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      Propulsion Phase of the Single Leg Triple Hop Test in Women with Patellofemoral Pain Syndrome: A Biomechanical Study

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          Abstract

          Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.

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          Development of recommendations for SEMG sensors and sensor placement procedures.

          The knowledge of surface electromyography (SEMG) and the number of applications have increased considerably during the past ten years. However, most methodological developments have taken place locally, resulting in different methodologies among the different groups of users.A specific objective of the European concerted action SENIAM (surface EMG for a non-invasive assessment of muscles) was, besides creating more collaboration among the various European groups, to develop recommendations on sensors, sensor placement, signal processing and modeling. This paper will present the process and the results of the development of the recommendations for the SEMG sensors and sensor placement procedures. Execution of the SENIAM sensor tasks, in the period 1996-1999, has been handled in a number of partly parallel and partly sequential activities. A literature scan was carried out on the use of sensors and sensor placement procedures in European laboratories. In total, 144 peer-reviewed papers were scanned on the applied SEMG sensor properties and sensor placement procedures. This showed a large variability of methodology as well as a rather insufficient description. A special workshop provided an overview on the scientific and clinical knowledge of the effects of sensor properties and sensor placement procedures on the SEMG characteristics. Based on the inventory, the results of the topical workshop and generally accepted state-of-the-art knowledge, a first proposal for sensors and sensor placement procedures was defined. Besides containing a general procedure and recommendations for sensor placement, this was worked out in detail for 27 different muscles. This proposal was evaluated in several European laboratories with respect to technical and practical aspects and also sent to all members of the SENIAM club (>100 members) together with a questionnaire to obtain their comments. Based on this evaluation the final recommendations of SENIAM were made and published (SENIAM 8: European recommendations for surface electromyography, 1999), both as a booklet and as a CD-ROM. In this way a common body of knowledge has been created on SEMG sensors and sensor placement properties as well as practical guidelines for the proper use of SEMG.
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            The influence of abnormal hip mechanics on knee injury: a biomechanical perspective.

            During the last decade, there has been a growing body of literature suggesting that proximal factors may play a contributory role with respect to knee injuries. A review of the biomechanical and clinical studies in this area indicated that impaired muscular control of the hip, pelvis, and trunk can affect tibiofemoral and patellofemoral joint kinematics and kinetics in multiple planes. In particular, there is evidence that motion impairments at the hip may underlie injuries such as anterior cruciate ligament tears, iliotibial band syndrome, and patellofemoral joint pain. In addition, the literature suggests that females may be more disposed to proximal influences than males. Based on the evidence presented as part of this clinical commentary, it can be argued that interventions which address proximal impairments may be beneficial for patients who present with various knee conditions. More specifically, a biomechanical argument can be made for the incorporation of pelvis and trunk stability, as well as dynamic hip joint control, into the design of knee rehabilitation programs. Aetiology/therapy, level 5.
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              The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective.

              Although patellofemoral pain (PFP) is recognized as being one of the most common disorders of the lower extremity, treatment guidelines and underlying rationales remain vague and controversial. The premise behind most treatment approaches is that PFP is the result of abnormal patellar tracking and/or patellar malalignment. Given as such, interventions typically focus on the joint itself and have traditionally included strengthening the vastus medialis oblique, taping, bracing, soft tissue mobilization, and patellar mobilization. More recently, it has been recognized that the patellofemoral joint and, therefore, PFP may be influenced by the interaction of the segments and joints of the lower extremity. In particular, abnormal motion of the tibia and femur in the transverse and frontal planes may have an effect on patellofemoral joint mechanics. With this in mind, interventions aimed at controlling hip and pelvic motion (proximal stability) and ankle/foot motion (distal stability) may be warranted and should be considered when treating persons with patellofemoral joint dysfunction. The purpose of this paper is to provide a biomechanical overview of how altered lower-extremity mechanics may influence the patellofemoral joint. By addressing these factors, better long-term treatment success and prevention may be achieved.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                15 May 2014
                : 9
                : 5
                : e97606
                Affiliations
                [1 ]Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
                [2 ]Post Graduation Program in Human Movement Science, Universidade Metodista de Piracicaba, UNIMEP, Piracicaba, São Paulo, Brazil
                [3 ]Faculty of Physical Education (YMCA), Sorocaba, São Paulo, Brazil
                University of Sao Paulo, Brazil
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: AB AR NR PM JC PL. Performed the experiments: AB AR NR PL. Analyzed the data: AB AR NR PM JC PL. Contributed reagents/materials/analysis tools: AB AR NR PM JC PL. Wrote the paper: AB AR NR PM JC PL.

                Article
                PONE-D-13-47686
                10.1371/journal.pone.0097606
                4022617
                24830289
                3e385ff4-2f03-426a-a5ab-950151851869
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 November 2013
                : 22 April 2014
                Page count
                Pages: 7
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Biomechanics
                Bone and Joint Mechanics
                Medicine and Health Sciences
                Diagnostic Medicine
                Health Care
                Physiotherapy
                Pathology and Laboratory Medicine
                Anatomical Pathology
                Sports and Exercise Medicine
                Research and Analysis Methods
                Research Design
                Clinical Research Design

                Uncategorized
                Uncategorized

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