Posterolateral
Hip Muscle Strengthening verses Quadriceps Strengthening for Patellofemoral
Pain: A Comparative Control Trial
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
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.
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.
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.
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?
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
by: Nicole Cattano
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
Related Posts:
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
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!
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?
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.
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?
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???