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Coupling Angle Variability in Healthy and Patellofemoral Pain Runners
Clinical Biomechanics (2014)
  • Tommy J. Cunningham
  • David R. Mullineaux
  • Brian Noehren, University of Kentucky
  • Robert Shapiro, University of Kentucky
  • Timothy L Uhl, University of Kentucky


Patellofemoral pain is hypothesized to result in less joint coordination variability. The ability to relate coordination variability to patellofemoral pain pathology could have many clinical uses; however, evidence to support its clinical application is lacking. The aim was to determine if vector coding's coupling angle variability, as a measure of joint coordination variability, was less for runners with patellofemoral pain than healthy controls as is commonly postulated.


Nineteen female recreational runners with patellofemoral pain and eleven healthy controls performed a treadmill acclimation protocol then ran at a self-selected pace for 15 min. 3-D kinematics, force plate kinetics, knee pain and rating of perceived exertion were recorded each minute. Data were selected for the: pain group at the highest pain reached (pain = 3/10) in a non-exerted state (exertion < 14/20), and; non-exerted healthy group from the eleventh minute. Coupling angle variability was calculated over several portions of the stride for six knee–ankle combinations during five non-consecutive strides.


46 of 48 coupling angle variability measures were greater for the pain group, with 7 significantly greater (P < .05).


These findings oppose the theory that less coupling angle variability is indicative of a pathological coordinate state during running. Greater coupling angle variability may be characteristic of patellofemoral pain in female treadmill running when a larger threshold of pain is reached than previously observed. A predictable and directional response of coupling angle variability measures in relation to knee pathology is not yet clear and requires further investigation prior to considerations for clinical utility.

  • Vector coding,
  • Gait,
  • Kinematics,
  • Dynamical systems,
  • Running
Publication Date
March, 2014
Citation Information
Tommy J. Cunningham, David R. Mullineaux, Brian Noehren, Robert Shapiro, et al.. "Coupling Angle Variability in Healthy and Patellofemoral Pain Runners" Clinical Biomechanics Vol. 29 Iss. 3 (2014)
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