Gluteal muscle activity and patellofemoral pain syndrome: a systematic review

Abstract

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.

Patellofemoral joint biomechanics in the females with anterior knee pain applying full weight bearing kinematic MRI

“…Investigators, who investigated different individuals with anterior knee pain and pain free ones, reported difference in medial femoral rotation to be 12.2-13° (15,16). Changes in femoral rotation might be caused by quadriceps muscle atrophy (17) or increased femoral anteversion (18). Another possible explanation for medial femoral rotation is a "screw home" mechanism.…”

Varied Response to Mirror Gait Retraining of Gluteus Medius Control, Hip Kinematics, Pain, and Function in 2 Female Runners With Patellofemoral Pain

“…Indeed, females with PFP have been reported to demonstrate delayed onset and decreased duration of gluteus medius activity during running and stair ascent. 2,8,11,36 A recent systematic review 4 similarly concluded that there is evidence for delayed onset and decreased duration of gluteus medius activation during running and stair negotiation in females with PFP, but, interestingly, there is little evidence to support alterations in the amplitude of gluteus medius activation. Further, increased onset latencies and reduced duration of activation of the gluteus medius have also been correlated with increased hip frontal plane motions during running in females with PFP.…”

A Systematic Review of Reviews in Patellofemoral Pain Syndrome. Exploring the Risk Factors, Diagnostic Tests, Outcome Measurements and Exercise Treatment

“…Additionally, three reviews were identified as high quality meta-analysis or systematic reviews of RCTs [11,38,39] whilst the other two [12,13] as high quality systematic reviews of case control or cohort studies. Therefore, the level of the first three reviews was found to have high methodological level (8)(9)(10)(11) in the AMSTAR tool whilst the two reviews of case control or cohort studies had moderate methodological level (4-7 in the AMSTAR tool). Only the reviews from Heintjes et al [38] and Collins et al [11] reported more than 20 items from the PRISMA checklist (24 and 26 out of 27 correspondingly) whilst the other three reported 14 or less.…”

“…Lately, researchers and decision makers have started to confront an overflow of reviews [5,6]. From July 2012 to March 2013 the British Journal of Sport Medicine alone has published 4 systematic reviews on PFPS [7][8][9][10]. Because there are several reviews on similar topics and because it is likely for reviews to be of varied scope and quality, a growing interest of systematic review of reviews (RoR) has been called for [3].…”