Improvements in Lower-Extremity Function Following a Rehabilitation Program With Patterned Electrical Neuromuscular Stimulation in Females With Patellofemoral Pain: A Randomized Controlled Trial

Context: Patellofemoral pain (PFP) is a challenging condition, with altered kinematics and muscle activity as 2 common impairments. Single applications of patterned electrical neuromuscular stimulation (PENS) have improved both kinematics and muscle activity in females with PFP; however, the use of PENS in conjunction with a rehabilitation program has not been evaluated. Objective: To determine the effects of a 4-week rehabilitation program with PENS on lower-extremity biomechanics and electromyography (EMG) during a single-leg squat (SLS) and a step-down task (SDT) in individuals with PFP. Study Design: Double-blinded randomized controlled trial. Setting: Laboratory. Patients of Other Participants: Sixteen females with PFP (age 23.3 [4.9] y, mass 66.3 [13.5] kg, height 166.1 [5.9] cm). Intervention: Patients completed a 4-week supervised rehabilitation program with or without PENS. Main Outcome Measures: Curve analyses for lower-extremity kinematics and EMG activity (gluteus maximus, gluteus medius, vastus medialis oblique, vastus lateralis, biceps femoris, and adductor longus) were constructed by plotting group means and 90% confidence intervals throughout 100% of each task, before and after the rehabilitation program. Mean differences (MDs) and SDs were calculated where statistical differences were identified. Results: No differences at baseline in lower-extremity kinematics or EMG were found between groups. Following rehabilitation, the PENS group had significant reduction in hip adduction between 29% and 47% of the SLS (MD = 4.62° [3.85°]) and between 43% and 69% of the SDT (MD = 6.55° [0.77°]). Throughout the entire SDT, there was a decrease in trunk flexion in the PENS group (MD = 10.91° [1.73°]). A significant decrease in gluteus medius activity was seen during both the SLS (MD = 2.77 [3.58]) and SDT (MD = 4.36 [5.38]), and gluteus maximus during the SLS (MD = 1.49 [1.46]). No differences were seen in the Sham group lower-extremity kinematics for either task. Conclusion: Rehabilitation with PENS improved kinematics in both tasks and decreased EMG activity. This suggests that rehabilitation with PENS may improve muscle function during functional tasks.

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Effects and underlying mechanisms of unstable shoes on chronic low back pain: a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215517753972 ◽

2018 ◽

Vol 32 (5) ◽

pp. 654-662 ◽

Cited By ~ 3

Author(s):

Juan Francisco Lisón ◽

Borja Ortega-Santana ◽

Álvaro Antón-Nogués ◽

Palmy González-Requena ◽

Cristina Vera-Hervás ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Back Pain ◽

Lumbar Spine ◽

Muscle Activity ◽

Controlled Trial ◽

Trunk Muscle ◽

Emg Activity ◽

Control Group ◽

Randomized Controlled ◽

Unstable Shoes

Objective: To investigate the effects that wearing unstable shoes has on disability, trunk muscle activity, and lumbar spine range of motion (ROM) in patients with chronic lower back pain (CLBP). Design: Randomized controlled trial. Setting: Orthopedic Surgery Service. Participants: We randomized 40 adults with nonspecific CLBP either to an unstable shoes group ( n = 20) or to the control group ( n = 20). Intervention: The participants in the unstable shoes group were advised to wear these shoes for a minimum of six hours a day for four weeks. Control group participants were asked to continue wearing their regular shoes. Outcome measures: Our primary outcome was measurement of back-related dysfunction, assessed using the Roland-Morris Disability Questionnaire. Secondary outcomes included changes in electromyographic (EMG) activity of erector spinae (ES), rectus abdominis (RA), internus obliquus (IO), and externus obliquus (EO) muscles, and changes in lumbar spine ROM. Results: Between-group analysis highlighted a significant decrease in disability in the unstable shoes group compared to the control (−5, 95% confidence interval (CI) = −8.4 to −1.6). Our results revealed a significant increase in the percentage of RA, ES, IO, and EO EMG activity and in lumbar spine ROM in the unstable shoes group compared to the control group. Moreover, our results showed a significant negative correlation between disability and the percentage of ES, RA, and IO muscle activity at the end of the intervention. Conclusion: This study shows that the use of unstable shoes contributes to improvements in disability, which are likely related to increased trunk muscle activity and lumbar spine ROM.

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The immediate effect of lumbopelvic manipulation on EMG of vasti and gluteus medius in athletes with patellofemoral pain syndrome: A randomized controlled trial

Manual Therapy ◽

10.1016/j.math.2016.02.002 ◽

2016 ◽

Vol 22 ◽

pp. 16-21 ◽

Cited By ~ 11

Author(s):

Alireza Motealleh ◽

Elham Gheysari ◽

Esmaeil Shokri ◽

Sobhan Sobhani

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Pain Syndrome ◽

Gluteus Medius ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Randomized Controlled ◽

Lumbopelvic Manipulation

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Gluteal Activity During Gait in Patients With Chronic Ankle Instability Following Rehabilitation: A Randomized Controlled Trial

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0148 ◽

2021 ◽

pp. 1-7

Author(s):

Alexandra F. DeJong Lempke ◽

Rachel M. Koldenhoven ◽

Abbis H. Jaffri ◽

Jay Hertel

Keyword(s):

Randomized Controlled Trial ◽

Repeated Measures ◽

Gait Cycle ◽

Ankle Instability ◽

Controlled Trial ◽

Gluteus Maximus ◽

Gluteus Medius ◽

Chronic Ankle Instability ◽

Initial Contact ◽

Randomized Controlled

Context: Ankle positioning gait biofeedback (GBF) has improved ankle inversion for patients with chronic ankle instability. However, the effects on proximal deficits remain unknown. The purpose of this study was to determine the effects of impairment-based rehabilitation with GBF and without biofeedback on gluteal activity during walking in patients with chronic ankle instability. Design: Randomized controlled trial. Methods: Eighteen patients with chronic ankle instability (14 women and 4 men; age 22 [4] y; height 171 [10] cm; mass 71.6 [13.8] kg) were recruited from a university setting, following International Ankle Consortium guidelines. Patients were randomly allocated to GBF or without biofeedback groups (N = 9 per group). Both groups performed 4 weeks of exercises and treadmill walking. The GBF group alone received feedback on frontal ankle positioning at initial contact during walking. Ultrasound videos of the gluteus maximus and medius were recorded during walking at baseline and follow-up by a blinded clinician. Gluteal activity ratios were obtained at each 10% of the gait cycle. Statistical parametric mapping repeated-measures analysis of variance were used to compare groups and time points. Results: Both groups demonstrated significantly increased gluteus medius activity across the gait cycle compared with baseline (P < .01, mean differences: 0.13–0.21, Hedge g: 0.97–1.89); however, there were no significant between-group differences. There were no statistically significant changes noted for the gluteus maximus. No adverse events were observed. Conclusions: Impairment-based rehabilitation led to increased gluteus medius activity, but GBF did not provide any additional improvement to this parameter. Clinicians may consider implementing impairment-based strengthening interventions to improve gluteus medius function during gait for patients with CAI.

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Effects of Taping on Pain and Function in Patellofemoral Pain Syndrome: A Randomized Controlled Trial

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2004.1484 ◽

2004 ◽

Author(s):

Martin Whittingham

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Randomized Controlled ◽

And Function

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Strengthening of the hip posterolateral musculature versus hip anteromedial musculature in patients with patellofemoral pain: A randomized controlled trial

Physical Therapy in Sport ◽

10.1016/j.ptsp.2020.11.019 ◽

2021 ◽

Vol 47 ◽

pp. e5

Author(s):

Carlos Augusto Silva Rodrigues ◽

Helena Larissa das Neves Rodrigues ◽

Bruno Augusto Lima Coelho ◽

Pedro Olavo de Paula Lima ◽

Gabriel Peixoto Leão Almeida

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Patellofemoral Pain ◽

Randomized Controlled

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Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121989729 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712198972

Author(s):

Anis Jellad ◽

Amine Kalai ◽

Mohamed Guedria ◽

Mahbouba Jguirim ◽

Sana Elmhamdi ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Level Of Evidence ◽

Randomized Controlled ◽

Group Standard ◽

Hip Muscle ◽

And Function

Background: Active rehabilitation has an important role in the management of patellofemoral pain syndrome (PFPS). Although some studies have shown the benefit of hip-muscle strengthening, the effect of combining hip-muscle stretching with strengthening has not yet been defined. Purpose: To evaluate the effect of combined strengthening of the hip external rotators and abductors and stretching of the hip internal rotators on pain and function in patients with PFPS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ± 10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A arm (BA group; standard rehabilitation with strengthening of the hip external rotators and abductors and stretching of the hip internal rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period, corresponding to a symptom-free period, rehabilitation programs were crossed over. A visual analog scale (VAS) evaluating perceived pain, the Functional Index Questionnaire (FIQ), and the Kujala score were administered at baseline, the end of each rehabilitation protocol, and 12 weeks after the completion of the second protocol for each group. Results: Until the final follow-up, VAS, FIQ, and Kujala scores were significantly improved in both the A-B and B-A arms ( P < .05 for all). Compared with protocol A, protocol B provided significant improvement in terms of pain and function in both the BA (VAS and Kujala; P < .001) and AB (VAS and Kujala; P < .001) groups. Conclusion: Combined strengthening of the hip abductors and external rotators with stretching of the hip internal rotators provided better outcomes, which were maintained for at least 12 weeks, in terms of pain and function in patients with PFPS.

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Adding Muscle Power Exercises To A Strength Training Program For People With Patellofemoral Pain: Protocol Of A Randomized Controlled Trial

10.21203/rs.3.rs-494156/v1 ◽

2021 ◽

Author(s):

Gabriela Souza de Vasconcelos ◽

Guilherme Silva Nunes ◽

Christian John Barton ◽

Raquel Fantinelli Munhoz ◽

Maria Eduarda Chinotti Batista da Silva ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Resistance Training ◽

Training Program ◽

Controlled Trial ◽

Patellofemoral Pain ◽

Resistance Training Program ◽

Randomized Controlled ◽

Rehabilitation Programs ◽

Strength Exercises ◽

Secondary Outcomes

Abstract Background: Strong evidence supports the proximal combined with quadriceps strengthening for patellofemoral pain (PFP) rehabilitation. However, most reported rehabilitation programs do not follow specific exercise prescription recommendations or do not provide adequate details for replication in clinical practice. Furthermore, people with PFP have power deficits in hip and knee muscles and remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. Therefore, this study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles composed by power and strength exercises are greater than those of a program composed by strength exercises only. Method: This study will be a randomized controlled trial, that will be conducted at university facilities. A minimum of 74 people with PFP between the ages of 18 and 45 years will be included. The experimental group will engage in a 12-week resistance training program focusing on proximal and knee muscles using power and strength exercises. The control group will engage in a 12-week resistance training program focusing on proximal and knee muscles using strength exercises only. Primary outcomes will be pain intensity and physical function; and secondary outcomes will be kinesiophobia, self-reported improvement, quality of life, peak hip and knee torque, and hip and knee rate of force development. The primary outcomes will be evaluated at baseline, and after six weeks, twelve weeks, three months, six months and one year. The secondary outcomes will be evaluated at baseline and immediately after the interventions. Therapists and participants will not be blinded to group allocation.Discussion: This randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for PFP rehabilitation. The study will provide additional knowledge to support rehabilitation programs for people with PFP.Trial registration: ClinicalTrials.gov NCT 03985254. Registered on 26 August 2019.

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