Neuromuscular training and muscle strengthening in patients with patellofemoral pain syndrome: a protocol of randomized controlled trial

Abstract

Background: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition, particularly among women. Patients with PFPS usually experience weakness in the gluteal muscles, as well as pain and impaired motor control during activities of daily living. Strengthening the hip muscles is an effective way of treating this disorder. Neuromuscular training has also been identified as a therapeutic tool, although the benefits of this intervention in patients with PFPS patients remain inconclusive.

Design: This is a protocol of randomized controlled trial with a blind assessor. Thirty-four women with a clinical diagnosis of PFPS participated. These participants were allocated into two groups (experimental and control). The experimental group performed twelve sessions to strengthen the knee extensors, hip abductor and lateral rotator muscles in association with neuromuscular training of the trunk and lower extremities. The control group performed the same number of sessions to strengthen the muscles of the hip and knee. The primary outcome was functional capacity (Anterior Knee Pain Scale - AKPS) at 4 weeks. Pain intensity, muscle strength and kinematic changes were also measured during the step down test after four weeks of intervention. Follow up assessments were conducted after three and six months to assess functional capacity and pain. The effects of the treatment (i.e. between-group differences) were calculated using mixed linear models.

Discussion: The present study was initiated on the 1st of April 2013 and is currently in progress. The results of this study may introduce another effective technique of conservative treatment and could guide physical therapists in the clinical decision-making process for women with PFPS.

Trial registration: Current Controlled Trials NCT01804608.

Figures

Figure 1

Fluxogram of the study design.

Figure 2

Strengthening of the hip and knee muscles in the first week of treatment. A) Straight Leg Raise (SLR) with slight hip extension. Physiotherapist stabilizes the pelvis to avoid compensatory movement; B) Abduction and lateral rotation at 30° of the hip flexion (clam) with resistance elastic around the knee. During the execution of the movement the therapist stabilizes the patient’s pelvis; C) Quadriceps strengthening without weight bearing. Initial position 90° and final position 45° of the knee flexion, such as safe angulation for the patellofemoral joint; D) Squat preventing the knee exceeds the midfoot.

Figure 3

Strengthening of the hip and knee muscles added in the second (A) and third week (B and C). A) Lateral walk with elastic resistance around the forefoot, B) Forward lunge C) Strengthening the hip abductors with weight bearing (Trendelenburg).

Figure 4

Double leg neuromuscular training associated with strengthening exercises. A and B) Squat with elastic resistance around the knees stimulating the constant activation of the hip abductors and lateral rotators durinig task execution. Respectively stable and unstable terrain; C and D) Modified forward lunge with elastic around the knee that is ahead for constant muscle activation abductors and lateral rotators of the hip and training of motor control during the execution of the activity. Respectively stable and unstable terrain.

Figure 5

One leg neuromuscular training associated with strengthening exercises. A) One-leg balance with knee extension, on stable terrain; B and C) One-leg balance at 30° of knee flexion, on stable and unstable terrain, respectively; D) Unipodal squat. These activities should keep the pelvis balanced and avoid excessive pronation of the foot.