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Gait retraining effect on hip kinematics, pain and function in patellofemoral pain

PainSci » bibliography » Noehren et al 2010
Tags: patellar pain, biomechanics, exercise, knee, arthritis, aging, pain problems, leg, limbs, overuse injury, injury, running, self-treatment, treatment, etiology, pro

One article on PainSci cites Noehren 2010: The Complete Guide to Patellofemoral Pain Syndrome

PainSci commentary on Noehren 2010: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a study of whether gait retraining would improve hip mechanics and reduce patellofemoral pain syndrome. It was an attempt to test a popular theory that hip weakness is a root cause of knee problems (see Does Hip Strengthening Work for IT Band Syndrome?).

Ten subjects ran on a treadmill and were given feedback on their stance and hip adduction while on the treadmill. The authors present a positive conclusion: “Gait retraining in individuals with PFPS resulted in a significant improvement of hip mechanics that was associated with a reduction in pain and improvements in function.”

Unfortunately, this is a tiny study of things that are difficult to measure, and the language is the abstract is suspiciously vague, acknowledging that improvements in two of three “variables of interest” were not found to be statistically significant … and they don’t even mention the third! Although intriguing, this evidence cannot yet be taken seriously.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Background Patellofemoral pain syndrome (PFPS) is the most common overuse injury in runners. Recent research suggests that hip mechanics play a role in the development of this syndrome. Currently, there are no treatments that directly address the atypical mechanics associated with this injury.

OBJECTIVE: The purpose of this study was to determine whether gait retraining using real-time feedback improves hip mechanics and reduces pain in subjects with PFPS.

METHODS: Ten runners with PFPS participated in this study. Real-time kinematic feedback of hip adduction (HADD) during stance was provided to the subjects as they ran on a treadmill. Subjects completed a total of eight training sessions. Feedback was gradually removed over the last four sessions. Variables of interest included peak HADD, hip internal rotation (HIR), contralateral pelvic drop, as well as pain on a verbal analogue scale and the lower-extremity function index. We also assessed HADD, HIR and contralateral pelvic drop during a single leg squat. Comparisons of variables of interest were made between the initial, final and 1-month follow-up visit. Results Following the gait retraining, there was a significant reduction in HADD and contralateral pelvic drop while running. Although not statistically significant, HIR decreased by 23% following gait retraining. The 18% reduction in HADD during a single leg squat was very close to significant. There were also significant improvements in pain and function. Subjects were able to maintain their improvements in running mechanics, pain and function at a 1-month follow-up. An unexpected benefit of the retraining was an 18% and 20% reduction in instantaneous and average vertical load rates, respectively.

CONCLUSIONS: Gait retraining in individuals with PFPS resulted in a significant improvement of hip mechanics that was associated with a reduction in pain and improvements in function. These results suggest that interventions for PFPS should focus on addressing the underlying mechanics associated with this injury. The reduction in vertical load rates may be protective for the knee and reduce the risk for other running-related injuries.

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