A Controlled Trial on Recreational Runners With Patellofemoral Pain
- Conditions
- Patellofemoral Pain (PFPS)
- Interventions
- Other: EducationOther: Exercise programOther: Gait retraining
- Registration Number
- NCT02352909
- Lead Sponsor
- Laval University
- Brief Summary
From a rehabilitation point of view, while several approaches exist to retrain runners with PFPS, it is not clear which one is most effective, or why. The goals of this randomised-controlled trial are: 1) to compare the effectiveness of three rehabilitation programs on pain and functional limitations of runners with PFPS and 2) to explain why the programs are effective or not based on laboratory analyses. After baseline evaluation, runners will be randomly assigned to one of three treatment groups, each with a specific 8-week rehabilitation program aimed at addressing the efficiency of a specific type of retraining. These groups are: 1) Control; 2) muscle recruitment; 3) reducing knee loading during running.
The investigators hypothesis is that the intervention targeting a reduction in knee loading will be significantly more effective in reducing symptoms and improving function of runners with patellofemoral pain syndrome.
- Detailed Description
Hypothesis will be tested using symptoms and functional status questionnaires. In addition, mechanistic analyses will be conducted using a running assessment using an instrumented treadmill and kinematics analyses.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 69
- Running mileage at least 15km
- Symptoms since at least 3 months
- Pain level at least 3/10 during running and 3 activities among: kneeling, squatting, stairs and resisted knee extension
- Score lower than 85/100 on the KOS-ADLS
- History of knee surgery or patellar dislocation
- Pain believed to originate either from meniscus or from patellar tendon
- Pain following an acute trauma
- Concurrent lower limb injuries
- History of neurological, inflammatory, rheumatoid disease
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Muscle recruitment Education Subjects will receive an additional exercise program targeting non task-specific strengthening and motor control exercises of the lower limb. Muscle recruitment Exercise program Subjects will receive an additional exercise program targeting non task-specific strengthening and motor control exercises of the lower limb. Control Education Education will be given on how to modify running training to encourage improvement of symptoms. Reduction of knee loading Education Subjects will receive additional personalized advice on how to modify running gait in order to reduce mechanical loads at the knee (gait retraining). Reduction of knee loading Gait retraining Subjects will receive additional personalized advice on how to modify running gait in order to reduce mechanical loads at the knee (gait retraining).
- Primary Outcome Measures
Name Time Method Changes in symptoms and function using a self-reported questionnaire, the Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) After 4 weeks and 8 weeks of rehabilitation; 3 months after the end of the rehabilitation program A validated self-reported questionnaire (found to have the best psychometric properties in this population by a systematic review; Esculier et al., Disabil Rehabil 2013;35(26):2181-90) will be used to assess the severity of symptoms and functional limitations during the activities of daily living because of knee impairment. Changes in scores to this questionnaire will allow to compare the efficacy of rehabilitation protocols.
- Secondary Outcome Measures
Name Time Method Changes in ankle, knee, hip and pelvis kinematics during the stance phase of running Baseline and after the intervention (8 weeks) Analysis of 3-dimensions motion of the lower limbs during running using VICON cameras. Peak angles and angular excursions will be assessed.
Changes in lower limb muscle strength Baseline and after the intervention (8 weeks) Maximum isometric strength testing of the knee extensors and hip abductors, extensors and external rotators will be assessed using a handheld dynamometer with standard procedures.
Changes in the vertical loading rate of ground reaction forces during treadmill running Baseline and after the intervention (8 weeks) Vertical ground reaction forces and vertical loading rate during running on a Bertec instrumented treadmill. The average and instantaneous rise in vertical ground reaction forces will be considered between initial contact and initial peak in vertical forces. Data will be collected during running between 8-10km/h on a Bertec instrumented treadmill.
Changes in pain scores using Visual analog scales (VAS) After 4 weeks and 8 weeks of rehabilitation; 3 months after the end of the rehabilitation program Visual analog scales will be used to assess levels of usual pain, worst pain and pain during running. Changes in scores to these scales will allow to compare the efficacy of rehabilitation protocols. These pain scales have been validated in this population.
Changes in patellofemoral joint load during the stance phase of running Baseline and after the intervention (8 weeks) Using inverse dynamics, patellofemoral joint load during the stance phase of running will be estimated by combining kinematics data with force plates data.
Global rating of change (GRC) After the intervention (8 weeks) Self-reported outcome used to monitor perception of improvement or worsening of the condition following the intervention.
Trial Locations
- Locations (1)
Centre for Interdisciplinary Research in Rehabilitation and Social Integration
🇨🇦Quebec City, Quebec, Canada