Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms

Abstract

BackgroundPatellofemoral pain (PFP) is highly prevalent in runners, and often leads to functional limitations and cessation of running. Training errors as well as decreased lower limb strength and control during running have all been associated with PFP. While strengthening and gait retraining are commonly used by clinicians, no randomised clinical trial has compared these modalities in runners with PFP. The primary objective of this randomised clinical trial will be to compare the effects of three rehabilitation programs targeting different key factors on symptoms and functional limitations of runners with PFP. The secondary objective will be to explore the factors leading to clinical improvement.Methods/designWe will conduct a single-blind randomised clinical trial to compare three different 8 week rehabilitation programs: Group 1 will receive education on symptoms management based on training modifications; Group 2 will receive an exercise program targeting lower limb strengthening and control in addition to the education component of Group 1; Group 3 will receive running gait retraining advice as well as the education component of Group 1. Sixty-nine runners with PFP will be recruited and will be seen by independent physiotherapists on five visits through 8 weeks. The primary outcome measure will be symptoms and functional limitations measured by the Knee Outcome Survey – Activities of Daily Living Scale questionnaire at baseline, and at the four, eight and 20 weeks follow-up. Secondary outcomes will include pain level measured using visual analog scales, and running mileage. Lower limb kinematics and kinetics during running, and isometric strength will also be evaluated at baseline and 8 weeks follow-up. The effects of rehabilitation programs on measures of symptoms and functional limitations will be assessed using a 2-way ANOVA (Groups x Time). Regression analyses will be used to identify if changes in running mechanics or strength are determinants of clinical success.DiscussionStudies with a high level of evidence are needed to determine the best rehabilitation interventions for runners with PFP. This randomised clinical trial will be the first to compare programs targeting different key factors linked with PFP. Results may guide clinicians and improve their clinical outcomes when treating runners with PFP.Trial RegistrationClinicalTrials.gov: NCT02352909. Registered on December 3, 2014.

Running related gluteus medius function in health and injury: A systematic review with meta-analysis

“…Current evidence suggests that increasing cadence can decrease patello-femoral joint stress (Willson et al, 2014) in people with and without PFPS, however a relationship between this and hip muscle activity or biomechanics has not yet been established. Further work is required to confirm the utility of increased running cadence as a management strategy for running related injuries (Esculier et al, 2016) but current evidence is promising.…”

“…This knowledge is useful for clinicians and researchers to consider potential targeted rehabilitation strategies for facilitating GMed activity (duration) in this population. We have discussed some potential examples based on recent and proposed work that my ultimately prove effective with further research (Esculier et al, 2016;Willson et al, 2014) The findings of this review also need to be viewed in light of a number of methodological limitations of the included studies. All 13 of the included studies used surface electrodes to analyse the EMG characteristics of GMed in running.…”

Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain?A randomised clinical trial

“…We hypothesised that all three approaches would be efficient in decreasing symptoms and improving function, but that both the exercises and gait retraining groups would experience greater improvements than the education group, with faster improvements in the gait retraining group secondary to decreased PFJ forces during running. This RCT was registered on ClinicalTrials.gov (NCT02352909) and the study protocol has been published 25…”

Reliability of a 2-Dimensional Running Gait Analysis

“…2,3 Others have shown that there are techniques that have been effective in modifying injury risk factors within runners once the risk factors have been identified. 4,5,6,7,8,9 If screening protocols were to be more widely employed to evaluate the risk factors for RRI, it would be important to determine the reliability of raters for such risk factors. Therefore, the purpose of this study was to examine the reliability of an experienced versus and experienced rater in the evaluation of running biomechanics using a 2dimensional running gait analysis.…”