Effects of neuromuscular training on pain intensity and self-reported functionality for patellofemoral pain syndrome in runners: study protocol for a randomized controlled clinical trial

Comparative analysis of isokinetic parameters in individuals with and without chondromalacia patellae

INTRODUCTION

Chondromalacia patella (CMP) is characterizsed by cartilage degeneration, affects young adults, more women (2:1) and is responsible for 75% of knee pain complaints in the active population. The etiology is multifactorial and may be related to extrinsic factors (trauma and burden) and intrinsic factors (patellar malalignment and quadriceps weakness). Isokinetic dynamometry (ID) can aid in the detection of the causal factors of knee pain related to CMP.

OBJECTIVES

To evaluate and compare the parameters of the ID of individuals with and without CMP and correlate them with the clinical aspects of individuals with CMP.

METHODS

This is a retrospective study that analyzed ID of the knee flexors and extensors, performed between 2013 and 2019 in the isokinetic dynamometry sector of the hospital. Six hundred ninety dynamometers tests were included, both sexes, aged between 14 and 59 years, divided into chondromalacia group (342) tests and control group (348) tests. All performed ID in concentric mode for knee extension and flexion, with five maximum repetitions at an angular speed of 60°/s and 180°/s and 20 repetitions at an angular speed of 300°/s, with 30-s intervals between each. After completing the test, the patient points out a number from 0 to 10 on the visual analog scale, regarding the presence and intensity of pain during and after the isokinetic assessment.

RESULTS

The groups had similar distribution from sex (P ​= ​0.071); age (P ​= ​0.99) but were different about pain (P ​< ​0.001). CMP had greater levels of pain. In most of the muscle parameters of the extensors and flexors at 60°/s were lower in the CMP group (P ​< ​0.001).

CONCLUSION

The main predictor of chondromalacia is pain. The greater coefficient of variability and time to reach peak torque on the involved side, the average power and morphology of the extensor curve can also be predictors of chondromalacia.

LEVEL OF EVIDENCE

III.

Effectiveness of self-management programmes for athletes with patellofemoral pain syndrome: A systematic review

Background

Patellofemoral pain syndrome (PFPS) is a common condition that can severely hinder an athlete's ability to perform and compete at their full potential and overall well-being. The emergence of self-management programmes presents a potential treatment avenue for athletes with PFPS. Self-management programmes aim to empower patients through education, symptom monitoring, tailored exercises, and gradual activity progression while respecting pain thresholds. Despite their potential benefits, limited data evaluates the effectiveness of self-management programmes specifically tailored for athletes with PFPS.

Objectives

To assess the effectiveness of self-management programmes in improving pain and functional ability among athletes with PFPS.

Methods

A systematic search was conducted across PubMed/MEDLINE, Cochrane Library, CINAHL, and PsycINFO databases. Randomised and non-randomised controlled trials comparing self-management interventions to other treatments or control groups for improving pain and functional ability among athletes with patellofemoral pain syndrome were included. Studies including athletes with PFPS (defined as pain persisting for ≥12 weeks) were eligible. Four reviewers independently extracted data and assessed quality using the Physiotherapy Evidence Database (PEDro) scale.

Results

Three trials involving 139 participants met the eligibility criteria. Identified self-management programmes comprised exercises, mindfulness training, and educational programmes tailored to athletes. Two of the eligible studies identified found that exercise consisting of the combination of mindfulness and/or dry needling reported an enhanced recovery rate in the studied population with regards to PFPS. The other study reported no added benefit whether exercise or education was used as a modality for the self-management of PFPS.

Conclusion

While some studies showed promising results for self-management programmes involving exercises and mindfulness in managing patellofemoral pain syndrome among athletes, the overall evidence could be more extensive and consistent. High-quality controlled trials with consistent methodology and athletic populations are needed to identify the most effective self-management approaches for patellofemoral pain syndrome in athletes.

Clinical value of questionnaires & physical tests for patellofemoral pain: Validity, reliability and predictive capacity

OBJECTIVES

To determine the most appropriate method of functional assessment for "patellofemoral pain" (PFP)/"chondromalacia patella" for its diagnostic value, (validity, reliability, sensitivity, specificity, predictive value and clinical applicability); to outline initial interpretations of the questionnaires and their appropriateness, through the cut-off points determined in their scores based on physical test and Magnetic Resonance Imaging (MRI); to establish which methods should be used in conjunction with each other to obtain clinical diagnoses that are robust effective and efficient.

METHODS

(1)Intra- and inter-observer reliability and of the relationship among PFP questionnaires/physical tests validated. (2)Predictive capacity of the questionnaires. Subject: 113 knees with PFP, assessed using "Knee-injury-and-Osteoarthritis Outcome-Score-for-Patellofemoral-pain-and-osteoarthritis" (KOOS-PF), "Kujala-Patellofemoral-Score" (KPS), "Victorian-Institute-of-Sports-Assessment-for-Patellar-tendons-questionnaire" (VISA-P), and the physical tests: "patellar-palpation", "patellar-tilt", "patellar-apprehension", "Clarke" and "squat".

RESULTS

Questionnaires correlations themselves was 0.78

CONCLUSIONS

KOOS-PF, KPS and VISA-P demonstrated their diagnostic value in PFP/chondromalacia (validity, reliability, sensitivity, specificity, predictive value and clinical applicability). KOOS-PF was the most versatile, and the most appropriate in mild cases and for early detection and prevention. Squat was the best due to its reliability and clinical relationship with the questionnaires, which predicted it correctly. The functional assessment tools discussed should be applied by combining them with each other.

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MESH Headings

• Humans
• Patellofemoral Pain Syndrome
• Reproducibility of Results
• Cartilage Diseases
• Osteoarthritis
• Surveys and Questionnaires
• Patellofemoral Joint

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Affiliation(s)

Gema Chamorro-Moriana Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain Research Group “Area of Physiotherapy CTS305”, Spain
Fernando Espuny-Ruiz Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
Carmen Ridao-Fernández Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain Research Group “Area of Physiotherapy CTS305”, Spain
Eleonora Magni Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain

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The effect of high-intensity laser therapy on pain and lower extremity function in patellofemoral pain syndrome: a single-blind randomized controlled trial

Patellofemoral pain syndrome (PFPS) is a set of symptoms that negatively affect the daily life activities of the individual, leading to functional disability and significant loss of labor, especially in young adults. PFPS is usually due to weakness of the vastus medialis obliquus (VMO) resulting in abnormal patellar tracking and pain. Our study aims to compare the efficacy of high-intensity laser therapy (HILT) on pain and lower extremity function in the treatment of PFPS with different electrophysical agents (EPAs). The study was designed as a single-blind randomized controlled trial. Forty-five people with PFPS (aged 25-45 years) were included in the study. The patients were randomly divided into three groups and a total of ten sessions of treatment were administered to all three groups for 2 weeks, 5 days a week. High-intensity laser (HILT) and exercise program were applied to group 1. Ultrasound (US), transcutaneous electrical nerve stimulation (TENS), and exercise program were applied to group 2. In group 3, US, interferential current (IFC), and exercise program were applied. Both groups underwent three evaluations: pre-treatment, post-treatment, and 12 weeks after treatment. Outcome measures included the visual analog scale for pain severity (VAS), knee flexion range of motion (FROM), Q angle, pain threshold, muscle strength of quadriceps and hamstring, Kujala patellofemoral scoring, lower extremity functional scale (LEFS), and Timed Up and Go Test (TUG). The ANOVA was used for comparing the data of the groups, and two-way repeated measure ANOVA was used to compare at the pre-post and post-intervention 3rd month. The LSD and Bonferroni post hoc tests were also used to identify the between-group differences. Groups 2 and 3 were statistically effective in pain and functionality (p < 0.05). Group 1 was found to be statistically more effective than other groups in reducing pain (95% confidence interval (CI), 0.000/0.000; p = 0.000), increasing knee flexion angle (95% CI, 127.524/135.809; p = 0.000), and increasing lower extremity function (95% CI, 75.970/79.362; p = 0.000). This study indicated that high-intensity laser therapy was found to be a more effective method in the treatment of patellofemoral pain syndrome after 3 months of follow-up compared to US-TENS combination and US-interferential current combination treatments. Also, HILT can be used as an effective method in combination with an appropriate exercise program including vastus medialis strengthening to reduce pain and increase functionality in the patients with PFPS.

Efficacy of Isometric Exercises and Somatosensory Training for Pain, Proprioception, and Balance in Runners with Patellofemoral Pain Syndrome

Background A significant cause of knee pain is patellofemoral pain syndrome (PFPS). Young adults are the most common population to be impacted, and this condition appears to affect both sexes. Patellofemoral joint (PFJ) compression, which is felt around the patella during any physical or athletic activity, usually causes patients to experience pain in the anterior part of the knee. Physiotherapy is essential for patients suffering from this illness, as it can improve their everyday activities and ability to return to their sport. Methodology The study's main goal was to evaluate the effectiveness of somatosensory training and isometric exercises for pain, proprioception, and balance in runners with PFPS. Before- and after-test approaches were used in the investigation. Eighty-five people made up the study, with the inclusion and exclusion criteria used to determine eligibility. Isometric exercises and somatosensory training were given to every individual; the group was not randomly assigned. The patient's diagnosis was made using the patellar grind test. Participants received 30-45 minutes of isometric exercises and 15 minutes of somatosensory training every four days. The visual analog scale, joint position sense test, and Y-balance test were taken as outcome measures to measure PFPS before and after the intervention. Results The result revealed significant (p=0.0001) improvement in PFPS following the intervention. Both the isometric exercises and somatosensory training were found to be significant in reducing the intensity of the pain and improving the proprioception and balance of the individuals. Conclusion Both treatment approaches were beneficial in lowering pain in the joints, developing balance, and helping the patient perceive the position of the joint. Individuals can use both therapy methods to improve their running abilities, and they should become ingrained in daily practice.

Effects of adding neuromuscular electrical stimulation to functional training on muscle recruitment, pain reduction, and knee joint function in patellofemoral pain syndrome patients

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.