Altered tensor fasciae latae activation during functional movements in women with patellofemoral pain

Year 2025, Volume: 11 Issue: 1, 1 - 9, 28.02.2025

David Clark Sarah Martinez-sepanski , Jennifer Caputo Kelton Mehls Sandra Stevens John Coons

https://doi.org/10.31459/turkjkin.1571373

Abstract

Patellofemoral pain syndrome (PFP) is a chronic injury seen in both the athletic and clinical setting. Because the cause of PFP is multifactorial, health professionals need to consider muscle activity differences in women with PFP compared to healthy controls to better diagnose, prevent, and rehabilitate this injury. Therefore, the aim of this study was to examine muscle activity differences during functional movements in women (N = 21) with PFP and their pain-free counterparts. Surface electromyography (sEMG) of the musculus gluteus medius (GMED), musculus gluteus maximus (GMAX), musculus abductor longus (AL), and the musculus tensor fasciae latae (TFL) in women diagnosed with PFP (n = 9; Age = 25.99 ± 8.4 years) and pain-free controls (n = 12; Age = 23.5 ± 6.5 years) during the forward lunge, lateral step down, and single leg squat. Peak muscle activity of the GMED, GMAX, and AL were not significantly different between groups for any movement; however, peak TFL activity was significantly higher in the PFP group during the descent phase (p = .015), and ascent phase (p = .010) of the forward lunge. In addition, peak TFL activity was significantly higher in the PFP group during the descent phase of the lateral step down (p = .042) and the ascent phase (p = .046) of the single leg squat. Women with PFP demonstrated higher peak TFL activity during functional movements. The results of this study provide critical information for healthcare and fitness professionals that can guide clinical assessments and treatment outcomes for individuals with PFP.

Keywords

EMG, functional movements, muscle activity, patellofemoral pain syndrome, tensor fascia latae

Ethical Statement

The study was approved by Middle Tennessee State University’s Institutional Review Board (IRB) and it was carried out in accordance with the Code of Ethics of the World Medical Association also known as a declaration of Helsinki.

References

• Baker, R.L., Souza, R.B., Rauh, M.J., Fredericson, M.D., & Rosenthal, M.D. (2018). Differences in knee and hip adduction and hip muscle activation in runners with and without patellofemoral pain syndrome. PM&R, 10(10), 1032-1039. doi:10.1016/j.pmrj.2018.04.004
• Baldon, R., Nakagawa, T. H., Muniz, T. B., Amorim, C. F., Maciel, C. D., & Serrão, F. V. (2009). Eccentric hip muscle function in females with and without patellofemoral pain syndrome. J Athl Train, 44(5), 490-496.
• Besomi, M., Maclachlan, L., Mellor, R., Vicenzino, B., & Hodges, P. W. (2020). Tensor fascia latae muscle structure and activation in individuals with lower limb musculoskeletal conditions: a systematic review and meta-analysis. Sports Med, 50(5), 965-985. doi:10.1007/s4 0279-019-01251-1
• Bolgla, L. A., & Uhl, T. L. (2007). Reliability of electromyographic normalization methods for evaluating the hip musculature. J Electromyogr Kinesiol, 17(1), 102-111. doi:10.1016/j.jelekin.2005.11.007
• Boling, M. C., Padua, D., Marshall, S., Guskiewicz, K., Pyne, S., & Beutler, A. (2010). Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports, 20(5), 725-730. doi:10.1111/j.1600-0838.2009.00996.x
• Brechter, J. H., & Powers, C. M. (2002). Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait Posture, 16(2), 115-123. doi:10.1016/s0966-6362(02)00090-5
• Cichanowski, H. R., Schmitt, J. S., Johnson, R. J., & Niemuth, P. E. (2007). Hip strength in collegiate female athletes with patellofemoral pain. Med Sci Sports Exerc, 39(8), 1227-1232. doi:10.1249/mss.0b013e3180601109
• Clarkson, H.M. (2000). Musculoskeletal Assessment: Joint range of motion and manual muscle strength. Lippincott, Williams and Wilkins.
• Cook, L. B., Hoogenboom, B. J., & Voight, M. (2014). Functional movement screening: the use of fundamental movements as an assessment of function‐part 1. Int J Sports Phys Ther, 9(3), 396.
• Crossley, K., Bennell, K., Green, S., Cowan, S., & McConnell, J. (2002). Physical therapy for patellofemoral pain - A randomized, double-blinded, placebo-controlled trial. Am J Sports Med, 30(6), 857-865. doi:10.1177/03635465020 300061701
• Crossley, K. M., Bennell, K. L., Cowan, S. M., & Green, S. (2004). Analysis of outcome measures for persons with patellofemoral pain: Which are reliable and valid? Archives of Physical Medicine and Rehabilitation, 85(5), 815–822. doi:10.1016/s0003-9993(0 3)00613-0
• Darós, D. L., Martins, J., Siqueira das Neves, L. M., de Cássia Registro Fonseca, M., Inacio Barbosa, R., Uliam Kuriki, H., & Marcolino, A. M. (2023). Are there Differences in the Muscles Activation during Exercise for Patellofemoral Pain Patients? A Cross-Sectional Study. Muscles Ligaments Tendons J, 13(4).
• Distefano, L. J., Blackburn, J. T., Marshall, S. W., & Padua, D. A. (2009). Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther, 39(7), 532-540. doi:10.2519/jospt.2009.2796
• Ferreira, A. S., de Oliveira Silva, D., Briani, R. V., Ferrari, D., Aragão, F. A., Pazzinatto, M. F., & de Azevedo, F. M. (2018). Which is the best predictor of excessive hip internal rotation in women with patellofemoral pain: Rearfoot eversion or hip muscle strength? Exploring subgroups. Gait Posture, 62, 366-371.
• Dwyer, M. K., Boudreau, S. N., Mattacola, C. G., Uhl, T. L., & Lattermann, C. (2010). Comparison of lower extremity kinematics and hip muscle activation during rehabilitation tasks between sexes. J Athl Train, 45(2), 181-190. doi:10. 4085/1062-6050-45.2.181
• Glaviano, N. R., & Saliba, S. (2022). Differences in gluteal and quadriceps muscle activation during weight-bearing exercises between female subjects with and without patellofemoral pain. J Strength Cond Res, 36(1), 55-62.
• Gottschalk, F., Kourosh, S., & Leveau, B. (1989). The functional anatomy of tensor fasciae latae and gluteus medius and minimus. J Anat, 166, 179 – 189.
• Hermens, H. J., Freriks, B., Merletti, R., Stegeman, D., Blok, J., Rau, G. (1999). Recommendations for sensor locations on individual muscles. Retrieved from http://www.seniam.org
• Hewett, T. E., Myer, G. D., Ford, K. R., Paterno, M. V., & Quatman, C. E. (2016). Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. J Orthop Res, 34(11), 1843-1855.
• Ireland, M. L., Willson, J. D., Ballantyne, B. T., & Davis, I. M. (2003). Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther, 33(11), 671-676. doi:10.2519/jospt.2003.33.11.671
• Janda, V. (1993). Muscle strength in relation to muscle length, pain, and muscle imbalance. In Harms-Ringdahl (Ed.), International perspectives in physical therapy (pp. 83-91). Churchill Livingstone.
• Kendall, F., McCreary, E., & Provance, P. (1993). Muscles, testing and function with posture and pain (4th ed.). Williams and Wilkins.
• Khayambashi, K., Fallah, A., Movahedi, A., Bagwell J., & Powers C. (2014). Quadriceps strengthening for patellofemoral pain: A comparative control trial. Arch Phys Med Rehabil, 95 (5), 900–907. doi:10.1016/j.apmr. 2013.12.022
• Liao, T. C., Yang, N., Ho, K. Y., Farrokhi, S., & Powers, C. M. (2015). Femur rotation increases patella cartilage stress in females with patellofemoral pain. Med Sci Sports Exerc, 47(9), 1775-1780.
• Lovell, G. A., Blanch, P. D., & Barnes, C. J. (2012). EMG of the hip adductor muscles in six clinical examination tests. Phys Ther Sport, 13(3), 134-140.
• Martinez, S., Clark, D., & Coons, J. (2021). Peak muscle activity during stance phase in women with patellofemoral pain versus without patellofemoral pain. Int J Motor Control Learn, 3(1), 4-13.
• Merican, A. M., & Amis, A. A. (2009). Iliotibial band tension affects patellofemoral and tibiofemoral kinematics. J Biomech, 42(10), 1539-1546.
• Mirzaie, G. H., Rahimi, A., Kajbafvala, M., Manshadi, F. D., Kalantari, K. K., & Saidee, A. (2019). Electromyographic activity of the hip and knee muscles during functional tasks in males with and without patellofemoral pain. J Bodyw Mov Ther, 23(1), 54-58.
• Neumann, D. (2010). Kinesiology of the hip: A focus on muscular actions. J Orthop Sports Phys Ther, 40(2), 82-94. doi:10.2519/jospt.2010.3025
• Piriyaprasarth, P., Morris M. E., Winter, A., Bialocerkowski, A. E. (2008). The reliabilty of knee joint position testing using electrogoniometry. BMC Musculoskelet Disord, 9(6)1-10. doi:10.1186/1471-2474-0-6
• Piva, S. R., Fitzgerald, K., Irrgang, J. J., Jones, S., Hando, B. R., Browder, D. A., & D Childs, J. (2006). Reliability of measures of impairments associated with patellofemoral pain syndrome. BMC Musculoskelet Disord, 7(33)1-13. doi:10.1186/1471-2474-7-33
• Rodrigues, R., Klein, K. D., Pompeo, K. D., & Vaz, M. A. (2022). Are there neuromuscular differences on proximal and distal joints in patellofemoral pain people? A systematic review and meta-analysis. J Electromyogr Kinesiol, 64, 102657.
• Sahrmann, S. A. (1987). Posture and muscle imbalance: Faulty lumbar-pelvic alignment and associated musculoskeletal pain syndromes. In Postgraduate Advances in Physical Therapy: Forum Medicum.
• Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. J Orthop Sports Phys Ther, 43(2), 54-64.
• Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2022). Persons with patellofemoral pain exhibit altered hip abductor muscle recruitment while performing hip abductor exercises. Physiother Theory Pract, 1-10.
• Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2024). Comparison of electromyographic activity of the gluteal muscles and tensor fascia lata in persons with patellofemoral pain: Evaluation of selected, hip-targeted exercises using indwelling fine-wire electrodes. Physiother Theory Pract, 40(8), 1775-1783.
• Shultz, S. J., Nguyen, A. D., & Schmitz, R. J. (2008). Differences in lower extremity anatomical and postural characteristics in males and females between maturation groups. J Orthop Sports Phys Ther, 38(3), 137-149.
• Souza, R.B., Draper, C. E., Fredericson, M., & Powers, C. M. (2010). Femur rotation and patellofemoral joint kinematics: A weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther, 40(5), 277-285. doi:10.2519/jospt.2010.3215
• Souza, R. B., & Powers, C. M. (2009). Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther, 39(1), 12-19. doi:10.2519/jospt. 2009.2885