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J Sci Med Sport. 2017 Apr;20(4):362-367. doi: 10.1016/j.jsams.2016.09.004. Epub 2016 Nov 11.

Local and widespread hyperalgesia in female runners with patellofemoral pain are influenced by running volume.

Author information

Physical Therapy Department, University of São Paulo State, School of Science and Technology, Brazil.
School of Allied Health, College of Science, Health and Engineering, La Trobe University, Australia; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.
Physical Therapy Department, University of São Paulo State, School of Science and Technology, Brazil. Electronic address:



To compare pressure pain threshold (PPT) around the knee (local hyperalgesia) and at a site remote to the knee (widespread hyperalgesia) between female runners with and without patellofemoral pain (PFP); and to evaluate the relationship between running volume, self-reported knee function and PPT measures.


Cross-sectional study.


Twenty female runners with PFP and twenty pain-free female runners participated in the study. PPTs were measured using a handheld pressure algometer at four sites in the patellar region: quadriceps tendon, medial patella, lateral patella and patellar tendon; and on the contralateral upper limb. Additionally, all participants were asked to report their average weekly running volume in a typical month and answer the anterior knee pain scale (AKPS) questionnaire.


For all sites, female runners with PFP presented lower PPT measures in comparison with control group (P<0.017). There were negative correlations between AKPS and running volume (ρ=-0.88; P<0.001) and between all PPTs and the running volume in the PFP group with correlation (ρ) values ranging between -0.46 and -0.70 (P<0.022). There were positive correlations between all PPTs and AKPS with correlation (ρ) value from 0.50 to 0.69 (P<0.030).


Lower PPTs locally and remote to the knee in female runners with PFP indicate the presence of local and widespread hyperalgesia. Additionally, this hyperalgesia, which is related to self-reported knee function, appears to be increased by greater running volumes. Development and evaluation of non-mechanical interventions for the management of running-related PFP in females may be needed to address this apparent hyperalgesia.


Anterior knee pain; Athlete; Hyperalgesia secondary; Knee; Pain; Patellofemoral joint

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