ORIGINAL PAPER
Is there a subgroup of females with patellofemoral pain syndrome likely to benefit from proximal control exercises?
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1
Department of Physical Therapy for Musculoskeletal Disorders and their Surgeries, Alhayah University, Cairo, Egypt
2
Department of Physical Therapy for Musculoskeletal Disorders and their Surgeries, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
3
Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
4
Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
Submission date: 2022-01-25
Acceptance date: 2022-06-27
Publication date: 2024-03-25
Corresponding author
Ahmed M. ElMelhat
Department of Physical Therapy for Musculoskeletal Disorders and their Surgeries,
Faculty of Physical Therapy, Cairo University, 7 Ahmed El Zaiat Street, Bein El, Sarayat, Cairo
Physiother Quart. 2024;32(1):43-49
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Patellofemoral pain syndrome (PFPS) is one of the most popular complaints among young females. Proximal hip control exercises can improve hip strength and reduce the stresses and pain. However, there is a lack of studies that investigate predictors of the success of proximal hip control exercises in this disorder. This predictive validity diagnostic trial aimed to investigate the effect of body mass index, age, duration of symptoms, and knee angle valgus on proximal control exercise success to improve hip muscle abductors and external rotator isometric strength.
Methods:
Fifty females with PFPS recruited from Ain shams University Hospital with a mean age of 25 years received proximal control exercises (transversus abdominis and multifidus activation, hip extensor, abductor and external rotator strengthening). Participants were assessed for hip strength using a handheld dynamometer, and dynamic knee valgus via video analysis using the Kinovea v.0.8.15 computer program.
Results:
Age was found to be a predictor of success in hip abductor strength, and duration of symptoms a predictor of success in hip external rotator strength with proximal control exercises in patellofemoral pain syndrome female individuals, with no specific cut-off points.
Conclusions:
Proximal control exercises can improve hip strength in females with PFPS with no specific cut-off points for the significant predictors found (age and duration of symptoms).
REFERENCES (41)
1.
van Middelkoop M, van Linschoten R, Berger MY, Koes BW, Bierma-Zeinstra SMA. Knee complaints seen in general practice: active sport participants versus non-sport participants. BMC Musculoskelet Disord. 2008;9:36; doi: 10.1186/1471-2474-9-36.
2.
Wood L, Muller S, Peat G. The epidemiology of patellofemoral disorders in adulthood: a review of routine general practice morbidity recording. Prim Health Care Res Dev. 2011;12(2):157–164; doi: 10.1017/S1463423610000460.
3.
Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002;6(2):95–101; doi: 10.1136/bjsm.36.2.95.
4.
Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F. Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis. PloS One. 2018;13(1):e0190892; doi: 10.1371/journal.pone.0190892.
5.
Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33(11):639–646; doi: 10.2519/jospt.2003.33.11.639.
6.
Cichanowski HR, Schmitt JS, Johnson RJ, Niemuth PE. Hip strength in collegiate female athletes with patellofemoral pain. Med Sci Sports Exerc. 2007;39(8):1227–1232; doi: 10.1249/mss.0b013e3180601109 .
7.
Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9–15; doi: 10.1016/s0004-9514(09)70055-8.
8.
Nunes GS, de Oliveira Silva D, Crossley KM, Serrão FV, Pizzari T, Barton CJ. People with patellofemoral pain have impaired functional performance, that is correlated to hip muscle capacity. Phys Ther Sport. 2019;40:85–90; doi: 10.1016/j.ptsp.2019.08.010.
9.
Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. 2000;10(3):169–175; doi: 10.1097/00042752-200007000-00004.
10.
Mascal CL, Landel R, Powers C. Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports. J Orthop Sports Phys Ther. 2003;33(11):647–660; doi: 10.2519/jospt.2003.33.11.647.
11.
Xu J, Zhou W, Luo X. Visual analysis of patellofemoral pain syndrome research hotspots and content. CJTER. 2022;26(12):1877.
12.
Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, Deprince M. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc. 2002;34(1):9–16; doi: 10.1097/00005768-200201000-00003.
13.
Childs JD, Cleland JA. Development and application of clinical prediction rules to improve decision making in physical therapist practice. Phys Ther. 2006;86(1):122–131; doi: 10.1093/ptj/86.1.122.
14.
Kannus P, Natri A, Paakkala T, Järvinen M. An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg Am. 1999;81(3):355–363; doi: 10.2106/00004623-199903000-00007.
15.
Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2007;37(5):232–238; doi: 10.2519/jospt.2007.2439.
16.
Papadopoulos K, Stasinopoulos D, Ganchev D. A systematic review of reviews on patellofemoral pain syndrome. Exploring the risk factors, diagnostic tests, outcome measurements and exercise treatment. Open Sports Med J. 2015;9(1):7–17.
17.
Emamvirdi M, Letafatkar A, Tazji MK. The effect of valgus control instruction exercises on pain, strength, and functionality in active females with patellofemoral pain syndrome. Sports Health. 2019;11(3):223–237; doi: 10.1177/1941738119837622.
18.
Hébert LJ, Maltais DB, Lepage C, Saulnier J, Crête M, Perron M. Isometric muscle strength in youth assessed by hand-held dynamometry: a feasibility, reliability, and validity study: a feasibility, reliability, and validity study. Pediatr Phys Ther. 2011;23(3):289–299; doi: 10.1097/PEP.0b013e318227ccff.
19.
Shukla R. A study on the applications of open source software for two dimensional video analysis of throwing angle of the shot in shotput. Int J Phys Educ Sports Health. 2016;3(3):353–355.
20.
Elwardany SH, El-Sayed WH, Ali MF. Reliability of Kinovea computer program in measuring cervical range of motion in sagittal plane. Open Access Library J. 2015;2(9):1.
21.
Schurr SA, Marshall AN, Resch JE, Saliba SA. Two-dimensional video analysis is comparable to 3D motion capture in lower extremity movement assessment. Int J Sports Phys Ther. 2017;12(2):163–172.
22.
Herrington L, Munro A. Drop jump landing knee valgus angle; normative data in a physically active population. Phys Ther Sport. 2010;11(2):56–59; doi: 10.1016/j.ptsp.2009.11.004.
23.
Holden S, Boreham C, Doherty C, Delahunt E. Two-dimensional knee valgus displacement as a predictor of patellofemoral pain in adolescent females. Scand J Med Sci Sports. 2017;27(2):188–194; doi: 10.1111/sms.12633.
24.
Earl JE, Hoch AZ. A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome. Am J Sports Med. 2011;39(1):154–163; doi: 10.1177/0363546510379967.
25.
Concato J, Feinstein AR, Holford TR. The risk of determining risk with multivariable models. Ann Intern Med. 1993;118(3):201–210; doi: 10.7326/0003-4819-118-3-199302010-00009.
26.
Beneciuk JM, Bishop MD, George SZ. Clinical prediction rules for physical therapy interventions: a systematic review. Phys Ther. 2009;89(2):114–124; doi: 10.2522/ptj.20080239.
27.
Samsa G, Edelman D, Rothman ML, Williams GR, Lipscomb J, Matchar D. Determining clinically important differences in health status measures. Pharmacoeconomics. 1999;15(2):141–155; doi: 10.2165/00019053-199915020-00003.
28.
Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30(6):857–865; doi: 10.1177/03635465020300061701.
29.
Sutlive TG, Mitchell SD, Maxfield SN, McLean CL, Neumann JC, Swiecki CR. Identification of individuals with patellofemoral pain whose symptoms improved after a combined program of foot orthosis use and modified activity: a preliminary investigation. Phys Ther. 2004;84(1):49–61.
30.
Na Y, Han C, Shi Y, Zhu Y, Ren Y, Liu W. Is isolated hip strengthening or traditional knee-based strengthening more effective in patients with patellofemoral pain syndrome? A systematic review with meta-analysis. Orthop J Sports Med. 2021;9(7):23259671211017503; doi: 10.1177/23259671211017503.
31.
Baldon RDM, Serrão FV, Scattone Silva R, Piva SR. Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44(4):240–251; doi: 10.2519/jospt.2014.4940.
32.
Ireland ML, Willson JD, Ballantyne BT, McClay Davis I. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther. 2003;33(11):671–676.
33.
Park SJ, Kim YM, Kim HR. The effect of hip joint muscle exercise on muscle strength and balance in the knee joint after meniscal injury. J Phys Ther Sci. 2016;28(4):1245–1249; doi: 10.1589/jpts.27.1245.
34.
Bolgla LA, Earl-Boehm J, Emery C, Hamstra-Wright K, Ferber R. Pain, function, and strength outcomes for males and females with patellofemoral pain who participate in either a hip/core-or knee-based rehabilitation program. Int J Sports Phys Ther. 2016;11(6):926–935.
35.
Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. Am J Sports Med. 2006;34(4):630–636; doi: 10.1177/0363546505281808.
36.
Willson JD, Davis IS. Utility of the frontal plane projection angle in females with patellofemoral pain. J Orthop Sports Phys Ther. 2008;38(10):606–615; doi: 10.2519/jospt.2008.2706 .
37.
Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42–51; doi: 10.2519/jospt.2010.3337.
38.
Kagaya Y, Fujii Y, Nishizono H. Association between hip abductor function, rear-foot dynamic alignment, and dynamic knee valgus during single-leg squats and drop landings. J Sport Health Sci. 2015;4(2):182–187.
39.
Saad MC, de Vasconcelos RA, de Oliveira Mancinelli LV, de Barros Munno MS, Liporaci RF, Grossi DB. Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises. Braz J Phys Ther. 2018;22(5):408–416; doi: 10.1016/j.bjpt.2018.03.009.
40.
Lack S, Barton C, Vicenzino B, Morrissey D. Outcome predictors for conservative patellofemoral pain management: a systematic review and meta-analysis. Sports Med. 2014;44(12):1703–1716; doi: 10.1007/s40279-014-0231-5.
41.
ElMelhat AM, Shalash KA, Chabara AE, Azzam AH, Mohamed NA. Identifying female responders to proximal control exercises in patellofemoral pain syndrome: a clinical prediction rule. J Taibah Univ Med Sci. 2022;17(6): 954–961; doi: 10.1016/j.jtumed.2022.05.008.