Neurodynamic tests for patellofemoral pain syndrome: a pilot study

Abstract

Background Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder. There is little consensus on the etiology, but one explanatory model suggests that PFPS can be caused by referred pain. Neurodynamic tests are used to explore the mechanosensitivity of peripheral nerves, and previous studies have shown a relationship between increased mechanosensitivity and anterior knee pain by using the femoral slump test (FST). Previously the prone knee bend test (PKB) does not appear to have been included. The main purpose of this pilot study was to examine whether there was an identifiable difference in mechanosensitivity between left and right sides that could be identified using both the PKB and FST tests for the femoral nerve in patients with unilateral PFPS. Methods This cross-sectional pilot study tested 12 patients with unilateral PFPS for altered mechanosensitivity using both PKB and FST. The pain-free knee was used as a control. The selected test procedures were similar to those clinicians use in everyday practice. Results 8 and 4 of the 12 patients were found to have increased levels of mechanosensitivity in the PFPS leg using the PKB and FST, respectively. Both tests provoked stronger pain in the leg with PFPS compared with the asymptomatic leg ( p < 0.05 Wilcoxon Signed Rank Test). The symptoms were more often located in the anterior knee, with structural differentiation by neck flexion appearing to increase the symptoms more when testing the leg with PFPS. Conclusions Although the reliability of the tests is unknown and the study sample size was small, the PKB and FST test procedures used in clinical practice appear capable of revealing altered mechanosensitivity in unilateral PFPS patients. The PKB test appears to detect mechanosensitivity in more patients than the FST. We recommend including both tests in future larger blinded controlled studies which should also assess reliability of the tests. Trial registration ISRCTN 12473526 . Registered 20 May 2015, retrospectively registered.

Frequency of Adverse Neural Tension and Its Association With Functional Disability in Upper Extremity Musculoskeletal Pain Syndromes: A Cross-sectional Study

“…Like Vegstein et al and Fernández-de-Las-Peñas et al study, our research suggests that patients with musculoskeletal pain syndromes may not initially present neurological symptoms [10,42]. However, according to neurological theory, injury to musculoskeletal structures can lead to microscopic damage in the connective tissue of peripheral nerves, affecting the axoplasmic flow of nerves and disrupting nerve function [14,43].…”

“…The results of our study indicate that at least one neurodynamic test was positive in 50% of patients with upper limb musculoskeletal pain syndromes (regardless of the type of lesion). Yaxley and Jull [11], showed adverse neural tension in some patients with tennis elbow; in addition, several other studies have pointed to neurodynamic disorders in patients with musculoskeletal pain syndromes [5,6,10].…”

“…Musculoskeletal injuries result from overuse after prolonged and inappropriate repetitive movements and submaximal loads [3,4]. Based on the pathomechanics of musculoskeletal pain syndrome, recent studies have reported the possibility of concurrent dynamic disorders and adverse neural tension in these syndromes [5][6][7][8][9][10][11]. In the same way, poor posture and inappropriate repetitive movements can predispose people to musculoskeletal pain syndromes, they may also affect the nerve neurodynamic (sliding, elongation, and normal tension capability of nerves).…”

The Clinical Prediction of Patients' Age & BMI to Quadriceps Muscle Strength Training on Knee Pain and the Functional Activity Level in Female Patients with Knee Osteoarthritis

“…Exclusion criteria: Patients were excluded if they; Had undergone total knee arthroplasty [7], exhibited uncontrolled hypertension [9], had a history of cardiovascular disease [9], had history of neurologic disorders that affect lower extremity function (e.g., stroke, peripheral neuropathy) or any health problem that will affect lower extremity function [9], had undergone knee surgery, oral steroids and knee injection were excluded from this study [10].…”