Changed Muscular Synergy of Selected Lower Limb Muscles in Individuals with Patellofemoral Pain Syndrome During Gait

Authors
F. Gholami 1
R. Sheikhhoseini 2
M. Yousefi 3
H. Zanguie 4
1 Sport Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, Allameh Tabataba’i University, Iran.
2 Associate Professor, Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran. Email: Rahman.pt82@gmail.com, ORCID: 0000-0002-9885-3591
3 Department of Sports Biomechanics, Faculty of Physical Education and Sport Sciences, University of Birjand, Birjand, Iran. Email: m.yousefi@birjand.ac.ir, ORCID ID: 0000-0002-2553-5277
4 Corrective Exercises, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran. Email: hr.zanguie@gmail.com, ORCID ID: 0000-0002-6020-668X
10.22034/IJMPP.10.2.1236
Abstract
Aims: Patellofemoral Pain Syndrome (PFPS) is a term used to describe various pathologies or anatomical abnormalities that result in anterior knee pain and is one of the most common causes of such pain. The present study aims first to extract the muscle synergies of individuals with and without PFPS during walking and subsequently analyze and compare their synergy patterns and corresponding activation coefficients throughout the gait cycle.

Methods: The statistical population of the present study consisted of adults aged 25 to 35 years, including two groups: a healthy group (12 individuals) and a group with patellofemoral pain syndrome (9 individuals). This study was designed using a force plate, motion analysis system, and EMG, based on specific inclusion and exclusion criteria. Data were analyzed using specialized software and statistical methods such as HALS, frequency analysis, and t-tests.

Findings: Results no significant difference in the number of muscle synergies and the contribution of each lower limb muscle in the extracted synergies between the control and affected groups (p ≤ 0.05).

Conclusion: This pioneering study in Iran investigated muscle synergies during walking in individuals with patellofemoral pain syndrome and revealed distinct neural control patterns, although no significant changes were observed in the structure of the synergies. The lack of statistical significance may be attributed to the limited sample size and variations in measurement methods, highlighting the importance of targeted rehabilitation considering the impact of this condition on balance.

Keywords: Patellofemoral Pain Syndrome, Muscular Synergy, Gait

Keywords

Subjects

1. Woo SL, Debski RE, Withrow JD, Janaushek MA. Biomechanics of knee ligaments. The American journal of sports medicine. 1999;27(4):533-43.
2. Fry W, Wulff V, Tucker D, Fry F. Physical factors involved in ultrasonically induced changes in living systems: I. Identification of non‐temperature effects. The Journal of the Acoustical Society of America. 1950;22(6):867-76.
3. Shultz SJ, Perrin DH, Adams MJ, Arnold BL, Gansneder BM, Granata KP. Neuromuscular response characteristics in men and women after knee perturbation in a single-leg, weight-bearing stance. Journal of athletic training. 2001;36(1):37.
.
4. Zanguie H, Sheikhhoseini R, Yousefi M, Hides JA. Mechanical energy flow analysis in athletes with and without anterior cruciate ligament reconstruction during single-leg drop landing. Scientific Reports. 2024;14(1):1321.
5. Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic medicine. 2008;7(1):1-14.
6. Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann G-P, et al. Patellofemoral pain syndrome. Knee surgery, sports traumatology, arthroscopy. 2014;22:2264-74.
7. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scandinavian journal of medicine & science in sports. 2010;20(5):725-30.
8. Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. Journal of orthopaedic & sports physical therapy. 2007;37(5):232-8.
9. Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI. Disability in young people and adults one year after head injury: prospective cohort study. Bmj. 2000;320(7250):1631-5.
10. Ghourbanpour A, Talebi GA, Hosseinzadeh S, Janmohammadi N, Taghipour M. Effects of patellar taping on knee pain, functional disability, and patellar alignments in patients with patellofemoral pain syndrome: a randomized clinical trial. Journal of Bodywork and Movement Therapies. 2018;22(2):493-7.
11. Nimon G, Murray D, Sandow M, Goodfellow J. Natural history of anterior knee pain: a 14-to 20-year follow-up of nonoperative management. Journal of Pediatric Orthopaedics. 1998;18(1):118-22.
12. Rainoldi A, Melchiorri G, Caruso I. A method for positioning electrodes during surface EMG recordings in lower limb muscles. Journal of neuroscience methods. 2004;134(1):37-43.
13. Park S, Caldwell GE. Muscle synergies are modified with improved task performance in skill learning. Human Movement Science. 2022;83:102946.
14. Yeung D, Guerra IM, Barner-Rasmussen I, Siponen E, Farina D, Vujaklija I. Co-adaptive control of bionic limbs via unsupervised adaptation of muscle synergies. IEEE Transactions on Biomedical Engineering. 2022;69(8):2581-92.
15. Agostini V, Ghislieri M, Rosati S, Balestra G, Dotti G, Knaflitz M. Statistical Gait Analysis Based on Surface Electromyography. Medicine-Based Informatics and Engineering. 2022:23-35.
16. Ting LH, McKay JL. Neuromechanics of muscle synergies for posture and movement. Current opinion in neurobiology. 2007;17(6):622-8.
17. Berniker M, Jarc A, Bizzi E, Tresch MC. Simplified and effective motor control based on muscle synergies to exploit musculoskeletal dynamics. Proceedings of the National Academy of Sciences. 2009;106(18):7601-6.
18. Neptune RR, Clark DJ, Kautz SA. Modular control of human walking: a simulation study. Journal of biomechanics. 2009;42(9):1282-7.
19. Rodriguez KL, Roemmich RT, Cam B, Fregly BJ, Hass CJ. Persons with Parkinson’s disease exhibit decreased neuromuscular complexity during gait. Clinical Neurophysiology. 2013;124(7):1390-7.
20. Hayes HB, Chvatal SA, French MA, Ting LH, Trumbower RD. Neuromuscular constraints on muscle coordination during overground walking in persons with chronic incomplete spinal cord injury. Clinical Neurophysiology. 2014;125(10):2024-35.
21. Chen J, Sun Y, Sun S. Muscle Synergy of Lower Limb Motion in Subjects with and without Knee Pathology. Diagnostics. 2021;11(8):1318.
22. Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic medicine. 2008;7:1-14.
23. Manske RC, Davies GJ. Examination of the patellofemoral joint. International journal of sports physical therapy. 2016;11(6):831.
24. Lankhorst NE, Bierma-Zeinstra S. Van middelkoop M. Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review journal of orthopaedic&sports physical therapy. 2012;42(2).
25. Kargo WJ, Giszter SF. Individual premotor drive pulses, not time-varying synergies, are the units of adjustment for limb trajectories constructed in spinal cord. Journal of Neuroscience. 2008;28(10):2409-25.
26. Earl JE, Hertel J, Denegar CR. Patterns of dynamic malalignment, muscle activation, joint motion, and patellofemoral-pain syndrome. Journal of sport rehabilitation. 2005;14(3):216-33.
27. Dileep K, Krishna H, Rameez M. Correlation of rearfoot angle to Q-angle in patellofemoral pain syndrome: a prospective study. Int J Res Orthop. 2017;3(4):688-91.
28. Thijs Y, Pattyn E, Van Tiggelen D, Rombaut L, Witvrouw E. Is hip muscle weakness a predisposing factor for patellofemoral pain in female novice runners? A prospective study. The American journal of sports medicine. 2011;39(9):1877-82.
29. Yang C, Best TM, Liu H, Yu B. Knee biomechanical factors associated with patellofemoral pain in recreational runners. The Knee. 2022;35:87-97.
30. Wallmann HW. Introduction to observational gait analysis. Home health care management & practice. 2009;22(1):66-8.
31. Torres-Oviedo G, Ting LH. Subject-specific muscle synergies in human balance control are consistent across different biomechanical contexts. Journal of neurophysiology. 2010;103(6):3084-98.
32. Thijs Y, De Clercq D, Roosen P, Witvrouw E. Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. British journal of sports medicine. 2008;42(6):466-71.
33. Sherrington CS. Flexion-reflex of the limb, crossed extension-reflex, and reflex stepping and standing. The Journal of physiology. 1910;40(1-2):28.
34. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. journal of orthopaedic & sports physical therapy. 2010;40(2):42-51.
35. Willson JD, Davis IS. Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clinical biomechanics. 2008;23(2):203-11.
36. Willson JD, Ireland ML, Davis I. Core strength and lower extremity alignment during single leg squats. Medicine and science in sports and exercise. 2006;38(5):945.
37. Decker MJ, Torry MR, Wyland DJ, Sterett WI, Steadman JR. Gender differences in lower extremity kinematics, kinetics and energy absorption during landing. Clinical biomechanics. 2003;18(7):662-9.
38. Fukuda O, Tsuji T, Kaneko M, Otsuka A. A human-assisting manipulator teleoperated by EMG signals and arm motions. IEEE transactions on robotics and automation. 2003;19(2):210-22.
39. Emami M-J, Ghahramani M-H, Abdinejad F, Namazi H. Q-angle: an invaluable parameter for evaluation of anterior knee pain. 2007.
40. Noehren B, Pohl MB, Sanchez Z, Cunningham T, Lattermann C. Proximal and distal kinematics in female runners with patellofemoral pain. Clinical biomechanics. 2012;27(4):366-71.
41. Piva SR, Fitzgerald K, Irrgang JJ, Jones S, Hando BR, Browder DA, et al. Reliability of measures of impairments associated with patellofemoral pain syndrome. BMC musculoskeletal disorders. 2006;7:1-13.
42. Sigward SM, Ota S, Powers CM. Predictors of frontal plane knee excursion during a drop land in young female soccer players. Journal of orthopaedic & sports physical therapy. 2008;38(11):661-7.
43. Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population: a two-year prospective study. The American journal of sports medicine. 2000;28(4):480-9.
44. Pirker W, Katzenschlager R. Gait disorders in adults and the elderly: A clinical guide. Wiener Klinische Wochenschrift. 2017;129(3-4):81-95.
International Journal of Musculoskeletal Pain Prevention
Volume 10, Issue 2
June 2025
Pages 1236-1243