Comparison of Lower Extremity Inter-Segmental Coordination Variability and Muscle ‎Functionality‏ ‏in Athletes with and without Patellofemoral Pain Syndrome During Running

Document Type : Original Article

Authors

1 Department of Sports Biomechanics, Faculty of Sports Sciences and Physical Education, ‎Kharazmi University, Tehran, Iran

2 Department of Sports Biomechanics, Faculty of Sports Sciences and Physical Education, ‎Bu‏-‏Ali‏-‏Sina University, Hamadan, Iran

Abstract

Propose:
Patellofemoral Pain Syndrome (PFPS) is a common ailment among runners and those leading active lifestyles. This study aimed to explore the differences in the coordination variability and muscle functionality in the lower limbs of professional athletes afflicted with PFPS compared to their healthy counterparts during running.
Methods:
Eighteen male athletes with Patellofemoral Pain Syndrome (PFPS) and 18 healthy male athletes participated in this study. Data recording was conducted using 6 Inertial Measurement Unit (IMU) sensors placed on both thighs, shins, and feet, along with surface electrodes on the vastus medialis, vastus lateralis, and gluteus medius muscles. The coordination variability and electrical activity of the lower limbs of each participant were examined while running at a self-selected speed on a treadmill for 21 minutes, during both the stance and swing phases at the test's beginning, and only during the stance phase at the test's end. An independent t-test was utilized for statistical analysis (p≥0.05).
Results:
Coordination variability between sagittal thigh-sagittal shin, sagittal thigh-transverse shin, transverse thigh-transverse shin, frontal thigh-transverse shin, sagittal shin-transverse foot, and transverse shin-sagittal foot was lower in the PFPS group compared to the healthy group during the stance phase (p≥0.05), and sagittal shin-transverse foot coordination variability was lower during the swing phase (p=0.001). The activation timing of the vastus medialis and gluteus medius muscles in the PFPS group was delayed compared to the healthy group (p=0.005 and p=0.002, respectively) and remained active for a longer duration (p=0.007 and p=0.001, respectively), with less overall activity (p=0.001).
Conclusion:
The research indicates that the performance of the muscles studied may be a contributing factor to the reduced coordination variability observed in the lower limbs.

Keywords


  1. Ibrahim Hassan IM, Keblawy ME, Elsalam MA, Embaby EA. Sagittal trunk excursion and lumbar repositioning error between female and male patients with patellofemoral pain syndrome. Hong Kong Physiother J 2023; 43(02): 81-91.
  2. Sinclair J, Chockalingam N, Taylor PJ. Lower Extremity Kinetics and Kinematics in Runners with Patellofemoral Pain: A Retrospective Case–Control Study Using Musculoskeletal Simulation. Appl Sci 2022; 12(2): 1-21.
  3. Waiteman MC, de Oliveira Silva D, Azevedo FM, Pazzinatto MF, et al. Women with patellofemoral pain and knee crepitus have reduced knee flexion angle during stair ascent. Phys Ther Sport 2021; 48: 60-66.
  4. Skouras AZ, Kanellopoulos AK, Stasi S, Triantafyllou A, et al. Clinical Significance of the Static and Dynamic Q-angle. Cureus 2022; 14(5): 1-12
  5. Dos Santos AF, Nakagawa TH, Serrão FV, Ferber R. Patellofemoral joint stress measured across three different running techniques. Gait Posture 2019; 68: 37-43.
  6. Glaviano NR, Saliba S. Differences in gluteal and quadriceps muscle activation during weight-bearing exercises between female subjects with and without patellofemoral pain. J Strength Cond Res 2022; 36(1): 55-62.
  7. 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. J Clin Orthop Trauma 2021; 18: 94-99.
  8. Hossein HS, Sara A, Hasan D. The effect of three types of exercises programs on the patella location in athletes with patellofemoral pain. Knee 2023; 41(1): 97-105.
  9. Clifford AM, Dillon S, Hartigan K, O’Leary H, Constantinou M. The effects of McConnell patellofemoral joint and tibial internal rotation limitation taping techniques in people with Patellofemoral pain syndrome. Gait Posture 2020; 82: 266-672
  10. Liu Y, Qi Y, Song Y, Feng L, Wang L. Influences of altering footstrike pattern and cadence on lower extremity joint coordination and variability among runners with patellofemoral pain. PloS One 2023; 18(1): 1-11.
  11. Souto LR, Serrão PR, Pisani GK, Tessarin BM, et al. Immediate effects of hip strap and foot orthoses on self-reported measures and lower limb kinematics during functional tasks in individuals with patellofemoral osteoarthritis: protocol for a randomised crossover clinical trial. Trials 2022; 23(1): 1-10.
  12. Pourahmad F, Daneshjoo A, Mousavi Sadati SK. The Effect of Resistance Training on Lower Extremity Pain, Strength and Kinematical Parameters in Women with Patellofemoral Complications. PTJ. 2021; 11(4): 217-226. [Persian]
  13. Lim J, Hamill J, Busa MA, van Emmerik RE. Changes in coordination and variability during running as a function of head stability demands. Hum Mov Sci 2020; 52(7): 720-720.
  14. Haghighat F, Rezaie M, Ebrahimi S, Shokuhian SM, et al. The correlation between intersegmental coordination variability and frontal plane hip kinematics during running in persons with patellofemoral pain. J Biomed Phy Eng 2021; 14(1): 89-98. [Persian]
  15. Bazett-Jones DM, Neal BS, Legg C, Hart HF, et al. Kinematic and kinetic gait characteristics in people with Patellofemoral Pain: a systematic review and Meta-analysis. Sports Med 2023; 53(2): 519-547.
  16. Alsubaie AM, Mazaheri M, Martinez-Valdes E, Falla D. Is movement variability altered in people with chronic non-specific low back pain? A systematic review. PloS One 2023; 18(6):  1-22.
  17. Taunton JE, Ryan MB, Clement DB, McKenzie DC, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002; 36(2): 95-101.
  18. Cappellini G, Ivanenko YP, Poppele RE, Lacquaniti F. Motor patterns in human walking and running. J Neurophysiol 2006; 95(6): 3426-3347.
  19. De David AC, Carpes FP, Stefanyshyn D. Effects of changing speed on knee and ankle joint load during walking and running. J Sports Sci 2015; 33(4): 391-397.
  20. De Almeida Britto PA, de Souza Muniz AM, Nadal J. Electromyographic activity of the lower limb in runners with anterior knee pain while running. Res Biomed Eng. 2021; 37(5): 135-142.
  21. Jewell C, Weir G, Hamill J, Boyer KA. The influence of patellofemoral pain on coordination variability over a prolonged treadmill run. ISBS Proceedings Archive 2018; 36(1): 634-637.
  22. Bergin M, Tucker K, Vicenzino B, Hodges PW. “Taking action” to reduce pain—Has interpretation of the motor adaptation to pain been too simplistic? PloS One 2021; 16(12): 1-19.
  23. Serdar CC, Cihan M, Yücel D, Serdar MA. Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies. Biochemia medica. 2021; 31(1): 27-53.
  24. Arjun R, Kishan R, Dhillon M, Chouhan D. Reliability of clinical methods in evaluating patellofemoral pain syndrome with malalignment. Int J Res Orthop 2017; 3(3): 334-338.
  25. Watson CJ, Propps M, Ratner J, Zeigler DL, Horton P, Smith SS. Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain. J Orthop Sports Phys Ther 2005; 35(3): 136-146.
  26. Elsais WM, Mohammad WS. Comparison of Electromyographic Amplitudes of the Adductor Magnus Muscle among Three Different Clinical Testing Positions. MJSSM 2020; 9(2): 21-26.
  27. Darch L, Chalmers S, Wiltshire J, Causby R, Arnold J. Running-induced fatigue and impact loading in runners: A systematic review and meta-analysis. J Sports Sci 2022; 40(13): 1512-1531.
  28. Letafatkar A, Mantashloo Z, Moradi M. Comparison the time to stabilization and activity of the lower extremity muscles during jump-landing in subjects with and without Genu Varum. Gait Posture 2018; 65: 256-261. [Persian]
  29. Robertson DG, Caldwell GE, Hamill J, Kamen G, Whittlesey S. Research methods in biomechanics. J Sports Sci Med 2014; 13(1): i.
  30. Abbasi A, Yazdanbakhsh F, Tazji MK, Aghaie AP, et al. A comparison of coordination and its variability in lower extremity segments during treadmill and overground running at different speeds. Gait Posture 2020; 79(6): 139-144.
  31. Miller RH, Meardon SA, Derrick TR, Gillette JC. Continuous relative phase variability during an exhaustive run in runners with a history of iliotibial band syndrome. J Appl Biomech 2008; 24(3): 262-270
  32. Mehri R, Abbasi A, Abbasi S, Khaleghi Tazji M, Nazarpour K. Intra-segment coordination variability in road cyclists during pedaling at different intensities. Appl Sci. 2020, 10(24): 1-11 
  33. O’Connor CM, Thorpe SK, O’Malley MJ, Vaughan CL. Automatic detection of gait events using kinematic data. Gait Posture 2007; 25(3): 469-674
  34. Li X, Zhou P, Aruin AS. Teager–Kaiser energy operation of surface EMG improves muscle activity onset detection. Ann Biomed Eng 2007; 35: 1532-1538
  35. Dos Santos SB. Detecção de início de ativação muscular no eletromiograma com o operador Teager-Kaiser [Doctoral dissertation]. Rio de Janeiro (RJ): Universidade Federal do Rio de Janeiro; 2011.
  36. Park J, Shin SW, Kang SB, Kim J. Acute Effects of Electromyography Biofeedback Training on the Joint Position Sense and Pain in Adults with Patellofemoral Pain. Asian J Kinesiol 2023; 25(2): 43-51.
  37. Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG. Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Arc phys med rehabil 2006; 87(11): 1428-1435.
  38. Kunene SH, Ramklass S, Taukobong NP. Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng. S Afr J Physiother 2018; 74(1): 452.
  39. Brindle TJ, Mattacola C, McCrory J. Electromyographic changes in the gluteus medius during stair ascent and descent in subjects with anterior knee pain. Knee Surg Sports Traumatol Arthrosc 2003; 11(1): 244-251.
  40. Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J. Simultaneous feedforward recruitment of the vasti in untrained postural tasks can be restored by physical therapy. J Orthop Res 2003; 21(3): 553-558.
  41. Van Cant J, Pitance L, Feipel V. Hip abductor, trunk extensor and ankle plantar flexor endurance in females with and without patellofemoral pain. J Back Musculoskelet Rehabil 2017; 30(2): 299-307.
  42. Jirsa V, Sheheitli H. Entropy, free energy, symmetry and dynamics in the brain. J Phys Complexity 2022; 3(1): 1-17.
  43. Kelso JA. Phase transitions and critical behavior in human bimanual coordination. Am J Physiol 1984; 246(6): 1000-1004.
  44. Hamill J, van Emmerik RE, Heiderscheit BC, Li L. A dynamical systems approach to lower extremity running injuries. Clin Biomech 1999; 14(5): 297-308.
  45. Chang R, van Emmerik R, Hamill J. Chronic plantar fasciitis reduces rearfoot to medial-forefoot anti-phase coordination. Clin Biomech 2021; 88: 105439.
  46. Miller RH, Chang R, Baird JL, Van Emmerik RE, Hamill J. Variability in kinematic coupling assessed by vector coding and continuous relative phase. J Biomech. 2010; 43(13): 2554-2560.
  47. Sanchis-Alfonso V, Baydal-Bertomeu JM. Kinetic and Kinematic Analysis in Evaluating Anterior Knee Pain Patients. InAnterior Knee Pain and Patellar Instability 2023; 675-687.
  48. Nascimento LR, Teixeira-Salmela LF, Souza RB, Resende RA. Hip and knee strengthening is more effective than knee strengthening alone for reducing pain and improving activity in individuals with patellofemoral pain: a systematic review with meta-analysis.  J Orthop Sports Phys Ther 2018; 48(1): 19-31.