Aspectos clínicos e cinemáticos de mulheres com e sem dor femoropatelar associados ao mau alinhamento dinâmico do membro inferior

Abstract

Introduction: Patellofemoral pain (PFP) is a multifactorial knee musculoskeletal disorder with a high prevalence in adolescents and young women. The relationship between PFD and kinematic changes has frequently been addressed in the literature, but there are no subsidies to conclude whether poor alignment is a predictor of this disease or if the pain intensity influences the strategies of movement adopted during weight-bearing tasks. Thus, the objectives of this thesis are: 1- To compare the kinematics of the trunk and lower limbs of women with different knee pain intensities; 2- To identify predictive factors of pain in women with and without dynamic knee valgus; 3- To discuss about causal factors of PFP, as well as the treatment and prevention approaches developed for this disease. Methods: One hundred and thirty-eight women, ages 18- 40 years, with and without PFP, participated in the study. The volunteers were submitted to evaluation of the strength of the hip and knee muscles, dorsiflexion range of motion (ROM), static foot posture and to the kinematic analysis of the trunk and lower limbs during the step down task (study 1) and single leg squat (study 2). For study 1 (n = 50), women were alocated into three groups: Without pain group (17 women), Moderate pain group (16 women) and Severe pain group (17 women) and the average range of motion of the trunk, pelvis, hip, knee and ankle were analyzed by the multivariate analysis test. For study 2 (n = 88), the volunteers were alocated into 4 subgroups based on pain and quality of movement: Pain and Valgo (n = 22); Pain and no valgus (n = 21); No pain and valgus (n = 25) and No pain and No valgus (n = 20). The predictive factors of PFP in women with and without valgus were identified using logistic regressions. Study 3 is a Masterclass about the current findings related to PFP. Results: Compared to the asymptomatic group, women with moderate pain demonstrate lower ROM of contralateral pelvic drop, hip flexion and hip internal rotation, knee flexion and dorsiflexion. Women with severe pain demonstrate greater ROM of the trunk and less contralateral pelvic drop, hip internal rotation, knee flexion, and dorsiflexion. Women with severe pain have greater ROM in the frontal and sagittal planes of the trunk, pelvis and hip than those with moderate pain. Strength of the lateral hip rotator (OR = 3.93) and knee extensors muscles (OR = 0.71), peak of the knee flexion (OR = 1.39) and ROM of the internal hip rotation (OR = 1.35) explain pain in women with valgus. Strength of knee extensor muscles (OR = 0.82) and dorsiflexion ROM (OR = 0.73) explain pain in women without valgus. Conclusion: Pain intensity and factors such as weakness of knee extensor muscles, hip range of motion, ankle ROM deficits, as well as psychosocial factors should be considered in the assessment, prevention and treatment of the women if PFP.