Doi Muscle Strength Analysis Of Hip And Knee Stabilizers-Books Pdf

DOI Muscle strength analysis of hip and knee stabilizers
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Fisioter Pesq 2014 21 4 327 332, RESUMEN El S ndrome de Dolor Patelofemoral es uno de los aductores flexores extensores rotadores laterales y mediales del. trastornos m s frecuentes de la rodilla caracterizado por dolor cuadril fue evaluada por una c lula de carga ajustada Mujeres. anterior en la rodilla que se agrava con actividades que aumen con el S ndrome de Dolor Patelofemoral presentaron reducci n. tan las fuerzas compresivas en la articulaci n Alteraciones en el del 22 de la fuerza de los rotadores mediales de cuadril y un 23. est ndar de fuerza muscular del cu driceps o de la musculatura de los extensores de la rodilla cuando comparadas con las sin el. estabilizadora del cuadril podr an cambiar la biomec nica de la arti S ndrome de Dolor Patelofemoral No fueron observadas diferen. culaci n patelofemoral y as aumentar el estr s articular y exacer cias en la fuerza isom trica entre los otros grupos musculares. bar los s ntomas de dolor El objetivo de eso estudio fue relacionar Por lo tanto los datos de eso trabajo resaltan que la musculatura. la fuerza de la musculatura del cuadril y de la rodilla en mujeres quadricipital y los rotadores mediales del cuadril son los m s com. con y sin el s ndrome Eso estudio incluy 45 voluntarias 20 sin y prometidos en sujetos con el S ndrome de Dolor Patelofemoral. 25 con el S ndrome de Dolor Patelofemoral La fuerza isom trica Palabras clave S ndrome de Dolor Patelofemoral Articulaci n. de los m sculos flexores y extensores de la rodilla abductores da la Rodilla Fuerza Muscular. INTRODUCTION rotators hip flexors and extensors and knee extensors among. women with and without PFPS This study was developed. The Patellofemoral Pain Syndrome PFPS is charac on the hypothesis that individuals affected by PFPS present. terized by a pain in the frontal part of the knee which deficit of strength of all hip and knee stabilizing muscles. is worsened by activities that increase the compressive. strength of the patellofemoral joint PFJ 1 2 such as walk. ing running jumping squatting going up and down, stairs and long periods in sitting position3 The etiology METHODOLOGY. of PFPS is considered as being multifactorial and is still. not clearly defined however some author relate its ori This cross sectional study was developed in the campus of. gins to biomechanic and structural changes of the lower the Universidade de S o Paulo USP in Ribeir o Preto. limbs such as the anteversion of the femoral neck the S o Paulo We selected and assessed 45 sedentary female. increase of adduction and medial rotation of the hip and individuals who met the inclusion criteria for the PFPS. muscle imbalances of the hip and knee It is one of the group which were feeling pain of at least 3 cm in the Visual. most common injuries by overuse of the lower limbs and Analog Scale for Pain having at least three clinical signs. therefore prevalently present in physically active individ indicating PFPS among excessive subtalar pronation patel. uals although also affecting sedentary ones3 5 lar mobility alterations pain during palpation of the patel. The quadriceps and pelvic girdle muscles play an lar edges and pain during range of movement of the knee. important role in stabilizing the PFJ6 7 Variations of the and reporting pain in at least two functional activities9 14. quadriceps muscle strength may affect the contact and The exclusion criteria were previous PFPS treatment and. the stress of the joint s cartilage interfering with the history of osteomioarticular injuries in lower limbs n 25. pain pattern3 8 The same way a deficit of strength of the The Control Group consisted of healthy individuals with. stabilizing muscles of the pelvis such as the abductors out history of knee pain and of osteomioarticular injury in. and the lateral rotators of the hip may lead to adduc lower limbs n 20 All participants were informed about. tion and excessive medial rotation of the hip in closed the procedures performed during the research and signed. kinetic chain which may be changed by the patellar an Informed Consent Form. biomechanics increasing the contact between the lat All volunteers in PFPS group had unilateral pain con. eral femoral condyle and the lateral facet of the patella sidering the comparison was made by using the symp. triggering and exacerbating painful conditions6 9 10 Some tomatic lower limb for the PFPS group and the domi. authors showed that the weakness of hip muscles is a nant leg for the Control Group Table 1. common characteristic among women with PFPS11 12, However Piva et al 13 found no such differences among Muscle strength measurement. women with PFPS, Thus the objective of this study was to assess the strength The strength kilograms versus force kgf of the abduc. of the abductors adductors muscles external rotators medial tor and adductor muscles the external rotators medial. Oliveira et al Muscular strength and Patellofemoral Pain Syndrome. rotators hip and knee flexors and extensors was measured standard deviation median minimum and maximum. isometrically Figure 1 with the use of an adapted load value was performed. cell KRATOS The comparisons were made by orthogonal contrasts. Tem patients were selected for the analysis of the test using the linear model of mixed effects random and. retest reliability of the muscle strength Patients were posi fixed ones which is applies in the analysis of the data in. tioned15 and three repetitions were performed in order which the answers of an individual are grouped and the. to assess the strength of each tested muscle group This assumption of independence between the observations in. same procedure was performed within intervals of three a same group is inadequate16 For the use of this model. to seven days for the analysis of the test retest reliability it is necessary that its residues have normal distribution. During data collection the participants was oriented with zero mean and Constant variance The adjust of the. to perform the maximum voluntary contraction of the model was made by using the PROC MIXED procedure. tested muscles in its greatest mechanical advantage posi of the SAS software version 9 117. tion with its proper segment stability15 There were per For the reliability analysis the intraclass correlation. formed three attempts of five seconds of contraction each coefficient ICC was used whose values were interpreted. for each muscle group and a 30 second rest between as poorly reliable when lower than 0 40 good between. them Only the peak of force was considered for each 0 40 and 0 75 and excellent when higher than 0 7518. group The strength values were normalized by the mass. of each individual, Processing and statistical analysis of the data RESULTS.
Initially an exploratory analysis of the data through The test retest reliability was excellent for the abductors. measures of the central and dispersion positions mean adductors and hip flexors and knee flexors and extensors. 0 80 except for the hip medial rotators 0 36 which. Table 1 Anthropometric data of the volunteers in the group with and. without Patellofemoral Pain Syndrome was poor and good for the hip extensors and external. rotators 0 48 and 0 55 respectively as seen in Table 2. Age years Height cm, Mean SD Mean SD, Mean SD The knee extension and hip medial rotator muscles. With PFPS n 20 22 2 2 19 159 62 3 4 55 34 1 9 of women with PFPS presented a significant deficit of. Without PFPS n 25 23 36 4 13 154 62 2 8 57 36 2 1 strength when compared to those without PFPS Table 3. PFPS Patellofemoral Pain Syndrome SD standard deviation No significant differences were observed for the assessed. Figure 1 Position for the measurement of isometric muscle strength by the load cell of the abductor A adductor muscles B hip external rotators C. medial rotators D hip flexors E hip extensors F knee extensors G and knee flexors H. Fisioter Pesq 2014 21 4 327 332, muscle groups knee flexors abductors adductors exter However it was observed a relevant decrease of 22 in the. nal rotators hip flexors and extensors strength of abductors and 21 in hip external rotators of. women with PFPS The present results reveal a significant. deficit of 23 of the quadriceps strength of women with. PFPS though the hip external rotators do not present. DISCUSSION the same The weakness of the quadriceps already doc. umented19 22 23 26 evidences fundamental importance on. Our results showed that the knee muscle extension mus the pain referred to by the patient with PFPS once it is. cles is yet the most affected one in individuals with PFPS considered responsible for the poor patellar stabilization. when compared to asymptomatic ones Despite the cur The medial rotators are also weaker despite the poor. rent tendency of focusing on hip muscles during reha reliability probably due to the positioning and the diffi. bilitation1 11 our data reinforce that the specific work for culty of stabilization of the segment during the perfor. the quadriceps muscle must be performed since its weak mance of the test Figure 1D which would facilitate. ness represents a risk factor in the development of PFPS5 compensation through the use of other muscle groups. These findings may positively influence rehabilitation such as knee extensors and evertors. so that previously proposed programs are resumed19 23 The other assessed groups did not show significant. Witvrouw et al 24 stated that the decrease in the quad differences with 3 for the abductors and 6 for exter. riceps strength the main dynamic patella stabilizer in the nal rotators considerably lower values in comparison to. femoral trochlea is directly related to the incidence of those mentioned by Nakagawa et al 7 who found 18. femoropatellar pain and plays an important role in the for the abductors and 17 for the external rotators a. beginning of PFPS Therefore it is indicated as a risk factor difference which may be justified by the fact that this. which was also concluded in a recent systematic review5 study assessed not only women but also men with PFPS. Few studies compared the quadriceps strength among There are evidences that women with PFPS have. women with and without PFPS Bolgla et al 25 related the deficit of strength of the abductor muscle ranging from. strength of the quadriceps muscle among women with 12 to 17 medial rotator from 5 to 36 and hip exten. PFPS and control individuals and despite finding differ sor from 16 to 52 and no evidence for the deficit of. ence of 13 between such groups it was not significant hip adductors27 which is not consistent with our results. since we did not find evidence that hip abductors and. Table 2 Coefficient values of the intraclass correlation confidence external rotators are weaker among women with PFPS. interval and measure standard deviation of the muscle strength data. in test and retest, Despite a deficit in the strength of the abductor and. Muscle group Test retest 95 CI SD MSD, external rotator muscles among PFPS patients being. Hip abductors 0 81 0 42 0 95 0 05 0 04 expected the present results corroborate with the ones. Hip adductors 0 82 0 31 0 95 0 03 0 02 of Piva et al 13 who also did not find this difference. Hip flexors 0 79 0 33 0 94 0 05 0 04 Perhaps this could be explained by the fact that the. Hip extensors 0 48 0 13 0 85 0 08 0 09 position of test used in our study muscles such as the. Hip internal rotators 0 36 0 22 0 78 0 04 0 05, gluteus maximus and the gluteus medius which are.
Hip external rotators 0 55 0 1 0 86 0 02 0 02, Knee flexors 0 87 0 55 0 96 0 04 0 03. external rotators in standing position became medial. Knee extensors 0 78 0 35 0 95 0 14 0 11 rotators in sitting position precisely where such differ. SD standard deviation MSD measure standard deviation CI confidence interval ences were found. Table 3 Comparison of strength deficits between muscle groups in control groups and groups with Patellofemoral Pain Syndrome n 45 kgf. PFPS Control Estimative of difference 95 CI, Muscle group p value Deficit. Mean SD Mean SD between means LI LS, Hip abductors 0 20 0 06 0 21 0 05 0 001 0 982 0 031 0 032 3. Hip adductors 0 16 0 04 0 16 0 03 0 007 0 546 0 015 0 029 4. Hip flexors 0 25 0 06 0 24 0 05 0 007 0 684 0 027 0 041 4. Hip extensors 0 33 0 09 0 39 0 10 0 053 0 058 0 108 0 002 16. Hip medial rotator 0 15 0 05 0 19 0 04 0 028 0 03 0 054 0 003 22. Hip external rotator 0 13 0 04 0 13 0 03 0 012 0 229 0 031 0 008 6. Knee flexor 0 20 0 04 0 22 0 06 0 011 0 561 0 05 0 028 9. Knee extensor 0 50 0 19 0 66 0 20 0 165 0 003 0 271 0 059 23. p 0 05 PFPS Patellofemoral Pain Syndrome SD standard deviation CI confidence interval. Oliveira et al Muscular strength and Patellofemoral Pain Syndrome. Despite the low and not significant deficit found 6 strengthening in females with patellofemoral pain syndrome a. for external rotators and 3 for abductors these muscles randomized controlled clinical trial J Orthop Sports Phys Ther. 2010 40 11 736 42, should also be paid attention to since other studies11 28. 2 Coppack RJ Etherington J Wills AK The effects of exercise for the. observed significant deficits which could lead to altered prevention of overuse anterior knee pain a randomized controlled. biomechanic patterns and consequently to an exacerba trial Am J Sports Med 2011 39 8 940 8. tion of the painful condition 3 Davis IS Powers CM Patellofemoral pain syndrome proximal distal. Studies which assessed hip strength11 29 observed impor and local factors an international retreat J Orthop Sports Phys Ther. Position for the measurement of isometric muscle strength by the load cell of the abductor A adductor muscles B hip external rotators C medial rotators D hip flexors E hip extensors F knee extensors G and knee flexors H A E B F C G D H Table 1 Anthropometric data of the volunteers in the group with and without Patellofemoral Pain Syndrome Group Age years Mean SD

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