Effect and Comparison of Core Stability and Abductor Strengthening Exercises with ‎Mobilization on Pain, Function, and Quality of Life Among Elderly Males with ‎Patellofemoral Pain Syndrome

Document Type : Original Article

Authors

1 Department of Sport Injuries and Corrective Exercises, Faculty of Sport Science, Shahid Bahonar University of Kerman ,Kerman, Iran

2 Department of Sports Science, Faculty of Literature, Zabol University, Zabol, Iran

Abstract

Purpose:
The patellofemoral pain syndrome (PFPS) is one of the most common diseases of the knee joint that causes pain, dysfunction, and reduces the quality of life in the elderly. The aim of the present study was to investigate the effects of core exercise stability and strength training of hip abductors with mobilization exercise on pain, functional disability, and quality of life in elderly patients with PFPS.
Methods:
Twenty elderly male patients with PFPS were purposefully selected and randomly and equally divided into two groups of central stability training group (age 63.7 ± 3.19 years, height 173.1 ± 6.2, weight 76.8 ± 7.92 kg) and mobilization exercise group (age 65.2 ± 3.22 years, height 174.3 ± 7.64, weight 77.5 ± 7.98 kg) were located. The first experimental group performed core stability exercises and strengthening the hip muscles for six weeks (three sessions, 45 minutes each session), and the second group performed mobilization exercises during the same period. Before and after the training protocol, the research variables were measured by using questionnaires for pain intensity (visual analogue scale), functional disability, and quality of life. For data analysis, repeated measures ANOVA with a significance level of p= 0.05 was used.
Results:
The results of this study showed a significant decrease in pain factors, functional disability, and quality of life in the groups of core stability exercises and strengthening the hip flexor muscles (p<0.05) and a significant decrease in pain intensity, performance, and quality in the mobilization training group. The number of variables in the two groups was not significant. But the effect size indicated that the exercises for core stability and strengthening of the hip flexor muscles were better in all variables (p>0.05).
Conclusion:
According to the results obtained from this study, it can be concluded that core stabilization exercises, strengthening hip abductor muscles, and mobilization exercises decrease pain and functional disability and increase quality of life. So, it is possible to use each exercise as a training method in the rehabilitation program of elderly patients with patellofemoral pain.

Keywords


  1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis & Rheumatism 2008; 58(1): 26-35.
  2. Netz Y, Wu M-J, Becker BJ, Tenenbaum G. Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies. Psychology and aging 2005; 20(2): 272.
  3. Ghasemi S, Keshavarz Mohammadi N, Mohammadi Shahboulaghi F, Ramezankhani A, et al. Physical health status and frailty index in community dwelling older adults in Tehran. Iranian Journal of Ageing 2019;13(5): 652-665. [Persian]
  4. Thomas MJ, Wood L, Selfe J, Peat G. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC musculoskeletal disorders 2010; 11(1): 1-8.
  5. Singh S, Thakur K, Shweta S, Ravi S. Concentric hip muscle function and quadriceps-hamstring ratio in athletes with and without patellofemoral pain syndrome. Ibnosina Journal of Medicine and Biomedical Sciences 2012; 4(01): 20-27.
  6. Hinman RS, Lentzos J, Vicenzino B, Crossley KM. Is patellofemoral osteoarthritis common in middle‐aged people with chronic patellofemoral pain?: Wiley Online Library; 2014.
  7. Sheehan FT, Derasari A, Fine KM, Brindle TJ, et al. Q-angle and J-sign: indicative of maltracking subgroups in patellofemoral pain. Clinical Orthopaedics and Related Research® 2010; 468(1): 266-275.
  8. Powers CM, Ward SR, Fredericson M, Guillet M, et al. Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. Journal of Orthopaedic & Sports Physical Therapy 2003; 33(11): 677-685.
  9. Cavazzuti L, Merlo A, Orlandi F, Campanini I. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Gait & posture 2010; 32(3): 290-295.
  10. Bolgla LA, Malone TR, Umberger BR, Uhl TL. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. journal of orthopaedic & sports physical therapy 2008; 38(1): 12-18.
  11. Dutton RA, Khadavi MJ, Fredericson M. Update on rehabilitation of patellofemoral pain. Current sports medicine reports 2014; 13(3): 172-178.
  12. Chevidikunnan MF, Al Saif A, Gaowgzeh RA, Mamdouh KA. Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome. Journal of physical therapy science 2016; 28(5): 1518-1523.
  13. Barati S, Khayambashi K, Rahnama N. Effect of a selected core stabilization training program on pain and function of the females with knee osteoarthritis. J Res Rehabil Sci 2012; 8(1): 1-9. [Persian]
  14. Hortoba´gyi T, Westerkamp L, Beam S. Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis. Clinical Biomechanics 2005; 20: 97-104.
  15. Shakeri A, shojaedin S, sokhangoei Y, Hoseini Y. Comparison between the effect of three methods of massage therapy, stability exercise and combination exercise on pain and disability in patients with nonspecific chronic low back pain. JAP 2014; 5(2): 55-62. [Persian]
  16. Hadadnezhad M, Rajabi R, Alizadeh MH, Letafatkar A. Does core stability predispose female athletes to lower extremity injuries? J Res Rehabil Sci 2010; 6(2): 89-98. [Persian]
  17. Tan SS, Van Linschoten R, Van Middelkoop M, Koes BW, et al. Cost‐utility of exercise therapy in adolescents and young adults suffering from the patellofemoral pain syndrome. Scandinavian journal of medicine & science in sports 2010; 20(4): 568-579.
  18. Thomee R, Renström P, Karlsson J, Grimby G. Patellofemoral pain syndrome in young women: I. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scandinavian journal of medicine & science in sports 1995; 5(4): 237-244.
  19. Jellad A, Kalai A, Guedria M, Jguirim M, et al. Combined hip abductor and external rotator strengthening and hip internal rotator stretching improves pain and function in patients with patellofemoral pain syndrome: a randomized controlled trial with crossover design. Orthopaedic Journal of Sports Medicine 2021; 9(4): 2325967121989729.
  20. Tazesh B, Mansournia MA, Halabchi F. Additional effects of core stability exercises on pain and function of patients with patellofemoral pain: A randomized controlled trial. Journal of Orthopaedics, Trauma and Rehabilitation 2021: 2210491721989075.
  21. da Silva Boitrago MV, de Mello NN, Barin FR, Júnior PL, et al. Effects of proprioceptive exercises and strengthening on pain and functionality for patellofemoral pain syndrome in women: A randomized controlled trial. Journal of clinical orthopaedics and trauma 2021; 18: 94-99.
  22. Raisi A, Shojaedin SS, Habibi R. The Effect and Durability of Hip and Core Exercises on Pain and Performance in Females With Patellofemoral Pain Syndrome. Physical Treatments-Specific Physical Therapy Journal 2020; 10(3): 145-158. [Persian]
  23. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Research in nursing & health 1990; 13(4): 227-236.
  24. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis care & research 2011; 63(S11): S240-S52.
  25. Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. The American journal of sports medicine 2006; 34(4): 630-636.
  26. Cheung RT, Zhang Z, Ngai SP. Different relationships between the level of patellofemoral pain and quality of life in professional and amateur athletes. PM&R 2013; 5(7): 568-572
  27. Montazeri A, Gashtasebi A, Vahedinia M. Translation, determination of reliability and validity of Persian version of SF-36 questionnaire. Journal of Payesh. 2005. [Persian]
  28. Nakagawa TH, Muniz TB, Baldon RdM, Dias Maciel C, et al. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study. Clinical rehabilitation 2008; 22(12): 1051-1060.
  29. Khayambashi K, Fallah A, Movahedi A, Bagwell J, et al. Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial. Archives of physical medicine and rehabilitation 2014; 95(5): 900-907. [Persian]
  30. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports medicine. 2006; 36(3): 189-198.
  31. Golpaigany M, Shavandi N, Mahdavi S, Hessari AF, et al. The effect of core stabilization training program on elderly postural control. Spor Hekimliği Dergisi 2010; 45(2): 037-44. [Persian]
  32. Prieto-García LF, Cortés-Reyes E, Lara-Cotacio G, Rodríguez-Corredor LC. Therapeutic effect of two muscle strengthening programs in patients with patellofemoral pain syndrome. A randomized controlled clinical trial. Revista de la Facultad de Medicina. 2021;69(2): e208.
  33. Pfluegler G, Kasper J, Luedtke K. The immediate effects of passive joint mobilisation on local muscle function. A systematic review of the literature. Musculoskeletal Science and Practice 2020; 45: 102106.
  34. Mousavi SM, Khayambashi K, Nejadian SL, Moradi H. The Effects of Kinesiotape and Strength Training on Knee Pain and Quadriceps Strength in People with Patellofemoral Pain Syndrome (PFPS). Journal of Isfahan Medical School 2011; 29(159): 1416-1427. [Persian]
  35. Naseri N, Fakhari Z, Senobari M, Sadria G. The relationship between core stability and lower extremity function in female athletes. Modern Rehabilitation 2012; 6(2): 42-49. [Persian]
  36. Holsgaard-Larsen A, Clausen B, Søndergaard J, Christensen R, et al. The effect on knee-joint load of instruction in analgesic use compared with neuromuscular exercise in patients with early knee osteoarthritis–A randomized, single-blind, controlled trial. Osteoarthritis and Cartilage 2016; 24: S497-S8.
  37. Earl JE, Hoch AZ. A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome. The American journal of sports medicine 2011; 39(1): 154-163.
  38. Ketabchi J, Rahnama N, Khayambashi K. A comparison of the effects of strength exercises and balance exercises on pain and performance of patients Afflicted with patellofemoralpain syndrome. Journal of Practical Studies of Biosciences in Sport 2018; 5(10): 99-109. [Persian]
  39. Demirci S, Kinikli GI, Callaghan MJ, Tunay VB. Comparison of short-term effects of mobilization with movement and Kinesiotaping on pain, function and balance in patellofemoral pain. Acta orthopaedica et traumatologica turcica 2017; 51(6): 442-447.
  40. McGill S. Low back disorders: evidence-based prevention and rehabilitation: Human Kinetics; 2015 :40-47.
  41. Khayambashi K, Mohammadkhani Z, Ghaznavi K, Lyle MA, et al. The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial. journal of orthopaedic & sports physical therapy. 2012; 42(1): 22-29. [Persian]
  42. Popova-Dobreva D. Assessment of the function of the knee joints and the impact of their state on the physical activity of the students. Bulletin of the Transilvania University of Braşov. Series IX: Sciences of Human Kinetics 2020: 173-178.
  43. Massé-Alarie H, Flamand VH, Moffet H, Schneider C. Corticomotor control of deep abdominal muscles in chronic low back pain and anticipatory postural adjustments. Experimental brain research 2012; 218(1): 99-109.
  44. Arabjafari Z, Fatahi H, Shamsehkohan P. The effect of 8 weeks combined exercises (core stability and theraband) on distance of knee medail condyles, Q angle and endurance of core muscles in adolescent students with genu varum. Journal for Research in Sport Rehabilitation 2020; 8(15): 101-13.
  45. Sartipzadeh M, Moazami M, Mohammadi M. The effect of core stabilization training on elderly balance and knee pain with knee osteoarthritis. JPRS 2016; 5(3): 7-17.
  46. Safdari S, Khayambashi K, Ghasemi GA, Falah A, et al. Effects of selected core stabilization exercise protocol on pain and functional disability in patients with chronic non-specific low back pain. Journal of Research in Rehabilitation Sciences 2014; 10(1): 56-66. [Persian]