05°-6.45° post protocol.

CONCLUSION

2D kinematic evaluation can be used during landing, before and after the application of an exhaustion protocol, but professionals should pay attention to the angles of the knee valgus and the inclination of the trunk, as they have a large CV.

Hydraulic distension as a treatment for patellofemoral pain syndrome (PFPS) non-responsive to standard rehabilitation

BACKGROUND

The occurrence of Patellofemoral Pain Syndrome (PFPS) is often found in daily medical care. Rehabilitation is usually applied with good results. However, patients often do not respond to standard rehabilitation, suggesting there may be some undetected factors that standard treatments cannot address. It is known that post-traumatic adhesive capsulitis in the knee often shows symptoms similar to those of PFPS, but idiopathic adhesive capsulitis (IAC) has seldom been mentioned as a possible cause of PFPS. Adhesive capsulitis in the shoulder joint causes frozen shoulder (FS), and hydraulic distension (HD) is often applied to FS effectively.

PURPOSE

The purpose of this study was to investigate and report on the clinical application of HD to treat PFPS non-responsive to rehabilitation treatment.

PATIENTS AND METHODS

HD was applied to 72 knees that had resisted regular conservative treatments for PFPS. Follow-up data (e.g. visual analogue scale) was collected immediately after HD, and at periods of 1, 3 and 6 months later.

RESULTS

Of the 72 patients, 64 patients obtained pain relief after HD. Pain was relieved for at least 6 months for 33 of the 64 patients. No benefit was received for 8 patients.

CONCLUSIONS

HD could be an additional conservative option for some PFPS that resisted rehabilitation. Assuming that the mechanisms of action for HD in the knee are the same as those in FS, there is evidence to suggest that IAC might play a role in the development of PFPS for some patients.

Influence of the Powers™ strap on pain and lower limb biomechanics in individuals with patellofemoral pain

BACKGROUND

Abnormal biomechanics, especially hip internal rotation and adduction are known to be associated with patellofemoral pain (PFP). The Powers™ strap was designed to decrease hip internal rotation and to thereby stabilise the patellofemoral joint.

OBJECTIVES

This study aimed to investigate whether the Powers™ strap influenced pain and lower limb biomechanics during running and squatting in individuals with PFP.

METHODS

Twenty-four individuals with PFP were recruited using advertisements that were placed at fitness centres. They were asked to perform a single leg squat task (SLS) and to run on an indoor track at their own selected speed during two conditions: with and without the Powers™ strap. Immediate pain was assessed with the numeric pain rating scale. Three-dimensional motion and ground reaction force data were collected with 10 Qualisys cameras and three AMTI force plates.

RESULTS

Immediate pain was significantly reduced with the Powers™ strap (without the Powers™ strap: 4.04 ± 1.91; with the Powers™ strap: 1.93 ± 2.13). The Powers™ strap condition significantly increased hip external rotation by 4.7° during the stance phase in running and by 2.5° during the single leg squat task. Furthermore, the external knee adduction moment during the SLS and running increased significantly.

CONCLUSION

This study assessed the effect of the Powers™ strap on lower limbs kinematics and kinetics in individual with PFP. The results suggest that the Powers™ strap has the potential to improve abnormal hip motion. Furthermore, the Powers™ strap demonstrated an ability to significantly reduce pain during functional tasks in patients with PFP.

Electromyographic analysis of hip and knee muscles during specific exercise movements in females with patellofemoral pain syndrome: An observational study

Hip muscle strengthening and knee extensor strengthening are common training exercises for patellofemoral pain syndrome (PFPS). PFPS engendered by insufficient hip abductor and external rotator muscle strength has been of interest, but these exercise movements may increase the lateral vector force of the patella warrants clarification. So, the purpose of this study was to assess muscular activations of vastus lateralis (VL), vastus medialis oblique (VMO), and gluteus medius muscles in electromyographic analysis during hip abduction and external rotator movements and open and closed kinetic chain knee extension movements.The gluteus medius, VMO, and VL muscles, in addition to the ratio of the VL and VMO muscles, were assessed through surface electromyography in 4 movements. Each muscle's amplitude expressed as a percent of maximum voluntary contraction (MVC). The differences on MVC at the terminal joint angle and during the movements were compared.Thirty female patients with PFPS were recruited. During hip abduction and external rotation movements, the MVC of the gluteus medius muscle increased, and those of the VMO and VL muscles increased in the open and closed kinetic chain knee extension movements. The MVCs of VL in the hip abduction and external rotation movements were significantly higher than those of the VMO muscle (P < .05). The ratios of the VL and VMO muscles in the open and closed kinetic chain knee extension movements approached 1, and they were significantly higher than those in the hip abduction and external rotation movements (P < .05). The highest MVC of the VMO muscle was observed at the terminal joint angle in the closed kinetic chain knee extension movement.Selective gluteus medius muscle activation was induced during the hip abduction and external rotation movements, accompanied by an increase in VL muscle activation. In open and closed kinetic chain knee movements, the ratios of the VL and VMO muscles approached 1. More selective VMO muscle activation was induced during the closed kinetic chain knee movements.

Postural assessment in class III patients before and after orthognathic surgery

PURPOSE

This study aimed to assess body posture before and after bimaxillary orthognathic surgery by photogrammetry in skeletal class III patients.

METHODS

Thirty-one patients with skeletal class III dentofacial deformities (14 men, 17 women) who underwent orthodontic preparation for surgery were included in this non-randomized controlled trial. Of these, 15 who did not undergo orthognathic surgery during the period of this study served as controls. Postural assessment was performed by photogrammetry using SAPO® (Postural Assessment Software) based on anterior-, posterior-, and lateral-view images taken 1 month before and 4 months after bimaxillary orthognathic surgery with internal rigid fixation (or 4 months after the initial assessment, for the control group). The study was approved by PUCRS Research Ethics Committee, and written informed consent was obtained from all individual participants prior to their inclusion in the study.

RESULTS

There was no significant difference between groups for age, gender, and GAP. In the intervention group, the right leg/hindfoot angle, which initially indicated a valgus deformity, normalized after intervention (P < 0.048). Posterior displacement of the head (P < 0.005) and trunk (P < 0.004) were observed after intervention.

CONCLUSIONS

These results suggest that correction of class III dentofacial deformities by bimaxillary orthognathic surgery can produce systemic postural adjustments, especially posterior displacement of the head and trunk and knee and ankle valgus.

Methods to assess patellofemoral joint stress: A systematic review

Changes in patellofemoral joint (PFJ) stress are related to the development and course of PFJ dysfunctions. Different methods for PFJ stress calculation have been used, making the comparison of PFJ stress values across different studies difficult. The purpose of this study was to systematically review the methods for PFJ stress calculation and highlight the differences among the methods. A systematic literature search was conducted in Medline, Embase, CINAHL, SPORTDiscus and Web of Science databases. Included studies examined PFJ stress in subjects with or without musculoskeletal conditions. Of 12,670 identified studies, 53 were included, with a total of 1134 subjects evaluated. The main differences among the methods to calculate PFJ stress were: i) method to calculate PFJ contact area; ii) method to calculate a constant (coefficient k) that defines the relation between quadriceps force and PFJ reaction force; iii) the inclusion of adjustments for sagittal plane forces. Considerable variability in PFJ stress results was observed. The greatest PFJ stress value was 55.03 MPa during a dance jump and the lowest value was 1.9 MPa during walking at the speed of 1.4 m/s. Most studies applied methods which use data from previous studies. However, methods which use data from their own participants for most parts of the calculation might be preferred to minimize potential errors. When direct measures are not possible, a standard method could be applied to facilitate comparisons among studies.