| Objective:Patellofemoral pain syndrome(PFPS)is a common clinical chronic musculoskeletal disease with high incidence in exercise population.The clinical presentation is anterior knee pain,and the pain worsens with weight-bearing bending movements of the knee(as follows squatting,walking up and down stairs,running and jumping).With the popularization of national fitness,more and more sports enthusiasts are affected by this condition,and lead to decreased activities of daily living and exercise termination.Therefore,the exploration of the mechanism of the condition and intervention are conducive to the management of the condition.At present,the biomechanical mechanism of PFPS has been explored widely,but the results are not consistent.One of the potential confounders is gender.Although previous studies have shown that the proportion of females with this disease is high,the number of males participating in sports in China is significantly higher than that in females,and the absolute number of male patients may even be higher than that in females.However,there is no targeted study on male patients now.Tibial spiral taping has been preliminarily applied in the management of PFPS,however its clinical effect and mechanism are still controversial.One of the reasons is that studies used spiral taping in different directions(tibia internal or external rotation),but there is no study comparing tibial spiral taping in different directions to help us deeply understand the possible biomechanism.Based on this,the research objectives of this thesis are as follows:(1)Through meta-analysis,to understand the existing research progress of tibial spiral taping in PFPS,as well as the existing problems and shortcomings,and to provide the basis for subsequent research.(2)On the basis of Study 1,we would further explore the characteristics of biomechanical differences between male patients with PFPS and healthy adult males.(3)To explore the efficacy and mechanism of tibial spiral taping in different directions for male patients with PFPS from a biomechanical point of view.Methods:This thesis consists of three studies,systematic review and meta-analysis completed the registration;human trials were approved by the Ethics Committee of Shanghai University of Sport.Study 1:The effects of tibial spiral taping in pain and kinematic for PFPS-A systematic review and meta-analysis.Seven electronic databases were systematically searched from inception to July 2021,using the Visual Analogue Scale,the Numerical Rating Scale,and lower limb kinematics as outcome measures.The quality of the included articles was evaluated using the PEDro scores and the Cochrane’s risk of bias tool,respectively.Meta-analysis was completed in Revman software(Version 5.3,The Cochrane Collaboration,Copenhagen,Denmark),weighted mean difference(WMD)and 95%confidence interval(CI)were used to analyze continuous variables,summary effect size was analyzed by random effects model,heterogeneity was assessed using I~2and results of meta-analysis were interpreted.Study 2:To explore the biomechanical differences for lower limbs between male patients with PFPS and healthy people.Through sample size calculation,28 healthy men and 14 men with PFPS were included to complete biomechanical tests under different functional actions(squatting–standing up,sitting knee extension,walking).The activation of the vastus medialis,rectus femoris,vastus lateralis,and biceps femoris muscles under different movements,as well as the knee 6-degree of freedom during movement were analyzed.Independent sample T-test was used to compare the differences in Surface Electromyography(s EMG)and kinematics.Study 3:To investigate the effect of different directions of tibial spiral taping on male patients with PFPS.Through sample size calculation,15 male patients with PFPS were included and randomly given no taping,tibial internal rotation taping and tibial external rotation taping.Functional action(squatting–standing up,sitting knee extension,walking)tests were completed under different taping conditions,and the orders of taping and action were randomized to analyze the activation of muscles,as well as the 6-degree of freedom of the knee joint.Repeated measures ANOVA were used to compare the effects of different taping on pain,s EMG and knee kinematics during each action task.Results:Study1.A total of 433 potential articles were searched,and finally 7 articles(121subjects)were included for meta-analysis.The results showed that tibial spiral taping significantly improved VAS scores in patients with PFPS compared with no taping(WMD=-1.07,95%CI:-1.53,-0.61,I~2=0%,p<0.001).However,the improvement in pain with the tibial spiral taping was not significant compared with other therapeutic or placebo taping.In kinematics,tibial spiral taping did not significantly alter the kinematics of the hip,knee,and ankle in all directions compared with no taping.Study2.Characterization of biomechanical in the lower limbs between male PFPS patients and healthy adult males during functional exercise.In terms of s EMG,the differences in lower limb biomechanical characteristics of male PFPS patients compared with healthy men are manifested as follows:Compared with healthy,the differences in the biomechanical characteristics of the lower limbs were shown in integrated EMG signal analysis that the rectus activation of the lower limbs in squatting(95%CI=-276.37,-46.38,p=0.007),standing(95%CI=-371.71,-106.25,p=0.001),supporting phase(95%CI=-3.23,-0.70,p=0.003)and swing phase(95%CI=-1.85,-0.13,p=0.026)was significantly smaller in PFPS than the healthy.During sitting knee extension reduction,vastus lateralis muscle activation was significantly higher in the lower limb of patients with PFPS than the healthy(95%CI=12.52,219.52,p=0.029).The mean square amplitude showed that patients with PFPS had significantly less rectus muscle activation than the healthy during squatting(95%CI=-0.19,-0.01,p=0.025),standing(95%CI=-0.27,-0.07,p=0.001),end squatting(95%CI=-0.33,-0.01,p=0.039),support phase(95%CI=-0.05,-0.01,p=0.007),swing phase(95%CI=-0.03,-0.01,p=0.018),and heel stage(95%CI=0.06,0.17,p<0.001).In kinematics,the differences between affected and unaffected side of PFPS,as well as the differences with healthy people,are mainly manifested in the increase of anterior-posterior and medial-lateral displacement of the knee joint.Specifically,at the end of the squatting,the anterior-posterior displacement(95%CI=2.91,4.91,p<0.001)and the medial-lateral displacement(95%CI=0.21,2.37,p=0.021)were significantly greater than those of the healthy side.The anterior-posterior(95%CI=2.16,4.14,p<0.001)and medial-lateral displacements(95%CI=0.16,2.16,p=0.025)were significantly greater than on the healthy side.At the end of the knee extension in the sitting position,the medial-lateral displacement was significantly larger(95%CI=0.14,1.54,p=0.020)than on the unaffected side.Compared with the healthy,the anterior-posterior displacement was significantly greater at the initial squat stage(95%CI=0.10,1.67,p=0.028).At the end of the squat,the anterior-posterior displacement(95%CI=2.36,4.81,p<0.001)and the medial-lateral displacement(95%CI=0.03,1.80,p=0.043)were significantly greater than those of the healthy side.At the initial stage of knee extension in the sitting position,anterior-posterior displacement(95%CI=3.26,5.16,p<0.001),and medial-lateral displacement(95%CI=0.20,1.76,p=0.015)were significantly greater than those in the unaffected side.At the end of the knee extension in the sitting position,anterior-posterior displacement(95%CI=0.06,2.00,p=0.038)were significantly greater than that of the unaffected side.Study3.Effect of different directions of tibial spiral taping on male patients with PFPS:For pain,for squatting–standing,sitting knee extension and resistance contraction,tibial internal rotation and external rotation taping have a significant improvement effect on VAS in PFPS(F=224.10,p<0.001,partialη2=0.94);further comparison of the effect of tibial internal rotation taping and tibial external rotation taping showed that the effect of external rotation taping was significant(F=4.90,p=0.044,partialη2=0.26).But for sitting knee extension and walking,the improvement in pain did not reach a statistically significant difference due to low initial pain values(F=3.37,p=0.066,partialη2=0.340).For s EMG signals,the integrated EMG of the rectus femoris muscle after taping was significantly increased during squatting(F=8.570,p=0.004,partialη2=0.015),and the results of post hoc analysis showed that the integrated EMG of the rectus femoris muscle for external rotation taping of the tibia was significantly greater than internal rotation taping(95%CI=153.81,731.39,p=0.05).The integrated EMG of the biceps femoris muscle was significantly increased after taping(F=9.786,p=0.003,partialη2=0.601).During squatting,the rectus femoris muscle after taping was significantly greater than that no taping(F=13.087,p=0.001,partialη2=0.668),and the results of post hoc analysis showed that the rectus femoris muscle integrated EMG of tibial external rotation taping was significantly greater than tibial internal rotation taping(95%CI=69.11,791.73,p=0.023).In the walking swing phase,the rectus femoris muscle after taping was significantly greater than no taping(F=5.666,p=0.017,partialη2=0.466).During sitting knee extension reduction,the integrated EMG of the biceps femoris muscle increased significantly after taping(F=8.164,p=0.005,partialη2=0.557),and post hoc analysis showed that there was a significant difference between internal and external rotation taping,with a greater activation of external tibial rotation than internal rotation taping(95%CI=21.88,111.73,p=0.007).In Kinematics,there were no significant changes after tibial spiral taping as well as between tibial interal and external rotation taping.Conclusion:1.Systematic review and meta-analysis showed that current studies of PFPS are gender-biased and lack specific studies on male patients.Studies based on female patients showed that tibial spiral taping can improve the pain symptoms of PFPS but has no significant effect on kinematics.2.In common functional movements,the significant difference in muscle activation between male PFPS patients and healthy mainly existed in rectus activation inhibition.In kinematics,the differences between affected and unaffected sides of PFPS,as well as the differences with healthy people,are mainly manifested in the increase of anterior-posterior and medial-lateral displacement of the knee joint,indicating that the motor control function of the knee joint decreases in patients with PFPS.3.Tibial spiral taping could improve pain,and the effect of tibial external rotation taping was better.s EMG showed that both tibial internal and external rotation taping could enhance the activation of rectus femoris and biceps femoris during squatting,and the improvement effect of external rotation taping in rectus femoris muscle activation was more obvious than that of tibial internal rotation taping.In kinematics,both tibial internal and external rotation taping had no significant effect on knee kinematics.4.This is the first study of tibial spiral taping on male PFPS,which compared the biomechanical differences of lower limbs and the effects of tibial spiral taping in different directions on pain,s EMG and kinematic between male PFPS and healthy group.The results showed that male patients with PFPS had abnormal lower limb muscle activation and knee movement control;tibial spiral taping could be used to clinically improve pain symptoms,and its biomechanical mechanism may not kinematics,but knee muscle activation patterns,especially through increasing rectus femoris muscle activation in functional movements to improve pain symptoms. |
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