Proprioceptive differences in individuals with Anterior knee pain

Rhode, Carlyn (2018-03)

Thesis (MScPhysio)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Introduction: Anterior knee pain (AKP) affects physically active as well as sedentary individuals and commonly leads to chronic knee pain among young adults. Anterior knee pain has a huge socioeconomic impact on those affected as management remains challenging with symptoms persisting for years even after medical intervention. Proprioception plays an important role in sensory motor control of the knee and impacts motor action and knee joint stability. There are conflicting reports in the current literature on whether people with AKP have altered proprioception. Objectives: The purpose of this study was to investigate the proprioceptive abilities of individuals affected with anterior knee pain using a gold standard measurement tool. Proprioception was measured by compare active joint position sense during a weight bearing (single leg stance) and a none weight bearing task (active knee extension in sitting) between knees with AKP and knees without AKP. Methodology: A laboratory based descriptive cross-sectional study design was used to conduct this study. The Vicon 3D motion analysis system was used to test proprioception. Twenty-five participants who met the inclusion criteria and gave informed consent, were included in the study. Fifty knees were evaluated; 37 knees with AKP and 13 without AKP. Proprioception was measured by means of two active joint position sense testing in both a weight bearing (single leg squat) and a non-weight bearing (active knee extension) test position. Target angles were selfdetermined based on each participant’s capabilities and pain levels. The absolute error (AE) was used as the main outcome measure to assess proprioception. A normative criterion of an AE equal and greater than five degrees was classified as altered proprioception. The proprioception of the knees with AKP were compared to that of the knees without AKP. Results: The study participants were predominantly female (n=22) with a mean age of 27.8 years. Seventy-six percent (76%, n= 19) of the population were physically active and 44%, (n=11) reported being runners. The main finding of this study was that there was no significant difference in proprioception when comparing the knees with AKP to the knees without AKP (p <0.05). However, individuals with altered proprioception was identified in both the knees with AKP and the knees without AKP. The mean AE for the knees with AKP was 7.4o during SLS and 8.3o during active knee extension; whereas the mean AE for the knees without AKP were 8.3o during SLS and 5.9o during active knee extension. Insignificant differences were found via Chi-square calculations between the knees with AKP compared to the knees without AKP during single leg squat and during active knee extension. Conclusion: The current study findings showed that proprioception is not significantly more impaired in knees with AKP compared to knees without AKP during active reproduction proprioceptive testing. This study did however identify a group of individuals with altered proprioception, in both the knees with AKP and the knees without AKP. A likely reason could be due to compensation during gait in patients with AKP as well as the accuracy of the Vicon 3D motion analysis system. There was a tendency towards a larger mean AE during active knee extension in sitting in the knees with AKP. This finding could be reflective of the proprioceptive abilities of the knee joint specifically. The findings in this study support the assessment of proprioception in both knees in individuals with AKP and not only the knees with AKP.

AFRIKAANSE OPSOMMING : Inleiding: Anterior kniepyn (AKP) affekteer beide aktiewe en onaktiewe mense en kan lei tot kroniese kniepyn in jong mense. Anterior kniepyn het ‘n groot sosio-ekonomiese impak op persone aangesien behandeling uitdagend is en simptome kan voortduur vir jare, selfs na mediese behandeling. Propriosepsie is baie belangrik tydens sensories-motoriese beheer van die knie en beinvloed motoriese beheer en knie gewrig stabiliteit. Daar is teenstrydige bevindinge in die huidige literatuur oor of persone met anterior kniepyn, versteurde propriosepsie het. Doelwit: Die doel van hierdie studie was om propriosepsie in persone met anterior kniepyn te evalueer deur gebruik te maak van ‘n goue standaard meet instrument. Propriosepsie was gemeet deur aktiewe gewrigsposisiesin te vergelyk tydens n nie gewigdraende toets posisie (enkel been hurk) en n gewigraende toets posisie (aktiewe knie ekstensie tydens sit), tussen knieë met AKP en knieë sonder AKP. Metode: ‘n Laboratorium-gebasseerde beskrywende deursnit studieontwerp was gebruik om die studie uit te voer. Die Vicon 3D bewegingsontledingsisteem was gebruik om propriosepsie te meet. Vyf en twintig persone wie voldoen het aan die insluitingsvereistes en ingeligte toestemming verskaf het, was ingesluit in die studie. Vyftig knieë was gemeet; 37 met AKP en 13 sonder AKP. Propriosepsie was gemeet deur middel van 2 aktiewe gewrigsposisiesin toetsing. Propriosepsie was getoests in twee posisies naamlik enkel been hurk (SLS) (gewigdraend) en aktiewe knie ekstensie tydens sit (nie gewigdraend). Die teikenhoek was self bepaal deur elke persoon volgens hulle vermoeë en pynvlakke. Die absolute fout (AE) was die hoof uitkomsmeting vir propriosepsie. ‘n Waarde gelyk aan of groter as vyf grade was gebruik om veranderde propriosepsie te klassifiseer. Die knieë met AKP was vergelyk met die knieë sonder AKP. Resultate: Die studie deelnemers was hoofsaaklik dames (n=22) met ‘n gemiddelde ouderdom van 27.8 jaar. Ses-en-sewentig persent (76%) van die deelnemers was aktief en 44% hardloop vir oefening. Die hoof bevinding van die studie was dat daar geen beduidende verskil was in propriosepsie tussen die knieë met AKP en die knieë sonder AKP (p<0.05). Daar was individue geidentifiseer met geaffekteerde propriosepsie in beide die knieë met AKP en die knieë sonder AKP. Die gemiddelde AE vir knieë met AKP was 7.4o tydens SLS en 8.3o tydens aktiewe knie ekstensie in sit in vergelyking met ‘n gemiddelde AE van 8.3o tydens SLS en 5.9o tydens aktiewe knie ekstensie in die kniee sonder AKP. Onbeduidende resultate was gevind met Kikwadraat (Chi-square) berekeninge tussen die knieë met AKP tydens SLS en aktiewe knie ekstensie in sit. Gevolgtrekking: Die huidige studie kon nie ‘n beduidende verskil in propriosepsie vind tussen die knieë met AKP en die knieë sonder AKP nie tydens aktiewe gewrigsposisiesin toetsing. Die studie het wel abnormale propriosepsie gevind in individue, in beide die knieë met AKP sowel as die knieë sonder AKP. Hierdie bevindinge kan toegeskryf word aan kompensasie tydens loop in persone met AKP asook die akkuraatheid van die Vicon 3D bewegingsontledingsisteem. Daar was ‘n tendens van ‘n groter gemiddelde AE tydens aktiewe knie ekstensie in sit in die knieë met AKP. Hierdie bevinding mag die spesifieke proprioseptiewe vermoeë van die kniegewrig weerspieël. Hierdie studie ondersteun die insluiting van proprioseptiewe toetsing van albei knieë in persone met AKP, en nie net die knie met AKP nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103620
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