Abstract
Patellofemoral pain (PFP) is often associated with impaired muscle strength, flexibility, and stability. It has been suggested that inter-leg asymmetries have an important role in increasing the risk of musculoskeletal injuries, including PFP. Thus, the aim of this study was to identify significant asymmetries and determine the effects of a symmetry targeted exercise program in patients with PFP. Eighteen patients aged 13 to 54 years (24.17 ± 12.52 years) with PFP participated in this study. Strength, flexibility and stability outcomes of the trunk, hip, knee and ankle muscles were assessed. A single-group pretest–posttest design was used to assess changes in inter-leg and agonist–antagonist asymmetries resulting from the 8-week period of the supervised exercise program. Results indicated a significant improvement in inter-leg symmetry regarding bilateral stance in a semi-squat position (p = 0.020, d = 0.61, df = 17) and ankle plantarflexion (p = 0.003, d = 0.32, df = 17) and ankle dorsiflexion strength (p < 0.001, d = 0.46, df = 17). In addition, the ratio of ankle dorsiflexion/plantarflexion (p = 0.036, d = 1.14, df = 17) and hip extension/flexion (p = 0.031, d = 0.94, df = 16) changed significantly during the intervention period. To our knowledge, this was the first study to evaluate inter-leg asymmetries resulting from a period of a supervised exercise program. The results indicate that an exercise program focusing on individual asymmetries may influence specific deficits and contribute to better rehabilitation outcomes.
Highlights
All stability measures showed a positive change during the intervention period in weight distribution symmetry, the change reached statistical significance only in the semi-squat position (p = 0.020, d = 0.61, df = 17)
The results indicate a significant improvement during the intervention period in inter-leg symmetry, both in terms of ankle plantarflexion (p = 0.003, d = 0.32, df = 17) and dorsiflexion strength (p < 0.001, d = 0.46, df = 17)
There were no significant asymmetries in knee flexion or extension strength, the Nordic hamstrings showed an overall improvement in muscle strength during the intervention period, as well as an increase in inter-leg symmetry (p = 0.010, d = 0.28, df = 16)
Summary
Patellofemoral pain (PFP) is a wide spread, non-traumatic knee condition, described as pain around or behind the patella, aggravated by activities excessively loading the patellofemoral joint (PFJ) [1]. Along with pain during jogging, squatting, stair climbing/descending or prolonged sitting with the knees flexed more than 90◦ , patients with. PFP often experience crepitus [2], decreased coordination [3] and strength impairments [4]. Biomechanical asymmetries have been associated with unilateral pain in knee osteoarthritis [5] and may contribute to an increased risk of injury [6]. The extent of muscle strength, flexibility, and knee loading asymmetries during standing, walking or running in patients with PFP remains to be clearly determined
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