Core Neuromuscular Training; a Physical Activity Intervention for Individuals with Patellofemoral Pain Syndrome

Abstract

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal disorder affecting a large population of clinical patients, with a higher prevalence among women. Patellar maltracking may lead to inappropriate timing of quadriceps muscle activity. In addition, core neuromuscular control especially hip muscles appears to be impaired in patients with PFPS, which may decreases neuromuscular system efficiency and dynamic stability. PURPOSE: To determine the effects of core neuromuscular training on pain, balance and performance in women with patellofemoral pain syndrome (PFPS). METHOD: This parallel, single-blinded randomized clinical trial (RCT) was designed to compare the effects of different treatment protocols on balance, function and pain in patients with PFPS. A convenience sample consisting 28 women with unilateral PFPS participated in this trial. Pain intensity, functional ability, functional performance and balance were evaluated before and after the intervention with a VAS, Kujala questionnaire, step-down test and Y balance test. All participants were assigned randomly to the intervention and control group. Control group’s intervention was merely focused on lower extremity strengthening exercises, while interventional group received core neuromuscular training in addition to control group exercises. All data were analyzed with SPSS software (version 16), and the alpha level was set as 0.05. Wilcoxon signed rank and Mann-Whitney tests were used respectively for within-group and between-group comparisons. RESULTS: In both groups the pain score decreased significantly after treatment (P=0.001). The slope of this trend was greater in the intervention group. The Kujala and step-down scores improved significantly after treatment in both groups, although the improvements were greater in the intervention group. The Y balance score improved in all three directions after therapy in both groups; improvement was greater in the intervention group only in the posteromedial direction (P<0.05). CONCLUSION: Core neuromuscular training exercises may be beneficial in improving pain, function and balance in women with PFPS. Because of the importance of core muscles in the control of loads imposed on the lower extremities, core training may be essential for rehabilitation in these patients.