A Prospective Investigation of Biomechanical Risk Factors for Patellofemoral Pain Syndrome The Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) Cohort

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 09/2009; 37(11):2108-16. DOI: 10.1177/0363546509337934
Source: PubMed


Patellofemoral pain syndrome is one of the most common chronic knee injuries; however, little research has been done to determine the risk factors for this injury.
Altered lower extremity kinematics and kinetics, decreased strength, and altered postural measurements will be risk factors.
Cohort study (prognosis); Level of evidence, 2.
A total of 1597 participants were enrolled in this investigation and prospectively followed from the date of their enrollment (July 2005, July 2006, or July 2007) through January 2008, a maximum of 2.5 years of follow-up. Each participant underwent baseline data collection during their pre-freshman summer at the United States Naval Academy. Baseline data collection included 3-dimensional motion analysis during a jump-landing task, 6 lower extremity isometric strength tests, and postural alignment measurements (navicular drop and Q angle).
Risk factors for the development of patellofemoral pain syndrome included decreased knee flexion angle, decreased vertical ground-reaction force, and increased hip internal rotation angle during the jump-landing task. Additionally, decreased quadriceps and hamstring strength, increased hip external rotator strength, and increased navicular drop were risk factors for the development of patellofemoral pain syndrome.
Multiple modifiable risk factors for patellofemoral pain syndrome pain have been identified in this investigation. To decrease the incidence of this chronic injury, the risk factors for patellofemoral pain syndrome need to be targeted in injury prevention programs.
Prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements to decrease the incidence of patellofemoral pain syndrome.

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Available from: Michelle C Boling, Oct 05, 2015
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    • "It has been theorized that these proximal compensations, associated with foot misalignments , could significantly influence patellofemoral joint mechanics and contribute to the development of patellofemoral pain (PFP) (Tiberio, 1987; Powers, 2003). Supporting these theories, prospective studies have demonstrated that FV and subtalar hyperpronation are risk factors for the development of PFP (Lun et al., 2004; Boling et al., 2009). However, very few studies have "
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    ABSTRACT: Foot misalignments, such as forefoot varus (FV), have been associated with musculoskeletal injuries in the proximal joints of the lower limb. Previous theories suggested that this association occurs because FV influences knee and hip kinematics during closed kinetic chain activities. However, research on the effects of FV in the kinematics of the lower limb is very scarce. Therefore, the purpose of this study was to compare the knee and hip kinematics between subjects with and without FV during a functional weight-bearing activity. Forty-six healthy adolescents were divided into two groups: group of subjects with FV (VG, n=23) and group of subjects with aligned forefoot (CG, n=23). A kinematic evaluation was conducted while the subjects performed a single-leg squat task. The variables of interest were hip internal rotation and adduction and knee abduction excursions at 15°, 30°, 45° and 60° of knee flexion. Between-group comparisons were performed with multivariate analysis of variance. Results showed that the VG presented greater hip internal rotation when compared with the CG across all evaluated knee flexion angles (P=0.02–0.0001). No differences between groups were observed in hip adduction or knee abduction (P>0.05). These results indicate that FV influences the transverse plane hip movement patterns during a functional weight-bearing activity. Considering that excessive hip internal rotation has been associated with knee injuries, these findings might contribute for a better understanding of the link between FV and injuries of the proximal joints of the lower limb.
    Manual Therapy 02/2015; 20(1):79-83. DOI:10.1016/j.math.2014.07.001 · 1.71 Impact Factor
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    • "Different parameters such as ground reaction forces (GRF), center of pressure displacement, electromyography activity of muscle groups mainly involved in these tasks, and movement analysis of hip, knee and trunk segments are studied to attempt to identify changes in movement control in these individuals (Boling et al., 2009; Nakagawa et al., 2012; Saad, Felício, Masullo, Liporaci, & Bevilaqua-Grossi, 2011). Overall, these studies showed that PFPS individuals presented lower values of vertical GRF for the affected limb in a jump-landing task (Boling et al., 2009) and when walking up and down stairs (Saad et al., 2011). They also presented reduced levels of EMG activity (Saad et al., 2011) and increased hip adduction, knee abduction, and trunk lean in the frontal plane (Nakagawa et al., 2012) when walking up and down stairs. "
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    ABSTRACT: Patellofemoral pain syndrome (PFPS) is a prevalent clinical condition and it affects gait behavior. Braking and propulsive impulses are important biomechanical parameters obtained from ground reaction forces (GRF), which combine the amount of force applied over a period of time. The aim of this study was to evaluate these impulses while walking up and down stairs in healthy controls and PFPS individuals. The results did not reveal significant differences in braking and propulsive impulses between groups during these activities. Thus, the painful condition on a simple functional activity was insufficient to change the motor strategy to walking up or down the stairs.
    Motriz. Revista de Educação Física 11/2014; 20(4):442-447. DOI:10.1590/S1980-65742014000400011 · 0.09 Impact Factor
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    • "ND has been suggested as the most appropriate parameter for a clinical assessment of foot eversion [2,3] and is a valid indicator of talonavicular motion [4] and rear foot movement [5]. Previous research on the risk of developing injury has highlighted the importance of ND, as an increased ND is associated with increased risk of overuse injuries, such as medial tibial stress syndrome and patellofemoral pain syndrome [6,7]. "
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    ABSTRACT: Increased navicular drop is associated with increased risk of lower extremity overuse injuries and foot orthoses are often prescribed to reduce navicular drop. For laboratory studies, transparent shoes may be used to monitor the effect of orthoses but no clinically feasible methods exist. We have developed a stretch-sensor that allows for in-shoe measurement of navicular drop but the reliability and validity is unknown. The purpose of this study was to investigate: 1) the reliability of the stretch-sensor for measuring navicular drop, and 2) the concurrent validity of the stretch-sensor compared to the static navicular drop test. Intra- and inter-rater reliability was tested on 27 participants walking on a treadmill on two separate days. The stretch-sensor was positioned 20 mm posterior to the tip of the medial malleolus and 20 mm posterior to the navicular tuberosity. The participants walked six minutes on the treadmill before navicular drop was measured. Reliability was quantified by the Intraclass Correlation Coefficient (ICC 2.1) and agreement was quantified by Limits of Agreement (LOA). To assess concurrent validity, static navicular drop was measured with the stretch-sensor and compared with static navicular drop measured with a ruler on 27 new participants. Linear regression was used to measure concurrent validity. The reliability of the stretch-sensor was acceptable for barefoot measurement (intra- and inter-rater ICC: 0.76-0.84) but lower for in-shoe measurement (ICC: 0.65). There was a significant association between static navicular drop measured with the stretch-sensor compared with a ruler (r = 0.745, p < 0.001). This study suggests that the stretch-sensor has acceptable reliability for dynamic barefoot measurement of navicular drop. Furthermore, the stretch-sensor shows concurrent validity compared with the static navicular drop test as performed by Brody. This new simple method may hold promise for both clinical assessment and research but more work is needed before the method can be recommended.
    Journal of Foot and Ankle Research 02/2014; 7(1):12. DOI:10.1186/1757-1146-7-12 · 1.46 Impact Factor
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