The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome

Abstract

Background Patellofemoral pain syndrome (PFPS) is the most common overuse injury in runners. Recent research suggests that hip mechanics play a role in the development of this syndrome. Currently, there are no treatments that directly address the atypical mechanics associated with this injury. Objective The purpose of this study was to determine whether gait retraining using real-time feedback improves hip mechanics and reduces pain in subjects with PFPS. Methods Ten runners with PFPS participated in this study. Real-time kinematic feedback of hip adduction (HADD) during stance was provided to the subjects as they ran on a treadmill. Subjects completed a total of eight training sessions. Feedback was gradually removed over the last four sessions. Variables of interest included peak HADD, hip internal rotation (HIR), contralateral pelvic drop, as well as pain on a verbal analogue scale and the lower-extremity function index. We also assessed HADD, HIR and contralateral pelvic drop during a single leg squat. Comparisons of variables of interest were made between the initial, fi nal and 1-month follow-up visit. Results Following the gait retraining, there was a signifi cant reduction in HADD and contralateral pelvic drop while running. Although not statistically signifi cant, HIR decreased by 23% following gait retraining. The 18% reduction in HADD during a single leg squat was very close to signifi cant. There were also signifi cant improvements in pain and function. Subjects were able to maintain their improvements in running mechanics, pain and function at a 1-month follow-up. An unexpected benefi t of the retraining was an 18% and 20% reduction in instantaneous and average vertical load rates, respectively. Conclusions Gait retraining in individuals with PFPS resulted in a signifi cant improvement of hip mechanics that was associated with a reduction in pain and improvements in function. These results suggest that interventions for PFPS should focus on addressing the underlying mechanics associated with this injury. The reduction in vertical load rates may be protective for the knee and reduce the risk for other running-related injuries.

The outcome of hip exercise in patellofemoral pain: A systematic review

“…A significant reduction in hip adduction and contra-lateral pelvic drop was evident in both studies and reduction of 23% in hip internal rotation in one (Noehren et al, 2011); this did not reach significance. There were kinematic improvements in untrained activities, in single leg squat and stepdescent, demonstrating transfer of motor skill learning.…”

“…A considerable reduction in pain occurred over a short time-frame in both neuromuscular studies given that participants had symptoms for an average of 75 and 51 months respectively. Although the effects were very positive the participantswere a pre-selected group who demonstrated abnormal hip alignment during running, which in one study was 10 out of 85 subjects analysed (Noehren et al, 2011). There may be a subset of people with PFP who would benefit from this type of rehabilitation.…”

“…www.casp-uk.net Beneficial effect of hip exercise in PFP Baldon et al, 2014Coppack et al, 2011Ferber et al, 2014Fukuda et al, 2010Fukuda et al, 2012Ismail et al,2013Nakagawa et al, 2008Dolak et al, 2011Khayambashi et al, 2012Avraham et al, 2007Boling et al, 2006Earl & Hoch 2011Ferber et al, 2011Khayambashi et al, 2014Lowry et al, 2008Mascal et al,2003Noehren et al .,2011Razheghi et al, 2010Tyler et al,2006Willy et al, 2012 No benefit of hip exercise in PFP Song et al, 2009 www.cebm.net/ocebm-levels-of-evidence…”

“…The improvements in motor skills were transferred to the untrained tasks of step down (Willy et al, 2012b) and single leg squat (Noehren et al, 2011;Willy et al, 2012b) with significant improvement in hip adduction, which was the focus of the motor retraining task. This suggests that similar motor sequences may offer the greatest potential for positive transfer.…”

Physiotherapy Effectiveness on Muscle Strength, Flexibility, Pain and Function in Patients with Patellofemoral Pain Syndrome

“…PFPS often becomes chronic, with up to 91% of patients reporting constant knee pain 4-18 years after being diagnosed [1], whilst 5 years after rehabilitation, 80% still reported pain and 74% had reduced their activity level [2]. A search of the literature did not reveal previous research studies which have investigated the effectiveness of the National Health Service (NHS) physiotherapy treatment of PFPS in a non-academic setting.…”