Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis

Neal, Brad; Barton, Christian J; Gallie, Rosa; O’Halloran, Patrick; Morrissey, Dylan

doi:10.1016/j.gaitpost.2015.11.018

Cited by 152 publications

(119 citation statements)

References 82 publications

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“…Athletic groin pain (AGP) is prevalent in field sports with recurrent accelerations, decelerations, and changes of direction . Despite this, the biomechanics contributing to AGP remains poorly understood and under investigated in comparison with other sporting injuries, such as anterior cruciate ligament injury and patella femoral pain syndrome …”

Section: Introductionmentioning

confidence: 99%

Is stiffness related to athletic groin pain?

Gore¹,

Franklyn-Miller

Richter

et al. 2018

Scandinavian Med Sci Sports

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Athletic groin pain (AGP) is a common injury prevalent in field sports. One biomechanical measure that may be of importance for injury risk is stiffness. To date however, stiffness has not been examined in AGP. The primary aim was to determine whether AGP affects vertical and joint stiffness and if so, whether successful rehabilitation is associated with a change in stiffness. Sixty-five male patients with AGP and fifty male controls were recruited to this study. Assessment included a biomechanical examination of stiffness during a lateral hurdle hop test. Subjects with AGP were tested pre- and post-rehabilitation, while controls were tested once. AGP subjects were cleared for return to play in a median time of 9.14 weeks (5.14-29.0). Stiffness was significantly different at pre-rehabilitation in comparison with controls for four of the ten stiffness values examined: ankle plantar flexor, knee extensor, hip abductor, and vertical stiffness (P < .05, D = 0.36-0.79). Despite clearance for return to play, of these four variables, only hip abductor stiffness changed significantly from pre- to post-rehabilitation (P = .05, D = 0.35) to become non-significantly different to the uninjured group (P = .18, D = 0.26). These findings suggest that hip abductor stiffness may represent a target for AGP rehabilitation. Conversely, given the clearance for return to play, the lower sagittal plane and vertical stiffness in the AGP group in comparison with the uninjured controls likely represents either a compensatory mechanism to reduce the risk of further injury or a consequence of neuromuscular detraining.

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Section: Introductionmentioning

confidence: 99%

Is stiffness related to athletic groin pain?

Gore¹,

Franklyn-Miller

Richter

et al. 2018

Scandinavian Med Sci Sports

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show abstract

“…Because there was no systematic review evaluating RCT evidence for gait retraining in patellofemoral pain, it was considered to be an adjunctive intervention. One systematic review was excluded from consideration on the basis that it did not identify any published RCTs at the time of their search (April 2015) 40. The expert panel voted that there was uncertainty regarding the short-term effects of gait retraining on pain and function, based on evidence available at the time of the consensus meeting.…”

Section: Discussionmentioning

confidence: 99%

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017

et al. 2018

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Patellofemoral pain affects a large proportion of the population, from adolescents to older adults, and carries a substantial personal and societal burden. An international group of scientists and clinicians meets biennially at the International Patellofemoral Research Retreat to share research findings related to patellofemoral pain conditions and develop consensus statements using best practice methods. This consensus statement, from the 5th International Patellofemoral Research Retreat held in Australia in July 2017, focuses on exercise therapy and physical interventions (eg, orthoses, taping and manual therapy) for patellofemoral pain. Literature searches were conducted to identify new systematic reviews and randomised controlled trials (RCTs) published since the 2016 Consensus Statement. The methodological quality of included systematic reviews and RCTs was graded using AMSTAR and PEDro, respectively. Evidence-based statements were developed from included papers and presented to a panel of 41 patellofemoral pain experts for consensus discussion and voting. Recommendations from the expert panel support the use of exercise therapy (especially the combination of hip-focused and knee-focused exercises), combined interventions and foot orthoses to improve pain and/or function in people with patellofemoral pain. The use of patellofemoral, knee or lumbar mobilisations in isolation, or electrophysical agents, is not recommended. There is uncertainty regarding the use of patellar taping/bracing, acupuncture/dry needling, manual soft tissue techniques, blood flow restriction training and gait retraining in patients with patellofemoral pain. In 2017, we launched the International Patellofemoral Research Network (www.ipfrn.org) to consolidate and grow our patellofemoral research community, facilitate collaboration and disseminate patellofemoral pain knowledge to clinicians and the general public. The 6th International Patellofemoral Research Retreat will be held in Milwaukee, Wisconsin, USA, in October 2019.

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“…Altered hip and knee kinematics during running are known to have moderate to strong cross sectional associations with PFP,13 yet there remains just one prospective investigation of these variables in women runners only 32. There is also an emerging evidence base surrounding the association between psychological variables and PFP, with levels of anxiety, depression, catastrophising and fear of movement reported to be elevated in persons with PFP by a recent systematic review 52…”

Section: Discussionmentioning

confidence: 99%

“…Increased navicular drop in military recruits,12 greater peak hip adduction during running13 and increased forces at foot level during both walking and running14 all increase the risk of future PFP. While these findings are statistically significant, the absence of data pooling and the small to moderate effect sizes limit their impact and clinical applicability.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for patellofemoral pain: a systematic review and meta-analysis

et al. 2018

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BackgroundPatellofemoral pain (PFP) is a prevalent condition commencing at various points throughout life. We aimed to provide an evidence synthesis concerning predictive variables for PFP, to aid development of preventative interventions.MethodsWe searched Medline, Web of Science and SCOPUS until February 2017 for prospective studies investigating at least one potential risk factor for future PFP. Two independent reviewers appraised methodological quality using the Newcastle–Ottawa Scale. We conducted meta-analysis where appropriate, with standardised mean differences (SMD) and risk ratios calculated for continuous and nominal scaled data.ResultsThis review included 18 studies involving 4818 participants, of whom 483 developed PFP (heterogeneous incidence 10%). Three distinct subgroups (military recruits, adolescents and recreational runners) were identified. Strong to moderate evidence indicated that age, height, weight, body mass index (BMI), body fat and Q angle were not risk factors for future PFP. Moderate evidence indicated that quadriceps weakness was a risk factor for future PFP in the military, especially when normalised by BMI (SMD −0.69, CI −1.02, –0.35). Moderate evidence indicated that hip weakness was not a risk factor for future PFP (multiple pooled SMDs, range −0.09 to −0.20), but in adolescents, moderate evidence indicated that increased hip abduction strength was a risk factor for future PFP (SMD 0.71, CI 0.39, 1.04).ConclusionsThis review identified multiple variables that did not predict future PFP, but quadriceps weakness in military recruits and higher hip strength in adolescents were risk factors for PFP. Identifying modifiable risk factors is an urgent priority to improve prevention and treatment outcomes.

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Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis

Cited by 152 publications

References 82 publications

Is stiffness related to athletic groin pain?

Is stiffness related to athletic groin pain?

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017

Risk factors for patellofemoral pain: a systematic review and meta-analysis

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