Outcomes of a Weight-Bearing Rehabilitation Program for Patients Diagnosed With Patellofemoral Pain Syndrome

Boling, Michelle C.; Bolgla, Lori A.; Mattacola, Carl G.; Uhl, Timothy L.; Hosey, Robert G.

doi:10.1016/j.apmr.2006.07.264

Cited by 193 publications

(215 citation statements)

References 34 publications

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“…The inclusion criteria were that participants needed to exhibit or report (1) anterior or retropatellar knee pain during at least 2 of the activities of stair climbing, hopping, running, squatting, kneeling, and prolonged sitting, (2) an insidious onset of symptoms not related to trauma, (3) pain with compression of the patella, and (4) pain on palpation of patellar facets. 7 Participants were excluded if they had (1) symptoms present for less than 1 month, (2) self-reported other knee pathology, such as cartilage injury or ligamentous tear, (3) a history of knee surgery within the last year, (4) a self-reported history of patella dislocations or subluxations, and (5) any other concurrent significant injury affecting the lower-extremity. 7 All individuals who met these criteria and were willing to participate in the study read and signed a consent/assent form approved by the University of Kentucky Institutional Review Board.…”

Section: Participantsmentioning

confidence: 99%

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Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Clinical Trial

Dolak¹,

Silkman²,

McKeon³

et al. 2011

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Randomized clinical trial. Objectives To determine if females with patellofemoral pain syndrome (PFPS) who perform hip strengthening prior to functional exercises demonstrate greater improvements than females who perform quadriceps strengthening prior to the same functional exercises. Background Although PFPS has previously been attributed to quadriceps dysfunction, more recent research has linked this condition to impairment of the hip musculature. Lower extremity strengthening has been deemed an effective intervention. However, research has often examined weight-bearing exercises, making it unclear if increased strength in the hip, quadriceps, or both is beneficial. Methods Thirty-three females with PFPS performed either initial hip strengthening (hip group) or initial quadriceps strengthening (quad group) for 4 weeks, prior to 4 weeks of a similar program of functional weight-bearing exercises. Self-reported pain, function, and functional strength were measured. Isometric strength was assessed for hip abductors, external rotators, and knee extensors. A mixed-model analysis of variance was used to determine group differences over time. Results After 4 weeks, there was less mean ± SD pain in the hip group (2.4 ± 2.0) than in the quad group (4.1 ± 2.5) (P = .035). From baseline to 8 weeks, the hip group demonstrated a 21% increase (P<.001) in hip abductor strength, while that remained unchanged in the quad group. All participants demonstrated improved subjective function (P<.006), objective function (P<.001), and hip external rotator strength (P = .004) from baseline to testing at 8 weeks. Conclusion Both rehabilitation approaches improved function and reduced pain. For patients with PFPS, initial hip strengthening may allow an earlier dissipation of pain than exercises focused on the quadriceps. Level of Evidence Therapy, level 2b-. J Orthop Sports Phys Ther 2011;41(8):560–570. Epub 7 June 2011. doi:10.2519/jospt.2011.3499

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Section: Participantsmentioning

confidence: 99%

“…7,[12][13][14][15]22,39,40,42 However, few of these studies evaluated the efficacy of isolated quadriceps strengthening. Many published rehabilitation protocols target functional exercises in a weight-bearing position, which requires a contribution of both hip and quadriceps musculature.…”

Section: T T Conclusionmentioning

confidence: 99%

Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Clinical Trial

Dolak¹,

Silkman²,

McKeon³

et al. 2011

Journal of Orthopaedic & Sports Physical Therapy

Self Cite

169

223

View full text Add to dashboard Cite

show abstract

“…Their findings suggest that the anterior and posterior fibers are activated in the same manner and not in isolation. However, these results were derived from subjects with numerous musculoskeletal disorders 2,15,[25][26][27] . Therefore, this provides further evidence that rehabilitation programs aimed at increasing the strength and activation of hip muscles, such as the GM, are effective at reducing pain and disability and improving lower limb kinematics and athletic performance 2,5,27) .…”

Section: Discussionmentioning

confidence: 99%

EMG Analysis of Gluteus Medius Subdivisions during Modified Unilateral Biofeedback Exercises for the Lower Limbs

Heo

Yoo

et al. 2013

J Phys Ther Sci

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Abstract.[Purpose] The purpose of this study was to investigate the activation of subdivisions of the gluteus medius during modified unilateral weight-bearing exercises using a pressure-biofeedback unit in order to suggest the most effective exercise method.[Subjects] We recruited 15 healthy adult females with no pain in the gluteus medius and no other orthopedic problems in the lower limbs.[Methods] The enrolled individuals performed four modified unilateral biofeedback exercises: wall-press with adduction force, WP-ADD; wall-press with abduction force, WP-ABD; wall-squat with adduction force, WS-ADD; and wall-squat with abduction force.[Results] The anterior and middle fibers of the gluteus medius were highly activated during WP-ADD, and the posterior fiber of the gluteus medius was activated during WS-ABD.[Conclusion] These results suggest that weight-bearing exercises for gluteus medius strengthening should be more specific, and chosen based on the characteristics of each subdivision.

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“…All subjects were recruited by convenience sampling. Two studies used an asymptomatic control group (Boling et al, 2006;Ferber et al, 2011). Confounding factors were poorly addressed.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…www.casp-uk.net Beneficial effect of hip exercise in PFP Baldon et al, 2014Coppack et al, 2011Ferber et al, 2014Fukuda et al, 2010Fukuda et al, 2012Ismail et al,2013Nakagawa et al, 2008Dolak et al, 2011Khayambashi et al, 2012Avraham et al, 2007Boling et al, 2006Earl & Hoch 2011Ferber et al, 2011Khayambashi et al, 2014Lowry et al, 2008Mascal et al,2003Noehren et al .,2011Razheghi et al, 2010Tyler et al,2006Willy et al, 2012 No benefit of hip exercise in PFP Song et al, 2009 www.cebm.net/ocebm-levels-of-evidence…”

Section: Quality Assessmentmentioning

confidence: 99%

The outcome of hip exercise in patellofemoral pain: A systematic review

et al. 2016

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Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in clinical practice. Current evidence shows that there are hip strength deficits, delayed onset and shorter activation of gluteus medius in people with PFP. The aim of this review was to systematically review the literature to investigate the outcome of hip exercise in people with PFP.Method AMED, CINAHL, Cochrane, EMBASE, PEDro, Pubmed, Science direct and SPORTDiscus databases were searched from inception to November 2014 for RCTs, non-randomised studies and case studies. Two independent reviewers assessed each paper for inclusion and quality. ResultsTwenty one papers were identified;eighteen investigating strengthening exercise, two investigating the effect of neuromuscular exercise and one study investigated the effect of hip exercise for the prevention of PFP.Hip and knee strengthening programmes were shown to be equally effective. Limited evidence indicates that the addition of hip exercise to an exercise programme is beneficial. Limited evidence demonstrates that motor skill retraining in a participant group who displayed abnormal hip alignment in running improves pain. ConclusionThe evidence consistently demonstrated that both hip strengthening and neuromuscular exercise has a beneficial effect on pain and function in people with PFP. Strengthening exercise predominantly addressed abductor and external rotator muscle groups. 2 A consensus from PFP researchers for standardisation of methodology is recommended to enable meaningful comparison between trials.

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Outcomes of a Weight-Bearing Rehabilitation Program for Patients Diagnosed With Patellofemoral Pain Syndrome

Cited by 193 publications

References 34 publications

Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Clinical Trial

Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Clinical Trial

EMG Analysis of Gluteus Medius Subdivisions during Modified Unilateral Biofeedback Exercises for the Lower Limbs

The outcome of hip exercise in patellofemoral pain: A systematic review

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