Rajiv Gandhi University of Health Sciences, Karnataka,
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
BANGLORE.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
|01 |Name of the Candidate |SHWETA YUVARAJ SURYVANSHI |
| |& Address |B-201 Yoginagar society, |
| | |Near Ambica Nagar, Gotri. |
| | |Vadodara,Gujarat-3900021 |
|02 |Name of the Institution and address | GOUTHAM COLLEGE OF PHYSIOTHERAPY, |
| | |No. 258, 5TH main road, 2nd cross, |
| | |Manjunathnagar, W.O.C road, Rajaji nagar, |
| | |Bangalore – 560010 |
|03 |Course of study and subject |MASTER OF PHYSIOTHERAPY |
| | |(Musculoskeletal disorders and Sports physiotherapy) |
|04 |Date of admission to course |9 july 2013 |
|05 |Title of the topic |
| |“EFFECT OF KNEE EXTENSORS STRENGTHENING VERSUS HIP POSTEROLATERAL MUSCULATURE STRENGTHENING WITH ANKLE DORSI FLEXORS IN PATELLOFEMORAL |
| |PAIN.” |
| 06 | Brief Resume of the intended work: |
| |6.1Need of the study: |
| |Patellofemoral pain syndrome (PFPS) is the medical term for pain in the |
| | |
| |front of the knee,usually under the kneecap. Patellofemoral pain syndrome, also referred to as |
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| |anterior knee pain or “runner’s knee,” is a common lower extremity diagnosis that physical |
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| |therapists and athletic trainers treat. Pain is typically worse with stairs, squats,lunges, running, |
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| |and sitting for a long period of time. Most cases of Patellofemoral syndrome are caused by |
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| |joint pressure at the patellofemoral joint . This may be caused by abnormal patellar tracking or |
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| |abnormal positioning of the femur during dynamic activities, such as running or going down |
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| |the stairs. Treatment options for Pain focus on improving the dynamic positioning of the |
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| |patella and femur and may include quadriceps strengthening, hip and core muscle |
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| |strengthening hamstring and iliotibial band flexibility exercises, patellar mobilization, patellar |
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| |taping, foot orthoses, and joint mobilization of the pelvis.1 The incidence rate for |
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| |Patellofemoral pain was 22/1000 person-years. Females were 2.23 times (95% CI: 1.19, 4.20) |
| | |
| |more likely to develop Patellofemoral pain syndrome compared with males. While not |
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| |statistically significant, the prevalence of Patellofemoral pain syndrome at study enrollment |
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| |tended to be higher in females (15%) than in males (12%) (P=0.09). Additionally, at the time |
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| |of admission to the academy, the prevalence of Patellofemoral pain syndrome was not |
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| |significantly different between genders.2 Below are some important points from the latest |
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| |research on this topic, |
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| |1.A weak quadriceps muscle is a risk factor for developing patellofemoral pain, Quadriceps |
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| |strengthening is therefore an important treatment consideration for patients in patellofemoral |
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| |pain. |
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| |2.Restricted ankle dorsiflexion, This one is often over looked but it can cause an anterior |
| |weight shift during squatting and lunging activities resulting in the knees over the toes and |
| |valgus positions. Reduced dorsiflexion in runners a history of patellofemoral pain, it has been |
| |proposed that increased rearfoot eversion positively correlated with peak tibia internal rotation |
| |in patellofemoral pain while greater rearfoot eversion range of motion positively correlated |
| |with hip adduction range. This has implications for patellofemoral joint loading because both |
| |tibia internal rotation and hip adduction are likely to increase patellofemoral joint stress.3 |
| |Important hip muscles to strengthen include: |
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| |Hip abductors: gluteus medius |
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| |Hip external rotators: gluteus maximus |
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| |Hip extensors: gluteus maximus |
| |Specific activities targeting performance of the lateral hip musculature have been incorporated into physical therapy intervention programs|
| |for improving pain, disability, and function in patients with patellofemoral pain.4 Weak hip extensors and quadriceps of the injured leg |
| |could lead to reduced hip extension and therefore a reduced hip displacement angle (HDA), step length and velocity.The primary contributors|
| |to hip extension in single limb stance are the vasti, hamstrings, and gluteus maximus. The hip and knee accelerations induced by four |
| |muscles during stance. They showed that the gluteus maximus and vasti accelerated the joints toward extension in early to mid stance, and |
| |that the soleus accelerated the joints toward extension in mid- to late stance. The hip extensors, knee extensors, and ankle plantar |
| |flexors all help to control hip and knee extension during the stance phase of normal gait. Hip external rotation and abduction musculature |
| |contribute to pelvic stability and leg alignment by eccentrically controlling femoral internal rotation and influencing hip adduction |
| |during weight-bearing activities,weakness of these muscles may increase medial femoral rotation, valgus knee movments, or cause a gluteus |
| |medius gait. These deviations may alter the abduction/adduction movments at the hip or lead to an increased Quadriceps angle, which may |
| |subsequently alter tracking of the patella, increase compressive forces on the patellofemoral joint, and ultimately lead to knee pain.5 |
| |Tightness of soft tissues, such as the gastrocnemius, quadriceps, and hamstring muscles and iliotibial band , it has been theorized that |
| |tightness of iliotibial band may pull the patella laterally and increase the stress over the patellofemoral joint. The ultimate goal of |
| |rehabilitation for patients with patellofemoral pain syndrome is to return to the highest functional level in the most efficient manner.6 |
| |The need of this study is to find out the effectiveness of knee extensors , hip posterolateral musculature with ankle dorsi flexors |
| |strengthening in patellofemoral pain syndrome so subjects can effectively improve their gait, muscle strength and activity of daily living.|
| |In addition we can also correct Quadriceps angle in subjects having pathomechanical dysfunction at patellofemoral joint, so subjects can |
| |perform pain free activity of daily living. |
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| |6.1 Research Question: |
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| |Whether there is difference in the effectiveness of knee extensor strengthening versus hip |
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| |posterolateral musculature strengthening with ankle dorsiflexors on knee function and pain for |
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| |subjects with patellofemoral pain syndrome? |
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| |6.2 Hypothesis: |
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| |Experimental Hypothesis: - ( 2-tailed hypothesis) |
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| |There will be significant difference between knee extensor strengthening versus hip |
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| |posterolateral musculature strengthening with ankle dorsiflexors on improving knee |
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| |function and pain for subjects with patellofemoral pain syndrome. |
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| |Null Hypothesis: - |
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| |There will be no significant difference between knee extensors strengthening versus hip |
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| |posterolateral musculature strengthening with ankle dorsiflexors on improving knee function |
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| |and pain for subjects with patellofemoral pain syndrome. |
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| |Objectives: |
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| |Primary Objective: |
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| |1.To compare the effects of knee extensor strengthening versus hip posterolateral musculature |
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| |strengthening with ankle dorsiflexors on improvment of knee function and pain for subjects |
| | |
| |with patellofemoral pain syndrome. |
| | |
| |Secondary Objective: |
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| |1.To determine the effectiveness of knee extensor strengthening on analysis of knee function |
| | |
| |and pain for subjects with patellofemoral pain syndrome. |
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| |2.To determine the hip posterolateral musculature strengthening with ankle dorsiflexors on |
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| |analysis of knee function and pain for subjects with patellofemoral pain syndrome. |
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| |6.3 Review of Literature: |
| |Brian Conway, Amy Goodson, Kiley Cohen (2013) have conducted a study on female |
| |athlete subjects for anterior knee pain by giving them weight bearing and non weight |
| |bearing exercise and conducted that hip, core and quad strengthening and neuromuscular re- |
| |education exercise can lead to decreased pain and improved function.1 |
| | |
| |Lankhorst NE et al (2013) have concluded in their study that a weak or Inhibited gluteus |
| | |
| |medius is unable to control femoral internal rotation and obligatory knee frontal plane motion. |
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| |The author examined 47 studies which looked at factor causing patellofemoral pain syndrome. |
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| |This review identified decreased muscle strength of hip abductors and hip external rotators |
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| |important factor associated with the cause of patellofemoral pain syndrome the pooled data |
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| |also found increased Quadriceps angle and sulcus angle –both which have been to muscle |
| | |
| |imbalance.7 |
| | |
| |Dudzinkis et al ( 2013) conducted a study to find out complementing the reduced Knee flexion |
| |during drop tests or squats is the fact that limited ankle dorsiflexion is accompanied by knee |
| |hyperextension during the stance phase of normal walking gait ,since forward progression of |
| |the tibia over the foot near the end of the stance phase requires ankle dorsiflexion. If ankle |
| |dorsiflexion range is not available , knee hyperextension would reduce the forward |
| |progression of the tibia, therefore clinician should routinely check ankle dorsi flexion range of |
| |motion in patient with knee pain.8 |
| | |
| |Thiago Yukio Fukuda, William Pagotti Melo et al (2012) conducted a study on |
| |posterolateral musculature strengthening in sedentary women with patellofemoral pain |
| |syndrome : A randomized controlled clinical trial with 1-year follow-up. Knee stretching |
| |and strengthening exercises supplemented by hip posterolateral musculature strengthening |
| |exercises were more effective than knee exercises alone in improving long-term function and |
| |reducing pain in sedentary women with patellofemoral pain syndrome.9 |
| | |
| |Cashman GE et al (2012) conducted a study that there is a small amount of evidence that |
| |healthy subjects with weak hip abductors and perhaps weak external rotators demonstrate |
| |increased knee valgus. However, due to the variation in methodology and lack of agreement |
| |between studies, eleven studies were selected for review, 4 of which found evidence that |
| |subjects with weak hip abductors or external rotators demonstrated increased knee valgus, and |
| |1 study found a correlation to the contrary.10 |
| | |
| |Defne Kaya, Michael James Callaghan et al (2011) have studied on the, effect of an |
| |exercise program in conjunction with short-period patellar taping on pain, Electromyogram |
| |activity, and muscle strength in patellofemoral pain syndrome. 11 patients and 16 |
| |healthy people participated. Patients underwent short-period patellar taping plus an exercise |
| |program for 3 months. Numeric pain rating, muscle strength of the knee extensors, and |
| |electromyogram activity of the vastus lateralis and vastus medialis oblique were evaluated, |
| |and they concluded that short-period patellar taping plus an exercise program improves and |
| |vastus lateralis and vastus medialis oblique activation.11 |
| | |
| |Fukuda TY, Rossetto FM et al (2010) performed a study on the Short-term effects of hip |
| |abductors and lateral rotators strengthening in females with patellofemoral pain syndrome, a |
| |randomized controlled clinical trial. The author concluded that ,in the short term, both |
| |treatment approaches were more effective that no treatment for improving function and |
| |reducing pain. However, improvements were greater in the group that performed a |
| |combination of hip and knee strengthening exercises.12 |
| | |
| |Tugba Kuru, Elif Elcin Dereli et al (2010) conducted in their study patellofemoral pain |
| |syndrome is one of the most common knee problems, with major effects on quality of life and |
| |function. The Kujala patellofemoral score is a functional evaluation instrument to evaluate |
| |knee problems related to the patellofemoral system. The aim of this study was to evaluate the |
| |validity of the Turkish version of the Kujala patellofemoral score in patients with |
| |patellofemoral pain syndrome. The study concluded that the internal consistency of the Turkish |
| |version of the Kujala patellofemoral score showed good reliability and test-retest results |
| |showed high reliability, suggesting that it is an appropriate functional instrument for Turkish |
| |patients with patellofemoral pain syndrome.13 |
| | |
| |Edith M Heintjes, Marjolein Berger et al (2009) conducted a study on exercise therapy for |
| |patellofemoral pain syndrome this review aims to summarise the evidence of effectiveness of |
| |exercise therapy in reducing anterior knee pain and improving knee function in patients with |
| |knee pain. From 750 publications 12 trials were selected. All included trials studied quadriceps |
| |strengthening exercises. Outcome assessments for knee pain and knee function in daily life |
| |were used in a best evidence synthesis to summarise evidence for effectiveness. The evidence |
| |that exercise therapy is more effective in treating Patellofemoral pain syndrome than no |
| |exercise was limited with respect to pain reduction, and conflicting with respect to functional |
| |improvement. There is strong evidence that open and closed kinetic chain exercise are equally |
| |effective.14 |
| | |
| |Michael P. Reiman, Lori A. Bolgla et al (2009) The purpose of this commentary is to |
| |describe the multifactorial relationships between the hip-joint strength, range of motion, |
| |kinetics,kinematics, and various knee pathologies, specifically as they relate across an |
| |individual’s life span. A growing body of evidence suggests that hip weakness, as well as |
| |altered lower extremity mechanics, might contribute to many knee injuries across the life span. |
| |Furthermore, authors from more recent studies have inferred that interventions at the hip can |
| |improve knee function. Screening for hip weakness and lack of rotation mobility also seems |
| |warranted to prevent potential knee injury.15 |
| | |
| |Michelle C. Boling, PhD, ATC; Darin A. Padua et al (2009) To compare concentric and |
| |eccentric torque of the hip musculature in individuals with and without patellofemoral pain. |
| |Twenty participants with patellofemoral pain concentric and eccentric torque of the hip |
| |musculature was measured on an isokinetic dynamometer. All volunteers performed 5 |
| |repetitions of each strength test. Average and peak concentric and eccentric torque of the hip |
| |extensors, abductors, and external rotators. Torque measures were normalized to the |
| |participant’s body weight multiplied by height. The patellofemoral pain group displayed |
| |weakness in eccentric hip abduction and hip external rotation, which may allow for increased |
| |hip adduction and internal rotation during functional movements.16 |
| | |
| |Theresa Helissa Nakagawa, Thiago Batista Muniz et al (2008) conducted a study to find |
| |out the effect of additional strengthening of hip abductor and lateral rotator muscles in a |
| |strengthening quadriceps exercise rehabilitation programme for patients with the |
| |patellofemoral pain syndrome. Fourteen patients with patellofemoral pain syndrome. The |
| |subjects were randomly assigned to the intervention group (strengthening of quadriceps plus |
| |strengthening of hip abductor and lateral rotator muscles) or to the control group |
| |(strengthening of quadriceps). Both groups participated in a six-week home exercise protocol. |
| |And concluded that supplementation of strengthening of hip abductor and lateral rotator |
| |muscles in a strengthening quadriceps exercise programme provided additional benefits with |
| |respect to the perceived pain symptoms during functional activities in patients with |
| |patellofemoral pain syndrome after six weeks of treatment.17 |
| | |
| |Timothy F. Tyler, Stephen J. Nicholas et al (2006) conducted a study on the role of hip |
| |muscle function in the treatment of patellofemoral pain syndrome with thirty-five patients. |
| |Patients were evaluated and placed on a 6-week treatment program. Hip flexion, abduction, |
| |and adduction strength, Thomas and Ober test results, and visual analog scale scores for pain |
| |with activities of daily living as well as with exercise were documented on initial evaluation |
| |and again 6 weeks later. Treatment consisted of strength and flexibility exercises primarily |
| |focusing on the hip improvements in hip flexion strength combined with increased iliotibial |
| |band and iliopsoas flexibility were associated with excellent results in patients with |
| |patellofemoral pain syndrome.18 |
| | |
| |Mizuno,Elias et al (2001) conducted a study that the quadriceps angle is form by the drawing |
| |a line the anterior superior iliac spine (ASIS) to the patella’s midpoint and another from |
| |patella’s midpoint to the tibial tubercle therefore the increase quadriceps angle predispose the |
| |patella excessive lateral tracking and stress resultant in patellofemoral joint stress.19 |
|07 |Materials and Methods: |
| |7.1 Study Design: |
| |Pre to post test two group comparative experimental study design. |
| |7.2 Methodology: |
| |Sample size: 50 subjects |
| |Sampling meathod: Random sampling method. |
| |Source of data: Patients will be recruited from different hospitals in Bangalore and protocol will be executed in Goutham physiotherapy |
| |clinic and rehabilitation centre. |
| | |
| |Study duration: 8 months |
| |Sample Selection: |
| |Inclusion Criteria: |
| |Age : 15-30 years20 |
| |Gender: both male and female |
| |Patellofemoral pain syndrome assessed by patellar grind test21 |
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| |The person had pain with following manual compression of the patella against the femur at rest |
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| |or while performing a quadriceps contraction with the knee extended, palpation of the |
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| |posteromedial and posterolateral border to the patella,on activities like squatting, stair |
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| |climbing,kneeling or prolonged sitting. |
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| |A history of insidious onset. |
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| |Exclusion Criteria: |
| |History of patellar dislocation. |
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| |Knee surgery in the past 2 years. |
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| |A concomitant diagnosis of bursitis, internal knee dearangement, systemic arthritis, |
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| |ligamentous knee injury or laxity, peripatellar tendonitis, plica syndrome. |
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| |Johansson disease, Osgood-Schlatter disease, infection of the knee, or cancer. |
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| |A concomitant musculoskeletal or neurological impairment in the involved lower |
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| |extremity that influenced their gait. |
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| |Pregnant women. |
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| |Variables: |
| | |
| |Independent variables: |
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| |Knee extensor strengthening exercises, hip Posterolateral musculature strengthening with ankle |
| | |
| |dorsiflexors, patellofemoral pain syndrome. |
| | |
| |Dependent Variables: |
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| |knee function and pain. |
| |Materials used: |
| |Couch |
| |Pen |
| |Paper |
| |Stop watch |
| |Quadriceps table. |
| |Weight cuff. |
| |stool |
| | |
| |Methods of data collection: |
| |Pre-test evaluation: |
| |Pain |
| |Gait analysis |
| |Intervention to be conducted on the participants: |
| |50 Subjects who meet the inclusion criteria will be assigned to two groups, group 1- |
| | |
| |subjects and group 2- 25 subjects based on convenient sampling. |
| | |
| |Informed consent will be taken. |
| | |
| |Group I- In this group ankle dorsiflexors with knee extensors muscle strengthening, |
| | |
| |Group II- strengthening of posterolateral hip muscles with ankle dorsiflexors. |
| | |
| |Interventions are given for four weeks. These criteria were based on the protocol of |
| | |
| |the daily adjustable progressive resistance excercise regimen.22 |
| | |
| |At the completion physical therapy sessions outcome measures will be reevaluated and |
| | |
| |pre and post scores are compared. |
| |Procedure:- |
| |The load during training was standardized to 70% of the estimated 1-repetition maximum, |
| |defined as the maximum load with which 1 repetition of the exercise could be completed with |
| |out pain. These criteria were based on the protocol of the daily adjustable progressive |
| |resistance exercise (DAPRE) regimen. Exercises utilizing elastic resistance and weight cuffs |
| |were standardized to the maximum resistance at which each patient was able to perform 10 |
| |repetitions of the exercise. The maximum load and resistance for all strengthening exercises |
| |were evaluated during the first treatment session and reviewed weekly to adjust as needed. |
| |After the 2-week treatment program, the patients were instructed to maintain their normal daily |
| |activities without performing a home exercise program. |
| |Group 1 knee extensor group:- Strengthening will be done as per the daily adjustable |
| |progressive resistance exercise regimen with subject positioned in supine lying and high sitting |
| |with mechanical weights. |
| |Group 2 posterolateral structures hip strengthening:- Strengthening will be done as per the |
| |daily adjustable progressive resistance exercise regimen for three groups of muscle, first is |
| |abductor group strengthening will be done with subjects positioned in side lying , second |
| |lateral rotator strengthening will be done with subject positioned in supine lying with legs out |
| |of the couch and third is hip extensor strengthening in prone lying with mechanical weights. |
| | |
| |The Daily Adjustable Progressive Resistance Exercise Regimen: |
| |The Daily Adjustable Progressive Resistance Exercise (DAPRE) technique is more systematic |
| |and takes into account the different rates at which individual’s progress during rehabilitation |
| |and conditioning programs. The system is based on a 6 RM working weight. The adjusted |
| |working weight, which is based on the maximum number of repetitions possible using the |
| |working wait in a set no 3of the regimen, determines the working weight of the next exercise session.22 |
| | |
| | |
| | |
| | |
| |DAPRE Technique |
| | |
| |Sets Repetitions Amount of Resistance |
| | |
| |1 10 50% 6 RM |
| |2 6 75% 6 RM |
| |3 Maximum possible 100% 6 RM |
| |4 Maximum possible 100% adjusted working weight |
| | |
| | |
| |Ankle dorsiflexors strengthening: |
| |1. Heel raise: Begin this ankle strengthening exercise standing at a bench or chair for balance. |
| | |
| |Keep your feet shoulder width apart and facing forwards. Slowly move up onto your toes, |
| | |
| |raising your heels as far as possible and comfortable without pain. Perform 3 sets of 10 |
| | |
| |repetition. |
| | |
| |2.Single leg calf raise: Begin this ankle strengthening exercise standing on one leg at a bench |
| | |
| |Or chair for balance. Keeping your foot facing forwards, slowly move up onto your toes, |
| | |
| |raising your heel as far as possible and comfortable without pain. perform 3 sets of 10 |
|08 | |
| |repetition. |
| | |
| |3.Single leg calf raises over a step with weight: Begin this ankle strengthening exercise |
| | |
| |standing on one leg and holding a light weight with your heel dropped below the level of a |
| | |
| |step. Slowly move up onto your toes, raising your heel as far as possible and comfortable |
| | |
| |without pain. Once this is too easy, the exercise can be progressed by increasing the weight |
| | |
| |gradually provided it does not cause or increase pain. |
| |Post Test Evaluation: |
| |Pain |
| |Gait analysis |
| |Outcome measres: |
| |Kujala patellofemoral pain syndrome questionnaire. |
| |Quadriceps Angle (Q Angle). |
| |Statistical tests: |
| |Statistical analysis will be performed by using SPSS software for window (version16) and p |
| | |
| |value will be set as 0.10 (2-tailed hypothesis). |
| | |
| |Descriptive statistics and Chi square test will be used to analyze baseline data for demographic |
| | |
| |data. |
| | |
| |Unpaired t test and Wilcoxon signed ranked test will be used to find the significance of |
| | |
| |parameters pre to post test. |
| | |
| |Independent t test and Mann Whitney U test will be used to find the significance of parameters |
| | |
| |between the groups. |
| | |
| |7.4 Ethical Clearance : |
| |As the study includes human subjects ethical clearance is obtained from research and |
| |ethical committee of Goutham college of physiotherapy, Bangalore as per the ethical |
| |guidelines for Bio-medical research on human subjects, 2000 ICMR, New Delhi. |
| | |
| |List of References : |
| |1. Brion Conway, Amy Goodson, Kiley Cohen. Anterior knee pain in female athletes. Texas |
| |Health Ben Hogan Sports Medicine. 2013, Issue 1 |
| |2. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler. A Gender differences in |
| |the incidence and prevalence of patellofemoral pain syndrome.Med Sci Sports. 2010;20:725- |
| |730 |
| |3. Joe Heiler Pt CSCS. Effect of limiting ankle dorsiflexion range of motion on lower |
| | |
| |extremity kinamatics and muscle activation pattern during a squat. J Sports Rehab 2012 |
| | |
| |MAY:21(2):144-50 |
| |4. Sara R. Piva, Edward A. Goodnite, John D. Childs. Strength around the hip and |
| |flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. |
| |Journal of Orthopaedic & Sports Physical Therapy. 2005;Nov-Dec ,Volume 35 No12 |
| |5. Mizuno Y, Kumagai M, Mattessich SM. Quadriceps angle influences tibiofemoral and |
| |patellofemoral kinematics. J Orthop Res. 2001;19:834-840 |
| |6. Edith M Heintjes, Marjolein Berger, Sita MA Bierma-Zeinstra, Roos Bernsen, Jan AN |
| |Verhaar, Bart W Koes. Exercise therapy for patellofemoral pain syndrome. Cochrane |
| |Database of Systematic Reviews 2003, Issue 4 |
| |7. Lankhorst NE, Bierma-zeinstra, SMA, and van Middelkoop M. Factors associated |
| |with patellofemoral pain syndrome a systematic review.Br J Sports Med,2013 |
| |8. Dudzinki K, Mulsson Cabak A . The effect of limitation in ankle dorsiflexion on knee joint |
| |function: a pilot study. Pub Med 2013 Mar-Apr15(2) |
| |9. Thiago Yukio Fukuda, William Pagotti Melo, Bruno Marcos Zaffalon, Flavio Marcondes |
| |Rossetto, Eduardo Magalhães, Flavio Fernandes Bryk, Robroy L. Martin. Hip posterolateral |
| |musculature strengthening in sedentary women with patellofemoral pain syndrome. A |
| |randomized controlled clinical trial with 1-year follow-up. Journal Of Orthopaedic & |
| |Sports Physical Therapy : October 2012 Volume 42 ;Number 10 ; - 823 |
| |10. Cashman GE. The effect of weak hip abductors or external rotators on knee valgus |
| |kinematics in healthy subjects: a systematic 11 review. Pub Med J Sport Rehabilitation.2012 |
| |AUG;21(3):273-84 |
| |11. Defne Kaya, Michael James Callaghan, Huseyin Ozkan, Fatih Ozdag, Ozgur Ahmet Atay |
| | |
| |, Inci Yuksel, Pand Mahmut Nedim Doral. The effect of an exercise program in conjunction |
| | |
| |with short-period patellar taping on pain, electromyogram activity, and muscle strength in |
| | |
| |patellofemoral pain syndrome. American Orthopaedic Society for Sports Medicine |
| | |
| |2011:November 26, 2: 410 1 |
| | |
| |12. Fukuda TY, Rossetto FM, Magalhães E, Bryk FF, Lucareli PRG, De Almeida Aparecida |
| | |
| |Carvalho N. Short-term effects of hip abductors and lateral rotators strengthening in females |
| | |
| |with patellofemoral pain syndrome: a randomized controlled clinical trial. J Orthop Sports |
| |Phys Ther. 2010;40:736-742. |
| |13. Bert M. Chesworth, Elsie G. Culham, G. Elizabeth Tata, Malcolm Peat. Validation of |
| |outcome measures in patients with patellofemoral syndrome. JOSPT February 1989;89:30 |
| |14. Edith M Heintjes, Marjolein Berger, Sita MA Bierma-Zeinstra, Roos Bernsen, Jan AN |
| |Verhaar, Bart W Koes. Exercise therapy for patellofemoral pain syndrome. Cochrane |
| |Database of Systematic Reviews 2003, Issue 4 |
| |15. Michelle C. Boling, ATC; Darin A. Padua, ATC; R. Alexander Creighton. Concentric |
| |and eccentric torque of the hip musculature in individuals with and without patellofemoral |
| |pain. Journal of Athletic Training 2009;44(1):7–13 9 |
| |16. Michael P. Reiman, Lori A. Bolgla, and Daniel Lorenz. Hip function’s influence on knee |
| |dysfunction: A proximal link to a distal problem. Journal of Sport Rehabilitation, 2009, 18, |
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| |17. Theresa Helissa Nakagawa, Thiago Batista Muniz, Rodrigo De Marche Baldon , |
| |Universidade Federal De Dias Maciel , Rodrigo Bezerra De Menezes Reiff and Fa´ bio |
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| |muscles in patellofemoral pain syndrome:a randomized controlled pilot study 2008; 22: |
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| |18. Timothy F. Tyler, MS, PT, ATC, Stephen J. Nicholas, MD, Michael J. Mullaney, MPT, |
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| |patellofemoral pain syndrome, thirty-five patients with patellofemoral pain syndrome. The |
| |American Journal of Sports Medicine 2006 Vol. 34, No. 4 |
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| |19. Mizuno Y, Kumagai M, Mattessich SM. Quadriceps angle influences tibiofemoral |
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| |and patellofemoral kinematics. J Orthop Res 2001;19:834-840 |
| |20. De Haven KE, Lintner DM. Athletic injuries: comparison by age, sport, and gender. |
| |Am J Sport Med. 1986;14:218–224. [PubMed] |
| |21. Walsh WM, De Lee JC, Drez D, Miller MD. Recurrent dislocation of the knee in the |
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| |adult. In: Orthopaedic Sports Medicine: Principles and Practice. 2nd ed. Philadelphia, Pa. |
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| |22. Carolyn Kisner PT MS, Lynn Allen Colby PT MS .Therapeutic exercise foundation and |
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| |techniques.5th eddition 2007 |
| | |
|09 |Signature of Candidate | |
|10 |Remarks of the Guide | |
|11 |Name & Designation of: | |
| |11.1 Guide |MR. ARUL JOSEPH ARUN J. |
| | |(ASSOCIATE PROFESSOR) |
| |11.2 Signature | |
| |11.3 Head of Department | |
| |11.4 Signature | |
| 12 |12.1 Remarks of the Chairman & Principal | |
| |12.2 Signature | |
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