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Effects of hip exercise on patellofemoral pain

PainSci » bibliography » Fukuda et al 2010
updated
Tags: patellar pain, treatment, exercise, arthritis, aging, pain problems, knee, leg, limbs, overuse injury, injury, running, self-treatment

One article on PainSci cites Fukuda 2010: The Complete Guide to Patellofemoral Pain Syndrome

PainSci commentary on Fukuda 2010: ?This page is one of thousands in the PainScience.com 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 is a test of the effects of exercise on patellofemoral pain. Participants were placed in one of three groups: knee exercise only, both hip and knee exercise, and no exercise (control group). Pain ratings and knee function was compared after four weeks.

Both exercise groups showed improvement in function and pain when compared to the control group. However, only the combined (hip and knee) exercise group had clinically important and meaningful differences. Conclusion? Exercise seems to work better than nothing, and more exercise is better! Whether there really is anything special about the hip is difficult to determine, since people may have improved more in that group simply due to receiving more exercise, period.

~ 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.

STUDY DESIGN: Randomized clinical trial.

OBJECTIVE: To investigate the influence of strengthening the hip abductor and lateral rotator musculature on pain and function of females with patellofemoral pain syndrome (PFPS).

BACKGROUND: Hip muscle weakness in women athletes has been the focus of many recent studies and is suggested as an important impairment to address in the conservative treatment of women with PFPS. However, it is still not well established if strengthening these muscles is associated with clinical improvement in pain and function in sedentary females with PFPS.

METHODS: Seventy females (average±SD age, 25±07 years), with a diagnosis of unilateral PFPS, were distributed randomly into 3 groups: 22 females in the knee exercise group, who received a conventional treatment that emphasized stretching and strengthening of the knee musculature; 23 females in the knee and hip exercise group, who performed exercises to strengthen the hip abductors and external rotators in addition to the same exercises performed by those in the knee exercise group; and of the 25 females who did not receive any treatment. The females of the nontreatment group (control) were instructed to maintain their normal daily activities. An 11-point numerical pain rating scale (NPRS) was used to assess pain during stair ascent and descent. The lower extremity functional scale (LEFS) and the anterior knee pain scale (AKPS) were used to assess function. The single-limb single hop test was also used as a functional outcome to measure preintervention and 4-week postintervention function.

RESULTS: The 3 groups were homogeneous prior to treatment in respect to demographic, pain, and functional scales data. Both the knee exercise and the knee and hip exercise groups showed significant improvement in the LEFS, the AKPS, and the NPRS, when compared to the control group (P<.05 and P<.001, respectively). But, when we considered minimal clinically important differences, only the knee and hip exercise group demonstrated mean improvements in AKPS and pain scores that were large enough to be clinically meaningful. For the single-limb single hop test, both groups receiving an intervention showed greater improvement than the control group, but there was no difference between the 2 interventions (P>.05).

CONCLUSION: Rehabilitation programs focusing on knee strengthening exercises and knee strengthening exercises supplemented by hip strengthening exercises were both effective in improving function and reducing pain in sedentary women with PFPS. Improvements of pain and function were greater for the group that performed the hip strengthening exercises, but the difference was significant only for pain rating while descending stairs.

LEVEL OF EVIDENCE: Therapy, level 1b-.

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