M.Tech.

Patellofemoral pain syndrome (PFPS) is one of the most common, but least understood, knee disorders. Fulkerson (1997) believes that pathology may result from an excessive valgus force being applied to the patella. Researchers have historically examined quadriceps strength and neuromuscular activity and knee kinematics. However, results from these works have not provided conclusive answers. Powers (2003) has theorized that other structures can influence knee function, and researchers have shown that PFPS subjects can exhibit hip weakness and demonstrate altered hip kinematics during functional activities. Although they provide preliminary evidence regarding hip influences, investigations that simultaneously examine hip and knee function in PFPS subjects are needed. The primary purpose of this study was to determine functional performance, strength, neuromuscular activity (amplitudes and onset timing differences), and kinematics of the hip and knee for people diagnosed with PFPS. Eighteen females diagnosed with PFPS and 18 asymptomatic female controls participated. Subjects initially completed a 10-cm visual analog scale. Next, they completed two functional performance tests and underwent a strength assessment for the hip abductors, hip external rotators, and knee extensors. Surface electromyography (EMG) electrodes and reflective markers were donned in order to collect EMG and kinematic data during a stair-stepping task. For this purpose, subjects ascended and descended two 20-cm high steps at a standardized rate. Seven PFPS and seven control subjects were retested five to seven days later to establish measurement reliability. A repeated measures analysis of variance was used to determine group differences. Correlation coefficients were calculated to identify associations between pain and dependent measures; intraclass correlation coefficients were calculated to determine measurement reliability for both control and PFPS subjects. Results from this study showed group differences for functional performance, strength, and EMG amplitudes but none for onset timing differences or kinematics. A strong association was found between pain and hip external rotator strength and EMG amplitudes during stair-stepping. Most tests provided reliable measures with repeat testing. PFPS subjects demonstrated quadriceps dysfunction but even greater hip weakness that was correlated more with pain. Contemporary rehabilitation has focused on quadriceps strengthening; however, results from this study support the importance of the hip.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2005. / Härtill 4 uppsatser.

Orientador: Sergio Rocha Piedade / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T10:38:39Z (GMT). No. of bitstreams: 1 Reis_JuliaGuimaraes_M.pdf: 2248238 bytes, checksum: 945fbd990c61ac6b327c4c18556ee2e0 (MD5) Previous issue date: 2008 / Resumo: Das anormalidades que envolvem a articulação do joelho, a disfunção do aparelho extensor é um dos problemas mais freqüentemente encontrados na prática ortopédica. Para abranger toda a complexidade de investigação da locomoção necessita-se de informações qualitativa e quantitativa da cinética (momentos e forças) e cinemática (ângulos). O objetivo do estudo foi identificar e analisar as alterações biomecânicas dos indivíduos com instabilidade patelofemoral objetiva durante a marcha. A amostra foi composta de 10 indivíduos com instabilidade patelofemoral (grupoI), média de idade de 25,6 (±7,6) anos, média de altura de 1,63 (±0,06) m e média de peso de 63,3 (±13,52) kg; e, 14 indivíduos sem história de lesão músculo-esquelética (grupo controle ou grupo II), com média de idade de 24,14 (±2,71) anos, média de altura de 1,63 (±0,05) m e média de peso de 59,43 (±10,02) kg. Ambos os grupos foram submetidos a uma análise cinemática e cinética, onde os mesmos caminharam em velocidade livre, numa passarela de 10 m de comprimento. As imagens foram filmadas por seis câmeras do sistema Qualysis, que capturou os sinais de marcadores reflexíveis posicionados no membro inferior das voluntárias. Paralelamente, aplicou-se no grupo I uma avaliação clínica do grau de funcionalidade dos joelhos lesados, onde a pontuação os classificou como funcionalmente ruins; e, um exame físico, onde ambos os membros apresentaram-se estatisticamente semelhantes. A análise dos dados cinemáticos e cinéticos foi realizada pelo programa Qgait que mostrou menor flexão de joelho, nas fases de apoio e balanço (p<0,0001); menor momento extensor de joelho, no apoio (p<0,0001); e, maior força de reação do solo (p=0,4094), no grupo de pacientes em relação ao controle. Foram avaliados também parâmetros espaços-temporais como velocidade (p=0,0053), cadência (p=0,0376) e comprimento da passada (p=0,0021), onde o grupo I apresentou valores inferiores comparado ao grupo controle. Já no período de apoio (p=0,1186), o grupo I superou o grupo II. Estes resultados sugerem que o grupo I utilizou várias estratégias durante a marcha, na tentativa de reduzir a dor e a pressão na articulação patelofemoral. Entretanto, a força de reação do solo não foi reduzida, o que poderá resultar em danos a outras articulações, em longo prazo, devido a cargas repetitivas na articulação tíbiofemoral / Abstract: Abnormalities involving knee joint, the dysfunction of the extensor apparatus, it is one of the problems most often found in orthopaedic practice. To cover the full complexity of of locomotion research, it is necessary qualitative and quantitative information of kinetic (moments and forces) and kinematics (angles). The objective of the study was to identify and analyse the biomechanical changes of individuals with objective patellofemoral instability during gait. The sample was composed of 10 individuals with patellofemoral instability (group I), mean age of 25.6 (± 7.6) years, the average height of 1.63 (± 0.06) m and mean weight of 63.3 (± 13 , 52) kg; and 14 individuals with no history of musculo-skeletal injury (control group or group II), with an average age of 24.14 (± 2.71) years, the average height of 1.63 (± 0.05) m and mean weight of 59.43 (± 10.02) kg. Both groups were subjected to an analysis kinematics and kinetics, where they walked naturally on a 10 m walkway. The images were filmed by six cameras Qualysis system, which captured the signs of reflective markers placed on the lower limb of the volunteers. Paralely, was applied in the group I a functional clinical assessment of the degree functionality in the knee injured that classified it as bad functionally; and, physical examination, where both limbs showed up statistically similar. The analysis of kinematic and kinetic data was performed by the Qgait program that showed less of knee flexion, in the stance and balance phase (p <0.0001), less knee extensor moment, in support (p <0.0001); and, greatest ground reaction force (p = 0.4094) in the group of patients with respect to control. They were also assessed spatiotemporal parameters such as speed (p = 0.0053), cadence (p = 0.0376) and stride length (p = 0.0021), where the group I showed lower values compared to control group. Already in the support period (p = 0.1186), group I overcame the group II. These results suggest that the group I used several strategies during gait, in an attempt to reduce the pain and pressure in patellofemoral joint. However, the ground reaction force was not reduced, which could result in damage to other joints, in the long term, due to repetitive loads in tibiofemoral joint / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

OBJECTIVE: Patellofemoral Pain Syndrome (PFPS) is the most common diagnosis in patients presenting knee pain (~25%), and one of the most common diagnosis in sports medicine centers. Here we examine believed risk factors in Patellofemoral Pain Syndrome (PFPS) and assess their relationship to PFPS. METHODS: The study was a retrospective study completed at Johns Hopkins Department of Orthopaedic Surgery. All patients, who were referred to physical therapy at Johns Hopkins Rehabilitation Therapy Services Clinic, were diagnosed with PFPS for the first time and were mostly recreational runners. Body mass indexes (BMI) were calculated from weight and height. Pain scores were taken using the visual analog scale. Strength measurements were taken from the left and right leg for the following measurements: hip abduction external rotation, hip abduction, knee extension, and hip extension. Balance measurements were also taken on the left and right sides measuring the postural sway with eyes open and eyes closed. Statistical analysis were accomplished using excel. RESULTS: A total of 23 patients were included in the present study, 9 females and 14 males. BMI's (lb/in^2) for the population was 25.1 (±4.2), males were 26.4 (±3.6) and females were 23.2 (±4.2). Pain scores were 6 (±1.9) out of 10 for the total population, males, and females. The total population had composite hip scores 35.0% and 22.9% for the right and left sides, while the knee extension was 50.7% and 51.7%. All hip scores were below 40 except for right hip ABD/ER in females and lower than knee extension scores in males, females, and total population. The ratio for right eyes closed to open was 34.2 (±62.7) and left eye closed to open was 24.7 (±44.3) for the total population CONCLUSION: This study demonstrated that age and BMI may have an effect on the development of PFPS but no statistical significance was confirmed. Results suggest that hip strength is a better indicator than knee strength in risk associated with PFPS. Balance appears to be more of an indicator of poor hip strength than as a measurement or potential risk factor for PFPS.

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: This review aims to present the available evidence for the effect of McConnell taping on knee biomechanics in individuals with Anterior Knee Pain (AKP). Pubmed, Medline, Cinahl, Sportdiscus, Pedro and Science Direct electronic databases were searched from inception until September 2014. Experimental research into knee biomechanical or EMG outcomes of McConnell taping compared to no tape or placebo tape were included. Two reviewers completed the searches, selected the full text articles and assessed the risk of bias of eligible studies. Authors were contacted for missing data. Eight heterogeneous studies with a total sample of 220 were included in this review. All of the studies had a moderate to low risk of bias and compared taping to no tape and/ or placebo tape. Pooling of data was possible for three outcomes; average knee extensor moment, average VMO/VL ratio and average VMO-VL onset timing. None of these outcomes revealed significant differences. The evidence is currently insufficient to justify the routine use of the McConnell Taping technique in the treatment of Anterior Knee Pain. There is a need for more evidence on the aetiological pathways of Anterior knee Pain; level one evidence and studies investigating other potential mechanisms of McConnell taping. / AFRIKAANSE OPSOMMING: Die objektief van hierdie resensie was om te bepaal wat die effekte van McConnell Patellar Vasbinding is op knie kinematika, kinetiek en spier aktivering in diegene met Voorafgaande Knie Pyn (VKP). Die navorsers het elektroniese databases soos Pubmed, Medline, Cinahl, Sportdiscus, Pedro en Science Direct, van aanvang tot September 2014, ondersoek. Eksperimenteel studie ontwerpe wat biomeganiese of EMG gevolge van McConnell Vasbinding vergelyk met geen vasbinding of placebo vasbinding, is ingesluit. Twee resente het die ondersoek voltooi, die volle tekse artikels gekies en die partydigheid risiko van die ingeslote studies, geskat. Skrywers is gekontak vir enige verlore data. Agt heterogeen studies uit ‘n totalle monster van 220 is in hierdie resensie ingesluit. Al die studies het ‘n gematigde tot laag risiko vir eensydigheid en vergelyk vasbinding met geen of placebo vasbinding. Data saamvoeging was moontlik vir drie uitslae, naamlik: gemiddelde knie ekstensor moment; gemiddelde VMO/VL ratio en gemiddelde aanval tydmeting. Geen gevolge het veelseggende verskille of afwykings vertoon. Tans is die bewys nie genoegsaam om die routiene gebruik van McConnell Vasbinding tegniek te regverdig nie in die behandeling van VKP. Meer bewyslewering op die etiologiese paaie van VKP; Graad een bewys en studies wat ander moontlike meganisme van Mc Connell Vasbinding ondersoek, is noodsaaklik.

Patellofemoral pain syndrome (PFPS) is the most common injury in runners. This thesis investigates the theory that prolonged eversion at the rear-foot causes prolonged tibial internal rotation and excessive femoral internal rotation, and predisposes female, distance runners to PFPS. Since eversion occurs at the subtalar joint, the morphology of the talus and calcaneus were also assessed. The study was a case-control investigation between female runners with a history of PFPS (n = 9) and normal controls (n = 10). Gait analysis was used to measure lower-limb joint angles during barefoot, treadmill running. It was hypothesised that runners with PFPS would demonstrate prolonged rearfoot eversion and tibial internal rotation, and increased hip internal rotation compared to normal controls. Computed tomography was used to image the foot and ankle in simulated weight-bearing using a custom-built loading rig. Three-dimensional models of the talus and calcaneus were generated and their shapes were quantified using principal axis lengths and orientations. The results did not support the theory that prolonged eversion and rear-foot structure predispose to PFPS during running, and attributing PFPS to these factors should be done with discretion. However, runners with a history of PFPS exhibited increased rear-foot eversion, reduced rear-foot dorsiflexion and increased knee internal rotation compared to normal controls during running, walking and squatting. Subjects with PFPS also demonstrated increased dorsiflexion at the mid-foot. It was proposed that increased eversion was secondary to reduced rear-foot dorsiflexion as this enabled compensatory dorsiflexion at the mid-tarsal complex. Due to the tight articulation of the ankle mortise, increased knee internal rotation corresponds well with excessive rear-foot eversion. A prospective study is required to establish whether these kinematic alterations are a cause or an effect of PFPS.

Previous studies for treating Patellofemoral Pain Syndrome (PFPS) are controversial regarding the effectiveness in alleviating anterior knee pain (AKP). The muscular imbalance between the vastus medialis oblique/vastus lateralis (VMO/VL) may be the underlying mechanical issue causing PFPS. It is hypothesized that Botox can decrease the force production capability of the lateral musculature mechanically similar to surgery. Strengthening the VMO while using Botox treatment can alleviating the muscular imbalance that occurs with subjects with PFPS. A double blind study, having all participants blinded and uninformed of the injection contents, was implemented to test this hypothesis testing three female subjects. Four knees were treated. One subject received the Botox treatment and serially a placebo injection in the other limb. Two other subjects received placebo injections. EMG was executed to evaluate functional testing and the performance of the injections during extension exercises. Electromyography (EMG) data were collected from the muscle groups while the subjects performed forceful knee extension activities on an isokinetic dynamometer. In addition, kinetic jump data and self-reports of pain and activity were collected. Data were collected four times during a 12-week period. The subject who received Botox injections expressed a significant decrease in reported PFP and an increase in daily activities. Botox was safe and effective in eliminating anterior knee pain. The VMO and VL resulted in similar fatigue indices at the completion of the 12- week study. The VMO and VL both resisted fatigue during at week 12.

A Síndrome Dolorosa Femoropatelar (SDFP), possui etiologia multifatorial e acomete cerca de 7 a 15% da população, em sua maioria mulheres, jovens, adultas e ativas. Ela causa dor anterior ou retropatelar e é exacerbada durante gestos motores funcionais, tais como subir e descer escadas ou permanecer longos períodos de tempo sentado, agachado ou ajoelhado. Como a avaliação diagnóstica desta síndrome ainda é indireta, diversos mecanismos e metodologias buscam realizar uma classificação que diferencie os portadores de SDFP com relação aos assintomáticos. Deste modo, o objetivo desse trabalho é estudar as relações entre os sinais eletromiográficos (EMG) do músculo quadríceps em indivíduos com SDFP durante exercícios isométricos distintos (dissipativo e conservativo) em diferentes ângulos da articulação tíbiofemoral, e compará-los com os indivíduos sem SDFP. Foram analisadas a intensidade do sinal EMG (RMS), a frequência mediana (Fmed) e a frequência em 95% (F95) do espectro de potência dos músculos vasto medial oblíquo (VMO), vasto lateral (VL) e reto femoral (RF) para as contrações isométricas dissipativa e conservativa. Participaram deste estudo 24 voluntários do sexo feminino (17 assintomáticos e 7 com SDFP) que realizaram 18 contrações nos ângulos de 90º, 60º e 20º de extensão de joelho, utilizando 30% da carga voluntária máxima. Eletrodos EMG foram posicionados nos referidos músculos para a coleta dos dados, os quais foram posteriormente tratados e processados, possibilitando a análises do sinal EMG nos domínio do tempo e da frequência. Os resultados indicam que o RMS do sinal EMG apresenta-se distinto entre as contrações isométricas para o grupo sintomático e evidenciam que não existe uma relação de intensidade de contração EMG de um músculo comparativamente ao outro quando se altera o gesto motor. A Fmed de VMO e VL podem ser utilizadas como ferramenta na detecção de SDFP, visto que atuam de maneira distinta entre os grupos. A F95 do músculo VMO comporta-se de um modo diferente entre os grupos, sendo que durante a contração isométrica dissipativa em 20º e 60º, seus valores em SDFP foram maiores do que no grupo Controle. Desta maneira, foi possível relatar que é possível diferenciar a SDFP, ou até mesmo detectá-la, utilizando parâmetros EMG de padrões diferentes de contrações isométricas. / The Patellofemoral Pain Syndrome (PFPS) has a multifactorial etiology and affects approximately 7-15% of the population, mostly active young women. PFPS causes retropatellar pain, that is exacerbated during motor functional gestures, such as climbing stairs, sitting, squatting or kneeling for long periods of time. Since the diagnostic evaluation of this syndrome is still indirect, different mechanisms and methodologies seek to achieve a classification able to distinguish patients with PFPS from asymptomatic ones. Thus, the purpose of this study is to find the relationship between the electromyographic (EMG) signals of quadriceps in individuals with and without PFPS during isometric exercises (dissipative and conservative) at different angles of the tibiofemoral joint, to analyze the signal pattern of the control subjects and to compare with the SDFP group. We compared the root means square (RMS) of the EMG signal, median frequency (Fmed) and frequency in 95% of the power spectrum (F95) on the vastus medialis oblique (VMO), vastus lateralis (VL) and rectus femoris (RF) for dissipative and conservative contractions. 24 female volunteers participated in this study (17 asymptomatic patients and 7 with PFPS), who performed 18 contractions at angles of 90º, 60º and 20º of knee extension, using 30% of the maximal voluntary contraction. EMG electrodes were placed on those muscles for data collection, which were further processed using AqDAnalysis software for selection of traits, and MatLab® for processing and analysis of the signal in time and frequency domain. The results indicate that the RMS of EMG signal presents differences among the isometric contractions for the symptomatic group and show that there is a relationship of contraction of a muscle compared to the other when it changes the motor gesture. The Fmed of VMO and VL can be used as a tool in the detection of PFPS, because it acts differently in each group. The F95 of the VMO muscle behaves differently between groups, and during the dissipative isometric contraction at 20º and 60º, their values were higher in PFPS than in the control group. Thus, it was possible to report that it is possible to differentiate the PFPS, or even detect it using EMG parameters of different patterns of isometric contractions