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Kim S, Wu Y, Glaviano NR, Pescatello LS. Physical Activity Levels in Persons With Patellofemoral Pain: A Systematic Review and Meta-analysis. Sports Health 2024:19417381241264494. [PMID: 39129377 DOI: 10.1177/19417381241264494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
CONTEXT Pain and symptoms of patellofemoral pain (PFP) are often exacerbated during daily activities, which may result in reduced overall physical activity levels. OBJECTIVE To summarize the evidence for physical activity levels among persons with PFP compared with pain-free controls. DATA SOURCES PubMed, Embase, CINHAL, Cochrane Library, and SPORTDiscus were searched from January 1, 2000 to February 22, 2024. STUDY SELECTION Peer-reviewed studies published in English that measured physical activity subjectively or objectively in persons with PFP and pain-free controls. STUDY DESIGN Systematic review with meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION Standardized mean difference (SMD) with 95% CI are reported based on Hedges' g effect sizes. RESULTS From 23,745 records, 41 studies met the eligibility criteria. There was high-to-moderate-certainty evidence that persons with PFP reported higher physical activity levels compared with pain-free controls using the International Physical Activity Questionnaire (SMD, 0.27; 95% CI 0.03, 0.51), whereas lower physical activity levels compared with pain-free controls using the Tegner Activity Scale (SMD, -0.31; 95% CI -0.57, -0.04). There was low-to-moderate-certainty evidence that there was no group difference in physical activity levels using the Baecke Physical Activity Questionnaire (SMD, 0.17; 95% CI -0.09, 0.44) or self-reported sports participation duration (SMD, -0.46; 95% CI -0.98, 0.05). There was high-certainty evidence that runners with PFP reported shorter running distances compared with pain-free runners (SMD, -0.36, 95% CI -0.57, -0.14). No data pooling was possible for objectively measured physical activity levels due to device heterogeneity (ie, different algorithms used to quantify the intensity of physical activity). CONCLUSION Self-reported physical activity levels among persons with PFP were inconsistent depending on the physical activity measurement tool used or which specific physical activity was measured. Clinicians should integrate multiple physical activity assessment tools to determine the extent to which PFP influences physical activity levels. TRIAL REGISTRATION PROSPERO #CRD42022314598.
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Affiliation(s)
- Sungwan Kim
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Institute for Sports Medicine, University of Connecticut, Storrs, Connecticut
| | - Yin Wu
- Department of Research, Hartford Hospital/Healthcare, Hartford, Connecticut
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- Institute for Sports Medicine, University of Connecticut, Storrs, Connecticut
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
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Melo SA, Macedo LDB, Bullhões LCC, Cavalcanti RL, Azevedo Rodolfo JID, Brasileiro JS. Effects of neuromuscular electrical stimulation on patellofemoral pain: A randomized controlled trial. J Bodyw Mov Ther 2024; 39:390-397. [PMID: 38876657 DOI: 10.1016/j.jbmt.2024.03.022] [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: 02/13/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Patellofemoral Pain (PFP) is a common dysfunction that can compromise the performance of daily activities. Neuromuscular electrical stimulation (NMES) has been proposed as a complementary tool in the therapeutic approach. OBJECTIVE To analyze the effects of adding NMES to therapeutic exercises in women with PFP. METHODS Randomized controlled trial involving 34 women with PFP (mean age 23.8 ± 4.1), randomly assigned to two groups: exercises combined with NMES (ESG) and exercises only (ExG). The ExG followed an exercise protocol, while the ESG performed the same exercises combined with NMES. Interventions were performed twice a week for eight weeks. Primary outcome measures included pain and functional disability, while secondary outcomes encompassed electromyographic activity of the quadriceps and hip abductors, along with isokinetic performance. Assessments were performed before the intervention, after 4 and 8 weeks from the start of the protocol and 8 weeks after the conclusion of the treatment. RESULTS We did not observe difference between the groups in any of the analyzed variables. Both groups showed a reduction in pain and an improvement in functional disability during intragroup comparisons. CONCLUSION A reduction in pain and an improvement in functional disability were observed; however, there was no additional effect of NMES. TRIAL REGISTRATION NCT03918863.
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Affiliation(s)
- Samara Alencar Melo
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Liane de Brito Macedo
- Faculty of Health Sciences of Trairi of the Federal University of Rio Grande do Norte, (UFRN), Av. Rio Branco, S/N, Santa Cruz, RN, CEP: 59.200-000, Brazil.
| | - Lidiane Cristina Correia Bullhões
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Rafael Limeira Cavalcanti
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Jully Israely de Azevedo Rodolfo
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Jamilson Simões Brasileiro
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
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Blazey P, Scott A, Ardern CL, Davis JC, Whittaker JL, Losciale JM, Khan KM. Consensus methods in patellofemoral pain: how rigorous are they? A scoping review. Br J Sports Med 2024; 58:733-744. [PMID: 38777386 PMCID: PMC11228197 DOI: 10.1136/bjsports-2023-107552] [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] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Clinicians treating patients with patellofemoral pain (PFP) rely on consensus statements to make the best practice recommendations in the absence of definitive evidence on how to manage PFP. However, the methods used to generate and assess agreement for these recommendations have not been examined. Our objective was to map the methods used to generate consensus-based recommendations for PFP and apply four novel questions to assess the rigour of consensus development. DESIGN Scoping review. DATA SOURCES We searched Medline, SPORTDiscus, CINAHL and Embase from inception to May 2022 to identify consensus-derived statements or practice guidelines on PFP. The Joanna Briggs Institute Manual for Evidence Synthesis was followed to map the existing evidence. We measured the consensus methods based on four sets of questions addressing the panel composition, application of the consensus method chosen, agreement process and the use of evidence mapping. ELIGIBILITY CRITERIA All consensus statements or clinical guidelines on PFP were considered. RESULTS Twenty-two PFP consensus statements were identified. Panel composition: 3 of the 22 (14%) consensus groups reported the panellists' experience, 2 (9%) defined a desired level of expertise, 10 (45%) reported panellist sex and only 2 (9%) included a patient. Consensus method: 7 of 22 (32%) reported using an established method of consensus measurement/development. Agreement process: 10 of 22 (45%) reported their consensus threshold and 2 (9%) acknowledged dissenting opinions among the panel. Evidence mapping: 6 of 22 (27%) reported using systematic methods to identify relevant evidence gaps. CONCLUSIONS PFP consensus panels have lacked diversity and excluded key partners including patients. Consensus statements on PFP frequently fail to use recognised consensus methods, rarely describe how 'agreement' was defined or measured and often neglect to use systematic methods to identify evidence gaps.
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Affiliation(s)
- Paul Blazey
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Alex Scott
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Clare L Ardern
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jennifer C Davis
- Applied Health Economics Laboratory, Faculty of Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Karim M Khan
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
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Coombes BK, Mendis MD, Leung F, Hides JA. Is It Time to Step outside the Laboratory? The Feasibility of Field-Based Examination of Exercise-Induced Hypoalgesia in Elite Badminton Athletes with and without Knee Pain. TRANSLATIONAL SPORTS MEDICINE 2024; 2024:2953220. [PMID: 38962163 PMCID: PMC11221980 DOI: 10.1155/2024/2953220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 07/05/2024]
Abstract
Aim To investigate the feasibility of testing exercise-induced hypoalgesia (EIH) in a field setting. The effect of knee pain on EIH was also explored. Design Within-group pre-post design. Materials and Methods Fourteen athletes (8 male, 6 female) competing at an international level in badminton were tested on the sideline during an in-season training session. Participants completed questionnaires and a single leg decline squat to evaluate the presence of knee pain. A blinded examiner measured PPT over the quadriceps muscle before and after two conditions (3-minute quiet rest and 3-minute isometric wall squat). Results The exercise protocol was completed by 13 (93%) participants. Mean (SD) exertion was 8.4 (1.7), and mean thigh pain was 7.9 (2.0) at 3 minutes. Very high reliability was observed for PPT collected before and after rest (ICC 0.94, 95% CI 0.85, 0.98). PPT significantly increased by 22.4% (95% CI 15.1, 29.7) after wall squat but not after rest. Relative increases in PPT were similar in participants with and without knee pain on single leg decline squat (22.2% versus 22.6%, 7 participants each). Conclusion Simple, field-based tests of endogenous analgesia are feasible and could provide new opportunities to evaluate an athlete's risk of persistent pain.
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Affiliation(s)
- Brooke K. Coombes
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, QLD 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan Campus, Nathan, QLD 4111, Australia
| | - M. Dilani Mendis
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, QLD 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan Campus, Nathan, QLD 4111, Australia
| | - Felix Leung
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, QLD 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan Campus, Nathan, QLD 4111, Australia
| | - Julie A. Hides
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, QLD 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan Campus, Nathan, QLD 4111, Australia
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Wang XQ, Wang YL, Witchalls J, Han J, Zhang ZJ, Page P, Zhu Y, Stecco C, Lin JH, El-Ansary D, Ma QS, Qi Q, Oh JS, Zhang WM, Pranata A, Wan L, Li K, Ma M, Liao LR, Zhu YL, Guo JW, Chen PJ. Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus. Clin Rehabil 2024; 38:715-731. [PMID: 38317586 DOI: 10.1177/02692155241229398] [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] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. DATA SOURCES A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. REVIEW METHODS Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. RESULTS Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. CONCLUSIONS The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.
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Affiliation(s)
- Xue-Qiang Wang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Ling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jeremy Witchalls
- Research Institute for Sports and Exercise, University of Canberra, Bruce, ACT, Australia
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Phillip Page
- Franciscan University, Franciscan Missionaries of Our Lady University, Baton Rouge, LA, USA
| | - Yi Zhu
- Department of Pain and Musculoskeletal Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Carla Stecco
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Jian-Hua Lin
- Department of Rehabilitation Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Doa El-Ansary
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Quan-Sheng Ma
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qi Qi
- Department of Rehabilitation Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Jae-Seop Oh
- Department of Physical Therapy, INJE University, Gimhae, Republic of Korea
| | - Wei-Ming Zhang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Adrian Pranata
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Li Wan
- Rehabilitation Center, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Kui Li
- Department of the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ming Ma
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
| | - Lin-Rong Liao
- Department of Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, China
| | - Yu-Lian Zhu
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
| | - Jing-Wei Guo
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Pei-Jie Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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Dzidotor GK, Moorhead JB, Ude CC, Ogueri KS, Ghosh D, Laurencin CT. Functions and Effectiveness of Unloader, Patellofemoral, and Knee Sleeve Orthoses: A Review. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2024; 10:147-171. [PMID: 38983777 PMCID: PMC11233114 DOI: 10.1007/s40883-023-00313-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/18/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2024]
Abstract
Background Knee orthoses have been extensively used as a nonsurgical approach to improving knee deficiencies. Currently, arthritic knee conditions remain the leading cause of disability, and this number is expected to increase. As the use of knee orthoses varies widely, so has their effectiveness which is still largely debatable. Here, we present the functions and effectiveness of the three most prominent knee orthotic models dedicated to supporting knee osteoarthritis-unloader, patellofemoral, and knee sleeves. Purpose/Research Question Considering the depth and diversity of the many clinical studies and documented laboratory reports published to date, this literature review was created to educate the clinician, patient, and researcher on common knee orthoses used for the management of arthritic knee conditions. In doing so, we discuss their design, biomechanical effects, and clinical efficacy, as well as broader outcomes, limitations, and recommendations for use. Results/Synthesis The knee orthoses discussed within the scope of this paper are dedicated to protecting the knee against strenuous compressive loads that may affect the patellofemoral and tibiofemoral joints of the knee. Since the knee has multiple axes of motion and articulating surfaces that experience different loads during functional activities, it can be implied that, to a large extent, knee brace designs can differ drastically. Unloader knee orthoses are designed to decrease tibiofemoral and patellofemoral joint pressures. Patellofemoral knee orthoses are designed to decrease strain on the patellofemoral and quadriceps tendons while stabilizing the patella. Knee sleeves are designed to stabilize movements, reduce pain in joints, and improve proprioception across the knee joint. Conclusion Although patients often report benefits from wearing braces, these benefits have not been confirmed by clinicians and scientific investigators. Results from these three orthosis types show that clinical efficacy is still elusive due to the different methodologies used by researchers. Layman Summary Knee orthoses also referred to as knee brace are commonly used for support and stability of the knee. Unloader knee braces are designed to relieve and support those suffering from knee osteoarthritis by improving physical impairment and reducing pain. Patellofemoral knee braces aim to help patients manage patellofemoral pain syndrome. Rehabilitative compression sleeves, also known as knee sleeves, are often used to assist patients suffering from knee pain and laxity. Important findings on the three knee braces discussed show discrepancies in results. Their effectiveness and validity are yet to be understood.
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Affiliation(s)
- Godwin K. Dzidotor
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
| | - Jeffrey B. Moorhead
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
| | - Chinedu C. Ude
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Kenneth S. Ogueri
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Institute of Materials Science, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Materials Science and Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
| | - Debolina Ghosh
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
| | - Cato T. Laurencin
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA
- Institute of Materials Science, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Materials Science and Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Biomedical Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA
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Delgadillo BE, Bui A, Debski AM, Miller B, Wu DO SS. Efficacy of Osteopathic Manipulative Treatment for Pain Reduction in Patients With Patellofemoral Pain Syndrome: A Meta-Analysis of Randomized Controlled Trials. Cureus 2024; 16:e59439. [PMID: 38826947 PMCID: PMC11140634 DOI: 10.7759/cureus.59439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Patellofemoral pain syndrome (PFPS) is among the most common causes of musculoskeletal pain in the United States. It is defined as retropatellar or peripatellar pain that is reproduced with functional activities that load the patellofemoral joint in a flexed position, such as stair climbing or squatting. While it presents in both adolescents and adults, it is commonly found in physically active individuals, such as athletes and military recruits. Exploring the role of osteopathic manipulative treatment (OMT) in PFPS is of particular interest given the absence of a definitive treatment and the poor long-term prognosis associated with PFPS. This meta-analysis includes three studies exploring the use of OMT to reduce pain in patients suffering from PFPS and exploring the efficacy of OMT as a primary intervention. In these studies, pain assessments, pre-treatment, and post-treatment follow-up of at least 30 days were performed using a 10-cm visual analog scale (VAS). The mean difference in pain between OMT and no treatment (NT) groups using the random effects model was -3.95 (-6.39; -1.50) with a p<0.01, suggesting OMT resulted in significant knee pain reduction in those with PFPS. A measure of heterogeneity, known as I2, was found to be high at 97%, which suggests caution should be taken when interpreting the overall results. Given the lack of definitive treatment and the poor long-term prognosis for PFPS, the authors suggest OMT provides an effective option for pain relief in patients with PFPS. Further research is needed to provide results that may be more clinically applicable or valuably interpreted.
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Affiliation(s)
- Blake E Delgadillo
- Orthopaedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Audrey Bui
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Alyssa M Debski
- Anatomy, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Brooke Miller
- Urology, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Shan Shan Wu DO
- Allergy/Immunology, Allergy/Immunology Associates, Inc., Mayfield Heights, USA
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Mostafaee N, Pashaei-Marandi M, Negahban H, Pirayeh N, Saki Malehi A, Ebrahimzadeh MH. Examining the diagnostic accuracy of common physical examination and functional tests in the diagnosis of patellofemoral pain syndrome among patients with anterior knee pain. Physiother Theory Pract 2024; 40:843-855. [PMID: 36537113 DOI: 10.1080/09593985.2022.2158053] [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: 08/01/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE The aims of this study were to evaluate the diagnostic accuracy of common physical examination and functional evaluation tests, and to determine a set of tests with the highest diagnostic accuracy for diagnosing patellofemoral pain syndrome (PFPS) in patients with anterior knee pain. METHODS Based on careful evaluation of clinical findings and imaging methods by orthopedic physicians, 162 patients with anterior knee pain were classified into two groups of PFPS and non-PFPS. The physical examination and functional tests were performed by two physiotherapists. The accuracy of these measures was determined by calculating sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC), likelihood ratio (LR), and predictive value (PV). RESULTS Our results showed the most sensitive tests in identifying patients with PFPS were as follows: eccentric step test [0.82 (95%CI: 0.72-0.89)]; palpation test [0.81(95%CI: 0.70-0.88)]; and prolonged sitting [0.73 (95%CI: 0.62-0.82)]. The palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending tests had an acceptable accuracy (AUC ≥ 70). The strongest combination of the physical examination and functional tests included pain severity between 3 and 10 during stair descending test and pain severity between 6 and 10 during prolonged sitting test. This combination showed a positive LR of 19.47 (95% CI: 6.36-59.65) and a posttest probability of 95%. CONCLUSION Our findings provide evidence for the good accuracy of the palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending and prolonged sitting tests for diagnosing PFPS. Also, the combination of stair descending test and prolonged sitting test could be very useful for ruling in PFPS patients.
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Affiliation(s)
- Neda Mostafaee
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Khorasan Razavi, Mashhad, Iran
| | - Melika Pashaei-Marandi
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Khorasan Razavi, Mashhad, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Khorasan Razavi, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Ghaem Hospital, Ahmad Abad St., Khorasan Razavi, Mashhad, Iran
| | - Nahid Pirayeh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amal Saki Malehi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hosein Ebrahimzadeh
- Orthopedic Research Center, Mashhad University of Medical Sciences, Ghaem Hospital, Ahmad Abad St., Khorasan Razavi, Mashhad, Iran
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Xu J, Cai Z, Chen M, Wang X, Luo X, Wang Y. Global research trends and hotspots in patellofemoral pain syndrome from 2000 to 2023: a bibliometric and visualization study. Front Med (Lausanne) 2024; 11:1370258. [PMID: 38566926 PMCID: PMC10985266 DOI: 10.3389/fmed.2024.1370258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is a prevalent condition in sports medicine, and as sports competitions become more popular, the incidence of sports injuries is on the rise. Despite the increasing research on PFPS, there remains a lack of bibliometric analyses on this topic. The aim of this study was to identify the research hotspots and trends in the field of PFPS by reviewing 23 years of literature in this field. Methods By analyzing the literature on PFPS research from 2000 to 2023 in the core dataset of the Web of Science database and utilizing bibliometric tools like CiteSpace 6.1, VOSviewer 1.6.18, R-bibliometrix 4.6.1, Pajek 5.16, and Scimago Graphica 1.0.26, our aim was to gain insights into the current status and key areas of PFPS research. The study examined various aspects including the number of publications, countries, institutions, journals, authors, collaborative networks, keywords, and more. Through the visualization of relevant data, we also attempted to forecast future trends in the field. Results There were 2,444 publications were included in this visualization study, published in 322 journals by 1,247 authors from 818 institutions in 67 countries. The Journal of Orthopaedic and Sports Physical Therapy had the highest number of publications, with the USA leading in article count. La Trobe University contributed the most articles, while Rathleff MS and Barton CJ emerged as the most prolific authors. Hip and knee strength and core strength, lower extremity kinematics and biomechanics, females (runners), muscle activation, risk factors, gait retraining, clinical practice guidelines, and rehabilitation were research hotspot keywords. Conclusion Current research suggests that there is still significant potential for the development of PFPS research. Key areas of focus include the clinical effectiveness of combined hip and knee strengthening to address PFPS, characterization of lower limb kinematics and biomechanics, gait retraining, risk factors, and clinical practice guidelines. Future research could explore the effectiveness of innovative exercise therapies such as blood flow restricting training, gait retraining, and neuromuscular control training for PFPS improvement. Further investigation into gait retraining for runners, particularly females, and clinical efficacy study of a novel PRP formulation for the treatment of PFPS.
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Affiliation(s)
- Jie Xu
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Zijuan Cai
- College of Physical Education and Health, Geely University of China, Chengdu, China
| | - Meng Chen
- Department of Emergency Medicine, Nanchong Hospital of Traditional Chinese Medicine, Nanchong, China
| | - Xin Wang
- Health Science Center, Peking University, Beijing, China
| | - Xiaobing Luo
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Yanjie Wang
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
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10
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Amirabadi N, Hessam M, Monjezi S, Molhemi F, Mehravar M, Hosseinpour P. Effectiveness of telerehabilitation intervention to improve pain and physical function in people with patellofemoral pain syndrome: study protocol for a randomized controlled trial. Trials 2024; 25:195. [PMID: 38504365 PMCID: PMC10949657 DOI: 10.1186/s13063-024-08047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition in young and active adults. Exercise therapy is an essential part of rehabilitation in people with PFPS (PwPFPS). Telerehabilitation is an innovative treatment approach that has been used in several musculoskeletal conditions. This study aims to investigate the non-inferiority of telerehabilitation through a smartphone application, the Vito App, compared to face-to-face physical therapy on reducing pain and improving physical function, quality of life, and psychological factors. METHODS This randomized controlled trial will include 60 PwPFPS. to a control group (face-to-face physical therapy) or an experimental group (telerehabilitation). The intervention for both groups consists of stretching, strengthening, balance, and functional exercises for 6 weeks and three sessions per week. The primary outcomes are pain intensity by visual analog scale (VAS), physical function by the Kujala questionnaire and functional tests including the bilateral squat, anteromedial lunge, and step down, and quality of life by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire quality of life subscale. Secondary outcomes are psychological factors such as anxiety and depression assessed with the Hospital Anxiety and Depression Scale (HADS) questionnaire, kinesiophobia assessed with the Tampa scale, and pain catastrophizing assessed with the Pain Catastrophizing Scale (PCS). Assessments will be held in 3 phases: pre-test (before the intervention), post-test (after the 6 weeks of intervention), and follow-up (1 month after the end of the intervention). DISCUSSION We expect that both the control group and experimental group will show similar improvements in clinical and psychological outcome measures. If our hypothesis becomes true, PwPFPS can use telerehabilitation as a practical treatment approach. Telerehabilitation can also enhance accessibility to rehabilitation services for active adults and for people living in remote and rural areas. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT) IRCT20201112049361N1. Registered on 29 October 2022.
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Affiliation(s)
- Negar Amirabadi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masumeh Hessam
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Saeideh Monjezi
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farshad Molhemi
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Mehravar
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Pardis Hosseinpour
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Beato M, de Keijzer KL, Muñoz-Lopez A, Raya-González J, Pozzo M, Alkner BA, Dello Iacono A, Vicens-Bordas J, Coratella G, Maroto-Izquierdo S, Gonzalo-Skok O, McErlain-Naylor SA, Martin-Rivera F, Hernandez-Davo JL, Arrones LS, Sabido R, de Hoyo M, Fernandez-Gonzalo R, Norrbrand L. Current Guidelines for the Implementation of Flywheel Resistance Training Technology in Sports: A Consensus Statement. Sports Med 2024; 54:541-556. [PMID: 38175461 PMCID: PMC10978721 DOI: 10.1007/s40279-023-01979-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Flywheel resistance training has become more integrated within resistance training programs in a variety of sports due to the neuromuscular, strength, and task-specific enhancements reported with this training. OBJECTIVE This paper aimed to present the consensus reached by internationally recognized experts during a meeting on current definitions and guidelines for the implementation of flywheel resistance training technology in sports. METHODS Nineteen experts from different countries took part in the consensus process; 16 of them were present at the consensus meeting (18 May 2023) while three submitted their recommendations by e-mail. Prior to the meeting, evidence summaries were developed relating to areas of priority. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of flywheel resistance training technology in sports. The process to gain consensus had five steps: (1) performing a systematic review of systematic reviews, (2) updating the most recent umbrella review published on this topic, (3) first round discussion among a sample of the research group included in this consensus statement, (4) selection of research group members-process of the consensus meeting and formulation of the recommendations, and (5) the consensus process. The systematic analysis of the literature was performed to select the most up-to-date review papers available on the topic, which resulted in nine articles; their methodological quality was assessed according to AMSTAR 2 (Assessing the Methodological Quality of Systematic Review 2) and GRADE (Grading Recommendations Assessment Development and Evaluation). Statements and recommendations scoring 7-9 were considered appropriate. RESULTS The recommendations were based on the evidence summary and researchers' expertise; the consensus statement included three statements and seven recommendations for the use of flywheel resistance training technology. These statements and recommendations were anonymously voted on and qualitatively analyzed. The three statements reported a score ranging from 8.1 to 8.8, and therefore, all statements included in this consensus were considered appropriate. The recommendations (1-7) had a score ranging from 7.7 to 8.6, and therefore, all recommendations were considered appropriate. CONCLUSIONS Because of the consensus achieved among the experts in this project, it is suggested that practitioners and researchers should adopt the guidelines reported in this consensus statement regarding the use of flywheel resistance technology in sports.
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Affiliation(s)
- Marco Beato
- School of Allied Health Sciences, University of Suffolk, Ipswich, UK.
| | | | - Alejandro Muñoz-Lopez
- Departamento de Motricidad Humana y Rendimiento Deportivo, University of Seville, Seville, Spain
| | | | - Marco Pozzo
- Master de Fútbol, Universidad Pablo de Olavide, Seville, Spain
- SmartCoach Technologies, Inc., Seville, Spain
| | - Björn A Alkner
- Department of Orthopaedic Surgery, Eksjö, Region Jönköping County, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Antonio Dello Iacono
- School of Health and Life Sciences, University of the West of Scotland, Paisley, Scotland
| | - Jordi Vicens-Bordas
- Sport, Exercise, and Human Movement (SEaHM), University of Vic-Central University of Catalonia, Barcelona, Spain
- Sport and Physical Activity Studies Centre (CEEAF), University of Vic-Central University of Catalonia, Barcelona, Spain
| | - Giuseppe Coratella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Oliver Gonzalo-Skok
- Department of Communication and Education, Universidad Loyola Andalucía, Seville, Spain
| | | | - Fernando Martin-Rivera
- Research Group in Prevention and Health in Exercise and Sport, University of Valencia, Valencia, Spain
| | | | | | - Rafael Sabido
- Sport Research Centre, Department of Sport Sciences, Miguel Hernández University, Elche, Spain
| | - Moises de Hoyo
- Department of Physical Education and Sport, University of Seville, Seville, Spain
- Performance Department, Aston Villa Football Club, Birmingham, UK
| | - Rodrigo Fernandez-Gonzalo
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
- Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Norrbrand
- Division of Environmental Physiology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Solna, Sweden
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12
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Çankaya M, Karakaya İÇ, Yargıç PM. Reliability and validity of the Turkish version of the patellofemoral pain severity scale in patients with patellofemoral pain syndrome. Disabil Rehabil 2024:1-8. [PMID: 38318771 DOI: 10.1080/09638288.2024.2312258] [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: 05/10/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE The aim of this study was to investigate the Turkish validity and reliability of the Patellofemoral Pain Severity Scale (PSS) in patients with patellofemoral pain (PFP) and to adapt it to Turkish. MATERIALS AND METHODS A pilot study was conducted with 10 patients. 123 patients underwent PSS test-retest at 24-48 h intervals. Construct validity, correlations of PSS with other scales Timed Up and Go Test (TUG), Stair Climbing and Descending Test (SCD), Anterior Knee Pain Scale (AKPS), Tegner Activity Scale (TAS), Lysholm Knee Scoring Scale (LDSS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) were evaluated. RESULTS The content validity index value of the scale was 0.95. The overall internal consistency (Cronbach α: 0.88) was high. Item-total correlations of the scale were between 0.51 and 0.7. In the evaluation of the convergent validity of the PSS, it was found that there was a positive correlation between the PSSS and TUG and SCD, and a negative correlation between the PSS, TAS, LDSS and KOS-ADL (p = 0.000). CONCLUSIONS In this study, it was determined that the PSSS scale had good internal consistency, test-retest validity and adequate construct validity when compared with the KOS-ADL, LDSS and AKPS.
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Affiliation(s)
- Musa Çankaya
- Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - İlkim Çıtak Karakaya
- Department of Physiotherapy and Rehabilitation, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Pelin Melda Yargıç
- Department of Sports Medicine, Ankara Medipol University, Ankara, Turkey
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13
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Kim S, Callahan EG, Malone ZC, Gilgallon TJ, Glaviano NR. Changes in Hip and Knee Strength Are Not Associated With Improved Clinical Outcomes After Rehabilitation in Individuals With Patellofemoral Pain: A Critically Appraised Topic. J Sport Rehabil 2024; 33:140-148. [PMID: 37931619 DOI: 10.1123/jsr.2023-0160] [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: 05/16/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 11/08/2023]
Abstract
CLINICAL SCENARIO Patellofemoral pain (PFP) is a widespread knee disorder encountered in clinical practice. Clinicians have often focused on strengthening hip and knee musculature to improve pain and disability, which are the ultimate clinical goals of PFP treatment. However, PFP literature has shown improvement in pain and disability without concurrent changes in lower-extremity strength after rehabilitation. Although some researchers have achieved a significant increase in strength after rehabilitation in PFP cohorts, there was no association with improved pain and disability. The inconsistent improvements in strength and the lack of association with clinical outcomes call for a critical appraisal of the available evidence to better understand the association between changes in hip and knee strength and improved clinical outcomes in individuals with PFP. CLINICAL QUESTION Are changes in hip and knee strength associated with improved pain and disability after rehabilitation in individuals with PFP? SUMMARY OF KEY FINDINGS Four studies met the inclusion criteria and were included in the appraisal. Following rehabilitation, one study achieved strength improvements in knee extension. One study achieved strength improvements in knee extension, but not in hip external rotation and hip abduction. Two studies did not achieve strength improvements in hip external rotation, hip abduction, hip extension, or knee extension. All included studies achieved improvements in pain or disability after rehabilitation. None of the studies found a significant association between changes in hip and knee strength (either improved or not) and improved pain and disability. CLINICAL BOTTOM LINE There is consistent evidence that changes in hip and knee strength are not associated with improved clinical outcomes after rehabilitation in adults with PFP. STRENGTH OF RECOMMENDATION Collectively, the body of evidence included is to answer the clinical question aligns with the strength of recommendation of B based on the Strength of Recommendation Taxonomy.
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Affiliation(s)
- Sungwan Kim
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
| | - Evyn G Callahan
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Zachary C Malone
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
| | - Timothy J Gilgallon
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
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14
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Hansford HJ, Cashin AG, Doyle J, Leake HB, McAuley JH, Jones MD. Barriers and Enablers to Using Intervention Reporting Guidelines in Sports and Exercise Medicine Trials: A Mixed-Methods Study. J Orthop Sports Phys Ther 2024; 54:142-152. [PMID: 37970804 DOI: 10.2519/jospt.2023.12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE: To identify barriers and facilitators for using intervention reporting guidelines (CERT and TIDieR) from authors of randomized controlled trials in sports and exercise medicine journals. DESIGN: Mixed-methods cross-sectional online survey. METHODS: We recruited authors of randomized controlled trials published from June 2, 2018, to June 2, 2022, in the 10 leading sports and exercise medicine journals. We invited authors of eligible trials to complete an online survey that included multiple-choice and Likert-scale questions, as well as open-ended free-text questions on the barriers and facilitators to using intervention reporting guidelines. We used descriptive analysis to summarize the quantitative data and a hybrid deductive-inductive thematic analysis to identify barriers and facilitators from the qualitative data. We conducted a subgroup analysis to explore differences in barriers and facilitators between early-mid career researchers and senior researchers. RESULTS: Eighty-four participants from 21 countries completed the survey (44 early-mid-career researchers, 40 senior researchers). We identified 8 themes relating to using intervention reporting guidelines. Themes classified as barriers related to publication constraints (word count limits), low awareness of intervention reporting guidelines, unclear benefits of the guidelines, and the increased burden imposed upon the researcher. Themes classified as facilitators related to journal requirements for guidelines use, the desire to accurately describe interventions, recommendations from other researchers, and reporting guideline use indicating "quality" of work. CONCLUSION: Barriers to using intervention reporting guidelines are largely modifiable and could be addressed by journals mandating their use, and educational initiatives. J Orthop Sports Phys Ther 2024;54(2):1-11. Epub 16 November 2023. doi:10.2519/jospt.2023.12110.
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Haghighat F, Rezaie M, Ebrahimi S, Shokuhian SM, Motealleh A, Salehi R, Parnianpour M. The Correlation between Intersegmental Coordination Variability and Frontal Plane Hip Kinematics during Running in Persons with Patellofemoral Pain. J Biomed Phys Eng 2024; 14:89-98. [PMID: 38357605 PMCID: PMC10862119 DOI: 10.31661/jbpe.v0i0.2101-1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/15/2021] [Indexed: 02/16/2024]
Abstract
Background Despite the existing evidence indicating altered hip kinematics as well as the studies showing altered movement coordination variability in persons with patellofemoral pain (PFP), there is no study investigating the correlation between hip joint kinematic and movement coordination variability in persons with patellofemoral pain (PFP). Objective This study aims to evaluate the correlation between peak hip adduction and variability of thigh frontal-shank transverse coordination during running in persons with PFP. Material and Methods In this cross-sectional correlational study, kinematic data were collected from 34 females (17 with and 17 without PFP) aged 18-35 years during treadmill running at preferred and fixed speeds, each for 30 s. The continuous relative phase method was used to calculate the coordination of thigh frontal-shank transverse. To calculate the deviation phase as the variability of intersegmental coordination, the standard deviation of the ensemble continuous relative phase curve points was averaged. The parameters of interest were peak hip adduction and coordination variability of thigh frontal-shank transverse. The Pearson Correlation Coefficient (r) was used to calculate the correlation between the variables. Results The Pearson correlation coefficient showed a significant negative correlation between the peak hip adduction angle and variability of thigh frontal- shank transverse during running at both fixed (r=-0.553, P<0.05) and preferred (r=-0.660, P<0.01) speeds in persons with PFP while the control group showed a small nonsignificant correlation (r<0.29, P>0.05). Conclusion The results indicated that greater adduction of the hip joint in persons with PFP during running is contributed to lesser variability of thigh frontal-shank transverse.
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Affiliation(s)
- Farzaneh Haghighat
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Rezaie
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Ebrahimi
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Motealleh
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Salehi
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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16
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Nunes GS, de Oliveira J, Iacob GS, Signori LU, Diel AP, Schreiner R, Solner MW. Effectiveness of Interventions Aimed at Changing Movement Patterns in People With Patellofemoral Pain: A Systematic Review With Network Meta-analysis. J Orthop Sports Phys Ther 2023; 53:748-760. [PMID: 37707784 DOI: 10.2519/jospt.2023.11956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE: To summarize the effectiveness of interventions for changing movement during weight-bearing functional tasks in people with patellofemoral pain (PFP). DESIGN: Systematic review with network meta-analysis (NMA). LITERATURE SEARCH: Medline, Embase, CINAHL, SPORTDiscus, and Cochrane Library were searched from inception up to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials involving people with PFP and nonsurgical, nonpharmacological interventions on task kinematics were included. DATA SYNTHESIS: NMA was conducted for frontal knee movement data, and pairwise meta-analysis was used to pool data when NMA was not possible. Reduced movements were those changes that indicated movements occurring with less amplitude. The GRADE approach was used to grade the certainty of the evidence. RESULTS: Thirty-seven trials were included (n = 1235 participants). Combining knee/hip exercises with internal feedback had the strongest effect on reducing frontal knee movements (standardized mean difference [SMD] from NMA = -2.66; GRADE: moderate evidence). On pairwise comparisons, the same combination of interventions reduced frontal hip movements (SMD = -0.47; GRADE: moderate evidence) and increased sagittal knee movements (SMD = 1.03; GRADE: moderate evidence), with no effects on sagittal hip movements (GRADE: very low evidence), compared to knee/hip exercises alone. There was no effect for single applications of braces on the frontal knee movement (GRADE: very low evidence) and taping on movements of the knee, hip, and ankle (GRADE: very low to low evidence) compared to no intervention. CONCLUSION: Knee/hip exercises combined with internal feedback techniques may change knee and hip movements in people with PFP. The combination of these interventions can reduce frontal knee and hip movements, and can increase sagittal knee movements. J Orthop Sports Phys Ther 2023;53(12):1-13. Epub 14 September 2023. doi:10.2519/jospt.2023.11956.
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Davis J, Doyle B, Ishii H, Jayanthi N. S.P.O.R.R.T.-A Comprehensive Approach to the Assessment and Non-Operative Management of Overuse Knee Conditions in Youth Athletes. Curr Rev Musculoskelet Med 2023; 16:627-638. [PMID: 37999828 PMCID: PMC10733244 DOI: 10.1007/s12178-023-09874-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW The evaluation of a young athlete with an overuse injury to the knee involves a comprehensive approach. There are a number of elements to consider including assessments of skeletal maturity (biologic maturation), workload (training load + competition load), sport specialization status, and biomechanics. The type of injury and treatment, as well as future prognosis, may be influenced by these and other factors. RECENT FINDINGS Calculating the percentage of predicted adult height (PPAH) is a valuable tool in assessing overuse injury patterns and diagnoses in youth athletes. Modifiable and non-modifiable overuse injury risk factors require monitoring from clinicians as young athletes mature and develop over time. Training and rehabilitation programs should be adapted to account for these. In this manuscript, we seek to introduce a novel, comprehensive approach: S.P.O.R.R.T. (Skeletal Maturity, Prior Injury Risk, One Sport Specialization, Rehabilitation, Return to Play, Training Recommendations) (Fig. 1). Overuse, non-traumatic injuries to the knee in youth athletes will be presented in a case-based and evidence-based model to provide a framework for a comprehensive approach to the assessment and treatment of youth athletes with overuse injuries.
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Affiliation(s)
- Jacob Davis
- Emory Sports Medicine Center, 6335 Hospital Parkway, Suite 302, Johns Creek, GA, 30097, USA
- Georgia Institute of Technology, Sports Medicine, Atlanta, GA, USA
| | - Bridget Doyle
- Emory Sports Medicine Center, 6335 Hospital Parkway, Suite 302, Johns Creek, GA, 30097, USA
| | - Haruki Ishii
- Emory Sports Medicine Center, 6335 Hospital Parkway, Suite 302, Johns Creek, GA, 30097, USA
| | - Neeru Jayanthi
- Emory Sports Medicine Center, 6335 Hospital Parkway, Suite 302, Johns Creek, GA, 30097, USA.
- Emory Sports Performance & Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, USA.
- Emory University School of Medicine, Department of Orthopedics and Family Medicine, Atlanta, GA, USA.
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Abstract
Importance Approximately 5% of all primary care visits in adults are related to knee pain. Osteoarthritis (OA), patellofemoral pain, and meniscal tears are among the most common causes of knee pain. Observations Knee OA, affecting an estimated 654 million people worldwide, is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness (95% sensitivity; 69% specificity). Patellofemoral pain typically affects people younger than 40 years who are physically active and has a lifetime prevalence of approximately 25%. The presence of anterior knee pain during a squat is approximately 91% sensitive and 50% specific for patellofemoral pain. Meniscal tears affect an estimated 12% of the adult population and can occur following acute trauma (eg, twisting injury) in people younger than 40 years. Alternatively, a meniscal tear may be a degenerative condition present in patients with knee OA who are aged 40 years or older. The McMurray test, consisting of concurrent knee rotation (internal or external to test lateral or medial meniscus, respectively) and extension (61% sensitivity; 84% specificity), and joint line tenderness (83% sensitivity; 83% specificity) assist diagnosis of meniscal tears. Radiographic imaging of all patients with possible knee OA is not recommended. First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition. Surgical referral for knee joint replacement can be considered for patients with end-stage OA (ie, no or minimal joint space with inability to cope with pain) after using all appropriate conservative options. For patellofemoral pain, hip and knee strengthening exercises in combination with foot orthoses or patellar taping are recommended, with no indication for surgery. Conservative management (exercise therapy for 4-6 weeks) is also appropriate for most meniscal tears. For severe traumatic (eg, bucket-handle) tears, consisting of displaced meniscal tissue, surgery is likely required. For degenerative meniscal tears, exercise therapy is first-line treatment; surgery is not indicated even in the presence of mechanical symptoms (eg, locking, catching). Conclusions and Relevance Knee OA, patellofemoral pain, and meniscal tears are common causes of knee pain, can be diagnosed clinically, and can be associated with significant disability. First-line treatment for each condition consists of conservative management, with a focus on exercise, education, and self-management.
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Affiliation(s)
- Vicky Duong
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Win Min Oo
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Australian IOC Research Centre, La Trobe University, Melbourne, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Rheumatology Department, Royal North Shore Hospital, St Leonards, Australia
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Jaffri A, Baellow A. Poor Mental Health Indicators in Individuals With Patellofemoral Pain. J Athl Train 2023; 58:849-854. [PMID: 37965988 PMCID: PMC11215708 DOI: 10.4085/1062-6050-0584.22] [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] [Indexed: 11/16/2023]
Abstract
CONTEXT Patellofemoral pain (PFP) is a common source of knee pain in active individuals, accounting for a large number of knee injuries examined in sports medicine clinics. As a chronic condition, PFP can affect mental health. However, this effect has not yet been studied in individuals with PFP. OBJECTIVE To determine how subjective physical and mental health measures in individuals with PFP differed from those measures in pain-free individuals. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Volunteers for the study were 30 people with PFP (19 women, 11 men; age = 20.23 ± 3.32 years, height = 166.69 ± 6.41 cm, mass = 69.55 ± 13.15 kg) and 30 matched pain-free individuals (19 women, 11 men; age = 20.33 ± 3.37 years, height = 169.31 ± 9.30 cm, mass = 64.02 ± 11.00 kg). MAIN OUTCOME MEASURE(S) Current and worst pain levels in the past 24 hours were determined using a visual analog scale (VAS). The Anterior Knee Pain Scale, Fear Avoidance Belief Questionnaire, and Lower Extremity Functional Scale were administered. Physical and mental health measures were obtained using a modified 12-item Short Form Health Survey. Scores for 2 subscales on the modified Short Form-12 were weighted and calculated: physical component and mental component.Independent t tests were calculated to compare variables between groups. Coefficient correlations were used to measure the associations between the variables. RESULTS Individuals with PFP reported lower levels of physical (pain free: 56.13 ± 1.63, PFP: 50.54 ± 7.10, P < .001) and mental (pain-free: 53.32 ± 4.71, PFP: 48.64 ± 10.53, P = .03) health. In the PFP group, we found moderate negative correlations between the VAS score for current pain and mental health (r = -0.52, P < .01) and between the VAS score for worst pain in the past 24 hours and mental health (r = -0.46, P = .01) and between activity limitations in individuals with PFP and fear avoidance beliefs (r = -0.61, P < .01). CONCLUSIONS Our results should encourage clinicians, especially musculoskeletal rehabilitation professionals, to acknowledge the importance of a whole-person approach when treating or planning rehabilitation programs for individuals with PFP.
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Affiliation(s)
- Abbis Jaffri
- Department of Physical Therapy, Creighton University, Omaha, NE
| | - Andrea Baellow
- Department of Kinesiology, University of Virginia, Charlottesville
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20
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Glaviano NR, Kim S. Lower extremity muscle volume in females with patellofemoral pain and its relationships to hip and knee torque: A cross-sectional study. Phys Ther Sport 2023; 63:50-57. [PMID: 37506654 DOI: 10.1016/j.ptsp.2023.07.003] [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: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES Compare lower extremity muscle volume in females with patellofemoral pain (PFP) to a cohort of pain-free females and investigate the relationship between thigh and hip muscle volume and torque. DESIGN Cross-sectional. PARTICIPANTS Twenty-one females, 13 with PFP and 8 pain-free controls. MAIN OUTCOME MEASURES We quantified normalized lower extremity muscle volume (cm3/kg*m) via magnetic resonance imaging and isometric hip and thigh torque (Nm/kg) via a multimodal dynamometer. RESULTS Versus pain-free individuals, females with PFP had smaller muscle volume of the anterior hip (P < 0.019; d = 0.97-2.42), deep external rotators (P < 0.006; d = 1.0-3.93), hamstrings (P < 0.009; d = 1.09-2.12), rectus femoris (P < 0.001; d = 1.79), and vastus intermedius (P < 0.001; d = 1.88). There was no difference in muscle volume of the gluteus maximus (P = 0.311; d = 0.22), gluteus medius (P = 0.087; d = 0.87), vastus lateralis (P = 0.22; d = 0.39), and vastus medialis (P = 0.47; d = 0.04). Gluteus maximus volume was moderately correlated to hip abduction torque (r = 0.60; P = 0.03). Vasti muscles and semitendinosus volume were moderately correlated to knee extension (r = 0.57-0.69; P < 0.05) and flexion (r = 0.66; P = 0.01) torque, respectively. CONCLUSION Females with PFP present with lesser thigh and hip muscle volumes, with variability in volumetric profiles across participants. Lower extremity knee extension and hip abduction strength are moderately associated with the vasti and gluteus maximus muscle volume, respectively.
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Affiliation(s)
- Neal R Glaviano
- Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA; Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA.
| | - Sungwan Kim
- Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA; Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
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21
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Maggioni DM, Giorgino R, Messina C, Albano D, Peretti GM, Mangiavini L. Framing Patellar Instability: From Diagnosis to the Treatment of the First Episode. J Pers Med 2023; 13:1225. [PMID: 37623475 PMCID: PMC10456090 DOI: 10.3390/jpm13081225] [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: 06/27/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
The patellofemoral joint (PFJ) is a complex articulation between the patella and the femur which is involved in the extensor mechanism of the knee. Patellofemoral disorders can be classified into objective patellar instability, potential patellar instability, and patellofemoral pain syndrome. Anatomical factors such as trochlear dysplasia, patella alta, and the tibial tuberosity-trochlear groove (TT-TG) distance contribute to instability. Patellofemoral instability can result in various types of dislocations, and the frequency of dislocation can be categorized as recurrent, habitual, or permanent. Primary patellar dislocation requires diagnostic framing, including physical examination and imaging. Magnetic resonance imaging (MRI) is essential for assessing the extent of damage, such as bone bruises, osteochondral fractures, and medial patellofemoral ligament (MPFL) rupture. Treatment options for primary dislocation include urgent surgery for osteochondral fragments or conservative treatment for cases without lesions. Follow-up after treatment involves imaging screening and assessing principal and secondary factors of instability. Detecting and addressing these factors is crucial for preventing recurrent dislocations and optimizing patient outcomes.
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Affiliation(s)
- Davide Maria Maggioni
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy;
| | - Riccardo Giorgino
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy;
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Via della Commenda 10, 20122 Milan, Italy
| | - Giuseppe Michele Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy; (C.M.); (D.A.); (G.M.P.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
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22
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Arslan T, Gültekin MZ. Is Cam Pincer Deformity a Predisposing Factor for Patellofemoral Pain Syndrome? Indian J Orthop 2023; 57:1139-1146. [PMID: 37383997 PMCID: PMC10293500 DOI: 10.1007/s43465-023-00902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/27/2023] [Indexed: 06/30/2023]
Abstract
Purpose This study aimed to investigate whether cam and pincer deformities (CPDs) are a risk factor for patellofemoral pain syndrome (PFPS) in women. In addition, it sought to compare the hip joint range of motion and the hip muscle strength of extremities with and without CPDs and PFPS. Materials and Methods A total of 82 hips of 41 women with PFPS were included in the study. The mean age of participants was 32.07 ± 7.13 years. The presence of CPDs was detected on digital anterior pelvis radiographs. Pain was evaluated using the visual analog scale, and function using the Kujala scoring system. Maximum isometric muscle strength around the hips was measured using a hand-held dynamometer. Hip joint range of movement angles were measured in all three planes using a universal goniometer. Results CPDs were found to predict PFPS in women (p = 0.011, p = 0.048). The rate of CPDs was significantly higher in extremities with PFPS compared to those without PFPS (p = 0.007). The Kujala scores of extremities with cam deformity were significantly lower than those of extremities without pincer deformity (p = 0.043). The internal/external muscle strength ratio was greater, and the abduction/adduction muscle strength ratio was lower in extremities with cam and PFPS than in those without (p = 0.040, p = 0.049). The external rotation and abduction range of movement angles were significantly smaller in extremities with pincer and PFPS compared to those without (p = 0.043, p = 0.035). Conclusion CPDs may be a structural predisposing factor in the development of PFPS in women. CPDs assessment when evaluating predisposing factors for PFPS may present an opportunity for the management of PFPS.
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Affiliation(s)
- Tuğba Arslan
- Department of Occupational Therapy, Faculty of Health Science, Karatekin University, Çankırı, Turkey
- Aksu Mah. Sıhhıye Sok. No:11 18200, Çankırı, Turkey
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23
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Doyle EW, Doyle TLA, Bonacci J, Beach AJ, Fuller JT. Cumulative patellofemoral force and stress are lower during faster running compared to slower running in recreational runners. Sports Biomech 2023:1-13. [PMID: 37364918 DOI: 10.1080/14763141.2023.2226111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Management strategies for patellofemoral pain often involve modifying running distance or speed. However, the optimal modification strategy to manage patellofemoral joint (PFJ) force and stress accumulated during running warrants further investigation. This study investigated the effect of running speed on peak and cumulative PFJ force and stress in recreational runners. Twenty recreational runners ran on an instrumented treadmill at four speeds (2.5-4.2 m/s). A musculoskeletal model derived peak and cumulative (per 1 km of continuous running) PFJ force and stress for each speed. Cumulative PFJ force and stress decreased with faster speeds (9.3-33.6% reduction for 3.1-4.2 m/s vs. 2.5 m/s). Peak PFJ force and stress significantly increased with faster speeds (9.3-35.6% increase for 3.1-4.2 m/s vs. 2.5 m/s). The largest cumulative PFJ kinetics reductions occurred when speeds increased from 2.5 to 3.1 m/s (13.7-14.2%). Running at faster speeds increases the magnitude of peak PFJ kinetics but conversely results in less accumulated force over a set distance. Selecting moderate running speeds (~3.1 m/s) with reduced training duration or an interval-based approach may be more effective for managing cumulative PFJ kinetics compared to running at slow speeds.
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Affiliation(s)
- Eoin W Doyle
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
| | - Tim L A Doyle
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Aaron J Beach
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joel T Fuller
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
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Kim S, Roh Y, Glaviano NR, Park J. Quadriceps Neuromuscular Function During and After Exercise-Induced Fatigue in Patients With Patellofemoral Pain. J Athl Train 2023; 58:554-562. [PMID: 36395370 PMCID: PMC10496447 DOI: 10.4085/1062-6050-0348.22] [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] [Indexed: 09/03/2023]
Abstract
CONTEXT Exercise-induced fatigue reduces muscle force production and motoneuron pool excitability. However, it is unclear if patients with patellofemoral pain (PFP) experience further loss in quadriceps neuromuscular function due to fatigue during exercise and postexercise. OBJECTIVE To observe how quadriceps maximal strength, activation, and force-generating capacity change during and after repetitive bouts of isokinetic knee-extension exercise in patients with PFP. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-two patients with PFP (visual analog scale mean pain severity = 4.2 of 10 cm, mean symptom duration = 38.6 months) and 19 healthy control individuals matched on age and body mass index. MAIN OUTCOME MEASURE(S) Quadriceps peak torque (PT), central activation ratio (CAR), and rate of torque development (RTD) were assessed at baseline and immediately after every 5 sets of knee-extension exercise (times 1-5). Participants continued knee-extension exercises until the baseline quadriceps PT dropped below 50% for 3 consecutive contractions. RESULTS No group-by-time interaction was observed for quadriceps PT (F5,195 = 1.03, P = .40). However, group-by-time interactions were detected for quadriceps CAR (F5,195 = 2.63, P= .03) and RTD (F5,195 = 3.85, P = .002). Quadriceps CAR (-3.6%, P = .04, Cohen d = 0.53) and RTD (-18.9%, P = .0008, Cohen d = 1.02) decreased between baseline and time 1 in patients with PFP but not in their healthy counterparts (CAR -1.9%, P = .86; RTD -9.8%, P = .22). Quadriceps RTD also decreased between times 4 and 5 in patients with PFP (-24.9%, P = .002, Cohen d = 0.89) but not in the healthy group (-0.9%, P = .99). CONCLUSIONS Patients with PFP appeared to experience an additional reduction in quadriceps activation, force-generating capacity, or both during the early and late stages of exercise compared with healthy individuals. Clinicians should be aware of such possible acute changes during exercise and postexercise and use fatigue-resistant rehabilitation programs for patients with PFP.
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Affiliation(s)
| | | | | | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Korea
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25
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Lack SD, Bartholomew C, North T, Miller SC, Neal BS. The effects of a two-week neuromuscular intervention on biopsychosocial variables in people with patellofemoral pain: an observational study. Front Sports Act Living 2023; 5:1087061. [PMID: 37255732 PMCID: PMC10225691 DOI: 10.3389/fspor.2023.1087061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Patellofemoral pain (PFP) is common and predominately affects active populations. Altered biomechanics and psychosocial variables have been reported in people with PFP, but the effects of neuromuscular exercise on these variables is unknown. We aimed to investigate changes in biopsychosocial measures following a two-week neuromuscular intervention in people with PFP. Materials and Methods We measured pain (visual analogue scale), function (Kujala), activity level (Tegner), psychological well-being (Orebro), lower-limb isometric strength (handheld dynamometry), three-dimensional (3D) lower limb kinematics, and surface electromyography (sEMG), in people with PFP. 3D lower-limb kinematics and sEMG were synchronously sampled during step-up, step-down, and overground running. All measures were repeated after participants had completed a two-week neuromuscular intervention consisting of three exercises completed once per day, five days per week. Results 18 participants completed pre/post testing (60% females, mean age 30.6 years ±7.0, height 173.4cm ±10.4, mass 70.2kg ±12.4, symptom duration 39.0 months ±58.8), with three of 21 participants lost to follow-up. Across all clinical measures (muscle onsets, muscle activation and kinematics), the 95% bootstrapped confidence intervals (CI) of the mean difference contained the null hypothesis following the two-week neuromuscular intervention, indicating no significant differences. Conclusion A two-week neuromuscular intervention did not change biomechanical or psychosocial measures in people with PFP. Interventions with a longer duration or greater load magnitude are required to fully evaluate the biopsychosocial mechanisms of effect for exercise in people with PFP.
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Affiliation(s)
- Simon David Lack
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
- Pure Sports Medicine, Point West Building, London, United Kingdom
| | - Clare Bartholomew
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Thomas North
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Stuart Charles Miller
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Bradley Stephen Neal
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, Essex, United Kingdom
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Priore LBD, Perez VO, Briani RV, Farinelli LALB, da Silva JDCP, Martins OMG, Lopes FA, Amorim AB, Pappas E, de Azevedo FM. Effects of an online program including mindfulness, exercise therapy and patient education compared to online exercise therapy and patient education for people with Patellofemoral Pain: protocol for a randomized clinical trial. BMC Musculoskelet Disord 2023; 24:372. [PMID: 37170262 PMCID: PMC10173555 DOI: 10.1186/s12891-023-06491-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: 12/07/2022] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common knee disorder that causes persistent pain, lower self-reported function and quality of life. People with PFP also present with altered psychological factors, which are associated with higher levels of pain and dysfunction. Mindfulness-based interventions (MBI) generally consist of meditative practices developed to provide a holistic approach to chronic conditions. However, the effects of MBI on clinical and psychological outcomes for people with PFP remains understudied. METHODS This assessor-blinded, parallel, two-arm randomized clinical trial aims to investigate the effects of adding an 8-week online MBI program to exercise therapy and patient education on clinical and psychological factors for people with PFP. We also aim to investigate whether psychological factors mediate changes in pain and function. Sixty-two participants with PFP will be recruited and randomized into one of two treatment groups (Mindfulness or Control group). Both groups will receive an 8-week intervention involving exercise therapy and education delivered through an online platform. The Mindfulness group will additionally receive a MBI component including formal and informal practices. Outcomes will be assessed online at baseline, intervention endpoint (follow-up 1) and 12 months after intervention completion (follow-up 2). Comparisons between groups will be performed at all time points with linear mixed models. A mediation analysis will be performed using a 3-variable framework. DISCUSSION Exercise therapy and patient education are considered the "best management" options for PFP. However, unsatisfactory long-term prognosis remains an issue. It is known that people with PFP present with altered psychological factors, which should be considered during the evaluation and treatment of people with PFP. Adding a MBI to the current best treatment for PFP may improve short and long-term effects by addressing the underlying psychological factors. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-4yhbqwk, registered in April 6, 2021.
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Affiliation(s)
- Liliam Barbuglio Del Priore
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil.
| | - Vitoria Ozores Perez
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
| | - Ronaldo Valdir Briani
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
| | - Lucca Andre Liporoni Bego Farinelli
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
| | - Júlia de Cássia Pinto da Silva
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
| | - Odisséia Marli Gimenes Martins
- Brazilian Center for Mindfulness and Health Promotion - Mente Aberta, Federal University of Sao Paulo (Unifesp), Sao Paulo, Brazil
| | - Fábio Arruda Lopes
- Department of Computer Engineering, Virtual University of Sao Paulo State (UNIVESP), Dracena, Brazil
| | - Anita Barros Amorim
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Evangelos Pappas
- School of Medicine and Illawarra Medical and Health Research Institute, University of Wollongong, Wollongong, Australia
| | - Fábio Mícolis de Azevedo
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Simonsen St, Presidente Prudente, SP, 19060-900, Brazil
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Pacini P, Martino M, Giuliani L, Santilli G, Agostini F, Del Gaudio G, Bernetti A, Mangone M, Paoloni M, Toscano M, De Vito C, Ottonello C, Santilli V, Cantisani V. Patello-Femoral Pain Syndrome: Magnetic Resonance Imaging versus Ultrasound. Diagnostics (Basel) 2023; 13:diagnostics13081496. [PMID: 37189597 DOI: 10.3390/diagnostics13081496] [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: 03/14/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) and Ultrasound (US) in combination with clinical data could contribute to the diagnosis, staging and follow-up of Patello-Femoral Syndrome (PFS), which often overlaps with other pathologies of the knee. PURPOSE OF THE STUDY To evaluate the diagnostic role of MRI and US findings associated with PFS and define the range values of instrumental measurements obtained in pathological cases and healthy controls, the performance of the two methods in comparison, and the correlation with clinical data. MATERIALS AND METHODS 100 subjects were examined: 60 patients with a high suspicion of PFS at the clinical evaluation and 40 healthy controls. All measurements obtained by MRI and US examination were correlated with clinical data. A descriptive analysis of all measurements was stratified for pathological cases and healthy controls. A Student's t-test for continuous variables was used to compare patients to controls and US to MRI. Logistic regression analysis was applied to test the correlation between MRI and US measurements with clinical data. RESULTS Statistical descriptive analysis determined the MRI and US range values of medial patello-femoral distance and the thickness of retinacles and cartilages in pathological cases and healthy controls. In pathological cases, the retinacle results of both increased; the medial appeared to be slightly more increased than the lateral. Furthermore, in some cases, the thickness of the cartilage decreased in both techniques; the medial cartilage was more thinned than the lateral. According to logistic regression analyses, the best diagnostic parameter was the medial patello-femoral distance due to the overlapping results of the US and MRI. Furthermore, all clinical data obtained by different tests showed a good correlation with patello-femoral distance. In particular, the correlation between medial patello-femoral distance and the VAS score is direct and equal to 97-99%, which is statistically significant (p < 0.001), and the correlation with the KOOS score is inverse and equal to 96-98%, which is statistically significant. CONCLUSIONS MRI and Ultrasound examination in combination with clinical data demonstrated high-value results in the diagnosis of PFS.
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Affiliation(s)
- Patrizia Pacini
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Milvia Martino
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Luca Giuliani
- San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Vetoio Stree, 67100 L'Aquila, Italy
| | - Gabriele Santilli
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Francesco Agostini
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Giovanni Del Gaudio
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Andrea Bernetti
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Massimiliano Mangone
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Marco Paoloni
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Martina Toscano
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Corrado De Vito
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Carlo Ottonello
- Fisiocard Medical Centre, Via Francesco Tovaglieri 17, 00155 Rome, Italy
| | - Valter Santilli
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Vito Cantisani
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
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Young JL, Sell TC, Boeth R, Foster K, Greenlee TA, Rhon DI. What is the Incidence of Subsequent Adjacent Joint Injury After Patellofemoral Pain? Clin Rehabil 2023:2692155231157177. [PMID: 36793225 DOI: 10.1177/02692155231157177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To investigate the incidence of subsequent lumbar spine, hip, and ankle-foot injuries after a diagnosis of patellofemoral pain. DESIGN Retrospective cohort study. SETTING Military Health System. PARTICIPANTS Individuals (n = 92,319) ages 17-60 diagnosed with patellofemoral pain between 2010-2011. INTERVENTIONS Therapeutic exercise. MAIN OUTCOME MEASURES Frequency of adjacent joint injuries in the 2-year period after initial patellofemoral pain injury, and hazard ratios (HR) with 95% confidence interval (CI) and Kaplan-Meier survival curves for risk of adjacent joint injury based on receiving therapeutic exercise for the initial injury. RESULTS After initial patellofemoral pain diagnosis, 42,983 (46.6%) individuals sought care for an adjacent joint injury. Of these, 19,587 (21.2%) were subsequently diagnosed with a lumbar injury, 2837 (3.1%) a hip injury, and 10,166 (11.0%) an ankle-foot injury. One in five (19.5%; n = 17,966) received therapeutic exercise which reduced the risk of having a subsequent lumbar (HR = 0.78, 95% CI 0.76-0.81), hip (HR = 0.93, 95% CI 0.87-0.98) or ankle-foot (HR = 0.86, 95% CI 0.83-0.90) injury. CONCLUSION The results suggest that a high number of individuals with patellofemoral pain will sustain an adjacent joint injury within 2 years although causal relationships cannot be determined. Receiving therapeutic exercise for the initial knee injury reduced the risk of sustaining an adjacent joint injury. This study helps provide normative data for subsequent injury rates in this population and guide development of future studies designed to understand causal factors.
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Affiliation(s)
- Jodi L Young
- 15638Physical Therapy Department, Bellin College, Green Bay, WI, USA.,104849The Geneva Foundation, Tacoma, WA, USA
| | - Timothy C Sell
- 2351Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Riley Boeth
- 104849The Geneva Foundation, Tacoma, WA, USA
| | - Kaitlyn Foster
- 104849The Geneva Foundation, Tacoma, WA, USA.,Department of Rehabilitation Medicine, 3998Brooke Army Medical Center, San Antonio, TX, USA
| | - Tina A Greenlee
- 104849The Geneva Foundation, Tacoma, WA, USA.,Department of Rehabilitation Medicine, 3998Brooke Army Medical Center, San Antonio, TX, USA
| | - Daniel I Rhon
- 104849The Geneva Foundation, Tacoma, WA, USA.,Department of Rehabilitation Medicine, 3998Brooke Army Medical Center, San Antonio, TX, USA.,Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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E T, Wang C, Cui Y, Nai R, Zhang Y, Zhang X, Wang X. Automatic diagnosis and grading of patellofemoral osteoarthritis from the axial radiographic view: a deep learning-based approach. Acta Radiol 2023; 64:658-665. [PMID: 35410487 DOI: 10.1177/02841851221092164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patellofemoral osteoarthritis (PFOA) has a high prevalence and is assessed on axial radiography of the patellofemoral joint (PFJ). A deep learning (DL)-based approach could help radiologists automatically diagnose and grade PFOA via interpreting axial radiographs. PURPOSE To develop and assess the performance of a DL-based approach for diagnosing and grading PFOA on axial radiographs. MATERIAL AND METHODS A total of 1280 (dataset 1) axial radiographs were retrospectively collected and utilized to develop the high-resolution network (HRNet)-based classification models. The ground truth was the interpretation from two experienced radiologists in consensus according to the K-L grading system. A binary-class model was trained to diagnose the presence (K-L 2∼4) or absence (K-L 0∼1) of PFOA. A multi-class model was used to grade the stage of PFOA, i.e. from K-L 0 to K-L 4. Model performances were evaluated using the receiver operating characteristics (ROC), confusion matrix, and the corresponding evaluation metrics (positive predictive value [PPV], negative predictive value [NPV], F1 score, sensitivity, specificity, accuracy) of the internal test set (n = 129) from dataset 1 and an external validation set (dataset 2, n = 187). RESULTS For the binary-class model, the area under the curve (AUC) was 0.91 in the internal test set and 0.90 in the external validation set. For grading PFOA, moderate to severe stage of PFOA exhibited a good performance in these two datasets (AUC = 0.91-0.98, PPV = 0.69-0.90, NPV = 0.92-0.99, F1 score = 0.72-0.87, sensitivity = 0.75-0.87, specificity = 0.90-0.99, accuracy = 0.87-0.98). CONCLUSION The HRNet-based approach performed well in diagnosing and grading radiographic PFOA, especially for the moderate to severe cases.
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Affiliation(s)
- Tuya E
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Cen Wang
- Department of Radiology, Beijing Nuclear Industry Hospital, Beijing, PR China
| | - Yingpu Cui
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Rile Nai
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Yaofeng Zhang
- Beijing Smart-imaging Technology Co.Ltd, Beijing, PR China
| | - Xiaodong Zhang
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Xiaoying Wang
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
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30
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Glaviano NR, Mangum LC, Bazett-Jones DM, DiStefano LJ, Toland MD, Boling M. Strength Training Rehabilitation Incorporating Power Exercises (STRIPE) for individuals with patellofemoral pain: a randomised controlled trial protocol. BMJ Open Sport Exerc Med 2023; 9:e001482. [PMID: 36684710 PMCID: PMC9853263 DOI: 10.1136/bmjsem-2022-001482] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/19/2023] Open
Abstract
Patellofemoral pain (PFP) is a chronic condition that presents with patellar pain during various daily and recreational activities. Individuals with PFP have a wide range of impairments that result in long-term disability and reduced quality of life. Current interventions target hip muscle weakness with strength-based exercises, but recurrence rates are as high as 90%. A single feasibility study demonstrated success with power-based exercises; however, there is limited evidence evaluating pain or self-reported function in larger cohorts, and no study has assessed recurrence rates. This protocol details a study evaluating a strength-based rehabilitation programme compared with a strength-based programme incorporating power-based exercises in individuals with PFP. This single-blinded randomised controlled trial will evaluate 88 participants with PFP, aged 18-40 years old. Participants will be recruited from three universities, the surrounding community and sports medicine clinics. Participants will receive three telemedicine rehabilitation sessions a week for 6 weeks. The rehabilitation programme will consist of either strength-based exercises or a combination of power and strength-based exercises. Pain, subjective function and recurrence rates will be assessed at baseline, immediately after the intervention and at four follow-up time points: 6-month, 12-month, 18-month and 24-month postintervention. We will also assess neuromuscular function of the hips and global rating of change at each postintervention time point. Trial registration number NCT05403944.
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Affiliation(s)
- Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - L Colby Mangum
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, USA
| | - David M Bazett-Jones
- Department of Exercise & Rehabilitation Sciences, The University of Toledo, Toledo, Ohio, USA
| | - Lindsay J DiStefano
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Michael D Toland
- The Herb Innovation Center, Judith Herb College of Education, University of Toledo, Toledo, Ohio, USA
| | - Michelle Boling
- Department of Clinical & Applied Movement Sciences, University of North Florida, Jacksonville, Florida, USA
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Seyyed Hossein H, Sara A, Hasan D, Navid K. The effect of three types of exercises programs on the patella location in athletes with patellofemoral pain. Knee 2023; 41:97-105. [PMID: 36642037 DOI: 10.1016/j.knee.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/07/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to compare the effect of exercises focusing on the proximal and distal joints to knee and knee local exercises on the Patellar location in athletes with patellofemoral pain (PFP). METHODS A randomized controlled, single-blinded trial was conducted. Thirty-five athletes with PFP were randomly divided into three groups; proximal (12), distal (11) and local (12). Q Angle was measured with goniometer, tilt and congruence angle were measured with digital radiology before and after the exercise programs. The exercises were performed three sessions of 70 min per week, for 8 weeks. Data were analyzed by mixed analysis of variance, post hoc test and dependent t-test. RESULTS In the pre-intervention, no significant difference was observed between the groups (P > 0.05). But in the post-intervention, Q angle, tilt angle, congruence angle and knee pain in the proximal group were significantly less than the distal and local groups (P < 0.01); while there were no significant differences between the distal and local groups (P > 0.05). Also, in the proximal group, there were significant differences between pre-intervention and post intervention in Q angle, tilt angle and congruence angle (P = 0.001), but no significant differences were observed in the distal and local groups (P > 0.05). Knee pain in all three groups showed significant differences between pre-intervention and post-intervention (P < 0.01). CONCLUSIONS The findings of the present study indicated further improvement in patellar location and knee pain in the proximal group. Accordingly, proximal group exercises can improve the pain and performance of athletes with PFP by patellar relocation to the normal position.
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Affiliation(s)
- Hosseini Seyyed Hossein
- Department of Sports Biomechanics, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
| | - Asadi Sara
- Department of Sports Injuries & Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
| | - Daneshmandi Hasan
- Department of Sports Injuries & Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
| | - Kalani Navid
- Department of Sports Injuries & Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
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Arslan T, Gültekin MZ. The effect of a supervised online group exercise program on symptoms associated with patellofemoral pain syndrome in women. Technol Health Care 2023; 31:771-782. [PMID: 36442169 DOI: 10.3233/thc-220533] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is one of the musculoskeletal system pathologies frequently encountered especially in women. OBJECTIVE The aim of the current study was to compare the efficacy of an online exercise program with a home exercise program including the same exercises, and a control group planned for females with PFPS. METHODS The study included 60 females with PFPS aged 33.17 ± 6.84. Participants were randomly divided into 3 groups. One of the groups was given a 6-week home program consisting of evidence-based exercises. Exercises consisting of the same exercises were supervised online to another group. The third group did not receive any intervention. Pain, knee joint range of motion, muscle strength in flexion and extension and hip posterolateral muscle group, patellofemoral joint functionality, quality of life, recurrence of injury and fear of movement were measured at preintervention and postintervention. RESULTS Participation in the online supervised exercise group was seen to result in a greater decrease in pain during activity and kinesiophobia, and a greater increase in the quality of life mental health sub-dimension compared to the home exercise group. CONCLUSION Online supervised exercise groups could be an alternative telerehabilitation method for exercise programs established for women with PFPS.
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Affiliation(s)
- Tuğba Arslan
- Faculty of Health Sciences, Karatekin University, Çankırı, Turkey
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33
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Hassan KA, Youssef RSEE, Mahmoud NF, Eltagy H, El-Desouky MA. The relationship between ankle dorsiflexion range of motion, frontal plane projection angle, and patellofemoral pain syndrome. Foot Ankle Surg 2022; 28:1427-1432. [PMID: 35989174 DOI: 10.1016/j.fas.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/05/2022] [Accepted: 08/07/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle range of motion abnormalities have been often linked with alteration in knee kinematics leading to the development of patellofemoral pain syndrome (PFPS). Literature exploring the relationship between ankle dorsiflexion range of motion (DF ROM) and knee kinematics during functional tasks is scanty. This study aims to assess the relation between ankle DF ROM and frontal plane projection angle (FPPA), one of the knee kinematic variables, in individuals with and without PFPS during a step-down test. METHODS This is a case-control study in which seventy PFPS patients and other 70 asymptomatic control subjects had their ankle DF ROM measured using an inclinometer with the knee flexed and extended. Their FPPA angles were measured using Kinovea software while doing the step-down test. RESULTS When the two groups were compared, ankle DF ROM measured with the knee flexed was higher in the control group (33.15 ± 4.96) than in the PFPS group (30.20 ± 6.93) (p = 0.03). In both the PFPS group and the control group, the correlation between FPPA and ankle DF ROM with the knee flexed was statistically insignificant (p = 0.075 and 0.323 respectively). CONCLUSION Decreased ankle DF ROM can be one of the contributing factors to the development of PFPS in the context of greater dynamic knee valgus.
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Affiliation(s)
- Karima Abdelaty Hassan
- Department of Musculoskeletal Disorders & its Surgery, Faculty of Physical Therapy, Cairo University, Egypt.
| | - Rana Seif El-Eslam Youssef
- Department of Musculoskeletal Disorders & its Surgery, Faculty of Physical Therapy, Cairo University, Egypt.
| | - Nesreen Fawzy Mahmoud
- Department of Musculoskeletal Disorders & its Surgery, Faculty of Physical Therapy, Cairo University, Egypt.
| | - Hassan Eltagy
- Orthopedic Surgery and Traumatology Department, Faculty of Medicine, Cairo University, Egypt.
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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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35
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Alexander JLN, Culvenor AG, Johnston RRT, Ezzat AM, Barton CJ. Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials. Br J Sports Med 2022; 56:1307-1319. [PMID: 36150753 DOI: 10.1136/bjsports-2022-105553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of interventions to prevent and manage knee injuries in runners. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus up to May 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials (RCTs) with a primary aim of evaluating the effectiveness of intervention(s) to prevent or manage running-related knee injury. RESULTS Thirty RCTs (18 prevention, 12 management) analysed multiple interventions in novice and recreational running populations. Low-certainty evidence (one trial, 320 participants) indicated that running technique retraining (to land softer) reduced the risk of knee injury compared with control treadmill running (risk ratio (RR) 0.32, 95% CI 0.16 to 0.63). Very low-certainty to low-certainty evidence from 17 other prevention trials (participant range: 24 -3287) indicated that various footwear options, multicomponent exercise therapy, graduated running programmes and online and in person injury prevention education programmes did not influence knee injury risk (RR range: 0.55-1.06). In runners with patellofemoral pain, very low-certainty to low-certainty evidence indicated that running technique retraining strategies, medial-wedged foot orthoses, multicomponent exercise therapy and osteopathic manipulation can reduce knee pain in the short-term (standardised mean difference range: -4.96 to -0.90). CONCLUSION There is low-certainty evidence that running technique retraining to land softer may reduce knee injury risk by two-thirds. Very low-certainty to low-certainty evidence suggests that running-related patellofemoral pain may be effectively managed through a variety of active (eg, running technique retraining, multicomponent exercise therapy) and passive interventions (eg, foot orthoses, osteopathic manipulation). PROSPERO REGISTRATION NUMBER CRD42020150630.
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Affiliation(s)
- James L N Alexander
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Evado Studios, Nelson Bay, New South Wales, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Richard R T Johnston
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia .,Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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36
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Wu CC, Xiong HY, Zheng JJ, Wang XQ. Dance movement therapy for neurodegenerative diseases: A systematic review. Front Aging Neurosci 2022; 14:975711. [PMID: 36004000 PMCID: PMC9394857 DOI: 10.3389/fnagi.2022.975711] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe proportion of the world's elderly population continues to rise, and the treatment and improvement of neurodegenerative diseases have become issue of public health importance as people live longer and many countries have aging populations. This systematic review aims to discuss the effects of dance movement therapy (DMT) on motor function, cognitive deficit, mood, and quality of life in people with neurodegenerative diseases, such as Parkinson's disease (PD), mild cognitive impairment (MCI), Alzheimer's disease (AD).MethodsTwo reviewers independently conducted systematic search on the Cochrane library, PubMed database, Web of Science Core Collection database, and Physiotherapy Evidence database until February 1, 2022. Only systematic analyses and randomized controlled trials were included and further analyzed.ResultsThirty-three studies on PD, 16 studies on MCI, 4 studies on AD were obtained. This systematic review found that DMT substantially improved the global cognitive function, memory, and executive function on the population with MCI. Compared with the non-dance group, DMT remarkably improved general disease condition, balance, and gait for individuals with PD. The evidence of the efficacy of DMT on AD is insufficient, and further research is needed.ConclusionDMT can effectively improve the motor function and cognitive deficits in neurodegenerative diseases. Positive effects of DMT on the mood and quality of life in ND patients are controversial and require further evidence. Future research on the effects of DMT on AD requires scientific design, large sample size, long-term comprehensive intervention, and clear reporting standards.Systematic review registrationwww.osf.io/wktez, identifier: 10.17605/OSF.IO/UYBKT.
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Affiliation(s)
- Cheng-Cheng Wu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Huan-Yu Xiong
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Jie-Jiao Zheng
- Huadong Hospital, Shanghai, China
- *Correspondence: Jie-Jiao Zheng
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
- Xue-Qiang Wang
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D'Ambrosi R, Meena A, Raj A, Ursino N, Hewett TE. Anterior Knee Pain: State of the Art. SPORTS MEDICINE - OPEN 2022; 8:98. [PMID: 35907139 PMCID: PMC9339054 DOI: 10.1186/s40798-022-00488-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022]
Abstract
Anterior knee pain (AKP) is one of the most common conditions to bring active young patients to a sports injury clinic. It is a heterogeneous condition related to multiple causative factors. Compared to the general population, there appears to be a higher risk of development of patellofemoral osteoarthritis in patients with AKP. AKP can be detrimental to the patient’s quality of life and, in the larger context, significantly burdens the economy with high healthcare costs. This study aims to present a comprehensive evaluation of AKP to improve clinical daily practice. The causes of AKP can be traced not only to structures within and around the knee, but also to factors outside the knee, such as limb malalignment, weakness of specific hip muscle groups, and core and ligamentous laxity. Hence, AKP warrants a pointed evaluation of history and thorough clinical examination, complemented with relevant radiological investigations to identify its origin in the knee and its cause. Conservative management of the condition achieves good results in a majority of patients with AKP. Surgical management becomes necessary only when it is deemed to provide benefit—when the patient has well-characterized structural abnormalities of the knee or limb that correlate with the AKP clinically or in situations where the patient does not obtain significant or sustained relief from symptoms. AKP has a multifactorial etiology. The treatment strategy must be individualized to the patient based on the patient profile and specific cause identified. Hence, treatment of AKP warrants a pointed evaluation of history and thorough clinical examination complemented with relevant radiological investigations to identify the condition’s origin and its cause. A holistic approach focused on the patient as a whole will ensure a good clinical outcome, as much as a focus on the joint as the therapeutic target.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi Di Milano, Milan, Italy.
| | - Amit Meena
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria
| | - Akshya Raj
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nicola Ursino
- IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
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Sinclair J, Stainton P, Dillon S, Taylor PJ, Richardson C, Bottoms L, Hobbs SJ, Shadwell G, Liles N, Allan R. The efficacy of a tart cherry drink for the treatment of patellofemoral pain in recreationally active individuals: a placebo randomized control trial. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Purpose
This study aimed to explore the efficacy of U.S. Montmorency tart cherry in treating recreationally active individuals with patellofemoral pain.
Methods
Twenty-four recreationally active participants with patellofemoral pain were randomly separated into either placebo (males N = 8, females N = 4, age = 43.30 ± 7.86 yrs, mass = 72.10 ± 17.89 kg, stature = 171.16 ± 10.17, BMI = 24.31 ± 3.75 kg/m2, symptom duration = 30.18 ± 10.90) or Montmorency tart cherry (males N = 9, females N = 3, age = 41.75 ± 7.52 yrs, mass = 76.96 ± 16.64 kg, stature = 173.05 ± 7.63, BMI = 25.53 ± 4.03 kg/m2, symptom duration = 29.73 ± 11.88) groups. Both groups ingested 60 mL of either Montmorency tart cherry concentrate or taste matched placebo daily for 6 weeks. Measures of self-reported pain (KOOS-PF), psychological wellbeing (COOP WONCA), and sleep quality (PSQI) alongside blood biomarkers (C-reactive protein, uric acid, TNF alpha, creatinine, and total antioxidant capacity) and knee biomechanics were quantified at baseline and 6 weeks. Differences between groups were examined using linear mixed-effects models.
Results
There was 1 withdrawal in the cherry and 0 in the placebo group and no adverse events were noted in either condition. The placebo condition exhibited significant improvements (baseline = 67.90 ± 16.18 & 6 weeks = 78.04 ± 14.83) in KOOS-PF scores compared to the tart cherry group (baseline = 67.28 ± 12.55& 6 weeks = 67.55 ± 20.61). No other statistically significant observations were observed.
Conclusion
Tart cherry supplementation as specifically ingested in the current investigation does not appear to be effective in mediating improvements in patellofemoral pain symptoms in recreationally active individuals.
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Chen Z, Wu J, Wang X, Ren Z. The effect of foot orthoses for patients with patellofemoral pain syndrome: A systematic review and meta-analysis. Heliyon 2022; 8:e09656. [PMID: 35721679 PMCID: PMC9204664 DOI: 10.1016/j.heliyon.2022.e09656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/16/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This research quantitatively studied the benefits of foot orthoses for patients with patellofemoral pain syndrome (PFPS) from five aspects: pain intensity, knee function, sport and recreation function, knee symptoms, and knee related quality of life. Data sources Potential articles were retrieved using five electronic databases (Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang). The search period was from inception to October 17, 2021. Review methods Two researchers independently completed record retrieval and selection, data extraction, and methodological quality assessment. Pooled effect sizes were calculated using a random-effects model or fixed-effect model and a 95% confidence interval (95% CI). Data from six randomized controlled trials (RCT) meeting the inclusion criteria were extracted for meta-analysis with methodological quality assessment scores ranging from seven to ten. Results Results showed that compared to the control group, foot orthoses can significantly improve knee function (SMD = -0.45[-0.74, -0.16], P = 0.002, I 2 = 0%), and improve sport and recreation function (SMD = -0.54[-1.04, -0.03], P = 0.04, I 2 = 0%). But the foot orthoses had no significant effect in pain intensity (SMD = -0.01[-0.32, 0.30], P = 0.95, I 2 = 64), knee injury symptoms (SMD = -0.36[-0.86, 0.14], P = 0.16, I 2 = 0%), and knee related quality of life (SMD = -0.45[-0.95, 0.05], P = 0.08, I 2 = 0%).Subgroup analysis of pain intensity showed that foot orthoses had some effect compared to flat/soft inserts (SMD = -0.28[-0.57, 0.00], P = 0.05, I 2 = 0%). The effect of other treatments (physiotherapy and gait retraining) was significantly better than that of foot orthoses (SMD = 0.45[0.09, 0.80], P = 0.01, I 2 = 46%). Compared with exercise alone, the effect of foot orthoses combined with exercise was more significant (SMD = -0.98[-1.64, -0.32], P = 0.004). Conclusion The findings suggested that foot orthoses significantly improved knee function and sport and recreation function in patients with PFPS, but had no significant effect on pain intensity, knee injury symptoms, and knee related quality of life. This study supported the positive therapeutic effect of foot orthoses on PFPS.
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Affiliation(s)
- Ziyan Chen
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Jinlong Wu
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
- College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Xiaodong Wang
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Zhanbing Ren
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
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Souto LR, Borges MS, Marcolino AM, Serrão FV, Padovez RDFCM. Effectiveness of adjunctive treatment combined with exercise therapy for patellofemoral pain: a protocol for a systematic review with network meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e054221. [PMID: 35589339 PMCID: PMC9121418 DOI: 10.1136/bmjopen-2021-054221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patellofemoral pain (PFP) is a chronic condition that affects up to 25% of the general population and has a negative impact on functionality and quality of life due to the high levels of pain experienced by these patients. In order to improve pain and function, rehabilitation programmes that combine adjunctive treatments with exercise therapy are often used in research and clinical settings. However, despite the variety of adjunctive treatments available, their effectiveness when compared with exercise therapy has yet to be elucidated. Thus, the aim of this study is to evaluate the effectiveness of adjunctive treatments plus exercise therapy versus exercise therapy, and determine the relative efficacy of different types of adjunctive treatments plus exercise therapy for individuals with PFP. METHODS AND ANALYSIS A systematic review and network meta-analysis will be conducted based on the Cochrane Collaboration recommendations and reported in line with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We will search Embase, PubMed (MEDLINE), CENTRAL, CINAHL, PEDro, SPORTDiscus, Web of Science and OpenGrey. It will be included randomised controlled trials that compared adjunctive treatment plus exercise therapy to placebo adjunctive treatment plus exercise therapy or exercise therapy. The outcomes of interest will be pain and function, with no restrictions on language, setting or year of publication. Study selection will be performed by two independent reviewers, based on the eligibility criteria. Risk of bias will be assessed using the Physiotherapy Evidence Database scale and the evidence summarised via the Grading of Recommendation, Assessment, Development and Evaluation approach. A Bayesian network meta-analysis will be performed to compare the efficacy of different adjunctive treatments plus exercise therapy. Consistency between direct and indirect comparisons will be assessed. ETHICS AND DISSEMINATION No ethical statement will be required for this systematic review and meta-analysis. The findings will be published in a relevant international peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42020197081.
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Affiliation(s)
| | - Malu Siqueira Borges
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | - Fábio Viadanna Serrão
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
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Watson R, Sullivan B, Stone AV, Jacobs C, Malone T, Heebner N, Noehren B. Lateral Patellar Dislocation: A Critical Review and Update of Evidence-Based Rehabilitation Practice Guidelines and Expected Outcomes. JBJS Rev 2022; 10:01874474-202205000-00004. [PMID: 35748823 DOI: 10.2106/jbjs.rvw.21.00159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Nonoperative treatment of a lateral patellar dislocation produces favorable functional results, but as high as 35% of individuals experience recurrent dislocations. » Medial patellofemoral ligament reconstruction is an effective treatment to prevent recurrent dislocations and yield excellent outcomes with a high rate of return to sport. » Both nonoperative and postoperative rehabilitation should center on resolving pain and edema, restoring motion, and incorporating isolated and multijoint progressive strengthening exercises targeting the hip and knee. » Prior to return to sports, both functional and isolated knee strength measurements should be used to determine leg symmetry strength and to utilize patient-reported outcome measures to assess the patient's perceived physical abilities and patellofemoral joint stability.
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Affiliation(s)
- Richard Watson
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Breanna Sullivan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Cale Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Terry Malone
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Nicholas Heebner
- Department of Athletic Training, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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Sahota B, Howes M, Rio E, Docking S, Cook J. Association between knee pain location and abnormal imaging or arthroscopic findings: A systematic review. Ann Phys Rehabil Med 2022; 65:101638. [PMID: 35093586 DOI: 10.1016/j.rehab.2022.101638] [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: 12/15/2019] [Revised: 11/19/2021] [Accepted: 12/30/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Assessment of pain location is an essential component of the differential diagnosis of knee pain because pain location is thought to indicate pathology. Previous studies have questioned whether abnormal imaging findings are related to the presence of pain, but none has systematically reviewed the association between knee pain location and the location of abnormal imaging or arthroscopic findings. OBJECTIVE To systematically review the association between the location of knee pain and the location of abnormal imaging or arthroscopic findings. METHODS Databases were searched up to November 2021 for articles in English that investigated the association between pain location reported using pain mapping and the location of abnormal imaging or arthroscopic findings. Risk of bias was assessed with the modified Newcastle-Ottawa scale. Results were sub-grouped by pathology and data analysis was performed as appropriate. RESULTS Among 7730 articles identified, 10 (n = 2034 participants) met the inclusion criteria. Three sub-pathologies were evaluated: patellar tendinopathy (n = 2), knee osteoarthritis (n = 7), and degenerative meniscal tears (n = 1). The primary analysis found poor sensitivity and specificity of patellar tendon hypoechogenic areas and local patellar tendon pain in adult (n = 55) and adolescent athletes (n = 114). The location of pain and the location of abnormal imaging findings was associated in 2 studies of knee osteoarthritis (n = 166). Five articles reported no relationship (n = 1563). No association was reported between the location of pain and the location of arthroscopic findings in degenerative meniscus tears (n = 193). All articles included were rated at low risk of bias. CONCLUSION Sensitivity and specificity of the presence of patellar tendon hypoechogenic areas and localised patellar tendon pain was poor. Pain location was not associated with the location of abnormal imaging findings in knee osteoarthritis or to abnormal arthroscopic findings in degenerative meniscus tears.
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Affiliation(s)
- Brent Sahota
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia.
| | - Melissa Howes
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia
| | - Ebonie Rio
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia
| | - Sean Docking
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia
| | - Jill Cook
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia
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Tibial internal and external rotation taping for improving pain in patients with patellofemoral pain syndrome. J Sci Med Sport 2022; 25:644-648. [DOI: 10.1016/j.jsams.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022]
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Location of anterior knee pain affects load tolerance in isometric single leg knee extension. J Sci Med Sport 2022; 25:569-573. [DOI: 10.1016/j.jsams.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/24/2022] [Accepted: 03/20/2022] [Indexed: 11/21/2022]
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Barber P, Lack SD, Bartholomew C, Curran AJ, Lowe CM, Morrissey D, Neal BS. Patient experience of the diagnosis and management of patellofemoral pain: A qualitative exploration. Musculoskelet Sci Pract 2022; 57:102473. [PMID: 34740149 DOI: 10.1016/j.msksp.2021.102473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is common and long-term treatment outcomes are unsatisfactory. Qualitative exploration of diagnosis and management from the perspective of people with PFP is lacking. OBJECTIVES To inform care and improve intervention delivery by exploring the experience of people with PFP regarding diagnosis and management. DESIGN Qualitative study with semi-structured interviews. METHOD Online recruiting yielded a convenience sample of participants with PFP for semi-structured interview. Interviews were recorded, transcribed verbatim, and analysed using thematic analysis until theoretical saturation by multiple investigators to determine themes and sub-themes. RESULTS 12 participants were interviewed, with three themes identified; the value of diagnosis, the need for tailored (individualised) care, and the role of education. Participants viewed receiving a diagnosis as essential to guide management, yet one was rarely provided, causing uncertainty about pain mechanisms; "it's nice to be told what it is that's wrong". Interventions needed to be tailored to the individual as not all participants responded in the same way to treatment(s) or had the same needs; "everyone copes and reacts differently". Finally, participants viewed education as essential to empower them to understand and manage the condition; "if I'd have been given more information, I think I'd know how to deal with it more". CONCLUSIONS The overarching narrative from three themes was a desire for clearly communicated personalised care that meets individual needs. People with PFP desire a diagnosis to explain their pain, tailored interventions, and appropriate education to optimise their experience and outcomes.
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Affiliation(s)
- Philip Barber
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK; Connect Health, The Light Box, Quorum Park, Benton Lane, Newcastle Upon Tyne, Tyne and Wear, NE12 8EU, UK
| | - Simon David Lack
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; Pure Sports Medicine, Point West Building, 116 Cromwell Road, London, SW7 4XR, UK
| | - Clare Bartholomew
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Amy Jessica Curran
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Catherine Minns Lowe
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; Physiotherapy Department, Barts Health NHS Trust, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Bradley Stephen Neal
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3WA, UK.
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Lower Extremity Kinetics and Kinematics in Runners with Patellofemoral Pain: A Retrospective Case–Control Study Using Musculoskeletal Simulation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patellofemoral pain (PFP) is a common atraumatic knee pathology in runners, with a complex multifactorial aetiology influenced by sex differences. This retrospective case–control study therefore aimed to evaluate lower limb kinetics and kinematics in symptomatic and control male and female runners using musculoskeletal simulation. Lower extremity biomechanics were assessed in 40 runners with PFP (15 females and 25 males) and 40 controls (15 females and 25 males), whilst running at a self-selected velocity. Lower extremity biomechanics were explored using a musculoskeletal simulation approach. Four intergroup comparisons—(1) overall PFP vs. control; (2) male PFP vs. male control; (3) female PFP vs. female control; and (4) male PFP vs. female PFP—were undertaken using linear mixed models. The overall (stress per mile: PFP = 1047.49 and control = 812.93) and female (peak stress: PFP = 13.07 KPa/BW and control = 10.82 KPa/BW) comparisons showed increased patellofemoral joint stress indices in PFP runners. A significantly lower strike index was also shown in PFP runners in the overall (PFP = 17.75% and control = 33.57%) and female analyses (PFP = 15.49% and control = 40.20%), revealing a midfoot strike in control, and a rearfoot pattern in PFP runners. Peak rearfoot eversion and contralateral pelvic drop range of motion (ROM) were shown to be greater in PFP runners in the overall (eversion: PFP = −8.15° and control = −15.09°/pelvic drop ROM: PFP = 3.64° and control = 1.88°), male (eversion: PFP = −8.05° and control = −14.69°/pelvic drop ROM: PFP = 3.16° and control = 1.77°) and female (eversion: PFP = 8.28° and control = −15.75°/pelvic drop ROM: PFP = 3.64° and control = 1.88°) PFP runners, whilst female PFP runners (11.30°) exhibited a significantly larger peak hip adduction compared to PFP males (7.62°). The findings from this investigation highlight biomechanical differences between control and PFP runners, as well as demonstrating distinctions in PFP presentation for many parameters between sexes, highlighting potential risk factors for PFP that may be addressed through focused intervention modalities, and also the need, where appropriate, for sex-specific targeted treatment approaches.
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Zambarano EK, Bazett-Jones DM, de Oliveira Silva D, Barton CJ, Glaviano NR. Confidence and Knowledge of Athletic Trainers in Managing Patellofemoral Pain. J Athl Train 2022; 57:79-91. [PMID: 35040987 PMCID: PMC8775279 DOI: 10.4085/1062-6050-0279.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Patellofemoral pain (PFP) is prevalent and challenging to manage. Most patients with PFP are unsatisfied with their knee function at 6 months after treatment and report ongoing pain up to 16 years after diagnosis. The confidence and knowledge of athletic trainers (ATs) in providing evidence-based care to people with PFP is unknown. OBJECTIVE To investigate the confidence and knowledge of ATs in the diagnosis, risk factors, prognosis, and treatment with current evidence for PFP. DESIGN Cross-sectional study. SETTING Online survey. PATIENT OR OTHER PARTICIPANTS A random sample of 3000 ATs were invited to participate; 261 completed the survey (10% participation rate, 88% completion rate). MAIN OUTCOME MEASURES(S) We surveyed AT demographics, confidence in PFP management, and knowledge related to diagnosis, risk factors, prognosis, and treatment. The confidence and knowledge of ATs in managing PFP was assessed. Their beliefs about evidence were compared with the available evidence (ie, consensus statements, position statements, systematic reviews). RESULTS Of the ATs surveyed, 91% were confident that their management of PFP aligned with the current evidence, but only 59% were confident in identifying risk factors for PFP development. In addition, 91% to 92% of ATs agreed that quadriceps and hip muscle weakness were risk factors for PFP, which aligns with the current evidence for the former but not the latter. Moreover, 93% to 97% of ATs' responses related to therapeutic exercise aligned with current evidence. However, 35% to 48% supported the use of passive treatments, such as electrophysical agents and ultrasound, which did not align with the current evidence. CONCLUSIONS Most ATs were aware of supporting evidence for therapeutic exercise in PFP management and were confident providing it, creating a strong foundation for evidence-based care. However, varying levels of awareness of the evidence related to risk factors and passive treatments for PFP highlight the need for professional development initiatives to better align ATs' knowledge with the current evidence.
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Affiliation(s)
- Erika K. Zambarano
- School of Exercise and Rehabilitation Sciences, University of Toledo, OH
| | | | - Danilo de Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Australia
| | - Christian J. Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Australia
,Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia
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Baellow A, Jaffri AH, Hertel J, Higgins MJ, Rangecroft CM, Hryvniak DJ, Saliba SF. Intrinsic foot muscle size and quality in a single leg weight bearing position across foot posture types in individuals with Patellofemoral Pain compared to healthy. Phys Ther Sport 2022; 54:58-64. [DOI: 10.1016/j.ptsp.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 02/06/2023]
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Theisen BJ, Larson PD, Chambers CC. Optimizing Rehabilitation and Return to Sport in Athletes With Anterior Knee Pain Using a Biomechanical Perspective. Arthrosc Sports Med Rehabil 2022; 4:e199-e207. [PMID: 35141552 PMCID: PMC8811520 DOI: 10.1016/j.asmr.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022] Open
Abstract
Anterior knee pain represents one of the most common athletic knee conditions and arguably also one of the most complex. The patellofemoral joint is at the center of several forces, and alterations in any of these force vectors due to muscular imbalance, soft-tissue tightness or laxity, and altered functional movement patterns can all combine to create a painful anterior knee. While typically anterior knee pain is not a surgical entity, the orthopaedic surgeon with an understanding of these biomechanical intricacies is best positioned to provide comprehensive evidence-based care for the patient with anterior knee pain. Level of Evidence V, expert opinion.
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Souza GDSD, Rossato CE, Silveira AFD. SEBT in individuals with patellofemoral pain: an integrative review. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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