The Role of Hip Muscle Function in the Treatment of Patellofemoral Pain Syndrome

Tyler, Timothy F.; Nicholas, Stephen; Mullaney, Michael J.; McHugh, Malachy P.

doi:10.1177/0363546505281808

Cited by 165 publications

(162 citation statements)

References 32 publications

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“…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

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

“…These changes in quadriceps activation have been associated with symptomatic relief and successful outcomes on patients with PFPS. 29 Several investigators have suggested that proximal hip muscle weakness, particularly of the hip abductors and external rotators, may be associated with patellofemoral pain, 2,30 and Tyler et al 31 reported that improvements in hip flexor strength and flexibility were associated with symptomatic improvement in patients with PFPS. 31 The implication of the findings of these studies is that addressing MT combined with physical therapy on the full kinetic chain may be an important element in the successful rehabilitation of patients with PFPS.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Manual Therapy Combined With Physical Therapy in Treatment of Patellofemoral Pain Syndrome: Systematic Review

Espí-López

Arnal‐Gómez

Balasch-Bernat

et al. 2017

Journal of Chiropractic Medicine

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Objectives: The purpose of this study was to conduct a review of randomized controlled trials (RCTs) to determine the treatment effectiveness of the combination of manual therapy (MT) with other physical therapy techniques. Methods: Systematic searches of scientific literature were undertaken on PubMed and the Cochrane Library (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). The following terms were used: "patellofemoral pain syndrome," "physical therapy," "manual therapy," and "manipulation." RCTs that studied adults diagnosed with patellofemoral pain syndrome (PFPS) treated by MT and physical therapy approaches were included. The quality of the studies was assessed by the Jadad Scale. Results: Five RCTs with an acceptable methodological quality (Jadad ≥ 3) were selected. The studies indicated that MT combined with physical therapy has some effect on reducing pain and improving function in PFPS, especially when applied on the full kinetic chain and when strengthening hip and knee muscles. Conclusions: The different combinations of MT and physical therapy programs analyzed in this review suggest that giving more emphasis to proximal stabilization and full kinetic chain treatments in PFPS will help better alleviation of symptoms. (J Chiropr Med 2017;16:139-146)

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“…This factor is justified in that adequate dynamic control of the pelvis helps patients improve the mechanics of the patellofemoral joint (15).…”

Section: Discussionmentioning

confidence: 99%

“…There is no standard recommended treatment, although it is believed that conservative non-surgical approaches produce good results, with a resolution rate of up to 87% (5). Conventional treatment generally includes physiotherapy (14), strengthening the quadriceps, using a knee brace and taping, as well as soft tissue mobilization and stretching (15,16). In this respect, muscle strengthening aims to combat neuromuscular deficits, which include the quadriceps, vastus medialis oblique muscle, proximal muscle strength deficits, soft tissue tightness or abnormal knee alignment (17).…”

Section: Introductionmentioning

confidence: 99%

Effects of strength training on the treatment of patellofemoral pain syndrome - a meta-analysis of randomized controlled trials

et al. 2017

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Introduction: Palletofemoral pain syndrome (PFPS) is anterior knee pain that affects around 25% of the population at some point in their lives. Muscle weakness is one of the main causal factors related to PFPS. Objective: Conduct a quantitative analysis on the effectiveness of strength training at reducing pain in PFPS sufferers. Methods: An electronic search was conducted on the MEDLINE, Pubmed, EMBASE, Lilacs and Scielo databases for studies published between January 2005 and September 2014. The following descriptors were used: "patellofemoral pain syndrome", "patellofemoral pain", "retropatellar pain", "exercise", "exercise therapy", "strength", "rehabilitation". Only randomized controlled trials (RCTs) that compared the effects of strength training to no exercise in terms of reducing pain among PFPS sufferers were included. Data were extracted by two independent authors using predefined quality indicators. Results: A total of 39 RCTs were initially identified in the search. However, only five met the inclusion criteria. Strength training exhibited a positive effect on PFPS (SMD = 0.85, CI: 0.45-1.25). However, high heterogeneity was observed between the studies (p < 0.05; I 2 = 68.3%). Conclusion: Strength training showed a statistically positive response in the treatment of PFPS.

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The Role of Hip Muscle Function in the Treatment of Patellofemoral Pain Syndrome

Abstract: Improvements in hip flexion strength combined with increased iliotibial band and iliopsoas flexibility were associated with excellent results in patients with patellofemoral pain syndrome.

Cited by 165 publications

References 32 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

Effectiveness of Manual Therapy Combined With Physical Therapy in Treatment of Patellofemoral Pain Syndrome: Systematic Review

Effects of strength training on the treatment of patellofemoral pain syndrome - a meta-analysis of randomized controlled trials

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