Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome

Abstract

Study Design Controlled laboratory study using a cross-sectional design. Objectives To determine whether there are any differences between the sexes in trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during the performance of a single-leg squat in individuals with patellofemoral pain syndrome (PFPS) and control participants. Background Though there is a greater incidence of PFPS in females, PFPS is also quite common in males. Trunk kinematics may affect hip and knee function; however, there is a lack of studies of the influence of the trunk in individuals with PFPS. Methods Eighty subjects were distributed into 4 groups: females with PFPS, female controls, males with PFPS, and male controls. Trunk, pelvis, hip, and knee kinematics and gluteal muscle activation were evaluated during a single-leg squat. Hip abduction and external rotation eccentric strength was measured on an isokinetic dynamometer. Group differences were assessed using a 2-way multivariate analysis of variance (sex by PFPS status). Results Compared to controls, subjects with PFPS had greater ipsilateral trunk lean (mean ± SD, 9.3° ± 5.3° versus 6.7° ± 3.0°; P = .012), contralateral pelvic drop (10.3° ± 4.7° versus 7.4° ± 3.8°; P = .003), hip adduction (14.8° ± 7.8° versus 10.8° ± 5.6°; P<.0001), and knee abduction (9.2° ± 5.0° versus 5.8° ± 3.4°; P<.0001) when performing a single-leg squat. Subjects with PFPS also had 18% less hip abduction and 17% less hip external rotation strength. Compared to female controls, females with PFPS had more hip internal rotation (P<.05) and less muscle activation of the gluteus medius (P = .017) during the single-leg squat. Conclusion Despite many similarities in findings for males and females with PFPS, there may be specific sex differences that warrant consideration in future studies and when clinically evaluating and treating females with PFPS. J Orthop Sports Phys Ther 2012;42(6):491–501, Epub 8 March 2012. doi:10.2519/jospt.2012.3987

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

“…Additionally, it has been shown that there are gender specific differences in hip abduction strength (Brent et al,2013;Ramskov et al, 2014), gluteal activation (Nakagawa et al, 2012) and trunk and lower limb kinematics (Nakagawa et al, 2012, Willy et al, 2012a in both the normal and PFP population. There have been shown to be differences in hip strength deficits in males and females in PFP (Rathleff et al, 2014) suggesting that rehabilitation and future research trials should be gender specific.…”

“…However, evidence demonstrating that reduced muscle strength is accompanied by altered hip kinematics in PFP is conflicting, with some studies showing an association between a reduction in muscle strength with altered kinematics (Boling and Padua, 2013;Souza and Powers, 2009;Nakagawa et al, 2012) and others that there is not (Willson et al, 2008). There is delayed onset and shorter activation of gluteus medius in adults with PFP (Barton et al, 2013) and some evidence to show that altered gluteal muscle activation patterns accompanies altered hip kinematics in PFP (Souza and Powers 2009;Nakagawa et al, 2012).…”

“…There is delayed onset and shorter activation of gluteus medius in adults with PFP (Barton et al, 2013) and some evidence to show that altered gluteal muscle activation patterns accompanies altered hip kinematics in PFP (Souza and Powers 2009;Nakagawa et al, 2012). It follows that both strength and neuromuscular exercises of the gluteal muscles may be important factors to include in the management of PFP.…”

Effectiveness of Routine Physical Therapy with and Without Pain Release Phenomenon in Patello-Femoral Pain Syndrome

“…This study was a trial to investigate not only the available evidence for physical interventions for Patellofemoral pain syndrome , and also to see the effective approach. (13,14) Fukuda et al ,2010 conducted a randomized controlled trial for the treatment of PFPS, in this study hip strengthening exercises and knee strengthening exercises were done. Combined effect of both exercises was found to be effective during a treatment session of 4 weeks.…”

Relação do valgo dinâmico do joelho com a força muscular do quadril e tronco em indivíduos com síndrome patelofemoral

“…Outro estudo prospectivo (113) Durante atividades dinâmicas, movimentos anormais ou instabilidade do tronco podem refletir em estratégias compensatórias dos membros inferiores (13) . A fraqueza dos músculos abdutores pode levar a um deslocamento ipsilateral do tronco em atividades unipodais, esta estratégia compensatória transfere o centro de massa corporal para o centro da articulação do quadril, diminuindo a sobrecarga sobre os abdutores do quadril (13,114) .…”