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Melo SA, Macedo LDB, Bullhões LCC, Cavalcanti RL, Azevedo Rodolfo JID, Brasileiro JS. Effects of neuromuscular electrical stimulation on patellofemoral pain: A randomized controlled trial. J Bodyw Mov Ther 2024; 39:390-397. [PMID: 38876657 DOI: 10.1016/j.jbmt.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Patellofemoral Pain (PFP) is a common dysfunction that can compromise the performance of daily activities. Neuromuscular electrical stimulation (NMES) has been proposed as a complementary tool in the therapeutic approach. OBJECTIVE To analyze the effects of adding NMES to therapeutic exercises in women with PFP. METHODS Randomized controlled trial involving 34 women with PFP (mean age 23.8 ± 4.1), randomly assigned to two groups: exercises combined with NMES (ESG) and exercises only (ExG). The ExG followed an exercise protocol, while the ESG performed the same exercises combined with NMES. Interventions were performed twice a week for eight weeks. Primary outcome measures included pain and functional disability, while secondary outcomes encompassed electromyographic activity of the quadriceps and hip abductors, along with isokinetic performance. Assessments were performed before the intervention, after 4 and 8 weeks from the start of the protocol and 8 weeks after the conclusion of the treatment. RESULTS We did not observe difference between the groups in any of the analyzed variables. Both groups showed a reduction in pain and an improvement in functional disability during intragroup comparisons. CONCLUSION A reduction in pain and an improvement in functional disability were observed; however, there was no additional effect of NMES. TRIAL REGISTRATION NCT03918863.
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Affiliation(s)
- Samara Alencar Melo
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Liane de Brito Macedo
- Faculty of Health Sciences of Trairi of the Federal University of Rio Grande do Norte, (UFRN), Av. Rio Branco, S/N, Santa Cruz, RN, CEP: 59.200-000, Brazil.
| | - Lidiane Cristina Correia Bullhões
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Rafael Limeira Cavalcanti
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Jully Israely de Azevedo Rodolfo
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Jamilson Simões Brasileiro
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
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Liu H, Chen X, Li Y, Gao Z, Huang W, Jiang Z. Neuromuscular control strategies of the lower limb during a typical Tai Chi brush knee and twist step in practitioners with and without knee pain: a pilot study. Res Sports Med 2024; 32:679-694. [PMID: 37246805 DOI: 10.1080/15438627.2023.2219799] [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: 01/03/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
As a complex movement, Tai Chi (TC) could be challenging for knee control, and the compensatory changes in TC biomechanics of knee pain patients are unknown. The Brush Knee and Twist Step (BKTS) is a typical TC movement that involves basic leg motion repeated in the whole TC. This pilot study examined electromyography and retro-reflective marker trajectory data to investigate neuromuscular control strategies of the lower extremity during BKTS in TC practitioners with and without knee pain. Twelve experienced TC practitioners with (n = 6) and without knee pain (n = 6) participated. Our results revealed that knee pain practitioners presented muscle imbalance in the vastus medialis-vastus lateralis and vastus lateralis-biceps femoris, and poor alignment of the knee with the toes in TC lunge. Additionally, they adaptively developed rigid coordination strategies, showing higher levels of lower limb muscle co-contraction and activity compared to controls. Training programs for TC practitioners with knee pain should be designed to modify both abnormal muscle synergy patterns and incorrect lunge during TC, which may improve exercise safety.
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Affiliation(s)
- Hong Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaolin Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yaping Li
- Department of Rehabilitation, Fujian Provincial Hospital, Fuzhou, China
| | - Zhen Gao
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- The First Clinical Medical College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Wujie Huang
- Department of Rehabilitation, Shenzhen Children's Hospital, Shenzhen, China
| | - Zheng Jiang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Deysel G, van Aswegen M, Kramer M. Assessing quadriceps strength in patellofemoral pain patients: A study on the reliability and validity of a low-cost strain-gauge for clinical practice. PLoS One 2024; 19:e0298570. [PMID: 38805492 PMCID: PMC11132478 DOI: 10.1371/journal.pone.0298570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common knee complaint affecting diverse populations both acutely and chronically. Quadriceps muscle weakness is one possible aetiology, but current devices for measuring muscle strength (isokinetic dynamometer [ID] and hand-held dynamometers [HHD]) are frequently too expensive (e.g., ID) or lack reliability (e.g., HHD) for practitioners, especially in under-resourced settings. There is a need to evaluate a low-cost device to manage rehabilitation of people with PFP. METHODS Isometric quadriceps strength of participants aged 18-35 years (total [n = 33], control group [n = 17] and PFP group [n = 16]) were evaluated on an isokinetic dynamometer and a commercially available strain gauge at baseline and after an 8-week non-standardised intervention. RESULTS The strain gauge showed high absolute and relative reliability (intraclass correlation coefficient = 0.89-0.99; typical error of measurement = 3.9-10.4%). Clinically meaningful difference scores (12.2-45 Nm) were greater than the typical error of measurement, implying sufficient sensitivity of the strain gauge to measure true changes in isometric quadricep strength. Strong to very strong correlations were evident between the strain gauge and isokinetic dynamometer torque measurements (r = 0.88-0.90, SEE = 0.05-0.07 Nm), but slope values (β = 0.65-0.77) indicated that torque from the strain gauge was lower than that obtained from the isokinetic dynamometer. An average systematic bias of 16.3-28.8 Nm was evident in favour of the isokinetic dynamometer, with no statistically significant between-group differences apparent between baseline and follow-up testing. CONCLUSION The present commercially available strain gauge is reliable and sensitive enough to detect clinically meaningful differences in quadriceps strength of both healthy individuals and those with PFP. However, the strain gauge lacks validity and therefore cannot replace isokinetic dynamometry. Given the low cost and excellent reliability, the strain gauge can be a valuable tool to assess quadriceps muscle deficits and track rehabilitation progress in people with PFP.
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Affiliation(s)
- Germari Deysel
- Physical Activity, Sport, and Recreation (PhasRec) Research Focus Area, North-West University, Potchefstroom, North West Province, South Africa
| | - Mariaan van Aswegen
- Physical Activity, Sport, and Recreation (PhasRec) Research Focus Area, North-West University, Potchefstroom, North West Province, South Africa
| | - Mark Kramer
- Physical Activity, Sport, and Recreation (PhasRec) Research Focus Area, North-West University, Potchefstroom, North West Province, South Africa
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Cederbaum LA, Yoon S, Côté JN. Males and females have similar neuromuscular coordination strategies of the quadriceps during fatiguing repeated all-out cycling. Front Sports Act Living 2023; 5:1248303. [PMID: 37780119 PMCID: PMC10541224 DOI: 10.3389/fspor.2023.1248303] [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: 06/27/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction An imbalance of vastus medialis (VM) and vastus lateralis (VL) muscle activation and patterns of dyscoordination may contribute to the sex discrepancy in the incidence of patellofemoral pain syndrome (PFPS). While some studies have examined sex-specific VM/VL coordination strategies in some tasks, no previous studies have examined sex-specific VM/VL coordination strategies during repeated sprint exercise (RSE). Methods In this study, asymptomatic young adults (N = 39, 19 females) completed a RSE protocol consisting of 10 × 10 s all-out cycling interspersed by 30 s of passive rest. Electromyographic (EMG) signals from the VM and VL muscles were recorded throughout exercise. Results VM:VL ratio did not change with fatigue and was not different between the sexes. From sprint 1 to 10, VM-VL onset delay increased from 9.62 to 16.95 ms and from 19.28 to 45.09 ms in males and females, respectively (p < 0.001); however, no sex difference was found (p = 0.524). Muscle activation amplitude plateaued at different sprint repetitions in males and females while mechanical work plateaued at similar repetitions. Discussion These findings suggest that sex differences in the incidence of PFPS may not be influenced by VM/VL muscle coordination as assessed by EMG.
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Affiliation(s)
- Lauren A. Cederbaum
- Department of Kinesiology and Physical Education, Biomechanics of Occupation and Sport Laboratory, McGill University, Montreal, QC, Canada
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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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Hatefi M, Hadadnezhad M, Shojaedin S, Babakhani F, Tazji MK. The effects of the Posterior X Taping versus augmented feedback on lower-extremity kinematic and muscle activity pattern during unilateral weight-bearing activities in men with tibiofemoral varus malalignment. J Exp Orthop 2023; 10:70. [PMID: 37468708 DOI: 10.1186/s40634-023-00636-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE Tibiofemoral Varus Malalignment (TFRV) contributes to overuse injuries by altering lower limb biomechanics. Both Posterior X Taping (PXT) and Real Time Feedback (RTF), have each been recommended for subjects with TFRV as they are thought to enhance control of excessive tibiofemoral rotations. This paper evaluates this claim. METHODS A total of recreational male 24 athletes with TFRV participated in the current study. Kinematic and electromyography variables of lower extremity were synchronously recorded on five consecutive repetitions of the single-legged-squat (SLS) and forward-step-down) FSD) tasks before and after applications of PXT and RTF. RESULTS The subjects at post-intervention in RTF group exhibited decreased hip adduction during FSD, and decreased hip adduction and internal rotation during eccentric and concentric phases of the SLS; Additionally, we observed increased gluteus medius activity during eccentric phase of the SLS and FSD tasks. In contrast, subjects at the post-intervention in PXT group exhibited decreased tibiofemoral external rotation and increased ankle external rotation during all the phases of both SLS and FSD tasks. CONCLUSION These results suggest that the PXT and RTF interventions are recommended to immediately improve the functional defects of the subjects with TFRV during SLS and FSD tasks.
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Affiliation(s)
- Mohamadreza Hatefi
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education, Kharazmi University, Tehran, Iran.
| | - Malihe Hadadnezhad
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education, Kharazmi University, Tehran, Iran
| | - Sadredin Shojaedin
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education, Kharazmi University, Tehran, Iran
| | - Farideh Babakhani
- Department of Sport Injuries and Corrective Exercises, Faculty of Physical Education, Allameh Tabataba'i University, Tehran, Iran
| | - Mehdi Khaleghi Tazji
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education, Kharazmi University, Tehran, Iran
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Frontal plane projection angle predicts patellofemoral pain: Prospective study in male military cadets. Phys Ther Sport 2023; 59:73-79. [PMID: 36525739 DOI: 10.1016/j.ptsp.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a major source of knee pain. Identifying who may develop PFP is of paramount importance. PURPOSE To assess whether Frontal plane projection angles (FPPA) and hand held dynamometry (HHD) strength measures can predict development of PFP. STUDY DESIGN Prospective evaluation of individuals undertaking a military training programme. METHODS Male military recruits were enrolled and prospectively followed up from enrolment to completion of 12-weeks training. Lower limb kinematics (FPPA, Q-angle, hip adduction angle, knee flexion, ankle dorsiflexion, and rearfoot eversion angle) measured during running, single leg squatting (SLS), and single leg landing (SLL) and isometric muscle strength of hip abductors and knee extensors. RESULTS Body mass, hip abductor muscle strength, Q-angle during SLS and SLL, FPPA during SLL all significantly different between the PFP and non-injured groups and predicted PFP, highest predictor variable was FPPA during SLL (Odds Ratio = 1.13, P = 0.01). A FPPA≥5.2° during SLL predicting PFP with a sensitivity of 70% and a specificity of 70%. CONCLUSION Participants who developed PFP had a number of physical factors significantly different than the non-injured group, most predictive was a larger FPPA during SLL, with angles greater than 5.2° associated with a 2.2x greater risk. CLINICAL RELEVANCE Assessing FPPA during SLL could be used to determine who was predisposed to PFP.
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Differences between vastus medialis and lateralis excitation onsets are dependent on the relative distance of surface electrodes placement from the innervation zone location. J Electromyogr Kinesiol 2022; 67:102713. [PMID: 36215780 DOI: 10.1016/j.jelekin.2022.102713] [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: 04/10/2022] [Revised: 08/31/2022] [Accepted: 09/28/2022] [Indexed: 12/12/2022] Open
Abstract
Conflictual results between the onset of vastus medialis (VM) and vastus lateralis (VL) excitation may arise from methodological aspects related to the detection of surface electromyograms. In this study we used an array of surface electrodes to assess the effect of detection site, relative to the muscle innervation zone, on the difference between VM and VL excitation onsets. Ten healthy males performed moderate isometric knee extension at 40 % of their maximal voluntary isometric contraction. After the actual VM-VL onset was defined (estimated when action potentials were generated at the neuromuscular junctions of both muscles), we calculated the largest bias that the detection site may introduce in the VM-VL onset estimation. We also assessed whether the location often considered for positioning bipolar electrodes on each muscle leads to VM-VL onset estimations comparable to the actual VM-VL onset. Our main results revealed that a maximum absolute bias of 20.48 ms may be introduced in VM-VL onset estimations due to the electrodes' detection site. In addition, mean differences of ∼ 12 ms in VM-VL onset estimations were attributable to largest possible discrepancies in the paired position of channels with respect to the innervation zone for VL and VM. When considering the classical location for positioning the bipolar electrodes over these muscles, differences error was subtle (∼3.4 ms) when compared with the actual VM-VL onset. Nonetheless, when accounting for the effect of relative differences in electrode position between muscles is not possible, our results suggest that a systematic absolute error of ∼ 12 ms should be considered in future studies regarding VM-VL onset estimations, suggesting that onset differences lower than that might not be clinically relevant.
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Frese C, Bubeck D, Alt W. Reduced Vastus Medialis/Lateralis EMG Ratio in Volleyballers with Chronic Knee Pain on Sports-Specific Surfaces: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9920. [PMID: 36011566 PMCID: PMC9408285 DOI: 10.3390/ijerph19169920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Even though chronic knee pain is common in volleyball, neuromuscular imbalance as a potential risk factor has not been investigated in volleyball-specific tasks. The aim of the study was to compare neuromuscular control between healthy and injured players in a clinical jump test and a volleyball-specific jump task in real field conditions. METHODS Six athletes with knee pain and nine controls were included. Surface electromyographic data were recorded from the mm. vastus medialis (VM) and lateralis (VL) of both legs. VM/VL activation ratio was calculated from countermovement jump (CMJ) and volleyball spike indoors and on two beach surfaces. RESULTS All subjects had pain in the leading leg. Mann-Whitney U Test (M-W-U Test) revealed a significantly lower VM/VL ratio of the leading leg (always affected) of the injured compared with that of the healthy control group for the CMJ and spike jump on all three grounds. Bland-Altman analysis revealed low bias and low difference in standard deviation for the injured leg but high values for the uninvolved leg and healthy controls between tasks and grounds. These results could indicate that neuromuscular control might not adapt too well to different movement tasks and grounds in the injured leg. CONCLUSION Athletes with chronic knee pain might have lower VM/VL ratios than controls independent from movement task and ground. Neuromuscular control in injured athletes might be less adaptable to new circumstances. The results of neuromuscular control in laboratory settings might be applicable to field conditions in injured legs but not healthy ones.
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Carvalho C, de Oliveira MPB, Pisani GK, Marolde IB, Serrão PRMDS. Biomechanical characteristics and muscle function in individuals with patellofemoral osteoarthritis: A systematic review of cross-sectional studies. Clin Biomech (Bristol, Avon) 2022; 98:105721. [PMID: 35868250 DOI: 10.1016/j.clinbiomech.2022.105721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our objective was to investigate kinematic and kinetic characteristics and changes in muscle function in individuals with patellofemoral osteoarthritis compared to healthy individuals. METHODS Searches were performed of the Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases until May of 2022 for observational studies comparing individuals with patellofemoral osteoarthritis to a control group. The PRISMA guidelines and recommendations of the Cochrane Collaboration were followed. The GRADE approach was used to analyze and synthesize the level of evidence. FINDINGS Fourteen studies were included, involving a total of 594 participants (360 with patellofemoral osteoarthritis and 234 controls). The level of evidence for pelvis, hip adduction and knee abduction angles at 45° of knee flexion during the single-leg squat, and knee flexion angle during the task of walking was very low. Regarding muscle strength, the level of evidence for isometric strength of the hip abductors, extensors and external rotators, and concentric strength of the knee extensors and flexors was very low. It was not possible to synthesize any type of evidence for kinetic, electromyography, or muscle volume variables. INTERPRETATION The level of evidence was very low for all synthesized evidence for kinematic and muscle strength variables. However, individuals with patellofemoral osteoarthritis have lower isometric strength of the hip abductor muscles. Further studies with adequate adjustment for confounding factors, such as the non-inclusion of individuals with osteoarthritis in the tibiofemoral compartment concomitant to patellofemoral osteoarthritis, are needed to gain a better understanding of the clinical characteristics of patellofemoral osteoarthritis.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Isabela Bianchini Marolde
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
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How to Work with Electromyography Decomposition in Practical Classes of Exercise Physiology and Biomechanics. Life (Basel) 2022; 12:life12040483. [PMID: 35454974 PMCID: PMC9033016 DOI: 10.3390/life12040483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Concepts about motor unit recruitment are important learning contents in exercise physiology and biomechanics classes that are usually taught theoretically. In the last few years, great advances have occurred in the decomposition of surface electromyography, allowing the learning of theoretical contents in an experimental way. In this tutorial paper, we have described the decomposition of surface electromyography methodological aspects and examples to teach motor unit recruitment concepts in exercise physiology and biomechanics practical lessons. This work has the aim to facilitate physiology and biomechanics academics to introduce this technique in practical classes.
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Effect of soft tissue manipulation of popliteus muscle on quadriceps muscle activity and torque production in athletes with anterior knee pain. BIOMEDICAL HUMAN KINETICS 2022. [DOI: 10.2478/bhk-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: Popliteus is majorly associated with posterior knee pain; however, this muscle can also have an impact on anterior knee pain. The purpose of this study was to determine the effect of soft tissue manipulation of popliteus muscle on non-traumatic anterior knee pain in athletes; as the relationship between popliteus and Quadriceps muscle has not been studied/explored much.
Materials and methods: In this experimental study, 15 subjects presenting with non-traumatic anterior knee pain were selected. Quadriceps muscle activity, torque production and knee pain were assessed. Followed by a single session of popliteus manipulation all the above parameters were re-assessed immediately and at 24 hours after intervention.
Results: Significant reduction in pain (P < 0.005) at 24 hours was observed. There was a significant increase in muscle activity of Vastus Medialis (P < 0.05) and Vastus Lateralis (P < 0.005) immediately after the intervention but not after 24 hours. No significant change was found in the activity of Rectus femoris and Peak torque of Quadriceps immediately after the intervention and at 24 hours.
Conclusion: Soft tissue manipulation decreased knee pain and improved muscle activity. Therefore, incorporating popliteus manipulation can be effective in treatment of anterior knee pain.
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Kesary Y, Singh V, Frenkel-Rutenberg T, Greenberg A, Dekel S, Schwarzkopf R, Snir N. Botulinum toxin injections as salvage therapy is beneficial for management of patellofemoral pain syndrome. Knee Surg Relat Res 2021; 33:39. [PMID: 34715941 PMCID: PMC8555335 DOI: 10.1186/s43019-021-00121-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Patellofemoral pain syndrome (PFPS) is a common pathology usually presenting with anterior or retropatellar pain. It is associated with a relative imbalance between the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles. This can lead to considerable morbidity and reduced quality of life (QOL). This study aims to assess the long-term functional outcome of PFPS treated with VL muscle botulinum toxin A (BoNT-A) injection. Materials and methods A retrospective review was performed on 26 consecutive patients (31 knees) with a mean age of 50.1 years (± 19.7 years) who were treated with BoNT-A injections to the VL muscle followed by physiotherapy between 2008 and 2015. Pre- and post-treatment pain levels (numerical rating scale, NRS), QOL (SF-6D), and functional scores (Kujala and Lysholm questionnaires) were measured. Demographics, physical therapy compliance, previous surgeries, perioperative complications, and patient satisfaction levels were collected. Results The mean follow-up time was 58.8 ± 36.4 months. There were significant improvements in all the examined domains. The average pain score (NRS) decreased from 7.6 to 3.2 (P < 0.01), and the Kujala, Lysholm, and SF-6D scores improved from 58.9 to 82.7 (P < 0.001), 56.2 to 83.2 (P < 0.001), and 0.6 to 0.8 (P < 0.001), respectively. Similar delta improvement was achieved irrespective of gender, age, compliance to post-treatment physical therapy, or coexisting osteoarthritis. Patients who presented with a worse pre-treatment clinical status achieved greater improvement. Prior to BoNT-A intervention, 16 patients (18 knees) were scheduled for surgery, of whom 12 (75%, 13 knees) did not require further surgical intervention at the last follow-up. Conclusions A single intervention of BoNT-A injections to the VL muscle combined with physiotherapy is beneficial for the treatment of patients with persistent PFPS. Level III evidence Retrospective cohort study.
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Affiliation(s)
- Yuval Kesary
- Sackler Faculty of Medicine, Tel Aviv University, P. O. Box 39040, 6997801, Tel Aviv, Israel.
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Tal Frenkel-Rutenberg
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Arie Greenberg
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Shmuel Dekel
- Sackler Faculty of Medicine, Tel Aviv University, P. O. Box 39040, 6997801, Tel Aviv, Israel
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Nimrod Snir
- Sackler Faculty of Medicine, Tel Aviv University, P. O. Box 39040, 6997801, Tel Aviv, Israel.,Division of Adult Reconstruction, Department of Orthopedics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Na Y, Han C, Shi Y, Zhu Y, Ren Y, Liu W. Is Isolated Hip Strengthening or Traditional Knee-Based Strengthening More Effective in Patients With Patellofemoral Pain Syndrome? A Systematic Review With Meta-analysis. Orthop J Sports Med 2021; 9:23259671211017503. [PMID: 34377715 PMCID: PMC8330492 DOI: 10.1177/23259671211017503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Focus on the importance of hip muscle strength in patients with patellofemoral pain syndrome (PFPS) has recently increased. It is unknown whether patients with PFPS will benefit more from hip strengthening compared with traditional knee-based strengthening. Purpose: To compare the efficiency of isolated hip strengthening versus traditional knee-based strengthening for patients with PFPS. Study Design: Systematic review; Level of evidence, 2. Methods: We conducted a search for studies comparing isolated hip strengthening and knee-based strengthening by using the MEDLINE, Embase, and Cochrane Library electronic databases. The methodological quality of included studies was assessed using the PEDro scale. Predetermined variables from each study were extracted and analyzed. Results: A total of 5 comparative studies were included in this review; all studies were of moderate to high quality and reflected good internal and external validity. Pain (visual analog scale [VAS]) and function (Anterior Knee Pain Scale) scores improved in both the hip and knee groups after strengthening intervention, although no statistically significant differences were seen between groups in the pooled analysis. In 2 studies, VAS pain scores were reduced earlier for patients in the hip group than for those in the knee group (P < .05). In 1 study, improvement in Western Ontario and McMaster Universities Osteoarthritis Index function scores in the hip group was statistically superior compared with those in the knee group after intervention and at 6-month follow-up (P < .05). In 2 studies, patients in the hip group exhibited statistically greater hip abductor and extensor strength than did those in the knee group after intervention (P < .05). Conclusion: The best-available evidence suggests that overall, isolated hip strengthening and knee strengthening were equivalent for treatment of PFPS.
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Affiliation(s)
- Yuyan Na
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Changxu Han
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yuting Shi
- Cardiac Function Department, Cadre Health Care Center, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yong Zhu
- Department of Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yizhong Ren
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Wanlin Liu
- Department of Pediatric Orthopedics, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
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15
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Scafoglieri A, Van den Broeck J, Willems S, Tamminga R, van der Hoeven H, Engelsma Y, Haverkamp S. Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:446. [PMID: 33992100 PMCID: PMC8126114 DOI: 10.1186/s12891-021-04310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Increasing evidence has shown benefits of spinal manipulations in patients with patellofemoral pain syndrome (PFPS). There is scarcity regarding medium term effects of spinal manual therapy on outcome measures in PFPS patients. Therefore, the aim of the present study was to compare the effectiveness of local exercise therapy and spinal manual therapy for knee pain, function and maximum voluntary peak force (MVPF) velocity of the quadriceps in PFPS patients. Methods Forty-three patients with PFPS were randomly assigned to a local exercise or spinal manual therapy group. The local exercise group received six sessions (one session per week) of supervised training of the knee-and hip muscles with mobilization of the patellofemoral joint. The spinal manual therapy group received six interventions (one intervention per week) of high velocity low thrust manipulations at the thoracolumbar region, sacroiliac joint, and/or hip. All patients were also asked to do home exercises. Maximum, minimum and current pain were measured using the visual analogue scale. Function was assessed with the anterior knee pain scale (AKPS) and MPFV was recorded using a Biodex System 3 dynamometer. Patients were assessed before intervention, after 6 weeks of intervention and after 6 weeks of follow-up. Between-group differences at assessments were analysed by way of analysis of covariance with Bonferroni correction. Results Pain and functionality improved more following spinal manipulative therapy than local exercise therapy. After 6 weeks of intervention the between-group difference (local versus spinal) for maximal pain was 23.4 mm [95% CI: 9.3, 37.6; effect size (ES): 1.04] and − 12.4 [95% CI: − 20.2, − 4.7; ES: 1.00] for the AKPS. At 6 weeks of follow-up the between-group difference for maximal pain was 18.7 mm [95% CI: 1.4, 36.0; ES: 0.68] and − 11.5 [95% CI: − 19.9, − 3.3; ES: − 0.87] for the AKPS. Conclusions This study suggests that spinal manual therapy is more effective than local exercise therapy in improving pain and function in patients with PFPS in the medium term. We suggest for future research to investigate whether combining local exercise therapy and spinal manual therapy is more effective than either single intervention on its own. This clinical trial study was approved by the Medical Ethics Committee METC Z under registration number NL57207.096. and registered retrospectively in ClinicalTrials.gov PRS with registration ID number NCT04748692 on the 10th of February 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04310-9.
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Affiliation(s)
- Aldo Scafoglieri
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Experimental Anatomy Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium. .,SOMT University of Physiotherapy, Softwareweg 5, Amersfoort, BN, 3821, The Netherlands.
| | - Jona Van den Broeck
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Experimental Anatomy Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium
| | - Stijn Willems
- Department of Neuroscience, VU University Medical Center, Amsterdam, HV, 1081, The Netherlands
| | - Rob Tamminga
- Fysioholland, Medicort, Rijksweg 69, Naarden, GE, 1411, The Netherlands
| | | | - Yde Engelsma
- Bergman Clinics BV, Rijksweg 69, Naarden, GE, 1411, The Netherlands
| | - Stijn Haverkamp
- Bergman Clinics BV, Rijksweg 69, Naarden, GE, 1411, The Netherlands
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16
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Dhondt E, Danneels L, Van Oosterwijck S, Palmans T, Rijckaert J, Van Oosterwijck J. The influence of physical activity on the nociceptive flexion reflex in healthy people. Eur J Pain 2020; 25:774-789. [PMID: 33290578 DOI: 10.1002/ejp.1708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The nociceptive flexion reflex (NFR) is a spinal reflex induced by painful stimuli resulting in an appropriate withdrawal response. The NFR is considered to be an objective physiological correlate of spinal nociception. Previous research has already demonstrated that physical activity (PA) can influence pain assessments. To date, no studies have directly examined the relationship between PA and spinal nociception. Hence, this study aimed to investigate whether the NFR threshold can be predicted by report-based and monitor-based measures of PA in healthy adults. METHODS PA and the NFR threshold of 58 healthy adults were assessed. PA was evaluated by self-report using the International Physical Activity Questionnaire and by monitor-based accelerometry data. The NFR threshold was elicited through transcutaneous electrical stimulation of the sural nerve and quantified by the biceps femoris muscle electromyogram. Hierarchical linear regression analyses were performed to determine the relationship between PA and the NFR, while controlling for confounders. RESULTS Monitor-based measured step count and activities of moderate- to vigorous-intensity predicted the NFR threshold accounting for 23.0% (p = .047) to 37.1% (p = .002) of the variance. Larger amounts of step counts and higher participation in moderate- to vigorous-intensity activities predicted higher NFR thresholds. Monitor-based activities of sedentary intensity predicted the NFR threshold accounting for 35.8% (p = .014) to 35.9% (p = .014) of the variance. Spending more time per day on activities of sedentary intensity predicted lower NFR thresholds. CONCLUSIONS The study provides preliminary evidence indicating that a physically active lifestyle may reduce spinal nociception in healthy adults, while a sedentary lifestyle enhances spinal nociception. SIGNIFICANCE The present study provides preliminary evidence that the influencing effects of physical activity on pain are the result of a strong descending control and do not purely rely on supraspinal mechanisms. These study results highlight the importance of considering physical activity levels when evaluating nociceptive processing, given the prognostic value of physical activity in spinal nociception. Furthermore, this study encourages future research to examine the effects of moderate- to vigorous-intensity exercise programmes on spinal nociception in chronic pain populations.
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Affiliation(s)
- Evy Dhondt
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion, International Research Group
| | - Lieven Danneels
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sophie Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion, International Research Group.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Tanneke Palmans
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Johan Rijckaert
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Audiology, Artevelde University College, Ghent, Belgium
| | - Jessica Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion, International Research Group.,Research Foundation - Flanders (FWO), Brussels, Belgium
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17
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Heydarian M, Babakhani F, Hatefi M, Balouchi R, Mohammadian M. Effects of a band loop on muscle activity and dynamic Knee valgus during pedaling. Gait Posture 2020; 82:301-305. [PMID: 33007687 DOI: 10.1016/j.gaitpost.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Change in the lower extremity alignments in the frontal plane and muscle activation patterns have been associated with lower extremity injuries. Therefore, to prevent injuries, many therapeutic protocols focus on find ways to correct dynamic knee valgus (DKV). METHODS Thirty-one recreational male cyclists with DKV (26.4 ± 4.5 years, 176.63 ± 7.51 cm, 75.81 ± 9.29 kg, 23.20 ± 4.15 kg/m2) volunteered to participate in this study. Simultaneous recordings of kinematic and electromyography data were performed on ten consecutive pedal cycles which began during the last 30 seconds of each four test condition: with band at 0.5 kg workload, with band at 2 kg workload, without band at 0.5 kg workload, and without band at 2 kg workload. The paired t-test was used for statistical analysis (p < 0.05). RESULTS The results indicated significant differences in VM (band = 0.029, no band = 0.031) and VL (band = 0.015, no band = 0.035) activation between workloads in each condition. Also there were significant differences in Gmed activation (0.5kg = 0.001, 2kg = 0.037), onset of Gmed (0.5kg = 0.048, 2kg = 0.012), offset of Gmed (0.5kg = 0.048, 2kg = 0.015), TFL activation (0.5kg = 0.001, 2kg = 0.041) and offset of TFL (0.5kg = 0.078, 2kg = 0.005) between the band and no band conditions. There was no different significant in VM/VL ratio between in each of four testing conditions (p > 0.05). The Gmed/TFL ratio was significantly greater in band condition than no band at both 0.5 (p = 0.045) and 2 kg (p = 0.001) workload. Knee abduction angle was affected by the band loop during the pedaling at two different workloads (0.5 kg: p = 0.047, 2 kg: p = 0.021) but mean (p = 0.027) and peak (p = 0.033) knee abduction angle significantly increased with increasing workload during the pedaling with band loop. CONCLUSIONS pedaling with the band loop can be considered as an effective method to increase the Gmed, Gmed/TFL ratio and control of DKV but increasing the workload during pedaling must be done with caution to prevent DKV.
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Affiliation(s)
- Mona Heydarian
- Department of Sports Injury and Corrective Exercise, Faculty of Physical Education, Allameh Tabataba'i University, Tehran, Iran
| | - Farideh Babakhani
- Department of Sports Injury and Corrective Exercise, Faculty of Physical Education, Allameh Tabataba'i University, Tehran, Iran
| | - Mohamadreza Hatefi
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education, Kharazmi University, Tehran, Iran.
| | - Ramin Balouchi
- Department of Sports Injury and Corrective Exercise, Faculty of Physical Education, Allameh Tabataba'i University, Tehran, Iran
| | - Mohammadamin Mohammadian
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education, Kharazmi University, Tehran, Iran
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18
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Sex differences in neuromuscular control of quadriceps. Eur J Appl Physiol 2020; 120:2193-2202. [PMID: 32712701 DOI: 10.1007/s00421-020-04443-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patellofemoral pain syndrome (PFPS) is twice as prevalent in females as males, yet a few studies have evaluated differences in quadriceps muscle control between sexes or across force levels. This study investigated sex differences in quadriceps EMG onset times and amplitude at different force levels during isometric knee extension in asymptomatic males and females and in females with PFPS. METHODS Thirteen healthy males, 12 healthy females, and 10 females with PFPS performed isometric knee extension ramp contractions at 25%, 50%, and 75% of maximal voluntary contraction (MVC). Surface EMG was recorded from the vastus lateralis (VL), vastus medialis oblique (VMO), vastus medialis (VM), and rectus femoris (RF). RESULTS Healthy females showed delayed VL (222 ± 67 ms, p = 0.002), VMO (357 ± 101 ms, p = 0.001), and VM (258 ± 62 ms, p < 0.001) recruitment in comparison with healthy males. Healthy males activated the VL earlier than the VM (156 ± 51 ms, p = 0.02) and RF (379 ± 74 ms, p < 0.001), and at a similar time as the VMO; healthy females activated the VL earlier than the VM (192 ± 53 ms, p = 0.004) and VMO (239 ± 73 ms, p = 0.01). A lower VMO:VL activation ratio was found at 25% MVC (p < 0.001) than at higher force levels. CONCLUSIONS Delayed activation of the VMO relative to the VL has been proposed as a risk factor for PFPS. This study confirms a delay in VMO onset time in females.
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19
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Y-Balance Test Asymmetry and Frontal Plane Knee Projection Angle During Single-leg squat as Predictors of Patellofemoral Pain in Male Military Recruits. Phys Ther Sport 2020; 44:121-127. [DOI: 10.1016/j.ptsp.2020.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW The patellofemoral joint is a complicated articulation of the patella and femur that is prone to pathologies. The purpose of this review is to report on the current methods of investigating patellofemoral mechanics, factors that affect joint function, and future directions in patellofemoral joint research with emerging technologies and techniques. RECENT FINDINGS While previous hypotheses have suggested that the patella is only a moment arm extender, recent literature has suggested that the patella influences the control of knee moments and forces acting on the tibia as well as contributes to various aspects of patellar function with minimal neural input. With advancements in simulating a six-degrees-of-freedom patellofemoral joint, we have gained a better understanding of patella motion and have shown that geometry and muscle activations impact patella mechanics. Research into influences on patella mechanics from other joints such as the hip and foot has become more prevalent. In this review, we report current in vivo, in vitro, and in silico approaches to studying the patellofemoral joint. Kinematic and anatomical factors that affect patellofemoral joint function such as patella alta and tilt or bone morphology and ligaments are discussed. Moving forward, we suggest that advanced in vivo dynamic imaging methods coupled to musculoskeletal simulation will provide further understanding of patellofemoral pathomechanics and allow engineers and clinicians to design interventions to mitigate or prevent patellofemoral pathologies.
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Ohyama Y, Yamaji T, Sato E, Watanabe H. Muscle activity of the vastus medialis obliquus during squat motion after static stretching of the tensor fasciae latae. J Phys Ther Sci 2020; 32:223-226. [PMID: 32184537 PMCID: PMC7064357 DOI: 10.1589/jpts.32.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the changes of muscle activity
during squat motion after stretching the tensor fasciae latae muscle. [Participants and
Methods] The participants comprised 19 healthy males. The test muscles were the vastus
medialis obliquus and vastus lateralis. The participants performed the squat motion before
and after stretching the tensor fasciae latae. We measured the muscle activities and the
onset timing of the vastus medialis obliquus relative to that of the vastus lateralis
during squat motions. [Results] The onset timing of the vastus medialis obliquus relative
to that of the vastus lateralis was decreased, and the vastus medialis obliquus activity
and vastus medialis obliquus/vastus lateralis activity ratio were increased after
stretching the tensor fasciae latae. [Conclusion] This study revealed that stretching of
the tensor fasciae latae increases the relative vastus medialis obliquus muscle
activity.
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Affiliation(s)
- Yuki Ohyama
- Graduate School of Health Sciences, Gunma University, Japan
- Rehabilitation Center, Hidaka Rehabilitation Hospital: 2204 Maniwa Yoshii-machi, Takasaki-shi, Gunma 370-2104, Japan
| | | | - Ena Sato
- Graduate School of Health Sciences, Gunma University, Japan
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22
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Adaptation of muscle activation after patellar loading demonstrates neural control of joint variables. Sci Rep 2019; 9:20370. [PMID: 31889142 PMCID: PMC6937258 DOI: 10.1038/s41598-019-56888-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/12/2019] [Indexed: 01/19/2023] Open
Abstract
We evaluated whether the central nervous system (CNS) chooses muscle activations not only to achieve behavioral goals but also to minimize stresses and strains within joints. We analyzed the coordination between quadriceps muscles during locomotion in rats before and after imposing a lateral force on the patella. Vastus lateralis (VL) and vastus medialis (VM) in the rat produce identical knee torques but opposing mediolateral patellar forces. If the CNS regulates internal joint stresses, we predicted that after imposing a lateral patellar load by attaching a spring between the patella and lateral femur, the CNS would reduce the ratio between VL and VM activation to minimize net mediolateral patellar forces. Our results confirmed this prediction, showing that VL activation was reduced after attaching the spring whereas VM and rectus femoris (RF) activations were not significantly changed. This adaptation was reversed after the spring was detached. These changes were not observed immediately after attaching the spring but only developed after 3–5 days, suggesting that they reflected gradual processes rather than immediate compensatory reflexes. Overall, these results support the hypothesis that the CNS chooses muscle activations to regulate internal joint variables.
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23
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Cai WS, Li HH, Konno SI, Numazaki H, Zhou SQ, Zhang YB, Han GT. Patellofemoral MRI Alterations Following Single Bundle ACL Reconstruction with Hamstring Autografts Are Associated with Quadriceps Femoris Atrophy. Curr Med Sci 2019; 39:1029-1036. [PMID: 31845237 DOI: 10.1007/s11596-019-2138-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 11/25/2019] [Indexed: 11/27/2022]
Abstract
High incidence of patellofemoral pain and patellofemoral joint osteoarthritis was found following anterior cruciate ligament (ACL) reconstruction. The unstability of patellofemoral joint might be an important contribution factor. This study was designed to define the relationship between the unstability of patellofemoral joint and quadriceps femoris atrophy. Twenty patients underwent MRI scan before ACL reconstruction and every two weeks after surgery, until 12 weeks. The merchant's patellar congruence angle, lateral inclination angle, and quadriceps femoris muscle cross-sectional area were measured and the relationship between the changes of angles and the ratio of quadriceps femoris atrophy was studied by multiple regression analysis. Significant quadriceps femoris atrophy was observed after ACL reconstruction during the follow-up period of 12 weeks. The merchant's patellar congruence angle and lateral inclination angle significantly changed after surgery. The alterations of the merchant's patellar congruence angle were significantly correlated with the atrophy ratio of vastus medialis (coefficient=-15.76) and vastus lateralis (coefficient=8.35) during the follow-up period of 12 weeks. The alterations of lateral inclination angle were significantly correlated with the atrophy ratio of vastus medialis (coefficient=20.62), vastus lateralis (coefficient=-11.38) and rectus femoris (coefficient=-0.469) during the follow-up period 12 weeks. To sum up, ACL reconstruction can alleviate the dysfunction of patellofemoral joint to a certain extent. But, the unbalanced atrophy of quadriceps femoris once again destroyed the stability of patellofemoral joint following the operation, which might be one cause of patellofemoral joint pain and early onset of osteoarthritis after ACL reconstruction. So, rehabilitation training that focuses on quadriceps femoris especially the vastus medialis shortly following operation is suggested.
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Affiliation(s)
- Wei-Song Cai
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hao-Huan Li
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Shin-Ichi Konno
- Department of Orthopedics, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Hironori Numazaki
- Department of Orthopedics, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Si-Qi Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yu-Biao Zhang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Guang-Tao Han
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
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Crossley KM, Cowan SM. Vastus medialis obliquus (VMO) retraining or graduated loading programme for patellofemoral pain: different paradigm with similar results? Br J Sports Med 2019; 53:917. [PMID: 31113773 DOI: 10.1136/bjsports-2017-098736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Kay M Crossley
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, Sports and Exercise Medicine Research Centre, Latrobe University, Bundoora, Victoria, Australia
| | - Sallie M Cowan
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, Sports and Exercise Medicine Research Centre, Latrobe University, Bundoora, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Rozenfeld E, Finestone AS, Moran U, Damri E, Kalichman L. The prevalence of myofascial trigger points in hip and thigh areas in anterior knee pain patients. J Bodyw Mov Ther 2019; 24:31-38. [PMID: 31987560 DOI: 10.1016/j.jbmt.2019.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anterior knee pain (AKP) is a widespread problem among young athletes and soldiers. There are many theories on the etiology of AKP but there is little reference to myofascial trigger points (MTrPs) as a possible contributor. AIM To evaluate the association between AKP and prevalence of active and latent MTrPs in the hip and thigh muscles in soldiers. METHODS A cross-sectional study was conducted in the Beer-Sheva military outpatient physical therapy clinic. Subjects were 42 men and 23 women referred for physical therapy, 33 with a diagnosis of AKP (cases) and 32 with upper limb complaints (without AKP, controls). All subjects underwent physical evaluation by an examiner blinded to their identity and medical condition. The following muscles were assessed bilaterally for active or latent MTrPs: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal). RESULTS In six out of eight areas, the cases had a higher prevalence of total active and latent MTrPs than the controls. When summarizing MTrPs by muscle, cases had significantly more MTrPs than controls in each muscle. The largest difference was found in vastus medialis and vastus lateralis; nearly half of the cases had MTrPs in these muscles. CONCLUSIONS Subjects with AKP have a greater prevalence of MTrPs in their hip and thigh muscles than controls, indicating an association between MTrPs and AKP. Further research is necessary to determine whether MTrPs are the cause or the consequence of AKP.
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Affiliation(s)
- Evgeni Rozenfeld
- Israel Defense Force, Medical Corps, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Aharon S Finestone
- Assaf HaRofeh Medical Center, Zeriffin, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Uria Moran
- Israel Defense Force, Medical Corps, Israel
| | - Elad Damri
- Israel Defense Force, Medical Corps, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Hébert-Losier K, Yin NS, Beaven CM, Tee CCL, Richards J. Physiological, kinematic, and electromyographic responses to kinesiology-type patella tape in elite cyclists. J Electromyogr Kinesiol 2018; 44:36-45. [PMID: 30496944 DOI: 10.1016/j.jelekin.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/05/2018] [Accepted: 11/18/2018] [Indexed: 11/30/2022] Open
Abstract
Kinesiology-type tape (KTT) has become popular in sports for injury prevention, rehabilitation, and performance enhancement. Many cyclists use patella KTT; however, its benefits remain unclear, especially in uninjured elite cyclists. We used an integrated approach to investigate acute physiological, kinematic, and electromyographic responses to patella KTT in twelve national-level male cyclists. Cyclists completed four, 4-minute submaximal efforts on an ergometer at 100 and 200 W with and without patella KTT. Economy, energy cost, oxygen cost, heart rate, efficiency, 3D kinematics, and lower-body electromyography signals were collected over the last minute of each effort. Comfort levels and perceived change in knee stability and performance with KTT were recorded. The effects of KTT were either unclear, non-significant, or clearly trivial on all collected physiological and kinematic measures. KTT significantly, clearly, and meaningfully enhanced vastus medialis peak, mean, and integrated electromyographic signals, and vastus medialis-to-lateralis activation. Electromyographic measures from biceps femoris and biceps-to-rectus femoris activation ratio decreased in either a significant or clinically meaningful manner. Despite most cyclists perceiving KTT as comfortable, increasing stability, and improving performance, the intervention exerted no considerable effects on all physiological and kinematic measures. KTT did alter neuromuscular recruitment, which has potential implications for injury prevention.
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Affiliation(s)
- Kim Hébert-Losier
- Faculty of Health, Sport and Human Performance, University of Waikato, Tauranga, New Zealand; Department of Sports Science, National Sports Institute of Malaysia, Kuala Lumpur, Malaysia.
| | - Ngieng Siew Yin
- Department of Sports Science, National Sports Institute of Malaysia, Kuala Lumpur, Malaysia
| | - C Martyn Beaven
- Faculty of Health, Sport and Human Performance, University of Waikato, Tauranga, New Zealand; Department of Sports Science, National Sports Institute of Malaysia, Kuala Lumpur, Malaysia
| | - Chris Chow Li Tee
- Department of Sports Science, National Sports Institute of Malaysia, Kuala Lumpur, Malaysia
| | - Jim Richards
- School of Health Sciences, University of Central Lancashire, Preston, Lancashire, United Kingdom
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Bolgla LA, Boling MC, Mace KL, DiStefano MJ, Fithian DC, Powers CM. National Athletic Trainers' Association Position Statement: Management of Individuals With Patellofemoral Pain. J Athl Train 2018; 53:820-836. [PMID: 30372640 DOI: 10.4085/1062-6050-231-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE: To present recommendations for athletic trainers and other health care providers regarding the identification of risk factors for and management of individuals with patellofemoral pain (PFP). BACKGROUND: Patellofemoral pain is one of the most common knee diagnoses; however, this condition continues to be one of the most challenging to manage. Recent evidence has suggested that certain risk factors may contribute to the development of PFP. Early identification of risk factors may allow clinicians to develop and implement programs aimed at reducing the incidence of this condition. To date, clinicians have used various treatment strategies that have not necessarily benefitted all patients. Suboptimal outcomes may reflect the need to integrate clinical practice with scientific evidence to facilitate clinical decision making. RECOMMENDATIONS: The recommendations are based on the best available evidence. They are intended to give athletic trainers and other health care professionals a framework for identifying risk factors for and managing patients with PFP.
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Affiliation(s)
- Lori A Bolgla
- Department of Physical Therapy, Augusta University, GA
| | - Michelle C Boling
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville
| | | | | | | | - Christopher M Powers
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
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Gallina A, Wakeling JM, Hodges PW, Hunt MA, Garland SJ. Regional Vastus Medialis and Vastus Lateralis Activation in Females with Patellofemoral Pain. Med Sci Sports Exerc 2018; 51:411-420. [PMID: 30339659 DOI: 10.1249/mss.0000000000001810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This study aimed to investigate whether regional activation patterns in the vasti muscles differ between females with and without patellofemoral pain (PFP), and whether muscle activation patterns correlate with knee extension strength. METHODS Thirty-six females with PFP and 20 pain-free controls performed a standardized knee flexion-extension task. The activation of vastus medialis (VM) and vastus lateralis (VL) was collected using high-density surface EMG and analyzed using principal component (PC) analysis. Spatial locations and temporal coefficients of the PC, and the percent variance they explain, were compared between groups and between the concentric and the eccentric phases of the movement. Correlations were assessed between PC features and knee extension strength. RESULTS The spatial weights of PC1 (general vasti activation) and PC2 (reflecting vastus-specific activation) were similar between groups (R > 0.95). Activation patterns in PFP were less complex than controls. Fewer PC features were necessary to reconstruct 90% of the signal for PFP participants in the concentric phase (P < 0.05), and the difference in bias of activation to VM (concentric phase) or VL (eccentric phase) was less between phases for PFP participants (P < 0.05). Smaller difference in vastus-specific activation in concentric and eccentric phases (less task specificity of VM/VL coordination) was related to greater maximal knee extension strength (P < 0.05, R < -0.43). CONCLUSION These data suggest PFP involves a simpler control strategy of VM and VL. The inverse association between task specificity and maximal knee extension strength suggests different presentations of PFP: lower knee extension strength but VM/VL coordination task specificity comparable with controls, or knee extension strength comparable with controls but lower VM/VL coordination task specificity.
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Affiliation(s)
- Alessio Gallina
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, CANADA
| | - James M Wakeling
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, St. Lucia, AUSTRALIA
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, CANADA
| | - S Jayne Garland
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, CANADA.,Faculty of Health Sciences, University of Western Ontario, London, Ontario, CANADA
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Neal BS, Lack SD, Lankhorst NE, Raye A, Morrissey D, van Middelkoop M. Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med 2018; 53:270-281. [PMID: 30242107 DOI: 10.1136/bjsports-2017-098890] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent condition commencing at various points throughout life. We aimed to provide an evidence synthesis concerning predictive variables for PFP, to aid development of preventative interventions. METHODS We searched Medline, Web of Science and SCOPUS until February 2017 for prospective studies investigating at least one potential risk factor for future PFP. Two independent reviewers appraised methodological quality using the Newcastle-Ottawa Scale. We conducted meta-analysis where appropriate, with standardised mean differences (SMD) and risk ratios calculated for continuous and nominal scaled data. RESULTS This review included 18 studies involving 4818 participants, of whom 483 developed PFP (heterogeneous incidence 10%). Three distinct subgroups (military recruits, adolescents and recreational runners) were identified. Strong to moderate evidence indicated that age, height, weight, body mass index (BMI), body fat and Q angle were not risk factors for future PFP. Moderate evidence indicated that quadriceps weakness was a risk factor for future PFP in the military, especially when normalised by BMI (SMD -0.69, CI -1.02, -0.35). Moderate evidence indicated that hip weakness was not a risk factor for future PFP (multiple pooled SMDs, range -0.09 to -0.20), but in adolescents, moderate evidence indicated that increased hip abduction strength was a risk factor for future PFP (SMD 0.71, CI 0.39, 1.04). CONCLUSIONS This review identified multiple variables that did not predict future PFP, but quadriceps weakness in military recruits and higher hip strength in adolescents were risk factors for PFP. Identifying modifiable risk factors is an urgent priority to improve prevention and treatment outcomes.
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Affiliation(s)
- Bradley S Neal
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Pure Sports Medicine, London, UK
| | - Simon D Lack
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Pure Sports Medicine, London, UK
| | | | - Andrew Raye
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Physiotherapy Department, Barts Health NHS Trust, London, UK
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30
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Sandercock TG, Wei Q, Dhaher YY, Pai DK, Tresch MC. Vastus lateralis and vastus medialis produce distinct mediolateral forces on the patella but similar forces on the tibia in the rat. J Biomech 2018; 81:45-51. [PMID: 30269930 DOI: 10.1016/j.jbiomech.2018.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/22/2018] [Accepted: 09/08/2018] [Indexed: 10/28/2022]
Abstract
Improper activation of the quadriceps muscles vastus medialis (VM) and vastus lateralis (VL) has been implicated in the development of patellofemoral pain (PFP). This explanation of PFP assumes that VM and VL produce opposing mediolateral forces on the patella. Although studies have provided evidence for opposing actions of VM and VL on the patella, other studies have suggested that their actions might be similar. In this study, we took advantage of the experimental accessibility of the rat to directly measure the forces on the patella produced by VM and VL. We found that VM and VL produce opposing mediolateral forces on the patella when the patella was lifted away from the femur. These distinct mediolateral forces were not transmitted to the tibia, however: forces measured at the distal tibia were very similar for VM and VL. Further, when the patella was placed within the trochlear groove, the forces on the patella produced by VM and VL were very similar to one another. These results suggest that mediolateral forces produced by VM and VL are balanced by reaction forces from the trochlear groove and so are not transmitted to the tibia. These results provide a rich characterization of the mechanical actions of VM and VL and have implications about the potential role of these muscles in PFP and their neural control during behavior.
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Affiliation(s)
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA
| | - Yasin Y Dhaher
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA; Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA; Department of Physical Medicine and Rehabilitation, Northwestern University and Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
| | - Dinesh K Pai
- Department of Computer Science, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Matthew C Tresch
- Department of Physiology, Northwestern University, Chicago, IL 60611, USA; Shirley Ryan AbilityLab, Chicago, IL 60611, USA; Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA; Department of Physical Medicine and Rehabilitation, Northwestern University and Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.
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Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review. Sports Med 2018; 46:1797-1808. [PMID: 27142536 DOI: 10.1007/s40279-016-0545-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The patellofemoral (PF) joint is the knee compartment most commonly affected by osteoarthritis (OA). Even mild PF OA is associated with considerable pain and functional limitations. Despite its prevalence and impact, little is understood of the etiology or structural and functional features of PF OA. The clinical symptoms of PF OA, such as anterior knee pain during stair ambulation and squatting, share many similarities with PF pain in adolescents and young adults. PF joint OA is most commonly diagnosed in people aged >40 years, many of whom report a history of PF pain. As such, there is growing evidence that PF pain and PF OA form a continuum of disease. This review explores the possible relationship between the presence of PF pain and the development of PF OA. We review the evidence for altered neuromotor control and biomechanical factors that may be associated with altered PF loading in people with PF pain and PF OA. In doing so, we highlight similarities and differences that may evolve along the continuum. By improving our understanding of the neuromotor and biomechanical links between PF pain and PF OA, we may highlight potential targets for new rehabilitation strategies.
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32
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Gallina A, Hunt MA, Hodges PW, Garland SJ. Vastus Lateralis Motor Unit Firing Rate Is Higher in Women With Patellofemoral Pain. Arch Phys Med Rehabil 2018; 99:907-913. [DOI: 10.1016/j.apmr.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
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Lack S, Neal B, De Oliveira Silva D, Barton C. How to manage patellofemoral pain - Understanding the multifactorial nature and treatment options. Phys Ther Sport 2018; 32:155-166. [PMID: 29793124 DOI: 10.1016/j.ptsp.2018.04.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 12/18/2022]
Abstract
Patellofemoral pain (PFP) is one of the most prevalent conditions within sports medicine, orthopaedic and general practice settings. Long-term treatment outcomes are poor, with estimates that more than 50% of people with the condition will report symptoms beyond 5 years following diagnosis. Additionally, emerging evidence indicates that PFP may be on a continuum with patellofemoral osteoarthritis. Consensus of world leading clinicians and academics highlights the potential benefit of delivering tailored interventions, specific to an individual's needs, to improve patient outcome. This clinical masterclass aims to develop the reader's understanding of PFP aetiology, inform clinical assessment and increase knowledge regarding individually tailored treatment approaches. It offers practical application guidance, and additional resources, that can positively impact clinical practice.
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Affiliation(s)
- Simon Lack
- Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom; Pure Sports Medicine, London, United Kingdom.
| | - Bradley Neal
- Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom; Pure Sports Medicine, London, United Kingdom
| | - Danilo De Oliveira Silva
- Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia; Laboratory of Biomechanics and Motor Control, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Christian Barton
- Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom; Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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de Souza LML, Cabral HV, de Oliveira LF, Vieira TM. Motor units in vastus lateralis and in different vastus medialis regions show different firing properties during low-level, isometric knee extension contraction. Hum Mov Sci 2018; 58:307-314. [DOI: 10.1016/j.humov.2017.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/17/2017] [Accepted: 12/15/2017] [Indexed: 11/27/2022]
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35
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Vora M, Curry E, Chipman A, Matzkin E, Li X. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options. Orthop Rev (Pavia) 2018; 9:7281. [PMID: 29564075 PMCID: PMC5850065 DOI: 10.4081/or.2017.7281] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/08/2017] [Accepted: 10/08/2017] [Indexed: 12/16/2022] Open
Abstract
Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS.
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Affiliation(s)
- Molly Vora
- Boston University School of Medicine, MA
| | - Emily Curry
- Boston University School of Public Health, MA
| | | | | | - Xinning Li
- Boston University School of Medicine, MA
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Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain. Pilot Feasibility Stud 2017; 4:24. [PMID: 28748107 PMCID: PMC5520346 DOI: 10.1186/s40814-017-0167-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis. The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful. High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation. Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain. Method This is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8–10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self-management. Baseline assessment will include demographic data, average pain within the last week (VAS), fear avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach. Discussion This study will evaluate the feasibility of running a definitive large-scale trial on patients with patellofemoral pain, within the NHS in the UK. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from this study will inform the design of a multicentre trial. Trial registration ISRCTN35272486.
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Affiliation(s)
- Benjamin E Smith
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK.,Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Carlson VR, Sheehan FT, Shen A, Yao L, Jackson JN, Boden BP. The Relationship of Static Tibial Tubercle-Trochlear Groove Measurement and Dynamic Patellar Tracking. Am J Sports Med 2017; 45:1856-1863. [PMID: 28419810 PMCID: PMC6010175 DOI: 10.1177/0363546517700119] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The tibial tubercle to trochlear groove (TT-TG) distance is used for screening patients with a variety of patellofemoral joint disorders to determine who may benefit from patellar medialization using a tibial tubercle osteotomy. Clinically, the TT-TG distance is predominately based on static imaging with the knee in full extension; however, the predictive ability of this measure for dynamic patellar tracking patterns is unknown. PURPOSE To determine whether the static TT-TG distance can predict dynamic lateral displacement of the patella. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS The static TT-TG distance was measured at full extension for 70 skeletally mature subjects with (n = 32) and without (n = 38) patellofemoral pain. The dynamic patellar tracking patterns were assessed from approximately 45° to 0° of knee flexion by use of dynamic cine-phase contrast magnetic resonance imaging. For each subject, the value of dynamic lateral tracking corresponding to the exact knee angle measured in the static images for that subject was identified. Linear regression analysis determined the predictive ability of static TT-TG distance for dynamic patellar lateral displacement for each cohort. RESULTS The static TT-TG distance measured with the knee in full extension cannot accurately predict dynamic lateral displacement of the patella. There was weak predictive ability among subjects with patellofemoral pain ( r2 = 0.18, P = .02) and no predictive capability among controls. Among subjects with patellofemoral pain and static TT-TG distances 15 mm or more, 8 of 13 subjects (62%) demonstrated neutral or medial patellar tracking patterns. CONCLUSION The static TT-TG distance cannot accurately predict dynamic lateral displacement of the patella. A large percentage of patients with patellofemoral pain and pathologically large TT-TG distances may have neutral to medial maltracking patterns.
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Affiliation(s)
- Victor R Carlson
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Frances T Sheehan
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Aricia Shen
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Lawrence Yao
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer N Jackson
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Barry P Boden
- The Orthopaedic Center, A Division of CAO, Rockville, Maryland, USA
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Brund RBK, Rasmussen S, Nielsen RO, Kersting UG, Laessoe U, Voigt M. The association between eccentric hip abduction strength and hip and knee angular movements in recreational male runners: An explorative study. Scand J Med Sci Sports 2017; 28:473-478. [DOI: 10.1111/sms.12923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 01/03/2023]
Affiliation(s)
- R. B. K. Brund
- Physical Activity and Human Performance; SMI®; Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - S. Rasmussen
- Orthopaedic Surgery Research Unit; Science and Innovation Center; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University
| | - R. O. Nielsen
- Section for Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
| | - U. G. Kersting
- Physical Activity and Human Performance; SMI®; Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - U. Laessoe
- Physical Activity and Human Performance; SMI®; Department of Health Science and Technology; Aalborg University; Aalborg Denmark
- Physiotherapy and Research & Development Department; UCN; Aalborg Denmark
| | - M. Voigt
- Physical Activity and Human Performance; SMI®; Department of Health Science and Technology; Aalborg University; Aalborg Denmark
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Carlson VR, Boden BP, Shen A, Jackson JN, Yao L, Sheehan FT. The Tibial Tubercle-Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions. Am J Sports Med 2017; 45:1110-1116. [PMID: 28056523 PMCID: PMC6010059 DOI: 10.1177/0363546516681002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The distance between the tibial tubercle (TT) and trochlear groove (TT-TG distance) is known to be greater in patients with patellar instability. However, the potential role and prevalence of pathological TT-TG distances in a large cohort of skeletally mature patients with isolated patellofemoral pain (PFP) are not clear. PURPOSE To determine if the mean TT-TG distance is greater in patients with PFP, who lack a history of patellar dislocations, knee trauma, or osteoarthritis, relative to healthy controls. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 50 knees (38 patients) with PFP and 60 knees (56 controls) without PFP formed the basis of this study. Magnetic resonance imaging was used to determine the TT-TG distance from 3-dimensional static scans. RESULTS The cohort with PFP demonstrated a significantly greater mean TT-TG distance relative to asymptomatic controls (13.0 vs 10.8 mm, respectively; P = .001). Among the cohort with PFP, 15 knees (30%) demonstrated TT-TG distances ≥15 mm, and 3 knees (6%) demonstrated TT-TG distances ≥20 mm. CONCLUSION Most adult patients with isolated PFP have elevated TT-TG distances compared with controls, which likely contributes to the force imbalance surrounding the knee.
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Affiliation(s)
- Victor R. Carlson
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
| | - Barry P. Boden
- The Orthopaedic Center, A Division of CAO, Rockville, Maryland
| | - Aricia Shen
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
| | - Jennifer N. Jackson
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
| | - Larry Yao
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
| | - Frances T. Sheehan
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
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Briani RV, Pazzinatto MF, De Oliveira Silva D, Azevedo FM. Different pain responses to distinct levels of physical activity in women with patellofemoral pain. Braz J Phys Ther 2017; 21:138-143. [PMID: 28460712 PMCID: PMC5537465 DOI: 10.1016/j.bjpt.2017.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Physical activity levels seem to play a role in patellofemoral pain (PFP); however, few studies have been conducted to confirm this hypothesis. OBJECTIVES To determine the reported pain levels of women with and without PFP who maintain different levels of physical activity; to determine the capability of these levels to predict pain; and to test the capability of two stair-negotiation protocols, with and without external load, to equalize pain between groups. METHOD Four groups were divided based on the women's physical activity levels: moderate activity PFP group (28), moderate activity control group (23), intense activity PFP group (22), and intense activity control group (22). All participants were asked to perform 15 repetitions of stair negotiation with and without external load on a seven-step staircase on two separate days. Pain levels were reported using a visual analog scale at five distinct moments: previous month, before stair negotiation, after stair negotiation, before patellofemoral joint (PFJ) loading protocol, and after PFJ loading protocol. RESULTS The intense activity PFP group showed higher levels of pain than the moderate activity PFP group (F(8,158)=11.714, p=0.000, η2=0.30). The PFJ loading protocol was able to equalize and exacerbate pain in the PFP groups. CONCLUSION Intense physical activity seems to have a higher association with knee pain than moderate physical activity. A PFJ loading protocol may be an alternative to equalize pain in women with PFP during clinical assessments.
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Affiliation(s)
- Ronaldo V Briani
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia (FCT), Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Presidente Prudente, SP, Brazil
| | - Marcella F Pazzinatto
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia (FCT), Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Presidente Prudente, SP, Brazil
| | - Danilo De Oliveira Silva
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia (FCT), Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Presidente Prudente, SP, Brazil
| | - Fábio M Azevedo
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia (FCT), Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Presidente Prudente, SP, Brazil.
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Benson LC, Almonroeder TG, O'Connor KM. Quantifying knee mechanics during balance training exercises. Hum Mov Sci 2016; 51:138-145. [PMID: 28027463 DOI: 10.1016/j.humov.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
Abstract
Patellofemoral pain (PFP) is common among runners and those recovering from anterior cruciate ligament reconstruction. Training programs designed to prevent or treat injuries often include balance training, although balance interventions have been reported to coincide with more knee injuries. Knowledge of the effect of balance exercises on knee mechanics may be useful when designing training programs. High knee abduction moment has been implicated in the development of PFP, and imbalance between vastus lateralis (VL) and vastus medialis oblique (VMO) may contribute to patellofemoral stress. The purpose was to quantify knee abduction moment and vasti muscle activity during balance exercises. Muscle activity of VMO and VL, three-dimensional lower-extremity kinematics, and ground reaction forces of healthy recreational athletes (12M, 13F) were recorded during five exercises. Peak knee abduction moment, ratio of VMO:VL activity, and delay in onset of VMO relative to VL were quantified for each exercise. The influence of sex and exercise on each variable was determined using a mixed-model ANOVA. All analyses indicated a significant main effect of exercise, p<0.05. Follow-up comparisons showed low peak knee abduction moment and high VMO:VL ratio for the task with anterior-posterior motion. Delay of VMO relative to VL was similar among balance board tasks.
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Affiliation(s)
- Lauren C Benson
- University of Wisconsin-Milwaukee, 2400 E. Hartford Ave. Milwaukee, WI, USA.
| | | | - Kristian M O'Connor
- University of Wisconsin-Milwaukee, 2400 E. Hartford Ave. Milwaukee, WI, USA.
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Hart HF, Barton CJ, Khan KM, Riel H, Crossley KM. Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta-regression and analysis. Br J Sports Med 2016; 51:781-790. [DOI: 10.1136/bjsports-2016-096768] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 01/25/2023]
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Serrão JC, Claudino JG, Miyashiro PLS, Mezêncio B, Soncin R, Pomi E, Borges E, Silva MCD, Gloria IP, Zanetti V, Mochizuki L, Amadio AC. KINESIO TAPING NÃO ALTERA A RELAÇÃO EMG ENTRE VASTO LATERAL E VASTO MEDIAL DURANTE MEIO-AGACHAMENTO. REV BRAS MED ESPORTE 2016. [DOI: 10.1590/1517-869220162203136466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Introdução: Kinesio Taping é uma técnica realizada com aplicação de fitas elásticas sobre a pele, que se propõe a produzir determinados efeitos com fins de prevenção e tratamento das lesões musculoesqueléticas. No entanto, os meios pelos quais tais efeitos ocorrem continuam sendo investigados e discutidos, principalmente no que diz respeito à utilização no campo da reabilitação e do esporte. Objetivo: Analisar a relação da atividade eletromiográfica encontrada nos músculos vasto lateral (VL) e vasto medial (VM) em duas condições: sem aplicação de Kinesio Taping (GnKT) e com aplicação de Kinesio Taping (GKT) em uma população saudável, com experiência em treinamento de força. Métodos: Dezoito sujeitos do sexo masculino (idade: 28,1 ± 6,9 anos; massa corporal: 85,5 ± 8,3 kg; estatura: 179,5 ± 6,9 cm; comprimento de membro inferior: 97,0 ± 4,2 cm) realizaram o exercício de meio-agachamento livre, com velocidade controlada, sem e com aplicação de Kinesio Taping. A relação foi verificada pela proporção de magnitude de ativação (VM/VL), utilizando-se os valores de root mean square (RMS). A sequência para realização dos exercícios nas condições mencionadas foi randomizada e balanceada. Resultados: Os valores encontrados para a razão VM/VL na situação GnKT foram de 83,96 ± 5,79% para VM e 84,13 ± 7,16% para VL. Já na situação GKT, 84,55 ± 16,97% para VM e 80,53 ± 9,20% para VL. Não foram observadas diferenças significativas nos valores de RMS para a relação VM/VL submetidos a aplicação de Kinesio Taping. Conclusão: A aplicação de Kinesio Taping não demonstrou influenciar a relação da atividade eletromiográfica entre os músculos vasto lateral e vasto medial durante a execução do exercício de meio-agachamento.
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The immediate effect of lumbopelvic manipulation on EMG of vasti and gluteus medius in athletes with patellofemoral pain syndrome: A randomized controlled trial. ACTA ACUST UNITED AC 2016; 22:16-21. [PMID: 26995778 DOI: 10.1016/j.math.2016.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/05/2016] [Accepted: 02/08/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the immediate effect of lubmopelvic manipulation on EMG activity of vastus medialis, vastus lateralis and gluteus medius as well as pain and functional performance of athletes with patellofemoral pain syndrome. DESIGN Randomized placebo-controlled trial. METHODS Twenty eight athletes with patellofemoral pain syndrome were randomly assigned to two groups. One group received a lubmopelvic manipulation at the side of the involved knee while the other group received a sham manipulation. EMG activity of the vasti and gluteus medius were recorded before and after manipulation while performing a rocking on heel task. The functional abilities were evaluated using two tests: step-down and single-leg hop. Additionally, the pain intensity during the functional tests was assessed using a visual analog scale. RESULTS The onset and amplitude of EMG activity from vastus medialis and gluteus medius were, respectively, earlier and higher in the manipulation group compared to the sham group. There were no significant differences, however, between two groups in EMG onset of vastus lateralis. While the scores of one-leg hop test were similar for both groups, significant improvement was observed in step-down test and pain intensity in the manipulation group compared to the sham group. CONCLUSIONS Lubmopelvic manipulation might improve patellofemoral pain and functional level in athletes with patellofemoral pain syndrome. These effects could be due to the changes observed in EMG activity of gluteus medius and vasti muscles. Therefore, the lubmopelvic manipulation might be considered in the rehabilitation protocol of the athletes with patellofemoral pain syndrome.
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Delayed onset of electromyographic activity of the vastus medialis relative to the vastus lateralis may be related to physical activity levels in females with patellofemoral pain. J Electromyogr Kinesiol 2016; 26:137-42. [DOI: 10.1016/j.jelekin.2015.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/10/2015] [Accepted: 10/23/2015] [Indexed: 11/19/2022] Open
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The Role of Botulinum Toxin Type A in the Clinical Management of Refractory Anterior Knee Pain. Toxins (Basel) 2015; 7:3388-404. [PMID: 26308056 PMCID: PMC4591644 DOI: 10.3390/toxins7093388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/12/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022] Open
Abstract
Anterior knee pain is a highly prevalent condition affecting largely young to middle aged adults. Symptoms can recur in more than two thirds of cases, often resulting in activity limitation and reduced participation in employment and recreational pursuits. Persistent anterior knee pain is difficult to treat and many individuals eventually consider a surgical intervention. Evidence for long term benefit of most conservative treatments or surgical approaches is currently lacking. Injection of Botulinum toxin type A to the distal region of vastus lateralis muscle causes a short term functional “denervation” which moderates the influence of vastus lateralis muscle on the knee extensor mechanism and increases the relative contribution of the vastus medialis muscle. Initial data suggest that, compared with other interventions for anterior knee pain, Botulinum toxin type A injection, in combination with an active exercise programme, can lead to sustained relief of symptoms, reduced health care utilisation and increased activity participation. The procedure is less invasive than surgical intervention, relatively easy to perform, and is time- and cost-effective. Further studies, including larger randomized placebo-controlled trials, are required to confirm the effectiveness of Botulinum toxin type A injection for anterior knee pain and to elaborate the possible mechanisms underpinning pain and symptom relief.
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Muscle force cannot be directly inferred from muscle activation: illustrated by the proposed imbalance of force between the vastus medialis and vastus lateralis in people with patellofemoral pain. J Orthop Sports Phys Ther 2015; 45:360-5. [PMID: 25808529 DOI: 10.2519/jospt.2015.5905] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Muscle force cannot be directly inferred from neural drive assessed using electromyography (EMG). Although the limitations associated with inferring force from EMG are well known, this has received little attention in the clinical literature. This commentary discusses these limitations within the context of the imbalance of force production between the vastus medialis (VM) and vastus lateralis (VL) muscles, which has been speculated to contribute to the development and/or persistence of patellofemoral pain. The balance of neural drive between vasti muscles is most frequently measured with 2 approaches: (1) the onset of VM EMG relative to that of the VL, and (2) the ratio of the EMG signal amplitude of the VM and VL. Here, we demonstrate that this classical approach cannot determine whether an imbalance of force exists between the VM and VL. Considerations such as altered electromechanical delay (time between the onsets of muscle activation and patellar motion) in people with patellofemoral pain may lead to a reconsideration of the classical interpretation of the onset of VM EMG signal relative to that of the VL. Also, beyond the amplitude of the neural drive, muscle force depends on several biomechanical factors (eg, specific tension and physiological cross-sectional area). Therefore, the VL/VM activation ratio does not provide information about the VL/VM force ratio, which is ultimately the most important information from a clinical perspective. Although the literature includes defenses for both the existence and absence of this force imbalance in people with patellofemoral pain, a reconsideration of the methods used to assess this imbalance is needed.
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Stastny P, Lehnert M, Zaatar A, Svoboda Z, Xaverova Z, Pietraszewski P. The Gluteus Medius Vs. Thigh Muscles Strength Ratio and Their Relation to Electromyography Amplitude During a Farmer's Walk Exercise. J Hum Kinet 2015; 45:157-65. [PMID: 25964819 PMCID: PMC4415828 DOI: 10.1515/hukin-2015-0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The strength ratio between hamstrings and quadriceps (H/Q) is associated with knee injuries as well as hip abductor muscle (HAB) weakness. Sixteen resistance trained men (age, 32.5 ± 4.2 years) performed 5 s maximal isometric contractions at 75° of knee flexion/extension and 15° of hip abduction on a dynamometer. After this isometric test they performed a Farmer’s walk exercise to find out if the muscle strength ratio predicted the electromyography amplitude expressed as a percentage of maximum voluntary isometric contraction (%MVIC). The carried load represented a moderate intensity of 75% of the exercise six repetitions maximum (6RM). Electromyography data from the vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF) and gluteus medius (Gmed) on each leg were collected during the procedure. The groups selected were participants with H/Q ≥ 0.5, HQ < 0.5, HAB/H ≥ 1, HAB/H < 1, HAB/Q ≥ 0.5 and HAB/Q < 0.5. One way ANOVA showed that Gmed activity was significantly greater in the group with HAB/H < 1 (42 ± 14 %MVIC) as compared to HAB/H ≥ 1 (26 ± 10 %MVIC) and HAB/Q < 0.5 (47 ± 19 %MVIC) compared to HAB/Q ≥ 0.5 (26 ± 12 %MVIC). The individuals with HAB/H < 1 were found to have greater activation of their Gmed during the Farmer’s walk exercise. Individuals with HAB/Q < 0.5 had greater activation of the Gmed. Gmed strength ratios predict the muscle involvement when a moderate amount of the external load is used. The Farmer’s walk is recommended as an exercise which can strengthen the gluteus medius, especially for individuals with a HAB/H ratio < 1 and HAB/Q < 0.5.
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Affiliation(s)
- Petr Stastny
- Palacky University in Olomouc, Faculty of Physical Culture, Tr. Miru 115, post. 771 11 Olomouc, Czech Republic
- Corresponding author: Peter Stastny, PhD, Palacky University in Olomouc, Faculty of Physical Culture, Tr. Miru 115, post. 771 11 Olomouc, Czech Republic, E-mail:
| | - Michal Lehnert
- Palacky University in Olomouc, Faculty of Physical Culture, Tr. Miru 115, post. 771 11 Olomouc, Czech Republic
| | - Amr Zaatar
- Palacky University in Olomouc, Faculty of Physical Culture, Tr. Miru 115, post. 771 11 Olomouc, Czech Republic
| | - Zdenek Svoboda
- Palacky University in Olomouc, Faculty of Physical Culture, Tr. Miru 115, post. 771 11 Olomouc, Czech Republic
| | - Zuzana Xaverova
- Palacky University in Olomouc, Faculty of Physical Culture, Tr. Miru 115, post. 771 11 Olomouc, Czech Republic
| | - Przemysław Pietraszewski
- Department of Theory and Practice of Sport; The Jerzy Kukuczka Academy of Physical Education in Katowice; Poland
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BELLI GUIDO, VITALI LUCA, BOTTEGHI MATTEO, VITTORI LEYDINATALIA, PETRACCI ELISABETTA, MAIETTA LATESSA PASQUALINO. ELECTROMYOGRAPHIC ANALYSIS OF LEG EXTENSION EXERCISE DURING DIFFERENT ANKLE AND KNEE POSITIONS. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The imbalance between vastus medialis oblique (VMO) and vastus lateralis (VL) strength is one of the main factor for patellofemoral pain syndrome (PFPS) onset, related to improper alignment of the patella. The aim of this paper is to investigate the effects of knee flexion, knee rotation and ankle flexion attitudes on the activity of the VMO and VL muscles during unilateral maximal voluntary isometric contraction (MIVC) of the quadriceps femoris. Eighteen healthy subjects volunteered for the study. Five conditions for two different knee flexion angles (90°; 30°) were tested using leg extension machine: Neutral (N) condition, maximal knee medial rotation (MR), maximal knee lateral rotation (LR), maximal ankle plantarflexion (PF) and maximal ankle dorsiflexion (DF). Data were normalized in order to calculate the normalized VMO/VL ratio. The normalized VMO/VL ratio for all the conditions occurred at 90° of knee flexion was higher than the same conditions at 30° of knee flexion (p = 0.02). No statistical differences between conditions at the same knee angle and for angle x condition interaction were observed (p > 0.05). These findings suggest that knee flexion should be the first variable to be managed during isometric knee extension movement performed by leg extension machine, in order to increase VMO/VL ratio.
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Affiliation(s)
- GUIDO BELLI
- School of Pharmacy, Biotechnology and Motor Sciences, University of Bologna, Via Berti Pichat 10, 40127 Bologna, Italy
| | - LUCA VITALI
- School of Pharmacy, Biotechnology and Motor Sciences, University of Bologna, Via Berti Pichat 10, 40127 Bologna, Italy
| | - MATTEO BOTTEGHI
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Piazza Roma 22, 60121 Ancona, Italy
| | - LEYDI NATALIA VITTORI
- School of Pharmacy, Biotechnology and Motor Sciences, University of Bologna, Via Berti Pichat 10, 40127 Bologna, Italy
| | - ELISABETTA PETRACCI
- Unit of Biostatistic and Experimental Medicine, Romagna Scientific Institute for Cancer Care and Research, Meldola, Forlì Cesena, Italy
| | - PASQUALINO MAIETTA LATESSA
- Department of Sciences for Quality of Life, University of Bologna, Via Berti Pichat 10, 40127 Bologna, Italy
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