Core stability has an important role in injury prevention. Future study may reveal that differences in postural stability partially explain the gender bias among female athletes.

Study Design: Cross-sectional. Objectives: To determine if females with anterior knee pain are more likely to demonstrate hip abduction or external rotation weakness than a similar, asymptomatic, age-matched control group. Background: Diminished hip strength has been implicated as being contributory to lower-extremity malalignment and patellofemoral pain. The identification of reliable and consistent patterns of weakness in this population may assist health care professionals establish a more effective treatment plan. Methods and Measures: Hip abduction and external rotation isometric strength measurements were recorded for the injured side of 15 female subjects with patellofemoral joint pain (mean ± SD age, 15.7 ± 2.7 years; age range, 12-21 years). These were compared with strength measurements from the corresponding hip of 15 age-matched female control subjects (mean ± SD age, 15.7 ± 2.7 years; age range, 12-21 years). All strength measurements were made using hand-held dynamometers. Results: Subjects with patellofemoral pain demonstrated 26% less hip abduction strength (PϽ.001) and 36% less hip external rotation strength (PϽ.001) than similar age-matched controls. Conclusions:The results indicate that young women with patellofemoral pain are more likely to demonstrate weakness in hip abduction as well as external rotation than age-matched women who are not symptomatic. J Orthop Sports Phys Ther. 2003;33:671-676. Key Words: anterior knee pain, hip abduction, hip external rotation, knee, patella P atellofemoral joint pain (PFP) remains one of the most common orthopaedic complaints among adolescents and young adults, with reported incidence rates among athletes greater than 25%. 2,26,31,38 It has also been reported that females, as compared with their male counterparts, are significantly more likely to experience PFP. 9,35 Typically, patients complain of generalized retropatellar symptoms that present insidiously and tend to be exacerbated by prolonged sitting or repetitive weight-bearing activities over a flexed knee. Unfortunately for these individuals, this pain often becomes a chronic condition that may fail to respond to conservative measures. Willson, Joyner Sportsmedicine Institute, 601 Perimeter Dr., Suite 110, Lexington, Current literature suggests that, in the absence of direct trauma, the etiology of PFP is multifactorial. Factors related directly to the patellofemoral joint, including vastus medialis obliquus insufficiency, decreased hamstring, quadriceps, or iliotibial band flexibility, patella alta, and femoral anteversion, have received the most attention.

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Notch-view radiographs were obtained from 108 persons with anterior cruciate ligament (ACL) injuries (55 women, 53 men) and 186 with intact ACL (94 women, 92 men). Notch width, femur width, and notch width index were determined from each of the 294 radiographs. The notch was also categorized as either A-shaped or non-A-shaped. Intrarater and interrater reliability ranged from 0.82 to 0.99 for notch width and femur width, respectively. Reliability within and between raters for the classification of notch shape ranged from 0.80 to 1.0. Notch width was significantly influenced by a 10 degree change in knee angle when repeated radiographs were taken. Femur width was not affected by knee angle across this range. Analysis revealed a higher proportion of A-shaped notches among women than men. However, notch shape was not related to injury status. Results showed a smaller notch width and notch width index in ACL-injured patients regardless of notch shape or gender. A-shaped notches were smaller than non-A-shaped notches regardless of injury status or gender. Both notch width and notch width index were found to be significant indicators of ACL injury. Knowledge of the shape of the notch added no useful information in differentiating patients based on injury status. Thus, regardless of gender, individuals who possess smaller notch dimensions appear to be at greater risk of injury than individuals with larger notches.

These results suggest that the pattern of muscle activation during specific shoulder movements in patients with shoulder pain may be related to pathology. Future studies are needed to determine whether an imbalance in neuromuscular control is a factor contributing directly to shoulder dysfunction or whether such an imbalance is secondary to some pathology.