Effects of Anterior Knee Displacement During Squatting on Patellofemoral Joint Stress

Kernozek, Thomas W.; Gheidi, Naghmeh; Zellmer, Matthew; Hove, Jordan; Heinert, Becky; Torry, Michael R.

doi:10.1123/jsr.2016-0197

Cited by 24 publications

(26 citation statements)

References 42 publications

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“…For both types of verbal instruction (FoAin and FoAex), participants demonstrated a medium or large reduction in PFJFs and PFJS compared with baseline (based on the effect size statistic). These results supplement earlier findings, which indicated that knee loading was reduced when anterior motion of the knees relative to the toes was restricted via guidewires 16 or altered by manipulating foot position during squatting. 37 A benefit of relying on simple verbal instruction is that this approach can be easily incorporated by exercise professionals who already typically utilize verbal cues to guide exercise technique.…”

Section: Discussionsupporting

confidence: 89%

“…[13][14][15] A common belief is that allowing the knees to translate forward in excess during squat performance increases the forces and stress on the knee. Results reported by Kernozek et al 16 appear to support this common belief, as they found that PFJFs and PFJS were greater when young females performed bodyweight squats where their knees were required to move past their toes, compared with squats where their knees needed to remain behind their toes. Guidewires were used to direct/restrict knee motion during the squat trials for both conditions (ie, knees past toes and knees behind toes).…”

mentioning

confidence: 71%

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Verbal Instruction Reduces Patellofemoral Joint Loading During Bodyweight Squatting

Almonroeder¹,

Watkins²,

Widenhoefer³

2020

Journal of Sport Rehabilitation

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Context: The bodyweight squat exercise is a common component for treatment and prevention of patellofemoral pain; however, it can also place a high load on the patellofemoral joint. Restricting anterior motion of the knees relative to the toes during squatting appears to reduce patellofemoral loading. However, exercise professionals typically rely on verbal instructions to alter squat technique. Objective: To evaluate the influence of verbal instructions regarding squat technique on patellofemoral joint loading. Design: Cross-sectional study. Setting: Motion analysis laboratory. Participants: Eleven uninjured females. Intervention: Participants performed bodyweight squats before (baseline) and after receiving verbal instructions to limit anterior knee motion. Two different types of verbal instruction were used, one intended to promote an internal focus of attention and the other intended to promote an external focus of attention. Three-dimensional kinematics and kinetics were recorded using a multicamera system and force plate. Main Outcome Measures: Sagittal plane patellofemoral joint forces and stress were estimated using a musculoskeletal model. Results: Participants demonstrated a reduction in patellofemoral joint forces (35.4 vs 31.3 N/kg; P = .01) and stress (10.7 vs 9.2 mPa; P = .002) after receiving instructions promoting an internal focus of attention, compared with their baseline trials. Participants also demonstrated a reduction in patellofemoral joint forces (35.4 vs 32.3 N/kg; P = .03) and stress (10.7 vs 9.6 mPa; P = .04) after receiving instructions promoting an external focus of attention (vs baseline). However, there were no significant differences in patellofemoral forces (P = .84) or stress (P = .41) for trials performed with an internal versus external attentional focus. Conclusion: It appears that verbal instruction regarding knee position influences patellofemoral joint loading during squatting.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 71%

Verbal Instruction Reduces Patellofemoral Joint Loading During Bodyweight Squatting

Almonroeder¹,

Watkins²,

Widenhoefer³

2020

Journal of Sport Rehabilitation

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“…However, the PFJRF in this study increased to a larger extent than PF contact area, thereby resulting in greater PFJS. Despite a larger contact area, increased PFJS is typically observed with increased knee flexion during weight bearing activities [27]. Previous work has shown that altering foot strike pattern and also cadence may influence PFJS and PFJRF, respectively [8,16].…”

Section: Discussionmentioning

confidence: 99%

Patellofemoral Joint Stress during Running with Added Load in Females

et al. 2020

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Patellofemoral joint (PFJ) pain syndrome is a commonly reported form of pain in female runners and military personnel. Increased PFJ stress may be a contributing factor. Few studies have examined PFJ stress running with added load. Our purpose was to analyze PFJ stress, PFJ reaction force, quadriceps force, knee flexion angle, and other kinematic and temporospatial variables running with and without a 9 kg load. Nineteen females ran across a force platform with no added load and 9.0 kg weight vest. Kinematic data were collected using 3D motion capture and kinetic data with a force platform. Muscle forces were estimated using a musculoskeletal model, and peak PFJ loading variables were calculated during stance. Multivariate analyses were run on PFJ loading variables and on cadence, step length and foot strike index. Differences were shown in PFJ stress, PFJ reaction force, peak knee flexion angle and quadriceps force. Joint specific kinetic variables increased between 5–16% with added load. PFJ loading variables increased with 9 kg of added load without changes in cadence, step length, or foot strike index compared to no load. Added load appears to increase the PFJ loading variables associated with PFJ pain in running.

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“…In the sagittal plane, forward trunk lean, anterior knee excursion, and ankle dorsiflexion mobility can all impact PFJS. 28,[33][34][35] PFJS can be reduced by increasing forward trunk lean during CKC knee-strengthening exercises. Escamilla et al 34 found that compared with wall squats, ascending from a single-leg squat creates less PFJS from 90 to 60 .…”

Section: Lower-extremity Mechanics In the Cardinal Planesmentioning

confidence: 99%

Optimizing Rehabilitation and Return to Sport in Athletes With Anterior Knee Pain Using a Biomechanical Perspective

Theisen

Larson

Chambers

2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Anterior knee pain represents one of the most common athletic knee conditions and arguably also one of the most complex. The patellofemoral joint is at the center of several forces, and alterations in any of these force vectors due to muscular imbalance, soft-tissue tightness or laxity, and altered functional movement patterns can all combine to create a painful anterior knee. While typically anterior knee pain is not a surgical entity, the orthopaedic surgeon with an understanding of these biomechanical intricacies is best positioned to provide comprehensive evidence-based care for the patient with anterior knee pain. Level of Evidence: V, expert opinion.

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Effects of Anterior Knee Displacement During Squatting on Patellofemoral Joint Stress

Abstract: Findings provide some general support for minimizing forward knee translation during squats for patients that may have patellofemoral pain syndrome.

Cited by 24 publications

References 42 publications

Verbal Instruction Reduces Patellofemoral Joint Loading During Bodyweight Squatting

Verbal Instruction Reduces Patellofemoral Joint Loading During Bodyweight Squatting

Patellofemoral Joint Stress during Running with Added Load in Females

Optimizing Rehabilitation and Return to Sport in Athletes With Anterior Knee Pain Using a Biomechanical Perspective

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