Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2014

01-10-2014 | Knee

Increased medial foot loading during drop jump in subjects with patellofemoral pain

Authors: Michael S. Rathleff, Camilla Richter, Christoffer Brushøj, Jesper Bencke, Thomas Bandholm, Per Hölmich, Kristian Thorborg

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2014

Login to get access

Abstract

Purpose

To compare medial-to-lateral plantar forces during drop jump and single leg squat in individuals with and without patellofemoral pain.

Methods

This cross-sectional study compared 23 young adults with patellofemoral pain to 20 age- and sex-matched controls without knee pain. The plantar pressure distribution was collected during drop jump and single leg squat using pressure-sensitive Pedar insoles, inserted into a standard flat shoe. The primary outcome was the medial-to-lateral force, quantified as the peak force under the medial forefoot as the percentage of force under the total forefoot during drop jump. Secondary outcomes included peak medial-to-lateral force during single leg squat and mean forces during drop jump and single leg squat.

Results

The primary outcome showed that individuals with patellofemoral pain had a 22 % higher medial-to-lateral peak force during drop jump, (p = 0.03). Secondary outcomes showed 32 % higher medial-to-lateral peak force during single leg squat (p = 0.01) and 19–23 % higher medial-to-lateral mean force during drop jump and single leg squat (p = 0.02–0.04).

Conclusion

These findings indicate that individuals with patellofemoral pain display a more medially oriented loading pattern of the forefoot compared to individuals without knee pain. This loading pattern may be associated with the distribution of forces acting on the patellofemoral joint and suggest treatment of PFP should consider interventions that target normalisation of foot loading.

Level of evidence

III.
Literature
1.
go back to reference Aliberti S, Costa Mde S, Passaro Ade C, Arnone AC, Hirata R, Sacco IC (2011) Influence of patellofemoral pain syndrome on plantar pressure in the foot rollover process during gait. Clinics (Sao Paulo) 66(3):367–372CrossRef Aliberti S, Costa Mde S, Passaro Ade C, Arnone AC, Hirata R, Sacco IC (2011) Influence of patellofemoral pain syndrome on plantar pressure in the foot rollover process during gait. Clinics (Sao Paulo) 66(3):367–372CrossRef
2.
go back to reference Aliberti S, Costa MS, Passaro AC, Arnone AC, Sacco IC (2010) Medial contact and smaller plantar loads characterize individuals with patellofemoral pain syndrome during stair descent. Phys Ther Sport 11(1):30–34PubMedCrossRef Aliberti S, Costa MS, Passaro AC, Arnone AC, Sacco IC (2010) Medial contact and smaller plantar loads characterize individuals with patellofemoral pain syndrome during stair descent. Phys Ther Sport 11(1):30–34PubMedCrossRef
3.
go back to reference Barnett S, Cunningham JL, West S (2001) A comparison of vertical force and temporal parameters produced by an in-shoe pressure measuring system and a force platform. Clin Biomech Bristol Avon 16(4):353–357CrossRef Barnett S, Cunningham JL, West S (2001) A comparison of vertical force and temporal parameters produced by an in-shoe pressure measuring system and a force platform. Clin Biomech Bristol Avon 16(4):353–357CrossRef
4.
go back to reference Barton CJ, Levinger P, Crossley KM, Webster KE, Menz HB (2012) The relationship between rearfoot, tibial and hip kinematics in individuals with patellofemoral pain syndrome. Clin Biomech 27(7):702–705CrossRef Barton CJ, Levinger P, Crossley KM, Webster KE, Menz HB (2012) The relationship between rearfoot, tibial and hip kinematics in individuals with patellofemoral pain syndrome. Clin Biomech 27(7):702–705CrossRef
5.
go back to reference Barton CJ, Levinger P, Menz HB, Webster KE (2009) Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait Posture 30(4):405–416PubMedCrossRef Barton CJ, Levinger P, Menz HB, Webster KE (2009) Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait Posture 30(4):405–416PubMedCrossRef
6.
go back to reference Barton CJ, Menz HB, Levinger P, Webster KE, Crossley KM (2011) Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome. Br J Sports Med 45(9):697–701PubMedCrossRef Barton CJ, Menz HB, Levinger P, Webster KE, Crossley KM (2011) Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome. Br J Sports Med 45(9):697–701PubMedCrossRef
7.
go back to reference Boling MC, Padua DA, Marshall SW, Guskiewicz K, Pyne S, Beutler A (2009) A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the joint undertaking to monitor and prevent ACL injury (JUMP-ACL) cohort. Am J Sports Med 37(11):2108–2116PubMedCrossRefPubMedCentral Boling MC, Padua DA, Marshall SW, Guskiewicz K, Pyne S, Beutler A (2009) A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the joint undertaking to monitor and prevent ACL injury (JUMP-ACL) cohort. Am J Sports Med 37(11):2108–2116PubMedCrossRefPubMedCentral
8.
go back to reference Dierks TA, Manal KT, Hamill J, Davis IS (2008) Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther 38(8):448–456PubMedCrossRef Dierks TA, Manal KT, Hamill J, Davis IS (2008) Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther 38(8):448–456PubMedCrossRef
9.
go back to reference Farrokhi S, Keyak JH, Powers CM (2011) Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study. Osteoarthr Cartil 19(3):287–294PubMedCrossRef Farrokhi S, Keyak JH, Powers CM (2011) Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study. Osteoarthr Cartil 19(3):287–294PubMedCrossRef
10.
go back to reference Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am 66(5):715–724PubMed Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am 66(5):715–724PubMed
11.
go back to reference Hurkmans HL, Bussmann JB, Benda E, Verhaar JA, Stam HJ (2006) Accuracy and repeatability of the pedar mobile system in long-term vertical force measurements. Gait Posture 23(1):118–125PubMedCrossRef Hurkmans HL, Bussmann JB, Benda E, Verhaar JA, Stam HJ (2006) Accuracy and repeatability of the pedar mobile system in long-term vertical force measurements. Gait Posture 23(1):118–125PubMedCrossRef
12.
go back to reference Hurkmans HL, Bussmann JB, Selles RW, Horemans HL, Benda E, Stam HJ, Verhaar JA (2006) Validity of the pedar mobile system for vertical force measurement during a seven-hour period. J Biomech 39(1):110–118PubMedCrossRef Hurkmans HL, Bussmann JB, Selles RW, Horemans HL, Benda E, Stam HJ, Verhaar JA (2006) Validity of the pedar mobile system for vertical force measurement during a seven-hour period. J Biomech 39(1):110–118PubMedCrossRef
13.
go back to reference Joseph M, Tiberio D, Baird JL, Trojian TH, Anderson JM, Kraemer WJ, Maresh CM (2008) Knee valgus during drop jumps in National Collegiate Athletic Association Division I female athletes: the effect of a medial post. Am J Sports Med 36(2):285–289PubMedCrossRef Joseph M, Tiberio D, Baird JL, Trojian TH, Anderson JM, Kraemer WJ, Maresh CM (2008) Knee valgus during drop jumps in National Collegiate Athletic Association Division I female athletes: the effect of a medial post. Am J Sports Med 36(2):285–289PubMedCrossRef
14.
go back to reference Kovacs I, Tihanyi J, Devita P, Racz L, Barrier J, Hortobagyi T (1999) Foot placement modifies kinematics and kinetics during drop jumping. Med Sci Sport Exer 31(5):708–716CrossRef Kovacs I, Tihanyi J, Devita P, Racz L, Barrier J, Hortobagyi T (1999) Foot placement modifies kinematics and kinetics during drop jumping. Med Sci Sport Exer 31(5):708–716CrossRef
15.
go back to reference Li G, DeFrate LE, Zayontz S, Park SE, Gill TJ (2004) The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads. J Orthop Res 22(4):801–806PubMedCrossRef Li G, DeFrate LE, Zayontz S, Park SE, Gill TJ (2004) The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads. J Orthop Res 22(4):801–806PubMedCrossRef
16.
go back to reference Mills K, Blanch P, Chapman AR, McPoil TG, Vicenzino B (2010) Foot orthoses and gait: a systematic review and meta-analysis of literature pertaining to potential mechanisms. Br J Sports Med 44(14):1035–1046PubMedCrossRef Mills K, Blanch P, Chapman AR, McPoil TG, Vicenzino B (2010) Foot orthoses and gait: a systematic review and meta-analysis of literature pertaining to potential mechanisms. Br J Sports Med 44(14):1035–1046PubMedCrossRef
17.
go back to reference Molgaard C, Rathleff MS, Simonsen O (2011) Patellofemoral pain syndrome and its association with hip, ankle, and foot function in 16- to 18-year-old high school students: a single-blind case-control study. J Am Podiatr Med Assoc 101(3):215–222PubMedCrossRef Molgaard C, Rathleff MS, Simonsen O (2011) Patellofemoral pain syndrome and its association with hip, ankle, and foot function in 16- to 18-year-old high school students: a single-blind case-control study. J Am Podiatr Med Assoc 101(3):215–222PubMedCrossRef
18.
go back to reference Myer GD, Brent JL, Ford KR, Hewett TE (2011) Real-time assessment and neuromuscular training feedback techniques to prevent ACL injury in female athletes. Strength Cond J 33(3):21–35PubMedCrossRefPubMedCentral Myer GD, Brent JL, Ford KR, Hewett TE (2011) Real-time assessment and neuromuscular training feedback techniques to prevent ACL injury in female athletes. Strength Cond J 33(3):21–35PubMedCrossRefPubMedCentral
19.
go back to reference Myer GD, Ford KR, Barber Foss KD, Goodman A, Ceasar A, Rauh MJ, Divine JG, Hewett TE (2010) The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech 25(7):700–707CrossRef Myer GD, Ford KR, Barber Foss KD, Goodman A, Ceasar A, Rauh MJ, Divine JG, Hewett TE (2010) The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech 25(7):700–707CrossRef
20.
go back to reference Myer GD, Stroube BW, DiCesare CA, Brent JL, Ford KR, Heidt RS Jr, Hewett TE (2013) Augmented feedback supports skill transfer and reduces high-risk injury landing mechanics: a double-blind, randomized controlled laboratory study. Am J Sports Med 41(3):669–677PubMedCrossRef Myer GD, Stroube BW, DiCesare CA, Brent JL, Ford KR, Heidt RS Jr, Hewett TE (2013) Augmented feedback supports skill transfer and reduces high-risk injury landing mechanics: a double-blind, randomized controlled laboratory study. Am J Sports Med 41(3):669–677PubMedCrossRef
21.
go back to reference Nagura T, Dyrby CO, Alexander EJ, Andriacchi TP (2002) Mechanical loads at the knee joint during deep flexion. J Orthop Res 20(4):881–886PubMedCrossRef Nagura T, Dyrby CO, Alexander EJ, Andriacchi TP (2002) Mechanical loads at the knee joint during deep flexion. J Orthop Res 20(4):881–886PubMedCrossRef
22.
go back to reference Neptune RR, Wright IC, van den Bogert AJ (2000) The influence of orthotic devices and vastus medialis strength and timing on patellofemoral loads during running. Clin Biomech 15(8):611–618CrossRef Neptune RR, Wright IC, van den Bogert AJ (2000) The influence of orthotic devices and vastus medialis strength and timing on patellofemoral loads during running. Clin Biomech 15(8):611–618CrossRef
23.
go back to reference Noehren B, Hamill J, Davis I (2013) Prospective evidence for a hip etiology in patellofemoral pain. Med Sci Sport Exer 45(6):1120–1124CrossRef Noehren B, Hamill J, Davis I (2013) Prospective evidence for a hip etiology in patellofemoral pain. Med Sci Sport Exer 45(6):1120–1124CrossRef
24.
go back to reference Powers CM (2010) The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther 40(2):42–51PubMedCrossRef Powers CM (2010) The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther 40(2):42–51PubMedCrossRef
25.
go back to reference Powers CM, Bolgla LA, Callaghan MJ, Collins N, Sheehan FT (2012) Patellofemoral pain: proximal, distal, and local factors, 2nd international research retreat. J Orthop Sports Phys Ther 42(6):A1–54PubMedCrossRef Powers CM, Bolgla LA, Callaghan MJ, Collins N, Sheehan FT (2012) Patellofemoral pain: proximal, distal, and local factors, 2nd international research retreat. J Orthop Sports Phys Ther 42(6):A1–54PubMedCrossRef
26.
go back to reference Powers CM, Bolgla LA, Callaghan MJ, Collins N, Sheehan FT (2012) Patellofemoral pain: proximal, distal, and local factors, 2nd international research retreat. J Orthop Sports Phys Ther 42(6):A1–54PubMedCrossRef Powers CM, Bolgla LA, Callaghan MJ, Collins N, Sheehan FT (2012) Patellofemoral pain: proximal, distal, and local factors, 2nd international research retreat. J Orthop Sports Phys Ther 42(6):A1–54PubMedCrossRef
27.
go back to reference Puniello MS (1993) Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther 17(3):144–148PubMedCrossRef Puniello MS (1993) Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther 17(3):144–148PubMedCrossRef
28.
go back to reference Reiman MP, Bolgla LA, Lorenz D (2009) Hip functions influence on knee dysfunction: a proximal link to a distal problem. J Sport Rehabil 18(1):33–46PubMed Reiman MP, Bolgla LA, Lorenz D (2009) Hip functions influence on knee dysfunction: a proximal link to a distal problem. J Sport Rehabil 18(1):33–46PubMed
29.
go back to reference Snyder KR, Earl JE, O’Connor KM, Ebersole KT (2009) Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin Biomech 24(1):26–34CrossRef Snyder KR, Earl JE, O’Connor KM, Ebersole KT (2009) Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin Biomech 24(1):26–34CrossRef
30.
go back to reference Souza RB, Powers CM (2009) Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther 39(1):12–19PubMedCrossRef Souza RB, Powers CM (2009) Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther 39(1):12–19PubMedCrossRef
31.
go back to reference Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD (2002) A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 36(2):95–101PubMedCrossRefPubMedCentral Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD (2002) A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 36(2):95–101PubMedCrossRefPubMedCentral
32.
go back to reference Thijs Y, De Clercq D, Roosen P, Witvrouw E (2008) Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. Br J Sports Med 42(6):466–471PubMedCrossRef Thijs Y, De Clercq D, Roosen P, Witvrouw E (2008) Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. Br J Sports Med 42(6):466–471PubMedCrossRef
33.
go back to reference Thijs Y, Van Tiggelen D, Roosen P, De Clercq D, Witvrouw E (2007) A prospective study on gait-related intrinsic risk factors for patellofemoral pain. Clin J Sport Med 17(6):437–445PubMedCrossRef Thijs Y, Van Tiggelen D, Roosen P, De Clercq D, Witvrouw E (2007) A prospective study on gait-related intrinsic risk factors for patellofemoral pain. Clin J Sport Med 17(6):437–445PubMedCrossRef
34.
go back to reference Vicenzino B, Collins N, Cleland J, McPoil T (2010) A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med 44(12):862–866PubMedCrossRef Vicenzino B, Collins N, Cleland J, McPoil T (2010) A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med 44(12):862–866PubMedCrossRef
35.
go back to reference Willy RW, Manal KT, Witvrouw EE, Davis IS (2012) Are mechanics different between male and female runners with patellofemoral pain? Med Sci Sports Exerc 44(11):2165–2171PubMedCrossRefPubMedCentral Willy RW, Manal KT, Witvrouw EE, Davis IS (2012) Are mechanics different between male and female runners with patellofemoral pain? Med Sci Sports Exerc 44(11):2165–2171PubMedCrossRefPubMedCentral
36.
go back to reference Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG, Gluud C, Martin RM, Wood AJ, Sterne JA (2008) Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 336(7644):601–605PubMedCrossRefPubMedCentral Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG, Gluud C, Martin RM, Wood AJ, Sterne JA (2008) Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 336(7644):601–605PubMedCrossRefPubMedCentral
37.
go back to reference Wu CC, Shih CH (2004) The influence of iliotibial tract on patellar tracking. Orthopedics 27(2):199–203PubMed Wu CC, Shih CH (2004) The influence of iliotibial tract on patellar tracking. Orthopedics 27(2):199–203PubMed
Metadata
Title
Increased medial foot loading during drop jump in subjects with patellofemoral pain
Authors
Michael S. Rathleff
Camilla Richter
Christoffer Brushøj
Jesper Bencke
Thomas Bandholm
Per Hölmich
Kristian Thorborg
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-2943-3

Other articles of this Issue 10/2014

Knee Surgery, Sports Traumatology, Arthroscopy 10/2014 Go to the issue