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Added Value of Isolated Core Postural Control Training on Knee Pain and Function in Women With Patellofemoral Pain Syndrome: A Randomized Controlled Trial

Published:September 26, 2018DOI:https://doi.org/10.1016/j.apmr.2018.08.180

      Abstract

      Objectives

      To evaluate the added value of isolated core postural control training on knee pain and function in women with patellofemoral pain syndrome (PFPS).

      Design

      Randomized controlled trial.

      Setting

      Rehabilitation sciences research center.

      Participants

      Women (N=33) between 18 and 30 years of age with PFPS were randomly assigned to a control group (n=16) or the experimental group (n=17).

      Interventions

      Participants in both groups received the same stretching and strengthening exercises during 4 weeks (12 sessions 3 days per week). The experimental group also received isolated core postural training with an unstable seat apparatus.

      Main Outcome Measures

      Center of pressure (CoP) trajectories in sitting postural control, pain intensity, and function were recorded before and after the 4-week intervention period. Functional capacity and pain intensity were reassessed 3 months after the intervention.

      Results

      After treatment, both groups had significant improvements in pain, function (P<.001), and CoP trajectories in sitting postural control (control group P<.05, experimental group P<.001). Between-group comparisons demonstrated greater improvements in pain, function, and CoP trajectories in the experimental group (P<.001). This group also had significantly greater improvements in pain and Kujala Anterior Knee Pain Scale score at 3-month follow-up compared to the control group (P<.001).

      Conclusions

      Adding isolated core postural control training to physiotherapy exercises was associated with significantly greater improvements in pain, function, and CoP trajectories than physiotherapy exercises alone. Therefore, unstable sitting postural control training is potentially useful to enhance rehabilitation management in patients with PFPS.

      Keywords

      List of abbreviations:

      AKPS (Anterior Knee Pain Scale), CoP (center of pressure), NRS (numeric rating scale), PFPS (patellofemoral pain syndrome), RMS (root mean square)
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      References

        • Piva S.R.
        • Fitzgerald G.K.
        • Irrgang J.J.
        • et al.
        Associates of physical function and pain in patients with patellofemoral pain syndrome.
        Arch Phys Med Rehabil. 2009; 90: 285-295
        • 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
        • Halabchi F.
        • Mazaheri R.
        • Seif-Barghi T.
        Patellofemoral pain syndrome and modifiable intrinsic risk factors; how to assess and address?.
        Asian J Sports Med. 2013; 4: 85
        • Cowan S.M.
        • Crossley K.M.
        • Bennell K.L.
        Altered hip and trunk muscle function in individuals with patellofemoral pain.
        Br J Sports Med. 2009; 43: 584-588
        • Almeida G.P.
        • Carvalho E Silva A.P.
        • França F.J.
        • Magalhães M.O.
        • Burke T.N.
        • Marques A.P.
        Does anterior knee pain severity and function relate to the frontal plane projection angle and trunk and hip strength in women with patellofemoral pain?.
        J Bodyw Mov Ther. 2015; 19: 558-564
        • Willson J.D.
        • Davis I.S.
        Lower extremity strength and mechanics during jumping in women with patellofemoral pain.
        J Sport Rehabil. 2009; 18: 76-90
        • Prins M.R.
        • van der Wurff P.
        Females with patellofemoral pain syndrome have weak hip muscles: a systematic review.
        Aust J Physiother. 2009; 55: 9-15
        • Dolak K.L.
        • Silkman C.
        • Medina McKeon J.
        • Hosey R.G.
        • Lattermann C.
        • Uhl T.L.
        Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial.
        J Orthop Sports Phys Ther. 2011; 41: 560-570
        • Earl J.E.
        • Hoch A.Z.
        A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome.
        Am J Sports Med. 2011; 39: 154-163
        • Chevidikunnan M.F.
        • Al Saif A.
        • Gaowgzeh R.A.
        • Mamdouh K.A.
        Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome.
        J Phys Ther Sci. 2016; 28: 1518-1523
        • Zazulak B.T.
        • Hewett T.E.
        • Reeves N.P.
        • Goldberg B.
        • Cholewicki J.
        Deficits in neuromuscular control of the trunk predict knee injury risk a prospective biomechanical-epidemiologic study.
        Am J Sports Med. 2007; 35: 1123-1130
        • Shirazi Z.R.
        • Moghaddam M.B.
        • Motealleh A.
        Comparative evaluation of core muscle recruitment pattern in response to sudden external perturbations in patients with patellofemoral pain syndrome and healthy subjects.
        Arch Phys Med Rehabil. 2014; 95: 1383-1389
        • Biabanimoghadam M.
        • Motealleh A.
        • Cowan S.M.
        Core muscle recruitment pattern during voluntary heel raises is different between patients with patellofemoral pain and healthy individuals.
        Knee. 2016; 23: 382-386
        • Citaker S.
        • Kaya D.
        • Yuksel I.
        • et al.
        Static balance in patients with patellofemoral pain syndrome.
        Sports Health. 2011; 3: 524-527
        • Arun B.
        • Vakkachan T.
        • Abraham B.
        Comparison of dynamic postural control with and without patellofemoral pain syndrome using star excursion balance test.
        J Med Sci Technol. 2013; 2: 1-6
        • Goto S.
        The effect of patellofemoral pain syndrome on the hip and knee neuromuscular control on dynamic postural control task.
        ([thesis]) University of Toledo, Toledo2009
      1. Motealleh A, Kordi Yoosefinejad A, Ghodousi M, et al. Trunk postural control during unstable sitting differs between patients with patellofemoral pain syndrome and healthy people: a cross-sectional study. Knee. [E-pub ahead of print.] https://doi.org/10.1016/j.knee.2018.10.002.

        • Cholewicki J.
        • Polzhofer G.
        • Radebold A.
        Postural control of trunk during unstable sitting.
        J Biomech. 2000; 33: 1733-1737
        • Willson J.D.
        • Kernozek T.W.
        • Arndt R.L.
        • Reznichek D.A.
        • Straker J.S.
        Gluteal muscle activation during running in females with and without patellofemoral pain syndrome.
        Clin Biomech. 2011; 26: 735-740
        • Yelvar G.D.
        • Baltaci G.
        • Tunay V.B.
        • Atay A.O.
        The effect of postural stabilization exercises on pain and function in females with patellofemoral pain syndrome.
        Acta Orthop Traumatol Turc. 2015; 49: 166-174
        • Mahmoud WSE-d
        • Kamel E.M.
        The effect of additional balance training program to gluteus medius strengthening exercises on patellofemoral pain syndrome.
        Int J Ther Rehabil Res. 2015; 4: 7-14
        • Rabelo N.D.
        • Lima B.
        • dos Reis A.C.
        • et al.
        Neuromuscular training and muscle strengthening in patients with patellofemoral pain syndrome: a protocol of randomized controlled trial.
        BMC Musculoskelet Disord. 2014; 15: 157
        • Willigenburg N.W.
        • Kingma I.
        • van Dieën J.H.
        Center of pressure trajectories, trunk kinematics and trunk muscle activation during unstable sitting in low back pain patients.
        Gait Posture. 2013; 38: 625-630
        • 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
        • Negahban H.
        • Pouretezad M.
        • Yazdi M.J.
        • et al.
        Persian translation and validation of the Kujala Patellofemoral Scale in patients with patellofemoral pain syndrome.
        Disabil Rehabil. 2012; 34: 2259-2263
        • Loudon J.K.
        • Wiesner D.
        • Goist-Foley H.L.
        • Asjes C.
        • Loudon K.L.
        Intrarater reliability of functional performance tests for subjects with patellofemoral pain syndrome.
        J Athl Train. 2002; 37: 256
        • Khayambashi K.
        • Fallah A.
        • Movahedi A.
        • Bagwell J.
        • Powers C.
        Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial.
        Arch Phys Med Rehabil. 2014; 95: 900-907
        • Nakagawa T.H.
        • Muniz T.B.
        • Baldon Rde M.
        • Dias Maciel C.
        • de Menezes Reiff R.B.
        • Serrão F.V.
        The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study.
        Clin Rehabil. 2008; 22: 1051-1060
        • Salles J.I.
        • Velasques B.
        • Cossich V.
        • et al.
        Strength training and shoulder proprioception.
        J Athl Train. 2015; 50: 277-280
        • Ferber R.
        • Bolgla L.
        • Earl-Boehm J.E.
        • Emery C.
        • Hamstra-Wright K.
        Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial.
        J Athl Train. 2015; 50: 366-377
        • Preuss R.A.
        • Grenier S.G.
        • McGill S.M.
        Postural control of the lumbar spine in unstable sitting.
        Arch Phys Med Rehabil. 2005; 86: 2309-2315
        • Freddolini M.
        • Strike S.
        • Lee R.Y.
        The role of trunk muscles in sitting balance control in people with low back pain.
        J Electromyogr Kinesiol. 2014; 24: 947-953
        • Wang H.
        • Weiss K.J.
        • Haggerty M.C.
        • Heath J.E.
        The effect of active sitting on trunk motion.
        J Sport Health Sci. 2014; 3: 333-337
        • Radebold A.
        • Cholewicki J.
        • Polzhofer G.K.
        • Greene H.S.
        Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain.
        Spine. 2001; 26: 724-730
        • Van der Burg J.
        • Van Wegen E.
        • Rietberg M.
        • Kwakkel G.
        • Van Dieën J.
        Postural control of the trunk during unstable sitting in Parkinson’s disease.
        Parkinsonism Relat Disord. 2006; 12: 492-498
        • Leetun D.T.
        • Ireland M.L.
        • Willson J.D.
        • Ballantyne B.T.
        • Davis I.M.
        Core stability measures as risk factors for lower extremity injury in athletes.
        Med Sci Sports Exerc. 2004; 36: 926-934