Eckenrode Brian J, Kietrys David M, Brown Allison, Parrott J Scott, Noehren Brian
Department of Physical Therapy Arcadia University.
Department of Rehabilitation and Movement Sciences Rutgers School of Health Professions.
Int J Sports Phys Ther. 2023 Feb 1;18(1):132-144. doi: 10.26603/001c.57603. eCollection 2023.
Patellofemoral pain (PFP) is a common overuse injury among runners, affecting females at a higher rate than males. PFP can often become chronic, with evidence suggesting it may be linked to both peripheral and central sensitization of the nervous system. Sensitization of the nervous system can be identified through quantitative sensory testing (QST).
HYPOTHESIS/PURPOSE: The primary objective of this pilot study was to quantify and compare pain sensitivity as identified through QST measures, in active female runners with and without PFP.
Cohort Study.
Twenty healthy female runners and 17 female runners with chronic PFP symptoms were enrolled. Subjects completed the Knee injury and Osteoarthritis Outcome Score for Patellofemoral Pain (KOOS-PF), University of Wisconsin Running Injury and Recovery Index (UWRI), and the Brief Pain Inventory (BPI). QST consisted of pressure pain threshold testing to three local and three distant sites to the knee, heat temporal summation, heat pain threshold, and conditioned pain modulation. Data was analyzed utilizing independent t-tests for comparison of between-group data, effect sizes for QST measures (Pearson's r), and Pearson's correlation coefficient between pressure pain threshold values at the knee and functional testing.
The PFP group exhibited significantly lower scores on the KOOS-PF (p<0.001), BPI Pain Severity and Interference Scores (p<0.001), and UWRI (p<0.001). Primary hyperalgesia, identified through decreased pressure pain threshold at the knee, was detected in the PFP group at the central patella (p<0.001), lateral patellar retinaculum (p=0.003), and patellar tendon (p=0.006). Secondary hyperalgesia, a sign of central sensitization, was observed via differences in pressure pain threshold testing for the PFP group at the uninvolved knee (p=0.012 to p=0.042), involved extremity remote sites (p=0.001 to p=0.006), and uninvolved extremity remote sites (p=0.013 to p=0.021).
Compared to healthy controls, female runners with chronic PFP symptoms exhibit signs of both peripheral sensitization. Despite actively participating in running, nervous system sensitization may contribute to continued pain in these individuals. For female runners with chronic PFP, physical therapy management may need to include interventions which address signs of central and peripheral sensitization.
Level 3.
髌股疼痛（PFP）是跑步者中常见的过度使用损伤，女性的发病率高于男性。PFP常常会发展为慢性疼痛，有证据表明它可能与神经系统的外周和中枢敏化有关。神经系统的敏化可以通过定量感觉测试（QST）来识别。
假设/目的：本初步研究的主要目的是通过QST测量来量化和比较有和没有PFP的活跃女性跑步者的疼痛敏感性。
队列研究。
招募了20名健康女性跑步者和17名有慢性PFP症状的女性跑步者。受试者完成了髌股疼痛的膝关节损伤和骨关节炎结局评分（KOOS-PF）、威斯康星大学跑步损伤和恢复指数（UWRI）以及简明疼痛量表（BPI）。QST包括对膝关节三个局部和三个远处部位进行压痛阈值测试、热时间总和、热痛阈值和条件性疼痛调制。数据分析采用独立t检验比较组间数据、QST测量的效应大小（皮尔逊r）以及膝关节压痛阈值与功能测试之间的皮尔逊相关系数。
PFP组在KOOS-PF（p<0.001）、BPI疼痛严重程度和干扰评分（p<0.001）以及UWRI（p<0.001）上的得分显著更低。PFP组在髌骨关节中央（p<0.001）、髌外侧支持带（p=0.003）和髌腱（p=0.006）处通过膝关节压痛阈值降低检测到原发性痛觉过敏。通过对PFP组未受累膝关节（p=0.012至p=0.042）、受累肢体远处部位（p=0.001至p=0.006）和未受累肢体远处部位（p=0.013至p=0.021）的压痛阈值测试差异观察到继发性痛觉过敏，这是中枢敏化的一个迹象。
与健康对照组相比，有慢性PFP症状的女性跑步者表现出外周敏化的迹象。尽管积极参与跑步，但神经系统的敏化可能导致这些个体持续疼痛。对于有慢性PFP的女性跑步者，物理治疗管理可能需要包括针对中枢和外周敏化迹象的干预措施。
3级。
