Advanced Biomedical Research

Restorative effects of exercise rehabilitation and bracing on females with lateral displacement of patella

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.  Back to cited text no. 1
    
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.  Back to cited text no. 2
    
3. DeHaven KE, Lintner DM. Athletic injuries: Comparison by age, sport, and gender. Am J Sports Med 1986;14:218-24.  Back to cited text no. 3
    
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.  Back to cited text no. 4
    
5. Grelsamer RP. Patellar Malalignment. J Bone Joint Surg 2000;82:1639-50.  Back to cited text no. 5
    
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.  Back to cited text no. 6
    
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.  Back to cited text no. 7
    
8. White LC, Dolphin P, Dixon J. Hamstring length in patellofemoral pain syndrome. Physiotherapy 2009;95:24-8.  Back to cited text no. 8
    
9. Fredericson M, Yoon K. Physical examination and patellofemoral pain syndrome. Am J Phys Med Rehab 2006;85:234-43.  Back to cited text no. 9
    
10. Juhn MS. Patellofemoral pain syndrome: A review and guidelines for treatment. Am Fam Physician 1999;60:2012-22.  Back to cited text no. 10
    
11. Kannus PA. Long patellar tendon: Radiographic sign of patellofemoral pain syndrome: A prospective study. Radiology 1992;185:859-63.  Back to cited text no. 11
    
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.  Back to cited text no. 12
    
13. Hyde TE, Gengenbach MS. Conservative management of sports injuries. USA: Jones and Bartlett Learning; 2007.  Back to cited text no. 13
    
14. Arendt E. Anatomy and malalignment of the patellofemoral joint: Its relation to patellofemoral arthrosis. Clin Orthop Relat Res 2005;436:71-5.  Back to cited text no. 14
    
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.  Back to cited text no. 15
    
16. Colvin AC, West RV. Patellar instability. J Bone Joint Surg 2008;90:2751-62.  Back to cited text no. 16
    
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.  Back to cited text no. 17
    
18. Martin TJ. Technical report: Knee brace use in the young athlete. Pediatrics 2001;108:503-7.  Back to cited text no. 18
    
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.  Back to cited text no. 19
    
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.  Back to cited text no. 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.  Back to cited text no. 21
    
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.  Back to cited text no. 22
    
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.  Back to cited text no. 23
    
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.  Back to cited text no. 24
    
25. Grygorowicz M, Kubacki J, Pilis W, Gieremek K, Rzepka R. Selected isokinetic tests in knee injury prevetion. Biol Sport 2010;27:47-51.  Back to cited text no. 25
    
26. Bakhtiari RA. Evaluation of static and dynamic balance and knee proprioception in young professional soccer players. Ann Biol Res 2012;3:2867-28.  Back to cited text no. 26
    
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.  Back to cited text no. 27
    
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.  Back to cited text no. 28
    
29. Dewhurst P. Conservative management of patellofemoral pain syndrome: What is the best approach? Clin Chiropr 2009;12:79-82.  Back to cited text no. 29
    
30. Smith AD, Stroud L, McQueen C. Flexibility and anterior knee pain in adolescent elite figure skaters. J Pediatr Orthop 1991;11:77-82.  Back to cited text no. 30
    
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.  Back to cited text no. 31
    
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.  Back to cited text no. 32
    
33. Callaghan MJ, Oldham JA. The role of quadriceps exercise in the treatment of patellofemoral pain syndrome. Sports Med 1996;21:384-91.  Back to cited text no. 33
    
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.  Back to cited text no. 34
    
35. Collado H, Fredericson M. Patellofemoral pain syndrome. Clin Sport Med 2010;29:379-98.  Back to cited text no. 35
    
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.  Back to cited text no. 36
    
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.  Back to cited text no. 37
    
38. Rannou F, Poiraudeau S, Beaudreuil J. Role of bracing in the management of knee osteoarthritis. Curr Opin Rheumatol 2010;22:218-22.  Back to cited text no. 38
    
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.  Back to cited text no. 39
    
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.  Back to cited text no. 40
    
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.  Back to cited text no. 41
    
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.  Back to cited text no. 42
Advanced Biomedical Research
Volume 2014, August
August 2014
Pages 1-7