Isometric exercises and somatosensory training as intervention programmes for patellofemoral pain in young dancers

Clinic- and laboratory-based measures of postural control in patellofemoral pain: A systematic review with meta-analysis and evidence gap map

BACKGROUND

Patellofemoral pain (PFP) is a prevalent musculoskeletal disorder associated with functional impairments. Although postural control is commonly assessed in people with PFP, there are inconsistent results regarding potential postural control deficits in this population.

RESEARCH QUESTION

This review aims to evaluate whether postural control is impaired in people with patellofemoral pain (PFP) and the effectiveness of interventions on postural control measures.

METHODS

We searched six databases from their inception to May 5, 2023. We included studies assessing clinic- or laboratory-based postural control measures in people with PFP compared to pain-free controls, and intervention studies with PFP populations. We assessed risk of bias using the Joanna Briggs Institute critical appraisal checklists and the Cochrane Risk of Bias 2 tool. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We used random-effects meta-analyses considering subgroups based on type of task, measure, and intervention.

RESULTS

Fifty-three studies were included. Very low certainty evidence indicated that people with PFP have shorter anterior (SMD = 0.53, 95 %CI:0.16,0.90), posteromedial (SMD = 0.54, 95 %CI:0.04,1.03) and posterolateral (SMD = 0.59, 95 %CI:0.11,1.07) reach distance, and worse composite score (SMD = 0.46, 95 %CI:0.22,0.70). Very low to moderate certainty evidence indicated that people with PFP have worse anterior-posterior and overall stability indexes during single-leg stance (SMD = -0.71, 95 %CI:-1.29,-0.14; SMD = -0.63, 95 %CI:-0.94,-0.32) and overall stability index during double-leg stance (SMD = -0.39, 95 %CI:-0.78,-0.00), but no differences in center of pressure area during stair ascent (SMD = 0.32, 95 %CI:-2.72, 3.36). Low certainty evidence indicated that kinesio taping improved anterior reach distance (SMD = -0.49, 95 %CI:-0.89,-0.09), while no significant differences were observed between pre- and post-intervention outcomes for conventional rehabilitation and rigid taping.

SIGNIFICANCE

Clinicians should use clinic- (star excursion or Y-balance tests) and laboratory-based (stability indexes) measures to identify impairments of postural control in people with PFP. Low certainty of evidence suggests short-term improvement in postural control with kinesio taping.

Efficacy of Isometric Exercises and Somatosensory Training for Pain, Proprioception, and Balance in Runners with Patellofemoral Pain Syndrome

Background A significant cause of knee pain is patellofemoral pain syndrome (PFPS). Young adults are the most common population to be impacted, and this condition appears to affect both sexes. Patellofemoral joint (PFJ) compression, which is felt around the patella during any physical or athletic activity, usually causes patients to experience pain in the anterior part of the knee. Physiotherapy is essential for patients suffering from this illness, as it can improve their everyday activities and ability to return to their sport. Methodology The study's main goal was to evaluate the effectiveness of somatosensory training and isometric exercises for pain, proprioception, and balance in runners with PFPS. Before- and after-test approaches were used in the investigation. Eighty-five people made up the study, with the inclusion and exclusion criteria used to determine eligibility. Isometric exercises and somatosensory training were given to every individual; the group was not randomly assigned. The patient's diagnosis was made using the patellar grind test. Participants received 30-45 minutes of isometric exercises and 15 minutes of somatosensory training every four days. The visual analog scale, joint position sense test, and Y-balance test were taken as outcome measures to measure PFPS before and after the intervention. Results The result revealed significant (p=0.0001) improvement in PFPS following the intervention. Both the isometric exercises and somatosensory training were found to be significant in reducing the intensity of the pain and improving the proprioception and balance of the individuals. Conclusion Both treatment approaches were beneficial in lowering pain in the joints, developing balance, and helping the patient perceive the position of the joint. Individuals can use both therapy methods to improve their running abilities, and they should become ingrained in daily practice.

Excellent Clinical Outcomes and Return to Dance of 6 Active, Professional Ballet Dancers Aged Younger Than 40 Years at Total Hip Arthroplasty Through Direct Anterior Approach With a Custom Stem: A Case Report

OBJECTIVE

To report clinical outcomes and return to dance after total hip arthroplasty (THA) by direct anterior approach (DAA) using custom stems in young, active, professional ballet dancers.

DESIGN

Case report.

SETTING

Tertiary.

PATIENTS

Six active, professional ballet dancers younger than 40 years who intended to resume ballet after THA.

INTERVENTIONS

Primary THA by muscle-sparing DAA using custom stems.

MAIN OUTCOME MEASURES

Return to dance, Oxford hip score (OHS), forgotten joint score (FJS), and satisfaction with surgery and pain using numeric rating scale (NRS). CTs were acquired 2 days after surgery to assess implant position. Descriptive statistics were used.

RESULTS

The cohort comprised 4 women and 2 men aged 15 to 39 years. At 2.5 to 5.1 years of follow-up, all patients returned to professional ballet dance. Time to return to dance was 3 to 4 months for 3 patients and 12 to 14 months for 3 patients. Clinical scores were excellent, except for FJS in 1 patient who had considerable pain at her spine and ipsilateral foot. All patients were satisfied with surgery (NRS = 10). There were no complications, reoperations, or revisions. CTs confirmed that stems and cups were correctly positioned.

CONCLUSIONS

All 6 young, active, professional ballet dancers who underwent THA by muscle-sparing DAA using custom stems returned to professional ballet dance and were completely satisfied with surgery. At >2 years of follow-up, 5 patients had excellent clinical outcomes and reported their dancing level to be as expected or better, whereas 1 patient had a lower FJS and was unable to return to her expected dance level.

Changes After a Conventional vs. an Alternative Therapy Program on Physical, Psychological, and Injury-Related Parameters in Male Youth Soccer Players With Patellar Tendinopathy During Return to Competition

ABSTRACT

Niering, M and Muehlbauer, T. Changes after a conventional vs. an alternative therapy program on physical, psychological and injury-related parameters in male youth soccer players with patellar tendinopathy during return to competition. J Strength Cond Res 37(9): 1834-1843, 2023-Changes after a conventional (CON) vs. alternative (ALT) therapy program on physical, psychological, and injury-related or pain-related parameters in soccer players with patellar tendinopathy (PT) during return to competition were examined. Thirty-four male youth soccer players (15-16 years) with PT were randomly assigned to a CON ( n = 18) or ALT ( n = 16) program. The ALT program consisted of 60 minutes of balance training, eccentric and isometric exercises, static stretching, and a dual-task progression. The CON program consisted of 30 minutes of eccentric and isometric exercises and static stretching. Both programs were conducted until painlessness was reported during full training load. Assessments of muscle power (drop jump, jump and reach), change of direction speed (CODS) (acyclic sprint), speed (tapping, 30-m linear sprint), endurance (Yo-Yo intermittent recovery test level-1), the Achievement Motives Scale Sport, and injury-related or pain-related correlates were performed immediately, 6 weeks, 16 weeks, and 20 weeks after the respective therapy program. Players in the ALT group required a shorter program duration (ALT: 47.1 ± 15.6 days, CON: 58.2 ± 24.6 days) and achieved the same (muscle power, speed, endurance) or greater (CODS) improvements in physical performances, the same enhancements in psychological measures (achievement motives), and better values for injury-related or pain-related correlates (injury incidence, pain-related training interruptions). Results indicate that both programs effectively improve relevant outcome parameters in players with PT. The ALT therapy is more time efficient than the CON therapy. Therapists should consider this multimodal training program for effective treatment of athletes to shorten their return to competition time and minimize the risk of secondary injuries.

Is Postural Control Affected in People with Patellofemoral Pain and Should it be Part of Rehabilitation? A Systematic Review with Meta-analysis

BACKGROUND

Growing evidence supports that exercise therapy is effective for patellofemoral pain (PFP) rehabilitation. Nevertheless, the improvements have been reported not to be sustained in the long term, suggesting that the current protocols may not comprehend all required functional factors to provide a consistent recovery. A potential neglected factor in treatment protocols for PFP is postural control. However, it is unclear whether this population presents balance impairments or the influence of postural control on pain and function during rehabilitation programmes.

OBJECTIVE

To investigate whether (Q1) balance is impaired in people with PFP compared to controls, (Q2) conservative interventions are effective to improve balance in people with PFP, and (Q3) balance exercises are effective to improve pain and function in people with PFP.

DATA SOURCES

Medline, Embase, CINAHL, SPORTDiscus, Web of Science and Cochrane Library, supplemented by hand searching of reference lists, citations and relevant systematic reviews in the field.

METHODS

A systematic review with meta-analysis was conducted according to the Cochrane recommendations and reported according to the PRISMA statement recommendations. We included cross-sectional studies comparing balance between people with and without PFP; and randomised controlled trials verifying the effect of conservative intervention on balance and the effect of balance intervention on pain and function in people with PFP. The risk of bias was assessed using the Epidemiological Appraisal Instrument for cross-sectional studies and the Physiotherapy Evidence Database scale for randomised controlled trials.

RESULTS

From 15,436 records, 57 studies (Q1 = 28, Q2 = 23, Q3 = 14) met the eligibility criteria. Meta-analyses indicated that people with PFP have worse anteroposterior (very low grade evidence, standardised mean difference [SMD] = 1.03, 95% CI 0.40-1.66) and mediolateral (moderate grade evidence, SMD = 0.87, 95% CI 0.31-1.42) balance compared to controls. Moderate grade evidence indicated that overall balance is not affected in people with PFP (SMD = 0.38, 95% CI - 0.05-0.82). Low to very low grade evidence indicates that interventions are ineffective for mediolateral (SMD = 0.01, 95% CI - 0.51-0.53) and overall (SMD = 0.49, 95% CI - 0.14-1.11) balance improvements, and low grade evidence indicates that interventions are effective to improve anteroposterior balance (SMD = 0.64, 95% CI 0.04-1.23). Moderate to low grade evidence indicated that balance interventions are effective to reduce pain (SMD = 0.82, 95% CI 0.26-1.38) and improve function (SMD = 0.44, 95% CI 0.09-0.80) when measured using questionnaires; and very low grade evidence indicated no efficacy for function measured via functional tests (SMD = 0.73, 95% CI - 0.16-1.61).

CONCLUSION

People with PFP likely present balance deficits compared to asymptomatic people. There was insufficient evidence to support the efficacy of interventions to improve or modify balance in people with PFP. Also, there was insufficient evidence to support the efficacy of balance exercises to improve pain and function in people with PFP. Trial Registration The present systematic review was registered in PROSPERO (CRD42018091717).

FUNCTIONAL TRAINING EFFECTS ON POSTURAL CONTROL CAPACITY IN SPORTS DANCERS

ABSTRACT Introduction Functional training can improve athletes’ coordination and physical control. Some studies prove the improvement of the strength of the core muscles after functional training. However, the research that questions athletes’ dynamic balance submitted to functional training is inconclusive. Objective To analyze the methods of postural control and the impact of functional training on sports dancers. Methods Young sports dancers were randomly divided into control and experimental groups. Both groups performed traditional fitness training, and a functional training protocol was added to the experimental group. Mathematical statistics were employed in the comparative analysis of the fitness of the two groups of athletes before and after training. Results The athletes in the functional training group rapidly achieved postural control ability, with high statistical relevance(P<0.05). Conclusion Athletes need to adopt a scientific and systematic training plan when performing sports dance training. The establishment of the test indexes for postural control ability in athletes can be diversified. Evidence Level II; Therapeutic Studies – Investigating the results.

SEBT in individuals with patellofemoral pain: an integrative review

Abstract Introduction: Decreased postural stability can be observed in individuals with patellofemoral pain (PP). The Star Excursion Balance Test (SEBT) is widely used to assess deficits that need to be improved, with different application methods and result presentation formats. Objective: To map SEBT use in individuals with PP, characterizing the studies that applied it to identify different application methods and result presentation formats. Methods: The review included randomized and non-randomized clinical trials, cross-sectional, case-control and cohort studies. Searches were performed in Pubmed and SciElo databases. Data extracted from eligible studies were divided into categories: (I) study characterization (II) SEBT application methods and result presentation formats. Results: A total of 177 studies were identified in the databases, 13 of which were selected. There are a growing number of new studies that assess the dynamic postural control of individuals with PP using the SEBT, and a variety of test application and result presentation formats. Conclusion: The SEBT is a useful, easy-to-apply test that identifies changes in dynamic postural control in individuals with PP. Different application and result presentation formats are in accordance with the literature, but it is recommended that future studies apply the protocols most widely used in previous studies that exhibit a low risk of bias, in order to improve repeatability and comparisons between studies.

Trunk, Hip and Knee Exercise Programs for Pain Relief, Functional Performance and Muscle Strength in Patellofemoral Pain: Systematic Review and Meta-Analysis

Objective

Previous research suggests that muscle strength exercise is the most effective rehabilitation methods in patients with patellofemoral pain (PFP). This systematic review with meta-analysis compared the effects of Hip&Knee, Hip-only and Knee-only exercise programs on pain relief, muscle strength, and functional performance in patients with PFP.

Methods

Literature searches of PubMed, PEDro and CINAHL databases revealed twenty-one studies included in the final descriptive review, thirteen of which were included in the meta-analysis. Data extraction included baseline and post-intervention means and standard deviations of all eligible outcome measures both for the intervention and control groups, participants baseline demographics and intervention characteristics.

Results

The results showed that Hip&Knee and Hip-only exercise programs were comparatively effective, while the Knee-only exercise programs proved to be inferior to the above-mentioned approaches. The Hip&Knee exercise programs showed the greatest pain relief (mean difference = -1.71 (-3.11, -0.30); p = 0.02; I² = 96%) and functional improvement (standardized mean difference = 1.28 (0.45, 2.12); p = 0.003; I² = 84%), although the subgroup analysis did not show any significant difference compared to Hip-only exercise programs (p > 0.05).

Conclusion

Overall, Hip&Knee exercise programs appear to reduce pain and improve function more than other exercise programs and could be used as a primary rehabilitation approach in patients with PFP. However, the difference between the subgroups in most outcome measures suggests that Hip&Knee exercise programs are no more effective than Hip-only exercise programs.

Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers

Background

Many young girls with generalized joint hypermobility (GJH) choose to participate in dance because their bodies are suited for this activity. Scoliosis tends to occur often in thin girls, who also are more likely to choose dance. Both anomalies (GJH and scoliosis) may be related to reduced abilities such as diminished strength and insufficient postural balance, with increased risk for musculoskeletal conditions. The main objectives of the present study were to determine the prevalence of dancers with GJH, the prevalence of dancers with scoliosis, and the prevalence of dancers with these two anomalies; and, to determine differences in physical abilities and the presence of patellofemoral pain (PFP) between young female dancers with and without such anomalies.

Methods

One hundred thirty-two female dancers, aged 12–14 years, were assessed for anthropometric parameters, GJH, scoliosis, knee muscle strength, postural balance, proprioception ability, and PFP.

Results

GJH was identified in 54 dancers (40.9%) and scoliosis in 38 dancers (28.8%). Significant differences were found in the proportion of dancers with no anomalies (74 dancers, 56.1%) and dancers with both anomalies (34 dancers, 25.8%) (p < .001). Dancers with both anomalies had reduced dynamic postural balance in the anterior direction (p = .023), reduced proprioception ability (p < .001), and weaker knee extensors (p = .036) and flexors (p = .040) compared with dancers with no anomalies. Among dancers with both anomalies, 73.5% suffered bilateral PFP, 17.6% suffered unilateral PFP, and 8.8% had no PFP (p < .001).

Conclusions

A high prevalence of young girls participating in dance classes had GJH, as the increased joint flexibility probably provides them with some esthetic advantages. The high prevalence of scoliosis found in these young dancers might be attributed to their relatively low body mass, their delayed maturation, and the selection process of dancers. Dancers with both GJH and scoliosis had decreased muscle strength, reduced postural balance, reduced proprioception, with higher risk of PFP. The main clinical implications are the need to reduce the risk of PFP among dancers by developing appropriate strength and stabilizing exercises combined with proprioceptive and postural balance training, to improve the correct alignment of the hyperextended and hypermobile joints, and to improve their supporting muscle strength.