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Thigh and hip exercises effective for patellofemoral pain

PainSci » bibliography » Peters et al 2013
Tags: patellar pain, exercise, treatment, arthritis, aging, pain problems, knee, leg, limbs, patellofemoral joint, overuse injury, injury, running, self-treatment

One page on PainSci cites Peters 2013: The Complete Guide to Patellofemoral Pain Syndrome

PainSci commentary on Peters 2013: ?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.

Patellofemoral pain syndrome (PFPS) is a common knee pain disorder that is often harder to solve than a Rubik’s Cube. This review of the existing research on exercise looked at studies of proximal exercises targeting muscles closer to the center of your body, like hip and trunk muscles, compared to more conventional knee exercises targeting muscles of the thigh (quadriceps and hamstrings).

The authors evaluated only better quality studies that precisely defined the type of exercise tested. They found that proximal exercises consistently outperform knee exercises — in both the short and long term — for reducing pain and improving function in people with PFPS. The results were impressive: on average, knee strengthening programs led to a 37% decrease in pain, and 21% increase in function, while proximal (hip) strengthening programs led to a 65% decrease in pain, and a 38% increase in function! None of the studies included in the review were perfect, but such large effects are very encouraging.

Not surprisingly, the authors of this review concluded: “physical therapists should consider using proximal interventions for treatment of patellofemoral pain.”

My bias is so not confirmed by this. I don’t like it. But I will report it anyway. Because that’s what it says.

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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.

BACKGROUND: Patellofemoral pain syndrome is a common disorder of the knee with multifactorial aetiology. Multimodal treatment, including exercise therapy, has been shown to be effective in the treatment of patellofemoral pain, although some patients continue to experience pain and dysfunction despite treatment. To address this, recent research has started to investigate the lumbo-pelvic and hip girdle in patellofemoral pain.

PURPOSE: The aim of this systematic review was to investigate the effectiveness of proximal exercises, compared with knee exercises, for patients with patellofemoral pain, in improving pain and function.

METHODS: A computer-based search (population: patients with patellofemoral pain,

INTERVENTION: proximal [hip or lumbo-pelvic] exercises, comparator: knee exercises, outcome: self-reported pain and/or functional questionnaire) was undertaken. Medline, Embase, CINAHL, SportsDiscus, Cochrane Library and PEDro were searched for studies published between January 2011 and January 2013. The included studies were appraised independently using the McMaster Critical Review Form for Quantitative Studies. Data was extracted for the exercise prescription and applicable outcome measures, and a descriptive analysis undertaken.

RESULTS: Eight studies (three randomized controlled trials, one clinical controlled trial, three cohort studies and one case series) of moderate to high methodological quality met the inclusion criteria. Proximal exercise programs showed a consistent reduction of pain and function in the treatment of patellofemoral pain. Knee exercise programs had variable outcomes.

CONCLUSION: Proximal interventions provide relief of pain and improved function in the short and long term and therefore physical therapists should consider using proximal interventions for treatment of patellofemoral pain.


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