Effects of neuromuscular training and strengthening of trunk and lower limbs muscles in women with Patellofemoral Pain: A protocol of randomized controlled clinical trial, blinded

Abstract

Background: Patellofemoral pain (PFP) often affects young women, and the etiology is multifactorial and poorly understood. Conservative intervention has been focused on risk factors or aggravating factors and is composed of hip- and knee-strengthening exercises, as this population often has muscle weakness and poor motor control during daily and sports activities. The objective of this study was to evaluate the additional effects of neuromuscular training in a conservative treatment of trunk-, hip-, and knee-muscle strengthening on pain, function, and kinematics of the trunk, pelvis, and lower limb in women with PFP.

Methods: This is a randomised clinical trial, controlled, blinded. Ninety women who are active and engage in physical activity up to twice a week will be recruited. All participants will undergo an individual physiotherapy assessment and then will be allocated randomly into two groups. Thereafter, both groups will undergo a 12-week intervention protocol: group 1 will perform strengthening exercises for the trunk, hip, and knee muscles, while group 2 will receive the same treatment, with the inclusion of neuromuscular training exercises on the fourth week. At the end of the intervention, the volunteers will be evaluated. The primary outcomes will be pain intensity (using a Visual Analog Scale: over the last month, squat 90°, and step of 26 cm during 1 min), functional capacity (Anterior Knee Pain Scale and Activities of Daily Living Scale), and 2D kinematics of the trunk, pelvis, and lower limb during the single-leg squat. The secondary outcomes correspond to the isometric muscular strength of the lower limb and the level of satisfaction from the intervention.

Discussion: The present study was initiated on 28 January 2018 and is currently in progress, scheduled for completion in July 2019. The results of this study should contribute to the physiotherapeutic treatment of women with PFP by aggregating information on the benefits of adding neuromuscular training to strengthening of the trunk and lower-limb muscles.

Trial registration: Registro Brasileiro de Ensaios Clínicos, ID: RBR-8c7267 . Registered on 2 August 2017.

Keywords: Hip and knee; Kinematics; Muscle strength; Neuromuscular training; Patellofemoral pain.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Flowchart of the study design. (Figure adapted according to the model used by Dos Anjos Rabelo ND, et al. [37]. Authorization granted by the authorship and original publisher.)

Fig. 2

Ventral Plank on a stable surface (1st–12th week). This exercise will be performed by the Strengthening Group (SG) and Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 3

Wall squat (1st–12th week). This exercise will be performed by the Strengthening Group (SG) and Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 4

Lateral Walk with elastic band (1st–12th week). 1st–2th week: elastic band strong average; 3st–5th week: elastic band strong; 6st–8th week: elastic band super strong; From the 9st week: elastic band extra strong. This exercise will be performed by the Strengthening Group (SG) and Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 5

Hip Extension in prone position (1st–12th week). This exercises will be performed by the Strengthening Group (SG) and Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 6

Leg Press 45° (1st–12th week). This exercise will be performed by the Strengthening Group (SG) and Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 7

Seated Knee Extension (1st–12th week). This exercises will be performed by the Strengthening Group (SG) and Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 8

“Clam” (1st≅6th week). 1st week: elastic band strong average; 2st–3th week: elastic band strong; 4st–5th week: elastic band super strong; From the 6th week: elastic band extra strong. This exercise will be performed by the Strengthening Group (SG) and Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 9

Pelvic Drop in standing (≅6st–12th week). This exercise will be performed by the Strengthening Group (SG) and Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 10.

Ventral plank on an unstable surface (4th–12th week). A) 4st–6th week. B) 7st–9th week. C) 10st–12th week. These exercises will be performed only by the Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 11

Lunge with elastic band (4th–12th week). 4st–6th week: elastic band strong average; 7st–9th week: elastic band strong; 10st–12th week: elastic band super strong. This exercise will be performed only by the Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 12

Single Leg Squat on a stable surface (4th–7th week). A) 4st–5th week: without elastic band; B) 6th week: elastic band medium strong, and 7th week: elastic band strong. This exercise will be performed only by the Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 13

Single Leg Squat on unstable surface (8th–10th week). This exercise will be performed only by the Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 14

Single Leg Squat on an unstable surface with elastic band (11th–12th week). 11th week: elastic band strong; 12th week: elastic band super strong. This exercise will be performed only by the Neuromuscular Training Group (NMTG). (Originals photos and own authorship)

Fig. 15

Schematic diagram wich depict the overall schedule and time commitment for trial participants