Search Results (54)

Background/Objectives: Patellofemoral pain (PFP) is a persistent knee disorder that impacts quality of life (QoL). Although holistic assessments are needed, no specific tools exist regarding QoL in PFP. The Knee Quality of Life 26-item questionnaire (KQoL-26), covering physical and psychosocial dimensions, could be useful but has not been adapted for Spanish speakers. This study aimed to cross-culturally adapt KQoL-26 into Spanish and assess its psychometric properties regarding PFP, including validity and reliability. Methods: This cross-cultural adaptation followed COSMIN recommendations. The cultural and linguistic adaptation of KQoL-26 included 104 subjects with PFP, involving 145 affected knees. Inclusion criteria: symptomatic PFP, aged between 16 and 55, and being native Spanish speakers. Validity (structural, construct, and external), reliability (internal consistency, test–retest, and agreement), discriminant ability, and feasibility were assessed. Results: Factor Analysis identified five dimensions. Convergent validity demonstrated a strong correlation between KQoL-26 and Knee Injury and Osteoarthritis Outcome Score for Patellofemoral pain and osteoarthritis, Kujala Score, Fulkerson Scale, and the Physical Component Summary of 12-item Short Form, while weak correlations with descriptive data supported discriminant validity. The questionnaire demonstrated high internal consistency (Cronbach’s α = 0.949) and test–retest reliability (ICC = 0.949), with adequate agreement parameters. No floor or ceiling effects were observed. Regarding feasibility, KQoL-26 was understandable and completed by all participants. Conclusions: The Spanish KQoL-26 is a valid, reliable, and feasible QoL assessment tool for Spanish speakers with PFP. Its use may support both clinical decision-making and research in this population group by providing a comprehensive assessment of patient-reported outcomes. Full article

Objective: Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain and is associated with biomechanical, muscular, and functional impairments affecting the extensor mechanism of the knee. Quadriceps muscle dysfunction, altered tendon morphology, and impaired lower extremity biomechanics have been suggested to contribute to patellofemoral joint instability and pain development. The aim of this study was to evaluate the muscle and tendon thicknesses of the extensor mechanism using ultrasonography in individuals with PFPS and to investigate the relationship of these measurements with knee pain, knee function, and physical performance, with particular emphasis on the combined assessment of muscle morphology, tendon morphology, and functional performance parameters. Methods: This cross-sectional study was conducted between 5 November 2019 and 15 December 2019, including 80 individuals aged 18–45 years who presented with anterior knee pain and were clinically diagnosed with patellofemoral pain syndrome (PFPS). Demographic characteristics of the participants were collected. Pain severity was assessed using the Visual Analog Scale (VAS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Physical performance was assessed using the 6 m walk test and the five-repetition sit-to-stand test. Ultrasonographic examination was used to measure rectus femoris muscle thickness, vastus intermedius muscle thickness, quadriceps tendon thickness, and patellar tendon thickness using a high-frequency linear probe in a standardized supine position with the knee relaxed and the lower extremity muscles at rest. Results: The mean age of the participants was 32.11 ± 7.08 years, and the mean body mass index (BMI) was 25.05 ± 4.11 kg/m². Of the participants, 42 (52.5%) were male and 38 (47.5%) were female; 46 (57.5%) were smokers and 34 (42.5%) were non-smokers. Ultrasonographic measurements showed that rectus femoris muscle thickness was 1.98 ± 0.45 cm, vastus intermedius muscle thickness was 1.75 ± 0.53 cm, quadriceps tendon thickness was 0.54 ± 0.12 cm, and patellar tendon thickness was 0.35 ± 0.08 cm. Rectus femoris, vastus intermedius, and quadriceps tendon thicknesses were significantly higher in males compared to females (p = 0.001). Individuals with BMI > 25 had greater rectus femoris (p = 0.023) and vastus intermedius (p = 0.001) muscle thicknesses. A negative correlation was found between rectus femoris muscle thickness and WOMAC total (r = −0.227, p = 0.042) and WOMAC pain scores (r = −0.233, p = 0.028). Additionally, a significant relationship was observed between quadriceps tendon thickness and the five-repetition sit-to-stand test (r = −0.247, p = 0.044). Conclusions: In patients with PFPS, quadriceps muscle and tendon thicknesses were found to be associated with certain demographic and clinical parameters. Ultrasonographic evaluation of muscle and tendon structures may be a useful, non-invasive, dynamic, and radiation-free method for better understanding the clinical characteristics of PFPS and its relationship with physical performance. Ultrasonographic assessment may also provide complementary information for rehabilitation planning and functional evaluation in individuals with PFPS, although these findings should be interpreted cautiously because of the cross-sectional design and weak correlations observed. Full article

Background/Objectives: Patellar chondromalacia (PC) is a clinical condition characterized by early cartilage degeneration in the patellofemoral joint. This study aimed to investigate the relationship between the lateral-to-medial femoral condyle length ratio (LFCL/MFCL) measured on standard anteroposterior (AP) knee radiographs and the presence of PC. Methods: A retrospective analysis was conducted on patients who presented with anterior knee pain between 2020 and 2024. PC was diagnosed using magnetic resonance imaging (MRI). The LFCL/MFCL ratio was measured on plain radiographs. Additional morphological condylar parameters were evaluated on MRI. Symptom severity was assessed using the Kujala score. Statistical analyses included t-tests, correlation analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: A total of 100 patients (50 with PC, 50 controls) were included. The LFCL/MFCL ratio was significantly higher in the PC group compared to controls (1.24 ± 0.19 vs. 1.08 ± 0.15, p = 0.002). A negative correlation was found between the LFCL/MFCL ratio and Kujala score (r = −0.322, p = 0.029). Other MRI-based parameters did not show statistically significant differences. In logistic regression, the LFCL/MFCL ratio was identified as an independent predictor of PC (p = 0.01). ROC analysis yielded an AUC of 0.743 (95% CI: 0.643–0.842). Conclusions: The LFCL/MFCL ratio, which can be easily measured on plain radiographs, may serve as a simple, cost-effective, and reproducible parameter to aid in the diagnosis of patellar chondromalacia. Further prospective studies with larger sample sizes are needed to validate this finding. Full article

Background: Proximal lower-extremity muscle strengthening is an important conservative intervention for patellofemoral pain syndrome (PFPS), as these muscle groups play critical roles in femoral stabilization and knee valgus control. However, evidence remains limited regarding the effectiveness of muscle strengthening in improving lower-extremity axial alignment through modulation of femoral neck anteversion, femoral internal rotation, and tibial external rotation. Therefore, the present study aimed to determine whether a strengthening protocol targeting the quadriceps and hip external rotator and hip abductor muscles could improve knee alignment and reduce bone torsion in young adults with patellofemoral pain syndrome. Methods: This prospective interventional cohort study implemented a muscle strengthening protocol in ten university students with PFPS. Outcomes included femoral neck anteversion angle (FNA), tibial tubercle–trochlear groove distance (TT–TG), tibial external torsion angle (TET), and the knee Q-angle, assessed via 3D reconstruction of computed tomography (3D-CT) images. Pre- and post-intervention data were analyzed using the Shapiro-Wilk test for normality and repeated-measures ANOVA (p < 0.05; 95% confidence interval). Results: Muscle strengthening improved lower-limb axial alignment, with reductions observed across all measures post-intervention. Mean changes were 0.68 ± 1.26° for FNA (p = 0.0626); 1.51 ± 0.97 mm for TT–TG (p = 0.0001); 1.38 ± 3.36° for TET (p = 0.2231); and 1.14 ± 1.52° for the Q-angle. Statistically significant improvements were observed for TT–TG and the Q-angle. Conclusions: Proximal muscle strengthening improved knee valgus and axial lower-limb alignment, as evidenced by significant reductions in Q angle and TT–TG distance. Reductions in femoral neck anteversion (FNA) and tibial external torsion angle (TET) were observed. However, these differences were not statistically significant. These findings support muscle strengthening as a noninvasive strategy for improving lower-limb alignment in individuals with patellofemoral pain syndrome. Full article

Background: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder that involves various biomechanical factors, including the altered positioning of the patella, weakness of the lower extremity muscles, delayed activation of the vastus medialis muscle, and excessive pronation of the foot. Although the short- and long-term effects of external support among the recommended conservative treatment methods for PFPS have been examined, there remains a lack of consensus regarding their impacts. This study was conducted to investigate the immediate effects of braces and rigid taping applied to control pain on proprioception, functional status, and balance in patients with PFPS, and to compare these outcomes with normative values obtained from healthy individuals. Methods: The study included 18 patients with PFPS and 18 healthy individuals who met the inclusion criteria. Through randomization of the intervention sequence, patients were evaluated under conditions of rigid taping, support, or without any support. Their pain levels before and after the application were assessed using the Visual Analog Scale; their functional status was evaluated with the Kujala Patellofemoral Scoring, the 10-Step Up Test, and the Squat; their balance performance was measured using the Y-Balance Test and the Single Leg Stance Test; and their proprioception was assessed with the Joint Position Sense Test. Results: It has been determined that rigid taping and bracing have similar effects in the immediate management of pain, proprioception, functional status, and balance issues in patients with PFPS. The interventions were observed to bring patients’ static balance and proprioception parameters closer to the values seen in healthy individuals. Conclusions: Rigid taping and bracing are both effective interventions in the management of PFPS, offering benefits such as pain relief, prevention of proprioceptive deficits, mitigation of balance impairments, and enhancement of functional outcomes. The selection of the most appropriate modality should be based on the individual patient’s characteristics and tolerance levels. Full article

Objectives: The aim of this systematic review was to evaluate the effectiveness of photobiomodulation (PBM) on pain and function in individuals with Patellofemoral Pain Syndrome (PFPS). Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Search was performed across PubMed/Midline, Scopus, Web of Science, EBSCO, ScienceDirect, Wiley Online Library, Springer, Cochrane CENTRAL, PEDro, ResearchGate, and Google Scholar from inception to January 2025. Randomized controlled trials (RCT) examining PBM in individuals with PFPS were included. Data extraction, risk-of-bias assessment (RoB 2), and quality of evidence evaluation (GRADE) were performed independently by multiple reviewers. Primary and secondary outcomes were pain and function, respectively. A random effect meta-analysis was performed to estimate the standardized mean difference (SMD) at 95% confidence interval (CI) and overall effect size. Results: Eight trials (340 participants) met the inclusion criteria. PBM significantly reduced pain compared with the control (SMD = −0.83; 95% CI −1.40 to −0.27). Functional outcomes demonstrated a significant improvement favoring PBM (SMD = 0.68; 95% CI 0.08 to 1.27), although substantial heterogeneity was present (I² = 83%). RoB2 showed five high-risk studies. GRADE showed a very low quality of evidence due to study limitations, imprecision, and inconsistency which limit the confidence to the effect estimate. Conclusions: PBM, combined with exercise, provides improvements in pain and knee function in individuals with PFPS. While findings support PBM as an effective adjunct modality, standardized dosing protocols and larger, high-quality RCTs are needed to strengthen future clinical recommendations. Full article

Background: Physical exercise can improve certain musculoskeletal conditions, but adherence remains low due to intimidating environments, limited government support, and financial constraints faced by many individuals. Home-based exercise is a potential strategy to treat that population. Objective: Discuss the main home-based resistance exercise protocols that have been studied and implemented for six highly prevalent musculoskeletal disorders. Methods: A narrative literature review was conducted, using the PubMed database to search for six highly prevalent musculoskeletal conditions: shoulder impingement syndrome (SIS), nonspecific low back pain (NSLBP), greater trochanteric pain syndrome (GTPS), knee osteoarthritis (OA), patellofemoral pain syndrome (PFPS), and Achilles tendinopathy (AT). The strategy included the listed pathologies and the keywords “physical exercise” or “physiotherapy”. Clinical trials, reviews, and retrospective studies from the last 30 years published in English, Portuguese, or Spanish were included. Only studies with sufficient details on the training protocols used and outcome measures were included in the analysis. Results: In SIS, exercise protocols have been more effective in the long term than in the short term. In PFPS and GTPS, strengthening the quadriceps and hip muscles helps reduce pain and improve function. For NSLBP, exercises like Pilates and core training demonstrate pain relief. In knee osteoarthritis, physical exercise improves pain, function, and quality of life both immediately and over time. Eccentric training promotes type I collagen formation in the tendons of patients with Achilles tendinopathy. Conclusions: Home-based resistance exercises studied and implemented in this review offer several general health benefits, including pain reduction, improved functionality, increased muscle strength, and enhanced motor control. Full article

Background and Objectives: Infrapatellar fat pad impingement syndrome (IFPIS) is a relatively underdiagnosed cause of anterior knee pain. While conservative management is the initial approach, some patients require surgical intervention. This study aimed to evaluate the long-term clinical and radiologic outcomes following arthroscopic resection of the infrapatellar fat pad in patients with IFPIS. Materials and Methods: Eighteen patients (10 females, 8 males; median age 22) diagnosed with IFPIS and unresponsive to conservative therapy underwent arthroscopic partial or subtotal resection between 2007 and 2013. Diagnosis was based on physical examination (Hoffa’s test), MRI findings, and response to lidocaine injection. Clinical outcomes (VAS, IKDC-2000, Kujala, Lysholm, Tegner activity scores) and radiologic assessments (ISR, CDI, PFJ osteoarthritis grade) were evaluated preoperatively, at 2 years, and at a final follow-up (mean 148.7 months). Results: All clinical scores significantly improved postoperatively. VAS decreased from 7.25 ± 0.79 to 2.43 ± 1.50 at 2 years, and to 3.66 ± 1.50 at the final follow-up (p < 0.001). Similar long-term improvements were observed in the Kujala, IKDC-2000, Lysholm, and Tegner scores (all p < 0.001). Radiographic parameters including ISR and CDI remained stable, and there was no statistically significant progression in patellofemoral osteoarthritis. However, 5 of 18 patients (27.8%) reported persistent symptoms at long-term follow-up. Conclusions: Arthroscopic resection of the infrapatellar fat pad in patients with IFPIS showed favorable and sustained clinical outcomes over a 10-year follow-up, without significant radiological changes. These results suggest that arthroscopic resection is a viable treatment option when accurate diagnosis is established. Full article

Background/Objectives: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition that causes anterior knee pain, often linked to increased joint stress. Rehabilitation typically includes education, strength training, and functional exercises. Recently, telerehabilitation has become a promising alternative, particularly useful in improving access to care in rural areas. This study compares the effects of supervised (SE), web-based (WBE), and self-guided (SGE) exercise programs on pain, functionality, and fear of movement (kinesiophobia) in individuals with PFPS. Materials and Methods: Sixty female patients with PFPS participated in this randomized controlled trial. They were randomly assigned to one of three groups: SE, WBE, or SGE. Each program lasted six weeks, with exercises adjusted based on individual tolerance. Outcomes were assessed using the Kujala Anterior Knee Pain Scale, the visual analog scale (VAS) for pain, the Timed Up and Go Test (TUG) for mobility, and the Tampa Kinesiophobia Scale. Results: All groups showed significant improvements in pain, functionality, and kinesiophobia (p < 0.05). The SE group achieved the greatest improvements across all measures, reducing pain and kinesiophobia while enhancing functionality (p < 0.017). The WBE group also showed significant improvements, outperforming the SGE group in all outcomes (p < 0.017). The SGE group demonstrated the least improvement but still achieved positive changes. Conclusions: Supervised exercise programs were the most effective in managing PFPS symptoms. However, the web-based programs also provided substantial benefits, making them a viable option when in-person supervision is not feasible. Future research should aim to enhance digital interventions for broader accessibility and engagement. Trial Registration: The study protocol was also registered on ClinicalTrials.gov (NCT06625086). Full article

Background/Objectives: Optimal activation of the quadriceps femoris, particularly the vastus medialis, while minimizing excessive activation of the vastus lateralis, is crucial for treating knee injuries like ACL ruptures and patellofemoral pain syndrome. Restoring proper muscle balance may enhance rehabilitation outcomes, but effective strategies for modulating muscle activity remain unclear. High-velocity low-amplitude hip manipulation has shown potential to influence neuromuscular function, yet its impact on quadriceps activation during knee extension has not been well studied. Therefore, the main aim of this study is to examine the effects of a single session of high-velocity low-amplitude hip manipulation on quadriceps femoris muscle activation and maximum voluntary contraction during knee extension. Methods: This study utilizes a randomized controlled design. Thirty physically active men and women (mean age: 21.9 ± 1.7 years) were randomly assigned to either an experimental group (n = 15; receiving hip joint manipulation) or a control group (n = 15; undergoing a sham intervention). Participants in the intervention group received a treatment involving hip manipulation and short-duration traction. Muscle activity of the rectus femoris, vastus lateralis, and vastus medialis was assessed using surface electromyography before and after the intervention, while muscle performance was measured by evaluating isometric knee extension strength in the lower limb. The isometric strength test was conducted in a seated position with the knee flexed at 60 degrees in Biodex System 4. Results: This study finds that the experimental group had significantly higher vastus lateralis mean amplitude (p = 0.020; effect size = 0.186) and vastus medialis mean amplitude (p < 0.001; effect size = 0.577) of electromyography root mean square electromyography compared to the control group. The experimental group also showed greater vastus medialis max amplitude (p < 0.001; effect size = 0.435). No significant differences were noted for rectus femoris mean amplitude (p = 0.078; effect size = 0.110), vastus lateralis max amplitude (p = 0.363; effect size = 0.031), rectus femoris max amplitude (p = 0.069; effect size = 0.117), or median frequency of the raw electromyography signal across muscle groups. Conclusions: In conclusion, high-velocity low-amplitude hip manipulation significantly enhances vastus medialis activation, highlighting its potential to improve quadriceps balance. These findings support the incorporation of hip manipulation into rehabilitation protocols. Full article

Background: This observational study investigates the efficacy of combining local muscle vibration (LMV) therapy and kinesiotaping using the McConnell method (KMcCM) in patients with patellofemoral pain syndrome (PFPS). PFPS is a prevalent knee condition characterized by anterior or medial knee pain exacerbated by activities that overload the patellofemoral joint. Objective: The primary aim of this study was to evaluate the effectiveness of LMV combined with KMcCM in reducing pain and improving function in PFPS patients. Methods: A total of 52 participants, aged 25–85, with PFPS were included. Participants underwent LMV and KMcCM treatments three times weekly for three weeks. Pain and function were assessed using the Visual Analog Scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline (T0) and six months post-treatment (T1). Radiological assessments of patellar alignment and biomechanics were also conducted through dynamic MRI. Results: Significant pain reduction and functional improvements were observed across all age groups. Notably, younger participants showed greater improvement compared to older participants. Among women, those in the younger age group experienced more substantial reductions in VAS scores compared to their older counterparts. KOOS scores improved significantly, indicating enhanced knee function overall. A significant decrease in VAS scores from T0 to T1 was observed across all patellar alignment groups, signifying a reduction in pain levels. However, Group 2 (Laxation and Subluxation) experienced the most substantial reduction in VAS scores at T1 compared to the other groups. These results suggest that the combination of LMV and KMcCM may be particularly effective in addressing biomechanical abnormalities associated with patellar maltracking and enhancing VMO muscle contraction, leading to more substantial improvements in these patients. Conclusions: The combination of LMV and KMcCM demonstrates promising efficacy in reducing pain and improving knee function in PFPS patients, with age and gender influencing treatment outcomes. The most significant improvements were observed in younger individuals and those with specific patellar alignment issues, highlighting the potential of this combined approach for the targeted treatment of PFPS. Full article

Patellar pathologies are a common cause of knee dysfunction, with Patellofemoral Pain Syndrome (PFPS) alone responsible for 25% of knee-related visits to sports medicine clinics. Non-traumatic conditions, while often overlooked, can also lead to significant discomfort and functional limitations, highlighting the importance of accurate and timely diagnosis for effective management and prevention of complications. This pictorial review examines the radiologic characteristics of various non-traumatic patellar disorders, focusing on imaging modalities such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Key diagnostic markers, including patellar tilt, tibial tuberosity–trochlear groove distance (TT-TG), and congruence angle (CA), are discussed for their significance in non-traumatic pathology identification. Furthermore, this review highlights specific radiologic features for a range of non-traumatic patellar conditions, including patellar tendinopathy, chondromalacia patellae, and trochlear dysplasia, emphasizing how distinct radiologic findings facilitate precise diagnosis and clinical assessment. Ultimately, it provides a practical guide for clinicians in diagnosing non-traumatic patellar pathologies through a comprehensive review of key radiologic features while also discussing advancements in imaging technologies and management strategies to support accurate diagnosis and effective clinical decision-making. Full article

Patellofemoral pain syndrome (PFPS) ranks among the most prevalent factors causing anterior knee pain. Quadriceps exercises such as forward lunges are important to treat PFPS. Aim: We investigated whether there is a difference in muscle activity between the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles and the center of pressure (CoP) among three hip positions, namely, hip adduction forward lunge (HADF), hip neutral forward lunge (HNEF), and hip abduction forward lunge (HABF), in healthy subjects. Method: This was a randomized controlled pilot study that included twenty healthy (age: 23.7 ± 2.51) volunteers. The CoP was measured using a “Wii Balance Board” from Nintendo, and VMO and VL muscle activity were measured via wireless surface electromyography. Results: The CoP outcomes showed significant differences among the three positions in terms of position (p < 0.001), sum distance (p < 0.001), range (p < 0.001), and max distance (p < 0.001). VMO (p < 0.000), and VL (p < 0.005) muscle activity and the ratio of VMO/VL (p < 0.000) significantly differed among the three positions. Conclusions: Although VMO and VL muscle activity increased in the HADF and HABF, excessive changes in the CoP occurred in the two positions. The change in the CoP during the HADF and HABF may result in valgus, varus, and loading of the knee joint, which may worsen PFPS. The HNEF is recommended for quadriceps strengthening in healthy subjects and PFPS patients. Full article

Background: Patellofemoral pain syndrome is a condition with an increasing incidence in recent years, being known as the most common cause of knee pain in adults and adolescents. Undiagnosed and untreated, this condition can worsen over time. The aggravation leads to an increase in the intensity of the pain and the risk of injury, along with an increase in stress on the other joints of the lower limb. The objective of this study was to evaluate the contribution of shockwave therapy to a functional rehabilitation programme for patients with patellofemoral pain syndrome. Materials and Methods: The study was carried out on a group of 64 subjects (32 males and 32 females), aged between 20 and 39 years. The subjects were divided into two groups: 32 subjects who followed a program of functional rehabilitation based on low- and medium-frequency electrotherapy, ultrasound and laser therapy, along with a physical therapy program lasting approximately 3 weeks, and 32 subjects who followed a functional rehabilitation program based on shockwave therapy and specific physical therapy exercises lasting approximately 3 weeks. Results: Following the protocols applied to the two groups, the pain reported by the patients decreased, while the functional parameters of the knee improved, better results being obtained in the group that performed shock wave therapy together with specific physical therapy programs (Cohen Index 5916, p < 0.001). Conclusions: This study indicates that radial shockwave therapy combined with physiotherapy may provide additional benefits for patellofemoral syndrome, including greater pain reduction and improved joint mobility, compared to traditional treatments. However, further research is needed to confirm these findings and their broader clinical applicability. Full article

Background: Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting. The purpose of this study was to compare the lower limb biomechanical differences during anticipated and unanticipated side-cutting in athletes with PFPS. Methods: Fifteen male basketball players diagnosed with PFPS were enrolled in the study. Participants executed both anticipated and unanticipated 45-degree side-cutting tasks. Motion analysis systems, force plates, and electromyography (EMG) were used to assess the lower limb joint angles, joint moments, joint stiffness, and patellofemoral joint contact forces. Analyzed biomechanical data were used to compare the differences between the two circumstances. Results: Unanticipated side-cutting resulted in significantly increased ankle plantarflexion and dorsiflexion angles, knee abduction and internal rotation angles, and hip abduction angles, as well as heightened knee adduction moments. Additionally, patellofemoral joint contact forces and stress increased, while contact area decreased during unanticipated tasks. Conclusions: Unanticipated movement raises the demands for joint stability and neuromuscular control, increasing injury risks in athletes with PFPS. These findings have practical implications for developing targeted rehabilitation programs and injury prevention strategies. Full article