Comparison of the knee valgus angle,leg muscle activity,and vastus medialis oblique/vastus lateralis ratio during a single leg squat on flat and declined surfaces in individuals with patellofemoral pain syndrome

Abstract

BACKGROUND:

The knee valgus angle and knee muscles activity on a declined surface have not yet provided enough biomechanical analyses and treatment guidelines for patellofemoral pain syndrome (PFPS) patients

OBJECTIVE:

The purpose of this study was to investigate the knee valgus angle, leg muscle activity, and the vastus medialis oblique (VMO)/vastus lateralis (VL) muscles ratio during a single leg squat (SLS) on a declined surface in individuals with PFPS.

METHODS:

Fifteen young adults with PFPS (9 men, 6 women; height, 168.6 ± 7.3 cm; weight, 62.4 ± 17.9 kg; age, 22.7 ± 2.8 y; body mass index, 22.7 ± 2.8) participated in this study. Knee valgus angle and leg muscle activity and VMO/VL ratios were collected in subjects with PFPS during SLS on flat and declined surfaces.

RESULTS:

During the SLS, the knee valgus angle was significantly increased on the declined surface than the flat surface (p< 0.05). Also, significantly higher EMG activity in the rectus femoris (RF), VMO, and VL muscles when doing the SLSs were present during the SLSs on the declined surface (p< 0.05).

CONCLUSIONS:

The results of this study suggest that significantly increased knee valgus angles and muscle activity of RF, VMO, and VL during SLSs occur on a declined surface. Therefore, individuals with PFPS should be cautious when stepping down on a declined surface, such as downhill terrain on a mountain.

Keywords

EMG knee exercise PFPS video analysis

References

Taunton

, Ryan

, Clement

, McKenzie

, Lloyd-Smith

, Zumbo

. A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine. 2002; 36(2): 95-101.

Devereaux

, Lachmann

. Patello-femoral arthralgia in athletes attending a Sports Injury Clinic. British Journal of Sports Medicine. 1984; 18(1): 18-21.

Loudon

, Wiesner

, Goist-Foley

, Asjes

, Loudon

. Intrarater reliability of functional performance tests for subjects with patellofemoral pain syndrome. Journal of Athletic Training. 2002; 37(3): 256.

McKenzie

, Galea

, Wessel

, Pierrynowski

. Lower extremity kinematics of females with patellofemoral pain syndrome while stair stepping. Journal of Orthopaedic & Sports Physical Therapy. 2010; 40(10): 625-32.

Heino

, Powers

. Patellofemoral stress during walking in persons with and without patellofemoral pain. Medicine and Science in Sports And Exercise. 2002; 34(10): 1582-93.

Cowan

, Bennell

, Hodges

, Crossley

, McConnell

. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Archives of Physical Medicine and Rehabilitation. 2001; 82(2): 183-9.

Dierks

, Manal

, Hamill

, Davis

. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. Journal of Orthopaedic & Sports Physical Therapy. 2008; 38(8): 448-56.

Isear

, Erickson

, Worrell

. EMG analysis of lower extremity muscle recruitment patterns during an unloaded squat. Medicine & Science in Sports & Exercise. 1997(29): 532-9.

Levinger

, Gilleard

, Coleman

. Femoral medial deviation angle during a one-leg squat test in individuals with patellofemoral pain syndrome. Physical Therapy in Sport. 2007; 8(4): 163-8.

10.

Willy

, Davis

. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. Journal of Orthopaedic & Sports Physical Therapy. 2011; 41(9): 625-32.

11.

Cerny

. Vastus medialis oblique/vastus lateralis muscle activity ratios for selected exercises in persons with and without patellofemoral pain syndrome. Physical Therapy. 1995; 75(8): 672-83.

12.

Cowan

, Bennell

, Crossley

, Hodges

, McConnell

. Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome. Medicine and Science in Sports and Exercise. 2002; 34(12): 1879-85.

13.

Souza

, Gross

. Comparison of vastus medialis obliquus: vastus lateralis muscle integrated electromyographic ratios between healthy subjects and patients with patellofemoral pain. Physical Therapy. 1991; 71(4): 310-6.

14.

Bolgla

, Malone

, Umberger

, Uhl

. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2008; 38(1): 12-8.

15.

Neumann

. Kinesiology of the musculoskeletal system: Foundations for physical rehabilitation. St. Louis: Mosby. Inc; 2002.

16.

Crossley

, Bennell

, Green

, Cowan

, McConnell

. Physical therapy for patellofemoral pain a randomized, double-blinded, placebo-controlled trial. The American Journal of Sports Medicine. 2002; 30(6): 857-65.

17.

Neptune

, Wright

, van den Bogert

. The influence of orthotic devices and vastus medialis strength and timing on patellofemoral loads during running. Clinical Biomechanics. 2000; 15(8): 611-8.

18.

Zwerver

, Bredeweg

, Hof

. Biomechanical analysis of the single-leg decline squat. British Journal of Sports Medicine. 2007; 41(4): 264-8.

19.

American Podiatric Medical Association. High heel survery; 2003 [updated 2016 March 03; cited 2016 March 03]. Available from: http://www.apma.org/.

20.

Yoon

J-Y

, An

D-H

, Yoo

W-G

, Kwon

Y-R

. Differences in activities of the lower extremity muscles with and without heel contact during stair ascent by young women wearing high-heeled shoes. Journal of Orthopaedic Science. 2009; 14(4): 418-22.

21.

Faul

, Erdfelder

, Lang

A-G

, Buchner

. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods. 2007; 39(2): 175-91.

22.

Collins

, Crossley

, Beller

, Darnell

, McPoil

, Vicenzino

. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: Randomised clinical trial. British journal of sports medicine. 2008; 337.

23.

Cram

, Kasman

. Introduction to Surface Electromyography. Gaithersburg: Aspen Publishers, Inc.; 1998.

24.

Kendall

, McCreary

, Provance

, Rodgers

, Romani

. Muscles: testing and function with posture and pain. 5th Ed. 2005.

25.

Herrington

. Knee valgus angle during single leg squat and landing in patellofemoral pain patients and controls. Knee. 2013.

26.

Munro

, Herrington

, Carolan

. Reliability of two-dimensional video assessment of frontal plane dynamic knee valgus during common athletic screening tasks. Journal of Sport Rehabilitation. 2012; 21(1): 7-11.

27.

Willson

, Davis

. Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clinical Biomechanics. 2008; 23(2): 203-11.

28.

Lee

, Morris

, Csintalan

. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. Journal of Orthopaedic & Sports Physical Therapy. 2003; 33(11): 686-93.

29.

Neumann

. Kinesiology of the musculoskeletal system. Mosby/Elsevier, 2002.

30.

Culvenor

, Cook

, Collins

, Crossley

. Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review. British Journal of Sports Medicine. 2013; 47(2): 66-70.

31.

Salsich

, Graci

, Maxam

. The effects of movement pattern modification on lower extremity kinematics and pain in women with patellofemoral pain. Journal of Orthopaedic & Sports Physical Therapy. 2012; 42(12): 1017-24.

32.

Edwards

, Dixon

, Kent

, Hodgson

, Whittaker

. Journal of Orthopaedic Surgery and Research. Journal of orthopaedic surgery and research. 2008; 3: 2.

33.

Stefanyshyn

, Nigg

, Fisher

, O'Flynn

, Liu

. The influence of high heeled shoes on kinematics, kinetics, and muscle EMG of normal female gait. Journal of Applied Biomechanics. 2000; 16(3): 309-19.

34.

Earl

, Schmitz

, Arnold

. Activation of the VMO and VL during dynamic mini-squat exercises with and without isometric hip adduction. Journal of Electromyography and Kinesiology. 2001; 11(6): 381-6.

35.

Headlee

, Leonard

, Hart

, Ingersoll

, Hertel

. Fatigue of the plantar intrinsic foot muscles increases navicular drop. Journal of Electromyography and Kinesiology. 2008; 18(3): 420-5.

36.

Ryan

, Rowe

. An electromyographical study to investigate the effects of patellar taping on the vastus medialis/vastus lateralis ratio in asymptomatic participants. Physiotherapy theory and practice. 2006; 22(6): 309-15.