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Proximal mechanics during stair ascent are more discriminate of females with patellofemoral pain than distal mechanics.
Clin Biomech (Bristol, Avon). 2016 06; 35:56-61.CB

Abstract

BACKGROUND

Several hypotheses have been proposed to explain the pathomechanisms underlying patellofemoral pain (PFP). Concurrent evaluation of lower limb mechanics in the same PFP population is needed to determine which may be more important to target during rehabilitation. This study aimed to investigate possible differences in rearfoot eversion, hip adduction, and knee flexion during stair ascent; the relationship between these variables; and the discriminatory capability of each in identifying females with PFP.

METHOD

Thirty-six females with PFP and 31 asymptomatic controls underwent three-dimensional kinematic analyses during stair ascent. Between-group comparisons were made for peak rearfoot eversion, hip adduction, and knee flexion. Pearson's correlation coefficients were calculated to evaluate relationships among these parameters. Receiver operating characteristic curves were applied to identify the discriminatory capability of each.

FINDINGS

Females with PFP ascended stairs with reduced peak knee flexion, greater peak hip adduction and peak rearfoot eversion. Peak hip adduction (>10.6°; sensitivity=67%, specificity=77%) discriminated females with PFP more effectively than rearfoot eversion (>5.0°; sensitivity=58%, specificity=67%). Reduced peak hip adduction was found to be associated with reduced peak knee flexion (r=0.54, p=0.002) in females with PFP.

INTERPRETATION

These findings indicate that proximal, local, and distal kinematics should be considered in PFP management, but proximally targeted interventions may be most important. The relationship of reduced knee flexion with reduced hip adduction also indicates a possible compensatory strategy to reduce patellofemoral joint stress, and this may need to be addressed during rehabilitation.

Authors+Show Affiliations

Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, Brazil.Lower Extremity Gait Studies, La Trobe University, Australia; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, Brazil.Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, Brazil.Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, Brazil. Electronic address: micolis@fct.unesp.br.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27128766

Citation

de Oliveira Silva, Danilo, et al. "Proximal Mechanics During Stair Ascent Are More Discriminate of Females With Patellofemoral Pain Than Distal Mechanics." Clinical Biomechanics (Bristol, Avon), vol. 35, 2016, pp. 56-61.
de Oliveira Silva D, Barton CJ, Pazzinatto MF, et al. Proximal mechanics during stair ascent are more discriminate of females with patellofemoral pain than distal mechanics. Clin Biomech (Bristol, Avon). 2016;35:56-61.
de Oliveira Silva, D., Barton, C. J., Pazzinatto, M. F., Briani, R. V., & de Azevedo, F. M. (2016). Proximal mechanics during stair ascent are more discriminate of females with patellofemoral pain than distal mechanics. Clinical Biomechanics (Bristol, Avon), 35, 56-61. https://doi.org/10.1016/j.clinbiomech.2016.04.009
de Oliveira Silva D, et al. Proximal Mechanics During Stair Ascent Are More Discriminate of Females With Patellofemoral Pain Than Distal Mechanics. Clin Biomech (Bristol, Avon). 2016;35:56-61. PubMed PMID: 27128766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proximal mechanics during stair ascent are more discriminate of females with patellofemoral pain than distal mechanics. AU - de Oliveira Silva,Danilo, AU - Barton,Christian John, AU - Pazzinatto,Marcella Ferraz, AU - Briani,Ronaldo Valdir, AU - de Azevedo,Fábio Mícolis, Y1 - 2016/04/20/ PY - 2016/01/03/received PY - 2016/04/08/revised PY - 2016/04/12/accepted PY - 2016/4/30/entrez PY - 2016/4/30/pubmed PY - 2017/2/23/medline KW - Biomechanics KW - Hip KW - Kinematics KW - Knee KW - Patellofemoral pain KW - Stair ascent SP - 56 EP - 61 JF - Clinical biomechanics (Bristol, Avon) JO - Clin Biomech (Bristol, Avon) VL - 35 N2 - BACKGROUND: Several hypotheses have been proposed to explain the pathomechanisms underlying patellofemoral pain (PFP). Concurrent evaluation of lower limb mechanics in the same PFP population is needed to determine which may be more important to target during rehabilitation. This study aimed to investigate possible differences in rearfoot eversion, hip adduction, and knee flexion during stair ascent; the relationship between these variables; and the discriminatory capability of each in identifying females with PFP. METHOD: Thirty-six females with PFP and 31 asymptomatic controls underwent three-dimensional kinematic analyses during stair ascent. Between-group comparisons were made for peak rearfoot eversion, hip adduction, and knee flexion. Pearson's correlation coefficients were calculated to evaluate relationships among these parameters. Receiver operating characteristic curves were applied to identify the discriminatory capability of each. FINDINGS: Females with PFP ascended stairs with reduced peak knee flexion, greater peak hip adduction and peak rearfoot eversion. Peak hip adduction (>10.6°; sensitivity=67%, specificity=77%) discriminated females with PFP more effectively than rearfoot eversion (>5.0°; sensitivity=58%, specificity=67%). Reduced peak hip adduction was found to be associated with reduced peak knee flexion (r=0.54, p=0.002) in females with PFP. INTERPRETATION: These findings indicate that proximal, local, and distal kinematics should be considered in PFP management, but proximally targeted interventions may be most important. The relationship of reduced knee flexion with reduced hip adduction also indicates a possible compensatory strategy to reduce patellofemoral joint stress, and this may need to be addressed during rehabilitation. SN - 1879-1271 UR - https://www.unboundmedicine.com/medline/citation/27128766/Proximal_mechanics_during_stair_ascent_are_more_discriminate_of_females_with_patellofemoral_pain_than_distal_mechanics_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0268-0033(16)30048-1 DB - PRIME DP - Unbound Medicine ER -