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Psychological factors, not biomechanical, correlate with anterior knee pain

PainSci » bibliography » Piva et al 2009
Tags: patellar pain, mind, knee, biomechanics, etiology, IT band pain, arthritis, aging, pain problems, leg, limbs, overuse injury, injury, running, exercise, self-treatment, treatment, pro, tendinosis

Two articles on PainSci cite Piva 2009: 1. The Complete Guide to Patellofemoral Pain Syndrome2. Patellofemoral Tracking Syndrome

PainSci commentary on Piva 2009: ?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.

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.”

~ 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.

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.

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