Comparison of Concentric-eccentric Exercises in Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is due to dysfunctional dynamic knee valgus resulting from decrease in strength of hip abductors or abnormal rear-foot eversion with pes pronatus valgus. It is also associated with vastus medialis/vastus lateralis disbalance, hamstring tightness or iliotibial tract tightness.

Study Overview

• Status: Recruiting
• Conditions: Knee Pain Chronic; Patellofemoral Pain; Patello Femoral Syndrome
• Intervention / Treatment: Other: eccentric exercises; Other: concentric exercises

Detailed Description

Patellofemoral pain syndrome is due to dysfunctional dynamic knee valgus resulting from decrease in strength of hip abductors or abnormal rear-foot eversion with pes pronatus valgus. It is also associated with vastus medialis/vastus lateralis disbalance, hamstring tightness or iliotibial tract tightness. The pain is felt around or behind the patella. The causes are multifactorial. A decline in ability to perform physical activity is seen. The aim of this study will be to compare the effects of concentric and eccentric exercises on pain, strength and ROM in patellofemoral pain syndrome.A randomized clinical trial will be performed at Barki Advance Physiotherapy Center Multan through convenience sampling technique on 24 patients which will be allocated through random sampling through sealed opaque enveloped into group A and group B. Group A will receive eccentric exercises like walking down stairs, lowering a weight during shoulder press, the downward motion of squatting, the downward motion of a push-up, lowering the body during a crunch, lowering the body during a pull-up 3 sets with 10 RM (repetition maximum) for six week training. The group B will receive concentric exercises like walking upstairs, pushing up in a bench press, the beginning portion of a deadlift when you lift the barbell off the ground, sitting up in a sit up, pushing up from a lowered push-up and standing up in a back squat 3 sets with 10 RM. Screening tools include patellar grind test with positive Clark's sign and VAS (visual analogue scale) for pain rating. Outcomes will be measured through knee resisted test and MMT grading for knee extensor/flexor strength and goniometer for ROM. Data will be analyzed using SPSS software version 25. After assessing normality, it will be decided either parametric or non parametric test will be used within a group or between two groups. Effectiveness of concentric and eccentric exercises will be analyzed by comparison in individuals with patellofemoral pain syndrome.

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Amna Shahid, MS-DPT; Phone Number: +92 334 4512823; Email: amna.shahid@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab
    • Multān, Punjab, Pakistan, 60000
      • Recruiting
      • barki advance physiotherapy center Multan
      • Contact: maryam shoaib, DPT; Phone Number: +92076769060; Email: maryamshoaib1@outlook.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Players between the age 18 to 36 years.
• Both male and female gender.
• Patients who have Patellar grind test positive.
• The presence of retropatellar or peripatellar pain.
• Reproduction of retropatellar or peripatellar pain with squatting, stair climbing, prolonged sitting, or other functional activities loading the PFJ in a flexed position.

Exclusion Criteria:

• Individuals with a history of recent trauma or surgery of lower limb (16), administration of steroid injection in the past 6 months.
• Recent administration of platelet-rich plasma containing growth factors, diagnosis of rheumatoid arthritis, myositis ossificans, diagnosis of other muscular disorder.
• Patients who had taken physical therapy of any sort in the past six months will be excluded from the study.
• Furthermore, individuals with any history of occupation-related pain will be ruled out

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: eccentric exercises; Group A: Group A will receive 3 sets of eccentric exercises with 10 RM (repetition maximum) in six sessions.	Other: eccentric exercises; eccentric exercises like walking down stairs, lowering a weight during shoulder press, the downward motion of squatting, the downward motion of a push-up, lowering the body during a crunch, lowering the body during a pull-up 3 sets with 10 RM (repetition maximum) for six week training.
Experimental: concentric exercises; Group B: Group B will receive 3 sets of concentric exercises with 10 RM in six sessions	Other: concentric exercises; concentric exercises like walking upstairs, pushing up in a bench press, the beginning portion of a deadlift when you lift the barbell off the ground, sitting up in a sit up, pushing up from a lowered push-up and standing up in a back squat 3 sets with 10 RM.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
patellofemoral pain	pain is measured by VAS (Visual Analogue Scale)	pre and 6 weeks post interventional
range of motion	ROM is measured by goniometer	pre and 6 weeks post interventional
knee extensor/flexor strength	knee extensor/flexor strength is measured by knee resisted test and MMT grading	pre and 6 weeks post interventional

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: moiz kamal, DPT, Study Principal Investigator

Publications and helpful links

General Publications

• Petersen W, Ellermann A, Gosele-Koppenburg A, Best R, Rembitzki IV, Bruggemann GP, Liebau C. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2264-74. doi: 10.1007/s00167-013-2759-6. Epub 2013 Nov 13.
• Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016 Jul;50(14):839-43. doi: 10.1136/bjsports-2016-096384. Epub 2016 Jun 24. No abstract available.
• Glaviano NR, Kew M, Hart JM, Saliba S. DEMOGRAPHIC AND EPIDEMIOLOGICAL TRENDS IN PATELLOFEMORAL PAIN. Int J Sports Phys Ther. 2015 Jun;10(3):281-90.
• Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, et al. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. Screen HR, editor. PLOS ONE [Internet]. 2018 Jan 11;13(1):e0190892. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190892

Study record dates

Study Major Dates

• Study Start (Actual): October 20, 2023
• Primary Completion (Estimated): February 20, 2024
• Study Completion (Estimated): February 20, 2024

Study Registration Dates

• First Submitted: December 26, 2023
• First Submitted That Met QC Criteria: December 26, 2023
• First Posted (Actual): January 9, 2024

Study Record Updates

• Last Update Posted (Actual): January 9, 2024
• Last Update Submitted That Met QC Criteria: December 26, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: concentric excercise; eccentric excercise; Iliotibial Band
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Joint Diseases; Musculoskeletal Diseases; Syndrome; Patellofemoral Pain Syndrome
• Other Study ID Numbers: REC/RCR&AHS/23/0455

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No