Académique Documents
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RESEARCH REPORT
patellofemoral
pain
syndrome
(PFPS).5,15,22,34,35 Forward lunges can be
performed with varying techniques, including variations in step length. In addition, forward lunges may or may not
incorporate the use of a stride. Lunging
without a stride involves keeping both
feet stationary throughout the knee-exing (descent) and knee-extending (ascent) lunging movements. Lunging with
a stride involves striding forward with the
lead lower extremity and either pushing
back to the starting position, or bringing
the trail lower extremity up to meet the
lead lower extremity (ie, a walking lunge).
A lunge with a longer step length typically
results in the lead knee being maintained
over the lead foot at the lowest position of
the lunge, while one with a shorter step
length typically results in the lead knee
translating anteriorly beyond the toes at
the lowest position of the lunge. Some clinicians believe that anterior translation
of the lead knee beyond the toes during
the forward lunge increases patellofemoral joint loading, but there is currently no
evidence to support this belief.
High patellofemoral joint force often
results in high patellofemoral joint stress
(patellofemoral force per unit patella
contact area), which may result in PFPS
1
Professor, Department of Physical Therapy, California State University, Sacramento, Sacramento, CA. 2 Assistant Professor, The Center for Biomedical Engineering, Department
of Mechanical Engineering and Engineering Science, University of North Carolina, Charlotte, NC. 3 Graduate Student (PhD), Department of Physical Therapy, Center for
Biomedical Engineering Research, University of Delaware, Newark, DE. 4 Graduate Student (PhD), Department of Kinesiology, Iowa State University, Ames, IA. 5 Associate
Professor, Kinesiology and Health Science Department, California State University, Sacramento, Sacramento, CA. 6 Smith and Nephew Chair of Research, American Sports
Medicine Institute, Birmingham, AL. 7 Vice President Education and Research, Champion Sports Medicine, Birmingham, AL. 8 Associate Professor, Orthopaedic Surgery, Duke
University Medical Center, Durham, NC. 9 Associate Professor, Kinesiology and Health Science Department, California State University, Sacramento, Sacramento, CA. 10 Medical
Director, American Sports Medicine Institute, Birmingham, AL; Medical Director, Andrews Institute, Gulf Breeze, FL. The protocol used in the current study was approved by
the Institutional Review Board at California State University, Sacramento. Please address correspondence to Dr Rafael Escamilla, Professor, Physical Therapy, California State
University, Sacramento, Department of Physical Therapy, 6000 J Street, Sacramento, CA 95819-6020. E-mail: rescamil@csus.edu
journal of orthopaedic & sports physical therapy | volume 38 | number 11 | november 2008 | 681
[
from numerous soft tissues, such as the
synovial plicae, infrapatellar fat pad, retinacula, joint capsule, and patellofemoral
ligaments.4 High patellofemoral joint
force can also elevate subchondral bone
stress in the patellofemoral joint. 3 Because the subchondral bone plate is rich
in pain receptors,36 increased subchondral bone stress may also result in PFPS.4
Patellofemoral joint stress can result in
cartilage degeneration and a decrease in
the ability of the cartilage to distribute
patellofemoral force.3 Therefore, understanding what patellofemoral force and
stress magnitudes are generated among
patellofemoral rehabilitation exercises
may be helpful to clinicians when prescribing therapeutic exercises to individuals with PFPS.
The goal of rehabilitation is to promote
muscle strengthening while minimizing
joint loading and pain. Understanding
how patellofemoral joint force and stress
vary among weight-bearing exercises
would allow athletes to better understand
the stress applied to this joint while performing various exercises. Moreover, it
would also allow clinicians to prescribe
and use these exercises in a safer and more
effective manner during rehabilitation of
individuals with various knee injuries, including those with PFPS. For example, if
lunging with a shorter step, with greater
anterior translation of the lead knee over
the toes, results in greater patellofemoral
joint force and stress compared to lunging with a longer step, with the lead knee
maintained over the foot, a shorter step
lunge may be discouraged during training
and rehabilitation. There may also be differences in patellofemoral joint force and
stress over a specic knee exion range of
motion between lunging with a short and
long step. Excess patellofemoral joint force
and stress over time may lead to PFPS in
individuals with asymptomatic patellofemoral joints, or may exacerbate PFPS
in patients with patellofemoral pathology
and delay the rehabilitation process.
Our purpose was to compare patellofemoral joint force and stress between a
forward lunge with a long and short step,
RESEARCH REPORT
METHODS
Subjects
Exercise Description
Each subject performed the forward lunge
long (FIGURE 1) and forward lunge short
(FIGURE 2), with and without a stride. The
starting and ending positions of the forward lunge long with stride and forward
lunge short with stride were the same,
which involved standing upright with
both feet together. From this position, the
subject held a dumbbell weight in each
hand and lunged forward with the right
lower extremity towards a force platform
682 | november 2008 | volume 38 | number 11 | journal of orthopaedic & sports physical therapy
Data Collection
Each subject attended a pretest session 1
week prior to testing. The experimental
protocol was reviewed, the subject was
given the opportunity to practice the
lunge variations, and each subjects step
length for the forward lunge long was determined. In addition, each subjects 12RM was determined while performing
the forward lunge with stride using a step
length halfway between the forward lunge
long and forward lunge short. This 12-RM
weight was used for the 4 lunge variations
during data collection. The mean SD
total dumbbell mass used was 49 11 kg
for males and 32 8 kg for females.
Blue Sensor disposable surface electrodes (type M-00-S; Ambu Inc, Linthicum, MD) were used to collect EMG
data. These oval shaped electrodes (22
mm wide and 30 mm long) were placed
in a bipolar conguration along the longitudinal axis of each muscle, with a center-to-center distance of approximately
3 cm between electrodes. Prior to applying the electrodes, the skin was prepared
by shaving, abrading, and cleaning with
isopropyl alcohol wipes to reduce skin
impedance. Electrode pairs were then
placed on the subjects right side, using
previously described locations,2 for the
following muscles: (a) rectus femoris, (b)
vastus lateralis, (c) vastus medialis, (d)
medial hamstrings (semimembranosus
and semitendinosus), (e) lateral hamstrings (biceps femoris), and (f) gastrocnemius (middle portion between medial
and lateral bellies).
Spheres (3.8 cm in diameter) covered
with 3M reective tape were attached to
adhesives and positioned over the following bony landmarks: (a) third metatarsal head of the right foot, (b) medial and
lateral malleoli of the right leg, (c) upper
edges of the medial and lateral tibial plateaus of the right knee, (d) posterosuperior greater trochanters of the left and
right femurs, and (e) lateral acromion of
the right shoulder.
Once the electrodes and spheres were
positioned, the subject warmed up and
practiced the exercises as needed, and
data collection commenced. A 6-camera Peak Performance motion analysis
system (Vicon-Peak Performance Technologies, Inc, Englewood, CO) was used
to collect 60-Hz video data. Force data
were collected at 960 Hz using a force
platform (model OR6-6-2000; Advanced
Mechanical Technologies, Inc, Watertown, MA). EMG data were collected at
960 Hz using a Noraxon Myosystem unit
(Noraxon USA, Inc, Scottsdale, AZ). The
EMG amplier bandwidth frequency was
10 to 500 Hz, with an input impedance
of 20 000 k8, and the common-mode
rejection ratio was 130 dB. Video, EMG,
and force data were electronically synchronized and simultaneously collected
as each subject performed 1 set of 3 repetitions of the forward lunge long with
stride, forward lunge long without stride,
forward lunge short with stride, and for-
Data Reduction
Video images for each reective marker
were tracked and digitized in 3-dimensional space with Peak Performance
software, utilizing the direct linear transformation calibration method.27 Testing
of the accuracy of the calibration system
resulted in reective markers that could
be located in 3-dimensional space with
an error less than 0.7 cm. The raw position data were smoothed with a doublepass fourth-order Butterworth low-pass
lter with a cut-off frequency of 6 Hz.12
Joint angles, linear and angular velocities, and linear and angular accelerations
were calculated in a 2-dimensional sagittal plane of the knee utilizing appropriate
kinematic equations.12
Raw EMG signals were full-waved
rectied, smoothed with a 10-millisecond, moving-average window and linear
enveloped throughout the knee range of
motion for each repetition. These EMG
data were then normalized for each muscle and expressed as a percentage of each
subjects highest corresponding MVIC
trial. The MVIC was calculated using
the highest EMG signal over a 1-second
interval throughout the 5-second MVIC
trials. Normalized EMG data for the 3
journal of orthopaedic & sports physical therapy | volume 38 | number 11 | november 2008 | 683
Biomechanical Model
A previously described12,38 biomechanical
model of the knee was used to continuously calculate patellofemoral joint forces
throughout a 0-to-90 knee range of motion during the descent and ascent phases
of the lunge. Resultant force and torque
equilibrium equations were calculated
using inverse dynamics and the biomechanical knee model.12,38 Moment arms
of muscle forces and angles of the line of
action for muscles were represented as
polynomial functions of the knee exion
angle.16
Quadriceps, hamstrings, and gastrocnemius muscle forces were calculated
as previously described.12,38 Because the
accuracy of calculating muscle forces depends on accurate calculations of a muscles physiological cross-sectional area
(PCSA), maximum voluntary contraction
force per unit PCSA, and the EMG-force
relationship, resultant force and torque
equilibrium equations may not be satised. Therefore, each muscle force Fm(i)
was modied by the following equation
at each knee angle:
Fm(i) = ciklikviAiTm(i) [EMGi /MVICi ],
where Ai was PCSA of the ith muscle;
Tm(i) was MVIC force per unit PCSA of
the ith muscle; EMGi and MVICi were
EMG window averages of the ith muscle
EMG during exercise and MVIC trials;
ci was a weight factor (explained below),
adjusted in a computer optimization
program to minimize the difference between the resultant torque from the inverse dynamics (Tres) and the resultant
torque calculation from the biomechanical model (Tmi); kli represented each
muscles force-length relationship as
function of hip and knee angles (based
on muscle length, ber length, sarcomere length, pennation angle, and crosssectional area)32; and kvi represented
4000
RESEARCH REPORT
3000
2000
1000
20
60
40
80
100
80
40
60
Descent
20
Ascent
Knee Angle ()
Forward lunge long with stride
FIGURE 3. Mean SD patellofemoral joint compressive force for the forward lunge long and short with stride.
10
0
0
20
60
40
80
100
80
40
60
Descent
20
Ascent
Knee Angle ()
Forward lunge long with stride
FIGURE 4. Mean SD patellofemoral joint stress for the forward lunge long and short with stride.
min f(ci) =
3 (1 c )
i=1
nm
+ M(Tres
3T
i=1
)2,
mi
684 | november 2008 | volume 38 | number 11 | journal of orthopaedic & sports physical therapy
= 0.99), which was used to determine contact areas for 70 knee angle (373 mm2),
80 knee angle (401 mm2), and 90 knee
angle (429 mm2). Like the current study,
a near-linear relationship between patellar contact area and knee angles has been
reported between 0 to 90 knee angles in
several studies involving weight-bearing
exercises.3,9,17,23,26
4000
3000
2000
1000
20
60
40
100
80
80
40
60
Descent
20
Ascent
Knee Angle ()
Forward lunge long without stride
FIGURE 5. Mean SD patellofemoral joint compressive force for the forward lunge long and short without stride.
10
0
0
20
60
40
100
80
80
40
60
20
Ascent
Descent
Knee Angle ()
Forward lunge long without stride
Data Analysis
A repeated-measures 2-way analysis of
variance (ANOVA), with step length (long
versus short) as 1 factor and stride (stride
versus no stride) as the second factor, was
used for each 10 angle (from 0 to 90)
during the descent phase and each 10
angle (from 90 to 0) during the ascent
phase. Bonferroni t tests were used to assess pairwise comparisons. To minimize
the probability of type I errors secondary
to the use of a separate ANOVA for each
knee angle, a Bonferroni adjustment was
performed with the level of signicance
established at 0.0025 (0.05/20 knee angles). A separate set of analyses was not
performed for patellofemoral joint stress
values because stress values for each knee
angle were derived from dividing force
data by a constant, therefore not affecting statistical results.
FIGURE 6. Mean SD patellofemoral joint stress for the forward lunge long and short without stride.
RESULTS
ittal plane. Patellofemoral joint force
was a function of patellar tendon force
and quadriceps tendon force. Patellar tendon force was calculated by the
quadriceps tendon force and the ratio
of the patellar tendon force and the
quadriceps tendon force, as previously
described.29,30 The angles between the
patellar tendon, quadriceps tendon, and
patellofemoral joint were expressed as
functions of knee angle.29,30
Patellofemoral joint stress, which was
calculated every 10 between 0 to 90
knee angles, was expressed as the ratio
of patellofemoral joint force (calculated
from the biomechanical model described
above12,38) and patellar contact area. Patellar contact areas were determined for 10
intervals between 0 to 90 knee angles.
Contact areas from in vivo magnetic resonance imaging (MRI) data from Salsich et
al,26 who also used both male and female
subjects with healthy knees and had them
perform weight-bearing exercise using resistance, were employed for 0 (146 mm2),
20 (184 mm2), 40 (290 mm2), and 60
(347 mm2) knee angles. These 4 contact
area values formed a near linear relationship as a function of knee angle, resulting
in a line of best-t equation of y = 3.55x +
135 (r = 0.98), with y as contact area and
x as knee angle. This line of best-t equation was used to determine contact areas
for 10 knee angle (171 mm2), 30 knee
angle (242 mm2), and 50 knee angle (313
mm2). The contact areas for 40, 50, and
60 knee angles were used to develop the
line of best-t equation y = 2.81x + 176 (r
escriptive data for patellofemoral joint force and stress for each
lunge condition are provided in FIGURES 3 to 6. Visual observation of the data
indicate that patellofemoral joint force
and stress generally increased progressively as knee exion increased during
the descent phase and decreased progressively as knee exion decreased during
the ascent phase. Moreover, for a given
knee angle, patellofemoral joint force and
stress were generally similar between descent and ascent phases.
TABLES 1 and 2 provide patellofemoral
joint force and stress values during the descent and ascent phases, and as a function
of knee angle between the forward lunge
long and short conditions, and between
journal of orthopaedic & sports physical therapy | volume 38 | number 11 | november 2008 | 685
[
TABLE 1
RESEARCH REPORT
Knee Angles
Long Step
Stride Variations
Short Step
P Value
With Stride
Without Stride
P Value
Descent phase
0
69 62
93 107
.255
106 81
62 52
.092
10
159 143
144 145
.100
212 154
97 55
.002
20
207 152
233 204
.222
306 230
147 63
.002
30
356 190
377 236
.966
440 261
298 126
.035
40
628 236
629 273
1.000
688 275
573 222
.024
50
1059 425
1051 382
.461
1106 443
1006 355
.292
60
1524 550
1660 514
.181
1601 557
1585 515
.960
70
1944 672
2335 759
.002
2121 831
2172 634
.625
80
2161 657
2836 889
.001
2450 929
2567 772
.287
90
2185 654
3039 853
.001
2588 935
2648 815
.328
90
2191 662
2860 786
.001
2505 804
2535 798
.702
80
2102 739
2768 839
.001
2416 895
2444 822
.868
70
1937 786
2365 807
.001
2214 935
2102 721
.478
60
1577 706
1839 728
.072
1839 859
1577 546
.086
50
1176 525
1298 567
.176
1395 653
1082 364
.013
40
780 344
829 360
.345
923 405
688 241
.002
30
504 240
500 217
.546
603 249
408 156
.001
20
312 180
287 137
.295
382 179
223 87
.001
10
168 119
149 83
.222
217 120
110 45
.001
66 46
81 65
.605
97 77
59 32
.041
Ascent phase
* Patellofemoral joint force values are mean SD N. The mean values given for the 2 step length variations (long step and short step) were collapsed across the
2 stride variations (with stride and without stride), while the mean values given for the 2 stride variations were collapsed across the 2 step length variations.
The P values shown for step length variations and stride variations represent the main effects of the ANOVA.
the lunge with and without stride conditions. At 70, 80, and 90 knee angles
during both the descent and ascent phases, signicant main effects for lunge step
(long step versus short step) were found.
On average, the patellofemoral forces and
stresses were greater in the forward lunge
short compared to the forward lunge
long. At 10 and 20 knee angles of the
descent phase and at 40, 30, 20, and
10 knee angles of the ascent phase, signicant main effects for lunge stride (with
stride versus without stride) were found.
On average, patellofemoral joint forces
and stresses were signicantly greater in
the forward lunge with stride compared
to the forward lunge without stride.
There was only 1 angle at which a
significant interaction (P = .001) be-
DISCUSSION
686 | november 2008 | volume 38 | number 11 | journal of orthopaedic & sports physical therapy
TABLE 2
Knee Angles
Long Step
Stride Variations
Short Step
P Value
With Stride
Without Stride
P Value
Descent phase
0
0.46 0.41
0.61 0.70
.255
0.70 0.76
0.40 0.34
.092
10
0.93 0.84
0.84 0.85
.100
1.24 1.08
0.57 0.33
.002
20
1.13 0.83
1.27 1.11
.222
1.66 1.25
0.80 0.34
.002
30
1.48 0.79
1.56 0.98
.966
1.82 1.08
1.24 0.52
.035
40
2.17 0.81
2.17 0.94
1.000
2.37 0.95
1.98 0.77
.024
.292
50
3.39 1.36
3.36 1.22
.461
3.54 1.42
3.22 1.14
60
4.39 1.58
4.78 1.48
.181
4.61 1.61
4.58 1.48
.960
70
5.22 1.80
6.21 2.04
.002
5.69 2.23
5.75 1.73
.625
80
5.39 1.64
7.08 2.22
.001
6.11 2.32
6.40 1.93
.287
90
5.09 1.53
7.09 1.99
.001
6.03 2.18
6.17 1.90
.328
90
5.11 1.54
6.67 1.83
.001
5.84 1.68
5.91 1.86
.702
80
5.24 1.84
6.91 2.09
.001
6.03 2.23
6.10 2.05
.868
70
5.20 2.11
6.32 2.17
.001
5.87 2.44
5.64 1.93
.478
60
4.54 2.04
5.30 2.10
.072
5.30 2.47
4.54 1.57
.086
50
3.76 1.68
4.15 1.82
.176
4.47 2.09
3.46 1.16
.013
40
2.69 1.19
2.89 1.24
.345
3.18 1.40
2.37 0.83
.002
30
2.09 0.99
2.07 0.90
.546
2.50 1.03
1.69 0.65
.001
20
1.70 0.98
1.56 0.75
.295
2.08 0.97
1.21 0.47
.001
10
0.99 0.70
0.88 0.49
.222
1.27 0.70
0.65 0.26
.001
0.43 0.30
0.53 0.43
.605
0.63 0.51
0.39 0.21
.041
Ascent phase
* Patellofemoral joint stress values are mean SD MPa. The mean values given for the 2 step length variations (long step and short step) were collapsed across
the 2 stride variations (with stride and without stride), while the mean values given for the 2 stride variations were collapsed across the 2 length variations.
The P values shown for step length variations and stride variations represent the main effects of the ANOVA.
greater in the forward lunge short compared to the forward lunge long. During
the forward lunge short, the lead knee
continued translating beyond the toes as
the lead knee continued exing, translating 8 3 cm beyond the distal toes at
maximum lead knee exion. In contrast,
the lead knee did not translate beyond the
toes throughout the knee range of motion
during the forward lunge long. Because
signicantly greater patellofemoral joint
force and stress occurred between 70 to
90 knee angles during the forward lunge
short compared to the forward lunge long,
there appears to be a relationship between
anterior knee translation and increased
patellofemoral joint force and stress.
The primary cause of the greater patellofemoral joint force and stress between
journal of orthopaedic & sports physical therapy | volume 38 | number 11 | november 2008 | 687
[
due to near proportional increases in patellofemoral joint forces and patellar contact areas with increased knee exion. One
exception was at higher knee angles between 70 to 90, in which patellofemoral
joint stress began to plateau or decrease.
This occurred because, although patellar contact area increased nearly linearly
between 70 to 90, patellofemoral joint
force did not increase proportionally but,
instead, began to plateau. These ndings
are consistent with patellofemoral joint
force and stress data during the barbell
squat from Escamilla et al12 and Salem
and Powers.25 Escamilla et al12 reported
that patellofemoral joint forces increased
until 75 to 80 knee exion, and then
began to plateau or slightly decrease. Salem and Powers25 reported no signicant
differences in patellofemoral joint force
or stress at 75, 100, and 110 knee exion. Therefore, injury risk to the patellofemoral joint may not increase with knee
angles between 75 to 110 due to similar
magnitudes in patellofemoral joint stress
during these knee angles, with the benet
of increased quadriceps, hamstrings, and
gastrocnemius activity when training at
higher knee angles (75-110) compared
to lower knee angles (0-70).12
Because patellofemoral joint force
and stress both increased with knee
exion and decreased with knee extension (FIGURES 3-6), a more functional knee
exion range between 0 to 50 may be
appropriate during the early phases of
patellofemoral rehabilitation due to lower patellofemoral joint force and stress.
Higher knee angles between 60 to 90
may be more appropriate later in the rehabilitation process due to higher patellofemoral joint force and stress. This
same pattern of increased patellofemoral joint force and stress with increased
knee exion has been reported during the
squat and leg press.8,12,13,25,28,31
Peak patellofemoral joint force and
stress magnitudes from the current study
are less than some weight-bearing exercises, such as the squat and leg press,12 but
more than some weight-bearing functional
activities, such as walking14 and going up
RESEARCH REPORT
and down stairs.6 Escamilla et al12 reported
peak patellofemoral joint force and stress
magnitudes of 4500 to 4700 N and 11 to 12
MPa, respectively, at a 90 knee angle during the 12-RM squat and leg press. These
are approximately 50% greater than the
peak patellofemoral joint force and stress
magnitudes measured in the current study
during the forward lunge long and short.
Peak patellofemoral joint force and stress
in healthy subjects during fast walking are
reported to be approximately 900 N and
3.13 MPa, respectively,14 which are approximately 2 to 3 times lower than the
peak patellofemoral joint force and stress
magnitudes measured in the current study.
However, peak patellofemoral joint force
and stress magnitudes in healthy subjects
going up and down stairs are approximately 2500 N and 7 MPa, respectively,14 which
are similar to the peak patellofemoral joint
force and stress magnitudes measured in
the current study.
The greater patellofemoral joint force
and stress with a stride, as compared to
without a stride, between 10 to 20 during the descent and 10 to 40 during the
ascent, occurred, in part, because the estimated quadriceps forces were approximately 40% greater with a stride during
these knee angles, and patellofemoral
force is proportional to quadriceps force.
Quadriceps forces were greater with a
stride because peak ground reaction
forces acting on the lead foot, which generated a knee exor torque throughout
the lunge that was opposed by the knee
extensors, were approximately 15% to
20% greater with a stride, compared to
without a stride, during these knee angles.
Just after lead foot contact during the descent phase, when the knee was exed
10 to 20, ground reaction forces acting on the lead foot were greater with a
stride because the body had more forward
and downward acceleration compared to
without a stride. Therefore, with a stride,
the lead foot had to push harder into the
ground to slow down the forward and
downward accelerating body and control
the rate of lead knee exion. Between
10 to 40 during the ascent phase, peak
]
ground reaction forces were greater with
a stride, compared to without a stride, because the subject had to forcefully push
off the force platform to accelerate the
body backwards and upwards, and return
the body back to the upright starting position. Because lunging without a stride
resulted in both feet remaining stationary throughout the lunging motion, there
were minimal accelerations that occurred
during the descent and ascent phases.
Unfortunately, it is currently unknown
what patellofemoral joint force or stress
magnitudes, and over what duration, ultimately lead to patellofemoral pathology.
There are many factors that may contribute to patellofemoral pathology, such as
overuse or trauma, dysfunctional extensor
mechanism, weakness in the quadriceps
or hip external rotators, tight quadriceps,
hamstrings, or iliotibial band, lower extremity malalignment, and excessive rearfoot pronation. Nevertheless, clinicians can
use information regarding patellofemoral
joint force and stress magnitudes among
different weight-bearing exercises, technique variations, and functional activities
to make informed decisions regarding
which exercise they choose to employ during patellofemoral rehabilitation.
There are limitations in the current
study. Firstly, MRI knee kinematic data
have shown that during the weight-bearing squat the femur moves and rotates
underneath a relatively stationary patella, and that excessive femoral rotation
may increase patellofemoral joint stress
on the contralateral patellar facets.10,18,24
Unfortunately, there are no MRI knee
kinematic data for performing the lunge.
Therefore, it is unknown how much femoral rotation occurs during the lunge and
how this rotation varies among healthy
individuals and those with pathologies.
Another limitation is the effect of
Q-angle on patellofemoral joint force
and stress. From cadaveric data during
a simulated squat it was shown that an
increased Q-angle signicantly caused a
lateral shift and medial tilt and rotation
of the patella, which may increase patellofemoral joint stress.19 Unfortunately,
688 | november 2008 | volume 38 | number 11 | journal of orthopaedic & sports physical therapy
CONCLUSIONS
rom visual observation, patellofemoral joint force and stress magnitudes were generally greater at
higher knee angles and smaller at lower
knee angles; but, for a given knee angle,
patellofemoral joint stress magnitudes
were generally similar between descent
and ascent phases. Patellofemoral joint
force and stress magnitudes were greater
during the forward lunge short compared
to the forward lunge long at 70, 80, and
90 knee angles during both descent and
ascent phases, and were greater with a
stride compared to without a stride at
10 and 20 knee angles of the descent
phase and at 40, 30, 20, and 10 knee
angles of the ascent phase. When the goal
is to minimize patellofemoral joint force
and stress during the forward lunge performed between 0 to 90 knee angles,
it may be prudent to perform the lunge
with a long step compared to a short step,
and without a stride compared to with a
stride, because patellofemoral joint force
and stress magnitudes were greater with
a short step compared to a long step at
higher knee exion angles and were
greater with a stride compared to without
a stride at lower knee exion angles. T
journal of orthopaedic & sports physical therapy | volume 38 | number 11 | november 2008 | 689
[
KEY POINTS
FINDINGS: Patellofemoral joint force and
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