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1.
Rev. ANACEM (Impresa) ; 14(1): 88-92, 2020. graf
Article in Spanish | LILACS | ID: biblio-1123599

ABSTRACT

Introducción: El síndrome de dolor patelofemoral, se define como aquel dolor retro o peripatelar agravado por al menos 1 actividad que cargue la articulación en flexión. Su diagnóstico, se basa en una correcta anamnesis, examen físico y pruebas de evocación de dolor e inestabilidad. El tratamiento puede ser quirúrgico o conservador, este último, tiene como objetivo disminuir el dolor e inflamación. Sin embargo, a pesar de su alta prevalencia, existen escasos protocolos sobre su manejo, por lo que el objetivo de este trabajo es entregar una revisión de la literatura con información reciente, a modo de dar una recomendación actualizada para su tratamiento. Materiales Y Métodos: Se realizó una revisión no sistemática de estudios publicados entre enero del 2005 y agosto del 2020, utilizando los términos MeSH "Anterior knee pain", "Patellofemoral pain syndrome" y "Treatment". Se usaron como motores de búsqueda PubMed, The Cochrane Library y Trip Data base, excluyendo estudios en animales y población pediátrica. Desarrollo: El tratamiento conservador del síndrome de dolor anterior de rodilla, puede dividirse en intervenciones proximales, locales y distales, todas centradas en una correcta pauta de fortalecimientos y estiramientos de los elementos comprometidos. Se recomienda esquemas asociados de fortalecimientos de core, cadera y rodilla, sin embargo, la literatura no es consistente en pautas de tratamiento protocolizados. Conclusión: El tratamiento conservador del síndrome del dolor patelofemoral depende exclusivamente de los resultados de un correcto examen físico y de las pruebas terapéuticas correspondientes.


Introduction: Patellofemoral pain syndrome is defined as that retro or peripatellar pain aggravated by at least one activity that loads the joint in flexion. Its diagnostic is based on the correct anamnesis, physical exam, pain evocation tests and instability. The treatment can be surgical or conservative, and the last one aims to reduce pain and inflammation. However, despite its high prevalence, there are few protocols concerning its handling, so the main objective of this research is to offer a literature review with updated information, in order to give an updated recommendation for its treatment. Materials And Methods: A non-systematic review of studies published between January 2005 and August 2020 were performed, using the MeSH "Anterior knee pain", "Patellofemoral pain syndrome" and "Treatment". PubMed, The Cochrane Library, and Trip Database were used as search engines, excluding studies in animals and the pediatric population. Development: The conservative treatment of anterior knee pain syndrome, can be divided into proximal, local and distal interventions, all of them focused on a correct guide of strengthening and stretching of the elements involved. Associated schemes of core, hip and knee strengthening are recommended, nevertheless, the literature is not consistent in terms of protocolized treatment guidelines. Conclusion: The conservative treatment of patellofemoral pain syndrome depends exclusively on the results of a correct physical examination, and the corresponding therapeutic tests.


Subject(s)
Humans , Patellofemoral Pain Syndrome/therapy , Exercise Therapy/methods , Knee Injuries/therapy , Patellofemoral Pain Syndrome/physiopathology , Conservative Treatment/methods
2.
Motriz (Online) ; 26(1): e10190103, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056775

ABSTRACT

Aims: The purpose of our study was to compare the hip and knee muscle activity before and after a hip abduction exercise program in women with patellofemoral pain (PFP). Methods: Eleven women with PFP were included in our pre/post design study. Participants were assessed before and after 12-week hip abduction exercise program. All participants performed 6 stair climbing repetitions, 3 sets of rope jumps over 30 s and 5 sets of 8 squats to standardize the physical activity level before data collection. We recorded the electromyographic activity from gluteus medius, vastus medialis (VM) and vastus lateralis (VL) for double-legged squat with and without isometric hip abduction. Additionally, participants were asked to perform a step-down test to assess objective function (maximum number of repetitions over 30 s) and completed a clinical evaluation. Results: Longer duration of VM (Mean difference [95% CI]) = -0.97 [-1.48; -0.46], ES [effect size] = 0.66) and VL (-0.81 [-1.35; -0.27], ES = 0.54) were found after the hip abduction exercise program only for free squat. The participants also performed higher number of step-down repetitions (-3.54 [-5.84; -1.25], ES = 1.03) after the hip abduction exercise program and showed improvement in pain reports. Conclusion: A 12-week hip abduction exercise program changed the quadriceps muscle activation pattern and improved pain and objective function of women with PFP. The exercises promoted a longer VM and VL activation duration. Additionally, they promoted a clinical improvement in the patients with PFP.(AU)


Subject(s)
Humans , Female , Exercise , Patellofemoral Pain Syndrome/physiopathology , Exercise Therapy/instrumentation , Biomechanical Phenomena , Electromyography/instrumentation , Hip , Knee
3.
Motriz rev. educ. fís. (Impr.) ; 20(4): 442-447, Oct-Dec/2014. tab, graf
Article in English | LILACS | ID: lil-731161

ABSTRACT

Patellofemoral pain syndrome (PFPS) is a prevalent clinical condition and it affects gait behavior. Braking and propulsive impulses are important biomechanical parameters obtained from ground reaction forces (GRF), which combine the amount of force applied over a period of time. The aim of this study was to evaluate these impulses while walking up and down stairs in healthy controls and PFPS individuals. The results did not reveal significant differences in braking and propulsive impulses between groups during these activities. Thus, the painful condition on a simple functional activity was insufficient to change the motor strategy to walking up or down the stairs...


"Análise dos impulsos de frenagem e de propulsão em indivíduos com síndrome da dor femoropatelar durante subida e descida de degraus." A síndrome da dor femoropatelar (SDFP) é uma condição clínica prevalente e que afeta o comportamento da marcha. Impulsos de frenagem e propulsão são importantes parâmetros biomecânicos obtidos a partir da força de reação do solo que combinam a quantidade de força aplicada sobre um período de tempo. O objetivo deste estudo foi avaliar esses impulsos durante a subida e descida de degraus em indivíduos controle saudáveis e com SDFP. Os resultados não revelaram diferenças significativas nos impulsos de frenagem e propulsão entre os grupos durante essas atividades. Assim, a condição dolorosa em uma atividade funcional simples foi insuficiente para modificar a estratégia motora de descer ou subir degraus...


"Análisis de los impulsos de frenado y propulsión en la personas con síndrome de dolor patelofemoral durante la actividad de subir y bajar un escalón." El Síndrome de dolor patelofemoral (SDPF) es una condición médica prevalente que afecta al comportamiento de la marcha. Impulso de propulsión y de frenado son parámetros biomecánicos importantes obtenidos a partir de la fuerza de reacción del suelo que combinan la cantidad de fuerza aplicada durante un período de tiempo. El objetivo del estudio fue evaluar estos impulsos durante las actividades de subir y bajar un escalón en sujetos sanos y con SDP. Los resultados no mostraron diferencias significativas en los impulsos de frenado y propulsion entre los grupos durante las actividades. Por lo tanto, Por lo tanto, la condición dolorosa en una actividad funcional simple, no fue suficiente para cambiar la estratégia de subir y bajar un escalón...


Subject(s)
Humans , Female , Adult , Patellofemoral Pain Syndrome/physiopathology , Exercise Test/methods
4.
Acta fisiátrica ; 21(1): 11-15, mar. 2014.
Article in English, Portuguese | LILACS | ID: lil-737209

ABSTRACT

Alterações musculares e anatômicas são em sua maioria responsáveis pela síndrome patelofemoral (SDPF). Sabendo que a musculatura do quadríceps é de grande importância na estabilização da patela, questiona-se como o músculo Vasto Medial Oblíquo (VMO) influencia na estabilizaçãopatelar evitando a SDPF. Muitos pesquisadores tem investigado o uso da bandagem funcional como meio de ativação muscular. Objetivo: O presente estudo teve como objetivo analisar o uso da bandagem como meio de ativação do VMO no exercício de agachamento. Método: A atividade dos músculos VMO e Vasto lateral (VL) foi avaliada através de eletromiografia durante o agachamento com adução e o agachamento com o uso de bandagem. A amostra composta por 39 indivíduos foi dividida em quatro grupos: indivíduos do sexo masculino sedentários e atletas, eindivíduos do sexo feminino sedentárias e atletas. Resultados: Embora tenha sido encontrada uma maior ativação do VMO em relação ao VL, com a presente metodologia e variáveis estudadas, não foi possível demonstrar diferença estatística entre os grupos nos agachamentos com e sem o uso da bandagem. No entanto, é importante ressaltar que a ausência de diferença na ativação do VMO durante o agachamento com adução e com bandagem sugerem um efeito positivo e facilitador da bandagem na ativação muscular. Este resultado é muito importante no tratamento de lesões agudas onde o movimento ativo está limitado. Conclusão: Sugere-se a execução de novos estudos aonde outros parâmetros da eletromiografia e estimulação reflexa sejam abordados, a fim de investigar o real papel da bandagem funcional na ativação muscular.


Muscular and anatomical changes are mostly responsible for patella femoral syndrome (PFPS). Knowing that the quadriceps muscles are very important in stabilizing the patella, studies have questioned the influence of the Vastus Medialis Obliquus (VMO) in the patellar stabilization avoiding the PFPS. Many researchers have investigated the use of taping as a means of muscleactivation. Objective: The present study aimed to analyze the use of functional taping to activate the VMO during the squat exercise. Method: The activity of the VMO and Vastus Lateralis (VL) was assessed by electromyography during squats and squats with adduction using functional taping. The sample, composed of 39 individuals, was divided into four groups: males and females, both separated into sedentary and athletic types. Results: Although greater activation of the VMO has been found in comparison with the VL, with the applied methodology and variables, we could not demonstrate a statistical difference between groups in squats with and without the use of functional taping. However, it is important to emphasize that the lack of difference in the activation of VMO during squats with adduction and taping suggests a positive effect of the taping in muscleactivation. This result is very important in the treatment of acute injuries where active movement is limited. Conclusion: Future studies should be done with other electromyography parameters and reflex activation in order to investigate the actual role of functional taping in muscle activation.


Subject(s)
Humans , Patellofemoral Pain Syndrome/physiopathology , Electromyography/instrumentation , Quadriceps Muscle , Sedentary Behavior , Athletes
5.
Artrosc. (B. Aires) ; 20(3): 104-107, sept. 2013. ilus
Article in Spanish | LILACS | ID: lil-743144

ABSTRACT

Los trastornos patelofemorales son una de las causas más frecuentes de consulta en ortopedia, y múltiples son los factores etiológicos descriptos en la fisiopatogenia. Un examen físico completo es imprescindible para detectar él o los factores influyentes en cada paciente para realizar un tratamiento “a la carta”. En la bibliografía se suele considerar a la realineación distal del aparato extensor como sinónimo de transposición de la TAT, sin embargo este concepto no contempla el factor rotacional generador de grandes fuerzas desestabilizantes en esta articulación. En este trabajo se describe un signo semiológico muy útil para decidir la realineación distal del aparato extensor, donde se agrega un vector más al ángulo Q clásico, desde el polo inferior de la rótula y paralelo a la diáfisis tibial y su relación con la posición del pie. Este signo se mide con rodilla en 30° de flexión, rótulas al cenit. Se describen 2 tipos de ángulo Q aumentado, contemplando la posición del pie que es fundamental para detectar trastorno rotacional con intrarotación de rodilla durante la marcha. También se describe y fundamenta la necesidad de diferenciar los 2 tipos de ángulo Q extendido para un tratamiento de realineación distal que respeta la biomecánica patelofemoral.


Patellofemoral problems are one of the most common cause of consult in orthopaedic practice. Multiple etiologic factors have been described in the genesis of the pathology. A complete physical exam is very important for the detection of factors that affect each patient, so that we can make a “a la carte” treatment. In the literature the distal realignement is consider as sinonym of transfer of the tibial tuberosity, but this concept not consider the rotational influence that generate grate forces at the articulation. Here we describe a new sign for the physical exam, useful for deciding distal realignement, where we add and other vector from the distal pole of the patella and paralel to the tibial diafisis and the relantionship with the foot. The sign must be taken in 30° of knee flexion, patellas facing straight to the cenit . We find that there is two types of extended Q angles considering the position of the foot and the presence of a rotational problem wich produce an inward knee. We describe the importance of different type of treatment for each extended Q angles in distal realignement procedures considering more physiological and anatomic treatment for patellofemoral problems.


Subject(s)
Humans , Male , Female , Patellofemoral Joint/physiopathology , Knee Joint/anatomy & histology , Arthrometry, Articular/methods , Joint Instability/diagnosis , Patellofemoral Pain Syndrome/diagnosis , Patellofemoral Pain Syndrome/physiopathology , Physical Examination/methods , Femur/anatomy & histology , Patella/anatomy & histology
7.
Braz. j. phys. ther. (Impr.) ; 15(1): 59-65, Jan.-Feb. 2011. ilus, tab
Article in English | LILACS | ID: lil-582723

ABSTRACT

BACKGROUND: Proximal factors have been proposed to influence the biomechanics of the patellofemoral joint. A delayed or diminished gluteus medius (GM) activation, before the foot contact on the ground during functional activities could lead to excessive femur adduction and internal rotation and be associated with anterior knee pain (AKP). There are few studies on this topic and the results were inconclusive, therefore, it is necessary to investigate the GM preactivation pattern during functional activities. OBJECTIVE: To compare the GM electromyographic (EMG) preactivation pattern during walking, descending stairs and in single leg jump task in women with and without AKP. METHODS: Nine women clinically diagnosed with AKP and ten control subjects with no history of knee injury participated in this study. We evaluated GM EMG linear envelope before the foot contact on the ground during walking and GM onset time and EMG linear envelope during descending stairs as well as in a single leg vertical jump. Mann-Whitney U tests were used to determine the between-group differences in GM EMG preactivation pattern. RESULTS: No between-group differences were observed in GM linear envelope during walking (P=0.41), GM onset time and linear envelope during descending stairs (P=0.17 and P=0.15) and single leg jump (P=0.81 and P=0.33). CONCLUSIONS: Women with AKP did not demonstrated altered GM preactivation pattern during functional weight bearing activities. Our results did not support the hypothesis that poor GM preactivation pattern could be associated with AKP.


CONTEXTUALIZAÇÃO: Tem sido proposto que fatores proximais influenciam a biomecânica da articulação fêmoro-patelar. Um atraso ou diminuição da ativação do glúteo médio (GM) antes do contato do pé no solo, durante atividades funcionais, poderia levar a adução e rotação interna excessiva do fêmur e provocar a dor anterior do joelho (DAJ). Existem poucos estudos sobre o assunto, e os resultados não foram conclusivos; assim, há necessidade de estudar a pré-ativação do GM durante atividades funcionais. OBJETIVO: Comparar o padrão de pré-ativação eletromiográfica (EMG) do GM durante a caminhada, descida de degraus e salto unipodal entre mulheres com e sem DAJ. MÉTODOS: Nove mulheres com diagnóstico clínico de DAJ e dez mulheres sem história de lesão no joelho participaram do estudo. Avaliou-se a envoltória linear do sinal EMG do GM antes do contato do pé no solo, durante caminhada; o tempo de ativação do GM e a envoltória linear do sinal EMG durante descida de degraus e salto unipodal. Utilizou-se o teste Mann-Whitney para determinar a diferença intergrupos no padrão de pré-ativação EMG do GM. RESULTADOS: Não se encontrou nenhuma diferença intergrupos na envoltória linear do GM durante caminhada (P=0.41), no tempo de ativação e na envoltória linear, durante descida de degraus (P=0.17 e P=0.15) e salto unipodal (P=0.81 e P=0.33). CONCLUSÕES: Mulheres com DAJ não apresentaram alterações significativas no padrão de pré-ativação do GM durante atividades funcionais. Os presentes resultados não sustentam a hipótese de que o pobre padrão de pré-ativação do GM esteja envolvido na DAJ.


Subject(s)
Adolescent , Adult , Female , Humans , Young Adult , Muscle, Skeletal/physiopathology , Patellofemoral Pain Syndrome/physiopathology , Weight-Bearing/physiology , Case-Control Studies , Electromyography , Hip
8.
Clinics ; Clinics;66(3): 367-372, 2011. ilus
Article in English | LILACS | ID: lil-585942

ABSTRACT

BACKGROUND: Patellofemoral Pain Syndrome is one of the most common knee disorders among physically active young women. Despite its high incidence, the multifactorial etiology of this disorder is not fully understood. OBJECTIVES: To investigate the influence of Patellofemoral Pain Syndrome on plantar pressure distribution during the foot rollover process (i.e., the initial heel contact, midstance and propulsion phases) of the gait. MATERIALS AND METHODS: Fifty-seven young adults, including 22 subjects with Patellofemoral Pain Syndrome (30 ± 7 years, 165 ± 9 cm, 63 ± 12 kg) and 35 control subjects (29 ± 7 years, 164 ± 8 cm, 60 ± 11 kg), volunteered for the study. The contact area and peak pressure were evaluated using the Pedar-X system (Novel, Germany) synchronized with ankle sagittal kinematics. RESULTS: Subjects with Patellofemoral Pain Syndrome showed a larger contact area over the medial (p = 0.004) and central (p = 0.002) rearfoot at the initial contact phase and a lower peak pressure over the medial forefoot (p = 0.033) during propulsion when compared with control subjects. CONCLUSIONS: Patellofemoral Pain Syndrome is related to a foot rollover pattern that is medially directed at the rearfoot during initial heel contact and laterally directed at the forefoot during propulsion. These detected alterations in the foot rollover process during gait may be used to develop clinical interventions using insoles, taping and therapeutic exercise to rehabilitate this dysfunction.


Subject(s)
Adult , Female , Humans , Male , Young Adult , Foot/physiopathology , Gait/physiology , Pressure , Patellofemoral Pain Syndrome/physiopathology , Biomechanical Phenomena/physiology , Case-Control Studies , Pain Measurement , Sex Factors , Statistics, Nonparametric , Time Factors
9.
Braz. j. phys. ther. (Impr.) ; 14(6): 477-482, nov.-dez. 2010. tab
Article in Portuguese | LILACS | ID: lil-574779

ABSTRACT

CONTEXTUALIZAÇÃO: O uso da eletromiografia de superfície (EMG-S) tem sido considerado como instrumento de avaliação quantitativa na síndrome da dor patelofemoral (SDPF). Tratamentos conservadores objetivam melhorar o alinhamento patelar, e a estimulação elétrica do músculo vasto medial oblíquo (VMO) tem sido considerada por ser seletiva e não causar irritação articular. OBJETIVO: Verificar o efeito de um programa de fortalecimento muscular com estimulação elétrica do VMO na SDPF por meio da capacidade de avaliação da EMG-S. MÉTODOS: Participaram deste estudo 10 mulheres jovens (idade: 23,1±4,9 anos; massa corporal: 66,8±14,0 kg; estatura: 1,63±6,9 cm; IMC: 25,1±5,6 kg/m²) com SDPF unilateral, as quais realizaram o teste funcional de subir degrau para captação da atividade eletromiográfica dos músculos VMO e vasto lateral (VL), antes e após um programa de estimulação elétrica do VMO. A eletroestimulação foi realizada três vezes por semana, durante seis semanas. Foram consideradas, para análise entre VMO e VL, as variáveis razão do tempo do início até o pico de ativação, razão da integral do sinal (teste t para amostras dependentes) e diferença de início de ativação (teste de Wilcoxon), com nível de significância de p<0,05. RESULTADOS: Os resultados mostraram que ocorreu alteração somente no comportamento eletromiográfico relativo à razão da integral do sinal, mostrando que, após o treinamento muscular, ocorreram mudanças na capacidade de geração da força. CONCLUSÃO: O uso da eletroestimulação deve ser considerado no sentido de complementar a abordagem terapêutica conservadora em portadores da SDFP e a análise da razão da integral do sinal de EMG-S, como instrumento de avaliação. Artigo registrado no Australian New Zealand Clinical Trials Registry (ANZCTR) sob o número ACTRN 12609000079246.


BACKGROUND: The use of surface electromyography (SEMG) has been considered a tool for quantitative assessment of patellofemoral pain syndrome (PFPS). Conservative treatments aim to improve patellar alignment, and electrical stimulation of the vastus medialis obliquus (VMO) muscle has been considered effective because it is selective and does not cause joint irritation. OBJECTIVE: This study aims to investigate the efficiency of a muscle strengthening program with electrical stimulation of the VMO muscle in PFPS by SEMG. METHODS: A group of ten young women (age: 23.1±4.9 years; body mass: 66.8±14.0 kg; height: 1.63±6.9 cm; BMI: 25.1±5.6 kg/m²) with unilateral PFPS participated in the study. They performed the functional test of stair stepping to capture the electromyographic (EMG) activity of the VMO and vastus lateralis (VL) muscles, before and after a program of electrical stimulation of the VMO muscle. The electrical stimulation was performed three times per week for six weeks. For analysis between the VMO and VL muscles, we considered the variables: ratio of time of onset to peak of activation, ratio of the integrals of the signals (t-test for dependent samples), and difference between onsets of activation (Wilcoxon test), with significance level of p<0.05. RESULTS: The results only showed change in behavior in the EMG signal for the ratio of the integrals of the signals, indicating that changes occurred in the force-generating capacity of the muscle after the training. CONCLUSION: The use of electrical stimulation should be considered to complement the conservative therapeutic approach in patients with PFPS, and the analysis of the ratio of the integrals of the SEMG signals should be considered as an instrument of evaluation. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under number ACTRN 12609000079246.


Subject(s)
Female , Humans , Young Adult , Patellofemoral Pain Syndrome/therapy , Transcutaneous Electric Nerve Stimulation , Muscle Strength , Muscle, Skeletal , Patellofemoral Pain Syndrome/physiopathology
10.
Acta ortop. bras ; Acta ortop. bras;17(5): 297-299, 2009. ilus, tab
Article in English, Portuguese | LILACS | ID: lil-531721

ABSTRACT

OBJETIVO: Avaliar a porcentagem de disparo inicial (PDI) dos músculos estabilizadores da patela durante exercícios de contração isométrica voluntária máxima (CIVM) em indivíduos com e sem sinais da síndrome da dor patelofemural (SDPF) nos exercícios de cadeia cinética aberta (CCA) e fechada (CCF). MÉTODO: Foram avaliadas 10 mulheres sem queixa de dor anterior no joelho e 12 mulheres com sinais de SDPF durante a CIM em CCA e CCF com o joelho posicionado a 90º de flexão do joelho. O início da atividade eletromiográfica dos músculos vasto medial obliquo (VMO), vasto lateral obliquo (VLO) e vasto lateral longo (VLL) foi identificada por meio de um algoritmo no programa Myosystem Br 1. A análise estatística empregada foi o teste Qui-Quadrado e o teste t de student, ambos os teste com nível de significância de 5 por cento. RESULTADOS: Os músculos VMO e VLO apresentaram uma maior PDI em relação ao músculo VLL durante os exercícios em CCA para ambos os grupo e para o grupo SDPF em CCF. Não foi observado diferença entre os grupos. CONCLUSÃO: Pode-se sugerir que tanto os exercícios em CCA quanto em CCF, parecem beneficiar o sincronismo na musculatura estabilizadora da patela, podendo ser indicado nos programas de tratamento fisioterapêutico.


OBJECTIVE: To asses the onset ( percent) of patella stabilizer muscles during maximal isometric contraction exercises (MIC) in individuals with and without signs of patellofemoral pain syndrome (PFPS) in open (OKC) and closed (CKC) kinetic chain exercises. METHOD: Assessments were carried out on 22 women; ten with no complains of anterior knee pain, and 12 with PFPS signs during MIC in OKC and CKC with the knee flexed at 90º. The onset of the electromyographic activity of the vastus mediallis obliquus (VMO), vastus lateralis obliquus (VLO) and vastus lateralis longus (VLL) was identified by means of an algorithm in the Myosystem Br 1 software. The statistical analysis used was Chi-Square test and student's t test, which are both tests with a level of significance at 5 percent. RESULTS: The VMO and VLO muscles presented a greater onset compared to the VLL during OKC exercises for both groups and for the PFPS group without CCF. No differences were observed between the groups. CONCLUSION: CKC and OKC exercises seem to benefit the synchronism of the musculature that supposedly benefits the patella stabilizer musculature, and can be recommended in physiotherapeutic treatment programs.


Subject(s)
Humans , Female , Adult , Exercise Therapy , Muscles/pathology , Patellofemoral Pain Syndrome , Patellofemoral Pain Syndrome/physiopathology , Exercise , Electromyography/methods
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