research report



Kinematic and Kinetic Analysis of the
Single-Leg Triple Hop Test in Women
With and Without Patellofemoral Pain


drop during single-leg activities,
iomechanical abnormalities of the lower extremities
shifting the center of mass medihave been associated with a number of ankle, knee,
ally away from the stance limb
hip, and lumbopelvic injuries.
and leading to a knee external
patellofemoral pain (PFP) commonly exhibit a medial
varus moment.
collapse of the knee, also called dynamic valgus.34,41 This
A number of kinematic and kinetic
dynamic valgus is characterized by a combination of excessive hip studies have described poor hip alignadduction and internal rotation and knee valgus during weight-bearing ment, often associated with excessive
activities, such as ascending and descending stairs, running, or jumping.6,40,50
Mechanically, this misalignment decreases patellofemoral joint contact area,
TTSTUDY DESIGN: Cross-sectional study.

TTOBJECTIVES: To compare the biomechanical

strategies of the trunk and lower extremity during
the transition period between the first and second
hop of a single-leg triple hop test in women with
and without patellofemoral pain (PFP).

TTBACKGROUND: Recent literature has shown

that PFP is associated with biomechanical
impairments of the lower extremities. A number
of studies have analyzed the position of the trunk
and lower extremities for functional activities such
as walking, squatting, jumping, and the step-down
test. However, studies on more challenging activities, such as the single-leg triple hop test, may be
more representative of sports requiring jumping

TTMETHODS: Women between 18 and 35 years

of age (control group, n = 20; PFP group, n =
20) participated in the study. Three-dimensional
kinematic and kinetic data were collected during
the transition period between the first and second

leading to increased articular stress and
potentially PFP.41,45 However, Powers39
theorized that hip abductor weakness can
alternately cause a contralateral pelvic
hops while participants performed the single-leg
triple hop test.

TTRESULTS: Compared to the control group,

women with PFP exhibited greater (P<.05) anterior
and ipsilateral trunk lean, contralateral pelvic drop,
hip internal rotation and adduction, and ankle
eversion, while exhibiting less hip and knee flexion.
A significant difference (P<.05) in time to peak
joint angle was also found between groups for
all the variables analyzed, except anterior pelvic
tilt and hip flexion. In addition, women with PFP
exhibited greater (P<.05) hip and knee abductor
internal moments.

TTCONCLUSION: Compared to the control group,
women with PFP exhibited altered trunk, pelvis,
hip, knee, and ankle kinematics and kinetics.
J Orthop Sports Phys Ther 2015;45(10):799-807.
Epub 24 Aug 2015. doi:10.2519/jospt.2015.5011

TTKEY WORDS: anterior knee pain, biomechanics,
hip, patella

trunk lean in the frontal plane, as well as
altered knee and hip internal moments
during low-impact activities in women
with PFP.10,15,33,39 But few data exist on
high-impact activities, which may add
important information, such as the timing and sequencing in which peak angles
of movement occur. The single-leg triple
hop test (SLTHT), which includes landing and propulsion phases, is widely used
in clinical practice to assess the dynamic
stability of the knee. A number of authors
have suggested that the hop test may be
an important tool in identifying individuals who are at risk for knee injuries and
to quantify improvements during the rehabilitation of individuals with PFP and
those recovering from anterior cruciate
ligament reconstruction.17,19,20,29
The aim of the present study was to
compare selected kinematics and kinetics of the trunk and lower extremities
of women with and without PFP during
the transition period between the first
and second hops of the SLTHT. We also
aimed to describe the time to peak joint

Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil, 2Instituto Trata - Knee and Hip Rehab, São Paulo,
Brazil. The protocol for this study was approved by the Universidade Nove de Julho Human Research Ethics Committee. This study was supported in part by grant 2012/089095 from the São Paulo Research Foundation. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial
interest in the subject matter or materials discussed in the article. Address correspondence to Dr Paulo Roberto Garcia Lucareli, Universidade Nove de Julho, Rua Vergueiro 235,
São Paulo, SP, Brazil. E-mail: plucareli@hotmail.com; paulolucareli@uninove.br t Copyright ©2015 Journal of Orthopaedic & Sports Physical Therapy®

journal of orthopaedic & sports physical therapy  |  volume 45  |  number 10  |  october 2015  |  799

The women in the PFP group were recruited from an outpatient rehabilitation program by a physical therapist with more than 10 years of clinical experience in knee rehabilitation. squatting. knee and ankle width.3  2. or tendinopathies. from the anterior superior iliac spine to the medial malleolus. and hip adduction and internal rotation. the distance reached with the first hop was measured.1  3.9  1. ankle. when measured in supine. kg/m2 21. the age range within which women commonly have PFP. and pain on palpation of the medial and/or lateral facet of the patella. height. Women of similar demographic characteristics.7 20. on the lateral femoral epicondyles. injury to the hip. † Zero is no pain and 10 is the worst imaginable pain. Procedures Individuals who met the inclusion and exclusion criteria and were willing to participate were scheduled for testing in the movement-analysis laboratory. 17 participants per group were required to adequately power the study for this variable of interest. contralateral pelvic drop.35 Calculations were performed using α = . women with PFP would exhibit greater ipsilateral trunk lean.13 Anthropometric assessment was subsequently performed and included measurements of body mass. meniscal or ligament tears.3. on the jugular 800 | october 2015 | volume 45 | number 10 | journal of orthopaedic & sports physical therapy . or lumbosacral region. *Values are mean  SD. based on their weekly engagement in physical activity. on the acromioclavicular joints. were also excluded. using a visual analog scale. patellofemoral pain. were recruited from the same clinic at the time of discharge to serve as the control group.65  0. osteoarthritis.3  4. body mass index.26-28.8 Height.15 The volunteers walked on a treadmill for 10 minutes at a speed of 2 m/s. The score is for the average pain intensity experienced during the last 2 weeks. kneeling.12 1. METHODS Participants T his cross-sectional study included 20 women with PFP (PFP group) and 20 age-matched painfree women (control group). they familiarized themselves with the SLTHT until they felt comfortable with the activity. on the lateral malleoli.10 (90% power). leg length.8 VAS (0-10)† . visual analog scale. resisted isometric knee extension research report TABLE 1 ] Demographic Data Control (n = 20)* PFP (n = 20)* Age. as outlined by Thomeé et al. which showed that maximal amplitudes of movement in the sagittal plane were related to changes in knee valgus kinetic and kinematic values. over the lower one third of the surface of the shanks. and tibial torsion.5  2.51-53 23 reflective spherical markers were placed on the participants in the following locations: on the 2 anterior and posterior superior iliac spines.1 55. compared to the control group. y 23. based on peak knee flexion angle reported in a previous study. patellofemoral dysplasia. We hypothesized that. previous surgery involving the lower extremities. over the center of the patella.30 Women with PFP were included if they had anterior knee pain for at least 3 months and reported increased pain for 2 or more activities that commonly provoke PFP.25 which has been used to assess hop tasks in the literature. The protocol for this study was approved by the Universidade Nove de Julho Human Research Ethics Committee... VAS. such as patellar instability. PFP.3 23.05.6 Abbreviations: BMI. The sample size was calculated a priori. All women in the study were between 18 and 35 years of age (TABLE 1). on the spinous process of the 10th thoracic vertebra.13 BMI. We also hypothesized that those with PFP would have higher hip and knee abductor internal moments. All participants were considered to be physically active. m 1.2  1. and this distance was used to determine the starting location of the participants so that they would land in the center of the concealed force platform when performing the subsequent SLTHT. All volunteers were informed about the study procedures and signed informed consent in accordance with the Brazilian National Health Council Resolution Number 196/96.71  0. on the calcanei.9  7. who came to the clinic for treatment of upper extremity tendinopathies and did not have lower extremity involvement.1 Body mass. kg 55. on the spinous process of the seventh cervical vertebra.[ angle in both groups during this task. Women who were symptomatic were first asked about the length of time they had experienced symptoms and the intensity of their pain.6 Potential participants were excluded if they exhibited any of the following: neurological disorder. After this warm-up.12. long periods of sitting. heart condition. Consistent with the conventional gait model. 4. Women who had other knee pathologies.21. as well as different timing and sequencing of peak joint angles. rheumatoid arthritis. β = . at 60° of knee flexion. Based on these parameters. as were those who exhibited a leg-length difference of more than 1 cm. During these practice hops.48 These activities included ascending and descending stairs. and a mean between-group difference of 11° for knee flexion. or pregnancy.14. jumping. over the second metatarsals. distance between anterior superior iliac spines. assuming a standard deviation of 10°.

2  2. These sampling rates have previously been used in a number of studies to assess the kinematics4. the participants An 8-camera BTS SMART-D (BTS SpA.3  2. and 0.0  5.9 (–11.3  0. defined based on the peak knee flexion angle.8  3. to standardize the position of the participants and to avoid compensatory movements of the upper limbs.7 . As in previous studies assessing dynamic tasks.3 –1. medium.5  3.2 10.4) 1. –1.6 3.4 9.9 . Based on the results of the pilot study. 12-Hz low-pass filter. 1.1  5.2 (2. 8.038 5.7  0. patellofemoral pain.2 0. UK)36 using the Plug in Gait model.003 35. enabling the synchronization of kinematic and kinetic data.8. 18 journal of orthopaedic & sports physical therapy  |  volume 45  |  number 10  |  october 2015  |  801 .1  1.5  1.6  4. and one offset anywhere over the right scapula. ‡ Determined using Cohen d (0.3-0.8 .614 32.001 Ipsilateral trunk rotation 17.46 of jump tasks.3 3.9 .4 (3.2 then labeled and processed in Vicon Nexus software (OMG plc.7.8 –8.9 . 4. For the conventional gait model.6  3.0 10. participants were barefoot during testing. 3.7 (1.6 –3. *Values are mean  SD degrees. 6.2 .2 (–7. Switzerland).3) 0.0  3.299 4.8  2.2  6.9  0.019 3.4.28. trivial. TABLE 2 Anterior trunk lean were asked to cross their arms in front of the thorax while performing the task.0% 60% 100% Landing Propulsion FIGURE 1.2) 0. Butterworth. notch where the clavicles meet the sternum.7 (4.001 Hip flexion 33. the same markers are required during static and dynamic trials.5.3) 0.003 6.4 2.11. zero-lag.9 47.24.10 code (Biomechanical ToolKit). Two minutes of rest was provided between each trial.6 (2.5  3.001 Anterior pelvic tilt Contralateral pelvic drop Ipsilateral pelvic rotation 14. MA).6) 1.0 Instrumentation PFP (n = 20)* Between-Group Differences† Effect Size P Value 35.7  2.9  0. Natick. applying the BTK 0.9 12. Inc.2) 0. –2.8 . The cameras were interfaced to a microcomputer and placed around a force plate embedded in the floor (model 9286. large).8.8 –5. The graph shows from initial contact (0%) to toe-off (100%). Hip.9 or higher.0-0.6 7. 5.6 (–1.27. 2. In addition.4 . Kistler Holding AG. † Values in parentheses are 95% confidence interval.5 26.2) 1.8 (–6.1. Data Analysis Kinematic data were converted to the C3D format using MATLAB software (The MathWorks.6 (–8.029 Hip adduction 6.7  4. Winterthur.4.8 (–4. 0.3 11.2 .0) 4.001 Knee flexion Knee adduction Ankle dorsiflexion Ankle eversion 7.3 0. Peak Joint Angle for the Trunk.1 4.6.2 –5.5. Knee.4) 1.4 .3 . The force plate was interfaced to the same microcomputer that was used for kinematic data collection via an analog-to-digital converter.8) 0.6 10.0 3.1 (–4.2. –6. Italy) system was used to capture the 3-D marker trajectories. –5.4 –4.1.002 56.1.2. –1.2 .4 . Landing and propulsion during the transition between the first and second hops of the single-leg triple hop test. Oxford. 1 static standing reference trial and 3 SLTHT trials were performed with the symptom- atic limb for those with PFP or with the dominant limb for those in the control group. and Ankle in Women With and Without PFP Control (n = 20)* 31.2) ‡ Ipsilateral trunk lean 3.2  3.9  1. After all markers were attached.4  2. the kinematic data were filtered using a fourth-order. sampling frequencies of 100 Hz (kinematic) and 400 Hz (kinetic) were used.1) Abbreviation: PFP. small.5  2.2.46 and kinetics1.9  5. As it was not possible to standardize footwear. Milan.8) 1.002 Hip internal rotation 8. on the xiphoid process of the sternum.4  5.7 54. Pelvis.0 8. 0. (1.6-0. with the transition from landing to propulsion occurring at 60%.

Trunk When compared to the control group. means. Kinematics. as well as the results of statistical analysis for between-group comparisons.001). *There was a significant group difference (P<. Kinetic data were normalized to body mass. Pelvis When compared to the control group. Kinematic and kinetic data were obtained for the weight-bearing period between the first and second hops of the SLTHT. but less ipsilateral trunk rotation (P = . There was no significant difference between groups for anterior pelvic tilt (P = . ground reaction forces.001).001) trunk lean.5. Chicago. univariate effects were tested for all relevant variables. time to peak joint angles. the period of interest was from initial foot contact with the force plate (0%) to toe-off (100%) (FIGURE 1). compared to 0.11 m for the women in the PFP group (P = . patellofemoral pain. The peak joint angles.05. The average of 3 trials was used for all statistical analyses of the kinematic and kinetic data. The average power recorded during the landing phase was used to compare groups. IL).299). knee.96  0. Redmond. Statistical Analysis The Kolmogorov-Smirnov test (with the Lilliefors correction factor) was used to test the normality of the kinematic and kinetic data.001). Descriptive statistics.05) for all variables except for anterior pelvic tilt and hip flexion.3 and 0. The significance level was set at P<.9 or higher.6 and 0. and ankle. and large if 0. WA) for statistical analysis. and joint powers (P<. the women in the PFP group exhibited greater anterior (P = . The time-to-peak-joint-angle analysis was performed to understand the timing and sequencing with which the maximum amplitude of each joint was achieved during the transition period between the first and second hops of the SLTHT.0 and 0. joint internal moments (P<. and anthropometric data were used to calculate articular internal moments and power (scalar product of moment and angular velocity) of the hip. small if between 0.8.003). Joint kinematics were calculated using a joint coordinate system approach14.038) and ipsilateral (P = .0 (SPSS Inc. 802 | october 2015 | volume 45 | number 10 | journal of orthopaedic & sports physical therapy .001) and less ipsilateral rotation (P = . Performance The mean  SD distance for the first jump of the SLTHT for the women in the control group was 1. If there were significant multivariate effects. and standard deviations were calculated for all variables.[ research report Trunk rotation PFP Hip adduction Pelvic rotation Knee adduction Hip internal rotation Ankle dorsiflexion Pelvic tilt Knee flexion Hip adduction Anterior trunk lean Ankle eversion Pelvic drop Pelvic drop Knee adduction Ipsilateral trunk lean Hip flexion Hip internal rotation ] Hip flexion Ankle dorsiflexion Anterior trunk lean Control Ipsilateral trunk lean Trunk rotation Knee flexion Pelvic tilt Ankle eversion Pelvic rotation 20% 40% 60% 80% 100% Percentage of the landing and propulsion cycle Landing Propulsion FIGURE 2.05  0. Cohen d effect sizes were calculated and defined as trivial if the value was between 0. Therefore. medium if between 0. and internal peak moments and power of each joint studied were imported into Excel (Microsoft Corporation.25 and were reported relative to a static standing trial. The kinematic and kinetic variables were compared between groups using 2 separate multivariate analyses of variance (ANOVAs). RESULTS T he multivariate ANOVAs indicated significant differences for kinematic variables (P<. Time to peak joint angle as a percent of the weight-bearing phase.38 All statistical comparisons were performed with SPSS Version 15.091). using inverse dynamic equations in Vicon Nexus software. Internal joint moment for the lower extremity was recorded at peak knee flexion angle and represented the end of the landing phase. Abbreviation: PFP. the women in the PFP group exhibited greater contralateral pelvic drop (P = . to quantify the movement of one segment in relation to another or of one segment relative to the laboratory.001). Kinematics TABLE 2 provides the descriptive peak joint angle data.17 m.2.

001 Hip internal rotation 22  1 12  2 –10 (–11. Furthermore. and ankle dorsiflexion. trivial. 12) 3.0-0. 0. 11) 5.31. but less ipsilateral trunk and pelvic rotation. and ankle dorsiflexion and eversion. women with PFP exhibited greater hip and knee internal abductor moment. † Values in parentheses are 95% confidence interval.100 38  1 10 (9.018).051) and ankle power absorption in the frontal plane (P = .931).1 .2. 10) 2.001 Hip flexion 35  3 36  3 1 (1.035) and less ankle power absorption in the sagittal plane (P = . er internal ankle plantar flexor moment than those in the control group (P = . However. hip and knee flexion. –2) 1. small. and ankle eversion.001 Ipsilateral pelvic rotation 24  2 14  1 –10 (–11. 11) 7. 2) 0. whereas it occurred later for anterior and ipsilateral trunk lean. Knee When compared to the control group. Hip  Women with PFP exhibited a greater internal hip abductor moment than those in the control group (P = . large).3-0.001).1 .6 . Conversely.019 Abbreviation: PFP.3 . ankle dorsiflexion.001 Knee flexion 62  3 60  3 –2 (–4. and 0. *Values are mean  SD percent.001 10 (9. but less knee extensor and ankle plantar flexor internal moments with less knee and ankle power absorption in the sagittal plane.5 .3 .8.05) faster time to peak joint angle for the following variables: ipsilateral trunk rotation.001) and less knee power absorption in the sagittal plane (P = . Hip  Women in the PFP group exhibited greater hip adduction (P = . 0) 0.029). time to peak joint angle for women with PFP occurred earlier for ipsilateral trunk and pelvic rotation. The novel finding of this study is related to the knee frontal journal of orthopaedic & sports physical therapy  |  volume 45  |  number 10  |  october 2015  |  803 .3 . contralateral pelvic drop.2 . DISCUSSION T his study compared selected trunk and lower extremity kinematic and kinetic variables between women with and without PFP for the weight-bearing period between the first and second hops of the SLTHT.001).4 . No significant difference was found for knee adduction (P = .5.3 .002).003 Ankle dorsiflexion 62  4 58  3 –4 (–6. knee adduction. There were no significant between-group differences (P>. knee flexion. 0.420). –1) 1. ipsilateral pelvic rotation.33 hip adduction. medium.31.9 or higher. No statistically significant differences were found between groups for internal hip extensor moment (P = . –10) 7.003) than those in the control group.6-0. those with anterior knee pain exhibited greater anterior and ipsilateral trunk lean.006). Kinetics  TABLE 4 provides the descriptive statistics for all kinetic variables as well as the results of the between-group comparisons. The women in the PFP group exhibited a significantly (P<. but less hip power absorption in the frontal plane (P = . less hip power absorption and greater knee power absorption in the frontal plane.001 –5 (–8.33 and hip internal rotation. Compared to the control group. the women in the PFP group exhibited less knee flexion (P = .05) slower time to peak joint angle for the following variables: anterior trunk lean. Knee Women with PFP exhibited a greater internal knee abductor moment than those in the control group (P = . especially the greater ipsilateral trunk lean.9 . contralateral pelvic drop. and hip adduction. knee flexion.017).032 Knee adduction 15  2 12  3 –3 (–5. and ankle eversion.006).33 are consistent with what has previously been reported in the literature when comparing individuals with PFP to a control group free of pathology. 3) 0.002) and internal rotation (P = . Some of these findings.019) and less dorsiflexion (P = . hip adduction and internal rotation. Ankle Women with PFP exhibited greater ankle eversion (P = . No significant differences were found between groups for the internal ankle invertor moment (P = . patellofemoral pain. they exhibited less hip flexion (P = . hip internal rotation.003 38  2 1 (0. In comparison to women in the control group. contralateral pelvic drop. –2) 1.15. Time to Peak  Data on the time to peak joint angle as a percentage of contact time are provided in FIGURE 2 and TABLE 3.614). knee adduction. they exhibited a lower internal knee extensor moment (P = .3 . ipsilateral trunk lean. hip internal rotation.1 .679) and hip power absorption in the sagittal plane (P = . and hip adduction.33 contralateral pelvic drop.032 Ankle eversion 62  4 58  3 –4 (–6.540 Hip adduction 23  3 33  3 10 (8. –2) 1. –9) 5. ‡ Determined using Cohen d (0.001) and greater knee power absorption in the frontal plane (P = .TABLE 3 Ankle  Women with PFP exhibited a low- Time to Peak Joint Angle as a Percent of the Weight-Bearing Phase Control (n = 20)* PFP (n = 20)* Anterior trunk lean 61  3 69  3 Ipsilateral trunk lean 28  2 38  1 Ipsilateral trunk rotation 17  5 12  1 Anterior pelvic tilt 37  2 Contralateral pelvic drop 28  1 Between-Group Differences† Effect Size‡ P Value 8 (6.05) for time to peak joint angle for hip flexion and anterior pelvic tilt. They conversely exhibited a significantly (P<.

1 0.40 In our opinion. 0.4 (–0.49 In the sagittal plane. –0.001 Knee extensor 2.2 (–0. pelvis. potentially reflecting hip abductor weakness.9  0. this excessive and early internal rotation could be attributed to weakness or a deficit of activation of the hip external rotators. Similar to hip adduction. The present study has a number of potential limitations. but they cannot sustain this position during the entire movement. and hip).5 –0.3 0.0.2 0.7 . requiring greater neuromuscular control.2 . In the transverse plane. –0.4  0.31.0 .2 1.0 .6. A greater knee flexion angle and greater internal knee extensor moment and power absorption lead to increased compressive force on the patellofemoral joint.2 (0.1.9 or higher.2) 1.9 (0. to decrease patellofemoral joint stress.6  0. 0.1) 0.2 (–0.0  1. The symptomatic women also exhibited exaggerated movements in terms of anterior trunk lean.2.33. based on data from a pilot study that showed greater kinetic and kinematic peak values oc- 804 | october 2015 | volume 45 | number 10 | journal of orthopaedic & sports physical therapy .3 .17. We believe that this knowledge can play an important role in clinical decision making aimed at interventions to prevent abnormal movements in lower limbs during functional activities.16. which.7) 2.43 In the frontal plane.37.7.3 –0.018 Ankle in the frontal plane 0.2) 1.001 Ankle plantar flexor 2.2 –0.32 We believe that women in the PFP group limited their sagittal plane movement during the SLTHT in an attempt to reduce the demand on the quadriceps and. Theoretically.5.1 (–0.2 0.8  0.3 0. ‡ Determined using Cohen d (0. women from the symptomatic group exhibited less hip and knee flexion. have previously been described by Powers39 as an alternate model of frontal plane deviations. increasing knee internal valgus moment. women with anterior knee pain exhibited a greater amount of hip internal rotation and reached peak hip internal rotation earlier.4.0.2 0. *Values are mean  SD.4 (0.8  0. W/kg Knee in the frontal plane 1. ductor moment and power absorption in the hip joint.035 Ankle invertor 0.3.2  0.4 1. women with PFP exhibited a greater amount of hip adduction. patellofemoral pain. which peaked later than it did in the control group.5 2.3 2. consequently.4  0. and 0.0  1. as well as less knee and ankle power absorption. Because contralateral pelvic drop occurs in association with an internal hip ab- ] research report TABLE 4 Power and Internal Moment for the Hip. the contralateral pelvic drop moves the center of mass of the body medially away from the knee joint. –0. trivial.1  0.006 Joint power absorption.0) 1.9 (–1.4 2.6. 0.1  0.017 Hip extensor 2. While both groups that participated in this study exhibited a similar movement pattern.25.39 Moreover.2) 0. –0.3.8  0.420 Abbreviation: PFP.006 Knee in the sagittal plane 1.1) 0.6-0.33.7 .1) 0. 0. less ankle dorsiflexion. Consistent with the findings of others. Nm/kg Hip abductor 1.1 .3-0. weak hip abductors may initially be able to control the pelvis.4) 3.0 . which leads to the contralateral pelvic drop and ipsilateral trunk lean. Furthermore.1 0. to reduce load-absorption demands on the lower extremity.0  0.5 . 0.33.[ plane data. though not previously reported in the literature.051 Hip in the sagittal plane 6. Knee.45 Specifically.9  0.4  0.9 .2 0. 1. –0. 0.8. ipsilateral trunk lean is expected as a compensatory adjustment to promote lateral displacement of the ground reaction forces. these findings may be explained by a deficit in torque produced by the hip abductor muscles.1 –0.4) 0.9  0.40.931 Hip in the frontal plane 1.3 –0. the pattern was more pronounced in those with PFP. small. both contralateral pelvic drop and ipsilateral trunk lean occurred later in the PFP group than in the control group.9  0. local (knee).4.5 2. those with PFP exhibited greater ipsilateral trunk lean and contralateral pelvic drop.1  0.3 (–0.41.679 Knee abductor 0.2.0  0.8. associated with greater hip internal abductor moment and less hip power absorption than individuals in the control group (FIGURE 3). and Ankle in Women With and Without PFP Control (n = 20)* PFP (n = 20)* Between-Group Differences† Effect Size‡ P Value Joint moment.2 –0. less internal knee extensor and ankle plantar flexor moment.4 1. and distal joints (ankle) to study a more challenging task (SLTHT). the study only assessed the transition between the first and second jumps. 0.7 .1 (–0.6 . which was reached later during the movement.6. These findings are consistent with the high demands placed on the hip abductors during the SLTHT.22.0-0.0 6.2 (1.9.2 –0.6 0.3  0.6) 0.43 The present study used 3-D analysis of proximal (trunk.001 Ankle in the sagittal plane 1. This may have occurred as a compensatory mechanism of the trunk. † Values in parentheses are 95% confidence interval. moving the center of mass of the trunk more directly above the knee joint. First.8  0.31.2. the contralateral pelvic drop explains the uncommon combination of hip adduction and knee adduction presented in our study.9  0.9  0. 1.1  0.0 (–0.6) 1. medium.7.47 A number of studies have assessed the biomechanical behavior of patients with PFP while performing less demanding tasks. large).

participants crossed their arms during testing. given the low standard deviation found in both groups. Walking kinematics in individuals with patellofemoral pain syndrome: a case–control study.x 2. Sell TC. Therefore. hip. we decided to test all participants barefoot. Third.16:400-407.doi. especially at the ankle. the potential “lab effect” (ie.org/10. Future studies should consider incorporating electromyographic assessment of the trunk. which might have influenced the performance of the task. A  ugustsson J. 2008. Fatigue alters lower extremity kinematics during a single-leg stop-jump task.doi. knee. org/10. and ankle in all 3 planes of motion during the weight-bearing transition period between the first and second hops of the SLTHT. Habu A.1016/j. and ankle in all 3 planes of motion during the weight-bearing transition period between the first and second hops of the SLTHT. Karlsson J. et al. http:// dx.1111/j. Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis.A B CONCLUSION C ompared to the control group.doi.2010. Piva SR. Bizzini M. Finally. org/10. However. incorporating higher-demand tasks in the clinical evaluation may provide additional information useful for intervention. The red line indicates the ground reaction forces at that same moment. knee.00446.012 3.1600-0838. Frontal plane alignment of the lower extremity and trunk at 60% of the weight-bearing phase between hops 1 and 2 for representative women in the control (A) and patellofemoral pain (B) groups (ONLINE VIDEO). Because the participants in the study were not aware that data were collected solely in this transition phase. REFERENCES 1.cmpb. women with PFP exhibited altered kinematics and kinetics of the trunk. Knee Surg Sports Traumatol Arthrosc. http://dx.2014. which is not typical for a jumping task. Barton CJ. hip. Benjaminse A. 2006. Folkesson M.022 4. Tranberg R. this position was used to avoid compensatory movements of the upper limbs.2005. Childs JD. System- journal of orthopaedic & sports physical therapy  |  volume 45  |  number 10  |  october 2015  |  805 . Scand J Med Sci Sports. IMPLICATIONS: These biomechanical alterations are different from those identified during other weight-bearing functional movements in this population.11. t KEY POINTS FINDINGS: Compared to the control group. http://dx. FIGURE 3.33:286-291.doi. The primary clinical implication of these findings is that it may be beneficial to consider highly challenging activities when assessing patients with PFP. soft tissue movement and other technical limitations might have affected the measurement of the small amount of motion that takes place in the frontal and transverse planes. Comput Methods Programs Biomed. these limitations probably did not affect the results of the present study. org/10. 2014. but likely not completely eliminated. Menz HB. CAUTION: These data are limited to young women during a specific high-impact activity (SLTHT) and do not establish cause and effect. and knee musculature. Second. Gait Posture.16:111-120.114:80-87.1007/s00167-007-0432-7 5. because it was difficult to standardize footwear used during data collection. Webster KE. Thomeé R. Levinger P. curring between the first and second jumps. Lindén C.gaitpost. http://dx. However. Delitto A.01. women with PFP exhibited altered kinematics and kinetics of the trunk. Armand S. Barre A. hip. 2011. Hawthorne effect) that may occur during data collection might have been minimized. Biomechanical ToolKit: open-source framework to visualize and process biomechanical data.1016/j.

Kujala UM. Cohen M. Accessed August 24. http://dx.org/10.3185 Mostamand J. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. A preliminary multifactorial approach describing the relationships among lower extremity alignment. 2008.16:217-223.doi.org/10. Powers CM. Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments. Õunpuu S. hip muscle activation. A. Moriya ET. Davis IS. Watkins MP.doi.10.003 Coventry E. Lucareli PR.gaitpost.2010.doi.doi. 2012. http:// dx.03. The relationship between isokinetic quadriceps strength test and hop tests for distance and one-legged vertical jump test following anterior cruciate ligament reconstruction. Bolgla LA.2008. Pires RS. http:// dx. Mazaheri R.edu/faculty/ricard/Classes/KINE-5350/ PIGManualver1.org/10. http:// dx. http://dx. 2010.2013. 2003. http://dx.003 Nakagawa TH. Stodółka J. Wootten ME. Baron R. Uhl TL. J Orthop Sports Phys Ther.0b013e318279793d McKenzie K. 39. J Orthop Sports Phys Ther.38:448-456. Schmitz RJ.1519/JSC. http://dx. 2013. 2012. Lower extremity kinematics of females with patellofemoral pain syndrome while stair stepping. Stodółka J. Hains F. 31.28. 2010.2003. Fukuda TY. 37. Knee kinetic pattern during gait and anterior knee pain before and after rehabilitation in patients with patellofemoral pain syndrome. Available at: http://wweb. 13.1016/j.doi.org/10. Green S.org/10. and lower extremity joint excursion. clinbiomech.1016/j. http://dx. Niemuth PE.33:4-20.1249/mss.1016/j.42:76-83.doi.0b013e3180601109 Claudon B.33.doi. Sagittal-plane trunk position. Umberger BR. how to assess and address? Asian J Sports Med. J Strength Cond Res.33. J Orthop Sports Phys Ther.doi.org/10.1519/ JSC. Hip strength in collegiate female athletes with patellofemoral pain. Mackala K. Billon-Grumillier C.30:556-569.org/10.org/10. http://dx.2519/ jospt.org/10.doi. Foundations of Clinical Research: Applications to Practice.doi. J Orthop Sports Phys Ther. Johnson RJ.31:588-597.4 Blackburn JT. clinbiomech. Costa LO.clch. Schmitt JS.40:736742. Pierrynowski M.21:1090-1097. Biomechanical analysis of squat jump and countermovement jump from varying starting positions.doi. O’Connor KM. 2010.27:2674-2684. Magalhães E. Abdalla RJ.org/10. 2004.27:2650-2661. Poussel M.27:2165-2170.org/10.jbmt. 2015. http://dx.36:554-565. http://dx. Heiderscheit BC. Paysant J.2490 Escamilla RF. 10. Avon).org/10. Siemienski A. Wainner RS.02. Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. 36. Rossetto FM. http://dx.40:625632. 12. 8. F itzgerald GK.3337 Powers CM. Hamill J. J Orthop Sports Phys Ther. Kadaba MP. 2006. 2013. Fukuda TY.2519/ jospt. Patellofemoral pain syndrome and modifiable intrinsic risk factors.2519/ WWW.ORG jospt. Cowan SM. Mattacola CG. http:// dx.2519/ jospt. Patellofemoral pain syndrome managed by ischemic compression to the trigger points located in the peri-patellar and retro-patellar areas: a randomized clinical trial.0102 24. Hains G. et al. Med Sci Sports Exerc.39:2021-2028.11. and quadriceps electromyographic activity. 7. 16. 15. J Orthop Sports Phys Ther.33:639-646. 2013. de Almeida Carvalho NA. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil.org/10. J Athl Train. 35. The effect of lower extremity fatigue on shock attenuation during singleleg landing. Ebersole KT. Ford KR. Kernozek TW. J Orthop Sports Phys Ther. Avon). J Athl Train. Zheng N. Sigward SM. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome.doi.org/10.org/10.4184 20. Isometric strength ratios of the hip musculature in females with patellofemoral pain: a comparison to pain-free controls. http://dx. org/10.44:174-179.4228 Davis RB. 33. Med Sci Sports Exerc. 2008. http://dx. Gage JR.2519/ jospt.2003. J Orthop Sports Phys Ther. Beyaert C. Lower extremity injuries: is it just about hip strength? J Orthop Sports Phys Ther. Measurement of lower extremity kinematics during level walking. NJ: Prentice Hall Health.2519/ jospt.2519/ jospt.doi.39:1227-1232. Fleisig GS. 32.0b013e31825fce65 29. 9.1002/jor. J Orthop Sports Phys Ther.1100080310 26.42:491-501.org/10.[ 6. Galea V. and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome.2010.doi. A gait analysis data collection and reduction technique.0b013e318149332d 19.43:332-339. 2013. org/10. Gait Posture. Hudson Z.1016/j.doi.doi.doi.23 Plug in Gait manual. Myer GD.1998.001 22. Am J Sports Med. 2010.1016/j. Clin Chiropr. landing forces. hip.588 18. Sacramento SN. J Orthop Sports Phys Ther. Upper Saddle River.46:246-256. Clin Biomech (Bristol. Reliability testing of the patellofemoral joint reaction force (PFJRF) measurement during double-legged squatting in healthy subjects: a pilot study. 34. Hop tests as predictors of dynamic knee stability.doi.doi.2519/jospt. Mackala K. Biomechanical analysis of standing long jump from varying starting positions.2001. Hwang JH. org/10.2009. hip strength. Magalhães E.doi. Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain.1. 2003.2519/jospt. J Orthop Sports Phys Ther.org/10.1.38:12-18.25:142-146. Wessel J. 2010. Fukuda TY. Silva AP. and knee kinematics. J Orthop Sports Phys Ther. http://dx. Maciel CD. Petschnig R.org/10. 2002.13:201-209. Barrentine SW.2519/jospt.639 @ 806 | october 2015 | volume 45 | number 10 | journal of orthopaedic & sports physical therapy MORE INFORMATION . and clinimetric testing of instruments used to assess patients with patellofemoral pain syndrome in the Brazilian population.org/10. 2007. http://dx. Trunk. Serrão FV.org/10. 2001. http://dx.2519/jospt.2006.org/10. Tyburski D. http://dx. Med Sci Sports Exerc. Iwasaki M.org/10. 40. Shortterm effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial. Powers CM. Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up. J Orthop Res. Padua DA. A comparison of hip strength between sedentary females with and without patellofemoral pain syndrome. 2011. Seif-Barghi T. pelvis. 2010. http://dx. http://dx. org/10.1016/0167-9457(91)90046-Z Dierks TA. Ramakrishnan HK. Hespanhol Junior LC.1016/ S0003-9993(03)00613-0 da Cunha RA. Hum Mov Sci. Torry MR.1016/S0966-6362(02)00090-5 Cichanowski HR.2012. 25.1519/JSC. Sacramento SN. Albrecht M. http://dx. Ćoh M.40:39-41.1177/0363546507308934 27. 1991.85:815-822. 2010.42:823-830. Jacobs CA. Halabchi F.36:139-143.2012.doi.2011.8:383-392.doi. http:// dx. http://dx. Siemienski A. cross-cultural adaptation. Gait Posture. Perrin DH.3987 Nguyen AD. J Orthop Sports Phys Ther. 14. J Strength Cond Res. J Athl Train. Manal KT. http://dx.doi. Martin RL. Lephart SM.07.doi. atic review of the quality of randomized controlled trials REFERENCES for patellofemoral pain syndrome.2010. 38. 2013. org/10. 1990.4:85-100. 1998. Gender differences in lower extremity landing mechanics caused by neuromuscular fatigue.16:115-123.2462 Brechter JH.3246 21.doi. Hewett TE.2008.0b013e31828909ec 28.doi. 2008. Ćoh M. uta. The influence of altered lowerextremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. Bader DL. Reliability of landing 3D motion analysis: implications for longitudinal analyses. 2000.28:23-31. Rayens WS.org/10. Hart BA.2010.2012. Uhl TL. Shultz SJ.JOSPT. 17. Luecht RM. Zaffalon BM. 2007. 2007. 3rd. Shapiro R. J Strength Cond Res. org/10. Earl JE. Hip abductor function and lower extremity landing kinematics: sex differences.10. Wilk KE. Lopes AD.004 Crossley KM. 2012. Forgas ] 30.3120 Magalhães E. Bennell KL.2519/ jospt. Translation. http://dx. 11. Melo WP. Pollard CD. Malone TR.05. Powers CM. J Bodyw Mov Ther.doi.2519/jospt. Andrews JR.doi. 2nd ed.pdf.2010.40:42-51. Bryk FF.2519/ jospt.005 Portney LG. 23. http://dx. http://dx. Clin Biomech (Bristol. research report 1998. 2009.40:641-647. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. 2012.31.2010.10:575-587.doi.1249/ mss. Fukuda TY. http://dx.

J Orthop Sports Phys Ther.36:1587-1596.44:785792.1016/j. Lee PV. Augustsson J. Yeow CH. http://dx.2007. 2008.2009. Effect of landing height on frontal plane kinematics. clinbiomech. Lee PV.3109/09593980903423111 44.humov.1177/0363546508315592 Willson JD. Graci V.4231 43. 2012. 42. Lee PV.017 45. Souza RB. org/10.2010.2519/jospt.2009. http://dx.jbiomech. Sagittal plane trunk posture influences patellofemoral joint stress during running.17:127-131. http://dx. Salsich GB. Zawadzki J.05.doi.30:624-635.doi. Powers CM.2014. Yeow CH.017 52. Thewlis D. Davis IS.doi.15:113-118.015 @ MORE INFORMATION WWW. The effects of movement pattern modification on lower extremity kinematics and pain in women with patellofemoral pain. van der Wurff P. 2010.doi.doi. kinetics and energy dissipation at lower extremity joints. Karlsson J.55:9-15.1016/j. 2008. ral pain. Davis IS. 2009.2007. Y eow CH. Clin Biomech (Bristol. 2013. Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Avon). knee. Richards J.doi.ORG journal of orthopaedic & sports physical therapy  |  volume 45  |  number 10  |  october 2015  |  807 . and muscle activation between subjects with and without patellofemo- 46.doi.11.2519/ jospt. http://dx.doi.1016/j.org/10. Hum Mov Sci. 1999. Am J Sports Med. Lower extremity jumping mechanics of female athletes with and without patellofemoral pain before and after exertion. Sagittal knee joint kinematics and energetics in response to different landing heights and techniques. J Orthop Sports Phys Ther. Goh JC. Goh JC.42:1967-1973.2519/jospt.org/10. 49.doi.5249 Thomeé R. 2009.org/10. 2009.07.025 51.2009. Powers CM. Gait Posture.org/10. 2011. J Biomech. org/10. Patellofemoral pain syndrome: a review of current issues.org/10. Selfe J. Teng HL. Long-Rossi F. org/10. 50. http://dx. An investigation of lower extremity energy dissipation strategies during single-leg and double-leg landing based on sagittal and frontal plane biomechanics.26:150-159. Knee.28:245-262. P  rins MR.org/10.42:1017-1024.010 53.2885 Struzik A. 41. 2008. Sports Med.1016/j. Maxam DE.27:258-263. http://dx. Leg stiffness during phases of countermovement and take-off in vertical jump.doi. Kilmurray S. Salsich GB.23:203-211.39:1219.03. org/10. 47. muscle strength.08. 2014. 2010.2012. Differences in hip kinematics.1016/j. Goh JC. Do females with patellofemoral pain have abnormal hip and knee kinematics during gait? Physiother Theory Pract. http://dx. J Orthop Sports Phys Ther. Binder-Macleod S. http:// dx. 48. Acta Bioeng Biomech. Aust J Physiother. http://dx. The biomechanics of step descent under different treatment modalities used in patellofemoral pain. Willson JD.gaitpost. http://dx.JOSPT. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review.