Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?

There is no clear consensus in the literature concerning the terminology, aetiology and treatment for pain in the anterior part of the knee. The term ‘anterior knee pain’ is suggested to encompass all pain-related problems. By excluding anterior knee pain due to intra-articular pathology, peripatellar tendinitis or bursitis, plica syndromes, Sinding Larsen’s disease,Osgood Schlatter’s disease, neuromas and other rarely occurring pathologies, it is suggested that remaining patients with a clinical presentation of anterior knee pain could be diagnosed with patello-femoral pain syndrome (PFPS). Three major contributing factors of PFPS are discussed: (i) malalignment of the lower extremity and/or the patella; (ii) muscular imbalance of the lower extremity; and (iii) overactivity.

Patellofemoral pain syndrome: a review of current issues.

https://www.archives-pmr.org/article/S0003-9993(01)74737-5/pdf

Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome.

BackgroundAlthough physical therapy forms the mainstay of nonoperative management for patellofemoral pain, its efficacy has not been established.HypothesisSignificantly more pain relief will be achieved from a 6-week regimen of physical therapy than from placebo treatment.Study DesignMulticenter, randomized, double-blinded, placebo-controlled trial.MethodsSeventy-one subjects, 40 years of age or younger with patellofemoral pain of 1 month or longer, were randomly allocated to a physical therapy or placebo group. A standardized treatment program consisted of six treatment sessions, once weekly. Physical therapy included quadriceps muscle retraining, patellofemoral joint mobilization, and patellar taping, and daily home exercises. The placebo treatment consisted of sham ultrasound, light application of a nontherapeutic gel, and placebo taping.ResultsSixty-seven participants completed the trial. The physical therapy group (N = 33) demonstrated significantly greater reduction in the scores for average pain, w...

Physical therapy for patellofemoral pain - A randomized, double-blinded, placebo-controlled trial

COWAN, S. M., K. L. BENNELL, K. M. CROSSLEY, P. W. HODGES, and J. MCCONNELL. Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome. Med. Sci. Sports Exerc., Vol. 34, No. 12, pp. 1879 –1885, 2002. Purpose: To investigate the effect of physical therapy treatment on the timing of electromyographic (EMG) activity of the vasti in individuals with patellofemoral pain syndrome (PFPS). Methods: Sixty-five (42 female, 23 male) participants aged 40 yr or less (29.2 7.8 yr) diagnosed with PFPS. Participants were randomly allocated into physical therapy treatment (McConnell-based) or placebo groups. Treatment programs were standardized and consisted of six-treatment sessions over 6 wk. Vastus medialis oblique (VMO) and vastus lateralis (VL) EMG activity was recorded with surface electrodes during a stair-stepping task and onsets of EMG activity were measured pre- and post-treatment. Results: Before treatment, the EMG onset of VL occurred before that of VMO in both participant groups. After physical therapy intervention, there was a reduction in symptoms, and this improvement was associated with a significant change in the time of onset of VMO EMG compared with that of VL in both phases of the stair-stepping task. After physical therapy treatment, the onset of VMO preceded VL in the eccentric phase and occurred at the same time in the concentric phase of the stair-stepping task. There was no change in time of EMG onset in the placebo group. Conclusion: This study demonstrates that a “McConnell”-based physical therapy treatment regime for PFPS alters the motor control of VMO relative to VL in a functional task and this is associated with a positive clinical outcome. Key Words: VASTUS MEDIALIS OBLIQUE, ELECTROMYOGRAPHY, STAIR STEPPING, TREATMENT

Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome

The purpose of this prospective study was to evaluate the efficacy of a patellar taping program in the conservative management of patellofemoral pain. Twenty-five patients with patellofemoral pain were randomized into two groups. One group underwent a standard physical therapy program for patellofemoral pain. The other group underwent the same physical therapy program, but use of a patellar taping technique was added to this program. Results of a subjective visual analog scale and changes in isokinetic strength and electromyographic activity of the quadriceps muscle were analyzed. Both the tape and no-tape groups experienced a statistically significant decrease in symptoms (P < 0.05), but no difference in improvement of patellofemoral pain was noted between the groups. Likewise, both groups demonstrated significant improvement in quadriceps muscle isokinetic strength (P < 0.05) and activity (P < 0.001), but no difference in improvement was noted between groups. The results of this study suggest no beneficial effect of adding a patellar taping program to a standard physical therapy program in the conservative treatment of patellofemoral pain. Larger prospective studies are warranted to support this opinion.

Mark G. Kowall

Papers

Patellar Taping in the Treatment of Patellofemoral Pain A Prospective Randomized Study