Original article
Posterolateral Hip Muscle Strengthening Versus Quadriceps Strengthening for Patellofemoral Pain: A Comparative Control Trial

https://doi.org/10.1016/j.apmr.2013.12.022Get rights and content

Abstract

Objective

To compare the efficacy of posterolateral hip muscle strengthening versus quadriceps strengthening in reducing pain and improving health status in persons with patellofemoral pain (PFP).

Design

Comparative control trial.

Setting

Rehabilitation facility.

Participants

Persons with a diagnosis of PFP (N=36; 18 men, 18 women).

Interventions

Patients were alternately assigned to a posterolateral hip muscle strengthening group (9 men and 9 women) or a quadriceps strengthening group (9 men and 9 women). The posterolateral hip muscle strengthening group performed hip abductor and external rotator strengthening exercises, whereas the quadriceps strengthening group performed quadriceps strengthening exercises (3 times a week for 8wk).

Main Outcome Measures

Pain (visual analog scale [VAS]) and health status (Western Ontario McMaster Universities Osteoarthritis Index [WOMAC]) were assessed at baseline, postintervention, and 6-month follow-up.

Results

Significant improvements in VAS and WOMAC scores were observed in both groups from baseline to postintervention and baseline to 6-month follow-up (P<.001). Improvements in VAS and WOMAC scores in the posterolateral hip exercise group were superior to those in the quadriceps exercise group postintervention and at 6-month follow-up (P<.05).

Conclusions

Although both intervention programs resulted in decreased pain and improved function in persons with PFP, outcomes in the posterolateral hip exercise group were superior to the quadriceps exercise group. The superior outcomes obtained in the posterolateral hip exercise group were maintained 6 months postintervention.

Section snippets

Methods

Screening for specific inclusion and exclusion criteria was performed by 2 physicians. Only subjects with a diagnosis of unilateral or bilateral PFP were included. The diagnosis of PFP was based on symptom location (peripatellar and/or retropatellar) and reproduction of pain with activities commonly associated with this condition (eg, stair decent, squatting, kneeling, prolonged sitting). Patients were screened by physical examination to rule out ligamentous laxity, meniscal injury, pes

Results

At baseline, demographic characteristics, VAS scores, and WOMAC scores were comparable between groups (see table 1). Patients in both groups were moderately to severely impaired with respect to pain intensity and health status. All subjects completed the postintervention and 6-month follow-up assessments. On average, patients assigned to the posterolateral hip exercise group attended 22.4 supervised exercise sessions, whereas subjects assigned to the quadriceps exercise group attended 22.1

Discussion

Historically, the etiology of PFP has been attributed to impairments in quadriceps muscle performance.4, 5, 6, 7 As such, strengthening the quadriceps muscles has been widely advocated as the treatment of choice for PFP.8 Over the last decade, there has been an emergence of research suggesting that PFP may have proximal origins. In particular, excessive hip adduction and internal rotation has been reported to contribute to abnormal patellofemoral joint loading.17, 18 Furthermore, recent

Conclusions

An 8-week program of posterolateral hip muscle strengthening was more effective in improving pain and health status in persons with PFP than a quadriceps strengthening program. The observed improvements were maintained at 6-month follow-up. Our results support the use of hip strengthening as a viable rehabilitation approach for persons with PFP.

Suppliers

  • a.

    Hygenic Corp, 1245 Home Ave, Akron, OH 44310.

  • b.

    IBM Corp, 1 New Orchard Rd, Armonk, NY 10504.

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