The incidence and potential pathomechanics of patellofemoral pain in female athletes

Myer, Gregory D.; Ford, Kevin R.; Foss, Kim D. Barber; Goodman, Arlene; Ceasar, Adrick; Rauh, Mitchell J.; Divine, Jon G.; Hewett, Timothy E.

doi:10.1016/j.clinbiomech.2010.04.001

Cited by 233 publications

(160 citation statements)

References 51 publications

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“…Previous studies have identified increased hip internal rotation 8 and knee abduction moment 32 as risk factors for PFPS. Although Leetun et al 28 showed that lower isometric hip external rotation strength predisposed collegiate athletes to lower-limb injuries, Thijs et al 44 recently suggested that isometric hip muscle strength might not be a predisposing factor for PFPS in female runners.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that increased ipsilateral trunk lean may increase the valgus moment of the knee joint. 23,31 Myer et al 32 demonstrated that higher knee abduction moments during landing were associated with a greater incidence of PFPS among female recreational athletes during a basketball season. Also, Hewett et al, 21 based on video analysis of noncontact anterior cruciate ligament injuries in female athletes, reported that greater ipsilateral trunk angle and knee abduction occur in combination.…”

Section: Discussionmentioning

confidence: 99%

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Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome

Nakagawa¹,

Moriya²,

Maciel³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

332

263

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Study Design Controlled laboratory study using a cross-sectional design. Objectives To determine whether there are any differences between the sexes in trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during the performance of a single-leg squat in individuals with patellofemoral pain syndrome (PFPS) and control participants. Background Though there is a greater incidence of PFPS in females, PFPS is also quite common in males. Trunk kinematics may affect hip and knee function; however, there is a lack of studies of the influence of the trunk in individuals with PFPS. Methods Eighty subjects were distributed into 4 groups: females with PFPS, female controls, males with PFPS, and male controls. Trunk, pelvis, hip, and knee kinematics and gluteal muscle activation were evaluated during a single-leg squat. Hip abduction and external rotation eccentric strength was measured on an isokinetic dynamometer. Group differences were assessed using a 2-way multivariate analysis of variance (sex by PFPS status). Results Compared to controls, subjects with PFPS had greater ipsilateral trunk lean (mean ± SD, 9.3° ± 5.3° versus 6.7° ± 3.0°; P = .012), contralateral pelvic drop (10.3° ± 4.7° versus 7.4° ± 3.8°; P = .003), hip adduction (14.8° ± 7.8° versus 10.8° ± 5.6°; P<.0001), and knee abduction (9.2° ± 5.0° versus 5.8° ± 3.4°; P<.0001) when performing a single-leg squat. Subjects with PFPS also had 18% less hip abduction and 17% less hip external rotation strength. Compared to female controls, females with PFPS had more hip internal rotation (P<.05) and less muscle activation of the gluteus medius (P = .017) during the single-leg squat. Conclusion Despite many similarities in findings for males and females with PFPS, there may be specific sex differences that warrant consideration in future studies and when clinically evaluating and treating females with PFPS. J Orthop Sports Phys Ther 2012;42(6):491–501, Epub 8 March 2012. doi:10.2519/jospt.2012.3987

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome

Nakagawa¹,

Moriya²,

Maciel³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

332

263

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“…2,4,7,19,39,40 Thus hip strengthening is often advocated to improve hip mechanics, 26 with the intent of reducing the incidence of, or symptoms related to, PFPS. 4,15,19,27,28 Although it has been shown that these programs improve strength 3,23,28 and reduce or might prevent symptoms, 3,15,21,23,28 it is not clear whether strengthening the hip actually results in improvement of abnormal hip and knee mechanics during functional activities such as running and squatting. …”

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confidence: 99%

“…39 This movement pattern is thought to increase frontal plane loading of the knee and the dynamic quadriceps angle, resulting in lateral tracking of the patella and abnormal loading of the patellofemoral joint. 6,18,22,27,33,34 Several studies suggest that females with PFPS demonstrate weakness of the musculature that controls hip adduction, hip internal rotation, contralateral pelvic drop, and knee external rotation. 2,4,7,19,39,40 Thus hip strengthening is often advocated to improve hip mechanics, 26 with the intent of reducing the incidence of, or symptoms related to, PFPS.…”

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confidence: 99%

The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat

Willy

Davis

2011

Journal of Orthopaedic & Sports Physical Therapy

203

142

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Study Design Block randomized controlled trial. Objectives To investigate whether a strengthening and movement education program, targeting the hip abductors and hip external rotators, alters hip mechanics during running and during a single-leg squat. Background Abnormal movement patterns during running and single-leg squatting have been associated with a number of running-related injuries in females. Therapeutic interventions for these aberrant movement patterns typically include hip strengthening. While these strengthening programs have been shown to improve symptoms, it is unknown if the underlying mechanics during functional movements is altered. Methods Twenty healthy females with excessive hip adduction during running, as determined by instrumented gait analysis, were recruited. The runners were matched by age and running distance, and randomized to either a training group or a control group. The training group completed a hip strengthening and movement education program 3 times per week for 6 weeks in addition to single-leg squat training with neuromuscular reeducation consisting of mirror and verbal feedback on proper mechanics. The control group did not receive an intervention but maintained the current running distance. Using a handheld dynamometer and standard motion capture procedures, hip strength and running and single-leg squat mechanics were compared before and after the strengthening and movement education program. Results While hip abductor and external rotation strength increased significantly (P<.005) in the training group, there were no significant changes in hip or knee mechanics during running. However, during the single-leg squat, hip adduction, hip internal rotation, and contralateral pelvic drop all decreased significantly (P = .006, P = .006, and P = .02, respectively). The control group exhibited no changes in hip strength, nor in the single-leg squat or running mechanics at the conclusion of the 6-week study. Conclusion A training program that included hip strengthening and movement training specific to single-leg squatting did not alter running mechanics but did improve single-leg squat mechanics. These results suggest that hip strengthening and movement training, when not specific to running, do not alter abnormal running mechanics. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2011;41(9):625–632, Epub 12 July 2011. doi:10.2519/jospt.2011.3470

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“…Individuals with PFPS have reported pain and limitations in ability, functioning, and quality of life [5,9]. According to some studies, the PFPS eventually leads to osteoarthritis [10,11].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Custom Made Foot Orthoses Fabricated With Medial Heel Skive Technique on Pain and Function in Individuals With Patellofemoral Pain Syndrome

Bahramian

Aminian

Bagherzadeh

et al. 2017

IRJ

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Objectives: Patellofemoral pain syndrome (PFPS) is one of the significant causes of knee pain that results in reduced functional performance.Interventional foot orthotics may lead to improvement in symptoms. In this study, the effects of custom-made foot orthoses with medial heel skive technique on pain and functional performance after four weeks were evaluated.Methods: Fourteen subjects with PFPS were given custom-made foot orthoses. The pain and function parameters were evaluated with a visual analog scale (VAS) and Kujala Patellofemoral Score (KPS) before the treatment and at four weeks follow-up.Results: Significant improvements in pain was observed in participants with initial pain at four weeks (P<0.001). Also, an increased functional performance was seen in individuals with PFPS at four weeks (P<0.001).Discussion: In this study, the custom-made foot orthoses with medial heel skive technique was found to be an effective conservative treatment to reduce the pain and improve the functional performance of patients with PFPS.

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The incidence and potential pathomechanics of patellofemoral pain in female athletes

Cited by 233 publications

References 51 publications

Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome

Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome

The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat

The Effect of Custom Made Foot Orthoses Fabricated With Medial Heel Skive Technique on Pain and Function in Individuals With Patellofemoral Pain Syndrome

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