Patellofemoral pain syndrome (PFPS) is one of the most prevalent musculoskeletal conditions of the lower limb. The muscle imbalance between the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles is one of the main factors leading to the development of PFPS. The disparity in research and the necessity to add to the existing literature base led to the development of this study. The aim of this study was to investigate the effect of 2 closed kinetic chain exercises and 1 open kinetic chain exercise on VMO and VL muscle activity. Twenty-two healthy asymptomatic individuals participated in this study. The surface electromyography (EMG) of VMO and VL was measured and used to calculate the VMO:VL ratio during 3 different quadriceps-strengthening exercises (a double leg squat with isometric hip adduction exercise, an open kinetic chain knee extension exercise, and a lunge exercise). The double leg squat with isometric hip adduction exercise was shown to produce a significantly greater VMO:VL ratio (1.14:1) than the other 2 exercises (p = 0.015 and p = 0.005). The open kinetic chain knee extension exercises produced significantly greater activation of VL than the lunge exercise (p = 0.001 and p = 0.036). The lunge exercise produced the VMO:VL ratio (1.18:1) closest to the idealized ratio of 1:1. Potential clinical recommendations can be made proposing the lunge exercise as a key tool in early rehabilitation when restoring preferential VMO:VL ratio is essential. The double leg squat with isometric hip adduction exercise would be useful in maintaining correct patella tracking and selectively strengthening VMO.

CRD42017070227.

Abstract Background and aims Patellofemoral pain (PFP) is a common knee condition causing pain around or behind the kneecap which is exacerbated by certain activities. Traditionally it has been viewed as a self-limiting condition. Recent research proves this is not the case and the evidence for poor long-term outcomes is growing. Whilst the evidence base for PFP treatment and the understanding of its aetiology is improving, it remains a complex and difficult to treat condition. In many physical conditions, it has been shown that anxiety and depression negatively affect both their management and duration. It is unclear how prevalent anxiety and depression are in PFP. This study aimed to identify the prevalence of anxiety and depression in people living with PFP in the UK. Methods In order to investigate this, a cross-sectional online survey was undertaken. Four hundred participants with self-reported symptoms of PFP were recruited through a tailored social media campaign, using modified snowball sampling. Eligibility criteria were (i) aged between 18 and 44, (ii) self-reported symptoms of PFP (using accepted criteria) (iii) resident in the UK. Exclusion criteria were previous history of patella dislocation or previous surgery to affected knee. The survey recorded demographic information, previous treatment for both PFP and anxiety and depression, the Hospital Anxiety and Depression Scale and the Anterior Knee Pain Scale. Ethical approval was gained from a University of Plymouth Ethics Committee. Results Half (49.5%; n=198) of respondents were classified as experiencing anxiety and 20.8% (n=83) as experiencing depression. The levels of anxiety and depression identified in this study are higher than those found in the general population (5.9–7.8% and 3.3–7.8%, respectively). This mirrors results which have been reported in other studies into PFP in different settings and with other musculoskeletal conditions, such as osteoarthritis and contracted shoulder. Conclusions Anxiety and depression are more common in people living with PFP than in the general population. These findings support the need for greater research into the effects of psychological factors, such as anxiety and depression, in PFP. A key area of future research will be to determine whether these psychological factors affect treatment outcomes in people living with PFP. Implications This is the first study to investigate the prevalence of anxiety and depression in people living with patellofemoral pain in the UK. This study shows that anxiety and depression are very common in people living with patellofemoral pain. The need for further work into the effects of psychological factors in patellofemoral pain is indicated.

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