The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study

Nakagawa, Theresa Helissa; Muniz, Thiago Batista; Baldon, Rodrigo de Marche; Maciel, Carlos Dias; Reiff, Rodrigo Bezerra de Menezes; Serrão, Fábio Viadanna

doi:10.1177/0269215508095357

Cited by 188 publications

(254 citation statements)

References 31 publications

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“…3,23,44 Limited research on the efficacy of isolated hip strengthening has provided evidence of improvements in pain, function, and strength in this population. 31,34 The presence of multiple effective interventions creates a dilemma for clinicians treating patients with PFPS. It is unclear whether initial hip or quadriceps strengthening will better prepare patients for more functional lower extremity exercises, particularly if functional activities cannot be initiated immediately or are not initially tolerated in some patients.…”

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

170

223

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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: 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

170

223

View full text Add to dashboard Cite

show abstract

“…2,4,7,19,39,40 Thus hip strengthening is often advocated to improve hip mechanics, 26 with the intent of reducing the incidence of, or symptoms related to, PFPS. 4,15,19,27,28 Although it has been shown that these programs improve strength 3,23,28 and reduce or might prevent symptoms, 3,15,21,23,28 it is not clear whether strengthening the hip actually results in improvement of abnormal hip and knee mechanics during functional activities such as running and squatting. …”

mentioning

confidence: 99%

The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat

Willy

Davis

2011

Journal of Orthopaedic & Sports Physical Therapy

203

142

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Study Design Block randomized controlled trial. Objectives To investigate whether a strengthening and movement education program, targeting the hip abductors and hip external rotators, alters hip mechanics during running and during a single-leg squat. Background Abnormal movement patterns during running and single-leg squatting have been associated with a number of running-related injuries in females. Therapeutic interventions for these aberrant movement patterns typically include hip strengthening. While these strengthening programs have been shown to improve symptoms, it is unknown if the underlying mechanics during functional movements is altered. Methods Twenty healthy females with excessive hip adduction during running, as determined by instrumented gait analysis, were recruited. The runners were matched by age and running distance, and randomized to either a training group or a control group. The training group completed a hip strengthening and movement education program 3 times per week for 6 weeks in addition to single-leg squat training with neuromuscular reeducation consisting of mirror and verbal feedback on proper mechanics. The control group did not receive an intervention but maintained the current running distance. Using a handheld dynamometer and standard motion capture procedures, hip strength and running and single-leg squat mechanics were compared before and after the strengthening and movement education program. Results While hip abductor and external rotation strength increased significantly (P<.005) in the training group, there were no significant changes in hip or knee mechanics during running. However, during the single-leg squat, hip adduction, hip internal rotation, and contralateral pelvic drop all decreased significantly (P = .006, P = .006, and P = .02, respectively). The control group exhibited no changes in hip strength, nor in the single-leg squat or running mechanics at the conclusion of the 6-week study. Conclusion A training program that included hip strengthening and movement training specific to single-leg squatting did not alter running mechanics but did improve single-leg squat mechanics. These results suggest that hip strengthening and movement training, when not specific to running, do not alter abnormal running mechanics. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2011;41(9):625–632, Epub 12 July 2011. doi:10.2519/jospt.2011.3470

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“…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%

“…Step-up Wall-squat Nakagawa et al, 2008 Step-up Wall slide Additionside -ly OKC abd Forward lunge Addition side-ly OKC abd, pelvic drop…”

Section: Pelvic Drop Single Leg Deadliftmentioning

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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The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study

Cited by 188 publications

References 31 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

The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat

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

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