Concepts for assessment and treatment of anterior knee pain related to altered spinal and pelvic biomechanics: a case report

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

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.

Immediate effects of lumbopelvic manipulation and lateral gluteal kinesio taping on unilateral patellofemoral pain syndrome: a pilot study

Objectives:

To determine the immediate effects of Kinesio taping directed to the hip and manipulation directed to the lumbopelvic region in individuals with unilateral patellofemoral pain syndrome (PFPS).

Background:

PFPS affects up to 25% of the general population. Despite the high prevalence, this condition is not clearly understood, as evidenced by the numerous proposed causes and recommended treatments. Notwithstanding, recent evidence suggests that treatments directed at the hip or spine may lead to beneficial results.

Methods:

A convenience sample of 18 participants (12 men and 6 women, 19.5 ± 1.15 years old) with unilateral PFPS was recruited. Participants were randomized by sex to 1 of 3 groups: Kinesio taping, manipulation, and control taping. The main outcome measures included the Y-balance test, squatting range of motion (ROM), and the Lower Extremity Functional Scale.

Results:

Compared with the lumbopelvic manipulation and control groups, those in the Kinesio taping group performed significantly better on the Y-balance test (F = 5.59, P = 0.02) and with squatting ROM (F = 3.93, P = 0.04). The Kinesio taping and lumbopelvic groups were also significantly better than the control (sham) group with double-leg squatting ROM performance 3 days later.

Conclusion:

Kinesio taping may facilitate gluteus medius activation and improve postural stability and a double-leg squat.

Clinical Relevance:

The improvement in affected limb reach and double-leg squatting ROM highlights the potential for Kinesio taping to improve gluteus medius activation. Lumbopelvic manipulation may also immediately improve rehabilitation programs for PFPS.

Multimodal and interdisciplinary management of an isolated partial tear of the posterior cruciate ligament: a case report

OBJECTIVE

The purpose of this case report is to describe the evaluation and conservative management of an isolated posterior cruciate ligament (PCL) tear.

CLINICAL FEATURES

A 32-year-old man with a traumatic right knee injury after tripping was initially diagnosed with medial patellar retinaculum tear at a multidisciplinary clinic. The patient received physiotherapy but reinjured the knee after returning to the sports field 3 weeks later. Subsequent clinical testing and magnetic resonance imaging confirmed a grade II isolated PCL tear.

INTERVENTION AND OUTCOME

Following the PCL tear diagnosis, a multimodal treatment approach over the course of 8 weeks consisting of chiropractic lumbopelvic manipulation, physiotherapy, and an exercise program emphasizing eccentric muscle action was implemented. Lunges, 1-leg squats, and trunk stabilization exercises were extensively used. Three months postinjury, the patient successfully returned to sports activity with no further complications.

CONCLUSION

The patient in this case report demonstrated successful return to preinjury functional status. This case highlights a multidisciplinary approach through the utilization of chiropractic, physiotherapy, and exercise therapies.

Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial

BACKGROUND

Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.

METHODS

Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.

RESULTS

Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes.

CONCLUSIONS

This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly.

TRIAL REGISTRATION

TRIAL REGISTRATION NUMBER

NCT01496144.