Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial

Abstract

Background: Exercise for patellofemoral pain (PFP) is traditionally knee focused, targeting quadriceps muscles. In recent years, hip-focused exercise has gained popularity. Patient education is likely an important factor but is underresearched. Purpose: To compare 3 treatment methods for PFP, each combined with patient education: hip-focused exercise, knee-focused exercise, or free physical activity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A single-blind randomized controlled trial was performed with 112 patients who were 16 to 40 years old (mean, 27.6 years) and had a symptom duration >3 months (mean, 39 months) with a clinical diagnosis of PFP and no radiograph or magnetic resonance evidence of other pathology. Patients were randomized to a 6-week intervention consisting of patient education combined with isolated hip-focused exercise (n = 39), traditional knee-focused exercise (n = 37), or free physical activity (n = 36). The primary outcome was Anterior Knee Pain Scale (0-100) at 3 months. Secondary outcomes were visual analog scale for pain, Tampa Scale for Kinesiophobia, Knee Self-efficacy Scale, EuroQol, step-down, and isometric strength. Results: There were no between-group differences in any primary or secondary outcomes at 3 months except for hip abduction strength and knee extension strength. Between-group differences at 3 months for Anterior Knee Pain Scale were as follows: knee versus control, 0.2 (95% CI, –5.5 to 6.0); hip versus control, 1.0 (95% CI, –4.6 to 6.6); and hip versus knee, 0.8 (95% CI, –4.8 to 6.4). The whole cohort of patients improved for all outcomes at 3 months except for knee extension strength. Conclusion: The authors found no difference in short-term effectiveness in combining patient education with knee-focused exercise, hip-focused exercise, or free training for patients with PFP. Registration: NCT02114294 (ClinicalTrials.gov identifier).

Patellofemoral pain: One year results of a randomized trial comparing hip exercise, knee exercise, or free activity

“…Recruitment took place between September 2014 and September 2017. The full‐trial protocol and 3‐month results have been published previously …”

“…Patients’ expectations about the effectiveness of each intervention were assessed at baseline (Table ). Statistical analysis was performed blinded for the 3 month results . As the blinding was opened in order to complete the 3‐month manuscript, a blinded analysis was not possible for the current report of 12‐month outcomes.…”

“…Initial dosage was three sets of 10 repetitions for each exercise, progressing to a maximum three sets of 20 repetitions. Additional resistance thereafter was achieved through weights or elastic tubing depending on the exercise (see ) . Dosage was adjusted individually such that the last repetitions were difficult while still maintaining high movement quality throughout the entire program.…”

“…We have previously reported no significant differences in short‐term effectiveness of isolated hip exercise to traditional knee exercise or a control group performing free physical activity in PFP . Long‐term outcomes within PFP are of special interest, as newer surveys suggest higher degrees of chronicity in PFP than has previously been appreciated .…”

“…Long‐term outcomes within PFP are of special interest, as newer surveys suggest higher degrees of chronicity in PFP than has previously been appreciated . The goal of the present study was therefore to assess the long‐term effectiveness of isolated hip exercises, traditional knee exercise, or free physical activity, through an extended follow‐up of a randomized trial for which the 3‐month results are previously reported …”