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An Evaluation of Lower Limb Mechanical Characteristics in People with Patellofemoral

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An Evaluation of Lower Limb Mechanical Characteristics in People with Patellofemoral i An evaluation of lower limb mechanical characteristics in people with Patellofemoral Pain Syndrome during repeated loading. by Elise Desira 16956940 Primary Supervisor: Dr Amitabh Gupta Co-supervisor: Dr Peter Clothier Thesis submitted for the degree of Master of Research. December 2019 ii Dedications I dedicate this thesis to my fiancé, Zion and my family; Michelle, Mark, Emma and Luke. Zion; It is safe to say that this whirlwind of a year would not have been possible without you. You have supported me in all my endeavours and have always encouraged me to embrace new opportunities. Thank you for all your support, reassurance, boring weekends in, excel expertise, laughs, lunch deliveries and love. Without you this thesis and my sanity would not be possible. I can’t wait discover what the future has in store for us and to begin our lives as husband and wife. Only eight weeks to go! I love you! To my family. Your patience, understanding, love and support has been invaluable throughout this process. You have always been there for me when life got overwhelming, offering a laugh, advice and listening ear. Thank you for teaching me the value of hard work and for being excellent role models in my life. I can’t thank you enough for all opportunities you have provided for us. I love you all! iii Acknowledgements Research is a difficult art (Smith, 2013). As such there are several people who need acknowledgement, whose efforts were fundamental in the completion of this project. I thank Dr Amitabh Gupta for his expertise and guidance throughout this research project. Your patience and persistence have been greatly appreciated. Thank you for the countless emails, phone calls and demonstrations. Your efforts have helped me grow as a clinician and budding researcher. I thank Dr Peter Clothier and Mr Daniel Thompson for their assistance throughout this research project. Your contributions have provided me with the skills and knowledge to learn and develop in the area of laboratory research and human movement. Dan, I also thank you for your friendship throughout the last few years. Your personal experience having been through this journey has been invaluable. I thank Mr Brendan Howe for his technical assistance throughout this project. I appreciate all the time you have dedicated to this project and for your unrelenting patience. I thank all the participants who volunteered their time to this project. Your willingness to participate and learn has been greatly appreciated. Without you this project would not be possible. Lastly, I thank Dani Hutchinson for her patience and understanding over the last two years. Thank you for being so flexible and allowing me to embrace new opportunities and grow as a practitioner. iv Statement of Authentication The work presented in this thesis is, to the best of my knowledge and belief, original except as acknowledged in the text. I hereby declare that I have not submitted this material, either in full or in part, for a degree at this or any other institution. …………… …………………….. (Signature) v Contents Dedications ................................................................................................................................. ii Acknowledgements ................................................................................................................... iii Statement of Authentication ...................................................................................................... iv List of Tables ............................................................................................................................ vii List of Figures .......................................................................................................................... xii Abbreviations .......................................................................................................................... xiv Appendices ............................................................................................................................. xvii Abstract ................................................................................................................................. xviii CHAPTER ONE ........................................................................................................................ 1 Introduction ................................................................................................................................ 1 1.1 Summary of the problem .................................................................................................. 1 1.2 Significance of the study .................................................................................................. 3 1.3 Research objectives .......................................................................................................... 4 1.4 Research hypotheses ........................................................................................................ 4 CHAPTER TWO ........................................................................................................................ 5 Literature Review ....................................................................................................................... 5 2.1. The incidence and pathogenesis of PFPS ........................................................................ 6 2.2 The etiological factors of PFPS ........................................................................................ 7 2.3 Intrinsic risk factors associated with the development of PFPS ...................................... 8 2.3.1 Non-modifiable risk factors associated with PFPS ................................................... 8 2.3.2 Modifiable risk factors associated with PFPS ......................................................... 10 2.4 Extrinsic risk factors associated with the development of PFPS ................................... 14 2.4.1 Modifiable extrinsic risk factors associated with PFPS .......................................... 15 2.5 Summary of PFPS etiology and risk factors. ................................................................. 17 2.6 Force attenuation in the lower limb ................................................................................ 18 2.7 The knee and ankle joint interaction .............................................................................. 21 2.8 Repeated single-leg hopping .......................................................................................... 23 CHAPTER THREE .................................................................................................................. 25 Methods .................................................................................................................................... 25 3.1 Study design ................................................................................................................... 25 3.2 Ethical considerations .................................................................................................... 25 3.3 Participant recruitment ................................................................................................... 26 3.4 Inclusion and exclusion criteria ...................................................................................... 26 3.5 Laboratory set up and instrumentation ........................................................................... 28 vi 3.6 Testing Procedure ........................................................................................................... 33 3.7 Data Processing .............................................................................................................. 34 3.8 Dependent Variables ...................................................................................................... 37 3.9 Statistical Analyses ........................................................................................................ 39 CHAPTER FOUR .................................................................................................................... 41 Results ...................................................................................................................................... 41 4.1 Participant profile ........................................................................................................... 41 4.2 Spatiotemporal characteristics of the hop cycle ............................................................. 42 4.3 Kinematic variables during the loading period. ............................................................. 44 4.4 Kinetic variables during the loading period ................................................................... 46 4.4.1 Knee flexion and ankle dorsiflexion moment ......................................................... 46 4.4.2 Vertical stiffness ...................................................................................................... 48 4.4.3 Knee and ankle joint stiffness ................................................................................. 49 4.4.4 Knee and ankle mechanical work ............................................................................ 52 4.4.5 Knee and ankle joint power ..................................................................................... 54 CHAPTER FIVE ...................................................................................................................... 57 5.1 Discussion .....................................................................................................................
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