Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Objective There is growing evidence to support the association of gluteal muscle strength deficits in individuals with patellofemoral pain syndrome (PFPS) and the effectiveness of gluteal strengthening when treating PFPS. In additiona, an impressive body of work evaluating gluteal electromyography (EMG) has recently emerged, further supporting the importance of gluteal muscle function in PFPS. This systematic review synthesises these EMG findings in order to better understand the role of gluteal muscle activity in the aetiology, presentation and management of PFPS.
Methods MEDLINE, EMBASE, CINAHL, Web of Knowledge and Google Scholar databases were searched in September 2011 for prospective and case–control studies evaluating the association of gluteal EMG with PFPS. Two independent reviewers assessed each paper for inclusion and quality. Means and SDs were extracted from each included study to allow effect size calculations and comparison of results.
Results Ten case–control, but no prospective studies were identified. Moderate-to-strong evidence indicates gluteus medius (GMed) activity is delayed and of shorter duration during stair negotiation in PFPS sufferers. In addition, limited evidence indicates GMed activity is delayed and of shorter duration during running, and gluteus maximus (GMax) activity is increased during stair descent.
Conclusions Delayed and shorter duration of GMed EMG may indicate impaired ability to control frontal and transverse plane hip motion. Further research evaluating the value of gluteal muscle activity screening in identifying individuals most likely to develop PFPS, and the effectiveness of interventions targeting changes to gluteal muscle activation patterns is needed.
Re: Patellofemoral pain and asymmetrical hip rotation
Foot and Hip Contributions to High Frontal Plane Knee Projection Angle in Athletes: A Classification and Regression Tree Approach.
Bittencourt NF, Ocarino JM, Mendonça LD, Hewett TE, Fonseca ST. J Orthop Sports Phys Ther. 2012 Sep 18. [Epub ahead of print]
Quote:
STUDY DESIGN:
Cross-sectional.
OBJECTIVE:
To investigate predictors of increased frontal plane knee projection angle (FPKPA) in athletes.
BACKGROUND:
The underlying mechanisms that lead to increased FPKPA are likely multi-factorial and depend on how the musculoskeletal system adapts to the possible interactions between its distal and proximal segments. Bivariate and linear analyses traditionally employed to analyze the occurrence of increased FPKPA are not sufficiently robust to capture complex relationships among predictors. Nonlinear interactions among biomechanical factors should be investigated to allow understanding of lower limb segments interdependence and resultant dynamic knee alignment.
METHODS:
The FPKPA was assessed in 101 athletes during single leg squat and in 72 athletes at the moment of landing from a jump. The predictors were: sex, hip abductor isometric torque, passive range of motion (ROM) of hip internal rotation (IR), and shank-forefoot alignment. Classification and Regression Trees (CART) were used to investigate non-linear interactions among predictors and their influence on the occurrence of increased FPKPA.
RESULTS:
During single leg squatting, the occurrence of High-FPKPA was predicted by the interaction between hip abductor isometric torque and passive hip IR ROM. At the moment of landing, the shank-forefoot alignment together with abductor isometric torque and passive hip IR ROM were predictors of High-FPKPA. In addition, the CART identified cut-off points that could be used in clinical practice to identify athletes with potential risk for excessive FPKPA.
CONCLUSION:
The models captured non-linear interactions between hip abductor isometric torque, passive hip IR ROM, and shank-forefoot alignment.
Purpose/Hypothesis : Patellofemoral pain syndrome (PFPS) is a common knee problem that may be influenced by proximal structures. While hip weakness and reduced core endurance are noted in females with PFPS, it has remained elusive if males with PFPS exhibit similar impairments. Identification of these differences will help determine the need for sex-specific interventions for PFPS. The purpose of this study was to compare hip strength and core endurance in males with and without PFPS. We hypothesized that males with PFPS would demonstrate less hip strength and core endurance than controls.
Number of Subjects : Sixteen males with PFPS and 16 controls participated. Participants were recreationally active in running and jumping activities. Those with PFPS experienced symptoms a minimum of 4 weeks and rated pain at least 3 cm on a 10-cm visual analog scale.
Materials/Methods : We assessed isometric hip strength using hand-held dynamometry and stabilization straps in accordance with the “make test.” Following practice trials, subjects performed 3 maximum voluntary isometric contractions of the hip abductors, extensors, and external rotators. Peak force values for the 3 trials were averaged and expressed as a percentage of body mass. Subjects performed the front plank, horizontal extension test and side-bridge to assess anterior, posterior and lateral core endurance, respectively. The time that subjects maintained each position was recorded to the nearest 1/10th of a second. Independent t-tests determined between-group differences for each variable. Statistical analyses were conducted using a significance level < 0.05, which was adjusted for multiple comparisons using the Bonferroni-Holm correction. Effect sizes (ES) were calculated using Cohen’s d.
Results : Males with PFPS generated less hip abductor (t=-2.55; P=.017), hip extensor (t=-2.65; P=.014) and hip external rotator (t=-3.67; P=.001) force than controls. No between-group differences existed for core endurance (P=.05). However, moderate effect sizes suggested that males with PFPS had less anterior (ES=.50), posterior (ES=.51) and lateral (ES=.60) core endurance.
Conclusions : Investigators have theorized that hip weakness and poor trunk control can lead to excessive pelvic drop, hip adduction and hip internal rotation, motions shown to increase patellofemoral joint loading. While evident in females with PFPS, our findings showed that males with PFPS exhibited hip weakness. These males also had less core endurance, particularly for the lateral trunk, than controls. Clinically, core endurance differences were relevant because these muscles work synergistically to maintain the trunk and pelvis in a vertical and level position, respectively. Together, reduced hip strength and core endurance suggested less than optimal proximal control that may cause increased patellofemoral joint loading and contribute to PFPS.
Clinical Relevance : Males with PFPS demonstrated less hip strength and core endurance. Clinicians should consider prescribing exercises that target the hip and trunk musculature when treating males with PFPS.
Objective
To determine the prevalence of myofascial trigger points (MTrPs) in the gluteus medius (GMe) and quadratus lumborum (QL) for subjects with patellofemoral pain (PFP), and to examine the relationship between MTrPs and force production of the GMe after treatment.
Design
Randomized controlled trial.
Setting
A physical therapy clinic.
Participants
52 subjects (age = 30±12 y/o, height = 172±10 cm, mass = 69±14 kg) volunteered and were divided into two groups. The PFP group (n=26) consisted of subjects with PFP and control group (n=26) with no history of PFP.
Interventions
PFP patients received trigger point release therapy (TPPRT).
Main Outcome Measures
Hip abduction isometric strength, and presence of MTrP.
Results
Prevalence of bilateral GMe and QL MTrPs for the PFP group was significantly higher compared to controls (p = 0.001). Subjects in the PFP group displayed significantly less hip abduction strength compared to the control group (p = 0.007). However, TPPRT did not result in increased force production.
Conclusions
Subjects with PFP have a higher prevalence of MTrPs in bilateral GMe and QL muscles. PFP subjects demonstrate less hip abduction strength compared to controls, but the trigger point release therapy did not result in an increase in hip abduction strength.
Re: Patellofemoral pain and asymmetrical hip rotation
Isometric Strength Ratios of the Hip Musculature in Females With Patellofemoral Pain: A Comparison to Painfree Controls
Magalhães, Eduardo (PT, MSc); Silva, Ana Paula M.C.C. (PT, MSc Student); Sacramento, Sylvio N. (MD); Martin, RobRoy L. (PT, PhD); Fukuda, Thiago Y. (PT, PhD) Journal of Strength & Conditioning Research: 30 November 2012
Quote:
The purpose of the study was to compare hip agonist-antagonist isometric strength ratios between females with patellofemoral pain syndrome (PFP) and pain-free control group. One hundred and twenty females between 15 and 40 years of age (control group: n=60; PFP group: n=60) participated. Hip adductor, abductor, medial rotator, lateral rotator, flexor, and extensor isometric strength was measured using a hand-held dynamometer. Comparisons in the hip adductor/abductor and medial/lateral rotator and flexor/extensor strength ratios were made between groups using independent t-tests. Group comparisons also were made between the anteromedial hip complex (adductor, medial rotator, and flexor musculature) and posterolateral hip complex (abductor, lateral rotator, and extensor musculature). On average, the hip adductor/abductor isometric strength ratio in the PFP group was 23% higher when compared to the control group (P=0.01). The anteromedial/posterolateral complex ratio also was significantly higher in the PFP group (average 8%; P=0.04). No significant group differences were found for the medial/lateral rotator ratio and flexor/extensor strength ratios. The results of this study demonstrate that females with PFP have altered hip strength ratios when compared to asymptomatic controls. These strength imbalances may explain the tendency of females with PFP to demonstrate kinematic tendencies that increase loading on the patellofemoral joint (ie. dynamic knee valgus).
PURPOSE:
Patellofemoral pain (PFP) is the leading cause of knee pain in runners. Proximal and distal running mechanics have been linked to the development of PFP. However, the lack of prospective studies limits establishing a causal relationship of these mechanics to PFP. The purpose of this study was to prospectively compare running mechanics in a group of female runners who went on to develop PFP compared to healthy controls. It was hypothesized that runners who go on to develop PFP would exhibit greater hip adduction, hip internal rotation, and greater rear foot eversion.
METHODS:
400 healthy female runners underwent an instrumented gait analysis and were then tracked for any injuries that they may have developed over a 2 year period. Fifteen cases of PFP developed which were confirmed by a medical professional. Their initial running mechanics were compared to an equal number of runners who remained uninjured.
RESULTS:
We found that female runners who developed PFP exhibited significantly greater hip adduction (p=0.007). No statistically significant differences were found for the hip internal rotation angle (p=0.47) or rearfoot eversion (p=0.1).
CONCLUSIONS:
The finding of greater hip adduction in female runners who develop PFP is in agreement with previous cross sectional studies. These results suggest that runners who develop PFP utilize a different proximal neuromuscular control strategy than those who remain healthy. Injury prevention and treatment strategies should consider addressing these altered hip mechanics.
Re: Patellofemoral pain and asymmetrical hip rotation
Comparison of hip abductor, extensor and external rotator strength in Women with and without patellofemoral pain syndrome
Moradi Z, Akbari M, Nakhostin Ansari N, Emrani A Modern Rehabilitation 2012;6(3) : 7-7
Quote:
Background and Aim: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition. Women with patellofemoral pain syndrome would present significant weakness in many of hip muscle groups when compared with the healthy group. The objective of the present study was to compare the strength of hip abductor, extensor and external rotator muscle groups in sedentary women with bilateral patellofemoral pain syndrome to a matched control group of sedentary women without patellofemoral pain syndrome.
Materials and Methods: Twelve women with bilateral patellofemoral pain syndrome as experimental group and other twelve matched women as control group participated in this study. Maximum isometric strength for three hip muscles including abductor, extensor and external rotator muscle groups was measured bilaterally in all subjects using a dynamometer fixed on a platform and finally averaged between two limbs and compared with the control group.
Results: The hip abductor, extensor and external rotator muscle groups of experimental group were statistically weaker than that of the control group (p< 0.001).
Conclusion: It seems that lower limb muscles including hip muscles of women with patellofemoral pain syndrome become weaker due to disuse conditions.
Re: Patellofemoral pain and asymmetrical hip rotation
Immediate Effects of Lumbopelvic Manipulation and Lateral Gluteal Kinesio Taping on Unilateral Patellofemoral Pain Syndrome
Joseph Miller, Richard Westrick, Angela Diebal, Christopher Marks, J. Parry Gerber Sports Health: A Multidisciplinary Approach January 24, 2013
Quote:
Objectives: To determine the immediate effects of Kinesio taping directed to the hip and manipulation directed to the lumbopelvic region in individuals with unilateral patellofemoral pain syndrome (PFPS).
Background: PFPS affects up to 25% of the general population. Despite the high prevalence, this condition is not clearly understood, as evidenced by the numerous proposed causes and recommended treatments. Notwithstanding, recent evidence suggests that treatments directed at the hip or spine may lead to beneficial results.
Methods: A convenience sample of 18 participants (12 men and 6 women, 19.5 ± 1.15 years old) with unilateral PFPS was recruited. Participants were randomized by sex to 1 of 3 groups: Kinesio taping, manipulation, and control taping. The main outcome measures included the Y-balance test, squatting range of motion (ROM), and the Lower Extremity Functional Scale.
Results: Compared with the lumbopelvic manipulation and control groups, those in the Kinesio taping group performed significantly better on the Y-balance test (F = 5.59, P = 0.02) and with squatting ROM (F = 3.93, P = 0.04). The Kinesio taping and lumbopelvic groups were also significantly better than the control (sham) group with double-leg squatting ROM performance 3 days later.
Conclusion: Kinesio taping may facilitate gluteus medius activation and improve postural stability and a double-leg squat.
Clinical Relevance: The improvement in affected limb reach and double-leg squatting ROM highlights the potential for Kinesio taping to improve gluteus medius activation. Lumbopelvic manipulation may also immediately improve rehabilitation programs for PFPS.
Re: Patellofemoral pain and asymmetrical hip rotation
Gluteal muscle activity and patellofemoral pain syndrome: a systematic review
Christian J Barton, Simon Lack, Peter Malliaras, Dylan Morrissey Br J Sports Med 2013;47:207-214
Quote:
Objective There is growing evidence to support the association of gluteal muscle strength deficits in individuals with patellofemoral pain syndrome (PFPS) and the effectiveness of gluteal strengthening when treating PFPS. In additiona, an impressive body of work evaluating gluteal electromyography (EMG) has recently emerged, further supporting the importance of gluteal muscle function in PFPS. This systematic review synthesises these EMG findings in order to better understand the role of gluteal muscle activity in the aetiology, presentation and management of PFPS.
Methods MEDLINE, EMBASE, CINAHL, Web of Knowledge and Google Scholar databases were searched in September 2011 for prospective and case–control studies evaluating the association of gluteal EMG with PFPS. Two independent reviewers assessed each paper for inclusion and quality. Means and SDs were extracted from each included study to allow effect size calculations and comparison of results.
Results Ten case–control, but no prospective studies were identified. Moderate-to-strong evidence indicates gluteus medius (GMed) activity is delayed and of shorter duration during stair negotiation in PFPS sufferers. In addition, limited evidence indicates GMed activity is delayed and of shorter duration during running, and gluteus maximus (GMax) activity is increased during stair descent.
Conclusions Delayed and shorter duration of GMed EMG may indicate impaired ability to control frontal and transverse plane hip motion. Further research evaluating the value of gluteal muscle activity screening in identifying individuals most likely to develop PFPS, and the effectiveness of interventions targeting changes to gluteal muscle activation patterns is needed.
Re: Patellofemoral pain and asymmetrical hip rotation
Linear Mode
