Psychological factors, not biomechanical, correlate with anterior knee pain
Two articles on PainSci cite Piva 2009: (1) The Complete Guide to Patellofemoral Pain Syndrome (2) Patellofemoral Tracking Syndrome
PainSci summary of Piva 2009: ?This page is one of thousands in the PainScience.com 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 at the bottom of the page, as often as possible.
Researchers tested 74 patients diagnosed with patellofemoral pain syndrome for the presence of several factor that are commonly suspected to be associated with that condition, the “usual biomechanical suspects”: muscle weakness and tightness, coordination, and postural and anatomical abnormalities. They also considered psychological factors, which is quite unusual for a study of knee pain.
They found no correlation at all with between the biomechanical factors and chronic anterior knee pain.
Interestingly, the researchers did find that “psychologic factors [anxiety and fear-avoidance beliefs about work and physical activity] were the only associates of function and pain in patients with PFPS.”
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.
OBJECTIVES: To explore whether impairment of muscle strength, soft tissue length, movement control, postural and biomechanic alterations, and psychologic factors are associated with physical function and pain in patients with patellofemoral pain syndrome (PFPS).
DESIGN: Cross-sectional study.
SETTING: Rehabilitation outpatient.
PARTICIPANTS: Seventy-four patients diagnosed with PFPS.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Measurements were self-reported function and pain; strength of quadriceps, hip abduction, and hip external rotation; length of hamstrings, quadriceps, plantar flexors, iliotibial band/tensor fasciae latae complex, and lateral retinaculum; foot pronation; Q-angle; tibial torsion; visual observation of quality of movement during a lateral step-down task; anxiety; and fear-avoidance beliefs.
RESULTS: After controlling for age and sex, anxiety and fear-avoidance beliefs about work and physical activity were associated with function, while only fear-avoidance beliefs about work and physical activity were associated with pain.
CONCLUSIONS: Psychologic factors were the only associates of function and pain in patients with PFPS. Factors related to physical impairments did not associate to function or pain. Our results should be validated in other samples of patients with PFPS. Further studies should determine the role of other psychologic factors, and how they relate to anxiety and fear-avoidance beliefs in these patients.
related content
- “The reliability and validity of assessing medio-lateral patellar position: a systematic review,” Toby O Smith, Leigh Davies, and Simon T Donell, Manual Therapy, 2009.
- “Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome,” N J MacIntyre, N A Hill, R A Fellows, R E Ellis, and D R Wilson, Journal of Bone & Joint Surgery, 2006.
- “Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function,” Gabriel Peixoto Leão Almeida, Ana Paula de Moura Campos Carvalho E Silva, Fábio Jorge Renovato França, Maurício Oliveira Magalhães, Thomaz Nogueira Burke, and Amélia Pasqual Marques, Rev Bras Ortop, 2016.
- “Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: An upright, weightbearing MRI study,” Saikat Pal, Thor F Besier, Gary S Beaupre, Michael Fredericson, Scott L Delp, and Garry E Gold, Journal of Orthopaedic Research, 2013.
- “Patello-femoral tracking in the weight-bearing knee: a study of asymptomatic volunteers utilising dynamic magnetic resonance imaging: a preliminary report,” S Tennant, A Williams, V Vedi, C Kinmont, W Gedroyc, and D M Hunt, Knee Surgery, Sports Traumatology, Arthroscopy, 2001.
- “The role of patellar alignment and tracking in vivo: the potential mechanism of patellofemoral pain syndrome,” Chen-Yi Song, Jiu-Jenq Lin, Mei-Hwa Jan, and Yeong-Fwu Lin, Physical Therapy in Sport, 2011.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.
- Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Nakale 2018 Foot Ankle Int.
- No Added Benefit of Combining Dry Needling With Guideline-Based Physical Therapy When Managing Chronic Neck Pain: A Randomized Controlled Trial. Stieven 2020 J Orthop Sports Phys Ther.
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.