Lower Extremity Kinetics and Kinematics in Runners with Patellofemoral Pain: A Retrospective Case–Control Study Using Musculoskeletal Simulation (original) (raw)
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Journal of Athletic Training
Context: Patellofemoral pain (PFP) is typically exacerbated by repetitive activities that load the patellofemoral joint, such as running. Understanding the mediating effects of changes in pain in individuals with PFP might inform injury progression, rehabilitation, or both. Objective: To investigate the effects of changing pain on muscular strength and running biomechanics in those with PFP. Design: Crossover study. Setting: University research laboratory. Patients or Other Participants: Seventeen participants (10 men, 7 women) with PFP. Intervention(s): Each participant completed knee pain-reducing and pain-inducing protocols in random order. The pain-reducing protocol consisted of 15 minutes of transcutaneous electric nerve stimulation (TENS) around the patella. The pain-inducing protocol was sets of 20 repeated single-legged squats (RSLS). Participants completed RSLS sets until either their pain was within at least 1 cm of their pain during an exhaustive run or they reached...
The American Journal of Sports Medicine
Background: Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP. Purpose: To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP. Study Design: Case series; Level of evidence, 4. Methods: Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining cons...
Objectives: To explore feasibility of recruitment and retention of runners with patellofemoral pain (PFP), before delivering a step rate intervention. Design: Feasibility study. Setting: Human performance laboratory. Participants: A mixed-sex sample of runners with PFP (n ¼ 11). Main outcome measures: Average/worst pain and the Kujala Scale were recorded pre/post intervention, alongside lower limb kinematics and surface electromyography (sEMG), sampled during a 3 KM treadmill run. Results: Recruitment and retention of a mixed-sex cohort was successful, losing one participant to public healthcare and with kinematic and sEMG data lost from single participants only. Clinically meaningful reductions in average (MD ¼ 2.1, d ¼ 1.7) and worst pain (MD ¼ 3.9, d ¼ 2.0) were observed. Reductions in both peak knee flexion (MD ¼ 3.7 , d ¼ 0.78) and peak hip internal rotation (MD ¼ 5.1 , d ¼ 0.96) were observed, which may provide some mechanistic explanation for the identified effects. An increase in both mean amplitude (d ¼ 0.53) and integral (d ¼ 0.58) were observed for the Vastus Medialis Obliqus (VMO) muscle only, of questionable clinical relevance. Conclusions: Recruitment and retention of a mixed sex PFP cohort to a step rate intervention involving detailed biomechanical measures is feasible. There are indications of both likely efficacy and associated mechanisms. Future studies comparing the efficacy of different running retraining approaches are warranted.
Effect of patellofemoral pain on strength and mechanics following an exhaustive run
Purpose: To investigate the effects of an exhaustive run on trunk and lower extremity strength and mechanics in patients with and without patellofemoral pain (PFP), we hypothesized that strength would decrease and mechanics would change after the exhaustive run. Methods: Nineteen subjects with PFP and 19 controls participated (10 men and 9 women per group). Lower extremity and trunk mechanics during running, body mass-normalized strength, and pain assessments before and after an exhaustive run were quantified. A repeated-measures ANOVA was used to assess group differences and exhaustion-related changes (P G 0.05), with t-test post hoc analyses performed when significant interactions were identified (P G 0.0125). Results: Pain significantly increased with the exhaustive run in the PFP group (P = 0.021). Hip strength was reduced after the exhaustive run, more so in those with PFP (abduction: before = 0.384 T 0.08, after = 0.314 T 0.08, P G 0.001; external rotation: before = 0.113 T 0.02, after = 0.090 T 0.02, P G 0.001). Persons with PFP also demonstrated increased knee flexion (before = 41.6-T 5.5-, after = 46.9-T 7.5-, P G 0.001), hip flexion (before = 30.4-T 6.8-, after = 42.5-T 9.7-, P G 0.001), and anterior pelvic tilt (before = 7.2-T 5.1-, after = 13.3-T 6.7-, P = 0.001) after the exhaustive run compared to controls. Trunk flexion increased in both PFP (before = 13.09-T 6.2-, after = 16.31-T 5.3-, P G 0.001) and control (before = 1393-T 4.7-, after = 15.99-T 5.9-, P G 0.001) groups. Hip extension (before = j2.09 T 0.49 NImIkg j1 , after = j2.49 T 0.54 NImIkg j1 , P = 0.002) moments increased only in subjects with PFP. Conclusions: Exhaustive running results in reduced hip strength in subjects with PFP; however, this did not result in changes to hip internal rotation or adduction kinematics. Kinematic and kinetic changes after the exhaustive run are more indicative of compensatory changes to reduce pain. Increasing trunk flexion during running might provide pain relief during running; however, reducing anterior pelvic tilt may also warrant attention during treatment.
Clinics and Practice
Dynamic knee valgus (DKV) is a frontal plane knee kinematic alteration that has been associated with patellofemoral pain (PFP) in female runners. DKV is commonly assessed in clinical practice by measuring frontal plane knee projection angle (FPPA) during squat tests. However, it remains unclear whether the DKV observed in these tests is similar to or correlates with that observed during running in female runners. The aims of this cross-sectional study were to correlate and compare DKV, by measuring FPPA values, in a lateral step-down (LSD) squat test and running in female runners with and without PFP. A two-dimensional (2D) video analysis of the LSD test and running was carried out for 21 asymptomatic female runners and 17 PFP female runners in order to determine FPPA values. A Pearson correlation test and a factorial ANOVA with Bonferroni post hoc correction were used for statistical analysis. The FPPAs recorded in the LSD test were significantly higher than those recorded during r...
Simplified methods to measure patellar anatomical and biomechanical variables in state level runners
2019
The endeavour of the present study was to establish simplified methods to measure Patellar anatomical and biomechanical variables. 100 state level runners (50 males and 50 females) of age group 18-27 years were selected purposively from various sports academies of Odisha for this study. All the variables were recorded thrice and median value considered as criterion to eradicate error. Selected variables such as patella length, patella breadth, patellar tendon length, patella to patellar tendon ratio, patellar medial to lateral glide, patellar lateral to medial glide, patellar cephal to caudal glide and patellar caudal to cephal glide were measured on each subject following standard techniques. The Results showed highly significant differences (p<0.001) in right patella length, right patella breadth, right patellar tendon length, and statistically significant difference (p<0.05) was seen in right patellar cephal to caudal glide on the right patellar side. However, in the left p...
Function and Disability Journal
Background and Objectives: Patellofemoral Arthropathy (PFA) is the most common knee disorder in runners and various factors can lead to the development of its symptoms. It has been proposed that frontal plane motions of the hip and knee can raise the dynamic quadriceps angle during functional tasks. The aim of this study was to evaluate frontal plane acting hip muscle flexibility and strength differences in male sprinter runners with unilateral PFA. Methods: A total of 38 male runners complaining of peripatellar pain or showing positive unilateral patellar grind test, assigned to the normal and sound legs, and 20 matched control groups were compared in this case-control study. Participants’ hip abductor and adductor muscles strength and their flexibility were evaluated through a hand-held dynamometer and 2D motion analysis tracker software. To measure the strength, participants were positioned side-lying position, performing abduction and adduction, while a dynamometer was placed on...