Changes in Quadriceps Function Following Local or Distant Interventions in Individuals With Patellofemoral Pain
Condition: Patellofemoral Pain Syndrome; Chondromalacia Patellae; Anterior Knee Pain Syndrome
MeSH terms: Patellofemoral Pain Syndrome; Cartilage Diseases; Chondromalacia Patellae; Syndrome; Somatoform Disorders
Study type: Interventional

Summary: 
      The purpose of this study is to determine if interventions applied at a distant site,
      lumbopelvic region (manipulation and TENS), have a similar effect as interventions applied
      locally at the knee (TENS) on quadriceps force output and activation as well as reports of
      pain during common exercises in individuals with PFPS.
    

Detailed description: 
      Interventions for PFPS usually focus on strengthening the quadriceps muscle and hip
      musculature. It is suggest that intervention programs specifically address muscle inhibition
      beyond typical strengthening exercises. To specifically address decreased muscle activation
      transcutaneous electrical neuromuscular stimulation (TENS), applied to the knee, has been
      shown to reduce pain and increase muscle activation in individuals with knee osteoarthritis.
      Interventions including joint manipulation applied at distant sites, such as the lumbopelvic
      region have also been shown to increase muscle activation following intervention in
      individuals with PFPS, but the duration of effect is unknown. It is hypothesized that
      interventions which alter spinal afferent signals may have an effect on efferent motor
      output. Since the lumbopelvic region and the knee joint share common nerve root levels it is
      possible that interventions applied to either site may influence efferent motor output to the
      quadriceps muscle. The magnitude and duration of this effect is unknown.

      Both TENS and lumbopelvic manipulation have also been shown to reduce pain during exercise in
      individuals with knee joint pathology. This study would better determine the magnitude of
      effective pain reduction between interventions applied at the knee joint and at a distant
      site, the lumbopelvic region.
    

Intervention name(s): Lumbopelvic Manipulation; TENS- Spine; TENS- Knee
Intervention type(s): Other; Other; Other
Intervention description(s): The lumbopelvic joint manipulation (Grade V mobilization) will be performed on the ipsilateral side of the test limb. The participant will be passively side-bent towards and rotated away from the selected lumbopelvic region which is followed by the delivery of a posterior/inferior force through the opposite anterior superior iliac spine. If a cavitation is not heard or felt by the patient or clinician, the technique will be repeated. If the second attempt does not produce cavitation the procedure will be repeated on the contralateral side using similar methods. If cavitation is not heard or felt by the participant or clinician following the second attempt on the contralateral side, the participant will proceed with the assessment of quadriceps strength and activation as usual.; The TENS electrodes will be applied lateral to L1 and L2 and lateral to S5 and S1. The TENS unit will be set to deliver a continuous TENS biphasic pulsatile current at 150 Hz, with a phase duration of 150 microseconds. The TENS unit will be worn during all exercise testing and for the first 30 minutes of quadriceps force output and activation testing. After the 30 minute post-intervention measures (Post30) are obtained, the TENS unit will be turned off.; The TENS electrodes will be applied on the medial and lateral superior, as well as the medial and lateral inferior, borders of the patella. Care will be taken not to place TENS electrodes on the quadriceps muscles or muscles of the anterior leg. The TENS unit will be set to deliver a continuous TENS biphasic pulsatile current at 150 Hz, with a phase duration of 150 microseconds. The TENS unit will be worn during all exercise testing and for the first 30 minutes of quadriceps force output and activation testing. After the 30 minute post-intervention measures (Post30) are obtained, the TENS unit will be turned off.
Other intervention name(s): Grade V mobilization; High velocity, low amplitude thrust mobilization; Transcutaneous electrical nerve stimulation (TENS); Electrical stimulation; Transcutaneous electrical nerve stimulation (TENS); Electrical stimulation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lumbopelvic Manipulation; Lumbosacral Manipulation; Sacroiliac Manipulation; TENS Spine; TENS Knee; Knee Pain; Chronic Knee Pain