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

      Abstract

      Objectives

      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.

      Design

      Cross-sectional observational study.

      Setting

      Laboratory of biomechanics and motor control.

      Participants

      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.

      Results

      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).

      Conclusions

      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.

      Keywords

      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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      References

        • Boling M.
        • Padua D.
        • Marshall S.
        • Guskiewicz K.
        • Pyne S.
        • Beutler A.
        Gender differences in the incidence and prevalence of patellofemoral pain syndrome.
        Scand J Med Sci Sports. 2010; 20: 725-730
        • Roush J.R.
        • Bay R.C.
        Prevalence of anterior knee pain in 18-35 year-old females.
        Int J Sports Phys Ther. 2012; 7: 396-401
        • Crossley K.M.
        Is patellofemoral osteoarthritis a common sequela of patellofemoral pain?.
        Br J Sports Med. 2014; 48: 409-410
        • Wyndow N.
        • Collins N.
        • Vicenzino B.
        • Tucker K.
        • Crossley K.
        Is there a biomechanical link between patellofemoral pain and osteoarthritis? A narrative review.
        Sport Med. 2016; 46: 1797-1808
        • Lankhorst N.E.
        • Bierma-Zeinstra S.M.
        • van Middelkoop M.
        Factors associated with patellofemoral pain syndrome: a systematic review.
        Br J Sports Med. 2013; 47: 193-206
        • Powers C.M.
        • Witvrouw E.
        • Davis I.S.
        • Crossley K.M.
        Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3.
        Br J Sports Med. 2017; 51: 1713-1723
        • Nakagawa T.H.
        • Serrão F.V.
        • Maciel C.D.
        • Powers C.M.
        Hip and knee kinematics are associated with pain and self-reported functional status in males and females with patellofemoral pain.
        Int J Sports Med. 2013; 34: 997-1002
        • de Oliveira Silva D.
        • Briani R.
        • Pazzinatto M.
        • Ferrari D.
        • Aragão F.
        • de Azevedo F.
        Vertical ground reaction forces are associated with pain and self-reported functional status in recreational athletes with patellofemoral pain.
        J Appl Biomech. 2015; 31: 409-414
        • Pierrot-Deseilligny E.
        • Burke D.
        The circuitry of the human spinal cord: its role in motor control and movement disorders.
        Cambridge University Press, New York2005
        • Mezzarane R.A.
        • Elias L.A.
        • Magalhaes F.H.
        • Chaud V.M.
        • Kohn A.F.
        Experimental and simulated EMG responses in the study of the human spinal cord.
        in: Turker H. Electrodiagnosis in new frontiers of clinical research. InTech, Rijeka, Croatia2013: 57-87
        • Park J.
        • Hopkins J.T.
        Induced anterior knee pain immediately reduces involuntary and voluntary quadriceps activation.
        Clin J Sport Med. 2013; 23: 19-24
        • Tucker K.
        • Larsson A.-K.
        • Oknelid S.
        • Hodges P.
        Similar alteration of motor unit recruitment strategies during the anticipation and experience of pain.
        Pain. 2012; 153: 636-643
        • de Oliveira Silva D.
        • Magalhães F.H.
        • Faria N.C.
        • et al.
        Lower amplitude of the Hoffmann reflex in women with patellofemoral pain: thinking beyond proximal, local, and distal factors.
        Arch Phys Med Rehabil. 2016; 97: 1115-1120
        • de Oliveira Silva D.
        • Magalhães F.H.
        • Faria N.C.
        • et al.
        Vastus medialis H-reflex excitability is associated with pain level, self-reported function and chronicity in women with patellofemoral pain.
        Arch Phys Med Rehabil. 2017; 98: 114-119
        • Pazzinatto M.F.
        • de Oliveira Silva D.
        • Pappas E.
        • Magalhães F.H.
        • de Azevedo F.M.
        Is quadriceps H-reflex excitability a risk factor for patellofemoral pain?.
        Med Hypotheses. 2017; 108: 124-127
        • Mezzarane R.A.
        • Magalhães F.H.
        • Chaud V.M.
        • Elias L.A.
        • Kohn A.F.
        Enhanced D1 and D2 inhibitions induced by low-frequency trains of conditioning stimuli: differential effects on H- and T-reflexes and possible mechanisms.
        PLoS One. 2015; 10e0121496
        • McNeil C.J.
        • Butler J.E.
        • Taylor J.L.
        • Gandevia S.C.
        Testing the excitability of human motoneurons.
        Front Hum Neurosci. 2013; 7: 152
        • Dafkin C.
        • Green A.
        • Kerr S.
        • Veliotes D.
        • McKinon W.
        The accuracy of subjective clinical assessments of the patellar reflex.
        Muscle Nerve. 2013; 47: 81-88
        • Crossley K.M.
        • Stefanik J.J.
        • Selfe J.
        • et al.
        2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures.
        Br J Sports Med. 2016; 50: 839-843
        • Pazzinatto M.F.
        • de Oliveira Silva D.
        • Pradela J.
        • Coura M.B.
        • Barton C.
        • de Azevedo F.M.
        Local and widespread hyperalgesia in female runners with patellofemoral pain are influenced by running volume.
        J Sci Med Sport. 2017; 20: 362-367
        • Rathleff M.S.
        • Petersen K.K.
        • Arendt-Nielsen L.
        • Thorborg K.
        • Graven-Nielsen T.
        Impaired conditioned pain modulation in young female adults with long-standing patellofemoral pain: a single blinded cross-sectional study.
        Pain Med. 2016; 17: 980-988
        • Selkow N.M.
        • Pietrosimone B.G.
        • Saliba S.A.
        Subcutaneous thigh fat assessment: a comparison of skinfold calipers and ultrasound imaging.
        J Athl Train. 2011; 46: 50-54
        • Watson C.J.
        • Propps M.
        • Ratner J.
        • Zeigler D.L.
        • Horton P.
        • Smith S.S.
        Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain.
        J Orthop Sport Phys Ther. 2005; 35: 136-146
        • Crossley K.M.
        • Bennell K.L.
        • Cowan S.M.
        • Green S.
        Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?.
        Arch Phys Med Rehabil. 2004; 85: 815-822
        • Palmieri R.M.
        • Ingersoll C.D.
        • Hoffman M.A.
        The hoffmann reflex: methodologic considerations and applications for use in sports medicine and athletic training research.
        J Athl Train. 2004; 39: 268-277
        • Doguet V.
        • Jubeau M.
        Reliability of H-reflex in vastus lateralis and vastus medialis muscles during passive and active isometric conditions.
        Eur J Appl Physiol. 2014; 114: 2509-2519
        • Vickery H.S.
        • Smith P.A.
        Surface electromyography reveals males have a slower patellar reflex than females.
        J Electromyogr Kinesiol. 2012; 22: 990-996
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        2nd ed. Routledge Academic, New York1988
        • Master S.
        • Tremblay F.
        Task-specific increase in corticomotor excitability during tactile discrimination.
        Exp Brain Res. 2009; 194: 163-172
        • Taube W.
        • Kullmann N.
        • Leukel C.
        • Kurz O.
        • Amtage F.
        • Gollhofer A.
        Differential reflex adaptations following sensorimotor and strength training in young elite athletes.
        Int J Sports Med. 2007; 28: 999-1005
        • Perez M.A.
        • Field-Fote E.C.
        • Floeter M.K.
        Patterned sensory stimulation induces plasticity in reciprocal ia inhibition in humans.
        J Neurosci. 2003; 23: 2014-2018
        • Thompson A.K.
        • Wolpaw J.R.
        The simplest motor skill: mechanisms and applications of reflex operant conditioning.
        Exerc Sport Sci Rev. 2014; 42: 82-90
        • Lack S.
        • Neal B.
        • De Oliveira Silva D.
        • Barton C.
        How to manage patellofemoral pain—understanding the multifactorial nature and treatment options.
        Phys Ther Sport. 2018; 32: 155-166
        • Chandrasekhar A.
        • Abu Osman N.A.
        • Tham L.K.
        • Lim K.S.
        • Wan Abas W.A.
        Influence of age on patellar tendon reflex response.
        PLoS One. 2013; 8e80799