By Tejal Ramaiya, DPT, CSCS
Patellofemoral Pain Syndrome (PFPS) is one of the most common conditions physical therapist’s encounter and yet one of the most challenging to treat. Hip weakness, quadricep weakness, and poor flexibility are just some of the factors that can contribute to PFPS, not to mention sub-par footwear, sport technique, joint arthrokinematics and/or foot abnormalities. Flexibilty exercises for psoas, quadricep, hamstrings, and gastroc-soleus are staple protocol when treating PFPS, however when it comes to strengthening, what is the most effective approach for the early stages of rehabilitation? Is there a difference between an early stage quadricep versus hip musculature strengthening approach?
A recent study published in Journal of Orthopedic and Sports Physical Therapy studied the effects of isolated hip strengthening compared to isolated quadricep strengthening prior to initiating a functional weight-bearing strengthening program in women with PFPS. This study included exclusively females due to their epidemiologically higher incidence of PFPS. The study was a randomized clinical trial where 33 women were randomly assigned to either a hip strengthening group or a quadricep strengthening group. The hip group performed exclusively hip abduction and external rotation strengthening for 4 weeks while the quadricep group performed only quadricep strengthening exercises for 4 week. At 4 weeks, both groups initiated a weight-bearing strengthening program.
Treatment was as follows: both groups performed stretching of the quadriceps, hamstrings, and triceps surae (3 times for 30 seconds each) throughout the 8-week program in addition to their respective strengthening programs (hip vs. quadricep).
Measures taken at baseline and at 8 weeks:
- Pain (Visual Analog Scale)
- Step-down Test
- Lower Extremely Functional Scale (LEFS).
Hip group exercises (weeks 0-4):
- Standing hip abduction
- Sidelying combination hip abduction and external rotation (clams)
- Seated hip external rotation
Quadricep group exercises (weeks 0-4):
- Quad sets
- Short-arc quads
- Terminal knee extensions
- Straight leg raises
Weight-bearing strengthening exercises (weeks 4-8):
- Single leg balance with front pull
- Wall slides with resistance
- Lateral step-downs
- Calf raises
The results of this study found that both groups experienced an overall increase in strength and improved function over the 8-week period, however, the hip group had a significant decrease in pain during the first 4 weeks of treatment whereas as the quadricep group reported no change in pain. The results of this study suggests that isolated hip strengthening in the early stages of treating patients with PFPS may be the more clinically efficient way of reducing pain and increasing function.
Click on the video below to see the correct technique for performing sidelying combination hip abduction and external rotation (clams). For videos of all other exercises mentioned in this post, please visit the FORCE Therapeutics online store.
embedded by Embedded Video
1. Dolak, K. et. al. Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Clinical Trial. J Ortho Sports Phys Ther 2011; 41(8): 560-571.
Tejal Ramaiya is National Client Representative at Force Therapeutics. Force Therapeutics provides a web and mobile application that extends physical therapy patient care beyond the office visit. The application provides physical therapists with clinically tested platform to manage patients, track compliance and effortlessly assign exercise videos. Tejal owns a private practice in NJ where she uses the Force Therapeutics platform to prescribe video based exercise programs to her patients. Please visit www.forcetherex.com for more information.