Joint position sense in individuals with anterior knee pain.

BACKGROUND: Anterior knee pain (AKP) commonly affects both physically active and sedentary individuals and the aetiology is unknown. Altered joint position sense (JPS) impacts accurate motor action and knee joint stability. It is unclear whether people with AKP have altered JPS. OBJECTIVE: The aim of our study was to investigate JPS in the knees of individuals with AKP. METHOD: A descriptive cross-sectional study measured JPS in 25 participants with unilateral or bilateral AKP. JPS was measured using active JPS testing during single leg squat (SLS) and active knee extension (AKE) in sitting. Target angles (TA) were self-determined based on each participant's capabilities. The absolute error (AE) was the main outcome measure. Impaired JPS was classified as an AE equal to or greater than five degrees. RESULTS: There were no significant differences in JPS when comparing the affected and unaffected knees in participants with AKP (p > 0.05). However, a subgroup of participants with altered knee JPS was identified. There was a tendency towards greater knee flexion in the TAs of knees without AKP. CONCLUSION: Our results showed that JPS is not significantly more impaired in knees with AKP compared with knees without AKP in a group of individuals with AKP. A subgroup with altered JPS in knees with and without AKP was identified. This finding could be because of compensatory gait patterns and the precision of the Vicon 3D motion analysis system. CLINICAL IMPLICATIONS: Joint position sense should be assessed bilaterally in individuals with AKP.

Current knowledge of idiopathic scoliosis among practising physiotherapists in South Africa.

BACKGROUND: Idiopathic scoliosis (IS) is a common musculoskeletal condition with a multi-factorial aetiology characterised by a three-dimensional torsional deformity of the spine. OBJECTIVES: To ascertain the current level of knowledge on IS among registered practising physiotherapists who expressed an interest in orthopaedic, muscular, manual and manipulative therapy in South Africa (SA). METHOD: An online survey was used to collect the data. The questions were based on an existing questionnaire, validated by a South African panel of experts in the field of musculoskeletal physiotherapy and updated based on the 2016 Society of Scoliosis Orthopaedic Rehabilitation Treatment (SOSORT) guidelines for the assessment and management of IS. RESULTS: Two hundred and twenty-three physiotherapists spread across the nine provinces of SA met the inclusion criteria and were included in our study. Our findings showed that about one-third (33.6%) of the physiotherapists could answer more than 50% of these questions correctly, and 16.5% could answer 70% of the questions correctly in relation to the widely accepted guidelines on IS management. CONCLUSION: The participants had a poor understanding of the diagnosis and treatment involved in managing patients with IS and a lack of knowledge regarding the methods of conservative treatment for scoliosis. Future studies should be aimed at assessing intervention strategies to improve the knowledge of IS in physiotherapists in SA, especially regarding diagnosis and identifying appropriate management strategies. CLINICAL IMPLICATIONS: Physiotherapists are often the first contact practitioners for patients presenting with scoliosis and therefore need to have the necessary clinical knowledge on the assessment and management of IS. Our study can improve the awareness among the South African physiotherapists regarding IS and its complex presentation and management.

Patients' perceptions of recovery following a 6-week exercise intervention for the treatment of patellofemoral pain: A mixed methods study.

BACKGROUND: Patellofemoral pain (PFP) is a common and complex condition. The diagnosis and causal mechanisms are not well understood and therefore the long-term prognosis tends to be poor. Exercise is currently the only evidence-based treatment strategy suggested to improve pain and function in the long term. However, no qualitative studies have been conducted to establish patients' perceptions of recovery in the long term following an exercise intervention. OBJECTIVES: To measure self-reported recovery on a 7-point Likert scale in 31 participants with PFP 6 months after a 6-week physiotherapy intervention. To explore the subjective accounts of patients who received a physiotherapy intervention for PFP, regarding their expectations and perceptions of recovery. METHOD: Semi-structured exit interviews were conducted electronically 6 months after intervention to ascertain the patients' perspectives on whether expectations of treatment were met, and factors that influenced their recovery experience. RESULTS: Quantitative analysis of self-reported recovery on a 7-point Likert scale showed that 48.4% of participants felt that they were 'recovered'. Qualitative analysis showed three main categories: expectations of treatment, perceptions of recovery and changes in functional abilities. CONCLUSION: Clinicians should address patients' expectations of treatment and include the patients in decision-making regarding their treatment. Long-term follow-up is essential to ensure that treatment effects have been maintained, and this should include information about patients' self-reported recovery. CLINICAL IMPLICATIONS: This study suggests that patients' expectations of treatment and perceptions of recovery from PFP may influence prognosis. Clinicians need to collaborate with patients and involve them in decision-making to achieve their goals. An individualised treatment approach is essential to adequately address patients' experiences, priorities and beliefs.

Targeted Functional Movement Retraining to Improve Pain, Function, and Biomechanics in Subjects With Anterior Knee Pain: A Case Series.

CONTEXT: Anterior knee pain (AKP) is a common condition, especially in a young active population. The clinical presentations of this condition vary considerably, and therefore, an individualized approach to treatment is needed. OBJECTIVE: The primary objective of this study was to assess the effect of a novel targeted biomechanical intervention on subjects with AKP. DESIGN: A case series was conducted on 8 participants with AKP. SETTING: The study was conducted at the Tygerberg Motion Analysis Laboratory and Tygerberg Physiotherapy Clinic in Cape Town, South Africa. PARTICIPANTS: Eight subjects (5 females and 3 males) diagnosed with AKP were included in this case series. INTERVENTION: Participants received a 6-week subject-specific functional movement retraining intervention. MAIN OUTCOME MEASURES: Three-dimensional hip, knee, and ankle kinematics were used for analysis for each participant preintervention and postintervention. Pain was measured weekly using the Numeric Pain Rating Scale. Two functional scales (Lower-Extremity Functional Scale and Anterior Knee Pain Scale) were used to assess pain and function the preintervention and postintervention. RESULTS: All 8 subjects demonstrated improved pain levels (Numeric Pain Rating Scale) and functional outcomes (Anterior Knee Pain Scale and Lower-Extremity Functional Scale). Seven of the 8 participants (87.7%) demonstrated improvements in their main biomechanical outcome. CONCLUSION: A subject-specific functional movement retraining intervention may be successful in the treatment of subjects with AKP presenting with biomechanical risk factors. Research on a larger sample is required to further investigate this approach.

The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain.

BACKGROUND: Anterior knee pain (AKP) or patellofemoral pain syndrome is common and may limit an individual's ability to perform common activities of daily living such as stair climbing and prolonged sitting. The diagnosis is difficult as there are multiple definitions for this disorder and there are no accepted criteria for diagnosis. It is therefore most commonly a diagnosis that is made once other pathologies have been excluded. OBJECTIVES: The aim of this study was to create an evidence-based checklist for researchers and clinicians to use for the diagnosis of AKP. METHODS: A systematic review was conducted in July 2016, and an evidence-based checklist was created based on the subjective and objective findings most commonly used to diagnose AKP. For the subjective factors, two or more of the systematic reviews needed to identify the factor as being important in the diagnosis of AKP. RESULTS: Two systematic reviews, consisting of nine different diagnostic studies, were identified by our search methods. Diagnosis of AKP is based on the area of pain, age, duration of symptoms, common aggravating factors, manual palpation and exclusion of other pathologies. Of the functional tests, squatting demonstrated the highest sensitivity. Other useful tests include pain during stair climbing and prolonged sitting. The cluster of two out of three positive tests for squatting, isometric quadriceps contraction and palpation of the patella borders and the patella tilt test were also recommended as useful tests to include in the clinical assessment. CONCLUSION: A diagnostic checklist is useful as it provides a structured method for diagnosing AKP in a clinical setting. Research is needed to establish the causes of AKP as it is difficult to diagnose a condition with unknown aetiology.

The use of McConnell taping to correct abnormal biomechanics and muscle activation patterns in subjects with anterior knee pain: a systematic review.

[Purpose] The aim of this review was to present the available evidence for the effect of McConnell taping on knee biomechanics in individuals with anterior knee pain. [Methods] The PubMed, Medline, Cinahl, SPORTDiscus, PEDro and ScienceDirect electronic databases were searched from inception until September 2014. Experimental research on knee biomechanical or EMG outcomes of McConnell taping compared with no tape or placebo tape were included. Two reviewers completed the searches, selected the full text articles, and assessed the risk of bias of eligible studies. Authors were contacted for missing data. [Results] Eight heterogeneous studies with a total sample of 220 were included in this review. All of the studies had a moderate to low risk of bias. Pooling of data was possible for three outcomes: average knee extensor moment, average VMO/VL ratio and average VMO-VL onset timing. None of these outcomes revealed significant differences. [Conclusion] The evidence is currently insufficient to justify routine use of the McConnell taping technique in the treatment of anterior knee pain. There is a need for more evidence on the aetiological pathways of anterior knee pain, level one evidence, and studies investigating other potential mechanisms of McConnell taping.