A comparison of closed kinetic chain and isokinetic joint isolation exercise in patients with patellofemoral dysfunction. Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Static and isokinetic treatments of chondromalacia patella: a comparative investigation. Physiotherapy for anterior knee pain: a randomised controlled trial. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Randomized controlled trial of Protonics on patellar pain, position, and function. Open versus closed kinetic chain exercises for patellofemoral pain. A prospective, randomized study. [Muscle training techniques and retropatellar chondropathy].
Recently, there has been attention to the clinical application of closed kinetic chain and joint isolation exercise. Our purpose was to compare the effect of joint isolation and closed kinetic chain exercise on quadriceps muscle performance and perceived function in patients with patellofemoral pain. Twenty-three patients participated in an 8-week training period and were assigned to either a closed kinetic chain or a joint isolation exercise training group. An 8-inch (20.3 cm) retro step-up test was performed at baseline, 8 weeks, and 1 year. Seated knee extension testing was measured at baseline and at 8 weeks using peak concentric torque on an isokinetic dynamometer at 90 degrees/sec, 180 degrees/sec, and 360 degrees/sec. Perceived functional status was rated as excellent, good, fair, or poor based on questionnaire response. Statistical analysis showed that both groups had significant improvement in peak torque at all speeds, but only the closed kinetic chain group showed significant improvement in closed kinetic chain testing and perceived functional status. We concluded that closed kinetic chain training may be more effective than joint isolation exercise in restoring function in patients with patellofemoral dysfunction. To determine the effects of electromyographic biofeedback treatment in patients with patellofemoral pain syndrome.
                Randomized controlled trial.
                A physical medicine and rehabilitation department in a research hospital of a university referral center.
                Sixty patients with patellofemoral pain syndrome. Patients were randomly placed into 2 groups: biofeedback group (n = 30) and a control group (n = 30).
                The biofeedback group received electromyographic biofeedback training and a conventional exercise program, whereas the control group received a conventional exercise program only.
                Maximum and mean contraction values of the vastus medialis and the vastus lateralis muscles were assessed with the biofeedback device. Pain and functional status of the patients were measured by a visual analog scale (VAS) and the Functional Index Questionnaire (FIQ), respectively.
                Contraction values improved significantly at the end of the first month, compared with the pretreatment values in both groups. Mean contraction values in the biofeedback group of the vastus medialis muscles in all 3 monthly measurements, and the vastus lateralis muscles at the end of the first month, were significantly higher than those of the control group. Significant improvements were shown for both the VAS and the FIQ in both groups. Monthly follow-ups showed no VAS and FIQ differences between the groups.
                Electromyographic biofeedback treatment did not result in further clinical improvement when compared with a conventional exercise program in patients with patellofemoral pain syndrome.
                Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Literature on the comparative effectiveness of nonoperative treatments for patellofemoral pathologies has been limited. The purpose of this investigation was to study the effectiveness of selected static and isokinetic physical therapy rehabilitation programs for subjects with a clinical diagnosis of chondromalacia patella. Criteria employed to assess the effects of these therapeutic programs included measures of knee functional capacity as measured by the Cincinnati Rating System and traditional measures of leg strength and flexibility. Twenty-nine subjects were screened by an orthopaedic physician and assigned to a control (N = 9), static (N = 11), or isokinetic (N = 9) exercise group. Noncontrol subjects were administered a program of 12 treatments, three times a week, for four weeks by a registered physical therapist. Results of the ANCOVA for 17 pretest and posttest measures indicated that the static and isokinetic groups demonstrated significant (P < 0.05) functional improvements over the control group in walking, stair activity, running, jumping/twisting, and overall activity level as well as increased quadriceps strength and hamstring range of motion. No significant differences, however, were determined to exist between the static and isokinetic groups. The major implication of this investigation is that static and isokinetic treatment programs provide positive and comparable rehabilitation effects on the functional capacity of the knee joint for subjects with chondromalacia patella. Static therapy, however, appears to be most cost-effective. J Orthop Sports Phys Ther 1990;12(6):256-266. To determine the efficacy of the individual components of physiotherapy in subjects with anterior knee pain.
                An observer blind, prospective, factorial design randomised controlled trial. 81 young adults with anterior knee pain were randomly allocated to one of four treatment groups: (1) exercise, taping, and education; (2) exercise and education; (3) taping and education; and (4) education alone. Each group received six physiotherapist-led treatments over three months. Follow up took place at three months using the following outcome measures: patient satisfaction (discharge/refer for further treatment); a visual analogue pain score; the WOMAC lower limb function score; the Hospital Anxiety and Depression scale (HAD); and quadriceps strength. At 12 months the WOMAC and HAD were assessed by postal questionnaire.
                All groups showed significant improvements in WOMAC, visual analogue, and HAD scores; these improvements did not vary significantly between the four groups or between exercising/non-exercising and taped/non-taped patients at three and 12 months. However, patients who exercised were significantly more likely to be discharged at three months than non-exercising patients (chi(2), p<0.001). Taping was not significantly associated with discharge. Significantly greater improvements in WOMAC, visual analogue, and the anxiety score (but not the depression score) were seen in patients who were discharged than in those who were referred.
                The proprioceptive muscle stretching and strengthening aspects of physiotherapy have a beneficial effect at three months sufficient to permit discharge from physiotherapy. These benefits are maintained at one year. Taping does not influence the outcome. The purposes of this study were (1) to evaluate a comprehensive treatment approach for patients with patellofemoral pain syndrome and (2) to compare a training program using isometric muscle contractions with a training program using eccentric muscle contractions.
                Forty female patients with patellofemoral pain syndrome, aged 15 to 28 years (mean = 20.2, SD = 3.2), were randomly assigned to either a group using isometric muscle contractions or a group using eccentric muscle contractions.
                The effects of 12 weeks of treatment, consisting of an educational component and a training program, on physical activity, pain, and muscle function were evaluated after 3 and 12 months.
                No differences were found between the two groups, except in one of the torque measurements. A reduction in pain and improvements in torque, vertical jumping ability, and physical activity level were seen in both groups after treatment. At the 12-month follow-up, 85% of the subjects were participating in sports without pain and 37 subjects rated their overall knee function as excellent or good.
                The results indicate that the improvements shown in this study may be due to spontaneous recovery over time, the education given to the subjects, the pain monitoring system, the gradually progressing training program, and the adjusted physical activity. [Thomeé R. A. Comprehensive treatment approach for patellofemoral pain syndrome in young women. Patellofemoral pain (PFP) and abnormal patellofemoral congruence (PFC) are common athletic problems whose treatment remains controversial. This study examined the effects of a high volume of submaximal knee muscle exercise on objective measures of PFP and PFC under a test-retest design.
                A sample of 100 subjects was randomly divided into two groups: control and treatment. All subjects of both groups were tested for PFC, using a Merchant x-ray view, function, via Kujala patellofemoral score (KPS), and pain, through a visual analog scale (VAS), initially and then 4 wk later. The treatment group exercised during activities of daily living (ADL) by wearing a Protonics device; the control group did not receive treatment.
                One-way analysis of variance tests found no difference between pre- and posttest results for the control group but found significant changes in PFC, KPS, and VAS (all P < 0.001). PFC and joint function improved, and PFP decreased in all subjects of the treatment group. CONCLUSIONS/CLINICAL RELEVANCE: It was concluded that the treatment reduced PFP and PFC as compared with the control. A high volume of submaximal knee exercise seems useful for clinical patients with PFP and abnormal PFC. The goal of this prospective study was to evaluate the efficacy of open versus closed kinetic chain exercises in the nonoperative management of patellofemoral pain. Sixty patients were randomized into a 5-week program that consisted of only closed kinetic chain exercises or only open kinetic chain exercises. Muscle characteristics, subjective symptoms, and functional performance were evaluated in this study at the time of the initial physical examination, at the end of the treatment period, and 3 months later. Both groups experienced a statistically significant decrease in pain and an increase in functional performance. This study shows that both open and closed kinetic chain exercise programs lead to an improved subjective and clinical outcome in patients with anterior knee pain. The few significantly better functional results for some of the tested parameters in the closed kinetic chain group suggest that this type of treatment is a little more effective than the open kinetic chain program in the treatment of these patients. The authors have studied the efficacy of 3 different muscle training programs (electromyostimulation, isokinetic training and isometric training) in cases of patellar chondromalacia. The evaluation of the results was made by measuring the isokinetic strength on a Cybex II+ dynamometer at a low (30 degrees/sec) and a high (300 degrees/sec) angular velocity. The clinical evaluation was based on a modified score determined by the Arpege group. The results showed a better improvement of the muscular strength after electromyostimulation or isokinetic training. The clinical improvement was better on patients of groups I and III.