Abstract
IntroductionPatellofemoral pain (PFP) is a common and often long-standing musculoskeletal condition. Evidence of the effectiveness of interventions addressing soft tissue flexibility is conflicting and of inconsistent scientific quality. However, reduced soft tissue flexibility can negatively affect patellofemoral joint kinematics. Lower limb range of motion (LLROM) reflects soft tissue flexibility throughout the kinetic chain. The aim was to evaluate the short-term effectiveness of an intervention targeting LLROM on pain and disability in patients with PFP. MethodsA randomized, non-concurrent, multiple-baseline single-case design with a two-week intervention phase and baseline and postintervention phase with varying length was conducted. Eight participants (5 females, 3 males) of age 19(±1.6) years, weekly sports participation 12(±3.1) hours and 17(±14) months symptom duration were included. The Anterior Knee Pain Scale – Dutch Version (AKPS-DV) and the Patient Specific Complaint Scale (PSCS) were administered twice a week. After allocating participants to one of four subgroups of reduced LLROM the intervention was applied. The intervention consisted of soft tissue techniques (mobilization, taping, and stretching). ResultsParticipant 3 and 6 showed a medium and small but statistically significant positive effect on the AKPS-DV. Participant 2 showed a large and statistically significant positive effect on the PSCS. ConclusionsThis study provides moderate evidence that an intervention targeting LLROM in patients with PFP reduces pain and disability in the short-term. Further research is needed to evaluate the long-term effectiveness and optimize individual treatment outcomes.
Highlights
Patellofemoral pain (PFP) is a common and often long-standing musculoskeletal condition
Step 1: Lower limb range of motion (LLROM) evaluation Based on the HipExtensionRotationAb/aDduction (HERAD) test (Tak et al, 2016) we developed a modified procedure for evaluating LLROM in patients with PFP
If participants did not meet these cut-off values depending on the localization of tension or pain, they were classified as either “subgroup 1: quadriceps and iliopsoas related PFP”, “subgroup 2: patellofemoral joint related PFP” or “subgroup: 3 iliotibial tract related PFP”
Summary
Continue suffering knee symptoms at a 6-year follow-up (Kastelein et al, 2015; Lack et al, 2018b). Several changes in the medial and lateral retinaculum (e.g. neovascularization, hyperinnervation, and thickening) and bone of the patella (e.g. increased intraosseous pressure and decreased arterial blood flow of the patella) were described previously (Dye, 2005; Lack et al, 2018a; Miltner et al, 2003; Na€slund et al, 2007; Sanchis-Alfonso, 2014; Schoots et al, 2013) Those changes may be mediated by reduced soft tissue flexibility as a result of structural and inflammatory changes in long-standing PFP (Arnoldi, 1991; Zügel et al, 2018). Tak et al (2016) developed a new clinical test measuring lower limb range of motion (LLROM) in patients with groin pain (Tak et al, 2016) They tested flexibility of soft tissue connecting the adjacent body segments in a 3D fashion rather than testing isolated movement directions in single joints.
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