Lower-Extremity Muscle Activity, Kinematics, and Dynamic Postural Control in Individuals With Patellofemoral Pain

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $74.00

1 year subscription

USD  $99.00

Student 2 year subscription

USD  $141.00

2 year subscription

USD  $185.00

Context: Altered lower-extremity muscle activity has been associated with lower-extremity kinematics in individuals with patellofemoral pain (PFP). However, few studies have examined these relationships, and the results are inconsistent. Objective: To compare the lower-extremity muscle activity, kinematics, pain level, and reach distance during the anterior reach of the star excursion balance test (SEBT) between participants with PFP and healthy individuals (control [CON] group). Design: Case control. Setting: Research laboratory. Participants: Twenty-eight (PFP = 14 and CON = 14) participants volunteered. Intervention: Each participant performed 3 maximal voluntary isometric contractions of the gluteus maximus, gluteus medius (GMED), adductor longus (AL), and vastus medialis, and 5 anterior reaches of the SEBT. Main Outcome Measures: Three-dimensional joint kinematics of the hip and knee at the time of touchdown of the SEBT and integrated electromyography of each muscle were recorded during the descent phase of the SEBT. Coactivation ratios between the GMED and AL were calculated (GMED/AL). Pain level was assessed at the baseline and during performance of the SEBT, using a visual analog scale. Results: Participants with PFP demonstrated decreased GMED/AL coactivation ratio (P = .01) and shorter reach distance (P = .01) during anterior reach of the SEBT compared with the CON group. Participants with PFP demonstrated higher pain levels at baseline (P = .03) and during test performance (P < .001) compared with the CON group and increased pain level during the test performance compared with the baseline (P < .001). No other significant differences were observed. Conclusions: There were alterations in muscle activity during SEBT performance, suggesting that overactivity of AL relative to GMED is a unique neural recruitment pattern in those with PFP. However, hip and knee joint kinematics did not seem to contribute to deficits in the anterior reach distance, suggesting a need for continued assessment of these deficiencies.

Goto is with Texas Health Sports Medicine, Fort Worth, TX. Aminaka is with the Department of Exercise and Sport Science, University of Wisconsin–La Crosse, La Crosse, WI. Gribble is with the Division of Athletic Training, University of Kentucky, Lexington, KY.

Goto (ShihoGoto@texashealth.org) is corresponding author.
  • 1.

    DeHaven KE, Lintner DM. Athletic injuries: comparison by age, sport, and gender. Am J Sports Med. 1986;14(3):218224. PubMed ID: 3752362 doi:10.1177/036354658601400307

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20(5):725730. PubMed ID: 19765240 doi:10.1111/j.1600-0838.2009.00996.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Lankhorst NE, van Middelkoop M, Crossley KM, et al. Factors that predict a poor outcome 5–8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis. Br J Sports Med. 2016;50(14):881886. PubMed ID: 26463119 doi:10.1136/bjsports-2015-094664

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Utting MR, Davies G, Newman JH. Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis? Knee. 2005;12(5):362365. PubMed ID: 16146626 doi:10.1016/j.knee.2004.12.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33(11):639646. PubMed ID: 14669959 doi:10.2519/jospt.2003.33.11.639

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Huberti H, Hayes W. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am. 1984;66(5):715724. PubMed ID: 6725318 doi:10.2106/00004623-198466050-00010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. 2003;33(11):686693. PubMed ID: 14669964 doi:10.2519/jospt.2003.33.11.686

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Nakagawa TH, Moriya ET, Maciel CD, Serrao FV. 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. J Orthop Sports Phys Ther. 2012;42(6):491501. PubMed ID: 22402604 doi:10.2519/jospt.2012.3987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Noehren B, Pohl MB, Sanchez Z, Cunningham T, Lattermann C. Proximal and distal kinematics in female runners with patellofemoral pain. Clin Biomech. 2012;27(4):366371. doi:10.1016/j.clinbiomech.2011.10.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Nakagawa TH, Moriya ET, Carlos Dias CD, Serrao FV. Frontal plane biomechanics in males and females with and without patellofemoral pain. Med Sci Sports Exerc. 2012;44(9):17471755. PubMed ID: 22460471 doi:10.1249/MSS.0b013e318256903a

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    de Oliveira Silva D, Briani RV, Pazzinatto MF, Ferrari D, Aragão FA, de Azevedo FM. Reduced knee flexion is a possible cause of increased loading rates in individuals with patellofemoral pain. Clin Biomech. 2015;30(9):971975. doi:10.1016/j.clinbiomech.2015.06.021

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Aminaka N, Pietrosimone BG, Armstrong CW, Meszaros A, Gribble PA. Patellofemoral pain syndrome alters neuromuscular control and kinetics during stair ambulation. J Electromyogr Kinesiol. 2011;21(4):645651. PubMed ID: 21524921 doi:10.1016/j.jelekin.2011.03.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Cowan SM, Crossley KM, Bennell KL. Altered hip and trunk muscle function in individuals with patellofemoral pain. Br J Sports Med. 2009;43(8):584588. PubMed ID: 18838402 doi:10.1136/bjsm.2008.053553

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Brindle TJ, Mattacola C, McCrory J. Electromyographic changes in the gluteus medius during stair ascent and descent in subjects with anterior knee pain. Knee Surg Sports Traumatol Arthrosc. 2003;11(4):244251. PubMed ID: 12695878 doi:10.1007/s00167-003-0353-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Willson JD, Kernozek TW, Arndt RL, Reznichek DA, Scott Straker J. Gluteal muscle activation during running in females with and without patellofemoral pain syndrome. Clin Biomech. 2011;26(7):735740. doi:10.1016/j.clinbiomech.2011.02.012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Souza RB, Powers CM. Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther. 2009;39(1):1219. PubMed ID: 19131677 doi:10.2519/jospt.2009.2885

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Bolgla LA, Malone TR, Umberger BR, Uhl TL. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2008;38(1):1218. PubMed ID: 18349475 doi:10.2519/jospt.2008.2462

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Willson JD, Davis IS. Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clin Biomech. 2008;23(2):203211. doi:10.1016/j.clinbiomech.2007.08.025

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Mauntel TC, Begalle RL, Cram TR, et al. The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. J Strength Cond Res. 2013;27(7):18131823. PubMed ID: 23096063 doi:10.1519/JSC.0b013e318276b886

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Padua DA, Bell DR, Clark MA. Neuromuscular characteristics of individuals displaying excessive medial knee displacement. J Athl Train. 2012;47(5):525536. PubMed ID: 23068590 doi:10.4085/1062-6050-47.5.10

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Palmieri-Smith RM, McLean SG, Ashton-Miller JA, Wojtys EM. Association of quadriceps and hamstrings cocontraction patterns with knee joint loading. J Athl Train. 2009;44(3):256263. PubMed ID: 19478837 doi:10.4085/1062-6050-44.3.256

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Lloyd DG, Buchanan TS. Strategies of muscular support of varus and valgus isometric loads at the human knee. J Biomech. 2001;34(10):12571267. PubMed ID: 11522305 doi:10.1016/S0021-9290(01)00095-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Gribble PA, Hertel J, Plisky P. Using the star excursion balance test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train. 2012;47(3):339357. PubMed ID: 22892416 doi:10.4085/1062-6050-47.3.08

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Aminaka N, Gribble PA. Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. J Athl Train. 2008;43(1):2128. PubMed ID: 18335009 doi:10.4085/1062-6050-43.1.21

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Earl JE, Hertel J. Lower-extremity muscle activation during the star excursion balance tests/Activation des muscles de la jambe lors des tests d ‘equilibre de l ‘etoile. J Sport Rehabil. 2001;10(2):93104. doi:10.1123/jsr.10.2.93

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Claiborne TL, Armstrong CW, Gandhi V, Pincivero DM. Relationship between hip and knee strength and knee valgus during a single leg squat. J Appl Biomech. 2006;22(1):4150. PubMed ID: 16760566 doi:10.1123/jab.22.1.41

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10(5):361374. PubMed ID: 11018445 doi:10.1016/S1050-6411(00)00027-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Gottschalk F, Kourosh S, Leveau B. The functional anatomy of tensor fasciae latae and gluteus medius and minimus. J Anat. 1989;166:179189. PubMed ID: 2621137

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Perotto AO, Delagi EF, Lazzetti JM, Morrison D. Anatomical Guide for the Electromyographer: The Limbs and the Trunk. 2nd ed. Springfield, IL: Charles C Thomas Pubisher Ltd; 1981.

    • Search Google Scholar
    • Export Citation
  • 30.

    Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther. 2003;33(11):671676. PubMed ID: 14669962 doi:10.2519/jospt.2003.33.11.671

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2007;37(5):232238. PubMed ID: 17549951 doi:10.2519/jospt.2007.2439

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Delagi EF. Anatomic Guide for the Electromyographer —The Limbs. 2nd ed. Springfield, IL: Charles C Thomas Publisher Ltd; 1981.

  • 33.

    Earl JE, Hertel J. Lower-extremity muscle activation during the star excursion balance tests. J Sport Rehabil. 2001;10(2):93104. doi:10.1123/jsr.10.2.93

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Robinson RH, Gribble PA. Support for a reduction in the number of trials needed for the star excursion balance test. Arch Phys Med Rehabil. 2008;89(2):364370. PubMed ID: 18226664 doi:10.1016/j.apmr.2007.08.139

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Robinson R, Gribble P. Kinematic predictors of performance on the star excursion balance test. J Sport Rehabil. 2008;17(4):347357. PubMed ID: 19160909 doi:10.1123/jsr.17.4.347

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Sousa A, Macedo R. Effect of the contraction of medial rotators of the tibia on the electromyographic activity of vastus medialis and vastus lateralis. J Electromyogr Kinesiol. 2010;20(5):967972. PubMed ID: 20194035 doi:10.1016/j.jelekin.2010.01.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: L. Erlbaum Associates; 1988.

  • 38.

    Dierks TA, Manal KT, Hamill J, Davis I. Lower extremity kinematics in runners with patellofemoral pain during a prolonged run. Med Sci Sports Exerc. 2011;43(4):693700. PubMed ID: 20798656 doi:10.1249/MSS.0b013e3181f744f5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Salsich GB, Perman WH. Patellofemoral joint contact area is influenced by tibiofemoral rotation alignment in individuals who have patellofemoral pain. J Orthop Sports Phys Ther. 2007;37(9):521528. PubMed ID: 17939611 doi:10.2519/jospt.2007.37.9.521

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Wirtz AD, Willson JD, Kernozek TW, Hong DA. Patellofemoral joint stress during running in females with and without patellofemoral pain. Knee. 2012;19(5):703708. PubMed ID: 22000909 doi:10.1016/j.knee.2011.09.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Barton CJ, Levinger P, Webster KE, Menz HB. Walking kinematics in individuals with patellofemoral pain syndrome: a case-control study. Gait Posture. 2011;33(2):286291. PubMed ID: 21194952 doi:10.1016/j.gaitpost.2010.11.022

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998;5(11):10861090. PubMed ID: 9835471 doi:10.1111/j.1553-2712.1998.tb02667.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Rathleff MS, Samani A, Olesen JL, et al. Neuromuscular activity and knee kinematics in adolescents with patellofemoral pain. Med Sci Sports Exerc. 2013;45(9):17301739. PubMed ID: 23524514 doi:10.1249/MSS.0b013e318292be30

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Neumann D. Kinesiology of the Musculoskeletal System: Foundations for Physical Rehabilitation. Philadelphia, PA: Mosby Inc; 2002.

  • 45.

    Boling MC, Padua DA, Alexander C, Reighton R. Concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain. J Athl Train. 2009;44(1):713. PubMed ID: 19180213 doi:10.4085/1062-6050-44.1.7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Mohr KJ, Kvitne RS, Pink MM, Fideler B, Perry J. Electromyography of the quadriceps in patellofemoral pain with patellar subluxation. Clin Orthop Relat Res. 415, 2003(415):261271. doi:10.1097/01.blo.0000093918.26658.6a

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Stensdotter AK, Grip H, Hodges PW, Häger-Ross C. Quadriceps activity and movement reactions in response to unpredictable sagittal support-surface translations in women with patellofemoral pain. J Electromyogr Kinesiol. 2008;18(2):298307. PubMed ID: 17158068 doi:10.1016/j.jelekin.2006.10.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Basnett CR, Hanish MJ, Wheeler TJ, et al. Ankle dorsiflexion range of motion influences dynamic balance in individuals with chronic ankle instability. Int J Sports Phys Ther. 2013;8(2):121128. PubMed ID: 23593550

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Hoch MC, Staton GS, McKeon PO. Dorsiflexion range of motion significantly influences dynamic balance. J Sci Med Sport. 2011;14(1):9092. PubMed ID: 20843744 doi:10.1016/j.jsams.2010.08.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Kang MH, Lee DK, Park KH, Oh JS. Association of ankle kinematics and performance on the y-balance test with inclinometer measurements on the weight-bearing-lunge test. J Sport Rehabil. 2015;24(1):6267. PubMed ID: 24458334 doi:10.1123/jsr.2013-0117

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2005;35(12):793801. PubMed ID: 16848100 doi:10.2519/jospt.2005.35.12.793

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Palmieri-Smith RM, Wojtys EM, Ashton-Miller JA. Association between preparatory muscle activation and peak valgus knee angle. J Electromyogr Kinesiol. 2008;18(6):973979. PubMed ID: 17498972 doi:10.1016/j.jelekin.2007.03.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Henriksen M, Alkjær T, Simonsen EB, Bliddal H. Experimental muscle pain during a forward lunge—the effects on knee joint dynamics and electromyographic activity. Br J Sports Med. 2009;43(7):503507. PubMed ID: 18718971 doi:10.1136/bjsm.2008.050393

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Kyrolainen H, Avela J, Komi PV. Changes in muscle activity with increasing running speed. J Sports Sci. 2005;23(10):11011109. PubMed ID: 16194986 doi:10.1080/02640410400021575

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 444 408 34
Full Text Views 14 14 0
PDF Downloads 6 6 0