Effects Of Neuromuscular Training Exercise On Patients With Patellofemoral Pain Syndrome(PFPS)

Objective: patellofemoral pain syndrome(PFPS)is the most common symptom of knee joint injury.The dysfunction of climbing the upper and down steps is the most common clinic syndrome in patients with patellofemoral pain,which can lead the patient get disability in prolonging walking or running.The abnormal trajectory of patella gliding in the femoral intercondylar fossa is the fundamental causes of PFPS among a variety of reasons.At present,there are different kind of treatment methods for PFPS,including the strength training,taping,the knee and foot orthotics and so on.However,several studies discuss about the joints and what type training methods can improve the knee joint function and relief knee pain in patients with PFPS.Neuromuscular exercise training is a combined treatment method which includes muscle strength training,balance training and proprioceptive sense training.However,few researches use neuromuscular training as an intervention method to treat PFPS.Most studies just give a single treatment as an intervention to treat the PFPS.Due to there are various reasons causing the patellofemoral pain syndrome,so if we just give the single treatment may not improve the function of the knee and relief the pain.This study aims to treat patellofemoral pain syndrome with neuromuscular exercise training and evaluate the differences between the intervention on the pain intensity,knee function and neuromuscular control ability.To compare the effects of neuromuscular training technique with taping and health education in patients with patellofemoral pain syndrome,in order to summary a system rehabilitation treatment techniques for PFPS patients.Methods: a total of 120 subjects are recruited,86 subjects met the inclusion criteria.The final measurements have 76 subjects.There are 49 men and 27 women.The subjects are randomly divided into three groups: neuromuscular exercise training group(26,38.70 ±6.62),taping training group(25,37.46 ±7.87)and health education group(25,35.25 ±7.11).Neuromuscular training group includes 5 groups of muscle strength training and balance training,three times a week,at least one day interval.The duration of each session is 40-50 minutes,which including five minutes warm-up,30-40 minutes of neuromuscular training,and 5 minutes rest.In the taping group,the shape "Y" and "I" tape are used to protect the knee joint for the subjects,which take twice a week,and the therapeutic effect last for 48 hours at one time.The subjects are able to move and live as normal during the treatment.There are two main ways in health education group.The first method is to organize a health lecture on how to protect the knee joint better and the matters need to pay attention in daily life and exercise.The second method is to share articles about the PFPS and knee joint by WeChat every week.The subjects in three groups need to complete the basic information before intervention.The subjective indexes included: visual analogue scale(VAS),anterior knee pain scale(AKPS),quality of life(SF-36),and the VAS and AKPS are the main indexes.Objective indexes include: knee joint function tests including 3 items,Y-Balance test,Con-trex isokinetic instrument to test the maximum torque and endurance of knee joint.The proprioceptive sensation of knee joint and the muscle thickness of quadriceps femoris are measured by ultrasound.Subjective indexes are collected before intervention,in 6 weeks and 12 weeks after intervention,and the objective indexes are collected before and at the end of intervention.The statistical software SPSS 22.0 is used to do the statistical analysis,and between –and within-group differences of these outcomes are evaluated through repeated-measurement analysis of variance.Single factor variance analysis is used to judge whether there is statistical difference between groups at the same time point(P < 0.05).Results:1.Subjective index: after 12 weeks of intervention,the pain of knee joint in the neuromuscular training group is obviously relieved and the difference has statistically significant compared with the other two groups(P < 0.05).In the neuromuscular training group,the pain intensity at the end of intervention is significantly improved compared with that in the early intervention and the difference has significant difference(P < 0.05).The pain intensity in the two treatment groups are better than that in the healthy education group whenever in the middle and end of intervention,and the difference has statistically significant(P < 0.05).However,there is no statistical difference in the health education group in different period of intervention.(P > 0.05).After 12 weeks of intervention,the results of AKPS scale showed that the knee joint function of the subjects in the neuromuscular training group is significantly improved compared to the healthy education group.There is also significant improvement within the group(P < 0.05).Taping training group also get better in knee function,but the results is not as good as the neuromuscular training group,and there is no significant difference between different periods of intervention.(P > 0.05).The results of quality of life(SF-36)index showed that only the neuromuscular training group and the health education group had statistical differences in the middle term of intervention compared with the initial intervention(P < 0.05).There is no statistical difference among the three groups at all three time points(P > 0.05).2.Objective index: the neuromuscular training group has significant difference between the end of intervention and at the beginning of the forward Y-balance test(P < 0.05),secondly there is significant difference between the taping and health education group at the end of the intervention(P < 0.05).There is no statistical difference among the three groups in left and right posterior test(P > 0.05).There is significant difference in between the neuromuscular training group and taping group(P < 0.05)in left posterior test.Only the neuromuscular training group has significant difference in rightposterior test(P < 0.05).The maximum muscle torque and muscle endurance of the extensor muscles in the knee joint are found significant difference in both 60 °/ s and 180 °/ s angular velocities in the neuromuscular training group and it is significantly improved at the end of intervention than the other two groups(P < 0.05).But there is no significant difference at the end of the intervention between the neuromuscular training group and the taping group for the average maximum torque in flexor muscle.The endurance of extensor muscle is the same results as the average maximum torque of extensor muscle.There is no significant difference in flexor endurance between the three groups(P > 0.05).The results of the study on the proprioception of knee joint showed that the knee flexion and extension proprioception in the neuromuscular training group and the taping group are significantly improved within the group(P < 0.05).The proprioception of the knee joint in both groups are better than that in health education group.The results on muscle thickness of quadriceps femoris are as follows: only the rectus femoris in neuromuscular training group become more thickness after 12 weeks intervention,and there is statistical difference compared with the other two groups(P < 0.05).The medial oblique femoris showed a tendency of thickening in the three groups after 12 weeks intervention,but the difference has no statistically significant(P > 0.05).Conclusion: twelve weeks of neuromuscular exercise training can relieve the knee joint pain and improve the function of knee joint in patients with patellofemoral pain syndrome.Systematic training can improve the neuromuscular function of patients,including the maximum torque of flexion and extensor muscle group of the knee joint,and the endurance of extensor muscle.The proprioception and forward Y-balancing ability of the knee joint get improved after 12 weeks intervention.12 weeks of taping training can also decrease the knee joint pain and improve the function of the knee joint in a short period of time.But there is no improvement on muscle strength and endurance to the knee.The improvement of proprioception of knee joint in the taping training group is the same with that in the neuromuscular training group.