Original research| Volume 100, ISSUE 3, P514-519, March 2019

Patellar Tendon Reflex and Vastus Medialis Hoffmann Reflex Are Down Regulated and Correlated in Women With Patellofemoral Pain



      The aims of this study were threefold: (1) to compare the amplitude of patellar tendon reflex (T-reflex) between women with patellofemoral pain (PFP) and pain-free controls; (2) to compare the amplitude of vastus medialis Hoffmann reflex (VM H-reflex) between women with PFP and pain-free controls; (3) to investigate the association between the amplitude of patellar T-reflex and VM H-reflex in women with PFP and pain-free controls.


      Cross-sectional observational study.


      Laboratory of biomechanics and motor control.


      Thirty women with PFP and 30 pain-free women aged 18 to 35 years (N=60).

      Main Outcome Measures

      Peak-to-peak amplitudes of maximal VM H-reflex (elicited via electrical stimulation on the femoral nerve) and patellar T-reflex (elicited via mechanical percussion on the patellar tendon) were estimated.


      Women with PFP had significant lower amplitude of patellar T-reflex (mean difference=0.086; 95% confidence interval=0.020 to 0.151; P=.010; moderate effect) and VM H-reflex (mean difference=0.150; 95% confidence interval =0.073 to 0.227; P<.001; large effect) compared to pain-free controls. The VM H-reflex was strongly correlated with patellar T-reflex in both PFP group (r=0.66; P<.001) and control group (r=0.72; P<.001).


      As the T-reflex is easier to perform than H-reflex assessments in a clinical setting, it represents a feasible option to assess the impaired excitability of the stretch reflex pathway associated with PFP.


      List of abbreviations:

      AKPS (anterior knee pain scale), BMI (body mass index), EMG (electromyogram), H-reflex (Hoffmann reflex), Hmax (maximal Hoffmann reflex), Mmax (maximal motor waves), PFP (patellofemoral pain), T-reflex (tendon reflex), VAS (visual analog scale), VM (vastus medialis)
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