Lumbopelvic Joint Manipulation and Quadriceps Activation of People With Patellofemoral Pain Syndrome.

KNEE physiology; PELVIC physiology; QUADRICEPS muscle physiology; LUMBAR vertebrae physiology; ANALYSIS of variance; ANTHROPOMETRY; CLINICAL trials; EVOKED potentials (Electrophysiology); EXERCISE physiology; RANGE of motion of joints; MANIPULATION therapy; MUSCLE contraction; MUSCLE strength; PHYSICAL therapists; RESEARCH funding; STATISTICAL sampling; STATISTICS; T-test (Statistics); STATISTICAL power analysis; DATA analysis; CONTINUING education units; REPEATED measures design; PLICA syndrome; BLIND experiment; DATA analysis software; FUNCTIONAL assessment; DESCRIPTIVE statistics

Context: Quadriceps weakness and inhibition are impairments associated with patellofemoral pain syndrome (PFPS). Lumbopelvic joint manipulation has been shown to improve quadriceps force output and inhibition, but the duration of the effect is unknown. Objective: To determine whether quadriceps strength and activation are increased and maintained for 1 hour after high- grade or low-grade joint mobilization or manipulation applied at the lumbopelvic region in people with PFPS. Design: Randomized controlled clinical trial. Setting: University laboratory. Patients or Other Participants: Forty-eight people with PFPS (age = 24.6 ±8.9 years, height =174.3 ±11.2 cm, mass = 78.4 ±16.8 kg) participated. Intervention(s): Participants were randomized to 1 of 3 groups: lumbopelvic joint manipulation (grade V), side-lying lumbar midrange flexion and extension passive range of motion (grade II) for 1 minute, or prone extension on the elbows for 3 minutes. Main Outcome Measure(s): Quadriceps force and activation were measured using the burst superimposition technique during a seated isometric knee extension task. A 2-way repeated-measures analysis of variance was performed to compare changes in quadriceps force and activation among groups over time (before intervention and at 0, 20, 40, and 60 minutes after intervention). Results: We found no differences in quadriceps force output (F5.33,101.18 = 0.65, P=.67) or central activation ratio (F4.84,92.03 = 0-38, P = .86) values among groups after intervention. When groups were pooled, we found differences across time for quadriceps force (F2.6,6101.18 = 5.03, P=.004) and activation (F2.42,92.03 = 3.85, P = .02). Quadriceps force was not different at 0 minutes after intervention (t40= 1.68, P=.10), but it decreased at 20 (t40 = 2.16, P=.04), 40 (t40 = 2.87, P=.01) and 60 (t40 = 3.04, P = .004) minutes after intervention. All groups demonstrated decreased quadriceps activation at 0 minutes after intervention (t40 = 4.17, P<.001), but subsequent measures were not different from preintervention levels (t40 range, 1.53-1.83, P>.09). Conclusions: Interventions directed at the lumbopelvic region did not have immediate effects on quadriceps force out put or activation. Muscle fatigue might have contributed to decreased force output and activation over 1 hour of testing. [ABSTRACT FROM AUTHOR]

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