Effect of McKenzie Techniques on Muscle Strengthening in Anterior Knee Pain
Introduction: The prevalence of Anterior Knee Pain (ANP) has been reported between 15% and 45% in Europe. Muscle weakness is a predisposing factor for ANP. The purpose of this study was to investigate and compare the effect of McKenzie and common exercises on quadriceps and hamstring muscles strengthening and consequently relieving anterior knee pain.
Materials and Methods: A total of 22 patients with ANP (Mean [SD] age: 29.191 [1.658]y) were randomly assigned into control and experiment groups. Each group consisted of 11 subjects. The treatment program included hot pack and acupuncture like TENS modalities for 10 sessions. From the third session, the exercise was added to each group’s treatment program separately. The control group exercises consisted of strengthening exercises of the knee, thigh and trunk muscles. In the experiment group, the subjects were initially classified according to mechanical diagnostic tests of McKenzie. This classification is based on patient’s response to repetitive movements or constant positions at their end range of motion. The exercise was prescribed according to directional preference which was specific for each case. The strength of quadriceps and hamstring muscles were assessed in three stages with hand held dynamometer. The repeated measure ANOVA test was used to compare variables between two groups. The ANOVA and the Tukey post hoc test were used for intra-group comparisons. All statistical analyses were performed in SPSS V. 21.
Results: The strength of quadriceps muscle in both groups showed a significant improvement (P<0.001) after the third evaluation. There was no significant difference between the two groups in this regard. There was no significant difference between two groups in hamstring strength among all stages.
Conclusion: In patients with ANP, McKenzie exercises like common exercises can improve the strength of quadriceps muscle.
Nunes GS, Stapait EL, Kirsten MH, de Noronha M, Santos GM. Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis. Physical therapy in sport : Official Journal of the Association of Chartered Physiotherapists in Sports Medicine. 2013; 14(1):54-9. [DOI:10.1016/j.ptsp.2012.11.003] [PMID]
Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. British Journal of Sports Medicine. 2016; 50(14):839-43. [DOI:10.1136/bjsports-2016-096384] [PMID] [PMCID]
Nguyen USD, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: Survey and cohort data. Annals of Internal Medicine. 2011; 155(11):725-32. [DOI:10.7326/0003-4819-155-11-201112060-00004] [PMID]
Roush JR, Curtis Bay R. Prevalence of anterior knee pain in 18-35 year-old females. International Journal of Sports Physical Therapy. 2012; 7(4):396-401. [PMID] [PMCID]
Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scandinavian Journal of Medicine & Science in Sports. 2010; 20(5):725-30. [DOI:10.1111/j.1600-0838.2009.00996.x] [PMID] [PMCID]
Rathleff MS, Vicenzino B, Middelkoop M, Graven-Nielsen T, van Linschoten R, Hölmich P, et al. Patellofemoral pain in adolescence and adulthood: Same same, but different? Sports Medicine. 2015; 45(11):1489-95. [DOI:10.1007/s40279-015-0364-1] [PMID]
Collado H, Fredericson M. Patellofemoral pain syndrome. Clinics in Sports Medicine. 2010; 29(3):379-98. [DOI:10.1016/j.csm.2010.03.012] [PMID]
Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. American Family Physician. 2007; 75(2):194-202. [PMID]
Sakai N, Luo ZP, Rand JA, An KN. The influence of weakness in the vastus medialis oblique muscle on the patellofemoral joint: An in vitro biomechanical study. Clinical Biomechanics. 2000; 15(5):335-9. [DOI:10.1016/S0268-0033(99)00089-3]
Werner S. Anterior knee pain: An update of physical therapy. Knee Surgery, Sports Traumatology, Arthroscopy. 2014; 22(10):2286-94. [DOI:10.1007/s00167-014-3150-y] [PMID]
Garrick JG. Anterior knee pain (Chondromalacia patellae). The Physician and Sportsmedicine. 1989; 17(1):75-84. [DOI:10.1080/00913847.1989.11709683] [PMID]
Peng YL, Tenan MS, Griffin L. Hip position and sex differences in motor unit firing patterns of the vastus medialis and vastus medialis oblique in healthy individuals. Journal of Applied Physiology. 2018; 124(6):1438-46. [DOI:10.1152/japplphysiol.00702.2017] [PMID]
Clark DI, Downing N, Mitchell J, Coulson L, Syzpryt EP, Doherty M. Physiotherapy for anterior knee pain: A randomised controlled trial. Annals of the Rheumatic Diseases. 2000; 59(9):700-4. [DOI:10.1136/ard.59.9.700] [PMID] [PMCID]
Roush MB, Sevier TL, Wilson JK, Jenkinson DM, Helfst RH, Gehlsen GM, et al. Anterior knee pain: A clinical comparison of rehabilitation methods. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine. 2000; 10(1):22-8. [DOI:10.1097/00042752-200001000-00005] [PMID]
Santos TR, Oliveira BA, Ocarino JM, Holt KG, Fonseca ST. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: A systematic review. Brazilian Journal of Physical Therapy. 2015; 19(3):167-76. [DOI:10.1590/bjpt-rbf.2014.0089] [PMID] [PMCID]
Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, et al. Current management strategies for patellofemoral pain: An online survey of 99 practising UK physiotherapists. BMC. 2017; 18:181. [DOI:10.1186/s12891-017-1539-8] [PMID] [PMCID]
Giles L, Webster KE, McClelland J, Cook JL. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: A double- blind randomised trial. British Journal of Sports Medicine. 2017; 51(23):1688-94. [DOI:10.1136/bjsports-2016-096329] [PMID]
Powers CM. Rehabilitation of patellofemoral joint disorders: A critical review. The Journal of Orthopaedic and Sports Physical Therapy. 1998; 28(5):345-54. [DOI:10.2519/jospt.19220.127.116.115] [PMID]
Baek JH, Kim JW, Kim SY, Oh DW, Yoo EY. Acute effect of repeated passive motion exercise on shoulder position sense in patients with hemiplegia: A pilot study. NeuroRehabilitation. 2009; 25(2):101-6. [PMID]
Kwon O, Lee S, Lee Y, Seo D, Jung S, Chol W. The effect of repetitive passive and active movements on proprioception ability in forearm supination. Journal of Physical Therapy Science. 2013; 25(5):587-90. [DOI:10.1589/jpts.25.587] [PMID] [PMCID]
Nielsen MM, Mortensen A, Sorensen JK, Simonsen O, Graven-Nielsen T. Reduction of experimental muscle pain by passive physiological movements. Manual Therapy. 2009; 14(1):101-9. [DOI:10.1016/j.math.2007.12.008] [PMID]
McKenzie RA, May S. The Cervical and thoracic spine: Mechanical diagnosis and therapy. New Zealand: Orthopedic Physical Therapy; 1990.
McKenzie RA, May S. lumbar spine mechanical diagnosis & therapy. Crichton, New Zealand: Spinal publication; 1990.
Hefford C. McKenzie classification of mechanical spinal pain: profile of syndromes and directions of preference. Manual therapy. 2008; 13(1):75-81. [DOI:10.1016/j.math.2006.08.005] [PMID]
McKenzie RA, May S. Human extremities: Mechanical diagnosis and therapy. New Zealand: Orthopedic Physical Therapy; 2000.
Menon A, May S. Shoulder pain: Differential diagnosis with mechanical diagnosis and therapy extremity assessment- A case report. Manual Therapy. 2013; 18(4):354-7. [DOI:10.1016/j.math.2012.06.011] [PMID]
Rosedale R, Rastogi R, May S, Chesworth BM, Filice F, Willis S, et al. Efficacy of exercise intervention as determined by the McKenzie system of mechanical diagnosis and therapy for knee osteoarthritis: A randomized controlled trial. The Journal of Orthopaedic and Sports Physical Therapy. 2014; 44(3):173-81.
American Heart Association. Healthy For Good [Internet]. 2017 [Updated 2017 June 6]. Available from: http://www.heart.org/HEARTORG/Affiliate/Healthy-For-Good_UCM_493007_SubHomePage.jsp
Shimano T, Kraemer WJ, Spiering BA, Volek JS. Relationship between the number of repetitions and selected percentages of one repetition maximum in free weight exercises in trained and untrained men. Journal of Strength and Conditioning Research. 2006; 20(4):819-23. [DOI:10.1519/R-18195.1] [PMID]
Tauchi R, Imagama S, Muramoto A, Tsuboi M, Ishiguro N, Hasegawa Y. Influence of spinal imbalance on knee osteoarthritis in community-living elderly adults. Nagoya Journal of Medical Science. 2015; 77(3):329-37. [PMID] [PMCID]
Hansen EM, McCartney CN, Sweeney RS, Palimenio MR, Grindstaff TL. Hand-held dynamometer positioning impacts discomfort during Quadriceps Strength Testing: A validity and reliability study. International Journal of Sports Physical Therapy. 2015; 10(1):62-8. [PMID] [PMCID]
Kollock Jr RO, Onate JA, Van Lunen B. The reliability of portable fixed dynamometry during hip and knee strength assessments. Journal of Athletic Training. 2010; 45(4):349-56. [DOI:10.4085/1062-6050-45.4.349] [PMID] [PMCID]
Moradi Z, Akbari M, Ansari NN, Emrani A, Mohammadi P. Strength of hip muscle groups in sedentary women with patellofemoral pain syndrome. Journal of Back and Musculoskeletal Rehabilitation. 2014; 27(3):299-306. [DOI:10.3233/BMR-130447] [PMID]
Nadler SF, DePrince ML, Hauesien N, Malanga GA, Stitik TP, Price E. Portable dynamometer anchoring station for measuring strength of the hip extensors and abductors. Archives of Physical Medicine and Rehabilitation. 2000; 81(8):1072-6. [DOI:10.1053/apmr.2000.7165] [PMID]
Scott DA, Bond EQ, Sisto SA, Nadler SF. The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station. Archives of Physical Medicine and Rehabilitation. 2004; 85(4):598-603. [DOI:10.1016/j.apmr.2003.07.013] [PMID]
Thorborg K, Petersen J, Magnusson SP, Holmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scandinavian Journal of Medicine & Science in Sports. 2010; 20(3):493-501. [DOI:10.1111/j.1600-0838.2009.00958.x] [PMID]
Kirk EA, Rice CL. Contractile function and motor unit firing rates of the human hamstrings. Journal of Neurophysiology. 2016; 117(1):243-50. [DOI:10.1152/jn.00620.2016] [PMID] [PMCID]
Park J, Hopkins JT. Induced anterior knee pain immediately reduces involuntary and voluntary quadriceps activation. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine. 2013; 23(1):19-24. [DOI:10.1097/JSM.0b013e3182717b7b] [PMID]
Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: A systematic review. The Journal of Orthopaedic and Sports Physical Therapy. 2012; 42(2):81-94. [DOI:10.2519/jospt.2012.3803] [PMID]
Akbari M, Mousavikhatir R. Changes in the muscle strength and functional performance of healthy women with aging. Medical Journal of the Islamic Republic of Iran. 2012; 26(3):125-31. [PMID] [PMCID]
Kamen G, Knight CA. Training-related adaptations in motor unit discharge rate in young and older adults. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences. 2004; 59(12):1334-8. [DOI:10.1093/gerona/59.12.1334]