scholarly journals Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of Patellofemoral Pain: A Multicenter Randomized Controlled Trial

2015 ◽  
Vol 50 (4) ◽  
pp. 366-377 ◽  
Author(s):  
Reed Ferber ◽  
Lori Bolgla ◽  
Jennifer E. Earl-Boehm ◽  
Carolyn Emery ◽  
Karrie Hamstra-Wright
Keyword(s):  
Muscle Strength ◽  
Randomized Controlled Trials ◽  
Knee Pain ◽  
Visual Analog Scale ◽  
Anterior Knee Pain ◽  
Pain Scale ◽  
Controlled Trials ◽  
Analog Scale ◽  
Randomized Controlled ◽  
Anterior Knee

Context Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized controlled trials have, to our knowledge, directly compared HIP and KNEE programs. Objective To compare PFP pain, function, hip- and knee-muscle strength, and core endurance between KNEE and HIP protocols after 6 weeks of rehabilitation. We hypothesized greater improvements in (1) pain and function, (2) hip strength and core endurance for patients with PFP involved in the HIP protocol, and (3) knee strength for patients involved in the KNEE protocol. Design Randomized controlled clinical trial. Setting Four clinical research laboratories in Calgary, Alberta; Chicago, Illinois; Milwaukee, Wisconsin; and Augusta, Georgia. Patients or Other Participants Of 721 patients with PFP screened, 199 (27.6%) met the inclusion criteria (66 men [31.2%], 133 women [66.8%], age = 29.0 ± 7.1 years, height = 170.4 ± 9.4 cm, weight = 67.6 ± 13.5 kg). Intervention(s) Patients with PFP were randomly assigned to a 6-week KNEE or HIP protocol. Main Outcome Measure(s) Primary variables were self-reported visual analog scale and Anterior Knee Pain Scale measures, which were conducted weekly. Secondary variables were muscle strength and core endurance measured at baseline and at 6 weeks. Results Compared with baseline, both the visual analog scale and the Anterior Knee Pain Scale improved for patients with PFP in both the HIP and KNEE protocols (P < .001), but the visual analog scale scores for those in the HIP protocol were reduced 1 week earlier than in the KNEE group. Both groups increased in strength (P < .001), but those in the HIP protocol gained more in hip-abductor (P = .01) and -extensor (P = .01) strength and posterior core endurance (P = .05) compared with the KNEE group. Conclusions Both the HIP and KNEE rehabilitation protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulted in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol.

Efficacy of Kinesio Taping and McConnell Taping Techniques in the Management of Anterior Knee Pain

2020 ◽  
Vol 29 (1) ◽  
pp. 79-86
Author(s):  
Rumit S. Kakar ◽  
Hilary B. Greenberger ◽  
Patrick O. McKeon
Keyword(s):  
Knee Pain ◽  
Visual Analog Scale ◽  
Anterior Knee Pain ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Drop Jump ◽  
Analog Scale ◽  
Kinesio Taping ◽  
Anterior Knee

Context: Anterior knee pain also known as patellofemoral pain syndrome is a frequently encountered musculoskeletal disorder that worsens with activity. The multifactorial etiology of patellofemoral pain syndrome alters lower-extremity mechanics, increasing patellofemoral joint stresses during weight-bearing tasks. Kinesio and McConnell tapings are often incorporated into the treatment, but their efficacy is still unclear. Objective: To test the efficacy of Kinesio taping, McConnell taping, and sham taping in improving knee mechanics and reducing pain during activity. Design: Cross-sectional design. Setting: Clinical biomechanics laboratory. Participants: Ten participants (age: 20.3 [1.5] y, height: 169.9 [10.4] cm, and mass: 70.17 [13.1] kg) with anterior knee pain and no history of trauma. Intervention: Three trials each of squat, drop jump, and step-down tasks with 3 taping conditions in a counterbalanced order. Main Outcome Measures: Two-dimensional motion capture data of lower-extremities in frontal and sagittal planes were recorded and analyzed using 3 iPads and Spark Motion® application. Pooled effect sizes (Hedges’ g), 95% confidence intervals, and repeated-measures analysis of variance (P < .05) compared baseline and taping conditions during exercises for pain Visual Analog Scale and knee flexion in all exercises, hip abduction during step-down and drop jump, frontal plane projection during step-downs, and knee translation in sagittal plane during squats. Results: Significant reductions in Visual Analog Scale were recorded during squats between tapes (F2.505,12.867 = 3.407, P = .04, Hedges’ g = −0.70). Pairwise comparison showed a decrease in Visual Analog Scale for sham taping (mean difference = 1.14 cm, P = .01) and Kinesio taping (mean difference = 1.54 cm, P = .02) compared with baseline during squats. Conclusions: A variety of taping methods can potentially reduce perceived pain in individuals with patellofemoral pain syndrome, allowing clinicians to perform rehabilitation exercises. Sensory effects associated with short-term taping may be sufficient enough to modify knee pain acutely by afferent input blocking nocioceptive pain before the participants could adapt. Most interestingly, the sham taping technique demonstrated promise for enhancing functional outcomes, depending on the length of the tape and area covered.

scholarly journals EFFICACY AND SAFETY OF CURCUMA LONGA EXTRACT IN THE TREATMENT OF OSTEOARTHRITIS: A SYSTEMATIC REVIEW

2019 ◽  
pp. 140-145
Author(s):  
ALESSA FAHIRA ◽  
ALLYSA SORAYA ◽  
ARMAND ACHMADSYAH ◽  
RANI WARDANI HAKIM
Keyword(s):  
Adverse Effects ◽  
Randomized Controlled Trials ◽  
Visual Analog Scale ◽  
Curcuma Longa ◽  
Control Group ◽  
Controlled Trials ◽  
Analog Scale ◽  
Randomized Controlled ◽  
Natural Remedies

Objective: Osteoarthritis (OA) is a chronic disease caused by inflammation of the tissue and bony structure of the joint, which affects more than 235 million people worldwide. Due to the adverse effects caused by the long-term use of standard treatment of OA, the attempt to find natural remedies to treat chronic diseases continues to rise. Curcuma longa is known to have anti-inflammatory effects, which may impact the pathophysiology of OA. While many randomized controlled trials show the efficacy of Curcuma longa extract in the treatment of OA, there has been no comprehensive review of this evidence. Methods: We systematically searched PubMed, Cochrane, Scopus, ProQuest, EBSCOhost, and ScienceDirect for randomized controlled trials that evaluated Curcuma longa extract (CE extract) vs. control (placebo or other therapy). Three trials were identified. Data were then extracted from the studies and summarized descriptively. Results: Across all trials, Curcuma longa therapy was proven to reduce Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores significantly compared to the control group. Adverse effects were less likely to appear in patients treated with Curcuma longa extract compared to other groups. Conclusion: CL extract is beneficial as an alternative medication for OA treatment, shown by the reduced scores of the Visual Analog Scale (VAS) and WOMAC in all studies we reviewed.

scholarly journals Treatment Success of Hip and Core or Knee Strengthening for Patellofemoral Pain: Development of Clinical Prediction Rules

2018 ◽  
Vol 53 (6) ◽  
pp. 545-552 ◽  
Author(s):  
Jennifer E. Earl-Boehm ◽  
Lori A. Bolgla ◽  
Carolyn Emory ◽  
Karrie L. Hamstra-Wright ◽  
Sergey Tarima ◽  
...  
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Treatment Success ◽  
Pain Scale ◽  
Successful Outcome ◽  
Clinical Prediction ◽  
Analog Scale ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Anterior Knee

Context:  Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is caused by proximal muscle dysfunction. Objectives:  To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP. Design:  Secondary analysis of data from a randomized control trial. Setting:  Four university laboratories. Patients or Other Participants:  A total of 199 participants with PFP. Intervention(s):  Participants were randomly allocated to either a hip and core-focused (n = 111) or knee-focused (n = 88) rehabilitation group for a 6-week program. Main Outcome Measure(s):  Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by ≥2 cm or an increase in the Anterior Knee Pain Scale score by ≥8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome. Results:  Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88% sensitivity and 54% specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82% sensitivity and 58% specificity). Conclusion:  The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.

Higher Function Scores and Satisfaction in Patients with Anteromedial Osteoarthritis Compared with Other Wear Patterns of the Knee: 2 Years after Both Total and Unicondylar Knee Arthroplasties

2019 ◽  
Vol 33 (07) ◽  
pp. 629-635
Author(s):  
Suzanne Witjes ◽  
Alexander Hoorntje ◽  
Koen L. M. Koenraadt ◽  
Gino M. M. J. Kerkhoffs ◽  
Rutger C. I. van Geenen
Keyword(s):  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Cross Sectional Study ◽  
Pain Scale ◽  
Specific Function ◽  
Cross Sectional ◽  
Wear Pattern ◽  
Unicondylar Arthroplasty ◽  
Anterior Knee

AbstractAnteromedial osteoarthritis (AMOA) is a common wear pattern in primary osteoarthritic knees. In patients with bone-on-bone disease, the most appropriate surgical intervention is still a matter of debate. Knee arthroplasty is a well-accepted treatment to relieve symptoms and regain function. Unfortunately, satisfaction is limited, especially related to activities. A cross-sectional study was performed among patients treated with total knee arthroplasty (TKA) and unicondylar arthroplasty (UKA) to determine if the osteoarthritis wear pattern or type of prosthesis affects knee-specific function scores and satisfaction related to activities. All UKA patients (N = 100) were treated for AMOA. Based on radiological assessment of the wear pattern, TKA patients were divided into two groups: TKA for AMOA (N = 68) and true TKA (N = 99). The Knee injury and Osteoarthritis Outcomes Score (KOOS), new Knee Society score (KSS), anterior knee pain scale, visual analog scales (VASs) for satisfaction about activities, and net promoter score were collected. After 2 years' follow-up, the anterior knee pain scale and VAS satisfaction showed significantly better scores for patients treated with TKA for AMOA compared with the true TKA group. Also in the KOOS subscales, some differences were seen in favor of the TKA for AMOA group. The new KSS was not in favor of a specific wear pattern, but patients with AMOA treated with UKA performed better on the symptoms subscale compared with patients treated with TKA. In conclusion, patients treated with TKA for AMOA showed better knee-specific function scores and satisfaction scores compared with patients treated with TKA for other wear patterns, and only slight differences were found between both the AMOA groups (TKA for AMOA and UKA). Thus, the radiologic assessment of wear patterns might be useful to take into account the shared decision-making process, when discussing expectations, timing, and outcomes with knee osteoarthritis patients considering knee arthroplasty. When AMOA is present, it might be beneficial to choose UKA over TKA.

Rasch analysis of the anterior knee pain scale in adolescents with patellofemoral pain

2020 ◽  
Vol 34 (12) ◽  
pp. 1512-1519
Author(s):  
Mitchell Selhorst ◽  
Alicia Fernandez-Fernandez ◽  
M Samuel Cheng
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Rasch Analysis ◽  
Principal Component ◽  
Pain Scale ◽  
Patellofemoral Pain ◽  
Level Measurement ◽  
Level Data ◽  
Item Responses ◽  
Anterior Knee

Objective: The aim of this study was to evaluate the Anterior Knee Pain Scale in a cohort of adolescents being treated conservatively for patellofemoral pain using Rasch analysis. Design: This is a psychometric study. Setting: Physical therapy clinics of a large pediatric hospital in Columbus, Ohio (United States) Subjects: A total of 646 adolescent patients with patellofemoral pain (76% female, 14.6 ± 1.6 years old). Intervention: Not applicable. Main Measure: The Anterior Knee Pain Scale. Results: The median Anterior Knee Pain Scale score was 73 (interquartile range 64–81), with scores ranging from 7 to 100 on the 100-point scale. The Rasch person reliability for the Anterior Knee Pain Scale was 0.74 and the Cronbach’s alpha was 0.75, representing an acceptable person reliability. Principal component analysis revealed a ratio of 5.2:1 demonstrating acceptable unidimensionality of the Anterior Knee Pain Scale. A significant misfit was observed in the item “Abnormal Painful Kneecap Movements” (Outfit Means Square 2.74, Infit Means Square 1.41). Ordering of item responses was unsatisfactory as only five of the 13 items demonstrated appropriate distinction between each of the responses. There was no differential item functioning for sex or age for all items of the Anterior Knee Pain Scale, based upon the criterion of ⩾ 0.5 logit difference. Conclusion: The Anterior Knee Pain Scale does not meet interval-level measurement criteria and should be considered ordinal level data.

Land-based Exercise for Osteoarthritis of the Knee: A Metaanalysis of Randomized Controlled Trials

2009 ◽  
Vol 36 (6) ◽  
pp. 1109-1117 ◽  
Author(s):  
MARLENE FRANSEN ◽  
SARA McCONNELL
Keyword(s):  
Randomized Controlled Trials ◽  
Physical Function ◽  
Knee Pain ◽  
Treatment Effect ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Therapeutic Exercise ◽  
Treatment Benefit ◽  
Randomized Controlled ◽  
Study Methodology

Objective.To determine if clinical guidelines recommending therapeutic exercise for people with knee osteoarthritis (OA) are supported by rigorous scientific evidence. To explore whether the magnitude of treatment benefit reported in randomized controlled trials (RCT) is associated with exercise dosage or study methodology.Methods.We conducted a metaanalysis of RCT comparing some form of land-based therapeutic exercise with a nonexercise group using pain and self-reported physical function outcomes.Results.The 32 included studies provided data on almost 3800 participants. Metaanalysis revealed a beneficial treatment effect: standardized mean difference (SMD) 0.40 [95% confidence interval (CI) 0.30 to 0.50] for knee pain; SMD 0.37 (95% CI 0.25 to 0.49) for physical function. While the pooled beneficial effects of the 9 RCT evaluating exercise programs providing fewer than 12 direct supervision occasions or the 9 RCT judged to have a low risk of bias remained significant and clinically relevant, the magnitude of treatment benefit pooled from these RCT was significantly smaller than the comparator group (12 or more supervision occasions, moderate to high risk of bias, respectively). The mode of treatment delivery (individual treatments, exercise classes, home program) was not significantly associated with the magnitude of treatment benefit.Conclusion.There is evidence that land-based therapeutic exercise has at least short-term benefit in terms of reduced knee pain and physical disability for people with knee OA. The magnitude of the treatment effect was significantly associated with the number of direct supervision occasions provided and study methodology (assessor blinding, adequate allocation concealment).

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