Journal of Rehabilitation Sciences & Research

Comparative Evaluation of Core and Knee Extensor Mechanism Muscle Activation Patterns in a Stair Stepping Task in Healthy Controls and Patellofemoral Pain Patients.

Document Type : Original Articles

Authors

Alireza Motealleh 1
Nader Maroufi 2
Javad Sarrafzadeh 2
Mohammad Ali Sanjari 3
Nasrin Salehi 4

1 Assistant professor of physiotherapy department, School of rehabilitation,Shiraz university of Medical Sciences, Shiraz, Iran

2 Associate Professor of physiotherapy department, School of rehabilitation, Iran university of Medical Sciences, Tehran, Iran

3 Assistant professor of physiotherapy department, School of rehabilitation, Iran university of Medical Sciences, Tehran, Iran

4 PhD student of physiotherapy, School of rehabilitation, Shiraz university of Medical Sciences, Shiraz, Iran

https://doi.org/10.30476/jrsr.2014.41061
Abstract
Background:Patellofemoral pain (PFP) is a common affliction and complex clinical entity. Deficit in neuromotor control of the core may be a remote contributing factor to the development of PFPS. Comparative evaluation of core and extensor mechanism muscle activation patterns between healthy group and patients involved by patellofemoral pain syndrome(PFPS) in a stair stepping task is the aim of this study.Methods: In this non-randomized interventional study fifteen males with PFPS and fifteen asymptomatic controls participated. Electromyographic(EMG) activity of Vastusmedialisobliquus(VMO),Vastuslateralis(VL), Gluteus medius (GMED),Gluteus Maximus (GMAX),Internal oblique (IO) and Erector spinae (ES) were recorded and EMG onsets were assessed in both stepping up (SU) and  down (SD).The time of foot contact determined by a foot switch.Results:During SU:Onset times of all muscles except, VL and ES in the controls were significantly less than PFPS group (P < 0.05). In PFPS group the temporal sequence ofES, VL and VMO were different from control groups.During SD:Onset times of all muscles except, GMAX and ES in the control group were significantly less than PFP group (P < 0.05). The sequence of muscle activity in both healthy and PFP groups were the same. Conclusion:Our findings are in line with previous researches about the effects of core on function and control of lower extremity. Activation patterns of core and vasti muscles are different between control and PFPS group during stair stepping task. Designing exercises to correct inappropriate timing of core muscles may have a role in management of PFPS and it needs more future researches.

Keywords

Electromyography
Patellofemoral pain
Stair Stepping
Core
  1. Cowan SM, Crossley KM. Does gender influence neuromotor control of the knee and hip? Journal of Electromyography and Kinesiology2009;19(2):276-82.
  2. Devereaux M, Lachmann S. Patello-femoral arthralgia in athletes attending a Sports Injury Clinic. British journal of sports medicine1984;18(1):18-21.
  3. Dye SF, Stabilu HU, Biedert RM, Vaupel GL. The mosaic of pathophysiologycausing patellofemoral pain: Therapeutic implications. Operative Techniques in Sports Medicine1999;7(2):46-54.
  4. Stensdotter A-K, Hodges P, Öhberg F, Häger-Ross C. Quadriceps EMG in open and closed kinetic chain tasks in women with patellofemoral pain. Journal of motor behavior2007;39(3):194-202.
  5. Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J. Delayed onset of electromyographic activity of vastusmedialisobliquus relative to vastuslateralis in subjects with patellofemoral pain syndrome. Archives of physical medicine and rehabilitation2001;82(2):183-9.
  6. Powers CM. Rehabilitation of patellofemoral joint disorders: a critical review. Journal of Orthopaedic& Sports Physical Therapy1998;28(5):345-54.
  7. Cowan SM, Crossley KM, Bennell KL. Altered hip and trunk muscle function in individuals with patellofemoral pain. British journal of sports medicine2009;43(8):584-8.
  8. Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. Core stability measures as risk factors for lower extremity injury in athletes. Medicine & Science in Sports & Exercise2004;36(6):926-34.
  9. Mascal CL, Landel R, Powers C. Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports. Journal of Orthopaedic& Sports Physical Therapy2003;33(11):647-60.
  10. Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy1997;77(2):132-42.
  11. Ireland ML. The female ACL: why is it more prone to injury? Orthopedic Clinics of North America2002;33(4):637-51.
  12. Tanaka K, Miyashita K, Urabe Y, Ijiri T, Takemoto Y, Ishii Y, et al. Characteristics of trunk lean motion during walking in patients with symptomatic knee osteoarthritis. The Knee2008;15(2):134-8.
  13. Zazulak B, Cholewicki J, Reeves NP. Neuromuscular control of trunk stability: clinical implications for sports injury prevention. Journal of the American Academy of Orthopaedic Surgeons2008;16(9):497-505.
  14. Brindle TJ, Mattacola C, McCrory J. Electromyographic changes in the gluteus medius during stair ascent and descent in subjects with anterior knee pain. Knee Surgery, Sports Traumatology, Arthroscopy2003;11(4):244-51.
  15. Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG. Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Archives of physical medicine and rehabilitation2006;87(11):1428-35.
  16. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. The American journal of sports medicine2002;30(3):447-56.
  17. Vack HJ, Nielsen DH, Shurp DG. Kinetic patterns during stair ascent in patients with transtibial amputations using three different prostheses. JPO: Journal of Prosthetics and Orthotics1999;11(3):57-62.
  18. Brechter JH, Powers CM. Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait & posture2002;16(2):115-23.
  19. Brask B, Lueke RH, Soderberg GL. Electromyographic analysis of selected muscles during the lateral step-up exercise. Physical Therapy1984;64(3):324-9.
  20. De Luca CJ. The use of surface electromyography in biomechanics. Journal of applied biomechanics1997;13:135-63.
  21. Cowan SM, Hodges PW, Bennell KL. Anticipatory activity of vastuslateralis and vastusmedialisobliquus occurs simultaneously in voluntary heel and toe raises. Physical Therapy in Sport2001;2(2):71-9.
  22. Kendal FP, McCreary EK. Muscle testing and function with Posture and Pain. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005
  23. Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine2003;28(14):1593-600.
  24. Marshall P, Murphy B. The validity and reliability of surface EMG to assess the neuromuscular response of the abdominal muscles to rapid limb movement. Journal of Electromyography and Kinesiology2003;13(5):477-89.
  25. Hodges P, Cresswell A, Thorstensson A. Preparatory trunk motion accompanies rapid upper limb movement. Experimental Brain Research1999;124(1):69-79.
  26. Salsich GB, Brechter JH, Powers CM. Lower extremity kinetics during stair ambulation in patients with and without patellofemoral pain. Clinical Biomechanics2001;16(10):906-12.
  27. Grenholm A, Stensdotter A-K, Häger-Ross C. Kinematic analyses during stair descent in young women with patellofemoral pain. Clinical Biomechanics2009;24(1):88-94.
  28. Peter Konard. The ABC of EMG: a practical introduction to Kinsiological Electromyography.1 st ed. Noraxon INC: 2005,42.
  29. Lyons K, Perry J, Gronley JK, Barnes L, Antonelli D. Timing and relative intensity of hip extensor and abductor muscle action during level and stair ambulation An EMG study. Physical Therapy1983;63(10):1597-605.
  30. Soderberg GL, Dostal WF. Electromyographic study of three parts of the gluteus medius muscle during functional activities. Physical therapy1978;58(6):691-6.
  31. Cresswell A, Oddsson L, Thorstensson A. The influence of sudden perturbations on trunk muscle activity and intra-abdominal pressure while standing. Experimental Brain Research1994;98(2):336-41.
  32. Richardson CA, Hodges PW, Hides J. Theraputic exercise for lumbopelvic stabilization. A Motor Control Approach for theTreatmentandPrevention of Low Back Pain. 2nd ed. Philadelphia: Churchill Livingstone; 2004.
  33. Boyling JD, Jull GA, Twomey LT. Grieve's Modern Manual Therapy.The vertebral column. 3rd ed. Churchill Livingstone; 2004
  34. Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Archives of physical medicine and rehabilitation1999;80(9):1005-12.
  35. Gibson J, McCarron T. Feedforward muscle activity: an investigation into the onset and activity of internal oblique during two functional reaching tasks. Journal of Bodywork and Movement Therapies2004;8(2):104-13.
  36. Tsao H, Hodges PW. Immediate changes in feedforward postural adjustments following voluntary motor training. Experimental brain research2007;181(4):537-46.
  37. Aruin AS, Latash ML. Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements. Experimental Brain Research1995;103(2):323-32.
  38. 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. Journal of Orthopaedic Research2003;21(3):553-8.
  39. Karst GM, Willett GM. Onset timing of electromyographic activity in the vastusmedialis oblique and vastuslateralis muscles in subjects with and without patellofemoral pain syndrome. Physical Therapy1995;75(9):813-23.
  40. Grabiner M, Koh T, Miller G. Fatigue rates of vastusmedialis oblique and vastuslateralis during static and dynamic knee extension. Journal of orthopaedic research1991;9(3):391-7.
  41. Lee PJ, Rogers EL, Granata KP. Active trunk stiffness increases with co-contraction. Journal of Electromyography and Kinesiology2006;16(1):51-7.
  42. Kavcic N, Grenier S, McGill SM. Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine2004;29(11):1254-65.
  43. Santos E, Bessa S, Lins C, Marinho A, Silva K, Brasileiro J. Electromyographic activity of vastusmedialisobliquus and vastuslateralis muscles during functional activities in subjects with patellofemoral pain syndrome. Brazilian Journal of Physical Therapy2008;12(4):304-10.
  44. Souza RB. The Influence of Hip and Femur Kinematics on Patellofemoral Joint Dysfunction: ProQuest; 2008.
  45. Matre DA, Sinkjaer T, Svensson P, Arendt-Nielsen L. Experimental muscle pain increases the human stretch reflex. Pain1998;75(2):331-9.
  46. Derbyshire SW, Jones AK, Gyulai F, Clark S, Townsend D, Firestone LL. Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain1997;73(3):431-45.
  47. Barrack Lephart SM, Fu FH. proprioception and neuromuscular control in joint stability. Human Kinetics; 2000.
  48. Gill KP, Callaghan MJ. The measurement of lumbar proprioception in individuals with and without low back pain. Spine1998;23(3):371-7.
  49. Myer GD, Chu DA, Brent JL, Hewett TE. Trunk and hip control neuromuscular training for the prevention of knee joint injury. Clinics in sports medicine2008;27(3):425-48.
  50. Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. Journal of orthopaedic& sports physical therapy2005;35(12):793-801.
  51. Nadeau S, McFadyen BJ, Malouin F. Frontal and agital plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking? Clinical Biomechanics2003;18(10):950-9.
Journal of Rehabilitation Sciences & Research
Volume 1, Issue 4 - Serial Number 4
8
Autumn 2014
Pages 84-91

Home

Guide for Authors

Submit Manuscript

Guide for Reviewers

Contact Us