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Is hip strength a risk factor for patellofemoral pain?

PainSci » bibliography » Rathleff et al 2014
Tags: patellar pain, etiology, arthritis, aging, pain problems, knee, leg, limbs, overuse injury, injury, running, exercise, self-treatment, treatment, pro

One article on PainSci cites Rathleff 2014: The Complete Guide to Patellofemoral Pain Syndrome

PainSci commentary on Rathleff 2014: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This review of 24 of the highest quality studies available found that patellofemoral pain and hip weakness are certainly associated, but weakness is not the cause of the pain — indeed, it’s probably the other way around. Correlations are easy to find, but causality can be tricky to nail down: you have to study runners before they develop pain (a prospective study design), and then wait and see who develops it. Experiments of that kind (Thijs 2011) andhave shown that hip strength was the same in runners regardless of whether or not they eventually ended up in pain.

(Was isometric strength too “simplistic” a measure to be meaningful? Maybe. But isometric strength usually doesn’t develop in isolation except in people who train isometrically, and when measured in study subjects like these I imagine it correlates reasonably well with dynamic strength.)

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To evaluate and synthesise the literature on hip strength among patients with patellofemoral pain (PFP) to address the following:

  1. differentiate between hip strength as a risk factor and associated deficit in PFP;
  2. describe hip strength in men and women with PFP across different age ranges;
  3. investigate the effects of hip strengthening on biomechanical knee variables associated with PFP development.

METHODS: MEDLINE, CINAHL, Web of Science, SportDiscus and Google Scholar were searched in November 2013 for studies investigating hip strength among patients with PFP. Two reviewers independently assessed papers for inclusion and quality. Means and SDs were extracted from each included study to allow effect size calculations and comparisons of results.

RESULTS: Moderate-to-strong evidence from prospective studies indicates no association between isometric hip strength and risk of developing PFP. Moderate evidence from cross-sectional studies indicates that men and women with PFP have lower isometric hip musculature strength compared to pain-free individuals. Limited evidence indicates that adolescents with PFP do not have the same strength deficits as adults with PFP.

CONCLUSIONS: This review highlights a possible discrepancy between prospective and cross-sectional research. Cross-sectional studies indicate that adult men and women with PFP appear to have lower hip strength compared to pain-free individuals. Contrary to this, a limited number of prospective studies indicate that there may be no association between isometric hip strength and risk of developing PFP. Therefore, reduced hip strength may be a result of PFP rather than the cause.

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