PriMera Scientific Medicine and Public Health (ISSN: 2833-5627)

Case Study

Volume 2 Issue 5

Changes in Functionality Induced by Conventional and Combined Electromyostimulation Knee Training, in Women with Patellofemoral Knee Syndrome

Theodoros M Kannas*, Magiou Eleni, Georgios Chalatzoglidis, Evangelia Germanou, Nikolaos E. Koukoulias and Fotini Arabatzi

April 17, 2023

DOI : 10.56831/PSMPH-02-061

View PDF

Abstract

Background: Patellofemoral pain (PFP) is a chronic condition that usually results in long-term functional impairments both in adults and adolescents PFP has been found to decrease activity levels in individuals.

Purpose: The purpose of the present study was to investigate whether the additional use of electrical stimulation to an intervention program could result in greater improvements in the knee function and the level of pain compared with the intervention program itself.

Material and Methods: 22 women reported anterior knee pain symptoms clinically allocated in the patellofemoral region and confirmed through the patellar position, analyzed by magnetic resonance imaging (MRI). They randomly assigned into two groups with the same strengthening program. The experimental group used electrical stimulation combined with knee extensors and flexors strengthening exercises. The main outcome of the study was the visual analogue scale (VAS) in order to assess pain and the Anterior Knee Pain Scale (AKPS) to evaluate the functionality of the knee joint. All the outcomes were analyzed and compared pre and post a 6-weeks intervention period.

Results: Statistically significant differences were found between the two rehabilitation groups at the end of the intervention period both in VAS (F1,20 = 44.083, p < 0.001) and functional assessment (F1,20 = 35.687, p < 0,001), suggesting that the conventional intervention program with the use of electrical stimulation is more effective regarding the pain degrees and the knee function.

Conclusion: The use of electrical stimulation, combined with conventional strengthening program, could provide greater beneficial effects on PFP female individuals compared to the strengthening program itself.

Keywords: Anterior knee pain; conventional training; electromyostimulation; pain; functionality

References

  1. BE Smith., et al. “Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis”. PLoS One 13.1 (2018).
  2. RW Willy., et al. “Patellofemoral pain clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American physical therapy association”. J. Orthop. Sports Phys. Ther 49.9 (2019): CPG1-CPG95.
  3. S Kobayashi., et al. “The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis”. Osteoarthr. Cartil 24.10 (2016): 1697-1707.
  4. M Boling., et al. “Gender differences in the incidence and prevalence of patellofemoral pain syndrome”. Scand. J. Med. Sci. Sports 20.5 (2010): 725-730.
  5. KM Crossley., et al. “2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome m”. Br. J. Sports Med 50.14 (2016): 839-843.
  6. BS Neal., et al. “Risk factors for patellofemoral pain: A systematic review and meta-analysis”. Br. J. Sports Med 53.5 (2019): 270-281.
  7. RV Briani., et al. “Knee flexor strength and rate of torque development deficits in women with patellofemoral pain are related to poor objective function”. Gait Posture 83 (2021): 100-106.
  8. H Guney., et al. “Correlation between quadriceps to hamstring ratio and functional outcomes in patellofemoral pain”. Knee 23.4 (2016): 610-615.
  9. RV Briani., et al. “Lower Trunk Muscle Thickness Is Associated with Pain in Women With Patellofemoral Pain”. J. Ultrasound Med 38.10 (2019): 2685-2693.
  10. A Motealleh., et al. “Trunk postural control during unstable sitting differs between patients with patellofemoral pain syndrome and healthy people: A cross-sectional study”. Knee 26.1 (2019): 26-32.
  11. TH Nakagawa, CD Maciel and FV Serrão. “Trunk biomechanics and its association with hip and knee kinematics in patients with and without patellofemoral pain”. Man. Ther 20.1 (2015): 189-193.
  12. U Röijezon, NC Clark and J Treleaven. “Proprioception in musculoskeletal rehabilitation: Part 1: Basic science and principles of assessment and clinical interventions”. Man. Ther 20.3 (2015): 368-377.
  13. NC Silva., et al. “Adding neuromuscular training to a strengthening program did not produce additional improvement in clinical or kinematic outcomes in women with patellofemoral pain: A blinded randomised controlled trial”. Musculoskelet. Sci. Pract (2023): 102720.
  14. MF Chevidikunnan., et al. “Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome”. J. Phys. Ther. Sci 28.5 (2016): 1518-1523.
  15. MV Nascimento-Ferreira., et al. “Reliability and Validity of a Questionnaire for Physical Activity Assessment in South American Children and Adolescents: The SAYCARE Study”. Obes. (Silver Spring) 26.Suppl 1 (2018): S23-S30.
  16. R Ferber., et al. “Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: A multicenter randomized controlled trial”. J. Athl. Train 50.4 (2015): 366-377.
  17. KD Pompeo., et al. “Can we replace exercises targeted on core/hip muscles by exercises targeted on leg/foot muscles in women with patellofemoral pain? A randomized controlled trial”. Phys. Ther. Sport 58 (2018): 1-7.
  18. JKW Chiu., et al. “The effects of quadriceps strengthening on pain, function, and patellofemoral joint contact area in persons with patellofemoral pain”. Am. J. Phys. Med. Rehabil 91.2 (2012): 98-106.
  19. MHM Ducatti., et al. “Knee flexor strength, rate of torque development and flexibility in women and men with patellofemoral pain: Relationship with pain and the performance in the single leg bridge test”. Phys. Ther. Sport 50 (2021): 166-172.
  20. NR Glaviano., et al. “Improvements in lower-extremity function following a rehabilitation program with patterned electrical neuromuscular stimulation in females with patellofemoral pain: A randomized controlled trial”. J. Sport Rehabil 29.8 (2020): 1075-1085.
  21. JD Willson and IS Davis. “Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands”. Clin. Biomech 23.2 (2008): 203-211.
  22. ES Di Filippo., et al. “Neuromuscular electrical stimulation improves skeletal muscle regeneration through satellite cell fusion with myofibers in healthy elderly subjects”. J. Appl. Physiol 123.3 (2017): 501-512.
  23. LD Hamilton., et al. “Electrical nerve stimulation modulates motor unit activity in contralateral biceps brachii during steady isometric contractions”. J. Neurophysiol 120.5 (2018): 2603-2613.
  24. J Gondin, PJ Cozzone and D Bendahan. “Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes?”. Eur. J. Appl. Physiol 111.10 (2011): 2473-2487.
  25. DF Collins, D Burke and SC Gandevia. “Sustained contractions produced by plateau-like behaviour in human motoneurones”. J. Physiol 538.1 (2002): 289-301.
  26. AJ Bergquist, JM Clair and DF Collins. “Motor unit recruitment when neuromuscular electrical stimulation is applied over a nerve trunk compared with a muscle belly: Triceps surae”. J. Appl. Physiol 110.3 (2011): 627-637.
  27. JE Stevens-Lapsley., et al. “Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial”. Phys. Ther 92.2 (2012): 210-226.
  28. P Banerjee., et al. “Prolonged electrical muscle stimulation exercise improves strength and aerobic capacity in healthy sedentary adults”. J. Appl. Physiol 99.6 (2005): 2307-2311.
  29. RM Enoka, IG Amiridis and J Duchateau. “Electrical stimulation of muscle: Electrophysiology and rehabilitation”. Physiology 35.1 (2020): 40-56.
  30. C Papadopoulos., et al. “Greek cultural adaption and validation of the Kujala anterior knee pain scale in patients with patellofemoral pain syndrome”. Disabil. Rehabil 39.7 (2017): 704-708.
  31. L Kooiker., et al. “Effects of physical therapist-guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: A systematic review”. J. Orthop. Sports Phys. Ther 44.6 (2014): 391-402.
  32. TY Fukuda., et al. “Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: A randomized controlled clinical trial”. J. Orthop. Sports Phys. Ther 40.11 (2010): 736-742.
  33. GPLA Almeida., et al. “Anteromedial versus posterolateral hip musculature strengthening with dose-controlled in women with patellofemoral pain: A randomized controlled trial”. Phys. Ther. Sport 49 (2021): 149-156.
  34. J Duchateau., et al. “Strength Training: In Search of Optimal Strategies to Maximize Neuromuscular Performance”. Exerc. Sport Sci. Rev 49.1 (2021): 2-14.
  35. MV da Silva Boitrago., 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 18 (2021): 94-99.
  36. D Mani., et al. “Neuromuscular electrical stimulation can improve mobility in older adults but the time course varies across tasks: Double-blind, randomized trial”. Exp. Gerontol 108 (2018): 269-275.
  37. AM Almuklass., et al. “Pulse width does not influence the gains achieved with neuromuscular electrical stimulation in people with multiple sclerosis: double-blind, randomized trial”. Neurorehabil. Neural Repair 32.1 (2018): 84-93.