Sports Medicine Research: In the Lab & In the Field: Hip Strengthening Better than Quads for Patellofemoral Pain (Sports Med Res)
Thursday, February 20, 2014

Hip Strengthening Better than Quads for Patellofemoral Pain

Posterolateral Hip Muscle Strengthening verses Quadriceps Strengthening for Patellofemoral Pain: A Comparative Control Trial

Khayambashi K, Fallah A, Movahedi A, Bagwell J, & Powers C. Archives of Physical Medicine and Rehabilitation. 2014 Published Online First December 28, 2013   doi:10.1016/j.ampr.2013.12.022

Take Home Message: Eight-week strengthening programs that address the posterolateral hip muscles or quadriceps improve patellofemoral pain for up to 6 months.  The outcomes were better for the posterolateral hip strengthening group. 

Patellofemoral pain (PFP) is often attributed to poor patella tracking, potentially caused by a quadriceps strength imbalance.  Conservative management often focuses on rehabilitation to strengthen the vastus medialis; however, poor patella tracking may also be a result of weak hip strength.  While several clinical trials support the use of quadriceps or hip strengthening very few studies have evaluated if one strengthening program may be more effective for patients with PFP. Therefore, the authors of this study directly compared the results of a quadriceps strengthening program to a posterolateral hip muscle strengthening program among 36 physically-inactive patients with chronic PFP who were alternately assigned to the groups by gender.  Each participant performed the 30 minute strengthening program 3 times per week for 8 weeks under supervision of a physical therapist.  Each program consisted of a warm up, two strengthening exercises, and a cool down. The authors assessed patient-reported outcomes with a visual analog scale for pain and a knee outcomes questionnaire (Western Ontario and McMaster Universities questionnaire) for knee pain, stiffness, and function.  The participants in both programs improved immediately following the program as well as at the 6-month follow up.  However, participants who performed the posterolateral hip strengthening reported better outcomes than the participants who did the quadriceps strengthening program.

Clinically, we see that simple strengthening programs may result in PFP improvements; however, this study added merit to the notion that hip strengthening may be the better intervention for PFP.  However, it is unclear if we could apply these findings to a physically active population because the authors recruited physically inactive patients.  Also, it may have been interesting to see a comparison between genders in PFP improvements since there were 9 patients of each gender in each strengthening program.  Finally, it would be interesting to see if the findings from the initial evaluation were related to how a participant responded. A patient may present with weak hip musculature or a larger Q angle and respond to one of the programs better than someone without this presentation.  It would be interesting to compare individualized intervention programs based on patient’s clinical presentations in comparison to standardized protocols that we see here.  Regardless, this study provides continued support for the use of quadriceps and more specifically hip strengthening for PFP.           

Questions for Discussion:  What intervention brings you the most success when dealing with PFP?  What are your thoughts about attempting to emphasize vastus medialis strengthening with knee rehabilitation?
    
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Khayambashi K, Fallah A, Movahedi A, Bagwell J, & Powers C (2014). Posterolateral Hip Muscle Strengthening verses Quadriceps Strengthening for Patellofemoral Pain: A Comparative Control Trial. Archives of Physical Medicine and Rehabilitation PMID: 24440362

5 comments:

Kaitlyn Grossman ATC said...

This is an interesting topic! I think it makes sense to not only look regionally, but globally as well. PFP is traditionally caused from poor patellar tracking; the thought strengthening the hips to decrease PFP brings up an interesting point. What if the PFP is coming from poor mechanics all together? It would make sense that hip strengthening would help decrease PFP when coupled with quad strengthening. If we work on the hips, it could help fix poor biomechanics of the lower extremity all together, thus decreasing PFP. Interesting evidence, would love to try this in an active population!

Nicole Cattano said...

Kaitlyn-I agree that this is exciting information and that the emphasis should be on addressing the entire kinetic chain. Have you or anyone else had any luck utilizing something like this in the population that you work with?

Courtney Flynn said...

This article is very helpful to better understanding and treating patellofemoral pain. I think that it would have been interesting to see the outcome of this study done in an athletic population rather than physically inactive group. I also wonder why the Q angle measurements of the participants were not included in the article and in the study.

Jeffrey Driban said...

Thanks for the comment Courtney. How do you think Q angle could influence the results of the study? Have you seen patients with larger Q angles responding less optimally to these types of programs?

Nicole Cattano said...

Thanks Courtney. I would have been interesting. Do you think that larger Q angles would have different outcomes? Or do you think that the intervention may have an effect on the Q angle, perhaps from a functional arch persepctive???

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