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BackgroundDynamic knee valgus and internal femoral rotation are proposed to be contributory risk factors for patellofemoral pain and anterior cruciate ligament injuries. Multimodal interventions including hip abductor strengthening or functional motor control programmes have a positive impact of pain, however their effect on knee kinematics and muscle strength is less clear. The aim of this study was to examine the effect of isolated hip abductor strengthening and a functional motor control exercise on knee kinematics and hip abductor strength.MethodsThis prospective, randomised, repeated measures design included 29 asymptomatic volunteers presenting with increase knee valgus and femoral internal rotation. Participants completed either isolated hip abductor strengthening or a functional motor control exercise for 5 weeks. Knee kinematics were measured using inertial sensors during 2 functional activities and hip abductor strength measured using a load cell during isometric hip abduction.ResultsThere were no significant differences in dynamic knee valgus and internal rotation following the isolated hip abductor or functional motor control intervention, and no significant differences between the groups for knee angles. Despite this, the actual magnitude of reduction in valgus was 10° and 5° for the functional motor control group and strengthening group respectively. The actual magnitude of reduction in internal rotation was 9° and 18° for the functional motor control group and strengthening group respectively. Therefore there was a tendency towards clinically significant improvements in knee kinematics in both exercise groups. A statistically significant improvement in hip abductor strength was evident for the functional motor control group (27% increase; p = 0.008) and strengthening group (35% increase; p = 0.009) with no significant difference between the groups being identified (p = 0.475).ConclusionsIsolated hip strengthening and functional motor control exercises resulted in non-statistically significant changes in knee kinematics, however there was a clear trend towards clinically meaningful reductions in valgus and internal rotation. Both groups demonstrated similar significant gains in hip abductor strength suggesting either approach could be used to strengthen the hip abductors.

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It is considered that implementation of the biopsychosocial model (BPSM) within physiotherapy is affected by its lack of conceptual clarity. This concept analysis explores the meaning and offers conceptual transparency to the BPSM and expands upon its current conceptual framework for practice. Method: Literature was selected through a systematic search. The studies were analysed and the data themed following 'thematic analysis'. Results: From the seventeen articles included, five master themes and four subthemes were constructed. The master themes were: 'Bio-medical', 'Psychological', 'Social factors', 'Communication' and 'Individualised Care'. The subthemes were: 'Education', 'Cognitive', 'Behavioural', 'Occupational factors' and 'Therapeutic Alliance'. Conclusion: A contemporary visual representation of the BPSM is presented which represents a holistic, humanist perspective. 'Communication' scaffolds the framework and supports the exploration of the person's lifeworld through the 'therapeutic alliance'.