Document Type : Original Articles
1 Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2 Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
3 MSc. of Physical Therapy, Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Background: Delayed activation of medial hamstrings (MH) relative to lateral hamstrings (LH) could lead to external tibial rotation. It is a long-held belief that altered force sharing between the vastus medialis obliquus (VMO) and the vastus lateralis (VL) plays a main role in the pathophysiology of PFP. It was presumed that patients with patellofemoral pain (PFP) exhibit altered muscular activation pattern of MH and LH during functional tasks. The aim of this study was to compare the electromyography (EMG) activity of hamstrings and quadriceps in patients with PFP and healthy subjects during stair descent.
Methods: Twenty-four women with PFP and 24 non-symptomatic individuals, aged 18-40 years, were recruited through convenience sampling and participated in this observational cross-sectional study. The EMG activity of MH and LH, VMO and VL was recorded during stair descent. The main outcome measures were onset latency and amplitude of muscle activity relative to the moment of foot contact measured by foot switch. Groups were compared by Mann-Whitney test. Repeatability of task was evaluated using intra-class correlation coefficient (ICC).
Results: A statistically significant difference was seen in the onset of hamstring heads between groups (p=0.014). The LH activated before the MH in the PFP group. Normalized muscular activity was significantly reduced for VMO (p=0.002), VL (p=0.045), and LH (p=0.019) in patients with PFP compared to the control group.
Conclusions: Differences in temporal activation patterns of LH and MH may result in a lack of rotational knee stabilization and lead to increased patellofemoral joint pressure. Earlier activation of LH rotates the tibia externally and likely produces lateral patellar tracking.
- Sinaei E, Foroozantabar V, Kordi Yoosefinejad A, Sobhani S, Motealleh A. Electromyographic comparison of vastus medialis obliquus facilitatory versus vastus lateralis inhibitory kinesio taping in athletes with patellofemoral pain: A randomized clinical trial. J Bodyw Mov Ther.2021; 28: 157-63.
- Behrangrad S, Abbaszadeh Amirdehi M, Kordi Yoosefinejad A, Esmaeilnejadganji SM. Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial. Acupunc. Med. 2020; 38(6): 371-9.
- Samani M, Kordi Yoosefinejad A, Campos MH, de Lira CAB, Motealleh A. Changes in knee vastii muscle activity in women with patellofemoral pain syndrome during the menstrual cycle. PM&R. 2020; 12(4): 382-390.
- Ebrahimi N, Rojhani-Shirazi Z, Kordi Yooseinejad A, Nami M. The effects of virtual reality training on clinical indices and brain mapping of women with patellofemoral pain: a randomized clinical trial. BMC Musculoskelet. Disord. 2021; 22(1): 1-10.
- Witvrouw E, Werner S, Mikkelsen C, Van Tiggelen D, Vanden Berghe L, Cerulli G. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg. Sports Traumatol. Arthrosc. 2005; 13(2): 122-30.
- Powers CM, Perry J, Hsu A, Hislop HJ. Are patellofemoral pain and quadriceps femoris muscle torque associated with locomotor function? Phys. Ther. 1997; 77(10): 1063-75.
- Cowan SM, Bennell KM,Hodges PW, Crossley KM, McConnell J. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Arch. Phys. Med. Rehabil. 2001; 82(2): 183-89.
- Rutherford DJ, Hubley-Kozey CH, Stanish WD, Dunbar MJ. Neuromuscular alterations exist with knee osteoarthritis presence and severity despite walking velocity similarities. Clin. Biomech. 2011; 26(4): 377-83.
- KurikiHU, de Azevedo FM ,de faria Negrao Filho R, Alves N. Onset of quadriceps activation and torque variation during stair ascent in individuals with patellofemoral pain. ConScientiae Saúde. 2012;11(4):642-50.
- Cavazzuti L, Merlo A, Orlandi F, Campanini I. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Gait & posture. 2010; 32(3): 290-5.
- Van Tiggelen D, Cowan S, Coorevits P, Duvigneaud N, Witvrouw E. Delayed vastus medialis obliquus to vastus lateralis onset timing contributes to the development of patellofemoral pain in previously healthy men a prospective study. Am. J. Sports Med. 2009; 37(6): 1099-105.
- SheehyP, Burdett RG, Irrgang JJ, VanSwearingen J. An electromyographic study of vastus medialis oblique and vastus lateralis activity while ascending and descending steps. J. Orthop. Sports Phys. Ther. 1998; 27(6): 423-29.
- MohrKJ, Kvitne RS, Pink MM, Fideler B, Perryet J. Electromyography of the quadriceps in patellofemoral pain with patellar subluxation. Clin. Orthop. Relat. Res. 2003; 415: 261-71.
- Chester R, Smith TO, Dixon J, Wood S, Song F. The relative timing of VMO and VL in the aetiology of anterior knee pain: a systematic review and meta-analysis. BMC musculoskelet. Disord. 2008; 9(1): 64.
- Elias JJ, Kirkpatrick MS, Saranathan A, Mani S, Smith LG, Tanaka MJ. Hamstrings loading contributes to lateral patellofemoral malalignment and elevated cartilage pressures: an in vitro study. Clinic. Biomech. 2011; 26(8): 841-46.
- Sheehan FT, Derasari A, Brindle TJ, Alter KE. Understanding patellofemoral pain with maltracking in the presence of joint laxity: complete 3D in vivo patellofemoral and tibiofemoral kinematics. J. Orthop. Res. 2009; 27(5): 561-70.
- Li G, Gill TJ, DeFrate LE, Zayontz S, Glatt V, Zarins B. Biomechanical consequences of PCL deficiency in the knee under simulated muscle loads—an in vitro experimental study. J. Orthop. Res. 2002; 20(4): 887-92.
- Kumagai M, Mizuno Y, Mattessich SM, Elias JJ, Cosgarea AJ, Chao EY. Posterior cruciate ligament rupture alters in vitro knee kinematics. Clin. Orthop. Relat. Res. 2002; 395: 241-48.
- Dieter BP, McGowan CP, Stoll SK, Vella CA. Muscle activation patterns and patellofemoral pain in cyclists. Med Sci Sports Exerc. 2014; 46(4): 753-61.
- Patil S, Dixon J, White LC, Jones AP, Hui ACW. An electromyographic exploratory study comparing the difference in the onset of hamstring and quadriceps contraction in patients with anterior knee pain. The Knee. 2011; 18(5): 329-32.
- CowanSM, Hodges PW, Bennell KL, Crossley KM. Altered vastii recruitment when people with patellofemoral pain syndrome complete a postural task. Arch. Phys. Med. Rehabil. 2002; 83(7): 989-95.
- Jordan K, Challis JH, Newell KM. Walking speed influences on gait cycle variability. Gait & posture. 2007; 26(1): 128-34.
- Aminaka N, Pietrosimone BG, Armstrong CW, Meszaros A, Gribble PA. Patellofemoral pain syndrome alters neuromuscular control and kinetics during stair ambulation. J Electromyogr Kinesiol. 2011; 21(4): 645-51.
- Stratford P, Heuff J. The validation of outcome measures in patients fulfilling the clinical diagnostic criteria of chondromalacia patella. in Annual Congress of the Canadian Physiotherapy Association, June, Halifax, Novia Scotia. 1982.
- Negahban H, Pouretezad M, Sohani SM, Mazaheri M, Salavati M, Mohammadi F. Validation of the Persian version of Functional Index Questionnaire (FIQ) and Modified FIQ in patients with patellofemoral pain syndrome. Physiother. Theory Pract. 2013; 29(7): 521-30.
- Motealleh A, Maroufi N, Sarrafzadeh J, Sanjari MA, Salehi N. Comparative Evaluation of Core and Knee Extensor Mechanism Muscle Activation Patterns in a Stair Stepping Task in Healthy Controls and Patellofemoral Pain Patients. JRSR. 2015; 1(4): 84-91.
- 27. Stefanyshyn D, Stergiou P, Lun VMY, Meeuwisse WH, Nigg BM. Knee joint moments and patellofemoral pain syndrome in runners part i: a case control study; part ii: a prospective cohort study. in Fourth Symposium on Footwear Biomechanics. Canmore, Alberta, Canada. 1999.
- 28. Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Arch. Phys. Med. Rehabil. 2006; 87(11): 1428-35.
- 29. Briani RV, de Oliveira Silva D, Pazzinatto MF, Ferreira AS, Ferrari D, de Azevedo Delayed onset of electromyographic activity of the vastus medialis relative to the vastus lateralis may be related to physical activity levels in females with patellofemoral pain. J Electromyogr. Kinesiol. 2016; 26: 137-42.
30 Santos E, Santos EP, Bessa SNF, Lins CAA, Marinho AMF, Silva KMP, Brasileiro JS. Electromyographic activity of vastus medialis obliquus and vastus lateralis muscles during functional activities in subjects with patellofemoral pain syndrome. Braz. J. Phys. Ther. 2008; 12(4): 304-10.
- 31. Shultz SJ, Perrin DH, Adams JM, Arnold BL, Gansneder BM, Granata Assessment of neuromuscular response characteristics at the knee following a functional perturbation. J Electromyogr Kinesiol. 2000; 10(3): 159-70.
- 32. Liebensteiner M, Szubski C, Raschner C, Krismer M, Burtscher M , Platzer HP, et al. Frontal plane leg alignment and muscular activity during maximum eccentric contractions in individuals with and without patellofemoral pain syndrome. The Knee. 2008; 15(3): 180-86.