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The role of hip muscle function in the treatment of patellofemoral pain syndrome
by
Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP.
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last modified
2009-10-09 15:17
Am J Sports Med. 2006 Apr;34(4):630-6. Epub 2005 Dec 19.
BACKGROUND: Previous literature has associated hip weakness with patellofemoral
pain syndrome. HYPOTHESIS: Improvements in hip strength and flexibility are
associated with a decrease in patellofemoral pain. STUDY DESIGN: Cohort study;
Level of evidence, 2. METHODS: Thirty-five patients with patellofemoral pain
syndrome, aged 33 +/- 16 years (29 women, 6 men; 43 knees), were evaluated and
placed on a 6-week treatment program. Hip flexion, abduction, and adduction
strengths, Thomas and Ober test results, and visual analog scale scores for pain
with activities of daily living as well as with exercise were documented on
initial evaluation and again 6 weeks later. Treatment consisted of strength and
flexibility exercises primarily focusing on the hip. RESULTS: Hip flexion
strength improved by 35% +/- 8.4% in 26 lower extremities treated successfully,
compared with -1.8% +/- 3.5% in 17 lower extremities with an unsuccessful outcome
(P < .001). Before treatment, there were positive Ober test results in 39 of 43
lower extremities; positive Thomas test results were seen in 31 of 43 lower
extremities. A successful outcome with a concurrent normalized Ober test result
was seen in 83% (20/24) of lower extremities, and successful outcomes with
normalized Thomas test results were seen in 80% (16/20) of lower extremities. A
combination of improved hip flexion strength (> 20%) as well as normal Ober and
Thomas test results was seen in 93% of successfully treated cases (14/15 lower
extremities), compared with 0% success (0/5 lower extremities) if there was no
change in hip flexion strength (< 20%) and if Ober and Thomas test results
remained positive. CONCLUSIONS: Improvements in hip flexion strength combined
with increased iliotibial band and iliopsoas flexibility were associated with
excellent results in patients with patellofemoral pain syndrome.