Lumbopelvic Manipulation for Patellofemoral Pain Syndrome Study Title: Lumbopelvic manipulation for the treatment of patients with Patello- femoral Pain Syndrome: Development of a Clinical Prediction Rule Authors: Iverson CA, Sutlive TG, Crowell MS et al. Publication Information: Journal of Orthopaedic & Sports Physical Therapy 2008; 38(6): 297-312. Summary: Below P Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. atellofemoral pain syndrome (PFPS) is a common and signifi cant knee disorder, although it remains poorly understood. It is thought that a combination of bio- mechanical, neuromuscular, and soft tissue changes contribute to abnormal patel- lofemoral joint contact pressures, resulting in local pain and dysfunction. Due to the variable clinical presentation and uncertainty regarding the exact etiology, numerous treatment options for PFPS have been proposed. Common goals of treatment include restoration of quadriceps length and strength, as well as normalizing tissue tension and neuromuscular function around the knee. Recent studies1,2,3 lumbopelvic region (SMT) can result in a reduction of quadriceps inhibition1,2 creased quadriceps strength3 have demonstrated that manipulation of the sacroiliac joint and , or in- in patients with PFPS. However, all three studies did not include measures of symptomatic response, and overall, this literature must be consid- ered preliminary. This study aimed to build on these previous studies to determine the value of certain clinical examination procedures for predicting which patients with PFPS, if any, would experience a positive immediate response to lumbopelvic manipulation. This type of prospective cohort/predictive validity study is the fi rst step in developing a Clinical Pre- diction Rule for SMT/PFPS, a tool designed to assist clinicians to choose appropriate interventions based on a group of symptoms and/or examination findings. Fifty subjects between the ages of 18-50 years old with a diagnosis of PFPS were in- cluded in this study. PFPS was diagnosed based on the presence of anterior knee pain provoked by two or more of the following: squatting, prolonged sitting, stair ascent, stair descent, kneeling, or isometric quadriceps contraction. Subjects were excluded if they were pregnant, had signs of nerve root compromise, had any positive knee ligament or meniscus test, palpatory tenderness of the tibiofemoral joint line or patellar tendon, prior surgery to the spine or symptomatic knee, osteoporosis or systemic disease, or were re- ceiving any treatment for their knee pain. Each subject made one clinical visit, where they underwent a standardized physical examination, followed by three functional tests: 20cm step-up, 20cm step-down, and squatting. Patients then completed two outcome measures – a Numeric Pain Rating Score (NPRS) and a Global Rating of Change questionnaire (GROC) for each task. Each subject then received a supine lumbopelvic manipulation -similar to that used by Childs, Fritz et al. in the development of the LBP Clinical Prediction Rule -– before repeating the functional tests and NPRS/GROC outcome measures. Subjects were then classified as a treatment success or non-success based on a 50 per cent improvement on the NPRS or a score of at least +4 – i.e., moderately better – on the GROC. A binary logistic 12 • CANADIAN CHIROPRACTOR | SEPTEMBER 2008 www.canadianchiropractor.ca Shawn Thistle, BKin (Hons), DC, CSCS
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