1.
The influence of cadence and shoes on patellofemoral joint kinetics in runners with patellofemoral pain.
Bonacci, J, Hall, M, Fox, A, Saunders, N, Shipsides, T, Vicenzino, B
Journal of science and medicine in sport. 2018;(6):574-578
Abstract
OBJECTIVES To determine the effect of a combination of a minimalist shoe and increased cadence on measures of patellofemoral joint loading during running in individuals with patellofemoral pain. DESIGN Within-participant repeated measures with four conditions presented in random order: (1) control shoe at preferred cadence; (2) control shoe with +10% cadence; (3) minimalist shoe at preferred cadence; (4) minimalist shoe with +10% cadence. METHODS Fifteen recreational runners with patellofemoral pain ran on an instrumented treadmill while three-dimensional motion capture data were acquired. Peak patellofemoral joint stress, joint reaction force, knee extensor moment and knee joint angle during the stance phase of running were calculated. One-way repeated measures ANOVA was used to compare the control condition (1) to the three experimental conditions (2-4). RESULTS Running in a minimalist shoe at an increased cadence reduced patellofemoral stress and joint reaction force on average by approximately 29% (p<0.001) compared to the control condition. Running in a minimalist shoe at preferred cadence reduced patellofemoral joint stress by 15% and joint reaction force by 17% (p<0.001), compared to the control condition. Running in control shoes at an increased cadence reduced patellofemoral joint stress and joint reaction force by 16% and 19% (p<0.001), respectively, compared to the control condition. CONCLUSIONS In individuals with patellofemoral pain, running in a minimalist shoe at an increased cadence had the greatest reduction in patellofemoral joint loading compared to a control shoe at preferred cadence. This may be an effective intervention to modulate biomechanical factors related to patellofemoral pain.
2.
Gait retraining versus foot orthoses for patellofemoral pain: a pilot randomised clinical trial.
Bonacci, J, Hall, M, Saunders, N, Vicenzino, B
Journal of science and medicine in sport. 2018;(5):457-461
Abstract
OBJECTIVES To determine the feasibility of a clinical trial that compares a 6-week, physiotherapist-guided gait retraining program with a foot orthoses intervention in runners with patellofemoral pain. DESIGN Pilot randomised controlled trial. METHODS Runners aged 18-40 years with clinically diagnosed patellofemoral pain were randomly allocated to either a 6-week gait retraining intervention of increasing cadence and use of a minimalist shoe or prefabricated foot orthoses. Outcomes at baseline and 12-weeks included recruitment, retention, adherence, adverse events, global improvement, anterior knee pain scale, worst and average pain on a 100mm visual analogue scale. RESULTS Of the 16 randomised participants, two withdrew prior to commencing treatment due to non-trial related matters (n=1 from each group) and 14 completed the pilot trial. Minor calf muscle soreness was reported by 3 participants in the gait retraining group while no adverse events were reported in the foot orthoses group. There were no deviations from the treatment protocols. There was a large between-group difference favouring gait retraining at 12-weeks in the anterior knee pain scale and the worst pain in the past week, which was reflected in the number needed-to-treat of 2. CONCLUSIONS This study supports the feasibility of a trial comparing gait retraining with foot orthoses and provides point estimates of effect that informs the design and planning of a larger clinical trial. It appears that a 6-week gait retraining program has a clinically meaningful effect on runners with patellofemoral pain when compared to an evidence-based treatment of foot orthoses.
3.
Comparison of hip and knee strength in males with and without patellofemoral pain.
Bolgla, LA, Earl-Boehm, J, Emery, C, Hamstra-Wright, K, Ferber, R
Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine. 2015;(3):215-21
Abstract
OBJECTIVES The primary purpose of this study was to compare hip strength in males with and without patellofemoral pain (PFP). The secondary purpose was to compare knee strength in males with and without PFP. DESIGN Secondary analysis of cross-sectional data for males with and without PFP from a larger randomized controlled trial examining hip and core versus knee-muscle strengthening for the treatment of PFP. SETTING Laboratory setting. PARTICIPANTS Sixty-six males with PFP and 36 controls. MAIN OUTCOME MEASURES Peak isometric force for the hip abductors, external rotators, internal rotators, extensors, and knee extensors expressed as a percentage of body mass (%BM). RESULTS No differences existed with respect to any of the hip strength measures (P > .05). Males with PFP demonstrated almost 17% less knee extensor strength than controls (mean difference = 7.3 %BM; 95% confidence interval, 1.3-13.4 %BM; t = 2.41; P = .02). CONCLUSIONS Unlike females, males with PFP did not demonstrate hip muscle weakness. However, differences did exist with knee extensor strength. These data provide preliminary evidence for the potential need for sex-specific interventions for individuals with PFP.
4.
Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up.
Fukuda, TY, Melo, WP, Zaffalon, BM, Rossetto, FM, Magalhães, E, Bryk, FF, Martin, RL
The Journal of orthopaedic and sports physical therapy. 2012;(10):823-30
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVES To determine if adding hip-strengthening exercises to a conventional knee exercise program produces better long-term outcomes than conventional knee exercises alone in women with patellofemoral pain syndrome (PFPS). BACKGROUND Recent studies have shown that a hip-strengthening program reduces pain and improves function in individuals with PFPS. However, there are no clinical trials evaluating long-term outcomes of this type of program compared to conventional knee-strengthening and -stretching exercises. METHODS Fifty-four sedentary women between 20 and 40 years of age, with a diagnosis of unilateral PFPS, were randomly assigned knee exercise (KE) or knee and hip exercise (KHE). The women in the KE group (n = 26; mean age, 23 years) performed a 4-week conventional knee-stretching and -strengthening program. The women in the KHE group (n = 28; mean age, 22 years) performed the same exercises as those in the KE group, as well as strengthening exercises for the hip abductors, lateral rotators, and extensors. An 11-point numeric pain rating scale, the Lower Extremity Functional Scale, the Anterior Knee Pain Scale, and a single-hop test were used as outcome measures at baseline (pretreatment) and 3, 6, and 12 months posttreatment. RESULTS At baseline, demographic, pain, and functional assessment data were similar between groups. Those in the KHE group had a higher level of function and less pain at 3, 6, and 12 months compared to baseline (P<.05). In contrast, the KE group had reduced pain only at the 3- and 6-month follow-ups (P<.05), without any changes in Lower Extremity Functional Scale, Anterior Knee Pain Scale, or hop testing (P>.05) through the course of the study. Compared to the KE group, the KHE group had less pain and better function at 3, 6, and 12 months posttreatment (P<.05). For the Lower Extremity Functional Scale, the between-group difference in change scores from baseline at 3, 6, and 12 months posttreatment favored the KHE group by 22.0, 22.0, and 20.8 points, respectively. CONCLUSION Knee-stretching and -strengthening exercises supplemented by hip posterolateral musculature-strengthening exercises were more effective than knee exercises alone in improving long-term function and reducing pain in sedentary women with PFPS.