Tag: Patellofemoral Pain Syndrome

Effect of foot orthoses on patellofemoral pain syndrome: A systematic review

Marihan Zakaria Aziz, Salwa Fadl Abd Elmajeed, Karima Abdelaty Hassan

Marihan Zakaria Aziz, Salwa Fadl Abd Elmajeed, Karima Abdelaty Hassan – Effect of foot orthoses on patellofemoral pain syndrome: A systematic review. Fizjoterapia Polska 2020; 20(5); 12-23

Abstract

Background. Although foot orthosis may play a role in treatment of patellofemoral pain syndrome, its significance is still conflicting and previous studies show a low level of evidence. Objective. To find the latest evidence regarding the effectiveness of foot orthosis (FO) on adult patients with patellofemoral pain syndrome (PFPS). Methods. A comprehensive electronic database search of PubMed, Cochrane Library Database, the Physiotherapy Evidence Database (Pedro), ProQuest, EBSCo host, and Ovid databases was performed for randomized controlled trials (RCTs) in English language since January 2000 till February 2019 on adults with patellofemoral pain syndrome treated by foot orthosis and physical therapy, with hand searching to reference lists of previous systematic reviews and included papers. At least one primary outcome measure for pain or function must have been reported. Two authors independently reviewed and assessed each citation for inclusion, The Cochrane risk of bias tool was used to rate methodological quality and risk of bias. Data was met analyzed when this was not possible, qualitative data analysis was performed. Results. A total of 9 RCTs with a total number of 415 patients (6 on non-runners and 3 on runners) were included. Findings were summarized in four main comparisons as follows 1)foot orthosis versus flat insoles these results showed the positive efficacy of FO on pain, function and muscular activity, 2) foot orthoses alone versus physiotherapy have a poor indication of PFO alone as an intervention alternative to physiotherapy for PFPS, 3)foot orthoses versus no treatment may provide greater improvements on pain, function and neuromotor changes than natural history concerning foot posture, and 4)foot orthoses combined physiotherapy is better than physiotherapy alone even though the success may relate to clinical foot predictors for foot orthosis. Conclusion. The clinical efficacy of foot orthoses may correlate with targeting specific individuals based on specific foot measures and the comfort perception of the orthosis. On the kinematics, foot orthosis may behave minor neuromotor activity changes at the lower extremity. The effects of combining foot orthoses with physical therapy may be superior to physical therapy alone and result in better outcomes.

Key words:
Patellofemoral pain syndrome, foot orthosis, systematic review
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Mechanical Response of Hip and Knee Muscles Following Randomized Crossover Trials in Patellofemoral Pain Syndrome

Hamada A. Hamada, Hossam E. Fawaz, Ghada Koura, Noran A. Elbehary, Salam M. Elhafez

Hamada A. Hamada, Hossam E. Fawaz, Ghada Koura, Noran A. Elbehary, Salam M. Elhafez – Mechanical Response of Hip and Knee Muscles Following Randomized Crossover Trials in Patellofemoral Pain Syndrome. Fizjoterapia Polska 2020; 20(1); 160-168

Abstract
Background. Faulty hip kinematics during weight bearing activities is proposed to contribute to patellofemoral pain syndrome (PFPS). However, limited information exists to determine the effectiveness of exercises programs that not only act on the knee joint, but also on the hip joint in patients with PFPS. Purpose. The purpose of this study was to compare between the effect of the starting with hip strengthening exercises before knee exercises program and the starting with knee exercises program before hip strengthening exercises on pain intensity, Kujala questionnaire scale, quadriceps angle (Q-angle), anteversion angle, and eccentric peak torques (PT) for hip abductors, external rotators, and knee extensors in patients with PFPS. Materials and Methods. Twenty-four patients suffering from PFPS were randomly assigned into two equal groups of twelve. Group (A): their mean age, weight, height and BMI values were 23.33 ± 5.39 years, 71.16 ± 13.05 kg, 164.75 ± 4.5 cm, and 26.21 ± 4.71 kg/m² respectively. They received hip abductors and external rotators strengthening exercises for three weeks followed by knee extensors strengthening exercises and stretching exercises for hamstring quadriceps, iliotibial band and gastrocnemus for another three weeks. Group (B): their mean age, weight, height and BMI values were 23.16 ± 6.33 years, 69.41 ± 18.14 kg, 164.66 ± 7.27 cm, and 25.2 ± 6.2 kg/m² respectively. They received knee extensors strengthening exercises and stretching exercises for hamstring, quadriceps, iliotibial band and gastrocnemus for three weeks followed by hip abductors and external rotators strengthening exercises for another three weeks. Both groups received three to four sessions per week for six weeks. Pain level, Kujala scale, Q-angle, anteversion angle, and isokinetic eccentric PT for hip abductors, external rotators, and knee extensors were recorded before, after three weeks, and after six weeks of exercises. Results. 2×3 Mixed Design MANOVA revealed that there was a significant reduction in level of perceived pain and improvement of Kujala scale in group (A) compared with group (B) after six weeks of exercise (p < 0.05). However, there was no significant difference in the Q-angle, anteversion angle, and isokinetic eccentric PT for hip abductors, external rotators, and knee extensors between the tested groups after six weeks of exercise (p > 0.05). Conclusion. Starting rehabilitation program with hip strengthening exercises before knee exercises program is more effective than starting with knee exercises program before hip strengthening exercises in reducing pain and improving knee function in patients with PFPS. Consequently, this may help physiotherapists in designing the most effective and efficient prevention and rehabilitation programs for patients suffering from PFPS.

Key words:
Patellofemoral Pain Syndrome, Hip, Knee, Strengthening Exercises, Q -Angle, Anteversion Angle

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