Are Physical Function and Fear of Movement Risk Factors for Patellofemoral Pain? A 2-Year Prospective Study

Click name to view affiliation

Marcella F. Pazzinatto La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia

Search for other papers by Marcella F. Pazzinatto in
Current site
Google Scholar
PubMed
Close
*
,
Christian J. Barton La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia

Search for other papers by Christian J. Barton in
Current site
Google Scholar
PubMed
Close
,
Richard W. Willy School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA

Search for other papers by Richard W. Willy in
Current site
Google Scholar
PubMed
Close
,
Amanda S. Ferreira UniAmérica Descomplica Centro Universitário, Foz do Iguaçu, Brazil

Search for other papers by Amanda S. Ferreira in
Current site
Google Scholar
PubMed
Close
,
Fábio M. Azevedo Laboratory of Biomechanics and Motor Control, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Brazil

Search for other papers by Fábio M. Azevedo in
Current site
Google Scholar
PubMed
Close
, and
Danilo de Oliveira Silva La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia

Search for other papers by Danilo de Oliveira Silva in
Current site
Google Scholar
PubMed
Close
Restricted access

Context: To determine (1) whether physical function and fear of movement are prospectively associated with the risk of females developing patellofemoral pain (PFP) and (2) whether they change following development of PFP. Design: Prospective observational study. Methods: A total of 114 asymptomatic females (18–22 y old) completed assessment of physical function (forward step-down test and single-leg hop for distance) and fear of movement using the Tampa Scale for Kinesiophobia at baseline and 2-year follow-up. Presence of symptoms of PFP was monitored bimonthly. Results: Ninety participants (retention rate = 79%) completed the 2-year follow-up assessment, with 27 (24% of the cohort) developing PFP. Physical function, including forward step-down test (P = .659) and single-leg hop for distance (P = .825), and fear of movement (P = .479) were not associated with the risk of developing PFP. Females who developed PFP presented with reduced forward step-down repetitions (mean difference = 2.8; 95% confidence interval, 0.2 to 5.3) and single-leg hop for distance (10.2; 95% confidence interval, 2.7 to 17.7 cm) at 2-year follow-up. There was no statistically significant difference between those who did and did not develop PFP for fear of movement (−3.4; 95% confidence interval, −7.0 to 0.2). Conclusions: Physical function and fear of movement were not associated with the risk of developing PFP in young females. However, the change over time in the step-down and single-leg hop for distance tests may suggest that, even in the early stages of PFP, young females present impaired physical function compared with females who did not develop symptoms. Fear of movement may develop due to persistent PFP, and does not appear to be a risk factor or key feature in females with PFP of short symptoms duration.

Pazzinatto (ferraz_mar@hotmail.com) is corresponding author.

  • Collapse
  • Expand
  • 1.

    Dey P, Callaghan M, Cook N, et al. A questionnaire to identify patellofemoral pain in the community: an exploration of measurement properties. BMC Musculoskelet Disord. 2016;17:237. PubMed ID: 27245443 doi:10.1186/s12891-016-1097-5

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

    Neal BS, Lack SD, Lankhorst NE, Raye A, Morrissey D, van Middelkoop M. Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med. 2019;53(5):270281. PubMed ID: 30242107 doi:10.1136/bjsports-2017-098890

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

    Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population: a two-year prospective study. Am J Sports Med. 2000;28(4):480489. PubMed ID: 10921638 doi:10.1177/03635465000280040701

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

    Barber Foss KD, Hornsby M, Edwards NM, Myer GD, Hewett TE. Is body composition associated with an increased risk of developing anterior knee pain in adolescent female athletes? Phys Sportsmed. 2012;40(1):1319. PubMed ID: 22508247 doi:10.3810/psm.2012.02.1947

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

    Holden S, Boreham C, Doherty C, Delahunt E. Two-dimensional knee valgus displacement as a predictor of patellofemoral pain in adolescent females. Scand J Med Sci Sports. 2017;27(2):188194. PubMed ID: 26712044 doi:10.1111/sms.12633

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

    Noehren B, Hamill J, Davis I. Prospective evidence for a hip etiology in patellofemoral pain. Med Sci Sports Exerc. 2013;45(6):11201124. PubMed ID: 23274607 doi:10.1249/MSS.0b013e31828249d2

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

    Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. 2012;42(2):8194. PubMed ID: 22031622 doi:10.2519/jospt.2012.3803

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

    de Oliveira Silva D, Barton CJ, Briani RV, et al. Kinesiophobia, but not strength is associated with altered movement in women with patellofemoral pain. Gait Posture. 2019;68:15. PubMed ID: 30408709 doi:10.1016/j.gaitpost.2018.10.033

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

    de Oliveira Silva D, Barton C, Crossley K, et al. Implications of knee crepitus to the overall clinical presentation of women with and without patellofemoral pain. Phys Ther Sport. 2018;33:8995. PubMed ID: 30059950 doi:10.1016/j.ptsp.2018.07.007

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

    Nunes GS, de Oliveira Silva D, Pizzari T, Serrao FV, Crossley KM, Barton CJ. Clinically measured hip muscle capacity deficits in people with patellofemoral pain. Phys Ther Sport. 2019;35:6974. PubMed ID: 30471549 doi:10.1016/j.ptsp.2018.11.003

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

    Priore LB, Azevedo FM, Pazzinatto MF, et al. Influence of kinesiophobia and pain catastrophism on objective function in women with patellofemoral pain. Phys Ther Sport. 2019;35:116121. PubMed ID: 30529861 doi:10.1016/j.ptsp.2018.11.013

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

    Glaviano NR, Bazett-Jones DM, Boling MC. Pain severity during functional activities in individuals with patellofemoral pain: a systematic review with meta-analysis. J Sci Med Sport. 2022:25(5):399406. PubMed ID: 35190263 doi:10.1016/j.jsams.2022.01.004

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

    Kemp JL, Schache AG, Makdissi M, Sims KJ, Crossley KM. Greater understanding of normal hip physical function may guide clinicians in providing targeted rehabilitation programmes. J Sci Med Sport. 2013;16(4):292296. PubMed ID: 23266242 doi:10.1016/j.jsams.2012.11.887

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

    Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral Pain. J Orthop Sports Phys Ther. 2019;49(9):CPG1CPG95. PubMed ID: 31475628 doi:10.2519/jospt.2019.0302

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

    Powers CM, Witvrouw E, Davis IS, Crossley KM. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med. 2017;51(24):17131723. PubMed ID: 29109118 doi:10.1136/bjsports-2017-098717

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

    Domenech J, Sanchis-Alfonso V, Lopez L, Espejo B. Influence of kinesiophobia and catastrophizing on pain and disability in anterior knee pain patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):15621568. PubMed ID: 23081711 doi:10.1007/s00167-012-2238-5

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

    Pazzinatto MF, Silva DO, Willy RW, Azevedo FM, Barton CJ. Fear of movement and (re)injury is associated with condition specific outcomes and health-related quality of life in women with patellofemoral pain. Physiother Theory Pract. Published online October 27, 2020. doi:10.1080/09593985.2020.1830323

    • Search Google Scholar
    • Export Citation
  • 19.

    de Oliveira Silva D, Pazzinatto MF, Rathleff MS, et al. Patient education for patellofemoral pain: a systematic review. J Orthop Sports Phys Ther. 2020;50(7):388396. PubMed ID: 32349640 doi:10.2519/jospt.2020.9400

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

    Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153(6):11441147. PubMed ID: 22321917 doi:10.1016/j.pain.2011.12.009

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

    Hoch JM, Sinnott CW, Robinson KP, Perkins WO, Hartman JW. The examination of patient-reported outcomes and postural control measures in patients with and without a history of ACL reconstruction: a case control study. J Sport Rehabil. 2018;27(2):170176. PubMed ID: 28253055 doi:10.1123/jsr.2016-0105

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

    San-Antolin M, Rodriguez-Sanz D, Vicente-Campos D, et al. Fear avoidance beliefs and kinesiophobia are presented in athletes who suffer from gastrocnemius chronic myofascial pain. Pain Med. 2020;21(8):16261635. PubMed ID: 32003802 doi:10.1093/pm/pnz362

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

    Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317332. PubMed ID: 10781906 doi:10.1016/S0304-3959(99)00242-0

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

    Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005;(436):100110. doi:10.1097/01.blo.0000172303.74414.7d

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

    Collins NJ, Crossley KM, Darnell R, Vicenzino B. Predictors of short and long term outcome in patellofemoral pain syndrome: a prospective longitudinal study. BMC Musculoskelet Disord. 2010;11(1):11. PubMed ID: 20082723 doi:10.1186/1471-2474-11-11

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

    Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573577. PubMed ID: 17938396 doi:10.7326/0003-4819-147-8-200710160-00010

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

    Barton CJ, De Oliveira Silva D, Morton S, et al. REPORT-PFP: a consensus from the International Patellofemoral Research Network to improve REPORTing of quantitative PatelloFemoral Pain studies. Br J Sports Med. 2021:55(20):11351143. PubMed ID: 34127482 doi:10.1136/bjsports-2020-103700

    • Search Google Scholar
    • Export Citation
  • 28.

    Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am. 2005;87(5):955962. PubMed ID: 15866956 doi:10.2106/jbjs.d.02338

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

    Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006;36(5):267288. PubMed ID: 16715828 doi:10.2519/jospt.2006.2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Purdam CR, Cook JL, Hopper DM, Khan KM, Griffiths L. Discriminative ability of functional loading tests for adolescent jumper’s knee. Phys Ther Sport. 2003;4(1):39. doi:10.1016/s1466-853x(02)00069-x

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

    Loudon J, Wiesnert D, Goist-Foley HL, Asjest C, Loudon K. Intrarater reliability of functional performance tests for subjects with patellofemoral pain syndrome. J Athl Train. 2002;37(3):256261. PubMed ID: 12937582

    • Search Google Scholar
    • Export Citation
  • 32.

    Park KM, Cynn HS, Choung SD. Musculoskeletal predictors of movement quality for the forward step-down test in asymptomatic women. J Orthop Sports Phys Ther. 2013;43(7):504510. PubMed ID: 23756380 doi:10.2519/jospt.2013.4073

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Kemp JL, Risberg MA, Schache AG, Makdissi M, Pritchard MG, Crossley KM. Patients with chondrolabral pathology have bilateral functional impairments 12 to 24 months after unilateral hip arthroscopy: a cross-sectional study. J Orthop Sports Phys Ther. 2016;46(11):947956. PubMed ID: 27802796 doi:10.2519/jospt.2016.6577

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

    Dingenen B, Truijen J, Bellemans J, Gokeler A. Test-retest reliability and discriminative ability of forward, medial and rotational single-leg hop tests. Knee. 2019;26(5):978987. PubMed ID: 31431339 doi:10.1016/j.knee.2019.06.010

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

    Clark M, Kori S, Brockel J. Kinesiophobia and chronic pain: psychometric characteristics and factor analysis of the Tampa Scale. Am Pain Soc Abstr. 1996;15:77.

    • Search Google Scholar
    • Export Citation
  • 36.

    French DJ, France CR, Vigneau F, French JA, Evans RT. Fear of movement/(re)injury in chronic pain: a psychometric assessment of the original English version of the Tampa scale for kinesiophobia (TSK). Pain. 2007;127(1–2):4251. PubMed ID: 16962238 doi:10.1016/j.pain.2006.07.016

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

    Crossley KM, Stefanik JJ, Selfe J, et al. 2016 Patellofemoral pain consensus statement from the 4th international patellofemoral pain research retreat, manchester. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):839843. PubMed ID: 27343241 doi:10.1136/bjsports-2016-096384

    • Search Google Scholar
    • Export Citation
  • 38.

    Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9(2):159163. PubMed ID: 8461073 doi:10.1016/s0749-8063(05)80366-4

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

    Rodriguez Del Águila M, Gonzalez-Ramirez A. Sample size calculation. Allergol Immunopathol. 2014;42(5):485492. doi:10.1016/j.aller.2013.03.008

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

    Field A. Discovering Statistics Using IBM SPSS Statistics. 5th ed. SAGE Publications Ltd; 2018.

  • 41.

    Maclachlan LR, Collins NJ, Hodges PW, Vicenzino B. Psychological and pain profiles in persons with patellofemoral pain as the primary symptom. Eur J Pain. 2020;24(6):11821196. PubMed ID: 32223042 doi:10.1002/ejp.1563

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

    Monticone M, Ambrosini E, Rocca B, Foti C, Ferrante S. Responsiveness and minimal clinically important changes for the Tampa Scale of Kinesiophobia after lumbar fusion during cognitive behavioral rehabilitation. Eur J Phys Rehabil Med. 2017;53(3):351358. PubMed ID: 27827516 doi:10.23736/S1973-9087.16.04362-8

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

    Priore LB, Lack S, Garcia C, Azevedo FM, de Oliveira Silva D. Two weeks of wearing a knee brace compared with minimal intervention on kinesiophobia at 2 and 6 weeks in people with patellofemoral pain: a randomized controlled trial. Arch Phys Med Rehabil. 2020;101(4):613623. PubMed ID: 31830433 doi:10.1016/j.apmr.2019.10.190

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

    De Oliveira Silva D, Pazzinatto MF, Crossley KM, Azevedo FM, Barton CJ. Novel stepped care approach to provide education and exercise therapy for patellofemoral pain: feasibility study. J Med Internet Res. 2020;22(7):e18584. PubMed ID: 32706674 doi:10.2196/18584

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Boudreau SA, Royo AC, Matthews M, et al. Distinct patterns of variation in the distribution of knee pain. Sci Rep. 2018;8(1):16522. PubMed ID: 30410031 doi:10.1038/s41598-018-34950-2

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

    van Middelkoop M, van der Heijden RA, Bierma-Zeinstra SMA. Characteristics and outcome of patellofemoral pain in adolescents: do they differ from adults? J Orthop Sports Phys Ther. 2017;47(10):801805. PubMed ID: 28870143 doi:10.2519/jospt.2017.7326

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

    Steinberg N, Tenenbaum S, Waddington G, et al. Unilateral and bilateral patellofemoral pain in young female dancers: associated factors. J Sports Sci. 2020;38(7):719730. PubMed ID: 32046623 doi:10.1080/02640414.2020.1727822

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

    Vicenzino BT, Rathleff MS, Holden S, et al. Developing clinical and research priorities for pain and psychological features in people with patellofemoral pain: an international consensus process with health care professionals. J Orthop Sports Phys Ther. 2022;52(1):2939. PubMed ID: 34972490 doi:10.2519/jospt.2022.10647

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

    Boling MC, Padua DA, Marshall SW, Guskiewicz K, Pyne S, Beutler A. A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) cohort. Am J Sports Med. 2009;37(11):21082116. PubMed ID: 19797162 doi:10.1177/0363546509337934

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2401 944 65
Full Text Views 578 69 5
PDF Downloads 357 33 7