Comparative Effects of Motor Control Retraining and Close Kinetic Chain Exercises on Pain, Function and Vastus Medialis Oblique Strength in Patients With Patellofemoral Pain Syndrome
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Pain Intensity
研究概览
简要总结
This study compares two treatments - motor control retraining and close kinetic chain exercises - to improves the pain, VMO strength, knee function. Fifty participants out of which 4 dropped out; will be randomly assigned to receive either motor control retraining or close kinetic chain exercises training for 45 minutes per session, three times per week, for six weeks. Pain intensity will be measured using the visual analogue scale. Knee function will be measured using Kujala anterior knee pain scale. Vastus medialis oblique strength will be measured using digital dynamometer. Dynamic knee valgus will be measured using Kinovea-2D video analysis. Q-angle will be measured using manual goniometer. Patellar maltracking will be measured using combined assessment of dynamic knee valgus and q-angle. This study aims to determine which treatment produces greater improvements, which may help physiotherapists choose more effective treatments for patient with patellofemoral pain syndrome in Pakistan.
详细描述
Background: Patellofemoral pain syndrome, another name for anterior knee discomfort, is brought on by a combination of abnormal patellar tracking, changed biomechanics, and muscle imbalances that put more strain on the patellofemoral joint during activities including jogging, squatting, and stair climbing. In general practice, patellofemoral pain contributes to 11-17% of all knee pain syndromes. Motor control retraining is a rehabilitation treatment that focus on activation and timing of VMO, controlled functional movements, dynamic integration while close kinetic chain exercises is also a rehabilitation treatment that focus on low and moderate load close kinetic chain exercises with advanced functional exercises that focuses on VMO activation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 40 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age between 18 and 40 years old.
- •Both genders male & female.
- •Clinically diagnosed PFPS patients.
- •Anterior knee pain >3 on VAS for > 2 weeks.
- •Retropatellar pain during at least 3 of the following activities, i.e., jumping, kneeling, ascending & descending stairs, squatting, running, prolonged sitting.
- •BMI range from 18.5 - 24.9 kg/m² .
- •Not receiving previously knee physiotherapy.
- •Insidious onset of symptoms unrelated to trauma.
- •Patellar compression test positive.
- •Clarke's test positive.
- •Snapps questionnaire score 6 or greater.
排除标准
- •Age > 40 years old.
- •Knee joint effusion .
- •BMI < 18 & > 29 kg/m².
- •Any other significant injury that affect lower limb .
- •Any history of previous knee surgery.
- •Having referred pain from the lumbar, hip, ankle, feet, and SIJ .
- •Any history of knee pathology, including OA, meniscus injury, ligament injury, tendon injury, cartilage injury, iliotibial band involvement, intra articular pathology, patellar instability, osgood-schlatter syndrome, pes anserine pain, RA of knee .
- •Any history of neurological condition .
- •Pregnant females .
- •Any condition affected muscle strength, i.e., gout, DM, RA .
- •History of head injury, vestibular disorder within 6 months.
- •Any history of patellar dislocation or subluxation .
- •Signs and symptoms < 1 month.
- •Use of corticosteroids, anti-inflammatory & intra-articular injections.
- •Heart condition that precluded performing exercises.
研究组 & 干预措施
Motor control retraining Group
Motor control retraining will receive baseline treatment including static stretching of the hamstrings, iliotibial band, and calf muscle of the affected limb with 2 sets of 5 repetitions with a 5-second hold, followed by a Motor Control Retraining program focused on vastus medialis oblique isometric activation with visual feedback, quadriceps setting with VMO emphasis; seated short arc quads (0-30°) with manual cueing will performed at low intensity by participant for 1st and 2nd week. In phase 2 (controlled functional recruitment), mini-squats with verbal and tactile cueing to optimize VMO activation and lateral step-downs focusing on medial quadriceps control will performed withlow to moderate intensity by participant for 3rd and 4th week. In phase 3 (dynamic integration), single leg squat to 45° with feedback and functional tasks (stair scent/descent drills,controlled landing from 20 cm) will performed with moderate intensity by participant for 5th and 6th week.
干预措施: Motor Control Retraining (Other)
Close kinetic chain exercises Group
Close kinetic chain exercises will receive baseline treatment including static stretching of the hamstrings, iliotibial band, and calf muscle of the affected limb with 2 sets of 5 repetitions with a 5-second hold, followed by a Closed Kinetic Chain Exercise program including wall squats / mini-squats (0-30°) and terminal knee extension in mini-CKC (band resistance) will performed with low intensity by participant for 1st and 2nd week. In phase 2 (moderate load CKC), step-ups / step-downs (20 cm) and forward lunges (partial range) will performed with low to moderate intensity by participant for 3rd and 4th week. In phase 3 (advanced functional), single-leg squat (to 45°) and lateral lunges will performed with moderate intensity by participant for 5th and 6th week. The dosage of these exercises will 3 sets × 10 reps with 5 sec hold for 3 days /week for 6 weeks. The mode of administration was one-on-one.
干预措施: Close Kinetic Chain Exercises (Other)
结局指标
主要结局
Pain Intensity
时间窗: Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)
The visual analogue scale (VAS), a robust and trustworthy self-reported measure of pain, was used to gauge pain severity. The VAS is a 10-cm straight line, with "no pain" at one end and "worst pain" at the other. The participants were asked to mark the location that most accurately reflected the level of pain they were experiencing at the time. Greater pain severity was reflected by higher scores. With reported validity coefficients ranging from r = 0.71 to 0.78 and great reliability (ICC = 0.97), the visual analogue scale is a reliable and valid tool for measuring pain intensity.
Knee Function
时间窗: Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)
The kujala anterior knee pain scale (AKPS), a disease-specific questionnaire intended to assess symptoms and functional limitations associated with patellofemoral diseases, was used to measure knee function. Thirteen elements make up the scale, which evaluates pain, limping, swelling, stair climbing, squatting, jogging, jumping, extended sitting, and other functional tasks. Better knee function and less complaints are indicated by higher scores, which range from 0 to 100. A highly valid and reliable tool for assessing symptoms and functional limitations related to patellofemoral diseases is the Kujala Anterior Knee Pain Scale (AKPS). It exhibits great test-retest reliability, greater internal consistency (Cronbach's α = 0.83-0.91), and strong validity (r = 0.90-0.92).
Vastus Medialis Oblique Strength
时间窗: Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)
A hand-held dynamometer (Lafayette Instrument Model 01160) was used to evaluate the strength of the vastus medialis oblique (VMO) muscle. In standardized testing positions, participants executed maximal voluntary isometric contractions, and the force produced was measured. Stronger quadriceps and VMO muscles were indicated by higher values. A Hand-Held Dynamometer (HHD; Lafayette 01160) was used to measure the strength of the Vastus Medialis Oblique (VMO) muscle at 60° knee flexion. The HHD's application for assessing lower-extremity muscle strength is supported by its moderate to strong validity (r = 0.62-0.91) and acceptable to excellent reliability (ICC ≥ 0.70).
次要结局
- Dynamic Knee Valgus(Baseline (week 0, before first intervention session) and post-intervention (week 6, within 48 hours after the final intervention session))
- Q-Angle(Baseline (week 0, before first intervention session) and post-intervention (week 6, within 48 hours after the final intervention session))
- Patellar Maltracking(Baseline (week 0, before first intervention session) and post-intervention (week 6, within 48 hours after the final intervention session))