The importance of low threshold testing in patellofemoral pain
So why is Low Threshold Muscle Testing important in clients with patello-femoral pain?
- Low threshold muscle testing evaluates movement efficiency and considers the central nervous system.
- For function we need to have the ability to recruit efficiently in different functional positions and tasks.
- A basic requirement for functional movement control is have efficient muscle activation in all ranges and the ability to control movement isometrically and eccentrically. This includes activities which require efficient low threshold recruitment - alignment and co-ordination tasks
Barton et al (2013) carried out a systematic review on gluteal activity in patello-femoral pain syndrome and concluded that delayed and shorter duration Gluteus Medius (GMed) EMG may indicate impaired ability to control transverse and frontal plane hip motion. This was evaluated in people with patello-femoral pain.
This review evaluated ten case controls where moderate to strong evidence indicated GMed activity was delayed and of shorter duration in stair ascent and descent. Limited evidence showed that this was even the case in such activities as running.
This article suggests that for people with patello-femoral problems there is strong evidence that timing delays and shorter duration muscle activity in the GMed has a strong link with patello-femoral pain. Further information is required to identify if it is part of the cause or the result of the problem.
Interesting data when evaluating the kinetic chain in clients with persistent mechanical problems. The Performance Matrix Movement and Performance Screens, tests for efficiency in high and low recruitment throughout the kinetic chain. The Running Matrix and Foundation Matrix are frequently used in many sporting populations to identify uncontrolled movements in both threshold categories so that the trainer can effectively identify suitable training strategy for each individual. These screens uniquely find the threshold, the site and the direction of the uncontrolled movement, and are suitable for clients with knee problems where the movement control of joint above or below is part of the picture.
Posted by Clare Pedersen
Barton CJ, Lack S, Malliaras P, Morrisey D ( 2013). Gluteal muscle activity and patellofemoral pain syndrome: a systemic review. Editors Choice, Br J Sports Med 2013,47: 207-214
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