Effects of Functional
Stabilization Training on Pain, Function, and Lower Extremity Biomechanics in
Females with Patellofemoral Pain: A Randomized Clinical Trial.

RD, Serrao FV, Silva RS, Piva SR. J Ortho Sports Phys Ther. 2014 Feb 25. [Epub
ahead of print]

Take Home Message: A rehabilitation program that uses hip and
trunk strengthening with verbal feedback and proper instruction during rehab
provided greater pain reduction, improved strength, and improved squatting
mechanics compared with a standard rehabilitation program that was focused on
quadriceps strengthening.

Patellofemoral Pain Syndrome (PFPS)
is a common knee pathology that is often challenging for clinicians because
there are many contributing factors. Clinicians have started to focus on proximal
strengthening for patients with PFPS but there is limited evidence about whether
these programs influence lower extremity biomechanics.  If these programs improve lower extremity
biomechanics then it may help explain how proximal strengthening programs
influence pain and suggest that these programs may modify an important risk
factor for PFPS.  Therefore, Baldon and
colleagues compared two rehabilitation programs among female individuals with
PFPS to assess changes in pain, Lower Extremity Functional Scale, Global Rating
of Change, single-leg triple hop distance, muscle strength, muscle endurance,
and single-leg squat kinematics.  The authors randomized 31 females with PFPS into two 8-week treatment groups: 1) a
standard rehabilitation program that focused on quadriceps strengthening or 2) a
functional stabilization program, which included hip and trunk strengthening
exercises as well as verbal cues during lower extremity and trunk movements. Both
groups improved in pain immediately after the intervention and at a 3-month
follow up compared with prior to treatment; however, those in the functional
stabilization program had greater improvements in pain.  Both groups also had improvements in the Lower
Extremity Functional Scale score immediately following the intervention and at
the 3-month follow up.  More participants
in the functional stabilization group (14 out of 14 participants) perceived
themselves as moderately better at the end of the intervention compared with
participants in the standard rehabilitation program (12 out of 16 participants).  Those in the functional stabilization group
also had better hopping distance, trunk endurance, and eccentric hip abductor
and knee flexor strength. Individuals in the functional stabilization group
also had improved biomechanics during a single-leg squat immediately after the
intervention. For example, increased hip flexion and decreased ipsilateral
trunk inclination, contralateral pelvis depression, hip adduction, and knee

findings show the value of using a functional stabilization program compared with
just quadriceps strengthening programs for individuals with PFPS.  The authors demonstrated that the functional
stabilization program and not the standard rehabilitation program influenced a
participant’s single-leg squat biomechanics. Patients with PFPS perform
functional tasks with more hip adducted, knee abducted, and ipsilateral trunk
inclination, which may place more pressure on the lateral patellofemoral
joint.  Since the functional
stabilization program modified these mechanics it might indicate that trunk and
gluteus medius strengthening with proper verbal cures can modify movement
patterns and minimize pain and stress placed on the patellofemoral joint. What
is unclear from this study is which component of the stabilization program is
beneficial for improving biomechanical assessment; gluteus medius strengthening,
trunk strengthening, verbal cues during exercise or a combination of the three?
Future research needs to continue to examine functional deficits in the PFPS
population, find the most effective components for a rehabilitation program,
and how we can individualize programs. Overall, this study supports the use of
functional stabilization programs over standard rehabilitation programs because
it provided greater pain relief and improved biomechanics, which may decrease
the high levels of recurrent rates for individuals experiencing PFPS (up to 91%)

Question for
Do you
currently use hip strengthening with your patients who have PFPS?  How have your long-term outcomes faired with
this rehabilitation approach?

by: Neal Glaviano
by: Jeffrey Driban


Baldon RD, Serrão FV, Silva RS, & Piva SR (2014). Effects of Functional Stabilization Training on Pain, Function, and Lower Extremity Biomechanics in Females With Patellofemoral Pain: A Randomized Clinical Trial. The Journal of Orthopaedic and Sports Physical Therapy PMID: 24568258