Marcella Ferraz Pazzinatto

Vertical Ground Reaction Forces are Associated with Pain and Self-Reported Functional Status in Recreational Athletes with Patellofemoral Pain.

Individuals with patellofemoral pain (PFP) use different motor strategies during unipodal support in stair climbing activities, which may be assessed by vertical ground reaction force parameters. Thus, the aims of this study were to investigate possible differences in first peak, valley, second peak, and loading rate between recreational female athletes with PFP and pain-free athletes during stair climbing in order to determine the association and prediction capability between these parameters, pain level, and functional status in females with PFP. Thirty-one recreational female athletes with PFP and 31 pain-free recreational female athletes were evaluated with three-dimensional kinetics while performing stair climbing to obtain vertical ground reaction force parameters. A visual analog scale was used to evaluate the usual knee pain. The anterior knee pain scale was used to evaluate knee functional score. First peak and loading rate were associated with pain (r = .46, P = .008; r = .56, P = .001, respectively) and functional limitation (r = .31, P = .049; r = -.36, P = .032, respectively). Forced entry regression revealed the first peak was a significant predictor of pain (36.5%) and functional limitation (28.7%). Our findings suggest that rehabilitation strategies aimed at correcting altered vertical ground reaction force may improve usual knee pain level and self-reported knee function in females with PFP.

Delayed onset of electromyographic activity of the vastus medialis relative to the vastus lateralis may be related to physical activity levels in females with patellofemoral pain

The aims of this study were to examine group differences in muscle activation onset of the vastus medialis (VM) in relation to the vastus lateralis (VL) and pain level during stair ascent in females with patellofemoral pain (PFP) who maintain high and moderate levels of physical activity; to determine the association between physical activity level and muscle activation onset. Forty-three females with PFP and thirty-eight pain-free females were recruited and divided into four groups based on their level of physical activity: females with PFP (n=26) and pain-free females (n=26) who practiced a moderate level of physical activity and females with PFP (n=17) and pain-free females (n=12) who practiced an intense amount of physical activity. Participants were asked to ascend a seven-step staircase and the VM and VL activation onset was determined. Females with PFP who practiced high level of physical activity demonstrated delayed onset of VM (4.06ms) compared to healthy females (-14.4ms). Conversely, females with PFP who practiced moderate level of physical activity did not present VM delay (-2.48ms) in comparison to healthy females (-9.89ms). Furthermore, physical activity significantly correlated to the muscle activation onset difference (p=0.005; R=0.60). These findings may explain why controversial results regarding VM and VL muscle activation onset have been found.

Different pain responses to distinct levels of physical activity in women with patellofemoral pain

Highlights • Intense physical activity can lead to higher levels of PFP.• Asymptomatic women were not influenced by the PFJ loading protocol.• The PFJ loading protocol has the capability to equalize pain in women with PFP.

Reliability of electromyography parameters during stair deambulation in patellofemoral pain syndrome

A reprodutibilidade e essencial para todos os aspectos da medida, uma vez que mostra a qualidade da informacao e permite conclusoes racionais no que diz respeito aos dados. Alem disso, os resultados sao controversos sobre parâmetros eletromiograficos avaliados durante a subida e descida de escada em individuos com sindrome da dor femoropatelar (SDFP). Portanto pretende-se determinar a reprodutibilidade de parâmetros eletromiograficos nos dominios do tempo e da frequencia em ambos os gestos em mulheres com SDFP. Foram selecionadas 31 mulheres com SDFP. Os dados dos musculos vasto lateral e vasto medial foram coletados durante a subida e a descida de escada. Os parâmetros selecionados foram: o onset automatico, frequencia mediana, bandas de baixa, media e alta frequencia. Determinou-se a reprodutibilidade atraves do coeficiente de correlacao intraclasse e do erro padrao da medida. As variaveis no dominio da frequencia apresentaram boa reprodutibilidade, com a subida apresentando os melhores indices, e o onset mostrou-se inconsistente. Os resultados sugerem que a subida de escada e mais confiavel do que a descida da escada para avaliar individuos com SDPF na maioria dos casos.La reproducibilidad es esencial para todos los aspectos de la medida, ya que muestra la calidad de la informacion y permite conclusiones racionales con respecto a los datos. Ademas, los resultados son controvertidos en parametros electromiograficos evaluados durante el ascenso y descenso escaleras en las personas con sindrome de dolor patelofemoral (SDPF). Por eso tenemos la intencion de determinar la reproducibilidad de los parametros electromiograficos en el tiempo y la frecuencia en ambos gestos en mujeres con SDPF. 31 mujeres com SDPF fueron seleccionadas. Se recogieron datos del vasto lateral y medial durante ascenso y descenso de escaleras. Los parametros seleccionados fueron: inicio automatico, frecuencia mediana, bandas de baja, media y alta frecuencia. La reproducibilidad se determino mediante el coeficiente de correlacion intraclase y el error estandar de medicion. Las variables en el dominio de la frecuencia mostraron buena reproducibilidad, el ascenso presento los mejores indices, y el inicio demostro ser inconsistente. Estos resultados sugieren que el ascenso de la escalera es mas confiable que el descenso para evaluar individuos con SDPF en la mayoria de los casos.

Association between increase in vertical ground reaction force loading rate and pain level in women with patellofemoral pain after a patellofemoral joint loading protocol

BACKGROUND The etiology of patellofemoral pain (PFP) is thought to be the result of increased patellofemoral joint (PFJ) load and aberrant lower extremity mechanics, including altered vertical ground reaction forces (VGRF). However, few studies have investigated the association between an increase in pain and VGRF loading rates in the context of PFP. Thus, this study aimed to investigate the immediate effects of PFJ loading on pain and VGRF loading rate, and to see if there is a link between modification of both pain and VGRF loading rate during stair negotiation. METHODS Thirty-four women with PFP underwent VGRF analysis during stair negotiation under two conditions: with (condition 2) and without (condition 1) being previously submitted to a PFJ loading protocol in order to or not to exacerbate their knee pain, respectively. RESULTS The VGRF loading rates were significantly higher in condition 2 (Mean ± standard deviation (SD)=4.0±0.6N/s) compared to condition 1 (Mean±SD=3.6±0.5N/s) during stair ascent and during stair descent (Mean±SD: condition 1=6.3±1.1N/s; condition 2=7.0±1.4N/s). In addition, VGRF loading rates were higher during stair descent compared to stair ascent in both conditions. There were significant correlations between the increase in pain and VGRF loading rate during both tasks. CONCLUSION There seemed to be an important relation between the increase in pain and VGRF loading rates in women with PFP. Based on these findings, interventions aimed at reducing VGRF loading rates are important in the context of PFP.

Which is the best predictor of excessive hip internal rotation in women with patellofemoral pain: Rearfoot eversion or hip muscle strength? Exploring subgroups

BACKGROUND Patellofemoral pain (PFP) has been linked to increased patellofemoral joint stress as a result of excessive hip internal rotation. Lower hip strength and/or excessive rearfoot eversion have been used to explain such altered movement pattern; however, it is unknown which one is the best predictor of excessive hip internal rotation. RESEARCH QUESTION To investigate if peak rearfoot eversion and/or peak concentric hip abductor strength can predict peak hip internal rotation during stair ascent in women with PFP. METHODS This cross-sectional study included thirty-seven women with PFP which underwent three-dimensional kinematic analysis during stair ascent and hip abductor strength analysis in an isokinetic dynamometer. A forced entry linear regression model analysis was carried out to determine which independent variables present the best capability to predict the hip internal rotation. RESULTS Peak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R2 = 0.27, p = 0.001). Peak rearfoot eversion did not predict peak hip internal rotation during stair ascent (R2 < 0.01, p = 0.62). A Post-hoc analysis was conducted to explore if a subgroup with excessive rearfoot eversion would predict hip internal rotation. Based on a previous reported cut-off point, 48.6% of the participants were classified as excessive rearfoot eversion. For the subgroup with excessive rearfoot eversion, peak concentric hip abductor strength and peak rearfoot eversion significantly predicted peak hip internal rotation during stair ascent (R2 = 0.26, p = 0.02; R2 = 0.42, p = 0.003, respectively). For non-excessive rearfoot eversion subgroup, peak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R2 = 0.53; p < 0.001); and peak rearfoot eversion did not (R2 = 0.01; p = 0.65). SIGNIFICANCE Findings indicate that hip muscle strength seems to be related with hip internal rotation in all women with PFP. Rearfoot eversion seems to be related with hip internal rotation only in a subgroup with excessive rearfoot eversion.

What interventions can improve quality of life or psychosocial factors of individuals with knee osteoarthritis? A systematic review with meta-analysis of primary outcomes from randomised controlled trials

Objective To systematically review evidence of primary outcomes from randomised controlled trials (RCTs) examining the effect of treatment strategies on quality of life (QoL) or psychosocial factors in individuals with knee osteoarthritis (OA). Design Systematic review with meta-analysis. Data sources Medline, Embase, SPORTDiscus, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from inception to November 2017. Eligibility criteria for selecting studies We included RCTs investigating the effect of conservative interventions on QoL or psychosocial factors in individuals with knee OA. Only RCTs considering these outcomes as primary were included. Results Pooled data supported the use of exercise therapy compared with controls for improving health-related and knee-related QoL. There was limited evidence that a combined treatment of yoga, transcutaneous electrical stimulation and ultrasound may be effective in improving QoL. Limited evidence supported the use of cognitive behavioural therapies (with or without being combined with exercise therapy) for improving psychosocial factors such as self-efficacy, depression and psychological distress. Summary/Conclusion Exercise therapy (with or without being combined with other interventions) seems to be effective in improving health-related and knee-related QoL or psychosocial factors of individuals with knee OA. In addition, evidence supports the use of cognitive behavioural therapies (with or without exercise therapy) for improving psychosocial factors such as self-efficacy, depression and psychological distress in individuals with knee OA. PROSPERO registration number CRD42016047602.

Patellofemoral pain and sports practice: reduced symptoms and higher quality of life in adolescent athletes as compared to non-athletes

Patellofemoral pain (PFP) is common in athletes and physically active individuals and it is one of the most frequent knee disorders among adolescents. However, the impact of the severity of PFP symptoms on quality of life (QOL) has been barely investigated. Thus, we aimed to compare the level of PFP and the self-reported QOL between adolescent athletes and non-athletes, and to explore the relationship between the severity of PFP symptoms and QOL. Fifty-six adolescents with PFP (22 athletes and 34 non-athletes) were asked to fulfill the Anterior Knee Pain Scale (AKPS) and the QOL dimension of the Knee Outcome in Osteoarthritis Survey (KOOS). Between groups comparisons indicated that adolescent non-athletes presented higher severity of PFP symptoms and lower QOF as compared with adolescent athletes. Significant correlations between the severity of PFP and QOL were found for both groups, regardless of the athletic status.

Knee crepitus is prevalent in women with patellofemoral pain, but is not related with function, physical activity and pain

OBJECTIVES (i) To assess the reliability of knee crepitus measures, (ii) to investigate the association between knee crepitus and PFP; (iii) to investigate the relationship between knee crepitus with self-reported function, physical activity and pain. DESIGN Cross-sectional. SETTING Laboratory-based study. PARTICIPANTS 165 women with PFP and 158 pain-free women. MAIN OUTCOME MEASURES Knee crepitus test, anterior knee pain scale (AKPS) and self-reported worst knee pain in the last month, knee pain after 10 squats and knee pain after 10 stairs climbing. RESULTS Knee crepitus clinical test presented high reliability Kappa value for PFP group was 0.860 and for pain-free group was 0.906. There is a significantly greater proportion of those with crepitus in the PFP group than in the pain-free group (OR = 4.19). Knee crepitus had no relationship with function (rpb = 0.03; p = 0.727), physical activity level (rpb = 0.010; p = 0.193), worst pain (rpb = 0.11; p = 0.141), pain climbing stairs (rpb = 0.10; p = 0.194) and pain squatting (rpb = 0.02; p = 0.802). CONCLUSION Women who presents knee crepitus have 4 times greater odds to be in a group with PFP compared to those who do not. However, knee crepitus has no relationship with self-reported clinical outcomes of women with PFP.

Influence of concern about falls in mobility and ground reaction force in elderly women's during stairs descent

OBJETIVOS: Verificar a diferenca entre idosas com e sem preocupacao com quedas na mobilidade e na forca vertical de reacao do solo durante a descida de escada. METODOS: O estudo incluiu idosas atendidas pelo Centro de Reabilitacao Fisica da Universidade Estadual do Oeste do Parana com idade entre 60 e 75 anos, sem doencas neurologicas e cardiovasculares que acarretassem risco pelas atividades do estudo. Foram excluidas tambem idosas com orteses para locomocao, doencas osteoarticulares ou cirurgias de membros inferiores e historico de queda. As participantes foram divididas em dois grupos, com e sem preocupacao com quedas em atividades diarias, identificados pela Falls Efficacy Scale International traduzida para o portugues. Para avaliacao da mobilidade, todas as voluntarias realizaram o teste Timed Up and Go . A forca de reacao do solo foi avaliada em cinco descidas de escada para coleta dos dados cineticos (primeiro pico da forca vertical de reacao do solo) atraves de uma plataforma de forca alocada no quarto degrau de uma escada de sete degraus. Apos ser confirmada a normalidade dos dados, o teste t de Student para amostras independentes foi utilizado para comparacao entre os grupos. RESULTADOS: A amostra foi composta por dezessete idosas sem preocupacao com quedas (idade de 66,57±4,1 anos) e dezesseis idosas com preocupacao com quedas (idade de 66,67±5,8 anos). O grupo sem preocupacao com quedas desempenhou o teste Timed Up and Go de forma mais veloz (9,71±1,02 segundos) comparado ao grupo preocupacao com quedas (11,5±1,04 segundos) (p=0,008). Nao houve diferenca entre os grupos para o primeiro pico da forca de reacao do solo vertical (p=0,66). CONCLUSOES: Idosas com preocupacao com queda apresentaram menor desempenho no teste funcional do que idosas com ausencia dessa preocupacao. Entretanto, nao houve diferenca entre os grupos quanto a variavel cinetica.