Patellofemoral Pain Syndrome and Its Effect on the Walking of Affected Subjects: Update Review
Received Date: Mar 14, 2018 / Accepted Date: Mar 24, 2014 / Published Date: Mar 31, 2018
Background: Patellofemoral pain syndrome (PFPS) is complication in the knee joint that can affect the gait of affected subjects. Various studies have been done in this field. The purpose of this study is to update the review article in the effect of PFPS on gait parameters.
Method: This update review includes articles published between 1990 and 2018. Our search has been done in PubMed, Google scholar, Science direct and ISI web of knowledge databases. Finally, 20 studies entered this review.
Results: Subjects with PFPS show changes in walking parameters such as speed, cadence, step length and some other parameters in comparison with normal people.
Conclusion: It can be concluded that some gait parameters in PFPS subjects change, and this change can be a mechanism for the reduction of patella femoral joint reaction force and pain.
Keywords: Gait; Walking; Gait parameters; Patellofemoral pain syndrome; PFPS
Patellofemoral pain syndrome (PFPS) is one of the disorders that are related to the knee joint which includes 10 to 25 percent of knee injuries [1,2]. The incidence of this complication is estimated to be between 7% and 15% in young adults in military . Studies have also shown that the PFPS is more common in women than in men [4-11].
Patellofemoral pain syndrome can cause changes in the gait of affected people [12,13]. Some of these changes have been reported on some studies, such as a decrease in velocity, cadence and knee extensor moment [14-19].
Other studies also show that the Patellofemoral pain syndrome causes the affected subjects to have other changes in walking, such as: increase hip adduction, delayed peak rear foot eversion, significant reduction of the knee flexion angle and step length [5,14-25].
There have been some papers that published relating to gait on the PFPS but a comprehensive study in gait of subjects with PFPS is needed. To help in this direction, it was thought useful to review studies which have evaluated gait in the individual with PFPS. We conducted this study with the aim of updating the review article on the impact of PFPS on the gait.
We searched Science Direct, Google scholar; PubMed and ISI web of knowledge from 1990 to 2018, by using the keywords include gait parameters, gait variability, walking and Patellofemoral pain syndrome. Finally, 20 articles were selected from final evaluation.
Inclusion and exclusion criteria
Table 1 utilized Inclusion and exclusion criteria to select articles. This update review contains those articles that investigation the gait of people with PFPS. Studies which involved other groups were excluded. Studies that included other knee disorders were excluded from this study. Also, only studies in English were included in this study.
|Inclusion Criteria||Exclusion criteria|
|Patellafemoral pain syndrome||Other pathological condition|
|Kinetic parameters in PFPS in gait||Subjects have other functional limitation or disable|
|Kinematic parameters in PFPS in gait||Gait parameters in knee osteoarthritis subjects|
|Spatiotemporal parameters in PFPS in gait||Gait parameters in chondromallishia subjects|
|Compared PFPS and healthy subjects in gait parameters||Knee pain with other reasons|
Table 1: Inclusion and exclusion criteria utilized to select articles.
According to a literature review published in 2016, most of this articles that evaluated the effects of PFPS on kinematic parameters reported that the speed of patients with PFPS, cadence and their flexion angles was lower than that of healthy subjects. We also from the data onto this review article in spatial parameters conclude that PFPS subjects usually have a shorter step length. Also, the most important results from the kinetic parameters mentioned in the study by Arazpour et al.  included increase contralateral pelvic drop and hip adduction reduce knee extensor moment and delayed peak rear foot eversion during gait (Tables 2 and 3).
|Variable||Study||P value||Mean (SD)||Mean (SD)||Mean diff (95% CI)||Significant change|
|Paoloni et al. ||p=0.5||1.15 ± 0.16||1.1 ± 0.15||-0.05 (-0.20 to 0.10)||-|
|Levinger and Gilleard ||P=0.22||1.36 ± 0.10||1.41 ± 0.07||0.05 (-0.02 to 0.12)||-|
|Powers et al. ||P=0.004||1.465 ± 0.18||1.29 ± 0.002||-0.175 (-0.27 to -0.08)||â|
|Powers et al. ||P<0.001)||1.16||0.94||-0.22||â|
|Barton et al. ||p=0.073||1.45 ± 0.16||1.37 ± 0.13 m/s||-0.08 (-0.17 to 0.01)||-|
|Nadeau et al. ||p=0.84||1.3 ± 0.2||1.2 ± 0.20||-0.1 (-0.39 to 0.19)||-|
|Cadence (steps/min)||Salsich et al. ||96.9||0.74||-96.16|
|Powers et al. ||P=0.31||121.7 ± 9.1||117.3 ± 12.3||-4.4 (-13.82 to 5.02)||-|
|Powers et al. ||P<0.001||125.2||114.1||-11.1||â|
|Nadeau et al. ||P=0.63||103.7 ± 6.9||101.3 ± 8.3||-2.4 (-13.53 to 8.73)||-|
|Stride length (m)||Powers et al. ||p>0.05m||1.43 ± 0.14||1.32 ± 0.11||-0.11 (-0.21 to -0.01)||-|
|Powers et al. ||P<.001||1.38||1.22||0.16||â|
|Nadeau et al. ||p=0.97||1.4 ± 0.1||1.5 ± 0.2||0.1 (-0.13 to -0.33)||-|
|Knee flexion||Nadeau et al. ||P<0.01||21.8 ± 4.6||13.14 ± 4.0||-8.66 (-14.95 to -2.37)||â|
|P=0.987||58.28 ± 11.95||58.22 ± 7.81||-0.06 (-7.90 to 7.78)||-|
|Goto et al. |
|Knee internal rotation||Goto et al. ||P=0.320||0.78 ± 11.66||-3.13 ± 8.53||-3.91 (-11.85 to -4.03)||-|
|Noehren et al. ||P=0.39||1.9||0.01||1.89||-|
|Hip adduction angle||Paoloni et al. ||p=0.046||17.8° ± 2.6||20.0° ± 3.5||2.2 (-0.03 to 4.43)||á|
|Barton et al. |
|Bolgla et al. |
|Noehren and Davis |
|Noehren and Davis ||P=0.877||7.7 ± 3.2||7.6 ± 3.3||-0.1 (-2.05 to 1.85||-|
|p>0.05||11.8° ± 3.9°||8.7° ± 5.2°||-3.1 (-6.04 to -0.16)||-|
|Hip internal rotation||Paoloni et al. ||p=0.002||5.2° ± 3.3||9.8° ± 4.2||4.6 (1.87 to 7.33)||á|
|Barton et al. |
|Souza and Powers |
|Bolgla et al. ||p=0.024||11.8 (6.9)||7.0 (6.6)||-4.8 (-8.83 to -0.77)||â|
|Noehren et al. ||P=0.001||1.2° ± 3.8°||7.6° ± 7.0°||6.4 (2.82 to 9.98)||á|
|Knee external rotation moment||Paoloni et al. ||P=0.007||0.042 ± 0.02||0.071 ± 0.02||0.029 (0.01 to 0.05)||á|
|knee abductor moment||Paoloni et al. ||P=0.01||0.398 ± 0.13||0.555 ± 0.13||0.157 (0.03 to 0.29)||á|
|Hip abductor moment||Paoloni et al. ||P=0.001||0.508 ± 0.17 (LR)||0.898 ± 0.24||0.39 (0.18 to 0.60)||á|
|P=0.002||0.450 ± 0.18 (TS)||0.842 ± 0.26||0.392 (0.17 to 0.62)||á|
|Noehren et al. ||P=0.896||-1.3||-1.3||-|
|Ground reaction force||Paoloni et al. ||P=0.01||56.7 ± 9.1||40.7 ± 15.6||-0.16 (-28.76 to -3.24)||â|
|Levinger and Gilleard |
|(P=0.03)||0.66 ± 0.14||0.52 ± 0.17||-0.14 (-0.26 to -0.02)||â|
|Powers et al. ||P=0.01||141.4 ± 10.7||129.5 ± 10.2||-11.9 (-20.68 to -3.12)||â|
|Rear foot eversion||Paoloni et al. ||P=0.27||-9.4° ± 5.3||−11.2° ± 4.0||-1.8 (-5.19 to 1.59)||-|
Table 2: Summary of gait characteristics for control and PFPS group [*An up arrow (↑) indicates a significant increase in intervention group than control, a down arrow (↓) indicates a significant decrease in intervention group than control, and a hyphen (-) indicates no change compared to baseline or between group.
LR: Loading Response, TS: Terminal Stance
|Authors||Study design||Sample size||Outcome measures||Results|
|Carlson et al.||Controlled laboratory study||12 PFPS||Patellofemoral kinematics (lateral patellar displacement)||This study finding that patients with PFPS have an abnormal lateral patellar displacement|
|Scholtes and Salsich||Controlled Laboratory Study||20 pfps||knee flexion||There were no group differences in angle of peak knee flexion during the usual condition (P=0.484)|
|Holden et al. ||-||8 pfps||Knee valgus displacement||The finding of this study demonstrated that knee valgus displacement was significantly increased in subjects with PFPS compared to healthy subjects|
|Goto et al.||Case-control||14 PFP||Hip flexion/adduction/internal rotation||They found that there is no significant difference between kinematic parameters in patients with patella femoral pain syndrome compared to healthy subjects (p>0.05)|
|Knee flexion/abduction/internal rotation|
Table 3: New studies investigating the effects of patella femoral pain syndrome on gait parameters.
In general, according to our findings from this study, we can say that subjects with PFPS have a slower walk than healthy people. It seems that these people reduce their speeds to reduce patella femoral joint loading and quadriceps muscle activity. They also have a shorter step length than healthy people [15,17,18,21,30]. Also, the results of the studies showed that people with Patella femoral pain syndrome have fewer cadences than normal people that contributing to the reduce knee moment [18,19,21,30]. There is a direct relationship between walking speed and step length, and when Walking speed in people with PFPS is reduced, so the length of the step decreases. Reducing this parameter in these individuals can be to reduce patella femoral joint stress [18,24,30].
Based on the data available in this review, we found that individuals with PFPS are likely to reduce the loading and their symptoms, so they have less knee joint flexion and knee extensor moment during gait [17-19,21]. The findings of this study also show that knee abductor and external rotator moments increased and knee internal rotation decrease with PFPS during gait and this change a reason for the greater tibia external rotation among individuals with PFPS [19,25]. There are contradictions in the results of studies regarding some parameters such as hip rotation that these differences in the results of these studies may be due to differences in methodology and the criteria for entering the patients in the investigation [15,22,31-33]. Also, based on the results of this review, it can be stated that this patients have a lower ground reaction force than healthy people and this can be related to a cause such as reduced velocity employed by the PFPS subjects and may be characterized by altered neuromata control due to knee pathologies [17,18,20].
In general, it can be concluded in conclusion that PFPS can cause changes in the walking of affected subjects, and some gait parameters in these individuals are different from healthy subjects. Also it can be noted that some of which changes during walking may be a compensatory mechanism to reduce pain and patella femoral joint reaction force in affected individuals.
Declaration of Interest
The authors report no declarations of interest.
- Saubade M, Martin R, Becker A, Gremion G (2014) Patellofemoral pain syndrome: Understand better in order to treat better. Revue Medicale Suisse 10: 1451-1456.
- Goto S, Aminaka N, Gribble PA (2017) Lower extremity muscle activity, kinematics and dynamic postural control in individuals with patellofemoral pain. J Sport Rehabil, pp: 1-29.
- Shwayhat AF, Linenger JM, Hofherr LK, Slymen DJ, Johnson CW (1994) Profiles of exercise history and overuse injuries among United States Navy Sea, Air and Land (SEAL) recruits. Am J Sports Med 22: 835-840.
- Baker MM, Juhn MS (2000) Patellofemoral pain syndrome in the female athlete. Clin Sports Med 19: 315-329.
- Bolgla LA, Malone TR, Umberger BR, Uhl TL (2008) Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 38: 12-28.
- Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, et al (2010) Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports 20: 725-730.
- Larson M (2014) Evaluation of risk factors associated with Patellofemoral Pain Syndrome: Boston University.
- Nejati P, Forogh B, Moeineddin R, Baradaran HR, Nejati M (2011) Patellofemoral pain syndrome in Iranian female athletes. Acta Medica Iranica 49: 169-172.
- Boling MC, Padua DA, Creighton RA (2009) Concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain. J Athl Train 44: 7.
- Dugan SA (2005) Sports-related knee injuries in female athletes: What gives? Am J Phys Med Rehabil 84: 122-130.
- Myer GD, Ford KR, Barber Foss KD, Goodman A, Ceasar A, et al (2010) The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech 25: 700-707.
- Arazpour M, Notarki TT, Salimi A, Bani MA, Nabavi H, et al. (2013) The effect of patellofemoral bracing on walking in individuals with patellofemoral pain syndrome. Prosthet Orthot Int 37: 465-470.
- Stauffer RN (1990) Disorders of the patellofemoral joint. Mayo Clin Proc. Elsevier.
- Barton CJ, Levinger P, Menz HB, Webster KE (2009) Kinematic gait characteristics associated with patellofemoral pain syndrome: A systematic review. Gait Posture 30: 405-416.
- Barton CJ, Levinger P, Webster KE, Menz HB (2011) Walking kinematics in individuals with patellofemoral pain syndrome: A case-control study. Gait Posture 33: 286-291.
- Levinger P, Gilleard W (2005) The heel strike transient during walking in subjects with patellofemoral pain syndrome. Phys Ther Sport 6: 83-88.
- Paoloni M, Mangone M, Fratocchi G, Murgia M, Saraceni VM, et al. (2010) Kinematic and kinetic features of normal level walking in patellofemoral pain syndrome: More than a sagittal plane alteration. J Biomech 43: 1794-1798.
- Powers CM, Heino JG, Rao S, Perry J (1999) The influence of patellofemoral pain on lower limb loading during gait. Clin Biomech 14: 722-728.
- Salsich GB, Brechter JH, Powers CM (2001) Lower extremity kinetics during stair ambulation in patients with and without patellofemoral pain. Clin Biomech 16: 906-912.
- Levinger P, Gilleard W (2007) Tibia and rear foot motion and ground reaction forces in subjects with patellofemoral pain syndrome during walking. Gait Posture 25: 2-8.
- Nadeau S, Gravel D, Hébert LJ, Arsenault AB, Lepage Y (1997) Gait study of patients with patellofemoral pain syndrome. Gait Posture 5: 21-27.
- Souza RB, Powers CM (2009) Differences in hip kinematics, muscle strength and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther 39: 12-19.
- Willson JD, Davis IS (2008) Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clin Biomech 23: 203-211.
- Willson JD, Sharpee R, Meardon SA, Kernozek TW (2014) Effects of step length on patellofemoral joint stress in female runners with and without patellofemoral pain. Clin Biomech 29: 243-247.
- Xergia S, Pappas E, Georgoulis AD (2014) Gait analysis in patellofemoral disorders. The Patellofemoral Joint: Springer 45-50.
- Arazpour M, Bahramian F, Abutorabi A, Nourbakhsh ST, Alidousti A, et al. (2016) The effect of patellofemoral pain syndrome on gait parameters: A literature review. Arch Bone Jt Surg 4: 298.
- Carlson VR, Boden BP, Sheehan FT (2017) Patellofemoral kinematics and tibial tuberosity-trochlear groove distances in female Adolescents with patellofemoral pain. Am J Sports Med 45: 1102-1109.
- Scholtes SA, Salsich GB (2017) A dynamic valgus index that combines hip and knee angles: Assessment of utility in females with patellofemoral pain. Int J Sports Phys Ther 12: 333.
- Holden S, Boreham C, Doherty C, Delahunt E (2017) Two-dimensional knee valgus displacement as a predictor of patellofemoral pain in adolescent females. Scand J Med Sci Sports 27: 188-194.
- Powers CM, Perry J, Hsu A, Hislop HJ (1997) Are patellofemoral pain and quadriceps femoris muscle torque associated with locomotor function? Phys Ther 77: 1063-1075.
- Noehren B, Pohl MB, Sanchez Z, Cunningham T, Lattermann C (2012) Proximal and distal kinematics in female runners with patellofemoral pain. Clin Biomech 27: 366-371.
- Noehren B, Davis I (2007) Prospective study of the biomechanical factors associated with patellofemoral pain syndrome. American Society of Biomechanics Annual Meeting Palo Alto, CA.
- Dierks TA, Manal KT, Hamill J, Davis IS (2008) Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther 38: 448-456.
Citation: Nourbakhsh ST, Bahramian F, Arazpour M, Abutorabi A, Mirzaee F, et al. (2018) Patellofemoral Pain Syndrome and Its Effect on the Walking of Affected Subjects: Update Review. J Osteopor Phys Act 6: 214. Doi: 10.4172/2329-9509.1000214
Copyright: © 2018 Nourbakhsh ST, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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