Do Individuals with History of Patellofemoral Pain Walk and Squat Similarly to Healthy Controls? A 3D Kinematic Analysis During Pain Remission Phase

Abstract

Background: Patellofemoral pain (PFP) is typically accompanied by changes in movement pattern. However, it is unclear if these changes persist in the remission phase of symptoms. Investigating movement patterns in individuals in remission phase of PFP may help to further guide the rehabilitation process and to understand whether changes are due to high levels of pain or related to other factors.

Purpose: To compare 3D kinematics during walking and the single leg squat (SLS) between individuals with history of PFP in remission phase and a control group without history of lower limb injuries and PFP.

Study design: Cross-sectional case-control study.

Methods: Individuals with onset of PFP for at least one year and in phase of remission of symptoms (experimental group [EG]; n=13, 30±8 years) were compared to a control group (CG, n=13, 28±7 years). A 10-camera motion analysis system (Vicon-Nexus®) was used to record 3D ankle, knee, hip and trunk angles during walking and SLS.

Results: The EG presented less ankle dorsiflexion, knee and hip flexion during the stance phase of walking compared to the CG (p=0.005, large effect size ηp2 = 0.141). During the SLS, no between-group differences were observed for the ankle, knee and hip angles at the peak of knee flexion (p>0.05). A trend for increased trunk range of movement in the EG compared to the CG was observed (p=0.075, medium effect size ηp2 = 0.127).

Conclusion: The results of this study indicate less movement in the sagittal plane during walking, and a trend towards more movement of the trunk during SLS in the EG compared to the CG. The participants of the EG had minimal symptoms, to the point of not classifying them as pathological. However, the between-group differences suggest that even in the remission phase, kinematic differences persist for some reason and may contribute to the recurring pain in PFP individuals.

Level of evidence: Level 3.

Keywords: biomechanical phenomena; knee; lower extremity; patellofemoral pain syndrome.

Figure 1.. Mean and 95% confidence interval IC95% of the pooled joint angles (ankle, knee and hip) at the Fy1, Fymin and Fy2 in the three planes of movement during gait.

* indicates statistically significant differences between groups (p <0.05).

Figure 2.. Mean and 95% confidence interval of ankle, knee and hip angles at the peak knee flexion (60°) during the single-leg squat. Signs/plans: sagittal: (+) flexion, (-) extension; frontal: (+) adduction, (-) abduction; transverse: (+) internal rotation, (-) external rotation.

Figure 3.. Mean and 95% confidence interval of trunk range of motion during the single-leg squat. Signs/plans: frontal: (+) ipsilateral inclination, (-) contralateral inclination; sagittal: (+) flexion, (-) extension; transverse: (+) contralateral rotation, (-) ipsilateral rotation.