Lumbopelvic manipulation alone versus combined with dry needling in physically active patients with patellofemoral pain syndrome: A randomized clinical trial.

INTRODUCTION: Patellofemoral pain syndrome (PFPS) is prevalent in physically active people. The multifactorial nature of PFPS necessitates multimodal treatment for this condition. The present study aimed to compare the efficacy of lumbopelvic manipulation alone versus manipulation plus dry needling in physically active patients with PFPS. METHOD: Thirty patients (18 women and 12 men) with a diagnosis of PFPS entered this randomized controlled clinical trial and were divided into two groups: lumbopelvic manipulation alone or lumbopelvic manipulation plus dry needling. The interventions were applied for 3 sessions every other day. Dry needling was performed on the quadratus lumborum and gluteus medius muscles. Pain intensity, Kujala score and side-plank time were recorded at baseline, post-intervention and 1 month after the intervention. RESULTS: The results of Friedman's test showed statistically significant differences in pain and function in participants during the study period, and post hoc tests revealed differences between the two groups in behavior of the marginal means (p < 0.001). CONCLUSION: The use of lumbopelvic manipulation plus dry needling in the quadratus lumborum and gluteus medius muscles may be more effective than manipulation alone in alleviating pain and promoting function in physically active patients with PFPS.

The effect of kinetic factors of dynamic knee valgus on patellofemoral pain: A systematic review and meta-analysis.

The speculation of dynamic knee valgus (DKV) correlates with kinetic changes in the frontal plane that increased loading patellofemoral joint (PFJ). Therefore, it is the purpose of this systematic review and meta-analysis study is the effect of kinetic factors DKV on patellofemoral pain (PFP). The search strategy was carried out in the electronic databases of Cochrane Library, PubMed, Springer Link, Science Direct, Scopus. Studies limited to the period 2000 to 2020 were extracted. The quality of study was assessment by modified Downs and Black checklist. Mean and standard deviation were also used to calculate the effect size. There were selected 8 articles for the systematic review and Meta-analysis. The results showed that in PFP patients compared to healthy individuals have increase knee abduction moment (SMD = 0.75; 95% CI = [0.47 to 1.02]) and impulse (SMD = 0.79; 95% CI = [0.50 to 1.07]). Furthermore, PFP patients compared to healthy individuals have decrease onset (SMD = -0.60; 95% CI = [-1.03 to -0.17]) and during (SMD = -0.93; 95% CI = [-1.57 to -0.29]) gluteus medius (GMED); vis-à-vis, PFP patients compared to healthy individuals have increase onset (SMD = 0.10; 95% CI = [-0.34 to 0.54]) and during (SMD = 0.29; 95% CI = [-0.15 to 0.73]) adductors longus (AL). As a result; PFP patients compared to healthy individuals show decrease co-contraction GMED/AL (SMD = -1.03; 95% CI = [-1.83 to -0.24]). The kinetic factors of DKV of leading to PFJ contact area decreases and the loading in a smaller contact area on PFJ in the outer part of the patella. Eventually, this abnormal distribution of contact pressure leads to etiology and osteoarthritis of the PFP.

Comparing the effects of positional versus myofascial release of gluteus medius to manage patellofemoral pain syndrome: single blinded randomized clinical trial.

OBJECTIVE: To determine the effects of positional release technique in comparison to myofascial release technique on gluteus medius trigger point along with exercises to manage patellofemoral pain syndrome. METHODS: The single-blind, two-arm, randomised clinical trial was conducted at the Department of Physiotherapy, Sindh Institute of Physical Medicine, Karachi, from December 7, 2020, to March 24, 2021, and comprised patellofemoral pain syndrome of either gender with gluteus medius trigger point. They were randomly allocated to positional release technique group A and myofascial release technique group B. The intervention comprised 3 sessions per week for 6 weeks for a total of 18 sessions, with each session lasting 45 minutes. Function through anterior knee pain scale, pain through visual analogue scale, strength via hand-held dynamometer, and quality of life via World Health Organisation quality of life brief questionnaire were assessed alongside pressure pain threshold via algometer which was taken as the gluteus medius trigger point. All measurements were taken at baseline and 6 week post-intervention. Data was analysed using SPSS 21. RESULTS: Of the 64 participants, 38(59.4%) were females and 26(40.6%) were males. There were 32(50%) subjects in group A with mean age 29.50±5.84 years and 32(50%) in group B with mean age 29.50±5.43 years (p>0.05). Both the groups showed a significant reduction in pain, improvement in function, pressure pain threshold, strength, and quality of life (p;lt;0.05). Intergroup comparisons revealed no significant differences (p>0.05). CONCLUSIONS: Treating myofascial trigger points of gluteus medius muscle, using either positional release technique or myofascial release technique together with exercise therapy was found to be equally beneficial. Clinical Trial gov ID: NCT04667091.

Patients with patellofemoral pain have lower soft tissue flexibility of the kinetic chain compared to healthy controls: A case-control study.

INTRODUCTION: Patellofemoral pain (PFP) is a common musculoskeletal condition. Lower limb range of motion (LLROM) evaluates soft tissue flexibility over multiple joints as part of the kinetic chain. The aims were to study: 1) the reliability of a new LLROM test; 2) differences in LLROM between PFP patients and controls; and 3) the relationship between LLROM and pain-free knee function. METHODS: Patients with PFP and matched controls were recruited from a university campus and private physiotherapy clinics, while observers were blinded for health status. Testing LLROM for maximal knee flexion and hip adduction and the sum of these (total ROM) were performed. Measures of reliability (ICC2,1) were established. Univariate linear regression between LLROM and health status and multivariate analysis between LLROM and knee function were performed. RESULTS: Patients (n = 32 (7 male/25 female, age = 22, BMI = 22.7)) and controls (n = 32 (7 male/25 female, age = 20, BMI = 22.3)) were included. The ICC's for intra- and interobserver reliability ranged from 0.83 (95%CI 0.30-0.93) to 0.89 (0.72-0.95). Symptomatic legs had 7°(3-11, p = 0.014) lower knee flexion, 6°(4-8, p ≤ 0.001) lower hip adduction and 13°(8-17, p ≤ 0.001) lower total ROM than non-symptomatic legs. Multivariate analysis revealed an association between total ROM and pain-free knee function (R2 = 0.438, F = 6.544, p ≤ 0.001). CONCLUSIONS: The new LLROM test was found to be reliable. Patients with PFP had lower LLROM, which was associated with impaired pain-free knee function. Whether improving soft tissue flexibility results in enhanced pain-free knee function should be the subject of future research.

Activation, strength, and resistance: Which variables predict the kinematics of women with and without patellofemoral pain?

INTRODUCTION: Investigating the possible relationship between neuromuscular changes and movement alterations could help to describe the mechanisms underlying patellofemoral pain (PFP). OBJECTIVE: To investigate whether activation and muscle strength of the trunk and lower limb and muscle resistance of the trunk predict the knee frontal and trunk sagittal kinematics in women with and without PFP. METHOD: Sixty women (PFP, n = 30; asymptomatic, n = 30) underwent the single-leg squat test to collect electromyographic and kinematic data. Activation of transversus abdominis/internal oblique, gluteus medius (GMed), and vastus medialis oblique (VMO); knee frontal and trunk sagittal angles were analyzed. Participants also underwent maximal isometric tests to determine lateral trunk, hip abductor, and knee extensor torques and performed a lateral trunk resistance test. Multiple regression was used to determine predictive models. RESULTS: In the PFP group, knee frontal angle (R2 = 0.39, p = 0.001) was predicted by GMed activation (ß = 0.23, p = 0.000) and hip abductor torque (ß = 0.08, p = 0.022). No variable was able to predict trunk sagittal kinematics in this group. In the asymptomatics, knee frontal angle (R2 = 0.16, p = 0.029) was predicted by hip abductor torque (ß = 0.07, p = 0.029), while trunk sagittal angle (R2 = 0.24, p = 0.024) was predicted by VMO activation (ß = 0.12, p = 0.016). CONCLUSION: Kinematics is predicted by the muscles acting in the respective planes, such that hip abductors capacities are related to the knee frontal alignment in both groups, and that of the VMO is related to the trunk sagittal alignment only in asymptomatic women.

Effects of an online program including mindfulness, exercise therapy and patient education compared to online exercise therapy and patient education for people with Patellofemoral Pain: protocol for a randomized clinical trial.

BACKGROUND: Patellofemoral pain (PFP) is a common knee disorder that causes persistent pain, lower self-reported function and quality of life. People with PFP also present with altered psychological factors, which are associated with higher levels of pain and dysfunction. Mindfulness-based interventions (MBI) generally consist of meditative practices developed to provide a holistic approach to chronic conditions. However, the effects of MBI on clinical and psychological outcomes for people with PFP remains understudied. METHODS: This assessor-blinded, parallel, two-arm randomized clinical trial aims to investigate the effects of adding an 8-week online MBI program to exercise therapy and patient education on clinical and psychological factors for people with PFP. We also aim to investigate whether psychological factors mediate changes in pain and function. Sixty-two participants with PFP will be recruited and randomized into one of two treatment groups (Mindfulness or Control group). Both groups will receive an 8-week intervention involving exercise therapy and education delivered through an online platform. The Mindfulness group will additionally receive a MBI component including formal and informal practices. Outcomes will be assessed online at baseline, intervention endpoint (follow-up 1) and 12 months after intervention completion (follow-up 2). Comparisons between groups will be performed at all time points with linear mixed models. A mediation analysis will be performed using a 3-variable framework. DISCUSSION: Exercise therapy and patient education are considered the "best management" options for PFP. However, unsatisfactory long-term prognosis remains an issue. It is known that people with PFP present with altered psychological factors, which should be considered during the evaluation and treatment of people with PFP. Adding a MBI to the current best treatment for PFP may improve short and long-term effects by addressing the underlying psychological factors. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-4yhbqwk, registered in April 6, 2021.

Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials.

OBJECTIVE: To evaluate the effectiveness of interventions to prevent and manage knee injuries in runners. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus up to May 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCTs) with a primary aim of evaluating the effectiveness of intervention(s) to prevent or manage running-related knee injury. RESULTS: Thirty RCTs (18 prevention, 12 management) analysed multiple interventions in novice and recreational running populations. Low-certainty evidence (one trial, 320 participants) indicated that running technique retraining (to land softer) reduced the risk of knee injury compared with control treadmill running (risk ratio (RR) 0.32, 95% CI 0.16 to 0.63). Very low-certainty to low-certainty evidence from 17 other prevention trials (participant range: 24 -3287) indicated that various footwear options, multicomponent exercise therapy, graduated running programmes and online and in person injury prevention education programmes did not influence knee injury risk (RR range: 0.55-1.06). In runners with patellofemoral pain, very low-certainty to low-certainty evidence indicated that running technique retraining strategies, medial-wedged foot orthoses, multicomponent exercise therapy and osteopathic manipulation can reduce knee pain in the short-term (standardised mean difference range: -4.96 to -0.90). CONCLUSION: There is low-certainty evidence that running technique retraining to land softer may reduce knee injury risk by two-thirds. Very low-certainty to low-certainty evidence suggests that running-related patellofemoral pain may be effectively managed through a variety of active (eg, running technique retraining, multicomponent exercise therapy) and passive interventions (eg, foot orthoses, osteopathic manipulation). PROSPERO REGISTRATION NUMBER: CRD42020150630.

Six Treatments Have Positive Effects at 3 Months for People With Patellofemoral Pain: A Systematic Review With Meta-analysis.

OBJECTIVE: To determine the effects of nonsurgical treatments on pain and function in people with patellofemoral pain (PFP). DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: We searched MEDLINE, Web of Science, and Scopus databases from their inception until May 2022 for interventional randomized controlled trials (RCTs) in people with PFP. STUDY SELECTION CRITERIA: We included RCTs that were scored ≥7 on the PEDro scale. DATA SYNTHESIS: We extracted homogenous pain and function data at short- (≤3 months), medium- (>3 to ≤12 months) and long-term (>12 months) follow-up. Interventions demonstrated primary efficacy if outcomes were superior to sham, placebo, or wait-and-see control. Interventions demonstrated secondary efficacy if outcomes were superior to an intervention with primary efficacy. RESULTS: We included 65 RCTs. Four interventions demonstrated short-term primary efficacy: knee-targeted exercise therapy for pain (standardized mean difference [SMD], 1.16; 95% CI: 0.66, 1.66) and function (SMD, 1.19; 95% CI: 0.51, 1.88), combined interventions for pain (SMD, 0.79; 95% CI: 0.26, 1.29) and function (SMD, 0.98; 95% CI: 0.47, 1.49), foot orthoses for global rating of change (OR = 4.31; 95% CI: 1.48, 12.56), and lower-quadrant manual therapy for function (SMD, 2.30; 95% CI: 1.60, 3.00). Two interventions demonstrated short-term secondary efficacy compared to knee-targeted exercise therapy: hip-and-knee-targeted exercise therapy for pain (SMD, 1.02; 95% CI: 0.58, 1.46) and function (SMD, 1.03; 95% CI: 0.61, 1.45), and knee-targeted exercise therapy and perineural dextrose injection for pain (SMD, 1.34; 95% CI: 0.72, 1.95) and function (SMD, 1.21; 95% CI: 0.60, 1.82). CONCLUSIONS: Six interventions had positive effects at 3 months for people with PFP, with no intervention adequately tested beyond this time point. J Orthop Sports Phys Ther 2022;52(11):750-768. Epub: 8 September 2022. doi:10.2519/jospt.2022.11359.

Efficacy of Patellar Taping and Electromyographic Biofeedback Training at Various Knee Angles on Quadriceps Strength and Functional Performance in Young Adult Male Athletes with Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

Background: The severity of the articular lesion is the single most essential element in investigating the extent of flexion that is required for activities. However, a prior study found no differences in muscle strength gains of quadriceps muscles at different knee angles in people with patellofemoral pain syndrome (PFPS). Objective: The effects of patellar taping and electromyographic biofeedback (EMG-BF)-guided isometric quadriceps strengthening at different knee angles (e.g., 30°, 60°, and 90° of knee flexion) on quadriceps strength and functional performance in people with PFPS were compared in this single-blind randomized controlled parallel trial. Methods: Sixty adult male athletes with PFPS (age: 26.9 ± 1.4 years) were randomly divided into two groups. The experimental group (n = 30) received patellar taping and EMG-BF-guided isometric contraction exercise at 30°, 60°, and 90° angles, and the control group (n = 30) received sham patellar taping without EMG-BF-guided exercises for six weeks. Pain intensity, knee function, muscle strength, and the single-leg triple hop (SLTH) test were assessed. Results: The pain intensity and SLTH scores between the groups were significantly different at the end of the trial (p ≤ 0.001). The EMG-BF and control groups had mean pain scores of 1.3 (0.8) and 4.5 (0.8), respectively. The EMG-BF and control groups had mean functional scores of 80.4 (5.1) and 69.1 (6.1), respectively. The mean SLTH score for the EMG-BF group was 540.7 (51.2) and for the control group it was 509.4 (49.8) after the trial. Quadriceps muscle strength was significantly higher in those who performed quadriceps strength training at 60° of knee flexion after six weeks than in those who performed strength training at 30° or 90° of knee flexion. Conclusion: The findings indicated that individuals who trained their quadriceps at a 60° knee angle had significantly stronger quadriceps muscles than individuals who trained at 30° or 90° of knee flexion. Trial Registration. This trial is registered at Clinical Trials.gov under the identifier NCT05055284.

The Effect of Gluteus Medius Dry Needling on Pain and Physical Function of Non-athlete women with Unilateral Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial.

BACKGROUND: One of the most common knee problems is patellofemoral pain syndrome (PFPS). It is of great importance to pay attention to the muscles of the hip area in people with PFPS, especially to the presence of trigger points within the gluteus medius (GM). Accordingly, using therapeutic interventions to eliminate trigger points is required. Therefore, the aim of the present study was to evaluate the effect of GM active trigger point dry needling (TrP-DN) on pain and physical function of non-athlete women with unilateral PFPS. METHODS: 29 young non-athlete women aged between 17 and 40 years old with unilateral PFPS were randomly divided into two groups of experimental (n = 15) and control (n = 14) through the simple and convenience sampling method. Both groups received conventional physiotherapy twice a week up to 6 sessions. The experimental group also received GM active TrP-DN once a week for 3 sessions in addition to the conventional physiotherapy. Pain intensity and physical function of women with PFPS were measured in both groups in three stages of before, immediately after and one week after performing the treatment sessions. FINDINGS: The six-session physiotherapy treatment led to a significant reduction in pain intensity as well as an improvement in physical function in both groups (p < 0.001). In addition, the intergroup comparison showed a significant improvement in physical function of the experimental group after one week from the GM active TrP-DN, compared to the control group (p = 0.048). CONCLUSION: The present study indicated that conventional physiotherapy with or without GM active TrP-DN can reduce pain and improve physical function in non-athlete women with unilateral PFPS. This study also revealed that conventional physiotherapy combined with dry needling can lead to further reduction in pain and a greater improvement in physical function of this group of patients.

Contribution of components of the quadriceps femoris muscle for producing external torque in patients with patellofemoral pain syndrome.

INTRODUCTION: Different muscular activities of the quadriceps components for producing necessary torque may change in patients with patellofemoral pain syndrome (PFPS). The aim of the current study, therefore, was to assess the contribution of each component of the quadriceps femoris muscle for producing external torque in patients with PFPS. METHOD: Twelve females with PFPS (24.7 ± 2.3 years) and twelve healthy matched females (25.4 ± 2.4 years) performed three consecutive knee flexion and extension movements with maximum effort at 45°/s and 300°/s using a Biodex system 3 dynamometer. Simultaneously, electromyographic (EMG) activities of the vastus medialis oblique (VMO), RF (rectus femoris) and vastus lateralis (VL) muscles were recorded using a DataLog instrument. Standard multiple regressions were used to assess the ability of EMG activities of the VMO, RF and VL muscles to predict normalized quadriceps femoris isokinetic concentric and eccentric torques at 45°/s and 300°/s in the normal and patient groups. RESULTS: In the normal group, the VL and the VMO were the good predictors of quadriceps concentric torque at 45°/s and 300°/s, respectively. The VL and the RF were the good predictors of quadriceps eccentric torque at 300°/s in the patient group. No other conditions showed a considerable prediction for quadriceps torque in the normal or patient group. CONCLUSION: Females with PFPS differ with normal females in terms of the contribution of each component of the quadriceps femoris for producing external torque. Training the VMO for concentric contraction at both high and low velocities should be included in the management of the patients with PFPS.

Electromyographic comparison of vastus medialis obliquus facilitatory versus vastus lateralis inhibitory kinesio taping in athletes with patellofemoral pain: A randomized clinical trial.

BACKGROUND: Patellofemoral pain (PFP) is among the most common orthopedic complications afflicting active young people. Diminished coordination of the vastii, delayed activation of the vastus medialis obliquus (VMO), and decreased VMO-to-vastus lateralis (VL) activity ratio are well documented as underlying causes of PFP. This study compares the effects of VMO facilitatory kinesio tape (KT) versus VL inhibitory KT on electromyographic (EMG) activity of the vastii, balance, and pain in athletes with PFP. METHODS: In this single-blind randomized clinical trial, thirty-two female athletes with PFP (mean age 26.33 ± 5.93 years) were randomly assigned to VMO facilitatory KT (n = 16) or VL inhibitory KT (n = 16) groups. In the facilitatory group, a Y-shaped strip of KT at 25% of its available tension was attached from the origin of the VMO to its insertion and in the inhibitory group, an insertion-to-origin Y-shaped strip of KT at 15% of its available tension was applied on the VL. Pain intensity, dynamic balance, and EMG data were assessed respectively with a visual analogue scale, the modified Star Excursion Balance Test, and an EMG telemetry system, before and immediately after KT application. RESULTS: Pain intensity decreased and dynamic balance improved significantly after taping in both groups, and VMO: VL activity ratio increased significantly in the VL group. However, none of the parameters differed significantly between groups. CONCLUSIONS: Both VMO facilitatory and VL inhibitory KT can improve pain and balance, while the inhibitory technique might be more effective in regulating the VMO to VL activity ratio in athletes with PFP.

The effects of virtual reality training on clinical indices and brain mapping of women with patellofemoral pain: a randomized clinical trial.

BACKGROUND: Virtual reality training (VRT) is a new method for the rehabilitation of musculoskeletal impairments. However, the clinical and central effects of VRT have not been investigated in patients with patellofemoral pain (PFP). To comprehensively assess the effects of VRT on clinical indices and brain function, we used a randomized clinical trial based on clinical and brain mapping assessment. METHODS: Twenty-six women with PFP for more than 6 months were randomly allocated to 2 groups: intervention and control. The intervention consisted of lifestyle education + 8 weeks VRT, in 24 sessions each lasting 40 min of training, whereas the control group just received lifestyle education. The balance was the primary outcome and was measured by the modified star excursion balance test. Secondary outcomes included pain, function, quality of life, and brain function which were assessed by visual analogue scale, step down test and Kujala questionnaire, SF-36, and EEG, respectively. Pre-intervention, post-intervention and follow-up (1 month after the end of the intervention) measurements were taken for all outcome measures except EEG, which was evaluated only at pre-intervention and post-intervention). Analyses of variance was used to compare the clinical outcomes between the two groups. The independent t-test also was used for between group EEG analyses. RESULTS: Balance score (P < 0.001), function (P < 0.001), and quality of life (P = 0.001) improved significantly at post-intervention and 1 month follow-up in the VRT group compared with the control group. VRT group showed a significantly decreased pain score (P = 0.004). Alpha (P < 0.05) and theta (P = 0.01) power activity also increased in the brain of the VRT group. CONCLUSION: This study demonstrated that long term VRT was capable of improving both clinical impairments and brain function in patients with PFP. Therefore, therapists and clinicians can use this method as a more holistic approach in the rehabilitation of PFP. TRIAL REGISTRATION: IRCT, IRCT20090831002391N40 . Registered 23 / 10 / 2019.

Visuomotor reaction time difference between patellofemoral pain syndrome and healthy individuals: Cross-sectional study.

OBJECTIVE: Although many studies indicated a decreased reaction time in post-traumatic complaints including ACL injury, no study has been devoted to measure reaction time in patients with patellofemoral pain syndrome (PFPS). The purpose of the present study was to compare the visuomotor reaction time between PFPS and healthy individuals. METHODS: Twenty five patients with PFPS (20 women and 5 men, mean age 29.28 years, SD 5.59) and 25 healthy controls (19 women, 6 men, mean age 29.32, years SD 5.30) were recruited in the present study. The dependent variables were upper extremity reaction time, upper extremity error rate, knee extension reaction time in both involved and non-involved legs, plantar flexion reaction time in both involved and non-involved legs. RESULTS: The results of one-way multiple analysis of variance showed that patients with PFPS had slower upper extremity reaction time (P=0.047, Effect size (ES)=0.39) and plantar flexion reaction time (symptomatic side) (P<0.001, ES=0.77) as compared with healthy control. The symptomatic knee extension reaction time was slower than the healthy matched leg, but this difference was not statistically significant (P=0.296, ES= 0.19). CONCLUSION: The present study suggests that the reaction time might be considered as a factor associated with PFPS.

A comparison between whole-body vibration and conventional training on pain and performance in athletes with patellofemoral pain.

INTRODUCTION: Patellofemoral pain (PFP) is the most common cause of anterior knee pain in athletes, which affects their performance especially during single leg activities. The aim of this study was to compare the effects of whole-body vibration training (WBVT) and conventional training (CT) on pain and performance in athletes with PFP. METHODS: 30 athletes with unilateral PFP were randomly assigned to the WBVT (6 women, 9 men) or CT (7 women, 8 men) group. All participants received training for 4 weeks in 12 sessions. The outcomes of pain and performance were measured at three points in time: baseline, immediately after training and 2 weeks after training. Pain was assessed with the Numeric Pain Rating Scale (NPRS). Performance was measured with the leg-press test and the Kujala Patellofemoral Score (KPS). RESULTS: In both groups, pain intensity decreased significantly (p < 0.001) and the KPS and number of leg presses increased significantly (p < 0.001) with time. There was no significant difference between groups for changes in the pain score (p = 0.896), KPS (p = 0.463) or leg press (p = 0.796) results. CONCLUSION: Whole-body vibration training had the same effect as exercise therapy on pain reduction and on improvements in performance in athletes with PFP.

[Kinesio Taping combined with electroacupuncture for the treatment of patellofemoral disorder in middle-aged and elderly exercise enthusiasts].

OBJECTIVE: To observe the clinical efficacy of Kinesio Taping combined with electroacupuncture in the treatment of patellofemoral disorder in middle-aged and elderly exercise enthusiasts. METHODS: From April 2018 to April 2020, 62 middle-aged and elderly exercisers with patellofemoral disorder were selected and divided into observation group and control group. In the observation group, there were 30 cases:12 males and 18 females, aged from 35 to 66 years old, with an average age of (48.32±6.80) years old. The observation group was treated with Kinesio Taping and electroacupuncture . In the control group, there were 32 cases:12 males and 20 females, aged from 35 to 67 years old, with an averageage of (48.67±8.13) years old. The patients in the control group was treated with knee electroacupuncture. All the patients in both groups were treated once every other day, 3 times a week, for a total of 4 weeks. The VAS pain score and knee Lysholm score before and after treatment were compared between the two groups before and after treatment, and statistical analysis was conducted. RESULTS: In the control group, 2 patients were not satisfied with the curative effect after 2 weeks of treatment and gave up treatment, while the remaining 60 patients completed all the treatments. After 4 weeks of treatment, the VAS and Lyshlom scores of the control group were 2.73±1.46 and 75.63±8.62 respectively;the VAS and Lyshlom scores of the observation group were 2.02±1.85 and 83.31±5.53 respectively;the VAS and Lyshlom scores of the observation group and the control group were better than those before treatment, and the Lyshlom scores of the observation group were better than those of the control group. CONCLUSION: Kinesio Taping combined with electroacupuncture is aimed at patellofemoral disorderof middle-aged and elderly sports enthusiasts. It has little trauma, can relieve pain and has a fast onset speed, which is readily accepted by patients, and promotes the rehabilitation of knee joint function of patients, thus providing a favorable reference for the promotion in clinical application.

Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial.

BACKGROUND: Increasing evidence has shown benefits of spinal manipulations in patients with patellofemoral pain syndrome (PFPS). There is scarcity regarding medium term effects of spinal manual therapy on outcome measures in PFPS patients. Therefore, the aim of the present study was to compare the effectiveness of local exercise therapy and spinal manual therapy for knee pain, function and maximum voluntary peak force (MVPF) velocity of the quadriceps in PFPS patients. METHODS: Forty-three patients with PFPS were randomly assigned to a local exercise or spinal manual therapy group. The local exercise group received six sessions (one session per week) of supervised training of the knee-and hip muscles with mobilization of the patellofemoral joint. The spinal manual therapy group received six interventions (one intervention per week) of high velocity low thrust manipulations at the thoracolumbar region, sacroiliac joint, and/or hip. All patients were also asked to do home exercises. Maximum, minimum and current pain were measured using the visual analogue scale. Function was assessed with the anterior knee pain scale (AKPS) and MPFV was recorded using a Biodex System 3 dynamometer. Patients were assessed before intervention, after 6 weeks of intervention and after 6 weeks of follow-up. Between-group differences at assessments were analysed by way of analysis of covariance with Bonferroni correction. RESULTS: Pain and functionality improved more following spinal manipulative therapy than local exercise therapy. After 6 weeks of intervention the between-group difference (local versus spinal) for maximal pain was 23.4 mm [95% CI: 9.3, 37.6; effect size (ES): 1.04] and - 12.4 [95% CI: - 20.2, - 4.7; ES: 1.00] for the AKPS. At 6 weeks of follow-up the between-group difference for maximal pain was 18.7 mm [95% CI: 1.4, 36.0; ES: 0.68] and - 11.5 [95% CI: - 19.9, - 3.3; ES: - 0.87] for the AKPS. CONCLUSIONS: This study suggests that spinal manual therapy is more effective than local exercise therapy in improving pain and function in patients with PFPS in the medium term. We suggest for future research to investigate whether combining local exercise therapy and spinal manual therapy is more effective than either single intervention on its own. This clinical trial study was approved by the Medical Ethics Committee METC Z under registration number NL57207.096. and registered retrospectively in ClinicalTrials.gov PRS with registration ID number NCT04748692 on the 10th of February 2021.

Effect of photobiomodulation in the patellofemoral pain syndrome; randomized clinical trial in young women.

OBJECTIVE: patellofemoral pain syndrome (PFPS) is one of the most frequent musculoskeletal disorders in the knee joint, affecting mainly physically active adolescents and young adults; its main symptom is pain. Physiotherapy has several therapeutic modalities aimed at pain relief, among which are photobiomodulation (PBM). The aim of the study was to analyze the effects of using PBM in cluster form (Laser + LED) in patients with PFPS. PATIENTS AND METHODS: This study is characterized as quantitative, experimental, randomized, composed of 30 women with PFPS, randomized into two groups: Control Group (CG) and PBM Group (PBMG). Both groups underwent three evaluations: pre-intervention, post-intervention, and after one month of follow-up. Participants of the PBMG were presented to the application of the cluster device, three times a week, for four weeks. The intensity of spontaneous pain and movement were evaluated, knee function tests and function questionnaires. The results showed a reduction in pain only for the landing of the jump. As for the other variables there was no interaction of factors; the questionnaires used showed larger effect sizes for PBMG when compared to CG. It is possible to conclude that the use of PBM showed benefit in reducing pain at the time of landing of the jump and functional assessment questionnaires.

Short-term effectiveness of an intervention targeting lower limb range of motion on pain and disability in patellofemoral pain patients: A randomized, non-concurrent multiple-baseline study.

INTRODUCTION: Patellofemoral pain (PFP) is a common and often long-standing musculoskeletal condition. Evidence of the effectiveness of interventions addressing soft tissue flexibility is conflicting and of inconsistent scientific quality. However, reduced soft tissue flexibility can negatively affect patellofemoral joint kinematics. Lower limb range of motion (LLROM) reflects soft tissue flexibility throughout the kinetic chain. The aim was to evaluate the short-term effectiveness of an intervention targeting LLROM on pain and disability in patients with PFP. METHODS: A randomized, non-concurrent, multiple-baseline single-case design with a two-week intervention phase and baseline and postintervention phase with varying length was conducted. Eight participants (5 females, 3 males) of age 19(±1.6) years, weekly sports participation 12(±3.1) hours and 17(±14) months symptom duration were included. The Anterior Knee Pain Scale - Dutch Version (AKPS-DV) and the Patient Specific Complaint Scale (PSCS) were administered twice a week. After allocating participants to one of four subgroups of reduced LLROM the intervention was applied. The intervention consisted of soft tissue techniques (mobilization, taping, and stretching). RESULTS: Participant 3 and 6 showed a medium and small but statistically significant positive effect on the AKPS-DV. Participant 2 showed a large and statistically significant positive effect on the PSCS. CONCLUSIONS: This study provides moderate evidence that an intervention targeting LLROM in patients with PFP reduces pain and disability in the short-term. Further research is needed to evaluate the long-term effectiveness and optimize individual treatment outcomes.

Efficacy of Electromyographic-Biofeedback Supplementation Training with Patellar Taping on Quadriceps Strengthening in Patellofemoral Pain Syndrome among Young Adult Male Athletes.

This study compares the effects of electromyographic-biofeedback (EMG-BF)-guided isometric quadriceps strengthening with patellar taping and isometric exercise alone in patellofemoral pain syndrome (PFPS) among young adult male athletes. Sixty young adult male athletes with PFPS participated in the study. Participants were randomly divided into two groups: (1) EMG-BF-guided isometric exercise training with patellar taping (experimental group, n = 30), and (2) sham EMG-BF training with an isometric exercise program (control group, n = 30). Participants conducted their respective exercise programs for five days per week across four weeks. Study outcomes were pain (measured by the visual analog scale), functional disability (measured by the Kujala Anterior Knee Pain scale), and quadriceps strength (measured by an ISOMOVE dynamometer). Measurements were taken at baseline, Week 2, Week 4, and during a follow-up at Week 6. The experimental group demonstrated significantly lower VAS score at Weeks 2 and 4 compared to that of the control group (p = 0.008 and 0.0005, respectively). The score remained significantly lower at the Week 6 follow-up compared to the control group (p = 0.0005). There were no differences in knee function at Weeks 2 and 4 between the two groups (p = 0.086 and 0.171, respectively); however, the experimental group showed significantly better knee function at Week 6 compared to the control group (p = 0.002). There were no differences in quadriceps strength at Week 2 between the two groups (p = 0.259); however, the experimental group demonstrated significantly higher quadriceps strength at Weeks 4 and 6 compared to the control group (p = 0.0008). Four weeks of EMG-BF supplementation training with patellar taping demonstrated significant improvements in pain intensity, functional disability, and quadriceps muscle strength in young adult male athletes with PFPS.