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Del Priore LB, Briani RV, Waiteman MC, Farinelli LALB, Silva GGMD, Silva TMDSBD, Glaviano N, Azevedo FMD. "I believe it will not get worse": A mixed-methods longitudinal study about patient's perspective of recently developed patellofemoral pain. Phys Ther Sport 2024; 70:29-35. [PMID: 39208547 DOI: 10.1016/j.ptsp.2024.08.007] [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: 07/01/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES This study aimed to: (i) understand how women perceived their recently developed patellofemoral pain (PFP) regarding its cause, prognosis, and willingness to seek treatment; (ii) investigate self-reported function, knee-related quality of life (QoL), fear of movement, and physical activity level at the onset of PFP. DESIGN Mixed-methods longitudinal study. SETTING University. PARTICIPANTS Sixty-eight pain-free women were followed up over one year. MAIN OUTCOME MEASURES Those who developed PFP were interviewed within one month of the development of symptoms. Self-reported function, kinesiophobia, knee-related QoL, and physical activity were obtained at baseline and follow-up assessments. RESULTS Twenty-one women developed PFP. Most participants reported believing the increase in physical activity and/or sitting time was associated with the onset of PFP. Many reported believing symptoms would improve over time without any treatment. Only a small number of participants intended to seek care. Quantitatively, decreases in self-reported function and QoL, as well as increases in the physical activity level were observed after PFP development. CONCLUSION Although decreases in self-reported function and QoL were observed, women reported believing their PFP is self-limiting and do not need treatment. Strategies to accurately disseminate knowledge about PFP are needed to help stimulating early care.
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Affiliation(s)
- Liliam Barbuglio Del Priore
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, Brazil
| | - Ronaldo V Briani
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, Brazil.
| | - Marina C Waiteman
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, Brazil
| | | | | | | | - Neal Glaviano
- College of Agriculture, Health, & Nature Resources, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Fábio M de Azevedo
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, Brazil
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Dubé MO, Dillon S, Gallagher K, Ryan J, McCreesh K. One and Done? The Effectiveness of a Single Session of Physiotherapy Compared With Multiple Sessions to Reduce Pain and Improve Function and Quality of Life in Patients With a Musculoskeletal Disorder: A Systematic Review With Meta-analyses. Arch Phys Med Rehabil 2024; 105:1171-1180. [PMID: 37805175 DOI: 10.1016/j.apmr.2023.09.017] [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: 04/23/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To compare single and multiple physiotherapy sessions to improve pain, function, and quality of life (QoL) in patients with musculoskeletal disorders (MSKDs). DATA SOURCES AMED, Cinahl, SportsDiscus, Medline, Cochrane Register of Clinical Trials, Physiotherapy Evidence Database, and reference lists. STUDY SELECTION Randomized controlled trials (RCTs) comparing single and multiple physiotherapy sessions for MSKDs. DATA EXTRACTION Two reviewers extracted data and assessed risk of bias and certainty of evidence using Cochrane Risk of Bias tool 2.0 and Grading of Recommendation Assessment, Development, and Evaluation. DATA SYNTHESIS Six RCTs (n=2090) were included (conditions studied: osteoporotic vertebral fracture, neck, knee, and shoulder pain). Meta-analyses with low-certainty evidence showed a significant pain improvement at 6 months in favor of multiple sessions compared with single session interventions (3 RCTs; n=1035; standardized mean difference [SMD]: 0.29; 95% CI: 0.05 to 0.53; P=.02) but this significant difference in pain improvement was not observed at 3 months (4 RCTs; n=1312; SMD: 0.39; 95% CI: -0.11 to 0.89; P=.13) and at 12 months (4 RCTs; n=1266; SMD: -0.05; 95% CI: -0.49 to 0.39; P=.82). Meta-analyses with low-certainty evidence showed no significant differences in function at 3 (4 RCTs; n=1583; SMD: 0.05; 95% CI: -0.11 to 0.21; P=.56), 6 (4 RCTs; n=1538; SMD: 0.06; 95% CI: -0.12 to 0.23; P=.53) and 12 months (4 RCTs; n=1528; SMD: 0.08; 95% CI: -0.08 to 0.25; P=.30) and QoL at 3 (4 RCTs; n=1779; SMD: 0.08; 95% CI: -0.02 to 0.17; P=.12), 6 (3 RCTs; n=1206; SMD: 0.03; 95% CI: -0.08 to 0.14; P=.59), and 12 months (4 RCTs; n=1729; SMD: -0.03; 95% CI: -0.12 to 0.07; P=.58). CONCLUSIONS Low certainty meta-analyses found no clinically significant differences in pain, function, and QoL between single and multiple physiotherapy sessions for MSKD management for the conditions studied. Future research should compare the cost-effectiveness of those different models of care.
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Affiliation(s)
- Marc-Olivier Dubé
- Rehabilitation Department, Faculty of Medicine, Université Laval, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada.
| | - Sarah Dillon
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kevin Gallagher
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Jake Ryan
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
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Eckenrode BJ, Kietrys DM, Brown A, Parrott JS, Noehren B. Effects of high frequency strengthening on pain sensitivity and function in female runners with chronic patellofemoral pain. Phys Ther Sport 2024; 67:31-40. [PMID: 38471409 DOI: 10.1016/j.ptsp.2024.02.007] [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: 10/16/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the effects of a high frequency strengthening program on function, pain, and pain sensitization in female runners with chronic patellofemoral pain (PFP). DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Thirty female runners (mean age 32 ± 8.1 years) with chronic PFP completed an 8-week home strengthening program. MAIN OUTCOME MEASURES Variables assessed at baseline, 8-weeks, and 12 weeks included single leg step down test (SLSD), pain, Anterior Knee Pain Scale (AKPS), University of Wisconsin Running Injury and Recovery Index (UWRI), and quantitative sensory testing. RESULTS There was large and statistically significant improvement at 8 and 12 weeks for average knee pain (ηp2 = 0.334, p < 0.001), worst knee pain (ηp2 = 0.351, p < 0.001), SLSD (ηp2 = 0.161, p = 0.001), AKPS (ηp2 = 0.463, p < 0.001), and UWRI (ηp2 = 0.366, p < 0.001). A medium to large effect and statistically significant improvement in pressure pain threshold testing was found for all local and remote structures (ηp2 range, 0.110 to 0.293, range p < 0.001 to p = 0.009) at 8 and 12 weeks. CONCLUSIONS There was a significant decrease in local and remote hyperalgesia via mechanical and thermal pain sensitivity testing in female runners with chronic PFP. There was a large effect and significant improvement in self-reported pain and function.
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Affiliation(s)
- Brian J Eckenrode
- Arcadia University, Department of Physical Therapy, Glenside, PA, 19038, USA.
| | - David M Kietrys
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences, Blackwood, NJ, 08012, USA
| | - Allison Brown
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences Newark, NJ, 07101, USA
| | - J Scott Parrott
- Rutgers School of Health Professions, Department of Interdisciplinary Studies, Blackwood, NJ, 08012, USA
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, KY, 40536, USA
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4
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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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Sheikhi B, Rabiei P, Letafatkar A, Rossettini G. Is Adding Education to Trunk and Hip Exercises Beneficial for Patellofemoral Pain? A Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:217-226. [PMID: 37717685 DOI: 10.1016/j.apmr.2023.08.030] [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: 02/26/2023] [Revised: 08/03/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To investigate the effect of adding education to trunk and hip exercises in patients with patellofemoral pain (PFP). DESIGN A randomized controlled trial. SETTING Research laboratory. PARTICIPANTS Sixty patients with PFP (N=60) were randomly assigned to either an experimental group (education followed by trunk and hip exercises, n=30) or a control group (trunk and hip exercises, n=30). INTERVENTIONS Both groups received 8 weeks of trunk and hip exercises, while patients in the experimental group participated in 3 prior education sessions. MAIN OUTCOME MEASURES The primary outcome was pain; secondary outcomes were pain catastrophizing, kinesiophobia, function, and muscle strength. Outcomes were assessed at baseline, after 8 weeks (post-intervention), and 3 months post-intervention (follow-up). RESULTS No significant between-group differences were observed for pain outcome post-intervention. The experimental group showed superiority over the control group in the improvement of pain catastrophizing (mean difference: -2.32; 95% confidence interval [CI] -1.059 to 0.028) and kinesiophobia (mean difference: -3.56; 95% CI -1.067 to -0.035) at post-intervention. In the experimental group, improvements were maintained at follow-up assessment for all outcomes, except muscle strength. CONCLUSION Adding education to trunk and hip exercises was associated with greater improvements in psychological outcomes than trunk and hip exercises alone after the intervention. Education can be incorporated when designing trunk and hip exercises for patients with PFP.
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Affiliation(s)
- Bahram Sheikhi
- Department of Biomechanics and Sports Injuries, Kharazmi University, Tehran, Iran.
| | - Pouya Rabiei
- Faculty of Medicine, Laval University, Quebec City, Canada; Interdisciplinary Center for Research in Rehabilitation and Social Integration (Cirris), Quebec City, Canada
| | - Amir Letafatkar
- Department of Biomechanics and Sports Injuries, Kharazmi University, Tehran, Iran
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de Souza Júnior JR, Rabelo PHR, Lemos TV, Esculier JF, Barbosa GMP, Matheus JPC. Effects of two gait retraining programs on pain, function, and lower limb kinematics in runners with patellofemoral pain: A randomized controlled trial. PLoS One 2024; 19:e0295645. [PMID: 38198492 PMCID: PMC10781021 DOI: 10.1371/journal.pone.0295645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Patellofemoral Pain (PFP) is one of the main injuries in runners. Consistent evidence support strengthening programs to modulate symptoms, however, few studies investigated the effects of gait retraining programs. OBJECTIVE To investigate the effects of two different two-week partially supervised gait retraining programs on pain, function, and lower limb kinematics of runners with PFP. METHODS Randomized controlled trial. Thirty runners were allocated to gait retraining groups focusing on impact (n = 10) or cadence (n = 10), or to a control group (n = 10). Impact group received guidance to reduce tibial acceleration by 50%, while cadence group was asked to increase cadence by 7.5-10%. The control group did not receive any intervention. Usual and running pain, knee function, and lower limb kinematics (contralateral pelvic drop, hip adduction, knee flexion, ankle dorsiflexion, tibia inclination, and foot inclination) were evaluated before (T0), immediately after the intervention (T2), and six months after the protocol (T24). RESULTS A significant group x time interaction was found for running pain (p = 0.010) and knee function (p = 0.019). Both programs had greater improvements in running pain compared to no intervention at T24 (Impact x Control-mean difference (MD) -3.2, 95% CI -5.1 to -1.3, p = 0.001; Cadence x Control-MD -2.9, 95% CI -4.8 to -1.0, p = 0.002). Participants of the impact group had greater improvements in knee function compared to no intervention at T2 (Impact x Control-MD 10.8, 95% CI 1.0 to 20.6, p = 0.027). No between-group differences in usual pain and lower limb kinematics were found (p>0.05). CONCLUSION Compared to no intervention, both programs were more effective in improving running pain six months after the protocol. The program focused on impact was more effective in improving knee function immediately after the intervention. Clinical trial registry number: RBR-8yb47v.
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Affiliation(s)
- José Roberto de Souza Júnior
- Graduate Program of Sciences and Technologies in Health, University of Brasília, Brasília, Federal District, Brazil
| | | | - Thiago Vilela Lemos
- Moving Physical Therapy, Goiânia, Goiás, Brazil
- Department of Physical Therapy, State University of Goiás, Goiânia, Goiás, Brazil
| | - Jean-Francois Esculier
- The Running Clinic, Lac Beauport, Quebec, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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7
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de Souza Júnior JR, Gaudette LW, Johnson CD, Matheus JPC, Lemos TV, Davis IS, Tenforde AS. Interaction of Biomechanical, Anthropometric, and Demographic Factors Associated with Patellofemoral Pain in Rearfoot Strike Runners: A Classification and Regression Tree Approach. SPORTS MEDICINE - OPEN 2024; 10:5. [PMID: 38190013 PMCID: PMC10774254 DOI: 10.1186/s40798-023-00671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Patellofemoral pain (PFP) is among the most common injuries in runners. While multiple risk factors for patellofemoral pain have been investigated, the interactions of variables contributing to this condition have not been explored. This study aimed to classify runners with patellofemoral pain using a combination of factors including biomechanical, anthropometric, and demographic factors through a Classification and Regression Tree analysis. RESULTS Thirty-eight runners with PFP and 38 healthy controls (CON) were selected with mean (standard deviation) age 33 (16) years old and body mass index 22.3 (2.6) kg/m2. Each ran at self-selected speed, but no between-group difference was identified (PFP = 2.54 (0.2) m/s x CON = 2.55 (0.1) m/s, P = .660). Runners with patellofemoral pain had different patterns of interactions involving braking ground reaction force impulse, contact time, vertical average loading rate, and age. The classification and regression tree model classified 84.2% of runners with patellofemoral pain, and 78.9% of healthy controls. The prevalence ratios ranged from 0.06 (95% confidence interval: 0.02-0.23) to 9.86 (95% confidence interval: 1.16-83.34). The strongest model identified runners with patellofemoral pain as having higher braking ground reaction force impulse, lower contact times, higher vertical average loading rate, and older age. The receiver operating characteristic curve demonstrated high accuracy at 0.83 (95% confidence interval: 0.74-0.93; standard error: 0.04; P < .001). CONCLUSIONS The classification and regression tree model identified an influence of multiple factors associated with patellofemoral pain in runners. Future studies may clarify whether addressing modifiable biomechanical factors may address this form of injury.
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Affiliation(s)
- José Roberto de Souza Júnior
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA.
- Graduate Program of Sciences and Technologies in Health, University of Brasília, Brasília, DF, Brazil.
- Spaulding National Running Center, 1575 Cambridge St, Cambridge, MA, 02138, USA.
| | - Logan Walter Gaudette
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - Caleb D Johnson
- United States Army Research Institute for Environmental Medicine, Natick, MA, USA
| | | | - Thiago Vilela Lemos
- Department of Physical Therapy, State University of Goiás, Goiânia, GO, Brazil
| | - Irene S Davis
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [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: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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9
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Otsudo T, Hattori H, Hasebe Y, Okubo Y, Sawada Y, Akasaka K. Effectiveness of an educational approach between adolescents and adults with patellofemoral pain syndrome: a scoping review with meta-analysis. J Phys Ther Sci 2023; 35:659-666. [PMID: 37670759 PMCID: PMC10475647 DOI: 10.1589/jpts.35.659] [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: 05/18/2023] [Accepted: 06/09/2023] [Indexed: 09/07/2023] Open
Abstract
[Purpose] This study aimed to compare the effectiveness of an educational approach between adolescents and adults with patellofemoral pain syndrome. [Participants and Methods] The PROSPERO protocol number is CRD42022362680. Four databases (PubMed, CINAHL, Scopus, Cochrane) were searched. Randomized control trials on the effectiveness of the educational approach for patellofemoral pain syndrome were compared between adolescents and adults. Two investigators independently screened eligible studies. Two randomized control trials proceeded through meta-analysis with a visual analogue scale in the mid-term (from 18 weeks to 6 months). [Results] The meta-analysis results indicated that no significant difference was observed between education and combined education with exercise. A tendency to improve in the intervention of combined education with exercise for adolescents was noted, whereas no effect of education for adults was observed. [Conclusion] Treatment strategies combining education with exercise for patellofemoral pain syndrome may differ between adolescents and adults.
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Affiliation(s)
- Takahiro Otsudo
- Major of Physical Therapy, Department of Rehabilitation,
School of Health Sciences, Tokyo University of Technology: 5-23-22 Nishikamata, Ota-ku,
Tokyo 144-8535, Japan
| | - Hiroshi Hattori
- School of Physical Therapy, Department of Health and
Medical Care, Saitama Medical University, Japan
| | - Yuki Hasebe
- Department of Rehabilitation, Saitama Medical Center,
Saitama Medical University, Japan
| | - Yu Okubo
- School of Physical Therapy, Department of Health and
Medical Care, Saitama Medical University, Japan
| | - Yutaka Sawada
- School of Physical Therapy, Department of Health and
Medical Care, Saitama Medical University, Japan
| | - Kiyokazu Akasaka
- School of Physical Therapy, Department of Health and
Medical Care, Saitama Medical University, Japan
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10
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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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11
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Esculier JF, Bouyer LJ, Roy JS. Running gait modifications can lead to immediate reductions in patellofemoral pain. Front Sports Act Living 2023; 4:1048655. [PMID: 36726397 PMCID: PMC9884822 DOI: 10.3389/fspor.2022.1048655] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Gait modifications are commonly advocated to decrease knee forces and pain in runners with patellofemoral pain (PFP). However, it remains unknown if clinicians can expect immediate effects on symptoms. Our objectives were (1) to compare the immediate effects of gait modifications on pain and kinetics of runners with PFP; (2) to compare kinetic changes in responders and non-responders; and (3) to compare the effects between rearfoot strikers (RFS) and non-RFS. Sixty-eight runners with PFP (42 women, 26 men) ran normally on a treadmill before testing six modifications: 1- increase step rate by 10%; 2- 180 steps per minute; 3- decrease step rate by 10%; 4- forefoot striking; 5- heel striking; 6- running softer. Overall, there were more responders (pain decreased ≥1/10 compared with normal gait) during forefoot striking and increasing step rate by 10% (both 35%). Responders showed greater reductions in peak patellofemoral joint force than non-responders during all conditions except heel striking. When compared with non-RFS, RFS reduced peak patellofemoral joint force in a significant manner (P < 0.001) during forefoot striking (partial η 2 = 0.452) and running softer (partial η 2 = 0.302). Increasing step rate by 10% reduced peak patellofemoral joint force in both RFS and non-RFS. Forty-two percent of symptomatic runners reported immediate reductions in pain during ≥1 modification, and 28% had reduced pain during ≥3 modifications. Gait modifications leading to decreased patellofemoral joint forces may be associated with immediate pain reductions in runners with PFP. Other mechanisms may be involved, given that some runners reported decreased symptoms regardless of kinetic changes.
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Affiliation(s)
- Jean-Francois Esculier
- The Running Clinic, Lac beauport, QC, Canada,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,MoveMed Physiotherapy, Kelowna, BC, Canada,Correspondence: Jean-Francois Esculier
| | - Laurent J. Bouyer
- Faculty of Medicine, Université Laval, Quebec, QC, Canada,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| | - Jean-Sébastien Roy
- Faculty of Medicine, Université Laval, Quebec, QC, Canada,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
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Anderson LM, Martin JF, Barton CJ, Bonanno DR. What is the Effect of Changing Running Step Rate on Injury, Performance and Biomechanics? A Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:112. [PMID: 36057913 PMCID: PMC9441414 DOI: 10.1186/s40798-022-00504-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/07/2022] [Indexed: 12/02/2022]
Abstract
Background Running-related injuries are prevalent among distance runners. Changing step rate is a commonly used running retraining strategy in the management and prevention of running-related injuries. Objective The aims of this review were to synthesise the evidence relating to the effects of changing running step rate on injury, performance and biomechanics. Design Systematic review and meta-analysis. Data Sources MEDLINE, EMBASE, CINAHL, and SPORTDiscus. Results Thirty-seven studies were included that related to injury (n = 2), performance (n = 5), and biomechanics (n = 36). Regarding injury, very limited evidence indicated that increasing running step rate is associated with improvements in pain (4 weeks: standard mean difference (SMD), 95% CI 2.68, 1.52 to 3.83; 12 weeks: 3.62, 2.24 to 4.99) and function (4 weeks: 2.31, 3.39 to 1.24); 12 weeks: 3.42, 4.75 to 2.09) in recreational runners with patellofemoral pain. Regarding performance, very limited evidence indicated that increasing step rate increases perceived exertion ( − 0.49, − 0.91 to − 0.07) and awkwardness (− 0.72, − 1.38 to − 0.06) and effort (− 0.69, − 1.34, − 0.03); and very limited evidence that an increase in preferred step rate is associated with increased metabolic energy consumption (− 0.84, − 1.57 to − 0.11). Regarding biomechanics, increasing running step rate was associated with strong evidence of reduced peak knee flexion angle (0.66, 0.40 to 0.92); moderate evidence of reduced step length (0.93, 0.49 to 1.37), peak hip adduction (0.40, 0.11 to 0.69), and peak knee extensor moment (0.50, 0.18 to 0.81); moderate evidence of reduced foot strike angle (0.62, 034 to 0.90); limited evidence of reduced braking impulse (0.64, 0.29 to 1.00), peak hip flexion (0.42, 0.10 to 0.75), and peak patellofemoral joint stress (0.56, 0.07 to 1.05); and limited evidence of reduced negative hip (0.55, 0.20 to 0.91) and knee work (0.84, 0.48 to 1.20). Decreasing running step rate was associated with moderate evidence of increased step length (− 0.76, − 1.31 to − 0.21); limited evidence of increased contact time (− 0.95, − 1.49 to − 0.40), braking impulse (− 0.73, − 1.08 to − 0.37), and negative knee work (− 0.88, − 1.25 to − 0.52); and limited evidence of reduced negative ankle work (0.38, 0.03 to 0.73) and negative hip work (0.49, 0.07 to 0.91). Conclusion In general, increasing running step rate results in a reduction (or no change), and reducing step rate results in an increase (or no change), to kinetic, kinematic, and loading rate variables at the ankle, knee and hip. At present there is insufficient evidence to conclusively determine the effects of altering running step rate on injury and performance. As most studies included in this review investigated the immediate effects of changing running step rate, the longer-term effects remain largely unknown. Prospero Registration CRD42020167657.
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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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Gaudette LW, Bradach MM, de Souza Junior JR, Heiderscheit B, Johnson CD, Posilkin J, Rauh MJ, Sara LK, Wasserman L, Hollander K, Tenforde AS. Clinical Application of Gait Retraining in the Injured Runner. J Clin Med 2022; 11:6497. [PMID: 36362725 PMCID: PMC9655004 DOI: 10.3390/jcm11216497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 06/22/2024] Open
Abstract
Despite its positive influence on physical and mental wellbeing, running is associated with a high incidence of musculoskeletal injury. Potential modifiable risk factors for running-related injury have been identified, including running biomechanics. Gait retraining is used to address these biomechanical risk factors in injured runners. While recent systematic reviews of biomechanical risk factors for running-related injury and gait retraining have been conducted, there is a lack of information surrounding the translation of gait retraining for injured runners into clinical settings. Gait retraining studies in patients with patellofemoral pain syndrome have shown a decrease in pain and increase in functionality through increasing cadence, decreasing hip adduction, transitioning to a non-rearfoot strike pattern, increasing forward trunk lean, or a combination of some of these techniques. This literature suggests that gait retraining could be applied to the treatment of other injuries in runners, although there is limited evidence to support this specific to other running-related injuries. Components of successful gait retraining to treat injured runners with running-related injuries are presented.
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Affiliation(s)
- Logan W. Gaudette
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Molly M. Bradach
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - José Roberto de Souza Junior
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
- Graduate Program of Sciences and Technologies in Health, University of Brasilia, Brasilia 72220-275, DF, Brazil
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Caleb D. Johnson
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
- United States Army Research Institute for Environmental Medicine, Military Performance Division, Natick, MA 01760, USA
| | - Joshua Posilkin
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA 92182, USA
| | - Lauren K. Sara
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Lindsay Wasserman
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Medicine, MSH, Medical School Hamburg, 20457 Hamburg, Germany
| | - Adam S. Tenforde
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
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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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16
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Reliability and validity of 2-dimensional video analysis for a running task: A systematic review. Phys Ther Sport 2022; 58:16-33. [DOI: 10.1016/j.ptsp.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
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17
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Soares A, Cintia LF, Glaviano NR, Rabelo NDDA, Lucareli PRG. Is there a correlation between isometric muscle strength and the kinematics of the pelvis, hip and knee during functional tasks in women with patellofemoral pain? Phys Ther Sport 2022; 57:33-39. [PMID: 35878554 DOI: 10.1016/j.ptsp.2022.07.003] [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: 03/28/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the correlation between isometric muscle strength of the hip abductors (HABD) and lateral rotators (HLR) with the range of motion (ROM) of the pelvis/hip in the frontal/transverse planes, respectively, and between the strength of the knee extensors (KExt) with the ROM of the knee in the sagittal plane during seven tasks. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS Thirty-five women with patellofemoral pain. MAIN OUTCOME MEASURES Maximum isometric muscle strength of the HABD, HLR, and KExt was measured using a manual dynamometer, and pelvis and lower limbs kinematics were evaluated using 3D optical system during gait, ascending and descending stairs, the forward and lateral step down tests, and the propulsion and landing phases of the single leg hop test (SLHT). RESULTS A weak correlation was found between KExt strength and knee ROM in the sagittal plane (p = 0.05; r = -0.33) during SLHT landing, and a moderate correlation between HABD strength and ROM of pelvic obliquity (p < 0.01; r = 0.50) during ascending stairs. CONCLUSIONS The lower strength of KExt has a weak correlation with higher knee flexion during the landing phase of the SLHT, and the lower strength of HABD has a moderate correlation with lower pelvis ROM in the frontal plane when ascending stairs.
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Affiliation(s)
- Alyne Soares
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Lopes Ferreira Cintia
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Neal Robert Glaviano
- Assistant Professor in the Department of Kinesiology at the University of Connecticut, USA
| | - Nayra Deise Dos Anjos Rabelo
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
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18
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Glaviano NR, Holden S, Bazett-Jones DM, Singe SM, Rathleff MS. Living well (or not) with patellofemoral pain: A qualitative study. Phys Ther Sport 2022; 56:1-7. [DOI: 10.1016/j.ptsp.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
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The Effectiveness of Gait Retraining on Running Kinematics, Kinetics, Performance, Pain, and Injury in Distance Runners: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:192-A5. [PMID: 35128941 DOI: 10.2519/jospt.2022.10585] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of running gait retraining on kinematics, kinetics, performance, pain, and injury in distance runners. DESIGN Intervention systematic review with meta-analysis. LITERATURE SEARCH Seven electronic databases from inception to March 2021. TRIAL SELECTION CRITERIA Randomized controlled trials that (1) evaluated running gait retraining compared to no intervention, usual training, placebo, or standard care and (2) reported biomechanical, physiological, performance, or clinical outcomes. DATA SYNTHESIS Random-effects metaanalyses were completed, and the certainty of evidence was judged using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We categorized interventions into step rate, non-rearfoot footstrike, impact, ground contact time, and multiparameter subgroups. RESULTS We included 19 trials (673 participants). Moderate-certainty evidence indicated step rate gait retraining increased step rate (SMD 1.03 [95% confidence interval {CI}: 0.63, 1.44]; number of trials (N): 4; I2: 0%) and reduced average vertical loading rate (SMD -0.57 [95% CI, -1.05 to -0.09], N: 3; I2: 0%). Low-certainty evidence indicated non-rearfoot footstrike retraining increased knee flexion at initial contact (SMD 0.74 [95% CI, 0.11 to 1.37]; N: 2; I2: 0%), but did not alter running economy (SMD 0.21 [95% CI, -1.11 to 1.52]; N: 3; I2: 19%).). Low-certainty evidence indicated multiparameter retraining did not alter running economy (SMD 0.32 [-0.39, 1.02]; N: 3; I2: 19%) or performance (SMD 0.14 [95% CI, -4.87 to 4.58]; N: 2; I2: 18%). Insufficient trials reported on pain outcomes. Two trials demonstrated reduced 1-year injury incidence following gait retraining. CONCLUSIONS Gait retraining interventions altered step rate and knee kinematics, lowered vertical loading rates, and did not affect running performance. J Orthop Sports Phys Ther 2022;52(4):192-206. Epub 05 Feb 2022. doi:10.2519/jospt.2022.10585.
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Yang C, Best TM, Liu H, Yu B. Knee biomechanical factors associated with patellofemoral pain in recreational runners. Knee 2022; 35:87-97. [PMID: 35255371 DOI: 10.1016/j.knee.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/06/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common injury among runners. Knee biomechanical factors associated with PFP, however, remain unclear. The purpose of this study was to determine possible associations between knee biomechanics and symptoms of PFP in recreational runners. METHODS Fifteen male and 15 female recreational runners with PFP were enrolled as the PFP group, 30 matched runners without PFP were recruited as the control group. The PFP group was tested running with and without knee pain, while the control group had only one running test. Reflective marker coordinates and ground reaction force data were collected in each test. Knee kinematics and kinetics during running were reduced and compared between groups (PFP group without knee pain and control group) and between pain conditions (PFP group with knee pain and without knee pain), as well as between sexes. RESULTS Female and male participants with PFP had an increased peak knee valgus angle when running without pain compared to matched controls (P = 0.001), and to themselves when running with pain (P = 0.001). Male participants with PFP also had an increased peak knee flexion angle when running without pain compared to matched controls (P = 0.008), however did not decrease their peak knee flexion angle when running with pain (P = 0.245). No significant main effect of group or pain condition on any peak knee joint moment during running was detected (P ≥ 0.175). CONCLUSIONS Increased peak knee valgus angle during running appears to be a critical biomechanical factor associated with PFP in recreational runners, while decreasing knee valgus angle during running may be an adaptation to reduce symptoms of PFP. Increased peak knee flexion angle during running appears to be another biomechanical factor associated with PFP that is sex specific for male recreational runners.
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Affiliation(s)
- Chen Yang
- School of Sports and Health, Nanjing Sport Institute, Nanjing 210014, China
| | - Thomas M Best
- UHealth Sports Medicine Institute, University of Miami, Miami, FL 33136, USA
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China.
| | - Bing Yu
- Center for Human Movement Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Souza Júnior JRD, Rabelo PHR, Lemos TV, Barbosa GMP, Matheus JPC. Knowledge, interest, and preference for gait retraining programs in street runners: a cross-sectional study. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21016929012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Some treatment modalities have been used to prevent or treat running-related musculoskeletal injuries, among them, gait retraining. This study aimed to evaluate street runners’ knowledge, interest, and preference for gait retraining programs and assess if these aspects differ between runners with and without history of injury. This is a cross-sectional study with 100 runners. Initially, a text showing what gait retraining was about was presented to participants. Then, they answered questions about their knowledge (yes x no) and interest (yes x no) on the programs. Subsequently, a text showing how fully and partially supervised programs would be conducted was offered to participants. Then, they reported their preference for one of them (fully x partially supervised). We found that most athletes were unaware of gait retraining programs (69.8%), though they showed great interest in performing them after explanation (87.1%). We observed no preference for a fully (48.2%) or partially supervised (51.8%) protocol. We also found a statistical difference in knowledge (p=0.029) in favor of participants with history of injury. Despite the growing evidence available, we observed that most runners lack any prior knowledge of this modality. Due to the great interest and lack of preference for different protocols shown, we suggest that healthcare providers who treat this population offer the programs described to patients.
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22
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Souza Júnior JRD, Rabelo PHR, Lemos TV, Barbosa GMP, Matheus JPC. Conhecimento, interesse e preferência por programas de retreinamento de corrida em corredores de rua: estudo transversal. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21016929012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
RESUMO Com o intuito de prevenir ou reabilitar lesões musculoesqueléticas relacionadas à corrida, algumas modalidades de tratamento têm sido utilizadas, entre elas o retreinamento de corrida. O objetivo deste estudo foi avaliar o conhecimento, o interesse e a preferência acerca de programas de retreinamento de corrida por parte de corredores de rua e verificar se esses aspectos diferem entre corredores sem e com histórico de lesão. Trata-se de estudo transversal feito com 100 corredores. Inicialmente, um texto mostrando do que se tratava o retreinamento de corrida foi apresentado aos participantes, que então responderam com relação ao conhecimento (sim ou não) e ao interesse na realização (sim ou não). Posteriormente, um texto mostrando como seria a realização de um programa supervisionado e outro parcialmente supervisionado foi apresentado aos participantes, que responderam acerca de sua preferência por um deles (supervisionado ou parcialmente supervisionado). Constatou-se que a maioria desconhece os programas de retreinamento de corrida (69,8%), porém houve um alto interesse (87,1%) na realização do programa após a leitura do texto. Os participantes não apresentaram preferência por um protocolo totalmente supervisionado (48,2%) ou parcialmente supervisionado (51,8%). Foi encontrada uma diferença estatística quanto ao conhecimento (p=0,029) a favor dos participantes com histórico de lesão. Apesar das crescentes evidências disponíveis, observou-se que a maioria dos corredores não tem conhecimento prévio sobre esta modalidade. Devido ao alto interesse e à ausência de preferência por diferentes protocolos, sugere-se que os programas descritos sejam apresentados aos pacientes por profissionais da saúde que trabalhem com essa população.
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Bagheri S, Naderi A, Mirali S, Calmeiro L, Brewer BW. Adding Mindfulness Practice to Exercise Therapy for Female Recreational Runners With Patellofemoral Pain: A Randomized Controlled Trial. J Athl Train 2021; 56:902-911. [PMID: 33237990 DOI: 10.4085/1062-6050-0214.20] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Considering current models that highlight the role of psychological components in pain management, mindfulness practice may be an effective strategy in the management of pain. OBJECTIVE To examine the effects of adding an 8-week mindfulness program to exercise therapy on the perceptions of pain severity, knee function, fear of movement, and pain catastrophizing of female recreational runners with patellofemoral pain (PFP). DESIGN Randomized controlled clinical trial. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty female runners (age = 28.3 ± 7.08 years) with PFP were randomly assigned to the exercise or mindfulness-exercise group. INTERVENTION(S) The exercise-only group followed a protocol (18 weeks, 3 sessions/wk) that featured training modifications to help control injury-related symptoms. The mindfulness-exercise group received an 8-week mindfulness intervention in addition to the exercise protocol. The mindfulness component started 4 weeks before the exercise component; therefore, the 2 components overlapped during the first 4 weeks of the intervention. MAIN OUTCOME MEASURE(S) Usual pain, pain during stepping, and pain during running were assessed using visual analog scales. Functional limitations of the knee were assessed using the Knee Outcome Survey. Fear of movement, pain catastrophizing, and coping strategies were measured via the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Coping Strategies Questionnaire, respectively. These outcomes were assessed at baseline, at week 9, and after 18 weeks. RESULTS Pain during running, pain during stepping, and functional limitations of the knee were less for the mindfulness-exercise group than for the exercise-only group (P values < .05). The mindfulness-exercise group reported greater perceived treatment effects than the exercise-only group (P < .05). Pain catastrophizing was less and coping strategies were more favorable for mindfulness-exercise participants than for exercise-only participants (P values < .05). CONCLUSIONS Mindfulness practice can be an effective adjunct to exercise therapy in the rehabilitation of PFP in recreational female runners.
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Affiliation(s)
| | - Aynollah Naderi
- School of Sport Sciences, Shahrood University of Technology, Iran
| | - Samira Mirali
- Department of Sport Science, University College of Omran and Tosseeh, Hamedan, Iran
| | - Luís Calmeiro
- School of Social and Health Sciences, Abertay University, Dundee, UK
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Kunene S, Taukobong N, Ramklass S. Community-based rehabilitation implementation framework to address patellofemoral pain amongst runners in under-resourced communities: Delphi consensus. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1531. [PMID: 34230899 PMCID: PMC8252162 DOI: 10.4102/sajp.v77i1.1531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/19/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Runners in under-resourced communities in parts of South Africa present with a high prevalence of patellofemoral pain (PFP), which affects their level of participation in sporting activities. Therefore, a specific rehabilitation approach is necessary to manage the PFP-related needs of these runners within their means and reach. OBJECTIVE To develop a community-based rehabilitation (CBR) implementation framework for PFP amongst runners in under-resourced communities. METHOD Our study used the Delphi technique to develop an appropriate rehabilitation implementation framework for PFP in community-based settings. Sport medicine experts, involved in the treatment and rehabilitation of PFP, were recruited to participate. The Delphi process consisted of three rounds to attain consensus amongst the experts on the components and elements that could be contained in a rehabilitation implementation framework for the management of PFP. Experts rated the framework items using a five-point Likert scale. RESULTS A total of 19 experts participated in our study: 10 were females and 9 were males of whom 13 were aged between 36 and 55 years. Most were local experts (15) with 11-20 years of clinical experience. Four core rehabilitation implementation items were identified through the Delphi process. These were: (1) the establishment of transdisciplinary rehabilitation teams, (2) upskilling of available clinicians, their assistants and trainers, (3) implementation of a CBR programme at low-level or no-cost and (4) referral of cases to secondary or tertiary institutions for further management. CONCLUSION Consensus was reached for a comprehensive CBR implementation framework aimed at addressing the specific needs of runners with PFP in under-resourced communities. CLINICAL IMPLICATIONS A further study to test the feasibility of the agreed-upon intervention is recommended.
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Affiliation(s)
- Siyabonga Kunene
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nomathemba Taukobong
- Department of Institutional Planning, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Serela Ramklass
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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de Souza Júnior JR, Rabelo PHR, Lemos TV, Esculier JF, Carto JPDS, Matheus JPC. Effects of gait retraining with focus on impact versus gait retraining with focus on cadence on pain, function and lower limb kinematics in runners with patellofemoral pain: Protocol of a randomized, blinded, parallel group trial with 6-month follow-up. PLoS One 2021; 16:e0250965. [PMID: 33979372 PMCID: PMC8116042 DOI: 10.1371/journal.pone.0250965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
Patellofemoral pain (PFP) is one of the most prevalent injuries in runners. Unfortunately, a substantial part of injured athletes do not recover fully from PFP in the long-term. Although previous studies have shown positive effects of gait retraining in this condition, retraining protocols often lack clinical applicability because they are time-consuming, costly for patients and require a treadmill. The primary objective of this study will be to compare the effects of two different two-week partially supervised gait retraining programs, with a control intervention; on pain, function and lower limb kinematics of runners with PFP. It will be a single-blind randomized clinical trial with six-month follow-up. The study will be composed of three groups: a group focusing on impact (group A), a group focusing on cadence (group B), and a control group that will not perform any intervention (group C). The primary outcome measure will be pain assessed using the Visual Analog Pain scale during running. Secondary outcomes will include pain during daily activities (usual), symptoms assessed using the Patellofemoral Disorders Scale and lower limb running kinematics in the frontal (contralateral pelvic drop; hip adduction) and sagittal planes (foot inclination; tibia inclination; ankle dorsiflexion; knee flexion) assessed using the MyoResearch 3.14-MyoVideo (Noraxon U.S.A. Inc.). The study outcomes will be evaluated before (t0), immediately after (t2), and six months (t24) after starting the protocol. Our hypothesis is that both partially supervised gait retraining programs will be more effective in reducing pain, improving symptoms, and modifying lower limb kinematics during running compared with the control group, and that the positive effects from these programs will persist for six months. Also, we believe that one gait retraining group will not be superior to the other. Results from this study will help improve care in runners with PFP, while maximizing clinical applicability as well as time and cost-effectiveness.
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Affiliation(s)
- José Roberto de Souza Júnior
- Sciences and Technologies in Health Post-graduation Program, University of Brasília, Brasília, Federal District, Brazil
| | - Pedro Henrique Reis Rabelo
- Sciences and Technologies in Health Post-graduation Program, University of Brasília, Brasília, Federal District, Brazil
| | - Thiago Vilela Lemos
- Department of Physical Therapy, State University of Goiás, Goiânia, Goiás, Brazil
| | - Jean-Francois Esculier
- The Running Clinic, Lac Beauport, Quebec, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - João Pedro da Silva Carto
- Sciences and Technologies in Health Post-graduation Program, University of Brasília, Brasília, Federal District, Brazil
| | - João Paulo Chieregato Matheus
- Sciences and Technologies in Health Post-graduation Program, University of Brasília, Brasília, Federal District, Brazil
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Almeida GPL, Rodrigues HLDN, Coelho BAL, Rodrigues CAS, Lima PODP. Anteromedial versus posterolateral hip musculature strengthening with dose-controlled in women with patellofemoral pain: A randomized controlled trial. Phys Ther Sport 2021; 49:149-156. [PMID: 33689989 DOI: 10.1016/j.ptsp.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To compare the effectiveness of adding anteromedial versus posterolateral hip musculature strengthening to knee strengthening in women with patellofemoral pain (PFP). DESIGN Randomized controlled trial. SETTING University physiotherapy clinic. PARTICIPANTS Fifty-two women with PFP were randomized to receive either anteromedial (AMHG) or posterolateral (PLHG) hip musculature strengthening. MAIN OUTCOME MEASURES The primary outcomes were pain intensity by the numeric pain rating scale and function by the Anterior Knee Pain Scale in six weeks. Secondary outcomes were pain and function at six months, global perceived effect at six weeks and six months, pain in step down, isometric torque of abductors, adductors and hip rotators measured with hand-held dynamometer, and dynamic knee valgus by step down in six weeks. RESULTS Both groups showed improvement in primary outcomes; however, no differences were found between groups in pain intensity and function in six weeks and the secondary outcomes. Group x time interaction found superior gains in abductor strength in the PLHG and increase in the strength of the adductors and internal rotators in AMHG. CONCLUSION There was no difference between the addition of anteromedial or posterolateral hip musculature strengthening to knee strengthening in improving pain and function in women with PFP.
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Affiliation(s)
- Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | | | - Bruno Augusto Lima Coelho
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Carlos Augusto Silva Rodrigues
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Pedro Olavo de Paula Lima
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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Gallina A, Abboud J, Blouin JS. A task-relevant experimental pain model to target motor adaptation. J Physiol 2021; 599:2401-2417. [PMID: 33638152 DOI: 10.1113/jp281145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/22/2021] [Indexed: 01/23/2023] Open
Abstract
KEY POINTS Motor adaptation is thought to be a strategy to avoid pain. Current experimental pain models do not allow for consistent modulation of pain perception depending on movement. We showed that low-frequency sinusoidal stimuli delivered at painful intensity result in minimal habituation of pain perception (over 60 s) and minimal stimulation artefacts on electromyographic signals. When the amplitude of the low-frequency sinusoidal stimuli was modulated based on the vertical force participants applied to the ground with their right leg while standing upright, we demonstrated a strong association between perceived pain and motor adaptation. By enabling task-relevant modulation of perceived pain intensity and the recording electromyographic signals during electrical painful stimulation, our novel pain model will permit direct experimental testing of the relationship between pain and motor adaptation. ABSTRACT Contemporary pain adaptation theories predict that motor adaptation occurs to limit pain. Current experimental pain models, however, do not allow for pain intensity modulation according to one's posture or movements. We developed a task-relevant experimental pain model using low-frequency sinusoidal electrical stimuli applied over the infrapatellar fat pad. In fourteen participants, we compared perceived pain habituation and stimulation-induced artefacts in vastus medialis electromyographic recordings elicited by sinusoidal (4, 10, 20 and 50 Hz) and square electrical waveforms delivered at constant peak stimulation amplitude. Next, we simulated a clinical condition where perceived knee pain intensity is proportional to the load applied on the leg by controlling sinusoidal current amplitude (4 Hz) according to the vertical force the participants applied with their right leg to the ground while standing upright. Pain ratings habituated over a 60 s period for 50 Hz sinusoidal and square waveforms but not for low-frequency sinusoidal stimuli (P < 0.001). EMG filters removed most stimulation artefacts for low-frequency sinusoidal stimuli (4 Hz). While balancing upright, participants' pain ratings were correlated with the force applied by the right leg (R2 = 0.65), demonstrating task-relevant changes in perceived pain intensity. Low-frequency sinusoidal stimuli can induce knee pain of constant intensity for 60 s with minimal EMG artefacts while enabling task-relevant pain modulation when controlling current amplitude. By enabling task-dependent modulation of perceived pain intensity, our novel experimental model replicates key temporal aspects of clinical musculoskeletal pain while allowing quantification of neuromuscular activation during painful electrical stimulation. This approach will enable researchers to test the predicted relationship between movement strategies and pain.
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Affiliation(s)
- Alessio Gallina
- School of Kinesiology, University of British Columbia, Vancouver, Canada.,Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jacques Abboud
- School of Kinesiology, University of British Columbia, Vancouver, Canada.,Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.,Institute for Computing, Information and Cognitive Systems, University of British Columbia, Vancouver, Canada
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Luz BC, Dos Santos AF, Serrão FV. Are hip and knee kinematics and training load characteristics relate to pain intensity and physical function level in runners with Patellofemoral Pain? Gait Posture 2021; 84:162-168. [PMID: 33340846 DOI: 10.1016/j.gaitpost.2020.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/26/2020] [Accepted: 11/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is the most common running-related injury. Altered hip and knee kinematics and increases in weekly distance and running pace are often associated with PFP development and exacerbation. RESEARCH QUESTION Are altered movements and training load characteristics (weekly distance and running pace) relate to pain intensity or physical function level in runners with PFP? METHODS Forty recreational runners with PFP (20 males and 20 females) participated in this cross-sectional observational study. Three-dimensional hip and knee kinematics were quantified during the stance phase of running. Weekly distance was defined as the average weekly kilometers of running and running pace as the average pace of the activity measured as minutes per kilometer. A visual analogue scale was used to evaluate worst knee pain during the last week. The anterior knee pain scale (AKPS) was used to evaluate knee functional score. A Pearson correlation matrix was used to investigate the association between each dependent variable (worst pain in the last week and AKPS score) and the independent variables (knee and hip kinematics, weekly distance and running pace). RESULTS There was no significantly correlation between kinematic variables, pain and functional score for both males and females separately and combined. Weekly distance (km/week) was found to positively correlate to pain intensity (r = 0.452; p < 0.05) in females with PFP. A simple linear regression revealed that weekly distance was significant predictor emerged of pain in females with PFP. Females exhibited significantly greater peak hip adduction and hip adduction ROM than the males and males had significantly greater running pace compared to females. SIGNIFICANCE Weekly distance should be considered in the clinical context during rehabilitation of PFP in females runners aiming at pain reduction.
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Affiliation(s)
- Bruna Calazans Luz
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
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Luedke LE, Rauh MJ. Factors Associated With Self-Selected Step Rates Between Collegiate and High School Cross Country Runners. Front Sports Act Living 2021; 2:628348. [PMID: 33575547 PMCID: PMC7870465 DOI: 10.3389/fspor.2020.628348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/29/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: Cross country is a popular high school and collegiate sport with a high rate of running-related injuries (RRI). Among high school runners, higher step rates have been associated with greater running experience and decreased body height, and lower step rates have been prospectively associated with increased risk of shin RRI. These associations have not been reported in collegiate cross country runners. The purpose of this study was to compare step rates between collegiate and high school cross country runners. Secondary objectives included determining if step rates in collegiate runners were related to experience and anthropometric variables, and whether their self-selected step rates were prospectively related to lower extremity RRI. Materials and methods: Twenty-nine NCAA Division III collegiate cross country runners (13 females, mean ± SD age 19.7 ± 1.3 years) completed a survey and ran at their self-selected speed. Step rate was assessed with Polar RCX5 wristwatches and S3+ Stride Sensors™ on the first day of the season. Runners were followed during the season for occurrence of time-loss lower extremity RRI. A cohort of 68 high school runners was used for comparison of step rates at their self-selected speeds. Results: Collegiate runners' self-selected step rates (177.1 ± 7.2 spm [steps per minute]) were higher than high school runners' (171.3 ± 8.3 spm) (p = 0.01). Collegiate runners ran at higher self-selected speeds (4.6 ± 0.5 m/s) than the high school runners (3.8 ± 0.5 m/s) (p < 0.001). A lower percentage of collegiate runners ran at ≤166 spm than high school runners. Body mass was negatively correlated with step rate in collegiate runners. During the season, 41.3% of collegiate runners experienced lower extremity RRI. Step rates for collegiate runners who did not experience RRI (178.9 ± 7.7 spm) were not significantly higher than runners who did experience RRI (174.5 ± 5.7 spm) (p = 0.10). Discussion: Higher step rates were found in collegiate than high school runners, but the difference was partially explained by higher self-selected running speeds. Thus, variations in step rate between high school and collegiate runners may be expected based on experience, speed, and body mass.
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Affiliation(s)
- Lace E. Luedke
- Department of Kinesiology, University of Wisconsin Oshkosh, Oshkosh, WI, United States
| | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, United States
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Färnqvist K. Treating tendinopathies – are we searching for a needle in a haystack, when we should include the whole haystack? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2020.1773921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Correlation of pain sensitization with muscle strength and angular kinematics in women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2021; 81:105217. [PMID: 33213931 DOI: 10.1016/j.clinbiomech.2020.105217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patellofemoral pain has a poor long-term prognosis, which can be explained by a pain sensitization process. The pain sensitization process may be related to the increase of stress in the patellofemoral joint that is already associated with kinematic alterations and weakness in the musculature of the hip and knee. METHODS Were compared the pressure pain threshold, temporal summation, conditioned pain modulation, angular kinematics, and muscle strength between 26 patellofemoral pain and 24 asymptomatic women and then correlated pain sensitization variables with biomechanical variables in pain group. The pressure pain threshold was determined on seven points of the knee, tibialis anterior muscle, and elbow. Ten consecutive stimuli were performed for temporal summation, and cold water was used as the conditioning stimulus for conditioned pain modulation. The strength of hip and knee muscles was determined using a manual dynamometer. Three-dimensional kinematics were evaluated during the lateral step down, considering peak and excursion values of the movement and the Movement Deviation Profile. FINDINGS The pressure pain threshold of the elbow (2.13 [1.84-2.41] vs. 1.63 [1.25-2] kg/cm2), all sites of the knee were lower, as well as the Movement Deviation Profile was higher (9.33 [9.20-9.46] vs. 12.43 [12.1-12.75]) in the pain group. No difference in temporal summation, conditioned pain modulation, muscle strength and discrete kinematic values were found. No significant correlation was found between the Movement Deviation Profile and pressure pain threshold. INTERPRETATION Biomechanical factors, pain processing, and modulation in women with patellofemoral pain, when different from asymptomatic individuals, are not necessarily associated.
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Bonacci J, Fox A, Hall M, Fuller JT, Vicenzino B. Effect of gait retraining on segment coordination and joint variability in individuals with patellofemoral pain. Clin Biomech (Bristol, Avon) 2020; 80:105179. [PMID: 32980619 DOI: 10.1016/j.clinbiomech.2020.105179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/26/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait retraining is advocated for the management of patellofemoral pain. This case series examined changes in lower limb variability following 6-weeks of gait retraining in individuals with patellofemoral pain. METHODS Six runners with patellofemoral pain completed a 6-week physiotherapist-guided gait retraining program using minimalist footwear and increased cadence. Approximate entropy joint variability and segment coordination variability were calculated across the entire gait cycle during running at baseline, 6 and 12 weeks and compared using repeated measures analysis of variance and the standardised mean difference (SMD). FINDINGS Compared to baseline, there were large increases in hip joint transverse plane kinematic variability at 6 (SMD = 1.7) and 12 weeks (SMD = 1.3). Moderate increases in hip joint frontal plane and knee joint sagittal plane kinematic variability were also observed at 6 (SMD = 1.1 & 0.96) and 12 weeks (SMD = 1.1 & 0.89). Knee joint frontal plane and hip joint transverse plane kinetic variability demonstrated large increases from baseline at 6 (SMD = 1.3 & 0.9) and 12 weeks (SMD = 0.9 & 1.0). There was no main effect of time for segment coordination variability. All participants had clinically meaningful improvements in pain (visual analogue change score > 20 mm). INTERPRETATION Gait retraining increased joint kinematic and kinetic variability in those with patellofemoral pain and these changes persisted over 12 weeks. Increased variability was observed in joint kinematics and kinetics known to influence patellofemoral joint stress, which may vary patellofemoral joint loading patterns and partly explain the clinical effect.
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Affiliation(s)
- Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - Aaron Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Joel T Fuller
- Facullty of Medicine and Health Sciences, Macquarie University, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, Physiotherapy, University of Queensland, Australia
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McClinton SM, Cobian DG, Heiderscheit BC. Physical Therapist Management of Anterior Knee Pain. Curr Rev Musculoskelet Med 2020; 13:776-787. [PMID: 33128200 PMCID: PMC7661565 DOI: 10.1007/s12178-020-09678-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Anterior knee pain is a common musculoskeletal complaint among people of all ages and activity levels. Non-operative approaches with an emphasis on physical therapy management are the recommended initial course of care. The purpose of this review is to describe the current evidence for physical therapist management of anterior knee pain with consideration of biomechanical and psychosocial factors. RECENT FINDINGS The latest research suggests anterior knee pain is a combination of biomechanical, neuromuscular, behavioral, and psychological factors. Education strategies to improve the patient's understanding of the condition and manage pain are supported by research. Strong evidence continues to support the primary role of exercise therapy and load progression to achieve long-term improvements in pain and function. Preliminary studies suggest blood flow restriction therapy and movement retraining may be useful adjunct techniques but require further well-designed studies. Anterior knee pain includes multiple conditions with patellofemoral pain being the most common. An insidious onset is typical and often attributed to changes in activity and underlying neuromuscular impairments. A thorough clinical history and physical examination aim to identify the patient's pain beliefs and behaviors, movement faults, and muscle performance that will guide treatment recommendations. Successful physical therapist management involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.
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Affiliation(s)
- Shane M. McClinton
- Doctor of Physical Therapy Program, Des Moines University, Des Moines, IA USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI USA
| | - Bryan C. Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA
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Miller EM, Crowell MS, Morris JB, Mason JS, Zifchock R, Goss DL. Gait Retraining Improves Running Impact Loading and Function in Previously Injured U.S. Military Cadets: A Pilot Study. Mil Med 2020; 186:e1077-e1087. [PMID: 33215669 DOI: 10.1093/milmed/usaa383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/16/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Running-related musculoskeletal injury (RRI) among U.S. military service members continues to negatively impact force readiness. There is a paucity of evidence supporting the use of RRI interventions, such as gait retraining, in military populations. Gait retraining has demonstrated effectiveness in altering running biomechanics and reducing running load. The purpose of this pilot study was to investigate the clinical effect of a gait retraining intervention on a military cadet population recovering from a lower-extremity RRI. MATERIALS AND METHODS The study design is a pilot study. Before study initiation, institutional approval was granted by the Keller Army Community Hospital Office of Human Research Protections. Nine rearfoot strike (RFS) runners recovering from a lower-extremity RRI at the U.S. Military Academy were prospectively enrolled and completed a gait retraining intervention. Participants followed-up with their assigned medical provider 6 times over 10 weeks for a clinical evaluation and running gait retraining. Gait retraining was provided utilizing verbal, visual, and audio feedback to facilitate a change in running foot strike pattern from RFS to non-rearfoot strike (NRFS) and increase preferred running step rate. At pre-intervention and post-intervention running ground reaction forces (GRF) [average vertical loading rate (AVLR), peak vertical GRF], kinematic (foot strike pattern) and temporospatial (step rate, contact time) data were collected. Participants self-reported their level of function via the Single Assessment Numeric Evaluation, Patient-Specific Functional Scale, and total weekly running minutes. Paired samples t-tests and Wilcoxon signed rank tests were used to compare pre- and post-intervention measures of interest. Values of P < .05 were considered statistically significant. RESULTS Nine patients completed the 10-week intervention (age, 20.3 ± 2.2 years; height, 170.7 ± 13.8 cm; mass, 71.7 ± 14.9 kg; duration of injury symptoms, 192.4 ± 345.5 days; running speed, 2.8 ± 0.38 m/s). All nine runners (100%) transitioned from RFS to NRFS. Left AVLR significantly decreased from 60.3 ± 17.0 bodyweight per second (BW/s) before intervention to 25.9 ± 9.1 BW/s after intervention (P = 0.008; effect size (d) = 2.5). Right AVLR significantly decreased from 60.5 ± 15.7 BW/s to 32.3 ± 12.5 BW/s (P < .001; d = 2.0). Similarly, step rate increased from 169.9 ± 10.0 steps per minute (steps/min) before intervention to 180.5 ± 6.5 steps/min following intervention (P = .005; d = 1.3). Single Assessment Numeric Evaluation scores improved significantly from 75 ± 23 to 100 ± 8 (P = .008; d = 1.5) and Patient-Specific Functional Scale values significantly improved from 6 ± 2.3 to 9.5 ± 1.6 (P = .007; d = 1.8) after intervention. Peak vertical GRF (left, P = .127, d = 0.42; right, P = .052, d = 0.53), contact time (left, P = 0.127, d = 0.42; right, P = 0.052, d = 0.53), and total weekly continuous running minutes (P = 0.095, d = 0.80) remained unchanged at post-intervention. All 9 patients remained injury free upon a 6-month medical record review. CONCLUSIONS In 9 military service members with a RRI, a 10-week NRFS gait retraining intervention was effective in improving running mechanics and measures of function. Patients remained injury-free 6 months following enrollment. The outcomes of this pilot study suggest that individuals recovering from certain lower-extremity RRIs may benefit from transitioning to an NRFS running pattern.
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Affiliation(s)
- Erin M Miller
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Michael S Crowell
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Jamie B Morris
- Army-Baylor Doctorate of Physical Therapy Program, United States Army Medical Center of Excellence,Fort Sam Houston, TX 78234, USA
| | - John S Mason
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Rebeca Zifchock
- Department of Civil and Mechanical Engineering, United States Military Academy, West Point, NY 10996, USA
| | - Donald L Goss
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268, USA
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Abstract
Patellofemoral pain (PFP) is among the most common injuries in recreational runners. Current evidence does not identify alignment, muscle weakness, and patellar maltracking or a combination of these as causes of PFP. Rather than solely investigating biomechanics, we suggest a holistic approach to address the causes of PFP. Both external loads, such as changes in training parameters and biomechanics, and internal loads, such as sleep and psychological stress, should be considered. As for the management of runners with PFP, recent research suggested that various interventions can be considered to help symptoms, even if these interventions target biomechanical factors that may not have caused the injury in the first place. In this Current Concepts article, we describe how the latest evidence on education about training modifications, strengthening exercises, gait and footwear modifications, and psychosocial factors can be applied when treating runners with PFP. The importance of maintaining relative homeostasis between load and capacity will be emphasized. Recommendations for temporary or longer-term interventions will be discussed. A holistic, evidence-based approach should consist of a graded exposure to load, including movement, exercise, and running, while considering the capacity of the individual, including sleep and psychosocial factors. Cost, accessibility, and the personal preferences of patients should also be considered.
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Affiliation(s)
- Jean-Francois Esculier
- The Running Clinic, Lac Beauport, QC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- MoveMed Physiotherapy, Kelowna, BC, Canada
| | - Kevin Maggs
- The Running Clinic, Lac Beauport, QC, Canada
- Lively Health Clinic, Gainesville, VA
| | - Ellora Maggs
- The Running Clinic, Lac Beauport, QC, Canada
- Peak Performance Care Physical Therapy, Sonora, CA
| | - Blaise Dubois
- The Running Clinic, Lac Beauport, QC, Canada
- Physiothérapie et médecine du sport PCN, Quebec City, QC, Canada
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Winters M, Holden S, Lura CB, Welton NJ, Caldwell DM, Vicenzino BT, Weir A, Rathleff MS. Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. Br J Sports Med 2020; 55:bjsports-2020-102819. [PMID: 33106251 PMCID: PMC7982922 DOI: 10.1136/bjsports-2020-102819] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP). DESIGN Living systematic review with network meta-analysis (NMA). DATA SOURCES Sensitive search in seven databases, three grey literature resources and four trial registers. ELIGIBILITY CRITERIA Randomised controlled trials evaluating any treatment for PFP with outcomes 'any improvement', and pain intensity. DATA EXTRACTION Two reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V.2. We used Grading of Recommendations, Assessment, Development and Evaluation to appraise the strength of the evidence. PRIMARY OUTCOME MEASURE 'Any improvement' measured with a Global Rating of Change Scale. RESULTS Twenty-two trials (with forty-eight treatment arms) were included, of which approximately 10 (45%) were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait and see for any improvement at 3 months (education (OR 9.6, 95% credible interval (CrI): 2.2 to 48.8); exercise (OR 13.0, 95% CrI: 2.4 to 83.5); education+orthosis (OR 16.5, 95% CrI: 4.9 to 65.8); education+exercise+patellar taping/mobilisations (OR 25.2, 95% CrI: 5.7 to 130.3) and education+exercise+patellar taping/mobilisations+orthosis (OR 38.8, 95% CrI: 7.3 to 236.9)). Education+exercise+patellar taping/mobilisations, with (OR 4.0, 95% CrI: 1.5 to 11.8) or without orthosis (OR 2.6, 95% CrI: 1.7 to 4.2), were superior to education alone. At 12 months, education or education+any combination yielded similar improvement rates. SUMMARY/CONCLUSION Education combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-and-see approach. PROSPERO REGISTERATION NUMBER PROSPERO registration CRD42018079502.
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Affiliation(s)
- Marinus Winters
- Centre for General Practice at Aalborg University, Aalborg, Denmark
| | - Sinéad Holden
- Centre for General Practice at Aalborg University, Aalborg, Denmark
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bill T Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, University of Queensland, Brisbane, Queensland, Australia
| | - Adam Weir
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Sports Medicine and Exercise Clinic Haarlem (SBK), Haarlem, Netherlands
- Department of Orthopaedics, Erasmus MC University Medical Center for Groin Injuries, Rotterdam, Netherlands
| | - Michael Skovdal Rathleff
- Centre for General Practice at Aalborg University, Aalborg, Denmark
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Abstract
OBJECTIVE To evaluate the effect of education interventions compared with any type of comparator on managing patellofemoral pain (PFP). DESIGN Intervention systematic review. PROSPERO identifier: CRD42018088671. LITERATURE SEARCH MEDLINE, Embase, CINAHL, and Web of Science were searched for studies evaluating the effect of education on clinical and functional outcomes in people with PFP. STUDY SELECTION CRITERIA Two reviewers independently assessed studies for inclusion and quality. We included randomized controlled trials on PFP where at least 1 group received an education intervention (in isolation or in combination with other interventions). DATA SYNTHESIS Available data were synthesized via meta-analysis where possible; data that were not appropriate for pooling were synthesized qualitatively. Interpretation was guided by the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Nine trials were identified. Low-credibility evidence indicated that health education material alone was inferior to exercise therapy for pain and function outcomes. Low- and very low-credibility evidence indicated that health professional-delivered education alone produced outcomes similar to those of exercise therapy combined with health professional-delivered education for pain and function, respectively. CONCLUSION Health professional-delivered education may produce similar outcomes in pain and function compared to exercise therapy plus health professional-delivered education in people with PFP. J Orthop Sports Phys Ther 2020;50(7):388-396. Epub 29 Apr 2020. doi:10.2519/jospt.2020.9400.
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Davis IS, Tenforde AS, Neal BS, Roper JL, Willy RW. Gait Retraining as an Intervention for Patellofemoral Pain. Curr Rev Musculoskelet Med 2020; 13:103-114. [PMID: 32170556 DOI: 10.1007/s12178-020-09605-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Movement retraining in rehabilitation is the process by which a motor program is changed with the overall goal of reducing pain or injury risk. Movement retraining is an important component of interventions to address patellofemoral pain. The purpose of this paper is to review the methods and results of current retraining studies that are aimed at reducing symptoms of patellofemoral pain. RECENT FINDINGS The majority of studies reviewed demonstrated some improvement in patellofemoral pain symptoms and overall function. However, the degree of improvement as well as the persistence of improvement over time varied between studies. The greatest pain reduction and persistent changes were noted in those studies that incorporated a faded feedback design including between 8 and 18 sessions over 2-6 weeks, typically 3-4 sessions per week. Additionally, dosage in these studies increased to 30-45 min during later sessions, resulting in 177-196 total minutes of retraining. In contrast, pain reductions and persistence of changes were the least in studies where overall retraining volume was low and feedback was either absent or continual. Faulty movement patterns have been associated with patellofemoral pain. Studies have shown that strengthening alone does not alter these patterns, and that addressing the motor program is needed to effect these changes. Based upon the studies reviewed here, retraining faulty patterns, when present, appears to play a significant role in addressing patellofemoral pain. Therefore, movement retraining, while adhering to basic motor control principles, should be part of a therapist's intervention skillset when treating patients with PFP.
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Affiliation(s)
- Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
- Spaulding National Running Center, 1575 Cambridge St, Cambridge, MA, 02138, USA.
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding National Running Center, 1575 Cambridge St, Cambridge, MA, 02138, USA
| | - Bradley S Neal
- Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - Jenevieve L Roper
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - Richard W Willy
- School of Physical Therapy & Health Sciences, University of Montana, Missoula, MT, USA
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Effect of neuromuscular training augmented with knee valgus control instructions on lower limb biomechanics of male runners. Phys Ther Sport 2020; 43:89-99. [PMID: 32135451 DOI: 10.1016/j.ptsp.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine if combining neuromuscular training (NMT) with knee valgus control instructions (VCIs) can affect lower limb biomechanics and injury incidence in male novice runners and assess over 1-year follow-up. DESIGN Controlled laboratory Study. SETTING University research laboratory. PARTICIPANTS 60 male novice runners randomly assigned into NMT (n = 20), NMT plus VCIs (n = 20), and sham (n = 20). MAIN OUTCOME MEASURES Kinematic and kinetic were measured at pre- and post-test and 1-year follow-up. Injury incidence assessed at pre-test and 1-year follow up. RESULTS There were significant between-group differences in kinetics after 6 weeks in NMT plus VCIs group. No significant differences were observed between NMT and NMT plus VCIs in kinematic variables. No significant change was seen in the sham in all variables. At 1-year follow-up, the minimal changes were seen in kinetic variables. Reduction reported running-related injuries were 31.58% in the NMT alone group, 65.52% in NMT plus VCIs group. In sham, it increased to 13.46%. CONCLUSIONS NMT plus VCIs was effective to reduce kinetics and improve kinematics in novice runners. Also, it could reduce injury incidence. This protocol may be an option for both athletic trainers and coaches for preventing of lower limbs' injury in male runners.
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Kunene SH, Taukobong NP, Ramklass S. Rehabilitation approaches to anterior knee pain among runners: A scoping review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1342. [PMID: 32161824 PMCID: PMC7059446 DOI: 10.4102/sajp.v76i1.1342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/04/2019] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Many athletes complain of anterior knee pain (AKP) which is the most common clinical problem, with a prevalence of 15% - 45%, posing a threat to their quality of life. Owing to a lack of consensus among clinicians and researchers, the causes and management of AKP remain controversial. OBJECTIVES The aim of this study was to map the range of non-surgical and non-pharmaceutical rehabilitation approaches to AKP among runners. METHOD A scoping review was conducted in five stages: (1) defining the research question, (2) identifying relevant studies, (3) selecting a topic, (4) charting and collecting data and (5) summarising and reporting the results. Included in the study were English original articles on AKP rehabilitation strategies for runners prior to November 2019. Six electronic databases were searched: EBSCOHOST, CINAHL, SPORTDISCUS, PUBMED, COCHRANE and SCOPUS. RESULTS Thirteen out of 1334 articles met the inclusion criteria. Two reviewers independently participated in the screening and extraction of articles. The identified articles included four randomised controlled trials, one systematic review, four observational studies, one cohort study, two case studies and one quasi-experimental study. The following rehabilitation strategies were found to be useful: education, gait re-education, exercise, foot orthoses and multimodal rehabilitation. CONCLUSION This study provided a range of rehabilitation strategies that were found useful in the rehabilitation of AKP. More comprehensive intervention studies are needed to address all physical and non-physical features of AKP. CLINICAL IMPLICATIONS The outcomes of this study make explicit the usefulness of the identified rehabilitation strategies among runners with AKP. These will guide clinicians in the development of rehabilitation programmes for runners.
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Affiliation(s)
- Siyabonga H Kunene
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomathemba P Taukobong
- Institutional Planning Department, Faculty of Administration and Support, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Serela Ramklass
- School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Hott A, Brox JI, Pripp AH, Juel NG, Liavaag S. Patellofemoral pain: One year results of a randomized trial comparing hip exercise, knee exercise, or free activity. Scand J Med Sci Sports 2020; 30:741-753. [PMID: 31846113 DOI: 10.1111/sms.13613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Extended follow-up of a randomized trial comparing hip-focused exercise, knee-focused exercise, and free physical activity in patellofemoral pain (PFP). METHODS A single-blind randomized controlled trial included 112 patients aged 16-40 years (mean 27.6 years) with a clinical diagnosis of PFP ≥3 months (mean 39 months) and pain ≥3/10 on a Visual Analog Scale. Patients were randomized to a 6-week exercise-based intervention consisting of either isolated hip-focused exercises (n = 39), traditional knee-focused exercise (n = 37), or free physical activity (n = 36). All patients received the same patient education. The primary outcome measure was the Anterior Knee Pain Scale (AKPS, 0-100). Secondary outcomes were usual and worst pain, Tampa Scale of Kinesiophobia, Knee Self-Efficacy Score, Euro-Qol (EQ-5D-5L), step-down test, and isometric strength. Blinded observers assessed outcomes at baseline, 3, and 12 months. The study was designed to detect a difference in AKPS >10 at 12 months. RESULTS After 1 year, there were no significant between-group differences in any primary or secondary outcomes. Between-group differences for AKPS were as follows: knee versus free physical activity -4.3 (95% CI -12.3 to 3.7); hip versus free physical activity -1.1 (95% CI -8.9 to 6.7); and hip versus Knee 3.2 (95% CI -4.6 to 11.0). The cohort as a whole improved significantly at 3 and 12 months compared to baseline for all measures except for knee extension strength. CONCLUSION After 1 year, there was no difference in effectiveness of knee exercise, hip exercise, or free physical activity, when combined with patient education in PFP.
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Affiliation(s)
- Alexandra Hott
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Jens Ivar Brox
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Sigurd Liavaag
- Department of Orthopedic Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway
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Bramah C, Preece SJ, Gill N, Herrington L. A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months. Am J Sports Med 2019; 47:3406-3413. [PMID: 31657964 PMCID: PMC6883353 DOI: 10.1177/0363546519879693] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP. PURPOSE To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP. STUDY DESIGN Case series; Level of evidence, 4. METHODS Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome. RESULTS After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction (P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12° [95% CI, 1.88°-4.37°]), hip adduction (MD, 3.99° [95% CI, 2.01°-5.96°]), and knee flexion (MD, 4.09° [95% CI, 0.04°-8.15°]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale. CONCLUSION A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately. REGISTRATION NCT03067545 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Christopher Bramah
- School of Health Sciences, University of
Salford, Salford, UK,Christopher Bramah, MSc,
MCSP, School of Health Sciences, University of Salford, Blatchford Building,
Salford, M6 6PU, UK () (Twitter:
@chrisbramah)
| | | | - Niamh Gill
- School of Health Sciences, University of
Salford, Salford, UK
| | - Lee Herrington
- School of Health Sciences, University of
Salford, Salford, UK
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43
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Sisk D, Fredericson M. Update of Risk Factors, Diagnosis, and Management of Patellofemoral Pain. Curr Rev Musculoskelet Med 2019; 12:534-541. [PMID: 31773479 DOI: 10.1007/s12178-019-09593-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Patellofemoral pain is the most common cause of anterior knee pain. The purpose of this review is to examine the latest research on risk factors, physical examination, and treatment of patellofemoral pain to improve accuracy of diagnosis and increase use of efficacious treatment modalities. RECENT FINDINGS The latest research suggests patellofemoral pain pathophysiology is a combination of biomechanical, behavioral, and psychological factors. Research into targeted exercise therapy and other conservative therapy modalities have shown efficacy especially when used in combination. New techniques such as blood flow restriction therapy, gait retraining, and acupuncture show promise but require further well-designed studies. Patellofemoral pain is most commonly attributed to altered stress to the patellofemoral joint from intrinsic knee factors, alterations in the kinetic chain, or errors in training. Diagnosis can be made with a thorough assessment of clinical history and risk factors, and a comprehensive physical examination. The ideal treatment is a combination of conservative treatment modalities ideally individualized to the risk factors identified in each patient. Ongoing research should continue to identify biomechanical risk factors and new treatments as well as look for more efficient ways to identify patients who are amenable to treatments.
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Affiliation(s)
- Daniel Sisk
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA.
| | - Michael Fredericson
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
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Langevin P, Fait P, Frémont P, Roy JS. Cervicovestibular rehabilitation in adult with mild traumatic brain injury: a randomised controlled trial protocol. BMC Sports Sci Med Rehabil 2019; 11:25. [PMID: 31737275 PMCID: PMC6844027 DOI: 10.1186/s13102-019-0139-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activation (SPA) alone in adults with persistent headache, neck pain and/or dizziness-related following a mTBI on the severity of symptoms and on other indicators of clinical recovery. We hypothesize that such a program will improve all outcomes faster than a conventional approach (between-group differences at 6-week and 12-week). Methods In this single-blind, parallel-group randomized controlled trial, 46 adults with subacute (3 to12 weeks post-injury) persistent mTBI symptoms will be randomly assigned to: 1) a 6-week SPA program or 2) SPA combined with a cervicovestibular rehabilitation program. The cervicovestibular rehabilitation program will include education, cervical spine manual therapy and exercises, vestibular rehabilitation and home exercises. All participants will take part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome will be the Post-Concussion Symptoms Scale. The secondary outcomes will be time to clearance to return to function, number of recurrent episodes, Global Rating of Change, Numerical Pain Rating Scale, Neck Disability Index, Headache Disability Inventory and Dizziness Handicap Inventory. A 2-way ANOVA and an intention-to-treat analysis will be used. Discussion Controlled trials are needed to determine the best rehabilitation approach for mTBI with persistent symptoms such as neck pain, headache and dizziness. This RCT will be crucial to guide future clinical management recommendations. Trial registration ClinicalTrials.gov Identifier - NCT03677661, Registered on September, 15th 2018.
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Affiliation(s)
- Pierre Langevin
- Clinique Cortex and Physio interactive, 205-1035, avenue Wilfrid-Pelletier, QC Quebec, G1W 0C5 Canada.,2Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, bureau 4431, QC Quebec City, G1R 1P5 Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), 525, Boulevard Wilfrid Hamel, QC Quebec City, G1M 2S8 Canada
| | - Philippe Fait
- Clinique Cortex and Physio interactive, 205-1035, avenue Wilfrid-Pelletier, QC Quebec, G1W 0C5 Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), 525, Boulevard Wilfrid Hamel, QC Quebec City, G1M 2S8 Canada.,4Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351, boul. des Forges, QC Trois-Rivières, G8Z 4M3 Canada.,5Research Center in Neuropsychology and Cognition (CERNEC), Pavillon Marie-Victorin, 90, rue Vincent d'Indy, QC Montreal, H2V 2S9 Canada
| | - Pierre Frémont
- 2Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, bureau 4431, QC Quebec City, G1R 1P5 Canada
| | - Jean-Sébastien Roy
- 2Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, bureau 4431, QC Quebec City, G1R 1P5 Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), 525, Boulevard Wilfrid Hamel, QC Quebec City, G1M 2S8 Canada
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Kedroff L, Li Ko Lun A, Shimoni D, Bearne LM. Cognitive behavioural therapy-informed physiotherapy for patellofemoral pain: A feasibility study. Musculoskeletal Care 2019; 17:382-389. [PMID: 31691524 DOI: 10.1002/msc.1429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Louise Kedroff
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Alain Li Ko Lun
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Doron Shimoni
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Lindsay M Bearne
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
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Hu H, Zheng Y, Liu X, Gong D, Chen C, Wang Y, Peng M, Wu B, Wang J, Song G, Zhang J, Guo J, Dong Y, Wang X. Effects of neuromuscular training on pain intensity and self-reported functionality for patellofemoral pain syndrome in runners: study protocol for a randomized controlled clinical trial. Trials 2019; 20:409. [PMID: 31288849 PMCID: PMC6617607 DOI: 10.1186/s13063-019-3503-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is common and affects approximately 15% of individuals at different ages and activity levels. As a non-surgical intervention, physiotherapy is widely used to treat PFPS. Neuromuscular training exercise is one of the most effective methods for decreasing musculoskeletal pain and improving knee function. However, the effectiveness of neuromuscular training exercise for treating PFPS is not without argument. The purpose of this study is to evaluate the effect of neuromuscular training exercise on patellofemoral pain and whether the neuromuscular training exercise have more advantage effects than taping and health education. METHODS We will operate a prospective, single-blind, randomized controlled trial of 60 patients with patellofemoral pain. Individuals will be indiscriminately assigned to two intervention groups and a health education group. The neuromuscular training exercise which includes the muscle strength training, balance training and knee joint proprioception training, and taping group will use "Y" and "I" type taping on the participants three times a week for three months. The health education group will be given education lectures once each week and which last for three months. The primary outcome measures include the adverse events, visual analog scale for pain, and Anterior Knee Pain Scale Index, which is a knee function self-report questionnaire to evaluate the function of the knee especially for PFPS patients. The secondary outcome measures are the muscle strength and endurance of knee joint flexion and extensor muscles, knee joint proprioception, muscle thickness of the quadriceps femoris, knee function ability, and quality of life. We will manage the intention-to-treat analysis for individuals who will withdraw from this study. DISCUSSION According to previous studies, neuromuscular training exercise and the taping method are effective treatment for PFPS patients. In this study, we will perform a neuromuscular training exercise for patients with PFPS. We believe that this study may prove the effectiveness of neuromuscular training exercise in treating PFPS. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1800014995 . Registered on 27 February 2018.
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Affiliation(s)
- Haoyu Hu
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Yili Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Xiaochen Liu
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Di Gong
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Changcheng Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Yizu Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Mengsi Peng
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Bao Wu
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Juan Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Ge Song
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Juan Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Jiabao Guo
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Yulin Dong
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai RD, Shanghai, China. .,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedics Hospital, Shanghai, 200438, China.
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Toward the Development of Data-Driven Diagnostic Subgroups for People With Patellofemoral Pain Using Modifiable Clinical, Biomechanical, and Imaging Features. J Orthop Sports Phys Ther 2019; 49:536-547. [PMID: 31213159 DOI: 10.2519/jospt.2019.8607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unfavorable treatment outcomes for people with patellofemoral pain (PFP) have been attributed to the potential existence of subgroups that respond differently to treatment. OBJECTIVES This study aimed to identify subgroups within PFP by combining modifiable clinical, biomechanical, and imaging features and exploring the prognosis of these subgroups. METHODS This was a longitudinal cohort study, with baseline cluster analyses. Baseline data were analyzed using a 2-stage cluster analysis; 10 features were analyzed within 4 health domains before being combined at the second stage. Prognosis of the subgroups was assessed at 12 months, with subgroup differences reported as global rating of change and analyzed with an exploratory logistic regression adjusted for known confounders. RESULTS Seventy participants were included (mean age, 31 years; 43 [61%] female). Cluster analysis revealed 4 subgroups: "strong," "pronation and malalignment," "weak," and "active and flexible." Descriptively, compared to the strong subgroup (55% favorable), the odds of a favorable outcome were lower in the weak subgroup (31% favorable; adjusted odds ratio [OR] = 0.30; 95% confidence interval [CI]: 0.07, 1.36) and the pronation and malalignment subgroup (50%; OR = 0.64; 95% CI: 0.11, 3.66), and higher in the active and flexible subgroup (63%; OR = 1.24; 95% CI: 0.20, 7.51). After adjustment, compared to the strong subgroup, differences between some subgroups remained substantive, but none were statistically significant. CONCLUSION In this relatively small cohort, 4 PFP subgroups were identified that show potentially different outcomes at 12 months. Further research is required to determine whether a stratified treatment approach using these subgroups would improve outcomes for people with PFP. LEVEL OF EVIDENCE Diagnosis, level 2b. J Orthop Sports Phys Ther 2019;49(7):536-547. doi:10.2519/jospt.2019.8607.
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A proximal progressive resistance training program targeting strength and power is feasible in people with patellofemoral pain. Phys Ther Sport 2019; 38:59-65. [PMID: 31055059 DOI: 10.1016/j.ptsp.2019.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the feasibility of a 12-week progressive resistance training program for people with patellofemoral pain (PFP) targeting proximal muscle strength and power; and resulting clinical and muscle capacity outcomes. DESIGN Feasibility study. SETTING Clinical environment. PARTICIPANTS Mixed-sex sample of people with PFP. MAIN OUTCOME MEASURES Feasibility outcomes included eligibility, recruitment rate, intervention adherence, and drop-outs. Secondary outcomes included perceived recovery, physical function (AKPS and KOOS-PF), worst pain (VAS-cm), kinesiophobia (Tampa), physical activity (IPAQ), and hip strength (isometric and 10 repetition maximum) and power. RESULTS Eleven people, from 36 who responded to advertisements, commenced the program. One participant withdrew. Ten participants who completed the program reported improvement (3 completely recovered; 6 marked; and 1 moderate). Higher AKPS (effect size [ES] = 1.81), improved KOOS-PF (ES = 1.37), and reduced pain (ES = 3.36) occurred alongside increased hip abduction and extension dynamic strength (ES = 2.22 and 1.92, respectively) and power (ES = 0.78 and 0.77, respectively). Isometric strength improved for hip abduction (ES = 0.99), but not hip extension. CONCLUSION A 12-week progressive resistance training program targeting proximal muscle strength and power is feasible and associated with moderate-large improvements in pain, function, and hip muscle capacity in people with PFP. Further research evaluating the efficacy of progressive resistance training is warranted.
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49
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Hott A, Brox JI, Pripp AH, Juel NG, Paulsen G, Liavaag S. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. Am J Sports Med 2019; 47:1312-1322. [PMID: 30958707 DOI: 10.1177/0363546519830644] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exercise for patellofemoral pain (PFP) is traditionally knee focused, targeting quadriceps muscles. In recent years, hip-focused exercise has gained popularity. Patient education is likely an important factor but is underresearched. PURPOSE To compare 3 treatment methods for PFP, each combined with patient education: hip-focused exercise, knee-focused exercise, or free physical activity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A single-blind randomized controlled trial was performed with 112 patients who were 16 to 40 years old (mean, 27.6 years) and had a symptom duration >3 months (mean, 39 months) with a clinical diagnosis of PFP and no radiograph or magnetic resonance evidence of other pathology. Patients were randomized to a 6-week intervention consisting of patient education combined with isolated hip-focused exercise (n = 39), traditional knee-focused exercise (n = 37), or free physical activity (n = 36). The primary outcome was Anterior Knee Pain Scale (0-100) at 3 months. Secondary outcomes were visual analog scale for pain, Tampa Scale for Kinesiophobia, Knee Self-efficacy Scale, EuroQol, step-down, and isometric strength. RESULTS There were no between-group differences in any primary or secondary outcomes at 3 months except for hip abduction strength and knee extension strength. Between-group differences at 3 months for Anterior Knee Pain Scale were as follows: knee versus control, 0.2 (95% CI, -5.5 to 6.0); hip versus control, 1.0 (95% CI, -4.6 to 6.6); and hip versus knee, 0.8 (95% CI, -4.8 to 6.4). The whole cohort of patients improved for all outcomes at 3 months except for knee extension strength. CONCLUSION The authors found no difference in short-term effectiveness in combining patient education with knee-focused exercise, hip-focused exercise, or free training for patients with PFP. REGISTRATION NCT02114294 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Alexandra Hott
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Jens Ivar Brox
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Gøran Paulsen
- The Norwegian Olympic and Paralympic Committee and Confederation of Sport, Oslo, Norway
| | - Sigurd Liavaag
- Department of Orthopedic Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway
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50
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Biomechanical Risk Factors Associated with Running-Related Injuries: A Systematic Review. Sports Med 2019; 49:1095-1115. [DOI: 10.1007/s40279-019-01110-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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