Walter Bily, Lukas Trimmel, Michaela Mödlin, Alexandra Kaider, Helmut Kern

To aim of this study was to evaluate the effect of a training program in patients with patellofemoral pain syndrome (PFPS) and the additional influence of electric muscle stimulation (EMS) to the quadricep muscles.

£8 patients with bilateral PFPS were divided into two groups. Group 1 received supervised physiotherapy (PT) training. Group 2 received the same physiotherapy program but also received home-based EMS. This consisted of 20 minute sessions, twice daily, 5 days a week over a twelve week period. The settings used were: 40Hz; pulse duration 0.26 ms; 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA.

Assessment of pain was by the visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment. Measures were also repeated at a one year follow-up.

Results demonstrated a statistically significant reduction of pain in both groups and significant improvement of the Kujala score in both groups  after 12 weeks of treatment. Improvement of function and reduction of pain  were also noted at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant and there was no significant increase in isometric strength.

The study concludes that PT programs can reduce pain and improve function in patients with PFPS. EMS does not appear to produce additional positive effects.

Archives of Physical Medicine and Rehabilitation, Volume 89, Issue 7, Pages 1230-1236 (July 2008)

Megan Y Shaw, Phillip A Gribble, Jamie L Frye

The aim of this study was to determine if the use of ankle braces helps improve dynamic stability during fatigue. 10 healthy volleyball palyers participated in the study and performed three jump-landing tasks with the following conditions: No brace; lace-up ankle brace and active ankle brace. Each condition was tested three times before and three times after induced functional fatigue.

Outcome measures were time to stabilisation in both anterior-posterior and medial-lateral directions using a single leg jump onto a force plate. Results showed that the lace-up ankle brace demonstrated faster anterior-posterior time to stabilisation that the active ankle brace and no brace conditions during fatigue. No significant findings were demonstrated for medial-lateral time to stabilisation.

The study concludes that wearing a lace-up ankle brace is the best bracing option for improving dynamic ankle stability.

J Athl Train, 2008; 43 (2):164-71 18345341

Tiggelen, Damien Van; Coorevits, Pascal; Witvrouw, Erik

The aim of this study is to determine the effectiveness of wearing a neoprene knee sleeve to improve proprioceptive function in fatigued and non-fatigued knees.

64 subjects underwent 4 consecutive assessments of the same active joint-repositioning test in the following conditions: braced; non-braced; fatigued; non-fatigued. The contra-lateral limb acted as control.

Results showed that only subjects with poor proprioception sense benefited from brace use when not fatigued. However, subjects with a good baseline proprioceptive sense benefited equally from bracing when fatigued. These results and results from other studies support the use of neoprene knee sleeves as prevention and treatment in individuals to improve proprioceptive sense in fatigued knees.

Clinical Journal of Sport Medicine. 18(3):259-265, May 2008

Cetin, Nuri MD; Aytar, Aydan PT, MSc; Atalay, Ayce MD; Akman, Mahmut Nafiz MD

The purpose of this study was to compare the effects of short-wave diathermy, TENS, ultrasound and hot packs on isokinetic knee extension strength, associated pain and function in women with knee osteoarthritis.

100 women were divided into 5 groups: Group1 - short-wave diathermy and hot packs; Group 2 - TENS and hot packs; Group 3 - ultrasound and hot packs; Group 4 - hot packs only; Group 5 - control group - no intervention.

The results demonstrated improvements in all four treatment groups for both pain and disability. Improvements in strength were also noted at all angles of knee extension, compared to the control group. In most outcome measures, improvements were greatest in group 1 (short-wave diathermy) or 2 (TENS).

American Journal of Physical Medicine & Rehabilitation. 87(6):443-451, June 2008.

Samuel K. Van de Velde, Thomas J. Gill, Louis E. DeFrate, Ramprasad Papannagari and Guoan Li

This study looked at the affect ACL tears, with and without reconstruction have on Patellofemoral joint biomechanics.

MRI and dual-orthogonal fluoroscopic imaging techniques  were used to compare function between ACL deficient, reconstructed and healthy knees during a single leg lunge. 8 patients were assessed prior to reconstruction surgery and 6 months post-operatively with results compared also to the uninjured knee.

Results showed that deficiency caused a significant elongation and change in orientation of the patella tendon. It also reduced flexion and limited patella tilt and  valgus rotation. ACL deficiency also caused a proximal and lateral shift in the point of contact for the patella cartilage.

Following reconstruction, the elongation of the patella tendon was reduced although orientation remained altered. Patella flexion and the altered point of contact were also corrected. However, Patella tilt and valgus rotation persisted.

The study concludes that altered patella positioning and tracking which occur in ACL deficient knees is not corrected following ACL reconstruction surgery. This suggests that following ACL injury, whether reconstruction is performed or not, the individual may be predisposed to patellofemoral cartilage degeneration.

The American Journal of Sports Medicine 36:1150-1159 (2008)

Wilco C Peul, Wilbert B van den Hout, Ronald Brand, , Ralph T W M Thomeer, Bart W Koes

This article is a two year follow-up from a previous research project into the effects of surgery on sciatica as a result of lumbar disc herniation.

283 patients with sciatica symptoms over a period of 6-12 weeks were divided randomly into two groups. 141 patients underwent early microdiscectomy surgery and 142 were consigned to a conservative treatment group for a period of 6 months.

62 of the conservative treatment group eventually required surgery. Follow-up assessment demonstrated no considerable difference between surgery and conservative groups at the two year point. An early improvement in leg pain in the surgery group was no longer present. Patient satisfaction also decreased over the two year period with 20% now reporting an unsatisfactory outcome.

Over the two year period, this research has shown that although surgery may show beneficial early effects in comparison to conservative treatment, following 1 and 2 years the outcome of the two groups were very similar.

BMJ, doi:10.1136/bmj.a143

Sturnieks, Daina L; Besier, Thor F; Hamer, Peter W; Ackland, Timothy R; Mills, Peter M; Stachowiak, Gwidon W; Podsiadlo, Pawel; Lloyd, David G

This study investigates relationships between strength of the muscles surrounding knee and knee joint moments during walking in patients who have previously undergone arthroscopic partial meniscectomy (APM).102 APM patients and 42 age-matched controls (with symptom free knees) completed strength testing and 3D analysis of their gait (walking) cycle. APM Patients were then split into weak and normal subgroups and compared with controls for spatiotemporal, kinematic, and kinetic gait parameters.

Spatiotemporal parameters, kinematics, and sagittal plane kinetics were similar between the control and experimental groups. The APM group displayed weaker concentric knee extension and flexion strength when compared with controls. The weak APM subgroup had an higher average and peak knee adduction moment over stance in comparison with the APM subgroup with normal strength levels and controls. The normal strength APM subgroup had a larger peak knee adduction moment in early stance compared with controls.

Achieving normal lower limb muscle strength following arthroscopy for a partial meniscectomy is important to resume normal frontal plane loading of the knee during walking.

Medicine & Science in Sports & Exercise. 40(6):991-997, June 2008

Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KA

This study reviewed the effects exercise training has on global well-being, signs and symptoms, and physical function in patients with fibromyalgia (FM).  Analysis of 6 studies provided evidence that aerobic exercise, at ACSM-recommended intensity levels, produces positive effects on well-being and physical function and possibly reduces pain and tender points. Strength and flexibility remain under evaluated although strength training might have a positive effect on FM symptoms.

Aerobic-only training has positive effects on physical function and some symptoms of FM. Strength training may improve FM symptoms, but requires further study.

Journal of Rheumatology, 2008 May 1, online article

Ng GY, Fung DT

This study looks at the effects of ultrasound intensity on the ultrastructural morphology of Achilles tendon healing. 20 Sprague-Dawley rats with surgically hemi-transected Achilles tendons were randomly assigned into four groups of 0 (control), 0.5, 1.2 and 2 W/cm(2) for ultrasound treatment, with 5 rats in each group. The treatments all used 1 MHz continuous ultrasound every day starting from day 5 after injury. On day 30, ultrathin slides of the Achilles tendons were prepared and examined. Results showed that the mean collagen fibril size of all treatment groups (0.5, 1, 2)  was higher than the control. There was no significant difference in the collagen fibril size among the treatment groups.

Therapeutic ultrasound can enhance the maturation of collagen fibrils of repairing tendons, and is not dependent on the intensity of ultrasound applied.

Ultrasound Med Biol. 2007 Nov;33(11):1750-4

Bakhtiary AH, Fatemi E

This study compares the effects of straight leg raise (SLR) and semi-squat exercises on patellar chondromalacia. 32 individuals with patellar chondromalacia were  assigned randomly to either the SLR or semi-squat exercise group.

Both groups subsequently followed a 3-week programme of quad muscle strengthening exercises starting with 20 exercises twice a day and increasing each session by 5 exercises every other day. A smaller Q angle and less crepitation, and an increase in the MIVCF (maximal isometric contraction strength)  of the quadriceps and thigh circumference were found in semi-squat group compared with SLR group. However, patellofemoral pain was decreased significantly in both groups.

The results of this study suggest that semi-squat exercises (closed kinetic chain) are more effective than SLR exercise (open kinetic chain) in the treatment of patellar chondromalacia.

British Journal of Sports Medicine, 2008, 42(2), 99-102