The effect of hip exercise programme for patients with patellofemoral pain syndrome

Uvod: Patelofemoralni bolečinski sindrom je eno izmed najpogostejših stanj v ortopedski medicini in medicini športa. Patologijo zaznamuje nepravilno drsenje pogačice, ki je posledica mišične disfunkcije oz. neravnovesja sil med posameznimi mišičnimi skupinami. Zaradi spremenjene biomehanike prihaja do preobremenitev posameznih struktur v patelofemoralnem sklepu, kar sproža sklepno okorelost ter značilno retropatelarno oz. peripatelarno bolečino. Simptomi se stopnjujejo pri aktivnostih, kot so kolesarjenje, tek, skakanje, sedenje, klečanje in hoja po stopnicah. Patelofemoralni sindrom se pojavi pogosteje pri ženskah in telesno aktivni populaciji, predvsem pri tekačih. Zdravljenje je konzervativno in obsega krepitev posameznih mišičnih skupin kolčnega in kolenskega sklepa, vaje za izboljšanje nevromišičnega nadzora, raztezanje mehkih tkiv, apliciranje kinezioterapevtskih trakov ter predpisovanje ortoz in opornic. Namen: Namen diplomskega dela je na osnovi pregleda strokovne in znanstvene literature predstaviti dodano vrednost vadbe mišičnih skupin kolčnega sklepa v primerjavi z vadbo mišic kolenskega sklepa na izraženost patelofemoralnega bolečinskega sindroma. Metode dela: Literatura je bila zbrana s pomočjo zbirk Pubmed, MEDLine in Pedro. Uporabljeni so bili prosto dostopni članki v angleškem jeziku, sistematični pregledi člankov in klinične randomizirane študije objavljene po letu 2004, ki so preučevale učinkovitost krepitve mišic kolenskega sklepa oz. učinkovitost krepitve mišic kolena v kombinaciji z mišicami kolčnega sklepa pri pacientih s patelofemoralnim bolečinskim sindromom. Rezultati: Na podlagi vključitvenih kriterijev je bilo analiziranih sedem raziskav, ki so bile objavljene med letoma 2009 in 2016. Vključevanje mišičnih skupin kolčnega sklepa v program krepitve mišic kolenskega sklepa prinaša boljše rezultate kot program, kjer je poudarjena le krepitev štiriglave stegenske mišice. Terapevtska vadba, katere del je trening za povečanje moči proksimalnih mišic, prispeva k hitrejšemu upadu bolečine in izboljšanju funkcije kolena. Razprava in sklep: Kljub dokazani učinkovitosti dodajanja mišičnih skupin kolka v program krepitve štiriglave stegenske mišice oz. mišic kolenskega sklepa je potrebnih v prihodnosti več metodološko kakovostnih študij, ki bodo preučevale posamezne komponente programa krepitve abduktorjev in zunanjih rotatorjev kolčnega sklepa. V nadaljevanju bi bilo potrebno več pozornosti usmeriti v primerjavo učinkov vadbe v odprti in zaprti kinetični verigi, pomenu koncentrične oz. ekscentrične kontrakcije, doziranju vadbe ter specificiranju progresivnosti.Introduction: Patellofemoral pain syndrome is one of the most common conditions in orthopaedic and sports medicine. Disproportionate forces generated during contraction of disfunctional muscles lead to patella maltracking. Abnormal biomechanics, which results in overloading of patellofemoral joint structures, triggers typical retropatellar or peripatellar pain and stiffnes of the knee joint. Symptoms escalate during activities such as cycling, running, jumping, prolonged sitting, kneeling and stair climbing. Females and physically active population, ecpecially runners, are more likely to develop patellofemoral pain syndrome. Conservative treatment is a treatment of choice and includes strengthening of hip and knee musculature, neuromuscular training, soft tissue stretching, taping, prescribing orthoses and bracing. Purpose: The purpose of this thesis is to present the advantages of adding hip exercise programme to conventional knee - preferentally quadriceps femoris exercise programme in patients with patellofemoral pain, based on review of professional and scientific literature. Methods: Literature was gathered using Pubmed, MEDLine and PEDro. Full access articles in English, systematic reviews, clinical randomized trials published after 2004 which studied the effects of knee strengthening programme alone or in combination with hip strengthening programme in patients with PFPS were used. Results: Based on our criteria, seven studies published between 2009 and 2016, were included in the analysis. Outcomes show that adding hip musculature strengthening to knee musculature strengthening programme gives better results than knee strengthening alone. Strengthening of proximal musculature, as a part of therapeutic exercise, is more effective in lowering the rate of pain and improving knee function. Discussion and conclusion: Despite positive results of adding hip muscle strengthening to knee exercise programme, more research is needed, especially studies with better methodology that would discuss different aspects of abductors and lateral rotators strengthening. Clinicians should address more concern to the effects of closed and open kinetic chain exercises, importance of concentric and eccentric contraction, defining optimal loading, exercise dosage and specifying progression