Authors
1 Department of Sports, Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, University of Isfahan, Isfahan, Iran
2 Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: This investigation compared the effects of exercise rehabilitation and bracing on muscle flexibility and strength as well as knee proprioception and pain in female sufferers of lateral displacement of patella (LDP).
Materials and Methods: Twenty-two females with unilateral LDP were randomly divided into two groups to receive exercises (n = 12) or patellar brace (n = 10). Both groups were evaluated before and after 8 weeks with isokinetic dynamometer (Biodex System 3 Pro) for muscle strength and proprioception, with SLR, Active Knee Flexion, and Sit and Reach tests for flexibility assessment and with a visual analog scale for pain.
Results: Muscle flexibility in both exercise and bracing groups improved (F(1,20)≥5.99 and P ≤ 0.024), whereas improvement in bracing group was not significant. Significant interaction was observed in favor of exercise group in 2 strength tests of knee flexion and knee extension (F(1,20)≥6.564 and P ≤ 0.019). For proprioception, a significant interaction was observed in favor of bracing group (F(1,20) =7.944 and P = 0.011). Also the results showed both exercise rehab and brace decreased significantly pain severity during stair ascending and descending.
Conclusion: These results suggest that better flexibility and more strength in exercise group somehow reduced the stress on patellofemoral joint and it, in turn, alleviated the symptoms and pain. It is also likely that relieving effects of brace and improvement of proprioception by it allows patients to be more physically active and it could have, more or less, effects similar to exercise. Therefore both exercise and brace could be prescribed for patients with LDP. It seems application of the patellar brace combined with exercise might be a better treatment for these patients, because they could improve strength, flexibility and proprioception.
Keywords
1. | Shellock FG, Mullin M, Stone KR, Coleman M, Crues JV. Kinematic magnetic resonance imaging of the effect of bracing on patellar position: Qualitative assessment using an extremity magnetic resonance system. J Athl Train 2000;35:44-9. |
2. | Draper CE, Besier TF, Fredericson M, Santos JM, Beaupre GS, Delp SL, et al. Differences in patellofemoral kinematics between weight bearing and non weight bearing conditions in patients with patellofemoral pain. J Orthopaed Res 2011;29:312-7. |
3. | DeHaven KE, Lintner DM. Athletic injuries: Comparison by age, sport, and gender. Am J Sports Med 1986;14:218-24. |
4. | Song CY, Lin JJ, Jan MH, Lin YF. The role of patellar alignment and tracking in vivo: The potential mechanism of patellofemoral pain syndrome. Phys Ther Sport 2011;12:140-7. |
5. | Grelsamer RP. Patellar Malalignment. J Bone Joint Surg 2000;82:1639-50. |
6. | Shellock F. Effect of a patella-stabilizing brace on lateral subluxation of the patella: Assessment using kinematic MRI. Am J Knee Surg 2000;13:137-42. |
7. | Douciette SA, Goble EM. The effect of exercise on patellar tracking in lateral patellar compression syndrome. Am J Sport Med 1992;20:434-40. |
8. | White LC, Dolphin P, Dixon J. Hamstring length in patellofemoral pain syndrome. Physiotherapy 2009;95:24-8. |
9. | Fredericson M, Yoon K. Physical examination and patellofemoral pain syndrome. Am J Phys Med Rehab 2006;85:234-43. |
10. | Juhn MS. Patellofemoral pain syndrome: A review and guidelines for treatment. Am Fam Physician 1999;60:2012-22. |
11. | Kannus PA. Long patellar tendon: Radiographic sign of patellofemoral pain syndrome: A prospective study. Radiology 1992;185:859-63. |
12. | Farahmand F, Sejiavongse W, Amis AA. Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res 2005;16:136-43. |
13. | Hyde TE, Gengenbach MS. Conservative management of sports injuries. USA: Jones and Bartlett Learning; 2007. |
14. | Arendt E. Anatomy and malalignment of the patellofemoral joint: Its relation to patellofemoral arthrosis. Clin Orthop Relat Res 2005;436:71-5. |
15. | Balci P, Tunay VB, Baltaci G, Atay AO. The effects of two different closed kinetic chain exercises on muscle strength and proprioception in patients with patellofemoral pain syndrome. Acta Orthop Traumatol Turc 2004;43:419-25. |
16. | Colvin AC, West RV. Patellar instability. J Bone Joint Surg 2008;90:2751-62. |
17. | Callaghan MJ, Bagley PJ, Selfe J, Oldham JA. The effects of patellar taping on knee joint proprioception. J Athl Train 2002;37:19-24. |
18. | Martin TJ. Technical report: Knee brace use in the young athlete. Pediatrics 2001;108:503-7. |
19. | Larsen B, Andreasen E, Urfer A, Mickelson MR, Newhouse KE. Patellar taping: A radiographic examination of the medial glide technique. Am J Sport Med 1995;23:465-71. |
20. | Worrell T, Ingersoll CD, Bockrath-Pugliese K, Minis P. Effect of patellar taping and bracing on patellar position as determined by MRI in patients with patellofemoral pain. J Athl Train 1998;33:16-20. |
21. | Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: An anatomic radiographic study. Knee Surg Sport Traumatol Arthrosc 1994;2:19-26. |
22. | Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis. Clin Rheumatol 2007;26:520-8. |
23. | Scopaz KA, Piva SR, Gil AB, Woollard JD, Oddis CV, Fitzgerald GK. Effect of baseline quadriceps activation on changes in quadriceps strength after exercise therapy in subjects with knee osteoarthritis. Arthritis Rheum 2009;61:951-7. |
24. | Piva SR, Fitzgerald GK, Wisniewski S, Delitto A. Predictors of pain and function outcome after rehabilitation in patients with patellofemoral pain syndrome. J Rehabil Med 2009;41:604-12. |
25. | Grygorowicz M, Kubacki J, Pilis W, Gieremek K, Rzepka R. Selected isokinetic tests in knee injury prevetion. Biol Sport 2010;27:47-51. |
26. | Bakhtiari RA. Evaluation of static and dynamic balance and knee proprioception in young professional soccer players. Ann Biol Res 2012;3:2867-28. |
27. | Myer GD, Ford KR, Brent JL, Hewett TE. Differential neuromuscular training effects on ACL injury risk factors in. BMC Musculoskelet Disord 2007;8:39. |
28. | Subasi SS, Gelecek N, Kasnakoglu G. Effect of different warm-up periods on knee proprioception and balance in healthy young individuals. J Sport Rehabil 2008;17:186-205. |
29. | Dewhurst P. Conservative management of patellofemoral pain syndrome: What is the best approach? Clin Chiropr 2009;12:79-82. |
30. | Smith AD, Stroud L, McQueen C. Flexibility and anterior knee pain in adolescent elite figure skaters. J Pediatr Orthop 1991;11:77-82. |
31. | Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. J Orthop Sports Phys 2005;35:793-801. |
32. | Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population: A two-year prospective study. Am J Sport Med 2000;28:480-9. |
33. | Callaghan MJ, Oldham JA. The role of quadriceps exercise in the treatment of patellofemoral pain syndrome. Sports Med 1996;21:384-91. |
34. | Choi EH, Kim KK, Jun AY, Choi EH, Choi SW, Shin KY. Effects of the off -loading brace on the activation of femoral muscles-A preliminary study. Ann Rehabil Med 2011;36:887-96. |
35. | Collado H, Fredericson M. Patellofemoral pain syndrome. Clin Sport Med 2010;29:379-98. |
36. | Hazneci B, Yildiz Y, Sekir U, Aydin T, Kalyon TA. Efficacy of isokinetic exercise on joint position sense and muscle strength in patellofemoral pain syndrome. Am J Phys Med Rehab 2005;84:521-7. |
37. | Loudon JK, Gajewski B, Goist-Foley HL, Loudon KL. The effectiveness of exercise in treating patellofemoral-pain syndrome. J Sport Rehabil 2004;13:323-42. |
38. | Rannou F, Poiraudeau S, Beaudreuil J. Role of bracing in the management of knee osteoarthritis. Curr Opin Rheumatol 2010;22:218-22. |
39. | Mohammadi Asl J, Kahrizi S, Ebrahimi E, Faghihzadeh S. The effect of short-term usage of rigid neoprene knee sleeve and soft neoprene knee sleeve on knee joint position sense perception after reconstruction surgery of anterior cruciate ligament. World J Sport Sci 2008;1:42-7. |
40. | Herrington L, Simmonds C, Hatcher J. The effect of a neoprene sleeve on knee joint position sense. Res Sports Med 2005;13:37-46. |
41. | Powers CM, Ward SR, Chan LD, Chen YJ, Terk MR. The effect of bracing on patella alignment and patellofemoral joint contact area. Med Sci Sport Exer 2004;36:1226-32. |
42. | Rahnama N, Lees A, Bambaecichi E. A comparison of muscle strength and flexibility between the preferred and non-preferred leg in English soccer players. Ergonomics 2005;48:1568-75. |