Patellofemoral Joint Loading Progression Across 35 Weightbearing Rehabilitation Exercises and Activities of Daily Living

• Published in: The American journal of sports medicine Vol. 51; no. 8; pp. 2110 - 2119
• Main Authors: Song, Ke, Scattone Silva, Rodrigo, Hullfish, Todd J., Silbernagel, Karin Grävare, Baxter, Josh R.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.07.2023
• Subjects: knee; physical therapy; biomechanics; patellofemoral pain; anterior knee pain; motion analysis
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/03635465231175160

Background: Exercises that provide progressive therapeutic loading are a central component of patellofemoral pain rehabilitation, but quantitative evidence on patellofemoral joint loading is scarce for a majority of common weightbearing rehabilitation exercises. Purpose: To define a loading index to quantify, compare, rank, and categorize overall loading levels in the patellofemoral joint across 35 types of weightbearing rehabilitation exercises and activities of daily living. Study Design: Descriptive laboratory study. Methods: Model-estimated knee flexion angles and extension moments based on motion capture and ground-reaction force data were used to quantify patellofemoral joint loading in 20 healthy participants who performed each exercise. A loading index was computed via a weighted sum of loading peak and cumulative loading impulse for each exercise. The 35 rehabilitation exercises and daily living activities were then ranked and categorized into low, moderate, and high “loading tiers” according to the loading index. Results: Overall patellofemoral loading levels varied substantially across the exercises and activities, with loading peak ranging from 0.6 times body weight during walking to 8.2 times body weight during single-leg decline squat. Most rehabilitation exercises generated a moderate level of patellofemoral joint loading. Few weightbearing exercises provided low-level loading that resembled walking or high-level loading with both high magnitude and duration. Exercises with high knee flexion tended to generate higher patellofemoral joint loading compared with high-intensity exercises. Conclusion: This study quantified patellofemoral joint loading across a large collection of weightbearing exercises in the same cohort. Clinical Relevance: The visualized loading index ranks and modifiable worksheet may assist clinicians in planning patient-specific exercise programs for patellofemoral pain rehabilitation.