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Bartsch A, Anderson FL, Fredericson M, Sherman SL. Biomechanical and biological factors of sexual dimorphism in anterior knee pain: Current concepts. J ISAKOS 2024; 9:788-793. [PMID: 38908481 DOI: 10.1016/j.jisako.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/24/2024]
Abstract
Female gender is one of the commonly mentioned risk factors for anterior knee pain (AKP), among a spectrum of other factors including anatomical, biomechanical, hormonal, behavioral and psychological elements contributing to its development. Despite the focus on individual risk factors, there's a notable gap in comprehending how gender influences and interacts with other risk factors. The objective of this review was to identify and emphasize the connections between these interactions, gender-related risk factors for AKP, and the potential mechanisms that explain their associations with other risk factors, aiming to aid in the creation of precise prevention and treatment approaches. Gender influences the majority of risk factors for AKP, including anatomical, biomechanical, hormonal, behavioral and psychological factors. Women have on average smaller patellae, higher patellofemoral cartilage stress and for AKP, disadvantageous trochlear morphology, ligament and muscle composition and unfavorable neuromuscular control pattern. In contrast, men show on average an increased ability to strengthen their hip external rotators, which are both protective against AKP. Particularly in kinetic and kinematic analysis, men have been shown to have a distinctly different risk factor profile than women. Sex hormones may also play a role in the risk of AKP, with estrogen potentially influencing ligamentous laxity, increasing midfoot loading and affecting neuromuscular control of the lower extremities and testosterone positively affecting muscle mass and strength. The higher incidence of AKP in women is likely due to a combination of slightly increased risk factors. Although all risk factors can be present in both men and women and the holistic evaluation of each individual's risk factor composition is imperative regardless of gender, knowing distinctive risk factors may help with focused evaluation, treatment and implementing preventive measures of AKP.
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Affiliation(s)
- Anna Bartsch
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA; Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA; Department of Orthopedics and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Forrest L Anderson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA; Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA
| | - Seth Lawrence Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA.
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Hoglund LT, Hulcher TA, Amabile AH. Males with patellofemoral pain have altered movements during step-down and single-leg squatting tasks compared to asymptomatic males: A cross-sectional study. Health Sci Rep 2024; 7:e2193. [PMID: 38868539 PMCID: PMC11168284 DOI: 10.1002/hsr2.2193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/18/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024] Open
Abstract
Background and Aims Patellofemoral pain (PFP) is common in males, causing reduced physical activity and chronic pain. One proposed cause of PFP is aberrant biomechanics during tasks loading the patellofemoral joint. Consistent evidence exists for females with PFP, but it is uncertain if males with PFP have altered biomechanics. This study investigated the kinematics of males with PFP compared to pain-free males during forward step-down (StDn) and single-leg squat (SLSq). Methods A cross-sectional study including 40 males aged 20-39 years (28.28 ± 5.46) was conducted (20 PFP, 20 pain-free). Participants performed StDn and SLSq while motion was captured with a video-based motion capture system (Motion Analysis Corporation). Triplanar peak angles and angular ranges of motion (ROM) of the trunk, pelvis, and weight-bearing hip, knee, and ankle were dependent variables. Mixed-model ANOVA tests were used to determine the presence of significant interactions and main effects of group and task. Results Males with PFP had significantly lower peak knee adduction angles compared to pain-free males (p = 0.01). Significant group x task interactions were found for hip and pelvis ROM (p < 0.05). PFP participants had increased hip and pelvis ROM during StDn in the frontal and transverse planes but reduced or nearly equal ROM for these variables during SLSq. Peak hip adduction, hip internal rotation, contralateral pelvic drop and anterior tilt, trunk flexion, and ankle dorsiflexion were greater during StDn compared to SLSq (p < 0.05). ROM of the hip, pelvis, trunk, and ankle were greater during StDn compared to SLSq (p < 0.05). Conclusion Males with PFP had reduced peak knee adduction angles in StDn and SLSq. Males with PFP demonstrated increased hip and pelvis ROM during StDn versus SLSq, particularly in the frontal and transverse planes. Clinicians should consider StDn as a clinical test since aberrant movement may be easier to detect than in SLSq.
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Affiliation(s)
- Lisa T. Hoglund
- Department of Physical Therapy, Jefferson College of Rehabilitation SciencesThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Thomas Alexander Hulcher
- Senior Clinical Research Coordinator and Biomechanist, Jefferson College of Rehabilitation SciencesThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Amy H. Amabile
- Department of Biomedical Education & Data Science, Lewis Katz School of Medicine at Temple UniversityTemple UniversityPhiladelphiaPennsylvaniaUSA
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Kamel AM, Ghuiba K, Abd Allah DS, Fayaz NA, Abdelkader NA. Effect of adding short foot exercise to hip and knee focused exercises in treatment of patients with patellofemoral pain syndrome: a randomized controlled trial. J Orthop Surg Res 2024; 19:207. [PMID: 38561773 PMCID: PMC10983661 DOI: 10.1186/s13018-024-04688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Patellofemoral pain syndrome is considered a common cause of anterior knee pain that could disturb function and limit daily activities. The purpose of the study was to investigate the effect of adding short foot exercise on pain, function, balance, and hip abductors, and quadriceps muscles strength in the treatment of patients with patellofemoral pain syndrome. METHODS Twenty-eight male and female patients with patellofemoral pain syndrome with age ranged from 18 to 35 years old participated in this study. They were equally and randomly assigned into two groups; the study group which received short foot exercise in addition to hip and knee exercises (n = 14) and thecontrol group which received hip and knee exercises only (n = 14). Participants received their interventions during 6 consecutive weeks (12 sessions). Pain intensity, function, abductors quadriceps muscle strength, and balance were assessed using the Visual Analog Scale, anterior knee pain scale (AKPS), hand-held dynamometer, and the Biodex Balance System respectively. All measurements were taken before and after 6 weeks of intervention in both groups. Multivariate analysis of variance was performed to compare the within and between groups effects for measured variables. RESULTS The within-group comparison showed significant improvement in pain severity, function, balance, and hip abductors, and quadriceps muscles strength in both groups post-treatment compared with pre-treatment. Between groups analysis, however, showed no significant statistical difference between both groups in all variables, except in pain, function, and mediolateral stability which showed better improvement compared to the control group. CONCLUSIONS Adding short foot exercise to hip and knee exercises improved pain, function, and mediolateral stability in patients with patellofemoral pain syndrome. TRIAL REGISTRATION clinicaltrials.gov. NO: NCT05383781. Date 19/ 5/2022.
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Affiliation(s)
- Abdallah Mohamed Kamel
- Department of Physical Therapy for Musculoskeletal disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Karim Ghuiba
- Department of Physical Therapy for Musculoskeletal disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Dina S Abd Allah
- Department of Physical Therapy for Musculoskeletal disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nadia Abdelazem Fayaz
- Department of Physical Therapy for Musculoskeletal disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nasr Awad Abdelkader
- Department of Physical Therapy for Musculoskeletal disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
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Gu Y, Zheng Z, Zeng Q, Yang C, Song Y, Wan X. Acute effects of negative heel shoes on perceived pain and knee biomechanical characteristics of runners with patellofemoral pain. J Foot Ankle Res 2024; 17:e12001. [PMID: 38551203 PMCID: PMC11296720 DOI: 10.1002/jfa2.12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND To determine the effects of negative heel shoes on perceived pain and knee biomechanical characteristics of runners with patellofemoral pain (PFP) during running. METHODS Sixteen runners with PFP ran in negative (-11 mm drops) and positive (5 mm drops) heel shoes while visual analog scale (VAS) scores, retroreflective markers, and ground reaction force were acquired by applying a 10-cm VAS, infrared motion capture system, and a three-dimensional force plate. Knee moment, patellofemoral joint stress (PFJS), and other biomechanical parameters during the stance phase were calculated based on inverse dynamics and a biomechanical model of the patellofemoral joint. RESULTS The foot inclination angle, peak PFJS during the stance phase, patellofemoral joint reaction force, knee extension moment, and quadriceps force at the time of peak PFJS of runners with PFP in negative heel shoes were lower than that in positive heel shoes, no significant difference was found in VAS scores, knee flexion angle, patellofemoral contact area, and quadriceps moment arm at the time of peak PFJS. CONCLUSIONS Compared to positive heel shoes, running in negative heel shoes decreases peak PFJS in runners with PFP, which may decrease patellofemoral joint loading, thus reducing the possibility of further development of PFP. TRAIL REGISTRATION Sports Science Experiment Ethics Committee of Beijing Sport University. 2023095H, April 18, 2023 (prospectively registered).
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Affiliation(s)
- Yu Gu
- Department of Sports BiomechanicsBeijing Sport UniversityBeijingChina
| | - Zhiyi Zheng
- ANTA Sports Science LaboratoryANTA (China) Co., Ltd.XiamenChina
| | - Quanshou Zeng
- ANTA Sports Science LaboratoryANTA (China) Co., Ltd.XiamenChina
| | - Chen Yang
- School of Sports and HealthNanjing Sport InstituteNanjingChina
| | - Yu Song
- Department of Health, Sport, & Exercise SciencesUniversity of KansasLawrenceKansasUSA
| | - Xianglin Wan
- Department of Sports BiomechanicsBeijing Sport UniversityBeijingChina
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Botta AFB, de Cássia Pinto da Silva J, Dos Santos Lopes H, Boling MC, Briani RV, de Azevedo FM. Group- and sex-related differences in psychological and pain processing factors in people with and without patellofemoral pain: correlation with clinical outcomes. BMC Musculoskelet Disord 2023; 24:397. [PMID: 37202816 DOI: 10.1186/s12891-023-06513-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND People with patellofemoral pain (PFP) exhibit impaired psychological and pain processing factors (i.e., kinesiophobia, pain catastrophizing and pressure pain thresholds [PPTs]). However, it remains unclear whether these factors have different presentations in women and men with PFP, as well as whether their correlation with clinical outcomes differ according to sex. The aims of this study were to: (1) compare psychological and pain processing factors between women and men with and without patellofemoral pain (PFP); (2) investigate their correlation with clinical outcomes in people with PFP. METHODS This cross-sectional study included 65 women and 38 men with PFP, 30 women and 30 men without PFP. The psychological and pain processing factors were assessed with the Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, and PPTs of shoulder and patella measured with an algometer. Clinical outcomes assessed were self-reported pain (Visual Analogue Scale), function (Anterior Knee Pain Scale), physical activity level (Baecke's Questionnaire), and physical performance (Single Leg Hop Test). Generalized linear models (GzLM) and effect sizes [Cohen's d] were calculated for group comparisons and Spearman's correlation coefficients were calculated to investigate correlations between outcomes. RESULTS Women and men with PFP had higher kinesiophobia (d = .82, p = .001; d = .80, p = .003), pain catastrophizing (d = .84, p < .001; d = 1.27, p < .001), and lower patella PPTs (d = -.85, p = .001; d = -.60, p = .033) than women and men without PFP, respectively. Women with PFP had lower shoulder and patella PPTs than men with PFP (d = -1.24, p < .001; d = -.95, p < .001), but there were no sex differences in those with PFP for psychological factors (p > .05). For women with PFP, kinesiophobia and pain catastrophizing had moderate positive correlations with self-reported pain (rho = .44 and .53, p < .001) and moderate negative correlations with function (rho = -.55 and -.58, p < .001), respectively. For men with PFP, only pain catastrophizing had moderate positive correlations with self-reported pain (rho = .42, p = .009) and moderate negative correlations with function (rho = -.43, p = .007). CONCLUSIONS Psychological and pain processing factors differ between people with and without PFP and between sexes, respectively. Also, correlations between psychological and pain processing factors with clinical outcomes differ among women and men with PFP. These findings should be considered when assessing and managing people with PFP.
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Affiliation(s)
- Ana Flavia Balotari Botta
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Júlia de Cássia Pinto da Silva
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Helder Dos Santos Lopes
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Michelle C Boling
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, FL, USA
| | - Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
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Ferreira AS, Mentiplay BF, Taborda B, Pazzinatto MF, de Azevedo FM, de Oliveira Silva D. Overweight and obesity in young adults with patellofemoral pain: Impact on functional capacity and strength. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:202-211. [PMID: 33296724 PMCID: PMC10105019 DOI: 10.1016/j.jshs.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/05/2020] [Accepted: 10/29/2020] [Indexed: 05/04/2023]
Abstract
PURPOSE This study aimed to (a) investigate the proportion of overweight/obesity in a cohort of young adults with patellofemoral pain (PFP) and (b) explore the association of body mass index (BMI), body fat, and lean mass with functional capacity and hip and knee strength in people with PFP. METHODS We included a mixed-sex sample of young adults (18-35 years old) with PFP (n = 100). Measurements for BMI, percentage of body fat, and lean mass (assessed by bioelectrical impedance) were obtained. Functional capacity was assessed by the Anterior Knee Pain Scale, plank test, and single-leg hop test. Strength of the knee extensors, knee flexors, and hip abductors was evaluated isometrically using an isokinetic dynamometer. The proportion of overweight/obesity was calculated based on BMI. The association between BMI, body fat, and lean mass and functional capacity and strength was investigated using partial correlations, followed by hierarchical regression analysis, adjusted for covariates (sex, bilateral pain, and current pain level). RESULTS A total of 38% of our cohort had their BMI categorized as overweight/obese. Higher BMI was associated with poor functional capacity (ΔR2 = 0.06-0.12, p ≤ 0.001) and with knee flexion strength only (ΔR2 = 0.04, p = 0.030). Higher body fat was associated with poor functional capacity (ΔR2 = 0.05-0.15, p ≤ 0.015) and reduced strength (ΔR2 = 0.15-0.23, p < 0.001). Lower lean mass was associated with poor functional capacity (ΔR2 = 0.04-0.13, p ≤ 0.032) and reduced strength (ΔR2 = 0.29- 0.31, p < 0.001). CONCLUSION BMI, body fat, and lean mass should be considered in the assessment and management of young people with PFP because it may be detrimental to function and strength.
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Affiliation(s)
- Amanda Schenatto Ferreira
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil.
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Bianca Taborda
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil
| | - Marcella Ferraz Pazzinatto
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Fábio Mícolis de Azevedo
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil
| | - Danilo de Oliveira Silva
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
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Frese C, Bubeck D, Alt W. Reduced Vastus Medialis/Lateralis EMG Ratio in Volleyballers with Chronic Knee Pain on Sports-Specific Surfaces: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9920. [PMID: 36011566 PMCID: PMC9408285 DOI: 10.3390/ijerph19169920] [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: 06/20/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Even though chronic knee pain is common in volleyball, neuromuscular imbalance as a potential risk factor has not been investigated in volleyball-specific tasks. The aim of the study was to compare neuromuscular control between healthy and injured players in a clinical jump test and a volleyball-specific jump task in real field conditions. METHODS Six athletes with knee pain and nine controls were included. Surface electromyographic data were recorded from the mm. vastus medialis (VM) and lateralis (VL) of both legs. VM/VL activation ratio was calculated from countermovement jump (CMJ) and volleyball spike indoors and on two beach surfaces. RESULTS All subjects had pain in the leading leg. Mann-Whitney U Test (M-W-U Test) revealed a significantly lower VM/VL ratio of the leading leg (always affected) of the injured compared with that of the healthy control group for the CMJ and spike jump on all three grounds. Bland-Altman analysis revealed low bias and low difference in standard deviation for the injured leg but high values for the uninvolved leg and healthy controls between tasks and grounds. These results could indicate that neuromuscular control might not adapt too well to different movement tasks and grounds in the injured leg. CONCLUSION Athletes with chronic knee pain might have lower VM/VL ratios than controls independent from movement task and ground. Neuromuscular control in injured athletes might be less adaptable to new circumstances. The results of neuromuscular control in laboratory settings might be applicable to field conditions in injured legs but not healthy ones.
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Bird MB, Mi Q, Koltun KJ, Lovalekar M, Martin BJ, Fain A, Bannister A, Vera Cruz A, Doyle TLA, Nindl BC. Unsupervised Clustering Techniques Identify Movement Strategies in the Countermovement Jump Associated With Musculoskeletal Injury Risk During US Marine Corps Officer Candidates School. Front Physiol 2022; 13:868002. [PMID: 35634154 PMCID: PMC9132209 DOI: 10.3389/fphys.2022.868002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Abstract
Musculoskeletal injuries (MSKI) are a significant burden on the military healthcare system. Movement strategies, genetics, and fitness level have been identified as potential contributors to MSKI risk. Screening measures associated with MSKI risk are emerging, including novel technologies, such as markerless motion capture (mMoCap) and force plates (FP) and allow for field expedient measures in dynamic military settings. The aim of the current study was to evaluate movement strategies (i.e., describe variables) of the countermovement jump (CMJ) in Marine officer candidates (MOCs) via mMoCap and FP technology by clustering variables to create distinct movement strategies associated with MSKI sustained during Officer Candidates School (OCS). 728 MOCs were tested and 668 MOCs (Male MOCs = 547, Female MOCs = 121) were used for analysis. MOCs performed 3 maximal CMJs in a mMoCap space with FP embedded into the system. De-identified MSKI data was acquired from internal OCS reports for those who presented to the OCS Physical Therapy department for MSKI treatment during the 10 weeks of OCS training. Three distinct clusters were formed with variables relating to CMJ kinetics and kinematics from the mMoCap and FPs. Proportions of MOCs with a lower extremity and torso MSKI across clusters were significantly different (p < 0.001), with the high-risk cluster having the highest proportions (30.5%), followed by moderate-risk cluster (22.5%) and low-risk cluster (13.8%). Kinetics, including braking rate of force development (BRFD), braking net impulse and propulsive net impulse, were higher in low-risk cluster compared to the high-risk cluster (p < 0.001). Lesser degrees of flexion and shorter CMJ phase durations (braking phase and propulsive phase) were observed in low-risk cluster compared to both moderate-risk and high-risk clusters. Male MOCs were distributed equally across clusters while female MOCs were primarily distributed in the high-risk cluster. Movement strategies (i.e., clusters), as quantified by mMoCap and FPs, were successfully described with MOCs MSKI risk proportions between clusters. These results provide actionable thresholds of key performance indicators for practitioners to use for screening measures in classifying greater MSKI risk. These tools may add value in creating modifiable strength and conditioning training programs before or during military training.
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Affiliation(s)
- Matthew B. Bird
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Matthew B. Bird,
| | - Qi Mi
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kristen J. Koltun
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mita Lovalekar
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brian J. Martin
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - AuraLea Fain
- Biomechanics, Physical Performance and Exercise Research Group, Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | | | | | - Tim L. A. Doyle
- Biomechanics, Physical Performance and Exercise Research Group, Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Bradley C. Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
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Strength, Flexibility and Postural Control of the Trunk and Lower Body in Participants with and without Patellofemoral Pain. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patellofemoral pain (PFP) is a frequent knee condition. The aim of this study was to investigate strength, flexibility and postural control in people with and without PFP. Fifty-five participants between 14 and 54 years of age (PFP = 18, control group = 37) were included. Strength and flexibility for all trunk, hip, knee and ankle muscle groups were measured along with postural control outcomes. Analyses were conducted based on the “affected” and “non-affected” leg within-group and between-groups. Between-groups analysis demonstrated a statistically lower strength of trunk muscles (range: 35.8–29.3%, p < 0.001), knee extensors (20.8%, p = 0.005) and knee flexors (17.4%, p = 0.020) in PFP participants. Within-group analysis proved an 8.7% (p = 0.018) greater hip internal rotation strength and ankle extension flexibility (p = 0.032) of the “affected side” in PFP participants. This was, to our knowledge, the first study to investigate the strength of all trunk muscle groups. The results indicate that participants with PFP exhibit impaired strength of trunk muscle groups, along with knee muscle deficits, which may present a rehabilitation target. Clinicians should consider implementing trunk strengthening exercises into PFP programs along with knee-targeting exercise programs.
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Effects of a Targeted Exercise Program on Inter-Leg Asymmetries in Patients with Patellofemoral Pain. Symmetry (Basel) 2021. [DOI: 10.3390/sym13061075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patellofemoral pain (PFP) is often associated with impaired muscle strength, flexibility, and stability. It has been suggested that inter-leg asymmetries have an important role in increasing the risk of musculoskeletal injuries, including PFP. Thus, the aim of this study was to identify significant asymmetries and determine the effects of a symmetry targeted exercise program in patients with PFP. Eighteen patients aged 13 to 54 years (24.17 ± 12.52 years) with PFP participated in this study. Strength, flexibility and stability outcomes of the trunk, hip, knee and ankle muscles were assessed. A single-group pretest–posttest design was used to assess changes in inter-leg and agonist–antagonist asymmetries resulting from the 8-week period of the supervised exercise program. Results indicated a significant improvement in inter-leg symmetry regarding bilateral stance in a semi-squat position (p = 0.020, d = 0.61, df = 17) and ankle plantarflexion (p = 0.003, d = 0.32, df = 17) and ankle dorsiflexion strength (p < 0.001, d = 0.46, df = 17). In addition, the ratio of ankle dorsiflexion/plantarflexion (p = 0.036, d = 1.14, df = 17) and hip extension/flexion (p = 0.031, d = 0.94, df = 16) changed significantly during the intervention period. To our knowledge, this was the first study to evaluate inter-leg asymmetries resulting from a period of a supervised exercise program. The results indicate that an exercise program focusing on individual asymmetries may influence specific deficits and contribute to better rehabilitation outcomes.
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da Silva Boitrago MV, de Mello NN, Barin FR, Júnior PL, de Souza Borges JH, Oliveira M. Effects of proprioceptive exercises and strengthening on pain and functionality for patellofemoral pain syndrome in women: A randomized controlled trial. J Clin Orthop Trauma 2021; 18:94-99. [PMID: 33996453 PMCID: PMC8100610 DOI: 10.1016/j.jcot.2021.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective of this study was to verify the effects of resisted and proprioceptive exercises program for the treatment of patients diagnosed with patellofemoral pain syndrome (PFPS). DESIGN METHOD Randomized Controlled Trial - level of evidence, II. METHODS Sixty female patients, clinically diagnosed with PFPS, were allocated into two experimental groups. The exercise group (ExG) underwent 6 weeks of a resisted and proprioceptive exercises for the trunk muscles, abductors and lateral hip rotators and knee extensors. The Guidance Group (GG) received educational, cognitive and behavioral guidance on healthcare. Before and after the program implementation period, all participants were evaluated in relation to the injured limb for pain assessment, subjective functionality, maximum isometric strength and 2D biomechanical analysis. RESULTS After a six-week follow-up, ExG showed significant improvement in the Numerical Pain Rating Scale, Anterior Knee Pain Scale and Knee Outcome Survey- Activities of Daily Living Scale when compared to the control group (p ≤ 0,05). The ExG also proved superior for increased muscle strength of knee extensors, hip abductors, decreased dynamic knee valgus and pelvic drop in relation to GG (p ≤ 0.05). However, when we consider the strength of the hip lateral rotator muscles there was no difference between the two interventions (p > 0.05). CONCLUSION Resisted and proprioceptive exercises yielded superior results to those of a treatment focused on educational, cognitive and behavioral guidance in improving pain and lower limb function for women with PFPS.
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Affiliation(s)
- Marcos Vinicius da Silva Boitrago
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil,Centro Universitário de Brasília (UniCEUB), Brasília, Distrito Federal, Brazil
| | - Nayara Nepomuceno de Mello
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - Fabrício Reichert Barin
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil,Corresponding author. Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), SGAS Quadra 613 - Conjunto C - Asa Sul, Brasília, Distrito Federal, Brazil.
| | - Paulo Lobo Júnior
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - José Humberto de Souza Borges
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - Marcio Oliveira
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil,Centro Universitário de Brasília (UniCEUB), Brasília, Distrito Federal, Brazil
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12
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Pedley JS, Lloyd RS, Read PJ, Moore IS, De Ste Croix M, Myer GD, Oliver JL. Utility of Kinetic and Kinematic Jumping and Landing Variables as Predictors of Injury Risk: A Systematic Review. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42978-020-00090-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
Jump-landing assessments provide a means to quantify an individual’s ability to attenuate ground reaction forces, generate lower limb explosive power and maintain joint alignment. In order to identify risk factors that can be targeted through appropriate training interventions, it is necessary to establish which (scalar) objective kinetic, kinematic, and performance measures are most associated with lower-extremity injury.
Methods
Online searches of MEDLINE, SCOPUS, EBSCOHost, SPORTDiscus and PubMed databases were completed for all articles published before March 2020 in accordance with PRISMA guidelines.
Results
40 articles investigating nine jump-landing assessments were included in this review. The 79% of studies using drop jump (n = 14) observed an association with future injury, while only 8% of countermovement jump studies (n = 13) observed an association with injury risk. The 57% of studies using unilateral assessments found associations with risk of injury (n = 14). Studies using performance measures (jump height/distance) as outcome measure were only associated with injury risk in 30% of cases. However, those using kinetic and/or kinematic analyses (knee abduction moment, knee valgus angle, knee separation distance, peak ground reaction force) found associations with injury in 89% of studies.
Conclusion
The landing element of jump-landing assessments appears to be superior for identifying individuals at greater risk of injury; likely due to a closer representation of the injury mechanism. Consequently, jump-landing assessments that involve attenuation of impact forces such as the drop jump appear most suited for this purpose but should involve assessment of frontal plane knee motion and ground reaction forces.
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De Bleecker C, Vermeulen S, De Blaiser C, Willems T, De Ridder R, Roosen P. Relationship Between Jump-Landing Kinematics and Lower Extremity Overuse Injuries in Physically Active Populations: A Systematic Review and Meta-Analysis. Sports Med 2020; 50:1515-1532. [DOI: 10.1007/s40279-020-01296-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Abstract
Women are increasingly participating in more and more sporting activities. For years, women athletes have been treated as the "female" equivalent of male athletes, with similar medical approaches but this is changing. The concept that women are unique in their "athletic arena" is further underscored with emerging scientific evidence--from the physiologic details not visible to the eye, to the more overt biomechanical and anatomic differences. We review a handful of conditions active women potentially may encounter: pregnancy, the female athlete triad, patellofemoral pain, potential injuries to the anterior cruciate ligament, and anemia.
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Affiliation(s)
- Siobhan M Statuta
- Primary Care Sports Medicine Fellowship, Department of Family Medicine, University of Virginia Sports Medicine, University of Virginia Health System, Charlottesville, VA 22908-0729, USA; Primary Care Sports Medicine Fellowship, Department of Physical Medicine & Rehabilitation, University of Virginia Sports Medicine, University of Virginia Health System, Charlottesville, VA 22908-0729, USA.
| | - Colton L Wood
- Department of Family Medicine, University of Virginia Health System, Charlottesville, VA 22908-0729, USA
| | - Lisa K Rollins
- Department of Family Medicine, Faculty Development Fellowship, University of Virginia Health System, Charlottesville, VA 22908-0729, USA
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