Effects of Motion Control Footwear and Therapeutic Exercise on Pain and Function in Runners with and without Patellofemoral Pain Syndrome

• Main Authors: TSENG, YEN CHEN, 曾嬿蓁
• Other Authors: YANG, CHICH-HAUNG
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/6u8knq

碩士 === 慈濟大學 === 物理治療學系碩士班 === 106 === Background: Patellofemoral pain syndrome (PFPS) is a common overuse injury in running. In recent years, running activity is getting more and more popular and many result in patellofemoral pain when performing daily activities. Therefore, it is an important issue to re-evaluate the current interventions of PFPS. It is widely known that patellofemoral pain may result from either proximal factors (e.g. hip muscle strength) or distal factors (e.g. foot posture). Previously, most literature has focused on effects of a single treatment on patellofemoral pain syndrome, however, PFPS, most likely, resulted from multiple factors. In addition, it is common for clinicians to treat patellofemoral pain syndrome with combined interventions on proximal and distal part of lower limb (multimodal therapy). On the other hand, runners with PFPS may not only have hip muscle weakness but also poor foot posture alignment. Therefore, it is necessary to investigate effects of combined interventions on proximal and distal in runners with PFPS. Purpose: (1) To investigate changes in knee pain and function in runners with patellofemoral pain syndrome after running with motion control footwear and performing therapeutic exercise. (2) To investigate effects of motion control footwear on foot posture in runners with patellofemoral pain syndrome. Methods: Twenty runners with and without patellofemoral pain, in the age range between 18 to 45 years old, were recruited in this study. The patellofemoral pain syndrome was diagnosed by a physiotherapist with 25-year clinical experience. The group without pain was assigned to the comparision group (CG) and the runners with pain was assigned to the patellofemoral pain group (PFPSG). The intervention in the current study was combined therapeutic exercise training (weight bearing exercise) viii and running with motion control footwear. Knee pain and function were assessed before and after first intervention in both groups. After the first assessment, the combined intervention of therapeutic exercise and motion control footwear was applied only to the PFPSG for six weeks. Pain, function, the hip and knee muscle strength, maximum rearfoot eversion angle, plantar pressure and muscle activation were evaluated before and after the first assessment and after combined intervention for six weeks. The hip and knee muscle strength, maximum rearfoot eversion angle, plantar pressure and muscle activation were analyzed during walking and running. Visual analog scale was used to evaluate knee pain. Changes in anterior knee pain scale and global rating scale were used to assess knee function. Statistic analysis: The Mann-Whitney U Test was used to examine differences of between-group effects. The Wilcoxon signed rank sum test was used to examine differences of within-group effects. The variables for between-group comparison were hip and knee muscle strength, maximum rearfoot eversion angle, muscle activation in the lower limb and seven areas of foot plantar pressure. The variables for within-group comparison were the score of visual analog scale and anterior knee pain scale, hip and knee muscle strength, maximum rearfoot eversion angle, muscle activation in the lower limb and seven areas of plantar pressure. The significant level was set at p<0.05. Results: After six-weeks interventions, significant decreased knee pain and improved knee function was found in the PFPSG. Decreased maximum rearfoot eversion angle, plantar pressure of mid-foot (contact area and maximum force) and muscle activation were observed in the conditions of motion control footwear. However, there is no significant difference of strength of hip abductor and hip external rotator muscle between both groups. In addition, there is a significant ix decrease of hip abductor muscle strength in female runners with patellofemoral pain syndrome. Conclusion: The current study showed that runners with PFPS may benefit from a six-weeks combined intervention of therapeutic exercise and motion control footwear. Wearing motion control footwear may improve foot alignment and decrease maximum rearfoot eversion angle and plantar pressure, which could be considered as the distal factor of lower limbs. The therapeutic exercise may improve hip muscle strength and neuromuscular control and considered as the proximal factor of lower limb. Clinicians may employ the findings in the current study as an option for their treatment plan in runners with PFPS.