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Nie Q, Yu Y, Yuan Z, Chen J. Effects of adding neuromuscular electrical stimulation to functional training on muscle recruitment, pain reduction, and knee joint function in patellofemoral pain syndrome patients. Medicine (Baltimore) 2024; 103:e36095. [PMID: 38241526 PMCID: PMC10798742 DOI: 10.1097/md.0000000000036095] [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: 08/17/2023] [Accepted: 10/23/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Impaired lower extremity motor function and knee pain are common concerns in patients with patellofemoral pain syndrome (PFPS). It is essential to plan therapeutic techniques to therapy PFPS. The objective of this study was to determine the effect of neuromuscular electrical stimulation (NMES) combined with functional training on pain, lower extremity function and muscle recruitment in patients with PFPS. METHODS Twenty-four PFPS patients (male-13, female-11) were selected to conduct this study finally. Two groups were formed: the control group (n = 12) which included functional training only and the experimental group (n = 12) which functional training along with NMES-in both groups interventions were performed for 45 minutes/session, 3 days/weeks for 6 weeks. The functional training consisted of warm-up activities, strength training, balance training, and relaxation activities. All patients were evaluated with surface electromyography testing system for the root mean square and integrated electromyography of vastus medial oblique (VMO), vastus lateralis (VL), and VMO/VL ratio, visual analog scores (VAS) for pain, and Kujala functional score for knee joint function before and after 6 weeks. Normality was tested for all outcome variables using Shapiro-Wilk test. Nonparametric (Mann-Whitney U test and Wilcoxon signed-rank test) tests were used to analyze data. A 2-way analysis of variance with repeated measures (group*time) was applied to analyze the data. RESULTS A significant increases (P < .001) root mean square and integrated electromyography of VMO, VMO/VL ratio, and Kujala score in both groups, For VAS scores, significant decreases was observed in both groups. When both groups were compared, greater improvement (P < .05) was observed in the experimental group in comparison the control group for both knee pain, lower extremity function and muscle recruitment. However, there was no difference in VL muscle recruitment between the 2 groups. CONCLUSIONS Functional training and NMES combined with functional training are helpful to improve pain, knee function and muscle recruitment of PFPS patients. NMES combined with functional training was more effective compared to the control group. This may help clinical trialists to use different NMES to synchronize other interventions in future studies to enhance rehabilitation efficacy in PFPS patients through passive training versus active stimulation.
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Affiliation(s)
- Qiu Nie
- Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yaming Yu
- Sichuan Orthopaedic Hospital, Chengdu, Sichuan China
| | - Zheng Yuan
- Sichuan Orthopaedic Hospital, Chengdu, Sichuan China
| | - Jian Chen
- Wuhan Sports Institute, Wuhan, Hubei, China
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Soares A, Cintia LF, Glaviano NR, Rabelo NDDA, Lucareli PRG. Is there a correlation between isometric muscle strength and the kinematics of the pelvis, hip and knee during functional tasks in women with patellofemoral pain? Phys Ther Sport 2022; 57:33-39. [PMID: 35878554 DOI: 10.1016/j.ptsp.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the correlation between isometric muscle strength of the hip abductors (HABD) and lateral rotators (HLR) with the range of motion (ROM) of the pelvis/hip in the frontal/transverse planes, respectively, and between the strength of the knee extensors (KExt) with the ROM of the knee in the sagittal plane during seven tasks. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS Thirty-five women with patellofemoral pain. MAIN OUTCOME MEASURES Maximum isometric muscle strength of the HABD, HLR, and KExt was measured using a manual dynamometer, and pelvis and lower limbs kinematics were evaluated using 3D optical system during gait, ascending and descending stairs, the forward and lateral step down tests, and the propulsion and landing phases of the single leg hop test (SLHT). RESULTS A weak correlation was found between KExt strength and knee ROM in the sagittal plane (p = 0.05; r = -0.33) during SLHT landing, and a moderate correlation between HABD strength and ROM of pelvic obliquity (p < 0.01; r = 0.50) during ascending stairs. CONCLUSIONS The lower strength of KExt has a weak correlation with higher knee flexion during the landing phase of the SLHT, and the lower strength of HABD has a moderate correlation with lower pelvis ROM in the frontal plane when ascending stairs.
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Affiliation(s)
- Alyne Soares
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Lopes Ferreira Cintia
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Neal Robert Glaviano
- Assistant Professor in the Department of Kinesiology at the University of Connecticut, USA
| | - Nayra Deise Dos Anjos Rabelo
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
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Manojlović D, Šarabon N, Prosen M. The influence of an 8-week therapeutic exercise program on the patient experience of patellofemoral pain: a qualitative descriptive study. Physiother Theory Pract 2022:1-9. [PMID: 35238271 DOI: 10.1080/09593985.2022.2045410] [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: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to explore patients' experience of patellofemoral pain (PFP), in order to help improve the mutual understanding between the patient and the physiotherapist and consequently enhance the efficacy of treatment. METHODS A qualitative study design with focus groups was used to explore patient experience prior to the implementation of the therapeutic exercise program, during its duration, and up to twelve months after its conclusion. RESULTS Patients provided a detailed description of their lifestyle prior to the enrollment in the therapeutic exercise program, their experience of the therapeutic exercise program and the behavioral changes that remained after its conclusion. Three main themes emerged from our data: 1) PFP characteristics and the impact of PFP on daily life; 2) experience with the therapeutic exercise program; and 3) changes in PFP and daily behaviors following the therapeutic exercise program. CONCLUSION Our findings suggest that a targeted therapeutic exercise program effectively reduces short- and long-term PFP and enhance overall well-being. Further research is needed to investigate the effects of different therapeutic exercise programs with a focus on the role of self-motivation.
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Affiliation(s)
- Denisa Manojlović
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Human Health Department, InnoRenew CoE, Izola, Slovenia.,S2P, Science to Practice, Ltd. Laboratory for Motor Control and Motor Behaviour, Ljubljana, Slovenia
| | - Mirko Prosen
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
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Rodrigues R, Daiana Klein K, Dalcero Pompeo K, Aurélio Vaz M. Are There Neuromuscular Differences on Proximal and Distal Joints in Patellofemoral Pain People? A Systematic Review and Meta-Analysis. J Electromyogr Kinesiol 2022; 64:102657. [DOI: 10.1016/j.jelekin.2022.102657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/11/2022] [Accepted: 03/16/2022] [Indexed: 12/26/2022] Open
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Ho KY, Liang JN, Budge S, Madriaga A, Meske K, Nguyenton D. Brain and Spinal Cord Adaptations Associated With Patellofemoral Pain: A Systematic Review and Meta-Analysis. Front Integr Neurosci 2022; 16:791719. [PMID: 35197832 PMCID: PMC8859985 DOI: 10.3389/fnint.2022.791719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the evidence for altered cortical and spinal cord functions in individuals with patellofemoral pain (PFP). Methods We conducted a comprehensive search of databases to appraise and analyze the studies published prior to December 10, 2021 that examined spinal reflex excitability measured using Hoffmann reflex (H-reflex) amplitudes, corticospinal excitability measured using transcranial magnetic stimulation (TMS)-elicited motor evoked potential (MEP) amplitudes, motor threshold (MT), or stimulus-response (SR) curves, cortical reorganization assessed using TMS cortical mapping or structural magnetic resonance imaging (MRI), or functional changes of the brain assessed using functional MRI (fMRI) in individuals with PFP. Results Eight studies were eligible for analyses. While an earlier study showed that pain had no effect on the H-reflex amplitude of the quadriceps muscle, more recent evidence reported a decrease in vastus medialis (VM) H-reflex amplitude in participants with PFP. VM H-reflex amplitude was correlated with pain, chronicity, physical function, and isometric knee extensor torque production in participants with PFP. Altered corticospinal excitability was reported in participants with PFP, observed as increased MT in the VM and vastus lateralis (VL) muscles. In addition, cortical reorganization has been observed, where decreased number of cortical peaks, shifts and reduced volumes, and increased overlap of motor cortex representations for the VM, VL, and rectus femoris (RF) muscles were reported in participants with PFP. Conclusion There is emerging evidence on altered cortical and spinal cord functions in individuals with PFP, however, solid conclusions cannot be drawn due to limited literature available. Further research is needed to better understand the adaptations of the brain and spinal cord in this population. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42020212128.
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A Review of the Relationships Between Knee Pain and Movement Neuromechanics. J Sport Rehabil 2021; 31:684-693. [PMID: 34942599 DOI: 10.1123/jsr.2021-0020] [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: 01/19/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Knee injury and disease are common, debilitating, and expensive. Pain is a chief symptom of knee injury and disease and likely contributes to arthrogenic muscle inhibition. Joint pain alters isolated motor function, muscular strength, and movement biomechanics. Because knee pain influences biomechanics, it likely also influences long-term knee joint health. OBJECTIVE The purpose of this article is 2-fold: (1) review effects of knee pain on lower-extremity muscular activation and corresponding biomechanics and (2) consider potential implications of neuromechanical alterations associated with knee pain for long-term knee joint health. Experimental knee pain is emphasized because it has been used to mimic clinical knee pain and clarify independent effects of knee pain. Three common sources of clinical knee pain are also discussed: patellofemoral pain, anterior cruciate ligament injury and reconstruction, and knee osteoarthritis. DATA SOURCES The PubMed, Web of Science, and SPORTDiscus databases were searched for articles relating to the purpose of this article. CONCLUSION Researchers have consistently reported that knee pain alters neuromuscular activation, often in the form of inhibition that likely occurs via voluntary and involuntary neural pathways. The effects of knee pain on quadriceps activation have been studied extensively. Knee pain decreases voluntary and involuntary quadriceps activation and strength and alters the biomechanics of various movement tasks. If allowed to persist, these neuromechanical alterations might change the response of articular cartilage to joint loads during movement and detrimentally affect long-term knee joint health. Physical rehabilitation professionals should consider neuromechanical effects of knee pain when treating knee injury and disease. Resolution of joint pain can likely help to restore normal movement neuromechanics and potentially improve long-term knee joint health and should be a top priority.
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Feasibility of Superimposed Neuromuscular Electrical Stimulation to the Gluteus Medius During a Resistance Training Program. J Sport Rehabil 2021; 31:279-285. [PMID: 34894628 DOI: 10.1123/jsr.2021-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Gluteus medius (GMed) weakness is a common impairment seen across multiple lower-extremity pathologies. Greater GMed weakness is moderately associated with greater frontal plane motion, often termed dynamic knee valgus during functional tasks which may increase risk of lower-extremity injury. Neuromuscular electrical stimulation (NMES) superimposed to targeted muscles has emerged in clinical practice; however, NMES superimposed to the GMed in unknown. It is essential to assess the safety, credibility, and expectancy of NMES superimposed to the GMed prior to implementation in clinical practice. The objective of this study was to evaluate feasibility, safety, credibility, and expectancy of improvement with a 2-week intervention with or without NMES to the GMed in females with dynamic knee valgus. DESIGN Feasibility study. METHODS A total of 22 adult females with dynamic knee valgus (age = 21.8 [1.4] y, mass = 76.9 [18.8] kg, height = 1.7 [0.1] m) completed a 2-week intervention with NMES or a sham treatment superimposed to the GMed during all therapeutic exercises. Feasibility was assessed by recruitment and completion rate, while safety was assessed by the total number of adverse events. Treatment credibility and expectancy was assessed with the Credibility Expectancy Questionnaire. Mixed-measure analysis of variance were used for statistical analysis (P ≤ .05). RESULTS Recruitment was completed in 5 months with 100% completion rate and no adverse events. There was no difference in treatment credibility between groups (NMES = 23.7 [2.3], sham = 21.7 [3.4], P = .12); however, the NMES group demonstrated a greater expectancy score (NMES = 20.0 [3.8], sham = 15.9 [5.1], P = .045). CONCLUSION Resistance training with NMES superimposed to the GMed is a feasible and safe intervention that resulted in greater expectance of success. Clinicians may consider superimposing NMES to the gluteal muscles when addressing muscle weakness in individuals with dynamic knee valgus.
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Gluteal Central Activation in Females With Patellofemoral Pain: A Preliminary Study. J Sport Rehabil 2021; 31:676-683. [PMID: 34883467 DOI: 10.1123/jsr.2021-0093] [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: 03/16/2021] [Revised: 09/14/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Lesser hip muscle strength is commonly observed in females with patellofemoral pain (PFP) compared with females without PFP and is associated with poor subjective function and single-leg squat (SLS) biomechanics. Hip muscle weakness is theorized to be related to PFP, suggesting centrally mediated muscle inhibition may influence the observed weakness. The central activation ratio (CAR) is a common metric used to quantify muscle inhibition via burst superimposition. However, gluteal inhibition has yet to be evaluated using this approach in females with PFP. The study objectives are to (1) describe gluteal activation in the context of subjective function, hip strength, and squatting biomechanics and (2) examine the relationship of gluteal activation with subjective function and squatting biomechanics in females with PFP. DESIGN Cross-sectional. METHODS Seven females with PFP (age = 22.8 [3.6] y; mass = 69.4 [18.0] kg; height = 1.67 [0.05] m, duration of pain = 6-96 mo) completed this study. Subjective function was assessed with the Anterior Knee Pain Scale, while fear-avoidance beliefs were assessed with the Fear-Avoidance Belief Questionnaire physical activity and work subscales. Biomechanical function was assessed with peak hip and knee angles and moments in the sagittal and frontal planes during SLS. Gluteus medius (GMed) and gluteus maximus (GMax) activation were assessed with the CAR. Descriptive statistics were calculated, and relationships between variables were assessed with Spearman rho correlations. RESULTS The CAR of GMed and GMax was 90.5% (8.1%) and 84.0% (6.3%), respectively. Lesser GMed CAR was strongly associated with greater hip adduction during SLS (ρ = -.775, P = .02) and greater fear-avoidance beliefs-physical activity subscale (ρ = -.764, P = .018). CONCLUSION We found a wide range in GMed and GMax activation across females with PFP. Lesser GMed activation was associated with greater hip adduction during SLS and fear of physical activity, suggesting that gluteal inhibition should be assessed in patients with PFP.
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Van Cant J, Declève P, Garnier A, Roy JS. Influence of symptom frequency and severity on hip abductor strength and endurance in individuals with patellofemoral pain. Phys Ther Sport 2021; 49:83-89. [PMID: 33631707 DOI: 10.1016/j.ptsp.2021.02.001] [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: 11/26/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare clinical measures of hip abductor strength and endurance of individuals with patellofemoral pain with more severe symptoms to those with less severe symptoms. DESIGN Cross-sectional. SETTINGS Laboratory. PARTICIPANTS Sixty participants with patellofemoral pain were divided three times into 2 groups according to three symptomatology criteria: functional capacity, pain frequency and pain severity. MAIN OUTCOME MEASURES Isometric strength evaluated using a hand-held dynamometer, endurance using maximum number of repetitions and maximum holding time, functional capacity using the Anterior Knee Pain Scale, pain frequency using a 2-category scale ("Less frequent" = 1-2 times a week; "More frequent" = >3 times a week) and pain severity using Numeric Pain Rating Scales. RESULTS Participants with more frequent symptoms and with more severe pain were significantly weaker (10%, p = 0.04 and 16%, p = 0.001, respectively), and had less isometric (17%, p = 0.02 and 24%, p = 0.002, respectively) and dynamic (13%, p = 0.02 and 23%, p = 0.007, respectively) endurance compared to those with less pronounced symptoms. CONCLUSION Our study highlighted that hip abductor strength and endurance deficits are more pronounced in individuals with more severe and frequent pain.
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Affiliation(s)
- J Van Cant
- Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Department of Physical Therapy, Institut Parnasse-ISEI, Avenue Mounier 84, 1200, Brussels, Belgium.
| | - P Declève
- Department of Physical Therapy, Institut Parnasse-ISEI, Avenue Mounier 84, 1200, Brussels, Belgium
| | - A Garnier
- Department of Physical Therapy, Institut Parnasse-ISEI, Avenue Mounier 84, 1200, Brussels, Belgium
| | - J S Roy
- Département de réadaptation, Faculté de médecine, Université Laval, Quebec City, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
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Rodrigues R, Souza da Rocha E, Klein KD, Sonda FC, Pompeo KD, Frasson VB, Vaz MA. Proximal and distal muscle thickness is different in women with patellofemoral pain but is not associated with knee frontal plane projection angle. J Bodyw Mov Ther 2020; 25:205-211. [PMID: 33714497 DOI: 10.1016/j.jbmt.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to compare proximal and distal muscle thickness between patellofemoral pain (PFP) and asymptomatic women (CG) and to verify the possible association between morphology and lower limb alignment during single leg-squat. METHODS Thirty women (PFP, n = 15 and CG, n = 15) performed the following evaluations: (i) muscle thickness of external oblique (EO), gluteus medius (GMed), tensor fascia latae (TFL), peroneus (PER) and tibialis anterior (TA); (ii) knee frontal plane projection angle (FPPA) during single-leg squat. RESULTS Compared with the CG, PFP showed: (1) smaller GMed (-10.02%; p = 0.04; effect size = 0.82), greater TFL (+18.44%; p = 0.02; effect size = 0.92) and PER (+14.23%; p = 0.02; effect size = 0.87) muscle thickness and greater knee FPPA during single-leg squat (+31.8%; p = 0.04; effect size = 1.12). No differences were observed in EO (+7.17%; p = 0.37; effect size = 0.34) and TA (-1.35%; p = 0.81; effect size = 0.12) muscle thickness. Additionally, we failed to observe significant associations between muscle morphology and knee FPPA in both groups. CONCLUSION PFP patients showed alterations in proximal and distal muscle thickness, despite the lack of association with poor lower limb alignment. Prospective studies are necessary to determine if differences in muscle morphology are the cause or the consequence of PFP and to confirm the absence of relationship with lower limb alignment.
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Affiliation(s)
- Rodrigo Rodrigues
- Exercise Physiology and Physical Assessment Laboratory, Serra Gaucha University Center, Caxias do Sul, RS, Brazil; Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Emmanuel Souza da Rocha
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Kelli Daiana Klein
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Francesca Chaida Sonda
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Klauber Dalcero Pompeo
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marco Aurélio Vaz
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Physique Physiotherapy Centre, Porto Alegre, RS, Brazil
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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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Kingston B, Murray A, Norte GE, Glaviano NR. Validity and reliability of 2-dimensional trunk, hip, and knee frontal plane kinematics during single-leg squat, drop jump, and single-leg hop in females with patellofemoral pain. Phys Ther Sport 2020; 45:181-187. [PMID: 32823213 DOI: 10.1016/j.ptsp.2020.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate validity and between-session reliability of frontal plane trunk, hip, and knee kinematics during three functional tasks in females with patellofemoral pain (PFP). DESIGN Observational. SETTING Research Laboratory. PARTICIPANTS 20 females with PFP (22.7 ± 3.2 years, 69.9 ± 9.2 kg, 167.7 ± 9.6 cm). MAIN OUTCOME MEASURES Trunk, hip, and knee frontal plane peak angles during the single leg squat (SLS), drop vertical jump (DVJ), and single leg hop (SLH) kinematics were evaluated using 2-dimensional (2D) and 3-dimensional (3D) motion capture. Participants returned to the lab one week later and competed a second 2D analysis of the functional tasks. Concurrent validity was assessed by evaluating relationship between 2D and 3D frontal plane kinematics with Pearson correlations. Between-session reliability was assessed by evaluating 2D kinematics with intraclass correlation coefficients by a single assessor. RESULTS Moderate to strong correlations (r = 0.55-0.76, p < .05) were found for frontal plane hip kinematics during all three tasks and the trunk during the SLH. Frontal plane kinematics demonstrated good to excellent test-retest reliability for each of the three tasks, (ICC (2,1) = 0.70-0.90). CONCLUSION 2D hip joint angles during the three functional tasks were the only valid frontal plane angles. Trunk, hip, and knee 2D frontal plane kinematics ranged between good-excellent reliability.
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Affiliation(s)
- Brianna Kingston
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA
| | - Amanda Murray
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA
| | - Neal R Glaviano
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
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Lucas KCH, Jacobs C, Lattermann C, Noehren B. Gait deviations and muscle strength deficits in subjects with patellar instability. Knee 2020; 27:1285-1290. [PMID: 32591208 DOI: 10.1016/j.knee.2020.05.008] [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] [Received: 09/24/2019] [Revised: 04/24/2020] [Accepted: 05/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormal tracking of the patella is a hallmark sign of patellar instability (PI). Gait deviations and strength deficits may exacerbate abnormal tracking. The identification of modifiable gait deviations and strength deficits can aid in developing more effective management strategies for individuals with PI. The purpose of this study was to identify modifiable gait and strength deficits in subjects with PI. METHODS 32 subjects (16 PI, 16 controls, 3 males/13 females in each group, 21.1 years old, 23.5 BMI), performed an instrumented gait analysis while walking at 1.5 m per second. Subjects' peak hip adduction angles, external rotation angles, hip abduction moments, knee flexion angles, knee adduction angles, and knee extensor moments were measured during walking. Hip abduction, hip external rotation, and knee extension strength were assessed with a handheld dynamometer. RESULTS Individuals with PI displayed significantly lower peak knee adduction angles (1.8 ± 2.8° PI, 5.5 ± 4.5° control, p < .01) and peak hip abduction moments (0.2 ± 0.1 Nm/kg*m PI, 0.4 ± 0.1 Nm/kg*m control, p < .01). Subjects with PI were weaker in knee extension strength (14.5 ± 4.1 kg/m PI, 23.8 ± 7.2 kg/m control, p < .01), hip abduction strength (12.1 ± 2.0 kg/m PI, 17.8 ± 4.0 kg/m control, p < .01), and hip external rotation strength (5.5 ± 1.9 kg/m PI, 7.1 ± 1.3 kg/m control, p = .01). CONCLUSION Subjects with patellar instability have smaller joint moments and a more valgus knee position while walking. Coupled with deficits in muscle strength, this likely contributes to subjective reports of chronic patellar instability. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kathryn C Hickey Lucas
- Department of Physical Therapy, University of Kentucky, Lexington, KY, United States of America
| | - Cale Jacobs
- Department of Physical Therapy, University of Kentucky, Lexington, KY, United States of America; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Christian Lattermann
- Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, United States of America
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, KY, United States of America; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, United States of America.
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