Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run

Dierks, Tracy A.<sup>1</sup>; Manal, Kurt T.<sup>2</sup>; Hamill, Joseph<sup>3</sup>; Davis, Irene S.<sup>4,5</sup>

Affiliations

¹Department of Physical Therapy, Indiana University, Indianapolis, IN

²Department of Mechanical Engineering, University of Delaware, Newark, DE

³Department of Exercise Science, University of Massachusetts, Amherst, MA

⁴Department of Physical Therapy, University of Delaware, Newark, DE

⁵Director of Research, Drayer Physical Therapy Institute, Hummelstown, PA

Abstract and keywords

Study Design: Cross-sectional experimental laboratory study.

Objectives: To investigate the relationships between hip strength and hip kinematics, and between arch structure and knee kinematics during prolonged treadmill running in runners with and without patellofemoral pain syndrome (PFPS).

Background: Hip weakness can lead to excessive femoral motions that adversely affect patellofemoral joint mechanics. Similarly, foot mechanics, which are influenced by foot structure, are also known to influence patellofemoral joint mechanics. Thus, proximal and distal factors should be considered when studying individuals with PFPS.

Methods and Measures: Twenty recreational runners with PFPS (5 male, 15 female) and 20 matched uninjured runners participated in the study. Hip abduction and hip external rotation isometric strength measurements were collected before and after a prolonged run, while the arch height index was recorded on all runners before the run. Lower extremity kinematic data were collected at the beginning and end of the run. Two-way repeated-measures analyses of variance (ANOVAs) were used for analysis.

Results: Both groups displayed decreases in hip abductor and external rotator strengths at the end of the run. The PFPS group displayed significantly lower hip abduction strength [(kg x cm)/body mass] compared to controls (PFPS group: begin 15.3, end 13.5; uninjured group: begin 17.3, end 15.4). At the end of the run, the level of association between hip abduction strength and the peak hip adduction angle for the PFPS group was statistically significant, indicating a strong relationship (r = −0.74). No other associations with hip strength were observed in either group. Arch height did not differ between groups and no significant association was observed between arch height and peak knee adduction angle during running.

Conclusions: Runners with PFPS displayed weaker hip abductor muscles that were associated with an increase in hip adduction during running. This relationship became more pronounced at the end of the run.

Level of Evidence: Therapy, level 5.

Keywords: arch height index; hip abductor muscle strength; hip external rotator muscle strength; knee valgus

Links

DOI: 10.2519/jospt.2008.2490

PubMed: 18678957

WoS: 000258474500002

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Cited By (12)

Year	Entry
2020	Reuter S. Angewandte Sportphysiotherapie - Untere Extremität: Evidenz Für Befund Und Behandlung [in German]. Berlin: Springer; 2020.
2010	Dierks TA, Davis IS, Hamill J. The effects of running in an exerted state on lower extremity kinematics and joint timing. J Biomech. November 16, 2010;43(15):2993-2998.
2011	Dierks T, Manal K, Hamill J, Davis I. Lower extremity kinematics in runners with patellofemoral pain during a prolonged run. Med Sci Sports Exer. 2011;43(4):693-700.
2015	Boyer ER. Rearfoot, Mid/forefoot, and Barefoot Running: Biomechanical Differences Related to Injury [PhD thesis]. Iowa State University; 2015.
2022	Bricarell KM. Biomechanical and Comfort Analyses on the Use of Commercial Insoles While Walking and Running [Master's thesis]. Iowa State University; 2022.
2021	Yan C. Tibial Bone Properties and Mechanics Under Atypical Loading Conditions [PhD thesis]. University of Illinois at Urbana-Champaign; 2021.
2017	Raabe ME. The Effect of Core Stability on Running Mechanics in Novice Runners [PhD thesis]. The Ohio State University; 2017.
2020	Rodgers LD. Investigating Measurement Modalities for Integrated Use in Overuse Injury Research [Master's thesis]. Queen's University; October 2020.
2016	Baltich J. The Effects of Resistance Strength Training and Functional Strength Training on Risk Factors for Running Injury [PhD thesis]. Calgary, AB: University of Calgary; June 2016.
2018	Lorenzen KN. A Comparison of Biomechanical Outcomes in Single Leg Squat and Vertical Drop Jump in Youth and Young Adults With and Without a Previous Youth Sport-Related Knee Joint Injury [Master's thesis]. Calgary, AB: University of Calgary; April 2018.
2009	Noehren B. A Mechanistic Approach to the Etiology and Treatment of Patellofemoral Pain Syndrome [PhD thesis]. University of Delaware; Summer 2009.
2011	Willy RW. Gender Differences in the Mechanics of Patellofemoral Pain Syndrome [PhD thesis]. University of Delaware; Summer 2011.