Psychological Factors Are Associated With Lower Limb Kinematics During Uphill Walking and Running in Women With Patellofemoral Pain

BACKGROUND AND PURPOSE: Patellofemoral pain (PFP) is a common condition in women and is associated with high recurrence rates. Kinematic alterations are among the factors that may persist even after muscle strengthening programs. Given the multifactorial nature of PFP, non-mechanical factors, such as kinesiophobia, may be related to the movement patterns adopted by this population. This study aimed to investigate the associations between kinesiophobia, pain-related factors, and lower limb kinematics during uphill walking and treadmill running in women with PFP. METHODS: This was a cross-sectional study. Data were collected from 22 young women (24.0 ± 5.87 years) with PFP. Anthropometric data were collected, and participants completed the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Numerical Rating Scale for pain. Subsequently, kinematics of the affected lower limb was analyzed during uphill walking and treadmill running. The angles of knee flexion, hip flexion, ankle dorsiflexion, knee valgus, and pelvic tilt were calculated. Pearson's correlation coefficient was used for statistical analysis, with the significance level set at p < 0.05. RESULTS: Significant negative correlations were observed between knee flexion angle and kinesiophobia (r = -0.381, p = 0.040) as well as pain catastrophizing (r = -0.482, p = 0.023) during uphill walking. During treadmill running, stronger negative correlations were found between knee flexion angle and both kinesiophobia (r = -0.694, p = 0.008) and pain catastrophizing (r = -0.972, p = 0.008). No significant correlations were observed for the other joint angles analyzed. DISCUSSION: The findings of this study indicate that higher levels of kinesiophobia and pain catastrophizing are associated with reduced knee flexion during uphill walking and treadmill running in women with PFP. Rather than suggesting a causal effect, these results highlight a meaningful relationship between psychological factors and movement patterns during functional activities. Reduced knee flexion may reflect a protective or avoidance strategy commonly observed in individuals with elevated fear of movement or maladaptive pain-related beliefs. Clinically, these associations underscore the importance of considering psychological factors during assessment and rehabilitation, as they may be related to altered movement strategies and functional performance in individuals with knee pain.