People With Patellofemoral Pain Have Bilateral Deficits in Physical Performance Regardless of Pain Laterality.

CONTEXT: People with patellofemoral pain (PFP) may have lower performance during the forward step-down and single-leg hop with their painful (unilateral complaints) or most painful (bilateral complaints) limb when compared with pain-free controls. However, no authors have investigated the appropriateness of using the pain-free or less painful limb as a reference standard in clinical practice or whether deficits might be present depending on the laterality of pain.

OBJECTIVE

To compare performance scores and proportion of side-to-side limb symmetry during the forward step-down and single-leg hop tests among people with unilateral and bilateral PFP and pain-free controls.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER

PARTICIPANTS

Fifty-two young adults (18-35 years old) with unilateral PFP, 72 with bilateral PFP, and 76 controls.

MAIN OUTCOME MEASURE(S): Group × limb interactions on performance during the step-down (repetitions) and single-leg hop (distance [cm] normalized by the limb length) tests were investigated using a repeated-measures analysis of covariance controlling for sex. Pairwise comparisons were interpreted using effect sizes. A χ2 test was used to compare the proportion of symmetry/asymmetry (cutoff point of ≥90% for symmetry indices) across groups and tests.

RESULTS

Main effects for groups (small to medium effects) but not limbs indicated lower performance of both limbs of individuals with unilateral and bilateral PFP than controls during forward step-down and single-leg hop tests. No significant differences for the proportion of symmetry/asymmetry were identified across groups (P ≥.05), which further suggests an impaired physical performance of the contralateral limb.

CONCLUSIONS

Our results indicate bilateral deficits in the physical performance of people with unilateral and bilateral PFP when compared with pain-free controls during the forward step-down and single-leg hop tests. Limb symmetry indices greater than 90% should be interpreted with caution, as they may overstate physical performance by not assuming bilateral deficits.