Efficacy of posterolateral hip muscles strengthening on patellofemoral pain
Keywords:Patellofemoral pain, Quadriceps strengthening, Posterolateral hip strengthening, VAS, WOMAC index
Background: Patellofemoral pain syndrome (PFPS) is a syndrome characterized by pain or discomfort seemingly originating from the contact of the posterior surface of the patella (back of the kneecap) with the femur (thigh bone). Moderate evidence supports the addition of hip abductor and external rotator strengthening, as well as exercises targeting hip flexion and hip extension.
Methods: 30 patients were taken from OPD of Department of Orthopedics, Guru Gobind Singh Medical College and Hospital, OPD of University College of Physiotherapy, Faridkot, Punjab, India. The patients were divided into two groups (15 patients each group). Group A was treated with quadriceps strengthening, Group B were treated with quadriceps strengthening with posterolateral hip strengthening (hip abductors and external rotators). Total treatment duration was 4 weeks. Both the groups were assessed for Pain (visual analog scale [VAS]) and health status (Western Ontario McMaster Universities Osteoarthritis Index [WOMAC]). Follow up was done on 2nd and 4th week.
Results: Significant improvements in VAS and WOMAC scores were observed in both groups from 0th-week to 2nd week and 0-week to 4th-week follow-up (P<0.05). Improvements in VAS and WOMAC scores in group B were superior to those in group A at 4-week follow-up (P<0.05).
Conclusions: The present study has concluded that both Group A and Group B were effective in the management of patello-femoral pain but statistically it was concluded that Group B is more effective as compared to Group A.
Bolgla LA, Boling MC. An update for the conservative management of patellofemoral pain syndrome a systematic review of the literature from 2000 to 2010. Int J Sports Phys Ther. 2011;6(2):112-25.
Callaghan MJ, Oldham JA. Quadriceps atrophy: To what extent does it exist in patellofemoral pain syndrome. Br J Sports Med. 2004;38:295-9.
Clement DB, Taunton JE, Smart GW, McNicol KL. A survey of overuse running injuries. Physician Sportsmed. 1981;9:47-58.
Collins NJ, Bisset LM, Crossley KM, Vicenzino B. Efficacy of nonsurgical interventions for anterior knee pain, systematic review and meta-analysis of randomized trials. Sports Med. 2012;42(1):31-49.
Devereaux M, Luchmann S. Patellofemoral arthralgia in athletes attending a sports injury clinic. Br. J. Sports Med. 1984;18:18-21.
Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. American Family Physician. 2007;75:195-201.
Dolak KL, Silkman C, McKeon JM, Hosey RG, Lattermann C. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome a randomized clinical trial. J Orthop Sport Phys Ther. 2011;41:560-70.
Fukuda TY, Melo WP, Zaffalon BM. Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up. J Orthop Sports Phys Ther. 2012;42(10):823-30.
Garrick JG. ‘Anterior knee pain chondromalacia patella. Physician Sports med. 1989;17:75-84.
Khayambashi K, Fallah A, Movahedi A, Bagwell J, Powers C. Posterolateral Hip Muscle Strengthening Versus Quadriceps Strengthening for Patellofemoral Pain A Comparative Control Trial. Archives of Physical Medicine and Rehabilitation. 2014;95:900-7.
Dolak KL, Silkman C, Medina McKeon J, Hosey RG, Lattermann C, Uhl TL. Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome A Randomized Clinical Trial. 2011;41(8):560-70.
Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002;36:95-101.
Witvrouw E, Lysens R, Bellemans J, Peers K, Vanderstraeten G. Open versus closed kinetic chain exercises for patellofemoral pain A prospective, randomized study’, Am J Sports Med. 2000;28:687-94.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC,A health status instrument for measuring clinically important patient relevant outcomes to ant rheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988;15:833-40.
Mc Connell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) a review of its utility and measurement properties. J. Arthritis Rheum. 2001;45:453-61.