Factors associated with visually assessed quality of movement during a lateral step-down test among individuals with patellofemoral pain.

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To determine what physical measures are associated with visually assessed quality of movement among patients with patellofemoral pain (PFP).

BACKGROUND

An altered movement pattern has been implicated as a risk factor for PFP. An understanding of physical measures associated with an altered movement pattern could potentially help guide prevention and management efforts in patients with PFP.

METHODS

Seventy-nine (40 women) Israel Defense Forces soldiers referred to physical therapy with a diagnosis of PFP were included. Movement pattern was assessed visually during a lateral step-down test and rated as "good" or "moderate," based on previously established criteria. Weight-bearing and non-weight-bearing ankle dorsiflexion (DF) range of motion (ROM); hip internal and external rotation ROM; and hip abduction, hip external rotation, and knee extension strength were also assessed. Differences in physical measures between those with good versus moderate quality of movement were assessed.

RESULTS

Weight-bearing DF ROM was more limited among participants with a moderate quality of movement compared to those with a good quality of movement (P<.01). Among men, non-weight-bearing DF ROM was more limited in those with a moderate quality of movement as well (P<.01). In addition, quality of movement was associated with weight-bearing DF ROM for both women (r = -0.39, P = .01) and men (r = -0.46, P<.01), and with non-weight-bearing DF ROM for men (r = -0.66, P<.01). When the subgroup of participants who exhibited more than 25° of non-weight-bearing DF ROM was assessed, those with a good quality of movement displayed greater hip external rotator and knee extensor muscle strength compared with those with a moderate quality of movement (P<.01).

CONCLUSION

Ankle DF ROM should be assessed when patients with PFP demonstrate a lower quality of movement during a lateral step-down test. Lower hip muscle strength may be associated with lower quality of movement among patients with relatively greater ankle DF ROM.