Patellofemoral Ağrılı ve Sağlıklı Bireyler Arasındaki Biyomekaniksel Farkların İncelenmesi

Abstract

The aim of this study was to determine the biomechanical and neuromuscular differences between individuals with patellofemoral pain (PFP) and healthy individuals. Eight participants, 4 with patellofemoral pain and 4 healthy individuals, between the ages of 20-40 were included in the study (mean age: 33.88 ± 4.67 years; mean height: 163.75 ± 5.97 cm; mean body weight: 62.63 ± 7.98 kg; mean body mass index: 23.36 ± 2.90 kg/m2). Participants performed 3 repetitions of maximum isometric contraction in a 65° squatting position while trying to lift a 140 kg loaded bar. Muscle activation, knee valgus angle, and ground reaction force were analyzed using motion capture, force platform, and EMG data. Joint angles for the pelvis, hip, knee, and ankle were calculated with the inverse kinematics tool in OpenSim. Ground reaction forces (GRF) were measured with the force platform. EMG data of vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), gluteus medius (GMed), gluteus maximus (GMax), adductor longus (AL) muscles were analyzed. In the analysis results, anterior pelvic tilt was observed in healthy individuals, while posterior pelvic tilt was observed in the patellofemoral pain group (p<0.05). Ankle dorsiflexion angles were found lower in the PFA group compared to the healthy group. In the PFA group, ankle dorsiflexion angles were found to be greater on the painful side than on the painless side (p<0.05). Knee valgus angles were higher in the PFA group compared to the healthy group in both legs. In the PFA group, vastus medialis activity on the painful side was found to be significantly lower than in healthy individuals (p<0.05). Gluteus medius muscle activity increased, and a decrease in gluteus maximus activity was observed on the non-dominant side. Positive strong linear correlations were found between ground reaction force and EMG values of the muscles (p<0.001). While more pronounced pressure shifts were observed in the mediolateral direction in healthy individuals, shifts were detected in the anteroposterior direction in the PFA group. In the experimental setup designed to observe these effects using biomechanical measurement methods, which was used for the first time in the literature by considering the human body as a closed mechanical system, these findings show that individuals with patellofemoral pain use different compensatory strategies. The results of the study emphasize that patellofemoral pain causes biomechanical and neuromuscular differences not only in the painful extremity but also on the unaffected side, and therefore both extremities should be taken into consideration in the treatment processes.