Background
Patellofemoral pain (PFP) often affects young women, and the etiology is multifactorial and poorly understood. Conservative intervention has been focused on risk factors or aggravating factors and is composed of hip- and knee-strengthening exercises, as this population often has muscle weakness and poor motor control during daily and sports activities. The objective of this study was to evaluate the additional effects of neuromuscular training in a conservative treatment of trunk-, hip-, and knee-muscle strengthening on pain, function, and kinematics of the trunk, pelvis, and lower limb in women with PFP.
Methods
This is a randomised clinical trial, controlled, blinded. Ninety women who are active and engage in physical activity up to twice a week will be recruited. All participants will undergo an individual physiotherapy assessment and then will be allocated randomly into two groups. Thereafter, both groups will undergo a 12-week intervention protocol: group 1 will perform strengthening exercises for the trunk, hip, and knee muscles, while group 2 will receive the same treatment, with the inclusion of neuromuscular training exercises on the fourth week. At the end of the intervention, the volunteers will be evaluated. The primary outcomes will be pain intensity (using a Visual Analog Scale: over the last month, squat 90°, and step of 26 cm during 1 min), functional capacity (Anterior Knee Pain Scale and Activities of Daily Living Scale), and 2D kinematics of the trunk, pelvis, and lower limb during the single-leg squat. The secondary outcomes correspond to the isometric muscular strength of the lower limb and the level of satisfaction from the intervention.
Discussion
The present study was initiated on 28 January 2018 and is currently in progress, scheduled for completion in July 2019. The results of this study should contribute to the physiotherapeutic treatment of women with PFP by aggregating information on the benefits of adding neuromuscular training to strengthening of the trunk and lower-limb muscles.
Trial registration
Registro Brasileiro de Ensaios Clínicos, ID: RBR-8c7267. Registered on 2 August 2017.
Background
The range of motion (RoM) of dorsiflexion (DF) plays an important role in human mobility, such as absorption of body weight during gait deceleration, jump landings, balance, and eccentric movements. This limitation can generate potentially damaging movements. This way, evaluating techniques for DF RoM increase could help improve immediate performance in such functional activities. This being the case, the objective of this study will be to verify the sum effect of different joint mobilization techniques for DF gain in persons practicing physical activities and its relationship with functional performance and balance.
Methodology
This is a randomized, controlled, and blind clinical trial. Fifty-four (54) volunteers will be recruited, aged between 18 and 40 years, who have DF limitations. After checking eligibility criteria, the participants will be submitted to a physiotherapeutic evaluation. A researcher, blind to evaluation and treatment, will perform the randomization of patients in groups: (A) Joint Mobilization - Mulligan Concept and (B) Joint Mobilization - Maitland Method. All volunteers will be submitted by two blind evaluators for randomization and treatment groups. They will realize the initial evaluation (A0), immediately after techniques (A1) and after 3–4 days of the technique application (A2). A different researcher, blind for evaluation, will perform the treatment, according to the randomization group.
Discussion
It is already known that DF RoM limitation can lead to compensatory and potentially damaging lower limb movements and that joint mobilizations are effective to treatment. However, there is no consensus whether the application of these techniques would also improve aspects of dynamic postural balance and performance in individuals practicing physical activity, and whether the sum of two joint mobilization techniques could enhance this effect.
Trial registration
Brazilian Registry of Clinical Trials (ReBEC) RBR-93xv9t. Registered on 09 April 2020.
Background: The range of motion (RoM) of dorsiflexion (DF) plays an important role in human mobility, such as absorption of body weight during gait deceleration, jump landings, balance and eccentric movements. This limitation can generate potentially damaging movements. This way, evaluating techniques for DF RoM increase could help improve immediate performance in such functional activities. This being the case, the objective of this study will be to verify the sum effect of different joint mobilization techniques for DF gain in persons practicing physical activities and its relationship with functional performance and balance. Methodology: This is a randomized, controlled and double-blind clinical trial. Sixty-four (64) volunteers will be recruited, aged between 18 and 40 years, who have DF limitation. After checking eligibility criteria, the participants will be submitted to a physiotherapeutic evaluation. Volunteers will be evaluated as to a DF for open kinetic chain (OKC) and closed kinetic chain (CKC), and also submitted to functional Y Balance Test under a force platform and Triple Hop Test, by a blind examiner. Another researcher, also blind, will perform the randomization of patients in groups: (A) Joint Mobilization - Mulligan Concept and (B) Joint Mobilization - Maitland Method. After the randomization, volunteers will be submitted to initial evaluation (A0) and, after 2-3 days, they will be submitted to application of the techniques, which will be randomized, and reassessed immediately (A1). After 3-4 days of the application of the techniques, the re-evaluation will be performed (A2). Discussion: It is already known that DF RoM limitation can lead to compensatory and potentially damaging lower limb movements and that joint mobilizations are effective to treatment. However, there is no consensus whether the application of these techniques would also improve aspects of dynamic postural balance and performance in individuals practicing physical activity, and whether the sum of two joint mobilization techniques could enhance this effect. Trial registration: RBR-93xv9t, Registered 09 April 2020, https://ensaiosclinicos.gov.br/rg/RBR-93xv9t.
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