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Melo SA, Macedo LDB, Bullhões LCC, Cavalcanti RL, Azevedo Rodolfo JID, Brasileiro JS. Effects of neuromuscular electrical stimulation on patellofemoral pain: A randomized controlled trial. J Bodyw Mov Ther 2024; 39:390-397. [PMID: 38876657 DOI: 10.1016/j.jbmt.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Patellofemoral Pain (PFP) is a common dysfunction that can compromise the performance of daily activities. Neuromuscular electrical stimulation (NMES) has been proposed as a complementary tool in the therapeutic approach. OBJECTIVE To analyze the effects of adding NMES to therapeutic exercises in women with PFP. METHODS Randomized controlled trial involving 34 women with PFP (mean age 23.8 ± 4.1), randomly assigned to two groups: exercises combined with NMES (ESG) and exercises only (ExG). The ExG followed an exercise protocol, while the ESG performed the same exercises combined with NMES. Interventions were performed twice a week for eight weeks. Primary outcome measures included pain and functional disability, while secondary outcomes encompassed electromyographic activity of the quadriceps and hip abductors, along with isokinetic performance. Assessments were performed before the intervention, after 4 and 8 weeks from the start of the protocol and 8 weeks after the conclusion of the treatment. RESULTS We did not observe difference between the groups in any of the analyzed variables. Both groups showed a reduction in pain and an improvement in functional disability during intragroup comparisons. CONCLUSION A reduction in pain and an improvement in functional disability were observed; however, there was no additional effect of NMES. TRIAL REGISTRATION NCT03918863.
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Affiliation(s)
- Samara Alencar Melo
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Liane de Brito Macedo
- Faculty of Health Sciences of Trairi of the Federal University of Rio Grande do Norte, (UFRN), Av. Rio Branco, S/N, Santa Cruz, RN, CEP: 59.200-000, Brazil.
| | - Lidiane Cristina Correia Bullhões
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Rafael Limeira Cavalcanti
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Jully Israely de Azevedo Rodolfo
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
| | - Jamilson Simões Brasileiro
- Department of Physiotherapy of the Federal University of Rio Grande do Norte, (UFRN), Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN, CEP: 59.078-970, Brazil.
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Eckenrode BJ, Kietrys DM, Brown A, Parrott JS, Noehren B. Effects of high frequency strengthening on pain sensitivity and function in female runners with chronic patellofemoral pain. Phys Ther Sport 2024; 67:31-40. [PMID: 38471409 DOI: 10.1016/j.ptsp.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the effects of a high frequency strengthening program on function, pain, and pain sensitization in female runners with chronic patellofemoral pain (PFP). DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Thirty female runners (mean age 32 ± 8.1 years) with chronic PFP completed an 8-week home strengthening program. MAIN OUTCOME MEASURES Variables assessed at baseline, 8-weeks, and 12 weeks included single leg step down test (SLSD), pain, Anterior Knee Pain Scale (AKPS), University of Wisconsin Running Injury and Recovery Index (UWRI), and quantitative sensory testing. RESULTS There was large and statistically significant improvement at 8 and 12 weeks for average knee pain (ηp2 = 0.334, p < 0.001), worst knee pain (ηp2 = 0.351, p < 0.001), SLSD (ηp2 = 0.161, p = 0.001), AKPS (ηp2 = 0.463, p < 0.001), and UWRI (ηp2 = 0.366, p < 0.001). A medium to large effect and statistically significant improvement in pressure pain threshold testing was found for all local and remote structures (ηp2 range, 0.110 to 0.293, range p < 0.001 to p = 0.009) at 8 and 12 weeks. CONCLUSIONS There was a significant decrease in local and remote hyperalgesia via mechanical and thermal pain sensitivity testing in female runners with chronic PFP. There was a large effect and significant improvement in self-reported pain and function.
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Affiliation(s)
- Brian J Eckenrode
- Arcadia University, Department of Physical Therapy, Glenside, PA, 19038, USA.
| | - David M Kietrys
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences, Blackwood, NJ, 08012, USA
| | - Allison Brown
- Rutgers School of Health Professions, Department of Rehabilitation and Movement Sciences Newark, NJ, 07101, USA
| | - J Scott Parrott
- Rutgers School of Health Professions, Department of Interdisciplinary Studies, Blackwood, NJ, 08012, USA
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, KY, 40536, USA
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Mousavi F, Kajbafvala M, Mohsenifar H, Salehi R, Hejazi A. The effect of movement system impairment-based classification treatment compared to routine physiotherapy on pain, disability, alignment, and movement impairments in individuals with tibiofemoral rotation syndrome: a randomized controlled trial. BMC Sports Sci Med Rehabil 2024; 16:94. [PMID: 38664767 PMCID: PMC11046785 DOI: 10.1186/s13102-024-00883-9] [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: 11/23/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Knee pain is a common musculoskeletal problem. Lower extremity movement impairments could alter stresses in different planes and contribute to knee pain. Classifying these impairments may be helpful in the diagnosis and treatment of knee problems. Movement system impairment (MSI)-based classification is a system to evaluate movement impairments. Trials that involve this classification are limited. Therefore, it will be of interest to examine the effect of movement system impairment-based classification treatment compared to routine physiotherapy in individuals with tibiofemoral rotation syndrome. METHODS Twenty-two individuals with knee pain aged 18-40 years (2 males, 20 females) diagnosed with tibiofemoral rotation (TFR) syndrome were included. After initial evaluation, individuals were randomly assigned into two treatment groups (MSI-based treatment and routine physiotherapy). Both treatment groups contained 8 treatment sessions over 4 weeks. Alignment and movement impairments data form, a numeric rating scale (NRS), and the Kujala Disability Questionnaire were assessed at baseline and after a four-week intervention. Independent samples t-test and Mann-Whitney U test were used for quantitative variables, and Fisher's exact test was employed for qualitative variables to compare the groups. One-way Analysis of variance (ANOVA) and paired samples t-test were utilized to within-group changes of quantitative variables, and qualitative variables were analyzed with the McNemar test. RESULTS The results showed that pain intensity and disability significantly decreased within and between groups after intervention (P > 0.05). There were also statistically significant differences between treatment groups for 3 out of 6 alignment and movement impairments (PS-FAdd/IR, Step down-Add/Valgus, and STS-Add/Valgus) (P > 0.05). Within-group differences for alignment and movement impairments were significant only for the MSI-based treatment group (P > 0.05). CONCLUSIONS The findings suggest that a specific MSI-based treatment, considering a homogenous group of individuals with knee pain, may contribute to pain, disability, and alignment and movement impairments improvement. Therefore, it is important to notice the classification-based treatment for individuals with knee pain. TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION The trial was registered at the ( https://www.irct.ir ), (IRCT20210505051181N3) on 17/7/2021.
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Affiliation(s)
- Forouzan Mousavi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Kajbafvala
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, University of Medical Sciences, Tehran, Iran.
| | - Holakoo Mohsenifar
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, University of Medical Sciences, Tehran, Iran
| | - Anahita Hejazi
- Department of Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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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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Hassan IMI, Keblawy ME, Elsalam MA, Embaby EA. Sagittal trunk excursion and lumbar repositioning error between female and male patients with patellofemoral pain syndrome. Hong Kong Physiother J 2023; 43:81-91. [PMID: 37583919 PMCID: PMC10423672 DOI: 10.1142/s1013702523500051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/04/2023] [Indexed: 08/17/2023] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is a challenging clinical problem affecting adults, adolescents, and physically active populations. PFPS impacts the patient's trunk kinematics in the frontal plane. Previous studies have found gender-based biomechanical differences in patients with PFPS; however, sagittal trunk kinematics during mini-squats and lumbar proprioception in PFPS have not been studied previously. Objectives To investigate sagittal trunk excursion (It is defined as the sagittal trunk flexion angle from the start to the end of the mini squat) during mini-squats as well as lumbar repositioning error between individuals with and without PFPS, and determine gender differences in the outcome variables. Methods A sample of 56 participants aged 18-25 years was enrolled; 30 with PFPS (13 males, 17 females) and 26 asymptomatic controls (11 males, 15 females). The sagittal trunk excursion during mini-squats was examined by two-dimensional (2D) photographic analysis using Surgimap software. Active lumbar flexion repositioning error was assessed using an isokinetic dynamometer. Results For sagittal trunk excursion, no significant main effect of group was observed (p = 0 . 136 ). On the other hand, the main effect was significant for gender (p = 0 . 005 ), as was the interaction effect. Compared to the control group, the PFPS group showed significantly (p = 0 . 01 ) lower sagittal trunk excursion in females than in males during mini-squats. For active lumbar flexion repositioning error, no evidence was found for significant main or interaction effects (p > 0 . 05 ). Conclusion Females with PFPS exhibit a more erect sagittal trunk posture than males during mini-squats. Trunk posture should be considered during weight-bearing activities in PFPS, and gender-specific assessment protocols should be developed.
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Hong QM, Wang HN, Liu XH, Zhou WQ, Zhang X, Luo XB. Home-based exercise program and Health education in patients with patellofemoral pain: a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:896. [PMID: 37980477 PMCID: PMC10657019 DOI: 10.1186/s12891-023-07027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is one of the most common disorders of the knee joint. Home-based exercise is an effective intervention to achieve self-management for chronic diseases. This study evaluated the effects of home-based exercise and health education in patients with PFP. METHODS Patients who had PFP were randomly allocated to an intervention group (IG) or control group (CG). Patients in the IG received a 6-week tailored home-based exercise program with health education via remote support, while patients in the CG group only received health education. Clinical outcomes were compared using the Anterior Knee Pain Scale (AKPS) to measure function and the Visual Analog Scale (VAS) to measure "worst pain" and "pain with daily activity". Muscle strength was measured according to the peak torque of the knee muscles using an isokinetic system. RESULTS Among a total of 112 participants screened for eligibility, 38 were randomized and analyzed, including 19 participants in the intervention group and 19 participants in the control group. There were no significant differences in baseline characteristics between the groups. At 6-week follow-up, the intervention group showed a greater worst pain reduction (between-group difference, -19.3 [95%CI, -23.2 to -15.5]; P < 0.01) and pain with daily activity (between-group difference, -22.9 [95%CI, -28.3 to -17.4]; P < 0.01) than the control group. Similarly, the intervention group had better improvements in AKPS (between-group difference, 9.0 [95%CI, 4.1 to 13.9]; P < 0.01) and knee extensor strength (between-group difference, 20.1 [95%CI, 14.5 to 25.8]; P < 0.01), compared to the control group. No adverse events were reported. CONCLUSION Home-based exercise and health education resulted in less pain, better function, and higher knee muscle strength compared with no exercise in patients with PFP. A large randomized controlled trial with long-term follow-up is required to confirm these findings. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200056224 ( https://www.chictr.org.cn/showproj.aspx?proj=135506 ). Registered on February 1, 2022.
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Affiliation(s)
- Qiao-Mei Hong
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Hao-Nan Wang
- Faculty of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xi-Hui Liu
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Wen-Qi Zhou
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Xiao Zhang
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Xiao-Bing Luo
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China.
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Kim S, Glaviano NR, Park J. Sex Differences in Knee Extensor Neuromuscular Function in Individuals With and Without Patellofemoral Pain. Sports Health 2023:19417381231209318. [PMID: 37978417 DOI: 10.1177/19417381231209318] [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: 11/19/2023] Open
Abstract
BACKGROUND Impaired knee extensor neuromuscular function has been frequently observed in individuals with patellofemoral pain (PFP); however, few researchers have aimed to understand the influence of sex on knee extensor neuromuscular function in this pathological population. The authors aimed to determine whether there are differences in knee extensor neuromuscular function between sexes in individuals with and without PFP. HYPOTHESIS Women with PFP would exhibit greater deficits in knee extensor neuromuscular function than men with PFP, compared with sex-matched individuals without PFP. STUDY DESIGN Cross-sectional, case-control study. LEVEL OF EVIDENCE Level 4. METHODS A total of 110 individuals were classified into 4 groups: women with PFP (n = 25); men with PFP (n = 30); women without PFP (n = 25); and men without PFP (n = 30). Knee extensor strength (isometric peak torque [PT]), activation (central activation ratio), early, late, and total phase rate of torque development (RTD0-100, RTD100-200, and RTD20-80%), and endurance (isokinetic average PT) were assessed using an isokinetic dynamometer. Group differences were assessed using a 2-way multivariate analysis of variance (sex by PFP). RESULTS Both women and men with PFP exhibited lower knee extensor strength, activation, early, late, and total phase RTD, and endurance versus sex-matched individuals without PFP (P < 0.05 for all comparisons). Women with PFP exhibited lower early phase (7.91 ± 2.02 versus 9.78 ± 2.43 N·m/s/kg; P < 0.01; Cohen d = 0.83), late phase (5.34 ± 1.02 versus 7.28±2.28 N·m/s/kg; P < 0.01; Cohen d = 1.37), and total phase (7.40 ± 2.57 versus 8.72 ± 2.57 N·m/s/kg; P = 0.03; Cohen d = 0.51) RTD than men with PFP. CONCLUSION Compared with sex-matched pain-free individuals, women with PFP displayed lower RTD than men with PFP. Clinicians should note that among individuals with PFP, women are more likely to experience a greater impairment in their knee extensor torque-generating capacity than men. CLINICAL RELEVANCE Additional treatment strategies that effectively improve the ability to rapidly generate torque should be developed and implemented, especially when treating women with PFP.
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Affiliation(s)
- Sungwan Kim
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
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Hansen R, Brushøj C, Rathleff MS, Magnusson SP, Henriksen M. Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial. Br J Sports Med 2023; 57:1287-1294. [PMID: 37137673 DOI: 10.1136/bjsports-2022-106197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To assess effectiveness equivalence between two commonly prescribed 12-week exercise programmes targeting either the quadriceps or the hip muscles in patients with patellofemoral pain (PFP). METHODS This randomised controlled equivalence trial included patients with a clinical diagnosis of PFP. Participants were randomly assigned to either a 12-week quadriceps-focused exercise (QE) or a hip-focused exercise (HE) programme. The primary outcome was the change in Anterior Knee Pain Scale (AKPS) (0-100) from baseline to 12-week follow-up. Prespecified equivalence margins of ±8 points on the AKPS were chosen to demonstrate comparable effectiveness. Key secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire pain, physical function and knee-related quality of life subscales. RESULTS 200 participants underwent randomisation; 100 assigned to QE and 100 to HE (mean age 27.2 years (SD 6.4); 69% women). The least squares mean changes in AKPS (primary outcome) were 7.6 for QE and 7.0 for HE (difference 0.6 points, 95% CI -2.0 to 3.2; test for equivalence p<0.0001), although neither programme surpassed the minimal clinically important change threshold. None of the group differences in key secondary outcomes exceeded predefined equivalence margins. CONCLUSION The 12-week QE and HE protocols provided equivalent improvements in symptoms and function for patients with PFP. TRIAL REGISTRATION NUMBER NCT03069547.
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Affiliation(s)
- Rudi Hansen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christoffer Brushøj
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
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Glaviano NR, Kim S. Lower extremity muscle volume in females with patellofemoral pain and its relationships to hip and knee torque: A cross-sectional study. Phys Ther Sport 2023; 63:50-57. [PMID: 37506654 DOI: 10.1016/j.ptsp.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES Compare lower extremity muscle volume in females with patellofemoral pain (PFP) to a cohort of pain-free females and investigate the relationship between thigh and hip muscle volume and torque. DESIGN Cross-sectional. PARTICIPANTS Twenty-one females, 13 with PFP and 8 pain-free controls. MAIN OUTCOME MEASURES We quantified normalized lower extremity muscle volume (cm3/kg*m) via magnetic resonance imaging and isometric hip and thigh torque (Nm/kg) via a multimodal dynamometer. RESULTS Versus pain-free individuals, females with PFP had smaller muscle volume of the anterior hip (P < 0.019; d = 0.97-2.42), deep external rotators (P < 0.006; d = 1.0-3.93), hamstrings (P < 0.009; d = 1.09-2.12), rectus femoris (P < 0.001; d = 1.79), and vastus intermedius (P < 0.001; d = 1.88). There was no difference in muscle volume of the gluteus maximus (P = 0.311; d = 0.22), gluteus medius (P = 0.087; d = 0.87), vastus lateralis (P = 0.22; d = 0.39), and vastus medialis (P = 0.47; d = 0.04). Gluteus maximus volume was moderately correlated to hip abduction torque (r = 0.60; P = 0.03). Vasti muscles and semitendinosus volume were moderately correlated to knee extension (r = 0.57-0.69; P < 0.05) and flexion (r = 0.66; P = 0.01) torque, respectively. CONCLUSION Females with PFP present with lesser thigh and hip muscle volumes, with variability in volumetric profiles across participants. Lower extremity knee extension and hip abduction strength are moderately associated with the vasti and gluteus maximus muscle volume, respectively.
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Affiliation(s)
- Neal R Glaviano
- Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA; Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA.
| | - Sungwan Kim
- Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA; Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
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Gasibat Q, Alexe CI, Raveica G, Tohănean DI, Vasilios K, Alexe DI. Decoding Hip Muscle Activation: A Comparative Electromyographic Analysis of Turn-Out Bent Knee Pulse and Single-Leg Banded Glute Bridge Exercises in Healthy Female Subjects. Eur J Investig Health Psychol Educ 2023; 13:1612-1623. [PMID: 37754456 PMCID: PMC10529521 DOI: 10.3390/ejihpe13090117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Individuals with lower extremity injuries and back pain may exhibit weakness and stiffness in important muscles such as the gluteus maximus and external hip rotators. To aid clinicians in understanding the impact of exercises on factors like stability, endurance, and strength, electromyography (EMG) examination can be employed to monitor muscle activation. In this investigation, the EMG activity of the gluteus maximus and medius were compared between two exercises: the turn-out bent knee pulse and the single-leg banded glute bridge. The study enrolled a group of 64 healthy young women, aged 19 to 24 years. The raw data collected were standardized and represented as a percentage of maximum voluntary isometric contraction (%MVIC). To assess the reliability of the EMG recordings, the test-retest analysis was performed using the intraclass correlation coefficient (ICC3,1). Statistical analysis involved conducting a one-way ANOVA to compare the EMG amplitudes between the two exercises. Remarkably, the results demonstrated a significantly higher EMG signal amplitude during the single-leg banded glute bridge exercise (mean ± SD: 90 ± 28% MVIC) when compared to the turn-out bent knee pulse exercise (mean ± SD: 70 ± 15% MVIC) (F = 16.584, p = 0.001). The study found that the single-leg banded glute bridge exercise had a significantly higher EMG signal amplitude compared to the turn-out bent knee pulse exercise. This suggests that the single-leg banded glute bridge exercise may be more effective in strengthening the gluteus maximus and medius muscles. Overall, this study highlights the importance of targeted muscle training in rehabilitation protocols and the use of EMG examination to monitor muscle activation.
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Affiliation(s)
- Qais Gasibat
- Department of Sports Studies, University Putra Malaysia UPM, Selangor 43400, Malaysia;
| | - Cristina Ioana Alexe
- Department of Physical Education and Sport Performance, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania
| | - Gabriela Raveica
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania;
| | - Dragoș Ioan Tohănean
- Department of Motric Performance, “Transilvania” University of Brașov, 600115 Brașov, Romania;
| | - Koronas Vasilios
- Department Private College Apostolas Pavlos, 55535 Thessaloniki, Greece;
| | - Dan Iulian Alexe
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania;
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Bolgla LA, Gibson HN, Hannah DC, Curry-McCoy T. Comparison of the Frontal Plane Projection Angle and the Dynamic Valgus Index to Identify Movement Dysfunction in Females with Patellofemoral Pain. Int J Sports Phys Ther 2023; V18:619-625. [PMID: 37425107 PMCID: PMC10324282 DOI: 10.26603/001c.74269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background Clinicians typically measure the knee frontal plane projection angle (FPPA) during a single-leg squat to identify females with patellofemoral pain (PFP). A limitation of this measure is minimal attention to movement of the pelvis on the femur that can create knee valgus loading. The dynamic valgus index (DVI) may be a better assessment. Hypothesis/Purpose The purpose of this study was to compare the knee FPPA and DVI between females with and without PFP and determine if the DVI better identified females with PFP than the knee FPPA. Study Design Case-control. Methods Sixteen females with and 16 without PFP underwent 2-dimensional motion analysis when performing five trials of a single-leg squat. The average peak knee FPPA and peak DVI were analyzed. Independent t-tests determined between-group peak knee FPPA and peak DVI differences. Receiver operating characteristic (ROC) curves determined the area under the curve (AUC) scores for sensitivity and 1 - specificity of each measure. Paired-sample area difference under the ROC curves was conducted to determine differences in the AUC for the knee FPPA and DVI. Positive likelihood ratios were calculated for each measure. The significance level was p < 0.05. Results Females with PFP exhibited a higher knee FPPA (p = 0.001) and DVI (p = 0.015) than controls. AUC scores were .85 (p = 0.001) and .76 (p = 0.012) for the knee FPPA and DVI, respectively. Paired-sample area difference under the ROC curves showed a similar (p = 0.10) AUC for the knee FPPA and DVI. The knee FPPA had 87.5% sensitivity and 68.8% specificity; the DVI had 81.3% sensitivity and 81.0% specificity. Positive likelihood ratios for the knee FPPA and DVI were 2.8 and 4.3, respectively. Conclusion The DVI during a single-leg squat may be another useful tool for discriminating between females with and without PFP. Level of Evidence 3a.
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Preszler JA, McInnis KC, Baute L, Tanaka MJ. Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester. Phys Ther Sport 2023; 60:34-46. [PMID: 36641951 DOI: 10.1016/j.ptsp.2023.01.001] [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: 09/16/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization. CLINICAL QUESTION What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy? KEY RESULTS We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team. CLINICAL APPLICATION The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.
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Affiliation(s)
- Jamie A Preszler
- Department of Sports Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
| | - Kelly C McInnis
- Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Baute
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kilic RT, Yosmaoglu HB, Bayrakcı Tunay V. Osteopathic treatment for cam-type Femoroacetabular impingement syndrome: A case report. INT J OSTEOPATH MED 2023. [DOI: 10.1016/j.ijosm.2023.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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14
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Jeon H, Donovan L, Thomas AC. Exercise-Induced Changes in Femoral Cartilage Thickness in Patients With Patellofemoral Pain. J Athl Train 2023; 58:128-135. [PMID: 35476136 PMCID: PMC10072095 DOI: 10.4085/1062-6050-0602.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Rehabilitative exercises alleviate pain in patients with patellofemoral pain (PFP); however, no researchers have analyzed the cartilage response after a bout of those athletic activities in patients with PFP. OBJECTIVE To determine if a single session of rehabilitative exercises alters femoral cartilage morphology. DESIGN Crossover study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twelve participants with PFP (age = 21.0 ± 2.0 years, height = 1.72 ± 0.1 m, mass = 68.7 ± 12.6 kg) and 12 matched healthy participants (age = 21.3 ± 2.8 years, height = 1.71 ± 0.1 m, mass = 65.9 ± 12.2 kg) were enrolled. INTERVENTION(S) Participants completed treadmill running, lower extremity strengthening exercises, and plyometric exercises for 30 minutes each. MAIN OUTCOME MEASURE(S) Patient-reported outcomes on the visual analog scale, Anterior Knee Pain Scale (AKPS), Knee injury and Osteoarthritis Outcome Score (KOOS), and Knee Injury and Osteoarthritis Outcome Score for Patellofemoral Pain and Osteoarthritis were collected. Femoral cartilage ultrasonographic images were obtained at 140° of knee flexion. Ultrasound images were segmented into medial and lateral images using the intercondylar notch. Medial and lateral cartilage cross-sectional area (mm2) and echo intensity (EI), defined as the average grayscale from 0 to 255, were analyzed by ImageJ software. The difference between loading conditions was calculated using repeated-measures analysis of variance. The Spearman correlation was calculated to find the association between the cartilage percentage change (Δ%) and patient-reported outcomes. RESULTS Pain increased in the PFP group after all loading conditions (P values < .007). No differences were found in cartilage cross-sectional area or EI alteration between or within groups (P values > .06). The KOOS was negatively associated with the Δ% of the lateral femoral cartilage EI after plyometric loading (ρ = -0.87, P = .001), and the AKPS score was positively correlated with the Δ% of lateral femoral cartilage EI (ρ = 0.57, P = .05). CONCLUSIONS Ultrasound imaging did not identify cartilaginous deformation after all loading conditions. However, because lateral cartilaginous EI changes were associated with the AKPS and KOOS score, those questionnaires may be useful for monitoring changes in femoral cartilage health.
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Affiliation(s)
- Hyunjae Jeon
- Dunnigan Movement Analysis Lab, School of Health Sciences, University of Evansville, IN
| | - Luke Donovan
- Biodynamics Laboratory, Department of Applied Physiology, Health, and Clinical Sciences, University of North Carolina at Charlotte
| | - Abbey C. Thomas
- Biodynamics Laboratory, Department of Applied Physiology, Health, and Clinical Sciences, University of North Carolina at Charlotte
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15
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Lee JH, Shin KH, Lee GB, Son S, Jang KM. Comparison of Functional Outcomes between Supervised Rehabilitation and Telerehabilitation in Female Patients with Patellofemoral Pain Syndrome during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2233. [PMID: 36767600 PMCID: PMC9915527 DOI: 10.3390/ijerph20032233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Patellofemoral pain syndrome (PFPS) is a common cause of anterior knee pain, and therapeutic exercises are recommended. During the COVID-19 pandemic, despite recommendations on the importance of telerehabilitation, insufficient studies have investigated functional outcomes between supervised rehabilitation and telerehabilitation in patients with PFPS. This study aimed to compare the muscle strength, muscle activation time, and patient-reported outcomes between supervised rehabilitation and telerehabilitation in female patients with PFPS. A total of 61 patients (supervised, n = 30; telerehabilitation, n = 31) participated. Muscle strength and activation time of the quadriceps and hamstrings were measured using an isokinetic device. Hip muscle strength was evaluated using a hand-held dynamometer. Patient-reported outcomes were measured using the visual analog scale (VAS) for pain, Kujala Anterior Knee Pain Scale (AKPS) for functional ability, and Tampa scale for kinesiophobia (TSK-11). No significant differences were found in muscle strength, muscle activation time, or patient-reported outcomes of the involved knees between the two groups (p > 0.05). In addition, the rate of change in all parameters did not significantly differ between the two groups (p > 0.05). Telerehabilitation, such as a home-exercise program supervised by physical therapists, may be as effective as supervised rehabilitation in improving functional outcomes in female patients with PFPS.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Ki Hun Shin
- Department of Sports Medical Center, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Gyu Bin Lee
- Department of Sports Medical Center, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Seiwook Son
- Department of Orthopaedic Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, Korea University College of Medicine, Seoul 02841, Republic of Korea
- Department of Orthopaedic Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea
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16
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Seyyed Hossein H, Sara A, Hasan D, Navid K. The effect of three types of exercises programs on the patella location in athletes with patellofemoral pain. Knee 2023; 41:97-105. [PMID: 36642037 DOI: 10.1016/j.knee.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/07/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to compare the effect of exercises focusing on the proximal and distal joints to knee and knee local exercises on the Patellar location in athletes with patellofemoral pain (PFP). METHODS A randomized controlled, single-blinded trial was conducted. Thirty-five athletes with PFP were randomly divided into three groups; proximal (12), distal (11) and local (12). Q Angle was measured with goniometer, tilt and congruence angle were measured with digital radiology before and after the exercise programs. The exercises were performed three sessions of 70 min per week, for 8 weeks. Data were analyzed by mixed analysis of variance, post hoc test and dependent t-test. RESULTS In the pre-intervention, no significant difference was observed between the groups (P > 0.05). But in the post-intervention, Q angle, tilt angle, congruence angle and knee pain in the proximal group were significantly less than the distal and local groups (P < 0.01); while there were no significant differences between the distal and local groups (P > 0.05). Also, in the proximal group, there were significant differences between pre-intervention and post intervention in Q angle, tilt angle and congruence angle (P = 0.001), but no significant differences were observed in the distal and local groups (P > 0.05). Knee pain in all three groups showed significant differences between pre-intervention and post-intervention (P < 0.01). CONCLUSIONS The findings of the present study indicated further improvement in patellar location and knee pain in the proximal group. Accordingly, proximal group exercises can improve the pain and performance of athletes with PFP by patellar relocation to the normal position.
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Affiliation(s)
- Hosseini Seyyed Hossein
- Department of Sports Biomechanics, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
| | - Asadi Sara
- Department of Sports Injuries & Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
| | - Daneshmandi Hasan
- Department of Sports Injuries & Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
| | - Kalani Navid
- Department of Sports Injuries & Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
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González J, Ortiz A. Impact of Pilates mat-based exercises on knee kinematics during running. J Bodyw Mov Ther 2023; 33:8-13. [PMID: 36775530 PMCID: PMC10949884 DOI: 10.1016/j.jbmt.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Core strengthening, balance, and flexibility programs such as Pilates have been advocated to positively impact running mechanics and prevent lower extremity injuries. The purpose of this study was to assess the effects of a 12-week mat-based Pilates exercise program on dynamic knee valgus alignment in runners. METHODS Thirty-four novice runners, including young male and female adults performed a running protocol at baseline. The protocol consisted of the participants running on a treadmill at a constant five miles per hour (mph) for 4 min. Post-examination, participants were randomly assigned to a Pilates or control group (n = 16 and n = 18, respectively). A certified Pilates instructor gave the Pilates group a 12-week home-based program. To ensure participants in the Pilates group performed exercises correctly, the Pilates instructor conducted the first session, and provided feedback to each participant. Participants in both groups performed the same running testing protocol every four weeks. Knee valgus was measured as the medial displacement of the knee joint center during the running stance phase. Repeated measures Analysis of Variance (RepANOVA) was calculated at baseline and 4-, 8-, and 12-weeks post examinations to compare knee valgus during running. RESULTS Although a reduction in dynamic knee valgus was observed within the Pilates group, the RepANOVA analysis revealed this change was not statistically significant. CONCLUSIONS Pilates mat-based exercises may improve knee valgus after 12 weeks but a larger sample size, longer intervention duration, or a supervised program should be considered for future research to evaluate its effectiveness.
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Affiliation(s)
- Jaime González
- Department of Physical Therapy, Midwestern University, Glendale, AZ, USA
| | - Alexis Ortiz
- Department of Physical Therapy, Augustana University, Sioux Falls, SD, USA.
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18
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Nunes GS, Rodrigues DZ, Hörbe L, Prates I, Tessarin BM, Serrão FV, de Noronha M. Is Postural Control Affected in People with Patellofemoral Pain and Should it be Part of Rehabilitation? A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:144. [PMID: 36504326 PMCID: PMC9742077 DOI: 10.1186/s40798-022-00538-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Growing evidence supports that exercise therapy is effective for patellofemoral pain (PFP) rehabilitation. Nevertheless, the improvements have been reported not to be sustained in the long term, suggesting that the current protocols may not comprehend all required functional factors to provide a consistent recovery. A potential neglected factor in treatment protocols for PFP is postural control. However, it is unclear whether this population presents balance impairments or the influence of postural control on pain and function during rehabilitation programmes. OBJECTIVE To investigate whether (Q1) balance is impaired in people with PFP compared to controls, (Q2) conservative interventions are effective to improve balance in people with PFP, and (Q3) balance exercises are effective to improve pain and function in people with PFP. DATA SOURCES Medline, Embase, CINAHL, SPORTDiscus, Web of Science and Cochrane Library, supplemented by hand searching of reference lists, citations and relevant systematic reviews in the field. METHODS A systematic review with meta-analysis was conducted according to the Cochrane recommendations and reported according to the PRISMA statement recommendations. We included cross-sectional studies comparing balance between people with and without PFP; and randomised controlled trials verifying the effect of conservative intervention on balance and the effect of balance intervention on pain and function in people with PFP. The risk of bias was assessed using the Epidemiological Appraisal Instrument for cross-sectional studies and the Physiotherapy Evidence Database scale for randomised controlled trials. RESULTS From 15,436 records, 57 studies (Q1 = 28, Q2 = 23, Q3 = 14) met the eligibility criteria. Meta-analyses indicated that people with PFP have worse anteroposterior (very low grade evidence, standardised mean difference [SMD] = 1.03, 95% CI 0.40-1.66) and mediolateral (moderate grade evidence, SMD = 0.87, 95% CI 0.31-1.42) balance compared to controls. Moderate grade evidence indicated that overall balance is not affected in people with PFP (SMD = 0.38, 95% CI - 0.05-0.82). Low to very low grade evidence indicates that interventions are ineffective for mediolateral (SMD = 0.01, 95% CI - 0.51-0.53) and overall (SMD = 0.49, 95% CI - 0.14-1.11) balance improvements, and low grade evidence indicates that interventions are effective to improve anteroposterior balance (SMD = 0.64, 95% CI 0.04-1.23). Moderate to low grade evidence indicated that balance interventions are effective to reduce pain (SMD = 0.82, 95% CI 0.26-1.38) and improve function (SMD = 0.44, 95% CI 0.09-0.80) when measured using questionnaires; and very low grade evidence indicated no efficacy for function measured via functional tests (SMD = 0.73, 95% CI - 0.16-1.61). CONCLUSION People with PFP likely present balance deficits compared to asymptomatic people. There was insufficient evidence to support the efficacy of interventions to improve or modify balance in people with PFP. Also, there was insufficient evidence to support the efficacy of balance exercises to improve pain and function in people with PFP. Trial Registration The present systematic review was registered in PROSPERO (CRD42018091717).
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Affiliation(s)
- Guilherme S Nunes
- Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, CEP 97105-900, Brazil.
| | - Diênifer Zilmer Rodrigues
- Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, CEP 97105-900, Brazil
| | - Luiza Hörbe
- Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, CEP 97105-900, Brazil
| | - Izabela Prates
- Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS, CEP 97105-900, Brazil
| | - Bruna M Tessarin
- Department of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | - Fábio V Serrão
- Department of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | - Marcos de Noronha
- Rural Department of Allied Health, La Trobe University, Bendigo, VIC, Australia
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19
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Pompeo KD, da Rocha ES, Melo MA, de Oliveira NT, Oliveira DF, Sonda FC, dos Santos PF, Rodrigues R, Baroni BM, Vaz MA. Can we replace exercises targeted on core/hip muscles by exercises targeted on leg/foot muscles in women with patellofemoral pain? A randomized controlled trial. Phys Ther Sport 2022; 58:1-7. [DOI: 10.1016/j.ptsp.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 10/31/2022]
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Pereira PM, Baptista JS, Conceição F, Duarte J, Ferraz J, Costa JT. Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159241. [PMID: 35954598 PMCID: PMC9367913 DOI: 10.3390/ijerph19159241] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Patellofemoral pain syndrome (PFPS) is highly prevalent; it can cause severe pain and evolve into progressive functional loss, leading to difficulties performing daily tasks such as climbing and descending stairs and squatting. This systematic review aimed to find evidence, in the literature, of squat movements that can cause or worsen PFPS. This work was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and its protocol was registered in PROSPERO (CRD42019128711). From the 6570 collected records, 37 were included. From these 37 articles, 27 present a causal relationship between knee flexion and PFPS, 8 describe a relationship, considering the greater existence of muscle contractions, and one article did not describe this relationship in its results. The main limitations stem from the fact that different studies used different evaluation parameters to compare the force exerted on the patellofemoral joint. Furthermore, most studies are focused on sports populations. After analysing the included works, it was concluded that all squat exercises can cause tension overload in the knee, especially with a knee flexion between 60° and 90° degrees. The main causal/worsening factors of PFPS symptoms are the knee translocation forward the toes (on the same body side) when flexing the knee, and the muscle imbalance between the thigh muscles.
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Affiliation(s)
- Pablo Monteiro Pereira
- Associated Laboratory for Energy, Transports and Aeronautics (PROA/LAETA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (P.M.P.); (J.D.); (J.F.)
| | - João Santos Baptista
- Associated Laboratory for Energy, Transports and Aeronautics (PROA/LAETA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (P.M.P.); (J.D.); (J.F.)
- Correspondence:
| | - Filipe Conceição
- Center for Research, Education, Innovation and Intervention in Sport (CIFI2D/LABIOMEP), Faculty of Sports, University of Porto, 4200-450 Porto, Portugal;
| | - Joana Duarte
- Associated Laboratory for Energy, Transports and Aeronautics (PROA/LAETA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (P.M.P.); (J.D.); (J.F.)
| | - João Ferraz
- Associated Laboratory for Energy, Transports and Aeronautics (PROA/LAETA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (P.M.P.); (J.D.); (J.F.)
| | - José Torres Costa
- Associated Laboratory for Energy, Transports and Aeronautics (PROA/LAETA), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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21
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Constantinou A, Mamais I, Papathanasiou G, Lamnisos D, Stasinopoulos D. Comparing hip and knee focused exercises versus hip and knee focused exercises with the use of blood flow restriction training in adults with patellofemoral pain. Eur J Phys Rehabil Med 2022; 58:225-235. [PMID: 34985237 PMCID: PMC9980495 DOI: 10.23736/s1973-9087.22.06691-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hip and knee strengthening exercises are implemented in rehabilitation of patellofemoral pain patients, but typically use high loads (70% of 1 repetition maximum). This may lead to increased patellofemoral joint stress. Low load training (20-30% of 1 repetition maximum) with blood flow restriction could allow for exercise strength benefits to proximal and distal muscles with reduced joint stress and by promoting hypoalgesia. AIM The aim of this study was to compare hip and knee focused exercises with and without blood flow restriction in adults with patellofemoral pain for short term effectiveness. DESIGN A randomized observed-blind controlled trial. SETTING Musculoskeletal laboratories of the European University Cyprus, Nicosia, Cyprus. POPULATION 60 volunteer patients, 18-40 years of age with patellofemoral pain. METHODS Participants were randomly assigned to (1 reference group) hip and knee strengthening at (70% of 1 repetition maximum) or (2 experimental group) Strengthening with blood flow restriction at (30% of 1 repetition maximum at 70% of limb occlution pressure). Treatments took place 3 times per week for 4weeks and outcomes were assessed at baseline, end of treatment and at 2-month follow-up. The primary outcome was the Kujala Anterior Knee Pain Scale and secondary outcomes were worst and usual pain, pain with Single leg Squats, the maximum pain free flexion angle, the Tampa Scale of kinesiophobia, the Pain Catastrophizing Scale and isometric strength of knee extensors, hip extensors and hip abductors. RESULTS No difference were found for the main outcome of this study between groups. There was a significant effect of time for all outcome measures in both groups. Between group differences showed a significant difference for isometric strength of Knee extensor values at 2 month follow-up F(1,58)=5.56, P=0.02, partial η2=0.09, 459.4 (412.13, 506.64) vs. 380.68 (333.42, 427.93) and in worst pain post-treatment F(1,58)=5.27, P=0.02, partial η2=0.08, 0.76 (0.48, 1.04) vs. reference group 1.30 (0.91, 1.68) with significantly better scores in the blood flow restriction group. CONCLUSIONS Blood flow restriction exercises of the hip and knee musculature used in this study were as effective as usual exercises of Hip and knee musculature in reducing symptoms in the short term. They also indicated greater increases in strength and reduction of worst pain post-treatment. CLINICAL REHABILITATION IMPACT Further research is needed to investigate the dose response relationship with longer follow-ups.
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Affiliation(s)
| | - Ioannis Mamais
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia Cyprus
| | - Giorgos Papathanasiou
- Department of Physiotherapy, Director of Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Demetris Lamnisos
- Department of Health Sciences, Cyprus Musculoskeletal and Sports Trauma Research Centre (CYMUSTREC) Physiotherapy Program, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
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22
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Plank Times and Lower Extremity Overuse Injury in Collegiate Track-and-Field and Cross Country Athletes. Sports (Basel) 2022; 10:sports10030045. [PMID: 35324654 PMCID: PMC8955794 DOI: 10.3390/sports10030045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Trunk muscle endurance has been theorized to play a role in running kinematics and lower extremity injury. However, the evidence examining the relationships between static trunk endurance tests, such as plank tests, and lower extremity injury in athletes is conflicting. The purpose of this study was to assess if collegiate cross country and track-and-field athletes with shorter pre-season prone and side plank hold times would have a higher incidence of lower extremity time-loss overuse injury during their competitive sport seasons. During the first week of their competitive season, 75 NCAA Division III uninjured collegiate cross country and track-and-field athletes (52% female; mean age 20.0 ± 1.3 years) performed three trunk endurance plank tests. Hold times for prone plank (PP), right-side plank (RSP) and left-side plank (LSP) were recorded in seconds. Athletes were followed prospectively during the season for lower extremity overuse injury that resulted in limited or missed practices or competitions. Among the athletes, 25 (33.3%) experienced a lower extremity overuse injury. There were no statistically significant mean differences or associations found between PP, RSP or LSP plank test hold times (seconds) and occurrence of lower extremity overuse injury. In isolation, plank hold times appear to have limited utility as a screening test in collegiate track-and-field and cross country athletes.
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23
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Talonavicular joint mobilization and foot core strengthening in patellofemoral pain syndrome: a single-blind, three-armed randomized controlled trial. BMC Musculoskelet Disord 2022; 23:150. [PMID: 35168620 PMCID: PMC8845242 DOI: 10.1186/s12891-022-05099-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is defined as pain around the patella while performing activities such as squats, running, and climbing steps. One of the inherent risk factors for PFPS is an excessively pronated foot posture. The aim of this study was to investigate the effect of foot intervention, talonavicular joint mobilization (TJM) and foot core strengthening (FCS), on PFPS. Methods Forty-eight patients with PFPS (mean age, 21.96 ± 2.34 years; BMI, 22.77 ± 2.95 kg/m2) were enrolled in the study. Participants were randomly assigned in a 1:1:1 ratio to three groups, and received 12 sessions of TJM, FCS, and blended intervention at university laboratory for 4 weeks. The primary outcomes were pain while the secondary outcomes were lower extremity function, valgus knee, foot posture, and muscle activity ratio measured at baseline, after 12 sessions, and at the 4-week follow-up. Results The two-way repeated-measures ANOVA revealed significant interactions in all groups (p < 0.05). TJM reduced pain more than the FCS at post-test (mean difference, − 0.938; 95% Confidence interval [CI], − 1.664 to − 0.211; p < 0.05), and blended intervention improved lower extremity function (mean difference, 6.250; 95% CI, 1.265 to 11.235; p < 0.05) and valgus knee (mean difference, − 11.019; 95% CI, − 17.007 to − 5.031; p < 0.05) more than the TJM at 4 weeks follow-up. TJM was more effective in post-test (mean difference, − 1.250; 95% CI, − 2.195 to − 0.305; p < 0.05), and TJM (mean difference, − 1.563; 95% CI, − 2.640 to − 0.485; p < 0.05) and blended intervention (mean difference, − 1.500; 95% CI, − 2.578 to − 0.422; p < 0.05) were more effective in foot posture than the FCS in 4 weeks follow-up. Blended intervention displayed greater improvement in muscle activity than the TJM (mean difference, 0.284; 95% CI, 0.069 to 0.500; p < 0.05) and the FCS (mean difference, 0.265; 95% CI, 0.050 to 0.481; p < 0.05) at 4 weeks follow-up. Conclusions Our study is a novel approach to the potential impact of foot interventions on patellofemoral pain. Foot intervention including TJM and FCS is effective for pain control and function improvement in individuals with PFPS. Trial registration KCT0003176, 16/08/2018 (retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05099-x.
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How Do Hip Exercises Improve Pain in Individuals With Patellofemoral Pain? Secondary Mediation Analysis of Strength and Psychological Factors as Mechanisms. J Orthop Sports Phys Ther 2021; 51:602-610. [PMID: 34847699 DOI: 10.2519/jospt.2021.10674] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether the effect of hip exercise on patellofemoral pain is mediated through changes in hip muscle strength or psychological factors. DESIGN Secondary mediation analysis of a randomized clinical trial, in which 218 participants with patellofemoral pain were randomly assigned to receive foot orthoses or hip exercises. METHODS Pain (Knee injury and Osteoarthritis Outcome Score pain subscale) and number of pain-free squats at 12 weeks were the outcomes for this mediation analysis, as they are pathognomonic of patellofemoral pain. Hip strength dynamometry (abduction, adduction, and external rotation) and psychological characteristics (pain catastrophizing, kinesiophobia, and anxiety) measured at 6 weeks were considered as potential mediators. We used mediation analysis to decompose the total effect of treatment on the outcome into (1) the "indirect effect" (ie, the portion acting through the mediator) and (2) the "direct effect." RESULTS The effect of hip exercise on pain and squats was not mediated by any of the strength or psychological mediators analyzed. All indirect effects were small and showed wide 95% confidence intervals (CIs) that contained zero (eg, for pain-free squats: abduction strength, -0.13; 95% CI: -0.49, 0.23; Tampa Scale of Kinesiophobia, -0.17; 95% CI: -0.64, 0.30). CONCLUSION Hip strength improved after hip exercise, yet strength did not mediate improvements in pain and pain-free squats, and alternative psychological mediators were not implicated. J Orthop Sports Phys Ther 2021;51(12):602-610. doi:10.2519/jospt.2021.10674.
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Su Y, Huang L, Liu H, Chen S, Peng L. The Effect of Exercise Intervention on Disability and Kinesiophobia in a Retired Athlete With Old Patella Fracture: A Case Report. Front Psychol 2021; 12:744433. [PMID: 34867625 PMCID: PMC8633896 DOI: 10.3389/fpsyg.2021.744433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To evaluate the effect of exercise intervention on disability, pain, and kinesiophobia in a retired athlete with old patella fracture. Methods: A 34-year-old retired football player with old patella fracture conducted the exercise intervention for 12 weeks, 1 h each time, three times a week. the retired football player completed the Lysholm Knee Score (LKS), Visual Analog Scale (VAS), and the Tampa Scale for Kinesiophobia (TSK) were measured at pre-intervention, mid-intervention, and post-intervention. Results: Based on the functional training perspective, the retired athlete was subjected to two stages of exercise intervention for a total of 12 weeks. The patient's LKS score increased from 76 to 95, and the pain level of various physical states was relieved. When walking, the VAS score was reduced from 3 to 1, and when running, the VAS score was reduced from 5 to 2. Jumping VAS score for actions was reduced from 6 to 3, and the VAS score for of daily life activities was reduced from 3 points to 2. The patient's TSK score from 50 to 37. Conclusion: A 12-week exercise intervention could improve knee joint function, relieve pain and relieve kinesiophobia.
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Affiliation(s)
- Yuqin Su
- College of Physical Education, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Li Huang
- College of Physical Education, Southwest University, Chongqing, China
| | - Haowei Liu
- College of Physical Education, Southwest University, Chongqing, China
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, Southwest University, Chongqing, China
| | - Shifan Chen
- Electrical Engineering and Automation Department, College of Automation, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Li Peng
- College of Physical Education, Southwest University, Chongqing, China
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, Southwest University, Chongqing, China
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Basbug P, Kilic RT, Atay AO, Bayrakcı Tunay V. The effects of progressive neuromuscular exercise program and taping on muscle strength and pain in patellofemoral pain. A randomized controlled blind study. Somatosens Mot Res 2021; 39:39-45. [PMID: 34713770 DOI: 10.1080/08990220.2021.1987877] [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: 10/20/2022]
Abstract
PURPOSE To investigate the effects of corrective kinesio taping applied on patellofemoral and foot joint in addition to a progressive neuromuscular exercise program in women with Patellofemoral Pain (PFP) on knee pain and muscle strength. METHODS Thirty females (20-45 years), diagnosed with unilateral PFP were randomly divided into two groups: the exercise (n = 15) and the exercise and taping (n = 15). Both groups performed three-stage progressive neuromuscular exercises for 12 weeks as home exercises. Plantar and knee corrective taping was additionally applied to the exercise and taping group. The knee pain was measured using the Visual Analogue Scale (VAS) during stair ascending and descending. Isokinetic dynamometer was used to evaluate the isokinetic muscle strength of the hamstring and quadriceps femoris muscles. All assessments were conducted before the treatment, at the end of the 6th-week treatment, and at the end of the 12th week of the treatment. RESULTS After intervention, pain, and muscles peak torque were improved in all groups (p ˂ 0.05). The decrease in pain and the increase in quadriceps and hamstring muscle peak tork were found to be significant for both groups (p < 0.05). In the taping group, the decrease in pain during stair descending and the increase in hamstring muscle tork were higher than that of the exercise group (p < 0.05). CONCLUSION In order to reduce pain in a short time and control it in the long term, it will be beneficial to tape the knee and foot in addition to neuromuscular exercises.
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Affiliation(s)
- Pinar Basbug
- Department of Physiotherapy and Rehabilitation, Mugla Sitki Kocman University, Faculty of Health Sciences, Mugla, Turkey
| | - Rabia Tugba Kilic
- Physical Theraphy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Turkey
| | | | - Volga Bayrakcı Tunay
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Trunk muscle endurance in individuals with and without patellofemoral pain: Sex differences and correlations with performance tests. Phys Ther Sport 2021; 52:248-255. [PMID: 34656829 DOI: 10.1016/j.ptsp.2021.09.012] [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: 08/17/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare trunk muscle endurance among females and males with and without patellofemoral pain (PFP), and to investigate the correlations between trunk muscle endurance and performance of the single leg hop test (SLHT) and forward step-down test (FSDT). DESIGN Cross-sectional. SETTING Laboratory-based study. PARTICIPANTS 110 females and 38 males with PFP, 61 females and 31males without PFP. MAIN OUTCOME MEASURES Anterior and lateral trunk muscle endurance were assessed with the prone and bilateral side-bridge tests, respectively. Performance during the SLHT and FSDT was also assessed. RESULTS Lower anterior and lateral trunk muscle endurance were identified in females (p < .001; d = -0.74 to -0.86), but not in males (p ≥ .806; d = -0.04 to 0.05) with PFP as compared to sex-matched controls. Moderate to large, positive correlations between anterior and lateral trunk muscle endurance with performance in the SLHT and FSDT were identified in females (r = .27 to .50; p < .004) and males (r = 0.27 to 0.59; p < .031) with PFP and females without PFP (r = 0.26 to 0.40; p < .044). CONCLUSION Our findings highlight that assessing trunk muscle endurance is advised in females with PFP. Trunk muscle endurance of individuals with PFP may have a role in the performance of hopping and stepping down tasks.
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Wu Z, Zou Z, Zhong J, Fu X, Yu L, Wang J, Wang X, Wu Q, Hou X. Effects of whole-body vibration plus hip-knee muscle strengthening training on adult patellofemoral pain syndrome: a randomized controlled trial. Disabil Rehabil 2021; 44:6017-6025. [PMID: 34346273 DOI: 10.1080/09638288.2021.1954703] [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: 10/20/2022]
Abstract
PURPOSE To investigate whether whole-body vibration (WBV) plus hip-knee muscle strengthening is more efficient in relieving pain and improving function than hip-knee strengthening alone. METHODS Thirty-six participants with patellofemoral pain syndrome (PFPS) were recruited and randomly allocated to either the (1) hip-knee strengthening only (HK group, n = 18) or (2) WBV plus hip-knee strengthening group (WHK group, n = 18). All participants attended 18 physiotherapy sessions (3 sessions/week, 40 min/session) over 6 weeks. Data on symptoms, function, surface electromyography (sEMG) signals from the vastus medialis and gluteus medius, and quality of life were evaluated at baseline (T0), 6 weeks after (T6), and the 12-week follow-up (T18). RESULTS Significant group × time interactions were found for the VAS score (p < 0.001) and vastus medialis performance (p ≤ 0.015). The WHK group exhibited a greater pain relief than did the HK group at T18 (p ≤ 0.014). The WHK group exhibited significantly larger improvements in the RMS value than did the HK group at T6 (p ≤ 0.011). CONCLUSIONS The present study shows that 6 weeks of WBV plus hip-knee strengthening can improve vastus medialis performance and maintain long-term pain relief to a significantly greater extent than can hip-knee strengthening alone.IMPLICATIONS FOR REHABILITATIONThe present study shows that 6 weeks of WBV plus hip-knee strengthening can improve vastus medialis performance and maintain long-term pain relief to a significantly greater extent than can hip-knee strengthening alone.
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Affiliation(s)
- Zhangxiang Wu
- Guangzhou Sports University, Guangzhou, China.,Department of Rehabilitation Medicine, People's Hospital of Longhua, Shenzhen, China
| | - Zhi Zou
- Guangzhou Sports University, Guangzhou, China
| | - Jiugen Zhong
- Guangzhou Sports University, Guangzhou, China.,Shanghai Sports University, Shanghai, China
| | - Xinbo Fu
- Guangzhou Sports University, Guangzhou, China
| | - Ligen Yu
- Guangzhou Sports University, Guangzhou, China
| | - Jinzhu Wang
- Guangzhou Sports University, Guangzhou, China
| | - Xin Wang
- Guangzhou Sports University, Guangzhou, China
| | - Qianwen Wu
- Guangzhou Sports University, Guangzhou, China
| | - Xiaohui Hou
- Guangzhou Sports University, Guangzhou, China.,Shanghai Sports University, Shanghai, China
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Na Y, Han C, Shi Y, Zhu Y, Ren Y, Liu W. Is Isolated Hip Strengthening or Traditional Knee-Based Strengthening More Effective in Patients With Patellofemoral Pain Syndrome? A Systematic Review With Meta-analysis. Orthop J Sports Med 2021; 9:23259671211017503. [PMID: 34377715 PMCID: PMC8330492 DOI: 10.1177/23259671211017503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Focus on the importance of hip muscle strength in patients with patellofemoral pain syndrome (PFPS) has recently increased. It is unknown whether patients with PFPS will benefit more from hip strengthening compared with traditional knee-based strengthening. Purpose: To compare the efficiency of isolated hip strengthening versus traditional knee-based strengthening for patients with PFPS. Study Design: Systematic review; Level of evidence, 2. Methods: We conducted a search for studies comparing isolated hip strengthening and knee-based strengthening by using the MEDLINE, Embase, and Cochrane Library electronic databases. The methodological quality of included studies was assessed using the PEDro scale. Predetermined variables from each study were extracted and analyzed. Results: A total of 5 comparative studies were included in this review; all studies were of moderate to high quality and reflected good internal and external validity. Pain (visual analog scale [VAS]) and function (Anterior Knee Pain Scale) scores improved in both the hip and knee groups after strengthening intervention, although no statistically significant differences were seen between groups in the pooled analysis. In 2 studies, VAS pain scores were reduced earlier for patients in the hip group than for those in the knee group (P < .05). In 1 study, improvement in Western Ontario and McMaster Universities Osteoarthritis Index function scores in the hip group was statistically superior compared with those in the knee group after intervention and at 6-month follow-up (P < .05). In 2 studies, patients in the hip group exhibited statistically greater hip abductor and extensor strength than did those in the knee group after intervention (P < .05). Conclusion: The best-available evidence suggests that overall, isolated hip strengthening and knee strengthening were equivalent for treatment of PFPS.
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Affiliation(s)
- Yuyan Na
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Changxu Han
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yuting Shi
- Cardiac Function Department, Cadre Health Care Center, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yong Zhu
- Department of Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yizhong Ren
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Wanlin Liu
- Department of Pediatric Orthopedics, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
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Effects of a Targeted Exercise Program on Inter-Leg Asymmetries in Patients with Patellofemoral Pain. Symmetry (Basel) 2021. [DOI: 10.3390/sym13061075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patellofemoral pain (PFP) is often associated with impaired muscle strength, flexibility, and stability. It has been suggested that inter-leg asymmetries have an important role in increasing the risk of musculoskeletal injuries, including PFP. Thus, the aim of this study was to identify significant asymmetries and determine the effects of a symmetry targeted exercise program in patients with PFP. Eighteen patients aged 13 to 54 years (24.17 ± 12.52 years) with PFP participated in this study. Strength, flexibility and stability outcomes of the trunk, hip, knee and ankle muscles were assessed. A single-group pretest–posttest design was used to assess changes in inter-leg and agonist–antagonist asymmetries resulting from the 8-week period of the supervised exercise program. Results indicated a significant improvement in inter-leg symmetry regarding bilateral stance in a semi-squat position (p = 0.020, d = 0.61, df = 17) and ankle plantarflexion (p = 0.003, d = 0.32, df = 17) and ankle dorsiflexion strength (p < 0.001, d = 0.46, df = 17). In addition, the ratio of ankle dorsiflexion/plantarflexion (p = 0.036, d = 1.14, df = 17) and hip extension/flexion (p = 0.031, d = 0.94, df = 16) changed significantly during the intervention period. To our knowledge, this was the first study to evaluate inter-leg asymmetries resulting from a period of a supervised exercise program. The results indicate that an exercise program focusing on individual asymmetries may influence specific deficits and contribute to better rehabilitation outcomes.
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Manojlović D, Kozinc Ž, Šarabon N. Trunk, Hip and Knee Exercise Programs for Pain Relief, Functional Performance and Muscle Strength in Patellofemoral Pain: Systematic Review and Meta-Analysis. J Pain Res 2021; 14:1431-1449. [PMID: 34079359 PMCID: PMC8165213 DOI: 10.2147/jpr.s301448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Previous research suggests that muscle strength exercise is the most effective rehabilitation methods in patients with patellofemoral pain (PFP). This systematic review with meta-analysis compared the effects of Hip&Knee, Hip-only and Knee-only exercise programs on pain relief, muscle strength, and functional performance in patients with PFP. Methods Literature searches of PubMed, PEDro and CINAHL databases revealed twenty-one studies included in the final descriptive review, thirteen of which were included in the meta-analysis. Data extraction included baseline and post-intervention means and standard deviations of all eligible outcome measures both for the intervention and control groups, participants baseline demographics and intervention characteristics. Results The results showed that Hip&Knee and Hip-only exercise programs were comparatively effective, while the Knee-only exercise programs proved to be inferior to the above-mentioned approaches. The Hip&Knee exercise programs showed the greatest pain relief (mean difference = -1.71 (-3.11, -0.30); p = 0.02; I2 = 96%) and functional improvement (standardized mean difference = 1.28 (0.45, 2.12); p = 0.003; I2 = 84%), although the subgroup analysis did not show any significant difference compared to Hip-only exercise programs (p > 0.05). Conclusion Overall, Hip&Knee exercise programs appear to reduce pain and improve function more than other exercise programs and could be used as a primary rehabilitation approach in patients with PFP. However, the difference between the subgroups in most outcome measures suggests that Hip&Knee exercise programs are no more effective than Hip-only exercise programs.
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Affiliation(s)
- Denisa Manojlović
- Department of Physiotherapy, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Žiga Kozinc
- Department of Kinesiology, Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Department of Health Study, Andrej Marušič Institute, University of Primorska, Koper, Slovenia
| | - Nejc Šarabon
- Department of Kinesiology, Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Department of Health Study, Andrej Marušič Institute, University of Primorska, Koper, Slovenia.,Human Health Department, InnoRenew CoE, Izola, Slovenia.,Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ltd., Ljubljana, Slovenia
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Scafoglieri A, Van den Broeck J, Willems S, Tamminga R, van der Hoeven H, Engelsma Y, Haverkamp S. Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:446. [PMID: 33992100 PMCID: PMC8126114 DOI: 10.1186/s12891-021-04310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Increasing evidence has shown benefits of spinal manipulations in patients with patellofemoral pain syndrome (PFPS). There is scarcity regarding medium term effects of spinal manual therapy on outcome measures in PFPS patients. Therefore, the aim of the present study was to compare the effectiveness of local exercise therapy and spinal manual therapy for knee pain, function and maximum voluntary peak force (MVPF) velocity of the quadriceps in PFPS patients. Methods Forty-three patients with PFPS were randomly assigned to a local exercise or spinal manual therapy group. The local exercise group received six sessions (one session per week) of supervised training of the knee-and hip muscles with mobilization of the patellofemoral joint. The spinal manual therapy group received six interventions (one intervention per week) of high velocity low thrust manipulations at the thoracolumbar region, sacroiliac joint, and/or hip. All patients were also asked to do home exercises. Maximum, minimum and current pain were measured using the visual analogue scale. Function was assessed with the anterior knee pain scale (AKPS) and MPFV was recorded using a Biodex System 3 dynamometer. Patients were assessed before intervention, after 6 weeks of intervention and after 6 weeks of follow-up. Between-group differences at assessments were analysed by way of analysis of covariance with Bonferroni correction. Results Pain and functionality improved more following spinal manipulative therapy than local exercise therapy. After 6 weeks of intervention the between-group difference (local versus spinal) for maximal pain was 23.4 mm [95% CI: 9.3, 37.6; effect size (ES): 1.04] and − 12.4 [95% CI: − 20.2, − 4.7; ES: 1.00] for the AKPS. At 6 weeks of follow-up the between-group difference for maximal pain was 18.7 mm [95% CI: 1.4, 36.0; ES: 0.68] and − 11.5 [95% CI: − 19.9, − 3.3; ES: − 0.87] for the AKPS. Conclusions This study suggests that spinal manual therapy is more effective than local exercise therapy in improving pain and function in patients with PFPS in the medium term. We suggest for future research to investigate whether combining local exercise therapy and spinal manual therapy is more effective than either single intervention on its own. This clinical trial study was approved by the Medical Ethics Committee METC Z under registration number NL57207.096. and registered retrospectively in ClinicalTrials.gov PRS with registration ID number NCT04748692 on the 10th of February 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04310-9.
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Affiliation(s)
- Aldo Scafoglieri
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Experimental Anatomy Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium. .,SOMT University of Physiotherapy, Softwareweg 5, Amersfoort, BN, 3821, The Netherlands.
| | - Jona Van den Broeck
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Experimental Anatomy Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium
| | - Stijn Willems
- Department of Neuroscience, VU University Medical Center, Amsterdam, HV, 1081, The Netherlands
| | - Rob Tamminga
- Fysioholland, Medicort, Rijksweg 69, Naarden, GE, 1411, The Netherlands
| | | | - Yde Engelsma
- Bergman Clinics BV, Rijksweg 69, Naarden, GE, 1411, The Netherlands
| | - Stijn Haverkamp
- Bergman Clinics BV, Rijksweg 69, Naarden, GE, 1411, The Netherlands
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The Utilization of Core Exercises in Patients With Patellofemoral Pain: A Critically Appraised Topic. J Sport Rehabil 2021; 30:1094-1097. [PMID: 33952714 DOI: 10.1123/jsr.2020-0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Patellofemoral pain (PFP) is characterized by general anterior knee pain around the patella and is one of the most prevalent knee conditions. PFP is challenging to treat due to a wide range of contributing factors and often has chronic, reoccurring symptoms. Traditional treatment focuses on quadriceps and gluteal strengthening with minimal emphasis on deep trunk musculature. Recently, there has been a growing body of literature supporting the beneficial effects of core stability exercises as a treatment option for PFP. Clinical Question: Are core stability exercises coupled with traditional rehabilitation more effective than only traditional rehabilitation techniques for decreasing pain in patients with PFP? Summary of Key Findings: Three articles met the inclusion criteria and investigated core strengthening exercises as a treatment for PFP. Two studies investigated a 4-week exercise protocol and demonstrated a greater decrease in pain when compared to the control group. The third study examined the effects of a 6-week program where both the intervention and control groups resulted in similar reduction of pain. All articles included received a minimum of 6 on the PEDro scale. Clinical Bottom Line: There is evidence that supports core stability exercise protocols coupled with traditional rehabilitation as being more effective in reducing pain in patients with PFP when compared to traditional rehabilitation alone. Strength of Recommendation: The grade of A is recommended based on the Strength of Recommendation Taxonomy.
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Jellad A, Kalai A, Guedria M, Jguirim M, Elmhamdi S, Salah S, Frih ZBS. Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design. Orthop J Sports Med 2021; 9:2325967121989729. [PMID: 33912615 PMCID: PMC8050763 DOI: 10.1177/2325967121989729] [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: 08/22/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Active rehabilitation has an important role in the management of
patellofemoral pain syndrome (PFPS). Although some studies have shown the
benefit of hip-muscle strengthening, the effect of combining hip-muscle
stretching with strengthening has not yet been defined. Purpose: To evaluate the effect of combined strengthening of the hip external rotators
and abductors and stretching of the hip internal rotators on pain and
function in patients with PFPS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ±
10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B
arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A
arm (BA group; standard rehabilitation with strengthening of the hip
external rotators and abductors and stretching of the hip internal
rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a
washout period, corresponding to a symptom-free period, rehabilitation
programs were crossed over. A visual analog scale (VAS) evaluating perceived
pain, the Functional Index Questionnaire (FIQ), and the Kujala score were
administered at baseline, the end of each rehabilitation protocol, and 12
weeks after the completion of the second protocol for each group. Results: Until the final follow-up, VAS, FIQ, and Kujala scores were significantly
improved in both the A-B and B-A arms (P < .05 for all).
Compared with protocol A, protocol B provided significant improvement in
terms of pain and function in both the BA (VAS and Kujala;
P < .001) and AB (VAS and Kujala; P
< .001) groups. Conclusion: Combined strengthening of the hip abductors and external rotators with
stretching of the hip internal rotators provided better outcomes, which were
maintained for at least 12 weeks, in terms of pain and function in patients
with PFPS.
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Affiliation(s)
- Anis Jellad
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Amine Kalai
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Mohamed Guedria
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Mahbouba Jguirim
- Department of Rheumatology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Elmhamdi
- Department of Preventive Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Salah
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Zohra Ben Salah Frih
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Flowers DW, Brewer W, Mitchell K, Ellison J. Why are we neglecting the core muscles in patients with knee osteoarthritis? A narrative review of the literature. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1907947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel W. Flowers
- Program in Physical Therapy, LSU Health-Shreveport, Shreveport, Louisiana, USA
| | - Wayne Brewer
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Katy Mitchell
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Jennifer Ellison
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
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Glaviano NR, Boling MC, Fraser JJ. Anterior Knee Pain Risk Differs Between Sex and Occupation in Military Tactical Athletes. J Athl Train 2021; 56:1180-1187. [PMID: 33787888 DOI: 10.4085/1062-6050-0578.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Anterior knee pain (AKP) is ubiquitous in early-career military members and exacerbated during functional tasks required during military duties. Therefore, it is important to understand risk of this condition in male and female tactical athletes in diverse military occupations. OBJECTIVE To assess sex and occupation on AKP risk in military members. DESIGN Descriptive Epidemiology Study. SETTING United States Armed Forces. Patients All military members diagnosed with anterior or retro-patellar pain, patellar instability, knee tendinopathy on their initial encounter from 2006 to 2015. OUTCOME MEASURES The Defense Medical Epidemiology Database was queried for the number of individuals with AKP. Relative risk (RR) and chi-square statistics were calculated in the assessment of sex and occupational category. Regressions were calculated to determine association between service branch, sex, and AKP across time. RESULTS From 2006-2015, a total of 151,263 enlisted and 14,335 officer services members were diagnosed with AKP. Enlisted females had an incidence rate of 16.7 per 1000 person-years compared to the enlisted male service members with an incidence rate of 12.7 per 1000 person-years (RR: 1.32, 95%CI: 1.30-1.34, p<0.001) across all AKP diagnoses. Female officers had an incidence rate of 10.7 per 1,000 person-years compared to male officers at an incidence rate of 5.3 per 1000 person-years (RR: 2.01, 95%CI: 1.94-2.09). Differences in risk were also noted across military occupation for both enlisted and officer service members (p<.05). CONCLUSION Sex and military occupation were salient factors for AKP risk. Evaluation of training requirements and developing interventions programs across military occupation could serve as a focus for future research aiming to mitigate associated risk factors of AKP.
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Affiliation(s)
- Neal R Glaviano
- 1Department of Kinesiology, University of Connecticut, Storrs, CT. . Twitter: @NealGlaviano
| | - Michelle C Boling
- 2Brooks College of Health, University of North Florida, Jacksonville, FL. . Twitter: @mcboling23
| | - John J Fraser
- 1Department of Kinesiology, University of Connecticut, Storrs, CT. . Twitter: @NealGlaviano
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Biomechanics Differ for Individuals With Similar Self-Reported Characteristics of Patellofemoral Pain During a High-Demand Multiplanar Movement Task. J Sport Rehabil 2021; 30:860-869. [PMID: 33596543 DOI: 10.1123/jsr.2020-0220] [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: 05/12/2020] [Revised: 11/05/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Patellofemoral pain (PFP) is often categorized by researchers and clinicians using subjective self-reported PFP characteristics; however, this practice might mask important differences in movement biomechanics between PFP patients. OBJECTIVE To determine whether biomechanical differences exist during a high-demand multiplanar movement task for PFP patients with similar self-reported PFP characteristics but different quadriceps activation levels. DESIGN Cross-sectional design. SETTING Biomechanics laboratory. PARTICIPANTS A total of 15 quadriceps deficient and 15 quadriceps functional (QF) PFP patients with similar self-reported PFP characteristics. INTERVENTION In total, 5 trials of a high-demand multiplanar land, cut, and jump movement task were performed. MAIN OUTCOME MEASURES Biomechanics were compared at each percentile of the ground contact phase of the movement task (α = .05) between the quadriceps deficient and QF groups. Biomechanical variables included (1) whole-body center of mass, trunk, hip, knee, and ankle kinematics; (2) hip, knee, and ankle kinetics; and (3) ground reaction forces. RESULTS The QF patients exhibited increased ground reaction force, joint torque, and movement, relative to the quadriceps deficient patients. The QF patients exhibited: (1) up to 90, 60, and 35 N more vertical, posterior, and medial ground reaction force at various times of the ground contact phase; (2) up to 4° more knee flexion during ground contact and up to 4° more plantarflexion and hip extension during the latter parts of ground contact; and (3) up to 26, 21, and 48 N·m more plantarflexion, knee extension, and hip extension torque, respectively, at various times of ground contact. CONCLUSIONS PFP patients with similar self-reported PFP characteristics exhibit different movement biomechanics, and these differences depend upon quadriceps activation levels. These differences are important because movement biomechanics affect injury risk and athletic performance. In addition, these biomechanical differences indicate that different therapeutic interventions may be needed for PFP patients with similar self-reported PFP characteristics.
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Tazesh B, Mansournia MA, Halabchi F. Additional effects of core stability exercises on pain and function of patients with patellofemoral pain: A randomized controlled trial. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/2210491721989075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background/purpose: Recently, there is more emphasis on the role of core muscles in pathogenesis and rehabilitation of patellofemoral pain (PFP). We aimed to investigate whether increased core muscle strength and endurance improve clinical outcomes. Methods: In a randomized controlled trial, 60 patients (M/F: 25/35, age = 32.28 (5.9) years) with PFP were randomly allocated into two groups of routine exercise (control) and combined core plus routine exercise (intervention). Home exercise was scheduled at least 5 times/week for 12 weeks. We assessed the outcomes of pain (Visual analogue scale) and function (Anterior knee pain score) before and immediately after interventions. Results: Significant improvements were reported in both groups (P < 0.001). There were significant between-group differences in both outcomes in favor of the intervention (Pain: 12.4, CI 95%: 7.1–17.8, P < 0.001; Function: 6.4, CI 95%: 2.2–10.5, P = 0.003). Conclusion: Outcome improvements were significantly greater in intervention group. Inclusion of core stability exercises may lead to additional benefits.
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Affiliation(s)
- Behnaz Tazesh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Halabchi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Flowers DW, Brewer W, Ellison J, Mitchell K, Frilot C. Transversus abdominis activation does not alter gait impairments in patients with and without knee osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 82:105270. [PMID: 33421757 DOI: 10.1016/j.clinbiomech.2020.105270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/12/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee osteoarthritis accounts for more years of disability than all other forms of osteoarthritis combined. Gait kinetic and kinematic changes, in addition to reduced gait speed, are commonly observed. This study investigates whether core activation, which modifies lower extremity movement in young, active populations, can alter the gait and baseline core activation of those with knee osteoarthritis as compared to controls, and alter osteoarthritic knee pain. METHODS Forty-four participants (22 controls and 22 with knee osteoarthritis) underwent biomechanical gait assessment, examining kinetic and kinematic variables, in addition to gait speed, with and without volitional transversus abdominis activation. Surface electromyography was used to measure baseline transversus abdominis activation under both conditions. Knee pain ratings were examined for those with knee osteoarthritis. FINDINGS No significant biomechanical differences were observed within groups, or in the time/group interaction. Between-groups kinetic (time to first peak ground reaction force and amplitude of second peak ground reaction force) and gait speed differences were observed under both conditions. There were no differences in baseline electromyography activation between or within-groups, or within-group for self-reported pain for the osteoarthritic group. INTERPRETATION Although previous studies have shown the benefit of core activation in correcting lower extremity movement patterns and kinetic loading in young, athletic populations, this study is the first to show this is not the case for persons with knee osteoarthritis. Future studies should examine the value of a progressive core stabilization program, of sufficient dose and mode, in correcting the observed gait differences in those with knee osteoarthritis. CLINICAL TRIAL REGISTRATION NUMBER NCT03776981.
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Affiliation(s)
- Daniel W Flowers
- Program in Physical Therapy, LSU Health-Shreveport, 1501 Kings Hwy., Shreveport, LA 71103, USA.
| | - Wayne Brewer
- School of Physical Therapy, Texas Woman's University, 6700 Fannin St., Houston, TX 77030, USA.
| | - Jennifer Ellison
- School of Physical Therapy, Texas Woman's University, 6700 Fannin St., Houston, TX 77030, USA.
| | - Katy Mitchell
- School of Physical Therapy, Texas Woman's University, 6700 Fannin St., Houston, TX 77030, USA.
| | - Clifton Frilot
- Program in Physical Therapy, LSU Health-Shreveport, 1501 Kings Hwy., Shreveport, LA 71103, USA.
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Rapp E, Shin S, Thomsen W, Ferber R, Halilaj E. Estimation of kinematics from inertial measurement units using a combined deep learning and optimization framework. J Biomech 2021; 116:110229. [PMID: 33485143 DOI: 10.1016/j.jbiomech.2021.110229] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/16/2020] [Accepted: 01/03/2021] [Indexed: 01/01/2023]
Abstract
The difficulty of estimating joint kinematics remains a critical barrier toward widespread use of inertial measurement units in biomechanics. Traditional sensor-fusion filters are largely reliant on magnetometer readings, which may be disturbed in uncontrolled environments. Careful sensor-to-segment alignment and calibration strategies are also necessary, which may burden users and lead to further error in uncontrolled settings. We introduce a new framework that combines deep learning and top-down optimization to accurately predict lower extremity joint angles directly from inertial data, without relying on magnetometer readings. We trained deep neural networks on a large set of synthetic inertial data derived from a clinical marker-based motion-tracking database of hundreds of subjects. We used data augmentation techniques and an automated calibration approach to reduce error due to variability in sensor placement and limb alignment. On left-out subjects, lower extremity kinematics could be predicted with a mean (±STD) root mean squared error of less than 1.27° (±0.38°) in flexion/extension, less than 2.52° (±0.98°) in ad/abduction, and less than 3.34° (±1.02°) internal/external rotation, across walking and running trials. Errors decreased exponentially with the amount of training data, confirming the need for large datasets when training deep neural networks. While this framework remains to be validated with true inertial measurement unit data, the results presented here are a promising advance toward convenient estimation of gait kinematics in natural environments. Progress in this direction could enable large-scale studies and offer new perspective into disease progression, patient recovery, and sports biomechanics.
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Affiliation(s)
- Eric Rapp
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Soyong Shin
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Wolf Thomsen
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Eni Halilaj
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA; Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
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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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McClinton SM, Cobian DG, Heiderscheit BC. Physical Therapist Management of Anterior Knee Pain. Curr Rev Musculoskelet Med 2020; 13:776-787. [PMID: 33128200 PMCID: PMC7661565 DOI: 10.1007/s12178-020-09678-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Anterior knee pain is a common musculoskeletal complaint among people of all ages and activity levels. Non-operative approaches with an emphasis on physical therapy management are the recommended initial course of care. The purpose of this review is to describe the current evidence for physical therapist management of anterior knee pain with consideration of biomechanical and psychosocial factors. RECENT FINDINGS The latest research suggests anterior knee pain is a combination of biomechanical, neuromuscular, behavioral, and psychological factors. Education strategies to improve the patient's understanding of the condition and manage pain are supported by research. Strong evidence continues to support the primary role of exercise therapy and load progression to achieve long-term improvements in pain and function. Preliminary studies suggest blood flow restriction therapy and movement retraining may be useful adjunct techniques but require further well-designed studies. Anterior knee pain includes multiple conditions with patellofemoral pain being the most common. An insidious onset is typical and often attributed to changes in activity and underlying neuromuscular impairments. A thorough clinical history and physical examination aim to identify the patient's pain beliefs and behaviors, movement faults, and muscle performance that will guide treatment recommendations. Successful physical therapist management involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.
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Affiliation(s)
- Shane M. McClinton
- Doctor of Physical Therapy Program, Des Moines University, Des Moines, IA USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI USA
| | - Bryan C. Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA
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Improvements in Lower-Extremity Function Following a Rehabilitation Program With Patterned Electrical Neuromuscular Stimulation in Females With Patellofemoral Pain: A Randomized Controlled Trial. J Sport Rehabil 2020; 29:1075-1085. [DOI: 10.1123/jsr.2019-0278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/24/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022]
Abstract
Context: Patellofemoral pain (PFP) is a challenging condition, with altered kinematics and muscle activity as 2 common impairments. Single applications of patterned electrical neuromuscular stimulation (PENS) have improved both kinematics and muscle activity in females with PFP; however, the use of PENS in conjunction with a rehabilitation program has not been evaluated. Objective: To determine the effects of a 4-week rehabilitation program with PENS on lower-extremity biomechanics and electromyography (EMG) during a single-leg squat (SLS) and a step-down task (SDT) in individuals with PFP. Study Design: Double-blinded randomized controlled trial. Setting: Laboratory. Patients of Other Participants: Sixteen females with PFP (age 23.3 [4.9] y, mass 66.3 [13.5] kg, height 166.1 [5.9] cm). Intervention: Patients completed a 4-week supervised rehabilitation program with or without PENS. Main Outcome Measures: Curve analyses for lower-extremity kinematics and EMG activity (gluteus maximus, gluteus medius, vastus medialis oblique, vastus lateralis, biceps femoris, and adductor longus) were constructed by plotting group means and 90% confidence intervals throughout 100% of each task, before and after the rehabilitation program. Mean differences (MDs) and SDs were calculated where statistical differences were identified. Results: No differences at baseline in lower-extremity kinematics or EMG were found between groups. Following rehabilitation, the PENS group had significant reduction in hip adduction between 29% and 47% of the SLS (MD = 4.62° [3.85°]) and between 43% and 69% of the SDT (MD = 6.55° [0.77°]). Throughout the entire SDT, there was a decrease in trunk flexion in the PENS group (MD = 10.91° [1.73°]). A significant decrease in gluteus medius activity was seen during both the SLS (MD = 2.77 [3.58]) and SDT (MD = 4.36 [5.38]), and gluteus maximus during the SLS (MD = 1.49 [1.46]). No differences were seen in the Sham group lower-extremity kinematics for either task. Conclusion: Rehabilitation with PENS improved kinematics in both tasks and decreased EMG activity. This suggests that rehabilitation with PENS may improve muscle function during functional tasks.
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Comparison of Trunk Flexion Proprioception Between Healthy Athletes and Athletes With Patellofemoral Pain. J Sport Rehabil 2020; 30:430-436. [PMID: 33049707 DOI: 10.1123/jsr.2019-0369] [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: 08/17/2019] [Revised: 06/24/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Patellofemoral pain (PFP) is the most commonly reported musculoskeletal overuse injury in active individuals, such as athletes, and is a multifactorial problem with no definite cause identified to date. Some studies have shown a relationship between impaired core and trunk sensorimotor control and knee disorders, especially PFP. The aim of this study was to evaluate trunk flexion proprioception by comparing the repositioning error between healthy athletes and athletes with PFP. DESIGN Cross-sectional case-control study. SETTING Rehabilitation sciences research center. PARTICIPANTS Twenty healthy athletes and 20 athletes with PFP. MAIN OUTCOME MEASURES To examine proprioception of trunk flexors, the absolute active and passive repositioning error at 30° and 60° trunk flexion were evaluated with isokinetic dynamometry. The results were compared between the two groups. RESULTS In the PFP group, the active trunk repositioning error at 30° flexion was significantly greater than in the healthy individuals (P < .001). The mean absolute active repositioning error at 30° flexion was 3.04° (1.37°) in the PFP group and 1.50° (0.70°) in the control group. There was no significant difference between groups in the active trunk repositioning error at 60° flexion (P = .066). The mean absolute active repositioning error at 60° flexion was 2.96° (1.26°) in the PFP group and 2.18° (0.99°) in the control group. The passive trunk repositioning error at 30° and 60° flexion was significantly greater in the PFP group (P = .013 and P = .004, respectively). The mean absolute passive repositioning error at 30° and 60° flexion in the PFP group was 2.94° (0.80°) and 3.13° (1.19°), respectively, and was 2.08° (1.08°) and 1.96° (0.71°), respectively, in the control group. The calculated eta-squared value showed that joint repositioning errors had large effect sizes (0.15-0.32). CONCLUSION Trunk proprioception in the flexion direction may be impaired in patients with PFP. This finding suggests that trunk proprioception training may be important in rehabilitation for athletes with PFP.
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Dischiavi SL, Wright AA, Tarara DT, Bleakley CM. Do exercises for patellofemoral pain reflect common injury mechanisms? A systematic review. J Sci Med Sport 2020; 24:229-240. [PMID: 32978070 DOI: 10.1016/j.jsams.2020.09.001] [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: 06/09/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Current best evidence has reported that therapeutic exercise programs that are designed to treat patellofemoral pain (PFP) should include both hip and knee specific exercises. The purpose of this review was to (1) examine the quality/comprehensiveness of exercise reporting in this field; (2) quantify the extent to which individual exercises comprised task-specific elements (single limb stance; eccentric control of the hip; rotational z-axis control) most likely to address key pathomechanics associated with PFP. DESIGN Systematic review: a systematic survey of RCTs. METHODS PubMed, CINAHL, Medline, Physiotherapy Evidence Database (PEDro) and SPORT Discus databases were searched for randomized controlled trials that addressed PFP utilizing a proximal control hip focused rehabilitation paradigm. The therapeutic exercise programs were evaluated, and each individual exercise was extracted for analysis. Quality assessments included the PEDro Scale and the Consensus on Exercise Reporting Template (CERT) was utilized to score the reporting of the interventions. RESULTS 19 studies were included in the final analysis. 178 total exercises were extracted from the proximal hip and knee rehabilitation programs. The exercises were analyzed for the inclusion of elements that align with reported underlying biomechanical mechanisms. CONCLUSIONS The vast majority of the exercises were sagittal plane, concentric, non-weight bearing exercises, whereas multiplanar exercises, single limb weightbearing, and exercises where loading was directed around the longitudinal z-axis, were considerably under-represented. Current exercises for PFP utilize simplistic frameworks that lack progression into more task specific exercise, and are not reflective of the complex injury etiology.
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Affiliation(s)
- Steven L Dischiavi
- Department of Physical Therapy, High Point University, One University Parkway, USA; Centre for Health and Rehabilitation Technologies, School of Health Sciences, Institute of Nursing and Health Research, University of Ulster, UK.
| | - Alexis A Wright
- Department of Physical Therapy, High Point University, One University Parkway, USA
| | - Daniel T Tarara
- Department of Exercise Science, High Point University, One University Parkway, USA
| | - Chris M Bleakley
- Centre for Health and Rehabilitation Technologies, School of Health Sciences, Institute of Nursing and Health Research, University of Ulster, UK
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Central Activation Ratio Is a Reliable Measure for Gluteal Neuromuscular Function. J Sport Rehabil 2020; 29:956-962. [PMID: 31775118 DOI: 10.1123/jsr.2019-0243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/12/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Central activation ratio (CAR) is a common outcome measure used to quantify gross neuromuscular function of the quadriceps using the superimposed burst technique, yet this outcome measure has not been validated in the gluteal musculature. OBJECTIVE To quantify gluteus medius (GMed) and gluteus maximus (GMax) CAR in a healthy population and evaluate its validity and reliability over a 1-week period. DESIGN Descriptive. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 20 healthy participants (9 males and 11 females; age 22.2 [1.4] y, height 173.4 [11.1] cm, mass 84.8 [25.8] kg) were enrolled in this study. INTERVENTIONS Participants were assessed at 2 sessions, separated by 1 week. Progressive electrical stimuli (25%, 50%, 75%, and 100%) were delivered to the GMed and GMax at rest, and 100% stimuli were delivered during progressive hip abduction and extension contractions (25%, 50%, 75%, and 100% maximal voluntary isometric contraction). MAIN OUTCOME MEASURES GMed and GMax CAR, and hip abduction and hip extension maximal voluntary isometric contraction torque. Line of best fit and coefficient of determination (r2) were used to assess the relationship between torque output and CAR at varying levels of stimuli. Intraclass correlation coefficients, ICCs(3,k), were used to assess the between-session reliability. RESULTS GMed CAR was 96.1% (3.4%) and 96.6% (3.2%), on visits 1 and 2, respectively, whereas GMax CAR was 86.5% (7.5%) and 87.2% (10.7%) over the 2 sessions. A third-order polynomial demonstrated the best line of fit between varying superimposed burst intensities at rest for both GMed (r2 = .156) and GMax (r2 = .602). Linear relationships were observed in the CAR during progressive contractions with a maximal superimposed burst, GMed (r2 = .409) and GMax (r2 = .639). Between-session reliability was excellent for GMed CAR, ICC(3,k) = .911, and moderate for GMax CAR, ICC(3,k) = .704. CONCLUSION CAR appears to be an acceptable measure of GMed and GMax neuromuscular function in healthy individuals. Gluteal CAR measurements are reliable measures over a 1-week test period.
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Haselhorst A, Rho M. Musculoskeletal Issues and Care Specific to the Female Athlete. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Matthews M, Rathleff MS, Claus A, McPoil T, Nee R, Crossley KM, Kasza J, Vicenzino BT. Does foot mobility affect the outcome in the management of patellofemoral pain with foot orthoses versus hip exercises? A randomised clinical trial. Br J Sports Med 2020; 54:1416-1422. [DOI: 10.1136/bjsports-2019-100935] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 01/10/2023]
Abstract
ObjectivesTo test (i) if greater foot pronation (measured as midfoot width mobility) is associated with better outcomes with foot orthoses treatment, compared with hip exercises and (ii) if hip exercises are superior to foot orthoses, irrespective of midfoot width mobility.MethodsA two-arm parallel, randomised superiority clinical trial was conducted in Australia and Denmark. Participants (18–40 years) were included who reported an insidious onset of knee pain (≥6 weeks duration); ≥3/10 numerical pain rating, that was aggravated by activities (eg, stairs, squatting, running). Participants were stratified by midfoot width mobility (high ≥11 mm change in midfoot width) and site, randomised to foot orthoses or hip exercises and blinded to objectives and stratification. Success was defined a priori as much better or better on a patient-perceived 7-point scale at 12 weeks.ResultsOf 218 stratified and randomised participants, 192 completed 12-week follow-up. This study found no difference in success rates between foot orthoses versus hip exercises in those with high (6/21 vs 9/20; 29% vs 45%, respectively) or low (42/79 vs 37/72; 53% vs 51%) midfoot width mobility. There was no association between midfoot width mobility and treatment outcome (Interaction effect p=0.19). This study found no difference in success rate between foot orthoses versus hip exercises (48/100 vs 46/92; 48% vs 50%).ConclusionMidfoot width mobility should not be used to help clinicians decide which patient with patellofemoral pain might benefit most from foot orthoses. Clinicians and patients may consider either foot orthoses or hip exercises in managing patellofemoral pain.Trial registration numberACTRN12614000260628.
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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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