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Sartori F, Fagnani PLF, Monne-Guasch L, La Cagnina G, Picañol J, Puig-Diví A. Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial. Front Med (Lausanne) 2024; 11:1410495. [PMID: 39021827 PMCID: PMC11251890 DOI: 10.3389/fmed.2024.1410495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/22/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Various pathophysiological contexts can be accompanied by weakness, arthrogenic muscle inhibition, and even disability. In this scenario, peripheral nerve stimulation has been studied not only for pain management but also for the improvement of neuromuscular parameters. For this purpose, the use of Transcutaneous Electrical Nerve Stimulation (TENS) has typically been investigated, but recently, the use of ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) has gained popularity. In this regard, electrical stimulation has a predisposition to activate Type II muscle fibers and has been shown to be capable of generating short-term potentiation by increasing calcium sensitivity. However, the evidence of pPNS applied in humans investigating such variables is rather limited. Objectives This pilot study aimed to assess the feasibility of the methodology and explore the potential of pPNS in enhancing hip extension performance in individuals suffering from knee pain, comparing it with TENS. Methods Twelve participants were divided into pPNS and TENS groups, undergoing pre- and post-intervention assessments of peak concentric power (W), strength (N), execution speed (m/s), and one-repetition maximum (1RM) (kg) estimation. For pPNS, two needles were positioned adjacent to the superior and inferior gluteal nerves under ultrasound guidance. For TENS, electrodes were positioned between the posterosuperior iliac spine and the ischial tuberosity, and halfway between the posterosuperior iliac spine and the greater trochanter. The interventions consisted of 10 stimulations of 10 s at a frequency of 10 Hz with a pulse width of 240 μs, with rest intervals of 10 s between stimulations. Results Peripheral nerve stimulation significantly improved concentric power at 30% (p = 0.03) and 50% (p = 0.03) of 1RM, surpassing TENS, which showed minimal changes. No significant strength differences were observed post-intervention in either group. Conclusion This work presents evidence where pPNS applied to the gluteal nerves results in an enhanced performance of hip extension at submaximal loads. However, this improvement does not seem to be reflected in short-term changes in the estimation of the 1RM by the force-velocity profile.
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Affiliation(s)
- Francesco Sartori
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | | | - Laia Monne-Guasch
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | | | - Javier Picañol
- Department of Health Sciences, Tecnocampus, Pompeu Fabra University, Mataró, Spain
| | - Albert Puig-Diví
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
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Mitomo S, Aizawa J, Hirohata K, Ohmi T, Ohji S, Furuya H, Kawasaki T, Sakai Y, Yagishita K, Okawa A. Effects of differences in femoral anteversion and hip flexion angle on hip abductor muscles activity during clam exercise in females. PLoS One 2024; 19:e0305515. [PMID: 38913672 PMCID: PMC11195955 DOI: 10.1371/journal.pone.0305515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/01/2024] [Indexed: 06/26/2024] Open
Abstract
This study aimed to determine differences in the hip abductor muscle activity during clam exercise at different hip flexion and femoral anteversion angles. Thirty healthy females were divided into two groups based on the femoral anteversion angle: the excessive femoral anteversion group and the normal group. Clam exercise was performed at three different hip flexion angles (60°, 45°, and 30°). Tensor fascia latae, gluteus medius, and superior portion of gluteus maximus activities were measured during the exercise, and the results were normalized to the activity during maximum voluntary isometric contraction to calculate the gluteal-to-tensor fascia latae muscle activation index. The superior portion of gluteus maximus activities at a hip flexion of 60° and 45° were greater than that at 30°. The excessive femoral anteversion group had a lower gluteal-to-tensor fascia latae muscle activation index than the normal group; the gluteal-to-tensor fascia latae muscle activation index for hip flexion at 60° was higher than that at 45°, and the gluteal-to-tensor fascia latae muscle activation index for hip flexion at 60° and 45° were higher than that at 30°. Therefore, the femoral anteversion angle and hip joint position were related to the activity of the hip abductor muscles during clam exercise. These findings may provide a rationale for instructing exercises to maximize the activity of the hip abductor muscles in individuals with an excessive femoral anteversion angle.
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Affiliation(s)
- Sho Mitomo
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Sports for Health Division, Japan Sports Agency, Tokyo, Japan
| | - Junya Aizawa
- Faculty of Health Science, Department of Physical Therapy, Juntendo University, Tokyo, Japan
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidetaka Furuya
- Department of Rehabilitation, Sonoda Third Hospital, Tokyo, Japan
- Department of Rehabilitation, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Tomoko Kawasaki
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yayoi Sakai
- Department of Rehabilitation, Kawakita General Hospital, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Wong BWX, Chan YH, Logan S, Kramer MS, Yong EL. Arthralgia in midlife Singaporean women: the Integrated Women's Health Program (IWHP). Climacteric 2024; 27:178-186. [PMID: 38099561 DOI: 10.1080/13697137.2023.2287626] [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: 08/22/2023] [Accepted: 11/16/2023] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Arthralgia is a common menopausal complaint in midlife women, and its causes remain unclear. We examined the prevalence of menopausal arthralgia with various factors including sleep quality, depression/anxiety, muscle strength and physical performance among midlife Singaporean women. METHODS The Integrated Women's Health Program (IWHP) comprised 1120 healthy, community-dwelling women of Chinese, Malay or Indian ethnicities (aged 45-69 years) attending well-women clinics at the National University Hospital, Singapore. Sociodemographic, menopausal, reproductive and health data were obtained with validated questionnaires. Muscle strength, physical performance and dual-energy X-ray absorptiometry were measured. Women with moderate to very severe symptoms using the Menopause Rating Scale were classified as having arthralgia. Multivariable logistic regression analyses examined risk factors for arthralgia. RESULTS One-third of the participants reported arthralgia, and 12.7%, 16.2% and 71.2% were in the premenopausal, perimenopausal and postmenopausal period, respectively. Menopausal symptoms, such as vaginal dryness (adjusted odds ratio [aOR]: 2.64, 95% confidence interval [CI]: 1.64, 4.24) and physical/mental exhaustion (aOR: 2.83, 95% CI: 1.79, 4.47), were independent risk factors for arthralgia. Poor muscle strength (aOR: 2.20, 95% CI: 1.29, 3.76), obesity (aOR: 1.94, 95% CI: 1.13, 3.32) and rheumatoid arthritis (aOR: 7.73, 95% CI: 4.47, 13.36) were also independently associated with arthralgia after adjustment for confounders. CONCLUSIONS Arthralgia in midlife Singaporean women was associated with menopausal symptoms of vaginal dryness and physical and mental exhaustion. Women with poor muscle strength were more likely to experience menopausal arthralgia.
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Affiliation(s)
- B W X Wong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Y H Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S Logan
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M S Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Quebec, Canada
| | - E L Yong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Raju A, Jayaraman K, Nuhmani S, Sebastian S, Khan M, Alghadir AH. Effects of hip abductor with external rotator strengthening versus proprioceptive training on pain and functions in patients with patellofemoral pain syndrome: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e37102. [PMID: 38363950 PMCID: PMC10869081 DOI: 10.1097/md.0000000000037102] [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: 08/09/2023] [Accepted: 01/08/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Strengthening the hip muscles, particularly the abductors and rotators, has been reported beneficial for treating Patellofemoral pain syndrome (PFPS). Proprioceptive training (PT) is also shown to improve musculoskeletal pain and function in PFPS. The most appropriate treatment from these 2 is unclear. This study aimed to compare the effects of hip abductors and external rotator strengthening exercises along with conventional physical therapy (CPT) vs the proprioceptive training of the knee along with CPT in patients with PFPS. METHODS Forty-five participants were divided into 3 groups, experimental group 1 (EG 1), experimental group 2 (EG 2), and control group (CG), with fifteen participants in each group. EG 1 received hip abductor and external rotator strengthening exercises in addition to CPT. EG 2 received proprioceptive training and CPT. CG received CPT alone. Intervention programs lasted for 4 weeks. The pain was measured by Kujala Anterior Knee Pain Scale (AKPS). The study was registered retrospectively in the protocol registration and results system (clinicaltrials.gov, ID: NCT05698797 on 26/01/2023). RESULTS AKPS scores significantly (P < .001) improved in all 3 groups. A significant (P < .05) difference was also observed between all 3 groups. The greatest improvement was observed in EG 1, followed by EG 2 and CG. CONCLUSION The addition of hip abductor and external rotator strengthening exercises to a 4-week CPT program showed a more significant improvement in AKPS scores than the addition of proprioceptive training in patients with PFPS.
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Affiliation(s)
- Aiswarya Raju
- Department of Physiotherapy, AWH Special College, Affiliated to Kerala University of Health Sciences, Kozhikode, Kerala, India
| | - Kavitha Jayaraman
- Department of Physiotherapy, AWH Special College, Affiliated to Kerala University of Health Sciences, Kozhikode, Kerala, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Salbin Sebastian
- Department of Physiotherapy, AWH Special College, Affiliated to Kerala University of Health Sciences, Kozhikode, Kerala, India
| | - Masood Khan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad H. Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Beischl S, Banke IJ, von Eisenhart-Rothe R, Twardy V. [Isolated Patellofemoral Osteoarthritis]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:93-107. [PMID: 38350459 DOI: 10.1055/a-2012-2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Isolated patellofemoral osteoarthritis is a complex pathology. It occurs frequently in women over 40 years and leads to a high degree of suffering. The causes of femoropatellar degeneration are manifold and require stage-specific therapy. This is very challenging for the treating physician. This article is intended to provide a structured overview of the symptoms, diagnostics and stage-specific therapy of patellofemoral osteoarthritis.
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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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7
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Liu Y, Wang Y. A comparative study of the efficacy of instrument-assisted soft tissue mobilization and massage techniques in patients with patellofemoral joint pain. Front Med (Lausanne) 2023; 10:1305733. [PMID: 38020090 PMCID: PMC10679753 DOI: 10.3389/fmed.2023.1305733] [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: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of this study was to compare the clinical efficacy of instrument-assisted soft tissue mobilization (IASTM) and manipulative therapy Tui-na techniques in the treatment of patients with patellofemoral joint pain syndrome, and to evaluate their impact on pain relief, functional improvement, and joint range of motion. Methods In this study, 25 patients with patellofemoral pain syndrome were enrolled, comprising of an intervention group of 13 patients who received IASTM treatment and a control group of 12 patients who received Tui-na manipulation therapy. The treatment cycle lasted for 4 weeks, featuring two interventions per week. Before treatment, the visual analog pain scale (VAS) of the knee, Lysholm score of the knee, modified Thomas test (MTT), and maximum isometric strength of the extensor muscles of the lower limbs were measured and recorded for both groups. After the first and last treatments, the aforementioned indexes were reassessed, and the maximum isometric muscle strength of the lower extremity extensors was measured only after 4 weeks of treatment had been completed. Results There was no significant difference in the basic information of the two intervention groups (p > 0. 05). After the first treatment and 4 weeks of treatment, the Lysholm score in both groups significantly improved (p < 0. 05), indicating that both interventions can improve the function of patients' lower limbs. However, the Lysholm score in the IASTM group significantly increased compared with that of the massage group after 4 weeks of treatment, indicating that its improvement in functional performance is superior. Both groups showed significant improvement in knee joint pain after the first treatment and 4 weeks of treatment (p < 0. 05), with the IASTM group having a lower VAS score and better pain improvement after 4 weeks of treatment. The strength of the two intervention groups significantly increased after the maximum isometric muscle strength test of the lower limb extensor muscles before and after 4 weeks of treatment (p < 0. 05). After the MTT test, the extension angle, deviation angle, and hip abduction angle of the tested legs in the two intervention groups were significantly reduced (p < 0. 001), indicating an improvement in lower limb joint mobility. Conclusion Instrument-assisted soft tissue mobilization treatment and Tui-na manipulation therapy significantly reduced pain, improved knee flexibility, and increased range of motion of the lower extremity in patients with PFPS. However, IASTM treatment significantly improved pain and function and sustained pain in the short to medium-term post-trial period. Clinical trial registration www.isrctn.com, ISRCTN88098928.
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Affiliation(s)
- Yang Liu
- SchoolGraduate School of Wuhan Sports University, Wuhan Sports University, Wuhan, China
| | - Yidan Wang
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia
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Albornoz-Cabello M, Ibáñez-Vera AJ, Barrios-Quinta CJ, Lara-Palomo IC, Cardero-Durán MDLÁ, Espejo-Antúnez L. Effects of Radiofrequency Diathermy Plus Therapeutic Exercises on Pain and Functionality of Patients with Patellofemoral Pain Syndrome: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12062348. [PMID: 36983348 PMCID: PMC10051503 DOI: 10.3390/jcm12062348] [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: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Although consensus has been reached about the use of therapeutic exercise in patellofemoral pain syndrome, several techniques used worldwide such as radiofrequency diathermy could be useful as complementary therapy. The objective of this randomized controlled trial was to compare the effects of adding radiofrequency diathermy to therapeutic exercises in patients with patellofemoral pain syndrome. Fifty-six participants were randomly assigned either to radiofrequency diathermy plus therapeutic exercises group (n = 29) or therapeutic exercises group (n = 27). Both groups received the same therapeutic exercises, and the diathermy group additionally received monopolar dielectric diathermy for three weeks (5-3-2 weekly sessions). Data related to intensity of pain, probability of neuropathic pain, functionality, and range of movement of the knee were measured at baseline and three weeks after the intervention. Comparing pre-treatment and values obtained at the third week, significant improvements were found in intensity of pain, neuropathic pain, functionality, and range of motion in both groups (p < 0.05). The diathermy plus exercises group had significantly better intensity of pain than the control group at the end of the three weeks (p < 0.01). The addition of diathermy by emission of radiofrequency to the therapeutic knee exercise protocol is more effective than a therapeutic exercise protocol alone in the relief of intensity of pain in patients with patellofemoral pain in the immediate post-treatment follow-up compared with baseline scores.
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Affiliation(s)
| | | | | | | | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
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Seijas-Otero D, Alonso-Calvete A, Cuña-Carrera ID, Justo-Cousiño LA. Effects of taping in patellofemoral pain syndrome: A systematic review. J Back Musculoskelet Rehabil 2023; 36:261-269. [PMID: 35964172 DOI: 10.3233/bmr-220099] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patellofemoral pain syndrome (PPS) is defined as a condition in the patellofemoral joint that can present with pain, functional deficit, crepitus, and instability. Its etiology appears to lie in excessive loading of the patellofemoral joint due to mispositioning of the patella. The application of taping has recently increased, to manage PPS. However, the level of scientific evidence in this sense is unknown. OBJECTIVE To determine the effect of different types of taping in subjects with PPS. METHODS A bibliographic search was carried out in January and February 2021 in Scopus, Web of Science, PubMed, Medline, SPORTDiscus, PEDro and CINAHL. RESULTS A total of 13 studies were included for qualitative analysis. The mean score on the PEDro scale was 5.30 points. Most of the articles reflect a decrease in pain after the taping intervention, while variables such as functionality, muscle activity and biomechanical modification do not show positive effects. CONCLUSION Taping appears to have positive effects on pain in subjects with PPS. However, the evidence is contradictory with the rest of the variables studied.
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Affiliation(s)
| | - Alejandra Alonso-Calvete
- Facultade de Fisioterapia, Universidade de Vigo, Pontevedra, Spain.,REMOSS Research Group. Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
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Girardi FM, Guenka LC. Quadriceps strengthening by the Kaatsu Training method in women with patellofemoral pain. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22001529022022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT This is a cross-sectional, comparative, and randomized study aimed to evaluate the effects of the partial vascular occlusion technique (Kaatsu Training) associated with low load exercises in the muscle strengthening of quadriceps in women with patellofemoral pain. We evaluated 18 women with patellofemoral pain, aged from 18 to 35 years, allocated into two groups. The experimental group performed the strengthening with blood flow reduction with the aid of a sphygmomanometer, associated with low load (≅20% RM). Whereas the control group performed exercises with the same load, but without blood flow reduction. The treatment was performed three times a week for six weeks, totaling 18 sessions. We used the numerical pain rating scale (NPRS) and the anterior knee pain scale (AKPS) questionnaire for evaluation; we evaluated the muscle strength of knee extensors by the digital dynamometer. The results showed that the partial vascular occlusion technique significantly improved the values of quadriceps strength gain in the right, 6.22kg (p=0.03) and left limb, 6.98kg (p=0.04), in women with patellofemoral pain. Therefore, training with partial vascular occlusion can be useful for strengthening of the knee extensor musculature in women with patellofemoral pain who, because of the pain, have low tolerance to high load exercises for muscle strengthening. An effective, safe and cost-effective technique, which does not require an investment in a leg extension machine, since, with a cuff, low load exercises can offer significant results.
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Girardi FM, Guenka LC. Fortalecimento do quadríceps através do método Kaatsu Training em mulheres com dor femoropatelar. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22001529022022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Este é um estudo transversal, comparativo e randomizado, cujo objetivo foi avaliar os efeitos da técnica de oclusão vascular parcial (Kaatsu Training) associada a exercícios de baixa carga no fortalecimento muscular de quadríceps em mulheres com dor femoropatelar. Foram avaliadas 18 mulheres com dor femoropatelar, com idade entre 18 e 35 anos, que foram alocadas em dois grupos. O grupo experimental realizou fortalecimento com redução do fluxo sanguíneo por meio de um esfigmomanômetro, associado com baixa carga (≅20% RM). Enquanto o grupo-controle realizou exercícios com a mesma carga, porém sem redução do fluxo sanguíneo. O tratamento foi realizado três vezes na semana, em um período de seis semanas, totalizando 18 sessões. Para avaliação foram utilizadas a escala numérica de avaliação da dor (NPRS) e o questionário anterior knee pain scale (AKPS); a força muscular de extensores do joelho foi avaliada através do dinamômetro digital. Os resultados mostraram que a técnica de oclusão vascular parcial provocou melhorias significativas nos valores de ganho de força do quadríceps no membro direito, 6,22kg (p=0,03), e esquerdo, 6,98kg (p=0,04), em mulheres com dor femoropatelar. Portanto, treinamento com oclusão vascular parcial pode ser uma alternativa útil para ganho de força da musculatura extensora do joelho em mulheres com dor femoropatelar que, devido à dor, tenham baixa tolerância a exercícios de alta carga para fortalecimento muscular, sendo uma técnica eficaz, segura e com boa relação de custo-benefício, não necessitando a compra de uma cadeira extensora, uma vez que utilizando um manguito é possível obter resultados significativos associados a exercícios de baixa carga.
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Can hip muscle strengthening interventions improve lower extremity kinematics among healthy subjects? A systematic review of randomized controlled trials. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Retrospective Observational Study on the Characteristics of Pain and Associated Factors of Breakthrough Pain in Advanced Cancer Patients. Pain Res Manag 2022; 2022:8943292. [PMID: 35463627 PMCID: PMC9023204 DOI: 10.1155/2022/8943292] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/08/2022] [Accepted: 03/29/2022] [Indexed: 12/25/2022]
Abstract
Objective This study aimed to conduct a retrospective observational study to understand the status of characteristics of pain and identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP) in advanced cancer patients. Methods Advanced cancer patients over 18 years of age; diagnosed with cancer of any type and stage III or IV in the palliative care ward with available data were enrolled between 2018 and 2020. Demographic data and pain-related information were collected by using structured electronic extraction form from Hospital Information System (HIS). Patients who had well-controlled background pain with an intensity ≤4 on a 0–10 numerical scale for >12 hours/day, the presence of transient exacerbations of pain with moderate-severe intensity (≧5), and clearly distinguish from background pain were regarded to have suffered BTP. Spearman correlation was conducted to explore the relationship between pain score and demographics characteristics. Factors significant in univariate analysis were included in the multiple regression model to explore independent predictive factors associated with the BTP. Results Of 798 advanced cancer patients, the mean age was 56.7 (SD = 11.84) years. Lung cancer (29.95%) was the most common cancer, and pain (93%) was the most common symptom. More than half (n = 428, 53.6%) of the patients experienced BTP. The median number of BTP episodes was 4 (IQR = 2, 7, range: 1–42). The median intensity of BTP was 6 (IQR = 6, 7, range 5–10). Patients with severe background pain or BTP had longer hospital stay and more symptoms. Besides, more severe background pain was related to higher activity of daily living. Intramuscular injection of hydromorphone hydrochloride was the main medication for BTP onset. Younger age, background pain, anorexia, and constipation were independently associated with the presentation of BTP. BTP pain intensity was independently associated with bloating. Symptom numbers were an independent factor and positively associated with BTP episodes. Conclusions BTP resulted in poor prognosis, which has a variable presentation depending on interdependent relationships among different characteristics. Good controlling of background pain and assessment of pain-related symptoms are essential for BTP management. BTP should be managed individually, especially the invisible pain among aged patients. Furthermore, BTP-related education and training were still needed.
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Lower Extremity Kinetics and Kinematics in Runners with Patellofemoral Pain: A Retrospective Case–Control Study Using Musculoskeletal Simulation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patellofemoral pain (PFP) is a common atraumatic knee pathology in runners, with a complex multifactorial aetiology influenced by sex differences. This retrospective case–control study therefore aimed to evaluate lower limb kinetics and kinematics in symptomatic and control male and female runners using musculoskeletal simulation. Lower extremity biomechanics were assessed in 40 runners with PFP (15 females and 25 males) and 40 controls (15 females and 25 males), whilst running at a self-selected velocity. Lower extremity biomechanics were explored using a musculoskeletal simulation approach. Four intergroup comparisons—(1) overall PFP vs. control; (2) male PFP vs. male control; (3) female PFP vs. female control; and (4) male PFP vs. female PFP—were undertaken using linear mixed models. The overall (stress per mile: PFP = 1047.49 and control = 812.93) and female (peak stress: PFP = 13.07 KPa/BW and control = 10.82 KPa/BW) comparisons showed increased patellofemoral joint stress indices in PFP runners. A significantly lower strike index was also shown in PFP runners in the overall (PFP = 17.75% and control = 33.57%) and female analyses (PFP = 15.49% and control = 40.20%), revealing a midfoot strike in control, and a rearfoot pattern in PFP runners. Peak rearfoot eversion and contralateral pelvic drop range of motion (ROM) were shown to be greater in PFP runners in the overall (eversion: PFP = −8.15° and control = −15.09°/pelvic drop ROM: PFP = 3.64° and control = 1.88°), male (eversion: PFP = −8.05° and control = −14.69°/pelvic drop ROM: PFP = 3.16° and control = 1.77°) and female (eversion: PFP = 8.28° and control = −15.75°/pelvic drop ROM: PFP = 3.64° and control = 1.88°) PFP runners, whilst female PFP runners (11.30°) exhibited a significantly larger peak hip adduction compared to PFP males (7.62°). The findings from this investigation highlight biomechanical differences between control and PFP runners, as well as demonstrating distinctions in PFP presentation for many parameters between sexes, highlighting potential risk factors for PFP that may be addressed through focused intervention modalities, and also the need, where appropriate, for sex-specific targeted treatment approaches.
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Fukuda TY, Aquino LM, Pereira P, Ayres I, Feio AF, de Jesus FLA, Neto MG. Does adding hip strengthening exercises to manual therapy and segmental stabilization improve outcomes in patients with nonspecific low back pain? A randomized controlled trial. Braz J Phys Ther 2021; 25:900-907. [PMID: 34824001 PMCID: PMC8721074 DOI: 10.1016/j.bjpt.2021.10.005] [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: 08/21/2020] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The literature is unclear on the need for hip strengthening in persons with low back pain (LBP). OBJECTIVES To investigate the effectiveness of hip strengthening exercises when added to manual therapy and lumbar segmental stabilization in patients with chronic nonspecific LBP. METHODS Seventy patients with chronic nonspecific LBP were randomly assigned to either the manual therapy and lumbar segmental stabilization group or the manual therapy and lumbar segmental stabilization plus specific hip strengthening group. A 10 cm visual analogue scale and the Rolland-Morris Questionnaire were the primary clinical outcome measures at baseline, at the end of treatment (posttreatment), and 6- and 12-months posttreatment. Hip strength and kinematics were measured as secondary outcomes . RESULTS While within-group improvements in pain, disability, and hip extensors strength occurred in both groups, there were no significant between-group differences at posttreatment or follow-ups. Mean difference in changes in pain level between groups at posttreatment and at 6- and 12-month follow-up were 0.5 points (95% confidence interval [CI]: -0.5, 1.5), 0.3 points (95% CI: -0.9, 1.5), and 0.0 points (95% CI: -1.1, 1.1), respectively. The mean differences in changes in disability were 0.8 points (95% CI: -1.3, 2.7), 0.0 points (95% CI: -2.4, 2.4), and 0.4 points (95% CI: -2.0, 2.8), respectively. Finally, we did not observe any between-group differences for any of the other outcomes at any timepoint. CONCLUSION The addition of specific hip strengthening does not appear to result in improved clinical outcomes for patients with nonspecific LBP.
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Affiliation(s)
- Thiago Yukio Fukuda
- Department of Physical Therapy, Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil; Trata Institute - Knee and Hip Rehabilitation / ITC Vertebral, São Paulo, SP, Brazil.
| | - Leticia Moraes Aquino
- Department of Physical Therapy, Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil
| | - Pedro Pereira
- Department of Physical Therapy, Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil
| | - Isabella Ayres
- Department of Physical Therapy, Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil
| | - Ana Francisca Feio
- Department of Physical Therapy, Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil
| | | | - Mansueto Gomes Neto
- Department of Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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Greaves H, Comfort P, Liu A, Lee Herrington, Richard Jones. How effective is an evidence-based exercise intervention in individuals with patellofemoral pain? Phys Ther Sport 2021; 51:92-101. [PMID: 34303900 DOI: 10.1016/j.ptsp.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/12/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Guidelines for a comprehensive rehabilitation programme for patellofemoral pain (PFP) have been developed by international experts. The aim of this study was to analyse the effect of such a rehabilitative exercise programme on pain, function, kinesiophobia, running biomechanics, quadriceps strength and quadriceps muscle inhibition in individuals with PFP. DESIGN Observational study. SETTING Clinical environment. PARTICIPANTS Twenty-seven participants with PFP. MAIN OUTCOME MEASURES Symptoms [numeric pain rating scale (NPRS)and the pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS)], function measured by using the KUJALA scale and KOOS, kinesiophobia measured by using the Tampa scale, three-dimensional biomechanical running data, quadriceps isometric, concentric and eccentric strength and arthrogenic muscle inhibition (AMI) were acquired before and after the six-week exercise programme. RESULTS Although pain did not significantly improve all patients were pain-free after the six-week exercise programme (NPRS: p = 0.074). Function, kinesiophobia and quadriceps AMI improved significantly after the six-week exercise programme (KUJALA: p = 0.001, KOOS: p = 0.0001, Tampa: p = 0.017, AMI: p = 0.018). Running biomechanics during stance phase did not change after the exercise intervention. Quadriceps strength was not different after the six-week exercise programme (isometric: p = 0.992, concentric: p = 0.075, eccentric: p = 0.351). CONCLUSION The results of this study demonstrate that the current exercise recommendations can improve function and kinesiophobia and reduce pain and AMI in individuals with PFP. There is a need for reconsideration of the current exercise guidelines in stronger individuals with PFP.
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Affiliation(s)
- Henrike Greaves
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Paul Comfort
- School of Health and Society, University of Salford, Salford, UK.
| | - Anmin Liu
- School of Health and Society, University of Salford, Salford, UK.
| | - Lee Herrington
- School of Health and Society, University of Salford, Salford, UK.
| | - Richard Jones
- School of Health and Society, University of Salford, Salford, UK.
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da Silva Boitrago MV, de Mello NN, Barin FR, Júnior PL, de Souza Borges JH, Oliveira M. Effects of proprioceptive exercises and strengthening on pain and functionality for patellofemoral pain syndrome in women: A randomized controlled trial. J Clin Orthop Trauma 2021; 18:94-99. [PMID: 33996453 PMCID: PMC8100610 DOI: 10.1016/j.jcot.2021.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective of this study was to verify the effects of resisted and proprioceptive exercises program for the treatment of patients diagnosed with patellofemoral pain syndrome (PFPS). DESIGN METHOD Randomized Controlled Trial - level of evidence, II. METHODS Sixty female patients, clinically diagnosed with PFPS, were allocated into two experimental groups. The exercise group (ExG) underwent 6 weeks of a resisted and proprioceptive exercises for the trunk muscles, abductors and lateral hip rotators and knee extensors. The Guidance Group (GG) received educational, cognitive and behavioral guidance on healthcare. Before and after the program implementation period, all participants were evaluated in relation to the injured limb for pain assessment, subjective functionality, maximum isometric strength and 2D biomechanical analysis. RESULTS After a six-week follow-up, ExG showed significant improvement in the Numerical Pain Rating Scale, Anterior Knee Pain Scale and Knee Outcome Survey- Activities of Daily Living Scale when compared to the control group (p ≤ 0,05). The ExG also proved superior for increased muscle strength of knee extensors, hip abductors, decreased dynamic knee valgus and pelvic drop in relation to GG (p ≤ 0.05). However, when we consider the strength of the hip lateral rotator muscles there was no difference between the two interventions (p > 0.05). CONCLUSION Resisted and proprioceptive exercises yielded superior results to those of a treatment focused on educational, cognitive and behavioral guidance in improving pain and lower limb function for women with PFPS.
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Affiliation(s)
- Marcos Vinicius da Silva Boitrago
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil,Centro Universitário de Brasília (UniCEUB), Brasília, Distrito Federal, Brazil
| | - Nayara Nepomuceno de Mello
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - Fabrício Reichert Barin
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil,Corresponding author. Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), SGAS Quadra 613 - Conjunto C - Asa Sul, Brasília, Distrito Federal, Brazil.
| | - Paulo Lobo Júnior
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - José Humberto de Souza Borges
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - Marcio Oliveira
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil,Centro Universitário de Brasília (UniCEUB), Brasília, Distrito Federal, Brazil
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Teixeira ASS, Silva PL, Cintra SP, Viegas F, Mendonça LD, Bittencourt NFN. Concurrent Validation and Reference Values of Gluteus Medius Clinical Test. Int J Sports Phys Ther 2021; 16:335-341. [PMID: 33842029 PMCID: PMC8016418 DOI: 10.26603/001c.21477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023] Open
Abstract
CONTEXT The hip abductor muscles, mainly the gluteus medius, are responsible for controlling hip adduction in a closed kinetic chain. Frontal plane knee alignment, assessed during functional activities such squatting, jumping and running, may overload joint structures, like the anterior cruciate ligament and patellofemoral joint. The hand-held dynamometer is reliable and effective for testing the muscular strength of the hip abductors. OBJECTIVES 1. To assess the concurrent validity between the gluteus medius clinical test and a maximum isometric force test of the hip abductors using the hand-held dynamometer; (2) to determine the intra and inter-examiner reliability for the application of the gluteus medius clinical test; and (3) to describe reference values of gluteus medius clinical test on a population of youth athletes. DESIGN Cross-sectional. METHODS Thirty healthy individuals were recruited for validity and reliability testing. On the first day, participants performed the maximal isometric test of the hip abductors, measured via hand-held dynamometry. On the following week, the gluteus medius clinical test was performed. Intraclass correlation coefficients (ICC2,2) were computed for the reliability analysis, with a 95% confidence interval. To generate reference values, the gluteus medius clinical test was performed on 273 athletes. RESULTS The results of this study indicated a weak positive correlation (r = 0.436, p = 0.001) between tests, which indicates that they examine different domains of gluteus medius muscle function, likely endurance and muscle strength. The magnitude of computed ICCs (>0.95) indicates excellent intra- and inter-examiner reliability. CONCLUSION The findings of the current study indicate that the gluteus medius clinical test is reliable and examines a domain of muscular function not fully captured by HHD. The clinical test developed in this study is low-cost and can be included for gluteus medius assessment. LEVEL OF EVIDENCE Level 3.
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Shadloo N, Kamali F, Salehi Dehno N. A comparison between whole-body vibration and conventional training on pain and performance in athletes with patellofemoral pain. J Bodyw Mov Ther 2021; 27:661-666. [PMID: 34391303 DOI: 10.1016/j.jbmt.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/19/2021] [Accepted: 03/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patellofemoral pain (PFP) is the most common cause of anterior knee pain in athletes, which affects their performance especially during single leg activities. The aim of this study was to compare the effects of whole-body vibration training (WBVT) and conventional training (CT) on pain and performance in athletes with PFP. METHODS 30 athletes with unilateral PFP were randomly assigned to the WBVT (6 women, 9 men) or CT (7 women, 8 men) group. All participants received training for 4 weeks in 12 sessions. The outcomes of pain and performance were measured at three points in time: baseline, immediately after training and 2 weeks after training. Pain was assessed with the Numeric Pain Rating Scale (NPRS). Performance was measured with the leg-press test and the Kujala Patellofemoral Score (KPS). RESULTS In both groups, pain intensity decreased significantly (p < 0.001) and the KPS and number of leg presses increased significantly (p < 0.001) with time. There was no significant difference between groups for changes in the pain score (p = 0.896), KPS (p = 0.463) or leg press (p = 0.796) results. CONCLUSION Whole-body vibration training had the same effect as exercise therapy on pain reduction and on improvements in performance in athletes with PFP.
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Affiliation(s)
- Najmeh Shadloo
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Nasrin Salehi Dehno
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Lee JH, Jang KM, Kim E, Rhim HC, Kim HD. Static and Dynamic Quadriceps Stretching Exercises in Patients With Patellofemoral Pain: A Randomized Controlled Trial. Sports Health 2021; 13:482-489. [PMID: 33615901 DOI: 10.1177/1941738121993777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Limited data are available on the effect of stretching exercise in patients with patellofemoral pain (PFP) who have inflexible quadriceps, which is one of the various causes of PFP syndrome. This study compares quadriceps flexibility, strength, muscle activation time, and patient-reported outcomes after static and dynamic quadriceps stretching exercises in patients with PFP who had inflexible quadriceps. HYPOTHESIS Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes would improve with dynamic quadriceps stretching as compared with static quadriceps stretching exercises. STUDY DESIGN Randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS Of the 44 patients included in the study, 20 performed static stretching and 24 performed dynamic stretching. Quadriceps flexibility was assessed by measuring the knee flexion angle during knee flexion in the prone position (the Ely test). Muscle strength and muscle activation time were measured using an isokinetic device. The patient-reported outcomes were evaluated using the visual analogue scale for pain and anterior knee pain scale. RESULTS No significant differences in quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in the involved knees were found between the 2 groups (P values > 0.05). CONCLUSION Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in patients with PFP who had inflexible quadriceps showed no significant differences between the static and dynamic quadriceps stretching exercise groups. CLINICAL RELEVANCE Both static and dynamic stretching exercises may be effective for improving pain and function in patients with PFP who have inflexible quadriceps.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Republic of Korea.,Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea.,Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Eunseon Kim
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Hye Chang Rhim
- Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Hyeong-Dong Kim
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Republic of Korea
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Raghava Neelapala YV, Bhagat M, Shah P. Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature. J Geriatr Phys Ther 2021; 43:89-98. [PMID: 30407271 DOI: 10.1519/jpt.0000000000000214] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Osteoarthritis (OA) of the knee joint results in chronic pain and functional decline among older adults. Hip muscle weakness has been observed in persons with knee OA and is claimed to increase the medial compartment loading on the knee joint. Although individual studies are available, no review has yet integrated the literature on the benefits of hip muscle strengthening for persons with knee OA. This review aims to systematically summarize the current evidence on the effectiveness of hip muscle strengthening on knee pain, lower extremity function, and biomechanical measures of the knee in persons with knee OA. METHODS An extensive electronic literature search was conducted in the databases PubMed, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) to identify the published trials in the English language from January 1990 to August 2017. Randomized controlled trials that studied the effectiveness of hip muscle strengthening in persons with knee OA on knee pain, physical function, and biomechanical measures of the knee were considered for inclusion. The key word combinations were knee osteoarthritis, degenerative arthritis, arthralgia, muscle strengthening, and resistance training using the Boolean operators AND, OR. Two reviewers independently performed the study selection, and a third reviewer intervened when the consensus was not attained. Quality assessment of the included studies was carried out using the PEDro scale. RESULTS AND DISCUSSION The search produced 774 results, from which 81 full-text articles were studied. Five randomized controlled trials of good methodological quality, including 331 participants, were included in the review. The effectiveness of hip muscle strengthening was assessed in isolation, combination, and comparison with other lower extremity exercise. Overall, the studies reported clear benefits of hip muscle strengthening on knee pain, physical function, and hip muscle strength. However, hip muscle strengthening was ineffective in improving the biomechanical measures such as dynamic alignment and knee adduction (also known as valgus) moment. CONCLUSION The current review identified strong, high-quality evidence to recommend hip muscle strengthening in the conservative management of persons with knee OA. Further research is needed to establish the underlying mechanisms for the clinical benefits.
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Affiliation(s)
- Y V Raghava Neelapala
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Madhura Bhagat
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Purvi Shah
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
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Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial. J Sport Rehabil 2020; 30:609-618. [PMID: 33333491 DOI: 10.1123/jsr.2020-0108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/22/2020] [Accepted: 09/05/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT The effects of an exercise program (EP) for the treatment of patellofemoral pain syndrome (PFPS) are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear. OBJECTIVE To evaluate the effects of OMT versus EP on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with PFPS. DESIGN This is a randomized controlled trial. SETTING Human performance laboratory. PARTICIPANTS A total of 82 runners with PFPS participated in this study. INTERVENTIONS The participants were randomized into 3 groups: OMT, EP, and control group. The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions. The EP group performed specific exercises for lower limbs. The control group received no intervention. MAIN OUTCOME MEASURES The main evaluations were pain through the visual analog scale, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry. The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up. RESULTS There was a significant pain decrease in the OMT and EP groups when compared with the control group. OMT group showed increased functionality, decreased PPMF, and increased PTF. The range of motion for hip extension increased only in the EP group. CONCLUSION Both OMT and EP are effective in treating runners with PFPS.
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Evaluation of patients with PFPS using a standardized Q angle measurement protocol. TURKISH JOURNAL OF KINESIOLOGY 2020. [DOI: 10.31459/turkjkin.814557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Effects of a 12-week home exercise therapy program on pain and neuromuscular activity in patients with patellofemoral pain syndrome. Arch Orthop Trauma Surg 2020; 140:1985-1992. [PMID: 32728976 DOI: 10.1007/s00402-020-03543-y] [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: 03/23/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of this study is to evaluate the effects of a 12-week home exercise therapy program on pain, function and neuromuscular activity of the vastus medialis and vastus lateralis. MATERIALS AND METHODS Fifty patients with patellofemoral pain syndrome were treated with a 12-week online home exercise program. The primary outcomes of pain and function were assessed at the 12-week follow-up using the Visual Analog Scale and Kujala Score, respectively. Secondary outcomes were the muscle onset time and the ratio of vastus medialis and vastus lateralis during different daily activities. RESULTS After 12 weeks, patients showed significant (p < 0.05) improvements of 27 points on the Visual Analog Scale and 10 points on Kujala Score. Differences in pre-post comparison regarding both temporal and amplitude-related neurophysiological differences between the vastus medialis and lateralis were only found when the subjects were divided into groups of different electromyographic patterns. Then changes in the pre-post comparison were particularly evident in the patient group with a delayed vastus medialis onset and a lower activity of the vastus medialis compared to the VL. CONCLUSION Pain and function improved significantly after a home exercise therapy program in patients with patellofemoral pain syndrome. In addition, patients with a delayed onset or reduced activity of the vastus medialis compared to the vastus lateralis experienced a reduction in this imbalance.
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Effect of 4 Weeks of Anti-Gravity Treadmill Training on Isokinetic Muscle Strength and Muscle Activity in Adults Patients with a Femoral Fracture: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228572. [PMID: 33227913 PMCID: PMC7699176 DOI: 10.3390/ijerph17228572] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022]
Abstract
This study aimed to identify the effect of anti-gravity treadmill training on isokinetic lower-limb muscle strength and muscle activities in patients surgically treated for a hip fracture. A total of 34 participants were randomly assigned into two groups: anti-gravity treadmill training group (n = 17) and control group (n = 17). The isokinetic muscle strength and endurance of hip flexor and extensor and the activities of the vastus lateralis (VL), vastus medialis (VM), gluteus maximus (GM), and gluteus medialis (Gm) muscles were measured before and after 4 weeks of the interventions. Significant improvements were observed in isokinetic muscle strength and endurance of hip flexors and extensors in both groups (p < 0.05); however, no significant differences were observed between the groups (p > 0.05) except for muscle strength of the hip extensor (d = 0.78, p = 0029). Statistically significant increases in the muscle activity of VL, VM, GM, and Gm were found before and after the intervention (p < 0.05), and significant differences in muscle activities of GM (d = 2.64, p < 0.001) and Gm (d = 2.59, p < 0.001) were observed between the groups. Our results indicate that both groups showed improvement in muscle strength, endurance, and activities after the intervention. Additionally, anti-gravity treadmill training improved significantly more muscle strength at 60°/s of the hip extensor and gluteus muscle activities than conventional therapy, which may be appropriate for patients with hip fracture surgery.
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Vorderer Knieschmerz. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jerez-Mayorga D, Delgado-Floody P, Intelangelo L, Campos-Jara C, Arias-Poblete L, García-Verazaluce J, Garcia-Ramos A, Chirosa LJ. Behavior of the muscle quality index and isometric strength in elderly women. Physiol Behav 2020; 227:113145. [PMID: 32822709 DOI: 10.1016/j.physbeh.2020.113145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
This study aimed (I) to compare the muscle quality index (MQI) and the isometric hip strength between younger and older women, and (II) to determine the relationship of the MQI with the sit-to-stand test (STS) and isometric hip strength in younger and older women. Twenty-eight elderly women (age= 66.2 ± 5.6 years) and twenty younger women (21.2 ± 2.2 years) participated in the study. The following dependent variables were measured: MQI, STS, body composition, and the peak isometric strength of the hip (PF) which was also normalized using three different methods (PF/Body Mass, PF/Fat-Free Mass, and PF/Body Mass0,335). Older women presented a lower PF in hip flexion, extension and external rotation regardless of the method of normalization (p < 0.001), but the PF of hip abductors and internal rotators was higher for older women (p < 0.05). No significant differences were found in the MQI between older and younger women (p = 0.443). The MQI was negatively correlated with the time in the STS in older women (r = -0.706, p < 0.001) and younger women (r = -0.729, p < 0.001), while the correlations of MQI with isometric hip strength were weaker in older women (r range: -0.082 - 0.556) and younger women (r range: -0.020 - 0.309). MQI is a clinical and practical tool to assess the muscular power of the lower extremities.
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Affiliation(s)
- Daniel Jerez-Mayorga
- Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha #700, Santiago. Chile.
| | - Pedro Delgado-Floody
- Department of Physical Education. Sports and Recreation. Universidad de La Frontera. Temuco. Chile
| | - Leonardo Intelangelo
- Musculoskeletal Research Group. University Center for Assistance. Teaching and Research. University of Gran Rosario. Rosario. Argentina
| | - Christian Campos-Jara
- Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha #700, Santiago. Chile
| | - Leonidas Arias-Poblete
- Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha #700, Santiago. Chile
| | | | - Amador Garcia-Ramos
- Department Physical Education and Sports. Faculty of Sport Sciences. University of Granada. Granada. Spain; Department of Sports Sciences and Physical Conditioning. Faculty of Education. Universidad Católica de la Santísima Concepción. Concepción. Chile
| | - Luis Javier Chirosa
- Department Physical Education and Sports. Faculty of Sport Sciences. University of Granada. Granada. Spain
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Pfluegler G, Borkovec M, Kasper J, McLean S. The immediate effects of passive hip joint mobilization on hip abductor/external rotator muscle strength in patients with anterior knee pain and impaired hip function. A randomized, placebo-controlled crossover trial. J Man Manip Ther 2020; 29:14-22. [PMID: 32452284 DOI: 10.1080/10669817.2020.1765625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Anterior knee pain (AKP) is often associated with persistent hip muscle weakness and facilitatory interventions may be beneficial for managing patients with AKP (pwAKP). Physiotherapists often employ passive oscillatory hip joint mobilizations to increase hip muscle function. However, there is little information about their effectiveness and the mechanisms of action involved. Objectives: To investigate the immediate effects of passive hip joint mobilization on eccentric hip abductor/external rotator muscle strength in pwAKP with impaired hip function. Design: A double-blinded, randomized, placebo-controlled crossover design. Method: Eighteen patients with AKP participated in two sessions of data collection with one week apart. They received passive hip joint mobilization or placebo mobilization in a randomized order. Eccentric hip muscle strength was measured immediately before and after each intervention using a portable hand-held dynamometer. Results: An ANCOVA with the sequence of treatment condition as the independent variable, the within-subject post-treatment differences as the dependent variable and the within-subject pre-treatment differences as the covariate was conducted. Patients showed a significant mean increase in eccentric hip muscle strength of 7.73% (p = 0.001) for the mobilization condition, compared to a mean decrease of 4.22% for the placebo condition. Seventeen out of eighteen participants reported having no pain during any of the strength testing. Conclusion: These data suggest that passive hip joint mobilization has an immediate positive effect on eccentric hip abductor/external rotator muscle strength in pwAKP with impaired hip function, even in the absence of current pain.
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Affiliation(s)
- Georg Pfluegler
- Faculty of Health and Well Being, Sheffield Hallam University , Sheffield, UK
| | - Martin Borkovec
- Department of Statistics, Ludwig Maximilian University of Munich , Munich, Germany
| | - Johanna Kasper
- Private Physiotherapy Practice "Teamphysios" , Vienna, Austria
| | - Sionnadh McLean
- Faculty of Health and Well Being, Sheffield Hallam University , Sheffield, UK
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Nielsen TG, Miller LL, Mygind-Klavsen B, Lind M. A simple rehabilitation regime improves functional outcome in patients with patellafemoral pain after 12 month. J Exp Orthop 2020; 7:5. [PMID: 32034562 PMCID: PMC7007455 DOI: 10.1186/s40634-020-00223-z] [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: 12/16/2019] [Accepted: 02/03/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of the present study was to investigate the effects of a 3-month multimodal intervention including patient education, a simple hip exercise program, footwear adjustment, and foot orthoses to reduce symptoms in patients with patellafemoral pain (PFP). METHODS Patients were diagnosed based on a physical examination, patient symptoms and ruled out intra-articular knee pathologies by MRI. Patients were educated on PFP and participated in a 3-month exercise program; shoes with solid heel-caps were recommended, and custom made orthoses with arch support were recommended to patients with foot pronation. The Anterior Knee Pain Scale (AKPS) and the pain numeric rating scale (NRS) were used to evaluate the outcomes of the intervention and collected at baseline, 3 and 12-months follow-ups. RESULTS Sixty-five patients (age 18 years (9-32)) were included in a consecutive prospective cohort. The AKPS score improved from 71 ± 24 to 89 ± 9 (p < 0.01) at 12 months follow up. The NRS-rest and NRS-activity improved from 3 to 0 (p < 0.01) and 7 to 3 (p < 0.01) respectively. 78% of the patients clinically improved (i.e., demonstrated a > 10-point improvement (minimal clinically important difference (MCID))) considering the AKPS; and 76% and 73% clinically improved (i.e., demonstrated (MCID) a ≥ 2-point improvement) in their NRS-rest and NRS-activity, respectively. No patients experienced a decrease in their AKPS score or an increase in their NRS-rest and NRS-activity scores at 12-months. CONCLUSION A 3-month PFP multimodal treatment strategy focusing on patient education, footwear adjustment, orthoses, and simple hip muscle exercises significantly improved functional outcomes and reduced pain at a 12 month follow-up.
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Affiliation(s)
- Torsten Grønbech Nielsen
- Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lene Lindberg Miller
- Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Bjarne Mygind-Klavsen
- Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Martin Lind
- Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Hott A, Brox JI, Pripp AH, Juel NG, Liavaag S. Patellofemoral pain: One year results of a randomized trial comparing hip exercise, knee exercise, or free activity. Scand J Med Sci Sports 2020; 30:741-753. [PMID: 31846113 DOI: 10.1111/sms.13613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Extended follow-up of a randomized trial comparing hip-focused exercise, knee-focused exercise, and free physical activity in patellofemoral pain (PFP). METHODS A single-blind randomized controlled trial included 112 patients aged 16-40 years (mean 27.6 years) with a clinical diagnosis of PFP ≥3 months (mean 39 months) and pain ≥3/10 on a Visual Analog Scale. Patients were randomized to a 6-week exercise-based intervention consisting of either isolated hip-focused exercises (n = 39), traditional knee-focused exercise (n = 37), or free physical activity (n = 36). All patients received the same patient education. The primary outcome measure was the Anterior Knee Pain Scale (AKPS, 0-100). Secondary outcomes were usual and worst pain, Tampa Scale of Kinesiophobia, Knee Self-Efficacy Score, Euro-Qol (EQ-5D-5L), step-down test, and isometric strength. Blinded observers assessed outcomes at baseline, 3, and 12 months. The study was designed to detect a difference in AKPS >10 at 12 months. RESULTS After 1 year, there were no significant between-group differences in any primary or secondary outcomes. Between-group differences for AKPS were as follows: knee versus free physical activity -4.3 (95% CI -12.3 to 3.7); hip versus free physical activity -1.1 (95% CI -8.9 to 6.7); and hip versus Knee 3.2 (95% CI -4.6 to 11.0). The cohort as a whole improved significantly at 3 and 12 months compared to baseline for all measures except for knee extension strength. CONCLUSION After 1 year, there was no difference in effectiveness of knee exercise, hip exercise, or free physical activity, when combined with patient education in PFP.
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Affiliation(s)
- Alexandra Hott
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Jens Ivar Brox
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Sigurd Liavaag
- Department of Orthopedic Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway
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Lima KMME, Flôr JDS, Barbosa RI, Marcolino AM, Almeida MGD, Silva DCD, Kuriki HU. Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study. MOTRIZ: REVISTA DE EDUCACAO FISICA 2020. [DOI: 10.1590/s1980-6574201900040103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Juliane da Silva Flôr
- Universidade Federal de Santa Catarina, Brasil; Universidade Federal de Santa Catarina, Brasil
| | - Rafael Inácio Barbosa
- Universidade Federal de Santa Catarina, Brasil; Universidade Federal de Santa Catarina, Brasil
| | | | | | | | - Heloyse Uliam Kuriki
- Universidade Federal de Santa Catarina, Brasil; Universidade Federal de Santa Catarina, Brasil
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Arrebola LS, Campos TVDO, Smith T, Pereira AL, Pinfildi CE. Translation, cross-cultural adaptation and validation of the Norwich Patellar Instability score for use in Brazilian Portuguese. SAO PAULO MED J 2019; 137:148-154. [PMID: 31314875 PMCID: PMC9721228 DOI: 10.1590/1516-3180.2018.0393280119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/28/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Norwich Patellar Instability (NPI) score is a tool for evaluating the impact of patellofemoral instability on joint function. It has not been translated or culturally adapted for the Brazilian population before. OBJECTIVE This study had the aims of translating and culturally adapting the NPI score for use in Brazilian Portuguese and subsequently assessing its validity for this population. DESIGN AND SETTING Translation, cross-cultural adaptation and validation study conducted at the State Public Servants' Institute of São Paulo, Brazil. METHODS Sixty patients of both sexes (aged 16-40 years) with diagnoses of patellar dislocation were recruited. The translation and cultural adaptation were undertaken through translation into Brazilian Portuguese and back-translation to English by an independent translator. Face validity was assessed by a committee of experts and by 20 patients. Concurrent validity was assessed through comparing the Brazilian Portuguese NPI score with the Brazilian Portuguese versions of the Lysholm knee score and the Kujala patellofemoral disorder score among the other 40 patients. Correlation analysis between the three scores was performed using Pearson correlation coefficients with significance levels of P < 0.05. RESULTS The Brazilian Portuguese version of the NPI score showed moderate correlation with the Brazilian Portuguese versions of the Lysholm score (r = -0.56; 95% confidence interval, CI: -0.74 to -0.30; P < 0.01) and Kujala score (r = -0.57; 95% CI: -0.75 to -0.31; P < 0.01). CONCLUSION The Brazilian Portuguese version of the NPI score is a validated tool for assessing patient-reported patellar instability for the Brazilian population.
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Affiliation(s)
- Lucas Simões Arrebola
- PT, MSc. Doctoral Student, Department of Human Movement Sciences, Universidade Federal de São Paulo (UNIFESP), Baixada Santista Campus, Santos (SP), and Physical Therapist, Department of Physical Therapy, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo (SP), Brazil.
| | - Túlio Vinícius de Oliveira Campos
- MD, PhD. Professor and Physician, Department of Orthopedics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Toby Smith
- PhD. Researcher, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - André Lourenço Pereira
- MD. Orthopedic Surgery Residency Student, Department of Orthopedics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Carlos Eduardo Pinfildi
- PT, PhD. Professor, Department of Human Movement Sciences, Universidade Federal de São Paulo (UNIFESP), Baixada Santista Campus, Santos (SP), Brazil.
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Hott A, Brox JI, Pripp AH, Juel NG, Paulsen G, Liavaag S. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. Am J Sports Med 2019; 47:1312-1322. [PMID: 30958707 DOI: 10.1177/0363546519830644] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exercise for patellofemoral pain (PFP) is traditionally knee focused, targeting quadriceps muscles. In recent years, hip-focused exercise has gained popularity. Patient education is likely an important factor but is underresearched. PURPOSE To compare 3 treatment methods for PFP, each combined with patient education: hip-focused exercise, knee-focused exercise, or free physical activity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A single-blind randomized controlled trial was performed with 112 patients who were 16 to 40 years old (mean, 27.6 years) and had a symptom duration >3 months (mean, 39 months) with a clinical diagnosis of PFP and no radiograph or magnetic resonance evidence of other pathology. Patients were randomized to a 6-week intervention consisting of patient education combined with isolated hip-focused exercise (n = 39), traditional knee-focused exercise (n = 37), or free physical activity (n = 36). The primary outcome was Anterior Knee Pain Scale (0-100) at 3 months. Secondary outcomes were visual analog scale for pain, Tampa Scale for Kinesiophobia, Knee Self-efficacy Scale, EuroQol, step-down, and isometric strength. RESULTS There were no between-group differences in any primary or secondary outcomes at 3 months except for hip abduction strength and knee extension strength. Between-group differences at 3 months for Anterior Knee Pain Scale were as follows: knee versus control, 0.2 (95% CI, -5.5 to 6.0); hip versus control, 1.0 (95% CI, -4.6 to 6.6); and hip versus knee, 0.8 (95% CI, -4.8 to 6.4). The whole cohort of patients improved for all outcomes at 3 months except for knee extension strength. CONCLUSION The authors found no difference in short-term effectiveness in combining patient education with knee-focused exercise, hip-focused exercise, or free training for patients with PFP. REGISTRATION NCT02114294 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Alexandra Hott
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Jens Ivar Brox
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Gøran Paulsen
- The Norwegian Olympic and Paralympic Committee and Confederation of Sport, Oslo, Norway
| | - Sigurd Liavaag
- Department of Orthopedic Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway
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Buckthorpe M, La Rosa G, Villa FD. RESTORING KNEE EXTENSOR STRENGTH AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CLINICAL COMMENTARY. Int J Sports Phys Ther 2019; 14:159-172. [PMID: 30746302 PMCID: PMC6350662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
UNLABELLED One of the main priorities of rehabilitation after anterior cruciate ligament reconstruction (ACLR) surgery is the restoration of knee extensor muscle strength. Residual deficits in knee extensor muscle size and strength after injury are linked to poor biomechanics, reduced knee function, increased knee osteoarthritis risk, as well as heightened risk of re-injury upon return to sport. Most studies indicate that knee extensor muscle strength is typically not resolved prior to return to sport. This clinical commentary discusses strategies to optimize and accelerate the recovery of knee extensor strength post-surgery, with the purpose to support the clinician with evidence-based strategies to implement into clinical practice. Principally, two strategies exist to normalize quadriceps strength after surgery, 1) limiting strength loss after injury and surgery and 2) maximizing and accelerating the recovery of strength after surgery. Optimal preparation for surgery and a focused attempt to resolve arthrogenic muscle inhibition are essential in the pre and post-operative period prior to the inclusion of a periodized strength training program. Often voluntary strengthening alone is insufficient to fully restore knee extensor muscle strength and the use of electrical stimulation and where necessary the use of blood flow restriction training with low loads can support strength recovery, particularly in patients who are significantly load compromised and experience pain during exercise. Resistance training should employ all contraction modes, utilize open and closed kinetic chain exercise of both limbs, and progress from isolated to functional strength training, as part of a periodized approach to restoring neuromuscular function. Furthermore, thinking beyond the knee musculature and correcting core and hip dysfunction is also important to ensure an optimal knee extension strengthening program. The purpose of this clinical commentary is to provide a series of evidenced based strategies which can be implemented by clinicians responsible for the rehabilitation of patients after ACLR. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Giovanni La Rosa
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, Education & Research Department, Bologna, Italy
| | - Francesco Della Villa
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, Education & Research Department, Bologna, Italy
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Chen S, Chang WD, Wu JY, Fong YC. Electromyographic analysis of hip and knee muscles during specific exercise movements in females with patellofemoral pain syndrome: An observational study. Medicine (Baltimore) 2018; 97:e11424. [PMID: 29995792 PMCID: PMC6076041 DOI: 10.1097/md.0000000000011424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hip muscle strengthening and knee extensor strengthening are common training exercises for patellofemoral pain syndrome (PFPS). PFPS engendered by insufficient hip abductor and external rotator muscle strength has been of interest, but these exercise movements may increase the lateral vector force of the patella warrants clarification. So, the purpose of this study was to assess muscular activations of vastus lateralis (VL), vastus medialis oblique (VMO), and gluteus medius muscles in electromyographic analysis during hip abduction and external rotator movements and open and closed kinetic chain knee extension movements.The gluteus medius, VMO, and VL muscles, in addition to the ratio of the VL and VMO muscles, were assessed through surface electromyography in 4 movements. Each muscle's amplitude expressed as a percent of maximum voluntary contraction (MVC). The differences on MVC at the terminal joint angle and during the movements were compared.Thirty female patients with PFPS were recruited. During hip abduction and external rotation movements, the MVC of the gluteus medius muscle increased, and those of the VMO and VL muscles increased in the open and closed kinetic chain knee extension movements. The MVCs of VL in the hip abduction and external rotation movements were significantly higher than those of the VMO muscle (P < .05). The ratios of the VL and VMO muscles in the open and closed kinetic chain knee extension movements approached 1, and they were significantly higher than those in the hip abduction and external rotation movements (P < .05). The highest MVC of the VMO muscle was observed at the terminal joint angle in the closed kinetic chain knee extension movement.Selective gluteus medius muscle activation was induced during the hip abduction and external rotation movements, accompanied by an increase in VL muscle activation. In open and closed kinetic chain knee movements, the ratios of the VL and VMO muscles approached 1. More selective VMO muscle activation was induced during the closed kinetic chain knee movements.
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Affiliation(s)
| | - Wen-Dien Chang
- Department of Sports Medicine, China Medical University, Taichung, Taiwan (R.O.C)
- Department of Sport Performance, National Taiwan University of Sport, Taichung, Taiwan (R.O.C)
| | - Jhih-Yun Wu
- Department of Sports Medicine, China Medical University, Taichung, Taiwan (R.O.C)
| | - Yi-Chin Fong
- Department of Sports Medicine, China Medical University, Taichung, Taiwan (R.O.C)
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Collins NJ, Barton CJ, van Middelkoop M, Callaghan MJ, Rathleff MS, Vicenzino BT, Davis IS, Powers CM, Macri EM, Hart HF, de Oliveira Silva D, Crossley KM. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med 2018; 52:1170-1178. [DOI: 10.1136/bjsports-2018-099397] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 01/01/2023]
Abstract
Patellofemoral pain affects a large proportion of the population, from adolescents to older adults, and carries a substantial personal and societal burden. An international group of scientists and clinicians meets biennially at the International Patellofemoral Research Retreat to share research findings related to patellofemoral pain conditions and develop consensus statements using best practice methods. This consensus statement, from the 5th International Patellofemoral Research Retreat held in Australia in July 2017, focuses on exercise therapy and physical interventions (eg, orthoses, taping and manual therapy) for patellofemoral pain. Literature searches were conducted to identify new systematic reviews and randomised controlled trials (RCTs) published since the 2016 Consensus Statement. The methodological quality of included systematic reviews and RCTs was graded using AMSTAR and PEDro, respectively. Evidence-based statements were developed from included papers and presented to a panel of 41 patellofemoral pain experts for consensus discussion and voting. Recommendations from the expert panel support the use of exercise therapy (especially the combination of hip-focused and knee-focused exercises), combined interventions and foot orthoses to improve pain and/or function in people with patellofemoral pain. The use of patellofemoral, knee or lumbar mobilisations in isolation, or electrophysical agents, is not recommended. There is uncertainty regarding the use of patellar taping/bracing, acupuncture/dry needling, manual soft tissue techniques, blood flow restriction training and gait retraining in patients with patellofemoral pain. In 2017, we launched the International Patellofemoral Research Network (www.ipfrn.org) to consolidate and grow our patellofemoral research community, facilitate collaboration and disseminate patellofemoral pain knowledge to clinicians and the general public. The 6th International Patellofemoral Research Retreat will be held in Milwaukee, Wisconsin, USA, in October 2019.
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Towards Subject-Specific Strength Training Design through Predictive Use of Musculoskeletal Models. Appl Bionics Biomech 2018; 2018:9721079. [PMID: 29796082 PMCID: PMC5896361 DOI: 10.1155/2018/9721079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/05/2018] [Accepted: 01/28/2018] [Indexed: 11/18/2022] Open
Abstract
Lower extremity dysfunction is often associated with hip muscle strength deficiencies. Detailed knowledge of the muscle forces generated in the hip under specific external loading conditions enables specific structures to be trained. The aim of this study was to find the most effective movement type and loading direction to enable the training of specific parts of the hip muscles using a standing posture and a pulley system. In a novel approach to release the predictive power of musculoskeletal modelling techniques based on inverse dynamics, flexion/extension and ab-/adduction movements were virtually created. To demonstrate the effectiveness of this approach, three hip orientations and an external loading force that was systematically rotated around the body were simulated using a state-of-the art OpenSim model in order to establish ideal designs for training of the anterior and posterior parts of the M. gluteus medius (GM). The external force direction as well as the hip orientation greatly influenced the muscle forces in the different parts of the GM. No setting was found for simultaneous training of the anterior and posterior parts with a muscle force higher than 50% of the maximum. Importantly, this study has demonstrated the use of musculoskeletal models as an approach to predict muscle force variations for different strength and rehabilitation exercise variations.
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Pairot de Fontenay B, Esculier JF, Bouyer L, Roy JS. Hip kinematics during functional tasks in females with patellofemoral pain: Modification following rehabilitation and correlation with clinical improvement. Phys Ther Sport 2018; 32:7-14. [PMID: 29655089 DOI: 10.1016/j.ptsp.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/27/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To compare hip kinematics during two functional tasks in females with and without patellofemoral pain (PFP), and to determine if hip kinematics and, symptoms and functional limitations were improved after a rehabilitation program. DESIGN Cross sectional and longitudinal. PARTICIPANTS Sixteen females with and 15 without PFP. SETTING Laboratory and physical therapy clinic. MAIN OUTCOME MEASURES Hip adduction (HADD) and medial rotation (HMR) peak angles, time integrals and inter-movement variability during step-down and vertical drop jump, symptoms and functional limitations evaluated using the Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS). RESULTS At baseline, no significant differences were found in step-down and vertical drop jump between PFP and controls. Following rehabilitation, significant improvements were reported in KOS-ADLS (p < 0.001). There was a significant decrease in HADD and HMR variability (p < 0.05), a trend for decreased peak HMR (p = 0.06) during step-down, and a significant decrease in HADD variability (p < 0.05) during vertical drop jump. These kinematic changes did not correlate with changes in KOS-ADLS (all p > 0.05). CONCLUSION Females with and without PFP demonstrated no hip kinematic differences during functional tasks. A rehabilitation program improved symptoms and functional status, and modified hip kinematics in females with PFP; however these changes were not correlated.
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Affiliation(s)
- Benoit Pairot de Fontenay
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada
| | - Jean-François Esculier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada
| | - Laurent Bouyer
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Universite Laval, Quebec City, Quebec G1R 1P5, Canada
| | - Jean-Sébastien Roy
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Universite Laval, Quebec City, Quebec G1R 1P5, Canada.
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Saad MC, Vasconcelos RAD, Mancinelli LVDO, Munno MSDB, Liporaci RF, Grossi DB. Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises. Braz J Phys Ther 2018; 22:408-416. [PMID: 29661570 DOI: 10.1016/j.bjpt.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/14/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics. METHODS A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention. RESULTS All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities. CONCLUSION Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/).
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Affiliation(s)
- Marcelo Camargo Saad
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil; Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
| | | | | | - Matheus Soares de Barros Munno
- Curso de Fisioterapia,Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rogério Ferreira Liporaci
- Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Débora Bevilaqua Grossi
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2018; 48:19-31. [PMID: 29034800 DOI: 10.2519/jospt.2018.7365] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review with meta-analysis. Background The addition of hip strengthening to knee strengthening for persons with patellofemoral pain has the potential to optimize treatment effects. There is a need to systematically review and pool the current evidence in this area. Objective To examine the efficacy of hip strengthening, associated or not with knee strengthening, to increase strength, reduce pain, and improve activity in individuals with patellofemoral pain. Methods A systematic review of randomized and/or controlled trials was performed. Participants in the reviewed studies were individuals with patellofemoral pain, and the experimental intervention was hip and knee strengthening. Outcome data related to muscle strength, pain, and activity were extracted from the eligible trials and combined in a meta-analysis. Results The review included 14 trials involving 673 participants. Random-effects meta-analyses revealed that hip and knee strengthening decreased pain (mean difference, -3.3; 95% confidence interval [CI]: -5.6, -1.1) and improved activity (standardized mean difference, 1.4; 95% CI: 0.03, 2.8) compared to no training/placebo. In addition, hip and knee strengthening was superior to knee strengthening alone for decreasing pain (mean difference, -1.5; 95% CI: -2.3, -0.8) and improving activity (standardized mean difference, 0.7; 95% CI: 0.2, 1.3). Results were maintained beyond the intervention period. Meta-analyses showed no significant changes in strength for any of the interventions. Conclusion Hip and knee strengthening is effective and superior to knee strengthening alone for decreasing pain and improving activity in persons with patellofemoral pain; however, these outcomes were achieved without a concurrent change in strength. Level of Evidence Therapy, level 1a-. J Orthop Sports Phys Ther 2018;48(1):19-31. Epub 15 Oct 2017. doi:10.2519/jospt.2018.7365.
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Rabelo NDDA, Costa LOP, Lima BMD, Dos Reis AC, Bley AS, Fukuda TY, Lucareli PRG. Adding motor control training to muscle strengthening did not substantially improve the effects on clinical or kinematic outcomes in women with patellofemoral pain: A randomised controlled trial. Gait Posture 2017; 58:280-286. [PMID: 28841508 DOI: 10.1016/j.gaitpost.2017.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/19/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
DESIGN Randomized controlled trial. BACKGROUND Patients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP. METHODS Thirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement Control & Strengthening group (MC&S group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization. RESULTS The MC&S group did not present significantly better function (MD -2.5 points, 95% CI;-10.7-5.5) or pain (MD -0.3 points, 95% CI;-1.7-1.0) at 4 weeks. There was a small difference in favour of the MC&S group for AKPS scores at 3 months (MD -8.5 points; 95% CI;-16.8 to -0.3). No significant between-group differences were observed for the other outcomes. CONCLUSION Movement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.
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Affiliation(s)
- Nayra Deise Dos Anjos Rabelo
- Human Motion Analysis Laboratory, Reabilitation Sciences Departament, Universidade Nove de Julho - UNINOVE, São Paulo, SP, Brazil.
| | - Leonardo Oliveira Pena Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, SP, Brazil.
| | - Bruna Maria de Lima
- Human Motion Analysis Laboratory, Reabilitation Sciences Departament, Universidade Nove de Julho - UNINOVE, São Paulo, SP, Brazil.
| | - Amir Curcio Dos Reis
- Human Motion Analysis Laboratory, Reabilitation Sciences Departament, Universidade Nove de Julho - UNINOVE, São Paulo, SP, Brazil.
| | - André Serra Bley
- Human Motion Analysis Laboratory, Reabilitation Sciences Departament, Universidade Nove de Julho - UNINOVE, São Paulo, SP, Brazil.
| | | | - Paulo Roberto Garcia Lucareli
- Human Motion Analysis Laboratory, Reabilitation Sciences Departament, Universidade Nove de Julho - UNINOVE, São Paulo, SP, Brazil.
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Rajasekar S, Kumar A, Patel J, Ramprasad M, Samuel AJ. Does Kinesio taping correct exaggerated dynamic knee valgus? A randomized double blinded sham-controlled trial. J Bodyw Mov Ther 2017; 22:727-732. [PMID: 30100304 DOI: 10.1016/j.jbmt.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/12/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deficiency in hip girdle neuromuscular control can cause exaggerated Dynamic Knee Valgus (DKV) which afflicts the knee joint and lead to knee injuries especially ACL injury in sports. Though Kinesio taping (KT) is known to improve function, stability and proprioception, the evidence is inconclusive on its effectiveness in athletes. We hypothesized that kinesio taping could enhance neuromuscular control of the hip girdle there by causing a reduction in DKV. AIM/OBJECTIVE To determine whether KT on Gluteus medius can correct exaggerated dynamic knee valgus and improves hip abductor strength when compared to sham KT. METHOD 40 collegiate level athletes, aged between 18 and 28 years, of both genders with presence of dynamic knee valgus (>8° for men and >13° for women) were recruited in the study. Athletes were excluded if they had history of lower back pain, history of any injury or surgery to the lower extremities during the past year. Subjects who met the inclusion criteria were randomized into kinesio taping (KT) group and sham taping (ST) group. The Drop Jump test and the Donnatelli Drop Leg Test (DDT) were performed before, and on the third day, immediately after the application of KT on them and documented. RESULTS There was a significant reduction in DKV among male [4.0° (95% CI 3.5-4.5); p < 0.001] and female [4.3° (95% CI 3.5-5.2); p < 0.002] immediately after application of taping but not on the third day after application of KT. There was a significant rise in DDT immediately and on the third day after application of KT between KT group and SC group. CONCLUSION There was a reduction in DKV immediately after the application of KT. However, there was no significant difference between KT group and SC group on the third day. Meanwhile, gluteus medius strength also showed significant improvement immediately after taping and it was maintained even on the third day.
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Affiliation(s)
- Sannasi Rajasekar
- College of Physiotherapy, Srinivas University, Mangalore 575001, Karnataka, India.
| | - Ajay Kumar
- College of Physiotherapy, Srinivas University, Mangalore 575001, Karnataka, India
| | - Jignesh Patel
- College of Physiotherapy, Srinivas University, Mangalore 575001, Karnataka, India
| | | | - Asir John Samuel
- Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar University, Mullana 133207, Haryana, India.
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Van Cant J, Pitance L, Feipel V. Hip abductor, trunk extensor and ankle plantar flexor endurance in females with and without patellofemoral pain. J Back Musculoskelet Rehabil 2017; 30:299-307. [PMID: 27689604 DOI: 10.3233/bmr-150505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous studies have reported strength deficit in hip abduction, extension and external rotation in females with patellofemoral pain (PFP) when compared with healthy control; however, there is conflicting evidence for a decrease in hip muscle endurance. Therefore, it seems important to evaluate hip muscle endurance in females with PFP. Moreover, trunk extensor and ankle plantar flexor endurance have not yet been evaluate in females with PFP. OBJECTIVE To compare hip abductor, trunk extensor and ankle plantar flexor endurance between females with and without PFP. METHODS Twenty females with PFP (mean age, 21.1 years) and 76 healthy females (mean age, 20.5 years) were recruited. Subject performed three endurance clinical tests: (1) The hip abductor isometric endurance test, (2) The Sorensen test and (3) The heel rise test. Group differences were assessed using an independent t tests, or Mann-Whitney U tests for non-normally distributed data. RESULTS Subjects with PFP exhibited significantly lower hip abductor, trunk extensor and ankle plantar flexor endurance than healthy controls. On average, subjects with PFP had deficits of 16% in hip abduction, 14% in trunk extension and 26% in ankle plantar flexion. CONCLUSION Females with PFP exhibited diminished hip abductor, trunk extensor and ankle plantar flexor endurance compared to healthy controls.
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Affiliation(s)
- Joachim Van Cant
- Department of Physical Therapy, Institut Parnasse-ISEI, Brussels, Belgium.,Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurent Pitance
- CARS institute, Faculty of Motor Sciences, Université Catholique de Louvain, Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
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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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Abadi L, Salahzadeh Z, Rezaei M, Oskouei AE, Azghani MR. Hip joint torques in type II diabetes with and without neuropathy. Hong Kong Physiother J 2017; 37:27-33. [PMID: 30931043 PMCID: PMC6385154 DOI: 10.1016/j.hkpj.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Patients with diabetes and peripheral neuropathy demonstrate significantly reduced peak torques at the peripheral joints. Objectives The aim of this study was to assess isometric and concentric peak torques of the hip joint in people with type II diabetes with and without peripheral neuropathy in comparison with healthy participants. Methods 27 patients with type II diabetes including 15 patients without peripheral neuropathy, 12 patients with diabetes and peripheral neuropathy and 15 healthy people participated. Isometric and concentric peak torques of hip flexion, extension, adduction and abduction of the non-dominant leg were measured by motorized dynamometer. Results Peak and average peak concentric torques of the hip extension and abduction in patients with diabetes and peripheral neuropathy were lower than those patients with diabetes and control group. Angle of extension peak torque was significantly greater in patients with diabetes and peripheral neuropathy compared with other groups. Angle of flexion peak torque was lower in the patients with diabetes and peripheral neuropathy. Conclusions Torque related parameters in patients with type II diabetes with or without peripheral neuropathy, are different from healthy subjects. As a result, patients with diabetes especially with peripheral neuropathy are more susceptible of injury and disability in lower limbs.
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Affiliation(s)
- Laleh Abadi
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Salahzadeh
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mandana Rezaei
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali E Oskouei
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmood Reza Azghani
- Biomechanics Department, Faculty of Biomechanics Engineering, Sahand University of Technology, Tabriz, Iran
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Chevidikunnan MF, Al Saif A, Gaowgzeh RA, Mamdouh KA. Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome. J Phys Ther Sci 2016; 28:1518-23. [PMID: 27313363 PMCID: PMC4905902 DOI: 10.1589/jpts.28.1518] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/02/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Patellofemoral pain syndrome is a frequent musculoskeletal disorder, which can
result from core muscles instability that can lead to pain and altered dynamic balance.
The objective of this study is to assess the effect of core muscle strengthening on pain
and dynamic balance in female patients with patellofemoral pain syndrome. [Subjects and
Methods] Twenty female patients with age ranging from 16 to 40 years with patellofemoral
pain syndrome were divided into study (N=10) and control (N=10) groups. Both groups were
given 4 weeks of conventional physical therapy program and an additional core muscle
strengthening for the study group. The tools used to assess the outcome were Visual
Analogue Scale and Star Excursion Balance Test. [Results] The results of the study show
that participants in the study group revealed a significantly greater improvement in the
intensity of pain and dynamic balance as compared to the control group. [Conclusion]
Adding a core muscle-strengthening program to the conventional physical therapy management
improves pain and dynamic balance in female patients with patellofemoral pain
syndrome.
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Affiliation(s)
| | - Amer Al Saif
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Saudi Arabia
| | - Riziq Allah Gaowgzeh
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Saudi Arabia
| | - Khaled A Mamdouh
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Saudi Arabia
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Petersen W, Ellermann A, Rembitzki IV, Scheffler S, Herbort M, Brüggemann GP, Best R, Zantop T, Liebau C. Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial. Arch Orthop Trauma Surg 2016; 136:975-82. [PMID: 27146819 PMCID: PMC4908172 DOI: 10.1007/s00402-016-2464-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Indexed: 10/27/2022]
Abstract
BACKGROUND It has been previously shown that exercise programs for patellofemoral pain syndrome (PFPS) can be supported by medially directed taping. Evidence supporting the use of patellar braces is limited because previous studies have been low quality. The aim of this study is to compare the outcomes of patients with PFPS after treatment with a medially directed patellar realignment brace and supervised exercise. METHODS In a prospective randomized multicenter trial, 156 patients with PFPS were included and randomly assigned to 6 weeks of supervised physiotherapy in combination with the patellar realignment brace, or supervised physiotherapy alone. Outcome measures were the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, numeric analog pain scores, and the Kujala score at baseline, 6 weeks, 3 months, and 1 year after the start of therapy. The patient's self-reported perception of recovery was also assessed at these points. RESULTS Both treatment groups showed a significant improvement in all outcome measures over the study period. After 6 and 12 weeks of therapy, patients in the brace group had significantly higher KOOS sub-scale scores, a higher mean Kujala score, and less pain while climbing stairs or playing sports. After 54 weeks a group difference could be only detected for the KOOS ADL sub-scale. CONCLUSION The use of a medially directed realignment brace leads to better outcomes in patients with PFPS than exercise alone after 6 and 12 weeks of treatment. After 1 year of follow-up this positive effect diminished.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus Berlin, Grunewald, Caspar Theyß Strasse 27-31, 14193 Berlin, Germany
| | | | - Ingo Volker Rembitzki
- Otto Bock, Duderstadt, Germany ,Asklepios, Harzkliniken GmbH, Fritz-König-Stift, Bad Harzburg, Germany
| | | | - Mirco Herbort
- Klinik für Unfall-, Hand-, und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
| | | | | | | | - Christian Liebau
- Asklepios, Harzkliniken GmbH, Fritz-König-Stift, Bad Harzburg, Germany
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