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Acute Responses of Strength and Running Mechanics to Increasing and Decreasing Pain in Patients With Patellofemoral Pain.
J Athl Train. 2017 May; 52(5):411-421.JA

Abstract

CONTEXT

Patellofemoral pain (PFP) is typically exacerbated by repetitive activities that load the patellofemoral joint, such as running. Understanding the mediating effects of changes in pain in individuals with PFP might inform injury progression, rehabilitation, or both.

OBJECTIVE

To investigate the effects of changing pain on muscular strength and running biomechanics in those with PFP.

DESIGN

Crossover study.

SETTING

University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Seventeen participants (10 men, 7 women) with PFP.

INTERVENTION(S)

Each participant completed knee pain-reducing and pain-inducing protocols in random order. The pain-reducing protocol consisted of 15 minutes of transcutaneous electric nerve stimulation (TENS) around the patella. The pain-inducing protocol was sets of 20 repeated single-legged squats (RSLS). Participants completed RSLS sets until either their pain was within at least 1 cm of their pain during an exhaustive run or they reached 10 sets.

MAIN OUTCOME MEASURE(S)

Pain, isometric hip and trunk strength, and running mechanics were assessed before and after the protocols. Dependent variables were pain, normalized strength (abduction, extension, external rotation, lateral trunk flexion), and peak lower extremity kinematics and kinetics in all planes. Pain scores were analyzed using a Friedman test. Strength and mechanical variables were analyzed using repeated-measures analyses of variance. The α level was set at P < .05.

RESULTS

Pain was decreased after the TENS (pretest: 3.10 ± 1.95, posttest: 1.89 ± 2.33) and increased after the RSLS (baseline: 3.10 ± 1.95, posttest: 4.38 ± 2.40) protocols (each P < .05). The RSLS protocol resulted in a decrease in hip-extension strength (baseline: 0.355 ± 0.08 kg/kg, posttest: 0.309 ± 0.09 kg/kg; P < .001). Peak plantar-flexion angle was decreased after RSLS (baseline: -13.97° ± 6.41°, posttest: -12.84° ± 6.45°; P = .003). Peak hip-extension (pretest: -2.31 ± 0.46) and hip-abduction (pretest: -2.02 ± 0.35) moments decreased after both the TENS (extension: -2.15 ± 0.48 Nm/kg, P = .015; abduction: -1.91 ± 0.33 Nm/kg, P = .015) and RSLS (extension: -2.18 ± 0.52 Nm/kg, P = .003; abduction: -1.87 ± 0.36 Nm/kg, P = .039) protocols.

CONCLUSIONS

This study presents a novel and effective method of increasing pain in persons with PFP. Functionally increased pain after RSLS coincides with reduced hip-extensor muscle strength and decreased plantar-flexion angle during running. The TENS treatment decreased pain during running in those with PFP but failed to influence strength. Hip moments were reduced by both protocols, which may demonstrate that acute increases or decreases in pain cause runners to change their mechanics.

Authors+Show Affiliations

Carroll University, Waukesha, WI.University of Wisconsin-Milwaukee.University of Wisconsin-Milwaukee.University of Wisconsin-Milwaukee.University of Wisconsin-Milwaukee.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28388232

Citation

Bazett-Jones, David M., et al. "Acute Responses of Strength and Running Mechanics to Increasing and Decreasing Pain in Patients With Patellofemoral Pain." Journal of Athletic Training, vol. 52, no. 5, 2017, pp. 411-421.
Bazett-Jones DM, Huddleston W, Cobb S, et al. Acute Responses of Strength and Running Mechanics to Increasing and Decreasing Pain in Patients With Patellofemoral Pain. J Athl Train. 2017;52(5):411-421.
Bazett-Jones, D. M., Huddleston, W., Cobb, S., O'Connor, K., & Earl-Boehm, J. E. (2017). Acute Responses of Strength and Running Mechanics to Increasing and Decreasing Pain in Patients With Patellofemoral Pain. Journal of Athletic Training, 52(5), 411-421. https://doi.org/10.4085/1062-6050-53.3.04
Bazett-Jones DM, et al. Acute Responses of Strength and Running Mechanics to Increasing and Decreasing Pain in Patients With Patellofemoral Pain. J Athl Train. 2017;52(5):411-421. PubMed PMID: 28388232.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Responses of Strength and Running Mechanics to Increasing and Decreasing Pain in Patients With Patellofemoral Pain. AU - Bazett-Jones,David M, AU - Huddleston,Wendy, AU - Cobb,Stephen, AU - O'Connor,Kristian, AU - Earl-Boehm,Jennifer E, Y1 - 2017/04/07/ PY - 2017/4/8/pubmed PY - 2018/1/18/medline PY - 2017/4/8/entrez KW - kinematics KW - kinetics KW - knee KW - transcutaneous electric nerve stimulation SP - 411 EP - 421 JF - Journal of athletic training JO - J Athl Train VL - 52 IS - 5 N2 - CONTEXT: Patellofemoral pain (PFP) is typically exacerbated by repetitive activities that load the patellofemoral joint, such as running. Understanding the mediating effects of changes in pain in individuals with PFP might inform injury progression, rehabilitation, or both. OBJECTIVE: To investigate the effects of changing pain on muscular strength and running biomechanics in those with PFP. DESIGN: Crossover study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Seventeen participants (10 men, 7 women) with PFP. INTERVENTION(S): Each participant completed knee pain-reducing and pain-inducing protocols in random order. The pain-reducing protocol consisted of 15 minutes of transcutaneous electric nerve stimulation (TENS) around the patella. The pain-inducing protocol was sets of 20 repeated single-legged squats (RSLS). Participants completed RSLS sets until either their pain was within at least 1 cm of their pain during an exhaustive run or they reached 10 sets. MAIN OUTCOME MEASURE(S): Pain, isometric hip and trunk strength, and running mechanics were assessed before and after the protocols. Dependent variables were pain, normalized strength (abduction, extension, external rotation, lateral trunk flexion), and peak lower extremity kinematics and kinetics in all planes. Pain scores were analyzed using a Friedman test. Strength and mechanical variables were analyzed using repeated-measures analyses of variance. The α level was set at P < .05. RESULTS: Pain was decreased after the TENS (pretest: 3.10 ± 1.95, posttest: 1.89 ± 2.33) and increased after the RSLS (baseline: 3.10 ± 1.95, posttest: 4.38 ± 2.40) protocols (each P < .05). The RSLS protocol resulted in a decrease in hip-extension strength (baseline: 0.355 ± 0.08 kg/kg, posttest: 0.309 ± 0.09 kg/kg; P < .001). Peak plantar-flexion angle was decreased after RSLS (baseline: -13.97° ± 6.41°, posttest: -12.84° ± 6.45°; P = .003). Peak hip-extension (pretest: -2.31 ± 0.46) and hip-abduction (pretest: -2.02 ± 0.35) moments decreased after both the TENS (extension: -2.15 ± 0.48 Nm/kg, P = .015; abduction: -1.91 ± 0.33 Nm/kg, P = .015) and RSLS (extension: -2.18 ± 0.52 Nm/kg, P = .003; abduction: -1.87 ± 0.36 Nm/kg, P = .039) protocols. CONCLUSIONS: This study presents a novel and effective method of increasing pain in persons with PFP. Functionally increased pain after RSLS coincides with reduced hip-extensor muscle strength and decreased plantar-flexion angle during running. The TENS treatment decreased pain during running in those with PFP but failed to influence strength. Hip moments were reduced by both protocols, which may demonstrate that acute increases or decreases in pain cause runners to change their mechanics. SN - 1938-162X UR - https://www.unboundmedicine.com/medline/citation/28388232/Acute_Responses_of_Strength_and_Running_Mechanics_to_Increasing_and_Decreasing_Pain_in_Patients_With_Patellofemoral_Pain_ DB - PRIME DP - Unbound Medicine ER -