Addition Effect of the Ankle Manual Therapy to Muscle Strengthening Exercise in Women With Patellofemoral Pain

NCT04631614 | Not Yet Recruiting DMC

• 1 other identifier: PhD_Bruno
• Study Type: interventional
• Target: 68
• Locations: 1 country
• Sites: 1

Brief Summary

Patellofemoral pain (PFP) is the most common overuse injury of the lower limb, its prevalence is around 20% in general population, and women are more likely to develop PFP compared to men. PFP may develop as a result of increased pressure and joint stress due to an reduction in contact area in the patellofemoral joint. The excessive dynamic knee valgus is an important contributor to patella misalignment and for the increasing of laterally directed forces on the patella, and restriction in ankle dorsiflexion range of motion (ROM) has been previously associated with excessive dynamic knee valgus. Although the evidence shows that strengthening exercises for the quadriceps and gluteus promote improvement of knee pain and function, there is a lack of studies that investigate if targeted interventions for improvement ankle dorsiflexion may promote additional benefits in knee pain and function when performed in combination with strengthening exercises. Thus, the aimed of this study is analyze the addition effect of calf stretching and ankle mobilization to quadriceps and gluteus strengthening on knee pain and function in women with PFP who display ankle dorsiflexion restriction.

Conditions

Patellofemoral Pain Syndrome

Keywords

knee; pain; ankle; manual therapy; exercise

Outcome Measures

Primary Outcomes (2)

• Numeric Pain Rating Scale

  Pain will be assessed by use of an 11-point Numeric Pain Scale, where 0 correspond to no pain and 10 correspond to worst imaginable pain.

  At the end of the six weeks of treatment

• Anterior Knee Pain Scale

  The subjective functional capacity of the participant will be recorded with the translated and validated Portuguese-language version of the Anterior Knee Pain Scale (AKPS). The scores for this scale, 0 to 100, represent the lowest to the highest levels of functional capacity, respectively.

  At the end of the six weeks of treatment

Secondary Outcomes (7)

• Numeric Pain Rating Scale

  At 3 and 6 months follow-up

• Anterior Knee Pain Scale

  At 3 and 6 months follow-up

• Weight-Bearing Lunge Test

  At the end of the six weeks of treatment

• Dynamic knee valgus

  At the end of the six weeks of treatment

• Isometric strength of the quadriceps

  At the end of the six weeks of treatment.

Study Arms (2)

Manual therapy plus muscle strengthening exercises

EXPERIMENTAL

The procedures to be performed with participants in the experimental group are as follows: (1) warm up with a walk or exercise bike for 5 minutes; (2) two ankle manual therapy techniques - \[a\] passive calf muscle stretching and \[b\] ankle joint mobilization; (3) five muscle strengthening exercises focusing on quadriceps and posterolateral hip complex - \[a\] clam exercise, \[b\] hip abduction exercise in side lying, \[c\] knee extension exercise in a sitting position, \[d\] squat exercise and \[e\] forward lunge exercise.

Other: Warm up; Other: Passive calf muscle stretching; Other: Ankle joint mobilization - weight-bearing mobilization with movement (WB-MWM) technique; Other: Clam exercise; Other: Hip abduction exercise in side lying; Other: Knee extension exercise in a sitting position; Other: Squat exercise; Other: Forward lunge exercise

Muscle strengthening exercises

ACTIVE COMPARATOR

The procedures to be performed with participants in the control group are as follows: (1) warm up with a walk or exercise bike for 5 minutes; (2) five muscle strengthening exercises focusing on quadriceps and posterolateral hip complex - \[a\] clam exercise, \[b\] hip abduction exercise in side lying, \[c\] knee extension exercise in a sitting position, \[d\] squat exercise and \[e\] forward lunge exercise.

Other: Warm up; Other: Clam exercise; Other: Hip abduction exercise in side lying; Other: Knee extension exercise in a sitting position; Other: Squat exercise; Other: Forward lunge exercise

Interventions

Warm up OTHER

Warm up through a walk or exercise bike for 5 minutes with moderate intensity according to modified Borg scale (CR-10)

Manual therapy plus muscle strengthening exercises; Muscle strengthening exercises

Passive calf muscle stretching OTHER

With the participant lying in the supine position, the physiotherapist will passively perform the ankle dorsiflexion movement to stretch the participant's calf to the limit tolerated by the participant. This procedure will be performed in two repetitions with 30 seconds of held in the stretching position and 30 seconds of rest between repetitions.

Manual therapy plus muscle strengthening exercises

Ankle joint mobilization - weight-bearing mobilization with movement (WB-MWM) technique OTHER

To perform the WB-MWM technique, the participant will be instructed to take a weight-bearing position with the tibia in a vertical position. The physiotherapist will be stay in front participant's ankle and will use the hands to stabilize the participant's foot as close as possible to the anterior region of the talus. A rigid belt will be placed on the participant's tibia and around physiotherapist´s hip. Then, the physiotherapist will project his hip backwards to produce a nonpainful anterior tibia glide. The participant will be asked to perform a forward lunge as far as possible without raising heel off the table and without reproducing knee symptoms. After achieving the maximum forward lunge, the participant will be instructed to hold this position for 5 seconds and then return to the starting position. This procedure will be performed in two sets of 10 repetitions with two minutes of rest between sets.

Manual therapy plus muscle strengthening exercises

Clam exercise OTHER

The participant will side lying with trunk straight and both hips and knees at 45º and 90º of flexion, respectively. An elastic band will be used as external resistance, that will be positioned above the participant's knee. The individual will be instructed to perform the abduction and lateral rotation of the hip (keeping the heels in contact) against the resistance of the elastic band and then return to starting position. This exercise will be performed in three sets of 12 repetitions with on minutes of rest between sets. The exercise will be carried out with a load between 60-80% of the capacity and level of effort reported by the participant, according to the specifications of the modified Borg scale (CR-10). The load will be increased by 2-10% when the patient is able to perform 12 full repetitions in the last set of the exercise with perceived effort \<60%.

Manual therapy plus muscle strengthening exercises; Muscle strengthening exercises

Hip abduction exercise in side lying OTHER

The participant will side lying with trunk straight, both hips in a neutral position and both knee in extension. An elastic band will be used as external resistance, that will be positioned above the participant's knee. The individual will be instructed to perform the hip abduction against the resistance of the elastic band and then return to starting position. This exercise will be performed in three sets of 12 repetitions with with on minutes of rest between sets. The exercise will be carried out with a load between 60-80% of the capacity and level of effort reported by the participant, according to the specifications of the modified Borg scale (CR-10). The load will be increased by 2-10% when the patient is able to perform 12 full repetitions in the last set of the exercise with perceived effort \<60%.

Manual therapy plus muscle strengthening exercises; Muscle strengthening exercises

Knee extension exercise in a sitting position OTHER

The participant will be seated at the treatment table with the trunk straight and both knees in 90º of flexion. The external resistance will be positioned above the participant's ankle. The individual will be instructed to perform the knee extension at a protective angle (90º-45º of flexion), progressing to full extension (90º-0º of flexion) as long as the full knee extension does not reproduce the knee pain symptoms. Then, the participant will should return to starting position. This exercise will be performed in three sets of 12 repetitions with with on minutes of rest between sets. The exercise will be carried out with a load between 60-80% of the capacity and level of effort reported by the participant, according to the specifications of the modified Borg scale (CR-10). The load will be increased by 2-10% when the patient is able to perform 12 full repetitions in the last set of the exercise with perceived effort \<60%.

Manual therapy plus muscle strengthening exercises; Muscle strengthening exercises

Squat exercise OTHER

The participant will be stand with the trunk straight, knees in extension and feet hip-width apart. Dumbbells will be used as external resistance.The individual will be instructed to perform the squat movement at a protective angle (0º-45º of knee flexion), progressing to a deep squat (90º of knee flexion) as long as the movement does not reproduce the knee pain symptoms. Then, the participant will should return to starting position. This exercise will be performed in three sets of 12 repetitions with with on minutes of rest between sets. The exercise will be carried out with a load between 60-80% of the capacity and level of effort reported by the participant, according to the specifications of the modified Borg scale (CR-10). The load will be increased by 2-10% when the patient is able to perform 12 full repetitions in the last set of the exercise with perceived effort \<60%.

Manual therapy plus muscle strengthening exercises; Muscle strengthening exercises

Forward lunge exercise OTHER

The participant will be stand with one lower limb in a long stride forwards of the other limb, trunk straight and both knee in extension. Dumbbells will be used as external resistance. From this position, the participant will be instructed to bend both knees to lower your body at a protective angle (0º-45º of knee flexion), progressing to a greater knee flexion (90º) as long as the movement does not reproduce the knee pain symptoms. Then, the participant will should return to starting position. This exercise will be performed in three sets of 12 repetitions with with on minutes of rest between sets. The exercise will be carried out with a load between 60-80% of the capacity and level of effort reported by the participant, according to the specifications of the modified Borg scale (CR-10). The load will be increased by 2-10% when the patient is able to perform 12 full repetitions in the last set of the exercise with perceived effort \<60%.

Manual therapy plus muscle strengthening exercises; Muscle strengthening exercises

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Presence of anterior knee pain for at least 3 months, unrelated to any traumatic knee event and reproducible by performing at least two of the following activities: sitting for a long time, squatting, kneeling, ascending or descending stairs, walking or running long distances, and performing jump-landing tasks;
• Anterior knee pain in the previous week with an intensity of at least 3 points on numeric pain rating scale (NPRS);
• Score in the Anterior Knee Pain Scale less than or equal to 86 points, and;
• Limited ankle dorsiflexion range of motion in closed kinetic chain, identified by a weight-bearing lunge test in which the distance between foot and wall being less than or equal to 10 cm.

You may not qualify if:

• History of surgery or fracture in the lumbar spine, hip, knee, ankle, or foot;
• Referred pain from the lumbar spine, hip, ankle, or foot;
• History of patellar subluxation;
• Presence of knee swelling;
• Presence of meniscal, ligament or tendon injury, and;
• Osgood-Schlatter or Siding-Larsen-Johansson syndrome.

Sponsors & Collaborators

• Universidade Federal do Ceara: lead

Study Sites (1)

Bruno Augusto Lima Coelho

Fortaleza, Ceará, 60420-025, Brazil

Location

MeSH Terms

Conditions

Patellofemoral Pain Syndrome; Pain; Motor Activity

Interventions

Warm-Up Exercise; Movement; Methods

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Behavior

Intervention Hierarchy (Ancestors)

Exercise; Motor Activity; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Physiological Phenomena; Investigative Techniques

Central Study Contacts

Bruno Augusto Lima Coelho, PhD student

CONTACT

+55 (85) 98804-1026; brunolimafisioterapia@outlook.com

Gabriel Peixoto Leão Almeida, PhD

CONTACT

+55 (85) 99959-0400; gabriel_alm@hotmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: November 10, 2020
• First Posted: November 17, 2020
• Study Start: October 1, 2024
• Primary Completion: December 1, 2024
• Study Completion: December 1, 2025
• Last Updated: June 4, 2024

Record last verified: 2024-06

Locations

BR (1)