Do Trunk & Leg Position Effect Patellofemoral Joint Stress During the Forward Lunge?

Background

The forward lunge is a common lower extremity exercise prescribed in both the fitness as well as rehab setting. While variables such as trunk and leg position affect the force (or stress) placed on the lower extremity (e.g. at the patellofemoral joint – PFJ), MOST research has been performed with respect to the lead (or forward) limb. Knowing how trunk AND leg position affects loading at the PFJ is important because overuse/overloading has been shown to be a causative factor of PFJ pain.

Study Objective

To describe patellofemoral joint (PFJ) forces on lead AND trail limbs during 3 variations of the forward lunge exercise

Methods

PFJ forces were measured for 18 persons (5 females, 13 males) who performed the forward lunge with either:

  • A vertical trunk AND vertical lead limb (VV)
  • A flexed trunk AND vertical lead limb (FV)
  • A flexed trunk AND flexed lead limb (FF)

Results

 The following study found that PFJ forces (affecting the trail limb) are GREATEST with a vertical trunk AND vertical lead limb followed by a flexed trunk AND vertical lead limb. While PFJ forces (affecting the trail limb) were LOWEST with a flexed trunk AND flexed lead limb, it should be kept in consideration that this condition produced the GREATEST PFJ forces on the lead limb.

Week 11 Review ✔️Do trunk AND leg positions affect patellofemoral joint (PFJ) forces while performing the forward lunge exercise?———————————————————— As mentioned Monday, the forward lunge is one of the most commonly utilized exercises 🏋 in both fitness and rehab settings. One concern 😳with the lunge is preventing excessive forces on the knee. The most common cue to prevent this is to ❌NOT let the knee go past the toe when lunging on the lead limb, BUT little attention is paid to preventing those same excessive forces on the trail limb. 🤔 . The following study showed that there are actually ⬆️GREATER patellofemoral joint (PFJ) forces on the trail limb when… 1️⃣ The trunk AND leg were kept vertical . 2️⃣ The trunk was flexed forward AND the leg was kept vertical . This tells us that it is just as important (if not more important) to be mindful of the forces on the trail limb 😲. Consequently, when designing an exercise program that involves the forward lunge, variation as to trunk AND leg position SHOULD be kept in mind to prevent overuse / overloading at the PFJ of BOTH the lead AND trial limb. 👍———————————————————— ‼️REMEMBER‼️ • The following information is NOT medical advice. If you are in ANY pain, see your local physical therapist by visiting www.MoveForwardPT.com———————————————————— ‼️TAG SOMEONE WHO NEEDS TO TRAIN LEGS‼️

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Take Home Message & Practical Application

One concern with the forward lunge is preventing excessive forces on the lead limb. The most common cue to prevent this is to not let the knee go past the toe when lunging on the forward limb, BUT little attention is paid to preventing those same excessive forces on the trail limb. The following study demonstrated that PFJ forces vary based on trunk AND forward leg position. Thus, when designing an exercise program that involves the forward lunge, variation as to trunk and leg position SHOULD be kept in mind to prevent overuse/overloading at the PFJ of both the lead and trail limb. To wrap things up, let’s take a look at what those variations look like as well as ways to progress the forward lunge exercise!

Week 11 Application ———————————————————— 🏋Lunge Variation Review . As seen Wednesday, Patellofemoral Joint (PFJ) forces vary based on trunk / front leg position during the 🏋forward lunge. In the 1st half of this video, we wanted to highlight what those positions look like as well as note important force considerations during each variation to help prevent overuse / overloading at the PFJ. 👍 . 1️⃣VV – vertical trunk / vertical front leg • Back Leg – when PFJ forces are greatest . 2️⃣FV – flexed trunk / vertical front leg • Front Leg – when PFJ forces are lowest . 3️⃣FF – flexed trunk / flexed front leg • Front Leg – when PFJ forces are greatest . • Back Leg – when PFJ forces are lowest———————————————————— 🏋Forward Lunge with Pallof Press . 1️⃣Begin standing w/ft slightly less than shoulder width apart w/resistance (i.e. cable or band) at pec level . 2️⃣Press the resistance away ➡️from your chest / MAINTAIN this extended position throughout the ENTIRE exercise ❗The pallof press adds variation to the fundamental movement of the lunge by imposing an anti-rotational demand. To resist the band's pull, Mike has to engage his obliques, rectus / transverse abdominis, paraspinals, and multifidus to dynamically maintain core stability . ❗Extending your arms throughout creates a longer lever arm, which in turn creates more torque to ultimately challenge stability MORE than performing a pallof press at the bottom of the lunge . 3️⃣Step up / over AND then descend in a controlled manner (until your back knee nearly touches the ground) ❗Do ❌NOT let your forward knee collapse AND make sure to maintain a neutral trunk throughout . 4️⃣Pause at the bottom AND then drive through your front heel (to raise back up)———————————————————— ‼️REMEMBER‼️ • The following information is NOT medical advice. If you are in ANY pain, see your local physical therapist by visiting www.MoveForwardPT.com———————————————————— ‼️TAG & COMMENT BELOW‼️

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References

  1. Hofmann et al (2017). Trunk / Shank Position Influences Patellofemoral Joint Stress in the Lead / Trail Limbs During the Forward Lunge Exercise. Journal of Orthopedic & Sports Physical Therapy, 47, 31 – 40.

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