Does kinesiophobia influence lower limb kinematics during uphill walking in women with patellofemoral pain?

Abstract

Background Patellofemoral pain (PFP) consists of pain around or behind the patella that is accentuated during overload activities, such as jumping. The cause of PFP is multifactorial and recent studies have reported kinesiophobia as a possible factor associated with high rates of functional disability in this population. Understanding how fear of movement can contribute to biomechanical alterations observed during functional tasks can help guide treatment strategies for people with PFD. Objectives To investigate the influence of kinesiophobia on lower limb movement patterns during uphill walking in women with patellofemoral pain. Methods Twenty-two women with PFP, aged between 18-35, were selected. Initially, the Tampa Kinesiophobia Scale and the Pain Catastrophizing Scale were applied. Next, a kinematic assessment of the lower limb was carried out during uphill walking on a treadmill. The volunteers walked on the treadmill at a 10% incline for three minutes. Photo-reflective markers were placed on the affected lower limb at specific anatomical points (anterior superior iliac spine bilaterally, greater trochanter of the femur, lateral condyle of the femur, midpoint of the patella, lateral malleolus, midpoint between the malleoli, dorsal region between the first and second metatarsals). The angles of hip flexion, knee flexion and ankle dorsiflexion were calculated. Pearson's correlation test was used for statistical analysis, with a significance level of p < 0.05. Results The knee flexion angle during uphill walking was negatively associated with the level of kinesiophobia (r = -0.341, p = 0.040) and pain catastrophizing (r = -0.482, p = 0.023). There was no correlation for the other angles evaluated. Conclusion Kinesiophobia reduces knee flexion during uphill walking in women with PFP. Implications The findings show that kinesiophobia can alter the movement pattern, especially of the knee joint, during uphill walking. Less knee flexion can be a strategy to reduce pain when performing the task, but it increases the ground reaction forces applied to the joint and, in the long term, can lead to joint damage. It is important to consider kinesiophobia in the treatment of PFP, recommending interventions aimed at reducing it, together with physical exercise, which can reduce pain and improve functionality.