Acute Effects of Hip Mobilization With Movement Technique on Pain and Biomechanics in Females With Patellofemoral Pain: A Randomized, Placebo-Controlled Trial

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: People with patellofemoral pain (PFP) present altered lower-limb movements during some activities. Perhaps, joint misalignment in the hip is one of the reasons for altered movement patterns in people with PFP. Some mobilization techniques have been designed to address joint misalignments. Objective: To investigate the acute effects of hip mobilization with movement (MWM) technique on pain and biomechanics during squats and jumps in females with and without PFP. Design: Randomized, placebo-controlled trial. Setting: Movement analysis laboratory. Patients: Fifty-six physically active females (28 with PFP and 28 asymptomatic) were divided into 4 groups: experimental group with PFP, sham group with PFP, experimental group without PFP, and sham group without PFP. Intervention(s): The experimental groups received MWM for the hip, and the sham groups received sham mobilization. Main Outcome Measures: Pain, trunk, and lower-limb kinematics, and hip and knee kinetics during single-leg squats and landings. Results: After the interventions, no difference between groups was found for pain. The PFP experimental group decreased hip internal rotation during squats compared with the PFP sham group (P = .03). There was no other significant difference between PFP groups for kinematic or kinetic outcomes during squats, as well as for any outcome during landings. There was no difference between asymptomatic groups for any of the outcomes in any of the tasks. Conclusions: Hip mobilization was ineffective to reduce pain in people with PFP. Hip MWM may contribute to dynamic lower-limb realignment in females with PFP by decreasing hip internal rotation during squats. Therefore, hip MWM could be potentially useful as a complementary intervention for patients with PFP.

Nunes, Wolf, dos Santos, and Serrão are with the Department of Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil. de Noronha is with the Department of Community and Allied Health, La Trobe University, Bendigo, VIC, Australia.

Nunes (nunesguilherme@live.com) is corresponding author.
Journal of Sport Rehabilitation
Article Sections
References
  • 1.

    Smith BESelfe JThacker Det al. Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis. PLoS ONE. 2018;13:e0190892. PubMed ID: 29324820 doi:

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

    Glaviano NRKew MHart JMSaliba S. Demographic and epidemiological trends in patellofemoral pain. Int J Sports Phys Ther. 2015;10:281290. PubMed ID: 26075143

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

    Crossley KMStefanik JJSelfe Jet 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;50:839843. PubMed ID: 27343241 doi:

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

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

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

    Powers CMWitvrouw EDavis ISCrossley 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;51:17131723. PubMed ID: 29109118 doi:

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

    Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40:4251. PubMed ID: 20118526 doi:

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

    Barton CJLack SMalliaras PMorrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47:207214. PubMed ID: 22945929 doi:

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

    Nunes GSBarton CJSerrão FV. Hip rate of force development and strength are impaired in females with patellofemoral pain without signs of altered gluteus medius and maximus morphology. J Sci Med Sport. 2018;21:123128. PubMed ID: 28606466 doi:

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

    Rathleff MSRathleff CRCrossley KMBarton CJ. Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. Br J Sports Med. 2014;48:10881088. PubMed ID: 24687010 doi:

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

    Neal BSLack SDLankhorst NERaye AMorrissey Dvan 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:

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

    Boling MPadua D. Relationship between hip strength and trunk, hip, and knee kinematics during a jump-landing task in individuals with patellofemoral pain. Int J Sports Phys Ther. 2013;8:661669. PubMed ID: 24175145

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

    Winters JMKleweno DG. Effect of initial upper-limb alignment on muscle contributions to isometric strength curves. J Biomech. 1993;26:143153. PubMed ID: 8429057 doi:

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

    Myers CALaz PJShelburne KBet al. The impact of hip implant alignment on muscle and joint loading during dynamic activities. Clin Biomech. 2018;53:93100. doi:

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

    American Physical Therapy Association (APTA) position: manipulation/mobilization [Internet]. 2018. https://www.apta.org/StateIssues/Manipulation/. Accessed May 09 2018.

    • Export Citation
  • 15.

    Beselga CNeto FAlburquerque-Sendín FHall TOliveira-Campelo N. Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: a randomised controlled trial. Man Ther. 2016;22:8085. PubMed ID: 26559319 doi:

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

    Eckenrode BJKietrys DMParrott JS. Effectiveness of manual therapy for pain and self-reported function in individuals with patellofemoral pain: systematic review and meta-analysis. J Orthop Sports Phys Ther. 2018;48:358371. PubMed ID: 29308698 doi:

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

    U.S. Department of Health and Human Services Current Guidelines for Physical Activity [Internet]. 2018. https://health.gov/paguidelines/second-edition/. Accessed March 18 2019.

    • Export Citation
  • 18.

    Nakagawa THMoriya ÉTUMaciel CDSerrão AFV. Frontal plane biomechanics in males and females with and without patellofemoral pain. Med Sci Sports Exerc. 2012;44(9):17471755. PubMed ID: 22460471 doi:

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

    Nakagawa THMoriya ETUMaciel CDSerrão 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;42:491501. PubMed ID: 22402604 doi:

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

    Motealleh AGheysari EShokri ESobhani S. The immediate effect of lumbopelvic manipulation on EMG of vasti and gluteus medius in athletes with patellofemoral pain syndrome: a randomized controlled trial. Man Ther. 2016;22:1621. PubMed ID: 26995778 doi:

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

    Vicenzino BPaungmali ATeys P. Mulligan’s mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature. Man Ther. 2007;12:98108. PubMed ID: 16959529 doi:

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

    Mulligan BR. Manual Therapy: NAGS SNAGS MWMS etc. 5th ed. Wellington, NZ/Minneapolis, MN: OPTP; 2004.

  • 23.

    Collins NTeys PVicenzino B. The initial effects of a Mulligan’s mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Man Ther. 2004;9:7782. PubMed ID: 15040966 doi:

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

    Paungmali AO’Leary SSouvlis TVicenzino B. Hypoalgesic and sympathoexcitatory effects of mobilization with movement for lateral epicondylalgia. Phys Ther. 2003;83:374383. PubMed ID: 12665408

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

    Hjermstad MJFayers PMHaugen DFet al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):10731093. PubMed ID: 21621130 doi:

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

    van der Heijden RALankhorst NEvan Linschoten RBierma-Zeinstra SMAvan Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015;1:CD010387. PubMed ID: 25603546

    • Search Google Scholar
    • Export Citation
  • 27.

    Willson JDBinder-Macleod SDavis IS. Lower extremity jumping mechanics of female athletes with and without patellofemoral pain before and after exertion. Am J Sports Med. 2008;36:15871596. PubMed ID: 18448577 doi:

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

    Wu GSiegler SAllard Pet al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. J Biomech. 2002;35:543548. PubMed ID: 11934426 doi:

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

    Winter DA. Biomechanics and Motor Control of Human Movement. 4th ed. Hoboken, NJ: Wiley; 2009.

  • 30.

    Powers CMHo KYChen YJSouza RBFarrokhi S. Patellofemoral joint stress during weight-bearing and non-weight-bearing quadriceps exercises. J Orthop Sports Phys Ther. 2014;44:320327. PubMed ID: 24673446 doi:

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

    Portney LGWatkins MP. Foundations of Clinical Research: Applications to Practice. New York, NY: McGraw-Hill/Appleton & Lange; 1993.

  • 32.

    Perneger TV. What’s wrong with Bonferroni adjustments. BMJ. 1998;316:12361238. PubMed ID: 9553006 doi:

  • 33.

    Cohen J. A power primer. Psychol Bull. 1992;112:155159. PubMed ID: 19565683 doi:

  • 34.

    Nakagawa THSerrão FVMaciel CDPowers CM. Hip and knee kinematics are associated with pain and self-reported functional status in males and females with patellofemoral pain. Int J Sports Med. 2013;34:9971002. PubMed ID: 23771827 doi:

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

    Boling MCPadua DAMarshall SWGuskiewicz KPyne SBeutler 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;37:21082116. PubMed ID: 19797162 doi:

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

    Souza RBDraper CEFredericson MPowers CM. Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther. 2010;40:277285. PubMed ID: 20436239 doi:

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

    Nunes GSSilva RSdos Santos AFFernandes RASSerrão FVde Noronha M. Methods to assess patellofemoral joint stress: a systematic review. Gait Posture. 2018;61:188196. PubMed ID: 29353744 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Mulligan BR. Mobilisations with movement (MWM’s). J Man Manip Ther. 1993;1:154156 . doi:

  • 39.

    Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd ed. St. Louis, MO: Mosby; 2009.

  • 40.

    Delahunt ECusack KWilson LDoherty C. Joint mobilization acutely improves landing kinematics in chronic ankle instability. Med Sci Sports Exerc. 2013;45:514519. PubMed ID: 23034641 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
Article Metrics
All Time Past Year Past 30 Days
Abstract Views 369 369 83
Full Text Views 46 46 6
PDF Downloads 13 13 5
Altmetric Badge
PubMed
Google Scholar