Volume 23, Issue 8 (1-2025)
JRUMS 2025, 23(8): 705-720 |
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Ethics code: IR.BASU.REC.1402.012
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Yalfani A, Ahadi F, Ahmadi M, Asgarpoor A. The Effect of Hip and Knee Strengthening Exercises Along with Gait Retraining on Vertical Ground Reaction Force and Loading Rate in Women with Patellofemoral Pain: A Clinical Trial Study. JRUMS 2025; 23 (8) :705-720
URL: http://journal.rums.ac.ir/article-1-7465-en.html
URL: http://journal.rums.ac.ir/article-1-7465-en.html
Abstract: (479 Views)
Background and Objectives: Vertical ground reaction force (Vertical ground reaction force; VGRF) is a kinetic variable that plays an important role in developing patellofemoral pain (Patellofemoral pain; PFP). This clinical trial aimed to determine the effect of hip and knee strengthening exercises along with gait retraining on VGRF and loading rate in women with PFP while walking.
Materials and Methods: In this clinical trial, 40 women with PFP were enrolled and randomly assigned to experimental (n=20) and control groups (n=20). In the experimental group, the patients received the relevant intervention for 8 weeks. The patients in the control group did not receive any intervention. Pain intensity, fear of movement, quadriceps muscle strength, hip abductor, hip extensor, VGRF components, and loading rate were the variables of this research which were evaluated in pre-test and post-test. Data was analyzed using multivariate analysis of covariance (MANCOVA).
Results: The results showed that there was a significant effect in the experimental group compared to the control group in pain intensity, fear of movement, quadriceps muscle strength, hip abductor muscle strength, hip extensor muscle strength, first force peak, valley, second force peak, and loading rate (p<0.001).
Conclusion: It appears that 8 weeks of hip and knee muscle strengthening exercises along with gait retraining can decrease pain intensity and fear of movement and increase muscle strength, and subsequently the first and second peak forces increase and the loading rate and valley decrease. It is recommended to combine strengthening exercises with movement pattern retraining to obtain better clinical results in the rehabilitation of women with PFP.
Key words: Patellofemoral pain, Vertical ground reaction force, Loading rate, Strengthening exercises, Gait retraining
Funding: This study did not have any funds.
Conflict of interest: None declared.
Ethical Considerations: The Ethics Committee of Bu-Ali Sina University approved the study (IR.BASU.REC.1402.012).
Authors’ Contributions:
- Conceptualization: Ali Yalfani, Fatemeh Ahadi
- Methodology: Ali Yalfani, Fatemeh Ahadi
- Data collection: Fatemeh Ahadi, Mohammadreza Ahmadi, Azadeh Asgarpoor
- Formal analysis: Fatemeh Ahadi, Mohammadreza Ahmadi, Azadeh Asgarpoor
- Supervision: Ali Yalfani
- Project administration: Ali Yalfani
- Writing – original draft: Ali Yalfani
- Writing – review & editing: Fatemeh Ahadi, Mohammadreza Ahmadi, Azadeh Asgarpoor
Materials and Methods: In this clinical trial, 40 women with PFP were enrolled and randomly assigned to experimental (n=20) and control groups (n=20). In the experimental group, the patients received the relevant intervention for 8 weeks. The patients in the control group did not receive any intervention. Pain intensity, fear of movement, quadriceps muscle strength, hip abductor, hip extensor, VGRF components, and loading rate were the variables of this research which were evaluated in pre-test and post-test. Data was analyzed using multivariate analysis of covariance (MANCOVA).
Results: The results showed that there was a significant effect in the experimental group compared to the control group in pain intensity, fear of movement, quadriceps muscle strength, hip abductor muscle strength, hip extensor muscle strength, first force peak, valley, second force peak, and loading rate (p<0.001).
Conclusion: It appears that 8 weeks of hip and knee muscle strengthening exercises along with gait retraining can decrease pain intensity and fear of movement and increase muscle strength, and subsequently the first and second peak forces increase and the loading rate and valley decrease. It is recommended to combine strengthening exercises with movement pattern retraining to obtain better clinical results in the rehabilitation of women with PFP.
Key words: Patellofemoral pain, Vertical ground reaction force, Loading rate, Strengthening exercises, Gait retraining
Funding: This study did not have any funds.
Conflict of interest: None declared.
Ethical Considerations: The Ethics Committee of Bu-Ali Sina University approved the study (IR.BASU.REC.1402.012).
Authors’ Contributions:
- Conceptualization: Ali Yalfani, Fatemeh Ahadi
- Methodology: Ali Yalfani, Fatemeh Ahadi
- Data collection: Fatemeh Ahadi, Mohammadreza Ahmadi, Azadeh Asgarpoor
- Formal analysis: Fatemeh Ahadi, Mohammadreza Ahmadi, Azadeh Asgarpoor
- Supervision: Ali Yalfani
- Project administration: Ali Yalfani
- Writing – original draft: Ali Yalfani
- Writing – review & editing: Fatemeh Ahadi, Mohammadreza Ahmadi, Azadeh Asgarpoor
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Citation: Ahadi F, Yalfani A, Ahmadi MR, Asgarpoor A. The Effect of Hip and Knee Strengthening Exercises Along with Gait Retraining on Vertical Ground Reaction Force and Loading Rate in Women with Patellofemoral Pain: A Clinical Trial Study. J Rafsanjan Univ Med Sci 2024; 23 (8): 705-20. [Farsi]
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Keywords: Patellofemoral pain, Vertical ground reaction force, Loading rate, Strengthening exercises, Gait retraining
Type of Study: Research |
Subject:
تربيت بدني
Received: 2024/07/31 | Accepted: 2024/12/25 | Published: 2025/01/21
Received: 2024/07/31 | Accepted: 2024/12/25 | Published: 2025/01/21
References
1. Yalfani A, Ahmadi M, Asgarpoor A. The effect of kinetic factors of dynamic knee valgus on patellofemoral pain syndrome: A systematic review and meta-analysis. J BMT 2023; 37(2); 246-253.
2. Yalfani A, Ahadi F, Ahmadi M, Asgarpoor A. Physical Therapy in Sport Relationship between exacerbating patellofemoral pain and dynamic knee valgus in females with patellofemoral pain after a patellofemoral joint loading protocol : A cross-sectional. PhThS 2024; 67(2): 13–8.
3. Yalfani A, Ahadi F, Ahmadi M. Effects of pain exacerbation on postural control in women with patellofemoral pain during single leg squat : a cross-sectional study. JOSR 2024; 19(9): 462–8.
4. Yalfani A AM. Patients with Patellofemoral Pain Exhibiting Decrease Vertical Ground Reaction Force Compared to Healthy Individuals during Weight Bearing Tasks: A Systematic Reviews and Meta-Analysis. JPH 2023; 52(2): 254–64.
5. Rathleff MS, Richter C, Brushøj C, Bencke J, Bandholm T, Hölmich P, et al. Increased medial foot loading during drop jump in subjects with patellofemoral pain. KSSTA 2014; 22(10): 2301–7.
6. Nunes GS, Barton CJ, Viadanna Serrão F. Females with patellofemoral pain have impaired impact absorption during a single-legged drop vertical jump. JGP 2019; 68(3): 346–51.
7. Ellis RG, Sumner BJ, Kram R. Gait & Posture Muscle contributions to propulsion and braking during walking and running : Insight from external force perturbations. JGP 2014; 40(4): 594–9.
8. Noehren B, Scholz J, Davis I. The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. JSMed 2011; 45(9): 691–6.
9. Greaves H, Comfort P, Liu A, Lee Herrington, Richard Jones. How effective is an evidence-based exercise intervention in individuals with patellofemoral pain? Phys Ther S 2021; 51(2): 92–101.
10. Nakagawa TH, Muniz TB, Baldon R de M, Dias Maciel C, de Menezes Reiff RB, Serrão FV. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: A randomized controlled pilot study. J ClinR 2008; 22(12): 1051–60.
11. Grenholm A, Stensdotter AK, Häger-Ross C. Kinematic analyses during stair descent in young women with patellofemoral pain. Clin Biomech 2009; 24(1): 88–94.
12. Yemm B, Krause DA. Management of a patient with patellofemoral pain syndrome using neuromuscular training in decreasing medial collapse: A case report. JPhThP 2015; 31(3): 221–9.
13. Esculier JF, Bouyer LJ, Roy JS. The effects of a multimodal rehabilitation program on symptoms and ground-reaction forces in runners with patellofemoral pain syndrome. JOSR 2016; 1; 25(1): 23-30.
14. Differding MK, Doyon M, Bouchard L, Perron P, Guérin R, Asselin C, et al. Potential interaction between timing of infant complementary feeding and breastfeeding duration in determination of early childhood gut microbiota composition and BMI JPO 2020; 15(8): 1–12.
15. Ahmad SN, Letafatkar A, Brewer BW, Sharifnezhad A. Comparison of cognitive functional therapy and movement system impairment treatment in chronic low back pain patients: a randomized controlled trial. BMCMD 2023; 29; 24(1): 684-94.
16. Chaharmahali L, Gandomi F, Yalfani A, Fazaeli A. The effect of self-reported knee instability on plantar pressure and postural sways in women with knee osteoarthritis. J Orthop Surg Res 2021; 16(1): 1-10.
17. Yalfani A, Ahmadi M. Effect of neurofeedback training on psychological features and plantar pressure distribution symmetry in patients with patellofemoral pain: A ransdomized controlled trial. J BMT 2024; 40 (3): 141–7.
18. Botta AFB, Waiteman MC, Ducatti MHM, Garcia CLG, Farinelli LALB, Bazett-Jones DM, et al. Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features. FSAL 2023; 4(4): 1–11.
19. Mohamadreza Ahmadi, Ali Yalfani, Farzaneh Gandomi KR. The Effect of Twelve-Week Neurofeedback Training on Pain, Proprioception, Strength and Postural Balance in Men with Patellofemoral Pain Syndrome: A Double-Blind Randomized Control Trial. J Rehabil Sci Res 2020; 10(1): 1–13.
20. Goto S, Aminaka N, Gribble PA. Lower-extremity muscle activity, kinematics, and dynamic postural control in individuals with patellofemoral pain. JSR 2018; 27(6): 505–12.
21. De Oliveira Silva D, Briani RV, Pazzinatto MF, Ferrari D, Aragão FA, De Azevedo FM. Reduced knee flexion is a possible cause of increased loading rates in individuals with patellofemoral pain. JCB 2015; 30(9): 971–5.
22. Behmaram S, Jalalvand A, Reza Jahani M. Effects of backpack-induced fatigue on gait ground reaction force characteristics in primary school children with flat-foot deformity. JB 2021; 129 (2): 110817.
23. Hott A, Brox JI, Pripp AH, Juel NG, Paulsen G, Liavaag S. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. JSMed 2019; 47(6): 1312–22.
24. Mølgaard CM, Rathleff MS, Andreasen J, Christensen M, Lundbye-Christensen S, Simonsen O, et al. Foot exercises and foot orthoses are more effective than knee focused exercises in individuals with patellofemoral pain. J Sci Med S 2018; 21(1): 5–10.
25. Willy RW, Scholz JP, Davis IS. Mirror gait retraining for the treatment of patellofemoral pain in female runners. JCB 2012; 27(10): 1045–51.
26. Fukuda TY, Melo WP, Zaffalon BM, Rossetto FM, Magalhães E, Bryk FF, et al. Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: A randomized controlled clinical trial with 1-year follow-up. JOSPT 2012; 42(10): 823–30.
27. Chiu JKW, Wong YM, Yung PSH, Ng GYF. The effects of quadriceps strengthening on pain, function, and patellofemoral joint contact area in persons with patellofemoral pain. J PMR 2012; 91(2): 98–106.
28. Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG. Outcomes of a Weight-Bearing Rehabilitation Program for Patients Diagnosed With Patellofemoral Pain Syndrome. JPMR 2006; 87(11): 1428–35.
29. Waiteman MC, Briani RV, Pazzinatto MF, Ferreira AS, Ferrari D, de Oliveira Silva D, et al. Relationship between knee abduction moment with patellofemoral joint reaction force, stress and self-reported pain during stair descent in women with patellofemoral pain. JCB 2018; 59(3): 106–10.
30. Hollman JH, Ginos BE, Kozuchowski J, Vaughn AS, Krause DA, Youdas JW. Relationships between knee valgus, hip-muscle strength, and hip-muscle recruitment during a single-limb step-down. JSR 2009; 18(1): 104–17.
31. Aghakeshizadeh F, Letafatkar A TA. Internal and external focus show similar effect on the gait kinematics in patients with patellofemoral pain: A randomised controlled trial. JGP 2021; 84(1): 155–61.
32. Ali yalfani M ahmadi. Do patellofemoral pain patients have higher loading rate compared to healthy indivalues? A systematic review and meta-analysis. Phys Treat Phys Ther 2022; 12(1): 13–22.
33. Davis HC, Luc-Harkey BA, Seeley MK, Troy Blackburn J, Pietrosimone B. Sagittal plane walking biomechanics in individuals with knee osteoarthritis after quadriceps strengthening. JOC 2019; 27(5): 771–80.
34. Esculier JF, Roy JS, Bouyer LJ. Lower limb control and strength in runners with and without patellofemoral pain syndrome. JGP 2015; 41(3): 813–9.
35. Sasaki K, Neptune RR, Burnfield JM, Mulroy SJ. Muscle compensatory mechanisms during able-bodied toe walking. JGP 2008; 27: 440–6.
36.
37. Yalfani A, Ahmadi M, Asgarpoor A. The effect of kinetic factors of dynamic knee valgus on patellofemoral pain syndrome: A systematic review and meta-analysis. J BMT 2023; 37(2); 246-253.
38. Yalfani A, Ahadi F, Ahmadi M, Asgarpoor A. Physical Therapy in Sport Relationship between exacerbating patellofemoral pain and dynamic knee valgus in females with patellofemoral pain after a patellofemoral joint loading protocol : A cross-sectional. PhThS 2024; 67(2): 13–8.
39. Yalfani A, Ahadi F, Ahmadi M. Effects of pain exacerbation on postural control in women with patellofemoral pain during single leg squat : a cross-sectional study. JOSR 2024; 19(9): 462–8.
40. Yalfani A AM. Patients with Patellofemoral Pain Exhibiting Decrease Vertical Ground Reaction Force Compared to Healthy Individuals during Weight Bearing Tasks: A Systematic Reviews and Meta-Analysis. JPH 2023; 52(2): 254–64.
41. Rathleff MS, Richter C, Brushøj C, Bencke J, Bandholm T, Hölmich P, et al. Increased medial foot loading during drop jump in subjects with patellofemoral pain. KSSTA 2014; 22(10): 2301–7.
42. Nunes GS, Barton CJ, Viadanna Serrão F. Females with patellofemoral pain have impaired impact absorption during a single-legged drop vertical jump. JGP 2019; 68(3): 346–51.
43. Ellis RG, Sumner BJ, Kram R. Gait & Posture Muscle contributions to propulsion and braking during walking and running : Insight from external force perturbations. JGP 2014; 40(4): 594–9.
44. Noehren B, Scholz J, Davis I. The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. JSMed 2011; 45(9): 691–6.
45. Greaves H, Comfort P, Liu A, Lee Herrington, Richard Jones. How effective is an evidence-based exercise intervention in individuals with patellofemoral pain? Phys Ther S 2021; 51(2): 92–101.
46. Nakagawa TH, Muniz TB, Baldon R de M, Dias Maciel C, de Menezes Reiff RB, Serrão FV. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: A randomized controlled pilot study. J ClinR 2008; 22(12): 1051–60.
47. Grenholm A, Stensdotter AK, Häger-Ross C. Kinematic analyses during stair descent in young women with patellofemoral pain. Clin Biomech 2009; 24(1): 88–94.
48. Yemm B, Krause DA. Management of a patient with patellofemoral pain syndrome using neuromuscular training in decreasing medial collapse: A case report. JPhThP 2015; 31(3): 221–9.
49. Esculier JF, Bouyer LJ, Roy JS. The effects of a multimodal rehabilitation program on symptoms and ground-reaction forces in runners with patellofemoral pain syndrome. JOSR 2016; 1; 25(1): 23-30.
50. Differding MK, Doyon M, Bouchard L, Perron P, Guérin R, Asselin C, et al. Potential interaction between timing of infant complementary feeding and breastfeeding duration in determination of early childhood gut microbiota composition and BMI JPO 2020; 15(8): 1–12.
51. Ahmad SN, Letafatkar A, Brewer BW, Sharifnezhad A. Comparison of cognitive functional therapy and movement system impairment treatment in chronic low back pain patients: a randomized controlled trial. BMCMD 2023; 29; 24(1): 684-94.
52. Chaharmahali L, Gandomi F, Yalfani A, Fazaeli A. The effect of self-reported knee instability on plantar pressure and postural sways in women with knee osteoarthritis. J Orthop Surg Res 2021; 16(1): 1-10.
53. Yalfani A, Ahmadi M. Effect of neurofeedback training on psychological features and plantar pressure distribution symmetry in patients with patellofemoral pain: A ransdomized controlled trial. J BMT 2024; 40 (3): 141–7.
54. Botta AFB, Waiteman MC, Ducatti MHM, Garcia CLG, Farinelli LALB, Bazett-Jones DM, et al. Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features. FSAL 2023; 4(4): 1–11.
55. Mohamadreza Ahmadi, Ali Yalfani, Farzaneh Gandomi KR. The Effect of Twelve-Week Neurofeedback Training on Pain, Proprioception, Strength and Postural Balance in Men with Patellofemoral Pain Syndrome: A Double-Blind Randomized Control Trial. J Rehabil Sci Res 2020; 10(1): 1–13.
56. Goto S, Aminaka N, Gribble PA. Lower-extremity muscle activity, kinematics, and dynamic postural control in individuals with patellofemoral pain. JSR 2018; 27(6): 505–12.
57. De Oliveira Silva D, Briani RV, Pazzinatto MF, Ferrari D, Aragão FA, De Azevedo FM. Reduced knee flexion is a possible cause of increased loading rates in individuals with patellofemoral pain. JCB 2015; 30(9): 971–5.
58. Behmaram S, Jalalvand A, Reza Jahani M. Effects of backpack-induced fatigue on gait ground reaction force characteristics in primary school children with flat-foot deformity. JB 2021; 129 (2): 110817.
59. Hott A, Brox JI, Pripp AH, Juel NG, Paulsen G, Liavaag S. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. JSMed 2019; 47(6): 1312–22.
60. Mølgaard CM, Rathleff MS, Andreasen J, Christensen M, Lundbye-Christensen S, Simonsen O, et al. Foot exercises and foot orthoses are more effective than knee focused exercises in individuals with patellofemoral pain. J Sci Med S 2018; 21(1): 5–10.
61. Willy RW, Scholz JP, Davis IS. Mirror gait retraining for the treatment of patellofemoral pain in female runners. JCB 2012; 27(10): 1045–51.
62. Fukuda TY, Melo WP, Zaffalon BM, Rossetto FM, Magalhães E, Bryk FF, et al. Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: A randomized controlled clinical trial with 1-year follow-up. JOSPT 2012; 42(10): 823–30.
63. Chiu JKW, Wong YM, Yung PSH, Ng GYF. The effects of quadriceps strengthening on pain, function, and patellofemoral joint contact area in persons with patellofemoral pain. J PMR 2012; 91(2): 98–106.
64. Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG. Outcomes of a Weight-Bearing Rehabilitation Program for Patients Diagnosed With Patellofemoral Pain Syndrome. JPMR 2006; 87(11): 1428–35.
65. Waiteman MC, Briani RV, Pazzinatto MF, Ferreira AS, Ferrari D, de Oliveira Silva D, et al. Relationship between knee abduction moment with patellofemoral joint reaction force, stress and self-reported pain during stair descent in women with patellofemoral pain. JCB 2018; 59(3): 106–10.
66. Hollman JH, Ginos BE, Kozuchowski J, Vaughn AS, Krause DA, Youdas JW. Relationships between knee valgus, hip-muscle strength, and hip-muscle recruitment during a single-limb step-down. JSR 2009; 18(1): 104–17.
67. Aghakeshizadeh F, Letafatkar A TA. Internal and external focus show similar effect on the gait kinematics in patients with patellofemoral pain: A randomised controlled trial. JGP 2021; 84(1): 155–61.
68. Ali yalfani M ahmadi. Do patellofemoral pain patients have higher loading rate compared to healthy indivalues? A systematic review and meta-analysis. Phys Treat Phys Ther 2022; 12(1): 13–22.
69. Davis HC, Luc-Harkey BA, Seeley MK, Troy Blackburn J, Pietrosimone B. Sagittal plane walking biomechanics in individuals with knee osteoarthritis after quadriceps strengthening. JOC 2019; 27(5): 771–80.
70. Esculier JF, Roy JS, Bouyer LJ. Lower limb control and strength in runners with and without patellofemoral pain syndrome. JGP 2015; 41(3): 813–9.
71. Sasaki K, Neptune RR, Burnfield JM, Mulroy SJ. Muscle compensatory mechanisms during able-bodied toe walking. JGP 2008; 27: 440–6.
72.
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