title: Lumbopelvic joint manipulation and quadriceps activation of people with patellofemoral pain syndrome.
abstract: BACKGROUND
  Quadriceps weakness and inhibition are impairments associated with patellofemoral pain syndrome (PFPS). Lumbopelvic joint manipulation has been shown to improve quadriceps force output and inhibition, but the duration of the effect is unknown.
  
  
  OBJECTIVE
  To determine whether quadriceps strength and activation are increased and maintained for 1 hour after high-grade or low-grade joint mobilization or manipulation applied at the lumbopelvic region in people with PFPS.
  
  
  METHODS
  Randomized controlled clinical trial.
  
  
  METHODS
  University laboratory.
  
  
  METHODS
  Forty-eight people with PFPS (age = 24.6 ± 8.9 years, height = 174.3 ± 11.2 cm, mass = 78.4 ± 16.8 kg) participated.
  
  
  METHODS
  Participants were randomized to 1 of 3 groups: lumbopelvic joint manipulation (grade V), side-lying lumbar midrange flexion and extension passive range of motion (grade II) for 1 minute, or prone extension on the elbows for 3 minutes.
  
  
  METHODS
  Quadriceps force and activation were measured using the burst superimposition technique during a seated isometric knee extension task. A 2-way repeated-measures analysis of variance was performed to compare changes in quadriceps force and activation among groups over time (before intervention and at 0, 20, 40, and 60 minutes after intervention).
  
  
  RESULTS
  We found no differences in quadriceps force output (F(5.33,101.18) = 0.65, P = .67) or central activation ratio (F(4.84,92.03) = 0.38, P = .86) values among groups after intervention. When groups were pooled, we found differences across time for quadriceps force (F(2.66,101.18) = 5.03, P = .004) and activation (F(2.42,92.03) = 3.85, P = .02). Quadriceps force was not different at 0 minutes after intervention (t(40) = 1.68, P = .10), but it decreased at 20 (t(40) = 2.16, P = .04), 40 (t(40) = 2.87, P = .01) and 60 (t(40) = 3.04, P = .004) minutes after intervention. All groups demonstrated decreased quadriceps activation at 0 minutes after intervention (t(40) = 4.17, P < .001), but subsequent measures were not different from preintervention levels (t(40) range, 1.53-1.83, P > .09).
  
  
  CONCLUSIONS
  Interventions directed at the lumbopelvic region did not have immediate effects on quadriceps force output or activation. Muscle fatigue might have contributed to decreased force output and activation over 1 hour of testing.
authors.affiliation: Physical Therapy Department, Creighton University, Omaha, NE 68178, USA. GrindstajfTL@creighton.edu
authors.forename: Terry L
authors.initials: TL
authors.lastname: Grindstaff
authors.forename: Jay
authors.initials: J
authors.lastname: Hertel
authors.forename: James R
authors.initials: JR
authors.lastname: Beazell
authors.forename: Eric M
authors.initials: EM
authors.lastname: Magrum
authors.forename: D Casey
authors.initials: DC
authors.lastname: Kerrigan
authors.forename: Xitao
authors.initials: X
authors.lastname: Fan
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Ingersoll
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007719:Knee Joint; D008161:Lumbosacral Region; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D018908:Muscle Weakness / Q000628:therapy; D010147:Pain Measurement; D046788:Patellofemoral Pain Syndrome / Q000628:therapy*; D052097:Quadriceps Muscle / Q000502:physiology*; D016059:Range of Motion, Articular