Original article
Training Program and Additional Electric Muscle Stimulation for Patellofemoral Pain Syndrome: A Pilot Study

https://doi.org/10.1016/j.apmr.2007.10.048Get rights and content

Abstract

Bily W, Trimmel L, Mödlin M, Kaider A, Kern H. Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study.

Objectives

To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles.

Setting

Supervised physiotherapy (PT) training and home-based EMS.

Participants

Patients (N=38; 14 men, 24 women) with bilateral PFPS.

Interventions

One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40Hz, with a pulse duration of .26ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA.

Main Outcome Measures

Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year.

Results

Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group.

Conclusions

A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.

Section snippets

Participants

Between June 2003 and August 2005, 64 participants were referred by outside orthopedic surgeons, and 40 fulfilled the eligibility criteria. Inclusion criteria were bilateral anterior knee pain for 6 to 120 months and at least 3 of the 4 following clinical criteria: pain associated with prolonged sitting with bended knees, descending stairs, kneeling and squatting, or sports activities.

Exclusion criteria were clinical evidence of patellar dislocation or subluxation, periarticular bursitis or

Pain and Function

In the supervised PT group, we started with 19 patients. One patient did not return for the 3-month control for personal reasons. Eighteen patients were analyzed after 3 months of training. In the PT group, 13 patients completed the 1-year follow-up. Of the 5 patients missing, 1 was diagnosed with rheumatoid arthritis, 1 had to undergo knee surgery because of his PFPS, and 3 patients did not return for the 1-year follow-up investigations.

Nineteen patients started in the PT and EMS group,

Discussion

The results of the study indicate that a supervised PT training program over a period of 3 months can decrease pain and improve function in patients with PFPS. Both groups, PT as well as PT and EMS, showed significant and clinically relevant treatment effects.

The results are similar to those reported by Thomeé,11 Crossley,16 Boling,17 and colleagues. Our training program consisted of concentric and eccentric exercises of trunk and leg musculature and balance and stretching exercises. We used a

Conclusions

The results of our investigation contribute to the evidence that a supervised physiotherapeutic training program alone can reduce pain and improve function in patients with PFPS. The training program was successful despite a relatively long duration of complaints, irrespective of sex differences and individual sports activities before the start of the treatment program. The effects were observed without concomitant improvement in isometric strength values and appeared to last for at least 1

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  • Cited by (0)

    Supported by Hochschuljubiläumsstiftung der Stadt Wien (grant no. 30/2000).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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