PATELLOFEMORAL AĞRI SENDROMU VE GÜNCEL TEDAVİ YAKLAŞIMLARI

Yıl 2022, Cilt: 2 Sayı: 5 - Ekim 2022, 20 - 27, 15.12.2022

Onur Turan Hilal Denizoğlu Külli

https://doi.org/10.54270/atljm.2022.24

Öz

Patellofemoral ağrı sendromu (PFAS) patellofemoral eklemde (PFE) yüklenme oluşturan aktiviteler ile provoke olan, patella çevresinde ve arkasında ağrı tariflenen, diğer ayırıcı patolojilerin yokluğunda bahsedilen, diz önünde ısrarcı ağrıya sebep olan kronik bir kas iskelet sistemi problemi olarak tanımlanmaktadır. Çömelme, uzun süreli dizler fleksiyonda oturma ve merdiven inme ve çıkma gibi PFE’ye yük bindiren aktiviteler sırasında ve sonrasında artan bir ağrı söz konusudur. Ortopedi ve travmatoloji, spor hekimliği, ortopedik ve sportif rehabilitasyon kliniklerine ön diz ağrısı ile başvurunun en sık karşılaşılan sebebidir. Görülme sıklığını araştıran kısıtlı sayıda çalışma bulunmasına rağmen PFAS alt ekstremitedeki en sık rastlanan ağrı nedeni olarak gösterilmektedir. PFA’nın tüm toplumu etkileyebildiği düşünülmekle beraber özellikle adolösanlar, genç aktif yetişkinler, elit atletler, askeri personelde ve yüksek insidans ve prevelans ile kadınlarda görülmektedir. PFAS’ın güncel tedavisinde fizyoterapinin önemli bir rol oynadığı konservatif tedaviye odaklanılmaktadır. Fizyoterapi PFAS’taki disfonksiyonun yönetilmesinde ve hastalar tarafından deneyimlenen ağrının azaltılmasına sıklıkla başvurulan bir tedavi yöntemidir ve ağrıyı azaltmak ve diz fonksiyonunu geliştirmek için egzersiz yaklaşımlarını ön planda tutar. Konservatif tedavinin en büyük amacı patellayı optimal bir biyomekanik dizilime getirmek ve diz çevresi kas yapısının tekrardan güçlenmesini sağlamaktır. Tedavide sıklıkla egzersiz yoluyla PFE mekaniklerini geliştirme, bantlama, tabanlıklar, biyofeedback ve diğer adjuvan tedavilerle desteklenen kombine bir yaklaşım benimsenmektedir. Geleneksel olarak quadriceps femoris kaslarında güç ve koordinasyon üzerinde duran diz odaklı egzersizler kullanılırken kalça odaklı egzersizler de son zamanlarda oldukça ilgi odağı haline gelmiş durumdadır

Anahtar Kelimeler

Patellofemoral Ağrı Sendromu, Egzersiz, Fizyoterapi, Fonksiyon, Ağrı

Kaynakça

• Muscolino JE. The Skeletal System and Muscle Function. Kinezyoloji: İskelet Sistemi ve Kas Fonksiyonu. Sürel YB. Nobel Tıp Kitabevleri, İstanbul; 2017.
• Demirkıran ND., İrey S., Karakaşlı A., Erduran M., Tatari MH. Patellofemoral Ağrı Sendromu. Balikesir Saglik Bil Derg. 2014;3(3):174-78.
• Willy RW., Hoglund LT., Barton CJ., Bolgla LA., Scalzitti DA., Logerstedt DS., Lynch AD., Snyder-Mackler L., McDonough CM. Patellofemoral Pain. J Orthop Sports Phys Ther. 2019;49(9): CPG1-CPG95.
• Gerbino PG., Griffin ED., d’Hemecourt PA., Kim T., Kocher MS., Zurakowski D., Micheli LY. Patellofemoral Pain Syndrome, Evaluation of Location and Intensity of Pain. Clin J Pain 2006;22(2):154-59.
• Hott A., Brox JI., Pripp AH., Juel NG., Liavaag S. Predictors of Pain, Function, and Change in Patellofemoral Pain. Am J Sports Med. 2019;48(2):351-58
• Yosmaoğlu HB., Selfe J., Sonmezer E., Sahin İE., Duygu SÇ., Acar Ozkoslu M., Richards J., Janssen J. 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.
• Moen MH., Weir A., Van de Port IGL., Kooiker L. Effects of Physical Therapist-Guided Quadriceps-Strengthening Exercises fort he Treatment of Patellofemoral Pain Syndrome: A Systematic Review. J Orthop Sports Phys Ther. 2014;44(6):391-402.
• 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.
• Hott A., Liavaag S., Juel NG., Brox JI. Study protocol: a randomised controlled trial comparing the lomg term effects of isolated hip strengthening, quadriceps -based training and free physical activity for patellofemoral pain syndrome (anterior knee pain). BMC Musculoskelet Disord. 2015;16:40
• Van Middelkoop M., Lankhorst NE., BiermaZeinstra SMA. Risk Factors for Patellofemoral Pain Syndrome. A Systematic Review, J Orthop Sports Phys Ther. 2012;42(2):81-94.
• Smith BE., Selfe J., Thacker D., Hendrick P., Bateman M., Moffatt F., Rathleff MS., Smith TO., Logan P. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One 2018;13(1):1-18.
• Nijs J., Van Geel C., Van der Auwera C., Van de Velde B. Diagnostic value of five clinical tests in patellofemoral pain syndrome. Man Ther. 2006;11(1):69-77.
• Hu H., Zheng Y., Lu X., Gong D., Chen C., Wang Y., Peng M., Wu B., Wang J., Song G., Zhang J., Guo J., Dong Y., Wang X. Effects of neuromuscular training on pain intensity and self-reported functionality for patellofemoral pain syndrome in runners: study protocol for a randomized controlled clinical trial. Trials 2019;20(1):409
• Rothermich MA., Glaviano NR., Li J., Hart JM. Patellofemoral Pain. Epidemiology, Pathophysiology, and Treatment Options. Clin Sports Med. 2015;34(2):313-27.
• Hott A., Brox JI., Pripp AH., Juel NG., Liavaag S. Patellofemoral Pain: One year results of a randomized trial comparing hip exercises, knee exercises, or free activity. Scand J Med Sci Sports 2020;30(4):741-53.
• Hott A., Brox JI., Pripp AH., Juel NG., Paulsen Gøran., Liavaag S. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain. Am J Sports Med. 2019;47(6):1312-22
• Dixit S., Difiori JP., Burton M., Mines B. Management of Patellofemoral Pain Syndrome. Am Fam Physician 2007;15;75(2):194-202.
• Motealleh A., Mohamadi M., Moghadam MB., Nejati N., Arjang N., Ebrahimi N. Effects of Core Neuromuscular Training on Pain, Balance, and Functional Perfomance in Women With Patellofemoral Pain Syndrome: A Clinical Trial. J Chiropr Med. 2019;18(1):9-18.
• Pappas E., Wong-Tom WM. Prospective Predictors of Patellofemoral Pain Sydrome: A Systematic Review With Meta-analysis. Sports Health. 2012;4(2):115-20.
• Boling M., Padua D., Marshall S., Guskiewicz K., Payne S., Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports 2010;20(5):725-730.
• Hall R., Barber FK., Hewett TE., Myer., GD. Sport specialization’s association with increased risk of developing anterior knee pain in adolescent female athletes. J Sport Rehabil. 2015;24(1):31-35.
• Giles LS., Webster KE., McClelland JA., Cook J. Does quadriceps atrophy exist in individuals with patellofemoral pain? A systematic literature review with meta-analysis. J Orthop Sports Phys Ther. 2013;43(11):766-776.
• Van Tiggelen D., Witvrouw E., Coorevits P., Croisier JL., Roget P. Analysis of isokinetic parameters in the development of anterior knee pain syndrome: a prospective study in a military setting. Isokinetic Exerc Sci. 2004;12(4):223-228.
• Semciw A., Neate E., Pizzari T. Running related gluteus medius function in health and injury: a systematic review with meta-analysis. J Electromyogr Kinesiol 2016;30:98-110.
• Maclachlan LR., Collins NJ., Matthews MLG., Hodges PW., Vicenzino B. The psychological features of patellofemoral pain:a systematic review. Br J Sports Med. 2017;51(9):732-42.
• Witvrouw E., Werner S., Mikkelsen C., Van Tiggelen D., Vanden Berghe L., Cerulli G. (2005) Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc. 2005;13(2):122-30.
• Hallaçeli H. Ortopedik Fizyoterapi: Diz. Hipokrat Kitabevi; 2019.
• Demirci S., Kinikli Gİ., Callaghan MJ., Bayrakci Tunay V. Comparison of short-term effects of mobilization with movement and Kinesiotaping on pain, function and balance in patellofemoral pain. Acta Orthop Traumatol Turc. 2017;51(6):442-47.
• Akarcalı İ., Tugay N., Kaya D., Atay A., Doral MN. The role of high voltage electrical stimulation in the rehabilitation of patellofemoral pain. Pain Clinic 2002;14(3):207-212.
• Collins, N. J., Barton, C. J., Van Middelkoop, M., Callaghan, M. J., Rathleff, M. S., Vicenzino, B. T.,... & Crossley, K. M. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. British journal of sports medicine 2018;52(18), 1170-1178.
• Espí-López GV, Arnal-Gómez A, BalaschBernat M, Inglés M. Effectiveness of Manual Therapy Combined With Physical Therapy in Treatment of Patellofemoral Pain Syndrome: Systematic Review. J Chiropr Med.2017;16(2):139-146.
• Afridi A., Rathore FA. Is neuromuscular electrical stimulation effective for management of patellofemoral pain syndrome? A Cochrane Review with commentary. Musculoskelet Sci Pract. 2019;44:102059.
• Fulkerson JP., Buuck DA., Dye SF., Farr J., Post WR. Disorders of the Patellofemoral Joint. 4th ed. Lippincott Wiliams & Wilkins; 2004.
• Davis IS., Tenforde AS., Neal BS., Roper JL., Willy RW. Gait Retraining as an Intervention for Patellofemoral Pain. Curr Rev Musculoskelet Med. 2020;13(1):103-114.
• Miller D., Tumia N., Maffulli N. Anterior Knee Pain. Trauma; 2005;7:11-18.
• Kettunen, J. A., Harilainen, A., Sandelin, J., Schlenzka, D., Hietaniemi, K., Seitsalo, S.,... & Kujala, U. M. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomizedcontrolled trial. BMC medicine 2007;5(1), 1-8.
• Tunay VB., Ergun N., Baltaci G. Treatment of patellar tracking and pain in patellofemoral malalignment: conservative versus surgery. The Pain Clinic 2003;15(2):185-192.