Lumbar Thrust-mobilization Effects on Hip Strength and Anterior Knee Pain

Lumbar Thrust-mobilization Effects on Hip Strength and Anterior Knee Pain, a Double Blind Randomized Control Trial

The purpose of this study is to investigate changes in lateral hip muscle strength as well as self-reported pain during the performance of three functional tests in patients with anterior knee pain following a lumbopelvic thrust-mobilization. Hypothesis(es): Lumbar thrust-mobilization will lead to increased lateral hip strength and decreased anterior knee pain during 3 functional activities (single leg step down, functional squat, drop jump).

The participant will complete a medical history form and undergo a brief physical exam of the lumbar spine and knees to include: lumbar range of motion and mobility testing, knee range of motion, palpation, and knee mobility testing. The participant will complete a hip strength test utilizing the Biodex System 4 Pro®. The participant will then perform three activities (single leg step down, squat, and drop jump from a 2 foot platform) and provide a self-reported knee pain measure with each activity. A sealed envelope indicating the intervention to be received will be given to the participant. An investigator blinded to the pre and post-measures will open the envelope indicating the intervention to be performed. The participant will be blinded to which intervention group they are categorized to. Th e participant will be positioned on a high-low treatment table to receive the assigned intervention. The participant will be positioned to receive either intervention 1 (thrust mobilization) or 2 (sham mobilization). The participant will either receive the thrust-mobilization or sham mobilization up to 2 times on the left and right side. An immediate re-test of hip strength will be conducted followed by performing the same three functional activities (single leg step down, squat, and drop jump from a 2 foot platform) while providing a self-reported pain measure after each activity. Follow-up measures at 15 minutes post-intervention and the final measure at 30 minutes post-intervention will be performed.

Participants will be randomly assigned to one of two interventions, thrust-mobilization or sham mobilization.

Double Blind: The subjects will not know what intervention they are receiving - same generic script is provided. One Investigator is performing all pre and post-tests without knowledge of intervention, the other investigator is opening the envelope and providing the intervention behind a screen without knowledge of test results. This investigator will record the subjects assigned # and which intervention they received. Investigators will record data on spreadsheet separately. The outcomes will be evaluated by a masked outcome assessor.

The investigator will perform a lumbar thrust-mobilization with the subject in right and then left sidelying position

No lumbar-thrust mobilization will be performed. Subject will receive simple passive inter-vertebral range of motion.

The intervention group will receive passive spinal rotational grade V thrust-mobilization, based on Maitland's approach. The intervention will be performed with the subject in right sidelying and left sidelying. The operator's palpating hand is placed over the L2-3 intervertebral space, and the other hand bends both legs of the participant up to the range at which the L2-3 midposition is found. The participant is then asked to straighten the lower leg and hook the upper leg over it with the upper leg's knee positioned over the side of the plinth. While the lower component is kept still, the participant's trunk is rotated until the hip starts to lift off from the plinth. The bottom hand and uppermost hand rest under a pillow and the chest wall, respectively. With the starting position settled, the operator stands behind the participant, takes up the slack within the spine and then provides a grade V thrust- mobilization while stabilizing the uppermost shoulder.

Subjects are positioned in right sidelying. The experimenter holds both knees with one arm while placing their opposite hand on the participant's lumbar spine. The experimenter performs 1 min of flexion and extension passive range of motion without reaching physiological end range in either direction of movement. This is repeated with the subject in left sidelying.

Pre-intervention, immediately following intervention, 15 min post-intervention & 30 min post-intervention

Subject will provide level of anterior knee pain via Visual Analogue Scale (VAS) while performing a single leg step down. The VAS pain scale is a 0 to 10 scale, 0 indicates no pain, 5 indicates distressing pain, 10 indicates unbearable pain. Any whole number between 0 and 10 may be chosen. 0 is better and 10 is worse.

Pre-intervention, immediately following intervention, 15 min post-intervention & 30 min post-intervention

Subject will provide level of anterior knee pain via Visual Analogue Scale (VAS) while performing a double leg squat. The VAS pain scale is a 0 to 10 scale, 0 indicates no pain, 5 indicates distressing pain, 10 indicates unbearable pain. Any whole number between 0 and 10 may be chosen. 0 is better and 10 is worse.

Pre-intervention, immediately following intervention, 15 min post-intervention & 30 min post-intervention

Subject will provide level of anterior knee pain via Visual Analogue Scale (VAS) while performing a drop jump from a 2 foot platform. The VAS pain scale is a 0 to 10 scale, 0 indicates no pain, 5 indicates distressing pain, 10 indicates unbearable pain. Any whole number between 0 and 10 may be chosen. 0 is better and 10 is worse.

Pre-intervention, immediately following intervention, 15 min post-intervention & 30 min post-intervention

Inclusion Criteria: Healthy males and females between the ages of 18 and 25 with non-traumatic anterior knee pain Able read and write in English Clearly understand the informed consent form Exclusion Criteria: Low back pain Pregnant or may be pregnant Previously diagnosed with spondylolisthesis, Previously diagnosed with a herniated disc, Signs and symptoms of nerve root compression History of spine surgery History of knee surgery History of cancer History of compression fracture History of osteoporosis History of osteopenia History of a systemic disease History of a connective tissue disease History of a neurological disease Pain with pre-manipulative hold Positive findings on medical history form, or physical exam Presence of anxiety during the procedure

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