Is spinopelvic sagittal alignment correlated with pain level, functional disability and frontal plane projection angle in women with patellofemoral pain syndrome? A cross-sectional study
Abstract
There is a growing interest concerning the understanding of measurements of spinal and leg alignment in patients with patellofemoral pain syndrome (PFPS). However, evaluating spinopelvic alignment in the sagittal plane with pain level, functional disability and frontal plane projection angle (FPPA) in PFPS has not been adequately addressed. The aim of the study was to identify the correlation of spinopelvic parameters with pain level, functional disability and frontal plane projection angle in women with PFPS. This was a cross–sectional study involving sixty female patients diagnosed with PEPS, with a mean age of 32±6.47. The measurements used in the study included: radiographic parameters (X-Ray), the numeric pain rating scale (NPRS), the Arabic anterior knee pain scale (AAKP/Kujala) and the 2D-FPPA. Spearman correlation analysis was conducted to evaluate the relationship between these parameters. The results of our study demonstrated a strong positive correlation of lumbar lordosis (LL) with pain level and FPPA (r=0.825, r=0.812, p=0.0001). Also, a strong positive correlation of sacral slope (SS) with pain level (r = 0.0.820) and FPPA (r= 0.783). Pelvic tilt (PT) showed a moderate correlation with pain level (r = 0.0.614) and FPPA (r= 0.605), while a weak negative correlation was found between LL, SS and PT and functional disability score (r=-0.397, r=-0.385 and, r=-0.215 p=0.002). It was concluded that LL, SS and PT were significantly related to the pain level, functional disability and frontal plane projection angle in women with PFPS. These spinal alignments should be considered in clinical evaluation of knee-related disorders associated with PFPS.
Downloads
References
Alghadir, A. H., Anwer, S., & Iqbal, Z. A. (2016). The psychometric properties of an Arabic numeric pain rating scale for measuring osteoarthritis knee pain. Disability and Rehabilitation, 38(24), 2392-2397. https://doi.org/10.3109/09638288.2015.1129441
Alshehri, A., Lohman, E., Daher, N. S., Bahijri, K., Alghamdi, A., Altorairi, N., . . . Matar, A. (2017). Cross-Cultural Adaptation and Psychometric Properties Testing of the Arabic Anterior Knee Pain Scale. Medical Science Monitor, 23, 1559-1582. https://doi.org/10.12659/msm.901264
Bailon, C., Damas, M., Pomares, H., & Banos, O. (2016). First approach to automatic measurement of frontal plane projection angle during single leg landing based on depth video. In International Conference on Ubiquitous Computing and Ambient Intelligence (pp. 44-55). Springer, Cham.
Baldon Rde, M., Serrao, F. V., Scattone Silva, R., & Piva, S. R. (2014). Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. The Journal of Orthopaedic and Sports Physical Therapy, 44(4), 240-251. https://doi.org/10.2519/jospt.2014.4940
Balsalobre-Fernandez, C., Tejero-Gonzalez, C. M., del Campo-Vecino, J., & Bavaresco, N. (2014). The concurrent validity and reliability of a low-cost, high-speed camera-based method for measuring the flight time of vertical jumps. Journal of Strength and Conditioning Research, 28(2), 528-533. https://doi.org/10.1519/JSC.0b013e318299a52e
Bennell, K., Wee, E., Crossley, K., Stillman, B., & Hodges, P. (2005). Effects of experimentally-induced anterior knee pain on knee joint position sense in healthy individuals. Journal of Orthopaedic Research Society, 23(1), 46-53. https://doi.org/10.1016/j.orthres.2004.06.008
Bolgla, L. A., Malone, T. R., Umberger, B. R., & Uhl, T. L. (2008). Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. The Journal of Orthopaedic and Sports Physical Therapy, 38(1), 12-18. https://doi.org/10.2519/jospt.2008.2462
Brechter, J. H., & Powers, C. M. (2002). Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait Posture, 16(2), 115-123. https://doi.org/10.1016/s0966-6362(02)00090-5
Brouwer, G. M., van Tol, A. W., Bergink, A. P., Belo, J. N., Bernsen, R. M., Reijman, M., . . . Bierma-Zeinstra, S. M. (2007). Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum, 56(4), 1204-1211. https://doi.org/10.1002/art.22515
Collins, N. J., Barton, C. J., van Middelkoop, M., Callaghan, M. J., Rathleff, M. S., Vicenzino, B. T., . . . Crossley, K. M. (2018). 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. British Journal of Sports Medicine, 52(18), 1170-1178. https://doi.org/10.1136/bjsports-2018-099397
Crossley, K. M., van Middelkoop, M., Callaghan, M. J., Collins, N. J., Rathleff, M. S., & Barton, C. J. (2016). 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). British Journal of Sports Medicine, 50(14), 844-852. https://doi.org/10.1136/bjsports-2016-096268
Earl, J. E., & Hoch, A. Z. (2011). A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome. The Americal Journal of Sports Medicine, 39(1), 154-163. https://doi.org/10.1177/0363546510379967
Gwynne, C. R., & Curran, S. A. (2014). Quantifying frontal plane knee motion during single limb squats: reliability and validity of 2-dimensional measures. International Journal of Sports Physical Therapy, 9(7), 898-906.
Iyer, S., Sheha, E., Fu, M. C., Varghese, J., Cunningham, M. E., Albert, T. J., . . . Kim, H. J. (2018). Sagittal Spinal Alignment in Adult Spinal Deformity: An Overview of Current Concepts and a Critical Analysis Review. JBJS Rev, 6(5), e2. https://doi.org/10.2106/JBJS.RVW.17.00117
Kujala, U. M., Jaakkola, L. H., Koskinen, S. K., Taimela, S., Hurme, M., & Nelimarkka, O. (1993). Scoring of patellofemoral disorders. Arthroscopy, 9(2), 159-163. https://doi.org/10.1016/s0749-8063(05)80366-4
Lewis, C. L., Foch, E., Luko, M. M., Loverro, K. L., & Khuu, A. (2015). Differences in Lower Extremity and Trunk Kinematics between Single Leg Squat and Step Down Tasks. PLoS One, 10(5), e0126258.https://doi.org/10.1371/journal.pone.0126258
Marquez-Lara, A., Nandyala, S. V., Sankaranarayanan, S., Noureldin, M., & Singh, K. (2014). Body mass index as a predictor of complications and mortality after lumbar spine surgery. Spine (Phila Pa 1976), 39(10), 798-804. https://doi.org/10.1097/BRS.0000000000000232
Maykut, J. N., Taylor-Haas, J. A., Paterno, M. V., DiCesare, C. A., & Ford, K. R. (2015). Concurrent validity and reliability of 2d kinematic analysis of frontal plane motion during running. International Journal of Sports Physical Therapy, 10(2), 136-146.
Munro, A., Herrington, L., & Carolan, M. (2012). Reliability of 2-dimensional video assessment of frontal-plane dynamic knee valgus during common athletic screening tasks. Journal of Sport Rehabilitation, 21(1), 7-11. https://doi.org/10.1123/jsr.21.1.7
Murata, Y., Takahashi, K., Yamagata, M., Hanaoka, E., & Moriya, H. (2003). The knee-spine syndrome. Association between lumbar lordosis and extension of the knee. The Journal of Bone and Joint Surgery. British volume, 85(1), 95-99. https://doi.org/10.1302/0301-620x.85b1.13389
Noehren, B., Pohl, M. B., Sanchez, Z., Cunningham, T., & Lattermann, C. (2012). Proximal and distal kinematics in female runners with patellofemoral pain. Clinical Biomechanics (Bristol, Avon), 27(4), 366-371. https://doi.org/10.1016/j.clinbiomech.2011.10.005
Oshima, Y., Watanabe, N., Iizawa, N., Majima, T., Kawata, M., & Takai, S. (2019). Knee-Hip-Spine Syndrome: Improvement in Preoperative Abnormal Posture following Total Knee Arthroplasty. Advances in Orthopaedics, 2019, 8484938. https://doi.org/10.1155/2019/8484938
Pollard, C. D., Sigward, S. M., & Powers, C. M. (2010). Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments. Clin Biomech (Bristol, Avon), 25(2), 142-146.
Powers, C. M. (2003). The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. Journal of Orthopaedic and Sports Physical Therapy, 33(11), 639-646. https://doi.org/10.1016/j.clinbiomech.2009.10.005
Powers, C. M. (2010). The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. The Journal of Orthopaedic and Sports Physical Therapy, 40(2), 42-51. https://doi.org/10.2519/jospt.2010.3337
Rathleff, M. S., Rathleff, C. R., Olesen, J. L., Rasmussen, S., & Roos, E. M. (2016). Is Knee Pain During Adolescence a Self-limiting Condition? Prognosis of Patellofemoral Pain and Other Types of Knee Pain. American Journal of Sports Medicine, 44(5), 1165-1171. https://doi.org/10.1177/0363546515622456
Robinson, M. D., & Smyth, G. K. (2007). Moderated statistical tests for assessing differences in tag abundance. Bioinformatics, 23(21), 2881-2887. https://doi.org/10.1093/bioinformatics/btm453
Schache, A. G., Blanch, P. D., & Murphy, A. T. (2000). Relation of anterior pelvic tilt during running to clinical and kinematic measures of hip extension. British Journal of Sports Medicine, 34(4), 279-283. https://doi.org/10.1136/bjsm.34.4.279
Souza, R. B., & Powers, C. M. (2009). Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. The Journal of Orthopaedic and Sports Physical Therapy, 39(1), 12-19. https://doi.org/10.2519/jospt.2009.2885
Stephen, J., Ephgrave, C., Ball, S., & Church, S. (2020). Current concepts in the management of patellofemoral pain - The role of alignment. Knee, 27(2), 280-286. https://doi.org/10.1016/j.knee.2019.12.006
Tonnis, D., & Heinecke, A. (1999). Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. The Journal of Bone and Joint Surgery, 81(12), 1747-1770.
Tsuji, T., Matsuyama, Y., Goto, M., Yimin, Y., Sato, K., Hasegawa, Y., & Ishiguro, N. (2002). Knee-spine syndrome: correlation between sacral inclination and patellofemoral joint pain. Journal of Orthopaedic Science, 7(5), 519-523. https://doi.org/10.1007/s007760200092
Wainner, R. S., Whitman, J. M., Cleland, J. A., & Flynn, T. W. (2007). Regional interdependence: a musculoskeletal examination model whose time has come. The Journal of Orthopaedic and Sports Physical Therapy, 37(11), 658-660. https://doi.org/10.2519/jospt.2007.0110
Williamson, A., & Hoggart, B. (2005). Pain: a review of three commonly used pain rating scales. Journal of Clinical Nursing, 14(7), 798-804. https://doi.org/10.1111/j.1365-2702.2005.01121.x
Willson, J. D., & Davis, I. S. (2008). Utility of the frontal plane projection angle in females with patellofemoral pain. The Journal of Orthopaedic and Sports Physical Therapy, 38(10), 606-615. https://doi.org/10.2519/jospt.2008.2706
Yasuda, T., Togawa, D., Hasegawa, T., Yamato, Y., Kobayashi, S., Yoshida, G., . . . Matsuyama, Y. (2020). Relationship between Knee Osteoarthritis and Spinopelvic Sagittal Alignment in Volunteers over 50 Years of Age. Asian Spine Journal, 14(4), 495-501. https://doi.org/10.31616/asj.2018.0266
The works and papers that are published in this Journal are subject to the following terms:
1. The Publication Service of the University of Murcia (the publisher) has the Publication Rights (Copyright) to the published papers and works, and favors and permits the reusing of the same under the license indicated in point 2.
© Servicio de Publicaciones, Universidad de Murcia, 2013
2. The papers and works are to be published in the digital edition of the Journal under the license Creative Commons Reconocimiento-No Comercial-Sin Obra Derivada 3.0 España (legal text). The copying, using, spreading, transmitting and publicly displaying of the papers, works or publication are permitted as long as: i) the authors and original sources (Journal, publisher and URL of the publication) are quoted; ii) it is not used for commercial benefit; iii) the existence and specifications of this users license are mentioned.
3. Conditions of Self-Archiving. It is permitted and encouraged that the authors spread electronically the pre-print (before printing) and/or post-print (the revised, evaluated and accepted) versions of their papers or works before their publication since this favors their circulation and early diffusion and therefore can help increase their citation and quotation, and also there reach through the academic community.
The works and papers that are published in this Journal are subject to the following terms:
1. The Publication Service of the University of Murcia (the publisher) has the Publication Rights (Copyright) to the published papers and works, and favors and permits the reusing of the same under the license indicated in point 2.
© Servicio de Publicaciones, Universidad de Murcia, 2013
2. The papers and works are to be published in the digital edition of the Journal under the license Creative Commons Reconocimiento-No Comercial-Sin Obra Derivada 3.0 España (legal text). The copying, using, spreading, transmitting and publicly displaying of the papers, works or publication are permitted as long as: i) the authors and original sources (Journal, publisher and URL of the publication) are quoted; ii) it is not used for commercial benefit; iii) the existence and specifications of this users license are mentioned.
3. Conditions of Self-Archiving. It is permitted and encouraged that the authors spread electronically the pre-print (before printing) and/or post-print (the revised, evaluated and accepted) versions of their papers or works before their publication since this favors their circulation and early diffusion and therefore can help increase their citation and quotation, and also there reach through the academic community.
