Current concepts in the management of patellofemoral pain — The role of alignment

Stephen, Joanna M.; Ephgrave, Caroline; Ball, Simon; Church, Sam

doi:10.1016/j.knee.2019.12.006

Cited by 9 publications

(5 citation statements)

References 44 publications

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“…During movements such as squatting, individuals with PFP have demonstrated greater knee abduction excursion than controls (Nakagawa et al, 2012;, and improvements in frontal and transverse plane pelvis and hip control have been linked to a reduction in pain (Mascal, Landel & Powers, 2003). Therefore, physiotherapists use visual assessment of dynamic alignment in their clinical decision-making process when considering prescription of exercises (Stephen et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Visual assessment of dynamic knee joint alignment in patients with patellofemoral pain: an agreement study

Hansen

Lundgaard-Nielsen

Henriksen

2021

PeerJ

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Background Assessment of knee kinematics plays an important role in the clinical examination of patients with patellofemoral pain (PFP). There is evidence that visual assessments are reliable in healthy subjects, but there is a lack of evidence in injured populations. The purpose of this study was to examine the intra- and interrater agreement in the visual assessment of dynamic knee joint alignment in patients with PFP. Methods The study was a cross-sectional agreement study. Sixty participants (42 females) were included. We assessed the intra- and interrater agreement of two functional tests: The single leg squat (SLS) and the forward lunge (FL). One investigator scored the movement according to preset criteria while video recording the movement for retest. Moreover, the performance was scored by another investigator using the video recording. Agreement was assessed using weighted kappa statistics. Results The intrarater agreement ranged from moderate to good (Kappa 0.58 (FL) to 0.70 (SLS)) whereas the interrater agreement ranged from fair to moderate (Kappa 0.22 (SLS) to 0.50 (FL)). Conclusion The agreement within raters was better than between raters, which suggests that assessments should preferably be performed by the same tester in research and in a clinical setting, e.g., to evaluate any treatment effect. We promote FL as a reliable clinical tool for evaluating dynamic knee alignment, since it shows equally good intra- and interrater agreement, and it is an inexpensive and easy method to use.

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Section: Introductionmentioning

confidence: 99%

Visual assessment of dynamic knee joint alignment in patients with patellofemoral pain: an agreement study

Hansen

Lundgaard-Nielsen

Henriksen

2021

PeerJ

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“…Such mechanical disturbance possibly aggravates symptoms and pain. They added that correction for excessive lumbar lordosis during strengthening exercises of hip abductors would eventually lead to a reduction of excessive hip internal rotation, less FPPA, greater mechanical advantage and less effort required by the gluteus medius muscle (Stephen et al, 2020). In addition, others reported that during the running action there is increasing in anterior pelvic tilt and lumbar lordosis due to tightness of the hip flexor musculature which reduces hip extension flexibility (Schache, Blanch & Murphy, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…More recently, it was found that patients with PFPS, hip abductor weakness and lumbar hyperlordosis, lead to a change in the mechanical advantage of hip abductor into internal rotator that aggravates symptoms of patellofemoral pain syndrome, so we assumed that may increase the frontal plane projection angle (Stephen, Ephgrave, Ball & Church, 2020).…”

Section: Introductionmentioning

confidence: 99%

Is spinopelvic sagittal alignment correlated with pain level, functional disability and frontal plane projection angle in women with patellofemoral pain syndrome? A cross-sectional study

ElMelhat¹,

Youssef²,

Abbas³

et al. 2022

sportk

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There is a growing interest concerning the understanding of measurements of spinal and leg alignment in patients with patellofemoral pain syndrome (PFPS). However, evaluating spinopelvic alignment in the sagittal plane with pain level, functional disability and frontal plane projection angle (FPPA) in PFPS has not been adequately addressed. The aim of the study was to identify the correlation of spinopelvic parameters with pain level, functional disability and frontal plane projection angle in women with PFPS. This was a cross–sectional study involving sixty female patients diagnosed with PEPS, with a mean age of 32±6.47. The measurements used in the study included: radiographic parameters (X-Ray), the numeric pain rating scale (NPRS), the Arabic anterior knee pain scale (AAKP/Kujala) and the 2D-FPPA. Spearman correlation analysis was conducted to evaluate the relationship between these parameters. The results of our study demonstrated a strong positive correlation of lumbar lordosis (LL) with pain level and FPPA (r=0.825, r=0.812, p=0.0001). Also, a strong positive correlation of sacral slope (SS) with pain level (r = 0.0.820) and FPPA (r= 0.783). Pelvic tilt (PT) showed a moderate correlation with pain level (r = 0.0.614) and FPPA (r= 0.605), while a weak negative correlation was found between LL, SS and PT and functional disability score (r=-0.397, r=-0.385 and, r=-0.215 p=0.002). It was concluded that LL, SS and PT were significantly related to the pain level, functional disability and frontal plane projection angle in women with PFPS. These spinal alignments should be considered in clinical evaluation of knee-related disorders associated with PFPS.

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“…Inevitably, any deviation in pelvic position, regardless of the plane in which it occurs, can potentially compromise sports performance, and increase the likelihood of injury [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Anterior pelvic tilt decreases both the upper and lower parts of rectus abdominis EMG activity while over-activating the rectus femoris, as opposed to the neutrally positioned or posteriorly tilted pelvis [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…This muscular imbalance, combined with imbalances between other antagonistic muscle groups of the core (e.g., trunk and hip extensors), may compromise the natural lumbar lordotic curve, promoting an unbalanced distribution of forces both locally and globally and the development of musculoskeletal pain syndromes (e.g., low back and sacroiliac joint pain) [ 16 , 17 , 18 , 19 ]. Excessive anterior tilt has also been associated with an increased likelihood of hamstring [ 20 ], anterior cruciate ligament injuries [ 21 ], and patellofemoral pain [ 22 ]. This is probably not unjustified if we consider the resultant misalignment in the lower extremity joints that occurs with excessive anterior pelvic tilt, such as genu valgus/femoral internal rotation/ankle inversion [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring 3D Pelvis Orientation: A Cross-Sectional Study in Athletes Engaged in Activities with and without Impact Loading and Non-Athletes

Glakousakis,

Kalatzis,

Mandalidis

2024

JFMK

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Female athletes subjected to various types of impact loading, especially over a long period of time, may experience changes in their pelvic orientation, which may affect their sport performance and increase the likelihood of injury. The aim of the present study was to determine whether female athletes involved in high-impact loading sports (HILS), odd-impact loading sports (OILS), and repetitive non-impact loading sports (NILS) demonstrate changes in pelvis orientation compared to non-athletes (NATH). Pelvic orientation was determined using Euler/Cardan angles, calculated from the coordinates of the right, and left anterior superior iliac spines and pubic symphysis via a novel method. Two-way ANOVA tests showed significant differences between groups for pelvis position in the frontal plane (p < 0.05), with HILS and OILS demonstrating greater pelvic obliquity compared to NILS athletes and NATH. Significant main effects were also obtained for directions within the sagittal plane (p < 0.001). Significant within-group differences were observed in sagittal pelvic position among female athletes engaged in NILS (p < 0.01) and non-athletes (NATH) (p < 0.05), with a greater anterior pelvic tilt compared to posterior. Our findings suggest that pelvis orientation in female athletes across sports is influenced by sport-specific impact loads, potentially affecting performance and injury occurrence.

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Current concepts in the management of patellofemoral pain — The role of alignment

Cited by 9 publications

References 44 publications

Visual assessment of dynamic knee joint alignment in patients with patellofemoral pain: an agreement study

Visual assessment of dynamic knee joint alignment in patients with patellofemoral pain: an agreement study

Is spinopelvic sagittal alignment correlated with pain level, functional disability and frontal plane projection angle in women with patellofemoral pain syndrome? A cross-sectional study

Exploring 3D Pelvis Orientation: A Cross-Sectional Study in Athletes Engaged in Activities with and without Impact Loading and Non-Athletes

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