Abstract
Patellofemoral pain (PFP) is a common atraumatic knee pathology in runners, with a complex multifactorial aetiology influenced by sex differences. This retrospective case–control study therefore aimed to evaluate lower limb kinetics and kinematics in symptomatic and control male and female runners using musculoskeletal simulation. Lower extremity biomechanics were assessed in 40 runners with PFP (15 females and 25 males) and 40 controls (15 females and 25 males), whilst running at a self-selected velocity. Lower extremity biomechanics were explored using a musculoskeletal simulation approach. Four intergroup comparisons—(1) overall PFP vs. control; (2) male PFP vs. male control; (3) female PFP vs. female control; and (4) male PFP vs. female PFP—were undertaken using linear mixed models. The overall (stress per mile: PFP = 1047.49 and control = 812.93) and female (peak stress: PFP = 13.07 KPa/BW and control = 10.82 KPa/BW) comparisons showed increased patellofemoral joint stress indices in PFP runners. A significantly lower strike index was also shown in PFP runners in the overall (PFP = 17.75% and control = 33.57%) and female analyses (PFP = 15.49% and control = 40.20%), revealing a midfoot strike in control, and a rearfoot pattern in PFP runners. Peak rearfoot eversion and contralateral pelvic drop range of motion (ROM) were shown to be greater in PFP runners in the overall (eversion: PFP = −8.15° and control = −15.09°/pelvic drop ROM: PFP = 3.64° and control = 1.88°), male (eversion: PFP = −8.05° and control = −14.69°/pelvic drop ROM: PFP = 3.16° and control = 1.77°) and female (eversion: PFP = 8.28° and control = −15.75°/pelvic drop ROM: PFP = 3.64° and control = 1.88°) PFP runners, whilst female PFP runners (11.30°) exhibited a significantly larger peak hip adduction compared to PFP males (7.62°). The findings from this investigation highlight biomechanical differences between control and PFP runners, as well as demonstrating distinctions in PFP presentation for many parameters between sexes, highlighting potential risk factors for PFP that may be addressed through focused intervention modalities, and also the need, where appropriate, for sex-specific targeted treatment approaches.
Highlights
This article is an open access articleBoth recreational and competitive distance running are associated with a plethora of physiological benefits [1]
Step length was shown to be significantly greater in the control group compared to overall Patellofemoral pain (PFP) (b = 0.27, t = 4.023, p < 0.001) and in male controls compared to male PFP runners (b = 0.15, t = 4.067, p < 0.001) (Table 1)
Ankle dorsiflexion at footstrike, ankle eversion at footstrike, ankle external rotation at footstrike, peak ankle dorsiflexion, peak ankle eversion, and pelvic range of motion (ROM) were significantly greater in the PFP group (Table 7)
Summary
This article is an open access article. Both recreational and competitive distance running are associated with a plethora of physiological benefits [1]. Despite the physical improvements caused by running, it is linked with a very high rate of overuse injuries [2,3]. Patellofemoral pain (PFP) is a common atraumatic knee pathology that typically manifests as retropatellar or peripatellar pain and inflammation, aggravated by activities that frequently load the joint [4]. PFP has distributed under the terms and conditions of the Creative Commons. PFP symptoms may later present with radiographic evidence of osteoarthritis at this joint [8], and pain symptoms force many to reduce or even end their running training [9], causing many to develop associated psychological disorders [10]
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