TY - JOUR
T1 - Assessment and management of somatic dysfunctions in patients with patellofemoral pain syndrome
AU - Tramontano, Marco
AU - Pagnotta, Simone
AU - Lunghi, Christian
AU - Manzo, Camilla
AU - Manzo, Francesca
AU - Consolo, Stefano
AU - Manzo, Vincenzo
N1 - Funding Information:
Forty participants between 18 and 60 years of age who had a medical diagnosis of PFPS were recruited. Patellofemoral pain syndrome was diagnosed if the participants had a complaint of retropatellar or anterior knee pain that was provoked by 2 or more of the following activities: prolonged sitting, stair ascent, stair descent, squatting, kneeling, or isometric quadriceps contraction. The diagnosis was supported by magnetic resonance imaging (MRI) findings. Individuals were excluded if they had a history of prior knee surgery, any competing knee injuries (meniscal tears, patellar tendinopathy, ligamentous sprains, osteoarthritis, patellar bursitis), any cause of possible referred pain to the knee (eg, hip osteoarthritis), any systemic disease or connective tissue disorders or signs of lumbosacral nerve root compression, and if they had received prior OMTh. Interventions were performed at 2 osteopathic outpatient clinical centers from March 2016 to July 2018. Participants were enrolled randomly in 2 groups on the basis of consecutive sampling: the OMTh group that received manual treatment and the placebo group that received passive touching. Participants were unaware of the study design and outcomes and of group allocation. A researcher (M.T.) who was not involved in the intervention sessions carried out the randomization.
Publisher Copyright:
© 2020 American Osteopathic Association.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3
Y1 - 2020/3
N2 - Context: Patellofemoral pain syndrome (PFPS) is one of the most common determinants of knee pain. The causes of PFPS are multifactorial, and most treatment approaches are conservative. There are many kinds of therapy for this syndrome, which are based on building strength, flexibility, proprioception, and endurance. Training is functional and progression is gradual. Our hypothesis is that total-body osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) focused on the management of somatic dysfunctions could be useful for managing the pain of patients with PFPS. Objective: To investigate the effect of OMTh on pain reduction in patients with PFPS. Methods: This pilot study was randomized, controlled, and single-blinded with 2 months of follow-up. Qualified participants were randomly assigned to 1 of 2 groups: OMTh group or placebo group. Each participant received either 4 sessions of OMTh or 4 sessions of manual placebo intervention that consisted of passive touching without joint mobilization in a protocolled order. A visual analogue scale (VAS) was used to assess general knee pain, peripatellar pain, pain after prolonged sitting, pain during the patellar compression test, and pain during stair ascent and descent. Pain assessment was performed before the baseline (T0), second (T1), third (T2), and fourth (T3) sessions, and follow-up (T4) was performed 8 weeks after T3. Results: Thirty-five participants were enrolled the study. The VAS score was significantly reduced and clinically relevant in the OMTh group after each treatment and after 2 months of follow-up. The change in the VAS score before each treatment indicates that the most improved areas at T1 compared with T0 were lumbar and sacral with improvements in 83% and 40% of patients, respectively. At T2 compared with T1, the most improved areas were cervical and sacral with improvements found in 58% and 36% of patients, respectively. The number of dysfunctions that were diagnosed decreased during the baseline to T3 period (40% change). The correlation analysis showed significant results for the dysfunction and the compression test at T2 (P=.01, ρ=0.543). Conclusion: Significant differences in VAS scores were found between the OMTh and placebo groups. These findings underline how OMTh can lead to reduced pain in patients with PFPS.
AB - Context: Patellofemoral pain syndrome (PFPS) is one of the most common determinants of knee pain. The causes of PFPS are multifactorial, and most treatment approaches are conservative. There are many kinds of therapy for this syndrome, which are based on building strength, flexibility, proprioception, and endurance. Training is functional and progression is gradual. Our hypothesis is that total-body osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) focused on the management of somatic dysfunctions could be useful for managing the pain of patients with PFPS. Objective: To investigate the effect of OMTh on pain reduction in patients with PFPS. Methods: This pilot study was randomized, controlled, and single-blinded with 2 months of follow-up. Qualified participants were randomly assigned to 1 of 2 groups: OMTh group or placebo group. Each participant received either 4 sessions of OMTh or 4 sessions of manual placebo intervention that consisted of passive touching without joint mobilization in a protocolled order. A visual analogue scale (VAS) was used to assess general knee pain, peripatellar pain, pain after prolonged sitting, pain during the patellar compression test, and pain during stair ascent and descent. Pain assessment was performed before the baseline (T0), second (T1), third (T2), and fourth (T3) sessions, and follow-up (T4) was performed 8 weeks after T3. Results: Thirty-five participants were enrolled the study. The VAS score was significantly reduced and clinically relevant in the OMTh group after each treatment and after 2 months of follow-up. The change in the VAS score before each treatment indicates that the most improved areas at T1 compared with T0 were lumbar and sacral with improvements in 83% and 40% of patients, respectively. At T2 compared with T1, the most improved areas were cervical and sacral with improvements found in 58% and 36% of patients, respectively. The number of dysfunctions that were diagnosed decreased during the baseline to T3 period (40% change). The correlation analysis showed significant results for the dysfunction and the compression test at T2 (P=.01, ρ=0.543). Conclusion: Significant differences in VAS scores were found between the OMTh and placebo groups. These findings underline how OMTh can lead to reduced pain in patients with PFPS.
KW - Chronic pain
KW - Osteopathic care
KW - Osteopathic manipulative therapy
KW - Patellofemoral pain syndrome
KW - Somatic dysfunction
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U2 - 10.7556/jaoa.2020.029
DO - 10.7556/jaoa.2020.029
M3 - Article
C2 - 32091560
AN - SCOPUS:85079871054
VL - 120
SP - 165
EP - 173
JO - The Journal of the American Osteopathic Association
JF - The Journal of the American Osteopathic Association
SN - 0098-6151
IS - 3
ER -