No description available.

No description available.

Background Patients with patellofemoral pain (PFS) are common in primary health care. Young women are most affected, limiting them in everyday life and in sports. There is an increased risk of PFS in case of impaired strength and motor control in proximal musculature. Consensus prevails that therapeutic physical training should be included as part of rehabilitation, where the multimodal method is the golden standard. Purpose The aim is to evaluate the efficacy of tailored physiotherapy intervention involving motor control and strength training of proximal musculature combined with education with respect to pain, strength and function in patients with patellofemoral pain. Method A single subject experimental design study (SSED) consisting of three young women with PFS was conducted. The design is an A-B design, which includes a baseline phase with repeated measurements (A) and an intervention phase with tailored physiotherapy (B). The primary outcome measures were estimated with a visual analog scale (VAS) as well as strength measurement of proximal musculature with a handheld dynamometer (HHD). The secondary outcome measure was self-perceived function, estimated with Patient Specific Functional Scale (PSFS). Results The results of this SSED show that tailored physiotherapy intervention involving motor control and strength training of proximal musculature combined with education can be effective for young women with PFS. The results are not entirely consistent in terms of pain, strenght and self-perceived function where one in three participants showed significant (alpha 0.05) reduced pain and two out of three participants showed significant (alpha 0.05) improvement of self-perceived function. Regarding strength, there was no significant (alpha 0.05) effect on the affected side of any of the participants:  Conclusion Motor control and strength training of proximal musculature combined with education may be effective for young women with PFS with respect to pain and self-perceived function.

No description available.

Osteoarthritis (OA) of the knee is common in Western society. OA of the patellofemoral (PF) compartment of the knee is prevalent in adults greater than 55 years of age. Isolated radiographic PFOA is present in 13.6-24% of females and 11-15.4% of males with knee pain. Biomechanical factors such as tibiofemoral alignment and high joint stress are associated with the development and progression of PFOA. PF joint stress is high when the quadriceps contracts with the knee in a position of extreme flexion, such as rising from sitting. The purposes of this study were to determine 1) the triplanar biomechanics of the hips and knees during sit-to-stand (STS) for persons with PFOA versus age- and gender-matched control subjects, 2) the impact of PFOA on physical performance, perceived functional status, and pain, and 3) the relationship between knee kinematics during STS and physical performance. The biomechanics of STS was examined using a video-based motion analysis system and two force plates. Physical performance was measured with the Timed Up and Go (TUG) and Fifty-Foot Walk (FFW) tests. Perceived functional status, pain, and stiffness were measured using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. Knee pain was measured with a Visual Analog Scale (VAS) following STS, TUG, and FFW. Persons with PFOA required a significantly longer time to perform STS and the TUG as compared to healthy controls. The PFOA group demonstrated greater hip flexion and knee abduction versus the control group. The hip and knee moments were significantly different with the PFOA group demonstrating greater hip extension, hip abduction, hip external rotation, knee extension, and knee adduction moments. Persons with PFOA were found to have significantly less perceived physical function, greater stiffness, and greater pain. Pain following STS, TUG, and FFW were all greater in the PFOA group. No significant association was found between any knee angle and time to perform the TUG or the FFW. These results indicate that dynamic malalignment of the TF joint is present during STS in persons with PFOA. This may contribute to the increased pain and decreased function in persons with PFOA. / Physical Therapy

Bakgrund: Patellofemoral smärta (PFS) är vanligt förekommande hos idrottsaktiva barn och ungdomar vilket kan leda till långvariga besvär och till att barn slutar vara fysiskt aktiv. Individuell fysioterapeutisk behandling används ofta inom primärvården för att tackla detta problem. Syftet med denna studie var att undersöka vad individuell fysioterapeutisk behandling innebär och granska evidensen för detta samt relatera prevalensen av PFS relaterat till tidig sportspecialisering.   Metod: Systematisk litteraturstudie. Sökning gjordes i databaserna PubMed och PEDro. Evidensgradering bedömdes med PEDro, SBUs GRADE och modifierade GRADE. Åtta studier inkluderades i litteraturstudien. En studie undersökte prevalensen av PFS relaterat till tidig specialisering. Sex studier undersökte en multimodal behandling med biopsykosociala faktorer för förbättrad knäsmärta samt självupplevd funktion hos barn och unga både kort- och långsiktigt. En studie undersökte effekten av knä- och höft-träning med gummiband.    Resultat: En studie kom fram till att tidig specialisering ökar risken för PFS 1.5 gånger. Sex studier visade på goda effekter av multimodal behandling med biopsykosociala faktorer för knäsmärta samt självupplevd funktion hos barn och unga både kort- och långsiktigt, dock bedömdes den gemensamma evidensen som otillräcklig enligt GRADE. En studie med hög evidens visade att knä- och höft-träning med gummiband gav minskad knäsmärta samt ökad muskelstyrka.    Konklusion: Tidig specialisering medför en ökad risk för PFS, detta bör kliniker vara uppmärksamma på vid behandling. Behandling för PFS bör inte enbart fokusera på styrketräning för knä- och höft-muskulatur utan även involvera en patientutbildning kring biomekanik av strukturer runt knät och smärthantering samt modifiera de aktiviteter som medför smärta. / Background: Patellofemoral pain (PFP) is common in children and adolescents that are physically active, if untreated it may lead to persistent inconvenience and an abrupt end to adolescents involvement in sports. Individual physiotherapeutic treatment is commonly used in primary care to assess this problem. The purpose of this study was to investigate the concept individual physiotherapeutic treatment in PFP while assessing their evidence and to investigate the prevalence of PFP related to early sport specialisation.   Method: Systematic review. The search was conducted in databases PubMed and PEDro. Eight studier were included in the study. These studies were assessed to evidence quality according to PEDro-scale, SBUs regular- and modified GRADE. One study investigated the prevalence of PFS related to early sports specialization (ESS). Six studies investigated a multimodal treatment involving biopsychological factors. One study investigated the effect of knee- and hip-training with Theraband.    Results: Early sport specialization increased the risk for PFP 1.5 times. Six studies showed promising results on factors as knee pain and self-assessed function within the population using a multimodal treatment, the combined evidence was estimated as insufficient. One study with high evidence concluded that knee- and hip-training with Theraband decreased knee pain and increased muscle strength.    Conclusion: ESS is associated with an increased risk of developing PFP, this could be a factor that clinicians should be aware of when treating PFP. An intervention treating PFP should include musclestrenghtening and involve psycosocial factors, one method could be through patient education.

De etiologia multifatorial, a síndrome dolorosa fêmoro-patelar (SDPF) acomete de 7 a 15% da população, em sua maioria jovens, adultos e ativos. Causa dor difusa anterior ou retropatelar e é exacerbada durante atividades funcionais, como subir e descer degraus, permanecer por um período prolongado sentado, agachado ou ajoelhado (COWAN, BENNELL e HODGES, 2002). Tanto o processo de avaliação quanto a evolução do tratamento baseiam-se, fundamentalmente, no relato de dor feito pelo paciente e na incapacidade funcional. Diagnosticar corretamente o distúrbio possibilitaria um tratamento mais adequado e permitiria o acompanhamento do quadro evolutivo do paciente ao longo do tratamento proposto. Desta maneira, propôs-se a análise de alguns parâmetros biomecânicos para melhor caracterização destes indivíduos. 33 voluntárias - 11 com diagnóstico médico de dor fêmoro-patelar e 22 clinicamente normais - foram submetidas à avaliação por meio de eletromiografia de superfície das porções medial e lateral do quadríceps; análise tridimensional de movimento; e plataforma de força durante a subida de degraus. As voluntárias do grupo SDFP foram caracterizadas por um atraso no tempo de atividade máxima do músculo vasto medial em relação ao vasto lateral (4 ms), aumento da rotação externa do fêmur (3,14 graus) e menor variação global do torque (1,14 Nm), quando comparadas aos indivíduos do grupo controle. Os resultados obtidos complementam-se e ajudam a entender características de comportamento neuromotor em indivíduos com dor fêmoro-patelar. Conjuntamente, esses instrumentos apresentam grande potencial para a avaliação e classificação dos indivíduos com relação à síndrome. / From multifactorial etiology, patellofemoral pain syndrome (PFPS) affects 7 to 15% of the population, mostly young, adults and active people. It causes anterior or behind patella diffuse pain and is exacerbated during functional activities such as climbing and descending stairs or stay for a long time sitting, kneeling or crouching down (COWAN, BENNELL e HODGES, 2002). The evaluation process as much as the evolution of treatment is fundamentally based in the reporting of pain by the patient and the functional disability. Correct diagnostic of the disorder would allow a more appropriate treatment as well as to keep up with the patient evolution during the proposed treatment. Thus, it was proposed the biomechanical analysis of some parameters to better characterize these individuals. 33 female volunteers - 11 with medical diagnosis of patellofemoral pain and 22 clinically normal - were submitted to evaluation of surface electromyography of the medial and lateral portions of the quadriceps, three-dimensional motion analysis and force plate during the ascent of steps. The volunteers of the PFPS group were characterized by a delay in time of maximum activity of the vastus medialis muscle related to the vastus lateralis (4 ms), increased femoral external rotation (3.14 degrees) and less overall variation in the torque (1.14 Nm) when compared to individuals in the control group. The results complement each other and help to understand features of neuromotor behavior in individuals with patellofemoral pain. Together, these tools have great potential for assessment and classification of these individuals related to the syndrome.

A síndrome da dor patelofemural é uma das disfunções mais comuns que acometem o joelho, principalmente mulheres jovens fisicamente ativas. No entanto, o tratamento permanece desafiador por carecer de bases científicas que direcionem sua reabilitação. Distúrbios no alinhamento estático e dinâmico dos membros inferiores, como a pronação excessiva do retropé, têm sido associados na clínica e embasados teoricamente como fatores de risco para a disfunção. No entanto, estudos experimentais que embasem esta relação ainda são controversos. O objetivo geral deste estudo foi verificar a influência da síndrome da dor patelofemural no alinhamento postural do retropé e joelho, assim como na distribuição da pressão plantar durante a fase apoio do descer escadas e em três subfases do apoio da marcha. Foram estudados 77 adultos jovens de ambos os sexos, divididos em grupo controle (GC=47) e grupo síndrome da dor patelofemural (GSPF=30). Para responder a questões científicas específicas, foram realizados três experimentos. O experimento 1 teve o objetivo específico de verificar a associação entre a síndrome da dor patelofemural e o alinhamento postural dos membros inferiores (n=77; GC=47,GSPF=30). Para tanto, foram avaliadas três medidas clínicas: o ângulo do retropé, o ângulo Q (fotogrametria digital) e a orientação médiolateral da patela (método adaptado de Mc Connell). O experimento 2 teve como objetivo específico investigar a distribuição da pressão plantar de indivíduos com e sem diagnóstico de síndrome da dor patelofemural durante o descer escadas, e avaliar a dor dos sujeitos com essa disfunção antes e após a tarefa proposta (n=74; GC=44,GSPF=30). Para tanto, avaliouse a distribuição da pressão plantar por meio de palmilhas capacitivas (Pedar X System) na fase de apoio do descer escadas e a dor referida pelos sujeitos pela escala analógica visual de dor antes e depois da tarefa motora. O experimento 3 (n=57; GC=35,GSPF=22) buscou especificamente avaliar a influência da síndrome da dor patelofemural na distribuição da pressão plantar durante o contato inicial, médio-apoio e propulsão da fase de apoio da marcha. Os principais resultados demonstraram que não houve influência da disfunção no alinhamento postural do retropé e joelho. No entanto, durante o descer escadas, a síndrome da dor patelofemural esteve associada à um contato medialmente direcionado no retropé e médio-pé, assim como menores sobrecargas plantares, provavelmente associadas ao aumento significativo da dor relatada pelos sujeitos após a tarefa. Na marcha, os sujeitos com a disfunção realizaram novamente um contato inicial medialmente direcionado no retropé e uma propulsão mais lateralizada no antepé. Os resultados deste estudo mostram que a síndrome da dor patelofemural não esteve relacionada ao alinhamento postural do retropé e joelho, mas influenciou o padrão dinâmico da distribuição da pressão plantar tanto na marcha como no descer escadas. Estes achados confirmam a importância da avaliação dinâmica durante a reabilitação dos indivíduos com esta disfunção. / Patellofemoral pain syndrome is one of the most common dysfunctions of the knee, particularly among young physically active females. Its treatment remains challenger due to the lack of scientific rationales bases to guide its rehabilitation. Static and dynamic misalignment of the lower extremity, like excessive rearfoot pronation has been clinically and theoretically associated as risk factors for this dysfunction. However, scientific studies to confirm this association are still controversial. The general purpose of this study was to verify the influence of patellofemoral pain syndrome on rearfoot and knee postural alignment as well as on plantar pressure distribution during the stance phase of stair descent and three sub phases of stance gait. 77 young adults of both sexes divided in to control group (GC=47) and patellofemoral pain goup(PFPG=30) were studied. Three experiments were realized in order to respond the specific scientific questions. The experiment 1 had the specific purpose of verify the association between patellofemoral pain syndrome and postural alignment of rearfoot and knee (n=77; CG=47, PFPG=30). Therefore, three clinical measurements were evaluated: rearfoot angle, Q angle (digital photogrammetry) and the medio-lateral orientation of the patella (adapted from McConnell). The experiment 2 aimed specifically to investigate plantar pressure distribution in subjects with and without patellofemoral pain syndrome, during the stair descent, and evaluate the pain referred by the subjects before and after the motor task (n=74;CG=44,PFPG=30), plantar pressure distribution was evaluated with capacitive insoles(Pedar X System) during the stance phase of stair descent as well as the pain referred by the subjects by Visual Analogue Scale before and after the task. The experiment 3 intended specifically to verify the influence of patellofemoral pain syndrome on plantar pressure distribution during initial contact, midstance and propulsion of the gait stance (n=57; GC=35, GSPF=22). The principal results of this study showed that there was no influence of the dysfunction on postural alignment of rearfoot and knee. However, patellofemoral pain syndrome during the stair descent was related to a medially directed contact at the rearfoot and midfoot and lower plantar loads probably due to the increase in pain observed after the task. During gait, the subjects with the dysfunction showed again an initial contact medially directed at the rearfoot and laterally directed propulsion on forefoot. The results of this study show that patellofemoral pain syndrome was not associated to postural alignment but influenced the plantar pressure distribution during gait as well as stair descending task. These findings confirm the importance of the dynamic evaluation of subjects with this dysfunction during their rehabilitation.

A síndrome da dor patelofemural é uma das disfunções mais comuns que acometem o joelho, principalmente mulheres jovens fisicamente ativas. No entanto, o tratamento permanece desafiador por carecer de bases científicas que direcionem sua reabilitação. Distúrbios no alinhamento estático e dinâmico dos membros inferiores, como a pronação excessiva do retropé, têm sido associados na clínica e embasados teoricamente como fatores de risco para a disfunção. No entanto, estudos experimentais que embasem esta relação ainda são controversos. O objetivo geral deste estudo foi verificar a influência da síndrome da dor patelofemural no alinhamento postural do retropé e joelho, assim como na distribuição da pressão plantar durante a fase apoio do descer escadas e em três subfases do apoio da marcha. Foram estudados 77 adultos jovens de ambos os sexos, divididos em grupo controle (GC=47) e grupo síndrome da dor patelofemural (GSPF=30). Para responder a questões científicas específicas, foram realizados três experimentos. O experimento 1 teve o objetivo específico de verificar a associação entre a síndrome da dor patelofemural e o alinhamento postural dos membros inferiores (n=77; GC=47,GSPF=30). Para tanto, foram avaliadas três medidas clínicas: o ângulo do retropé, o ângulo Q (fotogrametria digital) e a orientação médiolateral da patela (método adaptado de Mc Connell). O experimento 2 teve como objetivo específico investigar a distribuição da pressão plantar de indivíduos com e sem diagnóstico de síndrome da dor patelofemural durante o descer escadas, e avaliar a dor dos sujeitos com essa disfunção antes e após a tarefa proposta (n=74; GC=44,GSPF=30). Para tanto, avaliouse a distribuição da pressão plantar por meio de palmilhas capacitivas (Pedar X System) na fase de apoio do descer escadas e a dor referida pelos sujeitos pela escala analógica visual de dor antes e depois da tarefa motora. O experimento 3 (n=57; GC=35,GSPF=22) buscou especificamente avaliar a influência da síndrome da dor patelofemural na distribuição da pressão plantar durante o contato inicial, médio-apoio e propulsão da fase de apoio da marcha. Os principais resultados demonstraram que não houve influência da disfunção no alinhamento postural do retropé e joelho. No entanto, durante o descer escadas, a síndrome da dor patelofemural esteve associada à um contato medialmente direcionado no retropé e médio-pé, assim como menores sobrecargas plantares, provavelmente associadas ao aumento significativo da dor relatada pelos sujeitos após a tarefa. Na marcha, os sujeitos com a disfunção realizaram novamente um contato inicial medialmente direcionado no retropé e uma propulsão mais lateralizada no antepé. Os resultados deste estudo mostram que a síndrome da dor patelofemural não esteve relacionada ao alinhamento postural do retropé e joelho, mas influenciou o padrão dinâmico da distribuição da pressão plantar tanto na marcha como no descer escadas. Estes achados confirmam a importância da avaliação dinâmica durante a reabilitação dos indivíduos com esta disfunção. / Patellofemoral pain syndrome is one of the most common dysfunctions of the knee, particularly among young physically active females. Its treatment remains challenger due to the lack of scientific rationales bases to guide its rehabilitation. Static and dynamic misalignment of the lower extremity, like excessive rearfoot pronation has been clinically and theoretically associated as risk factors for this dysfunction. However, scientific studies to confirm this association are still controversial. The general purpose of this study was to verify the influence of patellofemoral pain syndrome on rearfoot and knee postural alignment as well as on plantar pressure distribution during the stance phase of stair descent and three sub phases of stance gait. 77 young adults of both sexes divided in to control group (GC=47) and patellofemoral pain goup(PFPG=30) were studied. Three experiments were realized in order to respond the specific scientific questions. The experiment 1 had the specific purpose of verify the association between patellofemoral pain syndrome and postural alignment of rearfoot and knee (n=77; CG=47, PFPG=30). Therefore, three clinical measurements were evaluated: rearfoot angle, Q angle (digital photogrammetry) and the medio-lateral orientation of the patella (adapted from McConnell). The experiment 2 aimed specifically to investigate plantar pressure distribution in subjects with and without patellofemoral pain syndrome, during the stair descent, and evaluate the pain referred by the subjects before and after the motor task (n=74;CG=44,PFPG=30), plantar pressure distribution was evaluated with capacitive insoles(Pedar X System) during the stance phase of stair descent as well as the pain referred by the subjects by Visual Analogue Scale before and after the task. The experiment 3 intended specifically to verify the influence of patellofemoral pain syndrome on plantar pressure distribution during initial contact, midstance and propulsion of the gait stance (n=57; GC=35, GSPF=22). The principal results of this study showed that there was no influence of the dysfunction on postural alignment of rearfoot and knee. However, patellofemoral pain syndrome during the stair descent was related to a medially directed contact at the rearfoot and midfoot and lower plantar loads probably due to the increase in pain observed after the task. During gait, the subjects with the dysfunction showed again an initial contact medially directed at the rearfoot and laterally directed propulsion on forefoot. The results of this study show that patellofemoral pain syndrome was not associated to postural alignment but influenced the plantar pressure distribution during gait as well as stair descending task. These findings confirm the importance of the dynamic evaluation of subjects with this dysfunction during their rehabilitation.

Anterior knee pain (AKP) is a common, chronic lower limb musculoskeletal overuse condition that represents substantial morbidity to those affected, and has a significant impact on the health care industry. Health practitioners frequently prescribe foot orthoses in the management of AKP as an alternative or adjunct to multimodal physiotherapy. The primary aim of this thesis was to investigate the clinical efficacy of foot orthoses in AKP, utilising high-quality research methodologies. The two systematic reviews conducted have identified a significant gap in the literature regarding evidence from randomised clinical trials (RCTs) for foot orthoses in AKP and other lower limb overuse conditions. While the best evidence for AKP management was for multimodal physiotherapy, there was insufficient evidence to support or refute the use of foot orthoses in the treatment of lower limb overuse conditions, including AKP. Meta-analysis provided evidence to support the use of foot orthoses in the prevention of the first incidence of lower limb overuse conditions. An interesting finding was evidence from pooled and individual study data of no difference between custom and prefabricated foot orthoses in both treatment and prevention of lower limb overuse conditions, inferring that either type of orthosis may be utilised. Both systematic reviews highlighted substantial methodological flaws of the included studies, and recommended that future studies include larger participant numbers, longer participant follow-up, more consistent use of reliable and valid outcome measures and reporting of outcome data, and utilisation of the CONSORT guidelines in the design and reporting of RCTs. A 12-month prospective RCT investigated the short- and long-term clinical efficacy of prefabricated foot orthoses in the treatment of 179 participants with AKP. Foot orthoses were more effective than flat shoe inserts in the short term, implying that their contoured form has some therapeutic effect. Foot orthoses were not significantly different to multimodal physiotherapy over 12 months, nor was there any benefit in adding foot orthoses to physiotherapy. Considering that all groups experienced clinically meaningful long-term improvements in pain and function, clinicians may prescribe foot orthoses for AKP to hasten recovery. Findings of post-hoc analyses to develop a clinical prediction rule indicate that those of older age and shorter height, who have a lower severity of AKP and a more mobile midfoot, are more than twice as likely to experience a successful outcome with foot orthoses. As a secondary aim, this thesis has provided a more comprehensive profile of AKP as a condition. Baseline data from the RCT participants confirms previous reports of higher rates of AKP in females, and a tendency towards bilaterality and chronicity. This AKP sample did not differ from asymptomatic individuals in terms of body mass index, physical activity level, general and mental health, and foot posture, although they tended to have a more mobile foot under load. These characteristics tend to be homogenous across a number of published RCTs, indicating that the findings of the RCT described above are likely to be generalisable to the broader population with AKP. An additional finding in this group was that those with AKP of long duration, higher pain levels, lower functional levels, and an overall lower score on a specific measure of AKP have a poorer prognosis over 12 months, irrespective of their age, gender or morphometry. These findings suggest that, in order to improve prognosis and the chance of a successful outcome, the primary goals of intervention should be to reduce the severity and duration of AKP, through the use of early intervention with foot orthoses, multimodal physiotherapy, or a combination of the two.