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Pablo Fanlo-Mazas, Elena Bueno-Gracia, Alazne Ruiz de Escudero-Zapico, José Miguel Tricás-Moreno and María Orosia Lucha-López

Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal presentations in general practice 1 and sports medicine clinics. 2 The source of patellofemoral pain (PFP) is believed to be multifactorial and could be related to proximal, local, and distal factors. 3 Tightness or

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Mastour S. Alshaharani, Everett B. Lohman, Khaled Bahjri, Travis Harp, Mansoor Alameri, Hatem Jaber and Noha S. Daher

Patellofemoral pain syndrome (PFPS) is characterized by pain at the patella that tends to worsen with certain movements such as squatting, running, and ascending or descending stairs. 1 The most recent statistics for PFPS in the United States show a steady increase in cases, with 1.5% to 7.3% of

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Janice Kaye Loudon, Byron Gajewski, Heather L. Goist-Foley and Karen Lee Loudon

Objective:

To determine the effect of exercise on patients with patellofemoral-pain syndrome (PFPS).

Patients:

29 subjects with unilateral PFPS, assigned to control, home-exercise (HE), or physical therapy (PT) group.

Intervention:

8-wk exercise program.

Main Outcome Measures:

A knee survey, visual analog scale (VAS), and 5 weight-bearing tests.

Results:

MANOVA indicated an overall statistical difference between groups (P < .05). The HE and PT groups experienced less pain than control, and PT experienced less pain than HE (P < .05). In overall knee function and most weight-bearing tests, HE and PT were stronger and more functional than control (P < .05). For anteromedial lunge only PT was stronger and more functional than control (P < .05).

Conclusions:

Intervention helps PFPS, but there appear to be no differences between home and in-clinic interventions.

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John P. Miller, Daniel Sedory and Ronald V. Croce

The purpose of this study was to examine the efficacy of closed kinetic chain exercises in preferentially recruiting the oblique fibers of the vastus medialis obliquus (VMO). Fifteen athletically active females, 6 with patellofemoral pain syndrome (PFPS) and 9 without PFPS, performed two isometric and two dynamic closed kinetic chain exercises. The isometric exercises were a static lunge with 30° of knee flexion (SL@30°) and with 70° of knee flexion (SL@70°). The dynamic exercises were a step-up/step-down exercise (SUSD) and a modified wall slide (MWS). Selective recruitment of the VMO occurred during the MWS (p < .05) and the SUSD in the subjects without PFPS (p < .05). For the SL@70° (p < .01), the MWS (p < .01), and the SUSD (p < .05), subjects with PFPS had greater activity of the vastus lateralis (VL), resulting in a lower VMO: VL ratio for those exercises (p < .05). It was concluded that the closed kinetic chain exercises examined in this study do not preferentially recruit the VMO in individuals with PFPS. In addition, individuals with PFPS have a lower VMO:VL ratio during these exercises compared to individuals without PFPS.

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Ben A. Bloomer and Chris J. Durall

Clinical Scenario:

Patellofemoral pain syndrome (PFPS) is one of the most common disorders affecting the lower extremities. To improve function and decrease pain, affected individuals often undergo a guided rehabilitation program. Traditional programs have concentrated on quadriceps strengthening and other knee-focused exercises, but recent literature suggests that adding hip-muscle strengthening may improve outcomes. This review was conducted to determine the extent to which current evidence supports the addition of hip-muscle strengthening to a knee-focused strengthening and stretching program in the treatment of PFPS.

Focused Clinical Question:

Does the addition of hip-muscle strengthening to a knee-focused strengthening and stretching program improve outcomes in patients with PFPS?

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Samantha A. Campbell and Alison R. Valier

Clinical Scenario:

Patellofemoral pain syndrome (PFPS) occurs in 25% of adolescents and adults and is the leading cause of knee pain in runners. Pain is commonly felt when ascending or descending stairs, deep squatting, kneeling, or running. There is no consensus on the etiology of this condition, but insufficient hip strength, malalignment of the lower extremity, hyperpronation of the foot, and patellar incongruence have been suggested. Common treatments of PFPS include strengthening of quadriceps and hip muscles, McConnell taping, electrical stimulation, and foot orthotics, but effectiveness of these treatments is inconclusive. Kinesio Taping is an alternative taping technique for musculoskeletal injuries including PFPS. Although research suggests that Kinesio Taping decreases pain and improves range of motion for some musculoskeletal injuries, its effectiveness in decreasing pain in patients with PFPS in unknown. Furthermore, Kinesio Taping has not been compared with other taping techniques including McConnell taping.

Focused Clinical Question:

For patients with anterior knee pain consistent with PFPS, does treatment with Kinesio Taping decrease pain more than McConnell taping or no tape at all?

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Andrew R. Boldt, John D. Willson, Joaquin A. Barrios and Thomas W. Kernozek

We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

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Adrick D. Harrison and Carl G. Mattacola

Column-editor : Carl G. Mattacola

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Adrick D. Harrison

Column-editor : Carl G. Mattacola