International Journal of Medical and Health Research

International Journal of Medical and Health Research

ISSN: 2454-9142, Impact Factor: RJIF 5.54
www.medicalsciencejournal.com
Volume 2; Issue 9; September 2016; Page No. 40-43

A study on effectiveness of Diadynamic current with Vastus Medialis oblique training in

Patellofemoral pain syndrome
1
Dr. Senthil kumar S, 2 Adhith KJ
1
MPT, PhD, Associate Professor Saveetha College of Physiotherapy, Saveetha University Chennai, Tami Nadu, India
II Year MPT, Saveetha College of Physiotherapy, Saveetha University, Chennai, Tamil Nadu, India

Abstract
Background and Purpose: Patellofemoral pain syndrome (PFPS) is a common knee disorder characterized by anterior or retro
patellar pain associated with activities that load the patellofemoral joint. Diadynamic current and VMO training was effective
treatment in patients with PFPS.
Objective: To find out the effect of Diadynamic current and Vastus Medialis Oblique training to reducing pain and improving
function in subjects with Patellofemoral Pain Syndrome
Study Design: Experimental design
Methods: 30 subjects with patellofemoral pain syndrome with age between 20-50 were recruited for the study and then randomly
assigned to either one training group. 10 cm- Visual Analogue Scale of pain (VAS), Anterior Knee Pain Scale (AKPS) and Lower
Extremity Functional Scale (LEFS) were the assessment tools used. The scores were measured before, after exercise training.
Results: The values were statistically analyzed using paired ‘t’ test and independent ‘t’ test. There was statistically significant
improvement both within the groups and in between the groups on all the 3 outcome measures. Group- A had greater improvement
than Group-B.
Conclusion: This study shows that Diadynamic current with VMO Training will be more beneficial effect in patients with
patellofemoral pain syndrome.

Keywords: Patellofemoral pain syndrome (PFPS), Vastus Medialis Obliquus (VMO), Diadynamic current

Introduction the effectiveness of Diadynamic current and VMO training in

Patello femoral Pain Syndrome is one of the most frequent reducing pain and improving function in individuals with
musculoskeletal disorders of the knee joint, [1-3] including Patellofemoral Pain Syndrome.
approximately 25% of the orthopaedic diagnosis [2] It is defined
as an anterior and/or retro patellar knee pain as a result of Objective
structural and biomechanical alterations of the joint [4-6]. It is To find out the effect of Diadynamic current and Vastus
one of the most prevalent knee conditions in adolescents and medialis Oblique training to reducing pain and improving
young adults [7, 8]. The etiology of Patello femoral Pain function in subjects with Patellofemoral Pain Syndrome.
Syndrome is likely to be multifactorial [9]. Among the most
frequent biomechanical factors related to the Patello femoral Methods
Pain Syndrome development, the static and dynamic unbalance 30 subjects with patellofemoral pain syndrome with age
stands out [5]. Among the alterations on the static unbalance, between 20-50 were recruited for the study and then randomly
some authors assure that abnormalities such as excessive assigned to either one training group. 10 cm- Visual Analogue
subtalar pronation, increase on the Q angle, external tibial Scale of pain (VAS), Anterior Knee Pain Scale (AKPS) and
torsion, retraction of the lateral retinaculum and improper Lower Extremity Functional Scale (LEFS) were the
patellar behavior can cause anterior knee pain [10, 11]. Along assessment tools used. The scores were measured before, after
with an evolving understanding of the pathomechanics of 2 weeks of exercise training.30 subjects with unilateral or
patellofemoral joint, came novel intervention approaches bilateral Patellofemoral Pain Syndrome were selected and
geared toward addressing flexibility and strength deficits of the randomly assigned into two experimental groups A and B.
knee structures, or structures immediately adjacent to the knee. Subjects of Group A were taught Knee Extension Exercises
Physical therapy plays an important role in the conservative Quadriceps sets: 3 sets of 10 repetitions at a time (1 minute rest
management of Patello femoral Pain Syndrome, with treatment between each set). It can be done several times throughout the
frequently advocated for pain control and muscle strengthening day. Subjects of Group B were Diadynamic current is
[14]
. However other authors relate Patellofemoral Pain a monophasic pulsed current that was sine wave, operating at
Syndrome with the unbalance on the dynamic stabilizer 50Hz (or 60Hz USA) which is then rectified (full wave or half
muscles, especially among the medialis and lateralis wave). The resulting monophasic pulses have a duration of 10
components [5, 10-13] Diadynamic current and Strengthening the milliseconds. MF is a half wave rectification which will deliver
VMO was believed to be the key to “proper tracking of the 50 pulses per second, delivering 10ms pulses with a 10ms
patella”. The purpose of this study was therefore to investigate interval given for 15 minutes.
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VMO training  Subjects with unilateral or bilateral Patello Femoral Pain

The subject is seated in a chair with back supported, the knees Syndrome
flexed to 90 degrees and the affected foot fully on the ground  Subjects having Anterior or Retro patellar Knee pain on at
(compression through a joint enhances activity in the
least two of the following activities
stabilizing muscles like the VMO). By pushing the foot
forward along the floor very gently and tightening the  Prolonged sitting
Quadriceps with the knee in 90 degrees of flexion, the subject  Squatting
simultaneously squeezes a towel placed between the knees and  Climbing up or down stairs
holds it for 10 seconds. Hips should not be internally rotated  Running
when trying to perform adduction. Different flexion angles can  Kneeling
be used on subsequent visits. 90 degrees is the usual starting  Jumping / Hopping
position as the VMO comes in more readily in this position. It
 Pain on at least two of the following evaluations
is repeated 10 times, twice or thrice daily. The total treatment
duration was 2 weeks. For the first week the subjects were  Palpation
supervised in the Physiotherapy department for atleast twice a  Patellar compression
week. After two weeks they were instructed to continue the  Resisted knee extension
exercises in their home itself and asked to come after 3weeks.  Subjects having symptoms for at least 1 month and pain
Pain and functional outcome scores were taken at the first visit, level >3 and <8 on Visual Analogue Scale (VAS).
two weeks after exercise and finally 6 weeks after exercise.
Treatment for Group B: Quadriceps sets: 3 sets of 10 Exclusion Criteria
repetitions at a time (1 minute rest between each set). It can be  Severe knee pain >8 on Visual Analogue Scale (VAS)
done several times throughout the day.
 Referred pain from back or hip
Study Design  Recent history of medications for pain relief (within 3
Experimental Design months)
 Recent knee surgeries
Population  Central or Peripheral neurologic pain
Individuals with unilateral or bilateral Patellofemoral Pain  Severe knee deformities or malalignment of lower
Syndrome who were referred to the Department of
extremities
Physiotherapy Saveetha Medical college Hospital, Chennai.

Sampling Method Outcomes Measured

Purposive Random Sampling, Subjects were selected in  Pain
accordance to a predetermined inclusion and exclusion criteria  Lower extremity functional outcome
to ensure homogeneity of the subjects. The subjects were then
randomly assigned into two groups, Group A and Group B. Measurement Tools
 Visual Analogue Scale (VAS)
Sample Size  Anterior Knee Pain Scale (AKPS)
Total: 30 Subjects.  Lower Extremity Functional Scale (LEFS)
Group A: 15 Subjects (Diadynamic currents and VMO
training). Results
Group B: 15 Subjects (Traditional Knee Extension Exercises The values were statistically analyzed using paired‘t’ test and
alone). independent ‘t’ test. There was statistically significant
improvement both within the groups and in between the groups
Inclusion Criteria
on all the 3 outcome measures. Group- A had greater
 Age: 20-50 Years
improvement than Group-B.
 Sex: Both Males and Females
Table 1: Pre Score
VAS AKPS LEFS
S. No Statistical Measurement
Group A Group B Group A Group B Group A Group B
1. Mean 8.13 8.2 73.7 74.5 59.8 60.4
2 Standard Deviation 0.74 0.67 7.1 7.2 13.9 14.8

Table 2: Post Score

VAS AKPS LEFS
S. No Statistical Measurement
Group A Group B Group A Group B Group A Group B
1. Mean 5.2 0.93 61.2 36.0 62.9 84.0
2 Standard Deviation 1.62 0.45 10.4 8.7 8.7 7.58

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International Journal of Medical and Health Research

Fig 1: Pre Score

Fig 2: Post Score

The Results shows that the unpaired t Test will be used to find the aetiology remains unclear and there is a limited consensus
out the outcome measures following: on the efficacy of selected exercises focusing on VMO
In VAS measurements are the two-tailed P value is less than retraining. The current debate when rehabilitating the
0.0001 by conventional criteria, The mean of Group One minus patellofemoral joint is over the type of strengthening of the
Group Two equals 4.2700, 95% confidence interval of this Quadriceps muscle. Rehabilitation that included selective
difference: From 3.3807 to 5.1593, t = 9.8360, df = 2, standard strengthening of the vastus medialis portion of the Quadriceps
error of difference = 0.434.In anterior knee pain scale results muscle has been shown to be an effective treatment option for
for the two-tailed P value is less than 0.0001 by conventional patellofemoral pain. Two portions of the vastus medialis
criteria, this difference is considered to be extremely muscle have been identified, the superior or longitudinal
statistically significant. The mean of Group One minus Group component and the oblique or inferior component (VMO). The
Two equals 25.200, 95% confidence interval of this difference: VMO originates partially from the adductor longus and the
From 18.029 to 32.371, t = 7.1980, df = 28, standard error of adductor magnus and has an orientation that is either oblique
difference = 3.501, the lower extremity functional scale or transverse, with the insertion of the inferior or oblique
compare to both groups are the two-tailed P value is less than section occupying half or more of the medial border of the
0.0001 by conventional criteria, this difference is considered to patella. Lieb and Perry [16] determined that the VMO was a
be extremely statistically significant. The mean of Group One significant stabilizer of the patella, as well as a knee extensor
minus Group Two equals -21.100, 95% confidence interval of which is frequently innervated independently from the rest of
this difference: From -27.175 to -15.025, t = 7.1144, df = 28, the quadriceps by a branch from the femoral nerve.
standard error of difference = 2.966. The results of this study Diadynamic current applied to the quadriceps muscle in the
concur with the findings that individuals symptomatic for anterior aspect of the knee to given. It is very effective pain
PFPS may benefit by Diadynamic current with VMO training. relief of Patello femoral pain syndrome. VMO, when compared
with the other vastus components, could easily be inhibited by
Discussion pain, effusion and atrophies. Training the VMO should be
Patellofemoral pain syndrome is a common condition regarded as a motor skill acquisition rather than a strengthening
presenting to physiotherapy practices. Despite its prevalence, procedure. Appropriate training allows the motor control
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International Journal of Medical and Health Research

system to acquire information necessary to change the length- 2001; 9:325-36.

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out. Connell J. Simultaneous feed forward recruitment of the
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4. Further studies are recommended to analyze the effect 14. Harrison E, Quinney H, Magee D, Sheppard MS,
some other modified exercise regimen. McQuarrie A. Analysis of outcome measures used in the
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