Lower Extremity Kinematics of Females With Patellofemoral Pain Syndrome While Stair Stepping

Abstract

Study Design Cross-sectional case-control design. Background Although the etiology of patellofemoral pain syndrome (PFPS) is not completely understood, there is some evidence to suggest that hip position during weight-bearing activities contributes to the disorder. Objective To compare the knee and hip motions (and their coordination) during stair stepping in female athletes with and without PFPS. Methods Two groups of female recreational athletes, 1 group with PFPS (n = 10) and a control group without PFPS (n = 10), were tested. All participants ascended and descended stairs (condition) at 2 speeds (self-selected comfortable and taxing [defined as 20% faster than the comfortable speed]), while the knee and hip angles were measured with a magnetic-based kinematic data acquisition system. Angle-angle diagrams were used to examine the relationship between flexion/extension of the knee and flexion/extension, adduction/abduction, and internal/external rotation of the hip. The angle of the knee and the 3 angles of the hip at foot contact on the third step were compared between groups by means of 3-way analyses of variance (ANOVA), with repeated measures on speed and condition. Results Group-by-speed interaction for knee angle was significant, with knee flexion being greater for the PFPS group for stair ascent and descent at a comfortable speed. Both the angle-angle diagrams and ANOVA demonstrated greater adduction and internal rotation of the hip in the individuals with PFPS compared to control participants during stair descent. Conclusions Compared to control participants, females with PFPS descend stairs with the knee in a more flexed position and have the hip in a more adducted and internally rotated position at foot contact during stair stepping at a comfortable speed. J Orthop Sports Phys Ther 2010;40(10):625–632.doi:10.2519/jospt.2010.3185

Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome

“…This was the only kinematic variable for which findings were similar in both males and females. The present study also adds to the growing body of literature that has reported increased hip adduction during functional and sports activities in subjects with PFPS, 12,30,39,[45][46][47] and is in agreement with previous studies showing greater hip adduction in females compared to males. 15,52 Recently, a prospective study demonstrated that increased hip internal rotation during jump landing was a risk factor that predisposed individuals to PFPS.…”

“…However, the findings of these studies have been inconsistent. In the frontal plane, some studies have reported increased hip adduction 12,30,39,[45][46][47] and others have not. 4,11,42 It is possible that hip adduction may be the result of adduction of the femur relative to the pelvis, the pelvis dropping on the contralateral side, or a combination of both.…”

Relação do valgo dinâmico do joelho com a força muscular do quadril e tronco em indivíduos com síndrome patelofemoral

“…Optou-se neste estudo por avaliar o ângulo de projeção no plano frontal do joelho durante step down em pacientes com SDP por ser uma atividade que exige controle do membro inferior para evitar valgo excessivo (65,70,88,89) . Além disso, ainda são escassos os estudos que avaliam a influência da força dos estabilizadores do quadril e tronco no valgo dinâmico do joelho em pacientes com SDP e controles.…”

“…Estudos avaliando a biomecânica do quadril durante atividades funcionais encontraram que mulheres com SDP tem maior pico de rotação medial do quadril durante corrida, descida de escada e aterrissagem do salto em relação ao grupo controle, não havendo diferenças quanto à adução do quadril (63) . Enquanto Willson e Davis (28) relatam maior adução do quadril durante salto, corrida e agachamento unipodal, Bolgla et al (9) não encontraram diferenças na rotação medial e adução do quadril durante descida de escada e McKenzie et al (65) relata que mulheres com SDP tem maior adução e rotação medial de quadril e pé rodado internamente durante descida de escada.…”

“…O déficit de força e ativação dos grupos musculares abdutores, rotadores laterais e extensores do quadril pode gerar alterações no controle do membro inferior, ocasionando maior pico de rotação medial e adução do quadril (63)(64)(65)(66)(67)(68) em atividades como descer escadas, agachamento unipodal e aterrisagem de um salto, resultando em um mecanismo compensatório chamado de valgo dinâmico ou colapso medial (10,13,69,70) . No valgo dinâmico do joelho, o centro da articulação do joelho desloca-se medialmente em relação ao pé devido à fraqueza dos estabilizadores póstero-laterais do quadril.…”