Patellofemoral Pain Syndrome, Hallux Valgus
Conditions
Keywords
Patellofemoral pain syndrome, Runner, First ray instability, Lower extremity closed chain exercise
Brief summary
The study purpose is to investigate the effectiveness of a program combining biomechanical taping with lower extremity neuromuscular exercises for runners with patellofemoral pain syndrome (PFPS) and hallux valgus
Detailed description
This will be a single-blind, experimental study with two treatment groups. A total of 30 college athletes with PFPS and hallux valgus and majoring in long distance running or soccer, or recreational runners in Taipei metropolitan area will be recruited. A set of clinical examination will be conducted to rule out abnormal knee structures, pathologies, or injuries apart from PFPS. The lower extremity alignment as well as hip and knee kinematics during a step down test will be tracked using Noraxon's myoMOTION system. Muscle activation of the muscles controlling the hip and knee movements during the step down test will be recorded using TELEmyo DTS of Noraxon. Hallux valgus angle will be measured with surface markers on photographs. Knee pain level will be rated in a visual analog scale. The investigators will analyze the data with Statistical Product and Service Solutions (SPSS) for Windows. Repeated-measure ANOVAs will be used to examine group-by-time interaction on all the outcome variables. All significance level will be set at 0.05.
Interventions
OTHERcombined training
The whole intervention period will last for 6 weeks, 2 visits per week, 1 hour per visit in the Research Building Room 630 of National Yang Ming University. All programs will be under the supervision of a physiotherapist with 2-year experience individually. 1. Hallux valgus correction: 1.1 Joint alignment correction (Grade II joint mobilization, 10 times/set, 3 sets/visit) - 1st MTP joint distraction - Proximal talofibular joint anteroposterior glide - (Grade III joint mobilization if any restriction being found) 1.2 Biomechanical taping (using Dynamic taping, 1 time/ visit, keep the taping for 2 days minimum) 1.3 Foot intrinsic muscle strengthening (10 times/set for each exercise, 3 sets/visit): - Short foot exercise - Toespread out exercise - Heel-rise exercises 2. Lower extremity neuromuscular exercises: (10-15 times/set, 3 sets/visit) 2.1 Single lunge 2.2 Stepping down 2.3 Vertical squat 2.4 Vertical jumping
OTHERProximal training
1\. Lower extremity neuromuscular exercises: (10-15 times/set, 3 sets/visit) 1.1 Single lunge 1.2 Stepping down 1.3 Vertical squat 1.4 Vertical jumping All exercises will first start on firm surface without additional resistance/weight. Later, settings will be gradually shifted into on firm surface with resisted band from random direction, on a cushion with/ without resisted band, on a BOSU balance trainer. Progression are made every 2 weeks ideally, while adjustments may be taken into concern due to individual differences.
Sponsors
National Yang Ming Chiao Tung University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* High physical activity level (running at least 5 times/week and at least 2 hours/time) * Presenting anterior/retropatellar knee pain in the past 6 months * At least two of the following activities provocated symptom: Prolonged sitting, ascending and/or descending stairs, squatting, kneeling, running, limping * Not having any pathologies of knee joint (ligament tear, menisci injury, patellofemoral joint dislocation, tendinitis, bursitis…etc.) * With hallux valgus angle\>15° * With 1st metatarsophalangeal joint instability * 20\ 40 y/o
Exclusion criteria
* Lower extremities osteoarthritis * Systematic diseases such as rheumatoid arthritis, systemic lupus erythematosus, DM…etc. * Lower extremities fracture history * Surgical history of lower extremities * Neurological pathology that would interfere with gait * Hallux could not be corrected to neutral through passive correction * Low back pain and/or sacroiliac joint dysfunction in the past six months * Excessive femoral anteversion
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| changes of the muscle activation time between vastus medialis oblique and vastus lateralis | changes from baseline and after 6 weeks of intervention | changes of the muscle activation time recorded in second |
| Displacement of tibia in step-down test | changes from baseline and after 6 weeks of intervention | displacement recorded in cm/BMI |
| Knee pain level | changes from baseline and after 6 weeks of intervention | The level of knee pain during daily activities will be quantified with visual analogue scale. |
| Changes of pain-free running distance | changes from baseline and after 6 weeks of intervention | The changes of pain-free running distance will be recorded in kilometers. |
| EMG amplitude of knee extensor | changes from baseline and after 6 weeks of intervention | amplitude recorded in %MVC |
| EMG amplitude of knee flexor | changes from baseline and after 6 weeks of intervention | amplitude recorded in %MVC |
| EMG amplitude of hip external rotator | changes from baseline and after 6 weeks of intervention | amplitude recorded in %MVC |
| Displacement of femur in step-down test | changes from baseline and after 6 weeks of intervention | displacement recorded in cm/BMI |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hallux valgus angle in relaxed standing | changes from baseline and after 6 weeks of intervention | recorded in degree |
| Navicular drop | changes from baseline and after 6 weeks of intervention | navicular position changes between sitting and relaxed standing, recording in cm |
| Arch height index | changes from baseline and after 6 weeks of intervention | arch height in one leg standing, recording in the ratio of arch height and truncated foot length |
| Hip rotation angle in relaxed standing | changes from baseline and after 6 weeks of intervention | recorded in degree |
| Knee rotation angle in relaxed standing | changes from baseline and after 6 weeks of intervention | recorded in degree |
| Tibiofemoral angle in relaxed standing | changes from baseline and after 6 weeks of intervention | recorded in degree |
Countries
Taiwan
Outcome results
None listed