The interaction of hip and foot biomechanics in the presentation and management of patellofemoral pain

Abstract

Background

Patellofemoral pain (PFP) is a common musculoskeletal complaint with inadequate long term outcomes. We aimed to review current evidence relating to tailored interventions, address knowledge gaps concerning how tailoring should best be delivered and establish whether such interventions are feasible. This thesis investigated whether the interaction of hip and foot biomechanics better explains PFP presentation and management, and could be used to inform feasibility studies of delivering tailored interventions for individuals with this recalcitrant condition. Methods

Two systematic reviews with meta-analysis identified predictors of conservative management outcomes and the effects and mechanisms of proximal rehabilitation interventions. A reliability study tested a battery of clinical measures, designed to identify biomechanical deficits common in individuals with PFP. An observational study of individuals with PFP investigated possible biomechanical mechanisms of effect for in shoe foot orthoses. A case control study design explored the electromyographic activity of the gluteal region during common rehabilitation exercises. A randomised intervention trial implemented a tailored intervention to determine feasibility. Results

Outcome predictors for conservative management are currently at a derivation stage of development. A clinical battery of 14 measures showed good intra and inter rater reliability for the assessment of lower limb biomechanics. Proximal rehabilitation, combined with quadriceps, achieves favourable outcomes in the short and medium term. Gluteal muscle electromyographic activity is comparable between symptomatic and asymptomatic individuals, with specific exercises achieving desired activation patterns. Tailored intervention using biomechanical characteristics, within a randomised trial, is feasible for recruitment and retention. Conclusion

Interventions directed proximal and distal to the patellofemoral joint are effective in the management of PFP. Indicators of treatment success are at a derivation stage,with findings from this thesis providing a comprehensive clinical test battery for lower limb biomechanical assessment. Feasibility of a biomechanically determined tailored intervention has been established.with findings from this thesis providing a comprehensive clinical test battery for lower limb biomechanical assessment. Feasibility of a biomechanically determined tailored intervention has been established.