A NOVEL EXPERIMENTAL APPROACH FOR IDENTIFYING BIOMECHANICAL PARAMETERS ASSOCIATED WITH PATELLOFEMORAL PAIN: A CASE REPORT
Year 2024,
Volume: 2 Issue: 3, 103 - 109, 31.12.2024
Damla Deniz
,
Nihat Özgören
,
Serdar Arıtan
,
Volga Bayrakcı Tunay
Abstract
PURPOSE: Individuals with patellofemoral pain may demonstrate asymmetries in muscle strength, influencing quadriceps strength and electromyographic (EMG) activity. These imbalances disrupt movement patterns and joint mechanics during weight-bearing activities, potentially compromising knee control and increasing patellofemoral stress. Observing these neuromuscular and kinematic alterations using biomechanical measurement methods might lead to a better understanding of effective management by objective evaluations. This study investigates the change of ground reaction force (GRF), knee valgus angle and muscle activation patterns of the quadriceps muscle group on the affected and unaffected sides in individuals with patellofemoral pain.
METHODS: A 38-year-old right-dominant woman with right-sided patellofemoral pain participated in the study. Marker-based motion capture, a force plate and surface EMG were used to measure physiological, kinematic and kinetic parameters during a maximal isometric contraction at half-squat position.
RESULTS: The muscle activation patterns at the affected and non-affected sides showed strong positive linear correlations (R > 0.84) with GRF-time history except for right Rectus Femoris (RF) (R: 0.61). The integrated EMG value of the right RF was less than that of the left RF, which aligns with the lower correlation. The valgus angle in the left knee was 5.7 ± 0.3 degrees higher than in the right knee.
CONCLUSION: Muscle activation values on the affected side were lower compared to the non-affected side, while the valgus angle of the non-affected side was higher during isometric quadriceps loading. This finding indicates that compensatory mechanisms on the non-affected side may counteract the increased valgus motion on the affected side, potentially contributing to pain.
Project Number
GO18/372-42
References
- 1. Papadopoulos K. Evaluating applied physiotherapy practice in managing Patellofemoral Pain Syndrome: extending the scope beyond clinical measures and treatment: Bangor University (United Kingdom); 2016.
- 2. Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, et al. Patellofemoral pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American physical therapy association. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95.
- 3. Glaviano NR, Holden S, Bazett-Jones DM, Singe SM, Rathleff MS. Living well (or not) with patellofemoral pain: a qualitative study. Phys Ther Sport. 2022;56:1-7.
- 4. Pattyn E, Mahieu N, Selfe J, Verdonk P, Steyaert A, Witvrouw E. What predicts functional outcome after treatment for patellofemoral pain? Med Sci Sports Exerc. 2012;44(10):1827-33.
- 5. Lobo Junior P, Barbosa Neto IA, Borges JHDS, Tobias RF, Boitrago MVDS, Oliveira MDP. Clinical muscular evaluation in patellofemoral pain syndrome. Acta Ortop. Bras. 2018;26:91-3.
- 6. Özgören N, Arıtan S. Peak counting in surface electromyography signals for quantification of muscle fatigue during dynamic contractions. Med Eng Phys. 2022;107:103844.
- 7. Guney H, Yuksel I, Kaya D, Doral MN. Correlation between quadriceps to hamstring ratio and functional outcomes in patellofemoral pain. Knee. 2016;23(4):610-5.
- 8. Prins MR, Van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9-15.
- 9. Briani RV, Pazzinatto MF, Waiteman MC, de Oliveira Silva D, de Azevedo FM. Association between increase in vertical ground reaction force loading rate and pain level in women with patellofemoral pain after a patellofemoral joint loading protocol. Knee. 2018;25(3):398-405.
- 10. Yalfani A, Ahmadi M. Patients with patellofemoral pain exhibiting decrease vertical ground reaction force compared to healthy individuals during weight bearing tasks: A systematic reviews and meta-analysis. Iran J Public Health. 2023;52(2):254.
- 11. Arıtan, S., Özgören, N. (2024). Biomechanical Measurement Methods to Analyze the Mechanisms of Sport Injuries. In: Doral, M.N., Karlsson, J. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36801-1_309-1
12. Wallace DA, Salem GJ, Salinas R, Powers CM. Patellofemoral joint kinetics while squatting with and without an external load. J Orthop Sports Phys Ther. 2002;32(4):141-8.
- 13. Leboeuf F, Baker R, Barré A, Reay J, Jones R, Sangeux M. The conventional gait model, an open-source implementation that reproduces the past but prepares for the future. Gait Posture. 2019;69:235-41.
- 14. Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, et al. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng. 2007;54(11):1940-50.
- 15. Field A. Discovering statistics using IBM SPSS statistics:(and sex and drugs and rock'n'roll): Andy Field: Sage; 2013.
- 16. Kaya D, Citaker S, Kerimoglu U, Atay OA, Nyland J, Callaghan M, et al. Women with patellofemoral pain syndrome have quadriceps femoris volume and strength deficiency. Knee Surg Sports Traumatol Arthrosc. 2011;19:242-7.
- 17. Werner S. An evaluation of knee extensor and knee flexor torques and EMGs in patients with patellofemoral pain syndrome in comparison with matched controls. Knee Surg Sports Traumatol Arthrosc. 1995;3(2):89-94.
- 18. Zaffagnini S, Dejour D, Arendt EA. Patellofemoral pain, instability, and arthritis: Springer; 2010.
- 19. Callaghan M, Oldham J. Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome? Br J Sports Med. 2004;38(3):295-9.
- 20. Maffiuletti NA. Assessment of hip and knee muscle function in orthopaedic practice and research. JBJS. 2010;92(1):220-9.
- 21. Yosmaoğlu HB, Selfe J, Sonmezer E, Sahin İE, Duygu SÇ, Acar Ozkoslu M, et al. Targeted treatment protocol in patellofemoral pain: does treatment designed according to subgroups improve clinical outcomes in patients unresponsive to multimodal treatment? Sports Health. 2020;12(2):170-80.
- 22. Basbug P, Kilic RT, Atay AO, Bayrakcı Tunay V. The effects of progressive neuromuscular exercise program and taping on muscle strength and pain in patellofemoral pain. A randomized controlled blind study. Somatosens Mot Res. 2022;39(1):39-45.
- 23. Wilczyński B, Zorena K, Ślęzak D. Dynamic knee valgus in single-leg movement tasks. Potentially modifiable factors and exercise training options. A literature review. International journal of environmental research and public health. 2020;17(21):8208.
- 24. Herrington L. Knee valgus angle during single leg squat and landing in patellofemoral pain patients and controls. Knee. 2014;21(2):514-7.
- 25. Hewett TE, Myer GD, Ford KR, Heidt Jr RS, Colosimo AJ, McLean SG, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492-501.
- 26. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33(11):639-46.
- 27. Lee JH, Lee SH, Choi GW, Jung HW, Jang WY. Individuals with recurrent ankle sprain demonstrate postural instability and neuromuscular control deficits in unaffected side. Knee Surg Sports Traumatol Arthrosc. 2020;28:184-92.
- 28. Tanaka S, Tamari K, Amano T, Robbins SM, Inoue Y, Tanaka R. Self-reported physical activity is related to knee muscle strength on the unaffected side and walking ability in patients with knee osteoarthritis awaiting total knee arthroplasty: A cross-sectional study. Physiother Theory Pract. 2022;38(3):441-7.