Effects of Anterior Knee Displacement During Squatting on Patellofemoral Joint Stress

in Journal of Sport Rehabilitation
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Context: Squatting is a common rehabilitation training exercise for patellofemoral pain syndrome (PFPS). Patellofemoral joint stress (PFJS) during squatting with more anterior knee displacement has not been systematically investigated. Objective: To compare PFJS during squatting using 2 techniques: squat while keeping the knees behind the toes (SBT) and squat while allowing the knees to go past the toes (SPT). Setting: University research laboratory. Participants: Twenty-five healthy females (age: 22.69 (0.74) y; height: 169.39 (6.44) cm; mass: 61.55 (9.74) kg) participated. Main Outcome Measures: Three-dimensional kinematic and kinetic data were collected at 180 and 1800 Hz, respectively. A musculoskeletal model was used to calculate muscle forces through static optimization. These muscle forces were used in a patellofemoral joint model to estimate PFJS. Results: The magnitudes of PFJS, reaction force, and quadriceps force were higher (P < .001) during SPT compared with the SBT technique. Knee flexion, hip flexion, and ankle dorsiflexion angles were reduced when using the SBT technique. Conclusions: Findings provide some general support for minimizing forward knee translation during squats for patients that may have patellofemoral pain syndrome.

Kernozek, Zellmer, and Hove are with Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA. Kernozek, Gheidi, and Heinert are with La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, WI, USA. Gheidi is also with the Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI, USA. Heinert is also with Sports Medicine Department, Gundersen Health System, La Crosse, WI, USA. Torry is with the School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA.

Kernozek (kernozek.thom@uwlax.edu) is corresponding author.
Journal of Sport Rehabilitation

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References

  • 1.

    Clijsen RFuchs JTaeymans J. Effectiveness of exercise therapy in treatment of patients with patellofemoral pain syndrome: systematic review and meta-analysis. Phys Ther. 2014;94(12):16971708. PubMed doi:10.2522/ptj.20130310

    • Search Google Scholar
    • Export Citation
  • 2.

    Heintjes EBerger MYBierma-Zeinstra SMABernsen RMDVerhaar JANKoes BW. Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2003; (4):CD003472. doi:10.1002/14651858.CD003472

    • Search Google Scholar
    • Export Citation
  • 3.

    Boling MPadua DMarshall SGuskiewicz KPyne SBeutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20(5):725730. PubMed doi:10.1111/j.1600-0838.2009.00996.x

    • Search Google Scholar
    • Export Citation
  • 4.

    Dixit SDiFiori JPBurton MMines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007;75(2):194202. PubMed

  • 5.

    Fredericson MPowers CM. Practical management of patellofemoral pain. Clin J Sport Med. 2002;12(1):3638. doi:10.1097/00042752-200201000-00010

    • Search Google Scholar
    • Export Citation
  • 6.

    Rodriguez-Merchan EC. Evidence based conservative management of patello-femoral syndrome. Arch Bone Jt Surg. 2014;2(1):46. PubMed

  • 7.

    Näslund JNäslund UBOdenbring SLundeberg T. Comparison of symptoms and clinical findings in subgroups of individuals with patellofemoral pain. Physiother Theory Pract. 2006;22(3):105118. doi:10.1080/09593980600724246

    • Search Google Scholar
    • Export Citation
  • 8.

    Shelton GLThigpen LK. Rehabilitation of patellofemoral dysfunction: a review of literature. J Orthop Sports Phys Ther. 1991;14(6):243249. PubMed doi:10.2519/jospt.1991.14.6.243

    • Search Google Scholar
    • Export Citation
  • 9.

    Myer GDFord KRBarber Foss KDet al. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech. 2010;25(7):700707. doi:10.1016/j.clinbiomech.2010.04.001

    • Search Google Scholar
    • Export Citation
  • 10.

    Thomas MJWood LSelfe JPeat G. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC Musculoskelet Disord. 2010;11:201. PubMed doi:10.1186/1471-2474-11-201

    • Search Google Scholar
    • Export Citation
  • 11.

    Balci PTunay VBBaltaci GAtay AO. The effects of two different closed kinetic chain exercises on muscle strength and proprioception in patients with patellofemoral pain syndrome. Acta Orthop Traumatol Turc. 2009;43(5):419425. PubMed doi:10.3944/AOTT.2009.419

    • Search Google Scholar
    • Export Citation
  • 12.

    Bily WTrimmel LMödlin MKaider AKern H. Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study. Arch Phys Med Rehabil. 2008;89(7):12301236. PubMed doi:10.1016/j.apmr.2007.10.048

    • Search Google Scholar
    • Export Citation
  • 13.

    Steinkamp LADillingham MFMarkel MDHill JAKaufman KR. Biomechanical considerations in patellofemoral joint rehabilitation. Am J Sports Med. 1993;21(3):438444. PubMed doi:10.1177/036354659302100319

    • Search Google Scholar
    • Export Citation
  • 14.

    Witvrouw ECallaghan MJStefanik JJet al. Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. Br J Sports Med. 2014;48(6):411414. PubMed doi:10.1136/bjsports-2014-093450

    • Search Google Scholar
    • Export Citation
  • 15.

    Dahlkvist NJMayo PSeedhom BB. Forces during squatting and rising from a deep squat. Eng Med. 1982;11(2):6976. PubMed doi:10.1243/EMED_JOUR_1982_011_019_02

    • Search Google Scholar
    • Export Citation
  • 16.

    Escamilla RF. Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc. 2001;33(1):127141. PubMed doi:10.1097/00005768-200101000-00020

    • Search Google Scholar
    • Export Citation
  • 17.

    Escamilla RFFleisig GSZheng Net al. Effects of technique variations on knee biomechanics during the squat and leg press. Med Sci Sports Exerc. 2001;33(9):15521566. PubMed doi:10.1097/00005768-200109000-00020

    • Search Google Scholar
    • Export Citation
  • 18.

    Escamilla RFZheng NMacleod TDet al. Patellofemoral joint force and stress during the wall squat and one-leg squat. Med Sci Sports Exerc. 2009;41(4):879888. PubMed doi:10.1249/MSS.0b013e31818e7ead

    • Search Google Scholar
    • Export Citation
  • 19.

    Fry ACSmith JCSchilling BK. Effect of knee position on hip and knee torques during the barbell squat. J Strength Cond. 2003;17(4):629633.

    • Search Google Scholar
    • Export Citation
  • 20.

    Gullett JCTillman MDGutierrez GMChow JW. A biomechanical comparison of back and front squats in healthy trained individuals. J Strength Cond Res. 2009;23(1):284292. PubMed doi:10.1519/JSC.0b013e31818546bb

    • Search Google Scholar
    • Export Citation
  • 21.

    Reilly DTMartens M. Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop Scand. 1972;43(2):126137. PubMed doi:10.3109/17453677208991251

    • Search Google Scholar
    • Export Citation
  • 22.

    Lorenzetti SGülay TStoop Met al. Comparison of the angles and corresponding moments in the knee and hip during restricted and unrestricted squats. J Strength Cond Res. 2012;26(10):28292836. doi:10.1519/JSC.0b013e318267918b

    • Search Google Scholar
    • Export Citation
  • 23.

    Andrews JHay JVaughan C. Knee shear forces during a squat using a barbell and weight machine. In: Matsui HKobayashi K eds. Biomechanics. Vol 8B. Champaign, IL: Human Kinetics; 1983:923927.

    • Search Google Scholar
    • Export Citation
  • 24.

    Schoenfeld BJ. Squatting kinematics and kinetics and their application to exercise performance. J Strength Cond Res. 2010;24(12):34973506. doi:10.1519/JSC.0b013e3181bac2d7

    • Search Google Scholar
    • Export Citation
  • 25.

    Chandler TJStone MH. The squat exercise in athletic conditioning: a position statement and review of the literature. J Strength Cond Res. 1992;13(5):5158.

    • Search Google Scholar
    • Export Citation
  • 26.

    Chandler JMcMillan JKibler BRichards D. Safety of the squat exercise. ACSM Curr Comment. 2000. https://blogs.umass.edu/bodyshop/files/2009/07/safetysquatexercise.pdf.

    • Search Google Scholar
    • Export Citation
  • 27.

    Brechter JHPowers CM. Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait Posture. 2002;16(2):115123. PubMed doi:10.1016/S0966-6362(02)00090-5

    • Search Google Scholar
    • Export Citation
  • 28.

    Salem GJPowers CM. Patellofemoral joint kinetics during squatting in collegiate women athletes. Clin Biomech. 2001;16(5):424430. doi:10.1016/S0268-0033(01)00017-1

    • Search Google Scholar
    • Export Citation
  • 29.

    Wallace DASalem GJSalinas RPowers CM. Patellofemoral joint kinetics while squatting with and without an external load. J Orthop Sports Phys Ther. 2002;32(4):141148. PubMed doi:10.2519/jospt.2002.32.4.141

    • Search Google Scholar
    • Export Citation
  • 30.

    Tegner YLysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):4349.

  • 31.

    Harriss DJAtkinson G. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med. 2015;36(14):11211124. PubMed doi:10.1055/s-0035-1565186

    • Search Google Scholar
    • Export Citation
  • 32.

    van den Bogert AJGeijtenbeek TEven-Zohar OSteenbrink FHardin EC. A real-time system for biomechanical analysis of human movement and muscle function. Med Biol Eng Comput. 2013;51(10):10691077. PubMed doi:10.1007/s11517-013-1076-z

    • Search Google Scholar
    • Export Citation
  • 33.

    Bell ALPedersen DRBrand RA. A comparison of the accuracy of several hip center location prediction methods. J Biomech. 1990;23(6):617621. PubMed doi:10.1016/0021-9290(90)90054-7

    • Search Google Scholar
    • Export Citation
  • 34.

    Delp SLLoan JPHoy MGZajac FETopp ELRosen JM. An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng. 1990;37(8):757767. PubMed doi:10.1109/10.102791

    • Search Google Scholar
    • Export Citation
  • 35.

    Lu TWO’Connor JJ. Bone position estimation from skin marker co-ordinates using global optimisation with joint constraints. J Biomech. 1999;32(2):129134. PubMed doi:10.1016/S0021-9290(98)00158-4

    • Search Google Scholar
    • Export Citation
  • 36.

    Erdemir AMcLean SHerzog Wvan den Bogert AJ. Model-based estimation of muscle forces exerted during movements. Clin Biomech. 2007;22(2):131154. doi:10.1016/j.clinbiomech.2006.09.005

    • Search Google Scholar
    • Export Citation
  • 37.

    Xia YFeng G. An improved neural network for convex quadratic optimization with application to real-time beamforming. Neurocomputing. 2005;64:359374. doi:10.1016/j.neucom.2004.11.009

    • Search Google Scholar
    • Export Citation
  • 38.

    Brechter JHPowers CM. Patellofemoral stress during walking in persons with and without patellofemoral pain. Med Sci Sports Exerc. 2002;34(10):15821593. doi:10.1097/00005768-200210000-00009

    • Search Google Scholar
    • Export Citation
  • 39.

    van Eijden TMKouwenhoven EVerburg JWeijs WA. A mathematical model of the patellofemoral joint. J Biomech. 1986;19(3):219229. PubMed doi:10.1016/0021-9290(86)90154-5

    • Search Google Scholar
    • Export Citation
  • 40.

    Connolly KDRonsky JLWestover LMKüpper JCFrayne R. Differences in patellofemoral contact mechanics associated with patellofemoral pain syndrome. J Biomech. 2009;42(16):28022807. PubMed doi:10.1016/j.jbiomech.2009.07.028

    • Search Google Scholar
    • Export Citation
  • 41.

    Salsich GBWard SRTerk MRPowers CM. In vivo assessment of patellofemoral joint contact area in individuals who are pain free. Clin Orthop Relat Res. 2003;(417):277284. doi:10.1097/01.blo.0000093024.56370.79

    • Search Google Scholar
    • Export Citation
  • 42.

    Besier TFDraper CEGold GEBeaupré GSDelp SL. Patellofemoral joint contact area increases with knee flexion and weight-bearing. J Orthop Res. 2005;23(2):345350. doi:10.1016/j.orthres.2004.08.003

    • Search Google Scholar
    • Export Citation
  • 43.

    Powers CMLilley JCLee TQ. The effects of axial and multi-plane loading of the extensor mechanism on the patellofemoral joint. Clin Biomech. 1998;13(8):616624. doi:10.1016/S0268-0033(98)00013-8

    • Search Google Scholar
    • Export Citation
  • 44.

    Salsich GBBrechter JHPowers CM. Lower extremity kinetics during stair ambulation in patients with and without patellofemoral pain. Clin Biomech. 2001;16(10):906912. doi:10.1016/S0268-0033(01)00085-7

    • Search Google Scholar
    • Export Citation
  • 45.

    Escamilla RFFleisig GSZheng NBarrentine SWWilk KEAndrews JR. Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. Med Sci Sports Exerc. 1998;30(4):556569. PubMed doi:10.1097/00005768-199804000-00014

    • Search Google Scholar
    • Export Citation
  • 46.

    Nagura TDyrby COAlexander EJAndriacchi TP. Mechanical loads at the knee joint during deep flexion. J Orthop Res. 2002;20(4):881886. doi:10.1016/S0736-0266(01)00178-4

    • Search Google Scholar
    • Export Citation
  • 47.

    Nisell REkholm J. Patellar forces during knee extension. Scand J Rehabil Med. 1985;17(2):6374. PubMed

  • 48.

    List RGülay TStoop MLorenzetti S. Kinematics of the trunk and the lower extremities during restricted and unrestricted squats. J Strength Cond Res. 2013;27(6):15291538. doi:10.1519/JSC.0b013e3182736034

    • Search Google Scholar
    • Export Citation
  • 49.

    Khorievin VIHorkovenko AVVereshchaka IV. Displacement of center of pressure on the support and changes of the joint angles of the lower extremity at squatting. Fiziol Zh. 2012;58(3):3242. PubMed

    • Search Google Scholar
    • Export Citation
  • 50.

    Dionisio VCAlmeida GLDuarte MHirata RP. Kinematic, kinetic and EMG patterns during downward squatting. J Electromyogr Kinesiol. 2008;18(1):134143. doi:10.1016/j.jelekin.2006.07.010

    • Search Google Scholar
    • Export Citation

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