To compare the efficacy of posterolateral hip muscle strengthening versus quadriceps strengthening in reducing pain and improving health status in persons with patellofemoral pain (PFP).
Comparative control trial.
Persons with a diagnosis of PFP (N=36; 18 men, 18 women).
Patients were alternately assigned to a posterolateral hip muscle strengthening group (9 men and 9 women) or a quadriceps strengthening group (9 men and 9 women). The posterolateral hip muscle strengthening group performed hip abductor and external rotator strengthening exercises, whereas the quadriceps strengthening group performed quadriceps strengthening exercises (3 times a week for 8wk).
Main Outcome Measures
Pain (visual analog scale [VAS]) and health status (Western Ontario McMaster Universities Osteoarthritis Index [WOMAC]) were assessed at baseline, postintervention, and 6-month follow-up.
Significant improvements in VAS and WOMAC scores were observed in both groups from baseline to postintervention and baseline to 6-month follow-up (P<.001). Improvements in VAS and WOMAC scores in the posterolateral hip exercise group were superior to those in the quadriceps exercise group postintervention and at 6-month follow-up (P<.05).
Although both intervention programs resulted in decreased pain and improved function in persons with PFP, outcomes in the posterolateral hip exercise group were superior to the quadriceps exercise group. The superior outcomes obtained in the posterolateral hip exercise group were maintained 6 months postintervention.
List of abbreviations:ANOVA (analysis of variance), PFP (patellofemoral pain), VAS (visual analog scale), WOMAC (Western Ontario McMaster Universities Osteoarthritis Index)
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- The incidence of overuse injuries in military recruits during basic military training.Mil Med. 1994; 159: 421-426
- Musculoskeletal disorders in physically active conscripts: a one-year follow-up study in the Finnish Defence Forces.BMC Musculoskelet Disord. 2009; 10: 89
- A retrospective case-control analysis of 2002 running injuries.Br J Sports Med. 2002; 36: 95-101
- An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial.J Bone Joint Surg [Am]. 1999; 81: 355-363
- Electromyography of the quadriceps in patellofemoral pain with patellar subluxation.Clin Orthop Relat Res. 2003 Oct; : 261-271
- Which factors predict the long-term outcome in chronic patellofemoral pain syndrome? A 7-yr prospective follow-up study.Med Sci Sports Exerc. 1998; 30: 1572-1577
- Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study.Am J Sports Med. 2000; 28: 480-489
- The evolution of rehabilitation for patellofemoral joint dysfunction.J Orthop Sports Phys Ther. 1993; 33: 637-638
- Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening.Man Ther. 2009; 14: 252-263
- An electromyographic study of the vastii muscles during open and closed kinetic chain submaximal isometric exercises.Int J Sports Phys Ther. 2012; 7: 617-626
- The VMO: VL activation ratio while squatting with hip adduction is influenced by the choice of recording electrode.J Electromyogr Kinesiol. 2013; 23: 443-447
- The effects of quadriceps strengthening on pain, function, and patellofemoral joint contact area in persons with patellofemoral pain.Am J Phys Med Rehabil. 2012; 91: 98-106
- The effect of exercise regimens on reflex response time of the vasti muscles in patients with anterior knee pain: a prospective randomized intervention study.Scand J Med Sci Sports. 2003; 13: 251-258
- Open versus closed kinetic chain exercises for patellofemoral pain. A prospective, randomized study.Am J Sports Med. 2000; 28: 687-694
- Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial.J Orthop Sports Phys Ther. 2010; 40: 736-742
- Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up.J Orthop Sports Phys Ther. 2012; 42: 823-830
- Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study.J Orthop Sports Phys Ther. 2003; 33: 677-685
- Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis.J Orthop Sports Phys Ther. 2010; 40: 277-285
- Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain.J Orthop Sports Phys Ther. 2009; 39: 12-19
- Predictors of hip internal rotation during running: an evaluation of hip strength and femoral structure in women with and without patellofemoral pain.Am J Sports Med. 2009; 37: 579-587
- Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome.J Orthop Sports Phys Ther. 2012; 42: 491-501
- Eccentric hip muscle function in females with and without patellofemoral pain syndrome.J Athl Train. 2009; 44: 490-496
- Frontal plane biomechanics in males and females with and without patellofemoral pain.Med Sci Sports Exerc. 2012; 44: 1747-1755
- Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial.J Orthop Sport Phys Ther. 2011; 41: 560-570
- The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial.J Orthop Sports Phys Ther. 2012; 42: 22-29
- The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study.Clin Rehabil. 2008; 22: 1051-1060
- Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?.Arch Phys Med Rehabil. 2004; 85: 815-822
- The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties.Arthritis Rheum. 2001; 45: 453-461
- Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.J Rheumatol. 1988; 15: 1833-1840
- A self-administered pain severity scale for patellofemoral pain syndrome.Clin Rehabil. 2002; 16: 780-788
- A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome.Am J Sports Med. 2011; 39: 154-163
- Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement.Osteoarthritis Cartilage. 2007; 15: 273-280
- Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports.J Orthop Sports Phys Ther. 2003; 33: 647-660
- The influence of abnormal hip mechanics on knee injury: a biomechanical perspective.J Orthop Sports Phys Ther. 2010; 40: 42-51
- The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective.J Orthop Sports Phys Ther. 2003; 33: 639-646
- Hip strength in females with and without patellofemoral pain.J Orthop Sports Phys Ther. 2003; 33: 671-676
- Females with patellofemoral pain syndrome have weak hip muscles: a systematic review.Aust J Physiother. 2009; 55: 9-15
- Induced anterior knee pain immediately reduces involuntary and voluntary quadriceps activation.Clin J Sport Med. 2013; 23: 19-24
- Neuromuscular activity and knee kinematics in adolescents with patellofemoral pain.Med Sci Sports Exerc. 2013; 45: 1730-1739
- Biomechanical considerations in patellofemoral joint rehabilitation.Am J Sports Med. 1993; 21: 438-444
Published online: January 21, 2014
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