Rehabilitation with Patterned Electrical Neuromuscular Stimulation for Individuals with Patellofemoral Pain

Patellofemoral pain (PFP) is one of the most common knee pathologies seen in clinical practice. It is challenging chronic condition due to its heterogeneous presentation of impairments, ranging from decreased flexibility, muscle weakness, altered muscle activation, and altered movement patterns during a variety of functional tasks. While traditional rehabilitation programs have produced improvement in strength and decrease pain, changes in muscle activity and movement patterns have not been found to improve. The long-term outcomes in those individuals are also sub-optimal, with pain and symptoms for years following initial diagnosis, suggesting that exercise alone may only be a small part at treating PFP. Exploring interventions to improve strength, muscle activation and correct altered movement patterns should be examined to improve these outcomes. Patterned electrical neuromuscular stimulation (PENS) has gained recent support when treating PFP, as single interventions have been found to decrease pain, improve muscle activation and improve altered kinematics during functional tasks. However, it is unknown the effect of PENS in conjunction with a rehabilitation program when treating individuals with PFP. Therefore, the purpose of this study is to determine the effect of a 4-week rehabilitation program with PENS on patient reported outcomes, range of motion, strength and activity level (Manuscript 1). Furthermore, we aimed to evaluated the effect of PENS with rehabilitation on muscle activity and movement patterns in both laboratory based tasks, such as a single leg squat and step down task (Manuscript 2) and in functional daily activities such as jogging (Manuscript 3).