Exploring the Pain in Patellofemoral Pain: A Systematic Review and Meta-Analysis Examining Signs of Central Sensitization

Sigmund, Kemery J; Bement, Marie Hoeger; Earl-Boehm, Jennifer E.

doi:10.4085/1062-6050-0190.20

Cited by 17 publications

(10 citation statements)

References 55 publications

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“…The somewhat modest improvements seen in our and other recent studies on exercises for PFP raise the question if treatment plans focusing on strengthening and biomechanically informed movement quality alone address the right components contributing to the pain experience. Growing evidence suggests that psychological features may play a role in long-standing PFP 52–54. Future studies should aim at identifying possible patient characteristics that predict successful outcomes.…”

Section: Discussionmentioning

confidence: 99%

Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial

et al. 2023

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ObjectiveTo assess effectiveness equivalence between two commonly prescribed 12-week exercise programmes targeting either the quadriceps or the hip muscles in patients with patellofemoral pain (PFP).MethodsThis randomised controlled equivalence trial included patients with a clinical diagnosis of PFP. Participants were randomly assigned to either a 12-week quadriceps-focused exercise (QE) or a hip-focused exercise (HE) programme. The primary outcome was the change in Anterior Knee Pain Scale (AKPS) (0–100) from baseline to 12-week follow-up. Prespecified equivalence margins of ±8 points on the AKPS were chosen to demonstrate comparable effectiveness. Key secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire pain, physical function and knee-related quality of life subscales.Results200 participants underwent randomisation; 100 assigned to QE and 100 to HE (mean age 27.2 years (SD 6.4); 69% women). The least squares mean changes in AKPS (primary outcome) were 7.6 for QE and 7.0 for HE (difference 0.6 points, 95% CI −2.0 to 3.2; test for equivalence p<0.0001), although neither programme surpassed the minimal clinically important change threshold. None of the group differences in key secondary outcomes exceeded predefined equivalence margins.ConclusionThe 12-week QE and HE protocols provided equivalent improvements in symptoms and function for patients with PFP.Trial registration numberNCT03069547.

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Section: Discussionmentioning

confidence: 99%

Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial

et al. 2023

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“…Another way to assess the existence of CS is through Quantitative Sensory Testing (QST), which are a battery of tests that assesses pain threshold (pressure, heat or electrical stimuli), temporal pain summation phenomenon (changes in pain perception over time during a sustained or repeated stimulus) and conditioned pain modulation (pain from a noxious stimulus is decreased by a second noxious stimulus). A systematic review of studies evaluating the presence of CS using QST in AKP patients found that signs of CS were present in some patients, indicating altered pain modulation [33]. Unlike QST, which assesses sensory system responses to sensory stimuli, CSI primarily assesses symptoms related to CS.…”

Section: Discussionmentioning

confidence: 99%

Central sensitization negatively influences the level of disability in female patients with anterior knee pain

Sanchis‐Alfonso,

Beser‐Robles,

Navarro‐Calvo

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To define the prevalence of Central Sensitization (CS) in patients with Anterior Knee Pain (AKP) and determine whether there is an association between CS and the magnitude of pain, disability, quality-of-life and psychological impairment. Methods The data of a total of 44 AKP female patients with a mean age of 27.7 years (15-50) recruited consecutively from hospital outpatient knee clinics were prospectively included in this study. The patients had no antecedents of knee trauma or surgery and no history of injury or disease of the nervous system. There were also 50 healthy female controls with a mean age of 26.1 years . CS was evaluated using the Central Sensitization Inventory (CSI). Quality-of-life was evaluated using the EuroQoL-5D questionnaire. Self-reporting of clinical pain intensity was obtained using the Visual Analogue Scale. The Kujala Knee Scale and IKDC form were used to evaluate disability. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Subscale (HAD). Kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK-11) and catastrophizing by means of the Pain Catastrophizing Scale (PCS). Results Sixteen AKP patients (36%), and 2 (4%) of the healthy controls presented with central sensitization (p < 0.01). AKP patients with CS have a greater degree of disability based on the Kujala Scale and higher levels of anxiety and depression than AKP patients without CS. The score of AKP patients in the CSI correlated weakly with disability and quality of life and moderately with anxiety and depression. However, no association was seen between CSI score and pain intensity, nor with catastrophizing and kinesiophobia. A multivariate logistic regression analysis showed that only depression was statistically significant in the prediction of the presence of CS (odds ratio 1.45; 95% CI 1.07 to 1.96). Conclusions AKP patients have a significantly higher prevalence of CS in comparison with what has been reported for the general population. This finding suggests the presence of altered pain modulation in a subgroup of AKP patients. Level of evidence Level III.

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“…Thus, altered central and peripheral pathways could be related to long lasting effects of interventions for PFPS. Because of the chronic character of PFPS, pain modulation mechanisms may deserve more attention in the treatment of patellofemoral pain (Bartholomew et al, 2019;Sigmund et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial.

Scafoglieri

Broeck

Willems

et al. 2021

Preprint

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Background Increasing evidence has shown benefits of spinal manipulations in patients with patellofemoral pain syndrome (PFPS). There is scarcity regarding medium term effects of spinal manual therapy on outcome measures in PFPS patients. Therefore, the aim of the present study was to compare the effectiveness of local exercise therapy and spinal manual therapy for knee pain, function and maximum voluntary peak force (MVPF) velocity of the quadriceps. Methods Forty-three patients with PFPS were randomly assigned to an intervention group. The local exercise group received six sessions of supervised training of the knee-and hip muscles with mobilization of the patellofemoral joint. The spinal manual therapy group received six interventions of high velocity low thrust manipulations at the thoracolumbar region, sacroiliac joint, and/or hip. Maximum, minimum and current pain were measured using the visual analogue scale. Function was assessed with the anterior knee pain scale (AKPS) and MPFV was recorded using a Biodex System 3 dynamometer. Patients were assessed before intervention, after 6 weeks of intervention and at 6 weeks follow-up. Results Pain and functionality improved more following spinal manipulative therapy than local exercise therapy. After 6 weeks of intervention the between-group difference (local versus spinal) for maximal pain was 23.4 mm [95% CI: 9.3, 37.6; effect size (ES): 1.04] and − 12.4 [95% CI: -20.2, -4.7; ES: 1.00] for the AKPS. At 6 weeks of follow-up the between-group difference for maximal pain was 18.7 mm [95% CI: 1.4, 36.0; ES: 0.68] and − 11.5 [95% CI: -19.9, -3.3; ES: -0.87] for the AKPS. Conclusions This study suggests that spinal manual therapy is more effective than local exercise therapy in improving pain and function in patients with PFPS in the medium term. Combining spinal manual therapy with local exercise therapy may be an important element in the successful rehabilitation of patients with PFPS.

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Exploring the Pain in Patellofemoral Pain: A Systematic Review and Meta-Analysis Examining Signs of Central Sensitization

Cited by 17 publications

References 55 publications

Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial

Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial

Central sensitization negatively influences the level of disability in female patients with anterior knee pain

Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial.

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