The kinematic differences between individuals with patellofemoral pain and matched controls during a single leg squat

Meiring Stephens, Solané (2019-04)

Thesis (MScPhysio)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Background: Patellofemoral pain (PFP) is a common knee condition characterised by retro- or peripatellar pain. It affects 11 percent of people who consult a general practitioner for knee pain. This condition has an impact on the daily lives of those suffering from it and causes pain during activities such as stair climbing, squatting and prolonged sitting. PFP has the tendency to become chronic. Altered lower limb and trunk kinematics may play an important role in the development of PFP and can be evaluated during a single leg squat (SLS). Findings regarding the kinematics of individuals with PFP compared to controls during a SLS are limited and inconsistent. Objective: The objective of the study was to describe the lower limb and trunk kinematic differences between individuals with PFP and matched controls during a SLS. Methodology: A cross-sectional design was followed in this study. The study was conducted in a laboratory setting in the Neuromechanics unit of the Central Analytical Facility of Stellenbosch University at the Coetzenburg Sports Complex, Stellenbosch. Study participants included 26 cases with PFP and 26 healthy gender- and age-matched controls. The Vicon 3D motion analysis system was utilised to capture the peak values of all outcomes (ipsilateral trunk lean, contralateral pelvic drop, hip adduction, knee abduction, rear-foot eversion, hip internal rotation and knee external rotation) during the static phase of the SLS. The kinematic outcomes of cases and controls were compared using the paired t-test. Results: The study population comprised 16 females and 10 males with PFP and their respective control group participants. The PFP group had a mean age of 28.5 years compared to 28 years for the control group. Participants with PFP presented with significantly more peak knee external rotation compared to healthy controls during the static phase of the SLS (MD, 4.68˚; 95% CI: 2.83, 6.53; p < 0.001). This also was the case when the groups were stratified for gender. When stratified for bilateral and unilateral PFP, only the bilateral PFP group demonstrated significantly increased peak knee external rotation compared to their control group, with a mean difference of 5.98˚ (95% CI: 3.79, 8.17; p < 0.001). There were no significant differences for the peak values of the other outcomes (ipsilateral trunk lean, contralateral pelvic drop, hip adduction, knee abduction, rear-foot eversion and hip internal rotation). The PFP group, however, presented with larger group means for all the outcomes in comparison with the control group. Conclusion: Peak knee external rotation was significantly increased in individuals with PFP compared to controls during the SLS. The findings of this study highlight the usefulness of the SLS as a test for altered kinematics in individuals with PFP. Future studies may explore possible contributing factors to excessive knee external rotation, such as trunk and lower limb muscle imbalances. Further studies are needed to evaluate the kinematic differences between individuals with unilateral and bilateral PFP.

AFRIKAANSE OPSOMMING : Agtergrond: Patellofemorale pyn (PFP) is ‘n algemene knietoestand wat deur pyn aan die anterior aspek van die knie gekenmerk word en affekteer 11 persent van mense wat 'n algemene praktisyn vir kniepyn raadpleeg. Hierdie toestand het ‘n impak op die daaglikse lewens van diegene wat daaraan ly en lei tot pyn tydens aktiwiteite soos trappe klim, hurk en sit vir lang periodes. Die toestand is ook geneig om kronies te word. Veranderde kinematika van die onderste ledemaat en romp kan ‘n belangrike rol in die ontwikkeling van PFP speel en kan gedurende ‘n een-beenhurk geëvalueer word. Daar is beperkte en strydige bevindinge rakende die kinematika van individue met PFP in vergelyking met kontroles tydens ‘n een-been-hurk. Doelwitte: Om die onderste ledemaat en romp kinematiese verskille tussen individue met PFP en ooreenstemmende kontrole deelnemers tydens ‘n een-been-hurk te beskryf. Metodiek: ‘n Beskrywende deursnitstudie-ontwerp is vir hierdie studie gevolg. Dit is in‘n labratoriumomgewing in die Neuromeganika-eenheid van die Universiteit Stellenbosch se Sentrale Analitiese Fasiliteit by die Coetzenburg Sportkompleks onderneem. Die deelnemers aan die studie het 26 gevalle met PFP en 26 geslags- en ouderdom-ooreenstemmende kontrole deelnemers ingesluit. Die Vicon 3D-bewegingsontledingsisteem is aangewend om die piekwaardes van alle uitkomste (ipsilaterale romp leun, kontralaterale pelviese sak, heupadduksie, knie-abduksie, agtervoeteversie, heup interne rotasie en knie eksterne rotasie) tydens die statiese fase van die een-been-hurk te meet. Die kinematiese verskille tussen gevalle en kontroles is met behulp van die gepaarde t-toets vergelyk. Resultate: Die studie populasie het uit 16 vroue en 10 mans met PFP, en hul ooreenstemmende kontrole groepe bestaan. Die PFP-groep het ‘n gemiddelde ouerdom van 28.5 jaar gehad, teenoor 28 jaar vir die kontrole groep. Deelnemers in die PFP-groep het aansienlik meer piek eksterne knie rotasie as die kontroles tydens die statiese fase van die een-been-hurk getoon (gemiddelde verskil, 4.68˚; 95% VI: 2.83, 6.53; p < 0.001). Dit was ook die geval toe die groepe volgens geslag verdeel is. Met die verdeling in bilaterale en unilaterale PFP-groepe, het net die bilaterale PFP-groep aansienlik meer piek knie eksterne rotasie in die mees geaffekteerde been getoon in vergelyking met hul kontrole-groep (gemiddelde verskil, 5.98˚; 95% VI: 3.79, 8.17; p < 0.001). Daar was geen beduidende verskille vir piekwaardes van die ander uitkomste nie (ipsilaterale romp leun, kontralaterale pelviese sak, heupadduksie, knie-abduksie, agtervoeteversie, heup interne rotasie), alhoewel die PFP-groep vir alle uitkomste groter groep gemiddelde waardes in vergelyking met die kontrole groep getoon het. Gevolgtrekking: Piek knie eksterne rotasie tydens die een-been-hurk was aansienlik meer in individue met PFP in vergelyking met kontrole deelnemers. Die bevindinge van hierdie studie beklemtoon die nut van die een-been-hurk as ‘n toets vir veranderde kinematika in individue met PFP. Toekomstige studies kan onderliggende redes vir die oormatige knie eksterne rotasie in individue met PFP, soos spierwanbalanse van die romp en onderste ledemaat, ondersoek. Verdere studies is ook nodig om die kinematiese verskille tussen individue met bilaterale en unilaterale PFP te ondersoek.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105899
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