Changes in Quadriceps Function Following Local or Distant Interventions in Individuals With Patellofemoral Pain
| Status: | Completed |
|---|---|
| Conditions: | Chronic Pain, Psychiatric |
| Therapuetic Areas: | Musculoskeletal, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 15 - 50 |
| Updated: | 4/21/2016 |
| Start Date: | September 2011 |
| End Date: | July 2015 |
The purpose of this study is to determine if interventions applied at a distant site,
lumbopelvic region (manipulation and TENS), have a similar effect as interventions applied
locally at the knee (TENS) on quadriceps force output and activation as well as reports of
pain during common exercises in individuals with PFPS.
lumbopelvic region (manipulation and TENS), have a similar effect as interventions applied
locally at the knee (TENS) on quadriceps force output and activation as well as reports of
pain during common exercises in individuals with PFPS.
Interventions for PFPS usually focus on strengthening the quadriceps muscle and hip
musculature. It is suggest that intervention programs specifically address muscle inhibition
beyond typical strengthening exercises. To specifically address decreased muscle activation
transcutaneous electrical neuromuscular stimulation (TENS), applied to the knee, has been
shown to reduce pain and increase muscle activation in individuals with knee osteoarthritis.
Interventions including joint manipulation applied at distant sites, such as the lumbopelvic
region have also been shown to increase muscle activation following intervention in
individuals with PFPS, but the duration of effect is unknown. It is hypothesized that
interventions which alter spinal afferent signals may have an effect on efferent motor
output. Since the lumbopelvic region and the knee joint share common nerve root levels it is
possible that interventions applied to either site may influence efferent motor output to
the quadriceps muscle. The magnitude and duration of this effect is unknown.
Both TENS and lumbopelvic manipulation have also been shown to reduce pain during exercise
in individuals with knee joint pathology. This study would better determine the magnitude of
effective pain reduction between interventions applied at the knee joint and at a distant
site, the lumbopelvic region.
musculature. It is suggest that intervention programs specifically address muscle inhibition
beyond typical strengthening exercises. To specifically address decreased muscle activation
transcutaneous electrical neuromuscular stimulation (TENS), applied to the knee, has been
shown to reduce pain and increase muscle activation in individuals with knee osteoarthritis.
Interventions including joint manipulation applied at distant sites, such as the lumbopelvic
region have also been shown to increase muscle activation following intervention in
individuals with PFPS, but the duration of effect is unknown. It is hypothesized that
interventions which alter spinal afferent signals may have an effect on efferent motor
output. Since the lumbopelvic region and the knee joint share common nerve root levels it is
possible that interventions applied to either site may influence efferent motor output to
the quadriceps muscle. The magnitude and duration of this effect is unknown.
Both TENS and lumbopelvic manipulation have also been shown to reduce pain during exercise
in individuals with knee joint pathology. This study would better determine the magnitude of
effective pain reduction between interventions applied at the knee joint and at a distant
site, the lumbopelvic region.
Inclusion Criteria:
- Age 15-50 years
- Insidious onset of patellofemoral pain lasting greater than 1 month in duration
- Unilateral or Bilateral knee pain or dysfunction with at least two of the following
symptoms: patella compression, squatting, prolonged sitting, going up or down stairs,
or isometric quadriceps contraction.
Exclusion Criteria:
- Participants who are outside of age range (to ensure bony maturity while reducing the
prevalence of age related degenerative changes and hypomobility.)
- Ligamentous insufficiency, meniscus damage, patellar tendonitis, history of
subluxation/dislocation
- Participants with traumatic spine or lower extremity injury within past 6 months
- Participants who have had previous adverse reactions to electrical stimulation (i.e.
electrode burns.)
- Participants with signs indicating lumbar nerve root compression or upper motor
neuron lesions (contraindication for lumbopelvic joint manipulation)
- Participants with ankylosing spondylitis (contraindication for lumbopelvic
manipulation)
- Participants with spinal cord disease or cauda equina (contraindication for
lumbopelvic manipulation)
- Participants with osteoporosis (contraindication for lumbopelvic joint manipulation)
- Participants with rheumatoid arthritis (contraindication to lumbopelvic joint
manipulation.)
- Participants who may be currently pregnant. (contraindication for electrical
stimulation and lumbopelvic joint manipulation.)
- Participants who have a demand-type cardiac pacemaker (contraindication for
electrical stimulation)
- Participants with diagnosis of cancer (current cancer is a contraindication for
electrical stimulation and relative contraindication for lumbopelvic joint
manipulation)
- Participants who are unable to give consent or are unable to understand procedures of
experiment.
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