An investigation of the relationship between anterior knee pain and lower limb biomechanics.
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The thesis presents an investigation of the relationship between anterior knee pain and lower limb biomechanics in symptomatic and asymptomatic individuals during walking. Although foot orthotic devices are often prescribed to realign lower extremity mechanics, there is conflicting evidence to support this. A quantitative study explored the dynamics of walking barefoot, shod and with orthotic devices using the 3D Kinematic Motion Analysis System, Vicon 370. Sample sizes of 30 control subjects and 30 subjects with anterior knee pain were recruited. Kinematic gait parameters and temporal-spatial gait parameters were compared between the two groups and a thorough static clinical examination was provided. The relationship of alignment and knee pain was also examined using the Positional Upright MRI Scanner. A group of 15 subjects with anterior knee pain and a group of 5 asymptomatic subjects were examined radiographically barefoot, shod and with orthotic devices. An increase in Q-angle was shown in the knee pain group with an added angle increase in the females in both groups. This could signify that a higher Q-angle may influence biomechanics of the knee joint by creating an abnormally increased valgus angle. Evidence was found that there was a strong relationship between eversion and inversion of the foot with internal and external tibial rotation of the leg. This coupling relationship may lend insight into the behavior of the lower leg and anterior knee pain whilst walking. Small changes were noted when wearing the orthotic devices which may be advantageous biomechanically and they were also of benefit in correcting pronatory changes or movements more distal to the foot. The results of the MRI study were disappointing but many limitations were shown to support the results. Upon finishing this thesis, it is apparent that documented evidence of any relationship between anterior knee pain and lower limb biomechanics is imperative to clinicians in order to aid in treatment plans of patients but also in preventative treatment. Further research is required to enhance the clinicians’ knowledge and understanding of the foot and leg dynamically.