Patellofemoral ağrı sendromlu kadınlarda postural stabilizasyon egzersizlerinin ağrı ve fonksiyon üzerine etkisi

Yıl 2015, Cilt: 49 Sayı: 2, 166 - 174, 22.05.2015

Gul Deniz Yilmaz Yelvar Gul Baltaci Volga Bayrakci Tunay Ahmet Ozgur Atay

https://doi.org/10.3944/AOTT.2015.13.0118

Öz

Amaç: Patellofemoral ağrısı olan kadınlarda postural stabilizasyon egzersizlerinin ağrı, kas kuvveti ve fonksiyonu üzerine etkisini araştırmak.

Çalışma planı: Patellofemoral ağrı sendromu (PFAS) olan 42 gönüllü kadın bu çalışmaya dahil edildi. Denekler rastgele iki gruba ayrıldı: 1. gruba terapatik diz egzersileri ve stabilizasyon egzersizleri uygulandı (n=22); 2. gruba (n=20) terapatik diz egzersizleri uygulandı. Tüm hastalar tedavi öncesi, sonrası ve 12. haftada ağrı, hamstring esnekliği, fonksiyon, alt ekstremite kas kuvveti ve postural kontrol yönünden değerlendirildi. İki yönlü ANOVA Tedavi öncesi, sonrası ve 12. haftada her grup içinde yapıldı. Gruplar arasında istatistiksel anlamlılık gözlendiğinde anlamlılığın hangi gruptan kaynaklandığını bulmak için Tukey testi kullanıldı. Anlamlılık düzeyi p<0.05 olarak belirlendi.

Bulgular: Sonuçlar ağrı, esneklik, fonksiyon, kuvvet, dayanıklılık, postural kontrol ve Kujala patellofemoral ağrı ölçek parametrelerine açısından iki grup arasında istatistiksel olarak anlamlı idi (p<0.05). Tüm parametreleri göz önüne alındığında, Grup 1 tedaviden sonra büyük başarı elde etti (p<0.05).

Çıkarımlar: PFAS’li hastalarda stabilizasyon egzersizleri de dahil olmak üzere fizyoterapi ve rehabilitasyon programlarının uygulanması kuvvet ve fonksiyonun gelişmesini, ağrının azalmasını sağlayacaktır.

 

Anahtar Kelimeler

Ağrı; fizyoterapi; fonksiyon; kuvvetlendirme; patellofemoral ağrı sendromu; postural stabilizasyon.

The effect of postural stabilization exercises on pain and function in females with patellofemoral pain syndrome

Öz

Objective: This study aimed to investigate the effect of postural stabilization exercises on pain, muscle strength and function in females with patellofemoral pain.
Methods: Forty-two volunteers with patellofemoral pain syndrome (PFPS) were included in this study. The subjects were randomly divided into two groups: Group 1 performed therapeutic knee and postural stabilization exercises (n=22); Group 2 performed therapeutic knee exercises only (n=20). All patients were evaluated for pain, hamstring flexibility, function, lower extremity strength and postural control before and after treatment and at the 12th week. A two-way ANOVA was done within each group before and after treatment and at the 12th week. The level of significance was set at p<0.05, and when this was observed, the Tukey test was used to determine which group had caused the significance.
Results: The results were statistically significant between the groups in terms of pain, flexibility, function, strength, endurance, postural control and the parameters of the Kujala patellofemoral pain scale (p<0.05). For all parameters, Group 1 achieved the greater success after treatment (p<0.05).
Conclusion: The implementation of physiotherapy and rehabilitation programs including postural stabilization exercises may improve strength and function and reduce pain in patients with PFPS.

Anahtar Kelimeler

Function, pain, patellofemoral pain syndrome, physiotherapy, postural stabilization, strengthening

Kaynakça

• Bolgla LA, Malone TR, Umberger BR, Uhl TL. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syn- drome. J Orthop Sports Phys Ther 2008;38:12–8.
• Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 2005;35:793–801.
• Tsuji T, Matsuyama Y, Goto M, Yimin Y, Sato K, Hasega- wa Y, et al. Knee-spine syndrome: correlation between sacral inclination and patellofemoral joint pain. J Orthop Sci 2002;7:519–23.
• Waryasz GR, McDermott AY. Patellofemoral pain syn- drome (PFPS): a systematic review of anatomy and po- tential risk factors. Dyn Med 2008;7:9.
• Witvrouw E, Lysens R, Bellemans J, Cambier D, Vander- straeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 2000;28:480–9.
• Powers CM. The influence of altered lower-extremity ki- nematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 2003;33:639–46.
• Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 2003;33:671–6.
• Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc 2004;36:926–34.
• Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother 2009;55:9–15.
• Hodges PW, Richardson CA. Contraction of the abdomi- nal muscles associated with movement of the lower limb. Phys Ther 1997;77:132–44.
• Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Chole- wicki J. The effects of core proprioception on knee injury: a prospective biomechanical-epidemiological study. Am J Sports Med 2007;35:368–73.
• Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study. Am J Sports Med 2004;32:1122–30.
• Kannus P, Natri A, Paakkala T, Järvinen M. An outcome study of chronic patellofemoral pain syndrome. Seven- year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg Am 1999;81:355–63.
• Earl JE, Hoch AZ. A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome. Am J Sports Med 2011;39:154–63.
• Mascal CL, Landel R, Powers C. Management of patel- lofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports. J Orthop Sports Phys Ther 2003;33:647–60.
• Earl JE, Monteiro SK, Snyder KR. Differences in lower extremity kinematics between a bilateral drop-vertical jump and a single-leg step-down. J Orthop Sports Phys Ther 2007;37:245–52.
• Hewett TE, Myer GD, Ford KR. Decrease in neuromus- cular control about the knee with maturation in female athletes. J Bone Joint Surg Am 2004;86-A:1601–8.
• Chesworth BM, Culham E, Tata GE, Peat M. Validation of outcome measures in patients with patellofemoral syn- drome. J Orthop Sports Phys Ther 1989;10:302–8.
• Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral dis- orders. Arthroscopy 1993;9:159–63.
• Kuru T, Dereli EE, Yaliman A. Validity of the Turk- ish version of the Kujala patellofemoral score in patel- lofemoral pain syndrome. Acta Orthop Traumatol Turc 2010;44:152–6.
• Nelson RT, Bandy WD. Eccentric Training and Static Stretching Improve Hamstring Flexibility of High School Males. J Athl Train 2004;39:254–258.
• Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W. Quantitative assessment of functional limi- tations in normal and anterior cruciate ligament-deficient knees. Clin Orthop Relat Res 1990;255:204–14.
• Risberg MA, Ekeland A. Assessment of functional tests after anterior cruciate ligament surgery. J Orthop Sports Phys Ther 1994;19:212–7.
• Wall JC, Bell C, Campbell S, Davis J. The Timed Get-up- and-Go test revisited: measurement of the component tasks. J Rehabil Res Dev 2000;37:109–13.
• McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Re- habil 1999;80:941–4.
• Costello JT, Donnelly AE. Cryotherapy and joint position sense in healthy participants: a systematic review. J Athl Train 2010;45:306–16.
• Watson CJ, Propps M, Ratner J, Zeigler DL, Horton P, Smith SS. Reliability and responsiveness of the lower ex- tremity functional scale and the anterior knee pain scale in patients with anterior knee pain. J Orthop Sports Phys Ther 2005;35:136–46.
• Lowry CD, Cleland JA, Dyke K. Management of pa- tients with patellofemoral pain syndrome using a multi- modal approach: a case series. J Orthop Sports Phys Ther 2008;38:691–702.
• Alaca R, Yilmaz B, Goktepe AS, Mohur H, Kalyon TA. Efficacy of isokinetic exercise on functional capacity and pain in patellofemoral pain syndrome. Am J Phys Med Re- habil 2002;81:807–13.
• Fukuda TY, Melo WP, Zaffalon BM, Rossetto FM, Magalhães E, Bryk FF, et al. Hip posterolateral muscu- lature strengthening in sedentary women with patello- femoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up. J Orthop Sports Phys Ther 2012;42:823–30.
• Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patel- lofemoral pain syndrome. J Orthop Sports Phys Ther 2007;37:232–8.
• Derasari A, Brindle TJ, Alter KE, Sheehan FT. McCon- nell taping shifts the patella inferiorly in patients with patellofemoral pain: a dynamic magnetic resonance imag- ing study. Phys Ther 2010;90:411–9.
• Akarcalı İ, Tugay N, Erden Z, Atay A, Leblebicioğlu G, Doral MN. Patellofemoral pain rehabilitation: Outcomes of a home based program. J Arthroplasty Arthroscopic Surg 2001;12:56–60.
• Tang SF, Chen CK, Hsu R, Chou SW, Hong WH, Lew HL. Vastus medialis obliquus and vastus lateralis activ- ity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study. Arch Phys Med Rehabil 2001;82:1441–5.
• Ekstrom RA, Donatelli RA, Carp KC. Electromyograph- ic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther 2007;37:754–62.
• Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and preva- lence of patellofemoral pain syndrome. Scand J Med Sci Sports 2010;20:725–30.
• Ott B, Cosby NL, Grindstaff TL, Hart JM. Hip and knee muscle function following aerobic exercise in individuals with patellofemoral pain syndrome. J Electromyogr Kine- siol 2011;21:631–7.