Volume 24, Issue 5 (December & January 2021)                   J Arak Uni Med Sci 2021, 24(5): 662-673 | Back to browse issues page

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Golpayegani M, Fayazi Z, Hosseini Y. The Effect of Strengthing Core Stabilization Training and the Knee Strengthening Training on Improving Pain in Older Women Athletes with Patellofemoral Pain Syndrome. J Arak Uni Med Sci 2021; 24 (5) :662-673
URL: http://jams.arakmu.ac.ir/article-1-6416-en.html
1- Department of Sport Pathology, Faculty of Sport Sciences, Arak University, Arak, Iran.
2- Department of Sport Pathology, Faculty of Sport Sciences, Arak University, Arak, Iran. , fayazi.zahra@yahoo.com
3- Department of Physical Education and Sport Science, School of Literature and Humanities, Malayer University, Malayer, Iran.
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Aging is not a disease and a pathological complication but a vital phenomenon that limits total physical and mental activity and affects the individual’s cultural, social and economic aspects [1]. Studies have reported that about one-fourth (21 to 43%) of all knee problems treated in sports medicine centers are due to Patellofemoral pain syndrome [6, 7]. Nakagawa et al., Stated that strengthening the quadriceps, abductor, and external rotator cuff muscles can improve pain in patients with Patellofemoral pain syndrome [11]. According to the studies, few studies have examined the effect of core stabilization training and strengthening training on pain of Patellofemoral syndrome in older women athletes The current study seeks to compare the effectiveness of a period of strengthening core stabilization training and the Knee strengthening training on improving the pain of elderly women athletes with Patellofemoral pain syndrome.
Materials and Methods
In this study, 20 women athletes with Patellofemoral Pain Syndrome participated. They were accidentally divided into two groups: strengthening core stabilization exercise (10 people (and strengthening knee exercise (10 people). inclusion criteria include: 1) age range 50 to 65 years (5), 2) having continuous aerobic activity for more than one year, 3) having clinical components of unilateral or bilateral patellar pain for more than 3 months (23), 4) Anterior or posterior pain reported in at least two activities such as prolonged sitting, going up and down stairs, squats, running and jumping, 5) Pain in at least 2-3 cases of tests such as pain during isometric resistance of quadriceps muscle contraction, Pain with palpation of the patella, and Pain during squatting [24]. Exercises were performed in both groups for eight weeks, three weekly sessions and about 45-60 minutes per session. In both groups, 10-15 minutes were used for warm-up, 30-35 minutes for exercise protocol, and 5-10 minutes for cooling. Visual analog scale measured patients’ pain before and after 8 weeks of practice interventions. Paired t-test and independent t-test were used at the significant level of (P<0.05) to analyze the results.
Descriptive findings show no significant difference between the mean of age, mass and height in the two groups; the groups were homogeneous with each other, and the studied variables had a natural distribution (P≥0.05).
The statistical analysis of paired t-tests in the study groups showed that in both groups, after eight weeks of treatment, a significant reduction in pain was observed (Table 2).

The results of the statistical analysis regarding intergroup comparison showed no significant difference between the rate of pain improvement in training groups after eight weeks of intervention (t=-1.975, P=0.064).
In evaluating the importance of research findings and the significant difference between the means, the effect size report indicates the effect of exercises on experimental groups and is of particular importance. The d index calculates the effect size between the two groups. If the effect size is more significant than 0.8, the effect of large exercises, between 0.5 and 0.8, has a moderate effect, and less than 0.2 indicates a small effect [29]. In the present study, the effect size values ​​for the pain variable were calculated, which was 1.8 for the knee strengthening exercises group and 0.7 for the main trunk stability training group, which can be considered the most practical effect of knee strengthening exercises.
Central trunk strengthening exercises with their control role on the trunk have improved lower limb movement and hip function because central trunk stability is defined as the body’s ability to maintain the correct alignment of the lumbar-pelvic and thigh complexes. Improving pelvic movement control following central trunk stability exercises reduces the Tensor fasciae latae muscle activity, which in turn reduces the elasticity of the external patellar retinaculum through the iliotibial band, ultimately helping to keep the patella in the right direction. And patellar contact with the external condyle of the thigh is reduced, thus, pain is reduced [34]. Weakness in the extensor muscles and external rotators can cause the femur to get closer, compensating for the tibia and leading to an increase in knee valgus. In the absence of sufficient strength of the upper extremities in approaching and rotating internally, the pressure on the external patellar region increases and causes pain, and ultimately reduces function [35 ,20]. Pain can cause abnormal movements, and vice versa; abnormal movements can cause pain. Therefore, since pain is related to posture and movement and its intensity can change posture and movements, these three are inseparably linked due to habits and body postures. The movement patterns related to the mechanical cause of the pain must be corrected [37]. 
The results showed that knee strengthening exercises and strengthening core stabilization exercises reduced the pain. But due to the higher effectiveness of knee strengthening exercises in improving pain, it is recommended to use this protocol to reduce the pain of these patients.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Research Ethics Committee of Bu Ali Sina University Hamedan with code: IR.BASU.REC.1398.032.

The paper was extracted from the MSc. thesis of the second author, Department of Sport Pathology, Faculty of Sport Sciences, University of Arak.

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declareed no conflict of interest.

We hereby thank and appreciate the sincere cooperation of professors, friends and especially all women participating in this research.

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Type of Study: Original Atricle | Subject: General
Received: 2020/08/22 | Accepted: 2021/08/28

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