Does Quadriceps Atrophy Exist in Individuals With Patellofemoral Pain? A Systematic Literature Review With Meta-analysis

Giles, Lachlan; Webster, Kate E.; McClelland, Jodie A.; Cook, Jillianne Leigh

doi:10.2519/jospt.2013.4833

Cited by 59 publications

(36 citation statements)

References 49 publications

(117 reference statements)

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“…There are limitations of this study. We chose the rectus femoris muscle because it is the only one of the quadriceps muscle group where the fibers continue to become the patellar tendon (the others blend with the retinaculum), and the concept that there is preferential wasting of certain quadriceps muscles is unsupported in PFJ pain (Giles et al., ) and there are no data for other AKP (such as fat pad) and quadriceps wasting. It is likely that a range of knee conditions was included in the AKP pain sample and future larger studies should aim to subgroup these.…”

Section: Discussionmentioning

confidence: 99%

Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain

Rio

Kidgell

Moseley

et al. 2015

Scandinavian Med Sci Sports

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Anterior knee pain (AKP) is a frequent clinical presentation in jumping athletes and may be aggravated by sustained sitting, stair use, and loading of the quadriceps. Corticospinal activation of the quadriceps in athletes with AKP has not yet been investigated, but is important in guiding efficacious treatment. This cross-sectional study assessed corticospinal excitability (CSE) of the quadriceps in jumping athletes using transcranial magnetic stimulation (TMS). Groups consisted of Control (no knee pain); patellar tendinopathy (PT) [localized inferior pole pain on single-leg decline squat (SLDS)]; and other AKP (nonlocalized pain around the patella). SLDS (numerical score of pain 0-10), Victorian Institute of Sport Assessment Patellar tendon (VISA-P), maximal voluntary isometric contraction (MVIC), active motor threshold (AMT), CSE, and Mmax were tested. Twenty nine athletes participated; control n = 8, PT n = 11, AKP n = 10. There were no group differences in age (P = 0.23), body mass index (P = 0.16), MVIC (P = 0.38) or weekly activity (P = 0.22). PT had elevated CSE compared with controls and other AKP (P < 0.001), but no differences were detected between AKP and controls (P = 0.47). CSE appears to be greater in PT than controls and other AKP. An improved understanding of the corticospinal responses in different sources of knee pain may direct better treatment approaches.

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Section: Discussionmentioning

confidence: 99%

Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain

Rio

Kidgell

Moseley

et al. 2015

Scandinavian Med Sci Sports

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show abstract

“…PFP has been linked to reduced contact area and increased stress in the lateral patellofemoral joint (PFJ)6 7 as a result of patellar maltracking, including greater lateral patellar translation,8–10 tilt8 and spin 9. The cause of maltracking in PFP is thought to be multifactorial with local,11 distal12 and proximal13 factors proposed to contribute to it, with good evidence that long axis femoral rotation in relation to the patella is a key contributor to maltracking and a valid rehabilitation target 14…”

Section: Introductionmentioning

confidence: 99%

Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis

et al. 2015

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BackgroundProximal muscle rehabilitation is commonly prescribed to address muscle strength and function deficits in individuals with patellofemoral pain (PFP). This review (1) evaluates the efficacy of proximal musculature rehabilitation for patients with PFP; (2) compares the efficacy of various rehabilitation protocols; and (3) identifies potential biomechanical mechanisms of effect in order to optimise outcomes from proximal rehabilitation in this problematic patient group.MethodsWeb of Knowledge, CINAHL, EMBASE and Medline databases were searched in December 2014 for randomised clinical trials and cohort studies evaluating proximal rehabilitation for PFP. Quality assessment was performed by two independent reviewers. Effect size calculations using standard mean differences and 95% CIs were calculated for each comparison.Results14 studies were identified, seven of high quality. Strong evidence indicated proximal combined with quadriceps rehabilitation decreased pain and improved function in the short term, with moderate evidence for medium-term outcomes. Moderate evidence indicated that proximal when compared with quadriceps rehabilitation decreased pain in the short-term and medium-term, and improved function in the medium term. Limited evidence indicated proximal combined with quadriceps rehabilitation decreased pain more than quadriceps rehabilitation in the long term. Very limited short-term mechanistic evidence indicated proximal rehabilitation compared with no intervention decreased pain, improved function, increased isometric hip strength and decreased knee valgum variability while running.ConclusionsA robust body of work shows proximal rehabilitation for PFP should be included in conservative management. Importantly, greater pain reduction and improved function at 1 year highlight the long-term value of proximal combined with quadriceps rehabilitation for PFP.

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“…In addition, during voluntary muscle contraction, it has been accepted that individuals with PFP present with a delayed muscle activation of VMO compared to vastus lateralis (VL). QFM strengthening, as part of a rehabilitation program for PFP patients, has been supported by Giles et al (37), as it has been identified that QFM atrophy is prevalent amongst PFP patients within the weak subgroups. Neuromuscular electrical stimulation (NMES), has also been shown to improve function and reduces pain amongst Osteoarthritis (OA) patients by targeting the injured/affected structures within the QFM (38).…”

Section: The Use Of Pass In the Management Of Patellofemoral Painmentioning

confidence: 96%

Assessment and Management of Pain, Alignment, Strength and Stability (PASS) in Patellofemoral Pain and Low Back Pain

Mbuli¹,

Chohan²,

Janssen³

et al. 2019

Profese on-line

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Clinical assessment and management of musculoskeletal conditions of different joints may be broken down into considerations of Pain, Alignment, Strength and Stability (PASS). In recent years these factors have allowed a systematic approach and has enabled the development in our understanding of clinical subgroups, which enable targeted or stratified care. This paper considers the use of the PASS concept to determine the most appropriate treatment and interventions, specifically when considering treatment of two common musculoskeletal conditions, patellofemoral pain and low back pain.

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Does Quadriceps Atrophy Exist in Individuals With Patellofemoral Pain? A Systematic Literature Review With Meta-analysis

Cited by 59 publications

References 49 publications

Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain

Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain

Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis

Assessment and Management of Pain, Alignment, Strength and Stability (PASS) in Patellofemoral Pain and Low Back Pain

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