Treatment Effects on Neuromuscular Properties on Young Women Symptomatic for Patellofemoral Pain Syndrome
Condition: Patellofemoral Pain Syndrome
MeSH terms: Patellofemoral Pain Syndrome; Syndrome; Somatoform Disorders
Study type: Interventional

Summary: 
      Patellofemoral Pain Syndrome (PFPS) is characterized by diffuse pain around the knee joint.
      This presence of pain is the most common manifestation in sports medicine among adults and
      young people. Women are more likely to develop PFPS. Among the young adult population, it is
      estimated that 13% of the women are affected by PFPS. There is a consensus among clinicians
      that PFPS etiology is multifactorial, including local factors (structures present or acting
      directly on the patellofemoral joint) and nonlocal factors [extrinsic to the patellofemoral
      joint, including proximal factors (hip, trunk and pelvis), and distal factors (ankle and
      foot)]. PFPS is not a degenerative syndrome, and conservative treatment offers good results.
      However, the most appropriate therapeutic approach is still unclear, and the rate of
      nonresponders to treatment is high. One of the possible explanations for failure of the
      therapeutic intervention is that the triggering mechanisms of PFPS are not the same for all
      subjects, and probably some patients cannot be reached by standard treatment. The traditional
      intervention model focuses on the strengthening of the knee extensor muscles, but recent
      literature has pointed out that multi-articular treatment models (i.e., exercises for the
      proximal or distal factors, in addition to exercises for the quadriceps) have shown better
      results. It is believed that the elaboration of treatment protocols combining local and
      non-local factors, present greater responsiveness and results retention, thus reducing
      treatment failure. Based on this, and due to the lack of experimental studies that aimed to
      compare the effects of a multi-articular intervention protocol combining local and non-local
      factors in women affected by PFPS, this study aims to evaluate the effects of two
      multi-articular intervention protocols based on exercises (1) for the proximal and local
      factors versus (2) for the distal and local factors on the clinical, functional and
      neuromechanical outcomes of young women with PFPS. Participants of the PFPS group will be
      submitted to one of two intervention models for an 12-week rehabilitation program. Model 1
      will be composed of exercises focusing on local and proximal PFPS factors, and Model 2 will
      be composed of exercises focused on the local and distal factors.
    

Detailed description: 
      Healthy females (CG, n=20) were not submited to intervention and PFP participants will be
      divided into 2 intervention groups (PFPS group, n=66). PFPS Participants' inclusion in the
      study will be done based on their anamnesis and clinical tests. Participants will be
      recruited primarily at the School of Physical Education, Physical Therapy and Dance of the
      Federal University of Rio Grande do Sul (UFRGS). The PFPS group will be submitted to one of
      two intervention models based on physical exercises, with an 12-week duration, and 2 sessions
      per week. Model 1 will be composed of exercises focusing on local and proximal factors, and
      Model 2 will be composed of exercises focused on the PFPS local and distal factors. Only the
      PFPS group will receive the intervention program. The allocation of each participant's
      intervention model will be randomized. All participants will be submitted to the following
      evaluations: (1) anthropometric measurements (mass, height and body mass index), (2) self
      reported functionality (Kujala Questionnaire), (3) single leg squat and drop landing tests
      (kinematic analysis), (4) muscle strength (evaluated with a hand held dynamometer), (5) pain
      (evaluated by numeric pain rating scale), (6) muscle activation (evaluated by EMG) and (7)
      muscle thickness (evaluated by ultrasonography).
    

Intervention name(s): Model 1; Model 2
Intervention type(s): Other; Other
Intervention description(s): Model 1 will be composed of exercises focusing on local (knee) and proximal (hip) factors.; Model 2 will be composed of exercises focused on the local (knee) and distal (ankle and foot) factors.
Other intervention name(s): Local and proximal factors; Local and distal factors
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Patellofemoral pain; Etiology; Multiarticular rehabilitation; Local factors; Nonlocal factors