How to manage patellofemoral pain – Understanding the multifactorial nature and treatment options

Lack, Simon; Neal, Brad; Silva, Danilo de Oliveira; Barton, Christian J

doi:10.1016/j.ptsp.2018.04.010

Cited by 72 publications

(49 citation statements)

References 134 publications

(189 reference statements)

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“…Patellofemoral pain (PFP) represents a common condition observed in orthopedic practice characterized by diffuse peripatellar and retropatellar pain [ 1 ]. PFP has an annual prevalence of 22.7% in the general population [ 2 , 3 ], affecting mainly physically active young women which are 2.23 times more prone to develop PFP as compared to men [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain

Briani¹,

Silva²,

Flóride³

et al. 2018

PLoS ONE

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The present study aimed at investigating whether the neuromuscular system behaves differently (in terms of force and muscle activity generation) as a function of the task being performed (i.e. maximal voluntary efforts vs stair negotiation) and the presence of patellofemoral pain (PFP) and possible influences of pain intensity. Thirty-eight women with (n = 19) and without PFP (n = 19) had their knee strength (extension joint torque) measured during maximal voluntary isometric contractions (MVIC) and electromyography (EMG) data recorded during both MVIC and stair ascent tasks, which were performed before and after a loading protocol designed to exacerbate pain symptoms. Women with PFP displayed lower levels of vastus medialis (p = 0.002) and vastus lateralis (p = 0.032) EMG activation during MVIC assessments. Conversely, the PFP group showed higher levels of vastus medialis muscle activity during stair climbing (p = 0.007), which happened exclusively after the loading protocol. Similarly, women with PFP displayed lower knee extensor torque only during the MVIC tests performed after the loading protocol, which was moderately correlated with the increase in self-reported pain (p = 0.041, r = 0.37), whereas the changes in EMG activity during stair ascent were not correlated with changes in pain intensity (p = 0.215, r = 0.12). These results suggest that, in comparison to pain-free controls, women with PFP display lower levels of quadriceps EMG activation during maximal contractions, but higher activation during dynamic tasks (stair ascent). In addition, the moderate association between the decrease in knee extensor torque and increase in self-reported pain indicates that care should be taken by clinicians during quadriceps strength evaluation in women with PFP, as misleading outcomes may emerge if the intensity of knee pain is not considered during screening. Additionally, rehabilitation strategies should focus on both restoring neuromuscular control and increasing muscle strength.

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Section: Introductionmentioning

confidence: 99%

Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain

Briani¹,

Silva²,

Flóride³

et al. 2018

PLoS ONE

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“…Our findings demonstrate that adolescent athletes with PFP presented poorer functional status than physically active non-athletes in almost all KOOS 0 dimensions, except for ADL. This finding may suggest that managing training loads according to symptoms could be an important issue to be considered by clinicians responsible for sports teams to reduce symptom aggravation of adolescent athletes with PFP (Lack, Neal, De Oliveira Silva, & Barton, 2018). Accordingly, Rathleff, Roos, Olesen, & Rasmussen, 2015, demonstrated that an exercise therapy associated with patient' load management education had long term (24 months) positive effect on reducing pain and improve overall function in adolescents with PFP.…”

Section: Discussionmentioning

confidence: 93%

Differences in pain and function between adolescent athletes and physically active non-athletes with patellofemoral pain

Ferreira

Silva

Priore

et al. 2018

Physical Therapy in Sport

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“…Most of the exercise trials in PFP focus their outcomes in patient-reported measures, not in objective measures 18,19 . Subjective and objective outcomes have different constructs 20 , therefore understanding the effect of a comprehensive exercise program in the objective function of women with PFP is a novel addition into PFP literature.…”

Section: Introductionmentioning

confidence: 99%

Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study

Lima

Flor

Barbosa

et al. 2020

Motriz: rev. educ. fis.

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Aims: The purpose of our study was to compare the hip and knee muscle activity before and after a hip abduction exercise program in women with patellofemoral pain (PFP). Methods: Eleven women with PFP were included in our pre/post design study. Participants were assessed before and after 12-week hip abduction exercise program. All participants performed 6 stair climbing repetitions, 3 sets of rope jumps over 30 s and 5 sets of 8 squats to standardize the physical activity level before data collection. We recorded the electromyographic activity from gluteus medius, vastus medialis (VM) and vastus lateralis (VL) for double-legged squat with and without isometric hip abduction. Additionally, participants were asked to perform a step-down test to assess objective function (maximum number of repetitions over 30 s) and completed a clinical evaluation. Results: Longer duration of VM (Mean difference [95% CI]) = -0.97 [-1.48; -0.46], ES [effect size] = 0.66) and VL (-0.81 [-1.35; -0.27], ES = 0.54) were found after the hip abduction exercise program only for free squat. The participants also performed higher number of step-down repetitions (-3.54 [-5.84; -1.25], ES = 1.03) after the hip abduction exercise program and showed improvement in pain reports. Conclusion: A 12-week hip abduction exercise program changed the quadriceps muscle activation pattern and improved pain and objective function of women with PFP. The exercises promoted a longer VM and VL activation duration. Additionally, they promoted a clinical improvement in the patients with PFP.

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How to manage patellofemoral pain – Understanding the multifactorial nature and treatment options

Cited by 72 publications

References 134 publications

Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain

Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain

Differences in pain and function between adolescent athletes and physically active non-athletes with patellofemoral pain

Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study

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