Exploring the Link Between Spinopelvic Alignment, Pain, Disability, and Dynamic knee valgus in Women with Patellofemoral Pain Syndrome

To investigate if there is any association between spinal measurements (lumbar lordosis, sacral slope, and pelvic tilt) and pain level, functional disability, and dynamic knee valgus in women with PFPS.

This was a cross-sectional study involving seventy-five women diagnosed with PEPS, with a mean age of 34±5.82. Clinically, participants were chosen with patellofemoral pain during the previous week with a minimum score of 3 on a 10-point numerical pain scale (NPR).The measurements used in the study included lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) measured by radiographic parameters (X-ray), pain level assessment using the Numeric Pain Rating Scale (NPRS), assessment of knee dysfunction by the Arabic Anterior Knee Pain Scale (AAKP/Kujala), and dynamic knee valgus by measurement of 2D Frontal Plane Projection Angle (2D-FPPA). Spearman correlation analysis was conducted to evaluate the relationship between these parameters.

The findings of this study revealed a strong positive correlation between lumbar lordosis (LL) and both pain levels and frontal plane projection angle (FPPA), with correlation coefficients of r = 0.72 and r = 0.82, respectively (p = 0.01). Similarly, sacral slope (SS) was strongly correlated with pain levels (r = 0.92) and FPPA (r = 0.78). Pelvic tilt (PT) showed a moderate positive correlation with pain levels (r = 0.62) and FPPA (r = 0.72). However, there was a weak negative correlation between LL, SS, and PT and functional disability scores, with r values of -0.40, -0.39, and p = 0.02. These results indicate that LL, SS, and PT are significantly associated with pain levels, functional disability, and frontal plane projection angle in women with PFPS.

This study identified significant correlations between spinopelvic alignment parameters—lumbar lordosis, sacral slope, and pelvic tilt and pain levels, functional disability, and dynamic knee valgus in women with patellofemoral pain syndrome (PFPS). The findings suggest that abnormalities in spinopelvic alignment are strongly associated with increased pain and altered knee mechanics, particularly dynamic knee valgus. These spinal alignments should be considered in clinical evaluation of knee-related disorders associated with PFPS.

It is recommended to assess spinal measurements during evaluation and rehabilitation of the patients that suffer from persistence of symptoms after traditional rehabilitation programs. This can eventually confirm the concept previously stated as knee-spine syndrome.