Clinical trial NCT03392688: Time Difference Between Onsets of Lateral And Medial Hamstring Muscles During Gait in Patients With Patellofemoral Pain.
Official title: Is There a Time Difference Between Onsets of Lateral and Medial Hamstring Muscles During Gait in Patients With Patellofemoral Pain Comparing to Healthy Subjects?
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Patellofemoral Pain
Keywords: onset , hamstring muscles, patellofemoral pain
Lead sponsor: Bahçeşehir University
Sponsor class: OTHER
First posted: 2018-01-08
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Maximum age (years): 40
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Participants which were included in the study were divided into 2 groups as patient group who included the patients diagnosed with Patellofemoral pain and asymptomatic group which was considered as control group.
Primary purpose: SCREENING

Brief summary: Early activation of lateral hamstrings (LH) in respect of medial hamstrings (MH) may cause abnormal knee abduction and external rotation moments in individuals. This situation may increase the risk of ligament injury and may be the reason for susceptibility of patellofemoral pain (PFP). The aim of this study is to compare the time delays in electromyographic studies between medial and lateral hamstrings in patients with PFP and asymptomatic subjects.

Detailed description: Patellofemoral pain (PFP) is a very common complaint in younger population with still unclear and controversial etiology. It was suggested that a combination of intrinsic and extrinsic factors cause PFP. The strain of the retropatellar subcondral bone caused by excessive lateral patellar tracking is known to be the one among intrinsic factors (Thomee R.1999). Imbalance of the dynamics between knee extensor muscles, Vastus Medialis (VM) and Vastus Lateralis (VL), has also received a great research interest during last 10 years. However, uneven timing between onsets of counterpart knee flexor muscles, Lateral and Medial hamstring, were just considered as a possible etiological factor of the PFP (Patil S.2011), yet this hypothesis remains to be proven. The investigators aimed to investigate whether there is a relative time delays of the LH (biceps femoris, BF) and MH (semitendinosus, ST) during the walking at the self-selected speed in patients with patellofemoral pain. Even though dynamic EMG investigations are challenging because of cross-talks between muscles, hence difficult to determine clearly onset times, the investigators think that any information acquired during walking would be highly important because patellofemoral pain is mainly exaggerated by dynamic activities.

15 patients who were diagnosed with PFP (age 28.73±7.44, height 169.73±7.09, weight 67.47±14.31) and 15 asymptomatic subjects (age 30.47±6.22, height 167.87±7.81, weight 67.87±13.48) were recruited in the study. The inclusion criteria for PFP subjects was presence of the anterior and retropatellar pain for minimum 2 months scaled as 3 in accordance with Numeric Analog Scale during at least two of the following activities: stair descending, ascending, squatting, prolonged sitting, jumping, sitting on the knees. Surface EMG was recorded from Medial Hamstring and Lateral Hamstring muscles at 1000 Hz sampling rate during walking at participants' normal walking speed. EMG data obtained from 5 gait trials were evaluated. The EMG traces were full wave rectified and low pass filtered at 50 Hz. Delay in timing before heel strikes between MH and LH was calculated. Statistical significance between differences in time delays was analysed using "paired sample t-test".

Eligibility criteria: Inclusion Criterias:

* Pain originating specifically from the patellofemoral articulation (vague or localized);
* At least 3/10 pain intensity accordingly to the Numeric Analog Scale (NAS) with at least 2 of the following functional activities commonly associated with PFP stair ascent or descent, squatting, kneeling, or prolonged sitting;
* Reports of pain greater than 2 months in duration.
* Being between 18-40 years of age

Exclusion Criterias:

* Previous history of knee surgery,
* History of patellar instability,
* Neurologic involvement that would influence gait

Primary outcomes:
measure: Time difference between the onsets of the medial and lateral hamstring muscles
timeFrame: Preparing participants that include skin preparation and electrodes placement, and recording EMG data took average one hour for each participant
Secondary outcomes:
measure: kujala patellofemoral pain scale
timeFrame: At the begining of the study each participant was asked to complete the scale. It took average 10 minutes. Performed once.
measure: Numeric Rating Scale (NRS)
timeFrame: Performed 1 day once.
measure: Q angle
timeFrame: Performed 1 day once.
Other outcomes:
Locations:
city: Istanbul
country: Turkey
facility: Istanbul University,Faculty of Medicine, Deparment of Orthopedics and Traumatology, Gait Analysis Laboratory
state: Europe
Study officials:
affiliation: Bahcesehir University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
name: Dilber Karagozoglu Coskunsu, Ass. Prof.
role: PRINCIPAL_INVESTIGATOR
affiliation: Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
name: Filiz Can, Prof.
role: STUDY_DIRECTOR
affiliation: Maltepe University, Faculty of Medicine, Deparment of Biophysics
name: Necla Ozturk, Prof.
role: STUDY_CHAIR
affiliation: Kultur University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
name: N. Ekin Akalın, Prof.
role: STUDY_CHAIR
References:
citation: Patil S, Dixon J, White LC, Jones AP, Hui AC. An electromyographic exploratory study comparing the difference in the onset of hamstring and quadriceps contraction in patients with anterior knee pain. Knee. 2011 Oct;18(5):329-32. doi: 10.1016/j.knee.2010.07.007. Epub 2010 Aug 17.
citation: Cowan S.M , Bennell K.L., Hodges P.W, Mc Connel J (2000). The test-retest reliability of the onset of concentric and eccentric vastus medialis obliquus and vastus lateralis electromyographic activity in a stair stepping task. Physical Therapy in Sport. 1, 129-136.
citation: Ng EC, Chui MP, Siu AY, Yam VW, Ng GY. Ankle positioning and knee perturbation affect temporal recruitment of the vasti muscles in people with patellofemoral pain. Physiotherapy. 2011 Mar;97(1):65-70. doi: 10.1016/j.physio.2010.05.009.
citation: Li G, DeFrate LE, Zayontz S, Park SE, Gill TJ. The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads. J Orthop Res. 2004 Jul;22(4):801-6. doi: 10.1016/j.orthres.2003.11.011.