Kinematic and Coordination Variability in Runners with and Without Patellofemoral Pain

Jessica A. Mutchler, Klarie Macias, Barry A. Munkasy, Samuel J. Wilson, John C. Garner, Li Li


Background: Patellofemoral pain (PFP) is a common overuse injury that has been suggested to cause abnormal gait kinematics and variability in runners with PFP. Conflicting results have been presented as to the variability of joint kinematics and joint coordination. Objective: The purpose of this study was to examine the variability of lower extremity kinematics and joint coordination in the presence of PFP and exertion. Methods: Six female runners with PFP and matched controls (CON) ran at a self-selected pace on an instrumented treadmill until exertion or pain criteria was met. Sixteen anatomical retroreflective markers and seven tracking clusters were placed on the participants’ lower extremities. Data collected for 20 steps from the beginning, middle, and end of the run were processed. Kinematic variability was assessed for each participant by calculating the standard deviation (SD) of peak knee flexion, internal rotation, and adduction angle and their velocities. Continuous relative phase (CRP) mean values were calculated from normalized phase plots for coordination relationships between knee horizontal plane motion and hip sagittal, frontal, and horizontal and ankle frontal plane motion. Coordination variability was calculated as the CRP coupling SD over 100% of stance for each time point for each participant. Statistical comparisons were assessed through a 2 (PFP vs. CON) x 3 (beginning, middle, end) repeated measures ANOVA. Results: There was an increase in variability for peak knee adduction angle, peak knee adduction velocity, hip flexion/knee rotation CRP, and knee rotation/rearfoot eversion CRP over time for the PFP group compared with CON (P<0.05). Conclusion: Pain and exertion increase the variability of joint kinematics and joint coordination reflecting decreased movement control towards the end of a run.


Physical Exertion, Joint Instability, Knee Joint, Running, Patellofemoral Joint, Female

Full Text:



Abbasi, A., Yazdanbakhsh, F., Tazji, M. K., Aghaei, P., Svoda, Z., Nazarpour, K., & Vieira, M. F. (2020). A comparison of coordination and its variability in lower extremity segments during treadmill and overground running at different speeds. Gait & posture, 79, 139-144 doi: 10.1016/j.gaitpost.2020.04.022

Barton, C. J., Levinger, P., Menz, H. B., & Webster, K. E. (2009). Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait & posture, 30(4), 405-416. doi: 10.1016/j.gaitpost.2009.07.109

Borg, G. (1998). Borg's perceived exertion and pain scales. Champaign (IL): Human Kinetics.

doi: 10.1097/00005768-199809000-00018

Cohen, J. (2013). Statistical power analysis for the behavioral sciences. (2nd ed.). New York: Routledge. doi: 10.4324/9780203771587

Crossley, K. M., Bennell, K. L., Cowan, S. M., & Green, S. (2004). Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Archives of physical medicine and rehabilitation, 85(5), 815-822. doi: 10.1016/S0003-9993(03)00613-0

Crossley, K. M., Callaghan, M. J., & van Linschoten, R. (2016). Patellofemoral pain. British journal of sports medicine, 50(4), 247-250. doi: 10.1136/bjsports-2015-h3939rep

Dierks, T. A., Davis, I. S., & Hamill, J. (2010). The effects of running in an exerted state on lower extremity kinematics and joint timing. Journal of biomechanics, 43(15), 2993-2998. doi: 10.1016/j.jbiomech.2010.07.001

Dierks, T. A., Manal, K. T., Hamill, J., & Davis, I. (2011). Lower extremity kinematics in runners with patellofemoral pain during a prolonged run. Medicine & Science in Sports & Exercise, 43(4), 693-700. doi: 10.1249/MSS.0b013e3181f744f5

Emamvirdi, M., Letafatkar, A., & Khaleghi Tazji, M. (2019). The effect of valgus control instruction exercises on pain, strength, and functionality in active females with patellofemoral pain syndrome. Sports health, 11(3), 223-237. doi: 10.1177/1941738119837622

Glaviano, N. R., Kew, M., Hart, J. M., & Saliba, S. (2015). Demographic and epidemiological trends in patellofemoral pain. International journal of sports physical therapy, 10(3), 281.

Hafer, J. F., Brown, A. M., & Boyer, K. A. (2017). Exertion and pain do not alter coordination variability in runners with iliotibial band syndrome. Clinical Biomechanics, 47(Aug), 73-78. doi: 10.1016/j.clinbiomech.2017.06.006

Hamill, J., Haddad, J. M., Heiderscheit, B. C., Emmerik, R., & Li, L. (2006). Clinical relevance of variability in coordination. In K. Davids, S. Bennett & K. Newell (Eds), Movement system variability (pp. 153-165). doi: 10.5040/

Hamill, J., van Emmerik, R. E., Heiderscheit, B. C., & Li, L. (1999). A dynamical systems approach to lower extremity running injuries. Clinical Biomechanics, 14(5), 297-308. doi: 10.1016/S0268-0033(98)90092-4

Kannus, P., Aho, H., Järvinen, M., & Nttymäki, S. (1987). Computerized recording of visits to an outpatient sports clinic. The American Journal of Sports Medicine, 15(1), 79-85. doi: 10.1177%2F036354658701500112

Koblbauer, I. F., van Schooten, K. S., Verhagen, E. A., & van Dieën, J. H. (2014). Kinematic changes during running-induced fatigue and relations with core endurance in novice runners. Journal of Science and Medicine in Sport, 17(4), 419-424. doi: 10.1016/j.jsams.2013.05.013

Kujala, U. M., Jaakkola, L. H., Koskinen, S. K., Taimela, S., Hurme, M., & Nelimarkka, O. (1993). Scoring of patellofemoral disorders. Arthroscopy, 9(2), 159-163. doi: 10.1016/S0749-8063(05)80366-4

Li, L. (2011). Motion and variability control during prolonged running with patellofemoral pain. Medicine and science in sports and exercise, 43(10), 2013; author reply 2014. doi: 10.1249/mss.0b013e3182297e21

Noehren, B., Pohl, M. B., Sanchez, Z., Cunningham, T., & Lattermann, C. (2012). Proximal and distal kinematics in female runners with patellofemoral pain. Clinical Biomechanics, 27(4), 366-371. doi: 10.1016/j.clinbiomech.2011.10.005

Noehren, B., Sanchez, Z., Cunningham, T., & McKeon, P. O. (2012). The effect of pain on hip and knee kinematics during running in females with chronic patellofemoral pain. Gait & posture, 36(3), 596-599. doi: 10.1016/j.gaitpost.2012.05.023

Powers, C. M., Bolgla, L. A., Callaghan, M. J., Collins, N., & Sheehan, F. T. (2012). Patellofemoral pain: proximal, distal, and local factors—second international research retreat, August 31–September 2, 2011, Ghent, belgium. Journal of orthopaedic & sports physical therapy, 42(6), A1-A54. doi: 10.2519/jospt.2012.0301

Schwane, B. G., Goerger, B. M., Goto, S., Blackburn, J. T., Aguilar, A. J., & Padua, D. A. (2015). Trunk and lower extremity kinematics during stair descent in women with or without patellofemoral pain. Journal of athletic training, 50(7), 704-712. doi: 10.4085/1062-6050-49.3.100

Silvernail, J. F., Boyer, K., Rohr, E., Brüggemann, G.-P., & Hamill, J. (2015). Running mechanics and variability with aging. Medicine & Science in Sports & Exercise, 47(10), 2175-2180. doi: 10.1249/MSS.0000000000000633

Stergiou, N., Harbourne, R. T., & Cavanaugh, J. T. (2006). Optimal movement variability: a new theoretical perspective for neurologic physical therapy. Journal of Neurologic Physical Therapy, 30(3), 120-129. doi: 10.1097/01.NPT.0000281949.48193.d9

Van Middelkoop, M., Van Linschoten, R., Berger, M. Y., Koes, B. W., & Bierma-Zeinstra, S. M. (2008). Knee complaints seen in general practice: active sport participants versus non-sport participants. BMC musculoskeletal disorders, 9(1), 36. doi: 10.1186/1471-2474-9-36

Wallace, D. A., Salem, G. J., Salinas, R., & Powers, C. M. (2002). Patellofemoral joint kinetics while squatting with and without an external load. journal of orthopaedic & sports physical therapy, 32(4), 141-148. doi: 10.2519/jospt.2002.32.4.141

Weinhandl, J. T., Joshi, M., & O’Connor, K. M. (2010). Gender comparisons between unilateral and bilateral landings. Journal of applied biomechanics, 26(4), 444-453. doi: 10.1123/jab.26.4.444

Wier, L., Ayers, G., Jackson, A., Rossum, A., Poston, W. C., & Foreyt, J. (2001). Determining the amount of physical activity needed for long-term weight control. International journal of obesity, 25(5), 613-621. doi: 10.1038/sj.ijo.0801586

Willson, J. D., & Davis, I. S. (2008). Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clinical Biomechanics, 23(2), 203-211. doi: 10.1016/j.clinbiomech.2007.08.025

Wood, L., Muller, S., & Peat, G. (2011). The epidemiology of patellofemoral disorders in adulthood: a review of routine general practice morbidity recording. Primary health care research & development, 12(2), 157-164. doi: 10.1017/S1463423610000460



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.

International Journal of Kinesiology and Sports Science

You may require to add the '' domain to your e-mail 'safe list’ If you do not receive e-mail in your 'inbox'. Otherwise, you may check your 'Spam mail' or 'junk mail' folders.