Lumbopelvic manipulation in patients with patellofemoral pain syndrome.

Objectives: A recent clinical prediction rule (CPR) identified characteristics that may predict an immediate reduction in pain following lumbopelvic manipulation in patients with patellofemoral pain syndrome. The purpose of this single-arm cohort study was to replicate the proposed CPR in a different population and investigate changes in self-reported pain, hip range of motion, strength, and function immediately following lumbopelvic manipulation. Methods: Forty-four subjects (63.6% female; mean age 27.4 years) met inclusion criteria. Hip internal rotation range of motion, lower extremity strength using a handheld dynamometer, and single/triple hop tests were assessed prior to and immediately following a spinal manipulation. A global rating of change questionnaire was administered after testing and telephonically at 1 week. Paired f-tests compared pre- and post-manipulation range of motion, strength, and hop test limb symmetry indices (<x=0.05). Results: Fifty-seven percent of subjects had a successful outcome measured by the numerical pain rating scale immediately following manipulation. Twenty-five of subjects experienced a successful outcome as measured by the global rating of change questionnaire at 1 week. No single individual or combination of predictor variables predicted a positive outcome immediately following the lumbopelvic manipulation ( + likelihood ratio 0.7 with three of five predictor variables present). Statistically significant differences (P<0.05) were found in hip extension and abduction strength and hip internal rotation symmetry post- manipulation, but do not appear to be clinically meaningful. Discussion: The previously identified CPR was not able to be replicated and no clinically meaningful changes in range of motion, strength, or function were apparent. Future research should focus on a comprehensive impairment-based treatment approach in patients with patellofemoral pain syndrome. [ABSTRACT FROM AUTHOR]