Retraining faulty movement patterns could play a role in patellofemoral pain
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Movement retraining without adhering to basic motor control principles may be associated with increased patellofemoral pain, according to published results.
Irene S. Davis, PhD, PT FACSM, FAPTA, FASB, of the department of physical medicine and rehabilitation at Harvard Medical School, and colleagues studied the effectiveness of gait retraining programs for the management of patellofemoral pain (PFP). They reviewed the findings of multiple movement retraining studies, analyzing each approach for design and outcomes.
“The most common intervention approach to changing abnormal movement patterns is strengthening the muscles that control those aberrant movements. However, studies that have involved strengthening report persistent symptoms in long-term follow-ups,” Davis and colleagues wrote in the study. “There are a number of motor learning principles that need to be adhered to in order to retrain a motor pattern. One of the most important features of a retraining program is the provision of some type of feedback,” they wrote.
According to the study, programs that utilized a faded feedback design through eight to 18 retraining sessions for 2 to 6 weeks had the greatest positive effect on PFP. Pain reductions were the least in programs in which retraining volume was low and feedback was absent.
“The majority of these studies have been conducted in running and have focused on reducing hip adduction, increasing forward lean, transitioning to a forefoot strike pattern and increasing cadence,” the authors wrote. “A number of investigations have focused on improvement in functional activities such as walking, squatting, stair negotiation and rising from a chair. Studies have all reported some improvements in mechanics, pain and function. However, the degree of improvement was not consistent across studies,” they added.
“Studies have shown that strengthening alone does not alter these patterns, and that addressing the motor program is needed to effect these changes. Based upon the studies reviewed here, retraining faulty patterns, when present, appears to play a significant role in addressing PFP,” Davis and colleagues concluded. “Therefore, movement retraining, while adhering to basic motor control principles, should be part of a therapist’s intervention skillset when treating patients with PFP,” they added.
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James Bicos, MD
This article looks at the use of gait retraining as an intervention for reducing patellofemoral pain. Motor programs have been successfully used in the past in treating many injuries, notably much of the work in preventing ACL tears in athletes also falls under this category. It is difficult to say what is the “chicken or the egg” in patellofemoral pain — ie, if the pain causes the resultant gait and motor deficiencies or if there are inherent issues in those patients that lead to the patellofemoral pain. Often times it is a combination of both. As physicians we see many patients with risk factors for patellofemoral pain, including weak gluteal muscles and improper exercise techniques, such as squats with the legs falling into valgus.
The authors do a very nice job of summarizing and evaluating the findings in various studies in the literature regarding if adding a motor program helps to decrease patellofemoral pain. They did show from the studies reviewed that retraining faulty movement patterns appeared to play a significant role in addressing patellofemoral pain, and that those motor control principles should be a part of a physical therapist’s armamentarium when treating patients with patellofemoral pain.
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