Document Type : Original Articles
Authors
1 Department of Corrective Exercises and Sport Injury, Faculty of Physical Education and Sport Sciences, Bu Ali Sina University, Hamedan, Iran.
2 Department of Corrective Exercises and Sport Injury, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran.
3 Department of Psychology, Faculty of Psychology, Bu Ali Sina University, Hamedan, Iran.
Abstract
Background: Patellofemoral pain syndrome (PFPS) has been reported as one of the most common reasons for knee pain which accounts for about 25 % to 40% of all knee injuries. These group of patients have Postural Balance disorder that can cause pain, dysfunction in proprioception and decreased muscle strength. We aimed to study a twelve-week neurofeedback training (NFT) on pain, proprioception, strength and Postural Balance in PFPS patients.
Methods: This randomized controlled trial included 32 patients with PFPS who were randomly allocated into experimental (n = 16) and control (n = 16) groups. The variables measured included pain, knee proprioception 20 and 60 degrees, muscular strength quadriceps and hip abductors and Postural Balance that were evaluated before and after intervention. The experimental group performed NFT during twelve weeks, three times per week and 30 min per session, while the control group did not receive any treatment during this time. Covariance statistical method was used for data analysis.
Results: The results of data analysis showed that the experimental group had significant improvement in postural balance index anterior-posterior (p<0.004), overall stability (p<0.003), knee proprioception 20 degrees (p<0.004), knee proprioception 60 degrees (p<0.004), quadriceps muscle strength (p<0.007) and pain reduction (p<0.001). However, postural balance index medial-lateral (p>0.140) and hip abductor muscle strength (p>0.164) had no improvement after twelve weeks of NFT.
Conclusions: The NFT through thalamus inhibition led to reduced pain and improved sensory pathways, sensory integrity, increased attention and cognition. They also led to improved proprioception, Postural Balance, overall stability and quadriceps muscle strength. It is suggested that future studies examine the impact of long-term and short-term NFT on the variables of the present study.
Keywords
on knee function and pain in athletes with patellofemoral pain
syndrome. J of bodywo and mo th. 2017, 1;21(4):835-9.
2. Devereaux MD, Lachmann SM. Patello-femoral arthralgia in
athletes attending a Sports Injury Clinic. Br j of sports med.
1984,1;18(1):18-21.
3. Chiba R, Takakusaki K, Ota J, Yozu A, Haga N. Human upright
posture control models based on multisensory inputs; in fast and
slow dynamics. Neu res. 2016,1;104:96-104.
4. Carvalho AP et al. Dynamic postural stability and muscle strength
in patellofemoral pain: Is there a correlation?. The Knee. 2016,
1;23(4):616-21.
5. Negahban H et al. The effects of muscle fatigue on dynamic
standing balance in people with and without patellofemoral pain
syndrome. Ga & pos. 2013, 1;37(3):336-9.
6. Ali yalfani, Zahra raeisi. investigate changes distribution of force
and center of pressure fluctuations in women with and without
patellofemoral pain syndrome in static condition. J Sports Med.
2015, 7;22(1):57-68.
7. Zeinalzadeh A et al. Effects of vision and cognitive load on static
postural control in subjects with and without patellofemoral pain
syndrome. Physio theo and prac. 2018, 3;34(4):276-85.
8. Akseki D, Akkaya G, Erduran M, Pinar H. Proprioception of
the knee joint in patellofemoral pain syndrome. Ac Orth Tra Tu.
2008, 1;42(5):316-21.
9. Röijezon U, Clark NC, Treleaven J. Proprioception in
musculoskeletal rehabilitation. Part 1: Basic science and
principles of assessment and clinical interventions. Man ther.
2015, 1;20(3):368-77.
10. Lederman E. Neuromuscular rehabilitation in manual and physical
therapy. Edinburgh: Churchill Livingstone. 2010; pp.178.
11. Hammond DC. What is neurofeedback?. J of neur. 2007,
29;10(4):25-36.
12. Christopher deCharms R et al. Control over brain activation and
pain learned by using real-time functional MRI. J of Pro of the
Nati Acaof Scie. 2005, 20;102(51): 626-631.
13. Kayıran S, Dursun E, Dursun N, Ermutlu N, Karamürsel S.
Neurofeedback intervention in fibromyalgia syndrome; a
randomized, controlled, rater blind clinical trial. App psyc and
biofeed. 2010, 1;35(4):293-302.
14. Azarpaikan A, Torbati HT. Effect of somatosensory and
neurofeedback training on balance in older healthy adults:
a preliminary investigation. Agi clin and expe rese. 2018,
1;30(7):745-53.
15. Domenech J, Sanchis-Alfonso V, López L, Espejo B. Influence
of kinesiophobia and catastrophizing on pain and disability in
anterior knee pain patients. Knee Surg. 2013, 1;21(7):1562-8.
16. Naserpour M, Goharpey S, Saki A, Mohammadi Z.
Dynamic postural control during step down task in patients
with patellofemoral pain syndrome. J of phy ther scie.
2018;30(10):1289-92.
17. Roper JL et al. The effects of gait retraining in runners with
patellofemoral pain: A randomized trial. Cli biome. 2016,
1;35:14-22.
18. Liao TC, Powers CM. Tibiofemoral kinematics in the transverse
and frontal planes influence the location and magnitude of peak
patella cartilage stress: An investigation of runners with and
without patellofemoral pain. Clil Biome. 2019, 1;62:72-8.
19. Yakut E, Bayar B, Meriç A, Bayar K, Yakut Y. Reliability and
validity of reverse visual analog scale (right to left) in different
intensity of pain. The Pa Cli. 2003, 1;15(1):1-6.
20. Rajabi R, Karimizadeh Ardakani M. determine the reliability
of Iranian new tool measure for ankle proprioception. J of sport
med. 2013;12 :43-52.
21. Callaghan MJ, Selfe J, McHenry A, Oldham JA. Effects of patellar
taping on knee joint proprioception in patients with patellofemoral
pain syndrome. Man ther. 2008, 1;13(3):192-9.
22. Salahzadeh Z et al. Proprioception in subjects with patellofemoral
pain syndrome: using the sense of force accuracy. J of Musc Pai.
2013, 1;21(4):341-9.
23. Rinne MB, Pasanen ME, Miilunpalo SI, Oja P. Test-retest
reproducibility and inter-rater reliability of a motor skill test
battery for adults. Inter J of Sports Med. 200,1;22(03):192-200.
24. Rome K, Dixon J, Gray M, Woodley R. Evaluation of static and
dynamic postural stability in established rheumatoid arthritis:
exploratory study. Cli Biome. 2009, 1;24(6):524-6.
25. Dunn JC, Iversen MD. Interrater reliability of knee muscle forces
obtained by hand-held dynamometer from elderly subjects with
degenerative back pain. J of Geri Phy Ther. 2003, 1;26(3):23.
26. Ali yalfani, Zahra raeisi. Comparsion of lower limb strength, Q
angle, varus and valgus knee musclein women with patellofemoral
pain syndrome. Cont Rese in sport manag. 2013, 2;23(4):37-12 7. 27. Goto S, Aminaka N, Gribble PA. Lower-Extremity Muscle
Activity, Kinematics, and Dynamic Postural Control in Individuals
With Patellofemoral Pain. Journal of sport rehabilitation. 2018,
1;27(6):505-12.
28. Mahdieh Rahmanian, Zahra Sarvarian, Maryam Zamani. Compare
the Effectiveness of Music Therapy and Neurofeedback on
Psychosomatic Disorder Pain Relief. Neurop .2016, 1;24(6):52-23.
29. Hamid s, Gholizadeh z, Maryame e. Effectiveness of Neurofeedback
on Risky Decision Making. Neurop.201,8;26(4): 109-120.
30. Cohen J. Set correlation and multivariate methods. Statistical
Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale,
NJ: Lawrence Erlbaum Associates, Inc. 1988:467-530.
31. Lipinski CL, Donovan L, McLoughlin TJ, Armstrong CW, Norte
GE. Surface electromyography of the forearm musculature during
an overhead throwing rehabilitation progression program. Physi
Ther in Sport. 2018, 1;33:109-16.
32. Marzbani H, Marateb HR, Mansourian M. Neurofeedback: a
comprehensive review on system design, methodology and clinical
applications. Ba and cli neuro. 201,6;7(2):143.
33. Jensen MP, Grierson C, Tracy-Smith V, Bacigalupi SC, Othmer
S. Neurofeedback treatment for pain associated with complex
regional pain syndrome type I. J of Neurothe. 2007, 20;11(1):45-53.
34. Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human
brain mechanisms of pain perception and regulation in health
and disease. Euro j of pai. 200,5;9(4):463-.
35. Enriquez-Geppert S, Huster RJ, Ros T, Wood G. Neurofeedback.
InTheory-driven approaches to cognitive enhancement 2017 (pp.
147-164). Springer, Cham.
36. Nan W, Qu X, Yang L, Wan F, Hu Y, Mou P, et al., editors. Beta/
theta neurofeedback training effects in physical balance of healthy
people. World Congress on Medical Physics and Biomedical
Engineering, June 7-12, 2015, Toronto, Canada; 2015: Springer.
37. Shahrbanian S, Hashemi A, Hemayattalab R. The comparison
of the effects of physical activity and neurofeedback training on
postural stability and risk of fall in elderly women: A single-blind
randomized controlled trial. Physioth theo and prac. 2019, 21:1-8.
38. Sohila Shahbazi, Ali Heyrani, Moslem Rahmani. Effects
of Sensory-Motor Integration Activities in Combination
With Feedback on Balance in Children With Developmental
Coordination Disorder. J of Exce Chil. 2017, 17(1): 97-110.
39. Frank C, Page P, Lardner R. Assessment and treatment of muscle
imbalance: the Janda approach. Human kinetics; 2009. pp.44.
40. Lee SP, Souza RB, Powers CM. The influence of hip abductor
muscle performance on dynamic postural stability in females with
patellofemoral pain. Gai & pos. 2012 , 1;36(3):425-9.
41. Hamid S, Ggolizadeh Z, Maryam E. Effectiveness of
Neurofeedback on Risky Decision Making. Neurop .2017, 3(10):
109-120.
42. Razieh Hojabrnia1, Shahzad Tahmasebi Boroujeni. Improvement
of Visual and Spatial Memory as a Result of Neurofeedback with
an Emphasis on Decreasing Beta Wave and Increasing SMR Wave.
Neurop. 2018, 9(12 ): 12 9-140.
43. Azarpaikan A, Taheri-Torbati HR, Sohrabi M. Effect of
Neurofeedback Training on Postural Stability and Fall Risk
in Patients with Parkinson’s Disease. J of Isfa Med Sch. 2014,
22;31(270).
44. Arvidsson I, Eriksson E, Knutsson E, Arner S. Reduction of pain
inhibition on voluntary muscle activation by epidural analgesia.
Ortho. 1986, 1;9(10):1415-9.
45. A.Tadeu,C et al. Correlation between isometric muscle strength,
pain, function and kinesiophobia in females with patellofemoral
pain. Gai & Pos. 2019, 73;8(1)326-327.
46. Page P. Sensorimotor training: A “global” approach for balance
training. J of bodyw and move therapie. 2006, 1;10(1):77-84.
)